1. Thursday 5th November 2015 CCG Clinical Commissioning Forum

3. Hackney Devolution Pilot: An Update Health and Wellbeing Board 4 November 2015

4. Why are we exploring being a devolution pilot in Hackney? We think it will help us address the financial challenges ahead and find a way to protect finances and access transformation funding There are plans to transform health and care systems nationally and within London These will deliver significant changes over the next 2 years in how integrated health and social care operates Devolution offers opportunities for ways of working that meet local areas’ needs with local commissioners, providers and patients/service working together to deliver real localism Hackney partners have expressed an interest in becoming a London devolution pilot and a short-term group has been meeting with representatives from across the partnership, to progress the proposal further.

5. What do we want?

6. We do not want to… Privatise services Break up the NHS Lose our high performing local hospital Have a model developed elsewhere imposed on us

7. What are the building blocks? Putting patients at the heart of service design and decisions-making Starting with adults, a focus on prevention and early intervention, living well at home and avoiding unnecessary use of hospital care or other long-term care Redesigning services with patients/service users to improve care by reducing fragmentation, delays and duplications currently experienced by patients and carers Our current partnerships, e.g. One Hackney and City, mental health alliances New ways of paying for care that make the best use of our resources and lead to better patient experiences and improved outcomes The ability to re-invest any savings back into local health, social care and wellbeing services.

8. How can devolution help us? Some of the freedoms we need: Financial flexibilities We want to explore new ways of paying for care, along with incentives for prevention, early intervention and better care overall Additional local powers We want new local powers, such as planning powers, to improve public health and to address the social determinants of health and reduce health inequalities New commissioning powers We want to be able to commission more services locally Common regulatory system We want a simpler way of regulating our integrated health and social care system Estates We plan to work across the partners to explore how we can best make use of our collective estates to deliver our vision.

9. What if we do nothing? Possible moves towards a single CCG covering Hackney, Tower Hamlets, Newham and Waltham Forest Exposure to the financial challenges facing Barts Health Less local control Possible Challenges to the independence of the Homerton

10. What happens in the next few weeks?

11. What is our timetable if we become a pilot?

12. How will we take our plans forward?

13. Good news! City and Hackney top of QOF for many LTC measures!

14. QOF results 2014/15 City and Hackney Results Top in the country for: Diabetes; CHD; Stroke / TIA or PAD and BP controlled to 150/90 CKD and BP controlled to 140/85 Diabetes and foot exam / risk classification AF with CHADS2 >1 and on anti- coagulation Asthma and COPD reviews CKD with a urine albumin:creatinine ratio Second in the country for: Diabetes and BP controlled to 140/80 Newly diagnosed diabetics referred to structured patient education CHD patients on anticoagulation Hypertension and BP controlled to 150/90 Third for: Diabetes and cholesterol 5 mmol/l or less COPD and FEV1 recorded Top Quintile on 21 measures

15. END | NOTES

16. Maternity, Children and Family Services- Early Years Contract Children’s Programme Board Maternity Programme Board November 2015

17. What we are trying to achieve 17 The CCG wants to commission an early years service from primary care in line with its Early Years Strategy. There is a good evidence base for early identification and intervention improving child and family outcomes. This must start as soon as possible, ideally before conception. This proactive care, coordinated by a multidisciplinary team including GPs, practices nurses, mental health, voluntary sector, midwives and health visitors, is beyond core and additional services under the GP contract. There is a continuum of opportunities to offer enhanced services to families, so we are presenting the children's and antenatal contracts under the umbrella of early years to make this focus on improved outcomes clear.

18. 1. Proposal 18 Opportunistic and targeted pre conception care- Outcomes Identify and treat medical issues early (and refer on) Health promotion e.g. folic acid, healthy weight, stopping smoking, Pregnancy presentation appointment- outcomes Identifying existing and new obstetric, medical, social and psychological risks right at the start of pregnancy Making good quality and swift referrals to maternity services including sharing needs and risks identified for pregnant women. Continuation of 16w antenatal and 6 week postnatal appointments (as now) including mental health screening Commission service standards for children 0-19 to achieve the following outcomes with partners Multidisciplinary partnership working with health visitors, school nurses and paediatricians Early intervention Increased numbers of development checks Increased immunisation uptake Improved access to breastfeeding support Coordinated approach to communication information and shared care (across Primary Care community services and secondary care) Equity of access and provision across City and Hackney Access to advice Support for vulnerable children including carers (as now) New patient health checks for children aged 5 – 17 (as now) 16th birthday health checks (as now) Quality standards for children in primary care LTC elements of VCC moving to LTC contract, for better join up

19. Rationale & Benefits 19 Rationale GPs are at the heart of services for families. See and know all the family: mum, dad, babies, children, siblings, extended family… Usually the “first port of call” for pregnant women so key opportunity here to offer enhanced care, right from the start. Seeing women, babies, children and fathers as early as possible – Prevention, Early Identification and Intervention. GPs can join the dots and understand the whole picture as know their patients medical and social histories. Can identify risks that would impact on healthy child development e.g. Children missing immunisations Parental mental health problems Social vulnerabilities like housing and money that are impacting on family wellbeing Familial safeguarding risks such as DV, FGM… Benefits Commissioning services based on children and family’s journey or “the care pathway” will make it easier for families (and professionals) to navigate services. Model will provide continuity of care to families that also takes account of individual and family needs. GPs can share detailed knowledge of family histories to partner agencies who need to work more intensively with the family – e.g. health visitors, school nurses, CAMHS Families with additional needs (medical, social, obstetric, psychological) will be: Identified early Offered appropriate support and care Signposted or referred for additional support Monitored via shared care plans Entrenched and chronic problems can be avoided – particularly on “wellbeing” issues such as support for positive parenting, confident access to services like healthy child programme reviews and getting help early for low level / emerging mental health problems. Young people will be supported to manage their health as they transition to adulthood

20. Questions for CCF 20 As clinical commissioners- Is this clinically the right thing to do Are there additional quality standards that we want to commission for children's health aged 0-19 Is there anything else we should be considering as part of this contract.