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4. strengthening the patient voice part 2v2 nick harding 5 july 2012
- 1. Strengthening the patient voice West Bromwich Albion 5 July 2012 1
- 2. Feedback Summary – morning session • Where will the money go – control/governance • Engagement – are we practising what we discussed • GP burnout • Access – appointments, phone access, telephone costs, choice, receptionists doing triage, online • Public health/local authority helping health agenda – schools and recreation centres going – obesity agenda • Access to mental health – making decisions on my behalf • Links between secondary (hospital) and primary care • Joined up approach for social care and discharge back into the community • Changing role of GP – home visits, out of hours
- 3. New NHS Parliament Key: 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 3
- 4. A wide range of services available to commission from Complex range of providers for healthcare: Hospitals Heart of England (3 hospitals), University Hospitals Birmingham, Sandwell West Sandwell Birmingham, Birmingham Children’s Hospital, Royal Orthopaedic, Birmingham Women’s Hospital and Birmingham Dental Hospital, Dudley Group of Hospitals Birmingham Specialist Birmingham and Solihull Mental Health Trust, Black Country Partnership Trust Community Birmingham Community Healthcare Acute & Urgent West Midlands Ambulance Service; Range of urgent care, walk-in and other providers – Assura, Care UK etc Third Sector – a wide range of provision e.g. over 40+ alcohol/drug dependency services 4
- 6. Our health needs 6
- 7. Our health needs Health without boundaries - November 2011 7
- 8. Our vision and values Mission Healthcare without boundaries Working together, to improve health and care in our Vision communities. 8
- 9. Achieving the right balance - Localism Big 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.” 9
- 10. Our 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 Committee Black Country (Vice Chair) (Accountable Officer) Specialist Members x2 GP Directors GP Directors GP Directors Chair and Vice Chair of Lay Director Finance Director GP Directors Nurse Senior Officers x3 HealthWorks (Chair of Audit) (Chief Finance Officer) Chair and Vice Chair of Public Health Member ICOF Chair and Vice Chair of Pioneers 4 Health Notes Chair and Vice Chair of •Directors are voting members •Other Board members are non voting members Sandwell 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 post One GP Directors to be Chair 10
- 11. Commissioning what it is and why Commissioning is: “Proactive strategic role in planning, designing and implementing the range of services required – rather than just purchasing. A commissioner decides which services or interventions should be provided, who provides them and how they should be paid for and may work closely with the provider in implementing the changes” 11
- 12. 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 Committee Remit: To have on-going Remit: To regularly Remit: To consider Remit: To help with Remit: To work with and responsibility 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 where healthcare system, and safe, and that outcomes commissioned for shorter legal obligations, challenges lay. Working to receive monthly are monitored. pathways, better value working with accountable and delivering on two monitoring reports. This for money and that officer. evolving agendas with group will highlight provision is appropriate LAs, Health & Well-being concerns to the Board. and adequate. Boards, HealthWatch and RCRH. 12
- 13. 13
- 14. Continuously improving quality of care Build feedback and improvement into Healthcare Commissioning what we commission and Quality Plans on your behalf Monitor the quality and safety of care from the information you provide back to us in a number of ways at our Quality and Safety Committee: 14
- 15. Creating a patient revolution • Co-production of services between patients and healthcare professionals • Community participation between public and the service • Improving customer experience of patients and carers We will be looking at: • The enquiries we receive and issues raised • Reports that the organisations providing care produce to see what is happening • Surveys that patients and public complete with feedback • Complaints and PALS enquiries • Carers’ support ………………to improve patient experience 15
- 16. 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 16
- 17. Clinical NHS Commissioning Public Health (local Commissioning Board authority) Group (CCG) Community health Primary care– pharmaceutical, Healthy Child Programme for Maternity dental & NHS sight tests school-age children Elective hospital care Highly specialised inc psychiatric Sexual health (exc. Rehabilitation contraceptive) Urgent and emergency care For those in prison and other Public mental health services inc A&E custodial settings Older people’s healthcare Some services for armed forces Local programmes to promote physical activity Children, mental health, Public health services aged 0-5 inc Drug and alcohol misuse, learning disabilities health visiting & FNP, immunisation tobacco control including stop Continuing healthcare & screening smoking and prevention Infertility & fertility Wheelchair NHS Health Checks Home oxygen Initiatives to prevent accidental Treatment of infectious injury diseases Initiatives to reduce seasonal 17 mortality
- 18. Our integrated plan Will be used to: ► Set our priorities, guiding our decisions on planning, investment and disinvestment ► Help partner organisations to see areas of focus, helping us align things strategically ► Provide a means of holding us to account 18
- 19. 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 19
- 20. 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 20
- 21. Our Model for Delivery Delivery Priorities Engage: Primary Care Capability CCG Staff & Frail elderly – Member practices independence & dignity Integrated Plan Changes Patients, carers Accelerate Right Care and Public Right Here Services Clinicians and No health without we buy Partners mental health Partnership for maternity and early Contracts with Contracts with years emergency & urgent Specialist hospitals & care e.g. Ambulance, support services services Performance & delivery NHS 111 often Third Quality, , Innovation, Joint Productivity and Contracts with arrangements sector community care e.g. Drug, Prevention with local providers e.g. District authorities for Alcohol nurses, therapies complex & Better Health
- 22. Our plans 2012/13 Develop Primary care capability Meet needs of Frail elderly - independence and dignity Accelerate Right Care Right Here – care closer to home No health without mental health – treat mental ill health and promote wellbeing Work in partnership to improve maternity and early years – every child best start in life 22
- 23. How we work with other CCGs, CSS ► System leadership - The Compact – an agreed way of collective leadership for the NHS system ► For contracts - Agreed clinical leads and teams for commissioning for contracts with appropriate CCG representation ► Commissioning support – there are some areas where it makes sense to buy support into the CCG so it can be shared for efficiencies such as HR, ICT, information processing 23
- 24. 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, their carer’s and communities to develop together the best healthcare Questions ? 24
- 25. Develop Primary care capability • Reach vulnerable people – make contact with primary care • Working with CCG members and NHSCB to identify and support to address inappropriate variation of primary care • Proactive identification and management of long term conditions - diabetes a priority - review lists, care plans, reviews • Development of services to support patients • Improve consistency of referral through systems & peer review • Patient repatriation – look at discharges in hospital • Making Every Contact Count – promote healthy lifestyles – work in partnership with voluntary and community sector • Improving screening and vaccinations e.g. Screening programmes e.g. Bowel cancer and vaccinations e.g. Seasonal flu to help prevent avoidable illness 25
- 26. Meet needs of Frail elderly - independence & dignity • Specific focus on dementia – implementing national dementia strategy, NICE guidance and identifying/scaling up local practice • Integrated working with social care & better case management • Working in partnership with social care for comprehensive package of ‘reablement ‘services to promote and maintain independence • Providing support to carers to ensure that their health and well being is not forgotten • Improving clinical input into nursing and residential care homes improving care and helping them with increasingly complex needs • Developing consistent intermediate care services and pathways • When hospital needed, clear arrangements for care to be transferred back to community safely 26
- 27. Accelerate Right Care Right Here – care closer to home Established track record of delivery improving and bringing services closer with over 30 care pathway reviews undertaken which £3.9m could be delivered locally for lower cost in community settings and reducing £600k of activity •Continue as active partners in Right Care Right Here •Review Care Pathway Reviews to see what more can be brought into community prioritising diabetes and other long term conditions •Remodel services as they are moved •Work with partners to educate patients and public as locations and pathways change •Support the trust to deliver final stage of programme in getting a new hospital facility 27
- 28. No health without mental health – treat mental ill health and promote wellbeing • Working with local authority and voluntary sector - develop specific programmes to ensure promoted well being in all service areas • Develop and improve current mental health provision in primary care • Including the IAPT programme • Making Every Contact Count on mental health – encouraging our partners to do the same • Review the Rapid Assessment Interface and Discharge (RAID) approach with view to making it standard • Adopt an assets-based approach to people with mental health problems and learning disabilities – promoting independence wherever possible • Review current major investments such as pooled budgets in Birmingham between health and social care ensuring focussed and achieving desired outcomes 28
- 29. Work in partnership to improve maternity and early years – every child best start in life • Improving access to maternity services esp vulnerable groups • Targeting lifestyle support at pregnant women, supporting mental health and healthier lifestyles • Increasing quality of health visiting – allied to Family Nurse Partnerships and post natal support services inc depression • Increasing uptake of childhood vaccines and screening programmes • Linking with local authority efforts to increase supply and uptake of evidence based parenting programmes and other interventions 29
- 30. 30
Editor's Notes
- This is the new world – as you can see SWBCCG manages contracts with a range of people providing services but very much in partnership with the local authorities
- As a major conurbation we are lucky to have a large range of people providing healthcare – we have a mix of hospitals such as Sandwell and City Hospital but also specialist hospitals such as Children’s Hospital
- Follow the first turquoise bar in this diagram which shows how long women live in Aston Ward – they are the oldest living to 84 years old – now look at the same colour in the next slide and see that men are some of the youngest to die – there are big variation between wards and that is why the membership approach –where local knowledge will monitor, commission and review services – so that it meets the needs of the population
- Healthcare without boundaries – we have much in common in Sandwell and West Birmingham – but in each local ward there are differences as I have shown you so that is why we have a membership approach – grassroots to really get to grips with the health differences
- In late 1980s and early 1990s we saw the start of internal market with public services encouraged to buy services from providers where purchasers or people buying services can choose from ‘any willing provider’ whether that was public, private or voluntary sector. We have seen a mixed economy such as social enterprises, NHS Foundation Trusts Shift from just buying back office or infrastructure to broader range of services including clinical Now it is much broader than just purchasing – much more encompassing Moving away from single agency buying services to systems buying services (and some high profile failures as NHS IT) Greater awareness to do at different levels and involving user, patient and public where appropriate to get better results
- Partnerships and working with others really important to us – particularly partnerships with patients Quality and Safety will be scrutinising feedback about services – especially comments from patient networks, PALS services, complaints Strategic Redesign will then be using feedback to look at how to improve services and what we commission for in the future
- This diagram shows how we will have patient voice heard throughout our infrastructure – the engagement team have been working with us have put this together – we will be continuing with existing networks but building upon this – for example increasing the number of patient participation groups, continuing our patient networks as well establishing a Patient and Partnership Reference Group with representatives from networks, Local Commissioning Group patient representatives, LINKs and voluntary community sector. You can see that our Local Commissioning Groups will have patient representatives as part of their ‘boards’ and our formal sub-committees will also have representatives for patients.
- This slide shows how commissioning splits across these three new organisations – so GPs will be responsible for commissioning services for young, old, urgent and emergency care and elective hospital care Commissioning board will be doing primary care but also specialist things likeprisons and armed forces and health visiting for under 5s Public health now based in local authority will be continuing with their prevention type activity such as stop smoking services
- Today is about discussing with you these areas and your hopes for our work this year – this is just the start of our dialogues with you and hopefully to a fruitful partnership in the future . I know many of you will be concerned about the future as you care about the NHS and care for patients passionately and thats why you are here. We are a new organisation and we are focusing on areas we feel that will put us in a strong position for the future if we do them this year but also realise there are many areas that need development. I hope you see these areas as those that you have fedback previously on – we know access to primary care is of concern to you, we know there is variability, you have said you are worried about those vulnerable such as the elderly and making sure prevention, particularly for early years, for the best start in life is crucial.
- As a Board we have agreed the 5 i’s - - I know everyone in this room is committed to investing in prevention not just healthcare services Our priorities have been decided from: Reviewing the Joint Strategic Needs Assessments from both local authorities Being part of the Health Well Being Boards and their developing strategies for our area Learning from what has gone before such as clinical strategies agreed by all partners across the health economy – nine of these strategies were developed in 2009-10 for the major areas of healthcare such as urgent care, childrens services – and these involved over 200 clinicians as well as patients and carers in their development well as our own knowledge from frontline services. We have also had two large events with clinicians from across the economy
- For many years you have told us that access to a doctor or primary care services is difficult- we will continued to develop and increase the capacity and capability of primary care. We know that those most vulnerable - frail elderly - need more support to retain their independence for longer – our End of Life programme which we have trialled last year and we are now rolling out across the CCG area, has brought together the voluntary sector, patients, carers and is built with the patient experience right at the heart of the way services will be designed. An area of high deprivation, we naturally see people with a range of mental health issues – we want to increase support at the front end of care Lastly in some of our area, we have a young population and we will be looking to develop partnerships to improve those important early years for our children
- This model shows that for the year ahead we are using our integrated plan (which links to those created by the two PCT Clusters – to the bottom you can see the range of services we will be commissioning on your behalf – of course GP contracts will be monitored by the NHS Commissioning Board. Ss, we have to engage and involved To the right you can see for us to achieve our priorities we have to engage –our staff, our practices, patients, carers, clinicians and partners – if we are to achieve change
- These are our priorities for our first year – what do you think?
- Of course we are one CCG out of eight in the Birmingham Black Country and Solihull area – so we will be working with these CCGs to ensure that we share expertise, knowledge, jointly negotiate contracts where that makes sense for our patients
- Patients with LTC often have poor outcomes – with NHS paying to treat consequences of reactive and unplanned care