Public Meeting 1 October 2015

Welcome

Julie Pal, CEO CommUnity Barnet

Public Health priorities

Melanie Smith - Director of Public Health Brent

Brent CCG Commissioning Intentions 2015/16

Duncan Ambrose, Commissioner Mental Health Brent CCG

Healthwatch Brent progress update

Ian Niven, Head of Healthwatch Brent

Enter and View - a volunteer’s experience

Meenara Islam

Agenda

Melanie Smith

Director of Public Health

Overview of Health Needs in Brent

Melanie Smith1 October 2015

Overall life expectancy

Page 5

1991

-199

3

1992

-199

4

1993

-199

5

1994

-199

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1995

-199

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1996

-199

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1997

-199

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1998

-200

0

1999

-200

1

2000

-200

2

2001

-200

3

2002

-200

4

2003

-200

5

2004

-200

6

2005

-200

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2006

-200

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2007

-200

9

2008

-201

0

2009

-201

1

2010

-201

2

2011

-201

3

6668707274767880828486

73.4

80.0

79.7

84.9

Brent Males Brent Females

Life

Exp

ecta

ncy

at b

irth

(yea

rs) f

or M

ales

and

Fe

mal

es

4.9 yrs

6.3 yrs

Healthy life expectancy

2009-11 2010-12 2011-1360.5

61

61.5

62

62.5

63

63.5

64

64.5

65

65.5

64.2

63.2

64.8

62.2

62.9

63.5

MalesFemales

He

alt

hy

life

ex

pe

cta

nc

y (

Ye

ars

)

Life expectancy and geography

Page 7

Male life expectancy at birth Female life expectancy at birth

81.985.4 85.3

81.5

88.2

84.2 85.0 85.788.1 86.8

Slope index of inequality

Page 8

Deprivation

Life

exp

ecta

ncy

(y

ears

)4.7 years

Life expectancy gapbetween most and least

deprived

4.4 years

Most deprived Least deprived

76.079.9 80.1 78.8

82.878.9 80.0

81.8 81.8 82.0

Male life expectancy at birth 2011-13

Female life expectancy at birth 2011-13

Estimated prevalence of diabetes

2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 20304

6

8

10

12

14

16 Diabetes (modelled prevalence percent England)Diabetes (modelled prevalence percent Brent)

Year

%

Mental health - dementia Dementia prevalence by GP practice

Proportion of patients aged 65 and over

Dementia prevalence (all ages)

More than 1%

0.75 to 1%

0.5 to 0.75%

0.25 to 0.5%

Under 0.25%

Mental health – depression and anxiety

Brent England

64.70

53.40

10.85 11.95Depression and anxiety prevalence

Depression and anxiety prevalence among social care users

Tuberculosis TB incidence rate for all TB and Pulmonary cases in 2013

2004 - 06

2005 - 07

2006 - 08

2007 - 09

2008 - 10

2009 - 11

2010 - 12

2011 - 13

0

20

40

60

80

100

120

92.2 95.9 96.4 100.5 100.6 98.6 98 94.9

14.7 15 15 15.1 15.1 15.2 15.1 14.8

43.9 43.9 43 42.7 42 41.9 41.2 39.6

Brent rate per 100,000

England rate per 100,000

London rate per 100,000

Rate

per

100

,000

Numbers of adults in treatment 2014/2015

Page 13

Substance Category Numbers in Treatment

%

Alcohol only 466 27%Alcohol and non-opiate only

305 18%

Non-opiate only 252 14%Opiate 716 41%Total Clients 1739 100%

27%

18%

14%

41%

Numbers in Treatment 2014/15

Alcohol only (Alc)

Alcohol and non-opiate only (A&N)

Non-opiate only (Non-o)

Opiate (Opi)

Healthy Eating Adults

Page 14

Source: Active People Survey, Sport England. Data for 2014

Brent London England

51.2%51.9%

56.3%Fruit and Vegetables ‘5-a-day’, 2014

Physical Activity and Active Travel

Page 15

Percentage of physically active adults, 2014

Brent (count) Brent (%) London (%) England (%)

Bicycle 3,859 1.7% 2.6% 1.9%

On foot 10,704 4.6% 5.8% 6.9%

Both methods 14,563 6.2% 8.4% 8.8%

Active methods of travel to work: Bicycle and On foot

Brent London England

52.2%

57.8%57.0%

Smoking prevalence

Page 16

Source: Active People Survey, Sport England. Data for 2014

0

5

10

15

20

25

17.3%

18.4%

Smoking prevalence (%) London average (%) England average (%)

Sm

oki

ng

pre

vale

nce

, %

Children’s oral healthPercentage of children aged five with one or more decayed missing or filled teeth, 2012

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50% 45.9%

England, 27.9%

London, 32.9%

%

Prevalence of obese children in Brent

2010/11 2011/12 2012/13 2013/140%

2%

4%

6%

8%

10%

12%

14%

16%

11.7% 11.7% 11.2%14.00%

12% 11% 11.5%13%

Year Reception Obese Brent (%) Year Reception Overweight Brent (%)

Year Reception Obese England (%) Year Reception Overweight England (%)

%

Young people’s mental health Estimated prevalence of any mental health disorder: % population aged 5-16, 2014

0

2

4

6

8

10

12

10%

Local authority

England average and London average (9.3%)

Pro

po

rtio

n (

%)

Young people’s mental health Hospital admissions for mental health conditions among young people (under 18 years), 2013/14

Richm

ond upon T

hames

Kingst

on upon T

hames

Brent

Barki

ng and D

agen

ham

Redbrid

ge

Hillin

gdon

Mer

ton

Gre

enw

ich

Kensi

ngton a

nd Chel

sea

Newham

Southw

ark

Wes

tmin

ster

Tower

Ham

lets

Bexle

y

Harin

gey

Islin

gton

0

50

100

150

200

250

300

350

400

LA England average London average

Rat

e p

er 1

00,0

00

Teenage pregnancies in Brent

Page 21

201320122011201020092008200720062005200420032002200120000

10

20

30

40

50

60

England London Brent

Co

nce

pti

on

rat

e p

er 1

,000

wo

men

in a

ge

gro

up

Female Genital Mutilation

Percentage of girls aged 15 to 49 who have undergone FGM by country

Female Genital Mutilation

Brent residents born in Somalia by output area

Duncan Ambrose

Commissioner Mental Health Brent CCG

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Brent CCGCommissioning Intentions

Healthwatch Meeting

1st October 2015

26

Brent is an outer London borough in north-west London. It has a population of 321,009 and is the most densely populated outer London borough Brent has 66 member practices which are all aligned to one of five locality based groups, each with an elected Clinical Director. 18 practices have a registered list of fewer than 3,000 patients and 5 practices have a registered list of greater than 10,000 patients.

NHS Brent CCG

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What is NHS Brent CCG?• The 66 GP practices in Brent make up the NHS Brent Clinical Commissioning Group. The GP practices are

divided into five localities – Harness, Kilburn, Kingsbury, Wembley and Willesden. http://brentccg.nhs.uk/en/member-pratices

• Day-to-day decisions are made by a Governing Body of elected GP practice members, lay members, and key executive staff. http://brentccg.nhs.uk/governing-body

How is planning and buying of healthcare services done?• The Brent Health and Wellbeing Board is a formal partnership between NHS Brent CCG, Brent Council, and

Brent HealthWatch. The Board has agreed priorities for improving health in Brent.

• The CCG works in partnership with Brent Council, HealthWatch, patient groups, and voluntary organisations to agree annual commissioning intentions and plans for the year ahead.

 

About NHS Brent CCG

What does the CCG do?• The CCG is responsible for planning and buying most

healthcare services for people registered with a Brent GP. This is known as ‘commissioning’, and follows an annual cycle: Analyse – Improve - Monitor

• The services commissioned by the CCG include planned hospital care, urgent and emergency care, rehabilitation care, mental health care, learning disability services, and care in the community. The CCG does not deliver clinical services itself.

 

ANALYSE IMPROVE MONITOR

Commissioning cycle

Developing our commissioning intentions for 2016/17

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OctoberHealthWatch talk

Big Brent Health DebateOnline Surveys

Focused discussions

ANALYSE IMPROVE MONITOR

Interpret data, new policies,

and new guidance

Share and gather ideas and

expectations

NovemberCCG Governing

Body meets in public to consider views of those impacted and

possible health inequalities

Health and Wellbeing Board

meets to consider priorities

Feedback on CCG decision,hear concerns and views

on implementation ahead of contract

agreements

December - JanuaryHealth Partners Forum

Public Member recruitmentNHS England allocates CCG

funds

February - MarchForm monitoring/ task groups

Contract negotiations Contract awards

April 2016New contract year

CCG decides on commissioning intentions

ahead of contract negotiations

August - SeptemberCCG staff review data,

budgets, and new policies to develop initial

ideas

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Working with Public Health to update and interpret needs• (Previous presentation)

Working with providers to sustain and reshape services• Providers have their own financial pressures and savings targets• Need to find ways to recruit and retain staff

Working with patients to be more independent• Need to find ways to promote and support effective self-care and peer support

Some challenges• Less public funding. Population increasing faster than CCG funding• Increasing dementia prevalence• High levels of Serious Mental Illness and Common Mental Disorder• High levels of diabetes• Providers have their own financial challenges

Some opportunities• Using technology to help people do more for themselves• Working with social services on integrated care• Delivering more care in community venues, local health centres, and GP practices

 

Health context

Financial Context

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• For a number of years, the CCG has enjoyed a good financial position, and had reported a surplus in 2014/15.

• The CCG is funded centrally and receives an allocation from NHS England. NHS England has recently undertaken an exercise to understand whether CCGs are funded fairly and Brent CCG has been deemed to be above its fair allocation.

• This means that any funding growth will be constrained for 2016/17 as funding levels are equalised to their fair funding level over a number of years.

• There have been significant increases in people accessing healthcare in hospital over the past 12 months, particularly in outpatient appointments, elective procedures and day cases.

• Under the current NHS funding system, the CCG pays out money under a standard tariff for each episode of care whenever a patient visits hospital.

• Because this activity has increased, when it is combined with low levels of funding growth, this means that the CCG is currently projecting a circa £2 million underlying deficit.

• Although the CCG is still expecting to break even in 2015/16, it is now spending more money than it receives in its allocation. If this is not corrected for future years, then the CCG would go into deficit.

• A recovery plan is currently being worked up, which means that the CCG’s ability to make new investments is constrained.

 

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Commissioning Intentions 2016 – 2017

Our thinking so far …..

Index of Brent CCG Commissioning Priorities DRAFT

Our commissioning intentions start on the following pages and are grouped as identified below:

Unplanned Care- Primary Care Led Urgent Care & 111- STARRSPlanned Care- Community outpatients- Long-Term conditions- Primary Care- Medicines optimisation- Cancer- Palliative CareIntegration of Health and Social Care- Whole Systems Integrated Care- Better Care FundEnabling Functions- Patient and Public Involvement- Continuing Healthcare and Personal Budgets- Contracting & Performance- Quality & SafetyChildren’s Services Mental HealthLearning DisabilitiesCarers

Unplanned Care - Introduction

The Five Year Forward set out an ambitious plan to take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, and to break down the divide between health and social care.

The current unplanned care system is a complicated and sometimes fragmented system. It includes A&E departments, admission to hospital wards in an emergency scenario, Urgent Care Centres, Walk-in Centres and 111. Additionally, our STARRS service also offers a rapid response to patients with long-term conditions who are at imminent risk of admission to hospital and facilitates early supported discharge for those patients who have been admitted.

Currently, people access services at locations that are not always best suited to their needs. For example, people will access care at A&E departments or Urgent Care Centres when it could be more appropriately dealt with by their GP, taking into account their full medical history.

The aim of our commissioning intentions for unplanned care are to simplify an often fragmented system, and to design a system that aims to redirect patients back to the most appropriate place. Educating patients and publicising what is the most appropriate place to access unplanned care will also play a key role in transforming the system.

This section of the commissioning intentions encompasses:

• Primary Care Led Urgent Care• 111• STARRS

Primary Care Led Urgent Care & 111

Strategic AimA GP-led and driven service, integrated and comprehensive, and working in partnership with other providers, is necessary to achieve improved long-term outcomes, both in terms of reduced ED demand and improved ‘whole’ patient management.

Brent CCG, in collaboration with neighbouring CCGs, will review the existing community-based service model to achieve a more integrated service and co-ordinated pathways for the benefit of patients

Rationale

This process is in accordance with both the 5 Year Forward View and the Keogh Review of urgent and emergency Care. It links also with the NW London Vanguard expression of interest submitted by NW London CCGs

Commissioning/ Contracting Change

Brent CCG will review all urgent and emergency care services including NHS 111, GP OOHs and other associated services including access to emergency mental health care. Current contracts for NHS 111 services are due to expire over the next year.

We plan to procure a safe, high quality NHS 111 service that will be integrated with the Out of Hours service, urgent care provision and emergency care including mental health services. The new NHS 111 service will support our vision to deliver care closer to home, provide for a single point of access and allow for special patient notes & summary care records to be up to date. The summary care records will be available to all the services that have contact with the patient.

Patient/ System ImpactAn integrated, flexible, responsive and sustainable service across NWL that provides a seamless patient journey which aligns with BCCG Out of Hospital Strategy and aims to reduce pressure on local urgent care systems

DOS is the enabling tool to support the implementation of the Urgent & Emergency Care Review by facilitating access to the right service, first time for patients and clinicians.

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The Short Term Assessment, Rehabilitation and Reablement Service (STARRS)

Strategic Aim•This is an integrated intermediate care service from London North West Hospitals NHS Trust (LNWHT) which consists of three key elements; a Rapid Response service, which operates in A&E majors to avoid admissions and accept direct GP referrals for patients at high risk of hospital admission, the Early Supported Discharge Team, which supports the discharge of patients who have undergone elective treatment in order to reduce time spend in hospital beds and the Short Term Rehabilitation team, which supports patients in the community providing on-going rehabilitation and re-ablement to ensure that patients can remain at home with appropriate support.

Rationale

•Brent is the most densely populated outer London borough. The population is younger than England generally, but the population aged 65 and above is projected to grow at a faster pace than the population at large (see slide 12 on population growth).

•Age is a significant determinant of the likelihood of an unplanned admission to hospital with increasing life expectancy comes a corresponding increase in the prevalence of many conditions such as falls, impaired mobility and dementia. STARRS could do more to support a reversal of the current trend for increasing admissions through the Emergency Department (ED) particularly for the frail elderly and Delayed transfers of Care (DToCs). There were 3,167 non-elective admissions in 2014/15 that could potentially have been avoided. Therefore the aim is to expand the rapid response component.

Commissioning/ Contracting Change

• We will jointly review the activity plan for the service to ensure that it reflects the underlying demand for rapid response. Analysis undertaken to date suggests that there are more patients who could benefit from rapid response, thereby avoiding unnecessary A&E attendances.

• The CCG wishes to work with LWNHT to ensure that the Rapid Response service is able to maximise admissions avoidance through greater efficiency.• We will work with the STARRS team to better manage demand for the service. Analysis undertaken to date suggests that there is unwarranted variation in referral

rates, leading to inequalities in care for Brent patients.• During 16/17 we will finalise a revised service specification and associated KPIs, as well as the contractual form and payment mechanism.• Brent CCG and London Borough of Brent will jointly commission and monitor the rehabilitation and re-ablement service to work with people over the age of 18,

living within Brent boundaries. • The CCG will commission a comprehensive falls bundle, working with the Trust and the Council to reconfigure these services.

Patient/ System Impact

• Increased admissions avoidance through greater efficiency• Patients stay in their own homes rather than being admitted to hospital• Patients get out of hospital more quickly• Co-ordinated care planning of health, social care, well-being and enablement through a person centred approach to meet the full spectrum of needs and

integrated Rapid Response Service –a range of services in place to prevent patients and service user from being admitted to hospital settings where appropriate. Integrated Discharge - working collaboratively to assess patients to ensure that discharge planning and transfer of care to community settings is seamless and timely

Planned Care - Introduction

For the purpose of these commissioning intentions, the following Planned Care section includes:

• Community-based outpatient services;• Primary Care/ Acute Pathway development;• Community services for long-term conditions;• Primary Care Services;• Medicines Optimisation;• Cancer;• Palliative Care. Patients will be treated on a best practice care pathway supported by the latest NICE guidance and clinical evidence. Where a clinical workup is possible within primary care, this will be undertaken and patients will benefit from a reduced number of different visits between primary and secondary care.

GP networks will undertake further development to increase their managerial capacity and take on a range of new services.

The CCG will review activity data with its member GP practices to develop ideas for new and innovative service models.

Where the CCG commissions block contracts, such as those for community services, clinical capacity should be fully utilised and, where appropriate, the contracts reviewed to ensure maximum value for money.

In turn, this will ensure that we maximise the opportunity for care outside of hospital and counter the trend of increasing referrals into secondary care.

Community Outpatient Services

Strategic AimThe underlying principle is to focus on outcomes not outputs with the outcomes intended to ensure that new services were better than the current services. The outcomes target the following key areas to drive improvement: Patient experience – the services were to ensure an excellent experience for the patientsClinical effectiveness – new services to deliver improved clinical outcomes from the baseline of where the service startsCost effectiveness – services should be provided at a total lower cost to the commissioner than current provision.

RationaleThe JSNA highlights the need to support the growing demand for services that support the management and treatment of long term conditions with diabetes and cardiac conditions being highly prevalent amongst our population. Prevention and care in a community setting will also allow the more specialist hospital services to accommodate the demand for more complex treatments.

Commissioning/ Contracting ChangePlanned care pathways are being developed through QIPP schemes for 2016/17 and the CCG is planning to develop a referral optimisation scheme which automates the process of referral to ensure best practice and adherence to primary care pathway protocols to ensure more appropriate referrals to secondary care.

The CCG will review the community dermatology service, with the intention of maximising clinical capacity and minimising onward referrals (or discharge back to GP with advice to refer on) to acute dermatology services. The CCG would also wish to see a transfer in responsibility for remunerating the GPwSIs from the CCG to the trust. A review of the MSK/ physio service will be undertaken, together with all community based providers of physiotherapy commissioned by the CCG. The CCG will look to consolidate the current services with a view to achieving improved waiting times, care pathway and value for money. The CCG will undertake a review of the existing community gynaecology pathway in terms of its impact on secondary care activity.   There is a need to undertake a stock take of ophthalmology and cardiology contracts at the 12 month review stage to assess how contractual terms and conditions may be improved or determine options to realise anticipated benefits from these services. Patient/ System ImpactPatients will have access to services in the community and be supported in managing their own conditions. Hospital services will have capacity released to manage the treatment of more complex cases and result in more cost effective pathways for the health economy.

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Primary Care/ Acute Pathway Development

Strategic AimReferrals from GP practices into acute services have been showing a rising trend over the past 12 months. The purpose of this programme is to develop systems and processes to control the rising demand for routine referrals which are not always clinically appropriate and therefore to reduce demand on acute services. The approach will be driven by locally approved clinical care pathways.

RationaleReferrals into secondary care have been showing a rising trend over the past 12 months across a number of different specialties, including T&O, gastroenterology, dermatology and ENT. This trend is unsustainable for the healthcare system and we need to do more to try to make the health economy more sustainable in the future. Additionally, standardisation of care pathways provides a benefit to patients because this ensures adherence to the best quality care pathways.

Commissioning/ Contracting ChangeWe will continue to work with our constituent GP practices to train them on usage of the DXS referral management system and continue to jointly design clinical care pathways in collaboration between the CCG’s clinical directors and hospital consultants. This ensures that the care pathway is jointly owned. We will launch further care pathways relating to paediatrics, gynaecology and gastroenterology.

We will also work through more detailed changes to the gastroenterology care pathway (which appears as a QIPP scheme) to introduce new care pathways for patients on DMARD drugs, those with abnormal liver function tests and for those patients requiring an endoscopy.

With regard to ENT, we will seek a reduced tariff for micro-suction by introducing a single cost tariff for micro suction at LNWHT and a one stop clinic for dizziness and vertigo.

We will work with our local acute trusts to pilot a teledermatology service, providing rapid diagnosis for a range of dermatological conditions in GP practices by qualified specialists viewing high quality photographic images via a remote secure system. Many cases diagnosed this way can be managed in the community. Patient/ System ImpactWhere appropriate, self-care will be incorporated into the care pathway (e.g. exercises that people can try to reduce their symptoms before onward referral). Patients will be diagnosed and treated using a clinically optimal care pathway supported by the latest evidence, NICE guidance and local clinical input, so that all GP practices operate to a standardised protocol. In turn, this should reduce any unnecessary demand for acute services, and therefore reduce waiting times for treatment and diagnostics.

Long Term Conditions

Strategic AimSupporting adults with long term conditions, including patients with Stroke, Respiratory conditions such as COPD, Parkinson’s Disease, Sickle Cell, Diabetes and Tuberculosis, to better manage their own care in the community and improve their quality of life.

RationaleDue to demographic and socio/economic factors, Brent has one of the high prevalence rates of patients with Long Term Conditions (LTCs) in the country. This prevalence rate continues to grow and joint action with public health, social services and other agencies is required to tackle it. There is also a wide variation in the range of community services available to patients in the Borough. While in some areas there has been progress, such as the new community services for Diabetic and CHD patients commissioned by the CCG, other areas requiring improvement. Without action, it is expected there will be rising health inequalities, poorer health outcomes for patients and greater demand on local acute/primary care services.

Commissioning/ Contracting Change• Respiratory/COPD service - we will work with the local provider to redesign the existing community respiratory service to better

meets the needs of patients.• Parkinson’s Disease Nurse – we look to commission a 2 year pilot for a new nurse-led community service for patients with

Parkinson’s Disease that provides care and treatment in people’s homes.• Tuberculosis (TB) – we will work with colleagues in Harrow CCG and Public Health colleagues in Brent & Harrow to develop and

deliver a screening programme for patients with TB in Brent.• Sickle Cell service – Following evaluation of the new sickle cell outreach service, the CCG will review this pilot and if shown to be

successful, will roll out the service afterwards.• Stroke ESD – we will review the performance of the Stroke Early Supported Discharge service pilot which commenced on

01/09/2015 and commission the service substantively based on the clinical findings• Diabetes: NHS Diabetes Prevention Programme – the CCG will work with PH colleagues to submit an Expression of Interest for

the Prevention Programme and if successful will implement the programme in 2016-17

Patient/ System ImpactOur long term aims will be to improve the quality and range of services closer to where patients live and improve health outcomes for patients with LTC. We will also develop an integrated health and social care pathway to enable an holistic approach to supporting people with complex care needs. Patients will be better able to better manage their own care, reducing demand on local acute services (particularly in terms of unscheduled admissions to hospitals).

39

Primary Care

Programme NarrativeDevelop primary care landscape to include GP networks and a federation across Brent as provider organisations in order that more care can be provided in the community and reduce variation across practices in clinical outcomes. Enable patients/carers to be better equipped to manage their own care through online access to appointments, e-prescriptions, self-management advice, support (through telecare, telephone consultations) and service signposting.

Need JSNA 2014 identified:-• While there are some practices whose performance is excellent, there is a wide level of variation between practices. There are a significant number

of Brent practices failing to meet key clinical performance indicators. • A key strand of improving delivery of services is to improve and extend Primary Care in Brent by working in partnership with the whole range of

health and social care providers as well as with the voluntary sector and vulnerable patient groups who are at risk of hospital admission to provide holistic services across Brent.

Access to extended GP services and primary care in Brent- A Scrutiny Task Group Report recommended:-• NHS England, Brent CCG and local GP networks carry out a review of current GP opening hours across the borough and consider additional ways of

accessing GP services, including Skype, telephone and email consultations where appropriate and within Information Governance principles. • Brent CCG carries out a detailed review of GP Access Hubs following the initial six months and first full year of operation against the new service

specification, providing a detailed evaluation on the level of take up, impact on patient satisfaction regarding access and impact on A&E and UCC attendances. Review includes public engagement to assess the extent to which the model reaches and benefits all residents in the borough.

Commissioning ChangeMore services will be commissioned via Networks:-• Care Home & High Risk Housebound patient service• Improving GP Clinical Outcomes • Phlebotomy services• GP Access HubsOther Out of Hospital services are provided at practice level however the formation of Networks enables provision of services for the whole population.Evaluate services that are commissioned to assess efficiency and relevance to population and review service where necessary.Impact• Care Home & High Risk Housebound patient service – reduce variation in service provision and provide proactive care to residents. Improved quality

of care for patients and reduction in non-elective admission, use of A7E and LAS.• Improving GP Clinical Outcomes – Reduction in variation across Brent practices in clinical outcomes• Phlebotomy services – Better access for patients within Brent CCG enabling patients to access services at any provider• GP Access Hubs – improved access for routine GP appointments upto 9pm weekdays and 6 hours at weekends i.e. 7 day service.• Reduce variation in patient care and reduce unnecessary demand.

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Medicines Optimisation

Strategic AimTo support effective medicines optimisation for Brent residents so that they get the most out of their medicines. This requires health and social care professionals, patients and carers working together in an integrated way.

RationaleThe prescribing team supports GP practices to deliver evidence based and cost-effective prescribing so that patients receive high quality, safe and effective medicines. The advisers also work across the local health economy to agree place in therapy of medicines and to improve systems for transfer of patient care.

Commissioning/ Contracting Change• The medicines optimisation commissioning intentions and prescribing QIPP plan build on existing work to drive improvements in

quality and efficiency through effective medicines use. Patient leaflets are produced/encouraged to be used to support patient self-

care.• Improve the interface transfer of prescribing with secondary care, community and mental health trusts by agreeing shared care

protocols for certain medicines.• Implement the NWL wide protocols for drugs and improve the contract management of acute prescribing.• Work with provider partner organisations, GP practices, other primary care contractors, patients and other partners to identify

areas where medicines waste occurs, analyse systems to identify areas for improvement, and implement system change to reduce

waste; to support patients with taking medicines to reduce unintentional waste. • We will support providers to improve systems for safe transfer of information on patient medication at admission and discharge.• Effective management of payment-by-results excluded (PbRE) and high cost drugs (HCD). Engage with partner providers to

prescribe high cost medicines, procured by NHS England. NHS England maintains a central repository of prices for excluded

drugs.

Patient/ System Impact• Improved medicines reconciliation for patients transferred between care settings. • Implementation of cost-effective evidence based medicine.• Realisation of the QIPP savings whilst maintaining quality prescribing.• Improvements in the practice repeat prescribing systems / processes with a view to reducing medicines wastage.

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Cancer commissioning Intentions (quality requirements)

Strategic AimIn April 2014, NHS England published five year cancer commissioning strategy for London, to give fresh impetus to implementing the Model of Care recommendations. One of the identified work streams in this strategy is reducing variation in secondary care services. 2016-17 will be year three of this strategy and the quality requirements will build upon those on the previous two years. Pan-London cancer commissioning board develop and endorse the cancer commissioning intentions, with input from key stakeholders, for all London CCG to agree with providers.

RationaleOne in two people will be diagnosed with cancer in their lifetime. 50% of cancer patients now survival at least ten years. There are a number of actions that can be taken to improve survival and quality of life, and the priorities for secondary care are included in the cancer commissioning intentions.

The updated NICE guidance on suspected cancer: recognition and referral (June 2015) places a greater emphasis on GP direct assess to investigations, to achieve earlier detection of cancer. Setting up direct access services has been, and continues to be a corner stone of the cancer commissioning intentions.

Commissioning/ Contracting ChangeThe 2016/17 cancer commissioning intentions will build upon the previous two years, ensuring service improvements are embedded and progressive targets continue to be stretched.Potential new requirements include: broader range of direct access tests, broadening the scope of services to manage some of the consequences of anti-cancer treatment and expanding stratified follow up pathways.There is a proposal to include commissioning with mental health providers to develop pathways for the management of psychological support for cancer patients.

Patient/ System ImpactImplementing the quality requirements aimed at earlier detection of cancer and improving access to effective treatment will save lives.Patient impact - Improving availability to direct access investigations will help identify cancers earlier, potentially giving a greater range of treatment option, some may be curative. It is important that patients receive the best treatment and care wherever they are treated, and the cancer commissioning intentions aim to achieve this.System impact - Earlier detection which results in improved outcomes will have a positive impact survival rates and on the quality of life for survivors, which will help control the cost of cancer in the medium and long term. 42

Palliative Care

Strategic AimIn 2010 Brent PCT developed an End of Life Care Strategy with their key stakeholders. The strategy set ambitious targets and established a steering group to oversee the activities planned. However, due to organisational change and staff turnover progress has been limited and inconsistent. Due to the issues highlighted a review of the current pathway and services commissioned is required.

RationaleEnd of Life Care Strategy (DH 2008). The NHS should provide support for patients to die in the place of their choosing (most frequently ‘at home’) and to prevent unnecessary reactions within the health and care system that prevents people from achieving this goal. Signposting and awareness of the needs of palliative care patients within the urgent care system is crucial to achieving this.Commissioning/ Contracting ChangeTo review the current pathway(s) for EOLC and specialist palliative care services to ensure they are fit for purpose and meet the current needs of the population of Brent. The outcome of the review will help determine the future commissioning arrangements.

In particular, we will review the care pathway for people estimated to be in the last year of their life and the opportunity to provide a single point of access, linking with the LAS, NHS 111, district nursing teams, the patient’s GP, GP out of hours service and care agencies. We will explore the potential benefits of providing access to a specialist palliative care advice and support hotline with 24/7 access.

Patient/ System Impact

• Patients will receive appropriate care in the right setting, will be treated by the right professionals and have their care managed more seamlessly. An integrated care pathway will support patients to die in their preferred place of death.

• Links to the Rapid Repsonse Team avoiding hospital admissions and able to put packages of care in place when appropriate in the out of hours period.

• Patients benefit from signposting on the basis of need in the last year of their life.

Better Care Fund (BCF)

Strategic Aim•The Better Care Fund is a commissioning driven redesign programme delivered in partnership with organisations from across the Brent Health and Social Care economy. The objective is to bring together health and social care in order to transform local services, providing people with the right care, at the right place, at the right time tailored to their individual needs and to the highest possible standards. NHS Brent has a five year Strategic Plan setting out our vision for a transformed health and care system, which includes these BCF schemes.

Rationale•The Brent Joint Strategic Needs Assessment has informed our vision and priorities to integrate care, reduce the high levels of health inequality which exist throughout Brent and improve the health and prosperity of those individuals and communities who experience high levels of social exclusion and disadvantages. This has ensured that we have a collaborative approach between health, the local authority and other key partners.

Commissioning/ Contracting Change

•BCF Scheme 1 – Keeping the most vulnerable well in the community. Please see the commissioning intention summarising the Whole Systems Integrated Care Model (WSIC)

•BCF Scheme 2 – Avoiding unnecessary hospital admissions. We will jointly commission with Brent Local Authority an urgent, rapid response service staffed by a multi-disciplinary team of nursing, therapeutic, and social worker staff who will proactively responding to potential A&E admissions and referrals from GPs over 7 day period.

•BCF Scheme 2.5 - Integrated rehabilitation and reablement. We will jointly commission with Brent Local Authority a multi-disciplined health and social care professional team of occupational therapists, physiotherapists, social workers, dieticians, speech and language therapists, psychologists, rehab assistants and externally commissioned reablement home care providers. The team will operate on a lead professional and trusted assessor model.

•BCF Scheme 3 – Efficient multi-agency hospital discharge and community bed provision. We will jointly commission with Brent Local Authority, an efficient multi-agency integrated hospital discharge service, combining existing health and social care discharge teams who are co-located within a hospital setting.

•BCF Scheme 4 – Mental Health Improvement – This scheme aims to find a sustainable liaison psychiatry service model that is fit for the future, and responsive to improvements in other parts of the physical and mental health services. Further changes are anticipated in 2015/16 with the development of out-of-hours Home Treatment Rapid Response Teams that will deliver emergency and urgent mental health assessments in the community.

Patient/ System Impact

• Reduction in permanent residential care admissions• Reduction in readmissions to hospital following period of reablement (increased effectiveness of reablement) • Reduction in delayed transfers of care• Reduction in non-elective hospital admissions (general + acute) • Improved patient experience and satisfaction

Whole Systems Integrated Care (WSIC)

Strategic AimFollowing the successful implementation of WSIC in Brent in 2014/15, the CCG will seek to evolve the model during 2016/17. Brent partner organisations have agreed to roll out multidisciplinary ‘core teams’ – staff working together to plan, deliver and manage care for people aged 65 and over with one or more long-term condition. These teams will work with groups of GP practices, overseen by a shadow Accountable Care Partnership (ACP) to deliver care that addresses medical, social and psychological needs.RationaleThe needs driving the shift to planned and preventative care, delivered in a Whole Systems framework include:

• Prevalence of long term conditions – Brent has seen a 38% increase in the prevalence of diabetes between 2008/09 and 2012/13 projected to rise further. Long-term chronic conditions are often related to lifestyle, poverty and deprivation – challenges in Brent.

• Emergency admissions and bed days – 35% of all emergency admissions in Brent are for those aged 65 and over; once admitted this group stays in hospital longer, using 55% of all bed days. This is caused by longer recovery times, infection, and delays to the discharge of medically fit patients.

Commissioning/ Contracting ChangeWe have to set our commissioning framework up to deliver and incentivise WSIC models. This means:

• Developing, agreeing and clearly articulating shared outcomes and priorities as commissioners – especially where the care we are commissioning needs to encompass medical, social and psychological support and facilitate wider wellbeing.

• Developing new contracting and payment models – providing a framework for these changes and a set of shared incentives and drivers.• Working with NHSE and the GP Networks to develop a strong and effective Primary Care system in Brent, with the capacity and capability to

underpin these models – which place GPs at the centre of planning and coordinating care alongside patients and carers. Harness and Kilburn are establishing shadow ACPs under WSIC and (as early adopters) will support Kingsbury & Willesden and Wembley to roll this out over time.

The founding stones of WSIC have already been built, and now is the time to build the model up further, with commissioners working closely together with patients, carers and providers to ensure we make concrete steps towards our longer term vision.

Patient/ System ImpactIndividuals will be empowered to direct their own care and support with care coordinated around them, and planned, managed and delivered in a way that supports their own goals and outcomes. Experienced professionals will support them, operating as an integrated multidisciplinary team. The WSIC 2 model will increase the number of days individuals are able to spend at home and when they have been in hospital, to support earlier discharge rates and timely access to support. The WSIC approach will assist in reducing variation in the care provided, contribute to improved patient experience, delivery of better care outcomes, improved user satisfaction and offers more cost effective care for patients with long term conditions.

Enabling Functions - Introduction

This section includes information on the following enabling functions:

• Patient & Public Involvement• Continuing Healthcare • Quality & Safety • Contracting & Performance• Procurement

CCGs have a legal obligation to promote the involvement of patients and carers in decisions which relate to their care or treatment. This requires collaboration between patients, carers and professionals, recognising the contribution made by all.

As commissioners, it is essential that we use contracting and procurement to maximise the value for our population and balance our resources into the right areas, as well as .

As a CCG we must ensure that we make intelligent commissioning decisions and that we prioritise procurements appropriately in our commissioning cycle.

Quality and safety also performs a vital role in ensuring that services are clinically effective, safe and offer a high standard of patient experience. On the rare occasions where an investigation is necessary, the team ensures that lessons are learned and steps taken to avoid future incidents.

The Continuing Healthcare team undertakes assessments to make sure that people who have a primary health need receive continuing healthcare provision when they need it.

Sometimes, Personal Health Budgets are a better solution for people with continuing care needs, so that they can manage their care in a more personalised way that suits them over the long-term. The Continuing Healthcare team plays a role in the administration of these budgets.

Patient and Public Engagement

Strategic aimsWe will use insight, outreach and communications with people in Brent to analyse, improve and monitor health services we commission, so that NHS Brent CCG meets the changing needs of our population and reduces health inequalities in the borough.

Need The aim supports the CCG’s Corporate Objective to ‘engage and empower patients, carers and the diverse communities of Brent.’ In meeting this aim, the CCG will fulfil its statutory obligations regarding PPIE.

Commissioning ChangeThe proposed model (Analysing, Improving, Monitoring) will empower people of Brent to influence decisions made about planning their local health services; reduce duplication between the CCG, Brent Council and HealthWatch; assure the ongoing effectiveness of engagement; and invest in a sustainable and cost effective system – including promoting, supporting and enhancing levels of self-care across Brent. The strategic model is to be applied across three categories of commissioning: transforming services through project management; individual complex care-planning through case management; and sustaining existing service quality through contract management.

ImpactInsight – Existing information will be pooled to better understand the health needs of the Brent population. This information will include data from Public Health, NHS contract monitoring, policy and survey data. Service improvements will consider the needs of specific patient groups and equality groups.Outreach – Expert and credible facilitators will reach out to targeted groups to capture ideas, concerns, expectations and views on specific commissioning proposals. These data will help the CCG and Brent patients to co-produce new and/or improved care pathways.Communications – Information about local services and publicity of proposed changes will be presented in accessible language and formats, and will be transmitted through a range of media/channels appropriate to reaching the Brent population. Assurance of the above will be via new governance structures, overseen by an Integrated Governance Committee, accountable to the Governing Body of the CCG.

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Continuing HealthCare, Complex Care and Personal Health Budgets

Strategic AimAdult Continuing HealthCare is provided when an individual has been assessed by a multi-disciplinary team and been deemed to have a ‘primary health need’ After this has been defined health will develop a package of care which is arranged and funded solely by the health for individuals outside of hospital who have on-going healthcare needs. You can receive continuing healthcare in any setting, including the patient’s own home or a care home.

Since October 2014 the CCG has offered and provide for those patients that wish to take up the offer and are in receipt of Continuing HealthCare a Personal Health Budget. This budget is provided to deliver care as defined in the patient’s personal plan which has to meet their health and wellbeing objectives

RationaleNational Framework for NHS Continuing HealthCare and NHS Funded Nursing Care (revised November 2012)

The NHS 2015/16 planning guidance: “CCGs to lead a major expansion in 2015/16…… CCGs should include clear goals on expanding personal health budgets within their published local Joint Health and Wellbeing Strategy.”

Commissioning/ Contracting ChangeTo ensure that the current Continuing HealthCare Service delivered to Brent CCG continues to offer an effective and efficient service that enables the CCG to deliver person centred care to those patients in receipt of Continuing HealthCare, Shared Care, Funded Nursing Care and Personal Health Budgets.

To undertake an expansion of Personal Health Budgets outside of Continuing HealthCare for those individuals with a long term condition or a child with specialist educational needs. To generate a published local offer for personal health budgets that includes a 3 year plan for implementation.

Patient/ System ImpactTo ensure that individuals requiring a Continuing HealthCare assessment experience an effective and efficient service that is delivered within the Continuing HealthCare Framework guidelines.

To ensure that the individuals deemed eligible for Continuing HealthCare funding are provided the opportunity to work collaboratively with the Continuing HealthCare team in how their care is commissioned.

Contracting & Performance

Strategic AimOur contracts embody the standards of care we have commissioned for patients and we will use them to secure greater local control over decision making; drive performance, deliver service improvements and better patient outcomes.  Brent CCG will change the way that we work with providers around performance. A detailed diagnostic was undertaken on contracts in 2015/16 and expects providers to undertake their remedial action plans in full.

RationaleImprove the performance of local Providers so that waiting times and quality services are achieved while supporting the financial recovery of CCGs and providers. In addition to managing the merger of staff and services the trust has a substantial financial deficit of ~£80m and is non compliant on several national metrics, most notably A&E, RTT and Cancer 62 day waits.

Commissioning ChangeIt is likely that more services will transfer back to CCGs from Specialist Commissioning at NHSE as part of a co-commissioning arrangement . Services to-date will include specialist wheelchairs, neurology and bariatric surgery. Other areas like renal dialysis are being reviewed and task and finish groups will assess the financial impacts for CCGs.

• Review the costing of planned procedures being charged at Day case rates at LNWHT. • Co-ordination of impact of non acute services on patient flow in acute sites as a health economy e.g. new Early Stroke Discharge service. • Review the impact of newly commissioned services – see Scheduled care reviews for Ophthalmology and Cardiac.• Ensure robust assessment of demand so that contracts and pathways manage demand.• Ensure that all contract metrics and levers are utilised and any support funding for providers is non recurrent and targeted so that future

sustainability of services are based on appropriate contractual basis.• Review impact of the CCG’s Referral to Treatment waiting times investment, the investment in 62 modular beds, and winter resilience funding• Review LNWHT’s fiscal recovery plans in collaboration with the TDA

High cost drugs • Continue progress towards the aims of the OP prescribing project.• Review of homecare drug gain share across NWL review all drugs at providers who charge on costs. 

ImpactImproved performance of our local key providers especially in Referral to Treatment times, A&E 4 hour wait and cancer targets.Balanced activity an finance contracts that support the financial sustainability of providers and commissioners.

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Strategic AimTo apply procurement skills, expertise, processes and methodologies that ensure robust, viable and value for money contracts that best serve the interests of patients in Brent.

RationaleThe CCG must comply with EU competition law and the Procurement, Patient Choice and Competition (No.2) Regulations 2013 and associated guidance from Monitor. The CCG also needs to take into account management capacity and time in prioritising contracts for procurement to ensure that it is focussing attention in areas that will maximise benefit.

Commissioning Change

The CCG will continue to adhere to the rules and guidance as set out by NHS England in ‘Better Procurement, Better Value, Better Care’ (2013), Monitor and Public Health England, encompass the ethos of being a responsible commissioner. We are committed to these principles in our commissioning role. We will:• Stimulate the provider market to provide competition to meet demand and secure required clinical, health and well being

outcomes. • Apply procurement skills, expertise, processes and methodologies that ensure robust, viable and value for money contracts.• Ensure procurement processes are effective, transparent and equitable. • Prioritise contracts for review in the most optimal way.• Continuously reviewing existing contracts, for both clinical and non-clinical services, to ensure that they deliver in accordance

with key performance indicators and offer maximum value for money and demonstrate continuous improvement in the quality and range of services on offer

Impact Procurement decisions should lead to the most capable provider of the services being selected, improving the quality of services for patients and reducing waiting times. They should also lead to the provider that is best value for money being selected, as well as improved impact and co-ordination with the whole system and linked care pathways.

Procurement

Strategic Aim

Brent CCG’s Vision for Quality & Safety is to deliver excellent health and wellbeing outcomes and great services for the people of Brent that are delivered in the right place and within budget.  This includes the requirement that robust assurance systems are in place so the public can have confidence that high quality standards are set within the services we commission and are regularly monitored. The team is shared across the BHH (Brent, Harrow, Hillingdon) Federation.

RationaleUsing the latest NHS approved methodologies to analyse, understand and prevent patient safety incidents is central to providing good quality NHS services. Promoting good systems of clinical governance is key to achieving this.

Commissioning/ Contracting ChangeBrent CCG, with the support of the Quality Team, will continue to manage quality within our commissioned services through the following: • Conducting regular detailed analysis of hard and soft quality data and information is used to triangulate the quality of services.• Gathering data from all of our commissioned services. This analysis allows for continuous monitoring to identify good practice as well

as areas where quality standards are not being met which initiates a deeper dive.• Maintaining good working relationships with our providers and continuing to hold monthly Clinical Quality Group (CQG) meetings with

our main providers. These are formal meetings held with the provider where there are open discussions in relation to performance and quality with the use of data and reports.

• Where we are not the lead commissioner, but we have commissioned services, we will continue to work closely with the Lead CCG to receive assurance that services are being delivered to the highest standards possible.

• Focusing on improving patient safety, patient experience and clinical effectiveness and will continue to share learning from serious incidents, never events, safeguarding cases, complaints and any associated reviews with providers to enhance services to patients.

• Working with regional and national initiatives and partners such as the “Sign Up To Safety” initiative and continuing our work with Imperial College Health Partners for the Foundations of Safety Programme.

• Implement the Prevent agenda, working with partner agencies to identify vulnerable individuals at risk of radicalisationImpact

• Improved reporting of incidents when they occur • Improved patient experience• Reduced legal costs to the NHS• Great care in a safe environment

 

Quality & Safety

Children’s Services

Strategic AimTo commission a range of high quality, effective, integrated acute and community children’s services, embedding integrated commissioning arrangements for children and young people and joint commissioning with key partners.

RationaleA quarter of the population of Brent is under the age of 20 years and 91% of the school children are from a Black or minority ethnic group. Given our dynamic demographic make-up we are focused on building on existing work to further reduce risk-taking behaviour amongst young people and support those young people with complex health needs, including mental health problems to stay well in the community.

Commissioning/ Contracting Change• Implement new Joint Commissioning Framework

arrangements with Brent LA for five priority groups: children under 5, Children Looked After, Young Carers, children with special education needs and disabilities and children with emotional and mental health problems.

• CAMHS – to work with our NWL CCG’s and Brent Local Authority to develop a single NWL Local Transformation Plan with clearly identified local priorities for Brent. This will include reviewing all care pathways for CAMHS and the introduction of a standardised training programme targeting all key professionals and parents. Included within this is to commission CAMHs for groups of identified vulnerable children and young people. To implement the new NWL Out

of Hours Service for CAMHs.52

• Looked After Children – develop robust and sustainable systems for collating and reporting timely and accurate data on all CLA assessments and reviews of Brent Children

• Special Education Needs and Disability (SEND) – continue to work with LA to meet our statutory duties and implement SEND requirements. Review the associated impact on health commissioning including the development of Personal Health Budgets

Patient/ System Impact• Integrated health and social care pathway to enable a

holistic approach to supporting children and young people with complex care needs

• Improved health outcomes for all Brent Children and Young People

• Robust care pathways in place to deliver the most appropriate treatment by the right clinician at the right time, with clear pathways in and out of secondary, primary and community care.

Adult mental health strategy on a page

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Nov 2015/16

2015/16 & 2016/17

2015/16 & 2016/17

Self-care and peer support

2016/17

Mental Health

Programme Narrative• Recognise the strengths people have to help themselves and each other stay well after acute mental illness• Increase resources in the community to reduce the need for inpatient services• Improve emergency and urgent mental health care, including sufficient effectively crisis management and in-patient care. • Offer more services in the community for post-traumatic stress disorder, personality disorder, and medically unexplained symptoms.

Need • Mental illness remains the single largest cause of morbidity within Brent, affecting one quarter of all adults at some time in their lives and is a key priority of our

commissioning intentions. Many people have low-levels of depression and anxiety that reduce their quality of life, and impact their employment. Some undiagnosed conditions can appear as physical symptoms (for example, post-traumatic stress disorder associated can present as limited physical function or unexplained pain).

• Historically, investment was made in inpatient services, rather than community services. Recent changes to improve mental health crisis care have reduce the reliance on inpatient care, giving an opportunity to move resources to the community.

Commissioning ChangeSELF-CARE: Move from ‘opt in’ to ‘opt out’ for attendance at the ‘recovery college’ for post-discharge advice and education about mental illness. This would reduce rates of relapse, and provide support to carers.

Primary care – Reshape peer support and specialist mental health nursing support to share learning in the recovery college, help people develop personal recovery plans, support social inclusion, help make best use of follow-up appointments, work with patients on wards to facilitate early discharge, provide advice about online support. Improve clinical support, peer support, and carer support for people who require regular antipsychotic medication to stay well, and for people with dementia. Continued development of talking therapies (including online services) working with a range of providers to increase access and recovery from common mental disorders.

Community care – Continue development of crisis response at home, in the community, as well as in A&E. Establish a new model of community mental health teams with shorter waiting times, and fewer internal waiting lists. Increase the care available for post-traumatic stress disorder and personality disorder.

Crisis houses – Develop options for single-sex, short-stay accommodation, offered as an alternative to inpatient admission when treatment cannot be offered at home. Provide less medicalised care for people who would otherwise be admitted to a ward.Inpatient care - Improve use of patient-rated clinical outcome measures in care-planning. Continued effort on improving the patient experience of care, ensuring the safety of the ward community. Reduce lengths of stay and readmission rates.

Impact• People in Brent will find more opportunities to improve their mental health and wellbeing for themselves, or with the support of peers in their community. Referrals for

more specialist support will be dealt with immediately, and appointments booked over the phone. Urgent assessments will be available in the community. Inpatient services will be focused on brief, intensive, and effective care.

• The CCG will change the balance of resources, to have more support in the community, and les demand on inpatient care.

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Learning Disability

Programme NarrativeUpdate and improve advocacy arrangements for people with learning disabilities in Brent, and strengthen the joint working arrangements between Brent Council and NHS Brent CCG.

Need The 2014 Learning Disability Joint Self-Assessment showed about 1,166 people aged 18 years and over are registered as having a learning disability in Brent. The prevalence of adults with learning disabilities in Brent is predicted to increase over the next 15 years, and a growing number of children and young people with complex and multiple disabilities are also continuing to survive into adulthood.

We have a responsibility to transform the health and care services, and improve the quality of the care offered to children, young people and adults with learning disabilities or autism who present with behaviours that are challenging and/or complex and ensure better outcomes for them. We need to improve access to primary care support and to mainstream health services, enabling those with the most complex learning disabilities support needs to be supported to remain in their own homes or continue with care and support packages.

Commissioning ChangeSELF-CARE: Local arrangements for advocacy will be updated, so that people with learning disabilities can find a number of ways to improve their health and wellbeing.Learning Disabilities Integrated Care Planning – Jointly invest with the Local Authority in a post to lead on and deliver an integrated approach to learning disabilities services locally. Review and re-design in-patient provision and care pathways. Develop and implement a joint strategy with the Local Authority people with learning disability in Brent.Transforming Care – Following the Winterbourne View Concordat, we will continue to identify suitable, local accommodation and support for people with a learning disability. We will review current inpatient services.

ImpactPatients will be encouraged to have Annual Health Checks with a good Health Actions Plan, and a self supported assessment and support plan, for people who are eligible. There will be opportunities for a personal health budget and a personal social care budget. Services will follow a joint health and social care strategy.

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Carers

Programme NarrativeReview current provision and support for carers in Brent. Ensure there is adequate, consistent and robust connectivity

between health and social care to deliver support based on needs. Direct carers to other forms of support they may have been unaware of.

Need Carers are able to apply for respite funding. This is provided by the CCG and LA, and administered through Brent Carers, LNWHT, and Brent Council. The use and effectiveness of this funding will be reviewed. The application process should be straight-forward, and the support should be based on the level of need that has been assessed.

Commissioning Change• SELF-CARE: People who care for patients will be encouraged to consider whether they are ‘carers’, and to have access

through the voluntary sector, GP or through the clinical specialist service to advice on informal support, as well as a more formal carer assessment of need.

• Early identification of carers and review, redesign and commissioning carers support locally that is more joined up.• Jointly commission or have a lead role in the commissioning of carers support services especially GP services,

Counselling, peer support, access to community mental health services, a range of befriending and volunteering schemes, employment support, and schemes to tackle social isolation.

• Improve the range of support services available to carers by developing the range of providers locally.• Develop pathways to ensure that the physical and mental health needs of carers are identified and that support plans

include respite breaks• Agree local processes to ensure that physical and mental health needs of carers are supported.

ImpactCarers will find services recognise their role and their needs. They will be supported to stay mentally and physically well, respected as care partners, treated with dignity and enabled to have a life of their own alongside their caring role. They may be offered an option to take up of personal health budgets, or have access to carers breaks to reduce carer breakdown. Services will be encouraged to identify carers, and make contact with services that can help them. This should improve the quality of life for patients, and reduce avoidable admissions to acute and residential care.

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Questions

• Any comments, ideas, or questions?• BRECCG.Brentenquiries@nhs.net. Questions• brentccg.engagement@nhs.net. Ideas

Events• Online survey 07 Oct• Big Brent Health Debate 07 Oct• Psychosis online survey 07 Oct• Dementia Conference 23 Oct• Mental Health CMHT and urgent care workshop 29 Oct• Post Traumatic Stress Disorder workshop TBC• Learning disability workshop TBC• Children’s workshop TBC• 111 workshop TBC

Ian Niven

Head of Healthwatch Brent

Our priorities

• Phlebotomy (blood tests) – charting the patient experience

• Mental Health - maintaining good health in the community

• Female Genital Mutilation - an area of great concern in Brent.

• Establishing a Community Chest

• Delivering our Healthwatch functions

CommUNITY Barnet Board of Trustees/CEO

Healthwatch Brent Advisory BoardHealthwatch Brent Team

Promotion and Reach Community Chest Communication and Engagement Group Enter and View Group Primary Care Group Shared Information and Signposting

Service

How we are delivering these

Working with partners – our story so far:

Establishing the Healthwatch Brent Community Voices Chest -

Creating a consortium of charity partners to capture reach data

Healthwatch Brent Advisory Board

Promotion and Reach Group

…. We still need 4 more partners

Healthwatch Brent – Facts and Figures

Healthwatch Brent Team – 4

No of active volunteers – 14

Charity partners on the Advisory Board – 6

Promotion and Reach Group members – 4

No of Enter and View Visits – 1

No of strategic meetings attended - 12

No of people reached by Healthwatch Brent - 3500

Healthwatch Brent 3 Rutherford Way Wembley HA9 0BP Telephone: 020 8912 5831 www.healthwatchbrent.co.uk @hwbrent

Information and signposting:

Telephone: 020 3598 6414 info@healthwatchbrent.co.uk

Contacting us:

A volunteer’s story - Meenara

CommUNITY Barnet

Working together works