Annual General Meeting

28th September 2017

WelcomeDr Sue Wells

Chair

Changes to our leadership teamand governance

• Dr Sue Wells appointed as Chair

• Simon Banks appointed as Chief Officer

• Dr Paula Cowan appointed as Medical Director

• Recognising the ongoing financial challenge, we have updated our constitution to ensure there is a clearer approach to financial governance.

• Development of a more integrated approach to commissioning with Wirral Council.

Our staff are dedicated to ensuring that we commission high quality services for patients. During the last year we have had a significant focus on how we develop as an organisation.

• Establishing an Organisational Development Group which has focused on a refreshed approach to training, development and coaching for staff.

• Our staff engagement group have introduced a new staff recognition scheme and are supporting Charles Thompson Mission with their activities to help homeless people in Birkenhead.

Valuing our staff

Engaging with our community

NHS Wirral CCG is committed to being open and transparent and seeks to engage as widely as possible about our plans:In the last year we have completed three formal consultations and engaged on a wide range of services and clinical pathways.

We have sought to expand the ways in which we engage to try and encourage participation:

Key engagement statistics:Consultation Survey Responses 3119 responsesFacebook 9200 viewsTwitter 1419 impressionsMedia (TV/Radio) BBC North West Tonight/BBC Radio

Merseyside/BBC R4 ‘Inside Health’

Consultation and engagement events held throughout the year:Gluten Free Prescribing/Over the Counter MedicationsService Review Policy (procedures of low clinical priority)Homeopathy and Iscador, Cancer Strategy, Learning Disability Strategy

Engaging with our community

Future engagement:

• Urgent care consultation commences - Nov 2017

• Public question time events commence - Nov 2017

• Patient and Public Advisory Group – Nov 2017

Commissioning Overview

Achievements 2016/17

Nesta HawkerDirector of Commissioning

Primary Care Achievements

• Primary Care Quality Scheme – provided additional funding (£1m) to support general practices in managing more appropriate and better referral management

• Secured national funding for clinical consultation system to support 7 day access pilot in 2016/17 –185 extra appointments each week

• Community Minor Surgery service started – provided at 8 practices across Wirral for all patients – more convenient service for patients – includes provision of joint injections.

• Started first programmes from GP Forward View – funding given to primary care to improve signposting and care navigation; which helped them improve their ways of working.

Planned Care Achievements

• The NHS Diabetes Prevention Programme (Own Life)

• Ongoing Transformation of Diabetes and Respiratory Services in the community

• IV antibiotics in the community - delivering a reduction of inpatient bed use of 500 days per month

Planned Care Achievements

• Cardiovascular

– Urgent review in the community for atrial fibrillation and heart failure

• Gastro

– Lifestyle advice for patients prior to referral for a camera looking at the stomach

– Healthy bowel clinics for patients with constipation

• Neuro

– New headache pathway for primary care

Urgent Care Achievements

• Co-ordination across a patient pathway – community and hospital

• Improvement of flow through the hospital to ensure more discharges earlier in the day to help people who are waiting for beds in A&E

• Launch of Transfer to Assess model – to undertake multidisciplinary assessments out of hospital in a more homely setting

• Hospital patients reviews – multidisciplinary review and actions to help people still in hospital after 7 days

• Think Pharmacy scheme

Learning Disabilities

• Transforming Care Programme • Reduction in patient bed numbers, national trajectories to achieve• Commenced work on the model for increased intensive support in

the community – step up and step down, emergency respite & planned short breaks

• Community Treatment Reviews (CTRs) – to support admission avoidance and facilitate discharges – In 2016 we undertook 12 inpatient CTRs in order to facilitate discharge

and 10 admission avoidance CTRs which resulted in 8 people not being admitted to hospital

• Joint All age Learning Disability Strategy– Formally recognised for this work by the Equality & Inclusion Report -

2016

• Health checks (adults 2015/16) – 63% achieved • Co-production – this is our mantra

Mental Health

Mental Health 5 Year Forward View• Early Intervention Psychosis• National referral to treatment targets met• Developed new shared care model for ADHD assessment and treatment to

improve waiting times• Improved and sustained Dementia diagnosis rate• Commenced collaboration between primary and secondary mental health services

to support patient experience. • Implementation of Integrated Provider Hub for Mental Health – undertaking

individual package of care reviews, ensuring outcomes based care. Through Future in Mind transformation plan:• Launch of a new Eating Disorder service for Children and Young People • Developed a Primary Mental health team to support schools, parents and young

people with early help, prevention and signposting.• Worked collaboratively with Local Authority and Public Health to co-commission

mental health services

2017/18 Developments

• Urgent Care Re-design• Psychiatric liaison – 24 hours, 7 days a week• External funding secured for cancer and diabetes to enable service

transformation• Lung pathway launch October 2017• Exemplar pathway pilot for suspected Colorectal Cancer patients• MSK Service (joints and bones etc) pathway redesign• Increasing access to GP services - 8am to 8pm – 7 days a week• Digital transformation – WIFI in every practice; improved IT infrastructure;

Wirral Care Record; improved broadband connectivity• Services for Frail people in the community – more co-ordinated and

targeted help• Further increase of intensive support in community for learning disabilities

Financial Report in 2016/17

2016/17 Annual Accounts

Mike Treharne, Chief Financial Officer

28th September 2017

Introduction

This presentation details the 2016/17 financial position for Wirral CCG and sets out the financial challenges facing the CCG in 2017/18

2016/17 Financial Duties

How was your money spent?

In 2016/17 Wirral CCG spent £1,491 per person as follows:

2017/18 Financial Challenges

Context of overall NHS and Social Care challenge

• Increasing elderly population and consequent demand pressures in respect of NHS Services and Packages of Care

• Despite increase in resource allocation (cash) impact of inflation and real terms position

2017/18 Financial Challenges

Context of overall NHS and Social Care challenge

• Continuing need to make significant savings

• Challenge of Health and Social Care economy financial deficits and related interdependencies

ROBBING PETERTO PAY PAUL

OPTIMISE THE WIRRAL £ -

Ensuring sustainability of Health and Social care services in the Wirral - Organisational expectations v strategic viability of services

There are no holes on my

side

2017/18 Financial Challenges

Requirement to deliver break even position for CCG in 2017/18, will need to :-

• Deliver additional £12m of savings; • Manage operational expenditure to budget • Manage increasing demand pressures in NHS and non NHS

activity including prescribing • Be cognisant of partner organisations financial pressures and

positions.

2017/18Financial Challenges

2017/18Financial Challenges

• It’s not that we don’t have any money – we have £512m

• We need to stop doing some things and do other things differently

• How do we manage/reduce demand?

• How do we manage the growth in continuing healthcare, prescribing and hospital activity?

• How do we get buy in to our plans?

2017/18Financial Challenges

• How do we make the Wirral a better place to live, with improved quality of life, improved quality of care, with greater independence and self help for residents and patients….And….

• How do we make the best use of our significant resources to do this?

Quality & Safeguarding

Lorna QuigleyDirector of Quality & Patient Safety

Quality

• Quality in care homes

– Integrated health and social care team

– Managers networks

• Worked with Public Health colleagues to raise awareness and know your numbers

• Developed an anti microbial resistance plan

Safeguarding

• Development of a combined Safeguarding board with Knowsley, Liverpool and Sefton.

• Supported Merseyside Police by coordinating health services in relation to the child sexual exploitation.

• Member of the Improvement Board following the OfSTED visit.

Looking aheadCreating a sustainable NHS for Wirral

Simon BanksChief Officer

‘The NHS is standing on a "burning platform" because its current model is not fit to serve the

public.’ The Telegraph 2nd Mar 2017

Prof Sir Mike Richards – CQC Chief Inspector of Hospitals

Drivers for Change

Our

burning

platform

Constrained funding

Increasing and changing

demand

Ageing population

Urgent care

Increasing customer

expectations

.(Non) Sustainability

Fragmented services

Health inequalities

(west v east)

Drivers for Change

57% of over 65’s have

a long term condition or disability that limits their daily activities

The overall

population

of Wirral

will have

an 18%increase in

those over

the age of

65

Relative to the England

average Wirral people

have less healthy years

and more years in poor health.

38,000 people are

estimated to have

hypertension but are unaware

and undiagnosed, and are at

an increased risk of CHD and

Stroke.

Wirral has a higher

mortality rate for

causes considered

amenable to healthcare

than England as a whole

and the North-West

region.

57% of over 65’s have

a long term condition

or disability that limits

their daily activities

Drivers for Change• The Wirral health and social care system is not sustainable in its currentguise.

• Demand on the system is increasing.

• Wirral people have less healthy years relative to the England average – sometimesdriven by wider determinants such as poor housing, education, unemployment.

• There is a wide variation in outcomes across Wirral – a difference in life expectancyof 11 years between each side of the peninsula.

• Our health and social care organisations do not always work effectively together sopeople do not receive joined up care.

• Too many people spend too much time in hospital, when they could be cared for in more appropriate settings.

• People have increased expectations of the care they should receive

• Without significant transformation there will be insufficient funding to maintain thequality and standards that we want our population to experience.

• We have made a pledge to the population – Wirral Plan, Healthy Wirral

HEALTHY WIRRAL

Healthy Wirral

Our Mission:

Better health and wellbeing in Wirral by working

together

Our Vision:

Our aim is to enable all people in Wirral to live longer and

healthier lives by taking simple steps of their own to improve

their health and wellbeing. By achieving this together we can

provide the very best health and social care services when

people really need them, as close to home as possible.

Healthy Wirral

Wirral

Residents Live

Healthier Lives

Older People

Live Well

Improved Outcomes for Children & Young People

Tackling the Wider Determinants of Health

People with

Disabilities Live

Independently

Better

Health

Primary & Community

Care

Transformation

Improving Care for

Vulnerable People

Improving

Mental

Health

Improving Urgent Care

Improving

Long-termConditions

Better

Care

Reducing Unwarranted

Variation

Acute Care Collaboration

Health & Care SystemRedesign

Efficient Use of System

Resources

Better

Value

Healthy Wirral

Better Health defined:

• Targeted prevention will increase the likelihood of Wirral residents

remaining healthy

• Encourage and support those people who are healthy to remain well

• Ensure those who are unwell receive timely and effective support

• The Wirral population will be supported to make informed choices

about their own care

To deliver Better Health we will:

• Help Wirral residents to live healthier lives

• Help older people to live well

• Improve outcomes for Children & Young people

• Tackle the wider determinants of health

• Assist those people with disabilities to live independently

The benefits of Better Health will be through:

• Improved Health & Wellbeing outcomes for the

Wirralpopulation.

Better

Health

Healthy Wirral

Better Care defined:

• Use early intervention and prevention approaches to manage demand

on services.

• When needed they will be assured of the highest quality services.

• Provision of effective care as close to the resident’s home as

possible. This could be non-medical as well as medical support.

To deliver Better Care we will:

• Improve long term conditions.

• Transform primary and community care.

• Improve care for vulnerable people.

• Improve mental health.

• Improve urgent care.

The benefits of Better Care will be through:

• Positive patient and service users experience

and high quality, safe outcomes for all.

Better

Care

Healthy Wirral

Better Value defined:

• Care will be delivered by the right person at the right time.

• Understand the holistic wellbeing needs of people to reduce waste

and target resources effectively

• There will be a fully integrated service across health and social care to

reduce duplication, repetition and improve efficiency.

To deliver Better Value we will:

• Make efficient use of resources.

• Reduce unwarranted variation.

• Collaborate across Acute Care.

• Redesign the Health & Care system.

The benefits of Better Value will be through:

• Reduced duplication and more efficient use of the Wirral pound and system sustainability.

Better

Value

• We understand our ‘burning platform’ challenges and we have a vision through our Healthy Wirral programme to start to transform our local heath and care system.

• Our immediate next steps is to look at the structures we have in place to deliver on this vision.

• Our ambition is to create a single integrated commissioner for health and care for Wirral by April 2018.

• This will enable us to commission services with local authority colleagues which deliver high quality and value for money services.

• This will be supplemented by the development of ‘place based care’ models which will provide more personalisedand coordinated health and social care services.

• We will actively seek to remove barriers between health and social care services to integrate services around the patient.

Next steps

Question and Answers

Paul EdwardsDirector of Corporate Affairs