East and North Hertfordshire Clinical Commissioning Group AGM 2014 Welcome

1. East and North Hertfordshire Clinical Commissioning Group AGM 2014 Welcome

2. Kate Harding Creative Practitioner Health Liaison Team

3. Lesley Watts Chief Executive

9. 2013/14ANNUAL ACCOUNTS Alan PondChief Finance Officer

10. Housekeeping • Draft Accounts submitted within 15 working days of the year end – before the 23rd April deadline • Annual Report and Accounts were agreed by Board, audited and submitted to NHS England before the 6th June deadline • Unqualified opinions on the Accounts and Value for Money statement received from the Auditor • Full Annual Accounts published with the Annual Report

11. A challenging first year • Complete reorganisation of commissioning landscape and funding • Increase in CCG baseline funding of only 2.3% – no more than inflation • CCG remains underfunded by over £30m • Activity growing faster than population growth and the growth in funding • NHS England requirement for CCGs to underspend on their budgets by 1% • Providers under financial stress

12. Balancing the funding • 2.3% funding uplift • Tariff reductions • Underspend carried forward £20m £38m • Population growth • Increased demand • 1% underspend

13. 2013/14 “A good first year” • Achievedstrong performance across the majority of key performance indicators with c75% delivered (e.g. hospital waiting times, long term conditions, cancer services and end-of-life care) • Achieved national requirement for additional efficiency savings • Achieved the required 1% underspend of £6m

14. Performance on statutory financial targets

15. Performance across the CCG

16. Where the money was spent Acute services 61% Prescribing 12% Mental health & learning disability services 12% Community services 7% Continuing care services 4% Other primary care 2% CCG running costs 2% Running costs Other primary care MH and LD Cont. care Acute Community Prescribing

17. Future cost drivers • Increasing population • Ageing population • Reduced Social Care funding • New technology and treatments • Patient expectations • Drive for continuous improvement So expenditure rises ever faster

18. The financial challenge ahead • Continued low growth in funding: • 3.38% in 2014/15 • 2.52% in 2015/16 • Estimate 2.6% for each of 2016/17 to 2018/19 • 10% reduction in running cost allocation • Gap between cost of demand and CCG funding – £80m by 2018/19 • CCG savings of at least £80m needed over the next 5 years

20. The good news • There are excellent and committed clinicians and managers in East and North Hertfordshire to make this work for local people • Relationships with Social Care Partners are good and we share the same objectives • Relationships with Providers are good and we challenge them to improve their services further • We have already identified the efficiencies needed in 2014/15 • We have delivered on tough challenges in the past and will do so again

21. Future proofing our strategy Assess our priorities Improve productivity and reduce waste Develop the market and improve providers Joint and clinically ledcommissioning Assess our priorities Assess our priorities

22. Dr Hari Pathmanathan CCG Chair

23. A clinically-led organisation • Most of the Governing Body members are clinicians – doctors, midwives, nurses. • Every ‘locality’ group of GP practices is represented on the board – diverse health needs inform commissioning decisions • We are the only CCG in the region to delegate £5 per head funding for over 75 year olds to practices.

24. Clinically-driven improvements • Home visits for acutely ill patients commissioned, GPs can focus on complex patients. • Better continuity of care for patients and staff in nursing homes • Additional winter capacity in the community, avoiding unnecessary hospital admissions

25. Challenges • Demand management – demographic, prescribing, staffing and infrastructure pressures • New QEII • Ongoing issues at Chase Farm Hospital • Need to scale up successful schemes across the whole CCG area, such as HomeFirst • Political uncertainty

26. Opportunities • New best-practice treatment ‘pathways’ for common conditions in development • Active and committed patient participation groups • Diverse opportunities for clinicians to get involved in new models of care • Ongoing learning from pilot projects is improving the services offered to patients

27. Thank you

28. The New QEII Hospital John Webster Director of Commissioning Dr Nicky Williams Vice Chair

29. Introduction • Highest priority for the CCG • History • Phases of the development • Services to be provided • Clinical perspective • Integration • Timescales for completion

30. A reminder • DQHH - Delivering Quality Healthcare for Hertfordshire • Public consultation across Hertfordshire concluded in 2007 • Key recommendations: • Centralise acute inpatient services at Lister • Provide a local general hospital in Welwyn Garden City

31. DQHH objectives • Centralise specialist services, skills and staff in one place • Improve clinical outcomes • Improve the patient experience and environment • To meet growing demand • To recruit the best staff

32. Timeline The new hospital completes in..…. 30 weeks

33. Timeline The next significant milestone is in…. 3 weeks Remaining wards, theatres and Emergency Department transfer to the Lister Hospital on 1st October

34. What’s happening and when? October 2014 April 2015 £30 million investment in new hospital New services, new buildings New services, existing buildings Remaining wards and theatres move to the Lister Urgent Care Centre QEII Therapy areas and children’s zone Outpatient appointments, ante-natal care and diagnostic tests £150 million investment Full emergency department and urgent care centre All surgery Lister All inpatient wards Inpatient maternity care Outpatient appointments and diagnostic tests

35. What is an Urgent Care Centre? • From October 2014, there will no longer be an A&E at the QEII • Open 24/7 to treat patients of all ages, including babies • Urgent Care Centres treat everything except the most serious injuries or illnesses – when people should call 999. • There will also be an Urgent Care Centre integrated within the new Lister emergency department to stream patients appropriately • Public understanding of the new way of working is crucial

36. Summary of services after October 2014 New QEII Lister Hertford County

37. Every year, the New QEII will deliver: • 105,000 outpatient appointments • 35,000 Urgent Care Centre attendances • 17,000 ultrasounds • 13,500 CT and MRI scans • 110,000 phlebotomy tests • 30,000 x-rays

38. The New QEII

40. Progress so far June 2014

42. Care home on the New QEII site • ENHT marketing site • CCG & HCC specification for bed based care service we want to commission • Joint bid evaluation • Links to Hospice and services within the New QEII • History

44. Nicky Photo No 2

45. Nicky Photo No 3

46. Community Hub HomeFirst Discharge to assess Doing things differently in the community NHS 111 Early Supported Discharge Acute in-hours visiting service

47. Mental health services • Hertfordshire Partnership University NHS Foundation Trust currently provide some adult mental health services at the QEII • Welwyn and Mymms inpatient wards will close in September and move to a purpose built facility at Kingfisher Court in Kingsley Green, near St Albans and Radlett • Community mental health outpatient clinics at the QEII will be run from Roseanne House in Welwyn Garden City.Appointments are also held in a range of other locations Kingsley Green: Kingfisher Court is easily accessible via the M25, the M1 and the A1M.  Public transport to the site is to be confirmed, but meanwhile HPFT will provide a free transport service from QEII & Hemel Hempstead Hospital and from Radlett, Potters Bar, St Albans City and Watford Junction train stations. 

48. Mental health services • Thumbswood mother and baby unit will move to Kingsley Green • The Acute Day Treatment Unit will move in due course. It is likely to move to the Glaxo Day Hospital at the rear of the Lister Hospital in Stevenage • Community outpatient clinics run from Roseanne House in Welwyn Garden City and other community settings, so these patients will not need to visit an acute hospital site

49. Investing £150 million New theatres block The Treatment Centre New wards block Car parking

50. Investing £150 million Refurbished wards Critical care unit Environmental Infrastructure Neonatal unit