Annual Members Meeting 2018/19 Annual Report and Accounts

Insert image of the CCG team E.g. mandy at the governing board session took when we were rated outstanding aprox 16th July)

CCG Improvement and Assessment Framework (IAF)

NGCCG Performance in 2018/19

Challenges Poor Health: % children overweight or obese Consequences- Injuries from falls in older people Antimicrobial resistance: prescribing in primary care (Improving) Avoidable Emergency admissions Population use of hospital beds following emergency admission Services- Improving access to Psychological therapies – recovery Reliance on specialist inpatient care for people with LD/autism(Improving) Workforce Waiting times- Cancer Personal Helath budgets moved into highest performers Inequalities emergency admissions – lowest to mid

Annual Accounts 2018/19

Statutory Financial duties of a CCG CCG statutory financial duties: Ensure expenditure does not exceed the aggregate of the allocations for the financial year (breakeven duty) Take account of any directions issued by the NHS England in respect of specified types of resource use in a financial year, to ensure the amount specified by the NHS England is not exceeded Publish an explanation of CCG expenditure on quality Keep appropriate accounting records and publish annual accounts CCG financial obligations: To pay 95% of its creditors within 30 days Control totals set by NHS England

2018/19 Annual Accounts The CCG annual accounts were issued with unqualified audit opinions The annual accounts were formally approved by the Governing Body on 21st May, submitted to NHS England on 25th May and published on the CCG website on 14th June 2019

Meeting Financial Duties: breakeven The CCG met its duty to breakeven At the start of 2018/19, the CCG had an approved commissioning budget of £734.5m, a running costs allocation of £10.6m and a planned surplus of £10.2m. In addition the CCG received its delegated Primary Care Commissioning Budget at £68.4m, giving an overall in year funding envelope of £813.4m.

Meeting Financial Duties: breakeven At the year end, with additional allocations in-year, the CCG had a full resource allocation of £822.6m and a total expenditure of £822.4m, giving an in year surplus of £0.2m Added to the previous year surplus the cumulative surplus is £14.8m

Meeting Financial Duties Revenue resource limit 2018/19 £000 Total net operating cost for the financial year 822,392 Final revenue resource limit for year 822,606 Underspend against revenue resource limit 214

Meeting Financial Duties Public Sector Payment Policy: 95% undisputed creditors to be paid within 30 days – the CCG met this duty Better Payment Practice Code   2018/19 Number £000 Non-NHS creditors Total bills paid in the year 18,044 213,144 Total bills paid within target 17,605 211,021 Percentage of bills paid within target 97.57% 99.00% NHS creditors 3,397 523,454 3,336 522,412 98.20% 99.80%

How the money was spent

How the money was spent – by provider

How the money was spent – by expenditure

Looking ahead - finances 2019/20 marks the first year of the new NHS funding settlement. This is part of NHS England’s five-year funding settlement; averaging growth of 3.4% a year in real terms and reaching £20.5bn extra a year by 2023/24. Year one of the new settlement has produced an increase to the CCG’s core programme funding allocation of 5.28%, recognising the impact of national pay awards and significant changes to national tariff and funding flows for NHS providers.

Financial Risks & Challenges Continuing Health Care and high cost packages of care Pressures arising from demand for acute services Drug Costs Workforce and capacity Moving investment upstream Economics SUSTAINABILITY AND TRANSFORMATION PLAN

Living within our budget

QIPP achievement 18/19 The CCG achieved £23.4m of savings in18/19 against a plan of £22.2m.

QIPP achievement 18/19 by area

Demand Management

Year on Year Activity Variance 17/18 – 18/19 Outpatient First Attendances 1,428 up (0.8%) Outpatient Follow-up Attendances 13,240 down(3.0%) Outpatient Procedures 1,891 up (2.1%) Elective Inpatients 644 down(6.1%) Day Case Admissions 2,593 down (4.2%) A&E Attendances 14,206 up (6.1%) Non-Elective Admissions 1,898 up (2.9%)

Outstanding rating Top 15% of all CCGs A proactive approach to quality Collaborative work. Top 1/4 patient experience of Primary care access High quality care in primary care and acute settings

System working

People

Patients

Networks

Place (Local Authority)

A Place-Based Approach to Health, Wealth and Wellbeing in Newcastle The JEG focuses collectively on the challenges and opportunities within Newcastle and the requirement to deliver the Newcastle plan with supporting governance and capacity arrangements. The group have agreed to include wider public sector stakeholders e.g. the two Universities in major strategic work on health for wealth, maximising social value and local investment with organisational spending power. The Joint Executive Group (JEG) brings together CEOs of Newcastle City Council, Newcastle upon Tyne Hospitals NHS Foundation Trust, Northumberland Tyne and Wear NHS Foundation Trust and Newcastle Gateshead CCG. The JEG aims to: Maintain high level dialogue on health and social care Better align services and opportunities to coordinate or share resources Realign the cycle of inequality into a cycle of opportunity and achievement to significantly improve the health, wealth and wellbeing of those who live and work in the city

Joint Delivery Group A JDG work plan has been agreed, including nominated sponsors and leads aligned to the following areas:   Primary Care Networks Integrated care provision Integrated intermediate care service Healthy start Newcastle £ - including pooled budgets Digital Leadership development Workforce Secondary prevention The Joint Delivery Group (JDG) has the following membership :   The Newcastle upon Tyne Hospitals NHS FT (NuTH) Northumberland Tyne and Wear (NTW) Newcastle Gateshead CCG Newcastle GP services Newcastle City Council West End Family Health Bluestone Consortium Newcastle CVS

Health Foundation Trust Gateshead Health & Care System A Place based approach to Integrated Health & Care Collective and best use of Gateshead £ Primacy of Gateshead Place Planning as a System Newcastle Gateshead CCG Gateshead Local Authority Public Health Gateshead GP Federation/CBC/PC Networks NUTH NTW Priority areas: Children’s health & wellbeing Multiple & complex needs Frailty Transformation Programme – 10 areas The 3 priority areas plus: Community services Intermediate care Falls Deciding Together, DT (MH) Community Model - LD End of life care Gateshead Health Foundation Trust Blue Stone Consortium

Gateshead Health & Care System A Place based approach to Integrated Health & Care This Year, we…….. developed the ‘skeleton’ for the Gateshead System (agreed an MoU etc.) are developing relationships with ICP (North) and ICS, advocating the ‘primacy of place’. have developed an iterative Gateshead Plan and a ‘system lens’ focus on performance and quality. progressed work on our priority and transformation areas. are working on enablers to integration and the linking with work at bigger geographies – e.g. workforce, IT. progressed a population health approach and a focus on prevention. provided a ‘system’ response to various issues – budget proposals, emerging PC Networks, local consultation on air quality etc. developed our profile as a system. We are recognised externally as a good emerging system.

North Integrated Care Partnership (ICP) The North ICP is the largest of the four ICPs in the North East and North Cumbria ICS. The footprint covers a population of 1.025m with the following statutory organisations: 3 CCGs -NHS Northumberland CCG, NHS North Tyneside CCG and NHS Newcastle Gateshead CCG 3 NHS Foundation Trusts –Northumbria Healthcare NHS FT, The Newcastle upon Tyne Hospitals NHS FT and Gateshead Health NHS FT 4 Local Authorities –Northumberland County Council, North Tyneside Council, Newcastle County and Gateshead Council 1 Mental Health Trust –Northumberland Tyne and Wear NHS FT 1 Ambulance Trust -North East Ambulance Service NHS FT

North East and North Cumbria Integrated Care System (NENC ICS) Working collaboratively with partners an ICS Vision for health and care services has been jointly developed: To work with our communities and partners to tackle health inequalities and fundamentally shift health outcomes for the people of the North East and North Cumbria; and To ensure the sustainability, quality and effectiveness of our services by working together as an integrated system with mutual accountability for our shared challenges. For neighbourhood and place-based activity, CCGs, Primary Care Networks and Foundation Trusts will continue to work with Local Authority and Voluntary Sector partners, with a focus on delivering and enhancing integrated health and social care.

ICS priority work streams Population Health and Prevention – using Prevention Health Management techniques, deliver a systematic approach to tackling the biggest causes of premature death in NENC: cardiovascular disease, respiratory disease and cancer. Optimising Health Services – setting clinical standards, maintaining oversight on quality and coordinating initiatives across the ICS to find sustainability solutions for our health services under the greatest pressure. Digital Care – improving how we use Information & Technology Services to meet the needs of care providers, patients and the public, helping clinicians to share information and our patients to manage their healthcare.

ICS priority work streams Workforce Transformation – building a future workforce by getting supply and education right, becoming a great place to work and then valuing and supporting leadership at all levels. Mental Health - improving outcomes for people who experience poor mental health and breaking down barriers between physical and mental health services. Learning Disabilities – transforming care for people with learning disabilities and autism so that more people can live closer to home, or in the community, with the right support.

Looking Ahead

Looking ahead – challenges for the NHS Ageing population with increasing needs Health inequalities Levels of smoking, alcohol consumption and obesity high Over-reliance on hospital based services Increasing high cost drugs and cost of new medical technologies Limited growth in financial allocations in future

Patient challenges – cancer

Waiting List – All Providers Total Waiters March 2018 32,093 March 2019 39,693 Change Since March 2018 +23.7% Change Excl.T&O +10.1%

CCG Financial challenges