Oxfordshire Oxfordshire Clinical Commissioning Group: Annual Public meeting Dr Joe McManners Clinical Chair 28 September 2017
Agenda Oxfordshire Review of the year: 2016 / 2017 Financial Accounts Bicester Healthy New Town Questions?
Oxfordshire Review of the year: 2016 / 2017 David Smith Chief Executive
Strategic plan Oxfordshire New and better ways of delivering good value services Consult on Oxfordshire Transformation Plan proposals Meet constitutional targets and reduce DToC and A&E attendance
How did we do? Oxfordshire Introduction of new ambulatory model of care to reduce acute hospital admissions o o Ambulatory Assessment Units at the JR and Horton General in Banbury Rapid Access Care Unit at Townlands in Henley Increasing access to primary care services o o o Care navigators coordinating support for patients in their own home, liaising with GPs and carers Email consultations Neighbourhood access hubs for urgent care appointments in the evening and weekend
How did we do? Oxfordshire Taking over commissioning of specialist learning disabilities services for adults from County Council and transferring services from Southern Health to Oxford Health A New Child and Adolescent Mental Health Services Contract to reduce waiting times Securing funding for Diabetes prevention and education
How did we do? Oxfordshire Oxfordshire Transformation Programme phase 1 - why? To ensure: high quality and safest care equality of access to best care care closer to home or at home
How did we do? Oxfordshire Oxfordshire Transformation Programme - the agreed changes: all acute stroke patients get best available treatment at JR s Hyper Acute Stroke Unit sickest patients all go to intensive care unit at JR all obstetrics services centred at JR closure of some acute beds to reinvest funds in care closer to home more outpatients and planned care services at Horton General
How did we do? Oxfordshire Oxfordshire Transformation Programme - but: Current legal challenges to the consultation process and some of the changes approved may delay implementation and could impact on the next phase of Transformation.
How did we do? Oxfordshire We must do better: Delayed Transfer of Care remains stubbornly high despite several joint initiatives with health and social care partners Work and joint investment continues to boost home care and nursing home providers and create extra capacity to manage more complex people outside of hospital
How did we do? Oxfordshire We must do better: A&E attendance increased by 6.7% in 2016/17 Ambulance response times Some cancer targets Work to improve access to primary care through extended and weekend hours More support for GP practices to offer more services
The Future Oxfordshire Meeting constitutional targets: A&E wait times what is being done? More consultants working in A&E Plans for streaming of patients arriving at A&E Ambulance response times what is being done? National Ambulance Response Programme: new clinical coding system for effective prioritisation based on patient clinical need Revised Ambulance Response targets to measure median time to patients rather percentage of achievement which will lead to long wait reduction. Cancer waits/diagnosis what is being done? Increasing awareness of screening for the public Straight to test/one stop shop diagnostics across a number of specialities
The Future Oxfordshire The need to successfully implement changes agreed in phase 1 Transformation Programme Transformation phase 2 the challenges: growing demand for services workforce shortages financial pressures unsuitable buildings health inequalities
Oxfordshire Annual Accounts 2016/17 Gareth Kenworthy Director of Finance
Context of 2016/17 Oxfordshire Fourth year of operation of CCG and Commissioning Support Unit First year of being fully responsible for GP Primary Care Commissioning from NHS England (received a transfer of allocation of 91m in order to achieve this) Management of in-year financial risks FNC price increase and development of new contracting arrangements with main providers
Financial highlights Oxfordshire Financial accounts produced to national deadlines Surplus of 21.1m achieved significantly higher than planned due to funds released by NHS England. This additional surplus will be carried forward for drawdown in future years. All financial duties achieved Unqualified audit opinion on the financial statements, regularity and value for money
Financial Performance targets Oxfordshire Target Position Revenue spend not to exceed allocation of 845,960,000 Revenue administration spend not to exceed allocation of 14,642,000 95% of all NHS invoices paid within 30 days Remain within cash funding Achieved Position Actual revenue surplus 21,131,000 Actual administration spend of 14,207,000 98% of total value of invoices paid within 30 days We have achieved our cash target
How was the money spent? Oxfordshire In 2016/17 we spent 825million That s... 1,146 per person per year 2.26m per day 1,570 per minute Plus 21.1m surplus carried forwards to 2017/18
How was the money spent? Oxfordshire Annual Actual Variance Budget Month 12 Month 12 '000 '000 '000 Acute 400,607 403,386 2,779 Community Health 70,637 70,999 362 Continuing Care 57,934 64,851 6,917 Mental Health and Learning Disability 68,439 68,922 483 Delegated Co Commissioning 89,546 89,012 (534) Primary care 100,516 97,659 (2,857) Other Programme 16,355 15,793 (562) Sub Total Programme costs 804,034 810,622 6,588 Running costs 14,642 14,207 (435) Sub Total 818,676 824,829 6,153 Transformation/risk management 0 0 0 Non recurrent reserve 8,198 0 (8,198) Contingency 6,161 0 (6,161) 1% Surplus 12,924 0 (12,924) Total 845,960 824,829 (21,131)
And what did it buy? Oxfordshire Acute Healthcare Services: 166,220 attendances at A&E & MIU, 455 per day 79,667 emergency inpatient admissions, 218 per day 61,078 planned inpatient admissions and day cases 661,128 outpatient appointments 87,832 ambulance incidents Community Health: 1,750 community hospital episodes 350,187 contacts with community services 88,577 podiatry appointments 105,251 contacts with out of hours GP services
And what did it buy? Oxfordshire Mental Health Services: 50,330 in-patient bed days 127,598 appointments Other: 198,725 calls to NHS 111 13,506 appointments in primary care neighbourhood access hubs (approx 6 months) Total drug items prescribed 11,085,290 1,751 referrals for NHS Continuing Care
External Audit Opinion Oxfordshire Financial statements an unqualified opinion that the accounts reported fairly on the CCGs finances Regularity of income and expenditure an unqualified opinion that financial transactions were conducted within the CCG legal framework Value for money no matters to report
Present and future Oxfordshire For the financial year 2017/18 OCCG has a 16m increase to our funding compared to 50m in 2016/17. The CCG will remain at 4.8% below target funding. OCCG has submitted a plan for 2017/18 that was compliant with financial planning targets including a surplus of 19.989m Key risk for OCCG moving forward into 2017/18 remains the same as it is for all NHS organisations across the country, which is to address the increasing demand for NHS services within the resources available
Bicester Healthy New Town Programme Dr Rosie Rowe, Bicester HNT Programme Director
In Oxfordshire our health needs are changing... INCREASING INCREASING CHRONIC DISEASE INCREASING POPULATION AGE INCREASING BIRTHS FROM GROWING POPULATIONS
The Healthy New Towns programme has three key objectives Health and wellbeing benefits Time (Years) Potential additional impact Current good practice To shape new towns, neighbourhoodsand communities to promote health and wellbeing, prevent illness and keep people independent; To radically rethink delivery of health and care services, supporting learning about new models of deeply integrated care To spread learning and good practice to other local areas and other national programmes
Growing Bicester: a place based approach The scope of the programme covers the whole of Bicester, with the NW eco town providing an example of how the built environment can promote healthy living 1 NW Bicester 6000 1 Elmsbrook 393 (90 homes complete) 2 Graven Hill 1900 SW Bicester Phase 1 1742(600 homes complete) 3 SW Bicester Phase 2 726 12 SE Bicester 1500 Rest of Bicester 30,845
Bicester Healthy New Town Partnership
Healthy Town, healthy lives
Programme Development: Objective Setting Stage 1 Expert workshops: What are the key health and care challenges faced by the current and future population of Bicester? Stage 2 Community engagement to agree direction, to identify how best to achieve our objectives and gain support for delivery
Programme Objectives Two key priorities: To increase the number of children and adults who are physically active and a healthy weight. To reduce the number of people who feel socially isolated or lonely in order to improve their mental wellbeing
Programme Work Streams 1. Bicester s built environment - making best use of the built environment to encourage healthy living 2. Community Activation enabling local people to live healthier lives, with the support of local community groups, families and schools, and employers 3. Health and care services -delivering new models of care that are focused on prevention and care closer to home which minimises hospital based care
A whole systems approach
Built Environment delivery (1) Transformation of relations between built environment and health professionals Outcomes: One plan for NHS estates for the town Generating maximum value from public assets Health promoting policies are being embedded in local plans Planners now understand new models of care and need for an estate that can provide it A coordinated ask for health services from S106 funds
Built Environment delivery (2) The built environment is supporting healthier lifestyles Outcomes: Early provision of community assets is delivering faster social connections Digital innovation is addressing social isolation Insight into barriers to use of green spaces identified The built environment is acting to nudge residents to be active
Neighbourhood Health Routes Bicester s Blue Line Built environment nudge to make walking part of daily routines This project delivers marked routes that are safe and accessible Developed with community engagement and schools Supported by Health Walk programme There is no cost to participation Suitable for a wide range of ages, at any time of the day
Community Activation - delivery Local stakeholders working togetherto deliver the programme in their organisations and across business, education, and voluntary sectors Outcomes: Local leaders own the programme and are willing to commit time and resources to support behaviour change Establishment of a Voluntary Organisation Network to increase the capacity of community groups Senior leadership support is ensuring a whole school / whole family approach
Family Fun Sessions 10 week programme offering: - Healthy Eating -Arts and Crafts - Forestry Schools - Walking Sports - Multi-Sports and Games Outcomes: total of 173 attendances Many parents had not attended any school event before New friendships were formed We have got ourselves into a routine of life. Go to work and school. Come home. Have dinner. We had forgotten how to have fun. These sessions have really opened my eyes to that.
Health care remodelling - delivery New models of care enabled through use of technology are being developed and tested with Bicester acting as a demonstrator site Outcomes: Improved use of health resources: Pilot new diabetes pathway Improved health and wellbeing: Development of online website offering mental health support for young people Improved access to services: Development of sustainable and enhanced primary care fit to meet the needs of the growing population Workforce Transformation:Integrated training programme for support workers
Evaluation How will we know if the HNT programme is working and what elements should be spread? What is the difference for residents of living in a healthy town? Outcomes: Bicester is leading the evaluation collaborative across sites and has identified common measures to evaluate what works Potential metrics are wide ranging Rapid cycle evaluation is already informing the programme Improvements in healthy behaviours expected 2018
Learning to date: Programme Value Positive engagement between health care and planning HNT is a catalystfor health to connect with local authorities, schools, businesses and the voluntary sector to promote health and wellbeing Holistic approach to health improvement focused on a whole population approach encourages local engagement Change in the built environmentis necessary but not sufficient to deliver behaviour change it needs support from community activation The more we do the more opportunities emerge Investment in early engagement is critical for local ownership of what it means to live in a Healthy New Town Meaningful community activation takes time but is essential to support behaviour change
Local Government working in partnership with health Systems for meaningful public engagement Responsibility for promotion of health and wellbeing Alignment with community development role Good links with the voluntary sector Planning lead for a healthy built environment Strong local accountability
Questions? Oxfordshire