Sandwell and West Birmingham CCG

Our approach to commissioning

Dr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)

26th June 2012

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Our health priorities

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Our health needs

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Our health needs

4Health without boundaries - November 2011

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Birmingham

Complex range of providers for healthcare:

HospitalsHeart of England (3 hospitals), University Hospitals Birmingham, Sandwell West Birmingham, Birmingham Children’s Hospital, Royal Orthopaedic, Birmingham Women’s Hospital and Birmingham Dental Hospital

SpecialistBirmingham and Solihull Mental Health Trust

Community Birmingham Community Healthcare

Acute & UrgentWest 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

A wide range of services available to commission from

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RCRH Comms and Engagement Chair and

RCRH Partnership Board Rep

Black Country Partnership (NHS) Trust

Birmingham and Solihull Mental Health Trust (BSMHT)

Birmingham City Council

Birmingham Community Healthcare NHS Trust

Birmingham and Solihull NHS Cluster (Heart of Birmingham tPCT)

Sandwell and West Birmingham Hospitals Trust

Black Country NHS Cluster (Sandwell PCT)

Sandwell Metropolitan Borough Council

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

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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

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Our quality priorities

Our priority How we monitor this

Safety Population health is improving

Effectiveness Treatments are effective

Patient experience Population is satisfied with their treatments

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Continuously improving quality

Build feedback and improvement into

annual commissioning intentions

Monitor effective delivery of quality and safe care through : information at Quality & Safety Committee,

Local Commissioning Groups feedback

Annual Quality and Safety Plan

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How we will ensure high quality in Primary 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

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Getting the best out of services - diabetes

Patients•Regular follow up•Easy physical access•Close to home

SWB•Managed care•Professional opinion•Costs covered

CCG•Patients managed safely•Upstream interventions•Value for money

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End of life – from pilot to rollout 2012/13

►Award winning pilot with experience-led commissioning – patients driving the processRange 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.”

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End of life –CCG rollout 2012/13

5 improvement workstreams have been established February 2012 supported by 2 underpinning foundation programmes:

Programme team established with wide range of clinicians, commissioners, carers, third sector delivering the workstreams to achieve improvements – with shared ownership.

► 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 dying

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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

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Any Willing Provider

Foundation TrustsPrivate Sector

3rd SectorPrimary Care

So who will overview new world

Commissioners: Providers

CQCCQC

National Provider

Development Authority

National Provider

Development Authority

• Set maximum prices

• Maintain continuity of care

• Quality• Safety

NHS Commissioning Board

NHS Commissioning Board

HealthWatchHealthWatch

Overview and Scrutiny

Committees

Overview and Scrutiny

Committees

MonitorMonitor

• Support & develop

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

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• 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.

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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…

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How we currently invest in secondary healthcare

Provider BSOL Sandwell Total

£000's £000's £000’s

SWBH 77,936 157,260 235196

BSMHT 23,724 1,443 25,167

BCPFT 230 33,915 34,145

Birmingham Children’s

634 5,065 5,699

SCHS 8,804 34,553 43,357

BCHS 27,409 3,628 31,037

TOTAL 374,60122

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

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Quality Priorities 2012/13

1. Developed draft CCG Quality and Safety Plan – out for consultation to members (issue 2) www.swbcg.link ]

2. Putting quality into all our contracts – ensuring we are commissioning for quality e.g. alcohol CQUIN

3. Monitoring delivery of quality and safety through Quality and Safety Committee and formal Clinical Quality Reviews (e.g. meetings, reviewing incidents/never events, visits)

4. Provider development5. Primary Care development

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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

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Questions?

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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

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

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Integrated Plan

Brief• Support the Frail Elderly Programme

Signed off by CEO Compact

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Patient/Clinician Journey

Dr S Mr/s D

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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

A constitution – why?

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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

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New NHS

LicensingLicensing

Department of Health

Department of Health

CQCCQCNHS Commissioning Board

NHS Commissioning Board

Local HealthWatchLocal HealthWatch

ParliamentParliament

MonitorMonitor

Patients & PublicPatients & Public

ProvidersProviders

PartnershipPartnershipLocal AuthoritiesLocal Authorities

SWB CCGSWB CCG ContractsContracts

Birmingham HealthWatchBirmingham HealthWatch

Sandwell HealthWatchSandwell HealthWatch

Accountability

Funding

Key:

Right Care Right Here partnership

BSMHT, BCP, BCHC, SWBH

Other providers BCH, BWH, ROH, DGH, RW, SWB, WM, and I/C.

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