CCG Annual General Meeting (AGM) AGENDA Thursday 19 July 2018, 17:30hrs to 19:00hrs Riverside Centre, The Quay, Newport, Isle of Wight, PO30 2QR Item Item Title/Heading Initial Paper No /Attachment 1. Apologies for absence: ML Verbal Timing 2. Chairs Welcome Dr Michele Legg ML Verbal 17:30 3. Minutes of the last meeting 13 July 2017 ML AGM18-001 4. The Last Year Loretta Outhwaite, Deputy Chief Officer LO Presentation 17:35 5. Looking Forward Gillian Baker, Director of Strategy and Partnerships GB/JS Presentation 17:55 6. Open Forum Questions and Answers All Verbal 18:15 7. Close ML Verbal 19:00 8. Date and Time of the next meeting To be confirmed
Annual General Meeting Minutes of the CCG s Annual General Meeting 13 July 2017 Sponsor: Helen Shields, Chief Officer Summary of issue: Action required/ recommendation: Minutes of the Isle of Wight Clinical Commissioning Group s Third Annual General Meeting 13 July 2017 To approve the minutes of the Annual General Meeting 13 July 2017 Principle risks: Other committees where this has been considered: Financial /resource implications: Legal implications/ impact: Public involvement /action taken: Equality and diversity impact: There are no risks relating to this paper. This paper has not been considered at any other committees. Members of the CCG s Governing Body and CCG Officers were in attendance at the Annual General Meeting. The Annual General Meeting reports the CCG s Annual Accounts for 2016/17. These minutes form a formal public record of the Annual General Meeting. The Annual General Meeting is a public meeting, where stakeholders and members of the public are invited to attend and submit questions. The CCG is consignant to the 9 protected equality and diversity characteristics. Author of paper: Rebecca Berryman, Governance Support Officer Date of Paper: 18 July 2017 Date of Meeting: Agenda Item: 1 Paper number: AGM18-001 1
NHS Isle of Wight Clinical Commissioning Group: Annual General Meeting Minutes of CCG Annual General Meeting held on 13 July September 2017 at 17:30hrs at Hunnyhill Room, The Riverside Centre, The Quay, Newport, Isle of Wight PO30 2QR PRESENT: Gillian Baker (GB) Director of Strategy and Partnerships Rida Elkheir (RE) Director of Public Health Dr Michele Legg (ML) CCG Chair Phil Hartwell (PH), CCG Head of Corporate Governance Andrew Heyes (AH), Head of Performance and Contracting Cath Love (CL) Acting Head of Quality Caroline Morris (CM) Assistant Director of Primary Care and Corporate Business Loretta Outhwaite (LO) Chief Finance Officer and Deputy Chief Officer Helen Shields (HS) Chief Officer Laurence Taylor (LT) Governing Body Lay Member- Independent Carole Truman (CT) Governing Body Lay Member Patient and Public Involvement Lindsay Voss (LV) Governing Body Nurse Timothy Whelan (TW) Deputy Clinical Chair MINUTED BY: Rebecca Berryman (RB) Governance Support Officer 17-001 Apologies for Absence Apologies for absence were received from Martyn Davies Lay Advisor Governance, Ian Reckless Secondary Care Doctor and Sarah Westmore Clinical Executive. 17-002 Minutes of the Last AGM held on 01 September 2016 The minutes of the last AGM held on 01 September 2016 were approved as a true and accurate record. 17-003 Chairs Welcome Dr Michele Legg, CCG Chair welcomed attendees to the CCG s fourth Annual General Meeting. 17-004 Annual Report HS outlined the following summary from 2015/16: This has been the most challenging year for the CCG to date; There have been performance issues across the system with some NHS Constitution targets missed all year; There have been quality issues including a highly critical CQC report where special measures was imposed on the IW NHS Trust; The CQC also inspected Earl Mountbatten Hospice which was rated outstanding and all of the GP practices have been rated good; The CCG together with system leaders put in place a Transformation Programme through the Vanguard; The first year of delegated commissioning of primary care has been successful with a new Primary Care Strategy published; 2
A Sustainability Transformation Plan across Hampshire and IOW has been established; A reconfiguration of Mental Health services has commenced; A redesign of acute services is in progress; The CCG achieved all of its statutory financial duties but with difficult decisions required. HS also set out the progress that has been made against the organisations objectives. Of particular challenge was not all performance targets were achieved and issues relating to the quality of services commissioned. HS highlighted the following challenges for the future: The CCG remains 10% above target allocation; There is increasing demand on all healthcare services, inflationary pressures and demographic growth; There is a significant financial deficit at IW NHS Trust; Primary care is increasingly under pressure in relation particularly to workforce and demand; The Island continues to experience significant workforce issues including recruitment and retention in all parts of health and care sector. The following areas were identified as areas to focus on for 2016/17 System leadership establishment of the IOW Local Care Board; Local Care Plan clear priorities for delivery and transformation; Delivery of savings in year; Supporting improvement in quality of services at IW NHS Trust; Delivery of 7 day services in primary care. 17-005 Performance Andrew Heyes presented the position of the Performance Metrics. The CCG met 8 of the 15 key National NHS Constitution Standards. Key problem areas were the A&E 4 hour waits, Ambulance responses, 18 week Referral to Treatment (RTT) target and cancer waiting times. It was highlighted that following the Isle of Wight NHS Trust CQC inspection the CCG has taken the following actions: Strengthening quality management, including: thematic reviews, quality visits, and deep dives into service areas; Setting a clear vision for mental health services and strengthening commissioning arrangements; Working with the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) and the Acute Care Alliance (University Hospitals Southampton, Portsmouth Hospitals and Isle of Wight NHS Trust) to ensure sustainable acute services for Islanders and visitors. 3
17-006 Annual Accounts Loretta Outhwaite outlined how the CCG spent its 2016/17 budget of 239m allocation. She confirmed that the CCG had met all its statutory financial duties. The CCG delivered a surplus of 2.3m, which was 2.3m above target, due to a national requirement to retain the 1% risk reserve. The Quality Innovation Productivity and Prevention (QIPP) plan delivered 6.5m (2.7%) savings in 2016/17. LO highlighted the challenges facing the CCG for 2017/18. The CCG is 10% (c 19m) above target, therefore received minimum growth of 0.3m (0.16%: average national growth 2.14%). In line with NHS business rules the 2017/18 CCG plans include: Achieve an in-year break-even position; Hold a 1% 2.3m risk reserve, 50% of which is un-committed; Hold a 0.5% 1.2m un-committed contingency; QIPP savings target of 12.9m (5.6%) is required to deliver a break-even position; currently estimating a delivery risk of 2m; Additional non-recurrent New Care Models funding, to invest in service transformation in 2017/18 is likely to be c 3.3m LO outlined the financial pressures on the Health & Social Care system and the actions being taken in relation to them: CCG has an underlying deficit (c 2.9m); Minimum growth funding for the CCG forecast to 2020/21; Significant pressure on Social Care budgets; Isle of Wight NHS Trust in significant financial deficit. Actions Partnership working through Local Care Board/Plan, with IW Council and IW NHS Trust; Partnership working within the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP); Service transformation through the implementation of the Isle of Wight My Life a Full Life Care Model; integration, care closer to home, prevention 16-010 Date of Next Meeting: July 2018 - TBC 4
Annual General Meeting 19 th July 2018 Welcome
We are celebrating 70 years since the launch of the NHS Our role is to ensure people receive high quality and effective care, shaped by our clinical leaders, workforce and local communities We have started to work together with partners through the: Hampshire and Isle of Wight Sustainability and Transformation Partnership Island Local Care Board which has membership from the CCG, Isle of Wight Council, Isle of Wight NHS Trust, One Wight Health (GP Federation) and the Voluntary Sector Our focus is on creating better care and community services designed with and around the experiences and needs of local people
Our challenges On the Island, we have much to celebrate about our way of life and the opportunities we have to live our lives to the full. However: We are living longer People increasingly have complex long-term health and care needs There is an unsustainable demand on health services The system is in financial difficulties We face a number of challenges: CCG remains 10% above target allocation Increasing demand on all healthcare services Significant financial deficit across the system Significant workforce issues Succession of changes in the CCG placed under Legal Directions by NHS England, changes in leadership
Doing things differently We need to do things differently and are doing this by: Working with health professionals, local people and our partners to transform services acute services redesign, community services review, mental health blueprint, learning disability strategy Improving access to GP services with extra weekday and weekend GP and nurse consultations available Strengthening the way we monitor the performance of NHS services on the Island Increasing the involvement of both clinicians and Island residents in decision making Improving our financial control Working as part of the Hampshire and Isle of Wight CCG Partnership which we joined in April 2018 Supporting the Trust to gain a CQC Good rating by 2020
Our performance during 2017/18
Our performance The CCG met seven of the 15 key National NHS Constitution Standards: Indicator Cancer Max 2-week wait for first appointment for patients referred by GP urgently with suspected cancer Cancer - Max 2-week wait for first appointment for patients referred by GP urgently with breast symptoms Cancer - Max 31-day wait from diagnosis to first definitive treatment for all cancers Cancer - Max 31-day wait for a subsequent treatment where the treatment is surgery Cancer - Max 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regime Cancer - Max 31-day wait for subsequent treatment where the treatment is a course of radiotherapy Cancer - Max 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers Target Actual 93% 97.25% 93% 96.77% 96% 98.51% 94% 99.16% 98% 100% 94% 98.32% 90% 95.16% We need to improve in a number of areas A&E four hour waits, ambulance responses, 18 week Referral to Treatment (RTT) target and cancer waiting times. Action plans have been developed and are being implement to improve performance during this year.
The financial picture 2017/18
How we spent our allocation 2017/18 spend of 239.7m Programme(healthcare) 217.9m Running costs 3m Delegated primary care 18.8m The funding included: Growth funding of 338k (0.16%) compared to 2016/17 2.8m (1.4%); Non-recurrent investment from the national New Care Models programme of 3.5m, to support service transformation.
Financial performance highlights All statutory financial duties achieved: Expenditure did not exceed income Cash balance 79k, within cash limit Running costs were within the allocation of 3m Audit letter: Financial Statements unqualified Audit letter: Income and Expenditure unqualified CCG delivered a surplus of 1.3m, which was 1.3m above target, due to a national requirement to retain the 0.5% risk reserve and release it to the bottom line to improve the position The Quality Innovation Productivity and Prevention (QIPP) plan delivered 8.2m (3.6%) savings in 2017/18
Financial issues There are a number of financial pressures: Health system has a 47m financial challenge in 2018/19 CCG had an underlying deficit in 2017/18 of 6.5m Minimum growth funding for the CCG forecast to 2020/21 Significant pressure on Social Care budgets Contract variation for Isle of Wight NHS Trust for 2018/19 not yet agreed (Two year contract signed 2017/18) We are addressing these by: Partnership working through Local Care Board/Plan, with IW Council and IW NHS Trust Partnership working within the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) Service transformation through the implementation of the Isle of Wight My Life A Full Life Care Model; integration, care closer to home, prevention
Formal approval of the annual report and accounts 2017/18
A key strand of our focus for 2018/19 Redesigning Acute Services
Redesigning acute (hospital based) services
Our aims and key principles We are aiming to ensure that local residents: Expect the same standards and outcomes from the care they receive on the Island as is provided across the country Access the widest possible range of acute services on the Island where clinically appropriate Only travel to receive the care they need when absolutely necessary Have services provided as close to home as possible and are supported by the local community Are seen by the most appropriate service with the local workforce developed and the boundaries between health and care roles removed
How have we been looking at this? Meeting with clinicians responsible for those services Talking to local people, community groups and staff at a series of events with over 3,000 people sharing their views Involving patients in wider discussions Looking at what works well in other parts of the country Developing different potential solutions Assessing their impact Putting together all of the information that will help us ultimately make a decision on what might work best Checking our progress with our regulators Preparing for a public consultation next year
What are the key steps? 1 2 3 4 5 6 What is the case for change from a clinical, workforce and financial perspective? What evaluation criteria should be used to assess the potential service configuration options? What are the range of clinical models that could underpin any future service configuration options? What is the shortlist of service configuration options that we should spend time subjecting to more detailed analysis? How do those options stack up against our evaluation criteria? What preferred option(s) should be taken forward to CCG Governing Body?
Developing different options/models We developed, with specialist modelling support, over 280 different options We agreed no change is not an option We agreed that we must have obstetric led (specialist doctor-led) maternity services rather than purely midwife-led services Narrowed down to five key options 280 244 28 8 5 We asked a clinical, workforce, and finance group to assess the five shortlisted options, using the following criteria, and make their recommendations Quality of care Access to care Affordability and value for money Workforce Deliverability
The ASR blueprint Feb 2018 The CCG Governing Body approved the blueprint for meeting the future acute services needs of local residents based on the recommendation made by the Local Care Board that: The optimal level of acute services to be retained On Island (approximately 89% of current activity) to provide maximum local access in a sustainable configuration A proportion of higher acuity/more complex activity (up to 11%) to be transferred to mainland providers where better outcomes can be ensured Overall patient journeys across the Solent should be reduced (by approximately 500 per annum) by repatriating activity back to the Island for routine planned care services - in recognition of the strong and consistent feedback from local stakeholders and the public on the impact of cross-solent travel
ASR blueprint key caveats The CCG recommendation noted the concerns of: o Clinicians regarding the safety risks of transferring activity o Deliverability concerns of mainland providers The CCG addressed these by making the decision contingent on further work to develop the proposals by: o Defining the workforce integration requirements by focusing on the key specialties where change is most required o Ensuring that any changes to capacity and the future critical care model will only be undertaken where they are matched by the actual changes to the pathways o This includes the need to define and ensure that a credible and seamless transfer and retrieval system is in place
Taking the proposals forward The CCG recommendation provides a clear direction of travel for meeting the acute services needs of Island residents over the next decade Before the proposals can be reviewed by our Regulators and then put forward for Public Consultation, detailed plans are being developed with STP and Solent Acute Alliance (SAA) partners to deliver the ASR blueprint The Community Services Redesign is being accelerated to ensure more people are treated in the community and reduce demand for acute services by at least 3.5% p.a. We are developing digital alternatives to reduce the need for IW residents to travel across the Solent for face-to-face outpatient attendances and ways of sharing records We are undertaking more intensive stakeholder and public pre-consultation engagement to discuss the recommended proposals to ensure that the work to refine and develop the proposals continues to reflect the views of local people As a direct result of public feedback a group specifically looking at improving the patient travel experience has been established, working with the ferry companies and patient group representatives, looking at what information is currently available, the clarity of that information, how accessible it is, and if it can be improved
How to share your views We welcome your feedback and we are listening Email us at System.Redesign@iow.nhs.uk Write to us at Acute Service Redesign Feedback, System Wide Transformation Team, Ground Floor, South Block, St Mary s Hospital, Newport, Isle of Wight PO30 5TG Call us on 01983 822099 x 3172 You can also find a list of frequently asked questions on our website www.isleofwightccg.nhs.uk
Any questions