NORTH SOMERSET CLINICAL COMMISSIONING GROUP CLEAR AND CREDIBLE PLAN Version7 (final) 300413

1. NORTH SOMERSET CLINICAL COMMISSIONING GROUPCLEAR AND CREDIBLE PLAN Version7 (final) 300413 Creating the healthiest community together

2. Contents • National Priorities • Health Inequalities/Joint Strategic Needs Assessment • Performance on Outcomes • CCG Vision, Local Priorities and Commissioning Plans • Quality, Innovation, Productivity and Prevention (QIPP) • Financial Plan • Timeline and Milestones

3. National Priorities

4. NHS Mandate • Reaffirms the Government’s commitment to an NHS that remains comprehensive and universal – available to all, based on clinical need and not ability to pay – and that is able to meet patients’ needs and expectations now and in the future. • Improvementsexpected in following areas: • preventing people from dying prematurely • enhancing quality of life for people with long-term conditions • helping people to recover from episodes of ill health or following injury • ensuring that people have a positive experience of care • treating and caring for people in a safe environment and protecting them from avoidable harm. • Through the Mandate, the NHS will be measured, for the first time, by how well it achieves the things that really matter to people. http://mandate.dh.gov.uk/b

5. Everyone counts: planning for patients for 2013/14 • Sets out the principles behind the NHS Commissioning Boards vision for a modern, patient centred NHS with improvements driven by clinically-led, local commissioning from April 2013. • Success in the future will be judged on: • Delivery of the NHS Constitution rights • Quality of outcomes as set out in the NHS Outcomes Framework. • Physical and mental health given equal weight • http://www.commissioningboard.nhs.uk/everyonecounts/ • http://www.dh.gov.uk/health/category/policy-areas/nhs/constitution/ • https://www.wp.dh.gov.uk/publications/files/2012/11/121109-NHS-Outcomes-Framework-2013-14.pdf

6. NHS Constitution • Establishes the principles and values of the NHS in England. • Sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. • All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of this Constitution in their decisions and actions.

7. NHS Constitution Rights • Toreceive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament. • To access NHS services. Patients will not be refused access on unreasonable grounds. • To expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary. • In certain circumstances, to go to other European Economic Area countries or Switzerland for treatment which would be available to you through your NHS commissioner. • Not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, religion or belief, sexual orientation, disability (including learning disability or mental illness) or age.1 • To access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of alternative providers if this is not possible.

8. NHS Outcomes Framework • Five domains - help shape what we are striving to achieve for the patients and populations of North Somerset. • Preventing people from dying prematurely • Enhancing quality of life for people with long-term conditions • Helping people to recover from episodes of ill health or following injury • Ensuring people have a positive experience of care • Treating and caring for people in a safe environment and protecting them from avoidable harm

9. CCG Outcomes Indicators

10. Helping people have a positive experience of care • Early Warning Dashboard / Patient Safety Thermometer key focus of CCG Governing Body • Robust commissioning / contracting of providers to ensure high quality safe services are in place • Action plans agreed / monitored to support continuing improvement cycle • Systematic review of serious incidents & clinical incident trends through Quality Assurance Group • Active engagement in safeguarding boards and serious case reviews

11. Helping people have a positive experience of care • Triangulation of data to identify experience of patients across care pathways within clinical outcome framework • Measuring how patients feel about services provided, including ‘Friends and Family Test’ • Accessible feedback opportunities for patients through PAL’s, working with Health Watch and offering carer / public engagement events • Participation and support to peer review of providers e.g. dementia care • Working with partners to maximise commissioning of integrated care

12. Health Inequalities/Joint Strategic Needs Assessment

13. Demographics • We have a fast growing population, especially among older people; • Higher proportion of people over the age of 50 compared with the rest of the SW or England - (35% in Clevedon); • Many live in rural communities – making access to services and amenities difficult. • Increasingly diverse population – rise in number of people from black and minority ethnic groups (approx 5%); • High number of Looked After Children (approx 240);

14. Deprivation (IMD) • Some areas in North Somerset are now in top 1% most deprived in the country; • Weston’s South and Central Wards are among the most deprived areas in England; • North Somerset has the 7th largest range of inequality of all the 326 districts in England.

15. Levels of deprivation

16. Life Expectancy • Life expectancy is higher than the England and South West average • Life expectancy men 80 years (England 79 yrs) • Life expectancy women 84 years (England 83 yrs) • 22 year gap in life expectancy between our most deprived areas (Weston Central) and least deprived (Clevedon Yeo)

17. Trends in male life expectancy Least deprived: life expectancy has increased by 4.3 years Most deprived: life expectancy has increased by 1.0 year

18. Trends in female life expectancy Least deprived: life expectancy has increased by 3.5 years Most deprived: life expectancy has increased by 0.7 year

19. Causes of death which account for the inequality gap

20. Trends in deaths from circulatory diseases Both groups fallen but mortality in deprived areas still 1.8x higher.

21. Lifestyle factors • Smoking • 16% of adults smoke in North Somerset (21% in England) • 40% of adults smoking in WSM South compared to 10% in Clevedon Walton • Alcohol - Rates of alcohol–related hospital admissions are higher in wards in Weston-super Mare

22. Binge drinking in North Somerset

23. Reducing health inequalities • We have significant health inequalities in North Somerset; • These result from a range of underlying factors (health, social, economic); • Benefits of reducing inequalities are huge and far reaching (economic, social and equality of opportunity); • We need action across all determinants of health by range of partners; • Clear role for PPGs - empowering local communities.

24. North Somerset CCG Performance on Outcomes

25. NS CCG performs well on….. • Non-elective admission rates • Non-elective admissions growth.  • GP Referral Rates • GP referral growth • Elective admission growth • Prescribing spend rates (biggest programmes) in primary care • Prescribing spend growth (biggest programmes) in primary care • Elective admission rate (although only at national level) • Emergency admissions for alcohol related liver disease

26. NS CCG performs less well on... • Under 75 mortality rate from cancer – we are worse than both the national and ONS median range. Work on the JSNA shows this relates to poor outcomes in relation to lung cancer • Patient Reported Outcome Measure (PROM) for elective surgery on groin hernias – below national and ONS median - under review • Healthcare acquired MRSA and C-dif – slightly lower than national and ONS median • Health related quality of life for people with long-term conditions – above the national median but lower than the ONS median • Under 75 mortality rate from cardiovascular disease – above national median but lower than ONS median

27. North Somerset CCG Vision, Local Priorities and Delivery Plans

28. Local Communities and Third Sector Our Vision - Moving from this….. 999, 111, OOH Social Services Secondary Care Community Services Patients and Carers Primary Care

29. Through this….. Coming together around the patient Local Communities and Third S Sector Secondary Care 999, 111, OOH Primary Care Patients and Carers Community Services Social Services

30. To this…. Seamless service provision around the patient Secondary Care Primary Care 999, 111, OOH Patients & Carers Patients and Carers Community Services Local Communities & Third Sector Social Services Always the right care, in the right place by the right person The right thing is the easy thing No decision about me without me

31. Long-term ambitions until 2017 • Work with partners to develop a patient-centred integrated system across all health and social care that minimizes duplication and provides a coordinated service across North Somerset. • Continual improvement of the quality and safety of services • Patients know how to access services appropriately and are better able to manage their own care • Ensuring that carers are supported • More patients supported with end of life care at home or another place of their choice • Reduced hospital beds and increased care and support in our community

32. Solving our key challenges • Needs of Frail Older People – coordinating the services, greater integration across health, social care and acute services • Quality and Safety of all commissioned services – learning from Winterbourne View and Mid Staffs • Weston General Hospital– reshaping the hospital for the future • Clevedon Community Hospital – securing services for the future • Reputational Integrity – given all of the above and some difficult decisions ahead

33. 7 ‘planks’ underpinning our commissioning plans • Integrate Care • Reduce hospital beds • More care closer to home • High Quality and Safe services • Active Patient Involvement • Reshape Provision • Financial sustainability

34. Clinically Led Delivery Plans • Planned Care • Urgent Care • Community Care • Long-term Conditions • End-of-Life Care • Children’s and Young People • Mental Health • Learning Disabilities • Primary Care Quality • Medicines Management

35. Local Commissioning Priorities for 2013/14 • Reduce under 75s mortality rate from cancer • Reduce under 75s mortality rate for cardiovascular disease • Improve health related quality of life for people with long term conditions • Reduce emergency admissions for alcohol related liver disease

36. Quality Premium and commissioning for quality and innovation

37. CCG Quality Premium

38. 2013/14 CQUIN Framework for allocation of the 2.5% across the various measures:

39. Providers need to satisfy at least 50% of the pre-qualification criteria:

40. CQUIN Gateways • Delivery of the 2012/13 high impact change CQUINs will be a nationally required gateway for achieving CQUINs.

41. National CQUIN’s - 0.5% 0.5 per cent of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to national CQUIN goals (where applicable). There are 4 national CQUIN goals for 2013/14 • Friends and Family Test– where commissioners will be empowered to incentivise high performing Trusts; • Improvement against the NHS Safety Thermometer(excluding VTE), particularly pressure sores; • Improving dementia care, including sustained improvement in Finding people with dementia, Assessing and Investigating their symptoms and Referring for support (FAIR); and • Venous thromboembolism (VTE)– 95 per cent of patients being risk assessed and achievement of a locally agreed goal for the number of VTE admissions that are reviewed through root cause analysis.

42. System CQUIN’s – 0.5% 0.5 per cent of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to system CQUIN goals (where applicable). BNSSG Commissioners intend to agree system level CQUINs for acute and community based providers. GOAL: Reduce volume of occupied bed days in acute hospitals for patients staying over 2 weeks. • Reduce volume of patients staying over 14 days in acute hospitals • Manage 95% of patients in 23 midnights GOAL: Improving End of life Care • Achievement of the following: • People dying from a long term condition who have a preferred place of care recorded and communicated and die in their preferred place of care • Production and implementation of project plans and reports. • Production and implementation of a single unified referral proforma.

43. Local CQUIN’s – up to 1.5% At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for WAHT: • Clinical treatment of pneumonia • Alcohol Brief Interventions / Stop Smoking • North Somerset ‘Amber’ Patients Management • Frail Older Peoples Pathway Improvement • Improvement in PROM’s for hernia repair

45. Local CQUIN’s – up to 1.5% At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for NSPT: • Complex Adults Pathway Improvement • Enhancing Integrated Working • Embedding enhanced management of pressure ulcer prevention and training • Alcohol Brief Interventions / Stop Smoking • Seven Day Community Working

46. Local CQUIN’s – up to 1.5% At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for AWP: • National Early Warning Score (NEWS) to include; adult physical health screening, stop smoking & alcohol • MencapCharter • Suicide Prevention tool kit

47. Financial Planning for 2013/14

48. Planning Context • Everyone Counts: Planning for 2013/14 • Re-allocation of the NHS budget to new organisations • 2012/13 Performance • 2012/13 Prior Commitments • QIPP Potential

49. Financial Planning and Business Rules 2.3% Increase in CCG allocation for commissioning 0.3% increase in CCG allocation for transfer to LA £25 per head allocation for running costs Income 4% provider efficiency requirement 2.7% provider inflation 0.2% CNST premium 1.1%-1.3% reduction in provider price tariff 30% marginal tariff for emergency admissions above 2008/09 levels Efficiency 2% headroom 1% operating surplus 0.5% contingency Risk Pooling with other CCGs Risk Management • 2.5% CQUIN payable to providers • Quality premium payable to CCGs Rewarding Quality

50. Reallocation of PCT Budget to CCG