1. Kingston Clinical Commissioning Group
Annual General Meeting 2017

2. Welcome Dr Naz Jivani – Chair of Kingston CCG
Review of 2016/17
Working in a new Alliance
A new cancer strategy for Kingston
The co-produced mental health strategy for our communities

3. AGM Agenda No. Item Lead 1. Welcome & introductions
Annual report overview
Dr Naz Jivani, Chair
Sarah Blow, Accountable Officer 2.
Our finances and annual accounts for 2016/17
Yarlini Roberts,
Local Director of Finance 3.
Our successes, challenges and plans
A new Cancer Strategy for Kingston communities
Kingston’s Mental Health Strategy
Tonia Michaelides
Managing Director
Lead GP for Cancer - Dr. Atin Goel
Lead GP Dr Phil Moore 4.
Question & answer session
Panel*
Chair, Accountable Officer, Local Director of Finance, Managing Director 5.
Close and thanks
Dr Naz Jivani
Chair

4. South West London Sustainability and Transformation Partnership
Sarah Blow, Kingston CCG AGM, 12 September 2017
Start well, live well, age well

5. About our five year forward plan
SW London STP plan – November Following publication the NHS Five Year Forward View by NHS England in , all regions of the NHS in England were required to produce five year Sustainability and Transformation Plans (STP). A draft plan was submitted to NHS England in November 2016.
Refresh and a local approach After talking to local people and communities, we believe a local approach, rather than a SW London-wide approach, works best. We have set up four local health and care partnerships in Croydon, Sutton, Merton/Wandsworth and Kingston/Richmond. The revised plan is expected to be published in November 2017.
Bottom-up planning with Councils at borough level, based on local people’s needs These local health and care partnerhips (LA and NHS) are are looking at what services should be provided in the community and what their local hospitals should provide. They are working together to provide more joined-up health and social care services, and how to make these local systems clincally and financially sustainable

6. Summary of current STP thinking
A local approach works best for planning health and care
The best bed is your own bed – lets keep people well and out of hospital
Care is better when it is centred around a person, not an organisation. Clinicians and care workers tell us this.
Likely to mean changes to services locally - we are not proposing to close any hospitals, evolution not revolution
We need to show people how it works better with local examples
Involving people at local level will remain critical.

7. Where we have delivered locally
Kingston and Richmond
Providing a short stay crisis house for people experiencing a mental health crisis and providing an alternative to hospital admission
People living in Kingston and Richmond who are experiencing a mental health crisis now have access to a “safe haven” residential home in the community where they can stay for up to five days.
The house is staffed 24 hours a day by specialist support workers who provide personalised support which focus on helping the person to stabilise and recover.  The service is linked to community and home treatment teams for clinical support.
Between July 2016 and February 2017 over 100 people accessed the service, with over 90% of them returning home without needing admission to hospital. 
S136 detentions (known as “sections” under the Mental Health Act) for Kingston and Richmond residents have dropped by 32% compared to the average for the previous two years.
Helping people with long term illnesses experiencing a mental health problem
People with long term illnesses (such as diabetes, heart disease and chronic obstructive pulmonary disease) are more likely to experience depression or mental health conditions which can affect their recovery and how they self-manage their illness
In Richmond, we have employed extra therapists and trainees to increase the appointments for “talking therapies” (also known as IAPT services) for people with long term conditions.
“Talking therapies”, such as counselling or cognitive behaviour therapy, encourage people to talk through their thoughts and feelings with a trained therapist.  Understanding feelings and behaviour can help people cope with physical health problems and manage their long-term conditions better, which has a positive impact on both their mental and physical health.
Start well, live well, age well

8. Involving local people
Keeping touch with local communities
There have been local events this year for people to discuss the STP with clinicians, managers and local authorities in our six boroughs
We have written to over 1,000 local voluntary and community organisations at every key stage of STP development: May 2016, September 2016 and March 2017 – setting out our emerging ideas, inviting feedback and offering to attend local meetings to discuss the issues raised.
Grass roots engagement
Working with local Healthwatch organisations, we have run an extensive grassroots engagement programme, which was shortlisted for a national award. This has led to representatives from the local NHS discussing the challenges and emerging ideas with groups and individuals the NHS does not always reach, at 88 separate events in 2017/17. The evaluation report from these events is available on our website and we have agreed to run the programme for a further year.
Patient and Public Engagement Steering Group
Our Patient and Public Engagement Steering Group advises us on all communications and engagement activity.
Start well, live well, age well

9. Financial performance Yarlini Roberts Local Director of Finance
About the money
Financial performance Yarlini Roberts Local Director of Finance

10. A reminder about our community

11. How healthy is our community?

12. Our finances and accounts in 2016/17
Total expenditure in 2016/17 - £248.5m
£126m was spent on hospital services
£25.6m on GP primary care budgets - delegated to the CCG from NHS England in April 2016
£22m on mental health services & care for people with learning disabilities
£21m on community services

13. Our finances and accounts in 2016/17
£21m prescribing costs
£18m related to continuing healthcare
£6m spent on small scale local services
A further £5m invested in primary care services
£4.2m on CCG running and management costs

14. Expenditure in 2016/17

15. How was 2016/17?
Our performance, success stories and challenges in 2016/17 Tonia Michaelides, Managing Director Kingston & Richmond CCGs

16. Performance against NHS targets
In 2016/17 Kingston CCG met 73.1% of national and local targets
Accident & Emergency (four hour wait) – Just over 90% of patients seen against the national standard (target is 95%)
Cancer – All cancer waiting time targets have been met
Referral to treatment – National 18 weeks waiting time target met
In addition, 99.6% of people seen within 6 weeks for diagnostic tests
The monthly friends and family test (FFT) surveys show excellent outcomes reported for patients, in inpatients, outpatients, community care, A&E and maternity services

17. Kingston co-ordinated care programme
The programme aims to place individual at the centre of co-ordinated and integrated support
Helps people maintain independence and achieve outcomes that matter to them
During partner agencies established plans and processes to support this new way of working
Services went live in April 2017

18. A new urgent care service
Combines the NHS 111 and GP Out of Hours (OOH) services, and went live in October 2016
Wider skill mix of specialised clinicians in a new NHS 111 clinical hub
NHS 111 and GP Out of Hours services brought together
Four of the boroughs of south west London (Kingston, Sutton, Merton and Wandsworth)

19. Improvements in GP services
From April 2016, the CCG became responsible for commissioning GP services across the borough
£25.6m was spent on primary care
In addition Kingston CCG successfully bid for funding to deliver extended GP access
By April 1, 2017, three extended GP services, offering 8am to 8pm appointments were established

20. GP extended hours
Surbiton Health Centre 7 days a week, 8am-8pm – with additional appointments from 5:30pm Kingston Health Centre Monday-Friday, 8am-8pm - with additional appointments from 5:30pm Saturday 8am-8pm and Sunday 8am-2pm Merritt Health Centre Monday-Friday, 8am-8pm with additional appointments from 5:30pm, and Saturday-Sunday, 8am-2pm Call own GP practice before 5pm for an evening Appointment. For weekend appointments call

21. Looking forward – developing new quality standards in GP services
Kingston and Richmond CCGs are looking to develop quality standards in GP care
Holding patient, staff and public conversations across the patch
Asking what matters most to people when they interact with their GP and GP surgery team

22. Quality standards
From this we will create a set of quality pledges or quality standards
Two-way process – also developing a patient responsibility charter
Quality pledges/standards to be introduced from April 2018

23. Cancer strategy for Kingston communities Dr Atin Goel

25. Prevention and public health
It is estimated that 43% of cancers are attributed to lifestyle
and environmental factors, meaning there is great potential to stop people from developing cancer in the first place

26. Improve provision & uptake of cancer screening
Cancer screening uptake in Kingston
Type of Cancer
Kingston
London
England
Breast
71.7%
68.3%
75.4%
Bowel
55.5%
47.8%
57.1%
Cervical
70.4%
68.4%
73.5%

27. Achieve an earlier diagnosis
One year survival statistics for breast, bowel and lung cancer
Type of cancer
Kingston
England
Breast
97.7%
96.4%
Lung
34.5%
33.4%
Bowel
78.1%
77.3%
Type of cancer
Kingston
England
Breast
97.7%
96.4%
Lung
34.5%
33.4%
Bowel
78.1%
77.3%

28. Building on existing high quality services
Clinical effectiveness, patient safety and experience make the foundations of our approach…
Cancer Vanguard
28 day faster pilot
2ww referral process
Direct Access imaging
Direct access and straight to test endoscopy
Cancer waiting time targets (2ww/62 day/100 day)
Promoting research

29. Support for people living with and beyond cancer
In Kingston 4,400 people were registered as living with and beyond cancer in this is estimated to reach 8,500 by 2030
15months after diagnosis 60% more A&E attendances and 50% more GP contacts than comparable group (Nuffield Trust)
Cancer is a long term condition
Recovery package
Stratified follow up pathways
Supported self management
Social Prescribing

30. Thank You

31. Thrive Kingston a mental health & wellbeing strategy
for the people of Kingston by the people of Kingston
Phil Moore - Mental Health
Clinical Lead, Kingston CCG
12th September 2017

32. Why a strategy for Kingston?
A blueprint
showing the vision for mental health and wellbeing for all of us
plotting the mental health services we all wish to see in the future
A guide
to the shape of future services for the CCG and RBK commissioners
to develop an action plan to improve local services
A plan
for how our health and social care services will help us maintain our mental wellbeing
for how we will provide good support and services when we need them
A direction & scope
setting our policy to span prevention, early intervention, self care, treatment and recovery
A priority
a top priority for the Kingston Health and Wellbeing Board
in line with national policy - the Five Year Forward View for Mental Health sets out actions for the NHS by 2020/21

33. How many of us?
The population registered with Kingston GPs is just over 200,000 people
Of those, approximately:
21,500 have a common mental health disorder – things like depression and anxiety
2,000 have a serious mental illness – things like schizophrenia or bipolar disorder
2,000 children and young people (almost 10%) experience some form of mental health issue
43% of all people with mental health problems are employed compared to 65% for people with other health conditions and 31% below that of the general population
25% of people with mental health problems receive the treatment recommended by the evidence
9/10 people with a mental health problem report stigma and discrimination have a negative effect on them

34. Thrive – what does it mean?
THRIVE is becoming an international term for mental health and wellbeing
New York
London
West Midlands
and growing
Mention how impressed we were about the number of people/organisations that have been involved so far in co-producing “Thrive Kingston”
Looking at next steps in terms of implementing the strategy over the next 5 years - Mention that three further workshops are planned for this year and in afternoon workshop were are asking delegates their views on how we should run the events.
Mention that Thrive LDN has been published and we will want to review possible synergies with Kingston’s strategy

35. Thrive – what does it mean?
Mention how impressed we were about the number of people/organisations that have been involved so far in co-producing “Thrive Kingston”
Looking at next steps in terms of implementing the strategy over the next 5 years - Mention that three further workshops are planned for this year and in afternoon workshop were are asking delegates their views on how we should run the events.
Mention that Thrive LDN has been published and we will want to review possible synergies with Kingston’s strategy

36. Thrive – what does it mean?
Starting a conversation with Londoners …
… that will grow into a social movement
Mention how impressed we were about the number of people/organisations that have been involved so far in co-producing “Thrive Kingston”
Looking at next steps in terms of implementing the strategy over the next 5 years - Mention that three further workshops are planned for this year and in afternoon workshop were are asking delegates their views on how we should run the events.
Mention that Thrive LDN has been published and we will want to review possible synergies with Kingston’s strategy

37. Thrive LDN – six key aspirations
Briefly mention the six aspirations for Thrive LDN but the key message we want to give here is that implementation of Thrive LDN does not mean that this will supersede our strategy and we will abandon Thrive Kingston. We see it as an opportunity to see what resources and support may be available to support implementation of Kingston’s strategy.

38. Thrive LDN – six key aspirations
Carers
Focus on the outcomes
Briefly mention the six aspirations for Thrive LDN but the key message we want to give here is that implementation of Thrive LDN does not mean that this will supersede our strategy and we will abandon Thrive Kingston. We see it as an opportunity to see what resources and support may be available to support implementation of Kingston’s strategy.
Mental wellbeing
Community connection
Joined up care & support
Early intervention
Access to services

39. Mental Health Stepped Care Model
Community Mental Health Team
General Medical Care via GP
Primary Care Mental Health service
Specialist Inpatient Care
IAPT
Community support
Peer-support

40. A new approach Specialist inpatient care Community & peer-support
Crisis house
Community & peer-support
GP care
CMHT
PCMH service
Crisis cafe

41. Thrive – Kingston too? An achievement! Next steps
We are proud of what has been achieved in Kingston
this is real co-production!
182 people attended last year’s workshops
and 42 organisations were represented
Thank you to every one of you who have helped co-produce the strategy:
Healthwatch Kingston
Kingston Council
Public Health
Kingston Clinical Commissioning Group
And many more!
Next steps
We can ensure the THRIVE LDN aspirations are adapted to us in ThRIVE Kingston
Three further co-production workshops planned for September 2017, December 2017 and March 2018
purpose to be agreed but may focus on:
communication of progress against work areas
agree priorities for forthcoming year
discuss involvement in future work areas, ways of communication, audit and monitoring of projects
Mention how impressed we were about the number of people/organisations that have been involved so far in co-producing “Thrive Kingston”
Looking at next steps in terms of implementing the strategy over the next 5 years - Mention that three further workshops are planned for this year and in afternoon workshop were are asking delegates their views on how we should run the events.
Mention that Thrive LDN has been published and we will want to review possible synergies with Kingston’s strategy

42. Kingston CCG and Kingston Council
YOU have helped us commit to:
Improving OUR mental health and wellbeing
and commissioning high quality mental health services
through the implementation of “Thrive Kingston”
over the next five years
A co-produced “person-centred” strategy (now and in the future)
by all of us as local residents
especially by those of us with lived experience of mental health problems & current service users
by the various providers of services – NHS, council and voluntary services
We want to reinforce the message that both organisations are committed to implementing/delivering the strategy and continuing to involve Kingston residents in doing this.
Can you please introduce Iona Lidington at the end of your presentation please.

43. Thank you