Managing Director s Report

Managing Director s Report 06 September 2018 1. Taking forward system-wide transformation in Southwark 1.1. Long Term Plan for the NHS On 18 June the Prime Minister set out a funding settlement for the NHS in England for the next five years. In return, the NHS has been asked to set out a long term plan for the future of the NHS by autumn, setting out our ambitions for improvement over the next decade, and our plans to meet them over the five years of the funding settlement. Development of the long term plan for the NHS will be based on the advice and experience of clinical experts, staff and other stakeholders, including representatives of patients and the public. Southwark CCG is currently feeding into the development of our plan both as part of south east London s STP and individually as a CCG. It is vital that all those who rely on and work in or alongside the NHS have the opportunity to contribute their ideas and insights into this process. To make it easy for these groups to have their say on the different aspects of the plan a discussion guide has been created for staff, clinicians, patients and the public and is available at the following address https://www.engage.england.nhs.uk/consultation/developing-the-long-term-plan-for-the-nhs/. An easy read version of this guide is also available. 1.2. Southwark Community based Care Programme The Southwark CBC Programme brings together system development workstreams to accelerate Local Care Networks (LCNs), alongside commissioning development workstreams that will support the Council and CCG to move towards commissioning for population outcomes. The three key strands feeding into the programme are: Local Care Networks Developing collaborative arrangements, including the development of Partnership Southwark Managing the interdependency between the CCG and Council s strategic commissioning agenda including Bridges to Health and Wellbeing and our joint strategies (e.g. Mental Health and Wellbeing). The CBC Programme Board will enable the CCG, Southwark Council, and system partners to steer and oversee key areas of work to drive integrated community-based care in Southwark; ensuring strategic coherence and making best use of our collective resources. Oversight of the programme sits with the Southwark CBC Programme Board, which had its inaugural meeting in June, with representation from the Council, CCG, and health, social care and voluntary sector providers. 1

The programme has recently been granted funding of 370,000 from the Guy s and St Thomas Charity to help progress work in 2018/19 including: Strengthening our system partnership and accountability arrangements to accelerate LCN development Engaging with providers and service users on Bridges to Health and Wellbeing to coproduce system-wide outcomes for priority population segments Co-designing a model for integrated neighbourhood working across local neighbourhoods of 30k to 50k people within LCNs to reduce fragmentation, improve health and social care outcomes, enable our workforce to give the best care and support possible and build healthy communities Developing a greater understanding across our commissioner and provider partnership of how we can create a sustained culture shift of integrated care; role modelling this at a senior leadership level, creating the conditions and permissions for staff to test new ways of working within LCNs and developing a shared approach to co-production with patients, service users and carers. 1.3. CCG planning for 2019-20 As a key input to the 2019-20 planning and commissioning round, CCGs across south east London including Southwark CCG are currently developing annual commissioning intentions, which signal to providers the CCG s commissioning priorities for the next financial year. These are being socialised and tested with partners across the system and will be fed into 30 September commissioning intention letters to our providers, as well as forming a key input to the CCG s workplan for the 2019-20 contracting round and our programme for Quality Innovation Productivity and Prevention (QIPP). 1.4. Engaging with local residents and stakeholders On 28 August the CCG held our Annual General Meeting. As well as presenting the CCG s progress and achievements during 2017-18 and our Annual Accounts, the CCG team led a series of presentations on the Southwark Community based Care Programme with a focus on three major enabling projects: community estates development, digital development and Clinical Effectiveness Southwark. A copy of key content will shortly be available on the CCG website at http://www.southwarkccg.nhs.uk/news-and-publications/meetingpapers/pages/annual-general-meeting.aspx. 2. System Resilience 2.1. Accident and Emergency 4 Hour Standard Performance for both GSTT and KCH have remained below the 95% national standard for patients being treated, admitted, transferred or discharged within 4 hours. 2

GSTT achieved 86.6% for July against the 4 hour performance target for all types which is a slight improvement on June performance of 85.6%. GSTT reported that they have seen higher than planned attendances over the last quarter with patients arriving in surges creating long waits. Internal and external key actions have been developed to address the unplanned activity. The Emergency Department is recruiting extra staff to ensure rotas match demand, as well as adding additional GP shifts in the UCC. GSTT is also reviewing the Rapid Assessment & Treatment (RAT) process in order to improve ambulance handover times. The Trust is continuing their expansion of ambulatory care pathways through the development of new hot clinics. Lambeth CCG is also working to expand the redirection service provided by Waterloo Health Centre to provide more GP appointments during the week. In preparation for winter pressures, GSTT is also developing their winter plan. KCH A&E performance for July was 77.9% for all types, which was a decrease on June performance of 82.7%. The Denmark Hill site continues to struggle with managing demand and has seen a number of days in July and August where attendances have been over 500. The Trust has developed a number of actions to help improve performance. In July, KCH worked with LAS to set up a new streaming process for ambulances to handover patients to the UCC. This is anticipated to allow LAS to redirect approximately 8% of patients per day away from the Majors department and help improve ambulance handover times. The Trust is also working on their streaming model at the front door of the ED/UCC to redirect patients who do not have urgent medical needs to other services. The Trust is also in the process of recruiting into the newly formed Alcohol Team which will support the Emergency Department daily. Transformation Nous continues their work in the Trust to help increase daily discharges in Medicine, Surgery and Networked Care to increase patient flow. The KCH Emergency Pathway Board continues to meet with regular attendance by the CCG, ICDT, Transformation Nous and NHS Improvement to help facilitate improvements on site. 2.2. Integrated Urgent Care (formally NHS 111) After a lengthy process to procure a new Integrated Urgent Care (formally NHS 111) service for South East London, we are happy to announce that a contract has been awarded to the London Ambulance Service. The new service will be operational on the 30 th of October, 2018. South East London CCGs are currently working with LAS to mobilise the new service. There will be significant work over the next two months around communications with our residents, as well as partners to ensure everyone is aware of the new service. 2.3. London Ambulance Service For the first time since the start of 2018/19, LAS has not achieved all ARP performance targets for all 4 Categories in Southwark. In July 2018, LAS missed achieving the performance target for Category 3 patients by a little over 21 minutes. In South East London, LAS missed the target for Category 3 across 5 out of the 6 CCGs. This will be monitored to ensure LAS delivers against all targets. 3

2.4. Referral to Treatment (RTT) Standard RTT performance for Southwark CCG in June 2018 was 85.3%, which was below the trajectory of 86.8% and was a decline from 86.0% in May 2018. The compliant specialties were Dermatology, General Medicine, Geriatric Medicine, Neurology, Thoracic Medicine and Rheumatology; the same as the previous month. RTT performance for Southwark at KCH was 79.8% and compliant specialties were Thoracic Medicine and Rheumatology. To improve performance, KCH has secured additional insourcing capacity by extending the contract with 18 Weeks Support to provide additional outpatient and day case activity, mainly in Ophthalmology and Dermatology. KCH has also identified an RTT Recovery Lead to focus on demand and capacity alignment, and long-wait PTL review. Ideal Healthcare has been re-commissioned to undertake validation of followups by the end of Q2 (2018/19) and a central RTT tracker team will continue to review data quality. RTT performance for Southwark at GSTT was 89.4% and nine out of 16 specialties were compliant. To improve performance, challenged specialties are revising trajectories and agreeing recovery plans. In addition, monthly PTL assurance meetings and weekly Red2Green meetings have been implemented from May 2018 to identify constraints. The number of patients waiting over 52 weeks for elective care was 102 in June 2018, an increase from 78 in May 2018. Of these, 100 occurred at KCH; 1 at GSTT and 1 at another trust. Specialties with the longest waits were General Surgery (42) and Trauma & Orthopaedics (40). To further support performance and reduce waiting times, we will be intensifying our efforts in working with local practices to optimise the value of referrals to ensure patients receive the right care, in the right setting, first time. We will be encouraging GPs to increase their use of decision support tools like Consultant Connect and VisualDx and increase use of nonsecondary care pathways like the optometrist triage and community dermatology services. 2.5. Cancer Waits Southwark CCG did not meet the national Two Week Wait standard of 93.0% in June 2018, achieving 91.7% for all cancers. This was a slight decrease in performance compared to 95.2% in May 2018. Southwark CCG missed the target of 85% for Cancer 62 Day performance in June 2018, reaching 83%. This was however an improvement from 77.6% in May 2018. In June 2018, there were 8 cancer 62 day breaches, of these, 4 were attributed to GSTT and 4 were attributed to KCH for first seen provider. Regarding breach reasons, 5 related to Health Care Provider Initiated Delay, 2 for patient Choice and 1 for Administrative Delay. 4

The main performance drivers in the SEL system are: staff capacity issues across a range of staff groups; challenges with Multidisciplinary Meeting (MDM) co-ordinators and tracking resource; diagnostics capacity - issues with a shortfall across CT/MRI and Endoscopy; and an increase in 2 Week Wait referrals. Key system wide actions are: New operating model from May 2018, with the establishment of a Shared Care Cancer Delivery Team to provide oversight to and increased support and focus to improving Cancer performance across South East London (SEL) Focus is to drive forward the revised Delivery Plan for 2018/19 Cancer 62 day Recovery trajectories agreed and expect to meet standard by November 2018 across SEL on a Trust basis Procurement of additional diagnostic capacity through the Accountable Cancer Network (ACN) Recovery Plan that focusses on challenged pathways (Prostate, Lung/Thoracic, Lower Gastrointestinal (Lower GI), Head and Neck, and Gynaecology). Ongoing recruitment of staff to support delivery of cancer pathways including MDT workforce at LGT, KCH and GSTT Focus on improving median waits and ensuring that there are consistent straight to test models across the sector. 2.6. Electronic Referral System (e-rs) Southwark CCG s e-rs utilisation in July 2018 was 62%, ranking Southwark 19 th out of the 32 CCGs in London. On 1 September, King s Denmark Hill, completed Phase 4 of their paper switch-off programme, with 2 Week Wait services becoming e-rs only. This means that both King s and GSTT have now completed their paper switch-off programmes and will meet the national deadline for all consultant-led first outpatient appointments to be made via e-rs from 1 October 2018. In Primary Care, there are GP IT Facilitators and Trainers available who provide e-rs training to practices, and practice level information is being used to identify and target those practices which may benefit from additional training. An e-rs workshop is being held in mid- September for GPs and administrative staff and webinars on e-rs worklists are being held in September, October and November. Resources for GPs (including training guides developed by the GP IT Facilitators) are available on the Members and Staff Zone and regular updates continue to be provided in the Planned Care Newsletter. 5

3. Primary Care Southwark CCG is pleased to confirm that following the GP practice contract procurement process, AT Medics has been awarded the contract for the delivery of general practice services at the Lister Primary Care Centre and Falmouth Road Group Practice from 1 October 2018. AT Medics is a reputable GP-led organisation that runs a number of GP practice services across London and has been providing the services at Falmouth Road Group Practice during caretaking. The procurement at the Lister practices included a combined list of patients from Dr Hossain s previous practice at the Lister Primary Care Centre and patients from the Hurley Group Practice also at the Lister. Dr Hossain s practice was being managed under caretaking arrangements. The CCG is working closely with the practices involved to ensure a smooth transition and mobilisation of these contracts and is in the process of writing to all patients to inform them of the outcome. AT Medics is also arranging meetings for patients to meet some of the new team and learn more about the services that will be offered and how patients can become involved in shaping future services provided at the practice. 4. SEND Local Area Review Final OfSTED / CQC report On behalf of the CCG I am pleased to announce that inspection of Special Education Needs and Disabilities in Southwark (known as the SEND Local Area Review inspection report) was published by OfSTED on 6th September. The joint OfSTED / CQC inspection took place at the end of June and describes how all services from Education, Health and Social Care work together to support our children with special educational needs (SEN) and Disabilities across Southwark. There is much to celebrate in the report with such statements in the main findings as; The Local Area is inclusive which is testament to the work of all our services and schools and young people say, they feel welcome in the local area and know how to stay safe. There is particular praise for the Support, Information and Advice service (SIAS) and the work of the SEND Team with the Youth Offending Team. Several excellent examples of coproduction were seen by the inspectors involving young people. What really matters is the outcomes young people with SEN and Disabilities achieve. These are impressive in Southwark with educational outcomes achieved at the end of all key stages comparing favourably with those of other pupils nationally. Leaders have detailed systems in place for evaluating the variety of education, health and social care outcomes. They use these to evaluate thoroughly the quality of education and/or projects that they have undertaken. There are areas for development which the inspection team acknowledged we were aware of and had already started making improvements. 6

We will continue to work with colleagues in the council and with children, young people and families to ensure that we strengthen our effectiveness in working together for our SEND population. Areas include further work with parents to ensure consistency of support across the local area, our SEND post-16 strategy and further development of our Education, Health and Care plans for children with the most complex needs. On behalf of the CCG I would like to extend our thanks to everyone who was a part of this and especially to our young people and parents who fully contributed to this process and who we will be working with closely to make Southwark an even better place for children, young people and their families with SEN and disabilities. Items for the Governing Body to formally approve 5. Managing the budget and process for Excess Treatment Costs NHS England are trialling a process where Local Clinical Research Networks (LCRNs) manage the process and budget for excess treatment costs (e.g. additional costs incurred for care associated with research). CCG budgets have been top sliced centrally and a standard commissioning policy is being put in place, but it has also been requested that from a commissioning governance perspective a single borough is delegated the host function on behalf of all CCGs supported by the LCRN. This includes the ability to approve these costs where the answer is not made clear through the designed policy. This trial process is from 01 October 2018 until 31 March 2019 and it is proposed that Southwark CCG will undertake this function for all of South London (subject to final confirmation for south west London). The Governing Body is asked to approve the delegation of the host function to Southwark CCG. 7