Annual General Meeting Thursday 27 September 2018 Welcome

Welcome Dr Caroline Dollery Chair

About NHS Mid Essex CCG We want everyone in mid Essex to Live Well We plan, buy and monitor most local NHS services. Bring together the 44 GP practices in mid Essex. Serve 392,000 people who live in Braintree District, Chelmsford City and Maldon District.

Caroline Rassell Accountable Officer Review of 2017/18 Caroline Rassell Accountable Officer Focus on next 12 months

Review of 2017/18 We said … We did… we would work closely with GPs to support them and help increase capacity Developed and delivered Primary Care Foundations programme based on feedback from GPs and practice staff. We have: invested £3.1m in primary care introduced clinical decision support tools for all practices implemented free public Wi-Fi for all practices improved IT systems including the ability for practices to text patients about appointments – trials in mid Essex have seen a 30% improvement in “did not attend” rates trained 83 staff (predominately receptionists) as care navigators across 38/44 practices brought 30 extra non-GP clinical staff to practices across mid Essex and 33 more – including pharmacists, paramedics and nurse practitioners – over the next few months Extended Access appointments across mid Essex from 1st Oct Work closely with GPs to support them and help increase capacity All practices were visited by the Director of Transformation, AO, Clinical Chair in the Autumn of 2017 to find out what problems each practice was facing and what the key things were that would make a difference to them. From their responses Primary Care Foundations was born. Primary Care Foundations is all about giving Primary Care the support and tools they need to become sustainable and build strong foundations to be able to build upon, broken down into 6 areas: Systems Digital Upskilling staff Workforce diversification Activating Primary Care Care navigation

Review of 2017/18 We said … We did… we would work to improve care of people living with dementia Commissioned a health and wellbeing service for people living with dementia and their families called the Dementia Intensive Support Service (DISS). It offers a “one-stop shop” for dementia care and people can refer themselves or loved ones without needing to contact a GP first. The DISS offers not only a crisis support for people living with dementia and their families but early intervention and physical health services too, all available by calling a single phone number.

Review of 2017/18 We said … We did… we would work to get patients “home first” after a hospital stay to support their recovery The CCG, along with its partners, has delivered the “Home First” model and now provides care for up to 20 patients at any one time across the whole of mid Essex, and across a mixture of domiciliary and enhanced nursing home beds. we would work to provide the best care possible for-end-of-life patients We have developed a framework that helps us to buy high-quality care at home for people in need of it very quickly, for example if they are at end of life to help them to Die Well Work to get patients “home first” after a hospital stay to support their recovery - Home First is a multidisciplinary team of experienced physiotherapists, occupational therapists, nurses and rehabilitation support workers who will work with our patients based on their individual needs, agree a personalised plan and rehabilitation goals and support for up to 28 days after a hospital stay. - We commissioned additional dedicated medical cover for the patients on the enhanced Nursing Home pathway through consultant cover and extra GP resource. Work to provide the best care possible for-end-of-life patients - Along with meeting an important need, the framework is also projected to save the local NHS about £75,000 compared to buying similar care without the framework in place.

Review of 2017/18 We said … We did… we would work with you, our patients, to help share our “Live Well” messages and promote self care We ran a Common Childhood Illnesses campaign. This included a series of clinically-led workshops for local parents offering guidance on how to identify children’s ailments and how to treat them at home. We received a Self Care Innovation Award for the this project. Helped to shape our strategic plans for commissioning by advocating patient voice on a multi-partner plan for a new health hub in Maldon and appointing patient representatives on our main Live Well committee. We engaged with more patient groups through involving them in our Patient Reference Group, an important channel for discussing our challenges and plans with our community representatives. Work to get patients “home first” after a hospital stay to support their recovery - Home First is a multidisciplinary team of experienced physiotherapists, occupational therapists, nurses and rehabilitation support workers who will work with our patients based on their individual needs, agree a personalised plan and rehabilitation goals and support for up to 28 days after a hospital stay. - We commissioned additional dedicated medical cover for the patients on the enhanced Nursing Home pathway through consultant cover and extra GP resource. Work to provide the best care possible for-end-of-life patients - Along with meeting an important need, the framework is also projected to save the local NHS about £75,000 compared to buying similar care without the framework in place.

Review of 2017/18 We said… We did… we would work with people to help share our “Live Well” messages and promote self care (continued) To support our staff personally to Live Well we launched three CCG-wide initiatives this year: 100 Days, 100 Ways – this saw staff sharing what they did to Live Well, with a different CCG employee holding the title of ‘Live Well Ambassador’ each day, sharing inspirational stories of what was important to them. Walk the World – staff were challenged to walk 25 million steps collectively over the 100 days. By the end of the challenge, staff tracked 58 million steps between them – enough to walk around the whole world. 100 Days in Mind – focusing on mental health and wellbeing. We have also overseen the training of a number of staff to be Mental Health First Aiders.

Other achievements 2017/18 We are rated by NHS England against equality and diversity goals to ensure everyone in our communities gets equal access to NHS care. We received our highest score to date this year, achieving 17 out of 18 outcomes. We delivered a cancer summit in November 2017 to share good practice in cancer diagnosis and care among mid Essex GP practices. The summit had the highest ever attendance with more than 250 GPs, nurses and administrative staff from across the patch. We maintained in 2017/18 the achievement from 2016/17 of avoiding inpatient grade 4 pressure ulcers (the most serious sort associated with breaches in recognised good practice) in all mid Essex acute and community wards. Second year we have achieved in-year surplus.

Mid and South Essex Sustainability and Transformation Partnership Caroline Rassell Lead Accountable Officer for Joint Committee Senior Responsible Officer – Mid and South Essex STP (Locality Health and Care) Focus on next 12 months

Working in partnership The five CCGs in mid and south Essex have created a team to concentrate on hospital and mental health commissioning – the STP joint commissioning team, and a Joint Committee so that decisions about these services need only be made once. We have: Agreed one plan and investment strategy for primary care Agreed one plan for hospital care Secured £118m of capital to support hospital changes Developed one plan for our buildings (estates strategy) Developed one workforce plan to support providers Work has commenced on one digital plan for our STP

Our year ahead Focus on prevention and Live Well Building stronger relationships with our districts and communities Developing and supporting our local practices to work together and to integrate other services Supporting the development of local Live Well hubs Continue to work with the Joint Commissioning Team to improve hospital and mental health access for our population

Quality and patient care Vivienne Barker Deputy Director of Nursing and Quality Focus on next 12 months

Achievements in quality 2017/18 Reduction in patient falls and in serious harm as a result of falls Lower incidence of more serious pressure ulcers Domiciliary Care Framework commenced Collaborative working by all partners to improve patient pathways, for example: End-of-life care Patient flow and discharge arrangements – integrated discharge team Increased support to Residential and Nursing Home care staff

Award winners Healthcare Transformation Awards 2018 – Improving Outcomes and Reducing Variation (rapid commissioning of high-quality end of life care)

Current ratings from the Care Quality Commission GOOD Provide Community Interest Company GOOD Essex Partnership University Trust GOOD Mid Essex Hospital Services NHS Trust http://www.cqc.org.uk

Patients who have shared their experiences Top Left – Eileen spoke about her experiences of the diabetes prevention programme Top Right – Jessica told us about the difficulties she encountered in arranging CHC funding for her mother Patricia Bottom – Margaret spoke about the end of life care given to her daughter Theresa and her experience of making a complaint about an NHS service

Quality focus 2018/19

Ruth Blake Deputy Chief Finance Officer Annual Accounts Ruth Blake Deputy Chief Finance Officer Focus on next 12 months

Funding Expenditure Historically below target formula funding 2017/18 – 1.85% below target funding (£8.4m) Even at target funding – less to spend per head than any other Essex CCG Expenditure £446m programme expenditure and £7.8m running costs

How your money was spent

Financial Duties Financial duty Our performance Contain capital expenditure within approved allocation £0k allocation £0k expenditure  Contain cash expenditure within allocation Achieved Contain management costs within approved allocation £7.8m expenditure £529k underspend Contain revenue expenditure within approved allocation (programme & running cost) £8.1m surplus in year – reduced cumulative £21.9m overspend from previous years to £13.8m x Clean audit opinion on the accounts, regularity of income and expenditure and value for money

What we have achieved Second year CCG has achieved in-year surplus Lowest expenditure per head in Essex Continued good performance in use of resources

Challenges ahead Managing increasing demand with low levels of funding and funding growth Short timescale from NHS England for fully repaying the accumulated deficit – £6m surplus required 2018/19 System-wide working to redesign services and build sustainability

Any questions?

Presentation of Mid Essex CCG Annual Report and Accounts Focus on next 12 months Dr Caroline Dollery Chair of Mid Essex CCG