3Chief Operating Officer / Director of Commissioning and Operations 2013/14 Operational PerformanceGina LawrenceChief Operating Officer / Director of Commissioning and Operations
4Our Constitution promises to update you on: How members of the public have been involved and engagedDelivery of our Quality StrategyImprovements made across Primary Care Services (GP’s)
5Annual Public Involvement Communication and awareness program for the implementation of Trafford New Health DealPatient involvement in service development including personal health budgetsDevelopment of New Health Deal Patient Reference Group to scrutinise integrated careRecruitment to Patient Reference and Advisory GroupEquality delivery system: where local stakeholders graded us as a CCG as amber (developing) on our performance against Goal 4 of the framework.
6Progress against delivery of the Quality Strategy NHS Trafford CCG has a three year Quality Strategy which is in the process of being refreshed; we have three main ambitions in respect of quality these are:Safer Care: We will ensure the care we commission is safeBetter Care: We will ensure that the care we commission is clinically effective delivering better health outcomes for our patientsPatients at the heart of care: We will ensure that we will engage, listen and respond to what our patients want at every stage of the commissioning process, to ensure our patients have a voice in everything we do.
7NHS Trafford CCG Quality Strategy Achievements 2013/14:CCG hospital visitsQuality standards in all contractsCommissioning for Quality and Innovation Schemes (CQUINs) in all providers across Greater Manchester encouraging them to use change improvement methodology to sustain change improvementPressure ulcersEarly warning system in placeAchievement of all locally agreed Commissioning for Quality and Innovation Schemes (CQUINs) in all providersExpert commissioners in placePatient engagement framework
8Quality improvements made across primary medical services (GP’s) Quality Improvement ProgrammeGP ITLocality partnership workingManagement of high risk patients
9Areas of work commenced / completed in 2013/14 Including;Quality and performanceAdult SafeguardingUrgent Care servicesCancerPatient Care Co-ordination Centre
10Performance Highlights for 2013/14 Central Manchester Hospitals (CMFT)Delivered the A&E standard of 95% of patients being seen, treated and discharged within 4 hours of arrival across the yearPatients’ privacy and dignity were prioritised and all patients were cared for in a same sex wardWaiting times were kept short and all national standards were deliveredPatients on a cancer pathway received timely diagnostics and treatments throughout the yearWythenshawe Hospital (UHSMFT)Speedy access to diagnostic tests to support clinical decision making was achieved throughout the yearFollowing a stroke, most patients spent at least 90% of their hospital stay on a dedicated stroke unitRecall systems for patients attending the breast service were changed to be brought in line with national best practiceWaiting times were kept short and national standards were delivered
11Quality Highlights for 2013/14 Central Manchester Hospitals (CMFT)Achieved in full the majority of CQUINsThe Quality Standards as set out in our contract with the Trust were fully met in 2013/14CMFT has undertaken a large programme of work in relation to harm free care with a focus on pressure ulcersCMFT were inspected by the Care Quality Commission (CQC) in December 2013, following this action plans were put in place around nutrition and recordsWythenshawe Hospital (UHSMFT)Achieved in full 27 quality improvement indicators (CQUINs), and partially achieved 6 indicators.The Quality Standards as set out in our contract with the Trust were met in full for the majority of areas. Where quality standards were not met in full and action plan was put in place.Following an inspection from the Care Quality Commission (CQC) an action plan was put in place monitoring the quality of service provision.Trafford Community Services (Pennine Care Foundation Trust)These services achieved all CQUINs and Quality Standards last year.
12Adult Safeguarding 2013/14 – year of partnership working and reform Led the reform of Trafford Adult Safeguarding BoardEstablished Operational Adult Safeguarding BoardImplemented new governance and risk management arrangementsImplementing Prevent agenda across local health servicesWorking with children’s services to look at the whole family pictureWorking to support implementation and develop understanding of Mental Capacity Act, 2005Supporting the Deprivation of Liberty SafeguardsWorking with NHS Providers and contractors to improve understanding of safeguarding adultsWorking to improve care, standards and safeguard vulnerable people in Care Homes
13Trafford Urgent Care Services- Planned changes to Trafford General Hospital 27th November 2013 – A&E Department closed28th November 2013 – Urgent Care Centre opened ( midnight daily) (impact on CMFT, UHSM & SRFT)Community Services delivering – enhanced servicesin the community, including Rapid response, community Matrons, IV therapy service etc.Travel Bureau in place to support patient transportTravel support scheme in place by Trafford CCG to support patientsContact numbersEnhanced servicesTravel Bureau Link services
15Trafford Urgent Care Centre This department is open from 0800 – midnightThis department will treat:All A&E activity delivered by ambulances(some Trafford Patients will be taken to other hospitals due to their complexities and symptoms decision by NWAS )All activity which self-presentThe medical admissions unit will receive all admissions by GP’sThis department is fully staff with A&E staff , the department will treat a wide range of emergencies.Patients will be treated quickly by professional and competent staff.
16Cancer: 2013/14 Macmillan GPs appointed: Dr Helen Marsden – End of Life careDr Ann Harrison - Cancer2013/14 Cancer was (and still is) a priority for the CCG:To influence the development of cancer services within the local commissioning structures.To improve cancer awareness in primary care to improve standardsTo educate primary health care teamsTo support pathway and service redesignTo enhance communication between all levels of care to promote a seamless service and improved patient experience.Living With & Beyond Cancer pilot – 2 GP Practices
17Patient Care Co-ordination Centre A Proactive Health and Social Care SystemThe patient care co-ordination centre is the ‘glue’ that will hold the provision of services togetherAll patient journeys will go through this serviceIt is an essential part of our integration strategyWill deliver efficiencies to all organisationsPatients always getting the right care at the right timeA focus on complex cases and vulnerable people
18Patient Care Co-ordination Centre Since October 2013 we have been running a tender process to select a provider capable of delivering the PCCCWe have spent a significant amount of time engaging in dialogue with providers to ensure that they will be able to deliver a service which meets the needs of the Trafford populationWe expect the PCCC to be in place, and making a difference to patients in Trafford, by June 2015
202013/14 Financial Duties / Performance Trafford CCG achieved all of its financial duties for 2013/14Delivered financial balance; achieving a surplus of 1% (£2.8m) meeting NHS England requirements.Remained within the notified revenue Cash Limit and its running cost target (£25 per head less than 2%)Managed to pay over 95% of its suppliers invoices within the NHS target of 30 daysDelivered £6.5m of savings, exceeding its plan by £0.5mHad an unqualified and clean audit report; accounts and value from money perspective
21New investments in 2013/14£1.7m (£3m in 14/15) in Community Services, Urgent Care, Community Matrons, IV Therapies etc.£1m key mental health initiatives; RAID/ RADAR/ IAPT£200,000 in a new stroke early support discharge service.£300,000 supporting new developments in COPD (chronic obstructive pulmonary disease) services£100,000 to improve access for patients with Musculoskeletal conditions
23What services did we commission from our hospitals? 29,000 ‘planned’ treatments; average £1,100 each25,000 ‘emergency’ treatments; average £1,900 each328,000 outpatient appointments; average £100 each88,000 A&E attendances; average £92 each3,900 days in critical care; average cost of £1,200 each
25What other services did Trafford CCG commission? A total of 4.8m of prescribed drugs; at a cost of £36m or just under £160 per person in TraffordCommunity (c£20m) and Mental Health Services (£18m)Funded nursing care and continuing care support and placements; at a cost of c£11mEmergency and non-emergency ambulance services; £6.5mGP ‘Out Of Hours’ services; c£1.7m
27National and local finance looking forward People continue to live longer; not necessarily healthier; so health illness prevention will need to be targeted to right outcomesTCCG has to deliver savings of £22m over next 5 years; £80m across health services within Trafford economy; challenging !Public involvement/engagement to focus on agreed investmentsClinical led re-design with General Practitioners, hospitals, social care working together to deliver sustainable better outcomesTCCG will continue to integrate care; greater quality/efficiencies; in line with its 5 year strategic plan
29Priorities and work underway and planned for this year Including;Co-commissioningCancer (local and Greater Manchester wide)Cervical screeningPersonal health budgetsAdult safeguardingMental Health (local and Greater Manchester wide)DiabetesMusculoskeletal ServicesCommunity dermatologyClinical Assessment and Treatment ServiceCardiologyBetter Care Fund
30Co-commissioning in primary care Trafford CCG will look to take back some of primary care commissioning, including but not exclusively;Contract management of extended GP servicesEducation and trainingComplaints managementDevelopment of new servicesRevising existing contracts
31Cancer (Greater Manchester level): 2014/15 Trafford CCG’s intentions as the lead organisation for cancer at a Greater Manchester level are:Support the Specialist Teams in buying compliant servicesDevelop and implement revised service specifications for breast cancer and acute oncology servicesDevelop a GM commissioning strategy for cancer
32Cancer (local level): 2014/15 Raising profile of Macmillan GPsPrimary CareAnalysis of cancer referrals and GP educationDermatology audit carried outConsider Macmillan Quality Standard Mark for practice (information/champions)Priority areas for Trafford CCGPalliative/End of LifeScreening with a particular focus on;- cervical screening- bowel screening- breast screeningSupport of Living With & Beyond scheme for a further year
33Cervical Screening: 2014/15Delivery of a joint Trafford CCG and Trafford Council Cervical Screening PlanCommitted to achieving the national target – striving for 80% of eligible patients to have had smear by April 2015Joint plan contains over 15 new initiatives including:A patient survey asking Trafford residents what the barriers are to attending for a smearTrafford local poster and radio campaign titled ‘It only takes a minute’Work with local community groups including BME community groups and Gay and Lesbian foundationIntensively working with GP practices with lower than average screening ratesBridgewater Services extending their service to offer smear for mums attending Children's Centres
34Personal Health Budgets The offer of a Personal Health Budgets is made to all patients who are eligible for continuing healthcare funding.Successful implementation of Personal Health Budgets programme – patients are already using theseA group are now meeting to offer this more widely to patientsThe programme works with three third sector organisations
35Adult Safeguarding 2014/15 – year of public engagement and participationImplement the requirements of Care Act 2014Further Prevent trainingRevision of adult safeguarding policies and proceduresNew training programmes – specialist and expert practitioner programmes for practitionersPublic engagement – Adult Safeguarding Board to be open to public from April 2015Adult Safeguarding Reference Groups to include public representatives – shape and influenceRecruit more “lay members” to sit on Adult Safeguarding Panel HearingsTargeted advertising campaigns throughout 2014/15Increased public awareness of and participation in Adult Safeguarding
36Mental Health across Greater Manchester Association of Governing Groups (AGG) 2014/15Leading joint working with key partners across Greater ManchesterWorking with Greater Manchester Police on delivering the Crisis ConcordatDevelopment of Greater Manchester Alcohol StrategyDevelopment of a learning disability standard to reduce premature deathsDevelopment of a Joint Health & Social Care Self Assessment for learning disabilities
37Mental Health progress in Trafford 2014/15 Performance in line with national / local prioritiesImproved access to psychological therapiesMore dementia diagnosis + post diagnostic support + less medsWorking to reduce demand on Police servicePsychological liaison service in place across TraffordMore autism supportExtra community eating disorders servicesFewer restrictive secure hospital placementsPublic sector reforms – Early Intervention and Working Well
38DiabetesPeople with diabetes in Trafford are more likely than the general population to have:Myocardial infarction 83.9%Stroke 77.2%Hospital admission, heart failure 22.3%Trafford Diabetes Network has been established to produce a Diabetes Strategy for Trafford focusing on prevention, early diagnosis and care.The Strategy builds on work already done around integrated careThe Diabetes Strategy for Trafford will be presented to Trafford CCGs Governing Body in February 2015.
39Musculoskeletal Services Service review discovered a lack of :integrationnot enough capacityincreasing patient demandPatients and professionals agreed that the service should be:joined upprovided by a multi-disciplinary teamself-management and prevention focusedmore capacityA service model has been created to ensure that future musculoskeletal services will be outcome driven and not activity based and support the above requirements for a successful service.
41Community Dermatology Issues with capacityBusiness case approved by Trafford CCG’s Management Team.Procurement process has commenced to identify one provider - to manage conditions that do not require specialist intervention at secondary care level - across all three CCG areas to get best value.Notice is being served on our main providers.Two community locations to be identified.
42(Clinical Assessment and Treatment Service) CATS(Clinical Assessment and Treatment Service)Trafford’s current performance:Year to date 2014 to M4 80% of 85% contract utilised£753k of services used, £152k not used up to M4GPs should continue to utilise CATSCurrent contract ends Feb 2016 – Care UK will stop accepting referrals from November 2015.
43E-consult service being set up to support GPs Cardiology30% of cardiology conditions are regarding irregular heart rhythm issues; 80% of these could be managed in the communityE-consult service being set up to support GPsSupported by ECG clinical interpretation serviceA Locally Commissioned Service will be set up with Primary Care for the ECG service
44This will be £15.4m for Trafford Better Care FundNational initiative to improve care for the most frail and elderly residentsBrings together existing health and social care resource into one budgetThis will be £15.4m for TraffordAims are to reduce admissions to hospital, reduce the amount of time people spend in hospital and supporting people to remain at home.Three Projects: (next slide)
45Health and Social care Integration Better Care FundBetter Care FundFrail and Older PeopleEnd of Life CareHealth and Social care IntegrationCommunity health and existing social care offer to delivered as one serviceImprove patient experienceAvoid duplicationAligned to neighbourhood modelFalls ServiceReducing the amount of time people spend in hospitalAvoiding admissionGeriatrician support in the communityGeneral practice for Nursing homesEducation to improve skills across the workforceImproving patient, family and carer experienceGreater connectivity between services through ITPrompting advance care planningSupporting the voluntary sector to deliver non-clinical care
47Priscilla Nkwenti Panel Chair, Trafford CCG Looking ahead: Introducing the NHS Trafford CCG Public Reference and Advisory Panel (PRAP)Priscilla NkwentiPanel Chair, Trafford CCG
48Public Reference & Advisory Panel Trafford CCG is committed to putting the voice of patients, public and stakeholders at the heart of decision-making.The Public Reference & Advisory Panel will be recruited to represent the views of the Trafford public and its representative groups.Sub-committee of Governing BodyMeet monthly initially, then bi-monthly
49Clinical Commissioning DutiesClinical PolicyClinical CommissioningClinical RedesignPerformancePrioritisationPublic engagementCulture & valuesFor example:In terms of- Clinical Commissioning & Performance – a member of the PRAP attends the Locally Commissioned Service Group meetings, which discusses progress on work programmes for the implementation of locally commissioned and enhanced services with GP, pharmacy and optometrist providersClinical redesign – the PRAP will be able to review and comment on Project Initiation Documents of upcoming projects (this will be highlighted later in the presentation)- Prioritisation – A member of the PRAP sits on the CCG’s Individual Funding Request PanelCulture & Values – the PRAP will be involved in the evaluation of the CCG’s performance in respect of its desired culture & values- Public Engagement – the PRAP can provide advice on the most appropriate way to engage with the public and stakeholders
50For example:Clinical redesign – the panel will be able to review and comment on Project Initiation Documents of upcoming projects (this will be highlighted later in the presentation).Clinical commissioning – A PRAP representative attends the Locally Commissioned Service Group meetings, which discusses progress on work programmes for the implementation of locally commissioned and enhanced services with GP, pharmacy and optometrist providers. PRAP will also consider the delivery of commissioned services from the perspective of value for money & contribution to health of Trafford populationPrioritisation – A PRAP representative sits on the CCG’s Individual Funding Request PanelPublic engagement – PRAP can provide advice regarding the most appropriate way to communicate and engage. PRAP recently considered how best to capture patient stories from a wide selection of communities in TraffordCulture and values – The PRAP will be a key contributor to the assessment and evaluation of the CCG’s performance in respect of its desired culture & values
51Public Reference and Advisory Panel Representation 4 x Public Reps North – Shabir AbdulCentral – Gill Leng West – George Devlin South – Pat Lees4 x Third Sector/Voluntary Organisation Reps Ann-Marie Jones - Age UK Chris Jacob - 42nd Street Khan Moghal - Voice of BME Trafford Lesley Thornton – Counselling & Family CentreCHAIRPriscilla Nkwenti – CCG Vice Chair/Lay member lead for engagement4 x GP Patient Participation Group RepsNorth (Ann Day to cover) Central West – John HoweSouth – Lesley Spencer1 x Trafford Healthwatch Rep Brian WilkinsFollowing recruitment process, recruited all our public reps and third sector reps.Still need to recruit from North and Central GP Patient Participation GroupsAnn Day from Healthwatch will cover North until we fill post. Central no-one to cover.Would you like to ask if HW could cover or shall we try to recruit again?1 formal rep from Healthwatch too – Brian Wilkins.North – Old Trafford, StretfordCentral – Sale, Ashton on MerseyWest – Flixton, Urmston, Davyhulme, PartingtonSouth – Altrincham, Timperley, Hale
52Where does the Panel fit in? Trafford Clinical Commissioning GroupGovernance & Commissioning focusPatient focusPatient focusHealthwatch TraffordTrafford CCG Governing BodyIntegrated Care Reference Group FeedbackFinance & Commissioning CommitteeQuality & Performance CommitteePublic Reference & Advisory PanelGP Patient Participation Groups Feedback- Prioritisation- Policies- Projects- Locally Commissioned ServicesFurther opportunities for PRAP rep involvement, for example:2 x PRAP Reps to sit on:- Individual Funding Request Panel- Process Review PanelAdditional groups to be developed
54Upcoming work programme: Projects include:- End of Life- Falls Strategy- Primary Care StrategyRespiratory ProgrammePatient Care Coordination Centre – role on Programme BoardOther projects will come to the panel once they are up for redesign