Sandwell and West Birmingham CCG

Healthcare Without BoundariesOur journey so far…Dr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)

26th June 2012

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NHS Changes

An introduction to Sandwell and West Birmingham CCG

Progress towards authorisation so far

The wider context for delivery

Overview

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• Clinical Commissioning Groups to take over responsibility of commissioning health services for local populations – abolition of PCTs and Strategic Health Authorities by 2013

• Creation of NHS Commissioning Board

• Establishment of HealthWatch and local Health and Wellbeing Boards to increase accountability for patients and the public

• Creation of Public Health England to improve the health of the population

• Commissioning Support Services

Health and Social Care Act 2012

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Before Now Future

Department of Health

Department of Health

Department of Health

Department of Health

Strategic Health

Authorities

10 SHAsWest Midlands

4 SHA Clusters (Midlands & East)

NHS Commissioning Board

Local Health Ecoonomy

151 PCTse.g. Sandwell. Heart of Birmingham

50 PCT Clusters e.g. Birmingham &Solihull, Black Country

27? Local offices for NHS Commissioning Board

Local 230 CCGs 200? CCGs(tbc)

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How things are changing

Delegating Responsibility

Delegated responsibility► From 2013 new organisations will take on PCT responsibilities

Public Health

Commissioning Support Service

Clinical Commissioning Groups

Local Office (NHS Commissioning Board)

NHS Property Co.

Individual PCTs Transition to Cluster Flip Future

Heart of Birmingham Teaching PCT

Up to 2010 2011 April 2012 2012 and beyond

Sandwell PCT

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From 1st April 2012, as part of a phased approach for transition, after a rigorous Board to Board Challenge pre-authorisation process, NHS PCT Clusters started delegating some responsibility to CCGs such as:

Commissioning and monitoring of servicesDelivery of improvements and savings (QIPP)Improving quality and safetyAchieving financial balanceHitting Key Performance MeasuresCommunications and engagement

..To help achieve a seamless transition for patient care

A phased approach

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►We are passionate about improving the healthcare for the people of Sandwell and West Birmingham.

►Our vision is for transforming services to ensure excellence for everyone and in everything we do.

►Our aspiration is to create a new kind of organisation really rooted in its membership, relationships and local knowledge.

►We will be using local and clinical knowledge for change and improvement in health for our patients.

An Introduction to CCG

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Our health priorities

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CCG area

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Our health needs

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• SWBH commissioning area is around 530,000SWBH commissioning area is around 530,000• West Birmingham West Birmingham ranked ranked 1010thth most deprived most deprived Local Local

Authority in England with Authority in England with 68% BME 68% BME populationpopulation• SandwellSandwell ranked ranked 1212thth most deprived most deprived Local Authority Local Authority

in England in England with approx with approx 20% BME 20% BME populationpopulation• Health challenges against rising costs and demands Health challenges against rising costs and demands

for healthcarefor healthcare• Absolute commitment to improving quality of careAbsolute commitment to improving quality of care

11Unsafe Journey © Amy Helene Johansson 11

Who we are

Building on long standing foundation of partnership working through

Right Care Right Here between Sandwell and West Birmingham

NHS and local authorities.

“Serve a unique population - diversity unifies us”.

Bridging the health gap

The journey so far

2002 PCT arrives

2003 Right Care Right Here partnership forms

2007 Practice Based Commissioning

2008 Primary Care Collaborative Clinical Commissioning Directors appointed

2009 Partnerships form: Vitality Partnership, ICOF 10 Strategic Models of Care and clinical strategies agreed

2010 GP Consortia HealthWorks, ICOF, Black Country Alliance and Pioneers for Health22 Care Pathway Reviews agreed across health economy

2011 Sandwell and West Birmingham Clinical Commissioning GroupSeptember - agree vision values with clinical leaders

2012 Interim Board is formed with five CCGs

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Our roleBy April 2012 - shadow form as a CCG in readiness for 2013.

We want to:

1. Be clear on the health needs of our population and how we are going to

improve their health

2. Get the balance right between local and strategic decisions

3. Show real clinical leadership and development across the health

economy

4. Do this new role in the most effective way we can

5. Create a Clinical Commissioning Group that leads by example

6. Be effective in communications within our organisations and the people

we serve

7. Be ready to lead and manage the NHS as a system by April 2013. 13

Our Clinical Commissioning Group

Local Commissioning Groups Chair Practices Population

Black Country Dr George Solomon 20 112,228

HealthWorks Dr Nick Harding 22 132,985

ICOF Dr Samar Mukherjee 27 106,953

Pioneers for Health Dr Vijay Bathla 10 46,151

Sandwell Health Alliance Dr Basil Andreou 31 127,519

Clinical Commissioning Group Chair Practices Population

Sandwell and West Birmingham Dr Nick Harding(Interim Chair)

110 525,836

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Our vision and values

Mission Healthcare without boundaries

VisionWorking together, to improve health and care in our communities.

Values

We will:• be the type of organisation that listens to and appreciates

its staff and member Practices be supportive, fostering a no blame culture, ensuring that everyone is knowledgeableandwell informed, communicating well at all times

• set out what we intend to do with clarityin order to ensure that we deliver

• be inclusiveand delegateresponsibilities where we can and be transparentin all our duties and we will go the extra milefor our staff, member Practices and partners.

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A Different Approach “Membership organisation” - Delivery by Local Commissioning Groups

HealthWorks Sandwell Health Alliance

Pioneers 4 HealthBlack Country ICOF

• Develop commissioning priorities

• Develop Clinical Pathways

• Primary Care Quality including Medicines Management

•QIPP Delivery

• Membership

• Patient Participation Groups/Patient Networks

• Engagement: members, stakeholders e.g. local authority, public

• Primary Care Demand Management

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At CCG level - preparation for authorisation & futurePhase I Preparation for

authorisationOrganisation readiness: Organisational strategy: vision & values; Commissioning plan, Financial Strategy, Risk register, OD and HR plan, Partnerships Agreement, Membership Agreement, Board Development and comms and engagement plan.Setting up robust governance and processes to ensure quality and safe care within financial limits.

Phase 2 Shadow year – until April 2013

CommissioningAssurance – relationship mgmt with Clusters/SHA/DHPerformance managing contracts with wide range of providersQIPP plan – efficiencies, improvements, managing new system risksForming effective partnerships for delivery CCGs/LAsEngagement – communicating the big changesSystems – establishing new systems, ICT/information, reporting

Phase 3 As a statutory body

Commissioning contract and performance across providers: SWBH, Dudley, BCHC, BCH, BWH, BSMHT, ROHPatient and public consultation & events on major changesStrategic partnerships e.g. HWBBs, OSCs, RCRHPrimary care strategy and developmentSystem management inc emergency planning 17

Big and small…Clinical Commissioning Group Local Commissioning GroupRobustness at scale Local ownership

Resilience Ideas into action quickly

Strong voice in the health economy and contracts

Relevance

Ability to deliver through major partnerships

Patient representation and involvement

Overview of system Ability to respond to feedback, deliver improvements and efficiencies at practice level

“As a membership organisation we would like to build ways of working that are not bureaucratic with the right safeguards for all.”

Achieving the right balance - Localism

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Our interim Board Structure

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GP Directors

Lay Directors

One GP Directors to be Chair

Chair(GP Director)

Chair and Vice Chair of HealthWorks

Chair and Vice Chair of Sandwell Health Alliance

Chair and Vice Chair of Pioneers 4 Health

Chair and Vice Chair of Black Country

Chair and Vice Chair of ICOF

Vice Chair(Lay Director)

Notes•Directors are voting members•Other Board members are non voting members•The Chair will be one of the GP Directors from the LCGs, not an additional post•Vice Chair will be one of the two Lay Directors, not an additional post

GP Directors

Lay Director(Vice Chair)

Lay Director(Chair of Audit)

GP Directors

Executive Directors

Managing Director(Accountable Officer)

Finance Director(Chief Finance Officer)

GP Directors

Clinical Directors

Secondary Care Specialist

Nurse GP Directors

Other Board Members(Non Voting)

Independent Committee Members x2

Senior Officers x3

Public Health Member

Finance & Performance Sub-

Committee

Quality & Safety Sub-Committee

Strategic Commissioning &

Redesign Sub-Committee

Audit Sub-Committee

Remuneration Sub-Committee

Partnerships

Our governance

Remit: To have on-going responsibility for the affordability of the local healthcare system, and to receive monthly monitoring reports. This group will highlight concerns to the Board.

Remit: To regularly review providers to ensure that services are safe, and that outcomes are monitored.

Remit: To consider service provision and ensure that services are commissioned for shorter pathways, better value for money and that provision is appropriate and adequate.

Remit: To help with discharging financial functions. Statutory and legal obligations, working with accountable officer.

Remit: To determine pay and remuneration for employees (likely to meet on an ad hoc basis)

Remit: To work with and lead partnerships, putting resources where challenges lay. Working and delivering on two evolving agendas with LAs, Health & Well-being Boards, HealthWatch and RCRH.

Main SWBCCG

Board

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OD Sub Group

Remit: To determine and implement the OD strategy for the CCG

Organisational StructureCCG Board

•Chair•Accountable Officer

Quality & Safety Sub-Committee

Sub-Committee Chair

Chief Officer (Quality)

Independent Committee

Member

Finance & Performance Sub-Committee

Sub-Committee Chair

Chief Finance Officer

Independent Committee

Member

Service Strategy & Primary Care Sub-

CommitteeSub-Committee

ChairChief Officer (Operations)

Independent Committee

Member

Partnerships & Collaboration Sub-

Committee

Sub-Committee Chair

Chief Officer (Partnerships)

Independent Committee

Member

SHAC LCG

Dr Basil AndreouSenior Commissioning Manager

HealthWorks LCG

Dr Nick HardingSenior Commissioning Manager

Black Country LCG

Dr George SolomonSenior Commissioning Manager

Pioneers for Health LCG

Dr Vijay BathlaSenior Commissioning Manager

ICOF LCG

Dr Sam MukherjeeSenior Commissioning Manager

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Continuously improving quality

Build feedback and improvement into

annual commissioning intentions

Monitor effective delivery of quality and safe care through :

information at Quality & Safety Committee, Local Commissioning Groups feedback

Annual Quality and Safety Plan

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Progress so far

What we have done for authorisation Membership – we have a fully signed up practice membership and risk

sharing agreements in place

Agreed priorities and focus for commissioning for 2012/3

Setting out monitoring processes for quality and safety

Developed plans to demonstrate how we will operate including financial,

OD and transition plan, comms and engagement

Setting out our arrangements how we will work with others

(collaborative working/partnership plan, risks)

Joint authorisation with Black Country & BSOL

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A Constitution – good governance

Clear and comprehensive constitutions – to ensure effective structures, strong governance systems and good relationships with practices.

• Describes our statutory responsibilities as a commissioning body • Set out who and how you can be a member of the CCG, how to leave• Our internal structures • Our Elections and appointment processes, and removal from office• How we can demonstrate transparency in how our decisions are taken• Accountability to our patients, the wider local community, local council

and health and well being board • Engagement with our membership, the wider profession

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Timetable

Key datesWe are moving at a good pace and to move into the first wave of

authorisation we have an ambitious timetable of key deadlines which need to be met:

Date Activities

April 18th April19th April

CCG Board meeting Resubmission of full set of authorisation documents

May 3rd May16th May

Members engagement event 30 day consultation for proposed structures

commences CCG Board Meeting

June Recruitment to structures of CCG Process for appointment  to Chair, Accountable

officer  and Chief Finance OfficerJuly Authorisation assessment

October Outcome authorisation

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What we have learned from board to board process

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Sandwell and West Birmingham CCG

Our approach to commissioning

Dr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)

26th June 2012

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Our health priorities

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Our health needs

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Our health needs

32Health without boundaries - November 2011

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Birmingham

Complex range of providers for healthcare:

HospitalsHeart of England (3 hospitals), University Hospitals Birmingham, Sandwell West Birmingham, Birmingham Children’s Hospital, Royal Orthopaedic, Birmingham Women’s Hospital and Birmingham Dental Hospital

SpecialistBirmingham and Solihull Mental Health Trust

Community Birmingham Community Healthcare

Acute & UrgentWest Midlands Ambulance Service; Range of urgent care, walk-in and other providers – Assura, Care UK etc

Third Sector – a wide range of provision e.g. over 40+ alcohol/drug dependency services

A wide range of services available to commission from

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RCRH Comms and Engagement Chair and

RCRH Partnership Board Rep

Black Country Partnership (NHS) Trust

Birmingham and Solihull Mental Health Trust (BSMHT)

Birmingham City Council

Birmingham Community Healthcare NHS Trust

Birmingham and Solihull NHS Cluster (Heart of Birmingham tPCT)

Sandwell and West Birmingham Hospitals Trust

Black Country NHS Cluster (Sandwell PCT)

Sandwell Metropolitan Borough Council

Our strategic priorities

► Instigate – intervening early to prevent problems before they occur

► Integrate – putting the patient at the centre of their care► Innovate – changing the way we do things to deliver more

with less► Improve – focusing on the quality and safety of services in

all parts of the system ► Influence – playing a full role in local partnerships,

affecting the determinants of health

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Our plans are to:

► Increase the capacity and capability of primary care, using it as a foundation for system change

► Focus on the frail elderly, supporting independence and dignity in old age

► Accelerate the Right Care Right Here programme - providing care in the community and treating hospitals as specialist providers

► Treat mental ill health and promote wellbeing, viewing good mental health as a precondition to better physical health

► Work in partnership to improve maternity and early years, giving every child the best start in life

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Our quality priorities

Our priority How we monitor this

Safety Population health is improving

Effectiveness Treatments are effective

Patient experience Population is satisfied with their treatments

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Continuously improving quality

Build feedback and improvement into

annual commissioning intentions

Monitor effective delivery of quality and safe care through : information at Quality & Safety Committee,

Local Commissioning Groups feedback

Annual Quality and Safety Plan

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How we will ensure high quality in Primary Care

► We want to be able to use information in a way that continuously improves services – as close to ‘real time’ as possible

► Our plan is to use same data as before – but in a smarter, more user friendly way so you can react more quickly to feedback – we can control this

► Reflected in improvements in GP dashboard► National GP quality dashboard► If we get the information reporting right at practice level, this will

make the job easier and create a more accurate bigger picture

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Getting the best out of services - diabetes

Patients•Regular follow up•Easy physical access•Close to home

SWB•Managed care•Professional opinion•Costs covered

CCG•Patients managed safely•Upstream interventions•Value for money

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End of life – from pilot to rollout 2012/13

►Award winning pilot with experience-led commissioning – patients driving the processRange of events to inform strategy development e.g. Planning Alternative Tomorrows with Hope (PATH) stakeholder event (55) to agree shared vision for end of life care; review of all existing strategies, documentation and initiatives; public health and service cost data and statistics pulled together; two experience co-design events held with third sector; one to one filmed interviews with front line professionals, managers and people living with dying and carers transcribed by University of Oxford for emerging themes

►Strategy co-created with patients, carers and stakeholders

►Our strategy: “in three years time, 90% of people will die in a place they choose.”

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End of life –CCG rollout 2012/13

5 improvement workstreams have been established February 2012 supported by 2 underpinning foundation programmes:

Programme team established with wide range of clinicians, commissioners, carers, third sector delivering the workstreams to achieve improvements – with shared ownership.

► Theme 1 Tell my story – helping people to articulate end of life to be

► Theme 2 Hospice everywhere

► Theme 3 24:7 coordinated care

► Theme 4 Keeping carers well

► Theme 5 Compassionate communities – changing the culture towards dying

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Maternity and Children’s Strategic Model of Care

Experienced clinical group developed vision for Maternity and Newborn Services – October 2009:

►120,000 women aged 15 to 44 in catchment area

►Share epidemiological and economic characteristics such as high levels of deprivation

►Issues: High levels of still births and infant mortality compared to England and Wales average

►Strong evidence impact quality maternity services can make to improve health and well being of teenagers and their babies increasing number of children on path to success

►Teenage pregnancy is a key issue in Sandwell and West Birmingham

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Any Willing Provider

Foundation TrustsPrivate Sector

3rd SectorPrimary Care

So who will overview new world

Commissioners: Providers

CQCCQC

National Provider

Development Authority

National Provider

Development Authority

• Set maximum prices

• Maintain continuity of care

• Quality• Safety

NHS Commissioning Board

NHS Commissioning Board

HealthWatchHealthWatch

Overview and Scrutiny

Committees

Overview and Scrutiny

Committees

MonitorMonitor

• Support & develop

The RATAR model

• Access to a Referral, Assessment, Treatment,

Advice and Recovery model through a single point.

• Provision of Care Closer to Home• A service based on outcomes with patients,

families and carers at the heart• Integrated Care Pathways• Collaborative Care

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• The CCG will have as a priority the ongoing commissioning and further development of mental health and well being services.

• Developments will focus on an integrated mental health service and the development of Primary Care mental health and wellbeing in the community to meet the needs of the population.

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Some successes already

► Reduction in A&E attendance by 6%

► Promotion of effective medicines management

► Good examples of GPs working together

► Defining agreed patient experience standards

► End of life pilot - being rolled out across CCG

► Dermatology – reductions in hospital attendances

► Improved access – radiography available in community

► Award winning patient consultation processes

► Approval to go for first wave authorisation…

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How we currently invest in secondary healthcare

Provider BSOL Sandwell Total

£000's £000's £000’s

SWBH 77,936 157,260 235196

BSMHT 23,724 1,443 25,167

BCPFT 230 33,915 34,145

Birmingham Children’s

634 5,065 5,699

SCHS 8,804 34,553 43,357

BCHS 27,409 3,628 31,037

TOTAL 374,60150

How we work with other CCGs

► Leadership /advice – clinical senate?► Clinical leads for commissioning for contracts?► Nominated contract leads – how this will work:

“hosted by a CCG but ensuring those CCGs with ‘significant interests’ are represented around the discussion table’ e.g. urgent care, BCHC

► Health and Well-being boards – shared strategy for city

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Quality Priorities 2012/13

1. Developed draft CCG Quality and Safety Plan – out for consultation to members (issue 2) www.swbcg.link ]

2. Putting quality into all our contracts – ensuring we are commissioning for quality e.g. alcohol CQUIN

3. Monitoring delivery of quality and safety through Quality and Safety Committee and formal Clinical Quality Reviews (e.g. meetings, reviewing incidents/never events, visits)

4. Provider development5. Primary Care development

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Thank you► Have learned a great deal already and much

to build on► Remain committed to what its all

about….patients and quality of care► Committed to working with the third sector,

patients, carers to develop together the best healthcare

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Questions?

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12 months on…

Shared vision and strategy - We have an integrated plan which has involved all health and local authority partners

Shared way of working through the Compact - for shared leadership across the NHS and local authorities

Resources - Good progress has been made - a coordinated structure was established pooling the resources of four PCTs

Results so far - Delivery is good - moving from forecast £50.5m deficit to £2m planned surplus; key quality and performance targets achieved

Greater push on transformation and delivering improvements

Greater emphasis on quality and improving primary care

Supporting development of future organisations More integrated working

→ specialised service pathways and joined up services → Councils working with health on care for older people

Financial planning - Still heading off increasing financial pressures for years ahead

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Integrated Plan

Brief• Support the Frail Elderly Programme

Signed off by CEO Compact

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Patient/Clinician Journey

Dr S Mr/s D

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Clear and comprehensive constitutions – to ensure effective structures, strong governance systems and good relationships with practices.

►Describes our statutory responsibilities as a commissioning body ►Set out who and how you can be a member, how to leave►Our internal structures ►Our Elections and appointment processes, and removal from office►How we can demonstrate transparency in how our decisions are taken►Accountability to our patients, the wider local community, local council and health and well being board ►Engagement with our membership, the wider profession

A constitution – why?

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The journey to authorisation

► Approval to go for first wave authorisation► What we need to demonstrate:

→ Examples of how member practices are involved in decision making within the CCG/LCG

→ How we work together - constitution

→ Election process – competency and representation

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New NHS

LicensingLicensing

Department of Health

Department of Health

CQCCQCNHS Commissioning Board

NHS Commissioning Board

Local HealthWatchLocal HealthWatch

ParliamentParliament

MonitorMonitor

Patients & PublicPatients & Public

ProvidersProviders

PartnershipPartnershipLocal AuthoritiesLocal Authorities

SWB CCGSWB CCG ContractsContracts

Birmingham HealthWatchBirmingham HealthWatch

Sandwell HealthWatchSandwell HealthWatch

Accountability

Funding

Key:

Right Care Right Here partnership

BSMHT, BCP, BCHC, SWBH

Other providers BCH, BWH, ROH, DGH, RW, SWB, WM, and I/C.

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