NHS Croydon Clinical Commissioning Group A Clear and ... · Programmes and Children’s Centres...

KF – Draft Version 2- of 20

NHS Croydon Clinical Commissioning Group

A Clear and Credible Plan – Executive Summary for commissioning sustainable health services for Croydon’s population

Longer, healthier lives for all the people in Croydon

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Contents

1. Executive Summary ..................................................................................................................................................................................................... 3

1.1. Transformation Programme ................................................................................................ 3 1.2. Performance and Quality Improvement .............................................................................. 4 2. Vision ........................................................................................................................................................................................................................... 5

3. Plan on a Page Overview ............................................................................................................................................................................................ 6

4. Programme 1 - Preventing Ill Health ........................................................................................................................................................................... 9

5. Programme 2 - Long Term Conditions (Overall) ....................................................................................................................................................... 10

6. Programme 3 - Older People .................................................................................................................................................................................... 11

7. Programme 4 - Adult Services .................................................................................................................................................................................. 12

8. Programme 5 - Children and Young People ............................................................................................................................................................. 13

9. Programme 6 - Planned Care ................................................................................................................................................................................... 14

11. Programme 6 - Primary and Community ............................................................................................................................................................... 15

12. Programme 7 - Urgent Care .................................................................................................................................................................................. 16

13. Programme 8 - Medicines Management ................................................................................................................................................................ 17

14. Financial ................................................................................................................................................................................................................. 18

15. Commissioning Plan on a Page ............................................................................................................................................................................. 20


1. Executive Summary This paper is an executive summary of the Integrated Strategic Operating Plan version 2.1. This executive summary highlights

• Our Vision

• Our Plan on a Page Overview

• Our Plans by each Priority Programme Area

• Our Financial Position

• Our Commissioning Plan on a Page

The Integrated Strategic Operating Plan and Executive Summary will remain in draft until final confirmation of funding allocations, activity modelling and Quality Innovation Productivity and Prevention Plans (QIPP). In producing the Integrated Strategic Operating Plan we have worked in partnership with the Health and Wellbeing Board to align our priorities and our vision of ‘Longer, Healthier Lives for all the People in Croydon’. The Joint Health and Wellbeing Strategy 2013 - 2018 sets out 3 strategic goals;

1. increased healthy life expectancy and reduced differences in life expectancy between communities

2. increased resilience and independence 3. a positive experience of care

We face many challenges over the coming years with growth in our population against tightening resources. We are determined that by implementing our transformation programme and by working closely with our commissioning partners, NHS Commissioning Board, the Local Borough of Croydon and neighbouring Clinical Commissioning Groups and our Providers that we will maximise the resources available to us to ensure that we can continue to deliver high quality services to the populations we serve. 1.1. Transformation Programme The Transformation Programme in addition to improving quality outcomes aims to release efficiencies and reduce an over reliance on hospital services. To ensure that there is choice available in settings other than hospital we aim to transform the way we deliver services at the intermediate, primary and community level. The aligned strategies to achieving this are for example:

• The Prevention, Self-Management and Shared Decision Making Strategy.

• Primary and Community Strategy • Dementia Strategy • Urgent Care Strategy, • Older People Strategy • Falls Strategy • Beginning to end Long Term Condition pathways, Dementia,

Diabetes, Cardiology, Respiratory Illness and Cancer – for all Adults and Children.


• Children’s Primary Prevention Strategy • Children’s Early Intervention Programme

One of the biggest areas of service change will be within Primary and Community Services. NHS Croydon CCG has developed 6 Geographical Networks with populations between 50,000 to 82,000. The Geographical Networks supported by Public Health will understand their communities by knowing:

• Pockets of deprivation • Prevalence of ill health example long term conditions • People who are vulnerable including those with a Mental Health

Diagnosis, People with a Learning Disability, Older People and Children and Families needing additional support

1.2. Performance and Quality Improvement When transforming our services quality will remain at the heart of everything we do. Croydon Clinical Commission Group consistently aims to ensure it commissions health services that are safe, that employ best clinical practice and offer information to inform patients’ choice in how, when and where they receive their health care services. We believe that by embedding performance and quality improvement in our commissioning processes and communicating and engaging with the public and patients who use our commissioned services, Croydon Clinical Commission Group can facilitate an honest dialogue about health, health services and patient needs and views – critical to effective and responsive care. In the way that we work, Croydon Clinical Commission Group will embody the principles of accountability, putting the patient first in everything we do as championed by the

Francis Report Recommendations.1 The CCG will also work with providers to embed these principles, to establish agreed levels of quality and encourage the development of service innovation and improvement. Croydon faces many challenges, both regarding quality and our finances. We must ensure we tackle each without having detrimental effect on the other. Our systems will need to be joined to ensure this. Equally with regard to quality and performance we must be clear about our priorities for improvement to ensure our patients receive safe, quality services. To both these ends we are reviewing with external support our current position and our arrangements currently in place to deliver improvement to develop a Performance and Quality Improvement Framework by the end of April 2013. From this work, the priorities for improvement will be identified.

1 Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, 6th March, 2013


2. Vision

Through working with our Member Practices and our Public, Patients and Providers and through the development of the Health and Wellbeing Strategy, Croydon Clinical Commissioning Group has jointly developed the following Vision, Organisational Objectives, Outcomes and Priorities.

Figure 1


3. Plan on a Page Overview

Population: Ethnically diverse population ● 6 Networks ● 61 GP Practices ● 1 Integrated Acute / Community ● 1 Local Authority ● 1 Mental Health Trust

● 2013/14: £19.9m deficit and £14m QIPP / CCG allocation 423.8 million (0.9 million) *£0.9m cancer fund not included 1. 2. 3. 4. Health and Wellbeing Strategic Priorities

Increased Healthy Life Expectancy Reduced difference in life expectancy between communities

Supporting children and young people to achieve their potential

Increased Independence A positive experience of care

Croydon CCG Organisational Objectives

Achieve financial stability in 3 years

Commission integrated safe, high quality services

Have collaborative relationships

Develop as a mature organisation

Strategic Principles of our Vision

Ensuring people are seen in the appropriate setting

Active case management within each care setting

Efficiency within each care setting

Croydon High Level Strategic Priorities 2013 / 14 Prevention, Self-

Care & Shared Decision Making

Long Term Conditions and Vulnerable Adults / Older People

Children and Young People

Planned Care

Primary and Community Care

Urgent Care Medicines Optimisation

Tran

sfor

mat

iona

l Cha

nge P

rogr

amm

es Development of

prevention, self-care and share decision making strategy People taking personal responsibility for healthy living through social marketing campaigns Access to early detection and screening services Access to prevention services e.g. smoking cessation, reducing harm from alcohol

Integrated working of GP’s , Pharmacists, Nurses, Therapists around the population needs within 6 Geographical Networks Single Point of Access (Health and Social Care) with redirections to appropriate services. Early intervention and planned health and social care case management for people with a long term condition and / or known to be vulnerable and identified through risk stratification and / or caseload intelligence.

Rapid Response for people with a known long term condition and / or known to be vulnerable (Home and in Care Homes) Development of Long Term Condition Pathways Diabetes / Respiratory / Cardiology / Dementia / Cancer

Integrated working of Health and Social Care around the population needs within our 6 geographical networks. Alignment with Early Intervention Programmes and Children’s Centres Pooled Budgets with Social Care

Full implementation of Croydon’s Referral Support Service Extension of patient navigation scheme Development of community pre-operative assessment and direct listing for surgery Development of community based initiation of warfarin for patients with AF

Development of Primary and Community strategy with all stakeholders to achieve alignment and / or integrated care to support the transformation programme. Includes Equitable Opening Hours Same Day appointment Slots

Evaluate Urgent Care Access Points Introduction of 111 Directory of Services and Single Point of Access Dispersal Routes and Protocols for LAS and OOH

Prescribing Efficiencies Extension of Medicines Review

Ambi

tions

Decreasing gap in life expectancy

To prevent exacerbation of ill health To create choice of service delivery in Primary and Community To reduce overall the numbers or people needing an Emergency Admission overall by 10% To reduce overall the numbers of people attending Emergency Department by 5%

Reducing effects of mental ill health Improve efficiencies and value for money Reducing % of still born and reduce % obesity Reducing service duplication and maximising efficiencies

4% (3,458) reduction in First Outpatient 8% (12,489) reduction in Follow Up Outpatient

Enabler to achieving transformation programme

Identify service change requirements Appropriate use of all services

Reducing Medicines Wastage Optimising Medicines Effectiveness

Patient Quality and Safety – Quality and Governance Patient Safety Incident Reporting / Reducing the incidence of avoidable harm / Improving the patient experience across the provider landscape

Performance NHS Commissioning Board Priority Mandates Domain 1 Reducing potential years of life lost from amenable mortality

Domain 2 & 3 Reducing avoidable emergency admissions

Domain 4 Improving patient experience of hospital services -A&E

Domain 5 Preventing Healthcare associated infections

3 Local Quality Premiums Improvement in meeting Diabetes 9 Care Processes

Uptake of MDT Case Managements

Reduction in emergency admission from Nursing Homes

Figure 2


Figure 3 shows our population at a glance and the different service levels to meet the health needs of our population from self-management through to hospital care. Over the 4 year period and through our transformation programme we expect to see a reduction in activity in hospital services; elective and non-elective (as shown in Figure 4).

Figure 3


Figure 4 shows the activity shifts expected from transformation

Figure 4


4. Programme 1 - Preventing Ill Health

Figure 5


5. Programme 2 - Long Term Conditions (Overall)

Figure 6


6. Programme 3 - Older People

Figure 7


7. Programme 4 - Adult Services

Figure 8


8. Programme 5 - Children and Young People

Figure 9


9. Programme 6 - Planned Care

Figure 10


11. Programme 6 - Primary and Community

Figure 11


12. Programme 7 - Urgent Care

Figure 12


13. Programme 8 - Medicines Management

Figure 13


14. Financial

2% Headroom, £8.2m

2% Surplus (2014/15 Target),

£8.2m

Allocaton Errors, £5.7m

Inherited Position, £15.2m

2013/14 Pressures, £4.8m

Analysis of 2013/14 Financial Challenge (£42m) Before QIPP

• Croydon CCG has inherited a significant financial challenge (£33m) from its predecessor organisation, Croydon PCT. This is in addition to the expected financial challenge (£9m) that all CCGs face going forward (in-year pressures and movement from 1% - 2% surplus in 2014/15). The position is exacerbated by historical underfunding of the Croydon health economy and lack of pace of change in addressing this to meet the current needs of the local population.

• Croydon CCG is currently proposing a £19.9m deficit plan for 2013/14, in line with its ambition and corporate objective to achieve financial targets over a 3 year period. This is achieved from the recurrent baseline gap of £42m, through exemption from the surplus requirement and delivery of £14m QIPP schemes across planned care, emergency care, continuing care and prescribing.


Acute, £246.0m, 56%

Other Programme, £0.4m, 0%

Contingency (NCB), £10.2m,

2%

Running Costs, £9.1m, 2%

Out of Hospital, £51.6m, 12%

Activity Reserve (Local), £11.6m,

3%

Prescribing and Primary Care, £50.0m, 12%

Mental Health,

£58.4m, 13%

Draft 2013/14 Expenditure (£437.3m) by Service Area

• Croydon CCG is proposing to commit expenditure in 2013/14 of £437.3m across the following care groups

• Croydon CCG has identified a number of risk to the proposed

financial plan, including growth in acute activity/costs beyond planning assumptions (3.7%), delivery of QIPP, contractual restrictions on acute KPIs, further corrections to allocations (e.g. specialist commissioning), and implications of 13/14 financial regime (maternity and diagnostic pricing)

• To mitigate the risks, the Croydon CCG has following NCB

guidance and set aside mandatory 0.5% contingency and 2% headroom, evidence based reserves for activity growth, and is proposing to enter into a financial risk sharing agreement with South West London CCGs, subject to all parties agreeing.

• In recognition of the inherited financial challenges, and as

required in the NHS Croydon CCG Directions 2013, the CCG has engaged PwC to provide a baseline review of the position and to support the development of QIPP schemes to underpin a 3 year clear and credible plan. This work will be completed and report on 30 April 2013.


15. Commissioning Plan on a Page

Figure 14

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