West Essex Clinical Commissioning Group Annual General Meeting 28th September 2017

CCG Performance: Secondary Care

CCG Performance: Other Key Measures

2016/17 Assurance Rating West Essex CCG Rating 2016/17: “Good” Improved rating 2015/16: “Requires Improvement” Methodology CCGs are assessed against 60 indicators within the national Improvement & Assessment Framework Indicators span 29 policy areas covering performance, delivery, outcomes, finance and leadership All indicators are rated and weighted to give each CCG a final aggregate score of between 0 and 2 CCGs are then banded: 1.45 – 2 Outstanding 1 – 1.44 Good Below 1 Requires Improvement NHSE assessed Inadequate

Improvements in 2016/17 The headline assurance rating for West Essex CCG in 2015/16 was “Requires Improvement”. This headline rating was driven by three specific elements: Well Led: At the time of the 2015/16 assessment the CCG did not have a substantive Chief Officer following the departure of Clare Morris, although an interim was in place. This is no longer the case and Deborah Fielding has been in post since Autumn 2016 Finance: Although the CCG achieved its control total in 2015/16, it was assessed as requires improvement as it implemented and delivered a financial recovery plan in year. The CCG has again achieved its control total in 2016/17, but did not require a recovery plan Performance: In 2015/16 the CCG was not achieving the key national constitutional targets for A&E 4 Hour Standard, 18 Week RTT and Cancer 62 Day Standard. The RTT and Cancer Standards are now being achieved on a consistent basis, although A&E remains a challenge.

Buckhurst Hill & Chigwell 25k The Neighbourhoods 306k North Uttlesford 41k South Uttlesford 49k Epping & Ongar 42k Uttlesford 90k Harlow 96k Waltham Abbey 22k Loughton 33k Epping Forest 122k Localities Buckhurst Hill & Chigwell 25k West Essex Neighbourhoods Harlow North 38k Harlow - Central 23k Harlow South 35k Primary Care

Multi-disciplinary neighbourhood team Community Nursing Pharmacy Social Care Geriatrician Mental Health Voluntary Sector Health care assistant GP Care Plan & enabling self care Primary Care

Primary Care

The STP for Hertfordshire and west Essex is called ‘A Healthier Future’ Background Draws on the national vision for the NHS – The Five Year Forward View – published in 2014 Serves to – Promote well-being Provide equal access to high-quality care Prevent ill-health Work ‘hand-in-hand’ with patients, carers and citizens Sustain affordability Healthier Future - STP

The Challenges we face Healthier Future - STP

Children’s and Family Services The past 'system' in west Essex Community Health Provider Community Health Provider Primary Care Family Nurse Partnership Community Health Provider School Nursing (5-19) Acute Trust: Maternity Health Visiting service (0-5 HCP) Social care Child and Family Wellbeing Service 3rd Sector Schools Children’s Centres

We co-developed Our New System Vision Child and Family Wellbeing Service

Commissioners want Virgin Care and Barnardo’s to create an integrated service that will: Provide a more flexible support model for families and children throughout childhood, by freeing up staff currently tied to Children Centre buildings Retain a 50 hour/week Family Hub (registered Children’s Centre) in each of the 12 Essex Districts Create 26 Family Hub delivery sites, and a network of outreach sites taking services to where parents/ families actually need them Create an integrated Pre-Birth to 19 workforce galvanised around a common set of outcomes, as articulated in the Our System Vision Reduce the pressures on expensive, acute/ crisis intervention services & systems such as Accident and Emergency, GP services and Children’s Social Care Retain universal services such as health visitors, but with real focus on families at greatest risk of not achieving desired outcomes Improve support to those in greatest need with significant focus on early intervention, and re-distribute resources across the County to the areas of greatest deprivation Invest to build stong, resiliant families who are able to identify when things need addressing and have the skills and confidence to find solutions or ask for help Harness and support families and communities to develop their own support activities through the community building work of the voluntary sector in Essex Child and Family Wellbeing Service

Emotional Wellbeing & Mental Health Service for Children & Young People Service Transformation Agile Working model for Staff Removal of Tiers & re-modelling of Care Pathways User Engagement for a co-designed model CYPIAPT & Outcome Measuring A Single Point to Access Service Improved Access for CYP & Families Schools Engagement & Training provision across Essex Digital Innovation & Development Open Access Across Southend, Essex & Thurrock Emotional Wellbeing & Mental Health Service for Children & Young People

Achievements Statistics Referrers seeking advice will be contacted within 24 hours of the initial request Referrals are prioritised according to the presenting clinical need All assessments will take place within 18 weeks Treatment will start within 18 weeks Dedicated Eating Disorders service Statistics 13,066 total referrals received from April 2016 to June 2017 Current Caseload 5866 CYP More CYP are accessing Mental Health Support than before Service Transformation 30% of referrals are currently sign-posted Emotional Wellbeing & Mental Health Service for Children & Young People Our Journey Continues

Mental Health Key Achievement 2016/17 The CCG rated GOOD on the CCG mental health assurance framework working to achieve excellence Achieved national standards for delivering mental health crisis and home treatment , two week referral to treatment in early intervention psychosis Achieved the national 15% access rate and 50 % recovery rates CCG was selected as a wave 1 early implementer for improving psychological conditions for long term conditions (IAPT LTC) Narrowly missed Dementia diagnosis target of 67% but performing above from April 2017 We will deliver from 17/18 working with multi-agency partners A model for an enhanced core 24 psychiatric liaison service at Princess Alexandra Hospital Roll out of Peri-natal mental health services across Essex Support people with mental health problems to return to work and deliver employment opportunities. Deliver parity and integration of mental health and physical health- piloting integrated services in local Neighbourhoods Delivering together - The Southend, Essex & Thurrock Mental Health and Wellbeing Strategy 2017-2021

Our Finances Successfully managed an annual allocation of £384.9 million, spending £377.3 million. This met our statutory duty to spend within our allocation Surplus achieved £7.6m (2% of resource) Achieved efficiency savings £8.7million against a target of £12.5 million (70% achievement) Pressures and complexity of 2016/2017 Financial challenges ahead Primary Care Delegated Commissioning

How we spent your money 2016-17

All Together, Better Care Developing an accountable care organisation in West Essex What have we achieved so far Reset the vision - ACO vision - " planning care around the person supporting their needs and enhancing their independence in the best place for them " Refocused system delivery structure through the ACO Delivery Board Aligned the key transformation priorities across the whole system and kicked off a system wide actuarial process which will provide the system with further clinical and financial evidence to drive further efficiencies and set the tone for our clinical transformation moving forward Engaged with all key stakeholders through a variety of forms i.e. healthy living events and an ACO video Challenged the system to work differently and together in terms of financial challenges and moving towards one control total Encouraged innovation and different ways of working through service development workshops and launching new ways of working Shaped the landscape for the next 12 months through the development of a clear delivery pipeline for the ACP for organisational boards to follow ACO

Key areas of priority moving forward Launch procurement process in November Revised system wide communications strategy to be launched in October Use the outcomes from the actuarial study to reshape the priorities of the system and ensure the transformation programme is moved forward at pace Launch workforce development strategy in October Redesign the out of hospital model of care for launch in 2018/19 Become an NHS England Phase 2 Pathfinder Move towards one system financial control total Engage more directly with our public about the changes we are making ACP

Neighbourhood pilot services 17/18 Identify “rising risk” patients and provider proactive support (all neighbourhoods) Emergency Care Practitioner (Epping & Ongar & Uttlesford) GP capacity for extended appointments (North & South Harlow) Pooled nurse appointments (Central Harlow & Loughton) Starting August to November 2017

GP Forward View Focus on transformation and sustainability of primary care Investment Workforce Workload Infrastructure (IT and estates) Care re-design

GP Forward View Investments IT – My Care Record, patient info screens, GP mobile working, Wi-fi in GP practices (1st CCG with 100% connectivity) Estates – new GP practice facilities in Harlow, Saffron Walden, Waltham Abbey and Dunmow planned IT to support GP practice workload Continued investment in GP seven day service Neighbourhood pilot services IT to support GP practice workload eg document mgt, dictation

GP practice commissioning CCG took over responsibility from NHS England for GP Practice contracts from 1st April 2017 Responsible for contract management, quality, performance and finances (budget of £39m) Opportunity to have local control over the support and development of primary care

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