1. HOUNSLOW CCG HOUNSLOW COMMUNITY NETWORK PARTNERSHIP WORKING Sue Jeffers Managing Director 7 th October 2014

2. Clinical Commissioning Groups Clinical Commissioning Groups (CCGs) are the cornerstone of the new health system. Each of the 8,000 GP practices in England is now part of a CCG. Each CCG is a statutory NHS body with its own governance arrangements which vary according to its Constitution. Each CCG is responsible for meeting the health needs of its populations and their main focus is on local issues. They are accountable to their GP membership and NHS England. In 2013/14 CCGs were responsible for a budget of £65 billion, around 60 per cent of the total NHS budget.

3. Hounslow CCG came into being on 1 st April 2013. 54 practices, registered population 288,000 Council of Members Governing Body There are 9 GPs on the Governing Body Dr Nicola Burbidge, GP Chair Dr Paul Shenton, GP Vice-Chair 5 localities CCG has a £285m commissioning budget for 2014/15

4. Central London CCG 36 GP Practices 190,000 registered population Budget approximately £258m West London CCG 55 GP Practices 230,000 registered population Budget approximately £342m Hammersmith and Fulham CCG 31 GP Practices 190,000 registered population Budget approximately £256m Ealing CCG 79 GP Practices 339,000 registered population Budget approximately £408m Hounslow CCG 54 GP Practices 288,000 registered population Budget approximately £285m

5. Responsible for planning and buying (commissioning) local health services for Hounslow with a budget in 14/15 of £285million. Joint Commissioning Services we do commission: - Hospital Services (inpatient and outpatient clinics) - Mental Health services (community and hospital) - Community Services (diabetes, ophthalmology, dermatology, physio, community nurses, GP out of hours) Services we do not commission: Childhood Immunisations; Sexual Health; Health Screening; Specialist Cancer treatment; Dentists and Opticians; Community Pharmacy; Core GP services; very expensive treatments (heart attacks, renal transplant, etc.) HOUNSLOW Clinical Commissioning Group

6. 6 6 Where the money is spent : Main suppliers Contract Values 2014/15 Acute West Middlesex University Hospital = £86.4m Imperial College Hospital = £29.2m Ashford St Peters = £12.1m Mental Health West London Mental Health Trust = £20.9m Community Hounslow & Richmond Community Healthcare = £19.6m Hounslow & Richmond Community Healthcare Urgent care centre @ WMUH = £5.0m = 75% of CCG acute spend = 73% of CCG MH spend = 75% of CCG community spend The CCG has 150+ healthcare suppliers but the market is dominated by a handful of large NHS organisations

7. Service reconfigurationWhole Systems Integrated Care Primary Care Transformation More health services available out of hospital, in settings closer to patients’ homes seven days a week. Patients with complex needs receive high quality multi-disciplinary care close to home, with a named GP acting as care co-ordinator. Patient Urgent appointments Care delivery teams and time for care plans Community hubs Convenient appointments Continuity appointments Access via range of channels GP as lead for patient care Local Authority and Social Care involvement Information systems and record sharing Capitated budgets More local diagnostic equipment More specialised hospital care Acute reconfiguration Less inappropriate time in hospital Assistive technology Carer Community support Family Patient’s own GP practice Supported to self manage and held together by resilience Groups of accountable care providers Patients have access to General Practice services at times, locations and via channels that suit them seven days a week.

8. Hounslow Whole Systems Vision Hounslow commissioners and providers have been developing an integrated care model since 2012 and now has in place strategies and programmes delivering integrated care to its residents. Our vision for whole system integrated care is based on what patients and carers tell us is most important to them – a seamless service to patients and carers, delivering person-centred care. To deliver Whose Systems integrated care will mean significant change across the whole of our current health and care provider landscape, and perhaps for voluntary and social organisations too. Whole Systems is the catalyst and enabler for this change. We must take this opportunity. If we can get it right, we know it will transform the daily lives of many of our residents.

9. Whole Systems Integrated Care vision of a Model of Care

10. Better Care Fund - £16.8 million The Better Care Fund will be used to develop integrated working through: 1. Co-ordinating care around individuals using a proactive and joined up case management approach 2. Improving outcomes for the individual, carer and local community 3. Improving the experience of care for patients, service users and their carers 4. Maximising independence, avoiding hospital admissions and use of nursing/care homes 5. Developing preventative services to support people to stay well and healthy for longer / Prevention Strategy

11. Areas for focus: THE BIG HEALTH ISSUES Children and Young People Long term conditions Mental health Dementia Cancer End of Life care

12. Children and Young People Better communication and earlier intervention Paediatric Hubs – specialist care closer to home Access to Occupational Health & Mental health services Improve access to leisure centres Translation service Children and Families Bill (Sept 2014) Invested in perinatal mental health and promoting breast feeding New Developments: - Review of children continence service - Re-commissioning children asthma nurse in the community in 15/16 - Roll out of children hubs - New Children and Adolescent Mental Health Service out of hospital service Integrated working with all children services (schools, LBH children service, public health)

13. Long Term Conditions Care Navigators based in localities Better communication Self Help: directory of self help groups, support for those with disabilities (inc benefit advice, help filling forms) Services need to be more community led (e.g. home base physiotherapy) Reduce fees for local facilities, especially for unemployed Psychological support and input Provide information for children moving into adulthood (transition) More Rehabilitation beds Increase preventive services New services to be provided through Whole Systems Integrated Care, Community Recovery Service and Diabetes Intermediate Services Scoping use of Telehealth technology New Developments: Whole Systems Integrated Care

14. Mental Health Mental Health Facilitator for Carers Groups Counselling Services (Improving Access to Psychological Services) Primary Mental Health Service ( Primary Care Plus) Developing urgent care (in-hours extended, home assessment) New Development: Brentford and Isleworth Whole Systems for Long Term Mental Health Needs - Early Intervention - Physical and Mental Health

15. Dementia Crisis Service from August 2014 : Duty clinical System (9am-5pm), Speedier diagnosis – MRI, Mapping Dementia Care Pathway New Developments: - Agreement for locality dementia nurses -Dementia awareness: Dementia friendly Hounslow -Whole Systems Integrated Care

16. Cancer Patient Care Pathway – reduce waiting times Local facilities – care closer to home Better Training for GP’s Support to patients and Carers New Developments: - Discussing with Public Health ways to promote awareness - Working closer with the Mulberry Centre - Screening

17. End of Life Care Better training for GP’s Misdiagnosis in primary care 'Co-ordinate my care' - Extending the Care Plan Specialist Palliative Care Services, District Nursing, Marie Curie Planned Nursing and Rapid Response, Integrated Community Response Service New Developments: Increasing Specialist Palliative Care provision between Secondary and Primary Care.

18. 1. RESOURCING : How could the voluntary sector work together to respond to joint commissioning? Through Helping people self-manage and provide care navigation working in partnership with voluntary, community and long-term conditions charitable groups Supporting our work on reablement and rehabilitation and prevention through an integrated Community Recovery model focused on short-term interventions and facilitating hospital discharge and avoiding admissions and promotes independence Supporting patients and families living with Dementia Increased use of assistive technology, including Telecare and Telehealth Specific proven early interventions e.g. falls prevention, housing related support Through promoting mobility and accessibility of community facilities (better transport services) Supporting Healthy living advice and self-management, e.g. exercise classes, dietary advice You have already responded: Systems Resilience Winter Pressure bids THE VOLUNTARY SECTOR INVOLVEMENT

19. 2.VOLUNTEERING : Hounslow Together emphasis on volunteering Dementia: Promote voluntary services to provide further help and training Prevention Strategy: Low level, practical services and support that enables people to continue to live in their own homes, e.g. Handy Van services, floating support, assisted shopping Reducing social isolation as loneliness and depression are recognised as major factors in the quality of life for people, particularly older people, good neighbourhood schemes Prevention Strategy: Situations where someone has a major life change and may need support to help them regain their independence, e.g. illness, bereavement Working in localities, for instance GPs receptionist-type work

20. 3.RIGHTS and RESPONSIBILITIES : To advocate on behalf of vulnerable people Integrated Dementia Services - ensure that we support people and their carers following diagnosis, improved pathways, early diagnosis, integrated working and dementia friendly communities To advocate on behalf of Mental Health BME users – culture and language may prevent use of services To support people with Dementia, Cancer and Mental illness, reducing the fear & stigma To advocate for people with Dementia: Service users have told us they want more say in care plans End of Life: To provide social support to patients and their families at end of life

21. 4. Signposting Using the Voluntary Sector reach Universal Information, Advice and Signposting - includes support to people to access low level support as well self funders, to help meet the statutory requirements of the Care Act and support the prevention agenda Dementia: Information pack & help recognising early signs Hounslow - dementia friendly Improve awareness and presentation Prevention Strategy: Access to Information, advice and signposting to community resources, so people are well informed, can help themselves and to support people who do not meet social care eligibility criteria, or who fund themselves, in finding services that can meet their needs. Hounslow Community Network Newsletter

22. LINKING WITH HOUNSLOW CCG: Through Website… www.hounslowccg.nhs.uk Through Contacting the CCG: Fiona Thomas on 020 8630 1000