Annual Review Highlights and developments in 2017/18 We want everyone in mid Essex to livewell
Contents Welcome from our Accountable Officer 5 What we do 6 Our vision 7 Local challenges 8 Working in partnership 9 What we achieved together 10 Our performance 12 How we spent your money 14 Our staff 17 Involving you in our plans 18 Get involved 19 We want everyone in mid Essex to livewell 3
Welcome from Caroline Rassell, Accountable Officer The past 12 months have been a very important time for NHS Mid Essex CCG and our communities. This year we will will continue to deliver safe and high quality services for the present as we look to transform services for the better into the future. We want you to be at the heart of transforming services to keep them local for years to come. You can follow us @MidEssexCCG on Twitter, like our Facebook page or use any of the other ways listed on our website to stay involved and join us on our journey to give you great care. I would also like to take this opportunity to thank our Board, staff and volunteers for their work and dedication over the past year. Their outstanding commitment ensures that we can continue to work together with our communities and partners to ensure everyone in mid Essex can Live Well. Caroline Caroline Rassell Accountable Officer We want you to be at the heart of transforming services to keep them local for years to come 5
What we do Our vision NHS Mid Essex Clinical Commissioning Group (CCG) plans, buys and monitors most local NHS services in mid Essex, a process called commissioning. These services include: Our goal is simple: We want everyone in mid Essex to Live Well. Community services such as district nursing, speech and language therapy, podiatry, community hospitals and stroke rehabilitation. Mental health services including psychological therapies, children and young adult mental health support and learning disability services. With partner organisations, we plan care around the stages of life, so we can work out the support people need when they are young, develop a long-term health condition or become frail as they get older. We call this approach Live Well and it has now been adopted across the area. There are five main stages. StartWell gives children in mid Essex the best possible start in life, from before birth through to early adulthood. Non-emergency patient transport. BeWell helps adults make healthy lifestyle choices, look after themselves and use the right NHS services. Continuing health care for people requiring ongoing NHS support. StayWell supports adults with long-term illness, poor mental health or social care concerns to lead fulfilling lives. Some additional services provided by local GP practices. And, jointly with other CCGs, acute hospital services, integrated urgent care including NHS 111 and emergency ambulance transport. AgeWell acknowledges that as we age, we are more likely to need the support of others and helps to build a strong network of support. DieWell tackles the difficult topic of death head-on, giving people nearing the end of their lives more choice. The CCG brings together 45 GP practices in the mid Essex area. Our member practices elect GPs who are part of our governing body including our Chair and Vice Chair. All GPs in our local area are closely involved in designing the CCG s plans through regular discussions. 6 The CCG serves 392,000 people who live in the districts Braintree District, Chelmsford City and Maldon District, which together make up mid Essex. We understand that our population cannot Live Well unless they enjoy optimal physical and mental health and our unwavering commitment to this remains 7
Local challenges Working in partnership We want people in mid Essex to be able to Live Well by receiving the right care and support, when they need it, and in the place that is best for them. Health and social care face a number of challenges: By 2020, the mid Essex population (currently 392,000) is expected to grow to more than 400,000. We recognise that health and care planning and delivery is most successful when it is collaborative, so we work with a range of organisations across Essex to deliver the best care for local residents. An important new way of helping people in our area to Live Well is planning some NHS care such as hospital services, mental health care and the NHS 111 phone service across a bigger area. Planning for more people together helps us offer better care and pool the expertise of the healthcare professionals who look after you. So we have been working more closely with the four CCGs in south Essex*, plus our hospital trusts, local authorities and other parts of the NHS. Together we have formed what is called a Sustainability and Transformation Partnership, or STP. During 2017/18, the Mid and South Essex STP had a big conversation with people across the area about how their hospitals worked and based on what they said, changes were agreed in July 2018. You can read more about them at nhsmidandsouthessex.co.uk. The number of frail elderly people with long term health conditions is rising faster than the national average. * These are: Basildon and Brentwood CCG; Castle Point and Rochford CCG; Southend CCG; and Thurrock CCG. Population: 392,000 Overall life expectancy is increasing bringing an ageing population and increasing the demand on our services. NHS Mid Essex CCG Braintree Halstead Witham Population: 269,000 Chelmsford BROOMFIELD HOSPITAL Maldon NHS Basildon & Brentwood CCG South Woodham Ferrers Southminster Population: 169,000 Billericay BASILDON HOSPITAL Basildon Rochford SOUTHEND HOSPITAL NHS Castle Point & Rochford CCG NHS Thurrock CCG South Ockendon Grays Southend-On-Sea NHS Southend CCG Population: 179,000 Essex County Council Population: 184,000 Thurrock Council Southend-On-Sea Borough Council 8
What we have achieved together We pride ourselves on the innovation, high quality and good value we bring to local NHS care. Working with our partners, providers and patient representatives, the CCG has taken the Live Well agenda forward in a number of important ways during 2017/18. Several of these achievements have received national recognition. We planned and delivered a cancer summit in November 2017 to share good practice in cancer diagnosis and care among mid Essex GP practices. Our speakers included clinicians from our regional Cancer Alliance, Cancer Research UK and Macmillan Cancer Support. The summit had the highest ever attendance for one of our GP shutdown events more than 250 GPs, nurses and administrative staff from across the patch. Feedback was very positive and a number of doctors told us they had learned a lot from the session. Together with Castle Point and Rochford CCG, we led an STP-wide campaign to highlight the impact that missing GP appointments can have on the care available to other patients and how people can tell their surgeries if they are unable to secure an appointment. During the campaign period, indicative numbers suggest missed appointments dropped by 8% across mid and south Essex. We have developed a framework that helps us to buy high quality care at home for people in need of it very quickly, for example if they are at end of life to help them Die Well. Along, with meeting an important need, the framework is also projected to save the local NHS about 75,000 compared to buying similar care without the framework. We commissioned a comprehensive health and wellbeing service for people living with dementia in mid Essex which we have called the Dementia Intensive Support Service, or DISS. Following its full launch on 1 December 2017, the DISS offers a one-stop shop for dementia care, not only crisis support for people with the condition and their families but early intervention and physical health services too, all available by calling a single phone number. People can refer themselves into the DISS without the need for a GP contact first if they are concerned about their health. We were honoured to receive a Self Care Innovation Award for the Common Childhood Illnesses campaign we ran in 2016 and early 2017. We organised a series of clinically-led workshops for local parents offering guidance on how to identify children s ailments and how to treat them at home or what to do about more serious illnesses. We designed and printed booklets sharing similar clinical advice that we distributed with the help of partner organisations to parents across mid Essex. We pride ourselves on the innovation, high quality and good value we bring to local NHS care 10 11
Our performance Mid Essex CCG has a number of responsibilities and targets set nationally. There are number of must dos for all CCGs in England. These include developing strong partnerships with neighbouring parts of the NHS but also meeting A&E and ambulance wait time targets, getting 92% of patients their first treatment within 18 weeks of being referred for it, and meeting cancer care standards. Over the past year we saw a big increase in demand for our local A&E services. It was not unusual for more than 300 people a day to pass through Broomfield Hospital's emergency department, a number that would have been exceptional two or three years ago. This meant the trust that runs the hospital was not able to see 95% of the patients arriving at A&E within four hours. The average proportion of patients seen in the target time during 2017/18 was 83.5%. Planned operations had to be cancelled to make way for people needing emergency beds, and the hospital trust also saw a lot of pressure on its plastic surgery (for patients needing procedures such as reconstruction after cancer) and orthopaedics services. As a result, fewer than the target 92% proportion of patients got their first treatment within the nationally agreed timescale. The hospital trust has recovery plans to address this and received external support. Early actions include using specialist operating theatres at Braintree Community Hospital for orthopaedic surgery. The hospital trust also didn t meet the two major cancer targets in 2017/18. The first target is that there should be no more than 31 days between clinical staff deciding to treat a patient for cancer and that patient receiving their first treatment. The other target says there should be no more than 62 days between a GP s urgent cancer referral to hospital and the first treatment for the patient. The hospital trust has worked with the CCG, the national hospital watchdog (called NHS Improvement) and Macmillan Cancer Support to set up an action plan, a cross-organisation cancer team and new tools to get closer to these targets in the coming year. Many of our performance indicators can be found on the My NHS section of the national NHS website, alongside those of other CCGs and NHS providers. Mid Essex residents can find these by searching using their postcode on the site. Some performance measures for the CCG compare favourably with neighbouring CCGs and national targets, but there are a number of areas where the CCG is rated as needing improvement. These are dementia and diabetes care, Improving Access to Psychological Therapies (IAPT) and learning disability services. To address this, the CCG has taken steps including: creating a new dementia crisis service (see page 10 for further information) and reshaping local jobs relating to dementia. redesigning how IAPT services work and launching a new online tool suitable for some people with mental health needs. setting up a register of local people with learning disabilities and a new service from Essex GPs for them. GP practices have also received training about how to best support these patients. helping to improve care for diabetes care, which is one of the most common health conditions the NHS supports the CCG had some real success during 2017/18 in improving care and helping people with type 2 diabetes manage their own health better. More work on this is planned for 2018/19. We also track our equality and diversity goals to ensure everyone in our communities gets equal access to NHS care. The CCG has improved year on year against these goals. Goal Better health outcomes Improved patient access and experience A representative and supported workforce Inclusive leadership Number of Outcomes Total 18 5 4 6 3 Final rating against outcomes 2015/2016 Developing 2 Achieving 3 Developing 0 Achieving 4 Developing 2 Achieving 4 Developing 1 Achieving 2 Developing 5 Achieving 13 Final rating against outcomes 2016/2017 Developing 2 Achieving 3 Developing 0 Achieving 4 Developing 1 Achieving 5 Developing 1 Achieving 2 Developing 4 Achieving 14 Final rating against outcomes 2017/2018 Developing 0 Achieving 5 Developing 0 Achieving 4 Developing 0 Achieving 6 Developing 1 Achieving 2 Developing 1 Achieving 17 The definitions for developing and achieving vary from category to category. Descriptions for these and other ESD2 ratings are available on the NHS England website. Over the past year we saw a big increase in demand for our local A&E services 12 13
How we spent your money The funding the CCG receives from the Government each year is set by a national formula designed to work out what care local people need. The formula is based on local people s age, average income and other factors. Mid Essex s population is considered to have a relatively low need for healthcare expenditure under the formula so our assessed spend (or target ) per head of population is the lowest in Essex. We received 447.8m baseline funding for healthcare in 2017/18 which was 1.85% ( 8.4m) below target funding. During the year we spent 446 million on local health and care for the people of mid Essex. The CCG has a historical deficit in our accounts that we now have to repay, requiring additional savings each year. The CCG repaid more than 6 million of that deficit in 2017/18 but with the reduced funding, we had to make savings of more than 20 million. We will need to do the same again in 2018/19. We are constantly working to make sure patients and the public have a say in how the money we receive is spent. The Lay Members of our Board, who are drawn from the local community, hold us to account for that and make sure the CCG is making wise use of its resources. We are constantly working to make sure patients and the public have a say in how the money we receive is spent 14 15
Our staff Working at NHS Mid Essex CCG How our staff feel about working at NHS Mid Essex CCG is really important to us, and our staff survey is one way for staff to share their feedback. Our staff told us that the CCG has a positive culture and is a supportive place to work which encourages teamwork and collaboration. The results also showed that: 97% 91% 98% of staff felt that the CCG had taken positive action on health and wellbeing in the workplace. of staff said their managers were supportive. of staff are aware of the CCG s values. Supporting staff to Live Well Our staff are committed to ensuring that the population of mid Essex Live Well. To support our staff personally to Live Well we launched three CCG-wide initiatives this year. 100 Days, 100 Ways this saw staff sharing what they did to Live Well, with a different CCG employee holding the title of Live Well Ambassador each day, sharing inspirational stories of what was important to them and what they did to look after their own wellbeing. Walk the World staff were challenged to walk 25 million steps collectively over the 100 days. Steps were plotted on a world map and each week a league table showed the number of steps each participant had completed. By the end of the challenge, staff tracked 58 million steps between them enough to walk around the whole world. 100 Days in Mind focusing on mental health and wellbeing. We have also overseen the training of a number of staff to be Mental Health First Aiders, empowering them to provide support to colleagues and signpost to appropriate services where required. Our people 16 Our staff told us that the CCG has a positive culture and is a supportive place to work which encourages teamwork and collaboration We have 149 employees, with some part time working meaning the whole-time equivalent of staff is 122.21. Four per cent of staff identify themselves as disabled. Our governing body, or Board, has a majority of healthcare professionals, a requirement for CCGs. The Board consists of seven men and seven women, and black and minority ethnic (BME) representation is above the percentage for the mid Essex population. 80.5% 19.5% 17
Involving you in our plans Get involved The NHS has a legal obligation to involve the public in how it plans services and in making changes to those services. We involved patients, the public and partners in our commissioning in a number of ways during 2017/18. Stakeholder meetings CCG senior managers go to a number of partnership meetings with local authorities, the local NHS watchdog Healthwatch Essex and other groups. Outreach in the community the CCG runs roadshows at regular events such as the Little Legs festival in Braintree and Broomfield Hospital open days. Public engagement through social media especially on Facebook, Twitter and Instagram. The CCG's Patient Reference Group representatives from local GP practice and hospital patient groups, Healthwatch Essex and the voluntary sector all hear CCG plans and offer their views. Formal engagement and consultation exercises asking the wider population over a number of weeks about particular changes the CCG is proposing to an aspect of the local NHS, so people can offer suggestions and help shape the final plans. Sharing people s experience of care through the Patient Story films shown to our Board when they meet. You can find out more about how the CCG involves local people in decision-making through the Communications and Engagement and Patient Experience reports prepared for quarterly Board meetings. They are available in the Board papers we post on our website at https://midessexccg. nhs.uk/about-us/ccg-board-meetings. Involving patients and the public in decision making is a priority for the CCG. We know this improves the quality of local health services and ensures we focus on the right issues. There are plenty of ways to get more involved yourself, if you want to, including joining your GP practice s patient group, sharing your story with us through our Patient Advice and Liaison Service, or taking part in our virtual involvement group. Live Well Network Our Live Well Network is a virtual group of patients, public and voluntary groups who are interested in getting more involved in how services are planned and designed. By becoming a member, you can take part as much or as little as you like. You will also: Receive our regular e-newsletters. Share ideas and views about local health services. Stay up-to-date with the health and wellbeing topics that interest you. Take part in focus groups, consultations and surveys about local healthcare. To sign up or find out other ways how you can get involved, visit our website: www.midessexccg.nhs.uk/get-involved. 18 19
Contact Us This annual review summarises NHS Mid Essex CCG s work during 2017/18. This is covered in detail in our Annual Report and Accounts, available on our website midessexccg.nhs.uk. To request the annual review in alternative formats, please contact the Communications and Engagement team on the details below. NHS Mid Essex Clinical Commissioning Group Wren House Hedgerows Business Park Chelmsford Essex CM2 5PF 01245 398750 meccg.ppe@nhs.net midessexccg.nhs.uk @midessexccg /CCGMidEssex Published by NHS Mid Essex CCG s Communications and Engagement team 2018: NHS Mid Essex Clinical Comissioning Group livewell