Dr Nick Harding - Healthcare Without Boundaries


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Dr Nick Harding's first presentation at "SWB Connect" event held in West Bromwich, 28th June 2012.

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  • Improve patient experience and quality of care Improve health for population Balance between local and strategic decisions Build on our partnerships at all levels from patients to Local Authorities
  • Improve patient experience and quality of care Improve health for population Balance between local and strategic decisions Build on our partnerships at all levels from patients to Local Authorities
  • The borough of Sandwell spans a densely populated part of both the Black Country , and the West Midlands conurbation , encompassing the urban towns of Blackheath , Cradley Heath , Oldbury , Rowley Regis , Smethwick , Tipton , Tividale , Wednesbury , and West Bromwich . Ladywood -Aston, Nechells,Lozells, Handsworth Soho
  • Called this presentation health without boundaries Here the line down the centre shows how one of our hospitals – currently City Hospital, and its planned replacement sits right alongside the geographical boundary between two local authorities
  • Transformation of primary care Delivery change in GP practice Areas of excellence e.g. ICOF Patient experience – to roll out across CCG; end of life care HealthWorks now roll out as main programme after piloting Partnership – 50% changes in QOF scores – increasing service delivery locally
  • 4 - Partnerships are a crucial way we will improve delivery
  • White paper 5 pathfinder groups Allowing local identity and GP ownership
  • Developed at an event late September with ALL Local Commissioning Groups – over 100 people were involved in agreeing our vision, values - agreed and owned together;
  • Much debate as a CCG about how we achieve and allows local ownership – larger decisions to be made at CCG
  •   internal structure – how we will do business – as a board, at sub committees, role and responsibilities of locality commissioning groups     demonstrate transparency member practices can petition to change commissioning policy direction   Accountability for the priorities set, investments made and the outcomes delivered   Currently in the process of consulting on the drafting of the document, important to be involved in shaping the development and ownership – this is your organisation........
  • Pilot in LCG PENNA award Co design event involving patients, carers third sector
  • Need to check themes – 4 now
  • Need something somewhere on this Didn’t we do a table on joint commissioning
  •   internal structure – how we will do business – as a board, at sub committees, role and responsibilities of locality commissioning groups     demonstrate transparency member practices can petition to change commissioning policy direction   Accountability for the priorities set, investments made and the outcomes delivered   Currently in the process of consulting on the drafting of the document, important to be involved in shaping the development and ownership – this is your organisation........
  • Dr Nick Harding - Healthcare Without Boundaries

    1. 1. Sandwell and West Birmingham CCGHealthcare Without BoundariesOur journey so far…Dr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)26th June 2012 1
    2. 2. Overview NHS Changes An introduction to Sandwell and West Birmingham CCG Progress towards authorisation so far The wider context for delivery 2
    3. 3. Health and Social Care Act 2012• Clinical Commissioning Groups to take over responsibility of commissioning health services for local populations – abolition of PCTs and Strategic Health Authorities by 2013• Creation of NHS Commissioning Board• Establishment of HealthWatch and local Health and Wellbeing Boards to increase accountability for patients and the public• Creation of Public Health England to improve the health of the population• Commissioning Support Services 3
    4. 4. Before Now FutureDepartment Department of Department of Department of of Health Health Health Health Strategic 10 SHAs 4 SHA Clusters NHS Health West Midlands (Midlands & Commissioning Authorities East) Board 151 PCTs 50 PCT Clusters 27? LocalLocal Health e.g. Sandwell. e.g. Birmingham offices for NHS Ecoonomy Heart of &Solihull, Black Commissioning Birmingham Country Board Local 230 CCGs 200? CCGs(tbc) 4
    5. 5. Delegating ResponsibilityHow things are changingDelegated responsibility► From 2013 new organisations will take on PCT responsibilities Individual PCTs Transition to Cluster Flip Future Public Health Heart of Birmingham Teaching PCT Commissioning Support Service Clinical Commissioning Groups Sandwell PCT Local Office (NHS Commissioning Board) NHS Property Co. Up to 2010 2011 April 2012 2012 and beyond 5
    6. 6. A phased approachFrom 1st April 2012, as part of a phased approach for transition, after arigorous Board to Board Challenge pre-authorisation process, NHSPCT Clusters started delegating some responsibility to CCGs such as:Commissioning and monitoring of servicesDelivery of improvements and savings (QIPP)Improving quality and safetyAchieving financial balanceHitting Key Performance MeasuresCommunications and engagement ..To help achieve a seamless transition for patient care 6
    7. 7. An Introduction to CCG►We are passionate about improving thehealthcare for the people of Sandwelland West Birmingham.►Our vision is for transforming servicesto ensure excellence for everyone andin everything we do.►Our aspiration is to create a new kind oforganisation really rooted in its membership,relationships and local knowledge.►We will be using local and clinical knowledgefor change and improvement in health for our patients. 7
    8. 8. Our health priorities 8
    9. 9. CCG area 9
    10. 10. Our health needs• SWBH commissioning area is around 530,000• West Birmingham ranked 10th most deprived Local Authority in England with 68% BME population• Sandwell ranked 12th most deprived Local Authority in England with approx 20% BME population• Health challenges against rising costs and demands for healthcare• Absolute commitment to improving quality of care 10
    11. 11. Who we areBuilding on long standing foundation of partnership working throughRight Care Right Here between Sandwell and West BirminghamNHS and local authorities. “Serve a unique population - diversity unifies us”. Bridging the health gap Unsafe Journey © Amy Helene Johansson 11 11
    12. 12. The journey so far 2002 PCT arrives 2003 Right Care Right Here partnership forms 2007 Practice Based Commissioning 2008 Primary Care Collaborative Clinical Commissioning Directors appointed 2009 Partnerships form: Vitality Partnership, ICOF 10 Strategic Models of Care and clinical strategies agreed 2010 GP Consortia HealthWorks, ICOF, Black Country Alliance and Pioneers for Health 22 Care Pathway Reviews agreed across health economy 2011 Sandwell and West Birmingham Clinical Commissioning Group September - agree vision values with clinical leaders 2012 Interim Board is formed with five CCGs 12
    13. 13. Our roleBy April 2012 - shadow form as a CCG in readiness for 2013.We want to: 1. Be clear on the health needs of our population and how we are going to improve their health 2. Get the balance right between local and strategic decisions 3. Show real clinical leadership and development across the health economy 4. Do this new role in the most effective way we can 5. Create a Clinical Commissioning Group that leads by example 6. Be effective in communications within our organisations and the people we serve 7. Be ready to lead and manage the NHS as a system by April 2013. 13
    14. 14. Our Clinical Commissioning Group Local Commissioning Groups Chair Practices Population Black Country Dr George Solomon 20 112,228 HealthWorks Dr Nick Harding 22 132,985 ICOF Dr Samar Mukherjee 27 106,953 Pioneers for Health Dr Vijay Bathla 10 46,151 Sandwell Health Alliance Dr Basil Andreou 31 127,519 Clinical Commissioning Group Chair Practices Population Dr Nick Harding Sandwell and West Birmingham 110 525,836 (Interim Chair) 14
    15. 15. Our vision and valuesMission Healthcare without boundaries Working together, to improve health and care in ourVision communities. We will: • be the type of organisation that listens to and appreciates its staff and member Practices be supportive, fostering a no blame culture, ensuring that everyone is knowledgeableandwell informed, communicating wellValues at all times • set out what we intend to do with clarityin order to ensure that we deliver • be inclusiveand delegateresponsibilities where we can and be transparentin all our duties and we will go the extra milefor our staff, member Practices and partners. 15
    16. 16. A Different Approach “Membership organisation”- Delivery by Local Commissioning Groups • Develop commissioning priorities • Develop Clinical Pathways • Primary Care Quality including Medicines Management •QIPP Delivery • Membership • Patient Participation Groups/Patient Networks • Engagement: members, stakeholders e.g. local authority, public • Primary Care Demand ManagementBlack Country HealthWorks ICOF Pioneers 4 Health Sandwell Health Alliance 16
    17. 17. At CCG level - preparation for authorisation & futurePhase I Preparation for Organisation readiness: Organisational strategy: vision & values; authorisation Commissioning plan, Financial Strategy, Risk register, OD and HR plan, Partnerships Agreement, Membership Agreement, Board Development and comms and engagement plan. Setting up robust governance and processes to ensure quality and safe care within financial limits.Phase 2 Shadow year – Commissioning until April 2013 Assurance – relationship mgmt with Clusters/SHA/DH Performance managing contracts with wide range of providers QIPP plan – efficiencies, improvements, managing new system risks Forming effective partnerships for delivery CCGs/LAs Engagement – communicating the big changes Systems – establishing new systems, ICT/information, reportingPhase 3 As a statutory Commissioning contract and performance across providers: SWBH, body Dudley, BCHC, BCH, BWH, BSMHT, ROH Patient and public consultation & events on major changes Strategic partnerships e.g. HWBBs, OSCs, RCRH Primary care strategy and development System management inc emergency planning 17
    18. 18. Achieving the right balance - LocalismBig and small… Clinical Commissioning Group Local Commissioning Group Robustness at scale Local ownership Resilience Ideas into action quickly Strong voice in the health economy Relevance and contracts Ability to deliver through major Patient representation and partnerships 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.” 18
    19. 19. Our interim Board Structure Chair Vice Chair (GP Director) (Lay Director) GP Directors Executive Directors Clinical Directors Other Board Members Lay Directors (Non Voting)Chair and Vice Chair of Lay Director Managing Director Secondary Care Independent CommitteeBlack Country (Vice Chair) (Accountable Officer) Specialist Members x2 GP Directors GP Directors GP DirectorsChair and Vice Chair of Lay Director Finance Director GP Directors Nurse Senior Officers x3HealthWorks (Chair of Audit) (Chief Finance Officer)Chair and Vice Chair of Public Health MemberICOFChair and Vice Chair ofPioneers 4 Health NotesChair and Vice Chair of •Directors are voting members •Other Board members are non voting membersSandwell Health Alliance •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 postOne GP Directors to be Chair 19
    20. 20. Our governance Remit: To determine OD Sub Main Remit: To determine pay and implement the Remuneration Sub- and remuneration for OD strategy for the Group SWBCCG Committee employees (likely to meet on CCG Board an ad hoc basis) Strategic Finance & Quality & Safety Commissioning & Audit Sub-Performance Sub- Partnerships Sub-Committee Redesign Sub- Committee Committee CommitteeRemit: To have on-going Remit: To regularly Remit: To consider Remit: To help with Remit: To work with andresponsibility for the review providers to service provision and discharging financial lead partnerships,affordability of the local ensure that services are ensure that services are functions. Statutory and putting resources wherehealthcare system, and safe, and that outcomes commissioned for shorter legal obligations, challenges lay. Workingto receive monthly are monitored. pathways, better value working with accountable and delivering on twomonitoring reports. This for money and that officer. evolving agendas withgroup will highlight provision is appropriate LAs, Health & Well-beingconcerns to the Board. and adequate. Boards, HealthWatch and RCRH. 20
    21. 21. Organisational Structure CCG Board Black Country LCG •Chair Dr George Solomon •Accountable Officer Senior Commissioning Manager HealthWorks LCGQuality & Safety Sub- Sub-Committee Chief Officer Independent Dr Nick Harding Committee Committee Senior Commissioning Manager Chair (Quality) Member ICOF LCG Dr Sam Mukherjee Independent Senior Commissioning ManagerFinance & Performance Sub-Committee Chief Finance Committee Sub-Committee Chair Officer Member Pioneers for Health LCG Dr Vijay Bathla Senior Commissioning Manager Service Strategy & Independent Primary Care Sub- Sub-Committee Chief Officer Committee Chair (Operations) SHAC LCG Committee Member Dr Basil Andreou Senior Commissioning Manager Partnerships & Independent Sub-Committee Chief Officer Collaboration Sub- Committee Chair (Partnerships) Committee Member 21
    22. 22. 22
    23. 23. Continuously improving quality Build feedback and Annual improvement into Quality and annual commissioning Safety Plan intentions Monitor effective delivery of quality and safe care through : information at Quality & Safety Committee, Local Commissioning Groups feedback 23
    24. 24. Progress so farWhat we have done for authorisation Membership – we have a fully signed up practice membership and risk sharing agreements in place Agreed priorities and focus for commissioning for 2012/3 Setting out monitoring processes for quality and safety Developed plans to demonstrate how we will operate including financial, OD and transition plan, comms and engagement Setting out our arrangements how we will work with others (collaborative working/partnership plan, risks) Joint authorisation with Black Country & BSOL 24
    25. 25. A Constitution – good governanceClear and comprehensive constitutions – to ensure effective structures, strong governance systems and good relationships with practices.• Describes our statutory responsibilities as a commissioning body• Set out who and how you can be a member of the CCG, how to leave• Our internal structures• Our Elections and appointment processes, and removal from office• How we can demonstrate transparency in how our decisions are taken• Accountability to our patients, the wider local community, local council and health and well being board• Engagement with our membership, the wider profession 25
    26. 26. TimetableKey datesWe are moving at a good pace and to move into the first wave of authorisation we have an ambitious timetable of key deadlines which need to be met: Date Activities April 18th April  CCG Board meeting 19th April  Resubmission of full set of authorisation documents May 3rd May  Members engagement event 16th May  30 day consultation for proposed structures commences  CCG Board Meeting June  Recruitment to structures of CCG  Process for appointment to Chair, Accountable officer and Chief Finance Officer July  Authorisation assessment October  Outcome authorisation 26
    27. 27. What we have learned from board to board process 27
    28. 28. 28
    29. 29. Sandwell and West Birmingham CCGOur approach to commissioningDr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)26th June 2012 29
    30. 30. Our health priorities 30
    31. 31. Our health needs 31
    32. 32. Our health needs Health without boundaries - November 2011 32
    33. 33. A wide range of services available tocommission fromComplex range of providers forhealthcare:HospitalsHeart of England (3 hospitals),University Hospitals Birmingham, Sandwell WestBirmingham, Birmingham Children’s Hospital, RoyalOrthopaedic, Birmingham Women’s Hospital andBirmingham Dental Hospital BirminghamSpecialistBirmingham and Solihull Mental Health TrustCommunityBirmingham Community HealthcareAcute & UrgentWest Midlands Ambulance Service; Range ofurgent care, walk-in and other providers – Assura,Care UK etcThird Sector – a wide range of provision e.g.over 40+ alcohol/drug dependency services 33
    34. 34. RCRH Comms and Engagement Chair and RCRH Partnership Board Rep Birmingham BirminghamBlack Sandwell and City Council and SolihullCountry NHS Black SandwellCluster Country Metropolitan West NHS Cluster(Sandwell Partnership Borough Birmingham (Heart ofPCT) (NHS) Trust Council Hospitals Trust Birmingham tPCT) Birmingham Birmingham Community and Solihull Healthcare NHS Mental Health Trust Trust (BSMHT) 34
    35. 35. 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 35
    36. 36. 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 36
    37. 37. 37
    38. 38. Our quality priorities Our priority How we monitor this Safety Population health is improving Effectiveness Treatments are effective Population is satisfied with their Patient experience treatments 38
    39. 39. Continuously improving quality Build feedback and Annual improvement into Quality and annual commissioning Safety Plan intentions Monitor effective delivery of quality and safe care through : information at Quality & Safety Committee, Local Commissioning Groups feedback 39
    40. 40. How we will ensure high quality inPrimary Care ► We want to be able to use information in a way that continuously improves services – as close to ‘real time’ as possible ► Our plan is to use same data as before – but in a smarter, more user friendly way so you can react more quickly to feedback – we can control this ► Reflected in improvements in GP dashboard ► National GP quality dashboard ► If we get the information reporting right at practice level, this will make the job easier and create a more accurate bigger picture 40
    41. 41. 41
    42. 42. Getting the best out of services - diabetes Patients •Regular follow up •Easy physical access •Close to home SWB CCG •Managed care •Patients •Professional opinion managed safely •Costs covered •Upstream interventions •Value for money 42
    43. 43. End of life – from pilot to rollout 2012/13 ►Award winning pilot with experience-led commissioning – patients driving the process Range of events to inform strategy development e.g. Planning Alternative Tomorrows with Hope (PATH) stakeholder event (55) to agree shared vision for end of life care; review of all existing strategies, documentation and initiatives; public health and service cost data and statistics pulled together; two experience co-design events held with third sector; one to one filmed interviews with front line professionals, managers and people living with dying and carers transcribed by University of Oxford for emerging themes ►Strategy co-created with patients, carers and stakeholders ►Our strategy: “in three years time, 90% of people will die in a place they choose.” 43
    44. 44. End of life –CCG rollout 2012/135 improvement workstreams have been established February2012 supported by 2 underpinning foundation programmes:► Theme 1 Tell my story – helping people to articulate end of life to be► Theme 2 Hospice everywhere► Theme 3 24:7 coordinated care► Theme 4 Keeping carers well► Theme 5 Compassionate communities – changing the culture towards dyingProgramme team established with wide range of clinicians,commissioners, carers, third sector delivering the workstreams toachieve improvements – with shared ownership. 44
    45. 45. Maternity and Children’s Strategic Model of Care Experienced clinical group developed vision for Maternity and Newborn Services – October 2009: ►120,000 women aged 15 to 44 in catchment area ►Share epidemiological and economic characteristics such as high levels of deprivation ►Issues: High levels of still births and infant mortality compared to England and Wales average ►Strong evidence impact quality maternity services can make to improve health and well being of teenagers and their babies increasing number of children on path to success ►Teenage pregnancy is a key issue in Sandwell and West Birmingham 45
    46. 46. So who will overview new worldCommissioners: Providers NationalNHS Commissioning Provider • Support & Board Development develop Authority • Set maximum prices • Maintain Overview and Monitor continuity of Scrutiny care Committees • Quality CQC • Safety HealthWatch Any Willing Provider Foundation Trusts Private Sector 3rd Sector Primary Care 46
    47. 47. The RATAR model• Access to a Referral, Assessment, Treatment, Advice and Recovery model through a single point.• Provision of Care Closer to Home• A service based on outcomes with patients, families and carers at the heart• Integrated Care Pathways• Collaborative Care 47
    48. 48. • The CCG will have as a priority the ongoing commissioning and further development of mental health and well being services.• Developments will focus on an integrated mental health service and the development of Primary Care mental health and wellbeing in the community to meet the needs of the population. 48
    49. 49. Some successes already► Reduction in A&E attendance by 6%► Promotion of effective medicines management► Good examples of GPs working together► Defining agreed patient experience standards► End of life pilot - being rolled out across CCG► Dermatology – reductions in hospital attendances► Improved access – radiography available in community► Award winning patient consultation processes► Approval to go for first wave authorisation… 49
    50. 50. How we currently invest in secondaryhealthcareProvider BSOL Sandwell Total £000s £000s £000’sSWBH 77,936 157,260 235196BSMHT 23,724 1,443 25,167BCPFT 230 33,915 34,145Birmingham 634 5,065 5,699Children’sSCHS 8,804 34,553 43,357BCHS 27,409 3,628 31,037 TOTAL 374,601 50
    51. 51. How we work with other CCGs ► Leadership /advice – clinical senate? ► Clinical leads for commissioning for contracts? ► Nominated contract leads – how this will work: “hosted by a CCG but ensuring those CCGs with ‘significant interests’ are represented around the discussion table’ e.g. urgent care, BCHC ► Health and Well-being boards – shared strategy for city 51
    52. 52. Quality Priorities 2012/13 • Developed draft CCG Quality and Safety Plan – out for consultation to members (issue 2) www.swbcg.link ] • Putting quality into all our contracts – ensuring we are commissioning for quality e.g. alcohol CQUIN • Monitoring delivery of quality and safety through Quality and Safety Committee and formal Clinical Quality Reviews (e.g. meetings, reviewing incidents/never events, visits) • Provider development • Primary Care development 52
    53. 53. 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, carers to develop together the best healthcare Questions? 53
    54. 54. 54
    55. 55. 12 months on… Shared vision and strategy - We have an integrated plan which has involved all health and local authority partners Shared way of working through the Compact - for shared leadership across the NHS and local authorities Resources - Good progress has been made - a coordinated structure was established pooling the resources of four PCTs Results so far - Delivery is good - moving from forecast £50.5m deficit to £2m planned surplus; key quality and performance targets achieved 55
    56. 56. Integrated Plan Greater push on transformation and delivering improvements Greater emphasis on quality and improving primary care Supporting development of future organisations More integrated working → specialised service pathways and joined up services → Councils working with health on care for older people Financial planning - Still heading off increasing financial pressures for years ahead 56
    57. 57. Brief• Support the Frail Elderly ProgrammeSigned off by CEO Compact 57
    58. 58. Patient/Clinician Journey Dr S Mr/s D 58
    59. 59. A constitution – why? Clear and comprehensive constitutions – to ensure effective structures, strong governance systems and good relationships with practices. ►Describes our statutory responsibilities as a commissioning body ►Set out who and how you can be a member, how to leave ►Our internal structures ►Our Elections and appointment processes, and removal from office ►How we can demonstrate transparency in how our decisions are taken ►Accountability to our patients, the wider local community, local council and health and well being board ►Engagement with our membership, the wider profession 59
    60. 60. The journey to authorisation ► Approval to go for first wave authorisation ► What we need to demonstrate: → Examples of how member practices are involved in decision making within the CCG/LCG → How we work together - constitution → Election process – competency and representation 60
    61. 61. New NHS ParliamentKey: Accountability Department of Funding Health Right Care Right Here partnership NHS Commissioning Monitor CQC Board Licensing Providers SWB CCG Contracts BSMHT, BCP, BCHC, SWBH Partnership Local Authorities Other providers BCH, Local HealthWatch BWH, ROH, DGH, RW, SWB, WM, and I/C. Birmingham HealthWatch Patients & Public Sandwell HealthWatch 61
    62. 62. 62