Annual General Meeting North Hampshire CCG successes

Annual General Meeting North Hampshire CCG successes

The CCG s Vision: 2015/16 To place each patient at the centre of their own health To make a positive impact on the health and wellbeing of our population To facilitate an improved integrated health and social care system. Do this by providing excellent patient experience and clinical outcomes.

The CCG s locality A total of 19 GP Practices Population of >218,000 Council split: 76% B&D BC 13% E. Hants DC 11% W. Hart DC Support the population using resource of ~ 232 Million (2015/16) Local Providers include Hampshire Hospitals FT and Southern Health Foundation Trust

The North Hampshire Population When compared to the rest of England: Higher Proportion <16 year olds Higher levels of emergency admissions and unplanned hospitalisations for <19 year olds Lower levels of Obesity in <16 year olds

Our population Life expectancy: Males 81 years Females 83.3 years Higher levels of preventable mortality for Serious Mental Illness Increase in people with dementia by 23% between 2014-2020 Increase in population size by 8.2% by 2021

Reducing health inequalities Tackling health inequalities at a local level Working with providers, local authorities and voluntary services to ensure unpaid carers needs are met

Challenges 2015-2016 Urgent and emergency care performance CCG Assurance Framework Sustainability and Transformation Programme Service Reviews Alton and New Models of Care Programme To reduce the deficit at the end the financial year

Urgent and emergency care performance Challenges: Reduce hospital ED admissions/attendance Reduce the length of stay in hospital Reduce delayed transfer of care from hospital

CCG Assessment Framework changes 2016/17 2015/16 NHCCG to address two key areas: Leadership and Financial Sustainability

Sustainability and Transformation Programme Create an environment through which systematic change can be delivered to improve patient outcomes across Hampshire and the Isle of Wight (HIoW). Locally there are two pieces of work that will contribute to the Improve STP: health-related quality of life for people with long-term conditions Increase number of people living independently at home after hospital discharge Reduce emergency admissions Priorities Drive efficiency and ensure value for money Deliver high quality and safe services 1. New Models of Care for North & Mid Hampshire (NMoC) 2. Alton Review Integrated health and Social care (delivery of NMoC)

The New Models of Care Programme (NMoC) To design new service models (in primary, community and hospital settings) to enable care closer to home To work alongside West Hampshire CCG and other health-care organisations To engage with the public to design a whole system model of health and social care for North and Mid Hampshire To consult formally with the public on any proposed significant service changes and fully consider the results prior to implementing NMoC.

Alton Service Review Review of health and health-related care services for Alton and surrounding communities. Help the CCG make sure that health and health-related care services in and around Alton are safe, high-quality, meet the changing needs of local people and are affordable. To improve service by implementing NMoC in the following areas: Urgent Care Mental Health Services Older People s Services Maternity and Children s Services

Financial Overview Pam Hobbs Chief Finance Officer

2015/16 Finances Our Financial Responsibilities Responsible for NHS care for our population across UK (excluding specialised services, contracts with GP s, pharmacists, dentists and optometrists) Money follows patients Hospital Contracts are Activity based with a tariff (price per treatment) Financial Duties How did we do? To ensure that the CCG stayed within the resources allocated to it duty not met To ensure the CCG running costs do not exceed the allowance duty met To manage the CCG cash to meet the draw down requirements duty met To pay 95% of our bills promptly (within 30 days) actual c99% duty met

2015/16 Finances Financial Overview Revenue allocation of 231.9m + 0.5m income from other organisations (e.g. prescriptions, public health) = 232.4m Net Expenditure 234.9m Split into two categories Programme which comprises cost of care from providers - 230.4m Running costs CCG costs of commissioning 4.5m Overspend of 2.9m repayable in 2016/17, however this was an improvement the plan of 5.5m deficit QIPP Savings required in 2015/16 plan of 10.9m. 9.8m (90%) delivered

2015/16 Finances Consequences of overspending in 2015/16 Section 30 to Secretary of State issued by External Auditors advising CCG exceeded Revenue Resource Limit Reduction from CCG allocated resources in 2016/17 to repay the deficit Need for Financial Recovery Plan and its implementation in 16/17 (also detailed in CCG legal direction)

Spending by care setting 234.9m

How did we spend our resources? Care provided by a wide range of NHS and Independent Sector providers, in patient homes and other community settings Any care provided anywhere in the country Most provided locally main providers being Hampshire Hospitals, Southern Health, BMI, Frimley Healthcare, North Hampshire Urgent Care and South Central Ambulance Service. Joint Commissioning (with NHS England) relating to General Practice Notable new or improved Services Admissions Avoidance Joint Emergency Team (JET) Cardiac (Familial Hypercholesterolemia screening and anticoagulant drugs, GPs trained in performing echo-cardiogram tests) Nursing home advice and support Child and Adolescent Mental Health Services - Reduction in waiting times and increased access to early intervention services New Musculoskeletal Service and Spinal Pathway

What did we get for our resources?

Looking ahead 2016/17 30bn funding gap across the NHS Treasury has agreed 8.4bn of new funding over 5 years, frontloaded to support NHS Five Year Forward View Restore and maintain financial balance across the NHS Deliver core access and quality standards for patients Requirement to close three gaps in health and well-being, care and quality, finance and efficiency 22bn of efficiency savings required across the NHS

Looking ahead 2016/17 The CCG has been set firm three year revenue allocations followed by two indicative years. 2016/17 2017/18 2018/19 2019/20 2020/21 Growth% 7.2% 2.6% 2.4% 2.4% 4.2% Programme Allocation 243.3m 249.7m 255.8m 262.0m 273.0m Running Costs Allowance 4.73m 4.75m 4.76m 4.77m 4.78m Distance from Target CCG Programme Allocation 4.7% Under 4.5% Under 4.4% Under 4.5% Under 4.4% Under

Looking ahead 2016/17 Increasing challenging financial position across the NHS Need to look at whole resource available deliver value from every 1 Deliver the Five Year Forward View Hampshire & Isle of Wight Five Year Sustainability & Transformation Plan (STP) to a sustainable local NHS e.g. deliver targets, quality and savings (e.g. best value, clinically evidenced) New models of care, emphasis on prevention and well being, pro-active approach supporting patients with a long term conditions

Dementia Friendly Practice Initiative Dr. Nicola Decker

Dementia Friendly Practice Initiative The CCG aim is to enable timely diagnosis and improve postdiagnostic support. Part of the Dementia Delivery project plan is to implement the quality improvement programme ispace. ispace is a toolkit available to practices

ispace Increase diagnosis rates Patient and carer experience improved Staff attitudes towards dementia improved Low resource cost Positive potential for spread HSJ Award

Cancer Improving Diagnosis & Survival Dr. Charlotte Hutchings

Cancer improving diagnosis and potential rate of survival Achieved cancer wait targets of two week rule, 31 day and 62 day targets In top 20 CCGs in England for one year cancer survival rates currently 70.2% > the English average (68.8%) Cancers detected at Stage I or II 44.2% compared to English average of 45.7% (recording issue rather than real picture)

Cancer aims for 2016/17 Aims over the next year are to : Decrease % of cancers diagnosed during emergency admission Improve % of cancers detected at Stage I or II Improve rate of cancer screening (especially cervical and bowel cancer) Improve communication between hospital and GP/patient with better treatment summary

Frailty Initiative Dr. Abigail Barkham

Frailty Initiative Frailty is a long-term condition. A state of impaired homeostasis leading to increased vulnerability to minor stressor events. Frailty is not age defined but is age-related. Frailty requires an holistic approach to care. Ellis et al. 2011 Review of 22 trials of 10,315 patients in 6 countries Showed that Comprehensive Geriatric Assessment (CGA) and Care Planning approach provided the following benefits: 1. Greater likelihood of being alive and living in their own homes at 6 months: OR 1.25 (p 0.0002) and at 12 months: OR 1.16 (p 0.003) 2. Lower likelihood of institutionalisation: OR 0.79 (p <0.0001) 3. Lower likelihood of death or functional decline: OR 0.76 (p 0.001) 4. Greater likelihood of improved cognition: OR 1.11 (p 0.02)

Frailty Initiative To direct better primary care pathways for older people by considering individual frailty rather than chronological age. If Identify frailty top is not 2% managed most vulnerable it can lead patients to poor for person targeted centred care outcomes. planning to reduce unplanned hospitalisations Eg. Structuring 10% of over integrated people over care 65 around are at risk frailty. of adverse outcomes after Enabling an apparently targeted minor medication event which reviews challenges for older their people health. with These frailty outcomes using evidence-based can include reduced checklists mobility, (e.g. STOPP/START loss of independence criteria) or death. Identifying the presence of frailty to guide more appropriate, shared decision making in secondary care Identifying those with advanced frailty who may be entering the terminal phase of life for advance care planning discussions

Frailty Pathways

Plans for 2016/17 Paul Sly

Plans for 2016/17 Ensuring that the interests of North Hampshire residents are fully reflection in the Hampshire and IoW Sustainability and Transformation Plan. To carry out a robust and evidence based review of the plan for centralising Acute care services. Completion of the CCGs Primary Care Strategy. Completion of the Alton service review. Completion and implementation of our Frailty and MSK care pathway reviews.

Plans for 2016/17 Patient empowerment and self care. Improving our Mental Health and Learning Disability services. Developing the North and Mid Hampshire system resilience group. Ensuring that the CCGs financial recovery is sustained and embedded. Developing a strong and robust organisation.

Questions?