Everyone CountsPlanning for Patients in Liverpool

2013/14

Welcome & Introductions

Dave AntrobusGoverning Body Lay Member – Patient & Public Involvement

Housekeeping• Toilets• Fire Alarm• Hearing Loop (T.coil position)

• Mobile Phones (silent)

Purpose of the Session / Follow up from Last Event

Moira CainPractice Nurse Brownlow Group Practice

& Governing Body Member

Our vision/your vision

From our Plan on the Page :

At our last event You said:

Since then we did :

Patient Participation Groups

You said, we did:

You said gather a register of community groups

Everyone Counts

How will the Clinical Commissioning Group (CCG) work with Liverpool Community Health.

Does the CCG have any plans for Integrated Wellness Services?

What Feedback will be available?

How will voluntary sector groups be involved in the decision making, specifically small charities

and service providers?

Liverpool Clinical Commissioning Group: The Journey So Far

Katherine SheerinChief 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 • 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 WoodsHead 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%)

• CVD (27%)

• Respiratory (15%)

• Digestive (6%)

Main causes of morbidity (DALY)

• Mental Health (23%)

• CVD (16%)

• Cancer (16%)

• 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

Vision

Context

Health Inequalities

No £ Growth Expected

Values

Improved Cancer Survival Rates

Org

an

isa

tio

n D

ev

elo

pm

en

t

Dementia

* Integrated Pathway for Earlier Detection, Diagnosis and Post Diagnosis Support* Secondary Care Services including Memory Services, Inpatient and Liaison* Focus on InnovationReduction in the Incidence of

Avoidable Harm in Hospitals

Improving Recovery from Stroke

Improved Patient Experience of Primary Care, Hospitals and Mental

Health Services

Delivery of access targets

Enhancing quality of life for people with mental illness and dementia

Supporting People to Manage their Condition and Enhancing Functional

Ability in People with Long Term Conditions

Reducing Time Spent in Hospital by People with Long Term Conditions

Reduction in emergency admissions for acute conditions and children with

lower respiratory tract infections

Reduction in Emergency Readmissions

Alcohol

* Maximise Liverpool Community Alcohol Service Utilisation* Shared Care Pathway for Problem Alcoholics* Increasing Awareness of Impact of Alcohol

Pa

tie

nt,

Pu

blic

an

d S

tak

eh

old

er

En

ga

ge

me

nt

* Supporting Choice* Liverpool Care Pathway* Carers Support

End of Life

* Focus on Access to Services* Right Care in the Right Place* Quality, Safety and Patient Experience* Demand Management

* 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)

Syste

m L

ead

ers

hip

Reducing Health Inequalities and Unnecessary Variation

Pre

sc

rib

ing

Re

se

arc

h a

nd

Inn

ov

ati

on

* Diabetes Model implementation* Improved diagnostics* Pathways Implementation* Reducing Variation in General Practice

Children

* Maternity Matters and Healthy Child * A&E attendance for primary care problems* Equipment Services * Transition to Adult Services

Urgent Care

* Right Care in Right Place* Access, waiting times and discharge planning* Implementation of 111* Same Day Emergency Care in Hospitals

Pri

ma

ry C

are

Qu

alit

y a

nd

imp

rov

em

en

t

Cancer

Respiratory

* Pathways Implementation* Reducing Variation in General Practice* Community Respiratory Team Utilisation

Integrated Care

Growing Elderly Population T

rea

tin

g a

nd

Ca

rin

g f

or

Pe

op

le in

a S

afe

En

vir

on

me

nt

an

d P

rote

cti

ng

th

em

fro

m H

arm

* Early Detection and Screening* Pathway Development and Implementation* Timely Access* Liverpool Cancer Centre

Lo

ng

Te

rm C

on

dit

ion

s CVD

Gen

era

l P

racti

ce &

Co

mm

un

ity

Serv

ices

Reducing Premature Mortality from Major Causes and reducing deaths in

people with SMI, babies and young children

Maxim

isin

g V

alu

e o

f C

om

mis

sio

nin

g S

pen

dH

igh Q

ualit

y S

erv

ices L

eadin

g t

o I

mpro

ved H

ealth O

utc

om

es a

t Low

Cost

Pre

ven

tio

n &

Earl

y

Iden

tifi

cati

on

Improvement Opportunities

Mental Health and Learning Disabilities

* Liverpool Model for Primary Mental Health Care* Rehabilitation Model of Care* Integrated Care Model* Physical Health Checks* Transition from Child Services

Jo

int

Co

mm

issio

nin

g

for

Inte

gra

ted

Deli

very

Seco

nd

ary

Care

S

erv

ices

Planned Care

Improving Outcomes from Planned Treatments

Info

rma

tic

s

Be patient focused / Believe in partnership and collaboration / Be locally-focused / Be progressive / Be accountable / Demonstrate integrity and respect

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.

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

Outcome IndicatorsWhole System

ApproachTransformational Change Initiatives

(Under Development tbc with Programme Leads)Enabling Themes

Excess Cancer and CVD Deaths

Pre

ve

nti

ng

Pe

op

le f

rom

Dy

ing

Pre

ma

ture

ly

En

ha

nc

ing

Qu

alit

y o

f L

ife

fo

r P

eo

ple

wit

h L

on

g T

erm

Co

nd

itio

ns

He

lpin

g P

eo

ple

to

Re

co

ve

r fr

om

Ep

iso

de

s o

f Ill

He

alt

h o

r F

ollo

win

g In

jury

En

su

rin

g t

ha

t P

eo

ple

ha

ve

a P

os

itiv

e E

xp

eri

en

ce

of

Ca

re

High Deprivation

High Hospitalisation

Cancer

Key Issues• 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

Key Plans for 13/14• 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 andLearning DisabilityKey Issues• 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

Key Plans for 13/14• 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

• 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 DiscussionsTime 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 LewisChief Executive

Liverpool Charity & Voluntary Services (LCVS)

19/04/23©LCVS 46

Partnership means….. ?

A partnership is an arrangement where

parties agree to cooperate to advance their mutual interests

19/04/23©LCVS 47

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.

19/04/23©LCVS 48

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

19/04/23©LCVS 49

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

19/04/23©LCVS 50

Doing different because the same won’t cope

2010 10,000 centenarians

2034 100,000 centenarians

UK

19/04/23©LCVS 51

The ChallengeThe 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

19/04/23©LCVS 52

"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

19/04/23©LCVS 53

"We can never get a re-creation of community and

heal our society without giving our citizens a sense

of belonging." -- Patch Adams

"Independence"... middle-class blasphemy. We are

all dependent on one another, every soul of us on

earth. -- George Bernard Shaw

19/04/23©LCVS 54

Ladder of Participation

Sherry Arnstein, (1969)

19/04/23©LCVS 55

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!

19/04/23©LCVS 56

The one system approach

PoliceJob

centre+Health Service

Local Authority

Schools

Individuals – Communities – Free association

TopDown

BottomUp

?? Possibilities ??

Structured power -– commercial, public, non-profit

19/04/23©LCVS 57

What is the deal?

Effective Health & Social Care system

Affordable

Accessible when needed Healthy Communities

19/04/23©LCVS 58

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.

19/04/23©LCVS 59

Cooperative action

• Reach out to community

• Realistic expectations

• Respect difference / diversity

• Responsibility for views & actions

• Results focused

• Reflection

• Recognition of contributions

• Review impact

19/04/23©LCVS 60

Social not Structure

19/04/23©LCVS 61

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

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?

63%

29%

8%

1. Yes2. No3. Not sure

Do you think that the plan will achieve what it is setting out to do?

25%

57%

18%

1. Yes2. No3. Not sure

Having listened to the presentations, do you have a better understanding of Liverpool Clinical

Commissioning Groups plans?83%

12%5%

1. Yes2. No3. Not sure

Have you had an opportunity at today’s event to have your views heard?

89%

8%3%

1. Yes2. No3. Not sure

Staying Involved

Katherine SheerinChief 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 AntrobusGoverning Body Lay Member – Patient

& Public Involvement