Working together for better health NHS Lewisham CCG Annual General Meeting 2015-16 15 September 2016

Table discussions on our plans for improving community based care Welcome Presentations Annual report and accounts for 2015-16 Q&A Transforming community based care Table discussions on our plans for improving community based care Closing remarks

Annual Report 2015/16 Full report available at www.lewishamccg.nhs.uk We produced our annual report on time and to comply with the national guidance. We have produced a summary annual review and copies are available today. If anyone would like to see the full copy they can view it on our website or speak to staff at the reception desk today.

Improving health and care Priority areas that we worked on Developmental Objectives: Establish Neighbourhood Care Networks Strong Primary Care delivering improved patient experience and outcomes, working within Neighbourhood Care Networks Core Objectives: Commission high quality care for all Ensure robust governance arrangements are in place Public engagement is intrinsic to all commissioning activities

How are we doing? Access Suspected cancer referrals to be seen within 2 weeks of referral: target 93% - actual 94.2% Patients treated within 18 weeks of referral to psychological therapies: target 95% - actual >95% Patients treated within 6 weeks of referral to psychological therapies: target 75% - actual >75% Psychological therapies accessed by the proportion of the population assessed to need them target 15% - actual >15% There is good news and bad news when it comes to targets relating to access. We did well in these areas.

How are we doing? Access Patients needing planned treatment within 18 weeks from referral target 92% - actual 91.6% Patients have diagnostic test within 6 weeks of referral target 99% - actual 98.96% Category A 999 calls result in ambulance arriving within 8 minutes target 75% - actual 68.19% Unfortunately our performance wasn’t as good in these areas. 1. Lewisham and Greenwich NHS Trust developed a plan for trauma, orthopaedics and ear, nose and throat 3. London Ambulance Service putting in place CQC actions including employing additional paramedics – performance against this target has improved in the first quarter of 2016/17.

How are we doing? Access Patients seen in A&E admitted or discharged within 4 hours target 95% - actual 89.8% Patients referred by a GP and diagnosed with cancer start treatment within 62 days target 85% - actual 78.1% Patients reaching recovery after psychological therapy target 50% - actual 44.49% We have worked with Lewisham and Greenwich NHS Trust and other partners to review how to improve Lewisham and Greenwich Trust NHS Trust have reviewed their cancer recovery plan to improve tracking and prioritisation and I am happy to report that their has been an improvement in this to 81.3% in the first quarter of 2016/17 but there is still some way to go. 3. We are working with our service providers to develop an integrated talking therapies pathway

How are we doing? Quality Improved diagnosis of dementia target 66.7% - actual 69.99% Increased vaccination rates: Pneumococcal Vaccine: 72.6% of over 65s - the highest across London Flu immunisation in over 65s: 68% of patients (above the London average) Flu immunisation in under 65s at risk: 44.3% of patients (above the London average) Flu immunisation in pregnant women: 43.6% (5% more than the London average and 5th highest in London) 1. The Health Innovation Network’s ‘DeAR-GP- Tool’ (Dementia Case Finding Tool for Care- and Nursing Homes) was introduced to all care- and nursing homes in Lewisham during the year. Care homes and managers trained and new tools developed for diagnosis.

How are we doing? Quality Redesigning fall prevention and management services and working towards implementing a community falls team and physical activity exercise programme Enhancing enablement services to maintain independence, to reduce unplanned emergency admissions and to reduce lengths of stay in hospital Improving core general practice access (including progress towards 8am to 8pm, seven days a week) Designing a new diabetes service that will reduce admissions and complications and improve life expectancy

NHS England rating Requires improvement: Planning Performance Good: Well led Delegated functions Financial management

Annual Accounts and Financial Review 2015/16

Summary Lewisham CCG achieved all of its financial duties under the NHS Act 2006 (as amended).

Financial performance targets - Statutory Measure Target Outcome Duty achieved? Expenditure not to exceed income £412,378k £405,010k Yes Capital resource use does not exceed the amount specified in Directions £0 Revenue resource use does not exceed the amount specified in Directions £409,860k £402,217k Revenue administration resource use does not exceed the amount specified in Directions (RCA) £6,881k £6,141k

Financial performance targets - Other Measure Target Outcome achieved? Deliver agreed surplus against budget against a revenue resource limit of £390,975k £7,600k £7,663k Yes Make prompt payments within expectations of the Better Practice payments Code (within 30 days of receipt of valid invoice) 95% 97.2% Cash spending not to exceed maximum cash drawdown limit £402,792k £402,808k Cash balance at year end < 1.25% of March cash drawdown £417k £116k

Independent auditors opinion The annual accounts have been audited by Grant Thornton LLP (External Auditors) Audit Opinion Opinion Issued Financial statements present a true and fair view Unqualified opinion issued Regularity of the financial statements

Expenditure by Category

Annual Accounts and Financial Review 2015/16

Summary Lewisham CCG achieved all of its financial duties under the NHS Act 2006 (as amended).

Financial performance targets - Statutory Measure Target Outcome Duty achieved? Expenditure not to exceed income £412,378k £405,010k Yes Capital resource use does not exceed the amount specified in Directions £0 Revenue resource use does not exceed the amount specified in Directions £409,860k £402,217k Revenue administration resource use does not exceed the amount specified in Directions (RCA) £6,881k £6,141k

Financial performance targets - Other Measure Target Outcome achieved? Deliver agreed surplus £7,600k £7,643k Yes Make prompt payments within expectations of the Better Practice payments Code (within 30 days of receipt of valid invoice) 95% 97.2% Cash spending not to exceed maximum cash drawdown limit £402,792k £402,808k Cash balance at year end < 1.25% of March cash drawdown £417k £116k

Independent auditors opinion The annual accounts have been audited by Grant Thornton LLP (External Auditors) Audit Opinion Opinion Issued Financial statements present a true and fair view Unqualified opinion issued Regularity of the financial statements

Expenditure by Category

Questions from the floor We produced our annual report on time and to comply with the national guidance. We have produced a summary annual review and copies are available today. If anyone would like to see the full copy they can view it on our website or speak to staff at the reception desk today.

Transforming community based care Dr Marc Rowland Chair, Lewisham CCG 15/11/2018

The perfect storm The perfect storm is on the horizon. If we don’t change how we do things the situation is going to get much worse. We are not in the storm yet but if we get things badly wrong in the next few years we will lose local control.

The affordability challenge Revenue/expenditure (£millions) Demand for care is increasing, both in numbers and complexity, particularly for urgent and emergency care The cost of delivering health and care services is increasing Many people are going to Accident and Emergency departments unnecessarily People are frequently admitted to hospital when this is not clinically justified because of a lack of alternative community based options Some health and care problems are not detected early enough and there is not proactive early intervention which would improve the person’s health and care outcomes and reduce cost of care

Life expectancy (years) 75.1 81.1 78.0 82.3 This slide is quite staggering as it shows a variance of 5 years in men and more than 5 years in women in terms of life expectancy in New Cross and Crofton Park wards. Too many people die early in Lewisham: Life expectancy lower than average in England. Main causes of death: 28.3% cancer 28.1% circulatory disease 13.8% respiratory disease 9% dementia Many of these deaths could have been prevented by healthier lifestyles - 80% of heart disease, stroke and type 2 diabetes and 40% of cancers could be avoided if people looked after themselves better: unhealthy diet physical inactivity tobacco use excess alcohol and drug use Too many people live with poor physical and mental health: 29% have 1 long term condition – such as diabetes, high blood pressure and mental illness Over 50% of over 75s likely to have two or more long term conditions 44% of people do not feel supported to manage their long term condition 20% of people living in the community and 40% of older people living in care homes are affected by depression New Cross Crofton Park New Cross Crofton Park

Public feedback Support and care in the community is not always delivered in the most effective or integrated way. The most common problems are: Experience and quality of care is variable Access to services can be confusing and difficult Care received is fragmented and not coordinated, resulting in duplication and confusion Suitable info or advice to keep fit and healthy can be hard to find

What is community based care? Advice, support and care provided outside a traditional hospital setting: Includes physical and mental health services provided by: GPs Social workers Pharmacists Opticians NHS and local authority services Voluntary and community sector Other organisations (eg care homes) North Central South East South West Community based care is joined up care that is preventative, high quality and efficient where: the majority of health and care services are accessed outside the hospital in neighbourhoods: health and care services are coordinated around the person people, and their families and carers, have a stronger network of support within their local communities to help them proactively maintain their health, wellbeing and independence. We are developing community based care in four neighbourhood areas in Lewisham. We are developing neighbourhood care networks to strengthen connections and links between those providing community based care. 15/11/2018

Community based care Outcomes and equality Value for money and sustainability Quality and patient experience To put this into practice we will be transforming the way in which community based care is delivered so that people can access proactive and coordinated advice, support and care, which is: Accessible to all – eg clear ways of accessing enhanced and urgent care when needed; improved access to community health services through children’s centres and health visiting Proactive and preventative – eg people able to easily find information and advice, and local activities and opportunities to manage their own health and care needs more effectively; working alongside voluntary sector organisations to build resilient communities Coordinated – eg people receive personalised care and support, closer to home, which integrates physical and mental health and adult social care services, to help them to live independently for as long as possible To conclude, we are doing this to ensure that we navigate around the perfect storm by commissioning affordable local services which look after the vulnerable better, addressing inequalities where patients have a good experience.

We all need to do our bit!

Table discussions 15/11/2018

Summary of early findings and closing remarks Dr Marc Rowland Chair, Lewisham CCG 15/11/2018

Thank you 15/11/2018