1. 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

2. 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

3. 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

4. Working as part of the
Mid and South Essex STP

5. 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

6. 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.

7. TBC
Supporting Primary Care
Development

8. Clinical Accountable Officer’s Report
Lisa Allen, Clinical Accountable Officer

9. 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

10. 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

11. 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

12. 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

13. Basildon and Brentwood CCG Transformation Journey towards our vision – April 2019 to March 2021

14. 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

15. 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

16. Quality and Safety Report 2018/19
Geraldine Rodgers, Deputy Chief Nurse
on behalf of Teresa Kearney, Chief Nurse

17. 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.

18. 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

19. 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

20. 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.

21. Performance 2018/19
Emma Timpson, Director of Planning, Performance & Demand Management

22. 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

23. Improving A&E performance

24. 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.

25. 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

26. 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.

27. 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

28. Annual Accounts 2018/19
Dee Davey, Interim Chief Finance Officer

29. 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

30. 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%

31. 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”

32. Where we spent our money

33. Patient and Community Reference Group
Bob Hackett, PCRG Member
Three brief points; who are the PCRG, what do we and how have done?

34. 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

35. Demographics Change = PATIENTS
Who are we?
Demographics
People power
Change
= PATIENTS

36. 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

37. 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!

38. 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

39. 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

40. 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

41. We need you

42. 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

43. Closing remarks and Questions?