Merton CCGAnnual General Meeting24 September 2015

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Agenda• Welcome and Chair’s Introduction

• The Annual Report

• Our accounts

• The challenges ahead

• Questions

• Mental health in Merton

• Questions

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IntroductionDr Andrew Murray,

Chair

The Annual ReportAdam Doyle,

Chief Officer

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Who we areWe are:

• a GP-led membership organisation responsible for planning, buying and monitoring local health services

• Our GP practices work in partnership with hospitals, community services, mental health services, pharmacists and dentists, Merton Council and our local community

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Merton’s Health Need

• Merton’s population expected to increase by over 21% by 2021

• We have an increasing and high birth rate and at the same time an aging population

• Levels of deprivation are much higher in wards in East Merton than West Merton

• Our population is increasingly diverse with BAME rising to 39% by 2017

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Our aims in 2014-15• To improve the health outcomes for the

people of Merton by buying services tailored to their needs while addressing the diverse health needs of our population

• Everyone in Merton should be able to receive the care they need, at the right time, in the right place and from the right health care professionals, bringing the right outcomes

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How we operate

• We have strong clinical input via the work of our localities, our Practice Leads Forum, the Practice Nurse Forum and our Clinical Reference Group (CRG)

• We have in place a strong executive leadership team

• We work in partnership with Merton Council and Healthwatch

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Our structure

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Delivering Our Priorities

• We agreed a set of priorities for 2014-15 which we believed would make a real difference to the quality of care in Merton

• Many of these initiatives aimed to tackle the most common diseases which affect local people and their quality of life

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Older Adults

• Expanded the community prevention of admission team (CPAT)

• Developed a new tool to support homes in identifying the best service

• Provided ‘in-reach’ nursing at St. George’s Hospital to support patient discharge

• Launched the Dementia Hub

• Developed a falls prevention pathway

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Children and Maternity

• Target time achieved for the provision of initial health assessments for children looked after away from home

• Review for children with complex health needs commissioned from the Royal College of Paediatrics and Child Health

• Maternity Clinical Network created to review and improve maternity services

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Mental Health and Learning Disabilities

• Mental Health Needs Assessment (HNA) commissioned

• The Improving Access to Psychological Therapies (IAPT) programme re-procured

• New complex depression and anxiety service launched to improve service provision

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Engagement

• Established the Merton Better Healthcare Closer to Home group

• Worked with Healthwatch, the public and patients to ensure local people have a voice in everything we do

• Greater use of digital and social media

• Ran Engage Merton and Mitcham Carnival ‘health hub’

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Keeping Healthy and Well

• Developed a joint weight management pathway and GP pilot in the more deprived areas of Merton

• Merton CCG and East Merton GP locality group began to develop a Model of Care for East Merton

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Early Detection

• Increased provision of cardiac rehabilitation - in particular targeting hard-to-reach groups

• Clinical health coaching telephone service pilot launched for patients with chronic obstructive pulmonary disease

• Macmillan GP recruited

• Invested in enhanced musculoskeletal service

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Urgent Care

• Urgent Care Centres incorporated into A&E departments at St. Helier and St. George’s Hospitals - ensured appropriate assessment and reduced pressure on A&E departments

• ‘Not Always A&E’ communication campaign helped raise awareness of the range of services available to local residents in addition to A&E

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Planned Care• Opened the state of the art Nelson Centre on

1 April 2015, allowing patients to be diagnosed and treated closer to home

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The Nelson Health Centre

• Community services well utilised

• Diagnostics working well

• Patient numbers are increasing steadily month on month

• Waiting times for many services are very short

• The pharmacy service opened this week

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New Health Centre for Mitcham• Wilson Hospital site agreed as the preferred

location

• Approval request submitted this month to NHS Property Committee to proceed

• Engagement with local people and groups begins in November

• Site and facility design to begin November/December

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Our performance 2014-15

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2014-15 PerformanceMerton achieved the following key performance targets helping to get people seen, diagnosed and treated – often more quickly:

• Diagnostics • Cancer 2 weeks / Cancer 31 days• IAPT (Improving Access to

Psychological Treatment)• Diagnosis rates for dementia

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2014-15 Performance

Targets not achieved:

• A&E 4hr waiting time (93.6%) - St Georges (92.4%) Kingston (94.4%). Lack of beds/staff

• Cancer 62 day wait (83.8%) – still ranked 8th of 32 London CCGs

• Ambulance red response times – not achieved across London, significant investment in 2015-16 from CCGs

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A&E

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Diagnostics

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Cancer – Two week wait

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Cancer – 31 days

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Cancer – 62 days

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Cancer – 62 days screening

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Improving Access to PsychologicalTherapies

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Dementia

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Our Accounts Cynthia Cardozo,

Chief Finance Officer

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2014/15 Financial allocation

• We were given £208m (c.£940 per head of population) 4.92% increase from 13/14, 7.67% below target

• A running cost allocation of £5m

• In-year extra funding of £4.7m (incl. 13/14 carry forward surplus of £2.1m and £1.1m for winter resilience)

• This created a total allocation of £218m

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2014/15 Financial requirementsWe achieved:

• A surplus of £2.7m (1.2% of resource allocation) against the budget of £218m

• Met our running cost target of £5m

• Achieved the Better Payment Practice Code - 97% in terms of invoices and 99% in terms of invoice value (Target 95%)

• Met the target for Capital expenditure (£0.8m)

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How we spent our money on NHS care

Acute services59%

Mental Health10%

Learning Disability

1%

Community9%

Continuing Care3%

Primary Care & Prescribing

11%

Primary Care services2%

Running costs2%

Other costs3%

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Acute Activity Performance

• Acute spend of £128m (59%) covers detailed activity

• Overall activity has increased from 2013/14

• Large increases in emergency and GP referred activity

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External Audit ConclusionsThe CCG fully met the relevant conditions and requirements on its 2014/15 annual accounts

Specifically:

• Unqualified opinion on financial statements

• Unqualified regularity opinion

• Unqualified opinion on remuneration report

• No issues on value for money review

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2015-16 and beyond: the challenges aheadDr Andrew Murray Chair

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Allocations for 2015-16

• An 8% increase in programme cost allocation (£226m), to buy services for an estimated population of 226,559

• This gives us £997 per head of population, however still 4.77% below target for our population

• A running cost allocation of £4.5m (reduction of £0.5m from 2014/15)

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Financial Plan for 2015-16

• To deliver 1% surplus (£2.3m)

• Invest £11.3m in Better Care Fund

• Invest 8% more in Mental Health services to deliver parity of esteem

• Invest in capacity at St George’s Hospital FT deliver A&E four hours wait

• Deliver QIPP plans of £4.9m (2.1%) to offset growth in demand for services

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Priorities going forward Whole Merton Model:

• Engagement and communications

• Culture and workforce

• Technology

• Partnerships

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Priorities going forward

• Planned care – review of referrals

• Taking forward the Mitcham development

• Delegated commissioning

• Working with other CCGs on the South West London Collaborative Commissioning (SWLCC) on our five-year plan

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SWLCC – ‘The Issues Paper’• In June 2015, six south west London CCGs

published an Issues Paper, summarising the challenges and emerging solutions set out in the strategy and putting forward questions for local people to respond to.

• You can read and respond to the Issues Paper online http://www.swlccgs.nhs.uk/issues-paper/

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Any questions?

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Mental health services in MertonDr Andrew Murray, Clinical Chair

and Emma Gennard, Mental

Health Commissioning

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Our population

• Total CCG population in 14/15: 217,802

• No. of GP practices: 26 (now 24)

• One in four adults will experience mental health problems

• One in six adults has a mental health problem at any given time

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Merton Community Mental Health Profile (2014)

• The profile for Merton looks at 3 areas; Mental Health and Illness, Treatment and Outcomes and then compares us with the rest of England using 26 indicators

• It helps us to understand better where we are doing well and if we need to review something

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• There are five indicators

• Merton has significantly lower figures than England across all five measures tested and compared to the rest of England

• This could indicate that depression and anxiety may be lower than other places

• Or could mean there is under-diagnosis and under-recording in general practice

Mental Health and Illness

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Example: Depression Prevalence

Merton = 4.7National= 5.8Category= Significantly Lower

• Recording people with depression

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Key points on Mental Health and Illness

• We need to understand better the variation between GP practices

• This will help us make better decisions about what services are needed

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Treatment

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Treatment Indicators (14 out of 26)

Significantly Higher than rest of England

Not significantly different than rest of England

Significantly lower than rest of England

Significance not calculated

• There were 14 Indicators • How does Merton compare?

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Key Points on Treatment

• Where a patient has been diagnosed we are good at keeping a record of this

• We are ensuring carers are offered assessments

• Our patients spend less time in hospital and don’t use A&E for mental health

• We need to get better at ensuring people can access mental health services when needed

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Outcomes

• There were 7 indicators for outcomes

• How does Merton compare?

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Outcome Indicators (7 out of 26)

Significantly Higher than rest of England

Not significantly different than rest of Eng-land

Significantly lower than rest of England

Significance not calculated

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Key Points on Outcomes

• We have more adults on CPA in settled accommodation than the England average

• We have lower emergency admissions for self harm and unintentional and deliberate harm (Good Home Treatment Teams)

• We need to help more people to recover during talking therapy treatment

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What the CCG buys

In 14/15 we spent £20.6m on mental health services

That money helped provide mental health services (clinical assessment and treatment) provided by:

• Talking Therapies (IAPT)

• Secondary Mental Health Services (SWLstG)

• Specialist Mental Health Services (SLAM)

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Mental health priorities 2014-15

We developed six aims to help us start to better meet the needs of our local

population:

• Improve mental health and well-being

• Reduce rates of admission and re-admission

• Improving crisis services

• Integrating mental and physical health

• Improving quality of life

• Improving access to community services

• Improving access to community service

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What did we do?

• Moved some specialist services locally

• Invested more money in talking therapy services and retendered the contract to help more prevent severe mental health problems

• Created a new local service for patients suffering complex depression and anxiety

• Developed a local crisis care concordat action plan

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What did we achieve?• We made progress against five out of the six

aims

– Improving mental health and well-being – Reduce rates of admission and re-admission– Improving crisis services– Improving quality of life– Improving access to community services

• We did not make good progress on integrating mental and physical health

• We still have a lot of work to do to make sure these aims are met across all our mental health services

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Our priorities for 2015-16

• Getting the new IAPT service up and running (begins 1 October)

• Creating a new Step Down service (ready to launch 1 April 2016)

• Making sure alcohol detoxification services are fully integrated and more local to Merton

• Getting a better understanding of patient/carer experience

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Measuring our progress

• We have set some key performance indicators for all our priorities to make sure we make good progress

• We will work with the providers to ensure they are able to meet the performance we agreed

• We will report to our Executive Management Team on progress

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Where do we need to do more• Establish the best way to work with patients,

carers, mental health service providers and employers

• Work with patients, their families and carers to review services to help us make it work better

• Monitor and review the number of urgent admissions and re-admissions

• Develop more local support services for patients with long term conditions

• Offer more services via GP practices

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Any questions on our mental health work?

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THANK YOU

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