Transcript Front Page Header - Lincolnshire East CCG

Patient Participation Groups
Engagement with
NHS Lincolnshire East CCG
Introduction and purpose
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The purpose of this morning’s session
How patient views feed into the CCG
The role of Healthwatch
PPG group discussion
Lunch and networking
PPE
structure
PPE
structure
Healthwatch Lincolnshire
Jean Hill & Sarah Fletcher
What is Healthwatch?
• Healthwatch is to champion the voice of Lincolnshire people.
• Gather intelligence to inform and influence changes to services.
• Healthwatch has a role in supporting local people find the services and
signpost appropriately.
What makes up Healthwatch Lincolnshire
What are our statutory powers
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Like all local Healthwatch bodies, we have a statutory seat on the Health
and Wellbeing Board, the body that oversees health and social care in the
county and have the power to influence commissioning decisions.
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We have statutory powers to enter and view health and social care
services using our authorised volunteers.
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Healthwatch also has a place on the new Quality Surveillance Groups that
are being set up in the NHS to monitor provider quality.
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A right to request information and to receive a response within 20 days.
What the People of Lincolnshire said…
• You said …partnership working with key agencies was important.
• You said …that HealthWatch should engage and consult with
existing groups and members and the community.
• You said …HealthWatch should talk to people.
• You said …HealthWatch should use existing groups and places to
promote itself.
• You said …HealthWatch should have a strong chair and board
members who are passionate about what they do.
• You said …meetings should be open, friendly, relaxed and not too
formal.
• You said …HealthWatch should inform the Health and Wellbeing
Board about the matters that concern the public, not just the
matters that concern the board members.
• You said …HealthWatch should scrutinise the services that people
use.
Getting involved and
being empowered
As a provider?
As a member of the public?
As a commissioner?
As a member of the community, voluntary
and wider support network?
Contact Us
Healthwatch Lincolnshire
Unit 11
Gateway Park
Lincoln
LN6 9HU
Telephone : 01522 705190
[email protected]
http://www.healthwatchlincolnshire.co.uk/
PPG group discussions
• Tell us your thoughts on our proposed structure
• What does the CCG need to do to help you carry out your
PPG role?
Lunch
An opportunity to meet with your fellow PPGs, network and
work towards developing locality PPG groups
Identifying Commissioning Intentions
Stakeholder Event
2014/15 – 2016/17
Welcome and Introductions
Gary James
Accountable Officer
NHS Lincolnshire East CCG
• NHS Lincolnshire East Clinical
Commissioning Group
authorised on 1 April 2013
• Skegness & Coast, East
Lindsey and Boston Area
localities include 30 practices
covering 1,060 square miles
including Skegness, Louth and
Boston
• Population 241,246
• Budget 2013/14: £310m
Purpose of today
• Update you on what we’ve done
• Identify how we achieve change
• Understand how we can engage with you in the future
Vision
We have a vision of a CCG where clinicians are working
together to improve the quality and cost effectiveness of care,
with resources based on need, and which benefits all of our
patients as fairly as possible
Mission
Ensure the optimum health and wellbeing of the people we
serve by commissioning high quality health services which
support choice; promoting healthy lifestyles and personal
responsibility; reducing inequalities in opportunity, experience
and health outcome; and managing our allocated resources
effectively and responsibly
Plan on a Page
Three phase process
for Commissioning Intentions
Public Health and health of the population in
Lincolnshire East CCG
August 2013
Chris Weston
Consultant in Public Health
Contents:
Public Health
Demography
Disease prevalence
Summary
What is Public Health?
The science and the art of improving health,
prolonging life and preventing disease through the
organised efforts of society
• Health promotion e.g. lifestyles, wider determinants of health
• Health protection e.g. communicable disease control, emergency
planning, screening
• Healthcare public health e.g. needs assessment, evidence of
effectiveness and cost effectiveness
Public Health - current landscape
1 Apr 2013 - Most extensive reorganisation of the structure of the
NHS in England came into life. Main changes:
• abolish Primary Care Trusts and Strategic Health Authorities
• shift of responsibility for local Public Health to Local Authorities and
Unitary Authorities
• establish several hundred Clinical Commissioning Groups
• transfer £60 to £80 billion of health care funds to CCGs
• establish new local authority Health and Wellbeing boards
• establish Public Health England
Joint Health and Wellbeing
Strategy Themes
The five themes of the Strategy are:
1. Promoting healthier lifestyles
2. Improve the health and wellbeing of older people in Lincolnshire
3. Delivering high quality systematic care for major causes of ill health and
disability
4. Improving health and social outcomes, and reducing inequalities for
children
5. Tackling the social determinants of health
What can we do?
Work together to ensure everyone that needs it, can access evidence based
programmes of:
• Primary prevention of the risks for many chronic diseases e.g. diet, alcohol,
smoking, obesity
• Risk identification and management
• Long term condition management
• Support end of life care
Key Demographic Information
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GP registered population is over
244,000 people
30 GP practices
High population of people aged 60
and over
Lower proportion of people aged 2040 than England average
Unemployment rate was 2.98% in
June 2013 (similar to Lincolnshire
average and below national level)
Highest in Lincolnshire levels of child
poverty (19.3%).
There is high population of A8
migrants living around the Boston
area.
Source: www.apho.org.uk/PracProf/Profile
Deprivation
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Lincolnshire East CCG has high
level of deprivation compared to
other areas in Lincolnshire.
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Around 19% of the population
within Lincolnshire East CCG
boundaries are living in what is
classified as one of the 20%
most deprived areas in England
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Areas of high deprivation can be
found mainly in Boston
(Fenside), Skegness and
Mablethorpe.
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Deprivation is a key factor in a
person’s health and wellbeing
Source: Department for Communities and Local Government
Health and lifestyle
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Under 75 mortality rates from cardiovascular disease, respiratory disease
and cancer are higher than rates for England
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Life expectancy at birth is 77.7 years for males, 81.5 years for females.
Both slightly lower than national average.
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Obesity prevalence is above the England average: 13.1% (CCG)
compared to 10.7% (England). The prevalence of obesity in Lincolnshire
East is the highest among Lincolnshire CCGs.
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Hypertension prevalence is significantly above the England average:
17.2% within Lincolnshire East CCG compared to 13.6% in England
Coronary Heart Disease
National Picture
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40% reduction in deaths from CHD in past 12 years
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Good evidence base – clinical management and lifestyle services, such as smoking
and weight management
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Each GP practice has a CHD register and the actual prevalence in Lincolnshire is
lower than the modelled prevalence. This could indicate that there are a number of
patients still missed off the disease register and not being treated appropriately
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CHD continues to be a key cause of premature death across the county
LECCG
Prevalence of coronary heart disease in Lincolnshire East is well above the
England average: 5.3% compared to 3.4% for England. It’s also highest of all
Lincolnshire CCGs.
Stroke
National picture
Stroke is the third biggest cause of death in the UK and the largest single cause of
severe disability. Each year over 110,000 people in England will have a stroke
(with direct costs to the NHS of over £2.8 billion)
Key issues regarding stroke include:
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The risk of stroke increases with age
Hypertension
People with diabetes are 2 to 4 times more likely to die from a stroke
Smokers are 50% more likely to have a stroke
LECCG
Stroke prevalence in Lincolnshire East is higher than the England average:
2.5% within CCG compared to 1.7% within England.
Diabetes
National Picture
Diabetes is a chronic and progressive disease that impacts upon almost every aspect
of life. It affects people of all ages, and is becoming more common.
20 x more likely to have diabetes if obese.
People with diabetes:
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On average have a reduced life expectancy of 15 years
Are five times more likely to die from coronary heart disease
Are three times more likely to have a stroke
Women who are pregnant have an increased risk
LECCG
The prevalence of diabetes in Lincolnshire East CCG (7.7%) is significantly
higher than the England average (5.8%) and highest out of all Lincolnshire
CCGs.
Chronic Obstructive Pulmonary Disease
National Picture
In the UK COPD is the fifth biggest killer, the second most common cause of
emergency admission to hospital and one of the most costly inpatient conditions
treated by the NHS
In 2009/10 the recorded COPD prevalence in Lincolnshire was 1.9% of the
population estimated prevalence
Possible large number misdiagnosed or undiagnosed patients
LECCG
In Lincolnshire East CCG recorded prevalence of COPD was 2.4% in
2011/2012, however, the estimated rate was 3.3% (both higher then national
figures)
Cancer
National Picture
• 1/3 cancers are preventable
• Around one in three of us will develop cancer at some time in our lives
• Cancer causes around one in four of all deaths
• Cancer rates in Lincolnshire are in line with the national average.
LECCG
The prevalence of cancer in Lincolnshire East CCG is above the England
average: 2.3% (CCG) – 1.8% (England).
Disease prevalence in LECCG
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7.7
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5.8
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5.3
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England
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Lincolnshire East
3.4
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2.4
2.3
1.7
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1.9
1.8
1.7
Cancer
COPD
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0
CHD
Diabetes
Stroke
Source: www.apho.org.uk/PracProf/Profile
Use of hospital services
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The rate of GP referrals to outpatients (1st attendance per 1,000) is
above the England average: 220.9 (LECCG) compared to 191.7
(England).
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The number of elective admissions (per 1,000) is above the England
rate: 165.2 (LECCG) compared to 121.0 (England). It’s also the highest
in Lincolnshire.
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The number of emergency admissions (per 1,000) is above the
England rate: 94.8 (LECCG) compared to 89.0 (England).
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The number of Cancer admissions (per 1,000) is also above the
England rate: 48.3 (LECCG) – 28.6 (England).
So in summary
People in LECCG are older, poorer and
sicker
Setting the Scene – Social Care
Glen Garrod
Director of Adult Social Services
Lincolnshire County Council
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A balanced budget out-turn
Improved performance (against a basket of indicators reflecting 8 themes). Where
relevant performance will be measured against the LCC comparator group. The
ambition is to achieve upper quartile performance in each.
Integration with Health – specific examples beyond just improved relationships: a)
one joint appointment of a senior manager, b) a signed Section 75 agreement for
Adult Learning Disability Services, c) an agreed Intermediate Care Layer for
Lincolnshire with established budget contributions.
Established plans for milestones for the delivery in 13/14 and 14/15 of both the
14Forward, Learning Disability and Capital Strategy initiatives: a) the future of the LD
operational division determined and b) two Extra Care Schemes commissioned.
A set of quality indicators to reflect both service quality improvements, system
improvements (i.e. our ability to understand and measure quality) and quality in
professional (operational) practice.
Adult Care Directorate Change Programme
Blueprint
Priority Areas 2013-2015
1. Prevention and Early Intervention
2. The development of an 'Intermediate Care' layer for
Lincolnshire
3. Case Management Partnership Programme (CMPP) and
Future Delivery of Support Services (FDSS)
4. Integration with Health
Adult Care Directorate Change Programme
Blueprint
New costs for local
authorities
Quality
Tracy Pilcher
Executive Nurse
NHS Lincolnshire East CCG
The Problems
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Patient safety problems exist throughout the NHS.
NHS staff are not to blame.
Incorrect priorities do damage.
Warning signals abounded and were not heeded.
Responsibility is diffused and therefore not clearly
owned.
6. Improvement requires a system of support.
7. Fear is toxic to both safety and improvement.
The Solutions
1. Recognise with clarity and courage the need for wide systemic
change.
2. Abandon blame as a tool.
3. Reassert the primacy of working with patients and carers to set
and achieve health care goals.
4. Use quantitative targets with caution.
5. Recognise that transparency is essential.
6. Ensure responsibility for functions related to safety &
improvement are vested clearly and simply.
7. Give the people of the NHS career-long help to learn, master and
apply modern methods for quality control, quality improvement and
quality planning.
8. Make sure pride and joy in work, not fear, infuse the NHS.
Culture will trump rules,
standards, and control strategies
every single time.
A safer NHS will depend far more
on major cultural change than on
a new regulatory regime.
Quality for the NHS
• Safety: Avoiding harm from the care that is intended to
help
• Effectiveness: Aligning care with science and ensuring
efficiency
• Patient-experience: Including patient-centeredness,
timeliness and equity
What we have done so far
Dr Brynnen Massey
Chair
NHS Lincolnshire East CCG
What we have done so far
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Keeping people out of hospital
Decrease acute admissions
Improve working together
Optimise Out of Hours provision
Optimise Urgent Care pathway
Improve medicines management
Optimise use of ambulance services
Improve dementia services
Improve end of life care
Empowering communities
Improve update of screening
services
Optimise diabetes pathway
Optimise atrial fibrillation pathway
Develop ENT pathway
Develop dermatology pathway
Prevention
Antibiotics
Atrial
Fibrillation
What we have done so far
Sandra Willamson
Chief Finance Officer
NHS Lincolnshire East CCG
How much money have we got?
2013/14
Programme budget allocation
£m
300.4
Uplift for growth
6.9
Amount available to spend
307.3
Equates to c £1,300 per patient
Where do we spend the money?
Acute Expenditure breakdown?
Planning guidance – what we have to do
• Buy safe and sustainable services
• End the year with a 1% surplus - £3.1m
• Plan for a contingency of 0.5% - £1.5m
• Commitment to spend 2% non recurrently in year - £6.2m
• Deliver QIPP
Where we’re at?
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Rising demand
Quality
Implications of NHS reform in monitoring performance for
2013/14
Achieving QIPP £6.2m
Achieving Financial balance
2014/15 onwards
• Spending review ring-fenced NHS funding but…
• Inflation and increased demand likely to require 4% pa
efficiency
• QIPP (Quality, Innovation, Productivity, Performance) targets
will remain
• In 2015/16 3% of health budgets (£9.5m for LECCG) to be
pooled with Social Care to encourage integration – creation
of Integration Transformation Fund (ITF)
Where do we need to be?
Improving Quality
Restructuring the way that care is delivered
• Sustainability Services Review for Lincolnshire
• Creation of Integration Transformation Fund (ITF)
Tea break
Round table discussions
Discussion one – How do we achieve change?
1. What does transformational change look like for
Lincolnshire East? (15 minutes)
2. What do we need to consider when prioritising services and
undertaking the sustainability review? (35 minutes)
3. Prioritise these criteria on flipcharts (10 minutes)
Discussion two – How can we engage with
you in the future?
1. How do you want to be engaged?
2. Is there anything preventing you from engaging with us?
Round up & next steps
What next
Analyse today’s feedback
Produce a report, available www.lincolnshireeastccg.nhs.uk
Next steps – phase 2 engagement
Close