Report to Patients A summary of NHS Norwich Clinical Commissioning Group s Annual Report for 2014/15 Healthy Norwich GP Care Patient Quality YourNorwich The work of the CCG, what it has achieved for patients, the challenges faced and how the local health system has performed. The full Annual Report is published online at www.norwichccg.nhs.uk/about-us
About the CCG NHS Norwich CCG commissions many of the NHS services that local people and visitors use. This means planning what services should be available and making sure they are put in place. We do so by talking with patients and clinicians, and holding contracts with providers such as NHS Trusts, which then deliver patient care. Services that the CCG commissions include acute hospital care, community, mental health and urgent/emergency health care. The CCG is also responsible for ensuring care is safe and of high quality. We have to be careful with the money - there is great demand for NHS care and we must remain within the budget we are allocated. The CCG is clinically-led which means NHS doctors and nurses set the local health strategy, supported by a small team of experienced NHS staff. Dr Chris Price Chair Jo Smithson Acting Chief Officer page 2
Our Priorities We work with neighbouring CCGs to commission acute hospital care chiefly from the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), community NHS care chiefly from Norfolk Community Health and Care NHS Trust (NCH&C), mental health services chiefly from Norfolk and Suffolk NHS Foundation Trust (NSFT), and also ambulance services and the 111/Out of Hours Primary Care service. The local focus of the CCG was in the following areas: Healthy Norwich projects to improve the health and wellbeing of the people of greater Norwich, in partnership with Norfolk Public Health, Norwich City Council, and Broadland District Council. Page 4. YourNorwich a programme to integrate and develop health and social care. Page 5. Quality Improvement such as reducing variation in clinical care. Page 6. Primary Care Page 7. Mental Health Page 8. Urgent care a programme of work across central Norfolk to continue improvements to the urgent care system. Page 9. QIPP (financial efficiency) the CCG was required to identify approximately 5.3 million of savings to remain in financial balance through Quality, Innovation, Productivity and Prevention measures. Page 11. page 3
Healthy Norwich http://www.norwichccg.nhs.uk/index.php/healthy-norwich Healthy Norwich awarded about 85,000 in grants to 23 local projects which will help people lead healthier lives. 740;C7H 1DB T dxsp]rt } 0SeXR 8]U^a\PcX^] } 6 For example Health Trainers will be running pop-up health promotions at bus stops across the City and the YMCA will train young health champions who can spread key health messages peer to peer. See our website and listen to Future Radio over the year to hear how these projects are getting on. Other Healthy Norwich work programmes included a project to advise and support people to keep their homes warm and dry and the commissioning of weight loss programmes. page 4
YourNorwich http://www.norwichccg.nhs.uk/index.php/healthy-norwich YourNorwich Milestones in 2014/15 include: This is our flagship project to develop and integrate health and care services in Norwich. It was launched at the CCG s AGM in July 2014, with a filmed message of support from the then Care Minister and Norfolk MP, Norman Lamb. Launch of a Virtual Ward by NCH&C in December 2014 - a team of nurses and therapists providing a higher level of support to patients at home, who might otherwise require a hospital bed. Moving into 2015/16 this project expanded, and together with a rapid response nursing service and community IV service is called HomeWard. Launch of a public database to help patients and clinicians find services provided by local voluntary groups www.yournorwich.org Virtual Ward patient, Mrs Heather Nicholls from Thorpe St Andrew, said: I found the virtual ward really helped me, it makes a big difference being able to come home to my husband, and we ve also got a number we can call if we have any problems, which is really reassuring. Age UK support service to help older people remain independent. Reprocurement of the Norwich Community Heart Failure Service, with additional funding and wider scope. Sleep service for families of disabled children. page 5
Quality and Safety Intelligence and information gathered about patient outcomes, safety and experience is used to drive continuous improvement, to plan and design services for the future. You can see and hear them at: For example patient experience was used to help the CCG recommission the Norwich Community Heart Failure Service and the appointment of a Dementia Care UK Admiral Nurse Consultant to the CCG. Two Norwich patients recorded interviews about their experiences of the Heart Failure Community Nursing Service. http://www.norwichccg.nhs.uk/index.php/have-your-say/ how-we-ve-listened/heart-failure-service Following publication of the national Transforming Care plan for people with learning difficulties, most people have been repatriated back into the community. Those that are left have discharge plans in place and will move back into the community in the near future. The CCG promotes Patient Opinion as a useful tool for patients to feedback on their experiences. Providers are encouraged to respond and make changes to services if required. www.patientopinion.org.uk page 6
Primary Care - Norwich s GP Practices The CCG has worked actively to support our 22 member GP Practices Launch of four Norwich localities, enabling GP Practices to work closer together. Support and funding to identify the 2% most at risk patients so they can be given closer support. A publicity campaign asking patients how to use Practice time appropriately. Seven local contracts with Member Practices to ensure patients are treated in the community for certain conditions or tests. Education and training - the CCG has a successful programme of primary care education for clinicians called Medibites with training on subjects such as improving outcomes in diabetes and respiratory medicines. The CCG also runs peer-review sessions to ensure referrals are consistent. Timber Hill Health Centre was required to move out of its premises in Castle Mall. The CCG contributed 350,000 towards the cost of re-locating the centre to Rouen House, nearby. page 7
Mental Health Primary Care Mental Health Service The CCGs for Norfolk and Waveney worked with patients, clinicians and other partners to commission a new Primary Care Mental Health (Wellbeing) Service, due to launch in September 2015. This extends community-based talking therapies (IAPT) and, importantly, incorporates a greater degree of social support by peer mentors and volunteers. Investing in mental health services The CCG commissioned an Admiral Nurse Consultant, hosted by Age UK, to review dementia services in Norwich and identify more ways of supporting primary care to help patients and their carers. The CCG spends more on mental health than in many areas and spends more on mental health than on community NHS care page 11. There has been considerable additional investment in Norfolk and Suffolk NHS Foundation Trust (NSFT) beyond the block contract, including: Psychiatric liaison staff at acute hospitals. Funding to reduce pressure on inpatient beds. Consultant Psychiatry time at NNUH. An intensive support team to avoid children and young people being placed in an in-patient setting. page 8
Urgent Care and Acute Commissioning Like the rest of the country, demand for hospital care reached unprecedented levels and remains high. The CCG encourages patients to think about calling 111, using the walk-in centre or asking a pharmacist rather than going to A&E when it is not a medical emergency. Over the winter, more than 6m was used in central Norfolk for short-term measures to ease pressures on local urgent care services including: An Urgent Care Centre at the Norfolk and Norwich University Hospital to treat patients who arrive at A&E with minor illness but who do not need to see a hospital specialist. Extra community and rehabilitation beds. More student paramedics for the ambulance service and Hospital Ambulance Liaison Officers to speed up handovers at hospital. Out of Hospital Norwich CCG took over the role of co-ordinating commissioner for out of hospital services in July 2014. This work included: The contract for the Non-Emergency Patient Transport Service transferred to a new provider. The Norfolk 111 and Out of Hours primary care services were re-procured, using patient engagement to inform commissioning. Thinking Ahead packs were launched, to help patients and carers discuss end of life care wishes. page 9
How the NHS in Norwich performed Indicator Plan April/ May/ June July/ Aug/ Sept Oct/ Nov/ Dec Jan/ Feb/ Mar Referral to treatment (non-admitted) 18 weeks 95% 95.3% 92.7% 95.0% 94.6% A&E under 4 hours % 95% 94.4% 92.0% 87.7% 86.3% Cancer first treatment under 31 days % 96% 96.7% 99.6% 95.5% 97.6% Cat A incidents response under 8 minutes % 75% 84.6% 81.3% 84.0% 93.4% Cat A incidents response under 8 minutes % 75% 75.8% 73.1% 74.5% 78.4% Community Nursing & Therapy Category A patients seen same day % 95% 95.9% 97.5% 95.9% 96.6% The CCG has worked with provider trusts to understand why some performance standards have not been met and to implement action plans for improvement. This is ongoing work into 2015/16. Throughout the year there was a concerted effort to reduce the number of people placed in mental health beds out of area. By January, the number had been reduced to 21 from a peak of 52 in October. page 10
Finances The CCG reported a surplus of 4.570m (2%), carried forward to 2015/16. It achieved QIPP savings of 4.512m - 85% of plan (these are financial efficiencies to help our budget stretch further). 2014/15 Actual Expenditure m Running Costs - 5m Other Programme Costs - 0.4m Actual Surplus - 5m Primary Care - 35m Continuing Care - 15m Community Services - 22m Acute Care - 115m Mental Health - 29m 2015/16 Planned Expenditure m Running Costs - 5m Other Programme Costs - 10m Contingency - 1m Planned Surplus - 3m Primary Care - 36m Continuing Care - 16m Acute Care - 116m Community Services - 23m Mental Health - 30m page 11
How to contact the CCG: Telephone: 01603 613325 Email: enquiries@norwichccg.nhs.uk NHS Norwich CCG, City Hall, Norwich, NR2 1NH If you would like to become involved in the work of the CCG, perhaps on our Community Involvement Panel then please contact our Engagement Manager, Laura McCartney-Gray Email: laura.mccartney-gray@nhs.net Telephone: 01603 751638 http://www.norwichccg.nhs.uk/index.php/have-your-say