Welcome to our Annual General Meeting

1. Welcome to our Annual General Meeting

2. Agenda • Chairman’s Welcome and Introduction to the • Annual General Meeting (AGM) • Dr Gina Palumbo, Clinical Commissioning Group Chair • Review of the Year 2013/14 • Jane Hawkard, Chief Officer • Annual Accounts 2013/14 • Richard Dodson, Chief Finance Officer • Questions and Answers

3. Introduction • Dr Gina Palumbo • Clinical Commissioning Group Chair

4. Basic Facts 1000 square miles340,000 approximate population37 GP Practices43 Dental Practices 60 Pharmacies 65 Optometry Practices3 Prisons4 Community Hospital Sites 9 Health Centres/Clinics 1 GP Access Centre3 Acute Hospitals 2 District Hospitals No A&E in the County

5. Our Population’s Health

6. Our Populations Health – Our Priorities • Addressing the health needs of the ageing population • (Quality of Life) • Opportunities through transformation of the service model to support the management of Long Term Conditions and promote self care • Addressing inequalities in health outcomes • (Quantity of Life) • Opportunities through preventing ill health development and minimising deterioration of existing conditions Addressing the mental and physical health and wellbeing of Children and Young People • National Priorities • Reduce infection from MRSA and C.difficile • Reduce hospital mortality • Budget Management • Meet statutory duty to balance budgets ERY Clinical Commissioning Group Operational & Strategic Plan 2014-2019

7. Your Local Clinical Commissioning Group Local GPs have been through a nomination and election process for the East Riding CCG and non-GP members have also been identified. Membership is as follows: • GP Members • Beverley and Driffield • Dr Gina Palumbo (CCG Chair) • Dr Richard Little • Goole, Howdenshire and West Wolds • Dr Clive Henderson • Dr Frank Thornton • Haltemprice • Dr Krishnaraj Sivarajan • Bridlington • Dr Alan Francis • Holderness • Dr David Fitzsimons Other members • Secondary Care Doctor • 3 lay members: • Vice Chair • Patient & Public Participation • Audit & Governance • 1 Local Authority representative • 3 Executive Directors: • Chief Officer • Chief Finance Officer • Director of Quality & Governance / Executive Nurse • Director of Public Health (ERYC) • ERY Healthwatch representative

8. A New Role for Clinicians • To buy and ensure delivery of services appropriate to meet reasonable local needs. • Work with all involved to drive out waste and maintain quality • To ensure sustainable, high quality, safe and effective services and good patient experience

9. Strong Locality Working

10. Pressures on the NHS • Demographics • The incremental nature of health care • The technological and therapeutic advances • The increased complexity and fragmentation • The expectations • The fiscal challenge • NHS has been relatively protected

11. So where will the resources for health and social care come from?

12. Scaling up of Small Changes We all have to do something different to achieve our aim of… …better care …closer to home …within budget Through Transformation GPs Patients Allied Health Professionals Local Authority Nurses Voluntary Sector Hospitals Private Sector Policy Makers Communities

13. What clinicians could do differently • Lead on changing clinical behaviour • Lead on collaboration and integration • Reduce variability of health care • Secondary care moving out into community • Centralisation of specialist services • Working with Local Authority and Public Health – Health and Well Being Board

14. What can patients and doctors do differently together? Aim of the Health and Social Care Act – Patients central, informed and empowered to co-produce solutions

15. “Doctor, what can I do to improve my own health and well being?”

16. A different conversation • Understand and own our own contribution to our (ill) health • Take responsibility for sharing in decisions • Agree our plan and help to monitor outcomes • Be our own expert • Be our own (biggest) change agent • Share our experience and inspire someone else

17. Keep it simple and straight forward • No smoking • Moderate alcohol consumption • Regular exercise • 7-8hrs sleep • Regular meals with no snacking • Maintenance of moderate body weight • Regular consumption of breakfast 1965 Lester Breslow’s benefits of seven healthy habits

18. Long Term Conditions – The Facts • Account for £7.00 out of every £10.00 spent in the NHS • In the East Riding… • 50% of all GP appointments… • 65% of all outpatient appointments and • 72% of all patient stays on hospital wards • are taken by people with long term conditions • But we have a pill for everything, Don’t we?

19. The Burden of Treatment

20. What can the Health and Social Care Community do differently?

21. Be honest, open and transparent • One voice, one message across Health and Social Care • With political support – H&WB • Doctors to maintain trust • Publish as much as we possibly can • Be accessible and open to challenge

23. The NHS belongs to the people It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

24. 2b. Patients and the public – your responsibilities The NHS belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly…

25. You should… recognisethat you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it. register with a GP practice – the main point of access to NHS care. treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution. provideaccurate information

26. keep appointments, or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do. follow the course of treatment which you have agreed, and talk to your clinician if you find this difficult. participatein important public health programmes such as vaccination. ensurethat those closest to you are aware of your wishes about organ donation. give feedback – both positive and negative – about the treatment and care you have received, including any adverse reactions you may have had.

27. Hard Truths and our Duty of Candour • Scandals of Mid Staffordshire Hospital and Winterbourne • Our collective future needs us all to face some hard truths about how we are all responsible for improving quality through being open and honest with patients / the public and across organisations • CCG Public Pledges in line with Hard Truths – to ensure focus is maintained on improving quality

28. Review of the Year 2013/14 Jane Hawkard, Chief Officer

29. East Riding of Yorkshire Clinical Commissioning Group Planning to do something different 2014/15 to 2018/19

30. CCG PLAN 2013 -14 Better management of people with long term conditions to reduce avoidable admissions. Increase access to early diagnosis and treatment for patients with dementia. Increase number of patients able to die in their place of choice. • Increase patient involvement in decision making about the right care for them through: • Improved patient information. • Roll out of Map of Medicine software use in GP surgeries. • Review access to locally based musculoskeletal services Improve services for older people Improve planned care services Reduce number of patients admitted with a hip fracture by 5% from 2012/13 levels. Improve patient experience of A&E services. Increase accessibility to minor injury services Improve patient experience of our Child and Adolescent Mental Health Services (CAMHS). Improve access to more local, primary care based psychological therapies. Increase the number of assessments for autism and access to programmes. Partnership working with local authority Improve emergency care services

31. What we have achievedand still more to do… Empowered patients, personalised care Supporting People with Long Term Conditions model • Long term condition clinics in primary care, 28 of our 38 practices, covering 86% of our population Dementia Services • Increased Memory Clinic capacity • Increased diagnosis rates from 37% to 41% in last few months of the year • Commissioning a Mild Cognitive Impairment service • We still need more capacity for diagnosis and treatment Access to Psychological Therapies for Anxiety and Depression • Increased the number of service Providers from 2 to 8 • Mobilisation of service between April and September 2014 • We need to see the new service working at full strength Early diagnosis, good information, supporting individuals to live well with their dementia diagnosis. Timely access to good quality psychological therapies’ with a focus on recovery.

32. What we have achievedand still more to do… Children and Adolescent Mental Health Services • reduce waiting times • increased out of hours access to service • further waiting time reductions to achieve Falls service • new specialist service, reducing emergency admissions for hip fractures by 25% Quality of Services • Reduced number of Hospital Acquired Infections • Reduced hospital mortality rates to within expected range in our local hospitals • Launched patient engagement initiative ‘involve’ • Reduced deaths in hospital by 37% by increasing choice for patients on end of life pathways Help with preventing falls

33. Patient Network www.eastridingofyorkshireccg.nhs.uk/involve involve Want to help improve NHS services across East Yorkshire? Join involve!

34. Challenges and what has not gone so well… • Some national targets not met – waiting times (A&E, 52 week waits, access to psychological therapies) • ‘involve’ patient network – slower start than we would have liked • The pace of change • Challenges for Primary Care Workforce • Care Quality Commission recommendations for the East Riding Community Hospital and Hull Hospitals Trust

35. 1. Improving Primary and Community Services 2. Transforming the Urgent Care system 3. Planningcare efficiently 4. Integrating services 5. Improving services for vulnerable people

36. Looking Forward to years 2 and 3Making a difference and improving outcomes for patients • SYSTEM VISION STATEMENTS • Individuals take greater ownership of their own health and wellbeing • Services are, in the main, delivered in the community by a range of providers • Integrated health and social care through locality focused service delivery hubs • The remit for hospital based services is clear and reflects where they can add value and expertise Integration of services to provide ‘Better Care’ Delivering More joined up health & social care services Outcome Increasing people (65+) discharged home from hospital rather than into a care home. Community Services and Primary Care Delivering Locality hubs for health & social care services Outcome Improving quality of life for people with long term conditions and complex needs Unplanned Care Services Delivering Community urgent response teams Outcome Reducing avoidable emergency admissions Productive Elective Care Delivering Consistent and systematic services Outcome Transforming follow up appointment systems Supporting Our Vulnerable People Delivering Better Dementia and for Children and Adolescents Mental Health Services Outcome Increase the levels of diagnosis of dementia and treatment services Safe, High Quality, Sustainable, Productive Care

37. Testing Our Pilot Locality Hub Model 1. Focus on self care and independent living 2. Locally delivered services where possible 3. Joined up health and social care Hospital based services available when needed 3. Rehab & Reablement 5. Wider Community 4.Staying Healthy & Independent Living 3. Community Care at Home 2. Rehab & Re-ablement 1. Complex Case Management Locality Hub Communication Communication

38. Annual Accounts 2013/14 Richard Dodson Chief Finance Officer

40. Financial Duties

41. 2013/14 Accounts An unqualified opinion was issued. • Financial statements give a true and fair view • In all material respects, the expenditure and income have been applied to the purposes intended by Parliament • Have been properly prepared in accordance with the accounting policies directed by the Secretary of State • Proper arrangements for securing economy, efficiency & effectiveness

42. Full Set of Accounts A full set of Accounts for 2013/2014 is available within the Annual Report here at the AGM, or on the CCG Internet http://www.eastridingofyorkshireccg.nhs.ukor by contacting us on 01482 672156