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NHS Mansfield and Ashfield CCG

Annual Public Meeting

7 September 2017

Civic Quarter, Civic Centre

Mansfield

Dr Gavin Lunn

Clinical Chair

Film

Review of Achievements 2016/17

and looking to the future

Amanda Sullivan

Chief Officer

Helping to shape future health and social care in Mid Nottinghamshire

Helping to shape future health and social care in Mid Nottinghamshire

Our role and responsibility is to:

• Plan, buy and monitor services

• Change the way that services work by integrating care across hospital and

community settings

• The NHS is a great success – people are living longer and more conditions

can be treated

• BUT – we develop more health problems as we get older and we need more

health care

• Re-prioritise NHS funding to provide increased levels of care – demand for

services is growing faster than funding for services

Helping to shape future health and social care in Mid Nottinghamshire

Aims of NHS Mansfield & Ashfield CCG:

1. Ensure best quality within available resources

(incorporating safety, effectiveness and patient

experience)

2. Ensure best service design

3. Ensure partnership working to achieve the safest and

most effective services within available resources

Helping to shape future health and social care in Mid Nottinghamshire

New types of services include:

• Local Integrated Care Teams (7 across mid-Nottinghamshire),

health and social care, linked to GP surgeries, joint care

planning

• Intensive home support – therapy, nursing, social care, capable

of more than traditional community services

• Call for Care – community service, navigation and rapid care

responses, linked to other professionals and take referrals

Helping to shape future health and social care in Mid Nottinghamshire

New types of services include:

• Primary care working in hubs – respond more quickly to

more problems, home visits earlier in the day

• Single front door - Kings Mill and Newark with primary

care

• Self care advice and links with community teams

• Proactive care home service, ambulatory care

Helping to shape future health and social care in Mid Nottinghamshire

Reduction in length of stay

4500

5000

5500

6000

6500

7000

7500

8000

8500

9000

9500

10000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

SFH Trust Total

15/16OBDLOS10daysplus

Reduction in mortality

Helping to shape future health and social care in Mid Nottinghamshire

Emergency Access within four hours Reduction in admissions to

nursing and residential

homes

12

What do patients say?

Integrated care team ….. Colin aged 85, was discharged from hospital. He

required help and support at home. Colin could

not lay flat in bed so was sleeping in his chair; he

had difficulty using the toilet as it was too low, he

couldn’t walk very well and when he did manage

to walk he couldn’t carry anything at the same

time.

Colin was visited on discharge by an

Occupational Therapist who assessed his needs

and within the day managed to obtain a back

rest for his bed, a raised toilet seat and a trolley

on wheels.

Colin could not thank the occupational therapist

enough and was so grateful that someone cared

enough to help him.

“It’s easier to go down a

hill than up a hill, I am

determined to keep

going up that hill one

foot in front of the

other”

Occupational

Therapist was

“fantastic”. “So grateful

that someone

cared enough

to help”.

Clinical Commissioning Group

Improvement and Assessment

Framework Overview

14

15

NHS England Ratings 2016/17 NHS Mansfield and

Ashfield CCG

NHS Newark and Sherwood CCG

Better Care

Cancer

Cancer Overall score based on early diagnosis and treatment, waiting times for treatment Inadequate Good

Care Ratings Provision of high quality care in hospitals, general practice and adult social care

Comparable with neighbouring areas –

significant improvement in provider CQC ratings in

2016/17

Comparable with

neighbouring areas –

significant improvement

in provider CQC ratings

in 2016/17

Dementia Dementia Overall score based on early diagnosis and post-diagnostic support Outstanding Outstanding

Elective Access Patients waiting 18 weeks or less from referral to hospital treatment 92.7% 92.3%

Learning Disability Learning Disability Reliance on inpatient care, annual health checks Needs Improvement Needs Improvement

Maternity

Maternity Neonatal mortality and still births, choices in maternity care and women’s experiences Needs Improvement Performing Well

Mental Health

Mental Health Psychological therapy recovery rate, 1st episode access within 2 weeks, transformation in children and young people and crisis / liaison, out of area placements Good Good

Emergency Care

Seen, treated and discharged from A&E within 4 hours Scores also on avoidable admissions, delayed transfers of care, integration of services 95.20% 93.40%

16

NHS England Ratings 2016/17 NHS Mansfield and

Ashfield CCG

NHS Newark and Sherwood CCG

Better Health

Diabetes Diabetes Treatment targets and attendance at structured education Needs Improvement Needs Improvement

Sustainability

Sustainability Financial plan Good Good

In year financial performance (did not achieve planned surplus)

New Models of Care Adoption of new care models

Y The CCG is leading the

development of a population health

vanguard

Y

The CCG is leading the development of a population health

vanguard

Well-led

Sustainability and Transformation Plan Good Good

Probity and corporate governance Fully compliant Fully compliant

Quality of CCG leadership (structure and process to deliver the scale of financial challenge) Inadequate Inadequate

Overall 2016/17 Assessment

Relating to financial position and confidence in achievement of level of required savings in 2017/18 Inadequate Inadequate

Developing new ways of

working with health,

social care and the

voluntary sector

• Managing population

healthcare demand more

effectively together

• Developing and

implementing new ways

of working

• Right care first time

Reduce waste, time and

effort

• Reducing duplication

• Review services

• Look at quality

• Maximising care in lowest

cost appropriate setting

• Save money internally

Prioritisation of services

based on the ones that

are most effective

• Evidence-based reviews of services

• Clinical criteria for NHS funded care for improved outcomes

• Value-based decision making

Having achieved considerable service

improvements, we now need to ensure

sustainability and efficiency

Need clear citizen engagement

FIT FOR PURPOSE FIT FOR TODAY FIT FOR THE FUTURE

Financial turnaround

Business cycle and processes

Staff restructuring to maximise

delivery impact and

triangulation across business

functions

Governing Body and staff development

Financial strategy, position and

delivery of savings requirements

Service performance and

constitutional standards

Service quality and safeguarding

Stakeholder relationships and

engagement

Improve NHS England rating and exit financial special measures

Alliance development moving

towards population approach and

accountable care across

organisations

Sustainability Transformation

Partnership development and

alignment

Vanguard delivery – new model of care development

2016/17 Finance Review

Marcus Pratt

Associate Director of Finance

2016/17:

Performance on Key Duties

Financial Duty Achieved Details

Fully utilise allocated funds £290.7 million spent on healthcare

services

Meet planned surplus target × Achieved a reduced surplus of £0.6

million

Remain within running cost

allowance Spent £3.6 million on running

costs. This is £19.14 per head of

population and within our target of

£23.13.

Remain within maximum cash

drawdown Cash balance of £42,000 at 31st

March

Pay suppliers within 30 days The CCG paid 95% of invoices in

30 days

2016/17: How the CCG Spent its

Allocation

The CCGs key providers were: (as a % of total CCG budget)

Notts Healthcare = 14%

Nottm Uni Hosp = 4% East Mid’s Ambulance = 2% Sherwood Forest = 40%

In 2016-17 Mansfield and Ashfield CCG experienced over £11

million of activity and price increases.

What services were delivered for the

patients?

Acute Services: hospital based services

651 hip/knee replacements (up 14%) 1178 cataract treatments (up 18%) 58523 seen in Outpatients (up 7%)

25710 Urgent care admissions (including pneumonia, COPD, heart conditions, urinary tract infections)(up 5%)

77122 Diagnostic tests including 8308 Endoscopic tests

Community Services: delivered close to patients

Service developments from 2015-16

Long Term Integrated care teams saw 12907 patients

Transfer to Assess enabled 171 patients to safely leave hospital more quickly

Primary Care & Prescribing

Over 4.7 million prescriptions issued

0.3m statins, 26 estimated lives saved

Diabetes and Prostate Cancer checks

Anticoagulation & rheumatology monitoring

Minor injury clinical

Ambulance Services

40993 calls to the service (up 2.7%)

21998 were transported to hospital (up 5.1%)

13182 patients were provided telephone advice or received treatment at location

(down 6%)

Continuing Healthcare Services

Individual packages of care for patients needing more

intensive support, either long term or at the end of life

Looking Ahead: 2017-18 and beyond

Key Challenges

• Lower growth in funding than required to

meet the rising demand for services.

• Primary care awarded an increase 1.8%

only in 2017-18.

• Increasing expectations of healthcare.

• A changing and ageing population with

differing demands.

• Fragmentation of services.

• Maintaining quality of services.

Response to the Challenge

• Turnaround Board and Financial recovery

plan in place.

• A significant savings plan to keep within

our financial allocation developed and

being delivered in 2017-18 and beyond.

• Increased partnership working across all

sectors, to increase service integration.

• Investments not yet committed for 2017-18

and 2018-19 are being deferred.

• Development of a countywide

Sustainability and Transformation

Partnership (STP).

2017-18 Allocation £ 288.2 million, an increase of £5.2 million (2.1%).

As a result of the increasing pressures in the local health system, the CCG has a

productivity and efficiency requirement of 6.6% or £19.1 million by April 2018.

Commissioning Quality

Services

Elaine Moss

Chief Nurse and

Director of Quality and Governance

How we ensure your voice is

heard in the CCG

Patient and Public

Involvement

• Citizens Reference Panel (Mansfield and Ashfield)

• Stakeholder Reference Group (Newark and Sherwood)

• Lay member representation on CCG Boards and Committees

• Lay member involvement in Quality visits

• CCG involvement with Third Sector and voluntary services

• Engagement sessions around service transformation/redesign

• Patient Advice and Liaison and complaints team

Engagement with Partner

Organisations

• Sustainability and Transformation Partnership (STP)

• Nottinghamshire Safeguarding Adult and Children Boards and sub groups

• Nottinghamshire Multi Agency Public Protection (MAPPA) Strategic Management Board

• Nottinghamshire Domestic and Sexual Abuse Executive

• Quality Panels

• Nottinghamshire County Council

• Care Quality Commission

Infection Prevention

& Control

Achievements

• Since audit visits were implemented, hand hygiene facilities have

improved in residential care homes across the county from a 53%

consistently having appropriate facilities to 83%; this contributes to

reducing the spread of infection in this vulnerable population.

• The ‘To Dip or Not to Dip’ quality improvement project continues to

improve the diagnosis and management of urine infections. The project

has led to reduction in the use of inappropriate antibiotics by early and

accurate diagnosis and highlights prevention messages including the

importance of hydration.

Managing Antibiotic Resistance

A local hydration campaign to reduce the risk of dehydration and urinary

infection - aimed particularly those aged over 60yrs

Success

This work has been recognised nationally and the group was presented

with the Antibiotic Guardian Award in June 2017. The award celebrates the

Group’s work with both NHS and private health providers in

Nottinghamshire to improve antibiotic prescribing and reduce infection resistance rates locally.

• Acute home visiting

• Best Practice promotion – focus on end of life

• Workforce improvements – therapy first, mental health and prescribing

pharmacists in practices

• Invested in technology solutions to support decision making and

standardisation

Primary Care

What was achieved……

• Diabetes – National Diabetes Prevention

Programme

• Extended Access – increased opening hours,

increasing online access

• International GP Recruitment

• Hubs where practices can develop specialist areas

Primary Care

What we will focus on next ……

A huge thank you

to all and PPGs

for the support

you have given to

our practices

Question Time Panel

Hosted by Tony Delahunty,

Mansfield 103.2

Celebrating Success in General Practice Awards

presented by

Peter Clay

Chair of Audit and Governance Committee

Partnership Working Award

This award reflects collaborative team work between

the practice and the PPG

Partnership Working Award

Winner

Orchard Medical Practice

Patient Participation Group

Going the Extra Mile Award

This award recognises a team or individual who

have gone that extra mile to make a positive

difference within their working environment, to a

patient or colleague

Going the Extra Mile Award

Highly Commended

Sam Harmsworth, Brierley Park Medical Centre

Going the Extra Mile Award

Winner Jane Campbell

“This nurse truly does go the extra mile. She is always

helpful, kind and approachable to all her patients. Nothing

is ever too much trouble and nothing phases her. All her

work is done with a smile even if she is having a bad day.

A real asset”.

Outstanding Contribution

Award

This award recognises a truly inspirational group or

individual who have had a positive impact on the

health and wellbeing of people living in Mansfield

and Ashfield

Outstanding Contribution

Award

Winner Dr. Sandeep Patel

“Dr. Patel always goes above and beyond for his patients and has turned

around Bull Farm Surgery providing continuity of care for its patients”.

“Always fitting patients in when appointments are all filled and never turning

urgent cases away”.

“Attending all locality, multi-disciplinary team, safeguarding meetings -again

for a single handed GP is not always easy”.

Innovation Award

This award celebrates an individual or a team who

have an excellent example of an innovative approach

to design and delivery of better patient care and can

provide evidence of change or outcomes

Innovation Award

Winner

Dr. Milind Tadpatrikar

Skype Consultations using iPad technology

for GP Virtual Ward Rounds

Outstanding Clinical

Leader Award

This award celebrates a clinical leader within General

Practice who has gone over and above what is

expected of them in their role and has had a positive

impact on delivery of one or more of the CCGs vision

and values

Outstanding Clinical

Leader Award

Winner Dr Karen Brown

“Dr. Brown has in a short time transformed Jacksdale Medical Centre

into a modern and welcoming place for patients that offers modern

treatment rooms. This same commitment is extending to Underwood

Branch Surgery.”

“The commitment to deliver high quality care with patients at the heart

of the practice can be evidenced in the practice mission statement and

by the online reviews of people using the service”.

Kindness Award

This award recognises a staff member who is working in Mansfield

and Ashfield who has shown exceptional kindness towards patients

and carers in the last year

Kindness Award

Winner Kellymarie Charlesworth

“Kellymarie has a can do approach to any requests for help that are wide

and varied and has many competing demands including supporting

Protected Learning Time events.

She has turned her hand to a range of challenges including filming,

photography, reception duties, mailings to practices- her talents are

endless and I would like to acknowledge the vital role she

fulfils at the CCG.”

Excellence in

Engagement Award

This award celebrates the contribution of a volunteer or

representative of a group of people who have gone

above and beyond in their position helping the CCG

Excellence in

Engagement Award

Winner Keith Wallace