Patients’ Congress 6 February 2014 1.30pm-4pm Catterick Leisure Centre

1. Patients’ Congress6 February 20141.30pm-4pmCatterick Leisure Centre

2. Welcome Henry Cronin Lay Chairman Jane Ritchie HEN representative for Richmondshire

3. CCG news update Dr Mark HodgsonGP and CCG Governing Body Member

4. Ambulance times • GP Urgent Pathway – GP Urgent patients to travel on non-emergency ambulance transport allowing more A&E vehicles to respond to 999 calls • GP “In Hours” Triage Pathway – Ambulance staff send patients to the GP practice from the scene, or the GP visits them at home as an alternative to sending to A&E, retaining ambulances in the local community • Paramedic Practitioners working in GP practices in Sleights/Sandsend and Harewood – they “see and treat” in the community and respond to emergency calls in the local area • New Ambulance ‘Stand By’ points are now working at locations in Catterick (GP Practice) and Richmond (Co-Op) with an additional point in Bedale (Health Centre) due to “go live” early in 2014 • Additional Static Defibrillator Points (e.g. Northallerton Civic Centre and Osmotherley) and a new C-Pad scheme (community defibrillator) scheme in Borrowby

5. Ambulance Response Times across the area Month Red 1 Response Red 1 Response Month YTD *April 55.2% 55.2% *May 50.0% 52.5% *June 47.8% 51.2% July 69.0% 57.1% August 79.7% 65.5% September 79.0% 68.7% October 84.0% 71.0% November 62.9% 70.2% * Pre new initiatives

6. Out of Hospital Contract

7. Plans for the future… • Introduce more community initiatives to improve ambulance response times • More investment in nurses and therapists in the community to keep care closer to home and achieve maximum potential • Closer working with the Voluntary sector and community support groups to reduce social isolation and give greater support to carers • Better identification of patients at high risk of repeat hospital admissions and targeting the right care • Speed up access to intensive support towards the end of life • Based on what you tell us, to redevelop services in the community to deliver care closer to home • New treatments and services in the community, e.g. IV antibiotics

8. Financial update Alison Levin Head of Finance, Governance & Support Services

9. Review of 2013/14 – Good News ! • CCG’s overall delegated budget for commissioning services in 2013/14 is £169m. • Repaid our share of the PCT brought forward deficit £1.8m • We are still planning to deliver a 0.45% surplus (£752k) at the 31st March 2014 (Note: below the 1% identified in the national planning guidance). • This has given us a platform to have a balanced financial position to start 2014/15 with.

10. Where do we spend the money?

11. Delivering our Financial Strategy What we have to do in 2014/15: Planning Guidance states: Buy safe and sustainable services Plan for Non Recurrent Spend 1.5% - £2.6m Create a Transformation Fund 1% - £1.7m Plan for a contingency of 0.5% - £0.9m End the year with a 1% surplus - £1.7m In 2015/16 Create the Better Care Fund £5.2m

12. How much money have we got? 2013/14 2014/15 2015/16 £’000 £’000 £’000 CCG Programme Budget 165,573 169,381 173,028 Uplift for growth 3,808 3,647 2,941 Amount available to spend 169,381 173,028 175,969 Growth 2.30% 2.15% 1.70%

13. How do we agree the budgets?

14. What does the bottom line look like?

15. Risks to the financial plan • Demographic growth increases more than expected • Providers cannot meet their efficiency targets • QIPP programme is not fully delivered • Unexpected pressures emerge throughout the year • Investing the Non Recurrent Spend or Transformation Fund does not reduce the number of people being admitted to hospital as an emergency, which we need to do to help us create the Better Care Fund in 2015/16

16. Delivering our Financial Strategy • With the application of growth the CCG’s overall delegated budget for commissioning services in 2014/15 is £173m. • This equates to £1,211 per head of population to spend on commissioning services for its population. • Deliver the QIPP • Implement the service change needed to help create the Better Care Fund in 2015/16. • The CCG is planning to deliver its full 1.0% surplus (£1.7m) at the 31st March 2015.

17. Questions

18. CCG planning 2014/15 • National and local context • A Call to Action • Fit 4 the Future • Our priorities • Group discussion

19. National Context • Changes to the NHS • Need for better quality and transparency • Integrated health and social care • Improve outcomes • Prioritise prevention and early intervention • Providing more personalised care The NHS is facing large and complex changes in the way it delivers care. This means that the way we provide care must be radically transformed if we are to meet the challenge of caring for our patients, particularly older people. Recent reforms to the health and care system and the Health and Social Care Act of 2012 focus on a drive towards integration to ensure the kind of care and support that best meets patients' needs. A range of current national policies have given renewed emphasis on the promotion of wellbeing, the prevention of ill health and early intervention. A personal health budgets policy is being implemented across the NHS, which is an amount of money to support a patient with identified healthcare and wellbeing needs and is planned and agreed between the patient and their local NHS/social care team. • Vulnerable and older people require homes and opportunities that meet their particular needs, foster self determination and support a good quality of life.

20. Our Local Context • Ageing population • Resources are under-utilised and acute care focussed • Community hospital estate needs investment • GPs want greater input in local care and services available 7 days a week • Innovation in healthcare e.g. telemedicine • Health economy is changing • Beds, clinic rooms, diagnostic rooms are not used to their full. The current hospital provision is out-dated and does not meet current healthcare standards. Much of the footprint is under-utilised and the design of the current building does not lend itself to developing integrated workforce. • Technology is under-utilised. • The Existing Whitby Hospital site is freehold and currently under York Teaching Hospital NHS FT control. Occupies a 4.25 acres (1.72HA) and is developed with 10,800 square metres of buildings, largely built around 1979, with 128 car parking spaces and green space. • From previous studies, it is considered the existing facilities are unlikely to have a future economic use for health purposes in current condition and therefore redevelopment of the site is recommended with H&SC. • The current spend for Whitby Community Services contract has not changed. The contract has made a 4% annual efficiency in line with national requirements and their has been no increase in overheads or staff costs. • Additional investment has come from health and social care monies (reablement). Trust overheads have increased significantly and we are working with the trust to benchmark and understand cost pressures in more detail. • Mobile diagnostics needs to be considered in bringing more services closer to patients homes. • The future challenge will be how we transfer specialist knowledge to the community and this may not necessarily require traditional outpatients appointments. We will look to use telemedicine, telehealth and telecare and make the most of the electronic health record integration programme to provide advice and guidance remotely. • Planned outcomes as part of the Fit 4 future transforming community services programme is to deliver an appropriate distribution of care moving out of high cost acute trusts into more low cost settings and provide as much care in a persons own home as is clinically safe. • Community services and community hospitals will therefore need investment and redesign to meet this challenge.

21. National impact – A Call to Action • Every day the NHS saves lives and helpspeople stay well. • However, the UK still lags behind internationallyin some important areas, such as cancer survival rates. • There is still too much unwarranted variation in care across the country, increasing health inequalities. • But improving the current system will not be enough. Future trends threaten the sustainability of our health and care system: an ageing population, an epidemic of long-term conditions, lifestyle risk factors in the young and greater public expectations. • Combined with rising costs and constrained financial resources, these trends pose the greatest challenge in the NHS’s 65-year history.

22. National impact – A Call to Action • The NHS is on track to find £20 billion of efficiency savings by 2015. • But this alone is not enough to meet the challenges ahead. Without bold and transformative change to how services are delivered, a high quality yet free at the point of use health service will not be available to future generations. • Not only will the NHS become financially unsustainable, the safety and quality of patient care will decline. • Fit 4 the Future is a major piece of work that we are carrying out locally to transform services and ensure local health services will meet current and future needs.

23. What is Fit 4 the Future? A large-scale initiative to seek the views of local people and organisations about how the NHS and its partners can start to prepare for an increase in demand for services arising from an ageing population. 5 public pre-engagement events attended by +270 people in spring/summer last year. Further engagement already this year in Whitby, lots to come in Richmondshire and Hambleton in the coming months. Please look out for this information. We were particularly interested in views on the following four key areas: • Staying healthy • Mental health/dementia • Long term conditions • End of life care

24. What we were told Keep people in their own homes for as long as possible Provide better patient transport Provide more information for patients and their carers Provide more support for carers Facilitate social interaction A role for technology

25. Our Priorities 1. Transforming the community system – to create effective, integrated community services that enable patients to be cared for as close to home as possible.2. Mental health and dementia care – to meet the challenge of providing the best possible care for the rising numbers of patients with dementia.3. Clinically appropriate planned care – to ensure care pathways and referrals across all specialties are as clinically efficient and effective as possible.

26. Our Priorities 4. Children’s health – to ensure that urgent care services are safe and sustainable and we build improved services in the community for vulnerable children and those with complex needs.5. Patients with long term conditions – to improve patient’s ability to self-care and achieve their own goals, supported by earlier diagnosis and better identification of patients who are at risk.6. Prevention of ill-health – to work with the North Yorkshire Health and Wellbeing Board to take forward plans and projects to improve the health of the local population. 7. Productivity in primary care

27. What we have done so far • Reduced the need for people to go into hospital by extending the range of services available at night and weekends in Hambleton and Richmondshire • Brought professionals from different organisations to work more closely together to provide better coordinated care • Reduced the amount of time people need to spend in hospital • Introduced advanced technology that people can use confidently in their own home to manage their illness • Funded more Community Nurses • Funded additional consultant cover in Friarage A&E to cover the winter period • Diagnose more illnesses so serious problems can be prevented

28. Planning for 2014/15 Over the past three years, North Yorkshire County Council and the PCT/CCGs have been working together to jointly agree and deliver proposals using Health and Social Care (H&SC) monies for integrated solutions, based on reablement, that will help to keep people out of hospital and long term social care.2014/15 is the final year of spend using these monies. In October 2013, the CCG's Governing Body held a workshop to look at emerging proposals. Based on these proposals the CCG management team has developed formal proposals for 18 schemes.

29. Group discussion Your views on our priorities. Each member will have a print out of the CCG’s priorities for the coming year. On your tables, please consider: • Choose three or four from the list that you think are the most urgent priorities. Why do you think this? Please discuss in your group. • Do you think anything is missing? What other issues matter to you? Again, please discuss in your group.

30. Feedback and next steps

31. Any other business • Q&A session • Next event • Please remember to fill in your evaluation form Thank you for attending