The Turnaround ChallengeWorkshop in SWF, 5 December 2012

Brief introduction to Mid Essex Clinical Commissioning Group (CCG)

Your local NHS – the current position The “turnaround challenge” How we are tackling the challenge Your views?

New organisation to take over from PCT Board led by GPs, senior nurse,

public health, social services rep, 3 lay members

Working in shadow since 1 April 2012 “On the job” managing & planning 50 member practices

Applying for authorisation – Nov 2012 Establishment - 1 April 2013

Dr Lisa Harrod-RothwellChairman, Mid Essex CCG

Commissioning – planning & buying healthcare Not providing – that’s Central Essex Community

Services (CECS)

Assess local needs, listen to people Plan in partnership Design services, agree contracts Manage quality & performance Manage the annual budget –

£540m in total for mid Essex in 2012/13CCGs responsible for around £390m

Brief introduction to Mid Essex Clinical Commissioning Group (CCG)

Your local NHS – the current position The “turnaround challenge” How we are tackling the challenge Your views?

Performance & quality among best in region Over 95% patients treated within 18 weeks Over 98% cancer patients treated within 31 days 90% stroke patients on specialist stroke unit Over 99% mental health patients followed up within

7 days of leaving hospital Patient experience survey shows improvement

Brief introduction to Mid Essex Clinical Commissioning Group (CCG)

Your local NHS – the current position The “turnaround challenge” How we are tackling the challenge Your views?

If we took no action… We would be overdrawn by £12.8m at end of year Bigger challenge in 2013/14 – an ever widening gap We would be unprepared for ageing population

▪ 12% increase by 2035▪ Increase in frailty, long term conditions, dementia

So we are managing two things… 2012/13 - quick action to finish year in balance 2013/14 & beyond – transform services & secure the NHS

for the future

Overall three main factors …

Managing with limited funds – our allocation one of the lowest

The activity we can afford – we spend more than other similar areas

Service transformation – plans take time to putinto practice

£1.3k per head (PCT spend last

yr)Others up to

£2.2k

£1.3k per head (PCT spend last

yr)Others up to

£2.2k

Need to review and “ramp up”

Need to review and “ramp up”

Activity increase not always right for good care

Activity increase not always right for good care

Brief introduction to Mid Essex Clinical Commissioning Group (CCG)

Your local NHS – the current position The “turnaround challenge” How we are tackling the challenge Your views?

Savings solutions £000

Existing service transformation schemes 1,803

Tighter criteria for some NHS services 1,687

Ensure contracts adhered to 465

Stop expenditure where possible 1,008

Budget underspends 2,118

Technical accounting adjustments 1,949

Draw down on reserves 3,787

12,817

Examples of existing schemes

Health & social care for people at home Rapid assessment for frail& older people

– avoid hospital emergencies Multiprofessional teams for end of life

care at home Closer work with nursing homes to avoid

hospital emergencies Practices managing referrals working with

central team of clinicians Prescriptions for less expensive drugs

Examples of tightening criteria

Team to manage treatment at A&E Reduce unnecessary use of ambulance Review clinical policies, ensure they are

adhered to “Stop before the op” smoking restriction Improve physio self-care, reduce wasted

appointments Comply with national guidelines on drugs Mental health rapid assessment to reduce

admissions

We are not talking about “cuts”

Don’t be misled by the press

Urgent care •Redesign out of hours services and NHS 111•GPs working in A&E•Rapid assessment for older people•Working with nursing homes •Integrated teams for people at home•Mental health rapid assessment

Frailty •Proactive care for high risk patients•Integrated care teams – community matrons•24/7 single point of contact for frail people•Tele-health

Long term conditions

•Prevention and early diagnosis•24/7 single point of contact for people with long term conditions•Care plans and shared records

Brief introduction to Mid Essex Clinical Commissioning Group (CCG)

Your local NHS – the current position The “turnaround challenge” How we are tackling the challenge Your views?

Group discussion

Short term:▪ Your views on what should we stop or change?

Long term:▪ Your ideas for doing things in a different way?▪ What do you want us to pay attention to?