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Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Annual General Meeting 26th July 2016 The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Welcome and Introductions Dr Paddy Hannigan Chair The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Annual Report & Annual Governance Statement Andrew Donald Chief Officer The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Annual Accounts 2015/16 Financial position Paul Simpson Director of Finance The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as How we spent the CCG’s money Stafford & Surrounds CCG Finance Report Month 12 (1st April - 31st March 2016) Revenue Resource Allocation Annual Budget £,000 -169,176 YTD Budget £,000 -169,176 YTD Expenditure £,000 -169,176 14,853 93,720 25,849 16,832 19,403 2,531 173,188 14,853 93,720 25,849 16,832 19,403 2,531 173,188 15,315 92,109 27,331 17,365 19,208 1,794 173,122 462 -1,611 1,482 533 -195 -737 -66 3,210 3,210 3,267 57 176,398 176,398 176,389 -9 7,222 7,222 7,213 -9 Repayment of prior year debt 18,744 18,744 18,744 0 Culmulative position (Surplus)/Deficit 25,966 25,966 25,957 -9 Expenditure Mental Health Acute Primary Care Cont Care & FNC Community Other Total HCHS Corporate/Running Costs Total Expenditure In Year position reported at Month 12 YTD Variance £,000 The healthiest place to live and work by 2025 0 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Commentary on 2015/16 Stafford & Surrounds CCG Financial Summary • The CCG delivered its control total of £7.213m (with a small “underspend” of £9k). This is a significant milestone in the CCGs recovery back to financial balance. • Stafford & Surrounds CCG have a cumulative deficit of £25.957m • The main financial variances in 2015/16 were as follows * The Acute, Mental Health and Community Services contracts combined 2015/16 financial position is a £1.344m underspend. The position is based on initial contracting information to the end of February (Month 11) for the majority of contracts. * The Continuing Healthcare financial position at year end is a £533k overspend. * Primary Care Services ended the financial year 2015/16 with a significant overspend of £1.482m which mainly relates to prescribing (£1.551m). • CCG Audit – Compliance with legislation * The audit opinion is that the financial statements give a true and fair view of the financial position. * The CCG received an unqualified opinion on the value for money measurement on the basis the 2016/17 is in balance. * The opinion against the regularity measurement was also qualified on the basis of the in year deficit. The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as The healthiest place to live and work by 2025 as Analysis of Contract Expenditure £000's 13,729 Analysis of Acute Expenditure £000's 6,368 15,542 15,542 5,229 804 8,001 4,821 836 12,793 6,368 5,229 804 4,821 58,509 836 58,509 Wolverhampton UHNM Wolverhampton Robert Jones & Agnes Hunt UHNM Ambulance Robert Jones & Agnes Hunt Shrewsbury & Telford Rowley Hall Ambulance Other Acute Shrewsbury & Telford Staffordshire & Shropshire FT Rowley Hall Starfish Mental Health Services Other Community & Mental Health Other Acute as Forward Look Revenue Resource Limit £ 000 Recurrent Non-Recurrent Total Income and Expenditure Acute Mental Health Community Continuing Care Primary Care Other Programme Primary Care Co-Commissioning Total Programme Costs Running Costs Contingency Total Costs Surplus/(Deficit) In-Year Movement 2016/17 2017/18 2018/19 171,420 174,779 178,178 -25,957 -25,956 -20,057 145,463 148,823 158,121 92,359 14,744 18,143 17,324 24,417 894 167,882 88,818 15,262 18,782 19,695 25,975 945 169,476 89,841 15,107 18,591 21,876 26,439 971 172,824 2,681 2,681 2,681 857 874 891 171,420 173,031 176,396 1,748 1,782 - Commentary • The financial plan is for the CCG to return to financial balance in 2016/17. This will enable the CCG meet the statutory obligation of remaining within its Revenue Resource Limit • The surpluses planned in 2017/18 & 2018/19 will enable the CCG to fully meet the national rules for CCGs to deliver a 1% surplus. as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Project Showcases The healthiest place to live and work by 2025 Dr Paddy Hannigan, Chair and GP Tracey Cox, Senior Primary Care Development Manager Atrial Fibrillation (AF) • AF is one of the most common forms of abnormal heart rhythm (5% of over 65s) • It is a major cause of stroke – 20% of strokes & tend to be severe • In England, there are approximately 12,500 AF related strokes per year • 49% of high risk patients with AF on a practice register may not be taking anticoagulation for stroke prevention • There is a need to improve the management of AF in Primary Care • Recent NICE Guidance also indicated aspirin used as stroke protection is inadequate AF Management • Control heart rate if too fast • Medication to prevent stroke • CHA2DS2-VASc , HAS-BLED scores used to ascertain risk and treatment needs Anticoagulation • Clear NICE guidance that aspirin not effective in preventing strokes • Warfarin thins the blood but needs regular monitoring, measure INR and check within the therapeutic range (2.0-3.0) • Time in Therapeutic Range (RTT) important as addresses if sufficient anticoagulant cover • Newer anticoagulants called NOACs, these do not need regular monitoring so easier to manage but still require monitoring but give anticoagulant cover • Stafford and Surrounds CCG decided to run the PCAF project to improve the prevalence of AF and optimise anticoagulation to prevent stroke and the consequences of catastrophic effects of stroke in high risk patients • Project supported and funded by Pharma (Pfizer) • PCAF project was a Consultant cardiologist supported service delivered locally at General Practices Project Aims • Improve the quality of AF register at practices • Improve the knowledge and skills of general practice workforce • Ensure all high risk patients are anticoagulated and optimally managed • Reduce the expected numbers of stroke in the Stafford and Surrounds CCG population Results • Patient records reviewed : 140,130 • Virtual Reviews undertaken: 60 • Face to Face review: 410 • New patients treated with anticoagulation: 219 • Overall the attendance for reviews was 83%, those who did not attend had a note added to clinical record to allow GP to follow up at a later date • 219 patients were started on treatment • There was a 60/40 split on patients taking NOAC or warfarin • 91 patients had there warfarin changed to NOAC as there treatment with warfarin was sub therapeutic Objectives Met • Improved prevalence registers of AF at practices • Practice education on AF and management • More patients anticoagulated and sufficiently protection • Up to 30 strokes were expected within the 12 months if no intervention was put in place as suggested by the GRASPAF tool • In total, at least 10 strokes prevented Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Antibiotic prescribing and antimicrobial resistance Sam Buckingham Pharmaceutical Advisor The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Antimicrobial Resistance – A growing problem •asThreatens treatment and prevention of infections • A serious threat to global public health. • Worldwide issue - new resistance mechanisms emerge and spread globally. • Already significant bacterial resistance to urinary tract infections, pneumonia, tuberculosis among others. • Patients with drug-resistant bacterial infections are generally: • at increased risk of worse clinical outcomes and death • consume more health-care resources than patients infected with the same bacteria that are not resistant. • By 2050 will lead to over 10million deaths worldwide The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Antimicrobial Resistance – A growing problem The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Antibiotic Guardian and Antibiotic Awareness Key Messages as • Right drug, at the right dose, at the right time and the right duration • AVOID unnecessary lengthy durations of antibiotic treatment • AVOID inappropriate use of broad-spectrum antibiotics • Communication is key – patients need information on expected course of illness. • Consider backup/delayed prescriptions when appropriate • GPs are also encouraged to focus on antimicrobial stewardship and to use the RCGP TARGET toolkit. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/465879/AG_and_Antibiotic_Awareness_Key _messages_2015_FINAL.pdf The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Local antibiotic prescribing improvements The CCG has been supporting practices and prescribers to review as antibiotic prescribing locally. During 2015/16 the CCG has: • Reduced overall antibiotic prescribing by 8.3% • Reduced broad spectrum antibiotic prescribing by 12.6% The reductions are particularly evident in period October 2015 – March 2016 where over 20% reduction in broad spectrum antibiotics has been seen. Despite excellent progress NHS Stafford & Surrounds remains above national average for antibiotic prescribing. The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group NHS Stafford & Surrounds CCG National Average The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group NHS Stafford & Surrounds CCG National Average The healthiest place to live and work by 2025 as Patient Information Resources When should I worry booklet • Developed by Cardiff University http://www.whenshouldiworry.com/training-in-use-of-the-booklet.php • Key information for parents and carers: • • • Symptom / condition specific advice Management / self care sections Contacts / summary European Antibiotic Awareness patient information leaflet Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Next Steps and Key Public Messages To astackle antimicrobial resistance requires professionals and patients working together. A public awareness campaign is planned for winter 2016 In addition, there are a few things that the public can do: • Manage self-limiting conditions like flu, coughs and colds with over-the-counter preparations • Discuss symptoms with your community pharmacist • Remember symptoms can take time to improve • Don’t expect antibiotics every time you see the doctor • Take antibiotics as prescribed and complete the full course • Do not share or use other people’s antibiotics The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Organisational Development Ian Baines Director of Transformation The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group OD – Key achievements in 2015/16 •as Good Organisations – invest in themselves and their staff • Good Achievements 2015/16 but difficult outlook 2016/17 • 3 CCGs – 1 Management Team OD Programme: • Ensure our people are able to grow and develop • Seamless integration of management team • Great place to work Tools used: Group Work, Feedback, Mind Maps, Prioritisation Exercises, Open Questions, STAR Model The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as The Values Diamond as Next Steps • Embed our Values Diamond • Start the “practicals” in terms of delivery: • Eliminate the duplication of process • Management Skills Programme • Health and Well Being • Masterclasses • Branding • Reporting and visibility • Understand the wider context – links to Councils, Sustainability and Transformation Programme The healthiest place to live and work by 2025 Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Back to Basics or Prevention is Better than Cure Encouraging people to take advantage of prevention opportunities within health care Ruth Goldstein, Public Health Speciality Registrar The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Back to basics OR Prevention is better than cure as Stafford and surrounds England The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stafford and Surrounds Demography as % aged 0 to 4 years 2015 CCG Value 4.8% % aged 5 to 14 years 2015 10.2% 11.4% % aged under 18 years 2015 18.1% 20.7% % aged 65+ years 2015 21.9% 17.1% % aged 75+ years 2015 9.5% 7.8% % aged 85+ years 2015 2.6% 2.3% Deprivation score (IMD 2015) 2015 13.1 21.8 Indicator Period England Value 5.9% The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group How can we stay healthy into our old age? as The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group ‘Health care’ ways to keep our population as as healthy as possible for as long as possible • Take up all opportunities for vaccinations (this will decrease the number of people with predictable preventable illnesses such as influenza and pneumonia) • Take up screening opportunities so any illnesses can be diagnosed before they becomes too serious to treat • Take prescribed medicines as prescribed The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Uptake of national screening programmes as Period CCG uptake England uptake 2014/15 75.2% 73.5% Females, 50-70, screened for breast cancer within 6 months of invitation 2014/15 76.0% 72.8% Persons, 60-69, screened for bowel cancer within 6 months of invitation 2014/15 62.4% 57.6% Abdominal Aortic Aneurysm screening 2014/15 83.8% 79.5% 2015/16 45.0% 47.9% Programme Females, 25-64, attending cervical screening within target period NHS Health Checks The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Vaccination rates as Vaccination Stafford and surrounds % uptake England % uptake MMR vaccination 93.6 92.3 Dtap/IPV/Hib vaccination 98.3 95.7 Seasonal Influenza Over 65s At risk population (< 65) Pregnant women 68.8 45.2 41.5 71.0 45.1 42.3 Pneumococcal 62.6 (43.4-78.2) 69.8 Shingles 70 year old’s vaccinated since 2013 78 year old’s vaccinated since 2013 39.45 (6.3-76.4) 45.5 (13.8-76.7) 46 46 Human Papilloma Virus 93.7 89.4 The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Long term condition monitoring as Primary care offer all patients with long term conditions such as heart disease, high BP etc. an annual review. Lots of patients don’t attend as they don’t think they need to. People prefer to wait until they feel ill rather than check their health is OK….(BUT we all MOT our cars, why not our bodies) The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Why don’t we get 100% uptake of preventative as measures? • • • • • • Public perception of safety Public awareness of benefits Convenience ‘It won’t happen to me’ Confusion in the messaging Fear…… The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group What can the CCG do to increase uptake of as preventative healthcare? • • • • • Publicise need for engagement Make it easy to have vaccinations/screening Make sure record keeping is accurate Keep reinforcing the needs and benefits Don’t assume people read their post! The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Taking prescribed medicines as intended……. as • An estimated £300million of medications are wasted annually within primary care in England1 • Equivalent to over £750,000 within NHS Stafford & Surrounds CCG Some wastage is inevitable however a lot of waste is preventable 50% waste is thought to be avoidable 1 Evaluation of the Scale, Causes and Costs of Waste Medicines (November 2010), York Health Economics Consortium/The School of Pharmacy, University of London The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Not only do our GPs prescribe the medicine as (because, in their expert opinions, it will help the patient) but our pharmacists dispense it and then we have to collect the waste returned to pharmacies and pay for it to be incinerated! • Across South Staffordshire over 20 tonnes of pharmaceutical waste is produced every year. • In Stafford & Surrounds 7 pharmacies had over 100kg of pharmaceutical waste collected in Jan 2014. The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Medicine waste is inevitable but WE can do as to reduce the quantity more Patient’s responsibilities • • • • Only order what’s needed Be honest Talk to GP and pharmacists Don’t stoke-pile CCGs responsibilities • Keep on the radar through press/social media etc. • Support local initiatives through medicine management • Work with care home and secondary care GP surgeries and community pharmacies’ responsibilities • Discuss medicine use with patients • Have repeat ordering system with built in checks • Talk to each other about systems/processes and patients • Never assume anything! The healthiest place to live and work by 2025 as Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group To conclude….. as Prevention IS better than cure….we need to do more prevention and less waiting until things go wrong • We need to do more to encourage the population to take up offers from the NHS like Vaccinations, screening and Long Term Condition clinics. • Need a more honest discussion with patients about their prescribed medicines. The healthiest place to live and work by 2025 June 2016 Purpose of the TWB programme • Together We’re Better is a commitment from all partner organisations to work together to bring about transformational and sustainable change to better meet the needs of local people and improves lives • The local NHS and councils are working together to produce a five year sustainability and transformation plan (STP) across Staffordshire and Stoke-on-Trent • The local health and care system will only become sustainable if it accelerates its work on prevention and care design • This will require: o Planning for the population of the whole of Staffordshire and Stoke-on-Trent o System leadership through team working across all organisations o A process involving clinicians, patients, carers, citizens and local community partners, including the independent and voluntary sectors, and local government Why do we need to change? Population health challenges Between 2014 and 2019 the number of people aged 85 years and over will rise by 22% Diabetes and Coronary Heart Disease prevalence exceeds the national average in 5 of 6 CCGs One in five people die from causes that are thought to be preventable – around 2,100 deaths every year One in 10 children aged four to five is obese one in five by age 11. Two out of three adults have weight problems one in four is obese. Half the CCGs exceed their peer average for injuries due to falls (in people aged 65+) Stoke-on-Trent was 30% above the national average Cancer mortality is the primary reason for premature deaths and is higher than average for 4 out of 6 of our CCGs Why do we need to change? Quality of care challenges 800 patients are admitted to hospital every day - 330 are unplanned Almost 60 are readmitted within 30 days of discharge 20% of health and care costs for those aged under 65 years, and 30% for those aged over 65 years are spent on hospital care The number of people offered reablement services to recover and regain independence (1.4%) is lower than the national average (3.1%) A third of people in a hospital bed at any one time don’t need to be there Local hospitals had higher attendances at A&E than their peer average 4 The acute hospitals in Staffordshire and Stokeon-Trent have failed to meet the waiting time target between 2012/13 to 2015/16 Why do we need to change? Financial challenges High A&E attendances Ageing population Length of hospital stay & readmissions Current financial position Staffordshire and Stoke-on-Trent’s health deficit is £160m (2015/16). This does not include social care. Forecast financial position for 2020/21 If we do nothing, the recurring deficit in 2020/21 is currently forecast to be £275 million. Add in the cost pressures in social care, this forecast currently increases to £367 million Addressing key challenges Workstreams Frail Elderly and LTC Urgent and Emergency care Planned care Enhanced Primary and Community Care End of life Cancer, Mental Health, Prevention and Well Being Enabling workstreams Next steps • The draft Sustainability and Transformation Plans was submitted on 30 June 2016. This will be followed by face to face meetings with national leaders, consideration, feedback and assurance of final plans • All programme workstreams are meeting regularly to work through plans and to identify key projects that will be progressed • Meaningful engagement with the public, health and care professionals, voluntary sector, workforce and organisational stakeholders will play a fundamental role at all stages of transformation • A dedicated programme workstream has been set up to ensure all transformation initiatives plan in and deliver meaningful engagement and consultation where needed • All organisations involved in the programme will identify people to act as champions of the programme, to extend the reach of engagement across Staffordshire and Stoke-on-Trent Starting the conversation • Do you think we have the right priority areas? • Is there anything you think we have missed? • What role can patients and the public play in helping us to transform the priority areas? • How can we ensure meaningful engagement? • Do you represent a community group? Would you like to be one of our programme champions? Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group as Public Questions Andrew Donald & Dr Paddy Hannigan The healthiest place to live and work by 2025