Transcript Slide 1

Everyone Counts
Planning for Patients in Liverpool
2013/14
Welcome & Introductions
Dave Antrobus
Governing Body Lay Member –
Patient & Public Involvement
Housekeeping
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Toilets
Fire Alarm
Hearing Loop (T.coil position)
Mobile Phones (silent)
Purpose of the Session / Follow
up from Last Event
Moira Cain
Practice Nurse Brownlow Group Practice
& Governing Body Member
Our vision/your vision
By 2020 health outcomes within Liverpool
will have improved relative to the rest of
England and health inequalities within
Liverpool will be narrowed.
We are here today to discuss and shape the
plans to deliver on this statement in 2013/14
From our Plan on the Page :
Do we have the Right Priorities?
Do we have the right services and providers
delivering on them?
Are they delivered in the right places?
At our last event You said:
Take the services to the people
Access points around the Community
Specific services in specific areas
Since then we did :
We have seen the completion of 9
Neighbourhood Centres across the city
The services in these centres were discussed
with the local communities
An example is Alder Hey delivering services
in the Garston Neighbourhood Centre
Patient Participation Groups
We now have 65 (68%) of patient participation
groups, with 3 functioning locality forums.
At these forums service change has been discussed
and local providers have spoken to the group
An example of which was the options for the
delivery of a Gynaecology service
You said, we did:
You said engage people in different areas:
North Locality have engaged patients through the Cobalt
tenants group and Communiversity Community
Engagement Forum.
A Neighbourhood in Earle Road engaged patients through
Health Champions going to Mosques, Churches and
Synagogues to spread the health message to attend for a
over 40’s health check. Using leaflets in their languages.
You said gather a register of
community groups
All the practices across Liverpool have
been asked to look into their close
communities and gather a practice list of
all local third sector and voluntary
organisations in the area. Some of which
many of their patients already access.
Everyone Counts
Planning for Patient
in Liverpool 2013/14
How will the Clinical Commissioning Group
(CCG) work with Liverpool Community Health.
Connection based on
relationship of commissioner
and service provider.
Commissioner has responsible
for budget and appropriate
spend to benefit needs of
population.
CCG will commission services
from Liverpool Community
Health. Services that will be
assessed as to whether they
meet the needs, in the same
way as all providers, and will
be expected to ensure the
patient is at the heart of care.
Does the CCG have any plans for Integrated
Wellness Services?
Liverpool CCG will work with
Liverpool City Council’s new Health
and Wellbeing Board.
Ensure the population needs receive
Wellness Services.
What Feedback will be available?
Issues
highlighted by
workshops and
Patient
Engagement
resulted in the
following
actions and
outcomes being
highlighted in
the initial event
at LACE.
• Work with GP’s to support and
establish Patient Participation
Groups
• Communication with patients
improved by newsletters, local
newspapers, internet, radio, and
printed publications.
• As suggested on the day a Patient
and Public workgroup to review
potential literature is envisaged.
How will voluntary sector groups be involved in
the decision making, specifically small charities
and service providers?
The CCG has
engaged
With patients
Groups
Shaping and
development
of new
services
Review of
existing
service
provision
Capturing
patient
experience.
Liverpool Clinical Commissioning
Group: The Journey So Far
Katherine Sheerin
Chief Officer
The Commissioning Landscape
• Liverpool PCT
£1bn
• Liverpool CCG
£730m
• Liverpool Local Authority
£40m
• NHS Commissioning Board £230m
LIVERPOOL CCG
• 493,000 Patients
• 95 practices
• 1 CCG for Liverpool
What is different about CCGs?
• Closer to patients
• Clinically led
• Practices are members
• Your GPs making decisions
• ‘Living by’ decisions
CCG Governing Body
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9 GPs
2 Nurses
2 Lay Members
1 Secondary Care Doctor
1 Chief Finance Officer
1 Chief Officer
Co-opted Members
CCG Plans
• The Mandate
• Everyone Counts - Planning for Patients 2013/14
• Health Outcomes Framework
• NHS Constitution
• Joint Strategic Needs Assessment
Understanding Liverpool:
Plans for 2013/14
Tony Woods
Head of Strategy & Outcomes
Our Population
• CCG Registered 493k, resident estimated at
466k
• Similar to national except for 20-24 & 25-29
which reflect students and young
professionals, increased notably since 2002
• Projected to increase age significantly over the
next 20 years
• 65+ population to increase by a third
• Small but growing BME population (9%)
Deprivation
• Most deprived LA in England
• 65% of our areas (LSAO) are ranked in the
bottom 20% nationally
• Almost all neighbourhoods in North Liverpool
are in the bottom 10% nationally
• 27% of households in Liverpool are classified
as ‘families in low-rise social housing with high
levels of benefit need’ – 5 times the national
average
Death and Morbidity
Main causes of death
• Cancer (31%)
Main causes of morbidity
(DALY)
• Mental Health (23%)
• CVD (27%)
• CVD (16%)
• Respiratory (15%)
• Cancer (16%)
• Digestive (6%)
• Respiratory (8%)
• Digestive (8%)
Life Expectancy
• Liverpool males is almost 4 years lower than
national average (74.81)
• Females is almost 3 ½ years lower (79.19)
• Males living in wards with highest life
expectancy in Liverpool can expect to live 11
years (8 years for females) than individuals
living in the ward with the lowest life
expectancy
OUR PRIORITIES AND PLANS FOR
2013/14
By 2020, health outcomes for people within Liverpool will have improved relative to the rest of England, and health inequalities within Liverpool will be narrowed. This will be
measured by life expectancy for Liverpool people and numbers of Disability Adjusted Life Years Lost.
Vision
The quality of health care received by Liverpool patients will be first class. This will be measured by patient feedback, provider assessment and external review processes
Growing Elderly
Population
No £ Growth
Expected
Improving Recovery from Stroke
Improved Patient Experience of
Primary Care, Hospitals and Mental
Health Services
Delivery of access targets
Reduction in the Incidence of
Avoidable Harm in Hospitals
Reducing Health Inequalities and
Unnecessary Variation
Values
Urgent Care
Planned Care
Mental Health and
Learning Disabilities
Dementia
Alcohol
* Delivery of Liverpool Integrated Care Model
* Risk Stratification, Self Care and Education
* Multi-Agency Neighbourhood teams
* Care Homes Support
* Enabling Technologies (dallas Feel Good Factory)
* Maternity Matters and Healthy Child
* A&E attendance for primary care problems
* Equipment Services
* Transition to Adult Services
* Right Care in Right Place
* Access, waiting times and discharge planning
* Implementation of 111
* Same Day Emergency Care in Hospitals
* Focus on Access to Services
* Right Care in the Right Place
* Quality, Safety and Patient Experience
* Demand Management
* Liverpool Model for Primary Mental Health Care
* Rehabilitation Model of Care
* Integrated Care Model
* Physical Health Checks
* Transition from Child Services
* Integrated Pathway for Earlier Detection,
Diagnosis and Post Diagnosis Support
* Secondary Care Services including Memory
Services, Inpatient and Liaison
* Focus on Innovation
* Maximise Liverpool Community Alcohol Service
Utilisation
* Shared Care Pathway for Problem Alcoholics
* Increasing Awareness of Impact of Alcohol
Be patient focused / Believe in partnership and collaboration / Be locally-focused / Be progressive / Be accountable / Demonstrate integrity and respect
System Leadership
Children
* Pathways Implementation
* Reducing Variation in General Practice
* Community Respiratory Team Utilisation
Patient, Public and Stakeholder Engagement
Improving Outcomes from Planned
Treatments
Integrated
Care
* Diabetes Model implementation
* Improved diagnostics
* Pathways Implementation
* Reducing Variation in General Practice
Informatics
Reduction in Emergency
Readmissions
Respiratory
* Supporting Choice
* Liverpool Care Pathway
* Carers Support
Organisation Development
Reduction in emergency admissions
for acute conditions and children with
lower respiratory tract infections
CVD
* Early Detection and Screening
* Pathway Development and Implementation
* Timely Access
* Liverpool Cancer Centre
Prescribing
Reducing Time Spent in Hospital by
People with Long Term Conditions
End of Life
Enabling Themes
Research and Innovation
Supporting People to Manage their
Condition and Enhancing Functional
Ability in People with Long Term
Conditions
Cancer
Long Term Conditions
Enhancing quality of life for people
with mental illness and dementia
Maximising Value of Commissioning Spend
High Quality Services Leading to Improved Health Outcomes at Low Cost
Treating and Caring for People in a Safe Environment and Protecting them from Harm
Improvement
Opportunities
Ensuring that People have a Positive Experience of Care
High Hospitalisation
Enhancing Quality of Life for People with Long Term Conditions
Health Inequalities
Preventing People from Dying Prematurely
High Deprivation
Helping People to Recover from Episodes of Ill Health or Following Injury
Improved Cancer Survival Rates
General Practice & Community
Services
Excess Cancer and
CVD Deaths
Prevention & Early
Identification
Reducing Premature Mortality from
Major Causes and reducing deaths in
people with SMI, babies and young
children
Transformational Change Initiatives
(Under Development tbc with Programme Leads)
Primary Care Quality and improvement
Whole System
Approach
Secondary Care
Services
Outcome Indicators
Joint Commissioning
for Integrated Delivery
Context
Cancer
Key Issues
Key Plans for 13/14
• High incidence and mortality
across most Cancers with
highest mortality rate in
England for Lung Cancer and
All Cancers combined
• Evidence of inequalities within
the city
• Evidence of late presentation.
Survival rates are
comparatively good once
detected
• Improved pathways (Lung,
Colorectal and Upper GI)
• Improve waiting times
• Focus on survivorship
• MacMillan GPs to provide GP
education
• Introduce Flexible Sigmoidoscopy
• Ensure cancer messages are
available for all with focus on
BME groups
• Audit of emergency admissions
Long Term Conditions
(CVD, Diabetes, Respiratory)
Key Issues
• High mortality rates
• High emergency admissions
• Variation in delivery of
quality standards
• Poor completion rates for
rehabilitation
• Significant opportunity to
reduce unnecessary cost
and reinvest for improved
outcomes
Key Plans for 13/14
• Implementation of Integrated
Care Model
• Improve Diabetes care
• Focus on reducing variation in
quality
• Service reviews – Heart Failure,
ECG, Anti-coagulation
• Pathways implementation for
CVD and Hypoglycemia
• Implement national specification
for Cardiac Rehabilitation
Children
Key Issues
• High rates of emergency
admissions
• Quality issues in transition
to adult services
• Early years affects life
choices
• Low breast feeding rates
• Maternal smoking and
alcohol
Key Plans for 13/14
• Reduce unplanned admissions at
Alder Hey
• Integrated pathway for children
with complex needs
• Focus on transition from child
services to adult (Mental Health,
LTC)
• Improvement of breast feeding
rates
• Reduce prevalence in maternal
smoking
Mental Health and
Learning Disability
Key Issues
Key Plans for 13/14
• High incidence of mental
illness
• Significant demand on general
practice
• Austerity measures will impact
on mental health and hit a city
like Liverpool hard
• Opportunity to change model
of care to improve primary
care and prevention
• Focus on primary mental health
care model improvement
• Reduce Out of Area Treatments
• Physical health needs for SMI
• Improved access to secondary
care
• Development of local personality
disorder rehabilitation
• Implementation of Winterbourne
Recommendations (repatriation)
• Reduce waiting lists for specialist
psychological therapies
Dementia
Key Issues
• Ageing population
• Increasing need
• Need to focus on early
detection
• New international evidence
and innovative approaches
emerging for more
proactive care models
Key Plans for 13/14
• Integrated pathway for the earlier
detection, diagnosis and post
diagnosis support
• Continued development of
secondary care services inc
memory services, inpatient
facilities and liaison
• Systematic approach to early
identification in general practice
• Care Homes Integrated Care
• Cares advice and support
• BME Champions programme
Alcohol
Key Issues
• High rates of emergency
admissions
• High use of A&E
• Rising cause of mortality
• Evidence of variation in
awareness in general
practice
• Public awareness
Key Plans for 13/14
• Improved utilisation of
Liverpool Community Alcohol
Service
• Development of shared care
pathway for problem alcoholics
• Awareness campaigns for
primary care teams and general
public
• Review service impact and care
model for Korsakoff Syndrome
End of Life
Key Issues
• Maintain focus on delivery
of high quality services
• Improve public
understanding of care
pathways for the dying
Key Plans for 13/14
• Review current status of
Liverpool End of Life Care
Strategy
• Implement and commission
full STARS care programme
• Roll out DNACPR policy
across Liverpool
Urgent Care
Key Issues
• High rates of emergency
admissions
• High use of A&E
• Continued pressure in
meeting 4 hour target
• General practice access
Key Plans for 13/14
• Same Day Emergency Care
tariffs
• Reduce GP in hours A&E
attendance (GP Spec)
• Implementation of 111
• Implementation of GP Out of
Hours provider
• Continued focus on access
targets
• Review of existing service
models
Planned Care
Key Issues
• Opportunity to move
services closer to home
(Right Care, Right Place)
• Improvement of quality
standards
• Improve patient experience
Key Plans for 13/14
• Service developments in
Orthopaedics, ENT,
Opthalmology, Gastroenterology
• Urology service shift to primary
care
• Improve management of
Dermatology in primary care
• Delivery of access targets
• Infection Control
• Family and Friends Test
• Patient Reported Outcome
Measures
Enabling Themes
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Primary Care Quality and Improvement
Prescribing
Research and Innovation
Informatics
Organisational Development
Patient, Public and Stakeholder Engagement
System Leadership
Summary
• High need within city
• Clear prioritisation and focus
• Clear plans for 13/14 and finalising longer
term plans
• Clinical leadership and support in place to
deliver improvements
Over to you . . . Table Discussions
Time to tell us what you think
Having heard the commissioning
plans for 2013/14, do you think
we are focusing on the right
priorities?
Feedback from the Floor
Creating a Partnership
Alan Lewis
Chief Executive
Liverpool Charity & Voluntary Services (LCVS)
Partnership means….. ?
A partnership is an
arrangement where
parties agree to
cooperate to advance
their mutual interests
Jul-15©LCVS
46
A partnership is a deal…
A partnership is a contract between
individuals who, in a spirit
of cooperation,
agree to carry on an enterprise;
contribute to it by combining
property, knowledge or activities;
and share its profit.
Jul-15©LCVS
47
Joint Ventures
• A legal organisation in the form of a
short term partnership
• Jointly undertake a transaction for
mutual profit.
• Each contributes assets and share
risks.
• Local examples:
• Liverpool Direct Limited (LDL)
• Enterprise-Liverpool
Jul-15©LCVS
48
Partnership advantage
will be achieved
– when an objective is met that no
organisation could have produced
on its own, and
– when each organisation is able to
achieve its own objectives better
that it could alone
or
1+1=3
Jul-15©LCVS
49
Doing different because
the same won’t cope
UK
2010 10,000
centenarians
2034 100,000
centenarians
Jul-15©LCVS
50
The Challenge
The big five avoidable killers
•Heart disease
•Cancer
•Stroke
•Lung disease
•Liver disease
Leading UK health risk factors
•Tobacco smoke (including second-hand
smoke)
•High blood pressure
•Obesity
•Too little exercise
•Alcohol use
•Poor diet
Source: Global Burden of Disease project
Jul-15©LCVS
51
"Despite some enviable recent
success, for example on smoking,
we in the UK need to take a hard
look at what can be done to help
people in the UK achieve the levels
of health already enjoyed by some
other countries. Central and local
government, charities, employers
and retail businesses all have a part
to play."
Prof John Newton,
Chief Knowledge Officer
Public Health England
Jul-15©LCVS
52
"We can never get a recreation of community and
heal our society without
giving our citizens a sense
of belonging."
-- Patch Adams
"Independence"... middleclass blasphemy. We are all
dependent on one another,
every soul of us on earth.
-- George Bernard Shaw
Jul-15©LCVS
53
Ladder of Participation
Sherry Arnstein,
(1969)
Jul-15©LCVS
54
21 Participation Techniques
Action Planning
Open Space
Act Create Experience (ACE)
Parish Maps
Choices Method
Participatory Budgeting
Citizens Juries
Participatory Strategic Planning
Community Appraisals
Participatory Theatre
Community Indicators
Planning For Real
Enspirited Envisioning
Round Table Workshops
Future Search
Social Audit
Guided Visualisation
TalkWorks
Imagine!
Team Syntegrity
Local Sustainability Model
………… and there are more!
Jul-15©LCVS
55
The one system approach
Structured power -– commercial, public, non-profit
Job
Health
Local
Police
Schools
centre+
Service Authority
Top
Down
?? Possibilities ??
Bottom
Up
Individuals – Communities – Free association
Jul-15©LCVS
56
What is the deal?
Accessible when needed
Effective Health & Social
Care system
Healthy Communities
Affordable
Jul-15©LCVS
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Community Investment
• Local assets as the primary building blocks
of sustainable community development.
• Building on the:
• skills of local residents,
• power of local associations,
• support of local institutions,
• Draws upon existing community strengths
• Builds stronger, more sustainable
communities for the future.
Jul-15©LCVS
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Cooperative action
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Reach out to community
Realistic expectations
Respect difference / diversity
Responsibility for views & actions
Results focused
Reflection
Recognition of contributions
Review impact
Jul-15©LCVS
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Social not Structure
Jul-15©LCVS
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Authorities’ Investment
• Sustainable neighbourhood-based
organisations
• Low level continuous ‘light touch’ support:
– a facilitator
– credit
– networking opportunities
– help with action planning
– a broker
• Intensive community development support
Jul-15©LCVS
61
Your Questions Answered
Your Views Count
Fingers on buttons
Looking over the 2013/14 plan for Liverpool
residents, do you agree the right issues and
areas are being focused on?
29%
e
su
r
No
t
No
8%
Ye
s
1. Yes
2. No
3. Not sure
63%
Do you think that the plan will achieve
what it is setting out to do?
57%
25%
e
su
r
No
t
No
18%
Ye
s
1. Yes
2. No
3. Not sure
Having listened to the presentations, do you have a
better understanding of Liverpool Clinical
Commissioning Groups plans?
83%
1. Yes
2. No
3. Not sure
e
su
r
No
t
No
Ye
s
5%
12%
Have you had an opportunity at today’s
event to have your views heard?
89%
1. Yes
2. No
3. Not sure
su
r
e
8%
No
t
No
Ye
s
3%
Staying Involved
Katherine Sheerin
Chief Officer
Dates for your Diary
5 Year Plan Engagement Events:
Wednesday 24th April, 1-4pm (North)
Thursday 2nd May, 1-4pm (South)
Tuesday 7th May, 1-4pm (Central)
Invites will be circulated shortly
Closing Comments
Dave Antrobus
Governing Body Lay Member – Patient
& Public Involvement