Prioritisation

Sandra ChadwickChief Operating Officer

June 2013

Context

• CCG authorised with conditions:– Result of 360 degree survey, 46% of Member

Practices didn’t know what the CCG priorities were.

The Problem is:

Stoke-on-Trent Shadow Clinical Commissioning Group (CCG) does not

have clearly defined priorities with measurable outcomes.

Objective

To clearly define the CCG’s 3 local priorities with measurable outcomes by March

2013

Root Cause Analysis• Policy: Radical reform of NHS system,

Emerging policy, • People: Less staff (40%), New Leaders and

stakeholders, changing dynamics of power, Population with high levels of deprivation, mortality and morbidity.

• Environment: New smaller acute hospital,

Strategy

• To work with Public Health to produce a prioritisation framework by end of December 2012

• The CCG top team to engage and consult with key stakeholders to agree the 3 quality priorities between January and March 2013

ImplementationAction Lead

1st 7th 14th 21st 28th 4th 11th 18th 25th 4th 11th 18th25thPrioritisation Framework PHReview Evidence HOCJSNA, HWB strategy PHBenchmarking PMCommunication Plan CommsEngagement Plan CAOCELG CAOMember Practices event COOPt Congress COOHealth Wellbeing Board CAOPrioritisation COOApproval COOCCG Governing Body COOHealth Wellbeing Board CAO

January February March

Evaluation Plan• CCG authorised without conditions end of June 2013• Increase from 54% to 70% in Member Practices that

know the CCG priorities measured by 360 degree stakeholder survey September 2013

• Delivery of targets in each of the 3 quality priorities by March 2014:– Maintain current levels of alcohol related admissions

(640 per year) to bring in line with rising national trends.– 5000 patients to be risk assessed and 30% have a care

plan for active case management– 10% increase in patients supported by simple telehealth

from February 2013 baseline

● Has quality at the heart of what we do ● Is trusted by local people ● Works with partners to reduce health inequalities ● Delivers best value Our

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Better and More: a community focused model of care Improved care and outcomes for people with LTCs Use patient experience to improve quality of care ‘Must Do’s’ delivered

● Work with patients ● Be a high performing organisation ● Work in strong collaborations

● Use clinical movement to drive change ● Develop the right culture and behaviours ● Work with Member Practices

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Aging population with a predicted increase in elderly from 2010 to 2015· 29% increase in >65· 17% increase in >85

Lower than average life expectancy and higher than average mortality.· Average life expectancy is almost 3

years below average for both males and females

· Mortality rate for cancers is 36.4% above national average.

· Death rate from lung cancer is 55% higher than the national average.

Over reliance on bed based services with poor flow across the system· Intermediate care audit shows 606/

100,000 admitted to intermediate bed base in 2011 compared to 261/100,000 naitonally

· 18% year on year increase in non-elective admissions

High prevalence rate, low quality of life for people with LTC compared to the national average· Death rates across all LTCs are

significantly higher than national average.

· Circulatory disease 16.7% higher· High prevalence of dementia (3,000)· Significantly worse in outcomes for

people with epilepsy

How

will

we

get t

here

: Tr

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Inte

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· Implementation of integrated local working to risk stratify and identify patients for proactive personalised care planning

· Expansion of IAPT service to wider target group· Improved community services and interventions

for dependent drinkers

· Implementation of shadow Year of Care Commissioning and Contracting model

· Remodelling of community tier 3 respiratory services:

● Hot clinics/crisis management● Patient education and self-management● Use of telehealth

· Locally enhanced service for diabetes· Implementation of stroke pathway· Implementation of new community mental health

outreach service· Drive continuous improvement in primary care

through the Quality Improvement Framework· Implementation of tele-health applications to

improve management of epilepsy

· Use patient feedback to improve patients experience of care

· Develop the Customer Insights Database as a mechanism for receiving patient and clinical intelligence and turning it into commissioning actions

· A clinically led programme of quality visits to main providers

· Where we have concerns we will go and look.

· No QIPP about me without me· PPI central to everything we do· Further development and embedding of the

patient congress

· 18 weeks RTT: ● Further development of tier 3 planned care services in gynae, ophthalmology, and dermatology● Reduction in out-patient follow-ups towards national average follow-up ratios

· Cancer waits: ● Macmillan project●Lung cancer pathway

· A&E 4-hour wait targets: ● Urgent care strategy● Implementation of 111● Implementation new GP OOHs contract

· Ensure NHS Outcomes Framework for CCGs are met using indicator set

How

will

we

know

we’

ve g

ot th

ere:

Out

com

es

· Reduction or a zero per cent change in emergency admissions for ACS conditions

· 5% reduction in the number of persons admitted to hospital due to alcohol-attributable conditions - males, females, all ages, directly standardised rate per 100,000 European Standard Population

· 5,000 patients to be risk assessed and 30% have a care plan for active case management by the end of 13/14

· Improvement in IAPT outcomes

· The potential years of life lost (adjusted for sex and age) from amenable mortality for our CCG population to reduce by at least 3.2% between 2013 and 2014

· 5% increase in the percentage of patients aged 18 years and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 15 months.

· Increase in numbers of patient with diabetes receiving 9 indicators of care

· Increase number of people following stroke who receive early supported discharge

· Increase in diagnosis rates for people with dementia and early diagnosis and support to remain independent as long as possible

· Improved patient experience of community mental health services

· Improve outcomes in clinical indicators with Primary Care Quality Improvement Framework

· Friends and Family Test - Ensure all relevant local providers of services commissioned by us have delivered the national agreed roll-out plan to the national timetable

· Friends and Family Test – Ensure that an improvement in average FFT scores for acute in-patient care and A&E services between Q1 14/15 for acute hospitals that serve our population

· Patient experience has impacted on commissioning decisions

· KPIs to be discussed and agreed with the patient congress on March 12th

· Ensure that there are no cases of MRSA bacteraemia for our population and ensure that C. difficile cases are at or below the CCG threshold (77 cases, a 25% reduction)

· Year on year improvement in NHS outcome measures

· Achievement of 18 weeks RTT · Achievement of A&E 4hr wait targets· Achievement of cancer wait targets· Reduction in premature deaths from cancer · Achieve financial balance to ensure sustainable local

health economy

Higher rates of hospital admission for alcohol related harm than national average· 32.2 per 100,000 (national average 25

per 100,000)

· Improve access to and flow through the urgent and emergency care system through better co-ordination, assessment and discharge by a central Care Hub.

· Redesign and recommission intermediate care services to reduce reliance on bed based care and strengthen and integrate with community services around practices and localities.

· Redesign the care of frail and complex elderly patients through better assessment and MDT management and providing general elderly care in the community.

· Simplified care system with single point of access, more people supported in the community, fewer acute admissions and improved patient flow.

· Fewer acute and community beds, enhanced community and mental health services integrated across primary, community and acute care with people cared for at home as the norm.

· More generalist and geriatrician support in the community so no general elderly care beds are provided in acute settings and fewer older people admitted through emergency portals.

Risk

s

Financial Challenges· UHNS financial challenge· LA financial challenge

System issues· Changing commissioning landscape· Monopoly providers, limited potential for market

development· No local providers have received FT status· Workforce

Demographics· Lifestyle behaviours: drugs and alcohol,

smoking· High levels of deprivation and health

inequalities

Health· Unwarranted variation in clinical care· Inequality in access to health services

Learning • Leaders – the Journey is as important as the

destination.• Problem Solving – Clear definition of the

objective is key.• Impact on organisation– Benefits of developing relationships with key

stakeholders– Alignment of strategies across the system– Organisational Development benefits– Staff morale and pride