Annual General Meeting

Reflections on 2016-17 Dr David Supple Clinical Chair

Who we are and what we do We are responsible for improving the health and wellbeing of people living in Brighton and Hove We make sure everyone has access to high quality care across the city We are led by GPs, nurses and other healthcare professionals We plan and buy (“commission”) most of the healthcare services in the city This year we spent £366m and we have to ensure money is spent in the most effective way

Overview of 2016-17 Challenging first half of the year Given ‘Inadequate’ assurance rating by NHS England Resulted in legal directions by NHS England Significant changes and improvements have been made in second half of the year We have made real progress in many areas, particularly: Waiting times for treatment going down Improved access to urgent care

Overview of 2016-17 Governance Governance review Clinical structure We have worked with Brighton & Hove City Council to develop Caring Together Big step to improving health and care of the city Renewed focus on engagement Improved membership engagement Staff conference Big Health and Care Conversation

Overview of 2016-17 Federating general practice Working with our members to develop a ‘federation’ Working at scale to provide more resilience to practices and improved access to services for patients Co-commissioning CCG agreed to take over full ‘delegated co-commissioning’ from April 2017 Previously commissioned by NHS England We are now responsible for commissioning general medical services

Look back at 2016-17 Adam Doyle Accountable Officer

Our performance Improvements in national standards A&E waiting times Waiting times for treatment Diagnostic waiting times Treatment for cancer Financial stability Achieved a balance budget Improvements in organisational development Staff survey Membership engagement Governance

National standards A&E waiting times End of last year over 85% of patients seen and treated Significant improvements Waiting times for treatment Performing better than planned throughout 2016-17 Diagnostic waiting times Performance improved Achieved better than national standard at end of the year We are measured against a number of national standards, which are important in ensuring we deliver the best possible healthcare. More detail of these in the full Annual Report. We have struggled to meet some of these targets in the past, but this year we have made some real improvements, including:

National standards Treatment for cancer Performed well for patients seen by specialist within two weeks of referral Achieved national standard for patients seen in 31 days from decision to treat them Improvements needed to ensure patients seen within 62 days from urgent referral to first definitive treatment Mental health access Need to do more in services to Improving Access to Psychological Therapies (IAPT) Procured a new service which started this month

Local priorities Helping patients manage their own healthcare MyLife online directory – ‘one stop shop’ for information on conditions, services and support Supported pilot for social prescribing to help vulnerable patients Transforming primary care Delegated commissioning GP federation Locally commissioned services Alongside the progress we have made against national targets, we have also been made progress in the key local targets that we set ourselves for the year. These are set out in the full Annual Report but some of the achievements included:

Local priorities Improving mental health Trained GPs in managing patients with serious mental illness Provided emotional and mental health support to pupils in secondary schools Launched a mental health anti-stigma campaign called #IAMWHOLE. Integrating health and social care Improved services for homeless Better at identifying patients with chronic obstructive pulmonary disease (COPD)

Local priorities Developing care closer to home Integrated diabetes service Programme that identifies people at risk of developing diabetes Medicines management Better Care Pharmacists working with GPs to review medication of most vulnerable patients #HELPMYNHS campaign to raise public awareness of self-care

Our challenges - demand Increasing hospital admissions Increasing number of patients with complex needs Increasing demand on GPs Increasing number of patients in hospital are fit to go home Population is increasing 2003: 278,00 2024: 298,400 Across the country, demand on services is increasing. Nationally hospital admissions between 2003 and 2016 increased by 65%. The health and care needs of these patients has become more complex, which has added further pressure of services. Demand on our GPs is at unprecedented levels. Nationally last year we saw a record number of patients medically fit for discharge (6,200) , an increase of 22% in previous year alone. The population is going up – the population of Brighton and Hove in 2003 was 278,00 and is expected to rise to 298,400 by 2024

Our challenges - inequality Higher rates of children in care than the rest of England Higher rate of older people live alone compared to rest of England 500 extra deaths each year because of inequalities in Brighton and Hove Brighton and Hove does significantly worse than England on: Alcohol specific hospital stays Drug misuse Sexually transmitted infections Smoking related deaths

Our challenges - funding Nationally, the funding is not keeping up with the increasing demand We have to find ways to work more efficiently and effectively We have to look at getting best value for money in everything we do Finish with…on the subject of funding, here is our Chief Finance Officer Pippa to present the annual accounts. Full accounts are available in the Annual Report.

Annual Accounts 2016-17 Pippa Ross-Smith Chief Finance Officer

What we spend

Our finances Last year we spent £366m and we achieved a balanced budget Independent auditor’s opinion of financial statements: “In our opinion the financial statements give a true and fair view of the financial position of NHS Brighton and Hove CCG as at 31 March 2017 and of its net operating costs for the year then ended” “…have been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.”

Our finances We achieved all our NHSE mandated business rules The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later The target percentage to be achieved is 95 per cent, this has been reached The CCG has achieved all targets in 2016-17

Our finances We have to ensure we get value for money out of every penny we spend for our local population Next year is likely to be financially challenging for the CCG We have to look at the best way to deliver services with the funding available

Looking ahead to 2017-18 Dr David Supple Clinical Chair

Looking ahead: Caring Together New programme that builds on work that is already underway in the city to improve local health and social care Sets out how we can improve and transform: Adult and children’s services Physical and mental health Social care Public health GPs and pharmacies, Community, Voluntary sector Hospital services

Looking ahead: Caring Together Aims: Helping people to stay healthy Keeping people out of hospital Improving care after being referred Making it easier to see GPs when needed Preventing people ending up in A&E Treating mental health equally Giving children and families a better start Making better use of medicine Supports wider plans to transform health services across Sussex and East Surrey

Looking ahead: Engagement The ‘Big Health and Care Conversation’ Significant amount of engagement for the rest of 2017 Launch event on 4 July We will be going out to the public to get their experience and views on what matters to them in health and social care Feedback will help us shape and influence our plans for the future

Improving access to primary and urgent care Dr Tim McMinn GP Clinical Lead

Context Important part of Caring Together Currently have multiple options for accessing urgent care (111, Walk In Centre, A&E, out of hours GP, ambulance, GP extended hours) When one part fails – patients will go elsewhere Need to simplify and integrate services Patients need to be directed smoothly to most appropriate service with one call Information sharing

PATIENT 111 NHS 111 & Clinical Hub model 999 GENERAL PRACTICE INTERNET SELF CARE PHONE 111 DENTAL EMERGENCY DEPARTMENT 999 PHARMACY CLINICAL TRIAGE HEAR and TREAT PALLIATIVE CARE HUB MENTAL HEALTH HUB EXTENDED PRIMARY CARE SERVICES COMMUNITY HUB GENERAL PRACTICE IN HOURS OUT OF HOURS ROVING GP UCC WIC GP A&E OOH VISITING REG GP APPT or VISIT CLINICAL HUB

NHS 111 New service in place for April 2019 Commissioned across seven CCGs in South East Clinical triage and decision making within service Review of geographic options and clinical pathways Appropriate diversions Use of care plans/shared information Care Home Line Self care options

Clinical Navigation Hubs Conditions where: not 999 or self care (managed within 111) not dental, not repeat prescription not community/specialist pathway Sensitive to local services Local Care plans – Mental health, Palliative Care Single point of access for first contact with local clinicians Clinician triage and booking into appropriate services Community clinics, Ambulatory Care, Extended GP appointments

‘Front door’ of hospital Particular problems - 4 hour targets, increasing demand, increasing acuity, capacity in hospital, capacity in community services Increase in capacity in Urgent Care Centre £30m investment in short stay beds on Acute Floor Improved ‘front door’ assessment Primary Care Streaming

Extending primary care access Currently have multiple services providing Primary Care services Currently have different types of service, different workforce mix on different pay scales, different IT systems and communication Competition for same workforce Confusion for patients on where to go for what condition and when

Questions from the public?

Thank you