NHS Trafford Clinical Commissioning Group RIGHT CARE RIGHT TIME RIGHT PLACE NHS Trafford Clinical Commissioning Group AGM 30th September 2014 www.traffordccg.nhs.uk

Dr Nigel Guest, Chief Clinical Officer Introduction Dr Nigel Guest, Chief Clinical Officer and Dr Kath Sutton, Chair www.traffordccg.nhs.uk

Chief Operating Officer / Director of Commissioning and Operations 2013/14 Operational Performance Gina Lawrence Chief Operating Officer / Director of Commissioning and Operations www.traffordccg.nhs.uk

Our Constitution promises to update you on: How members of the public have been involved and engaged Delivery of our Quality Strategy Improvements made across Primary Care Services (GP’s) www.traffordccg.nhs.uk

Annual Public Involvement Communication and awareness program for the implementation of Trafford New Health Deal Patient involvement in service development including personal health budgets Development of New Health Deal Patient Reference Group to scrutinise integrated care Recruitment to Patient Reference and Advisory Group Equality delivery system: where local stakeholders graded us as a CCG as amber (developing) on our performance against Goal 4 of the framework. www.traffordccg.nhs.uk

Progress 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 safe Better Care: We will ensure that the care we commission is clinically effective delivering better health outcomes for our patients Patients 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. www.traffordccg.nhs.uk

NHS Trafford CCG Quality Strategy Achievements 2013/14: CCG hospital visits Quality standards in all contracts Commissioning for Quality and Innovation Schemes (CQUINs) in all providers across Greater Manchester encouraging them to use change improvement methodology to sustain change improvement Pressure ulcers Early warning system in place Achievement of all locally agreed Commissioning for Quality and Innovation Schemes (CQUINs) in all providers Expert commissioners in place Patient engagement framework www.traffordccg.nhs.uk

Quality improvements made across primary medical services (GP’s) Quality Improvement Programme GP IT Locality partnership working Management of high risk patients www.traffordccg.nhs.uk

Areas of work commenced / completed in 2013/14 Including; Quality and performance Adult Safeguarding Urgent Care services Cancer Patient Care Co-ordination Centre www.traffordccg.nhs.uk

Performance 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 year Patients’ privacy and dignity were prioritised and all patients were cared for in a same sex ward Waiting times were kept short and all national standards were delivered Patients on a cancer pathway received timely diagnostics and treatments throughout the year Wythenshawe Hospital (UHSMFT) Speedy access to diagnostic tests to support clinical decision making was achieved throughout the year Following a stroke, most patients spent at least 90% of their hospital stay on a dedicated stroke unit Recall systems for patients attending the breast service were changed to be brought in line with national best practice Waiting times were kept short and national standards were delivered www.traffordccg.nhs.uk

Quality Highlights for 2013/14 Central Manchester Hospitals (CMFT) Achieved in full the majority of CQUINs The Quality Standards as set out in our contract with the Trust were fully met in 2013/14 CMFT has undertaken a large programme of work in relation to harm free care with a focus on pressure ulcers CMFT were inspected by the Care Quality Commission (CQC) in December 2013, following this action plans were put in place around nutrition and records Wythenshawe 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. www.traffordccg.nhs.uk

Adult Safeguarding 2013/14 – year of partnership working and reform Led the reform of Trafford Adult Safeguarding Board Established Operational Adult Safeguarding Board Implemented new governance and risk management arrangements Implementing Prevent agenda across local health services Working with children’s services to look at the whole family picture Working to support implementation and develop understanding of Mental Capacity Act, 2005 Supporting the Deprivation of Liberty Safeguards Working with NHS Providers and contractors to improve understanding of safeguarding adults Working to improve care, standards and safeguard vulnerable people in Care Homes www.traffordccg.nhs.uk

Trafford Urgent Care Services- Planned changes to Trafford General Hospital 27th November 2013 – A&E Department closed 28th November 2013 – Urgent Care Centre opened (08.00- midnight daily) (impact on CMFT, UHSM & SRFT) Community Services delivering – enhanced services in the community, including Rapid response, community Matrons, IV therapy service etc. Travel Bureau in place to support patient transport Travel support scheme in place by Trafford CCG to support patients Contact numbers Enhanced services - 0300 323 0303 Travel Bureau   - 0161 976 2555 Link services   - 0845 605 5505 www.traffordccg.nhs.uk

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Trafford Urgent Care Centre This department is open from 0800 – midnight This 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-present The medical admissions unit will receive all admissions by GP’s This 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.    www.traffordccg.nhs.uk

Cancer: 2013/14 Macmillan GPs appointed: Dr Helen Marsden – End of Life care Dr Ann Harrison - Cancer 2013/14 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 standards To educate primary health care teams To support pathway and service redesign To enhance communication between all levels of care to promote a seamless service and improved patient experience. Living With & Beyond Cancer pilot – 2 GP Practices www.traffordccg.nhs.uk

Patient Care Co-ordination Centre A Proactive Health and Social Care System The patient care co-ordination centre is the ‘glue’ that will hold the provision of services together All patient journeys will go through this service It is an essential part of our integration strategy Will deliver efficiencies to all organisations Patients always getting the right care at the right time A focus on complex cases and vulnerable people www.traffordccg.nhs.uk

Patient Care Co-ordination Centre Since October 2013 we have been running a tender process to select a provider capable of delivering the PCCC We 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 population We expect the PCCC to be in place, and making a difference to patients in Trafford, by June 2015 www.traffordccg.nhs.uk

Joe McGuigan Chief Financial Officer 2013/14 Financial Performance Joe McGuigan Chief Financial Officer www.traffordccg.nhs.uk

2013/14 Financial Duties / Performance Trafford CCG achieved all of its financial duties for 2013/14 Delivered 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 days Delivered £6.5m of savings, exceeding its plan by £0.5m Had an unqualified and clean audit report; accounts and value from money perspective www.traffordccg.nhs.uk

New 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 www.traffordccg.nhs.uk

2013/14 – Where was the money spent? www.traffordccg.nhs.uk

What services did we commission from our hospitals? 29,000 ‘planned’ treatments; average £1,100 each 25,000 ‘emergency’ treatments; average £1,900 each 328,000 outpatient appointments; average £100 each 88,000 A&E attendances; average £92 each 3,900 days in critical care; average cost of £1,200 each www.traffordccg.nhs.uk

So, how much did this cost in 2013/14? www.traffordccg.nhs.uk

What 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 Trafford Community (c£20m) and Mental Health Services (£18m) Funded nursing care and continuing care support and placements; at a cost of c£11m Emergency and non-emergency ambulance services; £6.5m GP ‘Out Of Hours’ services; c£1.7m www.traffordccg.nhs.uk

Financial Position, now and going forward www.traffordccg.nhs.uk

National and local finance looking forward People continue to live longer; not necessarily healthier; so health illness prevention will need to be targeted to right outcomes TCCG 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 investments Clinical led re-design with General Practitioners, hospitals, social care working together to deliver sustainable better outcomes TCCG will continue to integrate care; greater quality/efficiencies; in line with its 5 year strategic plan www.traffordccg.nhs.uk

Dr Nigel Guest Chief Clinical Officer Future NHS Trafford CCG plans 2014/15 Dr Nigel Guest Chief Clinical Officer www.traffordccg.nhs.uk

Priorities and work underway and planned for this year Including; Co-commissioning Cancer (local and Greater Manchester wide) Cervical screening Personal health budgets Adult safeguarding Mental Health (local and Greater Manchester wide) Diabetes Musculoskeletal Services Community dermatology Clinical Assessment and Treatment Service Cardiology Better Care Fund www.traffordccg.nhs.uk

Co-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 services Education and training Complaints management Development of new services Revising existing contracts www.traffordccg.nhs.uk

Cancer (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 services Develop and implement revised service specifications for breast cancer and acute oncology services Develop a GM commissioning strategy for cancer www.traffordccg.nhs.uk

Cancer (local level): 2014/15 Raising profile of Macmillan GPs Primary Care Analysis of cancer referrals and GP education Dermatology audit carried out Consider Macmillan Quality Standard Mark for practice (information/champions) Priority areas for Trafford CCG Palliative/End of Life Screening with a particular focus on; - cervical screening - bowel screening - breast screening Support of Living With & Beyond scheme for a further year www.traffordccg.nhs.uk

Cervical Screening: 2014/15 Delivery of a joint Trafford CCG and Trafford Council Cervical Screening Plan Committed to achieving the national target – striving for 80% of eligible patients to have had smear by April 2015 Joint plan contains over 15 new initiatives including: A patient survey asking Trafford residents what the barriers are to attending for a smear Trafford local poster and radio campaign titled ‘It only takes a minute’ Work with local community groups including BME community groups and Gay and Lesbian foundation Intensively working with GP practices with lower than average screening rates Bridgewater Services extending their service to offer smear for mums attending Children's Centres www.traffordccg.nhs.uk

Personal 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 these A group are now meeting to offer this more widely to patients The programme works with three third sector organisations www.traffordccg.nhs.uk

Adult Safeguarding 2014/15 – year of public engagement and participation Implement the requirements of Care Act 2014 Further Prevent training Revision of adult safeguarding policies and procedures New training programmes – specialist and expert practitioner programmes for practitioners Public engagement – Adult Safeguarding Board to be open to public from April 2015 Adult Safeguarding Reference Groups to include public representatives – shape and influence Recruit more “lay members” to sit on Adult Safeguarding Panel Hearings Targeted advertising campaigns throughout 2014/15 Increased public awareness of and participation in Adult Safeguarding www.traffordccg.nhs.uk

Mental Health across Greater Manchester Association of Governing Groups (AGG) 2014/15 Leading joint working with key partners across Greater Manchester Working with Greater Manchester Police on delivering the Crisis Concordat Development of Greater Manchester Alcohol Strategy Development of a learning disability standard to reduce premature deaths Development of a Joint Health & Social Care Self Assessment for learning disabilities www.traffordccg.nhs.uk

Mental Health progress in Trafford 2014/15 Performance in line with national / local priorities Improved access to psychological therapies More dementia diagnosis + post diagnostic support + less meds Working to reduce demand on Police service Psychological liaison service in place across Trafford More autism support Extra community eating disorders services Fewer restrictive secure hospital placements Public sector reforms – Early Intervention and Working Well www.traffordccg.nhs.uk

Diabetes People 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 care The Diabetes Strategy for Trafford will be presented to Trafford CCGs Governing Body in February 2015. www.traffordccg.nhs.uk

Musculoskeletal Services Service review discovered a lack of : integration not enough capacity increasing patient demand Patients and professionals agreed that the service should be: joined up provided by a multi-disciplinary team self-management and prevention focused more capacity A 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. www.traffordccg.nhs.uk

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Community Dermatology Issues with capacity Business 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. www.traffordccg.nhs.uk

(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 M4 GPs should continue to utilise CATS Current contract ends Feb 2016 – Care UK will stop accepting referrals from November 2015. www.traffordccg.nhs.uk

E-consult service being set up to support GPs Cardiology 30% of cardiology conditions are regarding irregular heart rhythm issues; 80% of these could be managed in the community E-consult service being set up to support GPs Supported by ECG clinical interpretation service A Locally Commissioned Service will be set up with Primary Care for the ECG service www.traffordccg.nhs.uk

This will be £15.4m for Trafford Better Care Fund National initiative to improve care for the most frail and elderly residents Brings together existing health and social care resource into one budget This will be £15.4m for Trafford Aims 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) www.traffordccg.nhs.uk

Health and Social care Integration Better Care Fund Better Care Fund Frail and Older People End of Life Care Health and Social care Integration Community health and existing social care offer to delivered as one service Improve patient experience Avoid duplication Aligned to neighbourhood model Falls Service Reducing the amount of time people spend in hospital Avoiding admission Geriatrician support in the community General practice for Nursing homes Education to improve skills across the workforce Improving patient, family and carer experience Greater connectivity between services through IT Prompting advance care planning Supporting the voluntary sector to deliver non-clinical care www.traffordccg.nhs.uk

Post / web deadline: 5pm on 24th October 2014 www.traffordccg.nhs.uk

Priscilla Nkwenti Panel Chair, Trafford CCG Looking ahead: Introducing the NHS Trafford CCG Public Reference and Advisory Panel (PRAP) Priscilla Nkwenti Panel Chair, Trafford CCG

Public 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 Body Meet monthly initially, then bi-monthly

Clinical Commissioning Duties Clinical Policy Clinical Commissioning Clinical Redesign Performance Prioritisation Public engagement Culture & values For 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 providers Clinical 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 Panel Culture & 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

For 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 population Prioritisation – A PRAP representative sits on the CCG’s Individual Funding Request Panel Public 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 Trafford Culture 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 www.traffordccg.nhs.uk

Public Reference and Advisory Panel Representation 4 x Public Reps  North – Shabir Abdul Central – Gill Leng  West – George Devlin  South – Pat Lees 4 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 Centre CHAIR Priscilla Nkwenti – CCG Vice Chair/Lay member lead for engagement 4 x GP Patient Participation Group Reps North (Ann Day to cover)  Central  West – John Howe South – Lesley Spencer 1 x Trafford Healthwatch Rep  Brian Wilkins Following recruitment process, recruited all our public reps and third sector reps. Still need to recruit from North and Central GP Patient Participation Groups Ann 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, Stretford Central – Sale, Ashton on Mersey West – Flixton, Urmston, Davyhulme, Partington South – Altrincham, Timperley, Hale

Where does the Panel fit in? Trafford Clinical Commissioning Group Governance & Commissioning focus Patient focus Patient focus Healthwatch Trafford Trafford CCG Governing Body Integrated Care Reference Group Feedback Finance & Commissioning Committee Quality & Performance Committee Public Reference & Advisory Panel GP Patient Participation Groups Feedback - Prioritisation - Policies - Projects - Locally Commissioned Services Further opportunities for PRAP rep involvement, for example: 2 x PRAP Reps to sit on: - Individual Funding Request Panel - Process Review Panel Additional groups to be developed

What has the panel been involved in www.traffordccg.nhs.uk

Upcoming work programme: Projects include: - End of Life - Falls Strategy - Primary Care Strategy Respiratory Programme Patient Care Coordination Centre – role on Programme Board Other projects will come to the panel once they are up for redesign www.traffordccg.nhs.uk

Questions??? www.traffordccg.nhs.uk

Concluding remarks www.traffordccg.nhs.uk