HOUNSLOW CCG

HOUNSLOW COMMUNITY NETWORK

PARTNERSHIP WORKING

Sue JeffersManaging Director

7th October 2014

Clinical Commissioning Groups Clinical Commissioning Groups (CCGs) are the cornerstone of the new health system. Each of the 8,000 GP practices in England is now part of a CCG.

Each CCG is a statutory NHS body with its own governance arrangements which vary according to its Constitution. Each CCG is responsible for meeting the health needs of its populations and their main focus is on local issues. They are accountable to their GP membership and NHS England.In 2013/14 CCGs were responsible for a budget of £65 billion, around 60 per cent of the total NHS budget.

Hounslow CCG came into being on 1st April 2013.• 54 practices, registered population 288,000 • Council of Members• Governing Body

There are 9 GPs on the Governing Body• Dr Nicola Burbidge, GP Chair• Dr Paul Shenton, GP Vice-Chair• 5 localities• CCG has a £285m commissioning budget for

2014/15

Central London CCG36 GP Practices190,000 registered populationBudget approximately £258m

West London CCG55 GP Practices230,000 registered populationBudget approximately £342m

Hammersmith and Fulham CCG31 GP Practices190,000 registered populationBudget approximately £256m

Ealing CCG79 GP Practices339,000 registered populationBudget approximately £408m

Hounslow CCG54 GP Practices288,000 registered populationBudget approximately £285m

• Responsible for planning and buying (commissioning) local health services for Hounslow with a budget in 14/15 of £285million.

• Joint Commissioning• Services we do commission: - Hospital Services (inpatient and outpatient clinics) - Mental Health services (community and hospital) - Community Services (diabetes, ophthalmology, dermatology, physio, community nurses, GP out of hours)• Services we do not commission: Childhood Immunisations;

Sexual Health; Health Screening; Specialist Cancer treatment; Dentists and Opticians; Community Pharmacy; Core GP services; very expensive treatments (heart attacks, renal transplant, etc.)

HOUNSLOW Clinical Commissioning Group

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Where the money is spent : Main suppliers

Contract Values 2014/15

AcuteWest Middlesex University Hospital = £86.4m Imperial College Hospital = £29.2mAshford St Peters = £12.1m

Mental HealthWest London Mental Health Trust = £20.9m Community Hounslow & Richmond Community Healthcare = £19.6m Hounslow & Richmond Community Healthcare Urgent care centre @ WMUH = £5.0m

= 75% of CCG acute spend

= 73% of CCG MH spend

= 75% of CCG community spend

The CCG has 150+ healthcare suppliers but the market is dominated by a handful of large NHS organisations

Service reconfiguration Whole Systems Integrated Care

Primary Care Transformation

More health services available out of hospital, in settings closer to

patients’ homes seven days a week.

Patients with complex needs receive high quality multi-disciplinary care

close to home, with a named GP acting as care co-ordinator.

Patient

Urgent appointments

Care delivery teams and time for care

plans

Community hubs

Convenient appointments

Continuity appointments

Access via range of channels

GP as lead for patient care

Local Authority and Social Care involvement

Information systems and record sharing Capitated budgets

More local diagnostic equipment

More specialised hospital care

Acute reconfiguration

Less inappropriate time in hospital

Assistive technology

Carer

Community support

Family Patient’s own GP practice

Supported to self manage and held

together by resilience

Groups of accountable care

providers

BCF

PMCF

Patients have access to General Practice services at times, locations

and via channels that suit them seven days a week.

Hounslow Whole Systems Vision Hounslow commissioners and providers have been developing an integrated care model since 2012 and now has in place strategies and programmes delivering integrated care to its residents.

Our vision for whole system integrated care is based on what patients and carers tell us is most important to them – a seamless service to patients and carers, delivering person-centred care.

To deliver Whose Systems integrated care will mean significant change across the whole of our current health and care provider landscape, and perhaps for voluntary and social organisations too.

Whole Systems is the catalyst and enabler for this change. We must take this opportunity.

If we can get it right, we know it will transform the daily lives of many of our residents.

Whole Systems Integrated Care vision of a Model of Care

Better Care Fund - £16.8 millionThe Better Care Fund will be used to develop integrated working through:

1. Co-ordinating care around individuals using a proactive and joined up case management approach

2. Improving outcomes for the individual, carer and local community

3. Improving the experience of care for patients, service users and their carers

4. Maximising independence, avoiding hospital admissions and use of nursing/care homes

5. Developing preventative services to support people to stay well and healthy for longer / Prevention Strategy

Areas for focus: THE BIG HEALTH ISSUES

• Children and Young People• Long term conditions• Mental health• Dementia • Cancer• End of Life care

Children and Young People• Better communication and earlier intervention • Paediatric Hubs – specialist care closer to home• Access to Occupational Health & Mental health services • Improve access to leisure centres • Translation service • Children and Families Bill (Sept 2014)• Invested in perinatal mental health and promoting breast feeding

New Developments: - Review of children continence service - Re-commissioning children asthma nurse in the community in 15/16- Roll out of children hubs- New Children and Adolescent Mental Health Service out of hospital service Integrated working with all children services (schools, LBH children service, public health)

Long Term Conditions• Care Navigators based in localities • Better communication • Self Help: directory of self help groups, support for those with disabilities (inc benefit advice, help filling forms)• Services need to be more community led (e.g. home base physiotherapy)• Reduce fees for local facilities, especially for unemployed • Psychological support and input • Provide information for children moving into adulthood (transition) • More Rehabilitation beds • Increase preventive services• New services to be provided through Whole Systems Integrated Care, Community

Recovery Service and Diabetes Intermediate Services• Scoping use of Telehealth technology

New Developments: Whole Systems Integrated Care

Mental Health

• Mental Health Facilitator for Carers Groups

• Counselling Services (Improving Access to Psychological Services)

• Primary Mental Health Service ( Primary Care Plus)

• Developing urgent care (in-hours extended, home assessment)

New Development: Brentford and Isleworth Whole Systems for

Long Term Mental Health Needs

- Early Intervention- Physical and Mental Health

Dementia Crisis Service from August 2014 : Duty clinical System (9am-5pm) , Speedier diagnosis – MRI, Mapping Dementia Care Pathway

New Developments:

- Agreement for locality dementia nurses

- Dementia awareness: Dementia friendly Hounslow

- Whole Systems Integrated Care

Cancer• Patient Care Pathway – reduce waiting times

• Local facilities – care closer to home

• Better Training for GP’s

• Support to patients and Carers

New Developments:

- Discussing with Public Health ways to promote awareness

- Working closer with the Mulberry Centre

- Screening

End of Life Care• Better training for GP’s

• Misdiagnosis in primary care

• 'Co-ordinate my care' - Extending the Care Plan

• Specialist Palliative Care Services, District Nursing, Marie Curie Planned

Nursing and Rapid Response, Integrated Community Response Service

New Developments:

Increasing Specialist Palliative Care provision between Secondary and

Primary Care.

1. RESOURCING:How could the voluntary sector work together to respond to joint commissioning?

• Through Helping people self-manage and provide care navigation working in partnership with voluntary, community and long-term conditions charitable groups

• Supporting our work on reablement and rehabilitation and prevention through an integrated Community Recovery model focused on short-term interventions and facilitating hospital discharge and avoiding admissions and promotes independence

• Supporting patients and families living with Dementia• Increased use of assistive technology, including Telecare and Telehealth• Specific proven early interventions e.g. falls prevention, housing related support• Through promoting mobility and accessibility of community facilities (better

transport services)• Supporting Healthy living advice and self-management, e.g. exercise classes,

dietary advice

You have already responded: Systems Resilience Winter Pressure bids

THE VOLUNTARY SECTOR INVOLVEMENT

2. VOLUNTEERING:Hounslow Together emphasis on volunteering

• Dementia: Promote voluntary services to provide further help and training

• Prevention Strategy: Low level, practical services and support that enables people to continue to live in their own homes, e.g. Handy Van services, floating support, assisted shopping

• Reducing social isolation as loneliness and depression are recognised as major factors in the quality of life for people, particularly older people, good neighbourhood schemes

• Prevention Strategy: Situations where someone has a major life change and may need support to help them regain their independence, e.g. illness, bereavement

• Working in localities, for instance GPs receptionist-type work

3. RIGHTS and RESPONSIBILITIES:To advocate on behalf of vulnerable people

• Integrated Dementia Services - ensure that we support people and their carers following diagnosis, improved pathways, early diagnosis, integrated working and dementia friendly communities

• To advocate on behalf of Mental Health BME users – culture and language may prevent use of services

• To support people with Dementia, Cancer and Mental illness, reducing the fear & stigma

• To advocate for people with Dementia: Service users have told us they want more say in care plans

• End of Life: To provide social support to patients and their families at end of life

4. SignpostingUsing the Voluntary Sector reach

• Universal Information, Advice and Signposting - includes support to people to access low level support as well self funders, to help meet the statutory requirements of the Care Act and support the prevention agenda

• Dementia: Information pack & help recognising early signs

• Hounslow - dementia friendly

• Improve awareness and presentation

• Prevention Strategy: Access to Information, advice and signposting to community resources, so people are well informed, can help themselves and to support people who do not meet social care eligibility criteria, or who fund themselves, in finding services that can meet their needs.

• Hounslow Community Network Newsletter

LINKING WITH HOUNSLOW CCG:

Through Website… www.hounslowccg.nhs.uk

Through Contacting the CCG:

Fiona Thomas on 020 8630 1000