Putting Patients First Involving Patients and Public in Healthcare Decisions Thursday 13 th February 2014

Welcome and introductions The plan for the day: Our chance to update you... Then its over to you... We value your feedback We want the day to be: Informative Open Collaborative

Who’s who... Chair: Rosemary Bolton, Independent Lay Member for Patient and Public Engagement Speakers:Dr Bhaskar Bora, Clinical Chair Debbie Stock, Chief Operating Officer Facilitator:Julie Van Ruyckevelt Communications, Engagement and Public Affairs

Agenda 12.30Arrival and Registration 13.00Welcome and Introduction 13.10Clinical Commissioning – Our First Year 13.30Question and Answer Session 13.50Our Five Year Strategy 14.00Question and Answer Session Clinical Commissioning Themes (Break out table top sessions) Involving People Healthwatch Close

Clinical Commissioning – Our First Year Dr Bhaskar Bora

Who We Are – The CCG Dartford, Gravesham and Swanley CCG: Serves 249,000 population – second largest CCG in Kent 34 GP practices (our “Council of Members”) £276 million commissioning budget Around £1,100 per person 40 members of staff work directly for CCG

Our vision is of primary, community, mental health and acute care services working seamlessly together, with local authority, voluntary, and other independent sector, organisations, to deliver improvements in both health and well- being for local people and communities and ensure a sustainable care economy. Our Vision

Keep people at the heart of everything we do, ensuring they are involved and listened to in the development of our plans Maximise independence by providing more integrated support at home and in the community and by empowering people to manage their own health and well-being Ensure the health and social care system works better for people, with a focus on delivering the right care, right time, right place, providing seamless, integrated care for patients, particularly those with complex needs. Our Values and Principles

Safeguard vital services, prioritising people with the greatest health needs and ensuring that there is clinical evidence behind every decision. Get the best possible outcomes within the resources we have available; delivering integrate services wherever possible to avoid duplication. Our Values and Principles

Our Challenges Demographic DGS has: high levels of deprivation – greater demand for healthcare a predicted 8% increase in the local population by 2020, a total of 20,800 more people Including 2,800 more people aged 85+ (34% increase) significant ethnic diversity – more than 50 languages spoken

Our Challenges Financial Challenging health economy – and the impact of changes across the wider health and social care system The impact of two local Private Financial Initiatives Co-location with London resulting in higher levels of referrals at higher cost

Our Challenges Other areas: Ensuring ongoing engagement with all stakeholders – including patients, public, carer and voluntary organisations Addressing health inequalities for our local population Working with providers and changing the way we commission to support people and meet local needs – including working to redesign local services

What we are proud of Strong clinical leadership – based on real patient experiences Development of integrated teams and single point of access Dementia nurses working with practices supporting patients Closer working with social care and local authority colleagues – particularly in relation to prevention and delivering improvements in health inequalities Primary Care Mental Health workers implemented and enabling people to be supported in the community

Feedback From Patients and Carers Since the last event, we have undertaken a ‘deep dive’ into key priority areas identified by patients and carers: Communication between health and social care professionals Communication between professionals and patients and carers Provision of information – accessible, relevant and clear Maintaining service standards Access to support and care out of hours/in an emergency Personalised care plans developed with and held by patient Integration of all services so that transfers/transitions are seamless and all are kept informed More help to help self More services available in community settings

This deep dive has allowed more detailed feedback to be gathered in terms of pinpointing specific areas for improvement and/or change – and are built into plans going forward: Enable and encourage easier information sharing Enable and encourage continuity of care whenever possible Patients & carers to hold health records/care plans (electronic or hard copy) Provide consistent information relating to health needs Simplify and educate about services available Encourage a more open and transparent culture – mental health Feedback From Patients and Carers

Questions?

Clinical Commissioning – Five Year Strategy Debbie Stock

Developing Our Strategy Health services Local population needs Feedback from patients and stakeholders Review of local services

Local Health Needs High prevalence of hypertension, hyperthyroidism, chronic kidney disease and obesity Higher emergency admission rate than Kent and Medway for diabetes, dementia and coronary heart disease The main causes of death are due to Circulatory disease Cancer Respiratory diseases

Outcome of Local Service Review: Audit and facilitative work undertaken (Kings Fund) identified: Only 16% of patients are consuming 70% of non-elective bed days in local trusts. Hospital audit data suggest that a significant proportion (30%) of these could be cared for in other settings, if alternatives exist for their care/support potential for significant reduction in length of stay

The Case for Change An ageing population Increased prevalence of chronic diseases The need for true integration across health and social care at pace Quality outcomes for patients and achieving efficiency of services and value for money Financial constraints across the public sector

The Case for Change – cont. Do nothing is not an option The following demonstrates the gap for commissioning and therefore health as a whole:

The Better Care Fund The Better Care Fund comes into effect in 2015/16 and Aims to facilitate integration between health and social care Will result in a shift of funds from health services to social care Will be used locally to deliver projects aimed at: supporting people to remain independent and manage their health for as long as possible, and, provide swift, appropriate services to support people after periods of ill health

Key programmes The principles of the Better Care Fund schemes underpin many of the projects for 2014 to 2016 and beyond: Integrated Primary Care Teams around general practice An improved approach to crisis management and recovery. Supported by the implementation of shared care records between providers, and early identification of at risk patients Improving communication and advice to the public

Preventing Ill Health To reduce life expectancy variation and improve the quality of life for local people Raise awareness of the causes of key conditions and support prevention and self management Link in with and provide support for difficult to reach communities Identified and work with people at risk

Urgent Care Focus on appropriate admissions management of patients and timely discharge Targeted support for care homes Palliative care case management, and improved utilisation of existing crisis response services for dementia and End of Life Care. Improving access to education for people with long term conditions – especially diabetes and COPD - reducing readmission rates

Community Services Development of Integrated Primary Care Teams – with GPs at the centre of organising and coordinating people's care, supported by community health and social care teams Provision of rapid response and crisis management services – avoiding admission, and providing support for people after periods of ill health Implementing systems to ensure patient records are available across organisations to facilitate continuity of care

Planned Care Aims to ensure that all patients have access to a wide range of high quality services so that patients can be seen quickly by the most appropriate clinician in a location as close as possible to their home, and includes: Update of key pathways: IBS, knee pathway and gynaecology Introduction of telephone follow-up clinics Review of Community Ophthalmology services and Dermatology Scoping and development of a Pain Management Programme over 2014/15. Review of cancer services to identify areas for development

Mental Health Roll out of Primary Care Community Link Worker ADHD all age pathway Personality Disorder Peer Support Group Early Intervention Worker to support young people and their families Achieving an early diagnosis for dementia, via continuation of key projects (e.g. buddy scheme) Expand the range of community based LD services and improve Quality of care

Childrens Services Development of multi-agency commissioning framework for Children with physical impairments Multi-agency commissioning framework for children and young people with speech language and communication needs (SLCN) Whole system approach to Urgent Care for Children and Young People and their families. Children's Community Nursing Service Development of CAF (Common Assessment Framework) business model Enable partnership working between GPs, HVs and Midwives Roll out of Personal Budgets

Strategy Development The CCG 5 year strategy builds upon the 2 year plan And outlines how we intend to deliver the longer term ambitions within the NHS planning guidance Summarised in the following ‘plan on a page’

Questions?

Clinical Commissioning – Developing The Story

We would like to hear your feedback on: Our future plans How can we engage with you going forward and how we might engage with other people Table Top Discussions

Get Involved! DGS Health Network Patient Participation Groups PPG Chairs Forum Public Meetings eg. Meetings like today and the Board Meetings that are in public Forum for the Voluntary Groups