NHS Horsham and Mid Sussex CCG Commissioning Plan Priorities 2015-16.

NHS Horsham and Mid Sussex CCG

Commissioning Plan Priorities2015-16

www.5communitieswestsussex.nhs.uk

Our population

5.0% 3.0% 1.0% 1.0% 3.0% 5.0%

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Horsham & Mid Sussex Males Horsham & Mid Sussex Females

England Males England Females


Some figures

• 1,000,000 NHS consultations per day

Community consultations

Hospital contacts

90%

10%

• 60-70% of activity is urgent care

• 40-60% urgent care is avoidable / ‘inappropriate’

• 70% on >65 years old• 75% on people with long-

term conditions• 60% of £ on urgent care• 55-60% £ on hospitals• Carers return approx £95M

in Mid-Sussex (estimate)


NHS HMS CCG – 2014225,800 persons

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89

90+

5 4 3 2 1 0 1 2 3 4 5

Males Females

% total population

Age

ban

d



0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89

90+

5 4 3 2 1 0 1 2 3 4 5

Males Females

% total population

Age

ban

d


CCG Priorities1. Development of a wider and sustainable range of primary care services located in our communities (in GP

practices and community hospitals as well as at home)

2. Join up the many services that a single patient may need so that, as far as possible, their care is delivered to them in a single package that ensures health and social care professionals work together and talk to each other regularly (a modern model of integrated care)

3. Timely access to appropriate urgent and emergency care, at any time

4. Improve non-emergency/planned care at our hospitals and enabling patients to access one-stop services and reduce repetitive attendance and therefore financial waste

5. Patient Participation and Empowerment• Ensure patients / families are included in service design and change• Patients will be supported to take decisions about their own care and promote self care

6. Help build specialised services located in specific centres of excellence

Clinical priority areasStroke and stroke prevention Frailty care – proactive, pre-crisis, crisis, recovery

Early cancer diagnosis and treatment esp breast, lung (MdSx), colorectal

Embedded mental health provision across all age groups and esp Tier 1 and 2 services

Children’s acute care, complex children, SEND, complex families Dementia and End of Life Care


What has already been achieved?• Community Dermatology services• Community Urology services• Hearing services• Musculoskeletal services• Pro-active care teams x 6• Rapid Access Medical Unit• Improvements in Continuing Care Assessment processes• Think Family, Early Help• Young peoples emotional needs services – piloting• Street triage (mental health crises)• Dementia crisis service, Admiral nursing, Memory Assessment Service and support• Inreach services into care homes – GP practices, dementia team, community team• Shared records / care plans – early phase• Integrated discharge planning from hospital – first phase• Initial roll-out of practice based care coordinators• Financial stability – just about


Work in progress

• A range of service areas of concern – digestive diseases, ambulance response, cancer 62 day waits, stroke

• Single community teams (health and social care) around each town• A more stable care home / domicillary care market• Community frailty services• Tailored health coaching and supporting people to look after their

long-term conditions• General practice infrastructure schemes (5 Communities Plan) and

community hospitals• Single point access to urgent service for professionals• The ‘front door’ of urgent services for the public


Work in progress

• General practice capacity and access• Step-down services, hospital-to-home• Shared records – next phase• Well-being services and community support• More public involvement in service development• End of Life Care services• Community-based specialist-led longterm condition services

(diabetes, respiratory, renal, cardiology)• 7 day services• ACE programme (early detection of cancers)


Major challenges 14/15 and 15/16

• Major quality issues that have needed urgent attention• Financial environment for both health and local authority• Payment mechanisms do not align for different providers• Integration great idea, but law has not caught up – e.g health and social care,

information sharing• Better care fund process• NHS Structure and fragmented commissioning• Large scale house building• Obligation / opportunity to re-procure services• Late guidance around key business functions – tariff, contracting• Staff vacancies and turnover (CCG) and a mandated 10% reduction in management

(running cost allowance) costs• Significant vacancies and turnover across range of provider services


On the horizon

• 111 and GP Out-of-hours improvements and how they work with GP practices and A&E

• Single health and social community teams around each community• Development of ‘integrated’ primary care centres in Horsham, Burgess Hill,

East Grinstead, smaller scale re-development around Haywards Heath where a number of services can be located together to improve care

• Exploration of social impact bond investment to develop the care market in West Sussex

• More attention to wellbeing services already in the community and filling the gaps

• More attention to prevention services e.g. diabetes, falls and fractures, early emotional support


Community Assets

Community geriatrician, social care,specialist nursing, children’s ‘MDT’

Integrated Care Team, community beds, Community Mental

Health Team

Shared information

/ patient held record

Workforce/

Education

Proactive care MDTs Community Nursing

Practice Nurses, GPs

Individuals on GP Registered lists

Therapies including talking therapiesIntegrated discharge TeamAdmissions Avoidance TeamSocial CareNursingMidwiferyTailored Health CoachingCommunity ICaRDS

ACUTE

Money / payment

mechanisms / Personal Health

Budgets

Partnership/

Alliance

Community Assets

Prevention and Wellbeing

Tissue Viability NursesIntegrated Response TeamsEnd of Life Care

Residential & Nursing Care at Home

Care Act Carers

entitlement

AdvocacySafeguarding

Menu of care

Wider Primary and Community Care at ScaleFigure 2 of our plan outlined the model for community based integrated teams. Our discussions in the formulation of the Better Care Fund have helped us develop this further to reflect our proactive approach to the provision of health and social care and support in the community to be delivered in partnership through GP practices, integrated health and social care multi-disciplinary teams, community based health and social care services and co-located specialist services. BCF Objective: By 2019 we want to provide a health and social care system where information, advice and support, early interventions and proactive care and support, prevents or delays the deterioration of people’s long term conditions

31


Extra slides if time / for reference


NHSE Five Year Forward View• CCG planning guidance and assurance to NHSE that plans align to 5YFV• Radical upgrade in prevention and public health – children, workplace,

sickness rates, FBB• Personal health and social care budgets• Carer support• Better working with voluntary sector• GPs-hospitals, physical-mental, health-social care, complexity-disease• Multi-Speciality Community Providers, Primary-Acute Care Systems• Urgent care design and role of smaller hospitals• Maternity care and midwifery• List-based care, increasing investment in 1ry care, more GPs in training


Health and Wellbeing BoardDuring 2014-15 the Health and Wellbeing Board have refreshed and updated the Joint Strategic Needs Assessment (JSNA). This has identified three priority focus areas which have been developed and refined through a series of workshops with stakeholders. The identified

areas and how the CCG will be contributing to these in 2015-16 are outlined below.

Children 0 to 2

Normalising births

Children & family Act / SEND

Children’s community nursing & therapies

Personal health Budgets

Emotional health & wellbeing services including pre pregnancy

services

Joint commissioning of targeted family services

Transition to adults

Improve Urgent care pathways (Paediatric area in UTC)

Primary Care Hubs

Workforce

WSCC Health and Wellbeing Board – Workforce project

SCDT workforce developmentWorking with Health Education

Kent Surrey and Sussex to highlight the House of Care

Model and the future changes both in ways of working

(collaborative care planning, shared decision making,

motivational styles, person centred care) and new models

of working (Multi-Speciality MDTs).

Wellbeing and Resilience

Developing person centred care:Tailored health coaching

HWB introduced to secondary care settings

HWB ChampionsPrimary Care Co-Ordinators

project

12Population Health Needs 4

Cross cutting all CCG programmes is the need to reduce health inequalities and this is built into the JSNA priorities and CCG outcomes aspirations on slides 10 and 11. The 2014 PHE Health profile 2014 shows a life expectancy gap of 5.5 years for men and 7.1 years for women in Horsham District. Crawley Borough area shows a wider gap for men at 7.9 years and for women 5.2 years.

NHS Horsham and Mid Sussex CCG Commissioning Plan Priorities 2015-16.

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Transcript of NHS Horsham and Mid Sussex CCG Commissioning Plan Priorities 2015-16.