1. CCG Clinical Commissioning Forum Thursday 7 th January 2016

3. UPDATE JANUARY 2016

4. PLANNING GUIDANCE 1. CCG allocations expected early January – will be 5 year allocation (3 years’ firm, 2 indicative) 2. Provider tariff announced in January – efficiency expectation of 2% 3. 4 elements to allocations – each with a new formula! 1. CCG spend 2. Primary care spend on GPs 3. Other primary care spend 4. Specialist spend 4. Each area gets an allocation for all 4 – these are added together and the total is how distance from target is calculated 5. Target is calculated in a new way – recognises age and sparsity not deprivation 6. DH is committed to increasing money for those under target rapidly 7. Under the old/current formula CH CCG is about 5.7% above target 8. CCG position now unclear – were ok over next 5 years but now??? 9. Position for Local Authorities is tough – also NHS providers 10. Good news is allowed access to centrally held surplus Collective perfect storm?

5. Growth in 16/17 is directed to Trusts to bring them back into financial balance No details yet Will be lots of strings attached to this A&E, cancer, waiting times Use of agency staff Efficiency Growth in 17/18 is dependent on an agreed 5 year Sustainability and Transformation plan (July) This has to show improvements to Health and wellbeing Quality and safety Finance over 5 years Plan must be developed and agreed by all local partners – commissioners and providers

6. WORKING TOGETHER Where are our local gaps and priorities cf 35 “national challenges” How are we going to address these Does this make the money work What powers do we need? Would a different delivery arrangement work? What powers do we need? Would a different delivery arrangement work? Devo

7. WHERE WE ARE NOW Devolution pilot approved Now need to develop our plans and the devolution tests Establishing a senior group across all organisations (providers and commissioners) to oversee and manage 5 year plan Supported by workstreams on IT, estates, manpower, finance and commissioning, organisational design, communications Start work on the specific plans (patient and clinical lead) and the financial outlook Contracts for 16/17 will carry on as now

8. DEVOLUTION Is an experiment – both locally and for London Is to test out whether local decision making and/or a different delivery vehicle would make the money work better than leaving things as they are

9. Local decision making So what things are decided outside Hackney where bringing it local might help us More political powers around smoking/fast food Should impact on preventable ill health Should therefore impact on health spend Test is – will we be able to do more and do it more quickly

10. Delivery vehicles Now separate organisations, contracts aligned Alliance model – mental health, One Hackney Providers are tied together to achieve outcomes collectively Lead provider model contract with one organisation who then subcontracts (anticoag model) One integrated organisation NHS and social care One budget to deliver outcomes (CCG commissioned?) Accountable care organisation (ACO) Has a budget for the population it serves Fewer contracts Fewer separate organisations – all in it together Fewer contracts Fewer separate organisations – all in it together

11. For GPs At present big influence in commissioning via CCG – 8 Programme Boards with GP Chairs, 6 elected consortia reps, Governing Body – but less so in primary care due to conflicts Provision is less well integrated – One Hackney and Mental Health are our main attempts to get providers to come together as teams.

12. END | NOTES

13. Integrated Care Programme Board Clinical Presentation to CCF January 2016

14. Key message re: event Community nursing workshop 20 th January 12:30 onwards at the Tomlinson Centre 14

15. Current Performance 1,247 >75s receive the frail home visiting service There are 398 >75s who receive this service Total = 1,645 (slightly less than 1,788 estimated) 15

16. Current performance Quadrant 1Quadrant 2Quadrant 3Quadrant 4 No of practices in each quadrant 911 12 No of practices on target for average number of visits (3.5) 8111011 Number of practices on target for minimum payment 5432 % of visits to date with care plan review 69%77%70%76% Minimum payment £ 219,875.99 £ 211,621.26£ 272,406.09£ 314,430.17 Maximum payment £ 289,665.98 £ 278,409.53£ 359,455.97£ 412,736.50 16

17. Evidence Base for FHV November 15 NICE Guidance on Integrated Care and Frail Elders http://www.nice.org.uk/guidance/ng22 http://www.nice.org.uk/guidance/ng22 - Recommendations back-up Frail Home Visiting Approach and One Hackney and City - Care planning for frail patients key part of guidance - However evidence of health gain achieved via care planning and integrated care is very limited Important for 16/17 to capture as much evidence as possible to back-up the impact that the FHV contract is having on improving patient experience and co-ordination of care 17

18. Frail Home Visiting Contract 1. Case finding 2. Undertaking visits for housebound patients 3. Care plans 4. MDTs 5. Quadrant meetings 18 We propose keeping the same core elements

19. Key aspect – data collection 19 We need individual patient-level data to support on-going evaluation The confederation are supporting CCG with an audit using c. 20 measures shown on next slide How many of these 20 measures – if any – should we collect on an on-going basis? Or should we collect this data via regular audits

20. Key aspect – data collection Medication review Medication Changes Dementia assessment Mental health assessment including depression/anxiety/low mood End of Life review/issues recorded Evidence of and assessment of substance misuse Skin care assessment including pressure ulcers Foot care assessment Assessment for vision Hearing assessment Dental or feeding issues identified Nutrition discussed and advice given Mobility assessment Housing and environment assessment Assessment for social isolation and loneliness Review of patients wishes and goals Carers review Onward referrals made and list of Was a geriatrician involved in the care planning Was the patient discussed at a practice MDT meeting Was the patient discussed at a quadrant MDT meeting 20

21. Improving the City and Hackney care plan Group of primary and secondary care clinicians will work on improving the care plan (CCG lead is Dr Nikhil Katiyar) Positive feedback on new version of co-ordinate my care – this could be used for all frail home visiting patients, or just those at the end of life GPs could also use a new updated version of the City and Hackney care plan What works well in the current care plan? What could be improved? 21

22. END | NOTES