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Challenges

and

opportunities

for health

Clare Duggan

Director for Commissioning Operations

NHS England – Cheshire & Merseyside

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The NHS in England deals with over 1 million patients every 36 hour

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• Population of over 1.5million

• 6 Health & Well Being Boards, Local Authorities

and Overview and Scrutiny Committees

• 7 CCGs

• 5 Acute Providers

• 5 Community/Mental Health Providers

• 5 Specialised Providers

• 14 Public Health Contracts

• 304 GP Contracts

• Circa 1100 GPs on Performers List

• 160 Optometry Contracts

• 431 Pharmacy Contracts

• 226 Dental Contracts

NHSE – Liverpool City Region at a glance …

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Challenges

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Challenges for the NHS

£22bn

challenge

Deliver for

today

5 year

forward

view

Better outcomes

Be more efficient

Health system for the outcomes we want

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Clinical outcomes challenge

Southport & Formby CCG

South Sefton CCG Liverpool CCG Knowsley CCG St Helens CCG Halton CCG Wirral CCG

DementiaNeeds Improvement

Needs Improvement Performing well Top Performing Top Performing

Needs Improvement

Needs Improvement

DiabetesNeeds Improvement Performing well

Greatest need for improvement poor particpation

Needs Improvement Performing well

Needs Improvement

Greatest need for improvement poor particpation

Learning Disabilities

Needs Improvement

Needs Improvement

Needs Improvement

Needs Improvement

Needs Improvement

Needs Improvement

Needs Improvement

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Accident and Emergency ChallengeThis indicator identifies the percentage of all A&E attendances where the patient spends less than four hours in A&E

from arrival to transfer, admission or discharge. This is a measure against the national waiting time standard of 95%

Source: July 2016 published - monthly Unify A&E Attendances and Emergency Admissions collection

NHS Providers failing the standard in July 2016

Aintree University Hospital NHS Foundation Trust 86.0% Southport and Ormskirk Hospital NHS Trust 88.0%

Royal Liverpool and Broadgreen University Hospitals

NHS Trust 92.0%

St Helens and Knowsley Hospitals NHS Trust 85.6%

Warrington and Halton Hospitals NHS Foundation Trust

92.7%

Wirral University Teaching Hospital NHS Foundation Trust

88.5%

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• Outstanding

• Liverpool Heart & Chest Hospital NHS Foundation Trust

• Good

• Aintree University Hospitals NHS Foundation Trust

• Alder Hey Children’s NHS Foundation Trust

• Cheshire & Wirral Partnership NHS Foundation Trust

• Liverpool Women’s NHS Foundation Trust

• Mersey Care NHS Foundation Trust

• Royal Liverpool & Broadgreen University Hospitals NHS Trust

• St Helens & Knowsley Teaching Hospitals NHS Trust

• Wirral Community NHS Trust

• Requires Improvement

• Liverpool Community Health NHS Trust

• Southport & Ormskirk Hospital NHS Trust

• Wirral University Teaching Hospital NHS Trust

• 5 Boroughs Partnership NHS Foundation Trust

Quality challenge – Provider CQC ratings

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• Restore and maintain financial balance

• Finite and stretched NHS resources

• Drive improvements in Health & Care

• Implement the 5 year forward view

• Deliver core access and quality standards

Challenge to deliver

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Opportunities

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• Partnership behaviours become the norm

• Stronger collaboration

• Joint work with partners – especially Local Authorities

• Third Sector

• Right care, right place, optimal value

• New Care models

• Get the basics right

• Unwarranted variation in quality and costs

Opportunity

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• Pathology services and back office function

• Procurement, hospital Pharmacy, Estates, Facilities Transformation plans

• Improving rostering and job planning

• Reduce use of agency costs

• Increase clinical productivity

• Specialised Commissioning – high cost drugs and devices

• Clinically led Getting it Right Frist Time programme

Unwarranted variation in quality and costs

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• Effective Commissioning function in the NHS

• Setting local priorities and incentives

• Oversight of contracts

• Best value for the taxpayer

• Provision of a comprehensive local NHS with the available resources

• Commissioning at the appropriate footprint

• Build on locally-led initiatives

• Focus is to improve services

Commissioning opportunity

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1. Sustainability and Transformation plans

2. Finance

3. Primary Care

4. Urgent and Emergency Care

5. Referral to treatment times and elective care

6. Cancer

7. Mental health

8. People with learning disabilities

9. Improving quality in organisations

Nine Must Dos

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• Right Care

• Continuing Health Care

• New models of Care

• Urgent and Emergency Care

• Self Care and Prevention

• Getting it Right First Time (GIRFT)

• Carter productivity

National Transformation and Efficiency

programmes

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GP Forward View - HeadlinesGeneral

•Addresses pressures in GP practices

•Commitment to increasing proportion of investment going in to GP services

•Sets out a number of measures to address immediate problems whilst funding comes on stream, which also support transformation.

Workforce

• 5,000 extra doctors

• 3,000 new fully funded practice-based mental health therapists

• 1,000 new physician associates

• £6 million for practice manager development

• Extra 1,5000 co-funded practice clinical pharmacists

• £15 million for GP nurse development strategy

Investment

•£2.4 billion a year by 2020/2021 (14% real terms increase)

•A five year £500 million national sustainability and transformation package to support GP practices (includes additional funds from local CCGs)

Workload

• Extra £16 million for services for doctors suffering burn-out (Dec 2016)

• £30 million “Releasing Time for Patients”

• 10 High Impact Actions

• £45 million extra over 5 years to support reception and clerical staff to play a greater role in signposting/clinical paperwork

• New legal requirements in NHS Standard Contract re hospital/GP Practice interface from 2016

Practice Infrastructure

•£900 million in capital investments for estates and technology

•£45 million to support on-line consultations

•18% increase in CCG allocations for IT and technology

•New technology and self-care

Care Re-design

•Delivering quality/improved access/ skilled health professionals

• Integrating extended access with OOH and UC, 111

•Supporting new models of care – voluntary MCP contract (April 2017

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Critical to

success

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• Patients and communities

• Partnership working – especially with Local Authorities

• Third Sector

• Effective public engagement

• Aligned CCG and provider plans

• Shared open book process

• Relentless focus on quality and efficiency

Critical to success

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Thank you