Annual General Meeting 11 September 2018
Welcome Dr Naz Jivani Chair, Kingston CCG
Housekeeping
Agenda 1pm Introductions and Kingston background Dr Naz Jivani, Chair, Kingston CCG 1.05pm – 1.15pm Finances and annual accounts for 2017/18 Yarlini Roberts, Director of Finance, Kingston and Richmond CCGs 1.15pm – 1.40pm Review of the year and future plans Dr Naz Jivani, Chair, Kingston CCG and Sarah Blow, Accountable Officer, Kingston CCG (part of the NHS South West London Alliance) 1.40pm – 1.50pm Children in Care Council Vicky Fraser, Designated Nurse for Children Looked After, Kingston and Richmond CCGs 1.50pm – 2pm Kingston’s Health and Care Plan Tonia Michaelides, Managing Director, Kingston and Richmond CCGs 2pm – 2.30pm Question & answer session 2.30pm Close
Panel introductions Dr Naz Jivani Chair, Kingston CCG
Our community – Kingston 21 209,500 31% £255m 176,000 Population
The Kingston story The population of Kingston is healthy with the life expectancy for both females and males above the national average (81.7years for men / 84.9 years for women) People living in more deprived areas of Kingston have a lower life expectancy. A geing population - and with this comes the challenge of caring for increased numbers of people with ill-health and multiple long-term conditions. We are also seeing growth in the number of children and young people who live and study in the borough.
Finance and annual accounts 2017/18 Yarlini Roberts Director of Finance Richmond and Kingston CCGs
Financial targets Maintain financial stability through not exceeding our budget Use the CCG’s resources wisely to meet the health needs of Kingston and to ensure value for money and fair and effective use of resources Stay within running cost allocation of £21.90/ head of population (£4.286m) Kingston CCG’s accounts and report were submitted on time with an unqualified audit opinion.
How much do we spend and what do we spend it on? £255m in 2017/18 for a population of just over 200,000 people registered with GPs in Kingston. Kingston CCG Expenditure in 2017/18 2% 2% 12% Acute Hospitals 8% Mental Health and Learning Disabilities Continuing Healthcare 52% 8% Community Services 7% Prescribing 9% Primary Care Other, including Social Care funding
Running costs – the cost of running the CCG Running Costs Allocation Actual Variance Running costs allocation (£000's) £4,286 £4,266 £20 ONS* resident population (000s) 195.5 195.5 - Running costs per head of population £ £21.9 £21.8 £0.1 • Running costs target for the CCG in 2017/18 was £21.90 per head of population which equates to £4.286m for Kingston CCG. • Expenditure for the year was £4.266m representing an underspend of £20k. This was primarily met by controls on expenditure on project and agency workers. • Realignment of budgets has been implemented following the new working arrangements with Richmond CCG.
Finance summary As a CCG we faced many challenges in 2017/18. Large increases in demand for hospital services and children’s placements led to substantial financial pressures on the CCG. The CCG has managed these cost pressures and met all key financial targets during 2017/18. 2018/19 is a very challenging year and the CCG has submitted a financial plan which achieves the required surplus of 0.4%. Despite these challenges, the CCG has delivered a strong financial performance. Robust financial governance will be crucial going forward
Performance summary 2017-18 Dr Naz Jivani Chair, Kingston CCG
Performance • Kingston CCG was rated as ‘good’ in NHS England’s end of year Improvement and Assessment Framework. • For 2017/18, Kingston CCG achieved these ratings against the following clinical priorities: Cancer Outstanding Maternity Outstanding Mental Health Good Dementia Requires improvement Diabetes Requires improvement
Performance against other NHS targets Cancer waiting time targets were met with the exception of the 62 day 1 st treatment target for those • referred through a screening service, and the 31 day subsequent treatment target for radiotherapy. • Referral to treatment – the national 18 weeks waiting time target was met. In addition, 99.1% of people were seen within 6 weeks for diagnostic tests against the 99% standard. • Accident & emergency performance at Kingston Hospital - just over 90% of patients were seen against the national standard (target is 95%) • Improving access to phycological therapies (IAPT). The access and recovery targets were achieved for quarter 4 of the year, and the IAPT waiting times targets for access to psychological therapies were met for the whole of 2017-18. • The Friends and Family Test surveys show excellent outcomes reported for inpatient, outpatient, community care, A&E and maternity services.
Key areas for improvement Kingston CCG will continue to work with Kingston Hospital and around the whole health and social care system to recover the A&E 95% target of arrival to admission, transfer or discharge. The proportion of people diagnosed with dementia is not at expected levels, despite a great deal of work with clinical reviewers and practices. The CCG has seconded a dementia nurse specialist from South West London and St George’s Mental Health Trust to support practices in identifying people requiring referral to the memory assessment service. We will support the mental health provider to increase the proportions of people with long term health conditions, older people and people from black and minority ethnic communities accessing psychological therapies in line with best practice. We will work to increase the numbers of people with newly diagnosed diabetes who receive support through structured education services – to help them manage their condition.
Summary of achievements 2017-18 Sarah Blow, Accountable Officer for Kingston CCG (part of the NHS South West London Alliance)
Primary care and social prescribing Primary care • Extended access to GP appointments 8am to 8pm • New referral management processes giving GPs quick access to expert advice • 1,349 improved referral outcomes • NHS switch over to paperless referrals from 1 October 2018 Social prescribing • Connected Kingston - social prescribing project • Trained ‘connected Kingston champions’ and introduced an online referral tool
Changes to prescriptions Engaged with our local communities on prescription items including gluten free foods, baby milk and IVF treatment In September 2017, we recommended no longer supporting routine prescriptions of gluten-free foods, vitamin D for maintenance and medicines readily available over the counter Natural sources of vitamin D
Children and young people’s mental health and wellbeing Guided by the views of children and young people Our plans were jointly agreed with the Health and Wellbeing Board Increased access to services, reduced waiting times for treatment and access to crisis counselling in child and adolescent mental health services. Priorities for 2018-20: • access to face to face and online counselling • shortening waiting times for a specialist neurodevelopmental assessment for ADHD and / or ASD through developing a local pathway
Adult mental health services • Working to introduce a single point of access • Re-modelled the service for adults with attention deficit hyperactivity disorder • Commissioned a new primary care based personality disorder service • Reviewed the Retreat crisis house Police: “The Retreat process was great. I made an initial phone call at the scene to see if they had space. On arrival at the Retreat they invited us in and after a quick handover staff were happy for us to leave.”
Improving care for people with musculoskeletal conditions Reviewed the current provision of care for MSK conditions which account for up to 30% of GP consultations Expanded a single point of triage for patients to improve the overall quality of care Triage through e-referral by a team of MSK specialist practitioners and physiotherapists All routine GP referrals are assessed within 48 hours
South West London Health and Care Partnership NHS, local councils and the voluntary sector in south west London strengthening our commitment to work together to deliver better care for local people In November 2017, we published The South West London Health and Care Partnership: One year on for discussion Commitment to champion children and young people’s mental health and wellbeing Developing Kingston’s Health and Care Plan to be published in March 2019
South West London CCGs Committees in Common agreeing collective decisions including funding for the transformation of primary care for 2018/19 £4.58 million NHS England funding for this implementation providing 18,000 extra appointments each month Cancer care to improve cancer care for local people by focusing on: Early and timely diagnosis and treatment Improving uptake of bowel screening Increasing screening uptake for people with learning disabilities Collective approach to staying well this winter to increase flu vaccine uptake and reduce pressure on A&E across south west London as a whole
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