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Agenda Item No: 9
Date of Meeting: 26th November 2015
Governing Body Meeting in Public
Paper Title: Review of progress against delivery of CCG ambitions
Decision Discussion Information Follow up from last meeting
Report author: Jacqui Bunce, Associate Director,
Grant Neofitou, Head of Programme Office Report signed off by: Chris Badger, Interim Director of Strategic Partnerships
Purpose of the paper: To present the Governing body with a review of progress
against delivering the CCG’s strategic ambitions.
Conflicts of Interest involved:
There are none identified.
Recommendations to the Governing Body:
That the Governing Body discuss progress against the ambitions and
identify any remedial actions that may need to be taken, and;
use the data to begin to inform the development of refreshed ambitions and priorities for 2016/17
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1.0 BACKGROUND 1.1 March 2015, the Governing Body agreed a series of priorities for 2015/16 as
part of its 2nd strategic plan, ‘Forward View into Action Plan 2015/16 1.2 The priorities set were:
1. Living healthier lives 2. Long Term Conditions 3. End of Life 4. Frail elderly 5. Independent Living 6. Emotional and Mental Health well-being of Children and Young People 7. Cancer 8. Dementia 9. Parity of Esteem
1.2.1 Further details on the priorities are attached at Appendix 1. 2.0 REVIEW OF PROGRESS 2.1 The attached slide pack aims to show the progress against the strategic
ambitions set in March, focusing on measurable metrics, rather than the delivery of projects or initiatives. Given the ambitions are on the whole outcome measures, they relate to areas where change may not be bought about quickly.
2.2 For each ambition relevant metrics from the plan have been highlighted to
show progress in reaching targets. Where metrics set out in the plan were not readily available, or are annual measures, either the latest available data since the plan was agreed in March has been used, or a proxy has been chosen.
2.3 The focus on the metrics has been prioritised because over the next few
months the CCG will be looking at range of intelligence sources to shape refreshed priorities, both at CCG level and at locality level. This will be a joined-up process, linking to the commissioning cycle, locality planning, and development of commissioning intention.
2.4 The Governing Body will spend time on December 3rd looking at a range of
data in more detail to agree prioritisation for the year ahead. The priorities will then be refreshed. Next year the priorities will:
have more consistent measurable targets, supported by measures
of progress against identified actions include specifics about localities where outcomes are significantly
different to the rest of the CCG reflect the outcome measures likely to be set national as part of
NHS England’s new mandate
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CCG Priorities for 2015/16 The ACTION PLANS for 2015/16 to deliver the CCG Ambitions are attached at Appendix 1 – the table below sets out the current projects linked to our ambitions. Key:
Strategic Objectives Target Projects related to objective Directorate Leading Governance Alignment1 .Living Healthier Lives
Obesity pathway LLV Commissioning Governing Body HWBStrategy to be agreed by end of Q1 Self Management Strategy Strategic Partnerships PH HWB
Over 75s Health Checks Commissioning PH HWB
Public Health Strategy Strategic Partnerships PH HWBReduction in prevalence from 46% MH Smoking Cessation CQUIN Strategic Partnerships Joint CommissioningImproving Patient experience MSK Pathway Commissioning
2. Long Term Conditions See framework for details Local Enhanced Framework Commissioning Governing Body
No of people with PHPs expanded to
MH intention to double CHC outturn
Personal Health Plans / Links to Self
Management StrategyStrategic Partnerships Joint Commissioning
Reduction in acute exacerbations by
localityRespiratory Pathway Commissioning Governing Body
40% patients discharged to home Stroke Early Supportive Commissioning Governing BodyIdentify caseload within community
and other care settingsNeurological conditions co‐production Commissioning Governing Body
Reduction in acute exacerbations Heart Failure Pathway Commissioning Governing BodyTo be fully implemented by end Q1 Implementation of Map of Medicine Commissioning Governing Body
Review current pathway and improve
identification and outcomesDiabetes pathway development Commissioning Governing Body
Linked to above Diabetes Expert Patient Programme Commissioning Governing Body
links to Self Management Strategy Strategic Partnerships Joint CommissioningTo develop new pathways and improve
guidance/informationAtrial Fibrillation & Anti Coagulation Commissioning Governing Body
To improve hypertension pathway for
patientsFlo TeleHealth Commissioning Governing Body
Optimising the use of medicines In‐practice pharmacists Strategic Partnerships Governing Body
3. End of LifeReduction in hospital episodes in final
30 days of lifeEnd of Life Commissioning Plan & Pathway Commissioning Governing Body
% patients dying in place of their
choiceElectronic Patient records Commissioning Governing Body
Patient & carers report good patient
experience and choiceHome First Pilot Commissioning Governing Body
As above CHC Fast Track Pilot Governing Body
Improvement in patients receiving
right care at right time
Immediate Access to emergency drug
service Strategic Partnerships Governing Body
4. Frail ElderlyNo of emergency admission hospital
spells for over 75sInterface Geriatrician Commissioning Governing Body
Vanguard programme outcomes Nursing Home LES Commissioning Governing BodyReduction in A&E and admissions
relating to fallsFalls Strategy Commissioning Governing Body
Joint review to be completed by end
Q1Bed Review Commissioning Governing Body
Plan for roll out of Home First or
equivalentHome First Pilot Commissioning Governing Body
Develop as part of integrated
approach to procurement of Out of
Hours and NHS 111
Acute In Hours Visiting ServiceCommissioning Governing Body
5. Independent LivingContinued reduction in excess bed
days acute settingsDischarge to Assess Operations Governing Body
Expand use of PHB and ensure choice
offeredContinuing Healthcare Review Strategic Partnerships Joint Commissioning
New model of care & commissioning
model tbaHealth & Enablement integration Operations Governing Body
Admission avoidance TeleHealth/Telecare commissioning Governing Body
HES Community Equipment Strategic Partnerships Joint CommissioningImplement HCT CQUIN link to Care Act
Implementation ‐ increased no of
carers identified
Carer StrategyStrategic Partnerships Joint Commissioning
Patients dying in preferred
place of death
Increasing Life expectancy
and Disability Free Years
improved quality of care for
over 75s and reduce acute
emergency spend
Increasing the proportion of
older people living
independently at home
Reduction in inpatient bed
days
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Strategic Objectives Target Projects related to objective Directorate Leading Governance Alignment
6. Emotional & Mental Health Wellbeing of Children and Young People tbc pending outcome of review HWB
JuneCAMHS review Strategic Partnerships Joint Commissioning
Implement national priority SEND Strategic Partnerships Joint CommissioningImplement system wide action plan All Age Autism Strategic Partnerships Joint CommissioningImplement national priorities and
pathwaysLooked After Children pathways Strategic Partnerships Joint Commissioning
Agree integrated commissioning
specificationSpeech & Language Commissioning Strategic Partnerships Joint Commissioning
Link to HCC work programme for 0‐25
age groupChildren's Services Integration Strategic Partnerships Joint Commissioning
Evaluate CCAT Crisis Support Strategic Partnerships Joint Commissioning
Deliver & maintain A&E target, reduce
inappropriate & multiple attendancesA&E pathways
Strategic Partnerships Joint Commissioning
Improved access to ADHD
medicinesUpdated shared care for ADHD drugs
Strategic Partnerships Governing Body
7. Cancer ProgrammeReduce variation and deliver national
outcomesCancer Variation Mortality rates Operations Governing Body
Maintain cancer waiting time
performance at specialty levelCancer Waiting Times Operations Governing Body
Improve uptake and deliver national
outcome measuresCancer Screening Targets Operations Governing Body
Work with SCN to implement best
practice
Cancer Pathway and Performance
Improvement Strategic Partnerships Governing Body
8. Dementia
Agree and implement action plan and
national requirements
Dementia Strategy ‐ sign off and action
plan Strategic Partnerships HWBAchieve & maintain national target Dementia Diagnosis Commissioning Governing Body
Review pathways and pilot alternative
models of community support
Dementia post diagnosis support, review
of EMDASS pathways Strategic Partnerships Joint CommissioningEvaluate pilot and recommend future
modelCrisis support for carers project Strategic Partnerships Joint Commissioning
Discharge from secondary care follow
up to primary care
Facilitation of Dementia drug transfer of
care Strategic Partnerships Governing Body
9. Parity of EsteemDeliver agreed system outcomes as
part of system wide delivery teamMH Crisis Concordat Action Plan Strategic Partnerships Joint Commissioning
Implement actions LD SAF & Action Plan implementation Strategic Partnerships Joint CommissioningDeliver and maintain national target
inc review of counselling servicesIAPT delivering 15% target Strategic Partnerships Joint Commissioning
Engage in HCC review Day opportunities Joint CommissioningIncrease access and choice of
dementia beds across the systemBed model Strategic Partnerships Joint Commissioning
Increase uptake LD Health checks Strategic Partnerships Joint Commissioning
Understand variation and
appropriateness
Length of stay reviews in acute trust ‐
reasonable adjustment Joint CommissioningEvaluate & recommend on future Excellent Depression Care Project Strategic Partnerships Joint Commissioning
Strategic Changes
Open Spring 2015 New QEII CommissioningNext steps of implementation to be
agreedIntegrated Care programme Strategic Partnerships Joint Commissioning
Stroke Board established to agree
configuration of services and delivery
of outcome measures
Stroke Strategic Changes ‐ HASU/ASUCommissioning Governing Body
To be completed during 2015/16 OOH AIHVS NHS 111 Procurement Commissioning Governing Body
Other work streamsTo be reviewed to improve outcome
measuresMaternity Specification Commissioning Governing Body
To develop new pathways and improve
guidance/informationSkin Health Pathway redesign Commissioning Governing Body
Reduce medicines waste Repeat Dispensing Sytems in GP practices Strategic Partnerships Governing Body
Reduction of healthcare
acquired infections &
antibiotic resistance
Antibiotic stewardship
Strategic Partnerships Governing Body
Tackling obesity, challenging
behaviour, domestic abuse
support, self harm
Clear strategy for Dementia
care / Dementia friends
Reduce the disparity between
physical and mental health
Improving patient outcomes
Delivering our ambitions 2015/16
A Review of Progress
Strategy introduction
Our vision, to see excellent joined-up services for everyone, remains unchanged. We stand by our determination to improve healthcare for our population while ensuring the long-term sustainability of our health and care services.
Living longer
Healthier Lives
Managing Long Term Conditions
End of Life
Frail Elderly
Independent Living
Children and young
People
Cancer
Parity of Esteem (Mental Health)
Dementia
When we look at the current figures for life expectancy and disability free life expectancy, it shows a significant gap between the different localities in the area. Stevenage, North Hertfordshire and Welwyn Hatfield show lower life expectancy than other localities and so part of our efforts now will be to invest in actions that focus on improving life expectancy. Latest figures in 2012/13 show a slight improvement in life expectancy overall.
Ambition 1: Living healthier lives for longer
Life expectancy at 65
(2011/12 figures)
Life expectancy at 65
(2012/13 figures)
Life expectancy at 65
Ambition 2018/19
Progress against 2018/19
Ambition
Male Female Male Female Male Female Male Female
Welwyn Hatfield 18.9 21.5 20.0 22.9 19.1 21.7 Achieved Achieved
Broxbourne 19.4 22.1 19.3 22.5 19.4 22.1 Worsened Achieved
East Hertfordshire 19.4 21.6 19.7 22.3 19.4 21.7 Achieved Achieved
Stevenage 18.1 20.9 18.4 20.7 19.0 21.5 Not on target Worsened
North Hertfordshire 18.5 20.5 18.6 20.6 19.4 21.5 Not on target Not on target
Hertfordshire County 19.0 21.5 19.2 21.8 19.1 21.7 Achieved Achieved
East of England 19.1 21.7 19.2 21.6
England 18.5 21.1 18.7 21.1
The CCG wants to encourage all patients with LTC to be supported with actively managed care plans and, as a consequence, to see the number of LTC bed days
reduce to no more than 65% of the total number of inpatient bed days by 2018/19. With demographic projections taken into account, this is an ambition to reduce LTC bed days by approximately 19,000. We are currently on track to deliver this ambition.
Ambition 2: Supporting people with long term conditions
The NHS England CCG Outcomes Tool shows that 63.1% of E&N Herts patients with LTCs “feel supported”. This is slightly worse than the average for England and worse than the regional mean. The best in England scored 74.6%. By 2018/19 the CCG aims to have 75% of patients with LTCs feeling supported and be in the top decile for England. Latest figures show a deterioration in this area.
Ambition 2: Supporting people with long term conditions
A key area is for patients to die in their preferred place of death. Recent data shows that in East & North Hertfordshire we have up to 34% of patients die in a place that is not their preferred option. Advanced care planning is key to helping reduce that figure further.
Ambition 3: Planning better end of Life care
Of patients died in their
preferred place of death
during the period 2014/15
Based on Post death audit returns excluding ‘Unknowns and ‘preference not expressed’
We aimed to reduce 0 to 2 day emergency admissions for over 75’s. The Projection for 2015/16 is further growth in emergency admissions for length of stay of 0 to 2 days. The next slide shows the wider A&E and Emergency admission flows.
Ambition 4: Looking after frail and elderly patients
Figures include all acute providers for E&N Hertfordshire CCG patients only
The growth in emergency admissions has been higher than A&E attendance growth. Therefore the proportion of patients admitted has also gone up since 2012/13 particularly at Lister Hospital.
Ambition 4: Looking after frail and elderly patients
Figures include all acute providers for E&N Hertfordshire CCG patients only
We have seen a reduction in longer length of stays (15+) which is positive. At the same time there is a higher proportion of patients staying between 0-2 days than in 2012/13.
Ambition 4: Looking after frail and elderly patients
Figures include all acute providers for E&N Hertfordshire CCG patients only
Ambition 5: Encouraging independent living The Adult Social Care Outcomes Framework measures the number of permanent admissions of people over the age of 65 to funded residential and nursing care and the CCG adopted the same measure in its ambition. We’re aiming to work together to support people in their own home for as long as possible. The number reported here is a Hertfordshire County wide number rather than an E&N Herts specific number.
One in ten children aged between 5 and 16 years has a mental health problem, and many continue to have mental health problems into adulthood. Half of those with lifetime mental health problems first experience symptoms by the age of 14, and three-quarters before their mid-20s. Self-harming in young people is not uncommon (10–13%) of 15–16-year-olds have self-harmed.
Ambition 6: Improving the emotional and mental well-being of children and young people
Admissions for self harm in under 16 year olds (Rate per 100,000 population) Key:
Ambition 7: Cancer Earlier diagnosis of cancer improves survival rates and the 2013 cancer indicators show that 4 out of the 5 areas in the CCG are above the England comparator rate with the exception of Broxbourne. The Crude mortality rate also shows the rate of cancer related deaths has reduced since 2012.
Ambition 7: Early detection and better treatment of cancer
Better screening improves outcomes for patients. The Hertfordshire screening coverage is better than the England coverage. However Stevenage is an area where improvements in screening is a priority.
Ambition 8: Improving Dementia Care
Our ambition is that at least 67% of people in East and North Hertfordshire with Dementia have a diagnosis by end of July 2015. The table below shows the progress against the target.
Ambition 8: Improving Dementia Care
The CCG is in discussion with partners about the feasibility of analysing the cohort of patients with dementia using a combination of the Mental Health Minimum data Set and Hospital data. The data we have shows that we have areas to improve on such as increasing the percentage of patients with dementia whose care has been reviewed face to face in a 12 month period (see chart on the right). The rate of emergency admissions is growing both locally and nationally as per below.
Emergency Admissions for patients age 65 and over with dementia (Directly standardised rate per 100,000 population)
The percentage of patients diagnosed with dementia whose care has been reviewed in a face to face review in the preceding 12 months
East & North Hertfordshire CCG
Target higher %
The orange line indicates the CCG admission rate. The centre line is the national average. Upper and lower lines are confidence limits.
Ambition 9: Ensuring physical and mental health services are given equal priority
Performance almost doubled between Q1 and Q4 2014/15 On track to deliver target (3.75% a quarter or 15% a year) in 2015/16
Ambition 9: Ensuring physical and mental health services are given equal priority
Percentage of Children and Young People seen within 28 days for their first routine appointment increased from 17% in April 2014 to 90% through July – Sept 2015
Additional intelligence
• Session on December 3rd to look at data in more detail to inform priorities for next year Benchmarking and national intelligence is being reviewed
primarily based on the following: Commissioning for Value Packs NHS Atlas of Variation NHS Outcomes tool (SPOT)
• The CCG will also be measured on new national CCG indicators which will influence the areas we prioritise
