Annual General Meeting 11 September 2014
CCG Annual Report and Key Achievements 2013/14
Annual Report and Key Achievements The CCG Annual Report highlights what the CCG has achieved in 2013/14 in all aspects of our planning and commissioning activities. A major theme is how we have been working with and listening to local people, patients and partner organisations, and how this has helped us to understand what needs to improve. We ve also benefited from this collaboration as we develop and implement the plans to make those changes happen. The Annual Report reflects on a number of the CCG s achievements in our inaugural year as a statutory body. A number of these successes are summarised on the following slides. 3
Transforming the health and care system in Southwark Successfully completed a comprehensive programme of engagement and a formal consultation to shape a model of services in Dulwich. Over 200 written response were received and the CCG actively engaged with over 560 people. Agreed and begun the initial stage of implementation of CCG Primary and Community Care Strategy to improve access and reduce inequity of provision in primary care in Southwark. Successful bidder to Prime Minister s Challenge Fund, receiving over 900,000 to improve patient access to primary care services in Southwark. Continued to participate as a lead partner organisation in programmes of integration, including through the Southwark and Lambeth Integrated Care Programme. Work in 2013/14 focussed on improving outcomes for older people and for people with long term health conditions. Successfully delivered a 1% surplus on a budget of 357 million, with a managed cash flow within the target balance of under 250,000. 4
Quality, Safety & Performance of Commissioned Providers Rolling programme of clinically-led site visits were completed including: A&E; elderly inpatient wards; SLaM inpatient facilities. The CCG worked with providers to reflect on the findings of visits and ensure actions were taken to improve care where this was deemed necessary. Dementia diagnosis target achieved, so more people with the condition are better managed with care coordinated by their GP. Cancer waiting times targets delivered with patients receiving diagnosis and treatment within the national standard timeframes. Mixed Sex Accommodation breaches minimised, which improved inpatients reported experience of care. 5
Quality, Safety & Performance of Commissioned Providers Published CCG Quality Framework, which articulates the series of actions the CCG will take in response to the publication of the Francis Report and the Review into Winterbourne View. These are being implemented in 2014/15 by the CCG Governing Body. Complete and continue to publish a quarterly Quality Report to CCG Governing Body, which details key quality issues by provider, flags system-wide quality alerts and provides assurance that issues are being addressed. Attendances and admissions of Southwark patients at King s Denmark Hill A&E department has stabilised in the face of growth elsewhere. 6
Engaging patients and local people Call to Action Event on 22 October 2013 drew over 100 attendees from the local community. Consultation on improving health services in Dulwich and the surrounding areas completed February-to-May 2013 and received stakeholder and community engagement completed on: primary care; urgent care and mental health to inform transformation programmes. CCG member practices each running Patient Participation Groups (PPGs), which meet as localities PPGs once a quarter. The CCG Engagement & Patient Experience Committee chaired by CCG Clinical lead is informed by locality PPG, and reports to each CCG Governing Body. Patient representatives on all CCG committees and programme boards. 7
Improving health outcomes CCG c.difficile trajectory delivered in 2013/14. Smoking cessation data shows an increased proportion of patients on COPD registers have been supported to quit smoking. That s 145 people with COPD who improved their health by quitting, an 8.3% improvement on last year. Better outcomes for Southwark patients with diabetes through work with the Diabetes Modernisation Initiative: In 2012/13 34% of all patients on the diabetic register had all 9 care processes completed, this increased to 47.7% in 2013/14 (1,937 more people with diabetes received all 9 care processes in 2013/14) In 2012/13 67.8% of patients on the diabetic register were controlled with HbA1c 64 mmol/mol and in 2013/14 this increased to 70% (491 additional patients controlled with HbA1c 64 mmol/mol in 2013/14) In 2012/13 65.6% of patients were controlled with BP 140/80 and in 2013/14 this increased to 73% (1,189 additional patients controlled with BP 140/80 in 2013/14) In 2012/13 73.7% of patients were controlled with cholesterol 5 mmol/l and in 2012/13 this increased to 76.1% Increased number of patients on end of life care pathways are registered on Coordinate My Care system and supported by their GP to ensure they benefit from good care and are supported to die in accordance with their preferences. 8
Keeping people safe and avoiding harm Robust arrangements in place to support effective safeguarding for adults and children. Southwark Safeguarding Adults Partnership Board ready to assume statutory requirements. Adult Safeguarding Strategy of the Board being refreshed to reflect the statutory requirements of the Care Bill. Multi-agency Winterbourne View Steering Group lead jointly by the local authority and CCG meets bi-monthly to review and challenge progress on discharge plans. It also reviews and oversees the implementation of the actions required by the Department of Health Winterbourne View Review Concordant. 9
1 0 Keeping people safe and avoiding harm All children, young people and adults who fall within the Winterbourne View Concordat definition have received a person centred review. CCG and local authority are working in partnership to identify local opportunities for commissioning care for people with learning disabilities. Well-developed and comprehensive systems to track Serious Incidents (SIs) and near misses. CCG updated systems to triangulate information from provider SIs and identify and oversee improvement plans. CCG and King s Health Partners organisations developed and implemented a Pressure Ulcer Prevention and Management policy across acute and community health services.
Working with partners Agreed plan for Better Care Fund with Southwark Local Authority, signed-off by Southwark Health & Wellbeing Board. Local Medical Committee and the Southwark Health & Wellbeing Board engaged on and endorse the CCG Primary & Community Care Strategy. Progress on Southwark and Lambeth Integrated Care Programme partnership across two CCGs and local authorities and King s Health Partners organisations. Comprehensive involvement in the development of the five year Strategic Plan for south east London. 360 degree stakeholder survey highest response rate in London (89%) with overall very positive results compared with previous year s results and against other CCGs in our local area. CCG did particularly well at effectively communicating commissioning decisions, the skills and experience of leadership ; and stakeholders knowledge of CCG plans and priorities. 11
CCG Annual Accounts 2013/14
Key Financial Performance Duties Duty 2013-14 Target 2013-14 Performance RAG Achieve planned surplus (Expenditure not to exceed income) 3,972k 4,185k Capital resource does not exceed the allowance N/A N/A Revenue resource does not exceed the allowance 365,121k 360,936k Capital resource use on specified matters does not exceed the allowance N/A N/A Revenue resource use on specified matters does not exceed the allowance 357,901k 353,766k Revenue administration resource use does not exceed the allowance 7,220k 7,170k 13
2013/14 Annual Accounts Southwark Clinical Commissioning Group met all of the statutory financial performance duties in 2013/14. The CCG showed a strong financial performance, achieving a surplus slightly higher than that originally planned - 4,185k against a plan of 3,972k. All assets previously belonging to the PCT (circa 50m in 2012/13) were transferred to other organisations at the end of the 2012/13 financial year. As a result of this, the CCG started the year with no property, plant or equipment in 2013/14. No fixed assets were added during the year. There were no capital resources allocated in 2013/14 and therefore the CCG had nothing to report on the capital financial performance duties. The CCG accounts were audited by Grant Thornton who gave an unqualified audit opinion. 14
2013/14: Where the money went Commissioned Services: Community Contract and Primary Care ( 30m) Prescribing ( 31m) Commissioned Services: Hospital: A&E ( 13m) Commissioned Services: Hospital: London Ambulance Service ( 11m) Commissioned Services: Hospital: Outpatients ( 40m) Commissioned Services: Client Groups (includes Mental Health and Continuing Care) ( 70m) Commissioned Services: Hospital: Emergency Admissions and Critical Care ( 58m) Corporate Costs ( 13m) Commissioned Services: Hospital: Other ( 24m) Commissioned Services: Hospital: Maternity ( 22m) Commissioned Services: Hospital: Planned Admissions ( 49m) 15
Questions and Answers
Public Health The Changing Health Profile in Southwark
Population Profile Southwark population facts and characteristics: Young Diverse Highly mobile Index of deprivation 18
What has changed? Population change between the 2001-2011 censuses 19
Wider determinants Key issues: Child poverty Violent crime Social isolation 20
What are the issues? Red box Summary of health issues in Southwark 21
Changes in Life Expectancy Southwark Life Expectancy some key facts: Life expectancy has increased significantly in Southwark over the decade Inequalities have reduced but remain a significant challenge www.southwark.gov.uk/jsn A 22
What are the issues? Preventable mortality Four key areas of avoidable deaths: Heart disease & stroke Cancers Respiratory disease Liver disease Source: Public Health Outcomes Framework & Longer Lives (PHE) 23
What are the issues? Teenage conceptions 24
What are the issues? HIV 25
What are the issues? Childhood obesity 26
Questions and Answers
Primary and Community Care Development
Primary and Community Care Strategy Objectives: 1. Reducing variation in the quality of, and outcomes from, care 2. Improving access and increasing equity 3. Integration and better care coordination 4. Increased range of services in community 29
Primary Care Development 2014/15 GP Units GP Neighbourhoods Transition to GP neighbourhoods supported by: Organisational and Workforce Development Neighbourhood Development Plan Scheme South East London Pathfinder Scheme Prime Minister s Challenge Fund, supporting the design and development of 8-8 7 day Access 30
GP Neighbourhoods 4 Neighbourhood groups of practices (Dulwich, Peckham and Camberwell, Bermondsey and Rotherhithe, Borough and Walworth) 2 GP provider organisations - Quay Health Solutions (North) and Improving Health (South) 31
Progress to Date on GP Neighbourhoods GP neighbourhoods are currently: Working together under a Neighbourhood Development Plan focusing on quality and access Preparing to deliver services over and above GP core contract Preparing to deliver 8am-8pm 7 day extended access 32
Key Challenges/ Opportunities Pace of Change Current demands of general practice make it difficult to achieve real headspace to drive change Provider ability to resource and build capability for business/management and service improvement CQC registration for federations Platform for a unified voice within primary care or collective decision making structures New ways of working for providers balancing trust and autonomy Translating changes in to real quality improvement 33
Patient Story: Integration
Key Developments for the CCG s Second Year: Integration
Integration Vision - Better Care, Better Quality of Life Better quality, community-based services that take a population and preventative approach to care, and which support multi-disciplinary working at neighbourhood level. Patients are empowered and supported in their independence. Improved management of long-term conditions. Key actions: Transformation of the system as a whole, building on existing initiatives (e.g. SLIC frail elderly, GP neighbourhoods). Change the way we commission and provide services to deliver more joined up coordinated care that better meets the needs of the population. More efficient use of health and social care funding (e.g. pooled budgets). 36
Direction of travel for integrated neighbourhood working 2014/15 2015/16 GP Units GP Neighbourhoods Primary care working within Integrated Care Neighbourhoods GP Neighbourhoods form the basis of integration between primary care and other services Integrated networks include Community Services, Social Care, Housing, & voluntary sector Integrated leadership team Matrix working approach Will link in with community hubs being developed across the borough 37
Emerging Thinking Build on GP neighbourhoods with a leadership team formed of key staff from different organisations More care delivered in the community Ability to bring in secondary care specialists where needed, and access to advice and expertise Harness the capacity of the non-registered workforce and community groups Ability to use finances flexibly to meet individual and population need 38
Challenges and Opportunities Freeing up people to invest time in developing new ways of working Removing organisational barriers Collective financial resources to support improved outcomes for a population (as opposed to a condition) Workforce, particularly community and primary care nursing capacity Scale and scope of leadership teams Information sharing 39
Questions and Answers
Closing remarks
Thank you