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2014/15 Annual General Meeting Welcome tweet #ENHCCGAGM follow us @enhertsccg Dr Hari Pathmanathan Chair A new start and fresh beginnings change is good for us all Care at home Local care in community hospitals Investing in specialist

  1. 2014/15 Annual General Meeting Welcome tweet #ENHCCGAGM follow us @enhertsccg

  2. Dr Hari Pathmanathan Chair

  3. “ A new start and fresh beginnings – change is good for us all”

  4. Care at home

  5. Local care in community hospitals

  6. Investing in specialist centres Stroke unit Specialist care in acute hospitals Emergency department Cancer centre Plastic surgery Cardiology Urology Scanning Sleep service Maternity Renal dialysis centre Sleep service

  7. Workforce ‐ our most valuable asset We are supporting staff through: • Creating fellowship schemes for GPs • Investing in practice nurse training and practice nurse tutors • Supporting GP practices through additional home visiting services • Planning ahead to keep the pressure out of the system ‐ through our winter schemes for example

  8. Patient engagement

  9. Thank you

  10. 2014/15 ANNUAL ACCOUNTS Alan Pond Chief Finance Officer

  11. Housekeeping • Draft Accounts submitted within 15 working days of the year end – before the 23 rd April deadline • Annual Report and Accounts were agreed by Board, audited and submitted to NHS England before the 29 th May deadline • Unqualified opinions on the Accounts and Value for Money statement received from the Auditor • Full Annual Accounts published with the Annual Report

  12. A challenging year • Increase in CCG baseline funding of 3.38% – a little more than inflation, but less than demographic and historic growth in demand • Activity growing faster than population growth and the growth in funding • NHS England requirement for CCGs to underspend on their budgets by 1% • CCG remains underfunded by over £30m • Providers under financial stress

  13. Balancing the funding 3.38% funding uplift • Tariff reductions • Underspend carried • forward £31.5m Population growth £45.1m • Increased demand • Service Development • Inflation • 1% underspend •

  14. 2014/15 “Another good year” • Achieved strong performance across the majority of key performance indicators with (e.g. hospital and community waiting times, management of long term conditions, cancer services and end ‐ of ‐ life care) • Achieved national requirement for additional efficiency savings • Achieved the required 1% underspend of £6.3m

  15. Performance on statutory financial targets Expenditure does not exceed sums ACHIEVED allotted to the CCG plus other income £7,913,000 underspent received [223H(1)] Capital resource does not exceed the ACHIEVED amount specified in Directions £170,000 underspent [223I(2)] Revenue resource use does not ACHIEVED exceed the amount specified in £7,743,000 underspent Directions [223I(3)] Revenue administration resource use ACHIEVED does not exceed the amount £3,496,000 underspent specified in Directions [223J(3)] Financial targets set out in Department of Health Group Manual for Accounts 2014 ‐ 15

  16. Performance across the CCG Budget Spend Variance Variance Description £000 £000 £000 % Lower Lea Valley 82,532 82,343 189 0.2% North Herts 120,211 119,238 973 0.8% Stevenage 96,067 95,940 127 0.1% Stort Valley and Villages 57,782 56,823 959 1.7% Upper Lea Valley 117,549 117,452 97 0.1% Welwyn Hatfield 113,573 112,206 1,367 1.2% Central Budgets 47,765 43,734 4,031 8.4% Total 635,479 627,736 7,743 1.2%

  17. Where the money was spent in 2014/15 2% 2% 2% Acute Services 4% 12% Mental Health & LD Community Services 8% Continuing Health Care 59% 11% GP Prescribing GP Services Running Costs Transformation

  18. Change from 2013/14 80.0% 72.7% 70.0% 61.7% 60.0% 50.0% 40.0% 30.0% 20.0% 10.7% 9.3% 10.0% 7.1% 5.8% 4.7% 3.6% 1.0% 0.0%

  19. Future cost drivers • Increasing population • Ageing population • Reduced Social Care funding • New technology and treatments • Patient expectations • Drive for continuous improvement So expenditure rises ever faster

  20. The financial challenge ahead • Return to low growth in funding:  Confirmed growth of 5.8% in 2015/16  Estimated growth of 1.7% in 2016/17  Estimated growth of 1.8% in 2017/18  Estimated growth of 1.9% in 2018/19 • 15% reduction in running cost allocation • Gap between cost of demand and CCG funding £54m by 2018/19 requiring savings of at least £54m

  21. The good news • There are excellent and committed clinicians and managers in East and North Hertfordshire to make this work for local people • Relationships with Social Care Partners are good and we share the same objectives • Relationships with Providers are good and we challenge them to improve their services further • We have already identified the efficiencies needed in 2015/16 • We have delivered on tough challenges in the past and will do so again

  22. Future proofing our strategy Assess our priorities Improve productivity and reduce waste Joint and Develop clinically led the market and commissioning improve providers

  23. Beverley Flowers Interim Chief Executive

  24. Improving mental health services for children and young people Depression Anxiety Weight Self ‐ issues harm Body Cyber ‐ image bullying • At least one child in ten in Hertfordshire has a diagnosable mental health problem • Current levels of mental health support for children, young people and families need to be improved

  25. Improving mental health services for children and young people Joining the dots We are bringing together existing good practice in schools with other support services, through a joint mental health training programme ‐ centred around individual needs. Breaking the cycle We need to identify and support mothers at risk ‐ there is a strong link between a mother’s mental health and the mental health of her children. A clear offer of mental health help Shared assessments and outcomes are vital. Support should be based on a child’s needs, not their diagnosis – whether that’s preventing problems, getting back on track or avoiding a crisis.

  26. Hertfordshire’s Crisis Care Concordat

  27. Hertfordshire’s Crisis Care Concordat We’ve commissioned a piece of work to map the crisis care pathways, analysing what works, what doesn’t, and how to transform patient and carer experiences of crises What’s working Where we need to improve • all the agencies (police, A&E, • stepped care pathway, GPs) involved should be able to access crisis contingency • specialist mental plans for patients health triage at A&Es • Early Intervention in Psychosis • Crisis Assessment and teams will be reintroduced Treatment Teams respond effectively and efficiently • Specialist training in the Mental Health Act for the • Partnership working with police the police

  28. Transforming care • The ‘Transforming Care’ programme ‐ designed to significantly re ‐ shape services for people with learning disabilities and/or autism who also have a mental health problem, or challenging behaviour. • Services will be provided in the community and closer to home, rather than in hospital settings. • The Fast Track plan will focus on integrating health and social services and the development of an all ‐ age pathway for learning disabilities.

  29. Improving stroke services Every year around 740 people in our area have a stroke. In the last year we have: • worked with East and North Hertfordshire NHS Trust to improve stroke mortality rates ‐ increasing the number of specialist stroke staff at the Lister hospital • worked with Hertfordshire Community NHS Trust ‐ developing a team of specialists who help patients to recover from strokes at home • added eight beds to the specialist stroke and rehabilitation unit in Welwyn • developed a stroke joint strategic needs assessment which sets out who is at risk and priorities for What next? improving stroke care.

  30. The future model for stroke services Hospital care on one site Community care Inpatient rehabilitation (up to 6 weeks) at Danesbury or Herts and Essex Hospital Acute (20 ‐ 30 % of patients) Specialist 6 month Stroke Unit Stroke specialist review Unit (HASU) to Patient looked after at home check progress 0 ‐ 3 DAYS AVERAGE STAY: by the Early Supported against goals 12 DAYS Discharge team (up to 6 (depending on weeks) (around 40% of patients) clinical need) Longer term support from primary care, social care and Fit to go home with support voluntary from community teams sector (30 ‐ 40 % of patients) Stroke We want to hear your views Association Reviewed by hospital teams Fill in the response form in your • after 6 weeks delegate pack – deadline 23 October www.enhertsccg.nhs.uk/stroke •

  31. Community respiratory service We want to reduce New multi ‐ disciplinary unnecessary hospital stays team to help prevent by 20% and reduce people with breathing re ‐ admission rates by 23% problems having to be admitted to hospital We want patients to feel because their condition empowered and confident has got worse to manage their own condition By doing this differently we can deliver: Advice line – one phone number to reach all members of the team • Rapid response – 5 days a week • Close links to the hospital so patients being discharged have the right support • Better use of technology for sharing information • Primary and community staff with additional skills •

  32. Thank you

  33. Question and answer session

  34. Dr Nicky Williams Deputy Clinical Chair

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