St Helens Clinical Commissioning
Group Annual General Meeting
Thursday 25th September 2014
Welcome
William Guest
Chair
Agenda
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Welcome and Introduction
Our Values
Working WELL Together
An overview of St Helens CCG’s Engagement Strategy
Public Health Annual Report 13/14
Annual Report Key Highlights
Annual accounts / Financial Overview
Integrated Commissioning Plan
Summary
Our Values
Making a difference – right care, right place,
right time
Dr Stephen Cox
Clinical Accountable Officer
St Helens CCG has six Core Values
• Efficient and Effective
• Respectful and Caring
• Leadership and Ambition
• Innovation and Creativity
• Collaborative and Inclusive
• Honest and Transparent
Developing our Values – themes from review
• Needs to be Jargon free and avoid too much ‘NHS
speak’
• Avoid clichés and unrealistic statements that will set
unrealistic expectations
• Reflect our role as commissioners and some of our
responsibilities as guardians of public money
• Make sense to staff and partners
St Helens CCG has six Core Values
Behaviours underpinning our values
Working WELL Together
Mary Radcliffe
Patient Group Member & St Helens CCG
Health Forum member
An overview of St Helens CCG’s Engagement
Strategy
William Guest
Chair
Why do we engage & involve the public?
The law states as a Clinical Commissioning Group we have a
legal duty to engage & involve the public (patients, carers &
families) in;
i) The commissioning of health and care services under the
amended Health & Social Care Act (NHS Act 2006)
ii) The engagement and involvement of individuals in their own
health and care.
iii) The Equality Act 2010 legally protects people from
discrimination in the work place and in wider society
2013/2014 has seen
improved stakeholder
relationships…
NHS IQ
Clinical
Colleagues
(Consultants)
Local
Authority
St Helens
NHS
Hospitals &
Fairfield
St Helens
Voluntary
Sector
Health &
Wellbeing
Board
GP
Members
Patients/Public –
in commissioning
services &
procurement
panels
Patient & Public
Health Forum
Mental
Health
Strategy
Event
Twitter –
2,500
followers
The Big
Health Day
Facebook
Working Well
Together
Event (150
attended)
CCG Public
Membership
Scheme – from 56
– 210 actively
involved
members of the
public
2013/2014 has seen
Improved public
Engagement…
Community
Group Visits –
BME, LD,
Homeless
Patient
Stories
“our house
of care
”
Improved
Patient
Family
Carer
experiences
500 actively
involved
members of
the St Helens
public
Individuals
making
decisions
about their
own health &
care needs
Families &
Carers
actively
involved
and engaged
‘real time”
communications
Patients on every
commissioning
panel
Patient
Family
Carer
Co-commissioned
Services
An effective
patient
group in
every GP
surgery
Effective
Communications
St Helens
joint public
engagement
Strategy
Working WELL Together…
Have you looked us up
on the internet…
www.sthelensccg.nhs.uk
Follow us on twitter
@sthelensccg
Look us up on facebook
Look us up on
Google +
Join our membership
www.sthelensccg.nhs.uk/get_involved/
Telephone us
01744 627596
St Helens Chamber,
Salisbury St,
St Helens,
Merseyside WA10 1YF
Public Health Annual
Report 2014
Better Health Together
Liz Gaulton – Director of Public Health
September 2014
Background
• The public health annual report is the independent
review by the Director of Public Health
• This is the first report since the implementation of
the health and social care act 2012.
• PHARs (and their equivalents) have been carried
out in St.Helens since 1873.
• The idea for this year was to reflect the reports
when public health was last in the local authority.
Borough Overview
• St.Helens’ population is 176,221. It has recently
stayed largely static in number but is predicted to
increase in next 10-20 years
• By 2020 the population aged 65 years and over is
projected to be 37,500, over 5000 more than in 2012.
This will increase pressure on services relating to old
age, such as social care
• Within the borough there are areas within most
deprived 1% nationally, as well as the 7% least
deprived. This suggests a wide variation in factors
affecting health and quality of life
Health in St. Helens
Infant Mortality in St Helens 1880 to 2012
200
180
181
188
170
Compulsory training for
midwives - 1902
168
Crude rate per 1,000
160
140
132
120
129
121
113
103
Formation of
NHS - 1948
94
100
80
78
80
60
60
33
40
39
39
28
19
20
0
1880
6
1900
1920
1940
1960
1980
Year
Infant Mortality Rate (Crude rate per 1000)
8
2000
3
2020
Life Expectancy
• Life expectancy in St.Helens is
increasing, and the gap between
male and female LE has reduced.
• However, Still wide variations by
wards
Source: ONS 2014; *St.Helens Public Heath Intelligence from Primary Care Mortality Database
Joint Working To Improve Health
• Across the Council
• Working with local
organisations
• Declaration on Tobacco Control.
• The Parks for Life project.
• ‘Other Ways of Telling’ project
• 2013/14 Winter Warm
Campaign
• Working with providers
• Work with St Helens CCG on
Smoke Free Homes Project.
• Encouraging uptake of flu
immunisation in St.Helens.
• Alcohol Liaison Service at
Whiston Hospital.
• Breastfeeding support service.
• Projects to improve child health
• Working with the public
• ‘Conversations About Alcohol’
focus groups.
• Public Health web pages and
Council's First magazine
• Working regionally
• projects undertaken on a larger
footprint, such as with CHAMPs and
PHE. E.g.
• Food Active (CHAMPs)
• “Get going this summer” (PHE)
Summary
• Picture of improving health, but still wide
inequalities and further to go.
• 2013/14 was a year of transition but have
achieved a great deal.
• Wide range of positive projects undertaken and
examples of good joint working .
• Need to continue building on good relationships to
work more effectively together going forward.
• Range of recommendations in report to improve
health and reduce inequalities.
St Helens CCG Annual Report 13/14 Key
Highlights
Dr Stephen Cox
Clinical Accountable Officer
NHS Constitution
Key patient rights and performance targets met eg:
• 18 weeks referral
• 4 hours AED wait
Strengthened Partnerships
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Patients
Local Authority
Our local hospitals
Community & Mental Health Providers
3rd Sector
NHS England
Resulting in:
• High quality hospital care
• Better access for vulnerable/frail elderly (Care Homes
Scheme, Eldercare, AVS, IASH)
• Improved Continuing Healthcare System
• Better Services for children with vulnerability or special
needs
• Managing winter pressures
Forward Together
• Better Care Fund
• Developing Primary Care Services, e.g.
Comprehensive Geriatric Assessment
• Re-design of Community Services
• Urgent Care Services
• Care Closer to Home
Explanation of the CCG’s Accounts
Paul Brickwood,
Chief Finance Officer
Financial duties & targets met
How much did the CCG get to spend?
Summary of CCG Income & Expenditure
Opening Baseline Allocation - Programme
Other Allocations - Programme
Opening Baseline Allocation - Running Costs
Total CCG Allocation
CCG Revenue - Admin
CCG Revenue - Programme
Total CCG Revenue (Income)
2013/14
£m
262.2
3.2
4.7
270.1
0.0
2.8
2.8
Total CCG Resources
272.9
Gross Operating Expenses - Admin
Gross Operating Expenses - Programme
Finance Costs
Total CCG Operating Expenses
4.3
265.9
0.0
270.2
Surplus/(Deficit) Carried Forward*
*This will be returned to the CCG in 2014/15
2.7
Where did the money get spent?
Integrated Commissioning Plan
Sarah Johnson
Deputy Accountable Officer
What is an Integrated Commissioning Plan?
NHS England
CCG
Health & Wellbeing
Board
Local
Authority
Integrated Commissioning Plan
Key Principals of the Strategy
• Community Resilience
• Integration (services &
vision)
• Out of Hospital redesign
• System Sustainability
• Quality & Safety
• Access
Why:
What:
How:
Why, what and how?
CCG Activity
2014/15 2015/16 2016/17 2017/18 2018/19
Elective Ordinary Admissions
Elective DayCase Admissions
Non-elective Admissions
Total Written Referrals (GP and Other)
All First Outpatient Attendances
GP Sourced First Outpatient Attendances
All Subsequent Follow Up Attendances
5,279
5,279
5,284
5,289
5,294
21,015 21,038 21,066 21,094 21,122
21,693 20,981 20,268 19,556 18,843
66,624 66,695 66,784 66,873 66,963
57,456 56,340 55,032 54,927 54,734
34,087 32,945 31,607 31,472 31,248
180,278 179,196 177,770 177,548 177,280
Elective and Non Elective Admissions
TOTAL OUTPATIENTS
250,000
(First and Follow Up Attendances)
245,000
238,999
240,000
237,734
235,536
232,802 232,475 232,014
235,000
230,000
5 year projections from baseline year
225,000
30,000
220,000
25,000
26,350
26,317
26,294
26,271
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
26,416
26,383
23,746
21,693
20,981
Key Deliverables:
20,268
19,556
20,000
8.54% NEL Reduction in 2014/15 from 2013/14 Baseline
18,843
15,000
10,000
ELECTIVE
ADMISSIONS
(Ordinary &
Daycase)
Impact of NEL reduction in 14/15 due to re-coding of
CHOBS/GPAU at STHK
NON ELECTIVE
ADMISSIONS
Incremental reduction in Outpatients attributable to Primary
Care schemes & Services e.g. ECG Telemedicine
Outpatient First Attends reduction of 1.5% in 14/15 and
reducing by a similar amount in 15/16 and 16/17
5,000
Minimal growth expected for Planned Electives
0
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
13% NEL Reduction by Yr 5 and maintain existing EL activity levels with reductions from growth
CCG will work with Primary Care to reduce GP referrals over
the next 5 years using Referral Management Schemes
Assumed 0.36% population growth each year
Why:
What:
How:
Key aims of
the
engagement
plan
• To develop a robust action plan of
communications, engagement and
consultation in relation to the CCG 5
year Strategy and gather views, and
consult with local people around key
messages.
• In line with Transforming
Participation in Health and Care – to
engage and consult local
people/patients in the development
of local services from strategy to
concept.
• To further develop CCG membership
and encourage participation in all
areas of commissioning.
• To ensure seldom heard groups have
a say in the development of the
strategy and thus in key
commissioning areas.
Forward Together
• Better Care Fund
• Developing Primary Care Services, e.g.
Comprehensive Geriatric Assessment
• Re-design of Community Services & support for
voluntary sector
• Co-ordination of intermediate care service
• Urgent Care Services – Frailty pathway/Unit
• Care Closer to Home – Mental Health
6 Characteristics of high quality
health & social care systems
2014/2015
2018/2019
Citizen inclusion and
empowerment
PPG in all member practices.
Early mobilisation of HealthWatch
Services commissioned for one population.
Borough based listening events. Highly proactive and flexible HealthWatch informing
commissioning. Services commissioned to meet the needs of a locality model.
Developed ‘App’ technology to support self-care and choice.
Information sharing across organisations and sectors for the benefit of improved
patient outcomes.
37 individual general practice contracts requiring commissioner support for
development. No workforce planning or succession assumptions. Wide variation
in quality of services and accessibility.
Direct commissioning is fragmented with unclear strategies 2014/15.
Individual practices running on a locality basis with a collaborative approach to
extended access, back office functions and specialist clinics based within a locality
clinical hub – fully supported by specialist consultants from the Hospital.
High achieving practices in terms of the CCG commissioned GP Quality Contract and
holistic approach to managing core contracts with the CCG acting as a cocommissioner of primary care services
A modern model of integrated
care
Integrated Health & Social care Commissioning team. Fully approved
overarching Section 75 with a pooled budget of £30m+ for CHC/FNC
BCF assumptions developed and mobilised .
Fully integrated health and social care services with borough based commissioning.
High quality care for all. Fully developed links to education and shared Children’s
services. A single integrated access point for all. A specialist Frailty Unit based in our
Community Hospital will support our over 75s along with a Primary and secondary
care shared ‘Comprehensive Geriatric Assessment’
Access to the highest quality
urgent and emergency care
Nurse led Walk –in-Centre based in a private building in the town centre with
limited paediatric capability and diagnostics.
Difficult to access routine primary care services OOH . StHK A&E department
that consistently see’s global growth in NEL care year on year. Higher than
average admission and re-admission rates.
Functioning Urgent Care Collaborative – non decision making both locally and on
a wider Merseyside footprint
The full mobilisation of the St Helens IAP that will see first line access to ‘step up and
step down community beds. Increased capacity of therapy and social services based
around the locality model of working.
A fully operational Urgent Care centre within St Helens Hospital that will see all minor
illness and injury within first class estates with supporting suite of diagnostics. A fully
operational executive level Urgent Care Board with delegated decision making across
the health economy to aid system sustainability.
A step-change in the productivity
of elective care
Higher than planned elective care episodes with growing backlog of patients on
RTT pathways.
GP Tutor engaged to support primary care referral education sessions. Wide
variety of choice open to our population with key risks of over performance
within the private sector. Planned Clinical Hubs based around localities with
consultant led community referral clinics and electronic/telephone advise for
GPs
The CCG fully supports the reconfiguration agenda across Cheshire and Merseyside.
We will see the formation of 2 ‘Super DGH’ with concentrated elective care in
excellent facilities.
It is also anticipated that the CCG will co-commission concentrated specialised
services within Merseyside in a stand alone trust configuration model. St Helens CCG
would also wish to explore the vertical integration of community and secondary care
services.
Specialised services concentrated
in centres of excellence
Inequity in access to specialised services exists despite there being a high
number of Trusts within the Merseyside region. Services are fragmented with
unclear intentions and strategies for 2014.15 .
The reconfiguration of a single specialist centre of excellence for Merseyside with
‘spoke’ clinics delivered at an appropriate level according to population need.
Wider primary care, provided at
scale
40
Summary
Dr Stephen Cox
Clinical Accountable Officer
Questions for our Governing Body?
Thank you for joining us