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Basildon and Brentwood CCG Annual General Meeting 4
Basildon and Brentwood CCG Annual General Meeting 4.30pm 12 September Dr Boye Tayo, Chair Lisa Allen, Clinical Accountable Officer
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Agenda Welcome and introductions Dr Boye Tayo, Chair
Accountable Officer’s Report Lisa Allen, Clinical Accountable Officer Annual Report for 2018/19 including: Quality & Safety Report 2018/19 Performance 2018/19 Annual Accounts 2018/19 Geraldine Rodgers on behalf of Teresa Kearney, Chief Nurse Emma Timpson, Director of Planning and Performance Dee Davey, Interim Chief Finance Officer Patient and Community Reference Group Robert Hackett, PCRG Member Questions and closing remarks
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Welcome and who we are CCG established 1st April 2013
Serve 279,000 residents across Basildon and Brentwood 2018/19 budget of £354m CCG commissions hospital, community, mental health and children’s services Key providers in the STP include; Basildon and Thurrock Hospital Southend Hospital Mid Essex Hospital (Broomfield) Barking, Havering and Redbridge Hospital (Queens) North East London Foundation Trust (Community and Children's Mental Health services) Essex Partnership University Trust (Mental Health) East of England Ambulance Service
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Working as part of the Mid and South Essex STP
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Basildon and Brentwood CCG Overview
Population of Basildon and Brentwood 279,000 Where we plan to spend our money GP prescriptions 4.5m items GP appointments last year 1.25million Budget £354m Required £3.4m surplus towards repaying historic debt Mental health contacts 60,000 Wickford Brentwood Billericay Primary Care Networks 6 proposed Mental Health Community CHC Acute Other Primary Care East Basildon West Basildon Central Basildon A&E attendances for last year 97,700 Our partners Community service contacts 31,000 Basildon and Thurrock University Hospitals NHS Trust North East London NHS Foundation Trust Essex Partnership University NHS Foundation Trust Essex County Council Basildon Council Brentwood Council Outpatient attendances 60,000
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TBC Overarching Focus 2018/19 saw the early impact of the CCG’s work that focuses on the out of hospital model and in particular the transformation of primary care. The CCG has worked closely with primary care colleagues to support the establishment of Primary Care Networks and new models for delivering primary care services such as the Acute Home Visiting Service. In addition, the CCG has worked collaboratively with local partners to develop a common vision and priorities for the future.
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TBC Supporting Primary Care Development
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Clinical Accountable Officer’s Report
Lisa Allen, Clinical Accountable Officer
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Achievements Further development and implementation of the Aligned Team Model Implemented a new “Acute Home Visiting Service” that provides a consistent approach to the delivery of primary care home visits across the whole CCG. Worked with the four other CCGs and other stakeholders within the STP to develop a Primary Care Strategy and investment plan Commission of signposting across primary care to offer suitable alternatives to seeing GPs. Piloted new roles in primary care including pharmacists, Advanced Nurse Practitioners and advanced Health Care Assistants
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Achievements Alongside Essex County Council, we have;
Embedded a Trusted Assessor Model within Basildon Hospital Supported the Frailty Assessment model at Basildon Hospital by funding additional therapists and a coordinator role Invested additional therapy capacity in intermediate care wards improving outcomes for patients. Working with stakeholders, we have supported a 25% reduction in the number of patients spending more than 21 days in hospital Successfully procured a new provider of Improving Access to Psychological Therapies services
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Achievements Embedding of social prescribing across key stakeholders
Working with partners, implemented a comprehensive Mental Health Rapid Assessment Service in Basildon Hospital Implemented a new Cows Milk Protein Allergy pathway across primary, community and acute paediatric services. Significantly improved compliance with the four hour A&E standard despite increased A&E Activity As a CCG we achieved a ‘Good’ rating from NHSE/I against the indicators in the CCG Improvement and Assessment Framework Implementation of an Organisational Development programme Internal and external audit rating of ‘satisfactory’ Improved staff survey Improved 360 stakeholder survey
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Plans for 2019/20 Operational Plan ‘Transforming Together’ set out CCG ambitions for next two years: Primary Care Networks to be at the heart of local health transformation Community services integrated and aligned around Primary Care Networks Implementation of Integrated Care System from April 2021 Single management team for five CCGs in Mid & South Essex Infrastructure, IT and Estates, supports new models of working CCG working within the STP will set out it’s plans over the next five years to meet the challenges set out in the NHS Long Term Plan
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Basildon and Brentwood CCG Transformation Journey towards our vision – April 2019 to March 2021
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Compassionate and Respectful
Operational Plan Summary 2019/20 Objectives We will: Work in partnership with our communities to enable people to live full, active, and independent lives, promoting self-care and building resilience Lead and enable our partners to deliver safe, high quality, equitable care with less variation Give clear and consistent messages on the availability of health services and fund the things we know will work and reduce waste Be an organisation of clinical and managerial leaders who have the necessary skills, capacity and capability to lead positive change for the communities we serve. Transformation Programme Primary Care development: change how care is delivered by moving towards GP led services supported by a wider range of roles, delivered at scale through Primary Care Networks Partnership working: move towards an Integrated Care System (ICS) that improves the health and well being of our local population Service delivery: transform out of hospital care and align services where possible around Primary Care Networks. Reconfigure acute hospital services to create larger specialist teams (STP led) Cross Cutting Programme Urgent & Emergency Care Ensure patients receive the right care in the right place Mental Health Improve access to services and crisis response services Children & Young People Establish system wide plan Maternity Improve safety, choice and personalisation Transforming Care Improve services and support for people with learning disabilities Continuing Healthcare & PHBs Adoption of best practice including Personal Health Budgets Medicines Management Ensure optimal prescribing Cancer and Elective Care Improve access and patient pathways (STP led) Outcomes Finance Move towards financial balance Achieve QIPP savings Support overall system sustainability Effective use of investment Deliver Mental Health Investment Standard Quality Better experience of care Improved access Better Health outcomes for people with long term conditions, cancer and mental health issues Sustainable workforce Performance Achieve constitutional standards Deliver NHSE Targets on Mental Health, Primary Care and LD Reduction in activity growth in acute sector Enablers Organisational form & governance: adapts to the changing commissioning and ICS landscape whilst supporting CCG staff through the change Workforce: create a modern health workforce that attracts and retains staff Infrastructure: provision of digital solutions, IT, data analytics and Estates that supports new models of care within available resources Our values B Be Honest B Be Accountable Clinically Led C C Compassionate and Respectful Growing Together G
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Partnership Working The CCG recognises that we cannot fulfil our ambitions without our partners and as such, we have worked closely with a broad range of partners throughout 2018/19. Our approach to partnership working is across three tiers; 1). At an STP level, the CCG has worked closely with fellow CCGs, councils and trusts to develop a cross organisational vision and key outputs such as the Primary Care Strategy. 2). At a CCG level, the CCG has engaged key partners from health, social care and local authorities to begin the implementation of a local model of care. 3). At a more local level, the CCG has worked with localities and the emerging PCNs to form strong partnerships with primary care and patients to ensure that local variation is addressed within any service change
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Quality and Safety Report 2018/19
Geraldine Rodgers, Deputy Chief Nurse on behalf of Teresa Kearney, Chief Nurse
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CCG Responsibility The CCG is accountable for the monitoring of patient safety and the quality of services. The commissioned providers range from the local maternity services, community care, continuing healthcare care plans through to end of life care services.
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Areas of focus this past year
Harm Free Care Agenda - Working collaboratively with health care partners The Learning Disability Mortality Review (LeDeR) Special Educational Needs & Disability (SEND) Discharge to Assess (D2A) Engaging people and communities Safeguarding for vulnerable adults and children
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Maternity Transformation Programme
Local Maternity System (LMS) Maternity Transformation Programme Recommendation from Better Births: Each pregnant woman will have consistency in having the same midwife or clinical team throughout the three phases of her maternity journey
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2019/20 Quality Priorities Learning Disability and Autism
Local Maternity Services Workforce Enhanced Care Homes Linking with the Long Term Plan 2019– making sure everyone gets the best start in life, delivering world class care for major health problems and supporting people to age well.
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Performance 2018/19 Emma Timpson, Director of Planning, Performance & Demand Management
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7,429 17,041 7,880 Delivery in 2018/19 – A&E more attendances
95.7% patients seen within 4 hours at Basildon Hospital (March 19) 80.9% patients seen within 4 hours at Basildon Hospital (March 18) South West A&E Delivery Board led improvement programme 7,429 more attendances than in 2017/18 17,041 more people seen within 4 hours than in 2017/18 7,880 less people waited 4 hours or longer compared with 2017/18
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Improving A&E performance
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Constitutional Standards
Delivery in 2018/19 – Constitutional Standards Referral to Treatment (RTT) Diagnostics 81.9% patients treated within 18 weeks (target 92%) 97.1% of diagnostic tests take place within 6 weeks of referral (target 99%) Basildon Hospital missed the RTT and diagnostic standard for 2018/19 year. The Hospital continues to implement a recovery plan focusing on reducing its waiting list size to less than the March 2018 position by March 2020 to meet the national guidance. Throughout 2018/19 the commissioning Quality Team worked with BTUH to ensure that all significant patient waits beyond 52 weeks were subject to a robust clinical harms review. Commissioners have expanded capacity with community providers and supported outsourcing patients in particular stretched specialties.
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94.3% 97.5% 73.3% Delivery in 2018/19 – Cancer
Suspected cancer referrals seen in 2 weeks (target 93%) 97.5% Confirmed cancers started treatment in 31 days (target 96%) 73.3% Started treatment within 62 days of GP referral (target 85%) The target for 2 week wait cancer pathways continued to be met in 2018/19, even with the 17.5% growth in referrals. The 31 day target was achieved for the year although not consistently each month Performance on starting treatment within 62 days of GP referral remains challenging and nationally over half of hospitals fail to achieve the target The CCG and hospitals have been working with regulators and with the East of England Cancer Alliance to target investment in 2019/20 to improve cancer access and early diagnosis for patients. Working for a better NHS for everyone
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Delivery in 2018/19 – Mental Health
Improving Access to Psychological Therapies 16.35% Adults with anxiety and depression entering psychological therapies (target 17.8%) 51.5% Of people entering psychological therapies who reported recovery (target 50%) 99.5% Of patients seen within 6 weeks of referral (standard 75%) 100% Of patients seen within 18 weeks of referral (Standard 95%) The CCG achieved the recovery and waiting time standards for Psychological Therapies for 2018/19 year. However, the % of patients accessing the service fell short of the target. This was due to reduced capacity in March 19 to support the transition to the new service provider from April 19.
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Delivery in 2018/19 – Mental Health
Dementia Whilst the dementia diagnosis rate continues to improve the CCG fell below the standard. Our focus for the next year is on: • Support provided to patients and carers post diagnosis • End of life pathway; • Patients diagnosed previously with mild cognitive impairment. 65.5% Dementia register size against estimated size (target 67%) 31.4% Access to community mental health services for children & young people (target 32%) Children & Young People The numbers of Children & Young People accessing mental health services increased in 2018/19 and the CCG was close to meeting the target. There has also been an increase in the number of referrals to the Eating Disorder service: 100% of children were seen within 4 weeks of referral 66.7% of children needing to be seen urgently were seen within a week
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Annual Accounts 2018/19 Dee Davey, Interim Chief Finance Officer
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Finance Review 2018/19 Publicly funded, from taxation, based upon an assessed need to spend We started the year with an accumulated deficit of £8.4m We were required to repay £3.4m of the deficit in 2018/19 We received £356.9m to meet service and management costs and to cover our required debt repayment = £1,284 per head of population
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Key Financial Duties 2018/19 Target Comments
Remain within Revenue Resource Limit We achieved the required in-year surplus of £3.4m which has reduced our accumulated debt to £5m. Manage within our allocated cash funding The CCG also achieved 3 of the 4 “95% Better Payments” targets and achieved 94.5% on the remaining target Remain within Administration costs allocation We spent £20.92 per head on administration (running) costs Increase expenditure on MH by at least the increase in recurrent funding Total recurrent funding increased by 3.2% and MH expenditure increased by 3.36%
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Finance Review 2018/19 £14.8m savings delivered
Unqualified audit opinion on the 2018/19 accounts External Audit concluded that the CCG has adequate arrangements in place to secure economy, efficiency and effectiveness on the CCG’s use of resources – known as the “value for money conclusion”
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Where we spent our money
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Patient and Community Reference Group
Bob Hackett, PCRG Member Three brief points; who are the PCRG, what do we and how have done?
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Brentwood Care Centre July 2018
Who are we? Brentwood Care Centre July 2018 Basildon Town Centre 2010 How representative is it of the people of Basildon or Brentwood? What else may it represent in the context of this gathering? I've labeled these thoughts as follows; Demographic; people power; change. NXT SLIDE
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Demographics Change = PATIENTS
Who are we? Demographics People power Change = PATIENTS
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Our fit? The CCG Governing Body will seek the views of the Patient & Community Reference Group (PCRG) in respect of commissioning developments or changes they are considering and will take these views into account in their decision making
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A CRITICAL FRIEND Our fit? - Challenge - Support
- Argue Constructively - Offer Alternatives And to make sure that policy makers have the ‘patients /service users’ view point, and best interests, at the centre of their decision making!
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Achievements 2018/19 How are we doing? MSK Connect: Patient Survey
IAPT: Improving Access to Psychological Therapy: Vita Minds Winter Communications Integrated Care for M&SE Community Teams Mental Health Pathway in A&E Workshops/ Focus groups Freestyle Libre/ Retinal Eye screening
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Achievements 2018/19 How are we doing? MSK Connect: Patient Survey
Patient complaints Met with providers Surveyed changes Followed up IAPT: Improving Access to Psychological Therapy: Vita Minds Presentations from provider Followed up feedback following launch
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Patient Participation is…
Patients who are Active in taking Responsibility for their health and work as a Team with their practice to ensure that patients are well Informed about health matters which affect the Community, Individual patients and the Practice, look to raise Awareness of wider issues in the NHS, including the use of Technology. Involved and can have influence in improving the quality of care. Objectives are to improve the patient experience in primary care in the NHS
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We need you
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Thank you – Bob Hackett, PCRG member, Basildon and Brentwood CCG
Any Questions? Please speak to any of the PCRG members during the breaks if you wish further discussion Thank you – Bob Hackett, PCRG member, Basildon and Brentwood CCG
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Closing remarks and Questions?
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