nhs mansfield and ashfield ccg annual public meeting · the ccg is leading the development of a...
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NHS Mansfield and Ashfield CCG
Annual Public Meeting
7 September 2017
Civic Quarter, Civic Centre
Mansfield
Dr Gavin Lunn
Clinical Chair
Film
Review of Achievements 2016/17
and looking to the future
Amanda Sullivan
Chief Officer
Helping to shape future health and social care in Mid Nottinghamshire
Helping to shape future health and social care in Mid Nottinghamshire
Our role and responsibility is to:
• Plan, buy and monitor services
• Change the way that services work by integrating care across hospital and
community settings
• The NHS is a great success – people are living longer and more conditions
can be treated
• BUT – we develop more health problems as we get older and we need more
health care
• Re-prioritise NHS funding to provide increased levels of care – demand for
services is growing faster than funding for services
Helping to shape future health and social care in Mid Nottinghamshire
Aims of NHS Mansfield & Ashfield CCG:
1. Ensure best quality within available resources
(incorporating safety, effectiveness and patient
experience)
2. Ensure best service design
3. Ensure partnership working to achieve the safest and
most effective services within available resources
Helping to shape future health and social care in Mid Nottinghamshire
New types of services include:
• Local Integrated Care Teams (7 across mid-Nottinghamshire),
health and social care, linked to GP surgeries, joint care
planning
• Intensive home support – therapy, nursing, social care, capable
of more than traditional community services
• Call for Care – community service, navigation and rapid care
responses, linked to other professionals and take referrals
Helping to shape future health and social care in Mid Nottinghamshire
New types of services include:
• Primary care working in hubs – respond more quickly to
more problems, home visits earlier in the day
• Single front door - Kings Mill and Newark with primary
care
• Self care advice and links with community teams
• Proactive care home service, ambulatory care
Helping to shape future health and social care in Mid Nottinghamshire
Reduction in length of stay
4500
5000
5500
6000
6500
7000
7500
8000
8500
9000
9500
10000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
SFH Trust Total
15/16OBDLOS10daysplus
Reduction in mortality
Helping to shape future health and social care in Mid Nottinghamshire
Emergency Access within four hours Reduction in admissions to
nursing and residential
homes
12
What do patients say?
Integrated care team ….. Colin aged 85, was discharged from hospital. He
required help and support at home. Colin could
not lay flat in bed so was sleeping in his chair; he
had difficulty using the toilet as it was too low, he
couldn’t walk very well and when he did manage
to walk he couldn’t carry anything at the same
time.
Colin was visited on discharge by an
Occupational Therapist who assessed his needs
and within the day managed to obtain a back
rest for his bed, a raised toilet seat and a trolley
on wheels.
Colin could not thank the occupational therapist
enough and was so grateful that someone cared
enough to help him.
“It’s easier to go down a
hill than up a hill, I am
determined to keep
going up that hill one
foot in front of the
other”
Occupational
Therapist was
“fantastic”. “So grateful
that someone
cared enough
to help”.
Clinical Commissioning Group
Improvement and Assessment
Framework Overview
14
15
NHS England Ratings 2016/17 NHS Mansfield and
Ashfield CCG
NHS Newark and Sherwood CCG
Better Care
Cancer
Cancer Overall score based on early diagnosis and treatment, waiting times for treatment Inadequate Good
Care Ratings Provision of high quality care in hospitals, general practice and adult social care
Comparable with neighbouring areas –
significant improvement in provider CQC ratings in
2016/17
Comparable with
neighbouring areas –
significant improvement
in provider CQC ratings
in 2016/17
Dementia Dementia Overall score based on early diagnosis and post-diagnostic support Outstanding Outstanding
Elective Access Patients waiting 18 weeks or less from referral to hospital treatment 92.7% 92.3%
Learning Disability Learning Disability Reliance on inpatient care, annual health checks Needs Improvement Needs Improvement
Maternity
Maternity Neonatal mortality and still births, choices in maternity care and women’s experiences Needs Improvement Performing Well
Mental Health
Mental Health Psychological therapy recovery rate, 1st episode access within 2 weeks, transformation in children and young people and crisis / liaison, out of area placements Good Good
Emergency Care
Seen, treated and discharged from A&E within 4 hours Scores also on avoidable admissions, delayed transfers of care, integration of services 95.20% 93.40%
16
NHS England Ratings 2016/17 NHS Mansfield and
Ashfield CCG
NHS Newark and Sherwood CCG
Better Health
Diabetes Diabetes Treatment targets and attendance at structured education Needs Improvement Needs Improvement
Sustainability
Sustainability Financial plan Good Good
In year financial performance (did not achieve planned surplus)
New Models of Care Adoption of new care models
Y The CCG is leading the
development of a population health
vanguard
Y
The CCG is leading the development of a population health
vanguard
Well-led
Sustainability and Transformation Plan Good Good
Probity and corporate governance Fully compliant Fully compliant
Quality of CCG leadership (structure and process to deliver the scale of financial challenge) Inadequate Inadequate
Overall 2016/17 Assessment
Relating to financial position and confidence in achievement of level of required savings in 2017/18 Inadequate Inadequate
Developing new ways of
working with health,
social care and the
voluntary sector
• Managing population
healthcare demand more
effectively together
• Developing and
implementing new ways
of working
• Right care first time
Reduce waste, time and
effort
• Reducing duplication
• Review services
• Look at quality
• Maximising care in lowest
cost appropriate setting
• Save money internally
Prioritisation of services
based on the ones that
are most effective
• Evidence-based reviews of services
• Clinical criteria for NHS funded care for improved outcomes
• Value-based decision making
Having achieved considerable service
improvements, we now need to ensure
sustainability and efficiency
Need clear citizen engagement
FIT FOR PURPOSE FIT FOR TODAY FIT FOR THE FUTURE
Financial turnaround
Business cycle and processes
Staff restructuring to maximise
delivery impact and
triangulation across business
functions
Governing Body and staff development
Financial strategy, position and
delivery of savings requirements
Service performance and
constitutional standards
Service quality and safeguarding
Stakeholder relationships and
engagement
Improve NHS England rating and exit financial special measures
Alliance development moving
towards population approach and
accountable care across
organisations
Sustainability Transformation
Partnership development and
alignment
Vanguard delivery – new model of care development
2016/17 Finance Review
Marcus Pratt
Associate Director of Finance
2016/17:
Performance on Key Duties
Financial Duty Achieved Details
Fully utilise allocated funds £290.7 million spent on healthcare
services
Meet planned surplus target × Achieved a reduced surplus of £0.6
million
Remain within running cost
allowance Spent £3.6 million on running
costs. This is £19.14 per head of
population and within our target of
£23.13.
Remain within maximum cash
drawdown Cash balance of £42,000 at 31st
March
Pay suppliers within 30 days The CCG paid 95% of invoices in
30 days
2016/17: How the CCG Spent its
Allocation
The CCGs key providers were: (as a % of total CCG budget)
Notts Healthcare = 14%
Nottm Uni Hosp = 4% East Mid’s Ambulance = 2% Sherwood Forest = 40%
In 2016-17 Mansfield and Ashfield CCG experienced over £11
million of activity and price increases.
What services were delivered for the
patients?
Acute Services: hospital based services
651 hip/knee replacements (up 14%) 1178 cataract treatments (up 18%) 58523 seen in Outpatients (up 7%)
25710 Urgent care admissions (including pneumonia, COPD, heart conditions, urinary tract infections)(up 5%)
77122 Diagnostic tests including 8308 Endoscopic tests
Community Services: delivered close to patients
Service developments from 2015-16
Long Term Integrated care teams saw 12907 patients
Transfer to Assess enabled 171 patients to safely leave hospital more quickly
Primary Care & Prescribing
Over 4.7 million prescriptions issued
0.3m statins, 26 estimated lives saved
Diabetes and Prostate Cancer checks
Anticoagulation & rheumatology monitoring
Minor injury clinical
Ambulance Services
40993 calls to the service (up 2.7%)
21998 were transported to hospital (up 5.1%)
13182 patients were provided telephone advice or received treatment at location
(down 6%)
Continuing Healthcare Services
Individual packages of care for patients needing more
intensive support, either long term or at the end of life
Looking Ahead: 2017-18 and beyond
Key Challenges
• Lower growth in funding than required to
meet the rising demand for services.
• Primary care awarded an increase 1.8%
only in 2017-18.
• Increasing expectations of healthcare.
• A changing and ageing population with
differing demands.
• Fragmentation of services.
• Maintaining quality of services.
Response to the Challenge
• Turnaround Board and Financial recovery
plan in place.
• A significant savings plan to keep within
our financial allocation developed and
being delivered in 2017-18 and beyond.
• Increased partnership working across all
sectors, to increase service integration.
• Investments not yet committed for 2017-18
and 2018-19 are being deferred.
• Development of a countywide
Sustainability and Transformation
Partnership (STP).
2017-18 Allocation £ 288.2 million, an increase of £5.2 million (2.1%).
As a result of the increasing pressures in the local health system, the CCG has a
productivity and efficiency requirement of 6.6% or £19.1 million by April 2018.
Commissioning Quality
Services
Elaine Moss
Chief Nurse and
Director of Quality and Governance
How we ensure your voice is
heard in the CCG
Patient and Public
Involvement
• Citizens Reference Panel (Mansfield and Ashfield)
• Stakeholder Reference Group (Newark and Sherwood)
• Lay member representation on CCG Boards and Committees
• Lay member involvement in Quality visits
• CCG involvement with Third Sector and voluntary services
• Engagement sessions around service transformation/redesign
• Patient Advice and Liaison and complaints team
Engagement with Partner
Organisations
• Sustainability and Transformation Partnership (STP)
• Nottinghamshire Safeguarding Adult and Children Boards and sub groups
• Nottinghamshire Multi Agency Public Protection (MAPPA) Strategic Management Board
• Nottinghamshire Domestic and Sexual Abuse Executive
• Quality Panels
• Nottinghamshire County Council
• Care Quality Commission
Infection Prevention
& Control
Achievements
• Since audit visits were implemented, hand hygiene facilities have
improved in residential care homes across the county from a 53%
consistently having appropriate facilities to 83%; this contributes to
reducing the spread of infection in this vulnerable population.
• The ‘To Dip or Not to Dip’ quality improvement project continues to
improve the diagnosis and management of urine infections. The project
has led to reduction in the use of inappropriate antibiotics by early and
accurate diagnosis and highlights prevention messages including the
importance of hydration.
Managing Antibiotic Resistance
A local hydration campaign to reduce the risk of dehydration and urinary
infection - aimed particularly those aged over 60yrs
Success
This work has been recognised nationally and the group was presented
with the Antibiotic Guardian Award in June 2017. The award celebrates the
Group’s work with both NHS and private health providers in
Nottinghamshire to improve antibiotic prescribing and reduce infection resistance rates locally.
• Acute home visiting
• Best Practice promotion – focus on end of life
• Workforce improvements – therapy first, mental health and prescribing
pharmacists in practices
• Invested in technology solutions to support decision making and
standardisation
Primary Care
What was achieved……
• Diabetes – National Diabetes Prevention
Programme
• Extended Access – increased opening hours,
increasing online access
• International GP Recruitment
• Hubs where practices can develop specialist areas
Primary Care
What we will focus on next ……
A huge thank you
to all and PPGs
for the support
you have given to
our practices
Question Time Panel
Hosted by Tony Delahunty,
Mansfield 103.2
Celebrating Success in General Practice Awards
presented by
Peter Clay
Chair of Audit and Governance Committee
Partnership Working Award
This award reflects collaborative team work between
the practice and the PPG
Partnership Working Award
Winner
Orchard Medical Practice
Patient Participation Group
Going the Extra Mile Award
This award recognises a team or individual who
have gone that extra mile to make a positive
difference within their working environment, to a
patient or colleague
Going the Extra Mile Award
Highly Commended
Sam Harmsworth, Brierley Park Medical Centre
Going the Extra Mile Award
Winner Jane Campbell
“This nurse truly does go the extra mile. She is always
helpful, kind and approachable to all her patients. Nothing
is ever too much trouble and nothing phases her. All her
work is done with a smile even if she is having a bad day.
A real asset”.
Outstanding Contribution
Award
This award recognises a truly inspirational group or
individual who have had a positive impact on the
health and wellbeing of people living in Mansfield
and Ashfield
Outstanding Contribution
Award
Winner Dr. Sandeep Patel
“Dr. Patel always goes above and beyond for his patients and has turned
around Bull Farm Surgery providing continuity of care for its patients”.
“Always fitting patients in when appointments are all filled and never turning
urgent cases away”.
“Attending all locality, multi-disciplinary team, safeguarding meetings -again
for a single handed GP is not always easy”.
Innovation Award
This award celebrates an individual or a team who
have an excellent example of an innovative approach
to design and delivery of better patient care and can
provide evidence of change or outcomes
Innovation Award
Winner
Dr. Milind Tadpatrikar
Skype Consultations using iPad technology
for GP Virtual Ward Rounds
Outstanding Clinical
Leader Award
This award celebrates a clinical leader within General
Practice who has gone over and above what is
expected of them in their role and has had a positive
impact on delivery of one or more of the CCGs vision
and values
Outstanding Clinical
Leader Award
Winner Dr Karen Brown
“Dr. Brown has in a short time transformed Jacksdale Medical Centre
into a modern and welcoming place for patients that offers modern
treatment rooms. This same commitment is extending to Underwood
Branch Surgery.”
“The commitment to deliver high quality care with patients at the heart
of the practice can be evidenced in the practice mission statement and
by the online reviews of people using the service”.
Kindness Award
This award recognises a staff member who is working in Mansfield
and Ashfield who has shown exceptional kindness towards patients
and carers in the last year
Kindness Award
Winner Kellymarie Charlesworth
“Kellymarie has a can do approach to any requests for help that are wide
and varied and has many competing demands including supporting
Protected Learning Time events.
She has turned her hand to a range of challenges including filming,
photography, reception duties, mailings to practices- her talents are
endless and I would like to acknowledge the vital role she
fulfils at the CCG.”
Excellence in
Engagement Award
This award celebrates the contribution of a volunteer or
representative of a group of people who have gone
above and beyond in their position helping the CCG
Excellence in
Engagement Award
Winner Keith Wallace