Everyone Counts Planning for Patients in Liverpool 2013/14

1. Everyone CountsPlanning for Patients in Liverpool 2013/14

2. Welcome & Introductions Dave Antrobus Governing Body Lay Member – Patient & Public Involvement

3. Housekeeping • Toilets • Fire Alarm • Hearing Loop (T.coil position) • Mobile Phones (silent)

4. Purpose of the Session / Follow up from Last Event Moira Cain Practice Nurse Brownlow Group Practice & Governing Body Member

5. Our vision/your vision

6. From our Plan on the Page :

7. At our last event You said:

8. Since then we did :

9. Patient Participation Groups

10. You said, we did:

11. You said gather a register of community groups

12. Everyone Counts

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

14. Does the CCG have any plans for Integrated Wellness Services?

15. What Feedback will be available?

17. How will voluntary sector groups be involved in the decision making, specifically small charities and service providers?

18. Liverpool Clinical Commissioning Group: The Journey So Far Katherine Sheerin Chief Officer

19. The Commissioning Landscape • Liverpool PCT £1bn • Liverpool CCG £730m • Liverpool Local Authority £40m • NHS Commissioning Board £230m

20. LIVERPOOL CCG • 493,000 Patients • 95 practices • 1 CCG for Liverpool

21. What is different about CCGs? • Closer to patients • Clinically led • Practices are members • Your GPs making decisions • ‘Living by’ decisions

22. CCG Governing Body • 9 GPs • 2 Nurses • 2 Lay Members • 1 Secondary Care Doctor • 1 Chief Finance Officer • 1 Chief Officer • Co-opted Members

23. CCG Plans • The Mandate • Everyone Counts - Planning for Patients 2013/14 • Health Outcomes Framework • NHS Constitution • Joint Strategic Needs Assessment

24. Understanding Liverpool: Plans for 2013/14 Tony Woods Head of Strategy & Outcomes

25. 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%)

26. 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

27. Death and Morbidity Main causes of death Main causes of morbidity (DALY) Mental Health (23%) CVD (16%) Cancer (16%) Respiratory (8%) Digestive (8%) • Cancer (31%) • CVD (27%) • Respiratory (15%) • Digestive (6%)

28. 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

29. Our PRIORITIES AND PLANS FOR 2013/14

31. Cancer Key Issues 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 • 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

32. Long Term Conditions(CVD, Diabetes, Respiratory) Key Issues 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 • 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

33. Children Key Issues 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 • 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

34. Mental Health andLearning Disability Key Issues 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 • 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

35. Dementia Key Issues 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 • Ageing population • Increasing need • Need to focus on early detection • New international evidence and innovative approaches emerging for more proactive care models

36. Alcohol Key Issues 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 • High rates of emergency admissions • High use of A&E • Rising cause of mortality • Evidence of variation in awareness in general practice • Public awareness

37. End of Life Key Issues 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 • Maintain focus on delivery of high quality services • Improve public understanding of care pathways for the dying

38. Urgent Care Key Issues 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 • High rates of emergency admissions • High use of A&E • Continued pressure in meeting 4 hour target • General practice access

39. Planned Care Key Issues 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 • Opportunity to move services closer to home (Right Care, Right Place) • Improvement of quality standards • Improve patient experience

40. Enabling Themes • Primary Care Quality and Improvement • Prescribing • Research and Innovation • Informatics • Organisational Development • Patient, Public and Stakeholder Engagement • System Leadership

41. 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

42. Over to you . . . Table Discussions Time to tell us what you think

43. Having heard the commissioning plans for 2013/14, do you think we are focusing on the right priorities?

44. Feedback from the Floor

45. Creating a Partnership Alan Lewis Chief Executive Liverpool Charity & Voluntary Services (LCVS)

46. Partnership means….. ? A partnership is an arrangement where parties agree to cooperate to advance their mutual interests

47. A partnership is a deal… A partnership is a contract between individuals who, in a spirit ofcooperation, agree to carry on an enterprise; contribute to it by combining property, knowledge or activities; and share its profit.

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

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

50. Doing different because the same won’t cope UK