Commissioning within the Voluntary Sector – Part 2

1. Commissioning within the Voluntary Sector – Part 2 Caroline Cunningham-Brown (Commissioning Manager Norfolk County Council and North Norfolk Clinical Commissioning Group)

2. Introduction Aims of the session • Update on issues raised at the last meeting • Discussing health priorities • Hub engagement plans

3. Follow up from 26th April 2017 • Levels of investment – CEP members asked for clarity of investment • Performance information – CEP asked for details of what performance measures the CCG collects and what these are used for • Health priorities from our QIPP Programme – CEP asked for more details of what our health priorities are.

4. Levels of Investment The CCG invests around £218,000 per annum in to voluntary sector delivered services with other CCG’s:

5. Levels of Investment The CCG invests around £183,500 per annum in to voluntary sector delivered services jointly commissioning with Norfolk County Council:

6. Performance NHS Grant or Contract sets out what performance information is collected. To date this includes: • Usage data - how many people use the service and how often. • Staffing - how many staff are employed by the service. • Where services are delivered – where services are delivered across more than one CCG we can see how well this is split. We don’t collect outcomes but do collect case studies from time to time. This needs to change

7. QIPP Health Priorities • Demand management – we need to keep people out of hospital unless they need to be there (and make room for people that need treatment routinely) • Avoidable admissions – we need to reduce the numbers of people that end up in hospital because a condition they have escalates or causes a fall • Delayed discharges – we need to get people that are healthy and well out of hospital faster

8. Health Priorities We collect a range of information about people that go in to hospital in an unplanned way. For the first time we’ve looked at this on a hub footprint.

9. Demographic Info (1) Gender The gender split across the hubs does not vary significantly and Norfolk is within 0.4% of the national average.

10. Demographic Info (2) Age • Hubs NN2 (Orange) and NN4 (Green) are similar in age ranges • Hubs NN1 (Turquoise) and NN3 (Dark Blue) have fewer people of working age and higher numbers of people in the 60+ groups. • There are fewer people of working age to look after people of older age • There are higher numbers of older people in these hubs • There is a link between proximity to urban areas and younger populations meaning more older people live in rural (and isolated) places.

11. Age Breakdown

12. Avoidable Admissions Avoidable admissions refer to an admission that relates to something that could have been managed at home or by primary care, these are usually linked to long term health conditions or falls. Between 2015/16 and 2016/17 there have been some improvements in some hubs for avoidable admissions.

13. Reasons for Avoidable Admissions • NN1, NN2 & NN3 have all had reductions in influenza and Pneumonia whereas NN4 has had an increase. • Other Forms of heart disease there’s been a reduction across each cluster, aside from NN2. • NN4 has had significant reductions in UTI’s. • Chronic lower respiratory diseases have seen significant increases for NN1, with NN2 & NN4 increasing and NN3 staying stable. • There has been an increase across all clusters for intestinal, significantly NN4. • Other infections has seen an increase across all clusters, significantly for NN4. • Acute upper respiratory has seen big reductions across all the clusters, except from NN4.

14. Length of Stay A stay in hospital has implications for a persons ability to maintain their independence on discharge. A person only has to be in hospital for 10 days for their independence to decrease significantly.

15. Falls We have had a 3% reduction in the number of people falling and being admitted to hospital in North Norfolk in the last year: Falls in NN1 have increased significantly, however, its worth noting that falls for people aged 65 – 85 have remained the same with a marked increase in falls of people aged over 85

16. Hub Avoidable Admission Priorities

17. How could this work?

18. Hub Engagement Approach We know the North Norfolk Provider Forum isn’t working, so how can we change this? • Integrated Care • Managed through 8 Integrated Care Co-ordinators • Links with the Voluntary Sector • Delivers access to support from non-statutory services • Key to reducing avoidable admissions

19. Locality Focus County Focus Engagement Structures Locality Provider Forum Locality Homecare Forum Community Engagement Panel Supported Care Group Independent Provider Forum Sustainability & Transformation Patient Groups Unpaid Carers Health Commissioners Voluntary Sector Providers Healthwatch Unpaid Carers Health Commissioners Voluntary Sector Providers Providers Social Care Commissioning Operational Social Care Teams Health watch Home Care Providers Social Care Commissioning Care Arranging Teams Homecare Providers Social Care Commissioners Independent and Private Providers Social Care Operational Teams Norfolk County Council Norfolk Clinical Commissioning Groups Norfolk Community Health Providers (NHS) Voluntary Sector Providers Healthwatch Across the CCG and NCC we have many engagement structures Locality Carer Network Patient Participation Groups Day Services Network Norfolk Older Person Strategic Partnership Making it Real Board Norfolk Learning Disabilities Partnership Carer Council for Norfolk

20. The Challenge • Understand what resources are available in which areas of the locality • Improve knowledge of the key health and social care issues facing the population in order to be in a position to respond • Increase engagement between locality issues and the broader strategic landscape underpinned by Promoting Independence and the Sustainability and Transformation Plan in Norfolk & Waveney • Improve access to shared resources to support the development of staff working in health and social care. • Have the ability to influence the direction of travel when determining how efficiency’s will be managed and implemented. • Improve the links between key work areas including Supported Care, Homecare, Hospital Discharge and Reducing avoidable admissions

21. The Proposal