Transcript Changing the way we deliver care

Our Five Year
Strategic Plan and Challenges
Dr Mary Backhouse
Chief Clinical Officer
North Somerset CCG – Our Vision
We know that for people to be truly healthy
it is not only the quality of healthcare
services that matters. That is why we are
committed to working together with our
whole population, individuals and other
organisations to create the healthiest
communities.
Life in North Somerset
Community
engagement,
involvement
and
leadership
Reducing
inequalities
Vulnerable
groups
known
Seamless
person centred
pathways/
networks
Employment
Creating
health
through
wealth
Life and Society
in
North
Somerset
High impact
families and
individuals
(supported)
Education
Politics/
civic life
Flexible/ integrated
deployment of
public resources
across N Som
Commerce
Integrated
health and
social care
Sustainable
provider
networks
Physical
environment
Strategic to do list for North Somerset
CCG
3. Grip FY14/15
1. Develop core
commissioning
functions
4. Build the
transformation
strategy
2. Understand
strategic
challenges
2
Our context - Joint Strategic Needs
Assessment
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Inequalities in health and employability
Mental health
Substance misuse
Growing population with significant very
elderly population
Our patients needs are changing with
demography -Demographic Growth Projection - 5 years to 2018
• North Somerset will see
around a 32% increase in
the number of people
aged over 75 in next 5
years compared with
national average of 11%
18000
16000
14000
12000
10000
8000
6000
4000
2000
2008 Registered Pop
2013 Registered Pop
AGE 90+
AGE 85-89
AGE 80-84
AGE 75-79
AGE 70-74
AGE 65-69
AGE 60-64
AGE 55-59
AGE 50-54
AGE 45-49
AGE 40-44
AGE 35-39
AGE 30-34
AGE 25-29
AGE 20-24
AGE 15-19
AGE 10-14
AGE 5-9
AGE 0-4
0
2018 ONS Projected Pop Growth
8
Our context – challenging finances
• Both the Clinical Commissioning Group and Local
Authority are under funded
• Clinical Commissioning Group Finances approx £250m
per year
• Underlying deficit £17m reduced to £4m
• Challenging savings targets and need to repay deficit
• £10m savings target this year
• Planning for recurrent balance within 3 years
• Cost pressures - ageing population, new medicines and
technologies, new central requirements
The construct of the funding formula requires a greater
level of efficiency than other CCGs, and may not be
possible to reach
•
Key messages
–
Non-acute spend is
below average on a
weighted capitation
basis – with very low
costs in community
care and Mental
Health
–
While acute spend
and CCG running
costs are around
average – CCG
funding is 7 % below
average
–
NHS funded nursing
care (FNC) spend
one of the highest
in the country - the
high number of
nursing home places
attracts residents
from elsewhere –
though this is a very
small proportion of
the overall budget
North Somerset CCG Spending per Wtd Capita % of Expected
CCG running costs
100
Medicines
86
CHC
82
FNC
146
MH and LD
81
Community and out of hours
67
Acute
96
-
20
40
60
80
100
120
140
160
£ per weighted capital %
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NSCCG is accountable for close to £250m of NHS
spending, more than half of which is undertaken with local
acute providers
•
North Somerset CCG - Total Spend (2013/14)
300
32
250
14
200
5
252
CCG running costs
Total
7
20
£ million
28
150
146
100
50
AcuteCommunity and out of hours
MH and LD Continuing care/FNC
High cost individuals Medicines
Key messages
–
Total budget £252m
–
Acute spending
accounts for 59% of
all commissioning
spend
–
Nearly 90% of acute
spend is with local
acute providers
–
Second biggest area
of spend is
medicines
–
Fastest growing
areas of spend
include
• Medical
Emergency
admissions
• A&E
• Elective
Orthopaedic
s
• NICE
• Diagnostic
scopes
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£30m cash savings from acute spend will not be achieved without
structural change in the way health and social care services are
provided
£30m acute spend
50% of Weston Hospital spend
100% of NBT spend
80% of UHB spend
250 emergency hospital beds
100% of medical and surgical
emergency beds
100% of outpatient services
Prioritisation criteria
• The CCG will prioritise its commissioning intentions based on
the following criteria:
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Health Outcomes
Safe effective care
Plans are affordable and achieve value for money
Reduction in health inequalities
Working together with partners.
Responding to national priorities
Local priorities
…and we are facing a number of
strategic challenges
1.
2.
3.
• Meeting rising
demand in a flat
cash environment
• Securing a safe
and sustainable
provider base
• Delivering
financial balance
4.
5.
6. External
• Supporting a
challenged social
care system
• High degree of
stakeholder
interest
processes
transforming acute
care (Weston, NBT
& NSCP)
7.
8.
9.
• Engaging and
motivating GPs
• Shifting care into
the community
and closing beds
• Agreeing a shared
integrated
transformation
position
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Plans for quality
• Action Area 1: Helping people to stay independent,
maximising well-being and improving health outcomes
• Action Area 2: Working with people to provide a
positive experience of care
• Action Area 3: Delivering safe, high quality care and
measuring impact
• Action Area 4: Building and strengthening leadership
• Action Area 5: Ensuring we have the right staff, with
the right skills, in the right place
• Action Area 6: Supporting positive staff experience
• Action Area 7: Safeguarding of children and adults
• Action Area 8: Seven Day Working
Changing the way we deliver care
• A completely new approach to ensuring that
citizens are fully included in all aspects of service
design and change and that patients are fully
empowered in their own care
• Wider primary care, provided at scale
• A modern model of integrated care
• Access to the highest quality urgent and
emergency care
• A step-change in the productivity of elective care
• Specialised services concentrated in centres of
excellence
North Somerset CCG – Plan on a Page
Vision: North Somerset – Creating the healthiest community together
Values and
Behaviours
Purpose
To be patient centred
To be fair and equitable
To be inclusive
To be committed to safe high quality and effective care
To be compassionate and kind
To be a good partner to work with to improve the health of the population
To be a trustworthy, honest, open and listening organisation
1. Ensuring an integrated health and social care system for adults and children, driven by quality and innovation
2. Commissioning health care for the patients of North Somerset which is cost effective and delivers Health Outcomes in line with the NHS
Outcomes Framework
3. Reducing health inequalities, working in partnership
4. Giving people confidence and skills to take care of themselves and stay as healthy as possible
5. Improving patient care by ensuring there is easy access to shared information, which is up to date, meaningful and accurate
6. Creating an environment which motivates member practices to be engaged commissioners and to deliver safe care, good patient experience
and evidence based practice
7. Being a successful dynamic organisation that provides a rewarding place to work
Strategic
Priorities
Developing a model of care which is clinically safe and sustainable
Achieving financial sustainability
Improving health outcomes and reducing inequalities
Programmes
of care
Continuum of care for Adults
Urgent Care
Planned Care
Children and Young
People and
Maternity
Developing Primary
Care
Objective
Improving Patient centred care
Promoting independence, intensive support
and end of life care
Parity of esteem between mental and
physical health
Ensure LTCs are effectively managed
Increase work with the voluntary sector
Supporting patients and their families to stay
living independently at home.
Increased senior decision making support
Developing a new model of rehabilitation
Providing high quality support for people with
mental health problems
Access to the highest quality
urgent and emergency care
Step change in the
productivity of elective
care
Developing care
focused around high
impact families
Support the development
of wider primary care
Increased out of hospital
accessible services
Increased ambulatory care and
reduced length of stay
Reduced emergency admissions
and ED attendances
Improve public understanding of
urgent care services
Improve referral
management
Develop pathways of
care
Increase productivity
Work with a range of
stakeholders to deliver
high quality support
for children and
families.
Interventions
Enabling
Workstreams
Partnership Working Arrangements
Wider Resource allocation strategy (inc capital)
Innovative commissioning and contracting arrangements
Workforce strategy
Knowledge management, research and evidence
Organisational Development
Better Care Fund Programme
Effective stakeholder engagement
Management of NHS infrastructure
IT Strategy
Developing the provider landscape
Medicines Optimisation/NICE
Work with primary care
providers to improve
quality and access.
Develop locality approach
to prevention, early
intervention and selfcare.
5 programmes - based on local
needs
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Continuum of Care
Urgent Care
Elective Care
Primary Care
Children and maternity services
Moving from the current fragmented
system towards a more integrated
approach
Fragmented approach
Coordinated system
Fully integrated H&SC
system
Housing
Education
TODAY
Current fragmented
approach
FY14/15
Coordination through
CQUIN and other
incentive schemes
FY15/16
Alignment though
outcome based
contracting
FY16+
Patient focused
integrated care
Strategic Level Participation
Public, Patient and Carer voices at the
centre of health care services:
Healthwatch and VANS
Public, Patient and carer
involvement
• North Somerset Health Overview Scrutiny Panel
• Healthwatch North Somerset - voices for health
• Community Services Procurement
• North Somerset Citizen’s Panel:
• North Somerset CCG Website and Social Media:
• North Somerset CCG Stakeholder Events:
• Practice Patient/Reference Groups (PPGs/PRGs) :
• Voices for Health Strategic Review Group and the
Equalities and Engagement Group
• Participation and Insight Reporting - collecting feedback