OxfordshireClinical Commissioning Group
Oxfordshire Clinical Commissioning Group: Annual Public meeting
Dr Joe McMannersClinical Chair
28 September 2017
OxfordshireClinical Commissioning Group
Agenda
Questions?
Financial AccountsReview of the year: 2016 / 2017
Bicester Healthy New Town
OxfordshireClinical Commissioning Group
Review of the year: 2016 / 2017
David SmithChief Executive
OxfordshireClinical Commissioning GroupStrategic plan
New and better ways of delivering good value services
Consult on Oxfordshire Transformation Plan proposals
Meet constitutional targets and reduce DToC and A&E attendance
OxfordshireClinical Commissioning GroupHow did we do?
Introduction of new ‘ambulatory’ model of care to reduce acute hospital admissionso Ambulatory Assessment Units at the JR and Horton
General in Banburyo Rapid Access Care Unit at Townlands in Henley
Increasing access to primary care services o Care navigators coordinating support for patients in
their own home, liaising with GPs and carerso Email consultationso Neighbourhood access hubs – for urgent care
appointments in the evening and weekend
OxfordshireClinical Commissioning GroupHow did we do?
Taking over commissioning of specialist learning disabilities services for adults from County Council and transferring services from Southern Health to Oxford Health
A New Child and Adolescent Mental Health Services Contract to reduce waiting times
Securing funding for Diabetes prevention and education
OxfordshireClinical Commissioning GroupHow did we do?
Oxfordshire Transformation Programme phase 1 - why?
To ensure: high quality and safest care equality of access to best care care closer to home or at home
OxfordshireClinical Commissioning GroupHow did we do?
Oxfordshire Transformation Programme -the agreed changes:
all acute stroke patients get best available treatment at JR’s Hyper Acute Stroke Unit
sickest patients all go to intensive care unit at JR all obstetrics services centred at JR closure of some acute beds to reinvest funds in care
closer to home more outpatients and planned care services at Horton
General
OxfordshireClinical Commissioning GroupHow did we do?
Oxfordshire Transformation Programme -but:
Current legal challenges to the consultation process and some of the changes approved may delay implementation and could impact on the next phase of Transformation.
OxfordshireClinical Commissioning GroupHow did we do?
We must do better:
Delayed Transfer of Care remains stubbornly high despite several joint initiatives with health and social care partners Work and joint investment continues to boost
home care and nursing home providers and create extra capacity to manage more complex people outside of hospital
OxfordshireClinical Commissioning GroupHow did we do?
We must do better:
A&E attendance increased by 6.7% in 2016/17 Ambulance response times Some cancer targets Work to improve access to primary care through
extended and weekend hours More support for GP practices to offer more
services
OxfordshireClinical Commissioning GroupThe Future
Meeting constitutional targets:A&E wait times – what is being done? More consultants working in A&E Plans for streaming of patients arriving at A&EAmbulance response times – what is being done? National Ambulance Response Programme: new clinical coding
system for effective prioritisation based on patient clinical need Revised Ambulance Response targets to measure median time to
patients rather percentage of achievement which will lead to long wait reduction.
Cancer waits/diagnosis – what is being done? Increasing awareness of screening for the public Straight to test/one stop shop diagnostics across a number of
specialities
OxfordshireClinical Commissioning GroupThe Future
The need to successfully implement changes agreed in phase 1 Transformation Programme
Transformation phase 2 – the challenges: growing demand for services workforce shortages financial pressures unsuitable buildings health inequalities
OxfordshireClinical Commissioning Group
Annual Accounts 2016/17
Gareth KenworthyDirector of Finance
OxfordshireClinical Commissioning GroupContext of 2016/17
Fourth year of operation of CCG and Commissioning Support Unit
First year of being fully responsible for GP Primary Care Commissioning from NHS England (received a transfer of allocation of £91m in order to achieve this)
Management of in-year financial risks – FNC price increase and development of new contracting arrangements with main providers
OxfordshireClinical Commissioning GroupFinancial highlights
Financial accounts produced to national deadlinesSurplus of £21.1m achieved – significantly higher
than planned due to funds released by NHS England. This additional surplus will be carried forward for drawdown in future years.
All financial duties achievedUnqualified audit opinion on the financial
statements, regularity and value for money
OxfordshireClinical Commissioning Group
Financial Performance targets
Target Position Achieved Position
Revenue spend not to exceed allocation
of £845,960,000
Actual revenue surplus £21,131,000
Revenue administration spend not to
exceed allocation of £14,642,000
Actual administration spend of
£14,207,000
95% of all NHS invoices paid within 30
days
98% of total value of invoices paid within
30 days
Remain within cash funding We have achieved our cash target
OxfordshireClinical Commissioning Group
How was the money spent?
In 2016/17 we spent £825million
That’s . . .£1,146 per person per year£2.26m per day£1,570 per minutePlus £21.1m ‘surplus’ carried forwards to 2017/18
OxfordshireClinical Commissioning Group
How was the money spent?
Annual Actual Variance
Budget Month 12 Month 12£'000 £'000 £'000
Acute 400,607 403,386 2,779Community Health 70,637 70,999 362Continuing Care 57,934 64,851 6,917Mental Health and Learning Disability 68,439 68,922 483Delegated Co‐Commissioning 89,546 89,012 (534)Primary care 100,516 97,659 (2,857)Other Programme 16,355 15,793 (562)
Sub Total Programme costs 804,034 810,622 6,588
Running costs 14,642 14,207 (435)
Sub Total 818,676 824,829 6,153
Transformation/risk management 0 0 0Non recurrent reserve 8,198 0 (8,198)Contingency 6,161 0 (6,161)1% Surplus 12,924 0 (12,924)Total 845,960 824,829 (21,131)
OxfordshireClinical Commissioning GroupAnd what did it buy?
Acute Healthcare Services: 166,220 attendances at A&E & MIU, 455 per day 79,667 emergency inpatient admissions, 218 per day 61,078 planned inpatient admissions and day cases 661,128 outpatient appointments 87,832 ambulance incidents
Community Health: 1,750 community hospital episodes 350,187 contacts with community services 88,577 podiatry appointments 105,251 contacts with out of hours GP services
OxfordshireClinical Commissioning GroupAnd what did it buy?
Mental Health Services: 50,330 in-patient bed days 127,598 appointments
Other: 198,725 calls to NHS 111 13,506 appointments in primary care
neighbourhood access hubs (approx 6 months) Total drug items prescribed – 11,085,290 1,751 referrals for NHS Continuing Care
OxfordshireClinical Commissioning Group
External Audit Opinion
Financial statements – an unqualified opinion that the accounts reported fairly on the CCGs finances
Regularity of income and expenditure – an unqualified opinion that financial transactions were conducted within the CCG legal framework
Value for money – no matters to report
OxfordshireClinical Commissioning GroupPresent and future
For the financial year 2017/18 OCCG has a £16m increase to our funding compared to £50m in 2016/17. The CCG will remain at 4.8% below target funding.
OCCG has submitted a plan for 2017/18 that was compliant with financial planning targets including a surplus of £19.989m
Key risk for OCCG moving forward into 2017/18 remains the same as it is for all NHS organisations across the country, which is to address the increasing demand for NHS services within the resources available
Bicester Healthy New Town Programme
Dr Rosie Rowe, Bicester HNT Programme Director
In Oxfordshire our health needs are changing...
INCREASINGCHRONICDISEASE
INCREASING
INCREASING BIRTHS FROMGROWING POPULATIONS
INCREASING POPULATION AGE
• To shape new towns, neighbourhoods and
communities to promote health and
wellbeing, prevent illness and keep people
independent;
• To radically rethink delivery of health and
care services, supporting learning about
new models of deeply integrated care
• To spread learning and good practice to
other local areas and other national
programmes
The Healthy New Towns programme has three key objectivesH
ealth
and
wel
lbei
ng
bene
fits
Time (Years)
Potential additional impact
Current good
practice
Growing Bicester: a place based approach
The scope of the programme
covers the whole of Bicester, with
the NW eco town providing an
example of how the built
environment can promote healthy
living
1 NW Bicester 6000
1 Elmsbrook 393 (90 homes
complete)
2 Graven Hill 1900
SW Bicester Phase 1 1742(600 homes
complete)
3 SW Bicester Phase 2 726
12 SE Bicester 1500
Rest of Bicester 30,845
Bicester Healthy New Town Partnership
Healthy Town, healthy lives
Programme Development: Objective Setting
Stage 1
Expert workshops:
What are the key health and care challenges faced by the current and future population of Bicester?
Stage 2
Community engagement to agree direction, toidentify how best to achieve our objectives and gain support for delivery
Two key priorities:
• To increase the number of children and adults
who are physically active and a healthy weight.
• To reduce the number of people who feel
socially isolated or lonely in order to improve
their mental wellbeing
Programme Objectives
1. Bicester’s built environment- making best use of the built environment to encourage healthy living
2. Community Activation – enabling local people to live healthier lives, with the support of local community groups, families and schools, and employers
3. Health and care services- delivering new models of care that are focused on prevention and care closer to home which minimises hospital based care
Programme Work Streams
A whole systems approach
Transformation of relations between built environment and health professionals
Outcomes:
• One plan for NHS estates for the town
• Generating maximum value from public assets
• Health promoting policies are being embedded
in local plans
• Planners now understand new models of care
and need for an estate that can provide it
• A coordinated ‘ask’ for health services from S106 funds
Built Environment – delivery (1)
The built environment is supporting healthier lifestyles
Outcomes:
• Early provision of community assets is
delivering faster social connections
• Digital innovation is addressing social isolation
• Insight into barriers to use of green spaces identified
• The built environment is acting to nudge
residents to be active
Built Environment – delivery (2)
• Built environment nudge to make walking part of daily routines
• This project delivers marked routes that are safe and accessible
• Developed with community engagement and schools
• Supported by ‘Health Walk’ programme
• There is no cost to participation
• Suitable for a wide range of ages,
at any time of the day
Neighbourhood Health Routes
‘Bicester’s Blue Line’
Local stakeholders working together to deliver the programme in their
organisations and across business, education, and voluntary sectors
Outcomes:
• Local leaders ‘own’ the programme and are willing to commit
time and resources to support behaviour change
• Establishment of a Voluntary Organisation Network to
increase the capacity of community groups
• Senior leadership support is ensuring a
‘whole school’ / whole family approach
Community Activation - delivery
10 week programme offering:
- Healthy Eating
- Arts and Crafts
- Forestry Schools
- Walking Sports
- Multi-Sports and Games
Outcomes:
• total of 173 attendances
• Many parents had not attended any school event before
• New friendships were formed
We have got ourselves into a routine of life. Go to work and school. Come home. Have
dinner. We had forgotten how to have fun. These sessions have really opened my eyes to
that.’
Family Fun Sessions
New models of care enabled through use of technology are being
developed and tested with Bicester acting as a ‘demonstrator site’
Outcomes:
• Improved use of health resources: Pilot new diabetes
pathway
• Improved health and wellbeing: Development of online website
offering mental health support for young people
• Improved access to services: Development of sustainable and
enhanced primary care fit to meet the needs of the growing population
• Workforce Transformation: Integrated training programme for support
workers
Health care remodelling - delivery
How will we know if the HNT programme is working and what elements
should be spread?
What is the difference for residents of living in a healthy town?
Outcomes:
• Bicester is leading the evaluation collaborative across sites and has identified
common measures to evaluate what ‘works’
• Potential metrics are wide ranging
• Rapid cycle evaluation is already informing the programme
• Improvements in healthy behaviours expected 2018
Evaluation
• Positive engagement between health care and planning
• HNT is a catalyst for health to connect with local authorities, schools,
businesses and the voluntary sector to promote health and wellbeing
• Holistic approach to health improvement focused on a whole
population approach encourages local engagement
• Change in the built environment is necessary but not sufficient to deliver
behaviour change – it needs support from community activation
• The more we do the more opportunities emerge
• Investment in early engagement is critical for local ownership
of what it means to live in a Healthy New Town
• Meaningful community activation takes time but is essential
to support behaviour change
Learning to date: Programme Value
• Systems for meaningful public engagement
• Responsibility for promotion of health and wellbeing
• Alignment with community development role
• Good links with the voluntary sector
• Planning lead for a healthy built environment
• Strong local accountability
Local Government working in partnership with health
OxfordshireClinical Commissioning Group
Questions?