1. Working together for better health
NHS Lewisham CCG Annual General Meeting
15 September 2016

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

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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.

9. 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

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

11. Annual Accounts and Financial Review 2015/16

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

13. 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

14. 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

15. 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

16. Expenditure by Category

17. Annual Accounts and Financial Review 2015/16

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

19. 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

20. 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

21. 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

22. Expenditure by Category

23. 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.

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

25. 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.

26. 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

27. 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

28. 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

29. 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

30. 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.

31. We all need to do our bit!

33. Table discussions
15/11/2018

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

35. Thank you
15/11/2018