Strengthening the patient voice West Bromwich Albion

1. Strengthening the patient voice West Bromwich Albion 5 July 2012

2. Feedback Summary – morning session • Where will the money go – control/governance • Engagement – are we practising what we discussed • GP burnout • Access – appointments, phone access, telephone costs, choice, receptionists doing triage, online • Public health/local authority helping health agenda – schools and recreation centres going – obesity agenda • Access to mental health – making decisions on my behalf • Links between secondary (hospital) and primary care • Joined up approach for social care and discharge back into the community • Changing role of GP – home visits, out of hours

3. New NHS Parliament Key: Accountability Department of Health Funding Right Care Right Here partnership Monitor CQC NHS Commissioning Board Licensing Providers SWB CCG Contracts BSMHT, BCP, BCHC, SWBH Partnership Local Authorities Local HealthWatch Other providers BCH, BWH, ROH, DGH, RW, SWB, WM, and I/C. Birmingham HealthWatch Patients & Public Sandwell HealthWatch

4. A wide range of services available to commission from Complex range of providers for healthcare: Hospitals Heart of England (3 hospitals), University Hospitals Birmingham, Sandwell West Birmingham, Birmingham Children’s Hospital, Royal Orthopaedic, Birmingham Women’s Hospital and Birmingham Dental Hospital, Dudley Group of Hospitals SpecialistBirmingham and Solihull Mental Health Trust, Black Country Partnership Trust Community Birmingham Community Healthcare Acute & UrgentWest Midlands Ambulance Service; Range of urgent care, walk-in and other providers – Assura, Care UK etc Third Sector – a wide range of provision e.g. over 40+ alcohol/drug dependency services Sandwell Birmingham

5. Our health priorities • From our health needs analysis: • Heart disease • Stroke • Cancer • Respiratory disease (COPD) • Other long term conditions: diabetes dementia, frail elderly • Mental health • Infant deaths • Lifestyles: • Smoking related conditions • Alcohol (hospital attendances/ admissions) • Lack of physical activity/poor diet/obesity

6. Our health needs

7. Our health needs Health without boundaries - November 2011

8. Our vision and values

9. Achieving the right balance - Localism Big and small… “As a membership organisation we would like to build ways of working that are not bureaucratic with the right safeguards for all.”

10. Our Board Structure Vice Chair (Lay Director) Chair (GP Director) GP Directors Executive Directors Clinical Directors Other Board Members(Non Voting) Lay Directors GP Directors GP Directors GP Directors One GP Directors to be Chair GP Directors Chair and Vice Chair of Black Country Lay Director(Vice Chair) Managing Director(Accountable Officer) Secondary Care Specialist Independent Committee Members x2 Chair and Vice Chair of HealthWorks Lay Director(Chair of Audit) Finance Director(Chief Finance Officer) Nurse Senior Officers x3 Chair and Vice Chair of ICOF Public Health Member Chair and Vice Chair of Pioneers 4 Health • Notes • Directors are voting members • Other Board members are non voting members • The Chair will be one of the GP Directors from the LCGs, not an additional post • Vice Chair will be one of the two Lay Directors, not an additional post Chair and Vice Chair of Sandwell Health Alliance

11. Commissioning what it is and why Commissioning is: “Proactive strategic role in planning, designing and implementingthe range of services required – rather than just purchasing. A commissioner decides which services or interventions should be provided, who provides them and how they should be paid for and may work closely with the provider in implementing the changes”

12. Our governance Remit: To determine and implement the OD strategy for the CCG OD Sub Group Main SWBCCG Board Remuneration Sub-Committee Remit: To determine pay and remuneration for employees (likely to meet on an ad hoc basis) Finance & Performance Sub-Committee Quality & Safety Sub-Committee Strategic Commissioning & Redesign Sub-Committee Audit Sub-Committee Partnerships Remit: To have on-going responsibility for the affordability of the local healthcare system, and to receive monthly monitoring reports. This group will highlight concerns to the Board. Remit: To regularly review providers to ensure that services are safe, and that outcomes are monitored. Remit: To consider service provision and ensure that services are commissioned for shorter pathways, better value for money and that provision is appropriate and adequate. Remit: To help with discharging financial functions. Statutory and legal obligations, working with accountable officer. Remit: To work with and lead partnerships, putting resources where challenges lay. Working and delivering on two evolving agendas with LAs, Health & Well-being Boards, HealthWatch and RCRH.

14. Healthcare Commissioning and Quality Plans Build feedback and improvement into what we commission on your behalf Monitor the quality and safety of care from the information you provide back to us in a number of ways at our Quality and Safety Committee: Continuously improving quality of care

15. Creating a patient revolution • Co-production of services between patients and healthcare professionals • Community participation between public and the service • Improving customer experience of patients and carers • We will be looking at: • The enquiries we receive and issues raised • Reports that the organisations providing care produce to see what is happening • Surveys that patients and public complete with feedback • Complaints and PALS enquiries • Carers’ support • ………………to improve patient experience

16. Our quality priorities

18. Our integrated plan • Will be used to: • Set our priorities, guiding our decisions on planning, investment and disinvestment • Help partner organisations to see areas of focus, helping us align things strategically • Provide a means of holding us to account

19. Our strategic priorities • Instigate – intervening early to prevent problems before they occur • Integrate – putting the patient at the centre of their care • Innovate – changing the way we do things to deliver more with less • Improve – focusing on the quality and safety of services in all parts of the system  • Influence – playing a full role in local partnerships, affecting the determinants of health

20. Our plans are to: • Increase the capacity and capability of primary care, using it as a foundation for system change • Focus on the frail elderly, supporting independence and dignity in old age • Accelerate the Right Care Right Here programme -  providing care in the community and treating hospitals as specialist providers • Treat mental ill health and promote wellbeing, viewing good mental health as a precondition to better physical health • Work in partnership to improve maternity and early years, giving every child the best start in life

21. Our Model for Delivery Delivery Priorities Engage: Primary Care Capability Changes CCG Staff & Member practices Integrated Plan Frail elderly – independence & dignity Accelerate Right Care Right Here Patients, carers and Public Services we buy Clinicians and Partners No health without mental health Partnership for maternity and early years Contracts with emergency & urgent care e.g. Ambulance, NHS 111 Contracts with hospitals & services Specialist support services often Third sector e.g. Drug, Alcohol Performance & delivery Quality, , Innovation, Productivity and Prevention Joint arrangements with local authorities for complex & continued care Contracts with community care providers e.g. District nurses, therapies Better Health

22. Our plans 2012/13 Develop Primary care capability Meet needs of Frail elderly - independence and dignity Accelerate Right Care Right Here – care closer to home No health without mental health – treat mental ill health and promote wellbeing Work in partnership to improve maternity and early years – every child best start in life

23. How we work with other CCGs, CSS • System leadership - The Compact – an agreed way of collective leadership for the NHS system • For contracts - Agreed clinical leads and teams for commissioning for contracts with appropriate CCG representation • Commissioning support – there are some areas where it makes sense to buy support into the CCG so it can be shared for efficiencies such as HR, ICT, information processing

24. Thank you • Have learned a great deal already and much to build on • Remain committed to what its all about….patients and quality of care • Committed to working with the third sector, patients, their carer’s and communities to develop together the best healthcare Questions ?

25. Develop Primary care capability • Reach vulnerable people – make contact with primary care • Working with CCG members and NHSCB to identify and support to address inappropriate variation of primary care • Proactive identification and management of long term conditions - diabetes a priority - review lists, care plans, reviews • Development of services to support patients • Improve consistency of referral through systems & peer review • Patient repatriation – look at discharges in hospital • Making Every Contact Count – promote healthy lifestyles – work in partnership with voluntary and community sector • Improving screening and vaccinations e.g. Screening programmes e.g. Bowel cancer and vaccinations e.g. Seasonal flu to help prevent avoidable illness

26. Meet needs of Frail elderly - independence & dignity Specific focus on dementia– implementing national dementia strategy, NICE guidance and identifying/scaling up local practice Integrated working with social care & better case management Working in partnership with social care for comprehensive package of ‘reablement ‘services to promote and maintain independence Providing support to carers to ensure that their health and well being is not forgotten Improving clinical input into nursing and residential care homes improving care and helping them with increasingly complex needs Developing consistent intermediate care services and pathways When hospital needed, clear arrangements for care to be transferred back to community safely

27. Accelerate Right Care Right Here – care closer to home Established track record of delivery improving and bringing services closer with over 30 care pathway reviews undertaken which £3.9m could be delivered locally for lower cost in community settings and reducing £600k of activity Continue as active partners in Right Care Right Here Review Care Pathway Reviews to see what more can be brought into community prioritising diabetes and other long term conditions Remodel services as they are moved Work with partners to educate patients and public as locations and pathways change Support the trust to deliver final stage of programme in getting a new hospital facility

28. No health without mental health – treat mental ill health and promote wellbeing Working with local authority and voluntary sector - develop specific programmes to ensure promoted well being in all service areas Develop and improve current mental health provision in primary care Including the IAPT programme Making Every Contact Count on mental health – encouraging our partners to do the same Review the Rapid Assessment Interface and Discharge (RAID) approach with view to making it standard Adopt an assets-based approach to people with mental health problems and learning disabilities – promoting independence wherever possible Review current major investments such as pooled budgets in Birmingham between health and social care ensuring focussed and achieving desired outcomes

29. Work in partnership to improve maternity and early years – every child best start in life • Improving access to maternity services esp vulnerable groups • Targeting lifestyle support at pregnant women, supporting mental health and healthier lifestyles • Increasing quality of health visiting – allied to Family Nurse Partnerships and post natal support services inc depression • Increasing uptake of childhood vaccines and screening programmes • Linking with local authority efforts to increase supply and uptake of evidence based parenting programmes and other interventions