oxfordshire clinical commissioning group: annual …...other programme 16,355 15,793 (562) sub total...

OxfordshireClinical Commissioning Group

Oxfordshire Clinical Commissioning Group: Annual Public meeting

Dr Joe McMannersClinical Chair

28 September 2017


Agenda

Questions?

Financial AccountsReview of the year: 2016 / 2017

Bicester Healthy New Town


Review of the year: 2016 / 2017

David SmithChief Executive

OxfordshireClinical Commissioning GroupStrategic plan

New and better ways of delivering good value services

Consult on Oxfordshire Transformation Plan proposals

Meet constitutional targets and reduce DToC and A&E attendance

OxfordshireClinical Commissioning GroupHow did we do?

Introduction of new ‘ambulatory’ model of care to reduce acute hospital admissionso Ambulatory Assessment Units at the JR and Horton

General in Banburyo Rapid Access Care Unit at Townlands in Henley

Increasing access to primary care services o Care navigators coordinating support for patients in

their own home, liaising with GPs and carerso Email consultationso Neighbourhood access hubs – for urgent care

appointments in the evening and weekend


Taking over commissioning of specialist learning disabilities services for adults from County Council and transferring services from Southern Health to Oxford Health

A New Child and Adolescent Mental Health Services Contract to reduce waiting times

Securing funding for Diabetes prevention and education


Oxfordshire Transformation Programme phase 1 - why?

To ensure: high quality and safest care equality of access to best care care closer to home or at home


Oxfordshire Transformation Programme -the agreed changes:

all acute stroke patients get best available treatment at JR’s Hyper Acute Stroke Unit

sickest patients all go to intensive care unit at JR all obstetrics services centred at JR closure of some acute beds to reinvest funds in care

closer to home more outpatients and planned care services at Horton

General


Oxfordshire Transformation Programme -but:

Current legal challenges to the consultation process and some of the changes approved may delay implementation and could impact on the next phase of Transformation.


We must do better:

Delayed Transfer of Care remains stubbornly high despite several joint initiatives with health and social care partners Work and joint investment continues to boost

home care and nursing home providers and create extra capacity to manage more complex people outside of hospital


We must do better:

A&E attendance increased by 6.7% in 2016/17 Ambulance response times Some cancer targets Work to improve access to primary care through

extended and weekend hours More support for GP practices to offer more

services

OxfordshireClinical Commissioning GroupThe Future

Meeting constitutional targets:A&E wait times – what is being done? More consultants working in A&E Plans for streaming of patients arriving at A&EAmbulance response times – what is being done? National Ambulance Response Programme: new clinical coding

system for effective prioritisation based on patient clinical need Revised Ambulance Response targets to measure median time to

patients rather percentage of achievement which will lead to long wait reduction.

Cancer waits/diagnosis – what is being done? Increasing awareness of screening for the public Straight to test/one stop shop diagnostics across a number of

specialities

OxfordshireClinical Commissioning GroupThe Future

The need to successfully implement changes agreed in phase 1 Transformation Programme

Transformation phase 2 – the challenges: growing demand for services workforce shortages financial pressures unsuitable buildings health inequalities


Annual Accounts 2016/17

Gareth KenworthyDirector of Finance

OxfordshireClinical Commissioning GroupContext of 2016/17

Fourth year of operation of CCG and Commissioning Support Unit

First year of being fully responsible for GP Primary Care Commissioning from NHS England (received a transfer of allocation of £91m in order to achieve this)

Management of in-year financial risks – FNC price increase and development of new contracting arrangements with main providers

OxfordshireClinical Commissioning GroupFinancial highlights

Financial accounts produced to national deadlinesSurplus of £21.1m achieved – significantly higher

than planned due to funds released by NHS England. This additional surplus will be carried forward for drawdown in future years.

All financial duties achievedUnqualified audit opinion on the financial

statements, regularity and value for money


Financial Performance targets

Target Position Achieved Position

Revenue spend not to exceed allocation

of £845,960,000

Actual revenue surplus £21,131,000

Revenue administration spend not to

exceed allocation of £14,642,000

Actual administration spend of

£14,207,000

95% of all NHS invoices paid within 30

days

98% of total value of invoices paid within

30 days

Remain within cash funding We have achieved our cash target


How was the money spent?

In 2016/17 we spent £825million

That’s . . .£1,146 per person per year£2.26m per day£1,570 per minutePlus £21.1m ‘surplus’ carried forwards to 2017/18


How was the money spent?

Annual Actual Variance

Budget Month 12 Month 12£'000 £'000 £'000

Acute 400,607 403,386 2,779Community Health 70,637 70,999 362Continuing Care 57,934 64,851 6,917Mental Health and Learning Disability 68,439 68,922 483Delegated Co‐Commissioning 89,546 89,012 (534)Primary care 100,516 97,659 (2,857)Other Programme 16,355 15,793 (562)

Sub Total Programme costs 804,034 810,622 6,588

Running costs 14,642 14,207 (435)

Sub Total 818,676 824,829 6,153

Transformation/risk management 0 0 0Non recurrent reserve 8,198 0 (8,198)Contingency 6,161 0 (6,161)1% Surplus 12,924 0 (12,924)Total 845,960 824,829 (21,131)

OxfordshireClinical Commissioning GroupAnd what did it buy?

Acute Healthcare Services: 166,220 attendances at A&E & MIU, 455 per day 79,667 emergency inpatient admissions, 218 per day 61,078 planned inpatient admissions and day cases 661,128 outpatient appointments 87,832 ambulance incidents

Community Health: 1,750 community hospital episodes 350,187 contacts with community services 88,577 podiatry appointments 105,251 contacts with out of hours GP services

OxfordshireClinical Commissioning GroupAnd what did it buy?

Mental Health Services: 50,330 in-patient bed days 127,598 appointments

Other: 198,725 calls to NHS 111 13,506 appointments in primary care

neighbourhood access hubs (approx 6 months) Total drug items prescribed – 11,085,290 1,751 referrals for NHS Continuing Care


External Audit Opinion

Financial statements – an unqualified opinion that the accounts reported fairly on the CCGs finances

Regularity of income and expenditure – an unqualified opinion that financial transactions were conducted within the CCG legal framework

Value for money – no matters to report

OxfordshireClinical Commissioning GroupPresent and future

For the financial year 2017/18 OCCG has a £16m increase to our funding compared to £50m in 2016/17. The CCG will remain at 4.8% below target funding.

OCCG has submitted a plan for 2017/18 that was compliant with financial planning targets including a surplus of £19.989m

Key risk for OCCG moving forward into 2017/18 remains the same as it is for all NHS organisations across the country, which is to address the increasing demand for NHS services within the resources available

Bicester Healthy New Town Programme

Dr Rosie Rowe, Bicester HNT Programme Director

In Oxfordshire our health needs are changing...

INCREASINGCHRONICDISEASE

INCREASING

INCREASING BIRTHS FROMGROWING POPULATIONS

INCREASING POPULATION AGE

• To shape new towns, neighbourhoods and

communities to promote health and

wellbeing, prevent illness and keep people

independent;

• To radically rethink delivery of health and

care services, supporting learning about

new models of deeply integrated care

• To spread learning and good practice to

other local areas and other national

programmes

The Healthy New Towns programme has three key objectivesH

ealth

and

wel

lbei

ng

bene

fits

Time (Years)

Potential additional impact

Current good

practice

Growing Bicester: a place based approach

The scope of the programme

covers the whole of Bicester, with

the NW eco town providing an

example of how the built

environment can promote healthy

living

1 NW Bicester 6000

1 Elmsbrook 393 (90 homes

complete)

2 Graven Hill 1900

SW Bicester Phase 1 1742(600 homes

complete)

3 SW Bicester Phase 2 726

12 SE Bicester 1500

Rest of Bicester 30,845

Bicester Healthy New Town Partnership

Healthy Town, healthy lives

Programme Development: Objective Setting

Stage 1

Expert workshops:

What are the key health and care challenges faced by the current and future population of Bicester?

Stage 2

Community engagement to agree direction, toidentify how best to achieve our objectives and gain support for delivery

Two key priorities:

• To increase the number of children and adults

who are physically active and a healthy weight.

• To reduce the number of people who feel

socially isolated or lonely in order to improve

their mental wellbeing

Programme Objectives

1. Bicester’s built environment- making best use of the built environment to encourage healthy living

2. Community Activation – enabling local people to live healthier lives, with the support of local community groups, families and schools, and employers

3. Health and care services- delivering new models of care that are focused on prevention and care closer to home which minimises hospital based care

Programme Work Streams

A whole systems approach

Transformation of relations between built environment and health professionals

Outcomes:

• One plan for NHS estates for the town

• Generating maximum value from public assets

• Health promoting policies are being embedded

in local plans

• Planners now understand new models of care

and need for an estate that can provide it

• A coordinated ‘ask’ for health services from S106 funds

Built Environment – delivery (1)

The built environment is supporting healthier lifestyles

Outcomes:

• Early provision of community assets is

delivering faster social connections

• Digital innovation is addressing social isolation

• Insight into barriers to use of green spaces identified

• The built environment is acting to nudge

residents to be active

Built Environment – delivery (2)

• Built environment nudge to make walking part of daily routines

• This project delivers marked routes that are safe and accessible

• Developed with community engagement and schools

• Supported by ‘Health Walk’ programme

• There is no cost to participation

• Suitable for a wide range of ages,

at any time of the day

Neighbourhood Health Routes

‘Bicester’s Blue Line’

Local stakeholders working together to deliver the programme in their

organisations and across business, education, and voluntary sectors

Outcomes:

• Local leaders ‘own’ the programme and are willing to commit

time and resources to support behaviour change

• Establishment of a Voluntary Organisation Network to

increase the capacity of community groups

• Senior leadership support is ensuring a

‘whole school’ / whole family approach

Community Activation - delivery

10 week programme offering:

- Healthy Eating

- Arts and Crafts

- Forestry Schools

- Walking Sports

- Multi-Sports and Games

Outcomes:

• total of 173 attendances

• Many parents had not attended any school event before

• New friendships were formed

We have got ourselves into a routine of life. Go to work and school. Come home. Have

dinner. We had forgotten how to have fun. These sessions have really opened my eyes to

that.’

Family Fun Sessions

New models of care enabled through use of technology are being

developed and tested with Bicester acting as a ‘demonstrator site’

Outcomes:

• Improved use of health resources: Pilot new diabetes

pathway

• Improved health and wellbeing: Development of online website

offering mental health support for young people

• Improved access to services: Development of sustainable and

enhanced primary care fit to meet the needs of the growing population

• Workforce Transformation: Integrated training programme for support

workers

Health care remodelling - delivery

How will we know if the HNT programme is working and what elements

should be spread?

What is the difference for residents of living in a healthy town?

Outcomes:

• Bicester is leading the evaluation collaborative across sites and has identified

common measures to evaluate what ‘works’

• Potential metrics are wide ranging

• Rapid cycle evaluation is already informing the programme

• Improvements in healthy behaviours expected 2018

Evaluation

• Positive engagement between health care and planning

• HNT is a catalyst for health to connect with local authorities, schools,

businesses and the voluntary sector to promote health and wellbeing

• Holistic approach to health improvement focused on a whole

population approach encourages local engagement

• Change in the built environment is necessary but not sufficient to deliver

behaviour change – it needs support from community activation

• The more we do the more opportunities emerge

• Investment in early engagement is critical for local ownership

of what it means to live in a Healthy New Town

• Meaningful community activation takes time but is essential

to support behaviour change

Learning to date: Programme Value

• Systems for meaningful public engagement

• Responsibility for promotion of health and wellbeing

• Alignment with community development role

• Good links with the voluntary sector

• Planning lead for a healthy built environment

• Strong local accountability

Local Government working in partnership with health


Questions?

oxfordshire clinical commissioning group: annual …...other programme 16,355 15,793 (562) sub total...

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