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 and Society in

North Somerset

Reducing inequalities

Community engagement, involvement

and leadership

Education

Employment

Creatinghealth

through wealth

Politics/ civic life

Vulnerable groups known

High impact families and individuals (supported)

Seamless person centred

pathways/ networks

Integrated health and social care

Commerce

Sustainable provider networks

Flexible/ integrated deployment of

public resources across N Som

Physical environment

Life in North Somerset

Strategic to do list for North Somerset CCG

1. Develop core commissioning functions

2. Understand strategic challenges

3. Grip FY14/15

4. Build the transformation strategy

2

Our context - Joint Strategic Needs Assessment

• Inequalities in health and employability• Mental health• Substance misuse• Growing population with significant very

elderly population

Our patients needs are changing with demography --

• 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%

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0

2000

4000

6000

8000

10000

12000

14000

16000

18000

AGE

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AGE

5-9

AGE

10-1

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AGE

15-1

9

AGE

20-2

4

AGE

25-2

9

AGE

30-3

4

AGE

35-3

9

AGE

40-4

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AGE

45-4

9

AGE

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4

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AGE

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AGE

75-7

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AGE

80-8

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AGE

85-8

9

AGE

90+

Demographic Growth Projection - 5 years to 2018

2008 Registered Pop 2013 Registered Pop 2018 ONS Projected Pop Growth

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

Acute

Community and out of hours

MH and LD

FNC

CHC

Medicines

CCG running costs

- 20 40 60 80 100 120 140 160

96

67

81

146

82

86

100

North Somerset CCG Spending per Wtd Capita % of Expected

£ per weighted capital %

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66ad7f2c1ea54ede9b74a90d8453739d

56b0ea2e08794717af -fa54473d8cef06

88bab05a940247e88fe92af1b927d5b1

c64d39ffaba64aa999f4b0b33db792b9

Bar Regular

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

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-

50

100

150

200

250

300

146

174

194

208 215

247 252 252

North Somerset CCG - Total Spend (2013/14)

£ m

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n

Bridge

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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

• 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

Orthopaedics• NICE• Diagnostic

scopes

10

£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:

•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.• Meeting rising

demand in a flat cash environment

2.• Securing a safe

and sustainable provider base

3. • Delivering

financial balance

4.• Supporting a

challenged social care system

5. • High degree of

stakeholder interest

6. External processes transforming acute care (Weston, NBT & NSCP)

7. • Engaging and

motivating GPs

8. • Shifting care into

the community and closing beds

9.• Agreeing a shared

integrated transformation position

9

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

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

Purpose 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

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

Interventions 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

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.

Work with primary care providers to improve quality and access. Develop locality approach to prevention, early intervention and selfcare.

Enabling Workstreams

Partnership Working Arrangements Better Care Fund Programme Wider Resource allocation strategy (inc capital) Effective stakeholder engagement Innovative commissioning and contracting arrangements Management of NHS infrastructure Workforce strategy IT Strategy Knowledge management, research and evidence Developing the provider landscape Organisational Development Medicines Optimisation/NICE

5 programmes - based on local needs

• Continuum of Care• Urgent Care• Elective Care• Primary Care• Children and maternity services

Moving from the current fragmented system towards a more integrated

approach

TODAYCurrent fragmented

approach

FY14/15Coordination through

CQUIN and other incentive schemes

FY15/16Alignment though outcome based

contracting

FY16+Patient focused integrated care

Fragmented approach Coordinated system Fully integrated H&SC system

Education

Housing

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