Annual Report 2016/17 Helen Shields Chief Officer
Summary • This has been the most challenging year for the CCG to date • There have been performance issues across the system with some NHS Constitution targets missed all year There have quality issues including a highly critical CQC report where special • measures was imposed on the IW NHS Trust • The CQC also inspected Earl Mountbatten Hospice which was rated outstanding and all of the GP practices have been rated good The CCG together with system leaders put in place a Transformation Programme • through the Vanguard • The CCG achieved all of its statutory financial duties but with difficult decisions required
Summary (cont…) • The first year of delegated commissioning of primary care has been successful with a new Primary Care Strategy published. • A Sustainability Transformation Plan across Hampshire and IOW has been established. • A reconfiguration of Mental Health services has commenced. • A redesign of acute services is in progress. • The CCG achieved all of its statutory financial duties but with difficult decisions required
Our Objectives • To support system transformation and sustainability We received vanguard funding to support My Life a Full Life Projects. – We appointed to a new senior post to lead the integration of commissioning across – health and social care – We agreed the Sustainability Transformation Plan for Hampshire and the Isle of Wight – We worked closely with NHS England to make the case for additional funding to support the island • To meet finance, quality, commissioning and performance targets – We achieved our financial targets – We did not achieve all of our performance targets – There were challenges with the quality of services we commission
Our Objectives • To implement and deliver delegated commissioning of Primary Care We published our Primary Care Strategy – We achieved our financial targets in relation to primary care – We have not yet agreed a quality framework for primary care – – We have not yet finalised the performance dashboards for primary care • To evolve the culture and governance of the CCG to deliver transformation – We did not make the progress we hoped in relation to organisational development across the system – We have agreed to review the Governance of the CCG. We have reviewed and recommissioned our communications and stakeholder – engagement support
Future Challenge The CCG remains 10% above target allocation • • There is increasing demand on all healthcare services, inflationary pressures and demographic growth • There is a significant financial deficit at IW NHS Trust • Primary care is increasingly under pressure in relation particularly to workforce and demand • The Island continues to experience significant workforce issues including recruitment and retention in all parts of health and care sector
Future Focus • System leadership – establishment of the IOW Local Care Board • Local Care Plan – clear priorities for delivery and transformation • Delivery of savings in year • Supporting improvement in quality of services at IW NHS Trust Delivery of 7 day services in primary care •
Performance 2016-2017 Andrew Heyes Head of Performance and Contracting 8
NHS Constitution T argets (1) The CCG met 8 of the 15 key National NHS Constitution Standards. Key problem areas were the A&E 4 hour waits, Ambulance responses , 18 week Referral to Treatment (RTT) target and cancer waiting times. Achieved Not Achieved Indicator Target Actual Indicator Target Actual Diagnostic - Patients waiting for test waiting less >99% 99.48% RTT - Patients on incomplete non-emergency 92% 87.29% than 6 weeks from referral pathways (yet to start treatment) waiting no more than 18 weeks from referral Cancer – Max 2-week wait for first appointment 93% 97.03% for patients referred by GP urgently with suspected cancer A&E - Patients should be admitted, transferred or 95% 85.74% discharged within 4 hours of their arrival at A&E Cancer - Max 2-week wait for first appointment for 93% 96.24% patients referred by GP urgently with breast Cancer – Max 62-days wait from urgent GP symptoms 85% 81.71% referral to first definitive treatment for cancer Cancer - Max 31-day wait from diagnosis to first 96% 98.64% definitive treatment for all cancers Cancer - Max 62-day wait for first definitive 86% 80.00% treatment following a consultants decision to Cancer - Max 31-day wait for a subsequent 94% 95.51% upgrade the priority of the patient (all cancers) treatment where the treatment is surgery Cancer - Max 31-day wait for subsequent Ambulance - Category A calls (Red1) 75% 63.16% 98% 99.38% An emergency response arriving within 8 minutes treatment where that treatment is an anti-cancer drug regime Cancer - Max 31-day wait for subsequent Ambulance - Category A calls (Red 2) 94% 98.76% 75% 70.03% treatment where the treatment is a course of An emergency response arriving within 8 minutes radiotherapy Cancer - Max 62-day wait from referral from an 90% 90.82% Ambulance - Category A calls (19) 95% 91.87% NHS screening service to first definitive treatment An ambulance arriving at the scene within 19 mins for all cancers 9
NHS Constitution T argets (2) Improvement plans, with target dates, have been put in place for the indicators that were not achieved. Indicator Action Expected date achieved Improving capacity – beds and theatres Referral to • March 18. • Recruitment to certain specialties Treatment within (90% by Sept) • Improve scheduling - booking efficiency 18 Weeks • Promoting patient choice to mainland providers A&E 4 hour Waits • Improving internal operational processes and latest March 18 best practice guidance– ECIST / CQC (90% by Oct) • Roll out of ambulatory Care • Improving internal patient flow and discharge • Recruitment plans Ambulance call out • Improved hospital handover (Turnaround) Red 1 March 18 Efficient use of Community First Responders • times (3 categories) Red 2 June 17 • Workforce Rotas re-design Red 3 July 17 • Recruitment and role development • Implementation of Nature of Call (NoC) and Dispatch on Disposition (DoD) initiatives Closer working with mainland cancer centres Cancer 62 Day • November 17 • Weekly patient tracking reviews. to treatment • Working with the Wessex area cancer alliance 10
Isle of Wight NHS T rust CQC (1) The Isle of Wight NHS Trust, who the CCG commissions most of its services from, was recently put into special measures following a CQC inspection. In response: The Trust , working with the CCG and other health and care partners and receiving advice from expert bodies, has developed an extensive improvement plan. T o monitor progress and achievement, target dates for step- change improvement have been set. The CCG will be working with the Trust’s regulators (NHS Improvement) to support delivery of the improvement plan. 1 1
Isle of Wight NHS T rust CQC (2) In response: The action being taken by the CCG includes : • Strengthening quality management, including: thematic reviews, quality visits, and “deep dives” into service areas; • Setting a clear vision for mental health services and strengthening commissioning arrangements; • Working with the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) and the Acute Care Alliance (University Hospitals Southampton, Portsmouth Hospitals and Isle of Wight NHS Trust) to ensure sustainable acute services for Islanders and visitors. 1 2
Finance 2016-2017 Loretta Outhwaite Chief Finance Officer
How we spent our allocation 2016/17 funding of £239m • Programme(healthcare) £217m Running costs £3m • • Delegated primary care £19m The funding included: • Growth funding of £2.8m (1.4%); • Non-recurrent investment from the national New Care Models programme of £4.9m, to support service transformation.
Financial Performance Highlights All statutory financial duties achieved : • Expenditure did not exceed income; • Cash balance £127k, within cash limit; • Running costs were within the allocation of £3.1m; • Audit Letter: Financial Statements – unqualified; • Audit Letter: Income & Expenditure – unqualified; • Audit Letter : Value for money conclusion: identified a weakness in planning finances effectively to support sustainable delivery of strategic priorities and maintaining statutory functions. CCG delivered a surplus of £2.3m, which was £2.3m above target, due to a national requirement to retain the 1% risk reserve. The Quality Innovation Productivity and Prevention (QIPP) plan delivered £6.5m (2.7%) savings in 2016/17.
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