Public Meeting
1 October 2015
Agenda
Welcome
Julie Pal, CEO CommUnity Barnet
Public Health priorities
Melanie Smith - Director of Public Health Brent
Brent CCG Commissioning Intentions 2015/16
Duncan Ambrose, Commissioner Mental Health Brent CCG
Healthwatch Brent progress update
Ian Niven, Head of Healthwatch Brent
Enter and View - a volunteer’s experience
Meenara Islam
Melanie Smith
Director of Public Health
Overview of Health Needs in Brent
Melanie Smith
1 October 2015
Brent Males
Page 5
Brent Females
79.7
6.3
yrs
2011-2013
2010-2012
2009-2011
2008-2010
2007-2009
2006-2008
2005-2007
2004-2006
2003-2005
2002-2004
2001-2003
2000-2002
1999-2001
1998-2000
1997-1999
1996-1998
1995-1997
1994-1996
1993-1995
1992-1994
86
84
82
80
78
76
74
72
70
68
66
1991-1993
Life Expectancy at birth (years) for Males and
Females
Overall life expectancy
84.9
4.9
yrs
80.0
73.4
Healthy life expectancy
65
64.8
Healthy life expectancy (Years)
64.5
64.2
64
63.5
63.2
63.5
63
62.9
Males
62.5
62
Females
62.2
61.5
61
60.5
2009-11
2010-12
2011-13
Life expectancy and geography
Male life expectancy at birth
Female life expectancy at birth
Page 7
Slope index of inequality
Male life expectancy at birth 2011-13
Life expectancy (years)
4.7
79.9
80.1
76.0
years
82.8
78.9
78.8
80.0
81.8
81.8
82.0
Life expectancy gap
between most and least
deprived
Female life expectancy at birth 2011-13
4.4
88.2
85.4
81.9
Most deprived
85.3
84.2
85.0
85.7
88.1
86.8
years
81.5
Deprivation
Least deprived
Page 8
Estimated prevalence of diabetes
Diabetes (modelled prevalence percent England)
16
Diabetes (modelled prevalence percent Brent)
14
%
12
10
8
6
4
2010
2012
2014
2016
2018
2020
Year
2022
2024
2026
2028
2030
Mental health - dementia
Dementia prevalence by GP practice
Proportion of patients
aged 65 and over
Dementia prevalence
(all ages)
More than 1%
0.75 to 1%
0.5 to 0.75%
0.25 to 0.5%
Under 0.25%
Mental health – depression and anxiety
64.70
53.40
Depression and anxiety prevalence
among social care users
Depression and anxiety prevalence
10.85
11.95
Brent
England
Tuberculosis
TB incidence rate for all TB and Pulmonary cases in 2013
120
Rate per 100,000
100
92.2
95.9
96.4
100.5
100.6
98.6
98
94.9
Brent rate per 100,000
80
60
43.9
43.9
43
42.7
42
41.9
41.2
14.7
15
15
15.1
15.1
15.2
15.1
39.6
40
20
0
14.8
England rate per
100,000
London rate per
100,000
Numbers of adults in treatment 2014/2015
Substance Category
Alcohol only
Alcohol and nonopiate only
Non-opiate only
Opiate
Total Clients
Numbers in
Treatment
466
305
252
716
1739
%
27%
18%
14%
41%
100%
Numbers in Treatment 2014/15
Alcohol only (Alc)
27%
41%
18%
14%
Page 13
Alcohol and nonopiate only (A&N)
Non-opiate only
(Non-o)
Opiate (Opi)
Healthy Eating Adults
Fruit and Vegetables ‘5-a-day’, 2014
56.3%
51.9%
51.2%
Brent
London
England
Source: Active People Survey, Sport England. Data for 2014
Page 14
Physical Activity and Active Travel
Percentage of physically active adults, 2014
57.8%
57%
London
England
52.2%
Brent
Active methods of travel to work: Bicycle and On foot
Brent (count)
Brent (%)
London (%)
England (%)
Bicycle
3,859
1.7%
2.6%
1.9%
On foot
10,704
4.6%
5.8%
6.9%
Both methods
14,563
6.2%
8.4%
8.8%
Page 15
Smoking prevalence
Smoking prevalence, %
25
20
15
18.4%
17.3%
10
5
0
Smoking prevalence (%)
London average (%)
Source: Active People Survey, Sport England. Data for 2014
Page 16
England average (%)
Children’s oral health
%
Percentage of children aged five with one or more decayed missing or
filled teeth, 2012
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
45.9%
London, 32.9%
England, 27.9%
Prevalence of obese children in Brent
16%
14%
12%
%
10%
8%
6%
11.7% 12%
11.7% 11%
11.2% 11.5%
2010/11
2011/12
2012/13
14% 13.1%
4%
2%
0%
2013/14
Year Reception Obese Brent (%)
Year Reception Overweight Brent (%)
Year Reception Obese England (%)
Year Reception Overweight England (%)
Young people’s mental health
Estimated prevalence of any mental health disorder: % population aged 5-16, 2014
12
Local authority
England average and London average (9.3%)
10
Proportion (%)
8
6
4
2
0
10%
Young people’s mental health
Hospital admissions for mental health conditions among young people
(under 18 years), 2013/14
400
Rate per 100,000
350
300
250
200
150
100
50
0
LA
England average
London average
Teenage pregnancies in Brent
50
40
30
20
10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
England
London
Brent
Page 21
Conception rate per 1,000 women in age group
60
Female Genital Mutilation
Percentage of girls aged 15 to 49 who have undergone FGM by country
Female Genital Mutilation
Brent residents born in Somalia by output area
Duncan Ambrose
Commissioner Mental Health Brent CCG
Brent CCG
Commissioning Intentions
Healthwatch Meeting
1st October 2015
25
NHS Brent CCG
Brent is an outer London borough in north-west London. It has a population of 321,009 and is the most densely populated outer London
borough Brent has 66 member practices which are all aligned to one of five locality based groups, each with an elected Clinical Director.
18 practices have a registered list of fewer than 3,000 patients and 5 practices have a registered list of greater than 10,000 patients.
26
About NHS Brent CCG
What is NHS Brent CCG?
• The 66 GP practices in Brent make up the NHS Brent Clinical Commissioning Group. The GP practices are
divided into five localities – Harness, Kilburn, Kingsbury, Wembley and Willesden.
http://brentccg.nhs.uk/en/member-pratices
•
Day-to-day decisions are made by a Governing Body of elected GP practice members, lay members, and
key executive staff. http://brentccg.nhs.uk/governing-body
What does the CCG do?
• The CCG is responsible for planning and buying most
healthcare services for people registered with a Brent GP. This
is known as ‘commissioning’, and follows an annual cycle:
Analyse – Improve - Monitor
•
Commissioning cycle
ANALYSE
IMPROVE
MONITOR
The services commissioned by the CCG include planned
hospital care, urgent and emergency care, rehabilitation care,
mental health care, learning disability services, and care in the
community. The CCG does not deliver clinical services itself.
How is planning and buying of healthcare services done?
• The Brent Health and Wellbeing Board is a formal partnership between NHS Brent CCG, Brent Council, and
Brent HealthWatch. The Board has agreed priorities for improving health in Brent.
•
The CCG works in partnership with Brent Council, HealthWatch, patient groups, and voluntary organisations
to agree annual commissioning intentions and plans for the year ahead.
27
Developing our commissioning intentions for 2016/17
ANALYSE
IMPROVE
Interpret data,
new policies,
and new guidance
Share and gather
ideas and
expectations
CCG decides on
commissioning intentions
ahead of contract
negotiations
Feedback on CCG decision,
hear concerns and views
on implementation
ahead of contract
agreements
August - September
CCG staff review data,
budgets, and new
policies to develop initial
ideas
October
HealthWatch talk
Big Brent Health Debate
Online Surveys
Focused discussions
November
CCG Governing
Body meets in public
to consider views of
those impacted and
possible health
inequalities
December - January
Health Partners Forum
Public Member recruitment
NHS England allocates CCG funds
MONITOR
Health and
Wellbeing Board
meets to consider
priorities
February - March
Form monitoring/ task groups
Contract negotiations
Contract awards
April 2016
New contract year
28
Health context
Working with Public Health to update and interpret needs
• (Previous presentation)
Working with providers to sustain and reshape services
• Providers have their own financial pressures and savings targets
• Need to find ways to recruit and retain staff
Working with patients to be more independent
• Need to find ways to promote and support effective self-care and peer support
Some challenges
• Less public funding. Population increasing faster than CCG funding
• Increasing dementia prevalence
• High levels of Serious Mental Illness and Common Mental Disorder
• High levels of diabetes
• Providers have their own financial challenges
Some opportunities
• Using technology to help people do more for themselves
• Working with social services on integrated care
• Delivering more care in community venues, local health centres, and GP practices
29
Financial Context
•
For a number of years, the CCG has enjoyed a good financial position, and had reported a surplus in
2014/15.
•
The CCG is funded centrally and receives an allocation from NHS England. NHS England has recently
undertaken an exercise to understand whether CCGs are funded fairly and Brent CCG has been
deemed to be above its fair allocation.
•
This means that any funding growth will be constrained for 2016/17 as funding levels are equalised
to their fair funding level over a number of years.
•
There have been significant increases in people accessing healthcare in hospital over the past 12
months, particularly in outpatient appointments, elective procedures and day cases.
•
Under the current NHS funding system, the CCG pays out money under a standard tariff for each
episode of care whenever a patient visits hospital.
•
Because this activity has increased, when it is combined with low levels of funding growth, this means
that the CCG is currently projecting a circa £2 million underlying deficit.
•
Although the CCG is still expecting to break even in 2015/16, it is now spending more money than it
receives in its allocation. If this is not corrected for future years, then the CCG would go into deficit.
•
A recovery plan is currently being worked up, which means that the CCG’s ability to make new
investments is constrained.
30
Commissioning Intentions
2016 – 2017
Our thinking so far …..
31
Index of Brent CCG Commissioning Priorities
DRAFT
Our commissioning intentions start on the following pages and are grouped as identified below:
Unplanned Care
- Primary Care Led Urgent Care & 111
- STARRS
Planned Care
- Community outpatients
- Long-Term conditions
- Primary Care
- Medicines optimisation
- Cancer
- Palliative Care
Integration of Health and Social Care
- Whole Systems Integrated Care
- Better Care Fund
Enabling Functions
- Patient and Public Involvement
- Continuing Healthcare and Personal Budgets
- Contracting & Performance
- Quality & Safety
Children’s Services
Mental Health
Learning Disabilities
Carers
Unplanned Care - Introduction
The Five Year Forward set out an ambitious plan to take
decisive steps to break down the barriers in how care is
provided between family doctors and hospitals, and to
break down the divide between health and social care.
The current unplanned care system is a complicated and
sometimes fragmented system. It includes A&E
departments, admission to hospital wards in an emergency
scenario, Urgent Care Centres, Walk-in Centres and 111.
Additionally, our STARRS service also offers a rapid
response to patients with long-term conditions who are at
imminent risk of admission to hospital and facilitates early
supported discharge for those patients who have been
admitted.
Currently, people access services at locations that are not
always best suited to their needs. For example, people will
access care at A&E departments or Urgent Care Centres
when it could be more appropriately dealt with by their GP,
taking into account their full medical history.
The aim of our commissioning intentions for unplanned
care are to simplify an often fragmented system, and to
design a system that aims to redirect patients back to the
most appropriate place. Educating patients and publicising
what is the most appropriate place to access unplanned
care will also play a key role in transforming the system.
This section of the commissioning intentions
encompasses:
• Primary Care Led Urgent Care
• 111
• STARRS
Primary Care Led Urgent Care & 111
Strategic Aim
A GP-led and driven service, integrated and comprehensive, and working in partnership with other providers, is necessary to
achieve improved long-term outcomes, both in terms of reduced ED demand and improved ‘whole’ patient management.
Brent CCG, in collaboration with neighbouring CCGs, will review the existing community-based service model to achieve a
more integrated service and co-ordinated pathways for the benefit of patients
Rationale
This process is in accordance with both the 5 Year Forward View and the Keogh Review of urgent and emergency Care. It
links also with the NW London Vanguard expression of interest submitted by NW London CCGs
Commissioning/ Contracting Change
Brent CCG will review all urgent and emergency care services including NHS 111, GP OOHs and other associated services
including access to emergency mental health care. Current contracts for NHS 111 services are due to expire over the next
year.
We plan to procure a safe, high quality NHS 111 service that will be integrated with the Out of Hours service, urgent care
provision and emergency care including mental health services. The new NHS 111 service will support our vision to deliver
care closer to home, provide for a single point of access and allow for special patient notes & summary care records to be up
to date. The summary care records will be available to all the services that have contact with the patient.
Patient/ System Impact
An integrated, flexible, responsive and sustainable service across NWL that provides a seamless patient journey which aligns
with BCCG Out of Hospital Strategy and aims to reduce pressure on local urgent care systems
DOS is the enabling tool to support the implementation of the Urgent & Emergency Care Review by facilitating access to the
right service, first time for patients and clinicians.
34
The Short Term Assessment, Rehabilitation and Reablement Service (STARRS)
Strategic Aim
•This is an integrated intermediate care service from London North West Hospitals NHS Trust (LNWHT) which consists of three key elements; a Rapid Response
service, which operates in A&E majors to avoid admissions and accept direct GP referrals for patients at high risk of hospital admission, the Early Supported
Discharge Team, which supports the discharge of patients who have undergone elective treatment in order to reduce time spend in hospital beds and the Short
Term Rehabilitation team, which supports patients in the community providing on-going rehabilitation and re-ablement to ensure that patients can remain at home
with appropriate support.
Rationale
•Brent is the most densely populated outer London borough. The population is younger than England generally, but the population aged 65 and above is projected to
grow at a faster pace than the population at large (see slide 12 on population growth).
•Age is a significant determinant of the likelihood of an unplanned admission to hospital with increasing life expectancy comes a corresponding increase in the
prevalence of many conditions such as falls, impaired mobility and dementia. STARRS could do more to support a reversal of the current trend for increasing
admissions through the Emergency Department (ED) particularly for the frail elderly and Delayed transfers of Care (DToCs). There were 3,167 non-elective
admissions in 2014/15 that could potentially have been avoided. Therefore the aim is to expand the rapid response component.
Commissioning/ Contracting Change
• We will jointly review the activity plan for the service to ensure that it reflects the underlying demand for rapid response. Analysis undertaken to date suggests
that there are more patients who could benefit from rapid response, thereby avoiding unnecessary A&E attendances.
• The CCG wishes to work with LWNHT to ensure that the Rapid Response service is able to maximise admissions avoidance through greater efficiency.
• We will work with the STARRS team to better manage demand for the service. Analysis undertaken to date suggests that there is unwarranted variation in
referral rates, leading to inequalities in care for Brent patients.
• During 16/17 we will finalise a revised service specification and associated KPIs, as well as the contractual form and payment mechanism.
• Brent CCG and London Borough of Brent will jointly commission and monitor the rehabilitation and re-ablement service to work with people over the age of 18,
living within Brent boundaries.
• The CCG will commission a comprehensive falls bundle, working with the Trust and the Council to reconfigure these services.
Patient/ System Impact
•
•
•
•
Increased admissions avoidance through greater efficiency
Patients stay in their own homes rather than being admitted to hospital
Patients get out of hospital more quickly
Co-ordinated care planning of health, social care, well-being and enablement through a person centred approach to meet the full spectrum of needs and
integrated Rapid Response Service –a range of services in place to prevent patients and service user from being admitted to hospital settings where appropriate.
Integrated Discharge - working collaboratively to assess patients to ensure that discharge planning and transfer of care to community settings is seamless and
timely
Planned Care - Introduction
For the purpose of these commissioning intentions, the
following Planned Care section includes:
•
•
•
•
•
•
•
Community-based outpatient services;
Primary Care/ Acute Pathway development;
Community services for long-term conditions;
Primary Care Services;
Medicines Optimisation;
Cancer;
Palliative Care.
Patients will be treated on a best practice care pathway
supported by the latest NICE guidance and clinical evidence.
Where a clinical workup is possible within primary care, this will
be undertaken and patients will benefit from a reduced number
of different visits between primary and secondary care.
GP networks will undertake further development to increase
their managerial capacity and take on a range of new services.
The CCG will review activity data with its member GP practices
to develop ideas for new and innovative service models.
Where the CCG commissions block contracts, such as those for
community services, clinical capacity should be fully utilised
and, where appropriate, the contracts reviewed to ensure
maximum value for money.
In turn, this will ensure that we maximise the opportunity for
care outside of hospital and counter the trend of increasing
referrals into secondary care.
Community Outpatient Services
Strategic Aim
The underlying principle is to focus on outcomes not outputs with the outcomes intended to ensure that new services were better than the
current services. The outcomes target the following key areas to drive improvement:
Patient experience – the services were to ensure an excellent experience for the patients
Clinical effectiveness – new services to deliver improved clinical outcomes from the baseline of where the service starts
Cost effectiveness – services should be provided at a total lower cost to the commissioner than current provision.
Rationale
The JSNA highlights the need to support the growing demand for services that support the management and treatment of long term conditions
with diabetes and cardiac conditions being highly prevalent amongst our population. Prevention and care in a community setting will also allow
the more specialist hospital services to accommodate the demand for more complex treatments.
Commissioning/ Contracting Change
Planned care pathways are being developed through QIPP schemes for 2016/17 and the CCG is planning to develop a referral optimisation
scheme which automates the process of referral to ensure best practice and adherence to primary care pathway protocols to ensure more
appropriate referrals to secondary care.
The CCG will review the community dermatology service, with the intention of maximising clinical capacity and minimising onward referrals (or
discharge back to GP with advice to refer on) to acute dermatology services. The CCG would also wish to see a transfer in responsibility for
remunerating the GPwSIs from the CCG to the trust.
A review of the MSK/ physio service will be undertaken, together with all community based providers of physiotherapy commissioned by the
CCG. The CCG will look to consolidate the current services with a view to achieving improved waiting times, care pathway and value for money.
The CCG will undertake a review of the existing community gynaecology pathway in terms of its impact on secondary care activity.
There is a need to undertake a stock take of ophthalmology and cardiology contracts at the 12 month review stage to assess how contractual
terms and conditions may be improved or determine options to realise anticipated benefits from these services.
Patient/ System Impact
Patients will have access to services in the community and be supported in managing their own conditions.
Hospital services will have capacity released to manage the treatment of more complex cases and result in more cost effective pathways for
the health economy.
37
Primary Care/ Acute Pathway Development
Strategic Aim
Referrals from GP practices into acute services have been showing a rising trend over the past 12 months. The purpose of this programme is to
develop systems and processes to control the rising demand for routine referrals which are not always clinically appropriate and therefore to
reduce demand on acute services. The approach will be driven by locally approved clinical care pathways.
Rationale
Referrals into secondary care have been showing a rising trend over the past 12 months across a number of different specialties, including
T&O, gastroenterology, dermatology and ENT. This trend is unsustainable for the healthcare system and we need to do more to try to make the
health economy more sustainable in the future. Additionally, standardisation of care pathways provides a benefit to patients because this
ensures adherence to the best quality care pathways.
Commissioning/ Contracting Change
We will continue to work with our constituent GP practices to train them on usage of the DXS referral management system and continue to
jointly design clinical care pathways in collaboration between the CCG’s clinical directors and hospital consultants. This ensures that the care
pathway is jointly owned. We will launch further care pathways relating to paediatrics, gynaecology and gastroenterology.
We will also work through more detailed changes to the gastroenterology care pathway (which appears as a QIPP scheme) to introduce new
care pathways for patients on DMARD drugs, those with abnormal liver function tests and for those patients requiring an endoscopy.
With regard to ENT, we will seek a reduced tariff for micro-suction by introducing a single cost tariff for micro suction at LNWHT and a one stop
clinic for dizziness and vertigo.
We will work with our local acute trusts to pilot a teledermatology service, providing rapid diagnosis for a range of dermatological conditions in
GP practices by qualified specialists viewing high quality photographic images via a remote secure system. Many cases diagnosed this way can
be managed in the community.
Patient/ System Impact
Where appropriate, self-care will be incorporated into the care pathway (e.g. exercises that people can try to reduce their symptoms before
onward referral). Patients will be diagnosed and treated using a clinically optimal care pathway supported by the latest evidence, NICE
guidance and local clinical input, so that all GP practices operate to a standardised protocol. In turn, this should reduce any unnecessary
demand for acute services, and therefore reduce waiting times for treatment and diagnostics.
Long Term Conditions
Strategic Aim
Supporting adults with long term conditions, including patients with Stroke, Respiratory conditions such as COPD, Parkinson’s
Disease, Sickle Cell, Diabetes and Tuberculosis, to better manage their own care in the community and improve their quality of life.
Rationale
Due to demographic and socio/economic factors, Brent has one of the high prevalence rates of patients with Long Term Conditions
(LTCs) in the country. This prevalence rate continues to grow and joint action with public health, social services and other agencies is
required to tackle it. There is also a wide variation in the range of community services available to patients in the Borough. While in
some areas there has been progress, such as the new community services for Diabetic and CHD patients commissioned by the CCG,
other areas requiring improvement. Without action, it is expected there will be rising health inequalities, poorer health outcomes for
patients and greater demand on local acute/primary care services.
Commissioning/ Contracting Change
• Respiratory/COPD service - we will work with the local provider to redesign the existing community respiratory service to better
meets the needs of patients.
• Parkinson’s Disease Nurse – we look to commission a 2 year pilot for a new nurse-led community service for patients with
Parkinson’s Disease that provides care and treatment in people’s homes.
• Tuberculosis (TB) – we will work with colleagues in Harrow CCG and Public Health colleagues in Brent & Harrow to develop and
deliver a screening programme for patients with TB in Brent.
• Sickle Cell service – Following evaluation of the new sickle cell outreach service, the CCG will review this pilot and if shown to be
successful, will roll out the service afterwards.
• Stroke ESD – we will review the performance of the Stroke Early Supported Discharge service pilot which commenced on
01/09/2015 and commission the service substantively based on the clinical findings
• Diabetes: NHS Diabetes Prevention Programme – the CCG will work with PH colleagues to submit an Expression of Interest for the
Prevention Programme and if successful will implement the programme in 2016-17
Patient/ System Impact
Our long term aims will be to improve the quality and range of services closer to where patients live and improve health outcomes for
patients with LTC. We will also develop an integrated health and social care pathway to enable an holistic approach to supporting
people with complex care needs. Patients will be better able to better manage their own care, reducing demand on local acute
services (particularly in terms of unscheduled admissions to hospitals).
39
Primary Care
Programme Narrative
Develop primary care landscape to include GP networks and a federation across Brent as provider organisations in order that more care can be
provided in the community and reduce variation across practices in clinical outcomes.
Enable patients/carers to be better equipped to manage their own care through online access to appointments, e-prescriptions, self-management
advice, support (through telecare, telephone consultations) and service signposting.
Need
JSNA 2014 identified:• While there are some practices whose performance is excellent, there is a wide level of variation between practices. There are a significant number
of Brent practices failing to meet key clinical performance indicators.
• A key strand of improving delivery of services is to improve and extend Primary Care in Brent by working in partnership with the whole range of
health and social care providers as well as with the voluntary sector and vulnerable patient groups who are at risk of hospital admission to provide
holistic services across Brent.
Access to extended GP services and primary care in Brent- A Scrutiny Task Group Report recommended:• NHS England, Brent CCG and local GP networks carry out a review of current GP opening hours across the borough and consider additional ways of
accessing GP services, including Skype, telephone and email consultations where appropriate and within Information Governance principles.
• Brent CCG carries out a detailed review of GP Access Hubs following the initial six months and first full year of operation against the new service
specification, providing a detailed evaluation on the level of take up, impact on patient satisfaction regarding access and impact on A&E and UCC
attendances. Review includes public engagement to assess the extent to which the model reaches and benefits all residents in the borough.
Commissioning Change
More services will be commissioned via Networks:• Care Home & High Risk Housebound patient service
• Improving GP Clinical Outcomes
• Phlebotomy services
• GP Access Hubs
Other Out of Hospital services are provided at practice level however the formation of Networks enables provision of services for the whole population.
Evaluate services that are commissioned to assess efficiency and relevance to population and review service where necessary.
Impact
• Care Home & High Risk Housebound patient service – reduce variation in service provision and provide proactive care to residents. Improved quality
of care for patients and reduction in non-elective admission, use of A7E and LAS.
• Improving GP Clinical Outcomes – Reduction in variation across Brent practices in clinical outcomes
• Phlebotomy services – Better access for patients within Brent CCG enabling patients to access services at any provider
• GP Access Hubs – improved access for routine GP appointments upto 9pm weekdays and 6 hours at weekends i.e. 7 day service.
• Reduce variation in patient care and reduce unnecessary demand.
40
Medicines Optimisation
Strategic Aim
To support effective medicines optimisation for Brent residents so that they get the most out of their medicines. This requires health and
social care professionals, patients and carers working together in an integrated way.
Rationale
The prescribing team supports GP practices to deliver evidence based and cost-effective prescribing so that patients receive high
quality, safe and effective medicines. The advisers also work across the local health economy to agree place in therapy of medicines
and to improve systems for transfer of patient care.
Commissioning/ Contracting Change
•
The medicines optimisation commissioning intentions and prescribing QIPP plan build on existing work to drive improvements in
quality and efficiency through effective medicines use. Patient leaflets are produced/encouraged to be used to support patient selfcare.
•
Improve the interface transfer of prescribing with secondary care, community and mental health trusts by agreeing shared care
protocols for certain medicines.
•
Implement the NWL wide protocols for drugs and improve the contract management of acute prescribing.
•
Work with provider partner organisations, GP practices, other primary care contractors, patients and other partners to identify areas
where medicines waste occurs, analyse systems to identify areas for improvement, and implement system change to reduce
waste; to support patients with taking medicines to reduce unintentional waste.
•
We will support providers to improve systems for safe transfer of information on patient medication at admission and discharge.
•
Effective management of payment-by-results excluded (PbRE) and high cost drugs (HCD). Engage with partner providers to
prescribe high cost medicines, procured by NHS England. NHS England maintains a central repository of prices for excluded drugs.
Patient/ System Impact
• Improved medicines reconciliation for patients transferred between care settings.
• Implementation of cost-effective evidence based medicine.
• Realisation of the QIPP savings whilst maintaining quality prescribing.
• Improvements in the practice repeat prescribing systems / processes with a view to reducing medicines wastage.
41
Cancer commissioning Intentions (quality requirements)
Strategic Aim
In April 2014, NHS England published five year cancer commissioning strategy for London, to give fresh impetus to
implementing the Model of Care recommendations. One of the identified work streams in this strategy is reducing variation in
secondary care services. 2016-17 will be year three of this strategy and the quality requirements will build upon those on the
previous two years. Pan-London cancer commissioning board develop and endorse the cancer commissioning intentions, with
input from key stakeholders, for all London CCG to agree with providers.
Rationale
One in two people will be diagnosed with cancer in their lifetime. 50% of cancer patients now survival at least ten years.
There are a number of actions that can be taken to improve survival and quality of life, and the priorities for secondary care
are included in the cancer commissioning intentions.
The updated NICE guidance on suspected cancer: recognition and referral (June 2015) places a greater emphasis on GP
direct assess to investigations, to achieve earlier detection of cancer. Setting up direct access services has been, and
continues to be a corner stone of the cancer commissioning intentions.
Commissioning/ Contracting Change
The 2016/17 cancer commissioning intentions will build upon the previous two years, ensuring service improvements are
embedded and progressive targets continue to be stretched.
Potential new requirements include: broader range of direct access tests, broadening the scope of services to manage some
of the consequences of anti-cancer treatment and expanding stratified follow up pathways.
There is a proposal to include commissioning with mental health providers to develop pathways for the management of
psychological support for cancer patients.
Patient/ System Impact
Implementing the quality requirements aimed at earlier detection of cancer and improving access to effective treatment will
save lives.
Patient impact - Improving availability to direct access investigations will help identify cancers earlier, potentially giving a
greater range of treatment option, some may be curative. It is important that patients receive the best treatment and care
wherever they are treated, and the cancer commissioning intentions aim to achieve this.
System impact - Earlier detection which results in improved outcomes will have a positive impact survival rates and on the
quality of life for survivors, which will help control the cost of cancer in the medium and long term.
42
Palliative Care
Strategic Aim
In 2010 Brent PCT developed an End of Life Care Strategy with their key stakeholders. The strategy set ambitious targets and
established a steering group to oversee the activities planned. However, due to organisational change and staff turnover progress
has been limited and inconsistent. Due to the issues highlighted a review of the current pathway and services commissioned is
required.
Rationale
End of Life Care Strategy (DH 2008).
The NHS should provide support for patients to die in the place of their choosing (most frequently ‘at home’) and to prevent
unnecessary reactions within the health and care system that prevents people from achieving this goal. Signposting and awareness
of the needs of palliative care patients within the urgent care system is crucial to achieving this.
Commissioning/ Contracting Change
To review the current pathway(s) for EOLC and specialist palliative care services to ensure they are fit for purpose and meet the
current needs of the population of Brent. The outcome of the review will help determine the future commissioning arrangements.
In particular, we will review the care pathway for people estimated to be in the last year of their life and the opportunity to provide a
single point of access, linking with the LAS, NHS 111, district nursing teams, the patient’s GP, GP out of hours service and care
agencies. We will explore the potential benefits of providing access to a specialist palliative care advice and support hotline with
24/7 access.
Patient/ System Impact
• Patients will receive appropriate care in the right setting, will be treated by the right professionals and have their care managed
more seamlessly. An integrated care pathway will support patients to die in their preferred place of death.
• Links to the Rapid Repsonse Team avoiding hospital admissions and able to put packages of care in place when appropriate in
the out of hours period.
• Patients benefit from signposting on the basis of need in the last year of their life.
Better Care Fund (BCF)
Strategic Aim
•The Better Care Fund is a commissioning driven redesign programme delivered in partnership with organisations from across the Brent Health and Social Care
economy. The objective is to bring together health and social care in order to transform local services, providing people with the right care, at the right place, at the
right time tailored to their individual needs and to the highest possible standards. NHS Brent has a five year Strategic Plan setting out our vision for a transformed
health and care system, which includes these BCF schemes.
Rationale
•The Brent Joint Strategic Needs Assessment has informed our vision and priorities to integrate care, reduce the high levels of health inequality which exist
throughout Brent and improve the health and prosperity of those individuals and communities who experience high levels of social exclusion and disadvantages.
This has ensured that we have a collaborative approach between health, the local authority and other key partners.
Commissioning/ Contracting Change
•BCF Scheme 1 – Keeping the most vulnerable well in the community. Please see the commissioning intention summarising the Whole Systems Integrated
Care Model (WSIC)
•BCF Scheme 2 – Avoiding unnecessary hospital admissions. We will jointly commission with Brent Local Authority an urgent, rapid response service staffed
by a multi-disciplinary team of nursing, therapeutic, and social worker staff who will proactively responding to potential A&E admissions and referrals from GPs over
7 day period.
•BCF Scheme 2.5 - Integrated rehabilitation and reablement. We will jointly commission with Brent Local Authority a multi-disciplined health and social care
professional team of occupational therapists, physiotherapists, social workers, dieticians, speech and language therapists, psychologists, rehab assistants and
externally commissioned reablement home care providers. The team will operate on a lead professional and trusted assessor model.
•BCF Scheme 3 – Efficient multi-agency hospital discharge and community bed provision. We will jointly commission with Brent Local Authority, an efficient
multi-agency integrated hospital discharge service, combining existing health and social care discharge teams who are co-located within a hospital setting.
•BCF Scheme 4 – Mental Health Improvement – This scheme aims to find a sustainable liaison psychiatry service model that is fit for the future, and responsive to
improvements in other parts of the physical and mental health services. Further changes are anticipated in 2015/16 with the development of out-of-hours Home
Treatment Rapid Response Teams that will deliver emergency and urgent mental health assessments in the community.
Patient/ System Impact
•
•
•
•
•
Reduction in permanent residential care admissions
Reduction in readmissions to hospital following period of reablement (increased effectiveness of reablement)
Reduction in delayed transfers of care
Reduction in non-elective hospital admissions (general + acute)
Improved patient experience and satisfaction
Whole Systems Integrated Care (WSIC)
Strategic Aim
Following the successful implementation of WSIC in Brent in 2014/15, the CCG will seek to evolve the model during 2016/17. Brent partner
organisations have agreed to roll out multidisciplinary ‘core teams’ – staff working together to plan, deliver and manage care for people aged 65 and
over with one or more long-term condition. These teams will work with groups of GP practices, overseen by a shadow Accountable Care Partnership
(ACP) to deliver care that addresses medical, social and psychological needs.
Rationale
The needs driving the shift to planned and preventative care, delivered in a Whole Systems framework include:
• Prevalence of long term conditions – Brent has seen a 38% increase in the prevalence of diabetes between 2008/09 and 2012/13 projected to
rise further. Long-term chronic conditions are often related to lifestyle, poverty and deprivation – challenges in Brent.
• Emergency admissions and bed days – 35% of all emergency admissions in Brent are for those aged 65 and over; once admitted this group
stays in hospital longer, using 55% of all bed days. This is caused by longer recovery times, infection, and delays to the discharge of medically fit
patients.
Commissioning/ Contracting Change
We have to set our commissioning framework up to deliver and incentivise WSIC models. This means:
• Developing, agreeing and clearly articulating shared outcomes and priorities as commissioners – especially where the care we are commissioning
needs to encompass medical, social and psychological support and facilitate wider wellbeing.
• Developing new contracting and payment models – providing a framework for these changes and a set of shared incentives and drivers.
• Working with NHSE and the GP Networks to develop a strong and effective Primary Care system in Brent, with the capacity and capability to
underpin these models – which place GPs at the centre of planning and coordinating care alongside patients and carers. Harness and Kilburn are
establishing shadow ACPs under WSIC and (as early adopters) will support Kingsbury & Willesden and Wembley to roll this out over time.
The founding stones of WSIC have already been built, and now is the time to build the model up further, with commissioners working closely together
with patients, carers and providers to ensure we make concrete steps towards our longer term vision.
Patient/ System Impact
Individuals will be empowered to direct their own care and support with care coordinated around them, and planned, managed and delivered in a way
that supports their own goals and outcomes. Experienced professionals will support them, operating as an integrated multidisciplinary team.
The WSIC 2 model will increase the number of days individuals are able to spend at home and when they have been in hospital, to support earlier
discharge rates and timely access to support. The WSIC approach will assist in reducing variation in the care provided, contribute to improved patient
experience, delivery of better care outcomes, improved user satisfaction and offers more cost effective care for patients with long term conditions.
Enabling Functions - Introduction
This section includes information on the following enabling
functions:
•
•
•
•
•
Patient & Public Involvement
Continuing Healthcare
Quality & Safety
Contracting & Performance
Procurement
CCGs have a legal obligation to promote the involvement of
patients and carers in decisions which relate to their care or
treatment. This requires collaboration between patients, carers
and professionals, recognising the contribution made by all.
As commissioners, it is essential that we use contracting and
procurement to maximise the value for our population and
balance our resources into the right areas, as well as .
As a CCG we must ensure that we make intelligent
commissioning decisions and that we prioritise procurements
appropriately in our commissioning cycle.
Quality and safety also performs a vital role in ensuring that
services are clinically effective, safe and offer a high standard
of patient experience. On the rare occasions where an
investigation is necessary, the team ensures that lessons are
learned and steps taken to avoid future incidents.
The Continuing Healthcare team undertakes assessments to
make sure that people who have a primary health need receive
continuing healthcare provision when they need it.
Sometimes, Personal Health Budgets are a better solution for
people with continuing care needs, so that they can manage
their care in a more personalised way that suits them over the
long-term. The Continuing Healthcare team plays a role in the
administration of these budgets.
Patient and Public Engagement
Strategic aims
We will use insight, outreach and communications with people in Brent to analyse, improve and monitor health services we
commission, so that NHS Brent CCG meets the changing needs of our population and reduces health inequalities in the
borough.
Need
The aim supports the CCG’s Corporate Objective to ‘engage and empower patients, carers and the diverse communities of
Brent.’ In meeting this aim, the CCG will fulfil its statutory obligations regarding PPIE.
Commissioning Change
The proposed model (Analysing, Improving, Monitoring) will empower people of Brent to influence decisions made about
planning their local health services; reduce duplication between the CCG, Brent Council and HealthWatch; assure the ongoing
effectiveness of engagement; and invest in a sustainable and cost effective system – including promoting, supporting and
enhancing levels of self-care across Brent. The strategic model is to be applied across three categories of commissioning:
transforming services through project management; individual complex care-planning through case management; and
sustaining existing service quality through contract management.
Impact
Insight – Existing information will be pooled to better understand the health needs of the Brent population. This information will
include data from Public Health, NHS contract monitoring, policy and survey data. Service improvements will consider the
needs of specific patient groups and equality groups.
Outreach – Expert and credible facilitators will reach out to targeted groups to capture ideas, concerns, expectations and
views on specific commissioning proposals. These data will help the CCG and Brent patients to co-produce new and/or
improved care pathways.
Communications – Information about local services and publicity of proposed changes will be presented in accessible
language and formats, and will be transmitted through a range of media/channels appropriate to reaching the Brent
population.
Assurance of the above will be via new governance structures, overseen by an Integrated Governance Committee,
accountable to the Governing Body of the CCG.
47
Continuing HealthCare, Complex Care and Personal Health Budgets
Strategic Aim
Adult Continuing HealthCare is provided when an individual has been assessed by a multi-disciplinary team and been deemed
to have a ‘primary health need’ After this has been defined health will develop a package of care which is arranged and funded
solely by the health for individuals outside of hospital who have on-going healthcare needs. You can receive continuing
healthcare in any setting, including the patient’s own home or a care home.
Since October 2014 the CCG has offered and provide for those patients that wish to take up the offer and are in receipt of
Continuing HealthCare a Personal Health Budget. This budget is provided to deliver care as defined in the patient’s personal
plan which has to meet their health and wellbeing objectives
Rationale
National Framework for NHS Continuing HealthCare and NHS Funded Nursing Care (revised November 2012)
The NHS 2015/16 planning guidance: “CCGs to lead a major expansion in 2015/16…… CCGs should include clear goals on
expanding personal health budgets within their published local Joint Health and Wellbeing Strategy.”
Commissioning/ Contracting Change
To ensure that the current Continuing HealthCare Service delivered to Brent CCG continues to offer an effective and efficient
service that enables the CCG to deliver person centred care to those patients in receipt of Continuing HealthCare, Shared
Care, Funded Nursing Care and Personal Health Budgets.
To undertake an expansion of Personal Health Budgets outside of Continuing HealthCare for those individuals with a long term
condition or a child with specialist educational needs. To generate a published local offer for personal health budgets that
includes a 3 year plan for implementation.
Patient/ System Impact
To ensure that individuals requiring a Continuing HealthCare assessment experience an effective and efficient service that is
delivered within the Continuing HealthCare Framework guidelines.
To ensure that the individuals deemed eligible for Continuing HealthCare funding are provided the opportunity to work
collaboratively with the Continuing HealthCare team in how their care is commissioned.
Contracting & Performance
Strategic Aim
Our contracts embody the standards of care we have commissioned for patients and we will use them to secure greater local control over
decision making; drive performance, deliver service improvements and better patient outcomes.
Brent CCG will change the way that we work with providers around performance. A detailed diagnostic was undertaken on contracts in 2015/16
and expects providers to undertake their remedial action plans in full.
Rationale
Improve the performance of local Providers so that waiting times and quality services are achieved while supporting the financial recovery of
CCGs and providers. In addition to managing the merger of staff and services the trust has a substantial financial deficit of ~£80m and is non
compliant on several national metrics, most notably A&E, RTT and Cancer 62 day waits.
Commissioning Change
It is likely that more services will transfer back to CCGs from Specialist Commissioning at NHSE as part of a co-commissioning arrangement .
Services to-date will include specialist wheelchairs, neurology and bariatric surgery. Other areas like renal dialysis are being reviewed and task
and finish groups will assess the financial impacts for CCGs.
•
•
•
•
•
Review the costing of planned procedures being charged at Day case rates at LNWHT.
Co-ordination of impact of non acute services on patient flow in acute sites as a health economy e.g. new Early Stroke Discharge service.
Review the impact of newly commissioned services – see Scheduled care reviews for Ophthalmology and Cardiac.
Ensure robust assessment of demand so that contracts and pathways manage demand.
Ensure that all contract metrics and levers are utilised and any support funding for providers is non recurrent and targeted so that future
sustainability of services are based on appropriate contractual basis.
• Review impact of the CCG’s Referral to Treatment waiting times investment, the investment in 62 modular beds, and winter resilience
funding
• Review LNWHT’s fiscal recovery plans in collaboration with the TDA
High cost drugs
• Continue progress towards the aims of the OP prescribing project.
• Review of homecare drug gain share across NWL review all drugs at providers who charge on costs.
Impact
Improved performance of our local key providers especially in Referral to Treatment times, A&E 4 hour wait and cancer targets.
Balanced activity an finance contracts that support the financial sustainability of providers and commissioners.
49
Procurement
Strategic Aim
To apply procurement skills, expertise, processes and methodologies that ensure robust, viable and value for money contracts
that best serve the interests of patients in Brent.
Rationale
The CCG must comply with EU competition law and the Procurement, Patient Choice and Competition (No.2) Regulations 2013
and associated guidance from Monitor. The CCG also needs to take into account management capacity and time in prioritising
contracts for procurement to ensure that it is focussing attention in areas that will maximise benefit.
Commissioning Change
The CCG will continue to adhere to the rules and guidance as set out by NHS England in ‘Better Procurement, Better Value,
Better Care’ (2013), Monitor and Public Health England, encompass the ethos of being a responsible commissioner. We are
committed to these principles in our commissioning role. We will:
• Stimulate the provider market to provide competition to meet demand and secure required clinical, health and well being
outcomes.
• Apply procurement skills, expertise, processes and methodologies that ensure robust, viable and value for money contracts.
• Ensure procurement processes are effective, transparent and equitable.
• Prioritise contracts for review in the most optimal way.
• Continuously reviewing existing contracts, for both clinical and non-clinical services, to ensure that they deliver in accordance
with key performance indicators and offer maximum value for money and demonstrate continuous improvement in the quality
and range of services on offer
Impact
Procurement decisions should lead to the most capable provider of the services being selected, improving the quality of services
for patients and reducing waiting times. They should also lead to the provider that is best value for money being selected, as well
as improved impact and co-ordination with the whole system and linked care pathways.
Quality & Safety
Strategic Aim
Brent CCG’s Vision for Quality & Safety is to deliver excellent health and wellbeing outcomes and great
services for the people of Brent that are delivered in the right place and within budget. This includes the
requirement that robust assurance systems are in place so the public can have confidence that high
quality standards are set within the services we commission and are regularly monitored. The team is
shared across the BHH (Brent, Harrow, Hillingdon) Federation.
Rationale
Using the latest NHS approved methodologies to analyse, understand and prevent patient safety incidents is central to providing good
quality NHS services. Promoting good systems of clinical governance is key to achieving this.
Commissioning/ Contracting Change
Brent CCG, with the support of the Quality Team, will continue to manage quality within our commissioned services through the
following:
• Conducting regular detailed analysis of hard and soft quality data and information is used to triangulate the quality of services.
• Gathering data from all of our commissioned services. This analysis allows for continuous monitoring to identify good practice as well
as areas where quality standards are not being met which initiates a deeper dive.
• Maintaining good working relationships with our providers and continuing to hold monthly Clinical Quality Group (CQG) meetings with
our main providers. These are formal meetings held with the provider where there are open discussions in relation to performance and
quality with the use of data and reports.
• Where we are not the lead commissioner, but we have commissioned services, we will continue to work closely with the Lead CCG to
receive assurance that services are being delivered to the highest standards possible.
• Focusing on improving patient safety, patient experience and clinical effectiveness and will continue to share learning from serious
incidents, never events, safeguarding cases, complaints and any associated reviews with providers to enhance services to patients.
• Working with regional and national initiatives and partners such as the “Sign Up To Safety” initiative and continuing our work with
Imperial College Health Partners for the Foundations of Safety Programme.
• Implement the Prevent agenda, working with partner agencies to identify vulnerable individuals at risk of radicalisation
Impact
•
•
•
•
Improved reporting of incidents when they occur
Improved patient experience
Reduced legal costs to the NHS
Great care in a safe environment
Children’s Services
Strategic Aim
To commission a range of high quality, effective, integrated
acute and community children’s services, embedding integrated
commissioning arrangements for children and young people
and joint commissioning with key partners.
Rationale
A quarter of the population of Brent is under the age of 20 years
and 91% of the school children are from a Black or minority
ethnic group. Given our dynamic demographic make-up we are
focused on building on existing work to further reduce risk-taking
behaviour amongst young people and support those young
people with complex health needs, including mental health
problems to stay well in the community.
Commissioning/ Contracting Change
• Implement new Joint Commissioning Framework
arrangements with Brent LA for five priority groups: children
under 5, Children Looked After, Young Carers, children with
special education needs and disabilities and children with
emotional and mental health problems.
• CAMHS – to work with our NWL CCG’s and Brent Local
Authority to develop a single NWL Local Transformation Plan
with clearly identified local priorities for Brent. This will include
reviewing all care pathways for CAMHS and the introduction
of a standardised training programme targeting all key
professionals and parents. Included within this is to
commission CAMHs for groups of identified vulnerable
children and young people. To implement the new NWL Out of
• Looked After Children – develop robust and sustainable
systems for collating and reporting timely and accurate data
on all CLA assessments and reviews of Brent Children
• Special Education Needs and Disability (SEND) – continue
to work with LA to meet our statutory duties and implement
SEND requirements. Review the associated impact on
health commissioning including the development of Personal
Health Budgets
Patient/ System Impact
• Integrated health and social care pathway to enable a
holistic approach to supporting children and young people
with complex care needs
• Improved health outcomes for all Brent Children and Young
People
• Robust care pathways in place to deliver the most
appropriate treatment by the right clinician at the right time,
with clear pathways in and out of secondary, primary and
community care.
Hours Service for CAMHs.
52
Adult mental health strategy on a page
2015/16 & 2016/17
Self-care and
peer support
2016/17
Nov
2015/16
2015/16 &
2016/17
53
Mental Health
Programme Narrative
• Recognise the strengths people have to help themselves and each other stay well after acute mental illness
• Increase resources in the community to reduce the need for inpatient services
• Improve emergency and urgent mental health care, including sufficient effectively crisis management and in-patient care.
• Offer more services in the community for post-traumatic stress disorder, personality disorder, and medically unexplained symptoms.
Need
• Mental illness remains the single largest cause of morbidity within Brent, affecting one quarter of all adults at some time in their lives and is a key priority of our
commissioning intentions. Many people have low-levels of depression and anxiety that reduce their quality of life, and impact their employment. Some undiagnosed
conditions can appear as physical symptoms (for example, post-traumatic stress disorder associated can present as limited physical function or unexplained pain).
• Historically, investment was made in inpatient services, rather than community services. Recent changes to improve mental health crisis care have reduce the
reliance on inpatient care, giving an opportunity to move resources to the community.
Commissioning Change
SELF-CARE: Move from ‘opt in’ to ‘opt out’ for attendance at the ‘recovery college’ for post-discharge advice and education about mental illness. This would reduce rates
of relapse, and provide support to carers.
Primary care – Reshape peer support and specialist mental health nursing support to share learning in the recovery college, help people develop personal recovery
plans, support social inclusion, help make best use of follow-up appointments, work with patients on wards to facilitate early discharge, provide advice about online
support. Improve clinical support, peer support, and carer support for people who require regular antipsychotic medication to stay well, and for people with dementia.
Continued development of talking therapies (including online services) working with a range of providers to increase access and recovery from common mental
disorders.
Community care – Continue development of crisis response at home, in the community, as well as in A&E. Establish a new model of community mental health teams
with shorter waiting times, and fewer internal waiting lists. Increase the care available for post-traumatic stress disorder and personality disorder.
Crisis houses – Develop options for single-sex, short-stay accommodation, offered as an alternative to inpatient admission when treatment cannot be offered at home.
Provide less medicalised care for people who would otherwise be admitted to a ward.
Inpatient care - Improve use of patient-rated clinical outcome measures in care-planning. Continued effort on improving the patient experience of care, ensuring the
safety of the ward community. Reduce lengths of stay and readmission rates.
54
Impact
People in Brent will find more opportunities to improve their mental health and wellbeing for themselves, or with the support of peers in their community. Referrals for
more specialist support will be dealt with immediately, and appointments booked over the phone. Urgent assessments will be available in the community. Inpatient
services will be focused on brief, intensive, and effective care.
• The CCG will change the balance of resources, to have more support in the community, and les demand on inpatient care.
•
Learning Disability
Programme Narrative
Update and improve advocacy arrangements for people with learning disabilities in Brent, and strengthen the joint working
arrangements between Brent Council and NHS Brent CCG.
Need
The 2014 Learning Disability Joint Self-Assessment showed about 1,166 people aged 18 years and over are registered as
having a learning disability in Brent. The prevalence of adults with learning disabilities in Brent is predicted to increase over the
next 15 years, and a growing number of children and young people with complex and multiple disabilities are also continuing
to survive into adulthood.
We have a responsibility to transform the health and care services, and improve the quality of the care offered to children,
young people and adults with learning disabilities or autism who present with behaviours that are challenging and/or complex
and ensure better outcomes for them. We need to improve access to primary care support and to mainstream health services,
enabling those with the most complex learning disabilities support needs to be supported to remain in their own homes or
continue with care and support packages.
Commissioning Change
SELF-CARE: Local arrangements for advocacy will be updated, so that people with learning disabilities can find a number of
ways to improve their health and wellbeing.
Learning Disabilities Integrated Care Planning – Jointly invest with the Local Authority in a post to lead on and deliver an
integrated approach to learning disabilities services locally. Review and re-design in-patient provision and care pathways.
Develop and implement a joint strategy with the Local Authority people with learning disability in Brent.
Transforming Care – Following the Winterbourne View Concordat, we will continue to identify suitable, local accommodation
and support for people with a learning disability. We will review current inpatient services.
Impact
Patients will be encouraged to have Annual Health Checks with a good Health Actions Plan, and a self supported assessment
and support plan, for people who are eligible. There will be opportunities for a personal health budget and a personal social
care budget. Services will follow a joint health and social care strategy.
55
Carers
Programme Narrative
Review current provision and support for carers in Brent. Ensure there is adequate, consistent and robust connectivity
between health and social care to deliver support based on needs. Direct carers to other forms of support they may have
been unaware of.
Need
Carers are able to apply for respite funding. This is provided by the CCG and LA, and administered through Brent Carers,
LNWHT, and Brent Council. The use and effectiveness of this funding will be reviewed. The application process should be
straight-forward, and the support should be based on the level of need that has been assessed.
Commissioning Change
• SELF-CARE: People who care for patients will be encouraged to consider whether they are ‘carers’, and to have access
through the voluntary sector, GP or through the clinical specialist service to advice on informal support, as well as a more
formal carer assessment of need.
• Early identification of carers and review, redesign and commissioning carers support locally that is more joined up.
• Jointly commission or have a lead role in the commissioning of carers support services especially GP services,
Counselling, peer support, access to community mental health services, a range of befriending and volunteering schemes,
employment support, and schemes to tackle social isolation.
• Improve the range of support services available to carers by developing the range of providers locally.
• Develop pathways to ensure that the physical and mental health needs of carers are identified and that support plans
include respite breaks
• Agree local processes to ensure that physical and mental health needs of carers are supported.
Impact
Carers will find services recognise their role and their needs. They will be supported to stay mentally and physically well,
respected as care partners, treated with dignity and enabled to have a life of their own alongside their caring role. They may
be offered an option to take up of personal health budgets, or have access to carers breaks to reduce carer breakdown.
Services will be encouraged to identify carers, and make contact with services that can help them. This should improve the
quality of life for patients, and reduce avoidable admissions to acute and residential care.
56
Questions
• Any comments, ideas, or questions?
• BRECCG.Brentenquiries@nhs.net. Questions
• brentccg.engagement@nhs.net. Ideas
Events
• Online survey 07 Oct
• Big Brent Health Debate 07 Oct
• Psychosis online survey 07 Oct
• Dementia Conference 23 Oct
• Mental Health CMHT and urgent care workshop 29 Oct
• Post Traumatic Stress Disorder workshop TBC
• Learning disability workshop TBC
• Children’s workshop TBC
• 111 workshop TBC
Ian Niven
Head of Healthwatch Brent
Our priorities
• Phlebotomy (blood tests) –
charting the patient
experience
• Mental Health - maintaining
good health in the community
• Female Genital Mutilation - an
area of great concern in Brent.
• Establishing a Community
Chest
• Delivering our Healthwatch
functions
How we are delivering these
CommUNITY Barnet
Board of Trustees/CEO
Healthwatch Brent Advisory Board
Healthwatch Brent Team
Promotion and
Reach
Community Chest
Communication
and Engagement
Group
Enter and View
Group
Primary Care
Group
Shared Information
and Signposting
Service
Working with partners – our story so far:
Creating Healthwatch Brent
Advisory Boad
Establishing the Healthwatch
Brent Community Voices Chest Creating a consortium of charity
partners to capture reach data
Healthwatch Brent Advisory Board
Promotion and Reach Group
…. We still need 4 more partners
Healthwatch Brent – Facts and Figures
Healthwatch Brent Team – 4
No of active volunteers – 14
Charity partners on the Advisory Board – 6
Promotion and Reach Group members – 4
No of Enter and View Visits – 1
No of strategic meetings attended - 12
No of people reached by Healthwatch Brent - 3500
Contacting us:
Healthwatch Brent 3
Rutherford Way
Wembley HA9 0BP
Telephone: 020 8912 5831
www.healthwatchbrent.co.uk
@hwbrent
Information and signposting:
Telephone: 020 3598 6414
info@healthwatchbrent.co.uk
A volunteer’s story - Meenara
CommUNITY Barnet
Working together
works