Luton CCG Annual General Meeting September 30 th 2014 Dr Nina Pearson Chair 1

Welcome CCGs have a statutory obligation to publish an annual report and accounts and to present this in public Our first year of operation An opportunity to engage – we want your views Celebrate success Highlight the challenges facing the system The system needs to work together 2

Year 1 – the Four P’s PeoplePrioritiesPrevention Partnerships 3

Agenda What have we achieved in 2013/14? Financial challenges Looking forward – 5 Year Strategy Engaging with the public Q&A Have your say 4

What did we achieve in 2013/14? Dr Monica Alabi Assistant Clinical Chair Dr Nina Pearson Chair 5

Better Together Working together with system partners to drive the development of Better Care Teams Wrapping services around the needs of individual patients You told us that different services do not work together as they should Re-procurement of Services Adult Mental Health CAMHS Intermediate Care Community Services 6

End of Life Care Advance Care Planning Multidisciplinary Team Working People given the choice of where to die You told us that people approaching the end of their lives should be treated with dignity 7

You told us we need to improve access to psychological therapies IAPT We now have a full DH compliant service in place The first CCG in the region to successfully integrate counselling and IAPT Achieved our local priority target for outcomes 8

You told us you agree that prevention is better than cure Healthchecks Focused on practices in deprived areas that had previously under delivered We did not achieve our overall stretching target BUT Over 1,800 more healthchecks were delivered in 2013/14 compared to the previous year – more than double % of Eligible Population who have received a Healthcheck Luton 17.3% Bedfordshire 14.6% Cambs 11.9% Bucks 11.1% Herts10.9% 9

Cancer survival needs to be improved in Luton Early Detection of Cancer Peer Educator Programme GP Education Programme CCG MacMillan GP Funding to increase bowel cancer screening 10

You told us we need to improve access to GPs GP Access CCG Access Improvement Programme, supporting and mentoring practices to utilise best practice GP recruitment initiative Most recent survey demonstrated an improvement in Luton, other surrounding areas did not improve Remains a key focus for the CCG 11

Too many people go to A&E Mothers of young children told us that the system is confusing Urgent Care “Is A&E for Me?” “Meet and Greet” service cited nationally as best practice Mums Doc Paediatric Pathways Partnership working to deliver core standards 12

The Financial Challenge Carol Hill Chief Officer 13

2013/14 Financial Performance - 1 The CCG’s original allocation was £225.2m; However we finished the year with total expenditure of £230.5m, resulting in an overspend against Revenue Resource Limit of £5.3m. 14

2013/14 Financial Performance - 1 The main areas of over spend were: – Emergency admissions (particularly in the second half of the year) – A&E – where plan was set at 20% less than the previous year – Outpatient first & follow ups showed significant increase – Outpatient procedures – high levels of growth in particular procedures 15

Current Financial Position The CCG’s position has worsened and has been formally identified as being in financial recovery The CCG’s current forecast of a deficit position of £-6.9m could be higher based upon current activity trends A recovery plan has been put in place to drive short, medium and long term resolution 16

Recovery Focus Short Term Medium Term 17

Looking Forward – Five Year Strategy Dr Nina Pearson Chair 18

Luton has Significant Health Challenges Life expectancy gap driven by CVD, COPD and Cancer 12,000 children live in poverty High infant mortality Low rates of physical activity High levels of child and adult obesity 19

The Sustainability Challenge Demand Ageing Population Increasing prevalence of long-term conditions Increasing expectations Supply Increasing costs of care Reducing gains in productivity Constrained public resources 20

How will the system be different in 2019? Summary A Personal Plan An e-plan that is personalised and can be shared across the system Care co-ordinated by the GP One Multidisciplinary Team Multi-disciplinary teams that will include social workers, district nurses, hospital at home nurses, hospital consultants and home help Planning around the person will take account of both physical and mental health needs and mental health professionals will be an integral part of the multi-disciplinary team. A focus on Prevention Delivering a wellness programme rather than a focus on treating illness Early intervention driving improved outcomes and reduced need for specialist intervention Using the Evidence Well Accurately predicting risk of a crisis and putting in place appropriate services to prevent hospital admission Putting the right services in place appropriate to the evidence 21

Vision for services – progress through Better Together Programme Prevention (keeping people well) Early intervention Help at home Specialist and acute Prevention (keeping people well) Early intervention Help at home Specialist and acute Prevention (keeping people well) Early intervention Help at home Specialist and acute Current Balance of Services 1-2 Years Vision3-5 Years Vision Service model has high spend in specialist services Provision shifted towards community capability in the medium term Spend strategically aligned to a prevention / early intervention model 22

Five Year Ambition 1. Securing additional years of life 2. Health related QoL for people with LTCs 3. Reducing the amount of time spent avoidably in hospital 4. Increasing the proportion of older people living independe ntly 5. Positive experience of hospital care 6. Positive experience of out of hospital care 7. Eliminating avoidable deaths in hospital Five Year Improvement 19%6%12.5%TBC6%10%TBC Improved Outcomes 23

Summary of Key Programmes 24

Critical Success Factors One system with a common vision – Effective integration of services – Driving reduction in demand – Driving change in patient / public behaviour Improvement of primary care Successful mobilisation of new mental health and community services providers Engaging the community Delivering a fit for purpose workforce 25

Engaging with the Public Carol Hill Chief Officer 26

Listening to Luton Our goal is to achieve an authentic partnership with our patients and public People should have a voice in their care – Participation in decision making – Service design – Measuring and monitoring quality and safety 27

How have we listened? Patient Reference Group Clinical Board Member to champion the patient voice Lay Board member to lead our activities Active partners in Neighbourhood Governance Extensive dialogue through working groups to inform procurement “Is A&E for me”? Deliberative Events 28

How to get involved? Patient Reference Group Patient participation groups Board meetings held in public Area Board meetings 29

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Have Your Say Integration Planned Care Urgent Care 31

Feedback Session How are services currently performing? What changes do we need to make? Questions and comments on this evening’s presentations 32