East and North Hertfordshire Clinical Commissioning Group

AGM 2014

Welcome

Kate HardingCreative PractitionerHealth Liaison Team

Lesley WattsChief Executive

2013/14ANNUAL ACCOUNTS

Alan PondChief Finance Officer

Housekeeping• Draft Accounts submitted within 15 working days

of the year end – before the 23rd April deadline• Annual Report and Accounts were agreed by

Board, audited and submitted to NHS England before the 6th June deadline

• Unqualified opinions on the Accounts and Value for Money statement received from the Auditor

• Full Annual Accounts published with the Annual Report

A challenging first year

• Complete reorganisation of commissioning landscape and funding

• Increase in CCG baseline funding of only 2.3% – no more than inflation

• CCG remains underfunded by over £30m• Activity growing faster than population growth and the

growth in funding• NHS England requirement for CCGs to underspend on

their budgets by 1%• Providers under financial stress

 

 

£38m

£20m

Balancing the funding

• Population growth• Increased demand• 1% underspend

• 2.3% funding uplift• Tariff reductions• Underspend

carried forward

2013/14 “A good first year”

• Achieved strong performance across the majority of key performance indicators with c75% delivered (e.g. hospital waiting times, long term conditions, cancer services and end-of-life care)

• Achieved national requirement for additional efficiency savings

• Achieved  the required 1% underspend of £6m

Performance on statutory financial targetsExpenditure does not exceed sums allotted to the CCG plus other income received [223H(1)]

ACHIEVED£6,020,000 underspent

Revenue resource use does not exceed the amount specified in Directions [223I(3)]

ACHIEVED£6,020,000 underspent

Revenue administration resource use does not exceed the amount specified in Directions [223J(3)]

ACHIEVED£3,204,000 underspent

Performance across the CCG

DescriptionBudget £000

Spend £000

Variance £000

Variance %

North Herts 115,581 115,442 139 0.1%Upper Lea Valley 112,985 112,968 16 0.0%Welwyn Hatfield 109,082 109,080 2 0.0%Stevenage 92,062 92,023 39 0.0%Lower Lea Valley 77,758 77,634 124 0.2%Stort Valley and Villages 55,775 55,637 138 0.2%Central Budgets 36,201 30,639 5,563 15.4%Total 599,442 593,422 6,020 1.0%

Where the money was spent

Acute services 61%

Prescribing 12%Mental health & learning disability services 12%

Community services 7%

Continuing care services 4%

Other primary care 2%

CCG running costs 2%

Acute

Prescribing

Community

Cont. careM

H and LD

Other prim

ary careRunning costs

Future cost drivers

• Increasing population• Ageing population• Reduced Social Care funding• New technology and treatments• Patient expectations• Drive for continuous improvement

So expenditure rises ever faster

The financial challenge ahead• Continued low growth in funding:

3.38% in 2014/15 2.52% in 2015/16 Estimate 2.6% for each of 2016/17 to 2018/19

• 10% reduction in running cost allocation

• Gap between cost of demand and CCG funding – £80m by 2018/19

• CCG savings of at least £80m needed over the next 5 years

The good news

• There are excellent and committed clinicians and managers in East and North Hertfordshire to make this work for local people

• Relationships with Social Care Partners are good and we share the same objectives

• Relationships with Providers are good and we challenge them to improve their services further

• We have already identified the efficiencies needed in 2014/15

• We have delivered on tough challenges in the past and will do so again

Future proofing our strategy

Develop the market and

improve providers

Improve productivity and

reduce waste

Joint andclinically led

commissioning

Assess o

ur 

prioritie

s

Assess our priorities

Assess our priorities

Dr Hari PathmanathanCCG Chair

A clinically-led organisation• Most of the Governing Body members are

clinicians – doctors, midwives, nurses.

• Every ‘locality’ group of GP practices is represented on the board – diverse health needs inform commissioning decisions

• We are the only CCG in the region to delegate £5 per head funding for over 75 year olds to practices.

Clinically-driven improvements

• Home visits for acutely ill patients commissioned, GPs can focus on complex patients.

• Better continuity of care for patients and staff in nursing homes

• Additional winter capacity in the community, avoiding unnecessary hospital admissions

Challenges• Demand management – demographic, prescribing,

staffing and infrastructure pressures

• New QEII

• Ongoing issues at Chase Farm Hospital

• Need to scale up successful schemes across the whole CCG area, such as HomeFirst

• Political uncertainty

Opportunities• New best-practice treatment ‘pathways’ for

common conditions in development

• Active and committed patient participation groups • Diverse opportunities for clinicians to get involved

in new models of care

• Ongoing learning from pilot projects is improving the services offered to patients

Thank you

The New QEII Hospital

John WebsterDirector of Commissioning

Dr Nicky WilliamsVice Chair

Introduction

• Highest priority for the CCG• History• Phases of the development• Services to be provided• Clinical perspective• Integration• Timescales for completion

A reminder• DQHH - Delivering Quality Healthcare for

Hertfordshire• Public consultation across Hertfordshire

concluded in 2007• Key recommendations:

Centralise acute inpatient services at Lister

Provide a local general hospital in Welwyn Garden City

DQHH objectives

• Centralise specialist services, skills and staff in one place

• Improve clinical outcomes• Improve the patient experience and

environment• To meet growing demand• To recruit the best staff

Timeline

The new hospital completes in..….

30 weeks

TimelineThe next significant milestone is in….

3 weeksRemaining wards, theatres and Emergency Department transfer to the Lister Hospital on 1st October

List

erQ

EII

October 2014 April 2015£30 million investment in new hospital

New services, new buildings

Urgent Care Centre

Outpatient appointments, ante-natal care and diagnostic tests

Therapy areas and children’s zone

Remaining wards and theatres move

to the Lister

£150 million investment

Inpatient maternity care

Outpatient appointments and diagnostic tests

All surgery

All inpatient wards

Full emergency department and urgent care centre

What’s happening and when?

New services, existing buildings

What is an Urgent Care Centre?• From October 2014, there will no longer be an A&E

at the QEII • Open 24/7 to treat patients of all ages, including

babies• Urgent Care Centres treat everything except the

most serious injuries or illnesses – when people should call 999.

• There will also be an Urgent Care Centre integrated within the new Lister emergency department to stream patients appropriately

• Public understanding of the new way of working is crucial

New QEII Lister Hertford County

Summary of services after October 2014

Local general hospital Centre for specialist care Local general hospital

24 /7 Urgent Care Centre for minor injuries and illnesses

Full emergency department No emergency care

Outpatients appointments Outpatients appointments and specialist clinics (e.g. sleep disorders, urgent eye clinic, etc.)

Outpatients appointments

Medical and surgical inpatient services

Specialty services – renal dialysis, heart attack centre, stroke unit, etc.

Blood tests Full range of diagnostic services Blood tests

Scanning: x-ray, ultrasound, MRI, CT scans Scanning: full range of scanning services including CT, Dexa, MRI, nuclear medicine, ultrasound

Scanning: ultrasound, x-ray

Endoscopy Endoscopy

Breast unit Breast surgery

Pharmacy Pharmacy – hospital pharmacy only

Children’s Zone Children’s inpatient and outpatient services Specialist children’s centre

Physiotherapy and other therapies Physiotherapy and other therapies Physiotherapy and other therapies

Rapid assessment for ill patients Critical care

Out-of-hours GPs

Ante-natal care Maternity including births, ante-natal and post-natal

Neonatal care

Routine blood treatments Routine blood treatments (e.g. anti-coagulants)

Planned & emergency surgery (inpatient & day)

Every year, the New QEII will deliver:

• 105,000 outpatient appointments• 35,000 Urgent Care Centre attendances • 17,000 ultrasounds• 13,500 CT and MRI scans• 110,000 phlebotomy tests • 30,000 x-rays

The New QEII

June 2014

Progress so far

Care home on the New QEII site

• History• ENHT marketing site• CCG & HCC specification

for bed based care service we want to commission

• Joint bid evaluation• Links to Hospice and

services within the New QEII

Nicky Photo No 2

Nicky Photo No 3

HomeFirst

Community Hub

Discharge to assess

Early Supported Discharge

NHS 111Acute in-hours visiting service

Doing things differently in the

community

Mental health services• Hertfordshire Partnership University NHS

Foundation Trust currently provide some adult mental health services at the QEII

• Welwyn and Mymms inpatient wards will close in September and move to a purpose built facility at Kingfisher Court in Kingsley Green, near St Albans and Radlett

• Community mental health outpatient clinics at the QEII will be run from Roseanne House in Welwyn Garden City. Appointments are also held in a range of other locations

Kingsley Green:Kingfisher Court is easily accessible via the M25, the M1 and the A1M.

Public transport to the site is to be confirmed, but meanwhile HPFT will provide a free transport service from QEII & Hemel Hempstead Hospital and from Radlett, Potters Bar, St Albans City and Watford Junction train stations.

• Thumbswood mother and baby unit will move to Kingsley Green

• The Acute Day Treatment Unit will move in due course. It is likely to move to the Glaxo Day Hospital at the rear of the Lister Hospital in Stevenage

• Community outpatient clinics run from Roseanne House in Welwyn Garden City and other community settings, so these patients will not need to visit an acute hospital site

Mental health services

New theatres block The Treatment Centre

Car parking

New wards block

Investing £150 million

Critical care unit

Neonatal unit EnvironmentalInfrastructure

Refurbished wards

Investing £150 million

• We’re delivering an extensive communications and engagement campaign to ensure everyone understands what’s happening and what’s available at the New QEII and Lister Hospitals

• NHS 111 will advise anyone with an urgent medical enquiry that is not an emergency, and people should always call 999 when there is a medical emergency

Sharing information

Summary

• Draws to a conclusion a significant planning exercise

• Strong partnership working and staff commitment

• The new QEII will be central to our future commissioning plans

• Will result in a fantastic new facility that the local community can feel proud of

Questions?

Workshop groups

Questions?

Thank you