NHS Oldham CCG Strategic Clinical Commissioning Plan 2014-2019

1. NHS Oldham CCG Strategic Clinical Commissioning Plan2014-2019

2. Contents

3. Contents

4. 1.Executive Summary As a single CCG supported by 8 practice-based clusters, this plan sets out our intention to commission high quality services in an innovative, affordable and sustainable health system, whilst at the same time delivering improvements in health to the people of Oldham. The CCG has a strong local focus with clinicians and partnerships working together to provide and secure services to meet the needs of patients based on day to day experience, supported by evidence and intelligence. The clinical leadership of the CCG will make a real difference to the health of the population and their experience of healthcare. It will clearly place patients at the heart of all our discussions with providers of healthcare ,and our commissioning decisions. This plan clearly sets out our vision, and our outcome ambitions, linked to the triple aim objectives, recognising the challenge of our current environment from a financial perspective, in the context of rising demand. Transformational change (the Quality, Innovation, Productivity and Prevention agenda) is required so that healthcare in Oldham is affordable, whilst providing excellent standards of service that the population rightfully expect. Clinical commissioning will enable Doctors, Nurses and other health and social care professionals in primary , community and secondary care, to become much more involved in planning improvements in services, than has previously been the case. The work described in this plan will be led by a senior team of clinicians, to ensure we achieve a sustainable health care system by working closely with our health and social care partners. The material presented is a result of extensive listening and engaging with clinicians, providers, patients and the public. We will ensure that views of patients and the public are considered in all our commissioning decisions, and that meaningful public and patient engagement is embedded in the way we work. Over recent months, the CCG has actively sought the views of patients, the public and organisations in Oldham concerning our commissioning plans and intentions for the next 5 years. The CCG will work collaboratively with Oldham Metropolitan Borough Council, Pennine Acute Hospitals NHS Trust, Pennine Care Trust, our smaller providers, and other CCG’s across the North East Sector/Greater Manchester footprint to improve care pathways and further develop integrated services. The Oldham Health and Wellbeing Board is a key forum for the CCG to work together with local commissioners from public health and social care, elected representatives and representatives from Healthwatch, to improve the outcomes of our local community and to reduce inequalities.

5. Within this plan, we set out : • Our vision, approach and outcomes we are aiming to achieve • Our clinical priorities for the CCG which have ben determined in conjunction with our public health team based on benchmarking data, the evidence base, patient feedback, and performance against key national constitution indicators • Our approach to strategic transformation with a particular focus on Wider Primary Care At Scale, Integrated Care, the Better Care Fund and Healthier Together • Our approach to the enabling factors • Our approach to maintaining the essentials • Our approach to delivery The main thrust of this strategy is based around the Primary Care Medical Home (PCMH) as part of the Care Vortex model (2006). We believe that in order to deliver year-on-year improvements in health inequalities we need to quicken the pace of change and the flow of investment towards Wider Primary Care At Scale. We wish to see more differentiation in traditional models of care and build on solid platforms of out of hospital services. Consistent with the Healthier Together Programme, the CCG believes that a strong, viable and coherent Primary Care sector will complement an equally strong, viable and sustainable acute and tertiary sector This strategy has been pulled together to respond to the challenging and changing climate impacting on Health, and more general Public Services. The style and presentation of the material contained is primarily for a professional and organisational leadership audience, whether they be in the CCG, its member practices (organisations in their own right), supply partners, NHS England and colleagues in Local Authorities. A separate and complementary document is being prepared for public engagement. It is assumed that leaders in organisations are familiar with strategic, economic and planning concepts and this the material presented has deliberately not been diluted.

6. 2. Our vision, approach and outcomes

7. Vision

8. Our CCG Vision The CCG’s vision is to improve health and healthcare for the people of Oldham, by commissioning the highest quality healthcare in services near to the patient, in an integrated fashion and at the best value for money Our Overarching Aim To become an authorised, Accountable Care Organisation that is an alliance of GP practices which involves the whole multidisciplinary practice team. All members will share risk and assume accountability for the resources used in enabling high quality care for the people of Oldham. To achieve our triple aim objectives of: Improving the health of the people of Oldham Improving the care they receive and their experience of it Delivering best value for money by using our resources effectively

9. Our vision The CCG’s vision is to improve health and healthcare for the people of Oldham, by commissioning the highest quality healthcare in services near to the patient, in an integrated fashion and at the best value for money The development for our vision for health and social care in Oldham is centred on the concept of the ‘Oldham Family’ (see appendix 1) .Our vision for the Oldham Family is simple. We will change the balance of health and social care in Oldham so that patients receive the right care at the right time. Care will be closer to home, where that is the right place for them, and will be provided by the most appropriate person, whether that is a nurse, carer or friend. People in Oldham will be independent, resilient and self-caring so fewer people reach crisis point. For those that need it, we will develop an integrated health and care system that enables people to proactively manage their own care with the support of their family, community and the right professionals at the right time in a properly joined up system. In a crisis, people in Oldham will know exactly what to do, who to contact, receive a rapid response and have their needs met in a completely organised, systematic and careful way. This economy vision is underpinned by three key considerations; • The ultimate key success factor will be for our people (our Oldham family) to tell us that they have seen a positive difference to the way in which contributors to their care are more organised, systematic and appreciative of their individual care requirements. This objective is embedded within our individual corporate strategies and corporate objectives. We have already started to invest in some core platforms for integration such as the re-procurement of community services, Clinical Director Programmes, a number of public health interventions such as our approach to affordable warmth and fuel poverty, and critically, the development of cluster based health and social care integration teams. • Prevention and intervention also remains a key priority: and ensuring that an improved population health alongside a higher quality, more innovative and more productive health care system is delivered. This is an important principle to retain as the drive for greater control over resources should not compromise the vision for optimal care systems, including both the need to enable people to retain health status and the need to prevent avoidable exposure to interventions that add little or no health benefit. This will be aligned to the Public Health Investment Plan, to build a solid platform for intervention and prevention.

10. Our local GPs will be at the centre of this system and will lead the changes necessary to deliver the future aspirations of the public. This new design will come from a shift of commissioning philosophy and practice from one which is geared around aggregated population-based services to one which is more individual, with personalised healthcare services as the norm. This vision is aligned with, and connected to a number of key CCG strategies and approaches that drive the ambitions of the local area; The Oldham Care Vortex places primary care at the centre of patient care and describes a way of transforming our thinking to move away from institutional care, with a move towards a managed system of service transformation. This places greater emphasis (including investment) on managing an increasing caseload within communities, closer to the patient. The model recognises international research and world-class managed care modelling and has guided the thinking, service modelling and service investment profiling in Oldham. Our 5 year plan on a page describes our strategic transformation programme, the outcomes we are aiming to achieve, and the enablers that we will put in place to support the delivery of our plan. It also describes the process through which we will hold ourselves to account

12. Our principles

13. The Oldham Care Vortex Model (2013) The Current & Emerging Landscape for Service Integration Opportunities for Integrated Care Threats for Integrated Care Resources & Investments Emergent Integrated Health & Social Partnership Services Core Primary Care (GP Practice Contracts) Primary Urgent Care (OOH) Managed Care Core Community Services (those transferred from PCT) Re-Commissioned Quality Improvement & Acute Services (EQALS & CATS) Any Qualified Provider Acute and Tertiary Segment Referral Gateway Subject to Significant Re-Shaping Coordinated Care Healthier Together PAHT Programme GM CCG Association

14. Approach

15. About us The NHS Oldham Clinical Commissioning Group operates with a clear focus on quality as its driving principle, by ensuring that clinical outcomes and quality are integral to all commissioning plans and decisions. NHS Oldham Clinical Commissioning Group has evolved from the previous Commissioning for Oldham Practice Based Commissioning Consortia, and is broadly coterminous with Oldham Metropolitan Borough Council with a resident population of 220,000. The CCG covers an area of 35,174 acres and serves a registered population of 240,000. There are 46 Constituent GP Practices in the Clinical Commissioning Group, one of which is located in Tameside. The 46 practices are subdivided into 8 clusters, which support the CCG and practices in achieving their objectives, at a more local level. Essential to the effectiveness of the CCG is clinical leadership, engagement and the individual professional accountability of all members of the Group. It is through these that transformational change will be enabled and a clear focus on continuous quality improvement in primary care and within all commissioned services will be established. Signing of the membership agreement is open to all GPs on the performer’s list in Oldham. Members will become part of an accountable care organisation responsible for commissioning services for all people living within the Oldham Council area. They will also be considered to have signed up to the strategy, consulted on from March – May 2011, which sets out the CCG’s ambitious aims and the healthcare system it wants to develop to deliver. Membership of the CCG will offer participating practices the opportunity to pool their budgets to share risks but also to influence, and where appropriate, participate in, new service delivery. The CCG wishes to foster innovation at a practice, or small group of practices level, and therefore reinvestment plans, where innovations are supported by robust business cases, will recognise these developments. The Dragons Den which ran in 2013 was a good example of this (see appendix 1). To enable NHS Oldham CCG to deliver its vision of becoming an Accountable Care Organisation, supported by its members, a signed membership agreement is now in place with all participating GPs/practices. To ensure that CCG can achieve its vision, on behalf of its members, to become a truly accountable organisation delivering the best possible clinical outcomes for the population of Oldham, an assurance framework has been developed to measure compliance with the membership agreement. This approach will also support practices in providing evidence to support QOF indicator delivery, appraisal and revalidation and practice/CQC accreditation. The membership agreement has been jointly written by the CCG, LMC and a group of Oldham GPs who, at the AGM, volunteered to develop the Constitution and the assurance framework which is an integral part of it.

16. The CCG commissions the majority of its acute services from Pennine Acute Hospitals Trust. The Trust is based across 4 sites, Fairfield, Oldham, North Manchester & Rochdale. The configuration has been reviewed by the Healthy Futures Programme, however is currently under review again, linked to the Trusts financial position, and the broader Greater Manchester Healthier Together strategy. • Mental health services are primarily provided by Pennine Care Foundation Trust, who also from the 1st April 2014, following the reprocurement of our community services, will also manage a large proportion of our community Services. The CCG has a track record of stimulating the market, and has a range of independent sector providers working within its footprint, to provide a range of different services. • The CCG has accepted the role to establish and build relationships with new and different organisations and consider the full range of perspectives, including those of patients and the public. A new more strategic, yet business focussed relationship with Oldham Metropolitan Borough Council (OMBC) is developing, building on the strengths within the Borough and the significant capabilities and altruism that exists between professionals from both social and health environments. There is a ‘One Borough’ movement building across Oldham and COG wish to see this develop further with the re-engineering of the Health and Wellbeing Board and the Joint Commissioning functions. The introduction of the Better Care Fund will accelerate this pace of change. • Other collaborative arrangements continue to develop, through the North East Sector Commissioning Board for the management of common providers (PAHT and PCFT) and the Association of Greater Manchester Governing Group linked to the Healthier Together Strategy. • The next three years are likely to be challenging ones for the population of Oldham as significant changes are made in the ways in which the public sector provides, and commissions healthcare services. It is likely that the population will remain with high levels of healthcare need and that deprivation levels will remain broadly similar. It is to be expected that many existing trends, including increases in life expectancy and the growth of the population of very elderly people, may continue. • The CCG are now fully influencing the commissioning process by understanding spend, where it is spent, and for what outcome. The CCG feel that the way to approach clinical commissioning moving forwards is clinical leadership applied to programme budget areas, to ensure clinical commissioning is established in a way that delivers enhanced services, experience and cost control. • In its first year of operation as a CCG, cost control has been demonstrated through the healthy financial position forecast, and the improving outcomes for the population, particularly in relation to elective and urgent care.

17. Our core values Our core values have been developed from those of the NHS Constitution and reflect the internal culture we need to underpin our overarching aim and objectives • Commitment to Quality of Care – we strive to commission high quality care for health and well being that is individualised, appropriate, safe and effective. We assume accountability for the cost and the quality of the care that we commission • Respect and Dignity – we value diversity and recognise each person as an individual. We respect each individual’s aspirations and commitments and seek to understand their priorities and needs. We understand the importance of what others have to say and the importance of an honest dialogue about what we are and are not able to do. • Improving Lives – we work hard to improve the health of our population and their experiences of health care. We value excellence, professionalism, innovation and a commitment to service improvement and doing things better. • Listening and Engaging with Others – we find the time to listen and talk where it is needed and make every effort to understand the needs and perspectives of others. We welcome feedback, learn from our mistakes and build on our successes. • Working Together – we put our patients first and at the heart of everything we do. We will work across localities, organisations and sectors to best understand and meet their needs. • Everyone Counts – we will work to ensure that we use our resources to best meet the needs of the whole community. We accept that some need more help than others and that our resources are best used in addressing the highest levels of need. We recognise that every single community and staff member has a part to play in making our communities healthier. • Clinically Led – we are committed to the model of clinical leadership and engagement described in our constitution. We will continue to develop opportunities for clinicians to be further involved within CCG structures and decision making forums. • Being Responsible – we accept that we must work within the resources available and put these to best use for the people of Oldham. We will always strive to reduce costs and/or to improve productivity to get the best value we can without compromising care quality. We will recognise excellence but will also hold our providers to account for the care we commission from them. • Employer of Choice – although we will not directly employ many staff, we will seek to be a responsible employer. We will look after the health, safety and welfare of our staff whilst they are at work and seek to offer them learning and development to further improve clinical commissioning.

18. The development journey • This strategic plan, is a key component of the Oldham CCG golden thread. It summarises the CCG’s strategic direction for the next 5 years, and describes the specific actions the CCG will take during 2014 – 2019, to make progress towards delivering its objectives and responding to the ‘Call to Action’. This plan will be reviewed and updated annually. • The development of this integrated commissioning plan has been taken account of a number of factors and key documents including: • CCG strategy to become an Accountable Care Organisation • CCG Integrated Care Strategy • CCG Wider Primary Care At Scale Strategy • Health and Wellbeing Strategy • CCG Business Plan • CCG Constitution and Membership Agreement • CCG Organisational Development plan • CCG Equality and Diversity strategy • CCG Quality Strategy • CCG Long Term Condition Strategy • CCG System Reform Strategy • CCG innovation strategy • CCG Communication and Engagement strategy • CCG System and Market Management Strategy • CCG Elective Care Strategy • CCG Managed Care Model • JSNA • CCG Clinical Commissioning plan 2012-2015 • Oldham CCG Healthier together submission July 2013 • Healthier Together standards of care • Greater Manchester Primary Care strategy

19. The CCG will learn from and improve upon previous experience of planning, commissioning and delivery. The key opportunity lies within Primary Care Clinicians as micro and macro commissioner's. Micro in day to day prescribing, referrals and so forth, and macro in terms of population health. By bringing together these two roles there is opportunity to accelerate action, improvements and learning • This plan will be refreshed on annual basis in line with cycle outlined on the following page. The value and assurance process map illustrates where this document fits within the wider organisational context of the CCG, and the intention of this document as a core planning document. • Contributions to this strategy have been received from: •  The CCG membership • CCG Clinical Directors working in conjunction with partners (including providers) • CCG Governing Body members and supporting CCG internal infrastructure (including the CSU) • Patients and the public • Broader partnership forums e.g. Health and Wellbeing Board, NES Commissioning Board and the Integrated Commissioning Partnership • Healthier Together Team • Greater Manchester Area Team

20. Development Journey of the Strategic Plan Internal drivers Health & Wellbeing Board Strategy JSNA 2012 Annual Public health report Commissioning for Value Atlas of variation/ programme budget data Clinical Director Plans on a Page Patient experience/ KPI data Cluster ideas/ evidence from Dragon’s Den Local CCG strategy • Engagement with • CCG Membership • Health & Wellbeing Board • Collaborative Commissioning Partners • Public • Patients • Providers 5 year CCG Strategic Plan External drivers Healthier Together Greater Manchester Primary Care Strategy 2 year delivery plan and prioritisation OMBC Integrated Commissioning Plan Provider Transformation Plans Annual contract negotiations Specialist Commissioning Plans

21. Outcomes

22. Our outcomes Since its beginnings as an aspirant GP Commissioning Consortium, and before that a PBC Consortium, the CCG has had a clear view on its intentions for the outcomes of clinical change programmes, in line with vision of the Oldham Care Vortex. This on-going work has created a body of knowledge, which has shaped our 5 year plan, taking into account our current landscape from the perspectives of population health, quality and economics, in line with our triple aim objectives. Our 2-year plans have been clearly defined over the past 6 months, through the leadership of our Clinical Directors to deliver improvements in our triple aim objectives. Since the publication of the national outcome ambitions, these have been aligned to our triple aim objectives, as can be seen through our 5 year plan on a page. We see nothing different published in ‘Everyone Counts’ than was our initial ambition as a CCG, and the journey we are already on to achieve our strategic vision. The CCG has been chosen as the unit of planning, though we will work collectively with our partners in the North East Sector and across Greater Manchester, where it makes sense to do so. Levels of ambition have been consulted on with the clinical council, based on interventions currently planned, and benchmarking data provided by the public health team. We have designed our interventions and level of ambition based upon: • Current performance • Benchmarking data • Content of clinical programme plans • Commissioning for value packs • Public health outcomes framework • Local health profiles • PHE/NNSE a call to action: commissioning for prevention • JSNA • Areas from 2012 CMO report • New national strategies expected in 2014 The plans for improving outcomes have been aligned to findings from the above data sources, and the intentions of the Oldham Health and Wellbeing Board strategy. The Health and Wellbeing Board have been consulted on with regard to our clinical commissioning priorities and the level of ambition planned in relation to outcomes. The ambitions for national outcomes and local measures for the CCG strategic plan and the Better Care Fund, were the subject of a workshop with the HWBB on the 7th February 2014.

23. Improving health outcomes in alignment with the seven ambitions • Our CCG strategic plan has been based, since its inception, on delivery of the triple aim objectives, with a focus delivery on the NHS outcomes framework and constitutional rights. This refresh of our 5 year plan describes how we will address through specific interventions, the specific ambitions of : • Securing additional years of life • Improving health related quality for people with long term conditions • Reducing amount of avoidable time spent in hospitals through better integrated care in the community • Increase proportion of older people living independently at home • Increase numbers of people having a positive experience of care within and external to hospitals (GP & Community) • Progress to eliminating deaths in hospitals caused by problems in care Reducing health inequalities • Health inequalities in Oldham still remain. The CCG is working with partners (including public health) to take action on the wider determinants of health, and take action with providers (including GP’s) to ensure inequalities are reduced. It is an expectation of Clinical Directors, that as they are developing their programme, that they plan service models that meet the needs of the diverse population and do not just adopt a one size fits all model. There is evidence of this approach already happening in relation to vascular disease, respiratory disease, diabetes and cancer screening. • The new community service teams currently being designed, will wrap around the Primary Care Medical Home. These teams will be configured to address cluster specific needs based on the JSNA. • The CCG and OMBC have has committed to producing a delivery plan to reduce health inequalities by the summer, building upon the work which is already taking place, and getting closer alignment between the clusters, district partnerships and the voluntary sector.

24. Parity of esteem • Parity of esteem is defined as making sure that we are just as focused on improving mental as physical health and that patients with mental health problems don’t suffer inequalities, either because of the mental health problem itself or because they then don’t get the best care for their physical health problems. Currently physical and mental health treatments tend to be viewed, and delivered, as separate health services. This means that people with poor mental health are more likely to have poor physical health that goes untreated, or treated too late and vice versa. • Achieving parity of esteem is not just the role of the health and care services: it has implications for everyone in the local economy, such as local government, police, employers, and schools. In Oldham, we will consider how we can leverage the full range of resources to fund prevention priorities. • The Parity of Esteem programme has identified three areas as initial priorities for urgent focus. These are IAPT, dementia, and areas within the Mental Health Capacity Act. This has been built into our clinical change programme - we are currently consulting with AQUA with regard to the potential of some tailored support Delivering the essentials • Essential elements remain: Quality, Access, Innovation, Value For Money. Our approach to these fundamentals is described in detail within the strategic plan. • We recognise the value of minimum standards, and patients constitutional rights, and will work with our providers through contracts and partnerships to ensure that the CCG delivers the highest standards for our patients. However we also recognise that quality goes beyond the minimum standards, and we will work through our Clinical Directors, to improve patient experience, health outcomes and quality of life of Oldham's diverse population, paying particular attention to under-served and marginalised groups. • We will also pay specific attention to patient safety, continuing to work with providers to reduce health acquired infections, to ensure serious incidents are investigated and learnt from, and ensuring our safeguarding systems protect children and vulnerable adults. Partnership working to support the improvement in the wellbeing of the population • The citizens definition of health, is not always as we imagine it in healthcare. Health is not just about the absence of disease, but about people being able to do what they want to in their lives with joy and fulfilment. • Asking people their views on health, thoughts include: - being able to do what they want to do in the absence of pain - combination of physical , psychological and environmental factors - growing old without illness -being able to go to  events and participate in social activities  they want to - combination of mental and physical wellbeing ( not being a perfect specimen but being able to cope) - having a positive mental attitude • The stresses of life today brought about by factors such as relationships, the economic climate and the different pressures which technological advances have created, means we need to have a focus on personal resilience, to ensure the population can maintain a healthy life.  There are clear links between a positive mental attitude and how people perceive their health. As part of 'Healthy Oldham', we are looking to develop a social marketing campaign support this ambition at cluster / district partnership level, working in conjunction with OMBC. The CCG  feel this is essential to reduce the burden on health service resources in the future .

30. From the indicators below, achieving an increase from 37.5% to 39% of patients dying in their preferred place of death was chosen by the clinical council, though all of the indicators below will be given a focus as part of the Clinical Directors clinical change programmes. • Patients dying in preferred place - Oldham 37.5 %. National 44.1% -39% trajectory • Dementia-prescribed anti-psychotic medication – Oldham 13%. National 13% • Total health gain assessed by Hip replacement patients – Oldham 0.440. National 0.439 • Stroke patients discharged with a joint health and social care plan- No measure yet • People with diabetes diagnosed less than one year referred to structured education – indicator in development • Bereaved carers’ views on the quality of care in the last three months of life – indicator in development Local Quality Premium Measure 2014/15

31. 3. Priorities for the CCG

32. Determining our priorities The CCG has undertaken a formal SWOT analysis as part of the Integrated Care and ACO strategies from an organisational perspective. Whilst many opportunities are afforded through the latest planning framework, our main areas of risk remain: • Financial viability of our local acute provider • Financial landscape for our social care partners With regard to opportunities from a clinical programme perspective, clinical areas of focus remain from 2013/14, with the additions of neurological disease, accident prevention and chronic liver disease, which have been added to the elective and urgent care clinical programme areas. Themes were determined utilising data from: • Commissioning for value packs • Public health outcomes framework • Local health profiles • PHE/NNSE a call to action: commissioning for prevention • Areas from 2012 CMO report • New national strategies expected in 2014 • JSNA • Patient views • Performance against national constitutional indicators With regard to specific interventions, the CCG is now undertaking a process to define what are the specific changes that need to take place over the next 5 years within the broad description of the intervention. The 2-year change programme has been defined. There will be a formal prioritisation process led by our Clinical Directors, involving our membership and the public throughout the spring / summer to determine the 5-year priorities. This programme is built upon in part, the evidence within the commissioning for prevention document produced by NHSE.

33. JSNA highlights

34. Key facts relating to mortality • All age all cause mortality is higher than the England and north west average.Inequalities remain high • There has been a reduction in mortality for CVD over the last decade, though rates are still higher than the national average - risk factors in the population for CVD remain high in Oldham • Stroke mortality rates for the under 75's are 33% higher than expected • Cancer is the biggest cause of mortality for the under 75's for men and women in Oldham, and has not seen the same trends seen nationally and regionally • Respiratory diseases are the third main cause of premature deaths. • Lung cancer is the biggest cause of under 75 mortality from cancer for both men and women in Oldham • The infant mortality rate is worse than the England average • Only 34% of Oldham residents who died, died in their usual place of residence, and was the 37th lowest proportion of all PCTS in England in 2010

35. Key population indicators • There are high admission rates for CVD, mental health , COPD and alcohol conditions with differences in wards according to deprivation • Compared to elsewhere in England , children's admissions are high, and has one of the highest admission rates for diabetes, asthma and epilepsy • Compared to other areas Oldham has high rates of admission from nursing or residential homes • Smoking is the single greatest cause of ill health with 27% of adults smoking compared to 20% nationally • An estimate of 42,000 people aged 16 and over are drinking above levels considered low risk • In 2011 only 11% of mothers had booked for antenatal care by 11 weeks of pregnancy • There has been an increase in referrals by 29% for drug and alcohol problems in under 18 year olds • Rates  of teenage conception rates are still below the national target • The number of people living with dementia is expected to increase by two thirds in 2030 • The CCG spends a high amount on prescribing when benchmarked against national indicators

38. Public Health suggestions for Emerging / Refocusing of Priorities • A. Cutting across more than one of the 3 H&WBS themes • 1. Long term condition prevention and management: • NHS Mandate priority objective - to ensure the NHS becomes dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment. • Stronger emphasis on ‘every contact counts’ re risk factors • Need to move from silo LTC to looking at generic LTC issues and multiple co-morbidities • Support to practices to get better with personalised care planning and supporting patients to be true partners in care / self-management including shared decision making – explicit commitments in NHS Mandate regarding this • 2. Neurological disease • 10% emergency admissions • High social care burden • New national neurological strategy expected during 2014 to include emergency access to specialist neurological opinions, community neuro MDTs, increase use of GPwSPI e.g. headache clinics

39. 3. Mental health and well being • Interrelationship between mental and physical health and learning disabilities and physical health • NHS Mandate objective is to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole. • Implementation of learning disabilities needs assessment / SAF action plan • Implementation of CAMHS needs assessment • NB:- CMO report 2013 – focus on poor mental health health/wellbeing children • Extension of IAPT esp. for children • Extending and ensuring more open access to the Improving Access to Psychological Therapies (IAPT) programme, in particular for children and young people, and for those out of work. NHS England has agreed to play its full part in delivering the commitments that at least 15% of adults with relevant disorders will have timely access to services, with a recovery rate of 50%. • RAID • 4. Accident prevention • Oldham has one of highest admission rates for injuries in country • 5. Advocacy services • Advocacy services have been cut in recent years • The difficulty that vulnerable groups e.g. mental health, learning disabilities, dementia, English as second language, have in accessing services contributes to health inequalities

40. B. Giving every child the best start in life • 1. Review of SALT with focus on SLAT provision via play and education settings. • 2. Consanguinity • H&WBB paper in Jan to recommend: • Review genetics services for at risk individuals and families, including identification of affected child(ren), family tracing and proactive offer of counselling and testing. Consider making available a local specialist health visitor or midwife to provide dedicated support and advice to affected families and to encourage community advocacy relating to consanguinity. • Look to offer training for health professionals, particularly primary care to increase confidence in discussing consanguinity related issues. • Commission community activities which will raise genetic literacy and encourage uptake of universal and targeted prenatal, antenatal and early childhood services. • Maximise the impact of prenatal, antenatal care and early years care and services through reviewing specifications relating to these services.

41. C. Living, Learning and Working Well • 1. Fit to work programme • Support for small and medium sized businesses to keep people with LTC and work related illnesses in work • Rapid access to rehabilitation services e.g. physiotherapy, OT • Rapid access to mental health services • 2. Liver disease • Increasing mortality, higher than national average, linked to alcohol • 3. Cancer • Increasingly an outlier in lack of reduction in cancer mortality

42. D. Ageing Well and Later Life • NHS Mandate - objective is to pursue the long-term aim of the NHS being recognised globally as having the highest standards of caring, particularly for older people and at the end of people’s lives. • 1. Implementation of Vulnerable older adults plan (not yet published) • NHS Mandate priority • 2. Malnutrition: • 1 in 10 over 65 malnourished, one of ten high impact changes; NICE identified 6th biggest saving to NHS by implementing NICE nutritional support guidelines; NICE quality standards recently published • Increase dietetic support • To provide training, mentoring and support for front line staff in primary, community, social care (social workers, day centres, domiciliary care, reablement services), carer services and voluntary sector organisations and local volunteers (e.g. community champions, peer health mentors) to understand causes of poor nutrition, early identification and management/prevention of malnutrition • To advise and work with agencies who provide food for the elderly to ensure high nutritional standards are met (e.g. day centres, care homes, community cafes, home delivery services / meals on wheels) • Clinical assessment and management of elderly who have been screened as malnourished / at high risk of malnutrition • Support to carers via Carers services • NB:- Public health investment plan proposed PH budget investment in luncheon clubs, ‘meals on wheels’, shopping services, peer health mentors

43. 3. Rehabilitation/reablement: • MDT input to Medlock Court, Limecroft, LA reablement services • Community geriatrics • Increased community physio, OT etc.. to provide rehab not just aids and adaptations • 4. Preventing Social isolation • Development of peer health and well-being champions for older people - Peer support and advice regarding healthy living, accident prevention, good nutrition; Signposting and support to access leisure and community activities; Fostering of friendship groups • Expansion of current befriending services and scheme to put people with like interests in touch with each other • Intergenerational schemes • Specialist support to help community groups/services to develop their services/activities to enable continued/enhanced access by frailer older people (e.g. use of libraries) • Development of volunteer car transport schemes • Voluntary sector ‘hub’ for older people to which older people can be referred by health and social care professionals for assessment and support to access above

44. 5. Dementia • NHS mandate objectives – The Government’s goal is that the diagnosis, treatment and care of people with dementia in England should be among the best in Europe. The objective for NHS England is to make measurable progress towards achieving this by March 2015, in particular ensuring timely diagnosis and the best available treatment for everyone who needs it, including support for their carers. NHS England have agreed a national ambition for diagnosis rates that by 2015 two-thirds of the estimated number of people with dementia in England should have a diagnosis, with appropriate post-diagnosis support • Older person’s RAID, • Dementia friendly communities • Access to intermediate care, Respite care and care at home for inter-current illnesses • Community mental health teams • 6. Carers • Implementation of carers strategy • Carers advocacy services

45. Key themes from “Call to Action” engagement • The need to reduce fragmented care for people with long term conditions • The need to make services more responsive and patient-focused • An increased expectation of patients’ involvement, both in their own care and in commissioning • A widespread understanding and acceptance that the NHS needs to change to be sustainable • Concern that key local services are protected • A 24/7 NHS with safe, effective care wherever and whenever I access it. • Timely access to services, especially same day access to primary care • Continuity of care, especially for patients with Long Term Conditions • Integrated, patient-centred health and social care • Shared decision making and good communication - clinicians who listen and tell me what¹s happening • Knowing that my views and experiences will be heard even though people don’t listen to people like me • Easy access, especially car parking/ and transport • Decisions based on my needs, not financial considerations

46. NHS Constitution Performance

47. CCG Outcomes and Local Priorities

48. Oldham CCG has faced challenges in delivering some aspects of core performance in 2013/14, commissioning the majority of care for its population, from a large multi-site provider. Performance at the end of quarter 4 2013/14 indicates that our main areas of focus need to be: Cancer waiting times Patient experience Mental health – IAPT intervention and recovery rates Unplanned admissions A&E 4 hour waits Healthcare associated infections Our approach to commissioning sets out our commitment to: Deliver as a minimum, the national performance targets required through continuous quality improvement Maintain excellent performance where this already exists Addressing the improvement in performance of these indicators and others from the Operating Framework and the NHS outcomes framework, have formed a critical part of programme plans for our Clinical Directors.

49. 4. Strategic transformation

50. A. Context