Patient and Public Forum Wednesday 5 October 2016
NHS Croydon CCG Aiming for financial balance PPI Forum Wednesday 5 October 2016
The current state of NHS finances • In July 2016, NHS Improvement and NHS England announced new measures to address the NHS’s financial challenges nationally • Croydon CCG and Croydon Health Services NHS Trust were among those judged to need extra support to address their financial deficits • Croydon CCG was put in financial special measures based on the result of the first quarter financial position Croydon CCG is required to make £5.7 million savings on top of existing plans to save £12.7 million this year This constitutes, in total, just under 4% of the CCG’s total commissioning budget of £475.4 million for 2016/17
Croydon’s historic financial position • The CCG was established in April 2013 with a substantial financial challenge • Croydon has historically been funded to a lower level than needed to meet the health requirements of our population • The CCG has adopted financial recovery as business as usual – focused on clinically led service redesign • The CCG has received additional allocations over the last two years and is now within an acceptable funding range of +/- 5% • We are required to deliver statutory financial balance for 2017/18 with a £4.2m deficit permitted for 2016/17 • The CCG must ‘live within its means’ and focus its resources to greatest need to deliver better outcomes.
We have a strong track record of savings… We have delivered savings of £72 million over the last five years We have consistently met financial targets whilst improving quality and performance each year This year will be our biggest challenge yet • We will focus on transforming services to make them more efficient, effective and sustainable, including: o Outcomes Based Commissioning (OBC) programme for patients over 65 years alongside Croydon Council o New network of urgent care services launching in April 2017 o Real improvements in cancer, mental health and A&E, urgent care and community services
…but we need to make more savings NHS England is expecting the CCG to deliver our statutory duty to break The CCG needs to even in 2017/18 save £18.4 million – £5.7 million more this year than we NHS England is expecting 2016/17 had planned forecast deficit of £9.9 million to be reduced to £4.2 million
Financial Recovery Action Plan • There is not enough money for us to do everything we want for the people of Croydon • We have to prioritise and make tough decisions to secure the future of local health services for everyone. We are doing this through: o Looking at every opportunity to make savings without impacting fundamental services o Holding clinically-led discussions to explore every option for further savings and assessing the impact on health and the savings they could deliver o Working closely with our health and social care partners
Financial Recovery Plan We have considered the following and will NOT be reducing or changing the following at this time: • Investment in the Better Care Fund • ‘Referral to treatment’ waiting times for outpatients, diagnostics and planned surgery • The number of planned GP hubs in the borough will remain at four • Investment in Child and Adolescent Mental Health Services • Investment to support our work around outcomes based commissioning
Financial Recovery Plan There are four types of expenditure reduction initiatives that we ARE considering: • 1 Re-commissioning services to gain better outcomes and experience for patients and better value for money for the NHS • E.g. promoting self care and support within the community • Strengthening existing policies to ensure the right people get the treatment they 2 need • E.g. restricting emollient (moisturiser) prescriptions to those diagnosed with eczema etc • Making sure patients get the best treatments that offer the most clinically effective 3 treatment and/or best value for money • E.g. Liothyronine prescribing over standard levothyroxine treatment • Reducing ‘back office’ and administration costs 4 • E.g. sharing more services across SWL CCGs
Engaging with the people of Croydon We have drafted a list of where we think expenditure can be reduced, now we want to hear how you think we should prioritise our spend Next steps: Local engagement will be carried Governing Body approved future Proposals go to Croydon out throughout the autumn to ask engagement proposals in the Financial Council Overview and Scrutiny how Croydon residents would Recovery Plan on 4 October Committee on 18 October like to prioritise spending and their thoughts on our proposals • We would welcome your advice and support in this process • If we propose any significant service change, we will fully engage and consult with the people of Croydon on what we should prioritise in order to get health services in the borough back into balance
How will we engage in the future? Our widespread engagement work means we have developed strong relationships within the community and voluntary sector. For example : • Mental Health service users (MIND, HereUs) • Refugee and Asylum seekers (through Croydon Voluntary Action) • BME led community groups (Asian Resource Centre, BME Forum) • Food banks (New Addington and Selhurst) • Young people with learning disabilities (People First, Wadhurst Youth Centre) • Frail older people (Age UK, New Addington Lunch Club, Shirley Neighbourhood Centre) • Parents of young children (under 5s) (Fieldway Family Centre, Woodlands Children’s Centre) • Voluntary and Community Support organisations working in the New Addington, Broad Green, Thornton Heath and West Croydon wards
Engaging with the people of Croydon • Work with well- established local networks including GP practices’ patient participation groups and CVS networks on specific service areas. • Equalities Impact Assessment to identify potential impacts on specific communities and call upon networks to help us reach marginalised groups • Started discussions with our partners, including Healthwatch Croydon and the Health Overview & Scrutiny Committee to help us reach the patient community and make sure we act on insightful local intelligence
Prescribing and Pharmacy WEDNESDAY 5 October 2016 Janice Steele Chief Pharmacist
What is Medicines Optimisation? Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time for the right clinical outcome. Goals • Improve patient outcomes • Take medicines correctly • Avoid taking unnecessary medicines • Reduce wastage of medicines • Improve medicines’ safety • Help encrouage patients to take ownership of their treatment
The most expensive medicine is one the patient does not take
You can help reduce medicines waste by: • Checking what medicines you still have at home before ordering your prescription • Only ticking the boxes on your repeat prescription forms for medicines you really need • If you use the electronic prescription service, telling your pharmacist if they give you medicines you're no longer using or already have enough of at home • Telling your GP or pharmacist if you've stopped taking any medicines, so they can be removed from your repeat list • Ordering online via your GP website which may also be quicker and more convenient for you • Not stockpiling medicines
The cost of medicines to the NHS This year the NHS will cost us around £124 billion, of which £14 billion will be spent on medicines – that’s £38 million every day The prescribing budget for Croydon alone is approximately £41 million (2016-17) This is an average of £107.61 per patient Ageing and growing population increases the demand for medicines and the NHS By prescribing the right medicines for less, the NHS will have more money to invest in better care for everyone like cancer treatments
Maximising prescribing spend We are looking at appropriate NHS spending on prescribing certain medicines and treatments where: • Some medicines can be bought more cheaply directly by patients than it costs the NHS on prescription. This is also faster for the patient than waiting for prescriptions/appointments • Less expensive but equally effective alternatives that provide the same health benefit • The cost to the NHS outweighs the benefit to the patients
Prescribing schemes The proposals we are looking at are: • Gluten free food • Vitamin D for maintenance • Emollients for patients who have not been diagnosed with a dermatological condition like eczema • Medicines for colds and flu • Self-care medicines like paracetamol or antihistamines unless a patient has chronic pain and need to use it routinely
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