Strengthening the patient voice
West Bromwich Albion
5 July 2012
1
Feedback Summary – morning session
•
•
•
•
•
•
•
•
•
Where will the money go – control/governance
Engagement – are we practising what we discussed
GP burnout
Access – appointments, phone access, telephone costs,
choice, receptionists doing triage, online
Public health/local authority helping health agenda – schools
and recreation centres going – obesity agenda
Access to mental health – making decisions on my behalf
Links between secondary (hospital) and primary care
Joined up approach for social care and discharge back into
the community
Changing role of GP – home visits, out of hours
New NHS
Parliament
Key:
Accountability
Department of
Health
Funding
Right Care Right
Here partnership
NHS Commissioning
Board
Monitor
CQC
Licensing
Providers
SWB CCG
Contracts
BSMHT, BCP, BCHC,
SWBH
Partnership
Local Authorities
Other providers BCH,
BWH, ROH, DGH, RW,
SWB, WM, and I/C.
Local HealthWatch
Birmingham HealthWatch
Sandwell HealthWatch
Patients & Public
3
A wide range of services available to
commission from
Complex range of providers for
healthcare:
Hospitals
Heart of England (3 hospitals),
University Hospitals Birmingham, Sandwell West
Birmingham, Birmingham Children’s Hospital, Royal
Orthopaedic, Birmingham Women’s Hospital and
Birmingham Dental Hospital, Dudley Group of
Hospitals
Sandwell
Birmingham
Specialist
Birmingham and Solihull Mental Health Trust,
Black Country Partnership Trust
Community
Birmingham Community Healthcare
Acute & Urgent
West Midlands Ambulance Service; Range of
urgent care, walk-in and other providers – Assura,
Care UK etc
Third Sector – a wide range of provision e.g.
over 40+ alcohol/drug dependency services
4
Our health priorities
From our health needs
analysis:
► Heart disease
► Stroke
► Smoking related conditions
► Alcohol (hospital
attendances/ admissions)
► Lack of physical activity/poor
diet/obesity
► Cancer
► Respiratory disease (COPD)
► Other long term conditions:
diabetes
dementia, frail elderly
► Mental health
► Infant deaths
Lifestyles:
5
Our health needs
6
Our health needs
Health without boundaries - November 2011
7
Our vision and values
Mission
Vision
Healthcare without boundaries
Working together, to improve health and care in our
communities.
8
Achieving the right balance - Localism
Big and small…
Clinical Commissioning Group
Local Commissioning Group
Robustness at scale
Local ownership
Resilience
Ideas into action quickly
Strong voice in the health economy
and contracts
Relevance
Ability to deliver through major
partnerships
Patient representation and
involvement
Overview of system
Ability to respond to feedback,
deliver improvements and
efficiencies at practice level
“As a membership organisation we would like to build ways of working that are
not bureaucratic with the right safeguards for all.”
9
Our Board Structure
GP Directors
Chair and Vice Chair of
Black Country
Lay Directors
Vice Chair
(Lay Director)
Executive Directors
Lay Director
Managing Director
(Vice Chair)
(Accountable Officer)
GP Directors
Chair and Vice Chair of
HealthWorks
Chair
(GP Director)
GP Directors
Lay Director
Finance Director
(Chair of Audit)
(Chief Finance Officer)
Clinical Directors
Secondary Care
Specialist
Other Board Members
(Non Voting)
Independent Committee
Members x2
GP Directors
Nurse
Chair and Vice Chair of
ICOF
GP Directors
Senior Officers x3
Public Health Member
Chair and Vice Chair of
Pioneers 4 Health
Chair and Vice Chair of
Sandwell Health
Alliance
Notes
• Directors are voting members
• Other Board members are non voting members
• The Chair will be one of the GP Directors from the LCGs, not an additional post
• Vice Chair will be one of the two Lay Directors, not an additional post
One GP Directors to be Chair
10
Commissioning what it is and why
Commissioning is:
“Proactive strategic role in planning, designing and
implementing the range of services required – rather
than just purchasing.
A commissioner decides which services or interventions
should be provided, who provides them and how
they should be paid for and may work closely with
the provider in implementing the changes”
11
Our governance
Remit: To determine
and implement the
OD strategy for the
CCG
Finance &
Performance SubCommittee
Remit: To have on-going
responsibility for the
affordability of the local
healthcare system, and
to receive monthly
monitoring reports. This
group will highlight
concerns to the Board.
OD Sub
Group
Main
SWBCCG
Board
Quality & Safety
Sub-Committee
Remit: To regularly
review providers to
ensure that services are
safe, and that outcomes
are monitored.
Remuneration SubCommittee
Strategic
Commissioning &
Redesign SubCommittee
Remit: To consider
service provision and
ensure that services are
commissioned for shorter
pathways, better value
for money and that
provision is appropriate
and adequate.
Remit: To determine pay
and remuneration for
employees (likely to meet on
an ad hoc basis)
Audit SubCommittee
Remit: To help with
discharging financial
functions. Statutory and
legal obligations,
working with accountable
officer.
Partnerships
Remit: To work with and
lead partnerships, putting
resources where
challenges lay. Working
and delivering on two
evolving agendas with
LAs, Health & Well-being
Boards, HealthWatch
and RCRH.
12
13
Continuously improving quality of care
Healthcare Commissioning
and Quality Plans
Build feedback and
improvement into
what we commission
on your behalf
Monitor the quality and safety of care from
the information you provide back to us
in a number of ways at our Quality and Safety Committee:
14
Creating a patient revolution
•
•
•
Co-production of services between patients and healthcare professionals
Community participation between public and the service
Improving customer experience of patients and carers
We will be looking at:
• The enquiries we receive and issues raised
• Reports that the organisations providing care produce to see what is
happening
• Surveys that patients and public complete with feedback
• Complaints and PALS enquiries
• Carers’ support
………………to improve patient experience
15
Our quality priorities
Our priority
How we monitor this
Safety
Population health is improving
Effectiveness
Treatments are effective
Patient experience
Population is satisfied with their
treatments
16
Clinical
Commissioning
Group (CCG)
NHS Commissioning
Board
Public Health (local
authority)
Community health
Maternity
Primary care– pharmaceutical,
dental & NHS sight tests
Healthy Child Programme for
school-age children
Elective hospital care
Rehabilitation
Highly specialised inc psychiatric
Sexual health (exc.
contraceptive)
Urgent and emergency care
inc A&E
For those in prison and other
custodial settings
Public mental health services
Older people’s healthcare
Some services for armed forces
Local programmes to promote
physical activity
Children, mental health,
learning disabilities
Continuing healthcare
Infertility & fertility
Public health services aged 0-5 inc
health visiting & FNP, immunisation
& screening
Drug and alcohol misuse,
tobacco control including stop
smoking and prevention
Wheelchair
Home oxygen
Treatment of infectious
diseases
NHS Health Checks
Initiatives to prevent accidental
injury
Initiatives to reduce seasonal
17
mortality
Our integrated plan
Will be used to:
► Set our priorities, guiding our decisions on planning,
investment and disinvestment
► Help partner organisations to see areas of focus, helping
us align things strategically
► Provide a means of holding us to account
18
Our strategic priorities
► Instigate – intervening early to prevent problems before
they occur
► Integrate – putting the patient at the centre of their care
► Innovate – changing the way we do things to deliver more
with less
► Improve – focusing on the quality and safety of services in
all parts of the system
► Influence – playing a full role in local partnerships, affecting
the determinants of health
19
Our plans are to:
► Increase the capacity and capability of primary care, using it
as a foundation for system change
► Focus on the frail elderly, supporting independence and
dignity in old age
► Accelerate the Right Care Right Here programme - providing
care in the community and treating hospitals as specialist
providers
► Treat mental ill health and promote wellbeing, viewing good
mental health as a precondition to better physical health
► Work in partnership to improve maternity and early years,
giving every child the best start in life
20
Our Model for Delivery
Engage:
Integrated Plan
Changes
Services
we buy
Contracts with
emergency & urgent
care e.g. Ambulance,
NHS 111
Contracts with
hospitals &
services
Contracts with
community care
providers e.g. District
Joint
arrangements
with local
authorities for
complex &
nurses, therapies
Delivery
Priorities
Primary Care Capability
CCG Staff &
Member practices
Frail elderly –
independence & dignity
Patients, carers
and Public
Accelerate Right Care
Right Here
Clinicians and
Partners
No health without
mental health
Specialist
support
services
often
Third
sector
e.g. Drug,
Alcohol
Partnership for
maternity and early
years
Performance & delivery
Quality, , Innovation,
Productivity and
Prevention
Better Health
Our plans 2012/13
Develop Primary care capability
Meet needs of Frail elderly - independence and dignity
Accelerate Right Care Right Here –
care closer to home
No health without mental health –
treat mental ill health and promote wellbeing
Work in partnership to improve maternity and early
years – every child best start in life
22
How we work with other CCGs, CSS
► System leadership - The Compact – an agreed way
of collective leadership for the NHS system
► For contracts - Agreed clinical leads and teams for
commissioning for contracts with appropriate CCG
representation
► Commissioning support – there are some areas
where it makes sense to buy support into the CCG
so it can be shared for efficiencies such as HR, ICT,
information processing
23
Thank you
► Have learned a great deal already and much to
build on
► Remain committed to what its all about….patients
and quality of care
► Committed to working with the third sector,
patients, their carer’s and communities to develop
together the best healthcare
Questions ?
24
Develop Primary care capability
1. Reach vulnerable people – make contact with primary care
2. Working with CCG members and NHSCB to identify and
support to address inappropriate variation of primary care
3. Proactive identification and management of long term
conditions - diabetes a priority - review lists, care plans,
reviews
4. Development of services to support patients
5. Improve consistency of referral through systems & peer
review
6. Patient repatriation – look at discharges in hospital
7. Making Every Contact Count – promote healthy lifestyles –
work in partnership with voluntary and community sector
8. Improving screening and vaccinations e.g. Screening
programmes e.g. Bowel cancer and vaccinations e.g.
Seasonal flu to help prevent avoidable illness
25
Meet needs of Frail elderly - independence & dignity
1. Specific focus on dementia – implementing national dementia
strategy, NICE guidance and identifying/scaling up local practice
2. Integrated working with social care & better case management
3. Working in partnership with social care for comprehensive package
of ‘reablement ‘services to promote and maintain independence
4. Providing support to carers to ensure that their health and well
being is not forgotten
5. Improving clinical input into nursing and residential care homes
improving care and helping them with increasingly complex needs
6. Developing consistent intermediate care services and pathways
7. When hospital needed, clear arrangements for care to be
transferred back to community safely
26
Accelerate Right Care Right Here –
care closer to home
Established track record of delivery improving and bringing services
closer with over 30 care pathway reviews undertaken which £3.9m
could be delivered locally for lower cost in community settings and
reducing £600k of activity
1. Continue as active partners in Right Care Right Here
2. Review Care Pathway Reviews to see what more can be
brought into community prioritising diabetes and other long term
conditions
3. Remodel services as they are moved
4. Work with partners to educate patients and public as locations
and pathways change
5. Support the trust to deliver final stage of programme in getting a
new hospital facility
27
No health without mental health –
treat mental ill health and promote wellbeing
1. Working with local authority and voluntary sector - develop specific
programmes to ensure promoted well being in all service areas
2. Develop and improve current mental health provision in primary
care
3. Including the IAPT programme
4. Making Every Contact Count on mental health – encouraging our
partners to do the same
5. Review the Rapid Assessment Interface and Discharge (RAID)
approach with view to making it standard
6. Adopt an assets-based approach to people with mental health
problems and learning disabilities – promoting independence
wherever possible
7. Review current major investments such as pooled budgets in
Birmingham between health and social care ensuring focussed and
achieving desired outcomes
28
Work in partnership to improve maternity and early
years – every child best start in life
1. Improving access to maternity services esp vulnerable
groups
2. Targeting lifestyle support at pregnant women, supporting
mental health and healthier lifestyles
3. Increasing quality of health visiting – allied to Family Nurse
Partnerships and post natal support services inc depression
4. Increasing uptake of childhood vaccines and screening
programmes
5. Linking with local authority efforts to increase supply and
uptake of evidence based parenting programmes and other
interventions
29
30