Hammersmith and Fulham CCG

Annual General Meeting

6 October 2020

Welcome to Hammersmith and Fulham CCG’s

Annual General Meeting

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Today’s agenda:

Welcome and AGM James Cavanagh, CCG Chair

Achievements 2019/20 James Cavanagh, CCG Chair Janet Cree, CCG Managing Director

2019/20 Annual Reports and Accounts

Jenny Greenshields, Chief Finance Officer

NW London plan 2019/20: Janet Cree, Managing Director

Finance Jenny Greenshields, Chief Finance Officer

Quality Diane Jones, Director of Nursing & Quality

CCG Covid-19 Response CCG Governing Body Members

Questions

James Cavanagh, CCG Chair

Who We Are and

What We Do

Dr James Cavanagh

Chairman

Who we are and

what we do

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• NHS Hammersmith and Fulham CCG plans and buys healthcare services for the borough and ensures these are of good quality and value for money.

• We work with clinicians, patients and carers to make sure your health and social care services are effective and coordinated.

• We have 29 GP member practices for a population of over 250 000

• We don’t commission alone but as part of an Integrated Care Partnership and in accordance with the NHS’s long term plan

• We are part of the North West London collaboration of clinical commissioning groups along with Ealing, Harrow, Hillingdon Hounslow, Central London, West London and Brent

2019/20

Some Key Achievements

Dr James Cavanagh Janet Cree

Chairman Managing Director

Achievements 2019/20

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Primary Care

• Primary Care Networks (PCN) were established and commenced delivering population-based care in line with national service specifications

• Completed the procurement and roll out of the online consultation offer to complement existing access channels

• PCNs have recruited new roles building the pharmacist and link worker staffing base to provide population-based care

• Agreed joint working principles with PCN Clinical Directors and the GP Federation to support the development of PCNs and deliver on shared priorities

• Pride in Practice programme was rolled out across general practice to provide training and support to strengthen and develop primary care services’ relationship with their LGBT patients.

Achievements 2019/20

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Perinatal Mental Health

• Received a positive CQC report highlighting consistently good practice across the board including examples of outstanding practice

• Positive feedback from peer review including: “There is a clear sense of strong leadership, coordination and organisation in the service, as well as a strong ethos.”

Early intervention in Psychosis (EIP)

• Expansion of service to treat all people between the ages of 14-65 with a first episode of psychosis

• Royal College of Psychiatrists audit puts us as one of the top performing EIP services for Cognitive Behavioural Therapy, employment support and support for carers .

Achievements 2019/20

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Children’s Mental Health

• Successful application to NHSE to be a trailblazer site for the

implementation of mental health support teams in schools.

• Established Dynamic Support Register and multi-agency oversight for children and young people with ASD and/or Learning Disability at risk of admission to inpatient mental health or residential settings

• Agreement to jointly commission an Intensive Behaviour Support Team for children and young people with behaviour that challenges.

Achievements 2019/20

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Patient and Public Engagement

• Maintained a strong and effective Patient Reference Group

• Continued to increase the number of groups and individuals

on our stakeholder list

• Undertook a full consultation on the proposed overnight

closure of Hammersmith Hospital Urgent Treatment Centre

• Established a Patient Participation

Group support programme with

Healthwatch Central West London

• Provided support to SOBUS to help

facilitate community involvement

Annual Report and

Accounts

19/20

Jenny Greenshields

Chief Financial Officer

Financial Position 2019/20

The below table shows that the CCG delivered its planned deficit of £6.7m in 19/20. The CCG also achieved its financial duties with regards to Running Costs.

How we spent your money – £352.9m in 2019/20

The pie chart below shows a breakdown of CCG expenditure by programme area.

NW London plans

2019/2020

Janet Cree

Managing Director

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Our vision for NW London Integrated Care System (ICS) is to reduce

inequalities and achieve health outcomes on a par with the best global

cities.

Care will be integrated within a single system, focused on the needs of

the individual and unhindered by organisational boundaries.

We will combine our collective resources, clinical expertise and local

knowledge to build a fair, effective and accessible health service for all.

In 19/20 we started working towards our

vision for NW London:

This meant that key focuses for the year were:

• The development of our five year (Long Term Plan)

• Working towards a single CCG and building relationships as part of

our Integrated Care Partnership and local borough partnerships

• The Covid19 pandemic changed accelerated our focus and joint

working.

Our five year plan

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• We developed a five year strategic plan with our partners, public and

stakeholders.

• This plan was developed to meet the new national requirements set out in the

NHS Long Term Plan, to improve the quality of patient care and health

outcomes, while focusing on building an NHS fit for the future.

• It also focuses on reducing local health inequalities and variation in services

across NW London.

• To deliver our ambitions set out in the plan, throughout 19/20, we have focussed

on seven interconnected areas:

Clinical and care strategy

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In conjunction with our five year plan we developed our clinical and care strategy. The clinical strategy has nine clear priorities for delivery in 2020/21: • Access to specialist opinion • Frailty/last phase of life • Care planning • Long term conditions • Early detection of cancer • Social isolation • Safer care – maternity • Proactive urgent care • High intensity users

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A single CCG for NW London As part of merging the eight CCGs we are making the following six

commitments:

1. Move resources across NW London and within boroughs to

reduce inequalities over the next four years

2. Increase our proportion of investment in out of hospital

services, as a first step we will level up investment in

primary care services outside the core contracts

3. Ensure consistency in services across NW London

4. Ensure equity of access to services, to enable our

providers to improve outcomes for patients and reduce

health inequalities

5. Patients and GP member practices will continue

to be involved in the single CCG and at local level

6. We will devolve decision making on delivery and integration

of services to neighbourhood and borough level as our

integrated care partnerships develop.

In September 2019, the CCG

agreed that a single CCG for

NW London was the right

direction of travel. It was also

agreed that 20/21 would be a

transitional year focused on

financial recovery, developing

a single CCG operating model

and working through financial

implications.

Our system’s financial

challenge

Jenny Greenshields

Chief Financial Officer

Financial position

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2019/20

• The year ended with a deficit of £50.9m

for the NW London CCGs – this is in

line with our plan.

• Five CCGs reported a deficit (Brent,

Central, Ealing, Hammersmith & Fulham

and Harrow).

• The major pressure in 19/20 was acute

spend.

• Achievement of the 19/20 plan was

largely through non-recurrent measures,

therefore our underlying deficit has not

improved significantly.

2020/21

• A new financial regime was put in place

for 2020/21 following the Covid19

pandemic.

• For the first six months of the year we

are expecting to receive a resource

allocation that matches both our Covid

and non-Covid spend.

• NHS providers receive a block payment

to meet their costs and the opportunity

to claim for a ‘top-up’ of this block

payment is insufficient to cover their

costs.

• We are awaiting guidance on what the

funding arrangements will be for the

second half of the year.

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Reduction of the deficit

• Whilst we achieved the planned deficit target, the underlying position remains broadly the same at the end of the year at just under £100m

• We have continued to reduce our management costs under-spending by £6m against budget

• Towards the end of the financial year we did start to see a reduction in acute (hospital) activity growth, which should impact on future costs

System alignment • Our five year plan is a combined plan for

providers and commissioners

• Introduction of new payment regime moving

from purely costs and volume for acute

contracts to agreed contract values with

marginal rates for over and under

performance

Controls established • Vacancy freeze and review of interim staff

continued through 19/20

• Investment Scrutiny Panel imbedded to review

every proposed contract change or new

business case

System recovery • System recovery linked to five year plan and

key programmes of work

• Development of ICS (Integrated Care System)

recovery work streams

• Focus on schemes that will deliver system

wide savings

What we have achieved

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Returning to financial balance as a system Covid-19 has significantly changed the way we are working as a health system in NW

London with activity from both providers and commissioners being refocused on the Coivd-19

response and recovery.

Therefore our original 20/21 commissioner and provider cost recovery plans have not started

to deliver or be monitored in the normal way. However there are areas where transformation

across the system has been accelerated beyond our plan and areas that are currently on

hold that may or may not restart after Covid-19 activities have been normalised.

The focus for the immediate future in order to return the system to financial balance will be

to:

• Reset 20/21 commissioner and provider cost recovery plans

• Alignment with ICS recovery work streams

• Determine gap to financial balance and

• Determine further ICS Recovery work stream opportunities.

Quality

Diane Jones

Chief Nurse and Director of Quality

Quality in 2019/20 The CCG has a statutory duty to report on the performance of services as defined in the NHS

Constitution. In addition, it has a remit to improve quality within the services that it commissions

The CCG uses three domains to monitor quality of services and measure quality improvement:

– Patient experience

– Patient safety

– Clinical effectiveness

During 2019/20 the Quality Team has:

– Undertaken quality assurance support visits to primary and secondary care as well as care

homes to support quality improvements

– Been a central resource for all clinical quality issues e.g. supporting robust systems for

sepsis management in a trust

– Undertaken and reviewed Quality Impact Assessments (QIA) and Equality Health Impact

Assessments (EHIA) for pathway changes in commissioned services

– Worked with providers of care and the Care Quality Commission (CQC) where there are

quality concerns (and good practice) to support system learning and improvement

– Supported the GP quality alert process to highlight quality concerns to trusts for their

investigation and resolution.

Patient experience

Engagement

The CCG work with and talk to patients and the public about our services feedback is shared and discussed at CCG Committees and Governing Body meetings.

Complaints

The CCG analysed trends and themes relating to complaints received during 2019/20 with key themes being:

Delays within the Continuing Health Care process (CHC) claims

Disputes about the outcomes of CHC assessments and nursing home placements

The NWL CCGs’ IVF policy

The introduction of a new policy relating to injections to treat patients suffering from lower back pain

Introduction of Prescribing Wisely and NHS England’s guidance relating to medicines that should not be prescribed routinely in primary care.

– ensured lessons learned were disseminated for wider learning, e.g. through discussion at team meetings or multi-disciplinary professional meetings, incorporated in to training

Continuing Health Care (CHC)

– Ensuring that individuals are appropriately assessed to identify if they have a “primary health need”

– If need is determined then a package of care was commissioned by the CHC team and reviewed in line with national guidance

– As a result of complaints received our systems and processes have been strengthened

Patient safety

Serious Incidents (SIs)

Our service providers reported 933 serious incidents (Sis) in 2019/20, Imperial was

the highest reporter as they report all 12 hour breaches in A&E as SIs.

Treatment delay, maternity and diagnostic incidents are the top three types of

incidents reported.

Maternity cases are high due to the number investigated by the Healthcare Safety

Investigation Branch which would not normally meet SI criteria.

In the majority of cases, providers identify learning and create actions to address the

learning which is monitored locally.

The CCG is developing new ways of reviewing and closing SIs with wider

involvement of provider partners.

Safeguarding

• The CCG has worked with partners to ensure effective arrangements are in place to

meet the safeguarding framework requirements for Children & Adults

Clinical effectiveness

Medicines management

– CCG pharmacists worked with GPs and other providers to:

• Identify opportunities for quality improvements

• Increase effectiveness of joint working with secondary care

• Find and investigate any medicine incident related harm

Infection Prevention and Control (IPC)

– Worked with providers to ensure that appropriate systems and processes are in place

to ensure the risk from healthcare associated infections is minimised

– Ensure outbreaks are managed and lessons are learnt/shared across the system

– Identified the preparedness required for the COVID-19 outbreak

Clinical effectiveness

– NW London’s Policy Development Group worked with healthcare providers across the

system to develop evidence-based polices

– We undertook an analysis of CQC quality ratings for providers and set out a plan to

support improvements in areas assessed as below good.

Local response to

COVID-19

Governing Body Members

Covid-19 pandemic

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• February and March 2020, saw the focus of the organisation shift to

support and react to the Covid19 pandemic.

• The CCG worked as part of the NW London health and care partnership to change ways of working and staff were redeployed to support the emerging situation.

• A lot of work happened in a short space of time and the development of our NW London system ensured that we had a united response in terms of implementing national guidance, sharing resources and ensuring that as a system we provided the best possible outcomes for all patients through the crisis.

An overview of the 19/20 response

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February • Community testing centres and services were set up - the Heathrow isolation hotel was also opened. March onwards • Rapid expansion of intensive care capacity • Hospital and community services were changed to reduce the spread of the virus

• Outpatient appointments were provided virtually

• Across London, emergency powers were put in place

to maintain urgent cancer and cardiac care in hubs and the private sector were brought in to resume elective surgery

• In our GP practices video and telephone appointments were set-up and hot clinics were then launched to provide dedicated sites to see patients with symptoms of Covid19

• A dedicated programme of support for care homes, including greater GP support, infection control guidance and dedicated point of contact with the CCG.

The NHS is now working on the recovery, and ensuring services can be safely maintained in the event of a second wave this winter

Joint working / mutual

support & at scale

working

New model – total

digital triage, home

visiting, escalated

care clinics

Recovery focused on

priority groups based

on those most

affected by COVID

Shielded patients –

mutual aid groups

& link workers

Additional support

to care homes

Covid-19 Response

Primary

Care

Triage and streaming of

patients during first wave

Self assessment of

readiness for

reopening of

services in relation

to IPC

Virtual and physical

visits from NWL IPC

Lead to help provide

1:1 advice where

needed

NWL checklist to

ensure compliant

with obligations as

employer and

health care

provider

Online training re

IPC provided to all

practices and guidance shared

Covid-19 Response

PPE support

throughout and

ongoing

Infection

Prevention

Control

4 CQC registered

nursing care homes in

H&F

GP clinical lead in

each care home

PPE champions

identified in each

care home to

support ongoing

correct use of PPE

and infection

prevention and

control

Care home clinical

advice provided

by *6 111 out of

hours service

Pharmacy and

medication

support put in

place to facilitate

medication

supply

Covid-19 Response

All nursing home

residents tested

weekly as part of a

pilot with Dementia

Research Institute

and Imperial.

Care Home

support

Additional

support 8am-

12 midnight 7

days per week

from Imperial

(ICHT) frailty

team

Use of digital technology

has accelerated since

the start of the pandemic

Feedback and

evidence tells us that

there is digital poverty,

with inequality in

access and ability to

use the technology

Working with

local and NWL

partners to

reduce the digital

inequalities that

have become

more apparent

since the

outbreak of

Coronavirus

Covid-19 Response

Focus on

digital

We continually raise

awareness that digital is

just one option and face-

to-face appointments will

be offered to those who

need them

Between May and

July, 78 per cent of

people who use

eConsult say they are

either very satisfied

or satisfied with the

service

Promptly send all of the latest

Coronavirus information to

our patients and stakeholders

Maintain a strong two-

way conversation

through monthly PRG

meetings

Working with a

new Healthwatch

and others to

address patient

concerns and co-

design patient

involvement Covid-19 Response

Patient and

public

engagement

We are well-

represented on the

NWL EPIC steering

programme which has

a focus on Covid

recovery

Questions

Dr James Cavanagh

Chair