Strengthening the patient voice

West Bromwich Albion

5 July 2012

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Feedback Summary – morning session

• Where will the money go – control/governance• Engagement – are we practising what we discussed• GP burnout• Access – appointments, phone access, telephone costs,

choice, receptionists doing triage, online• Public health/local authority helping health agenda – schools

and recreation centres going – obesity agenda• Access to mental health – making decisions on my behalf• Links between secondary (hospital) and primary care• Joined up approach for social care and discharge back into

the community• Changing role of GP – home visits, out of hours

New NHS

LicensingLicensing

Department of Health

Department of Health

CQCCQCNHS Commissioning Board

NHS Commissioning Board

Local HealthWatchLocal HealthWatch

ParliamentParliament

MonitorMonitor

Patients & PublicPatients & Public

ProvidersProviders

PartnershipPartnershipLocal AuthoritiesLocal Authorities

SWB CCGSWB CCG ContractsContracts

Birmingham HealthWatchBirmingham HealthWatch

Sandwell HealthWatchSandwell HealthWatch

Accountability

Funding

Key:

Right Care Right Here partnership

BSMHT, BCP, BCHC, SWBH

Other providers BCH, BWH, ROH, DGH, RW, SWB, WM, and I/C.

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Birmingham

Complex range of providers for healthcare:

HospitalsHeart of England (3 hospitals), University Hospitals Birmingham, Sandwell West Birmingham, Birmingham Children’s Hospital, Royal Orthopaedic, Birmingham Women’s Hospital and Birmingham Dental Hospital, Dudley Group of Hospitals

SpecialistBirmingham and Solihull Mental Health Trust, Black Country Partnership Trust

Community Birmingham Community Healthcare

Acute & UrgentWest Midlands Ambulance Service; Range of urgent care, walk-in and other providers – Assura, Care UK etc

Third Sector – a wide range of provision e.g. over 40+ alcohol/drug dependency services

A wide range of services available to commission from

Sandwell

Our health priorities

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Our health needs

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Our health needs

7Health without boundaries - November 2011

Our vision and values

Mission Healthcare without boundaries

VisionWorking together, to improve health and care in our communities.

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Big and small…Clinical Commissioning Group Local Commissioning GroupRobustness at scale Local ownership

Resilience Ideas into action quickly

Strong voice in the health economy and contracts

Relevance

Ability to deliver through major partnerships

Patient representation and involvement

Overview of system Ability to respond to feedback, deliver improvements and efficiencies at practice level

“As a membership organisation we would like to build ways of working that are not bureaucratic with the right safeguards for all.”

Achieving the right balance - Localism

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Our Board Structure

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GP Directors

Lay Directors

One GP Directors to be Chair

Chair(GP Director)

Chair and Vice Chair of HealthWorks

Chair and Vice Chair of Sandwell Health Alliance

Chair and Vice Chair of Pioneers 4 Health

Chair and Vice Chair of Black Country

Chair and Vice Chair of ICOF

Vice Chair(Lay Director)

Notes•Directors are voting members•Other Board members are non voting members•The Chair will be one of the GP Directors from the LCGs, not an additional post•Vice Chair will be one of the two Lay Directors, not an additional post

GP Directors

Lay Director(Vice Chair)

Lay Director(Chair of Audit)

GP Directors

Executive Directors

Managing Director(Accountable Officer)

Finance Director(Chief Finance Officer)

GP Directors

Clinical Directors

Secondary Care Specialist

Nurse GP Directors

Other Board Members(Non Voting)

Independent Committee Members x2

Senior Officers x3

Public Health Member

Commissioning is:“Proactive strategic role in planning, designing and

implementing the range of services required – rather than just purchasing.

A commissioner decides which services or interventions should be provided, who provides them and how they should be paid for and may work closely with the provider in implementing the changes”

Commissioning what it is and why

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Finance & Performance Sub-

Committee

Quality & Safety Sub-Committee

Strategic Commissioning &

Redesign Sub-Committee

Audit Sub-Committee

Remuneration Sub-Committee

Partnerships

Our governance

Remit: To have on-going responsibility for the affordability of the local healthcare system, and to receive monthly monitoring reports. This group will highlight concerns to the Board.

Remit: To regularly review providers to ensure that services are safe, and that outcomes are monitored.

Remit: To consider service provision and ensure that services are commissioned for shorter pathways, better value for money and that provision is appropriate and adequate.

Remit: To help with discharging financial functions. Statutory and legal obligations, working with accountable officer.

Remit: To determine pay and remuneration for employees (likely to meet on an ad hoc basis)

Remit: To work with and lead partnerships, putting resources where challenges lay. Working and delivering on two evolving agendas with LAs, Health & Well-being Boards, HealthWatch and RCRH.

Main SWBCCG

Board

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OD Sub Group

Remit: To determine and implement the OD strategy for the CCG

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Continuously improving quality of care

Build feedback and improvement into

what we commission on your behalf

Monitor the quality and safety of care from the information you provide back to us

in a number of ways at our Quality and Safety Committee:

Healthcare Commissioning and Quality Plans

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Creating a patient revolution

• Co-production of services between patients and healthcare professionals• Community participation between public and the service• Improving customer experience of patients and carers

We will be looking at:• The enquiries we receive and issues raised• Reports that the organisations providing care produce to see what is happening• Surveys that patients and public complete with feedback• Complaints and PALS enquiries• Carers’ support

………………to improve patient experience

Our quality priorities

Our priority How we monitor this

Safety Population health is improving

Effectiveness Treatments are effective

Patient experience Population is satisfied with their treatments

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Clinical Commissioning Group (CCG)

NHS Commissioning Board

Public Health (local authority)

Community healthMaternity

Primary care– pharmaceutical, dental & NHS sight tests

Healthy Child Programme for school-age children

Elective hospital careRehabilitation

Highly specialised inc psychiatric Sexual health (exc. contraceptive)

Urgent and emergency care inc A&E

For those in prison and other custodial settings

Public mental health services

Older people’s healthcare Some services for armed forces Local programmes to promote physical activity

Children, mental health, learning disabilitiesContinuing healthcareInfertility & fertility

Public health services aged 0-5 inc health visiting & FNP, immunisation & screening

Drug and alcohol misuse, tobacco control including stop smoking and prevention

Wheelchair Home oxygenTreatment of infectious diseases

NHS Health ChecksInitiatives to prevent accidental injuryInitiatives to reduce seasonal mortality

Our integrated plan

Will be used to:

► Set our priorities, guiding our decisions on planning, investment and disinvestment

► Help partner organisations to see areas of focus, helping us align things strategically

► Provide a means of holding us to account

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Our strategic priorities

► Instigate – intervening early to prevent problems before they occur

► Integrate – putting the patient at the centre of their care► Innovate – changing the way we do things to deliver more

with less► Improve – focusing on the quality and safety of services in

all parts of the system ► Influence – playing a full role in local partnerships,

affecting the determinants of health

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Our plans are to:

► Increase the capacity and capability of primary care, using it as a foundation for system change

► Focus on the frail elderly, supporting independence and dignity in old age

► Accelerate the Right Care Right Here programme - providing care in the community and treating hospitals as specialist providers

► Treat mental ill health and promote wellbeing, viewing good mental health as a precondition to better physical health

► Work in partnership to improve maternity and early years, giving every child the best start in life

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Changes

Services we buy

Patients, carers and Public

CCG Staff & Member practices

Frail elderly – independence & dignity

Primary Care Capability

Partnership for maternity and early

years

Accelerate Right Care Right Here

No health without mental health

Integrated Plan

Performance & delivery

Clinicians and Partners

Contracts with emergency & urgent care e.g. Ambulance,

NHS 111

Contracts with community care

providers e.g. District nurses, therapies

Specialist support services

often Third sector

e.g. Drug, Alcohol Better Health

Contracts with hospitals &

services

Joint arrangements

with local authorities for

complex & continued care

Our Model for Delivery DeliveryPriorities

Engage:

Quality, , Innovation, Productivity and

Prevention

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Our plans 2012/13

Develop Primary care capability

Meet needs of Frail elderly - independence and dignity

Accelerate Right Care Right Here – care closer to home

No health without mental health – treat mental ill health and promote wellbeing

Work in partnership to improve maternity and early years – every child best start in life

How we work with other CCGs, CSS

► System leadership - The Compact – an agreed way of collective leadership for the NHS system

► For contracts - Agreed clinical leads and teams for commissioning for contracts with appropriate CCG representation

► Commissioning support – there are some areas where it makes sense to buy support into the CCG so it can be shared for efficiencies such as HR, ICT, information processing

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Thank you► Have learned a great deal already and much to

build on► Remain committed to what its all about….patients

and quality of care► Committed to working with the third sector,

patients, their carer’s and communities to develop together the best healthcare

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Questions ?

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Develop Primary care capability

1. Reach vulnerable people – make contact with primary care2. Working with CCG members and NHSCB to identify and

support to address inappropriate variation of primary care3. Proactive identification and management of long term

conditions - diabetes a priority - review lists, care plans, reviews

4. Development of services to support patients5. Improve consistency of referral through systems & peer

review6. Patient repatriation – look at discharges in hospital7. Making Every Contact Count – promote healthy lifestyles –

work in partnership with voluntary and community sector8. Improving screening and vaccinations e.g. Screening

programmes e.g. Bowel cancer and vaccinations e.g. Seasonal flu to help prevent avoidable illness

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Meet needs of Frail elderly - independence & dignity

1. Specific focus on dementia – implementing national dementia strategy, NICE guidance and identifying/scaling up local practice

2. Integrated working with social care & better case management3. Working in partnership with social care for comprehensive

package of ‘reablement ‘services to promote and maintain independence

4. Providing support to carers to ensure that their health and well being is not forgotten

5. Improving clinical input into nursing and residential care homes improving care and helping them with increasingly complex needs

6. Developing consistent intermediate care services and pathways7. When hospital needed, clear arrangements for care to be

transferred back to community safely

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Accelerate Right Care Right Here – care closer to home

Established track record of delivery improving and bringing services closer with over 30 care pathway reviews undertaken which £3.9m could be delivered locally for lower cost in community settings and reducing £600k of activity

1.Continue as active partners in Right Care Right Here2.Review Care Pathway Reviews to see what more can be brought into community prioritising diabetes and other long term conditions3.Remodel services as they are moved4.Work with partners to educate patients and public as locations and pathways change5.Support the trust to deliver final stage of programme in getting a new hospital facility

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No health without mental health – treat mental ill health and promote wellbeing

1. Working with local authority and voluntary sector - develop specific programmes to ensure promoted well being in all service areas

2. Develop and improve current mental health provision in primary care

3. Including the IAPT programme4. Making Every Contact Count on mental health – encouraging our

partners to do the same5. Review the Rapid Assessment Interface and Discharge (RAID)

approach with view to making it standard6. Adopt an assets-based approach to people with mental health

problems and learning disabilities – promoting independence wherever possible

7. Review current major investments such as pooled budgets in Birmingham between health and social care ensuring focussed and achieving desired outcomes

1. Improving access to maternity services esp vulnerable groups

2. Targeting lifestyle support at pregnant women, supporting mental health and healthier lifestyles

3. Increasing quality of health visiting – allied to Family Nurse Partnerships and post natal support services inc depression

4. Increasing uptake of childhood vaccines and screening programmes

5. Linking with local authority efforts to increase supply and uptake of evidence based parenting programmes and other interventions

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Work in partnership to improve maternity and early years – every child best start in life

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