1 VCS Adult Health & Social Care Forum 5 March 2013

2 Understanding the challenge….

On average city residents live 4 years less than those in the county In some areas of the city the life expectancy gap rises to 10 years While life expectancy is improving, the gap with the rest of England is widening

4 Test Our journey so far…. Setting the foundation - establishing base camp….

Democracy and responsibility CCG established during the first quarter of 2011 City-wide CCG formed by all 63 city practices as preferred option following ballot Co-terminous with local authority – retaining city focus and mirroring former PCT boundaries PCT Cluster enablement to get on with the job quickly. Fully delegated budget and commissioning responsibility from April 2012 to CCG (£390m) 5

We have established an effective Governing Body Enthusiastic, democratically-elected clinical leaders (10 GPs from 4 localities) A Senior Management Team with specifically selected expertise Specialist advice in the form of Public Health; a secondary care clinician and Link rep 4 lay members to strengthen accountability 6

Key relationships established Energetic programme of early communications and engagement with patients and the public Partners in Shadow Health and Wellbeing Board We have a unique model of collaboration with the other LLR CCGs for commissioning, contracting and QIPP supported by a large number of shared posts Authorised on 5 December

8 Planning the ascent…

Using public health data, our JSNA and input from patients we developed… …a clinical commissioning strategy with four key strategic priorities…  Reducing premature deaths from cardiovascular disease  Reducing premature deaths from respiratory disease  Improving the mental health of the city  Better management and care of frail older people Alongside three key operational priorities…  Improving the quality of primary care  Building a sustainable financial future  Becoming a statutory body 9

Alongside this we have developed a robust Operating Model SMT selected for expertise in key areas Operating model agreed with ‘build’ provision of primary care, and service redesign, communications and share for contracting and quality All other services being purchased from CSS 10

11 Test Our journey so far…. The big challenges that lie ahead…. A perfect storm? The challenges that lie ahead…. Challenges on the way up…

The CCG faces three key quality challenges Poor population health, driven from high levels of deprivation and health inequalities Quality in primary care performance with a need to improve capacity and capability Two monopoly non-FT providers with varying challenges – and the need to gain buy in to our strategy to ensure financial sustainability of UHL and operation within tariff 12

We also have a number of financial challenges We have inherited significant non-recurrent and recurrent surpluses Planning for future years of little or no growth – understanding how to do ‘more with less’ A need to refocus QIPP from an overt focus on productivity to a programme that is innovative, addresses quality issues for population health, focuses on prevention and treatment and which genuinely costs less and deliver sustainable change 13

14 Our journey so far…. The big challenges that lie ahead…. A perfect storm? The challenges that lie ahead…. The view from the top… Our successes so far…

Our achievements compared to the PCT PCTCCG LD health checks53%100% Choose and Book49%71% Vascular checks Prescribing costs£49.5m£46.9m saving £2.6m Emergency admissions Outpatients +2-3% Down c % saving £1.7m Saving £0.6m Protected Learning Time-350 per month 15

16 Our journey so far…. The big challenges that lie ahead…. A perfect storm? The challenges that lie ahead…. Plans for the future…

Moving forwards Build on our strengths: One city – GPs, Local Authority and providers- opportunity for synergy Exploit financial opportunity to drive outcomes up (health economics assessment) Leverage GP and management skills in Quality, Communications, Commissioning and Primary Care Extensive and effective collaboration with LLR CCGs

Resolve concerns: Build support for a strategy for UHL and enable achievement FT status - Implement the contract - Deliver transformation support - KPIs for transformation delivery Address primary care quality issues through a combination of developing capacity, peer review and performance monitoring Moving forwards

Our 3-5 year view Financially sustainable delivering control total surplus but maximising health gain from available spend Deliver primary care quality, capacity and capability improvements Both providers will be thriving Foundation Trusts Transformed a number of clinical pathways linked to our Commissioning Strategy Life expectancy gap with the rest of England has narrowed and continuing to improve

20 Questions…?