1. Annual General Meeting 30 September 2015

2. Welcome to our AGM Programme for the afternoon
Prevention of ill health exhibition – CCG and public health teams pm
Welcome - Dr Tim Burke, Chairman pm
Annual report 2014/15 – video summary pm
Presenting the highlights of the annual report 2014/15 – Dr Tim Burke, Chairman pm
Presenting the annual accounts 2014/15 and financial recovery plan 2015/16 – Hugh Groves, Chief Finance Officer pm
Ask the CCG – a panel of CCG Chair, Chief Officer and Chief Finance Officer
6.45 – 7.00pm
Closing remarks
7pm

3. Public health prevention programmes
Devon County Council - Listen to your gut campaign to increase awareness of common illnesses and to reduce the use of unnecessary antibiotics
Thrive Plymouth
is a movement for a healthier Plymouth. There is currently a life expectancy gap of 12.2 years between neighbourhoods in Plymouth.
Reading well books on prescription
- A scheme launched this year to support people with dementia and their carers
I Love Life campaign – to tackle obesity, stopping smoking and improving mental health and wellbeing

4. AGM Prevention
Self-Reported Health Bad or Very Bad from 2011 Census

5. Annual report 2014/15

6. CCG financial recovery
Turnaround
How has the CCG addressed the challenge?
Quality Innovation Productivity and Prevention
NHS RightCare
Longer term sustainability
Whole health economy problem to solve
Success Regime
NHS England
In Q4 of 2014/15 the CCG were issued with Directions from NHS England

7. Highlights from the Annual Report 2014/15
Dr Tim Burke, Chairman

8. Local context Geography – > 2500 sq. m. - rural / urban mix
900,000 population
123 member practices in 2014/15
Three localities - working together within a financially challenged health economy
Closer working between Northern and Eastern localities
Demographics
- Aging population
- Co-morbidities

9. Population Structure / Change
Over the next 20 years Devon will experience more significant growth in those aged 70 and over especially in those aged 90 and over, and a more significant proportionate reduction in those aged 40 to 65

10. Multi-Morbidity and Deprivation

11. Our performance Diagnostic waiting times
There has been significant improvement this year in patients waiting less than 6 weeks for a diagnostic test.
At the beginning of the year % cent
At the end of the year per cent.
Target 99 per cent
Ambulance services
Ambulances responded to more than 78.9 per cent of category A (Red 1) calls within eight minutes.
Target 75%
Diagnostic - Significant improvement but still doesn’t meet the target
Ambulance – positive, above the target of 75%
Mixed sex accommodation – good news
Mixed sex accommodation
No patients have been treated within mixed sex accommodation in 2014/15.

12. Our performance continued..
Cancer waiting time standards
In 2014/15 we achieved four of the nine cancer waiting time standards.
The standards not met include: two week urgent referral; two week referral for breast symptomatic; 62- day urgent referrals, 62-day consultant upgrade; 31-day subsequent treatment within 31 days for radiotherapy.
We are working hard to improve these.
Negative – issues include capacity, waiting times and a national campaign for breast cancer awareness increased activity at local trusts

13. Our performance continued..
18 week referral to treatment times .
We have achieved the target of over 95 per cent of patients not needing to be admitted to hospital for treatment being seen within 18 weeks.
Target 90%
The number of patients needing to be admitted to hospital for treatment within 18 weeks is slightly less per cent
Good news – non admitted
Bad news - admitted

14. Our performance continued…
A&E four hour waits
A&E and minor injuries units combined treated 92 per cent of patients within four hours. Target – 95%
Negative – below the national target of 95%
Complex issues, NHS 111, individual behaviours
Areas for improvement
PHT and to a lesser extent the RD&E have struggled to meet this target during the winter due to higher than usual capacity pressures. In Plymouth there has been a higher demand on hospital beds over the winter and in Exeter there has been a high number of forced bed closures due to infections (mainly norovirus). This has restricted the flow of patients out of A&Es in the winter, and meant they have struggled to meet the A&E standard targets. System resilience groups have been set up to make sure patients are in the right place in the healthcare system so patient flow through the hospital is maintained at all times.

15. Our performance continued..
Mental health
Care Programme Approach
Over 99 per cent of patients on the care programme approach received a follow-up within seven days of discharge.
Increasing Access to Psychological Therapies (IAPT service)
The target rate is 15 per cent of patients into the service but it has been 8.7 per cent for 2014/15. We will continue to improve access to IAPT services to achieve the national standard by the first quarter of 2015/16.
Target – 15%

16. Our performance continued…
Infection control
Good news – Cdiff below target. MRSA improvement from 7 cases the previous year.
The overall number of Clostridium Difficile (C-Diff) cases was 201 in 2014/15.
Target – below 204
There have been two cases of MRSA in 2014/15, a significant reduction in cases from the previous year.

17. Annual accounts 2014/15 Hugh Groves Chief Finance Officer

18. NEW Devon CCG 14/15 Plan & Risk
Guideline Actual
Surplus 1% £10m Deficit planned £15m
Headroom 2% Headroom 0%
Contingency 0.5% Contingency 0%
Risks -
£10m from start of plan
Increases in demands, elective referrals to secondary care, Continuing and Complex Care, emergencies and urgent care

19. How does the CCG spend its money?

20. Financial performance 2014/15
Target
£000’s
Actual
Difference
£’000 %
Revenue Expenditure  
  1,085,611
1,124,468 
 38,857  
Capital resource use  
  1,802
 1,790
  -12  
Running Costs
 21,645
 18,809
 - 2,836  

21. Financial Performance 2014/15
Target
£’000k
Actual
£’m
Difference
£’000
deficit as % of allocation
In year deficit
14,700
24,327
9,627
2.2%
Brought Forward Deficit
14,560
1.3%
Total Deficit
29,260
38,827
3.6%

22. Auditors Findings 14/15 Accounts
Financial statements opinion:
Unqualified - statements give a true and fair view
Regularity Opinion :
CCG exceeded its resource limit therefore a qualified regularity opinion
Value for Money Opinion
CCG exceeded its resource limit therefore a qualified VFM opinion
Area for Attention
Good progress in implementing sound governance arrangements
Agreed projected deficit for 15/16.
QIPP targets are significant risk in 15/16

23. Plans and Performance 15/16
Deficit Plan for 15/16 - but with sound financial recovery plan based on improved performance Q4 2014/15
Investments
Acute Care - waiting times and access, urgent care
Better Care Fund - increased investment in integrated services
Mental Health - Places of Safety, Parity of Esteem
Community Services – local parity on investment
Development of personal care budgets
Current Financial Plans - On track

24. Finance Recovery Plan
CCG targeting following areas in order to generate system-wide financial stability and greater operational resilience in 15/16:
Management of urgent/unplanned care, including sustainable models for winter and in primary care;
Reductions in elective care costs based on RightCare
Reduced reliance on temporary staff;
Pursuit of procurement opportunities and better incentives to control costs of drugs and devices;
Appropriate packages of care (e.g. in CHC), plus best use of NHS services and facilities where appropriate;
Repatriation of some specialised services

25. Financial Turnaround and Recovery
What the RightCare approach to comparative data has told us:
Weighting of spend in favour of acute & in particular acute services
Allocation of resources in line with health needs
Significant outlier in CHC spend
Areas at England average to move to top quartile e.g. prescribing
Levels of investment in prevention and community to be benchmarked and reviewed

26. Integration with the Success Regime
Our approach to the Success Regime is:
Our use of RightCare will be the backbone of the Success Regime
CCG will integrate with the Success Regime
The CCG will work with providers to agree to pathways changes
CCG and providers will need some flexibility from the regulators to profile plans

27. Thank you, any questions?
Ask the CCG
Thank you, any questions?

28. Thank you to everyone for their continued commitment and hard work