Agenda item

Ian Atkinson, Deputy Chief Officer Rotherham CCG and Lydia George, Planning and Assurance Manager Rotherham CCG to present

Ian Atkinson, Deputy Chief Officer, Rotherham CCG, presented the annual review of NHS Rotherham CCG’s Commissioning Plan.  The powerpoint informed the Commission of:-

 

Process for reviewing the Plan

Purpose

-          To fully engage CCG member practices and stakeholders in the CCG’s 2016-17 planning process through the review and refresh of the CCG’s 2015-19 Commissioning Plan

-          It was important to note that for 2016-17 the CCG would only refresh the Plan

Process

-          Locality members and stakeholders were asked to review the identified key priorities within the 2015-19 Commissioning Plan, ratify the Plan and suggest any amendments for 2016-17

-          Stakeholders would receive the first draft version of the Plan for comment in mid-December, Plan signed off in February

 

2015-19 Strategic Direction

-          The CCG strategic aims sought to address all six Health and Wellbeing Strategic aims across all life stages and for all communities both geographical and communities of interest:-

·           Unscheduled Care (unplanned care) – Emergency Centre, GP Case Management, 7 day working, enhanced care co-ordination centre

·           Clinical Referrals (planned care) – improving care pathways so patients get the right care at the right time including reducing the number of hospital follow-ups

·           Mental Health – delivery Adults and CAMHS transformation plans including Adult Mental Health Liaison and Parity of Esteem

·           Rotherham Partnerships – to deliver the Better Care Fund and the joint children’s agenda with RMBC

·           Transforming Community Services – Locality-based nursing, safer discharge, admissions prevention, integrated out of hours

·           Medicines Management – increase quality, efficiency, reduce variation and waste across thirty-six practices, six service redesign projects

·           Developing General Practice – delegated responsibility for commissioning general practice and co-commissioning of Primary Care and Specialised Services

·           Regional Partnerships – deliver the ‘Working Together Collaboration’ with other CCGs across South Yorkshire

 

Financial Challenge

-          Rotherham has a £75M financial efficiency challenge over the 5 year period 2014-2019

-          In 2015-16 providers of health care would receive around 2% less for providing the same service

-          Rotherham Hospital has an Efficiency Plan of £12.5M in 2015-16

-          Increased costs and activity meant that Health Services would need an extra 6% in the budget each year just to stay still.  Budgets were increasing at around 1-2%

 

2016-17 Refresh of the Plan

-          CCG Governing Body, Strategic Clinical Executive Members and RMBC representatives had already reviewed the current Plan (2^nd September) and had identified the following key elements for specific discussion and feedback:-

·           Approach to joint commissioning with RMBC including Better Care Fund

·           Commissioning of Children’s Services

·           Response to Child Sexual Exploitation (CSE)

·           Hospital and Community Services

·           Mental Health Services (including Learning Disability)

·           Primary Care

 

Joint Commission with RMBC including the Better Care Fund

-          Current Plan states

·           In 2015-16 we will Consolidate the Better Care Fund plan

-          2016-17 propose to include

·           Review of the current Better Care Fund initiatives

·           Explore opportunity for future joint commissioning in the following areas:-

Children

Learning Disabilities

Continuing Health Care

Mental Health

Social Care

 

Commissioning of Children’s Services

-          Current Plan states

·           Focus on Integration of the Rotherham Foundation Trust (TRFT) Acute and Community Children’s Services

·           Collaboration between South Yorkshire Hospitals Children’s Services (Working Together)

-          2016-17 propose to include

·           The development of a Children’s Joint Commissioning Strategy

Children and Adolescent Mental Health Services (CAMHS)

0-5 year olds

Special Educational Needs and Disability

CSE post support

Looked After Children

Early Help (Children’s Centres)

·           Delivery of Care Quality Commission (CQC) action plans affecting children (TRFT and Rotherham Looked After Children and Safeguarding)

·           Focus on efficiency with the Hospital (number of beds, assessment beds and rapid assessments)

·           Explore potential for locality working

 

Response to Child Sexual Exploitation (CSE)

-          Current Plan states

·           We will work with partners to address all issues that arise from the Jay and Casey Reports into CSE

-          2016-17 propose to include

·           Delivery of Child Sexual Exploitation Strategy (Evolve)

Prevent

Pursue

Victim Support

 

Hospital and Community Care

-          Current Plan states

·           Unscheduled Care – Commission New Emergency Centre (Spring 2017)

·           Elective Care – focus on pathway work to manage demand

·           Commission 7 day Hospital services working

·           Quality:

Care Quality Commission (CQC) action plan

Stroke action plan

Commissioning for Quality and Innovation (CQUIN)/local outcome framework

·           QIPP

3.5% year on year efficiency

Non-elective activity to flat line

Follow-ups reduce by 8%

-          2016-17 propose to include

·           Focus on the Development of Information Technology interoperability

·           Working together (including implementing regular Ward rounds and including RMBC)

·           Sustainability review and consider Integrated models spanning organisational boundaries/Acute Care collaboration with Federation Board

-          Community Transformation Phase 1

·           Community nursing – invest, reconfigure and distribute according to need

·           Care Co-ordination Centre

·           Community Unit

·           Falls and Bone health

·           Neuro-rehabilitation

-          2016-17 propose to include

·           Community Transformation Phase 2

Realign Intermediate Care

Integrated rapid response

Reduce delayed transfers of care

Further develop Care Co-ordination Centre

Joint protocols with Social Care and Rotherham Doncaster and South Humber NHS Trust (RDaSH)

Review of respiratory pathway

 

Primary Care

-          Quality driven services

·           Four year investment plan – needed to stabilise practices

·           Benchmarking e.g. staffing

·           New models of delivery  - primary/community-led services

·           Quality and Outcomes

-          Services as local as possible

·           Telephone consultations, skype

·           Wider use of workforce

·           Integrating Out of Hours and Urgent Care

·           Estates review – Rotherham CCG Strategy

-          Equality of Service provision

·           Explore opportunity to develop a basket of enhanced services

·           Review opportunity for Primary Care to work jointly to deliver Borough-wide coverage of provision

-          Increasing appropriate capacity and capability

·           Develop Workforce plan

·           Explore new workforce models given difficulty in recruitment

·           Recruitment Strategy

-          Access

·           Weekend/Bank Holiday pilot

·           Provision of wrap-around services to support pilot

-          New models of care

·           Collaborating practices to deliver care in the community

-          Self-care

·           Social prescribing – extension

·           Technology assisted

·           Case management

·           Improved patient education – this was felt to be fundamental – where to go, who to see, how we handle ‘dissatisfaction’

-          Robust performance management

·           Performance dashboard to support consistency

·           Use of RAIDR (Reporting Analysis and Intelligence Delivering Results)

-          Continued improvements to Medicines Management

·           Waste scheme

·           Prescribing Local Incentive Scheme

·           Minor ailments – out of practice and into pharmacy

-          Engaging patients to optimise patient pathways

·           Reinvigoration of Practice Participation Groups

·           Condition specific focus groups

 

Mental Health, CAMHS and Learning Disabilities

Current Plan states

-          Parity of Esteem/Crisis Care Concordat

-          Quality Innovation Productivity and Prevention (QIPP) – 3.5% year on year efficiency for RDASH but re-invested in Mental Health e.g. voluntary sector or Primary Care mental health

-          Quality agenda (nb CCG and RDaSH CQC reports)

-          Support to historical victims of child abuse and ensure Safeguarding arrangements are fit for purpose

-          Reducing delayed transfers of care

2016-17 proposal

-          National waiting time targets – Improving Access to Psychological Therapies (IAPT) and Early Intervention in Psychosis

-          CAMHS Transformation Plan – 5 year plan

-          National programmes to improve perinatal mental health and eating disorders

-          Winterbourne and new commissioning models for Learning Disability

Adult and Older People’s Mental Health Transformation Plan

-          Adult Mental Health Liaison (Better Care Fund – better reporting on outcomes

-          Improving access to Psychological Therapies (IAPT) – single of access, reduce Did Not Attend (DNA) rates, reduce waiting times and improve recovery

-          Dementia Carer Resilience and Mental Health Social Prescribing Pathways – provide GP link workers in practices, support locality working and improve recovery

-          Dementia (including GP Local Enhanced Services) – emphasis on prevention, reduce waiting times, recovery and locality focus

-          Learning Disabilities – new community investment, Assessment and Treatment Unit future plan and moves towards joint commission with RMBC

-          CAMHS Transformation Plan – universal services, review efficiency of existing service, getting best value for CCG 20% additional investment and review pressures on the system Tier 3/4 interface and impact on Adult Wards

 

Discussion ensued with the following issues raised/clarified:-

 

·           Hospital Trusts had been nationally mandated that there would be limits put upon the amount of spend they and local providers could spend on agency costs.  Within the next 2-3 years there would be new minimums which would maintain the costs that agencies could charge Trusts.  The Trust was required by the CCG to have safe staffing levels on the Wards but in order to meet those levels, agencies would be used.  In terms of agency staff levels at the moment, the programme was unaffordable and significant pressure would also be faced in delivering a CIP Programme which would be at a similar level of challenge for the Trust.  The challenge Rotherham had at the moment was to reduce expenditure on agency staff by 8%.  Currently Rotherham was ranked in band 6 out of 8 (8 being the highest) 

 

·           The overall contract value for Acute and Mental Health Services was 224.2M, £160M with TRFT - £130M on Acute and Hospital Services and £30M for Community Services (District Nurses, Physiotherapy, Occupational Therapy).  Mental Health spend with RDaSH was £30M for both Acute and Inpatient and Community Services.  Also the CCG spent money with the Sheffield Teaching Hospitals and Sheffield Children’s Hospital to the value of £20M for Acute Services.  Members requested a more detailed breakdown of spending

 

·           Medicine management and waste medicine within the community was high on the CCG’s agenda.  There was an awareness raising campaign starting next week on the issue and where GP practices could take on new ways of working to reduce waste in terms of prescribing.  The system of automatic repeat prescriptions would also be included.  It was a big opportunity to save money as well as a safety issue.     The CCG would forward more information about the campaign to the Select Commission

 

·           As yet there had been no decision or discussion on who would take the lead on future joint commissioning between the Council and the CCG.  The CCG had stated what their direction of travel and aspiration was and the Council was developing its vision for Social Care

 

·           With regard to the inter-operability of IT, the CCG was required to submit a digital roadmap by the end of the month but was very clear in its intention of having systems that worked together by 2020.  Great strides had been made in Rotherham over the last 6-12 months and work on the joint vision commenced.  The Council was currently in the process of procuring a new Social Care system and already bringing NHS numbers across into the Swift system.  It would also include the Mental Health system.  The aspiration was that a client would only have to “tell their story” once and all health professionals would have access to records

 

·           As part of the development of a Children’s Joint Commissioning Strategy, the CCG wanted to have specific discussions around Children’s Centres.  Although part of the same overarching strategy they were seen as a separate workstream to that of 0-5s.

 

·           Wherever possible, working with the Hospital, they would move pathways and the wider workforce into the community

 

·           There was funding of £23M within the Better Care Fund; £19M was Health funding and £3-4M from the Council.  However, the Fund could be as large as it needed to be with further integration and pooling of resources

 

·           A range of services were commissioned from RDaSH by the CCG and Council.  There could be efficiencies and improvement in the pathways for patients and members of the public if the services were jointly commissioned.  It also crossed over into the Social Care agenda where it was known that members of the public were being referred into Mental Health Services and also needed Social Care support

 

·           There had been no detailed discussion as to how Children’s joint commissioning (0-25) would link in with the provision of Adult Services.  However, young people did not stop being young people at the age of 18; they still had needs that had to be met.  Further discussion about pathways was required

 

·           There was a parking strategy associated with the new Emergency Centre.  Additional spaces had been agreed and already generated as well as one of the car parks being resurfaced.   The situation would continue to be reviewed and ways to improve considered

 

·           The CCG was currently engaged in discussion with the Council regarding the development of a wider strategy for Intermediate Care in the future.  It would be an ongoing priority

 

·           With regard to support for victims of CSE, there was a helpline and current patients were accessing counselling services and signposted to other services.  Over the last 6-12 months’ work had taken place on enhancing the provision to support professionals in specific services such as  Alcohol Abuse Services.  Public Health commissioned a number of substance misuse services.  All the pathways needed to be accessible to those who needed them.  It was about building resilience for them to be able to adapt and rebuild their lives

 

·           Families were frustrated with the conflicting messages of support available and what was actually provided and became disengaged.  There needed to be clear pathways and processes for what psychological services were available. 

 

·           Rotherham was challenged in terms of the number of Rotherham residents that were currently referred into the IAPT (Improving Access to Psychological Therapies) against available capacity.  There were significantly long waiting times in certain parts of the Borough.  The Service had been reconfigured in the last 6 months to try and address some of that inequality but it was still a challenge.  Additional money was to be put into the Service to get over the waiting time issue.  It was an absolute priority for the CCG at the moment in terms of working with the existing provider in order to improve the waiting times.  In the short term there was a need to look at other opportunities and different providers

 

·           Members of the public with Learning Disabilities needed to be engaged in the commissioning process

 

·           Any service development was subject to an Equality Impact Assessment by the CCG and formed a key part of the processes

 

·           A scheme was under development utilising the skills in Acute in the Community settling and having the expertise available in the Community to prevent hospital admission.  It was work in partnership with Mental Health and Community Care so a person’s needs could be considered before their admission.  It was really important that there was a balance of skills across all the teams.  The piece of work commissioned to support the Acute transformation was to enhance the locality-based model so there were multi-disciplinary teams working in the community that could draw upon any experience required to meet the patients at source

 

·           NHS England was responsible for inpatient CAMHS, not the CCG, and there was work being carried out nationally on Tier 4.  It was looking to enhance the existing Tier 3 service as part of the CAMHS Transformation Plan. The aspiration would be that a service be commissioned where there was young person in crisis that allowed intense resources to go into the home setting to support the family, young person and carer to prevent them becoming an inpatient.

 

·           If there was no provision for Tier 4 service in terms of hospital admission, as part of the CAMHS Transformation Plan, the aspiration would be that a service be commissioned where there was a young person in crisis that allowed intense resources to go into the home setting to support the family, young person and carer to prevent them becoming an inpatient

 

·           The CCG’s strategy around Dementia, in an attempt to provide additional resources and resilience in Primary Care, was to commission a Primary Care Enhanced Service.  This would offer additional resources into Primary Care to both identify members of the public with Dementia and support them and their families in the community setting and alleviate the pressure in Secondary Care in terms of waiting time.  It would  bring its own challenges in terms of Primary Care capacity and consistency but the CCG felt it was their responsibility and how they would look to take it forward

 

Councillor Parker had submitted a question in relation to the Yorkshire Ambulance Service regarding a recent experience.  Details of the incident would be forwarded to Ian and to YAS.

 

Scrutiny of health partners’ delivery of the action plans in response to CSE was discussed as the Improving Lives Select Commission was leading on scrutiny of CSE.

 

Resolved:-  (1)  That the proposed priorities for the refresh plan for 2015 be noted.

 

(2)  That the draft plan be circulated to the Select Commission for final comments in December, 2015.

 

(3)  That Councillors Ahmed, Rose and M. Vines, report back to the Select Commission on the work of the Improving Lives Select Commission in respect of CSE.