Our Five Year Strategic Plan and Challenges
Dr Mary Backhouse
Chief Clinical Officer
North Somerset CCG – Our Vision
We know that for people to be truly healthy it is not only the quality of healthcare services that matters. That is why we are committed to working together with our whole population, individuals and other organisations to create the healthiest communities.
Life and Society in
North Somerset
Reducing inequalities
Community engagement, involvement
and leadership
Education
Employment
Creatinghealth
through wealth
Politics/ civic life
Vulnerable groups known
High impact families and individuals (supported)
Seamless person centred
pathways/ networks
Integrated health and social care
Commerce
Sustainable provider networks
Flexible/ integrated deployment of
public resources across N Som
Physical environment
Life in North Somerset
Strategic to do list for North Somerset CCG
1. Develop core commissioning functions
2. Understand strategic challenges
3. Grip FY14/15
4. Build the transformation strategy
2
Our context - Joint Strategic Needs Assessment
• Inequalities in health and employability• Mental health• Substance misuse• Growing population with significant very
elderly population
Our patients needs are changing with demography --
• North Somerset will see around a 32% increase in the number of people aged over 75 in next 5 years compared with national average of 11%
8
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
AGE
0-4
AGE
5-9
AGE
10-1
4
AGE
15-1
9
AGE
20-2
4
AGE
25-2
9
AGE
30-3
4
AGE
35-3
9
AGE
40-4
4
AGE
45-4
9
AGE
50-5
4
AGE
55-5
9
AGE
60-6
4
AGE
65-6
9
AGE
70-7
4
AGE
75-7
9
AGE
80-8
4
AGE
85-8
9
AGE
90+
Demographic Growth Projection - 5 years to 2018
2008 Registered Pop 2013 Registered Pop 2018 ONS Projected Pop Growth
Our context – challenging finances• Both the Clinical Commissioning Group and Local
Authority are under funded• Clinical Commissioning Group Finances approx £250m
per year• Underlying deficit £17m reduced to £4m• Challenging savings targets and need to repay deficit• £10m savings target this year• Planning for recurrent balance within 3 years • Cost pressures - ageing population, new medicines and
technologies, new central requirements
Acute
Community and out of hours
MH and LD
FNC
CHC
Medicines
CCG running costs
- 20 40 60 80 100 120 140 160
96
67
81
146
82
86
100
North Somerset CCG Spending per Wtd Capita % of Expected
£ per weighted capital %
8ca128d9fcc34d2498d4b218bcca4b0a
66ad7f2c1ea54ede9b74a90d8453739d
56b0ea2e08794717af -fa54473d8cef06
88bab05a940247e88fe92af1b927d5b1
c64d39ffaba64aa999f4b0b33db792b9
Bar Regular
The construct of the funding formula requires a greater level of efficiency than other CCGs, and may not be possible to reach
• Key messages– Non-acute spend is
below average on a weighted capitation basis – with very low costs in community care and Mental Health
– While acute spend and CCG running costs are around average – CCG funding is 7 % below average
– NHS funded nursing care (FNC) spend one of the highest in the country - the high number of nursing home places attracts residents from elsewhere – though this is a very small proportion of the overall budget
11
-
50
100
150
200
250
300
146
174
194
208 215
247 252 252
North Somerset CCG - Total Spend (2013/14)
£ m
illio
n
Bridge
ab64f19b66a341909aeaf69d6c52d729
NSCCG is accountable for close to £250m of NHS spending, more than half of which is undertaken with local
acute providers
• Key messages– Total budget £252m – Acute spending
accounts for 59% of all commissioning spend
– Nearly 90% of acute spend is with local acute providers
– Second biggest area of spend is medicines
– Fastest growing areas of spend include
• Medical Emergency admissions
• A&E• Elective
Orthopaedics• NICE• Diagnostic
scopes
10
£30m cash savings from acute spend will not be achieved without structural change in the way health and social care services are provided
£30m acute spend 50% of Weston Hospital spend
100% of NBT spend
80% of UHB spend
250 emergency hospital beds
100% of medical and surgical emergency beds
100% of outpatient services
Prioritisation criteria• The CCG will prioritise its commissioning intentions based on
the following criteria:
•Health Outcomes •Safe effective care •Plans are affordable and achieve value for money •Reduction in health inequalities •Working together with partners. •Responding to national priorities •Local priorities
…and we are facing a number of strategic challenges
1.• Meeting rising
demand in a flat cash environment
2.• Securing a safe
and sustainable provider base
3. • Delivering
financial balance
4.• Supporting a
challenged social care system
5. • High degree of
stakeholder interest
6. External processes transforming acute care (Weston, NBT & NSCP)
7. • Engaging and
motivating GPs
8. • Shifting care into
the community and closing beds
9.• Agreeing a shared
integrated transformation position
9
Plans for quality
• Action Area 1: Helping people to stay independent, maximising well-being and improving health outcomes
• Action Area 2: Working with people to provide a positive experience of care
• Action Area 3: Delivering safe, high quality care and measuring impact
• Action Area 4: Building and strengthening leadership• Action Area 5: Ensuring we have the right staff, with the right
skills, in the right place• Action Area 6: Supporting positive staff experience• Action Area 7: Safeguarding of children and adults• Action Area 8: Seven Day Working
Changing the way we deliver care
• A completely new approach to ensuring that citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care
• Wider primary care, provided at scale• A modern model of integrated care• Access to the highest quality urgent and emergency
care• A step-change in the productivity of elective care• Specialised services concentrated in centres of
excellence
North Somerset CCG – Plan on a Page Vision: North Somerset – Creating the healthiest community together
Values and Behaviours
To be patient centred To be fair and equitable To be inclusive To be committed to safe high quality and effective care To be compassionate and kind To be a good partner to work with to improve the health of the population To be a trustworthy, honest, open and listening organisation
Purpose 1. Ensuring an integrated health and social care system for adults and children, driven by quality and innovation 2. Commissioning health care for the patients of North Somerset which is cost effective and delivers Health Outcomes in line with the NHS
Outcomes Framework 3. Reducing health inequalities, working in partnership 4. Giving people confidence and skills to take care of themselves and stay as healthy as possible 5. Improving patient care by ensuring there is easy access to shared information, which is up to date, meaningful and accurate 6. Creating an environment which motivates member practices to be engaged commissioners and to deliver safe care, good patient experience
and evidence based practice 7. Being a successful dynamic organisation that provides a rewarding place to work
Strategic Priorities
Developing a model of care which is clinically safe and sustainable Achieving financial sustainability Improving health outcomes and reducing inequalities
Programmes of care
Continuum of care for Adults Urgent Care
Planned Care
Children and Young People and Maternity
Developing Primary Care
Objective Improving Patient centred care Promoting independence, intensive support and end of life care Parity of esteem between mental and physical health
Access to the highest quality urgent and emergency care
Step change in the productivity of elective care
Developing care focused around high impact families
Support the development of wider primary care
Interventions Ensure LTCs are effectively managed Increase work with the voluntary sector Supporting patients and their families to stay living independently at home. Increased senior decision making support Developing a new model of rehabilitation Providing high quality support for people with mental health problems
Increased out of hospital accessible services Increased ambulatory care and reduced length of stay Reduced emergency admissions and ED attendances Improve public understanding of urgent care services
Improve referral management Develop pathways of care Increase productivity
Work with a range of stakeholders to deliver high quality support for children and families.
Work with primary care providers to improve quality and access. Develop locality approach to prevention, early intervention and selfcare.
Enabling Workstreams
Partnership Working Arrangements Better Care Fund Programme Wider Resource allocation strategy (inc capital) Effective stakeholder engagement Innovative commissioning and contracting arrangements Management of NHS infrastructure Workforce strategy IT Strategy Knowledge management, research and evidence Developing the provider landscape Organisational Development Medicines Optimisation/NICE
5 programmes - based on local needs
• Continuum of Care• Urgent Care• Elective Care• Primary Care• Children and maternity services
Moving from the current fragmented system towards a more integrated
approach
TODAYCurrent fragmented
approach
FY14/15Coordination through
CQUIN and other incentive schemes
FY15/16Alignment though outcome based
contracting
FY16+Patient focused integrated care
Fragmented approach Coordinated system Fully integrated H&SC system
Education
Housing
Strategic Level Participation
Public, Patient and Carer voices at the centre of health care services:
Healthwatch and VANS
Public, Patient and carer involvement
• North Somerset Health Overview Scrutiny Panel• Healthwatch North Somerset - voices for health• Community Services Procurement• North Somerset Citizen’s Panel:• North Somerset CCG Website and Social Media:• North Somerset CCG Stakeholder Events:• Practice Patient/Reference Groups (PPGs/PRGs) :• Voices for Health Strategic Review Group and the Equalities and
Engagement Group• Participation and Insight Reporting - collecting feedback