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Better care, more locally, within budget, through transformation
Welcome to our Annual General Meeting
Better care, more locally, within budget, through transformation
AgendaChairman’s Welcome and Introduction to the
Annual General Meeting (AGM)Dr Gina Palumbo, Clinical Commissioning Group Chair
Review of the Year 2013/14Jane Hawkard, Chief Officer
Annual Accounts 2013/14Richard Dodson, Chief Finance Officer
Questions and Answers
Better care, more locally, within budget, through transformation
Introduction
Dr Gina PalumboClinical Commissioning Group Chair
Better care, more locally, within budget, through transformation
Basic Facts1000 square miles340,000 approximate population37 GP Practices43 Dental Practices 60 Pharmacies 65 Optometry Practices3 Prisons4 Community Hospital Sites 9 Health Centres/Clinics 1 GP Access Centre3 Acute Hospitals2 District Hospitals
No A&E in the County
Better care, more locally, within budget, through transformation
Our Population’s HealthLife ExpectancyLife expectancy for men is higher than England averageButThere is a difference in life expectancy between those in the most deprived and those in the least deprived
Obesity is a problem19% of Year 6 Children are classified as obeseLevels of adult obesity is higher than England average
DeprivationLower than averageButThis masks the fact that some areas are very deprived
Early death rates have fallenEarly death rates for cancer, heart disease and stroke are better than England average
Better care, more locally, within budget, through transformation
Our Populations Health – Our PrioritiesAddressing the health needs of the ageing population
(Quality of Life)· Opportunities through transformation of the service model to support the management of Long Term Conditions
and promote self care
Addressing inequalities in health outcomes (Quantity of Life)
· Opportunities through preventing ill health development and minimising deterioration of existing conditions
ERY Clinical Commissioning Group Operational & Strategic Plan 2014-2019
Addressing the mental and physical health and wellbeing ofChildren and Young People
National Priorities•Reduce infection from MRSA and C.difficile•Reduce hospital mortality
Budget Management•Meet statutory duty to balance budgets
Better care, more locally, within budget, through transformation
Your Local Clinical Commissioning Group
Local GPs have been through a nomination and election process for the East Riding CCG and non-GP members have also been identified. Membership is as follows:GP Members• Beverley and Driffield
Dr Gina Palumbo (CCG Chair)Dr Richard Little
• Goole, Howdenshire and West Wolds • Dr Clive Henderson
Dr Frank Thornton• Haltemprice
Dr Krishnaraj Sivarajan• Bridlington
Dr Alan Francis• Holderness
Dr David Fitzsimons
Other members • Secondary Care Doctor• 3 lay members:
– Vice Chair – Patient & Public Participation– Audit & Governance
• 1 Local Authority representative• 3 Executive Directors:
• Chief Officer• Chief Finance Officer• Director of Quality & Governance /
Executive Nurse• Director of Public Health (ERYC)• ERY Healthwatch representative
Better care, more locally, within budget, through transformation
A New Role for Clinicians• To buy and ensure delivery of
services appropriate to meet reasonable local needs.
• Work with all involved to drive out waste and maintain quality
• To ensure sustainable, high quality, safe and effective services and good patient experience
Better care, more locally, within budget, through transformation
Strong Locality Working
Better care, more locally, within budget, through transformation
Pressures on the NHS• Demographics• The incremental nature of health
care• The technological and therapeutic
advances• The increased complexity and
fragmentation• The expectations• The fiscal challenge• NHS has been relatively protected
Better care, more locally, within budget, through transformation
So where will the resources for health
and social care come from?
Better care, more locally, within budget, through transformation
Scaling up of Small ChangesWe all have to do something different
to achieve our aim of…
…better care …closer to home …within budget
Through TransformationGPsPatients
Local Authority
Hospitals CommunitiesVoluntary
SectorPrivate Sector
Policy Makers
NursesAllied Health
Professionals
Better care, more locally, within budget, through transformation
What clinicians could do differently
• Lead on changing clinical behaviour• Lead on collaboration and integration• Reduce variability of health care• Secondary care moving out into community• Centralisation of specialist
services• Working with Local Authority
and Public Health – Health and Well Being Board
Better care, more locally, within budget, through transformation
What can patients and doctors do differently together?
Aim of the Health and Social Care Act – Patients central,
informed and empowered to
co-produce solutions
Better care, more locally, within budget, through transformation
“Doctor, what can I do to improve my own health and
well being?”
Better care, more locally, within budget, through transformation
A different conversation• Understand and own our own
contribution to our (ill) health• Take responsibility for sharing in
decisions• Agree our plan and help to monitor
outcomes• Be our own expert• Be our own (biggest) change agent• Share our experience and inspire
someone else
Better care, more locally, within budget, through transformation
Keep it simple and straight forward
• No smoking• Moderate alcohol consumption• Regular exercise• 7-8hrs sleep• Regular meals with no snacking• Maintenance of moderate body
weight• Regular consumption of breakfast
1965 Lester Breslow’s benefits of seven healthy habits
Better care, more locally, within budget, through transformation
Long Term Conditions – The Facts
• Account for £7.00 out of every £10.00 spent in the NHS• In the East Riding…
• 50% of all GP appointments… • 65% of all outpatient appointments and • 72% of all patient stays on hospital wards• are taken by people with long term conditions
• But we have a pill for everything, Don’t we?
Better care, more locally, within budget, through transformation
The Burden of Treatment
Better care, more locally, within budget, through transformation
What can the Health and Social Care
Community do differently?
Better care, more locally, within budget, through transformation
Be honest, open and transparent
• One voice, one message across Health and Social Care
• With political support – H&WB• Doctors to maintain trust• Publish as much as we possibly
can• Be accessible and open to
challenge
Better care, more locally, within budget, through transformation
Better care, more locally, within budget, through transformation
It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.
The NHS belongs to the people
Better care, more locally, within budget, through transformation
2b. Patients and the public – your responsibilities
The NHS belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly…
Better care, more locally, within budget, through transformation
You should…
recognise that you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it.
register with a GP practice – the main point of access to NHS care.
treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution.
provide accurate information
Better care, more locally, within budget, through transformation
keep appointments, or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.
follow the course of treatment which you have agreed, and talk to your clinician if you find this difficult.
participate in important public health programmes such as vaccination.
ensure that those closest to you are aware of your wishes about organ donation.
give feedback – both positive and negative – about the treatment and care you have received, including any adverse reactions you may have had.
Better care, more locally, within budget, through transformation
Hard Truths and our Duty of Candour
• Scandals of Mid Staffordshire Hospital and Winterbourne• Our collective future needs us all to face some hard
truths about how we are all responsible for improving quality through being open and honest with patients / the public and across organisations
• CCG Public Pledges in line with Hard Truths – to ensure focus is maintained on improving quality
Better care, more locally, within budget, through transformation
Review of the Year 2013/14
Jane Hawkard, Chief Officer
Better care, more locally, within budget, through transformation
East Riding of Yorkshire Clinical Commissioning
GroupPlanning to do something different
2014/15 to 2018/19
Better care, more locally, within budget, through transformation
Improve services for older
people
Improve planned
care services
Partnership working
with local authority
Improve emergency
care services
Better management of people with long term conditions to reduce avoidable admissions.
Increase access to early diagnosis and treatment for
patients with dementia.
Increase number of patients able to die in their place of choice.
Increase patient involvement in decision making about the
right care for them through:
•Improved patient information.
• Roll out of Map of Medicine software use in GP surgeries.
Review access to locally based musculoskeletal services
Reduce number of patients admitted with a hip fracture by
5% from 2012/13 levels.
Improve patient experience of A&E services.
Increase accessibility to minor injury services
Improve patient experience of our Child and Adolescent
Mental Health Services (CAMHS).
Improve access to more local, primary care based
psychological therapies.
Increase the number of assessments for autism and
access to programmes.
CCG PLAN 2013 -14
Better care, more locally, within budget, through transformation
Supporting People with Long Term Conditions model– Long term condition clinics in primary care, 28 of
our 38 practices, covering 86% of our population
Dementia Services– Increased Memory Clinic capacity– Increased diagnosis rates from 37% to 41% in last
few months of the year– Commissioning a Mild Cognitive Impairment
service– We still need more capacity for diagnosis and
treatment
Access to Psychological Therapies for Anxiety and Depression
– Increased the number of service Providers from 2 to 8
– Mobilisation of service between April and September 2014
– We need to see the new service working at full strength
Timely access to good quality psychological therapies’ with a focus on recovery.
Early diagnosis, good information, supporting individuals to live well with their dementia diagnosis.
Empowered patients, personalised care
What we have achievedand still more to do…
Better care, more locally, within budget, through transformation
Children and Adolescent Mental Health Services• reduce waiting times• increased out of hours access to service • further waiting time reductions to achieve
Falls service• new specialist service, reducing emergency
admissions for hip fractures by 25%
Quality of Services• Reduced number of Hospital Acquired Infections• Reduced hospital mortality rates to within expected
range in our local hospitals • Launched patient engagement initiative ‘involve’ • Reduced deaths in hospital by 37% by increasing
choice for patients on end of life pathways
What we have achievedand still more to do…
Help with preventing falls
Better care, more locally, within budget, through transformation
Patient Network
involve
www.eastridingofyorkshireccg.nhs.uk/involve
Want to help improve NHS services across East Yorkshire?
Join involve!
Better care, more locally, within budget, through transformation
Challenges and what has not gone so well…
• Some national targets not met – waiting times (A&E, 52 week waits, access to psychological therapies)
• ‘involve’ patient network – slower start than we would have liked
• The pace of change
• Challenges for Primary Care Workforce
• Care Quality Commission recommendations for the East Riding Community Hospital and Hull Hospitals Trust
Better care, more locally, within budget, through transformation
1. Improving Primary and Community Services2. Transforming the Urgent Care system3. Planning care efficiently4. Integrating services5. Improving services for vulnerable people
Better care, more locally, within budget, through transformation
Looking Forward to years 2 and 3Making a difference and improving outcomes for patients
Safe, High Quality, Sustainable, Productive Care
Unplanned Care Services
DeliveringCommunity urgent response teams
OutcomeReducing avoidable emergency admissions
SYSTEM VISION STATEMENTS
• Individuals take greater ownership of their own health and wellbeing• Services are, in the main, delivered in the community by a range of providers• Integrated health and social care through locality focused service delivery hubs • The remit for hospital based services is clear and reflects where they can add
value and expertiseProductive
Elective Care
Delivering Consistent and systematic services
OutcomeTransforming follow up appointment systems
Integration of services to
provide ‘Better Care’
DeliveringMore joined up health & social care services
OutcomeIncreasing people (65+) discharged home from hospital rather than into a care home.
Community Services
and Primary Care
DeliveringLocality hubs for health & social care services
OutcomeImproving quality of life for people with long term conditions and complex needs
Supporting Our Vulnerable People
Delivering Better Dementia and for Children and Adolescents Mental Health Services
OutcomeIncrease the levels of diagnosis of dementia and treatment services
Better care, more locally, within budget, through transformation
3. Rehab & Reablement
Locality
HubCommunication Communication
Testing Our Pilot Locality Hub Model1. Focus on self care
and independent living
2. Locally delivered services where possible
3. Joined up health and social care
4. Hospital based services available when needed
Better care, more locally, within budget, through transformation
Annual Accounts 2013/14
Richard Dodson Chief Finance Officer
Better care, more locally, within budget, through transformation
Secondary Care
Mental Health Continuing Healthcare
Prescribing
Community
Primary Care
Running costs
Other
Better care, more locally, within budget, through transformation
Financial Duties
Manage within Budget
Manage within Cash Limit
Manage within Capital Limits
Manage within Running Costs Target
Better care, more locally, within budget, through transformation
An unqualified opinion was issued. Financial statements give a true and fair view In all material respects, the expenditure and income
have been applied to the purposes intended by Parliament
Have been properly prepared in accordance with the accounting policies directed by the Secretary of State
Proper arrangements for securing economy, efficiency & effectiveness
2013/14 Accounts
Better care, more locally, within budget, through transformation
Full Set of Accounts
A full set of Accounts for 2013/2014 is available within the Annual Report here at the AGM, or on the
CCG Internet http://www.eastridingofyorkshireccg.nhs.uk
or by contacting us on 01482 672156