East and North Hertfordshire
Clinical Commissioning Group
AGM 2014
Welcome
Kate Harding
Creative Practitioner
Health Liaison Team
Lesley Watts
Chief Executive
2013/14
ANNUAL ACCOUNTS
Alan Pond
Chief Finance Officer
Housekeeping
• Draft Accounts submitted within 15 working days
of the year end – before the 23rd April deadline
• Annual Report and Accounts were agreed by
Board, audited and submitted to NHS England
before the 6th June deadline
• Unqualified opinions on the Accounts and Value
for Money statement received from the Auditor
• Full Annual Accounts published with the Annual
Report
A challenging first year
• Complete reorganisation of commissioning
landscape and funding
• Increase in CCG baseline funding of only 2.3% –
no more than inflation
• CCG remains underfunded by over £30m
• Activity growing faster than population growth
and the growth in funding
• NHS England requirement for CCGs to
underspend on their budgets by 1%
• Providers under financial stress
Balancing the funding
• 2.3% funding uplift
• Tariff reductions
• Underspend
carried forward
£20m
• Population growth
• Increased demand
• 1% underspend
£38m
2013/14 “A good first year”
• Achieved strong performance across the
majority of key performance indicators with
c75% delivered (e.g. hospital waiting times, long
term conditions, cancer services and end-of-life
care)
• Achieved national requirement for additional
efficiency savings
• Achieved the required 1% underspend of £6m
Performance on statutory financial targets
Expenditure does not exceed sums
allotted to the CCG plus other
income received [223H(1)]
Revenue resource use does not
exceed the amount specified in
Directions [223I(3)]
Revenue administration resource
use does not exceed the amount
specified in Directions [223J(3)]
ACHIEVED
£6,020,000 underspent
ACHIEVED
£6,020,000 underspent
ACHIEVED
£3,204,000 underspent
Performance across the CCG
Description
North Herts
Upper Lea Valley
Welwyn Hatfield
Stevenage
Lower Lea Valley
Stort Valley and Villages
Central Budgets
Total
Budget
£000
115,581
112,985
109,082
92,062
77,758
55,775
36,201
599,442
Spend
£000
115,442
112,968
109,080
92,023
77,634
55,637
30,639
593,422
Variance
£000
139
16
2
39
124
138
5,563
6,020
Variance
%
0.1%
0.0%
0.0%
0.0%
0.2%
0.2%
15.4%
1.0%
Where the money was spent
Acute services
61%
Prescribing
Mental health
& learning disability services
12%
Community services
7%
Continuing care services
4%
Other primary care
2%
CCG running costs
2%
12%
Community
Acute
Future cost drivers
•
•
•
•
•
•
Increasing population
Ageing population
Reduced Social Care funding
New technology and treatments
Patient expectations
Drive for continuous improvement
So expenditure rises ever faster
The financial challenge ahead
• Continued low growth in funding:
 3.38% in 2014/15
 2.52% in 2015/16
 Estimate 2.6% for each of 2016/17 to 2018/19
• 10% reduction in running cost allocation
• Gap between cost of demand and CCG funding
– £80m by 2018/19
• CCG savings of at least £80m needed over the next
5 years
The good news
• There are excellent and committed clinicians and
managers in East and North Hertfordshire to make this
work for local people
• Relationships with Social Care Partners are good and we
share the same objectives
• Relationships with Providers are good and we challenge
them to improve their services further
• We have already identified the efficiencies needed in
2014/15
• We have delivered on tough challenges in the past
and will do so again
Future proofing our strategy
Assess our
priorities
Improve
productivity and
reduce waste
Joint and
clinically led
commissioning
Develop
the market and
improve providers
Dr Hari Pathmanathan
CCG Chair
A clinically-led organisation
•
Most of the Governing Body members are
clinicians – doctors, midwives, nurses.
•
Every ‘locality’ group of GP practices is
represented on the board – diverse health
needs inform commissioning decisions
•
We are the only CCG in the region to delegate
£5 per head funding for over 75 year olds to
practices.
Clinically-driven improvements
• Home visits for acutely ill patients
commissioned, GPs can focus on complex
patients.
• Better continuity of care for patients and
staff in nursing homes
• Additional winter capacity in the community,
avoiding unnecessary hospital admissions
Challenges
• Demand management – demographic, prescribing,
staffing and infrastructure pressures
• New QEII
• Ongoing issues at Chase Farm Hospital
• Need to scale up successful schemes across the
whole CCG area, such as HomeFirst
• Political uncertainty
Opportunities
• New best-practice treatment ‘pathways’ for
common conditions in development
• Active and committed patient participation groups
• Diverse opportunities for clinicians to get involved
in new models of care
• Ongoing learning from pilot projects is improving
the services offered to patients
Thank you
The New QEII Hospital
John Webster
Director of Commissioning
Dr Nicky Williams
Vice Chair
Introduction
•
•
•
•
•
•
•
Highest priority for the CCG
History
Phases of the development
Services to be provided
Clinical perspective
Integration
Timescales for completion
A reminder
• DQHH - Delivering Quality Healthcare for
Hertfordshire
• Public consultation across Hertfordshire
concluded in 2007
• Key recommendations:
 Centralise acute inpatient services at
Lister
 Provide a local general hospital in
Welwyn Garden City
DQHH objectives
• Centralise specialist services, skills and
staff in one place
• Improve clinical outcomes
• Improve the patient experience and
environment
• To meet growing demand
• To recruit the best staff
Timeline
The new hospital completes in..….
30 weeks
Timeline
The next significant milestone is in….
3 weeks
Remaining wards, theatres and Emergency
Department transfer to the Lister Hospital
on 1st October
What’s happening and when?
October 2014
£30 million investment in new hospital
April 2015
New services, new buildings
QEII
New services, existing buildings
Remaining wards
and theatres move
to the Lister
Urgent Care Centre
Therapy areas and children’s zone
Outpatient appointments, ante-natal care and diagnostic tests
£150 million investment
Lister
Full emergency department and urgent care centre
All surgery
All inpatient wards
Inpatient maternity care
Outpatient appointments and diagnostic tests
What is an Urgent Care Centre?
• From October 2014, there will no longer be an A&E
at the QEII
• Open 24/7 to treat patients of all ages, including
babies
• Urgent Care Centres treat everything except the
most serious injuries or illnesses – when people
should call 999.
• There will also be an Urgent Care Centre integrated
within the new Lister emergency department to
stream patients appropriately
• Public understanding of the new way of working
is crucial
Summary of services after October 2014
New QEII
Lister
Hertford County
Local general hospital
Centre for specialist care
Local general hospital
24 /7 Urgent Care Centre for minor injuries and
illnesses
Full emergency department
No emergency care
Outpatients appointments
Outpatients appointments and specialist clinics
(e.g. sleep disorders, urgent eye clinic, etc.)
Outpatients appointments
Medical and surgical inpatient services
Specialty services – renal dialysis, heart attack
centre, stroke unit, etc.
Blood tests
Full range of diagnostic services
Blood tests
Scanning: x-ray, ultrasound, MRI, CT scans
Scanning: full range of scanning services including
CT, Dexa, MRI, nuclear medicine, ultrasound
Scanning: ultrasound, x-ray
Endoscopy
Endoscopy
Breast unit
Breast surgery
Pharmacy
Pharmacy – hospital pharmacy only
Children’s Zone
Children’s inpatient and outpatient services
Specialist children’s centre
Physiotherapy and other therapies
Physiotherapy and other therapies
Physiotherapy and other therapies
Rapid assessment for ill patients
Critical care
Out-of-hours GPs
Ante-natal care
Maternity including births, ante-natal and post-natal
Neonatal care
Routine blood treatments
Routine blood treatments (e.g. anti-coagulants)
Planned & emergency surgery (inpatient & day)
Every year, the New QEII will deliver:
•
•
•
•
•
•
105,000 outpatient appointments
35,000 Urgent Care Centre attendances
17,000 ultrasounds
13,500 CT and MRI scans
110,000 phlebotomy tests
30,000 x-rays
The New QEII
Progress so far
June 2014
Care home on the New QEII site
• History
• ENHT marketing site
• CCG & HCC specification
for bed based care
service we want to
commission
• Joint bid evaluation
• Links to Hospice and
services within the New
QEII
Nicky Photo No 2
Nicky Photo No 3
Community
Hub
Discharge
to assess
Early
Supported
Discharge
HomeFirst
Doing things
differently in the
community
Acute
in-hours
visiting
service
NHS 111
Mental health services
• Hertfordshire Partnership University NHS
Foundation Trust currently provide some
adult mental health services at the QEII
Kingsley Green:
• Welwyn and Mymms inpatient wards will
close in September and move to a purpose
built facility at Kingfisher Court in Kingsley
Green, near St Albans and Radlett
• Community mental health outpatient
clinics at the QEII will be run from
Roseanne House in Welwyn Garden
City. Appointments are also held in a range
of other locations
Kingfisher Court is easily
accessible via the M25, the
M1 and the A1M.
Public transport to the site is
to be confirmed, but
meanwhile HPFT will
provide a free transport
service from QEII & Hemel
Hempstead Hospital and
from Radlett, Potters Bar,
St Albans City and Watford
Junction train stations.
Mental health services
• Thumbswood mother and baby
unit will move to Kingsley Green
• The Acute Day Treatment Unit will
move in due course. It is likely to
move to the Glaxo Day Hospital at the
rear of the Lister Hospital in
Stevenage
• Community outpatient clinics run
from Roseanne House in Welwyn
Garden City and other community
settings, so these patients will not
need to visit an acute hospital site
Investing £150 million
New theatres block
The Treatment Centre
New wards block
Car parking
Investing £150 million
Refurbished wards
Neonatal unit
Critical care unit
Environmental
Infrastructure
Sharing information
• We’re delivering an extensive
communications and engagement
campaign to ensure everyone
understands what’s happening
and what’s available at the New
QEII and Lister Hospitals
• NHS 111 will advise anyone with an urgent medical
enquiry that is not an emergency, and people
should always call 999 when there is a medical
emergency
Summary
• Draws to a conclusion a significant
planning exercise
• Strong partnership working and staff
commitment
• The new QEII will be central to our
future commissioning plans
• Will result in a fantastic new facility that
the local community can feel proud of
Questions?
Workshop groups
Questions?
Thank you