1. Patient Participation Groups
Engagement with
NHS Lincolnshire East CCG

2. Introduction and purpose
The purpose of this morning’s session
How patient views feed into the CCG
The role of Healthwatch
PPG group discussion
Lunch and networking

3. PPE
structure

4. PPE
structure

5. Healthwatch Lincolnshire
Jean Hill & Sarah Fletcher

6. What is Healthwatch?
Healthwatch is to champion the voice of Lincolnshire people.
Gather intelligence to inform and influence changes to services.
Healthwatch has a role in supporting local people find the services and signpost appropriately.

7. What makes up Healthwatch Lincolnshire

8. What are our statutory powers
Like all local Healthwatch bodies, we have a statutory seat on the Health and Wellbeing Board, the body that oversees health and social care in the county and have the power to influence commissioning decisions.
We have statutory powers to enter and view health and social care services using our authorised volunteers.
Healthwatch also has a place on the new Quality Surveillance Groups that are being set up in the NHS to monitor provider quality.
A right to request information and to receive a response within 20 days.

9. What the People of Lincolnshire said…
You said …partnership working with key agencies was important.
You said …that HealthWatch should engage and consult with existing groups and members and the community.
You said …HealthWatch should talk to people.
You said …HealthWatch should use existing groups and places to promote itself.
You said …HealthWatch should have a strong chair and board members who are passionate about what they do.
You said …meetings should be open, friendly, relaxed and not too formal.
You said …HealthWatch should inform the Health and Wellbeing Board about the matters that concern the public, not just the matters that concern the board members.
You said …HealthWatch should scrutinise the services that people use.

10. Getting involved and being empowered
As a provider? As a member of the public? As a commissioner? As a member of the community, voluntary and wider support network?

11. Contact Us Healthwatch Lincolnshire Unit 11 Gateway Park Lincoln
LN6 9HU
Telephone :

12. PPG group discussions Tell us your thoughts on our proposed structure
What does the CCG need to do to help you carry out your PPG role?

13. Lunch
An opportunity to meet with your fellow PPGs, network and work towards developing locality PPG groups

14. Identifying Commissioning Intentions
Stakeholder Event
2014/15 – 2016/17

15. Welcome and Introductions
Gary James
Accountable Officer
NHS Lincolnshire East CCG

16. NHS Lincolnshire East Clinical Commissioning Group authorised on 1 April 2013
Skegness & Coast, East Lindsey and Boston Area localities include 30 practices covering 1,060 square miles including Skegness, Louth and Boston
Population 241,246
Budget 2013/14: £310m

17. Purpose of today Update you on what we’ve done
Identify how we achieve change
Understand how we can engage with you in the future

18. Vision
We have a vision of a CCG where clinicians are working together to improve the quality and cost effectiveness of care, with resources based on need, and which benefits all of our patients as fairly as possible

19. Mission
Ensure the optimum health and wellbeing of the people we serve by commissioning high quality health services which support choice; promoting healthy lifestyles and personal responsibility; reducing inequalities in opportunity, experience and health outcome; and managing our allocated resources effectively and responsibly

20. Plan on a Page

21. Three phase process
for Commissioning Intentions

22. Chris Weston Consultant in Public Health
Public Health and health of the population in
Lincolnshire East CCG
August 2013
Chris Weston Consultant in Public Health

23. Contents: Public Health Demography Disease prevalence Summary

24. What is Public Health?
The science and the art of improving health, prolonging life and preventing disease through the organised efforts of society
Health promotion e.g. lifestyles, wider determinants of health
Health protection e.g. communicable disease control, emergency planning, screening
Healthcare public health e.g. needs assessment, evidence of effectiveness and cost effectiveness

25. Public Health - current landscape
1 Apr Most extensive reorganisation of the structure of the NHS in England came into life. Main changes:
abolish Primary Care Trusts and Strategic Health Authorities
shift of responsibility for local Public Health to Local Authorities and Unitary Authorities
establish several hundred Clinical Commissioning Groups
transfer £60 to £80 billion of health care funds to CCGs
establish new local authority Health and Wellbeing boards
establish Public Health England

26. Joint Health and Wellbeing Strategy Themes
The five themes of the Strategy are:
1. Promoting healthier lifestyles
2. Improve the health and wellbeing of older people in Lincolnshire
3. Delivering high quality systematic care for major causes of ill health and
disability
4. Improving health and social outcomes, and reducing inequalities for
children
5. Tackling the social determinants of health

27. What can we do?
Work together to ensure everyone that needs it, can access evidence based programmes of:
Primary prevention of the risks for many chronic diseases e.g. diet, alcohol, smoking, obesity
Risk identification and management
Long term condition management
Support end of life care

28. Key Demographic Information
GP registered population is over 244,000 people
30 GP practices
High population of people aged 60 and over
Lower proportion of people aged than England average
Unemployment rate was 2.98% in June 2013 (similar to Lincolnshire average and below national level)
Highest in Lincolnshire levels of child poverty (19.3%).
There is high population of A8 migrants living around the Boston area.
Source:

29. Deprivation
Lincolnshire East CCG has high level of deprivation compared to other areas in Lincolnshire.
Around 19% of the population within Lincolnshire East CCG boundaries are living in what is classified as one of the 20% most deprived areas in England
Areas of high deprivation can be found mainly in Boston (Fenside), Skegness and Mablethorpe.
Deprivation is a key factor in a person’s health and wellbeing
Source: Department for Communities and Local Government

30. Health and lifestyle
Under 75 mortality rates from cardiovascular disease, respiratory disease and cancer are higher than rates for England
Life expectancy at birth is 77.7 years for males, 81.5 years for females. Both slightly lower than national average.
Obesity prevalence is above the England average: 13.1% (CCG) compared to 10.7% (England). The prevalence of obesity in Lincolnshire East is the highest among Lincolnshire CCGs.
Hypertension prevalence is significantly above the England average: 17.2% within Lincolnshire East CCG compared to 13.6% in England

31. Coronary Heart Disease
National Picture
40% reduction in deaths from CHD in past 12 years
Good evidence base – clinical management and lifestyle services, such as smoking and weight management
Each GP practice has a CHD register and the actual prevalence in Lincolnshire is lower than the modelled prevalence. This could indicate that there are a number of patients still missed off the disease register and not being treated appropriately
CHD continues to be a key cause of premature death across the county
LECCG
Prevalence of coronary heart disease in Lincolnshire East is well above the England average: 5.3% compared to 3.4% for England. It’s also highest of all Lincolnshire CCGs.

32. Stroke National picture
Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year over 110,000 people in England will have a stroke (with direct costs to the NHS of over £2.8 billion)
Key issues regarding stroke include:
The risk of stroke increases with age
Hypertension
People with diabetes are 2 to 4 times more likely to die from a stroke
Smokers are 50% more likely to have a stroke
LECCG
Stroke prevalence in Lincolnshire East is higher than the England average: 2.5% within CCG compared to 1.7% within England.

33. Diabetes National Picture
Diabetes is a chronic and progressive disease that impacts upon almost every aspect of life. It affects people of all ages, and is becoming more common.
20 x more likely to have diabetes if obese.
People with diabetes:
On average have a reduced life expectancy of 15 years
Are five times more likely to die from coronary heart disease
Are three times more likely to have a stroke
Women who are pregnant have an increased risk
LECCG
The prevalence of diabetes in Lincolnshire East CCG (7.7%) is significantly higher than the England average (5.8%) and highest out of all Lincolnshire CCGs.

34. National Picture Chronic Obstructive Pulmonary Disease
In the UK COPD is the fifth biggest killer, the second most common cause of emergency admission to hospital and one of the most costly inpatient conditions treated by the NHS
In 2009/10 the recorded COPD prevalence in Lincolnshire was 1.9% of the population estimated prevalence
Possible large number misdiagnosed or undiagnosed patients
LECCG
In Lincolnshire East CCG recorded prevalence of COPD was 2.4% in 2011/2012, however, the estimated rate was 3.3% (both higher then national figures)

35. National Picture Cancer 1/3 cancers are preventable
Around one in three of us will develop cancer at some time in our lives
Cancer causes around one in four of all deaths
Cancer rates in Lincolnshire are in line with the national average.
LECCG
The prevalence of cancer in Lincolnshire East CCG is above the England average: 2.3% (CCG) – 1.8% (England).

36. Disease prevalence in LECCG
Source:

37. Use of hospital services
The rate of GP referrals to outpatients (1st attendance per 1,000) is above the England average: (LECCG) compared to (England).
The number of elective admissions (per 1,000) is above the England rate: (LECCG) compared to (England). It’s also the highest in Lincolnshire.
The number of emergency admissions (per 1,000) is above the England rate: 94.8 (LECCG) compared to 89.0 (England).
The number of Cancer admissions (per 1,000) is also above the England rate: 48.3 (LECCG) – 28.6 (England).

38. So in summary
People in LECCG are older, poorer and sicker

39. Setting the Scene – Social Care
Glen Garrod
Director of Adult Social Services
Lincolnshire County Council

40. Priorities for Adult Social Care 2013/14
A balanced budget out-turn
Improved performance (against a basket of indicators reflecting 8 themes). Where relevant performance will be measured against the LCC comparator group. The ambition is to achieve upper quartile performance in each.
Integration with Health – specific examples beyond just improved relationships: a) one joint appointment of a senior manager, b) a signed Section 75 agreement for Adult Learning Disability Services, c) an agreed Intermediate Care Layer for Lincolnshire with established budget contributions.
Established plans for milestones for the delivery in 13/14 and 14/15 of both the 14Forward, Learning Disability and Capital Strategy initiatives: a) the future of the LD operational division determined and b) two Extra Care Schemes commissioned.
A set of quality indicators to reflect both service quality improvements, system improvements (i.e. our ability to understand and measure quality) and quality in professional (operational) practice.

41. Adult Care Directorate Change Programme Blueprint
Priority Areas
Prevention and Early Intervention
The development of an 'Intermediate Care' layer for Lincolnshire
Case Management Partnership Programme (CMPP) and Future Delivery of Support Services (FDSS)
Integration with Health

42. Adult Care Directorate Change Programme Blueprint
New costs for local authorities

43. Quality
Tracy Pilcher
Executive Nurse
NHS Lincolnshire East CCG

45. The Problems Patient safety problems exist throughout the NHS.
NHS staff are not to blame.
Incorrect priorities do damage.
Warning signals abounded and were not heeded.
Responsibility is diffused and therefore not clearly owned.
Improvement requires a system of support.
Fear is toxic to both safety and improvement.

46. The Solutions
Recognise with clarity and courage the need for wide systemic change.
Abandon blame as a tool.
Reassert the primacy of working with patients and carers to set and achieve health care goals.
Use quantitative targets with caution.
Recognise that transparency is essential.
Ensure responsibility for functions related to safety & improvement are vested clearly and simply.
Give the people of the NHS career-long help to learn, master and apply modern methods for quality control, quality improvement and quality planning.
Make sure pride and joy in work, not fear, infuse the NHS.

47. Culture will trump rules, standards, and control strategies every single time. A safer NHS will depend far more on major cultural change than on a new regulatory regime.

48. Quality for the NHS
Safety: Avoiding harm from the care that is intended to help
Effectiveness: Aligning care with science and ensuring efficiency
Patient-experience: Including patient-centeredness, timeliness and equity

49. What we have done so far Dr Brynnen Massey Chair
NHS Lincolnshire East CCG

50. What we have done so far Keeping people out of hospital
Decrease acute admissions
Improve working together
Optimise Out of Hours provision
Optimise Urgent Care pathway
Improve medicines management
Optimise use of ambulance services
Improve dementia services
Improve end of life care
Empowering communities
Improve update of screening services
Optimise diabetes pathway
Optimise atrial fibrillation pathway
Develop ENT pathway
Develop dermatology pathway

52. Prevention

53. Antibiotics

55. Atrial
Fibrillation

56. What we have done so far Sandra Willamson Chief Finance Officer
NHS Lincolnshire East CCG

57. How much money have we got?
Programme budget allocation
Uplift for growth
Amount available to spend
Equates to c £1,300 per patient

58. Where do we spend the money?

59. Acute Expenditure breakdown?

60. Planning guidance – what we have to do
Buy safe and sustainable services
End the year with a 1% surplus - £3.1m
Plan for a contingency of 0.5% - £1.5m
Commitment to spend 2% non recurrently in year - £6.2m
Deliver QIPP

61. Where we’re at? Rising demand Quality
Implications of NHS reform in monitoring performance for 2013/14
Achieving QIPP £6.2m
Achieving Financial balance

62. 2014/15 onwards Spending review ring-fenced NHS funding but…
Inflation and increased demand likely to require 4% pa efficiency
QIPP (Quality, Innovation, Productivity, Performance) targets will remain
In 2015/16 3% of health budgets (£9.5m for LECCG) to be pooled with Social Care to encourage integration – creation of Integration Transformation Fund (ITF)

63. Where do we need to be?
Improving Quality
Restructuring the way that care is delivered
Sustainability Services Review for Lincolnshire
Creation of Integration Transformation Fund (ITF)

64. Tea break

65. Round table discussions

66. Discussion one – How do we achieve change?
What does transformational change look like for Lincolnshire East? (15 minutes)
What do we need to consider when prioritising services and undertaking the sustainability review? (35 minutes)
Prioritise these criteria on flipcharts (10 minutes)

67. Discussion two – How can we engage with you in the future?
How do you want to be engaged?
Is there anything preventing you from engaging with us?

68. Round up & next steps

69. What next Analyse today’s feedback
Produce a report, available
Next steps – phase 2 engagement

70. Close