NHS Harrogate and Rural District CCG Annual General Meeting . Annual General Meeting 20 September 2016

Welcome and Introductions Dr Alistair Ingram, Clinical Chair NHS Harrogate and Rural District Clinical Commissioning Group

This is your chance to hear about: Welcome This is your chance to hear about: Achievements and Performance Commissioning Challenges “What Matters to Us” 1. Hear about our achievements and performance over the past 12 months 2. Learn about the commissioning challenges we face over the coming months due to the very pressured financial position 3. Hear about proposed solutions and the progress of the “What Matters To Us?” programme 4. Ask questions

Welcome and Introductions Amanda Bloor, Chief Officer NHS Harrogate and Rural District Clinical Commissioning Group This is our annual report which we are required to produce and what we have to do at the AGM is to present our annual accounts, which Dilani will do. What I want to do is to highlight some key milestones from last year and give an overview of our future plans. We have printed a few copies, however in the interest of the environment, it’s available on our website. Additional copies are available on request – ask a member of CCG staff and we will post one to you.

Highlights of the Last Year Consistent delivery of high quality local services Delivered our in-year financial requirements ‘Outstanding’ award in our annual CCG Assurance Assessment Yorkshire and Humber Dementia Quality Award Implementing the “What Matters To Us?” new care models programme Measured against 6 domains: Etc etc 360 feedback Meet constitutional standards – A&E, treatment times, cancer etc Also improved YAS response times etc Money – statutory requirements – but challenging Changing the way services are delivered – based on feedback We will cover later – but we need to constantly monitor and evaluate to ensure its working

Highlights of the Last Year Continued focus on implementing our 6 strategic priorities Public Services Leadership Board CCG was highly commended at the Health Service Journal (HSJ) Awards in London The new Section 136 assessment suite opened at Harrogate District Hospital Selected to be one of 2 national sites working on Elective Care Vanguard Rapid Testing Programme. What are the priorities Urgent care, LTC, planned care, Health and wellbeing Vulnerable people, primary care Any achievements against them last year?? Mental health IAPT – improved acces these services 136 n0w open Staff survey - positive What do patients say – GP survey – positive GP survey

Communications and Engagement 346 HaRD Net Members 3555 Twitter Followers 4 Hot Topics: Dementia, Ophthalmology, Patient Decision Aids and Equality Delivery System 22 New Patient Advocates in Training ‘Open Space’ Event, 200 members of the public, voluntary sector organisations and providers Stand at the Nidderdale Show HDFT Showcase Open Event Elective Care Rapid Testing Event You Matter Most – continued conversations PCU engagement – Discover Programme Twitter stuff HaRD Net pieces of work New models stuff Other engagement Dementia event at pavilions – making Harrogate dementia friendly Governing body – patient stories Kate Allat – fighting strokes presentation We have worked really hard to establish our engagement network of local residents who care about the NHS, so we can gather views, through surveys, focus groups and conversations. We are keen to continue to seek views when ideas and developments are at a very early stage so that involvement can contribute to shaping of plans. We have two public events each year, which many of you have previously attended and its an opportunity to meet members of the CCG team face to face, hear about developments and give your views in person. We have continues with our Hot Topics survey, where members of HaRD Net have completed surveys based on their specific interests, this is proving to be of great value in obtaining feedback based on ongoing projects

Review of the Year and Look Forward Dilani Gamble, Chief Finance Officer NHS Harrogate and Rural District Clinical Commissioning Group This is our annual report which we are required to produce and what we have to do at the AGM is to present our annual accounts, which Dilani will do. What I want to do is to highlight some key milestones from last year and give an overview of our future plans. We have printed a few copies, however in the interest of the environment, it’s available on our website. Additional copies are available on request – ask a member of CCG staff and we will post one to you.

2015/16 Annual Accounts A full set of Accounts for 2015/16 is available within the CCGs Annual Report: Here at the AGM On our website www.harrogateandruraldistrictccg.nhs.uk Or by contacting us on 01423 799300

2015/16 – Financial Duties Any internal audits?

2015/16 – Financial Challenge Increased actual costs £11m (11.2%) Increased budget £7m (8%)

Looking Forward – Financial Challenge £28.8m gap £8.4m gap

Read All About It…

Read All About It…

Commissioning Challenge Challenging Local Financial Position – FACTS As the statutory health commissioner we have a fixed allocation and we have to manage within it The NHS is under extreme pressure across the country – HaRD has a significant challenge locally The CCG has to commission for the whole population Demand and public expectation continues to grow HaRD population use more planned hospital services than similar populations elsewhere Need to look at cost effective options to provide services needed CCGs have a number of statutory responsibilities: Improving health outcomes, reducing health inequalities and delivering financial balanced position. We focus on populations rather than individuals Healthy population and the funding is based on this. So we do receive less than Y&H average and England average – the allocation is based on NEED so we receive less because this population require less acute healthcare. We have less NEED, however we do have a growing demand – this is different. We also have a growing older population – all allocations are based on local demographic. We do not receive anything additional as we have an older population There are many other alternatives to A&E. All practices offer on the day triage and appointments. Many offer telephone consultations. Pharmacies can provide advice and medication for a number of minor ailments, with very good access Eg going to pharmacy for cold, cough etc rather than GP Buying some medicines OTC rather than on prescription

Commissioning Challenge We all need to have difficult conversations and make tough decisions in order to ensure we can continue to provide essential services for all our local population

This is what we are doing… New models of care – based on patient feedback Reviewing all areas of spend and contracts to ensure both quality and value for money Redesigning clinical pathways to streamline and reduce duplication Utilising national benchmarking and best practice commissioning guidelines CCG response to the commissioning challenges – one big piece of work is NCM CCG responsibilities to deliver within budget; We need to reduce variation across pathways, between practices and clinicians We are moving towards integrated commissioning in H&SC, working more closely with NYCC on local services

This is what we now need to do… Health and wellbeing strategy that includes referral pathways Reduction in follow ups – where there is evidence these are not necessary or adding any clinical value Using evidence based thresholds for treatment Review prescribing of ‘over the counter’ medicines Reduce waste in repeat prescriptions Prioritisation of spend in key areas Financial position requires further measures. We cant spend more than the allocation we have been given. £900,000 each year on over the counter medication We have to maximise value to ensure we can commission population wide services

Prevention is better than cure We know that 15% of HaRD population smoke We know that 66% of North yorkshire residents are overweight or obese (BMI over 25) We know that Get serious about obesity or bankrupt the NHS – Simon Stevens 2014 25% of adults are obese up from 15% 20 years ago. Obesity is one of the biggest causes of type 2 diabetes. Diabetes UK estimate that it already costs the NHS £9m a year PHE estimate that the cost of obesity to the UK NHS is £4.2bn a year.

Reducing waste releases money Reducing waste, duplication of services and variation is proven to reduce cost and also improve quality. We know from Rightcare and benchmarking we have significant opportunity to release funding spend in the wrong areas and use elsewhere

Q2.) the options available to reduce waste and spend in HaRD area Table Conversations Discuss on your tables: Q1) What more could the NHS and social care do to support people to have the confidence to take more control of their health and how best to manage it? Q2) The options available to reduce waste and spend in HaRD area We want you to have conversations on the tables around the commissioning challenges we face locally. By waste we mean appointments or medicines that add little value or examples of duplication of services We value your feedback and suggestions on areas where we can reduce waste and spend Each table has a GP member of the GB on the table and they can answer any questions and support the discussion on your tables Q1.) what more could the NHS and social care do to support people to have the confidence to take more control of their health and how best to manage it? Q2.) the options available to reduce waste and spend in HaRD area

Question and Answer Session

Thank You for Attending – Please Stay in Touch Sign up to HaRD Net and find other useful info on our website: www.harrogateandruraldistrictccg.nhs.uk Email us at: hardccg.enquiries@nhs.net Call us on: 01423 799300 @HaRD_CCG