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1215-1430 Wednesday 28 August 2013 Nowton Court, Bury St Edmunds

1215-1430 Wednesday 28 August 2013 Nowton Court, Bury St Edmunds. WSCCG Commissioning Intentions 2014/16. Introduction. Running Order Introduce our CCG Clinical Leads 10 min presentation from each Clinical Lead Cancer Andrew Yager

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1215-1430 Wednesday 28 August 2013 Nowton Court, Bury St Edmunds

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  1. 1215-1430Wednesday 28 August 2013Nowton Court,Bury St Edmunds WSCCG Commissioning Intentions 2014/16

  2. Introduction • Running Order • Introduce our CCG Clinical Leads • 10 min presentation from each Clinical Lead • Cancer Andrew Yager • Children, Young People and Maternity R akesh Raja • Integrated Care/ End of Life Emma Derbyshire Simon Arthur • Breakout Session • Mental Health/ Learning Disabilities Roz Tandy • Planned Care Jon Ferdinand • Prescribing Linda Lord • Breakout Session

  3. 2014/15 Planning Cycle • Patient and Stakeholder engagement: WSCCG Patient Revolution Events (x2) WSCCG Community Engagement Group • WSCCG Clinical Work streams (x6) • Member practice engagement ongoing • Send to Providers of Services: 30 September • Negotiate contracts: January-March 14 • Agree 14/15 Provider contracts: 31 March 14

  4. Financial Context • Financial Challenge: NHS England warns that by 2020-21 the financial gap between the budget and rising costs could reach £30bn • 2013/14 WSCCG Savings Target of £5M • Health & Social Care Integration Transformation Fund: £3.8billion nationally 2015/16

  5. Quality • Patient Safety • Clinical Effectiveness • Patient Experience • Culture

  6. Suffolk Health & Wellbeing Strategy • Four County Priorities • Every child in Suffolk has the best start in life. • Suffolk residents have access to a healthy environment and take responsibility for their own health and wellbeing. • Older people in Suffolk have a good quality of life. • People in Suffolk have the opportunity to improve their mental health and wellbeing.

  7. WSCCG Ambition • WS CCG Ambition – deliver the highest quality health services in West Suffolk through integrated working. • Develop clinical leadership • Demonstrate excellence in patient experience and patient engagement • Improve health and care of older people • Improve access to mental health services • Improve health and wellbeing through partnership working • Deliver financial sustainability through quality improvement

  8. Treating the whole person recognising the interrelation between physical and mental health regardless of age, diagnosis or severity Wide and inclusive Community based provision – building on community assets and enabling participation Genuine integrated working across health and social care No gaps or bounce back – support to the right place from any access point Early intervention and confident self management Where will we be in five years? Seamless service across organisations Prevention Primary Care Community services Acute services Tertiary care Palliative care Shared decision making and patient engagement

  9. Provider Challenges • Future of West Suffolk Hospital • SERCO and NSFT – implementation of new service models • Out of Hours and 111 contracts – March 2015 • SERCO contract – September 2015 • Primary Care strategy • Home care provision

  10. Summary • Significant financial challenges • Policy direction is Integrated Commissioning • Strategy required for our Provider Landscape, focusing on the urgent care pathway

  11. Cancer Commissioning Intentions 2014/16 Dr. Andrew Yager: Clinical Lead

  12. Cancer – where will we be in five years time? • Cancer Care provision open and accessible to all within the West Suffolk Locality • Supporting cancer survivors and improving cancer survivorship • Improvement in early diagnosis and embedding cancer as a long term condition • Streamlined cancer information/ Shared Decision Making (SDM) • Cancer care closer to home • Roll-out of the Community Cancer Nurse

  13. Cancer - what did patients say? • ‘GP to have close contact with Specialist’ CCG Public engagement event May 2013 • ‘Cancer survivorship programmes should be embedded into core delivery’ Chair of local Cancer Network 2013

  14. Extending and Embedding 2014/16 priorities • Acute Oncology Service – promotion/education • Endoscopy – Supporting facilitation of the national screening recall system • Early Access to Diagnostics - Weight Loss Pathway evaluation • GP Education - extending ‘Top-Tips’ alongside national and local awareness campaigns • Supporting the WSFT to embed the HOPE programme within West Suffolk • User involvement in shaping cancer services

  15. Further Areas for Development 2014/16 • Expansion of the existing Acute Oncology Service (AOS) – 7/7 • Introduction of Complementary Therapies for cancer patients • Supporting the whole national survivorship agenda • End of treatment summaries and care plans • Information • Access to education and Psychological support – HOPE • Holistic Needs Assessment • Support for Carers • Improvement in early diagnosis

  16. Children Young People and Maternity Commissioning Intentions 2014/16 Dr. Rakesh Raja: Clinical Lead

  17. CYPM- where will we be in five years time? • Promotion of Early Intervention and Prevention Approaches • Single Point of Access for Children’s Services (across health and local authority provided services) • Improved Multi-agency/Professional Working based around the child and family • A better experience for patients/service users, their families and carers • Delivering better value for money and use of resources

  18. Putting children, young people and their families at the heart of what happens Acting early and intervening at the right time Integration and partnership Safe and sustainable services Workforce, education and training knowledge and evidence Leadership, accountability and assurance Incentives. CYPM - what did patients say?CYP Outcomes Forum Report July 2012

  19. Extending and Embedding 2014/16 priorities 1 • Continuing development of the West Suffolk Hospital Urgent Care/ Emergency Pathway • Development of a short stay tariff at WSH/ Urgent OP clinics. • Evaluate and Embed Paediatrician Led GP Telephone Advice Line. • Production of Education Materials for Primary Care/ Patients etc • Management of Long Term Conditions – Diabetes, Asthma, Epilepsy, Other? • Development of an <18 Eating Disorder Service • Respond to the Maternity Needs Assessment –e.g. Perinatal Mental Health

  20. Extending and Embedding 2014/16 priorities 2 • Looked After Children (LAC) review recommendations. • Autism / Conduct Disorder / Behaviour – CAHMS development with MH • Support Children’s & Family Bill 2014 - access to services - SEND • Modernising Learning Disability Service/ support carers of Children with SCC.

  21. Extending and Embedding 2014/16 priorities 3 • Jointly Commission Speech and Language Therapy (SALT) with Suffolk County Council • Support teenage mothers using Family Nurse Partnership programme • Develop new priorities in response to Clinical Reference Groups (CRGs). • Joint working with other partners - Children’s Trust JCG, School Readiness Programme, - Maternity, Newborn, Children & Young People Strategic Clinical Network - Suffolk Health and Wellbeing Strategy

  22. Integrated Care & End of Life Commissioning Intentions 2014/16 Dr. Emma Derbyshire: Clinical Lead

  23. Integrated Care – where will we be in five years time? • Pooled investment (ITF) • System-wide cohesive approach to assessment and delivery of care • Patient and Family Carer Centric Service • Supported Self Management including single information offer • Co-ordination of Care • Single point of access • Established Prevention Programme • Community asset-based network • Improved patient experience • Supporting the patient to be cared for in their preferred place/usual place of residence

  24. Integrated Care and EOL - what did patients say? • ‘Need to do more work in GP practices as it’s not just about medicine. GPs need to look at social circumstances and ensure patients are aware of all the other services available to patients to direct them to these accordingly. The patients don’t know the services available to them.’ CCG Public engagement event May 2013 • ‘There needs to be a ‘net’ – community services can’t work in isolation’ CCG Public engagement event May 2013 • ‘Need to find ways to reach people who choose not to seek help early’ CCG CEG engagement workshop August 2013 • ‘Integration with social care is important particularly out of hours’ CCG CEG engagement workshop August 2013

  25. Extending and Embedding 2014/16 priorities • Community Development • Via a targeted joint approach improve the health and well being of the local community • Preventing avoidable admissions by: • Identifying those at risk – upstream and proactive • Helping people to take responsibility for their lives for as long as possible – without ‘formal care’ • Improving access to rapid response, care co-ordination, OOH services including a 7day response and adoption of EPaCCs to support patients dying in preferred place • Community based support (including care homes) • Co-ordinated approach to the delivery of health and social care • Self Management • Shared decision making to support health and well being • Support people who need extra support but based on what works for them, not what works for our systems • Improving overall length of stay within the acute trust setting • Senior clinical assessment and improved discharge profile • A joint workforce for purpose • Competent, well educated workforce to support service delivery including EoL care

  26. Further Areas for Development 2014 / 16 • Review of Urgent and Emergency care provision: • Urgent and Emergency Care • OOHs primary care • ‘111’ provision • Integrated 24/7 Crisis at Home Service • Assistive technology • Social Marketing • Market development: • Voluntary sector • Family Carers • Neurology • Whole system commissioning: • Pathway commissioning • Joint commissioning: strategic and operational • No long term care decision when in the acute setting

  27. Breakout Session Questions

  28. Mental Health and Learning Disability Commissioning Intentions 2014/16 Dr. Roz Tandy: Clinical Lead

  29. Where will we be in 5 years time? • Local mental health services will be open and accessible to all people regardless of their age or diagnosis and severity of mental health condition. No mental health service user should need to be returned to their GP for onward referral for another mental health service. • Commission mental health and LD services which are integrated into the wider health and social system, and which support the recognition that peoples mental health should be seen as part of their overall physical and mental well being

  30. What did patients say? • Flexible access to services (enabling patients to re-access care and support) • Equity of access to lower level interventions and secondary care • Developing self-help support peer awareness accessible in local communities • Need to focus on Personality Disorder and other excluded minority groups • Combatting the stigma of mental health • Focus on Family Carers/ Dementia/ Learning Disabilities

  31. Extending and Embedding 2014/16 priorities • NSFT – monitoring and managing new service model - embedding and refining pathways • ED and Autism pilots – evaluate and plan future service model • CAHMS – cross organisational boundaries approach with focus on early intervention and prevention – CYPand families emotional wellbeing - PMHWs & conduct disorder • Dementia - increased diagnosis rates and jointly commissioned post diagnostic support, workforce development,

  32. Extending and Embedding 2014/16 priorities • Psychiatric Liaison - evaluate to inform plans to mainstream and prioritise opportunities to extend eg, CYP, OP, MUS • Joint working with other partners to promote recovery and maximise independence - focus on county wide providers keeping local priorities – Suffolk Health And Wellbeing Strategy - Managed Clinical Network for Mental Health, Learning Disability and Neurological Conditions

  33. Further Areas for Development 2014/16 • Learning Disabilities – joint commissioning to improve response of universal services • Mental Health Pooled Fund – future joint commissioning arrangements to support rehabilitation pathway • Mental Health Payment By Results – monitoring & aligning clusters to NSFT Service Pathways • Mental Health Needs Assessment – Developing action plans in partnership with commissioners and providers

  34. Planned Care Commissioning Intentions 2014/16 Dr. Jon Ferdinand: Clinical Lead

  35. Planned Care – Where will be be in five years • Local services in the community, where possible and clinically appropriate. • Shared decision making throughout the pathway. • Patients with long term conditions supported physically and psychologically. • Integration between healthcare providers with timely communication. • Patients have the right care in the right place at the right time.

  36. What public and patients tell us From our pathway work, forum and patient revolution: • Joined up commissioning and easy access when needed. • Self help and emotional needs reflected for a patient centred approach. • Family carers needs to be considered • Complementary therapies as an alternative to drugs and treatments • Reduce isolation from long term conditions

  37. Extending and embedding 2014/16 priorities • Pain – monitoring and sustaining the new model of care. • Ophthalmology – sustaining the commissioned model and develop further pathways for children, glaucoma and wAMD etc. • Dermatology – continue to develop the new model of care. • T&O – monitor and sustain the current pathways for OA hips, Knee problems, shoulders and carpal tunnel along with developing new initiatives. • CMS – develop further specialties and providers for advice and guidance. • IBS – monitoring and sustaining the new pathway. • Pathology – Continue the development of the micro-haematuria pathway. • Diabetes – Development of community services informed by the current review. Integrate services for the diabetic foot

  38. Further Areas for Development 2014/16 • Contractual must dos’s - Community physiotherapy, lymphedema services and DESMOND. • Cardiology – Enhance heart failure services and develop community cardiology services • Respiratory– COPD services • Practice referral plan – Develop a support package to GPs on the pathways and appropriate services to secondary care. Support GPs in reviewing their referrals in relations to their peers and any subsequent outcomes e.g. education event, detailed audit. • Clinical Thresholds – review and develop appropriate clinical thresholds.

  39. Breakout Sessions Questions

  40. Prescribing Commissioning Intentions 2014/16 Linda Lord: Head of Medicines Management

  41. Prescribing – Where will we be in five years? • Primary and secondary care have shared prescribing recommendations • Closer working relationships • Joint development and agreement of prescribing guidelines • Traffic light system and shared care agreements updated, promoted, valued, used • Prescribing budgets aligned with actual spends

  42. What public and patients tell us • Keen for medicines not to be wasted • Interested in complementary therapies • Yoga, pilates, tai chi to help co-ordination, e.g. in Parkinson’s Disease • Relaxation techniques, dance to prevent stress • Would like GPs to signpost patients to complementary therapies • Differing opinions on self care • Happy to purchase meds for minor conditions • Demands for meds on prescription • Information: Posters/leaflets preferred by elderly

  43. Extending and embedding 14/16 priorities • Prescribing recommendations • DROP-List (drugs of low priority) • Dietetic reviews • Gluten free foods • Oral nutritional supplements • Infant formulae • Complex medication reviews • Technician and sessional pharmacist support, including for care homes

  44. Further Areas for Development 2014/16 • Optimising safe and appropriate medicines use • Event on 9th Oct 2013 • Traffic lights and shared care agreements • Robust, accurate documents • SCAs agreed not enforced • Readily accessible via WSCCG website • Support of planned care projects • Lipid pathway, pain ladder, IBS, ophthalmology etc. • PresQIPP • EoE initiatives, benchmarking/scorecards

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