Our Five Year Strategic Plan and Challenges Dr Mary Backhouse Chief Clinical Officer

1. Our Five Year Strategic Plan and Challenges Dr Mary Backhouse Chief Clinical Officer

2. 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.

4. Life in North Somerset Community engagement, involvement and leadership Education Employment Reducing inequalities Creating health through wealth Vulnerable groups known Life and Society in North Somerset Politics/ civic life High impact families and individuals (supported) Flexible/ integrated deployment of public resources across N Som Commerce Integrated health and social care Seamless person centred pathways/ networks Sustainable provider networks Physical environment

5. Strategic to do list for North Somerset CCG 2

6. Our context - Joint Strategic Needs Assessment • Inequalities in health and employability • Mental health • Substance misuse • Growing population with significant very elderly population

7. 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% 8

8. 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

9. 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 11

10. 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

11. £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

12. 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

13. …and we are facing a number of strategic challenges 9

14. 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

15. 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

17. 5 programmes - based on local needs • Continuum of Care • Urgent Care • Elective Care • Primary Care • Children and maternity services

18. Moving from the current fragmented system towards a more integrated approach Fragmented approach Coordinated system Fully integrated H&SC system Housing Education FY14/15Coordination through CQUIN and other incentive schemes FY15/16Alignment though outcome based contracting TODAY Current fragmented approach FY16+Patient focused integrated care

19. Strategic Level Participation Public, Patient and Carer voices at the centre of health care services: Healthwatch and VANS

20. 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