Annual General Meeting 17 September 2014
Introduction Dr Nicola Burbidge HCCG Chair
Introduction 2013/14 was our first year as a fully authorised Clinical Commissioning Group (CCG) The CCG is a GP-led organisation responsible for planning and buying (commissioning) health services in Hounslow Planned hospital care Urgent care Community services Mental health services Made up of 54 GP practices that serve a registered population of 288,000
CCG facing a number of challenges: population is growing with more long term conditions, limited resources available, so the way we provide care needs to change We work with 4 other CCG s Central London, West London, Hammersmith & Fulham & Ealing CCG We work with London Borough Hounslow Joint Commissioning Board Co Chair with LBH CEO Whole systems integration pioneer site successful application On going patient and public engagement 4
Local Successes 2013/2014 Sue Jeffers Managing Director & Dr Paul Shenton Vice Chair
Feedback on our first year as a CCG Authorised with 2 conditions (finance and patient engagement) April 2013 Conditions discharged and fully authorised July 2013 NHS England Assurance received July 2014 Ended the 2013/14 financial year with a 1.5m surplus Set up patient and carer reference group Development of five localities, including multidisciplinary group meetings, and care planning, with a focus on diabetic patients and people over 75 years old, set up weekend surgeries, one in each locality 6
Commissioning Commissioned a new consultant led community pulmonary rehabilitation and home oxygen service, a sleep apnoea service, and a community heart failure service Procured the Urgent Care Centre service at WMUH Commissioned a locality based care navigator service Recruitment to a care home pharmacist, who is working closely with CQC, LBH and GPs Procured a new IAPT (Improving Access to Psychological therapies) service Commissioned primary mental health nurses 7
Our progress across North West London in 2013/14 Daniel Elkeles Chief Officer
Our priorities Focus on developing CCG as an organisation while delivering service improvement CCG facing a number of challenges: population is growing with more long term conditions, limited resources available, so the way we provide care needs to change Addressing this through Shaping a Healthier Future programme to redesign hospital services to deliver better outcomes for patients Out of Hospital strategy - patients receive high quality care closer to home We achieved all our statutory duties in 2013/14 and fully assured in all domains by NHS England
Shaping a Healthier Future Programme to improve health services across NW London Centralising specialist hospital care on specific sites so that more expertise is available more of the time Changes will save at least 130 lives per year In 2013, Secretary of State for Health accepted advice from Independent Reconfiguration Panel that changes should proceed Five major acute hospitals, including West Middlesex Hospital We work with all CCGs in North West London to deliver Shaping a Healthier Future
Out of hospital strategy: Delivering better care closer to home Shift care to community and primary care settings, closer to people s homes Improving access to quality, responsive primary care Rapid response to urgent needs so that fewer patients need to access emergency care Health and social care providers working together with patients at the centre Improving early discharge from hospital 11
Collaborative working with neighbouring North West London CCGs We work in a collaborative with Central London, West London, Hammersmith & Fulham and Ealing CCGs Prime Minister s Challenge Fund Whole Systems Integrated Care Working with other 7 CCGs in NW London to deliver Shaping a Healthier Future Developing Out of Hospital care including primary care Co-commissioning Primary Care 12
Shaping a Healthier Future Whole Systems Integrated Care Primary Care Transformation Self-management More health services available out of hospital, in settings closer to patients homes seven days a week. People with complex needs receive high quality multidisciplinary care close to home, with a named GP coordinating care People have access to General Practice services at times, locations and via channels that suit them seven days a week. People are supported to self manage and held together by resilience BCF PMCF Family Patient s own GP practice Community hubs More local diagnostic equipment Acute reconfiguratio n More specialised hospital care GP as lead for patient care Care delivery teams and time for care plans Groups of accountable care providers Local Authority and Social Care involvement Less inappropriate time in hospital Urgent appointments Continuity appointments Information systems and record sharing Convenient appointments Communit y support Capitated budgets Carer Access via range of channels Assistive technology Person
Quality and safeguarding Dr Jonathan Webster Director of nursing, quality and safety
Provider Assurance Terms of Reference agreed and aligned across CWHHE for Clinical Quality Groups Quality Schedule developed and included in contracts for greater scrutiny Programme of Clinical Visits Practice Nursing Development Primary care Lead Nurses working group Collaboration and scoping exercise with Bucks New University Foundation and further development programmes in place for nurses new to GP practices. Safeguarding (Children & Adults) Established multiagency Working Winterbourne response and planning FGM strategy in place Quality Achievements Supporting Strategy Development Patient Experience Strategy Quality and Safety Strategy workshops scheduled Infection Control strategy in development Equality and Diversity embedded Quality Assurance Group Multi agency working group with monthly meetings. Monitoring and scrutiny for Continuing Care and the performance of Care Homes. Performance Dashboard in development Clinical Quality Improvement Networks Pressure ulcers working group Quality and Safety Learning Network Maternity Network Infection control Network Falls Group Designated Leads
Finance Annual Reports & Accounts Clare Parker, Chief Financial Officer 16
NHS Finance Language Surplus not profit Deficit not loss Control total - the planned surplus / deficit for the year - fixed and cannot be missed without agreement Surpluses bigger than plan are nearly as bad as deficits Underperformance where activity is lower than plan, and we spend less than intended Over performance where activity is higher than plan, and we spend more than intended QIPP Quality, Innovation, Productivity and Prevention NHS language usually used to denote savings or cost reduction plans
Financial duties Most of our income comes straight from the Department of Health (DH) Called Revenue Resource allocation (or Capital Resource allocation for capital spend) Can be recurrent - fixed and then subject to an annual uplift; or non recurrent - usually small amounts for specific purposes The total of the allocations that we receive is called the Revenue Resource Limit (RRL) (or Capital Resource Limit CRL) We have a statutory duty not to exceed our RRL or our CRL i.e. we aren't allowed to spend more than we are given We receive a separate allowance to pay for our running costs this is set at 25 per head of population. Again we are not allowed to exceed this amount We are not allowed to borrow money or go overdrawn. We are also not allowed to hold cash at year end.
2013/14 Financial Position Expenditure must not exceed income Revenue resource limit Duty Revenue resource use on specified matter(s) does not exceed the amount specified in Directions Revenue administration resource use does not exceed the amount specified in Directions Actual Compliant 290,079k 281,728k 6,419k - CCG Surplus 1,932k The CCG did not have a capital resource allocation for 2013/14, and spent no money on capital assets.
2013/14 Summary of Net Expenditure Commissioning Area '000's Acute Services 166,011 Community Services 30,525 Prescribing 29,831 Mental Health Services 28,551 Continuing Care 8,976 Primary Care 7,761 Other Services 10,074 Other Programme 5,082 Costs Total Programme 286,811 Costs Running Costs 1,336 Total Expenditure 288,147 The table and chart above show how the CCG spent its money. The highest proportion of spend goes on acute services, at 56% of total expenditure.
Underlying position The Hounslow CCG financial position is improving, but still fragile, as it moves from a historical deficit into generating a year on year surplus At 1 April 14: Brought forward surplus 1.932m, underlying (recurrent) surplus 2.012m Plan 31 March 15: Carry forward surplus 4.2m, underlying (recurrent) surplus of 3.096m CCG ALLOCATION There is a national formula that sets out how much funding each CCG should receive based on its population s characteristics and need its capitation target This formula shows the CCG is 12% or 39m per year below its fair share funding, and currently the least well funded CCG in England. As a result our funding uplift for 2014/15 & 2015/16 is 4.3%. This is above the average CCG uplift of [2.1%] and begins to move the CCG towards a fairer allocation.
Financial strategy Our high level financial strategy is therefore: To assume within our 3 year planning that the 4.3% uplift to our revenue allocation continues and the CCG moves towards a more equitable allocation. The CCG needs to generate sufficient QIPP savings to offset the growth in demand for services year on year The CCG needs to strengthen its underlying financial position, by only committing reserves non recurrently where possible and using them to pump prime new services that will lead to reduced costs (i.e. investing to save).
2014/15 Budget Commissioning Area Plan 000's Acute Services 171,524 Community services 32,011 Mental health 29,826 Prescribing 30,863 Continuing Care 8,994 Primary Care Service 8,586 Other Services 7,055 Contingency & Reserves 7,285 Total Programme costs 296,144 Running costs 6,602 Total Expenditure 302,746 Planned Surplus/(Deficit) 4,176 Resource Limit 306,922 The planned surplus for 2014/15 remains consistent with the surplus delivered in 2013/14. At month 5 we remain on track to deliver the planned surplus.
Key financial risks The key financial risks we are facing are: Short term Acute over performance Under spending on investments Delivery of QIPP savings Medium term Acute over performance Delivery of the out of hospital agenda Better Care Fund (Social Care integration fund)
Commissioning Intentions 2015/16 Sue Jeffers Managing Director
Developing the Commissioning Intentions for Hounslow for 2015/16 High level commissioning intentions drafted Linking in with whole systems work and planning Patient Reference/Carer Group event held 5 th August Contracting letters/intentions to providers at the end of September Drafting intentions with LBH public health and childrens and adults social care Discussions to be held with PPGs and with the COM in October Final sign off at Governing Body 11 th November 26
General Practice is the lynchpin in our vision for healthcare in North West London + General Practice Shaping a Healthier Future More health services available out of hospital, in settings closer to patients homes seven days a week. Community hubs More local diagnostic equipment Acute reconfigura tion Whole Systems Integrated Care People with complex needs receive high quality multi-disciplinary care close to home, with a named GP coordinating care GP as lead for patient care More specialised hospital care BCF Care delivery teams and time for care plans Groups of accountabl e care providers Local Authority and Social Care involvement Less inappropriat e time in hospital Primary Care Transformation People have access to General Practice services at times, locations and via channels that suit them seven days a week. Urgent appointmen ts Continuity appointmen ts Information systems and record sharing PMC F Convenient appointmen ts Commun ity support Capitated budgets Selfmanagement Carer People are supported to self manage and held together by resilience Family Access via range of channels Patient s own GP practice Person Assistive technolo gy North West London GP practices will collaborate as Networks + + + GP networks will be supported to develop in North West London via Piloting service improvements Organisational development Workforce development IT enablers Estates To improve patient experience To reduce avoidable A&E visits To avoid unscheduled admissions 27
Children s Services update Dr Mandy Baum 28
Progress/work done so far Clinical lead for children and young people appointed April 14 Joint children and young people strategy in development (launch March 2015) Start-up of Children's Delivery Group Commissioning intentions meeting with public in August. CAMHS network meeting and workshop with CAMHS/Early intervention to look at pathways between services. Children Hub development work (joint clinic with GP and consultant at GP practice)- Pilot Oct/Nov HEAT event planned on Children (Oct ) Communicating with LBH & Public Health Met with Cllr Tom Bruce (Children Lead) and Natalie Douglass (Assistant Director for Children's Services/HRCH) 29
Challenges ahead /future planning Integrated working with all children services i.e. schools, LBH children service, public health, NHSE Improving Oral Hygiene (working with Public Health, NHSE & I.T) Tackling obesity Move Hounslow up from bottom of "school readiness Improving communication from LBH/Public health direct to GPs Blue Sky event in Oct/ Move of HVs in Oct 15 Supporting implementation of children and family Bill in Sept 2014 Supporting children in the community Children's Continuing Care and Palliative Care Pathway Review of children continence service (hopefully to include a new constipation service) Re-commissioning children asthma nurse in the community in 15/16 Monitoring and roll out of children hubs Educate parents re 111 and also red flags/when it's safe to wait. Working with WMUH Improving paediatric diabetes service (with Raquel). Perinatal mental health Breast feeding Working with WLMHT Improve diagnostic pathways for ASD/ADHD Training about Tier 2 and improving pathways between. New CAMHS OOH service 30
Integrated Health and Social Care Making the connections Dr Richard Baxter
Key Milestones Single GP clinical IT system across Hounslow. Community clinics using the same system. Urgent Care accessing the same system. Single GP clinical system across CWHHE. HRCH moving to the same clinical system. WMUH selectively using the same system. Council using NHS Number & interoperating.? 32
Mental Health Services Dr Annabel Crowe 33
Building on Achievements of this Year Primary Mental Health Service ( Primary Care Plus): Aim to expand and develop Social worker, dementia nurse, peer support, consultant, physical health Greater role in initial assessment IAPT: Extra capacity 0.5 million pa More groups, Extended role, Use of IT, Self Referral Psychiatry Liaison Service Urgent Care: Slow progress but things are happening ( CQUIN) Extended in-hours, more home assessment, Single point of access, timely standardised paperwork Dementia: Crisis Duty clinical System from August 9-5pm Speedier diagnosis MRI Agreement for locality dementia nurses Carers training Dementia awareness 34
Addressing Gaps in Services CAMHS: Counselling - IAPT Review of referral pathway confusion Tier 2/3 Autism service Review of Out of Hours service Perinatal: No existing service. Plans to develop one across 3 CCGs. Homeless and rough sleepers: Very limited service exists?cpn Whole Systems Pilot in Brentford & Isleworth: Physical health care Reducing dependency and supporting recovery in the community 35
Q & A Session
Thank you