1. NHS Horsham and Mid Sussex CCG Commissioning Plan Priorities 2015-16

2. www.5communitieswestsussex.nhs.uk Our population

3. www.5communitieswestsussex.nhs.uk Some figures 1,000,000 NHS consultations per day 10% 60-70% of activity is urgent care 40-60% urgent care is avoidable / ‘inappropriate’ 70% on >65 years old 75% on people with long- term conditions 60% of £ on urgent care 55-60% £ on hospitals Carers return approx £95M in Mid-Sussex (estimate) 60-70% of activity is urgent care 40-60% urgent care is avoidable / ‘inappropriate’ 70% on >65 years old 75% on people with long- term conditions 60% of £ on urgent care 55-60% £ on hospitals Carers return approx £95M in Mid-Sussex (estimate)

4. www.5communitieswestsussex.nhs.uk NHS HMS CCG – 2014 225,800 persons

5. www.5communitieswestsussex.nhs.uk NHS HMS CCG – 2019 233,400 persons

6. www.5communitieswestsussex.nhs.uk NHS HMS CCG – 2024 241,300 persons

7. www.5communitieswestsussex.nhs.uk NHS HMS CCG – 2029 248,300 persons

8. www.5communitieswestsussex.nhs.uk

9. CCG Priorities 1.Development of a wider and sustainable range of primary care services located in our communities (in GP practices and community hospitals as well as at home) 2.Join up the many services that a single patient may need so that, as far as possible, their care is delivered to them in a single package that ensures health and social care professionals work together and talk to each other regularly (a modern model of integrated care) 3.Timely access to appropriate urgent and emergency care, at any time 4.Improve non-emergency/planned care at our hospitals and enabling patients to access one-stop services and reduce repetitive attendance and therefore financial waste 5.Patient Participation and Empowerment Ensure patients / families are included in service design and change Patients will be supported to take decisions about their own care and promote self care 6.Help build specialised services located in specific centres of excellence Clinical priority areas Stroke and stroke preventionFrailty care – proactive, pre-crisis, crisis, recovery Early cancer diagnosis and treatment esp breast, lung (MdSx), colorectal Embedded mental health provision across all age groups and esp Tier 1 and 2 services Children’s acute care, complex children, SEND, complex familiesDementia and End of Life Care

10. www.5communitieswestsussex.nhs.uk What has already been achieved? Community Dermatology services Community Urology services Hearing services Musculoskeletal services Pro-active care teams x 6 Rapid Access Medical Unit Improvements in Continuing Care Assessment processes Think Family, Early Help Young peoples emotional needs services – piloting Street triage (mental health crises) Dementia crisis service, Admiral nursing, Memory Assessment Service and support Inreach services into care homes – GP practices, dementia team, community team Shared records / care plans – early phase Integrated discharge planning from hospital – first phase Initial roll-out of practice based care coordinators Financial stability – just about

11. www.5communitieswestsussex.nhs.uk Work in progress A range of service areas of concern – digestive diseases, ambulance response, cancer 62 day waits, stroke Single community teams (health and social care) around each town A more stable care home / domicillary care market Community frailty services Tailored health coaching and supporting people to look after their long-term conditions General practice infrastructure schemes (5 Communities Plan) and community hospitals Single point access to urgent service for professionals The ‘front door’ of urgent services for the public

12. www.5communitieswestsussex.nhs.uk Work in progress General practice capacity and access Step-down services, hospital-to-home Shared records – next phase Well-being services and community support More public involvement in service development End of Life Care services Community-based specialist-led longterm condition services (diabetes, respiratory, renal, cardiology) 7 day services ACE programme (early detection of cancers)

13. www.5communitieswestsussex.nhs.uk Major challenges 14/15 and 15/16 Major quality issues that have needed urgent attention Financial environment for both health and local authority Payment mechanisms do not align for different providers Integration great idea, but law has not caught up – e.g health and social care, information sharing Better care fund process NHS Structure and fragmented commissioning Large scale house building Obligation / opportunity to re-procure services Late guidance around key business functions – tariff, contracting Staff vacancies and turnover (CCG) and a mandated 10% reduction in management (running cost allowance) costs Significant vacancies and turnover across range of provider services

14. www.5communitieswestsussex.nhs.uk On the horizon 111 and GP Out-of-hours improvements and how they work with GP practices and A&E Single health and social community teams around each community Development of ‘integrated’ primary care centres in Horsham, Burgess Hill, East Grinstead, smaller scale re-development around Haywards Heath where a number of services can be located together to improve care Exploration of social impact bond investment to develop the care market in West Sussex More attention to wellbeing services already in the community and filling the gaps More attention to prevention services e.g. diabetes, falls and fractures, early emotional support

15. www.5communitieswestsussex.nhs.uk Community Assets Community geriatrician, social care, specialist nursing, children’s ‘MDT’ Integrated Care Team, community beds, Community Mental Health Team Community geriatrician, social care, specialist nursing, children’s ‘MDT’ Integrated Care Team, community beds, Community Mental Health Team Shared information / patient held record Workforce/ Education Proactive care MDTs Community Nursing Practice Nurses, GPs Proactive care MDTs Community Nursing Practice Nurses, GPs Individuals on GP Registered lists Therapies including talking therapies Integrated discharge Team Admissions Avoidance Team Social Care Nursing Midwifery Tailored Health Coaching Community ICaRDS ACUTE Money / payment mechanisms / Personal Health Budgets Partnership/ Alliance Community Assets Prevention and Wellbeing Tissue Viability Nurses Integrated Response Teams End of Life Care Residential & Nursing Care at Home Care Act Carers entitlement Advocacy Safeguarding Menu of care Wider Primary and Community Care at Scale Figure 2 of our plan outlined the model for community based integrated teams. Our discussions in the formulation of the Better Care Fund have helped us develop this further to reflect our proactive approach to the provision of health and social care and support in the community to be delivered in partnership through GP practices, integrated health and social care multi-disciplinary teams, community based health and social care services and co-located specialist services. BCF Objective: By 2019 we want to provide a health and social care system where information, advice and support, early interventions and proactive care and support, prevents or delays the deterioration of people’s long term conditions 31

16. www.5communitieswestsussex.nhs.uk Extra slides if time / for reference

17. www.5communitieswestsussex.nhs.uk NHSE Five Year Forward View CCG planning guidance and assurance to NHSE that plans align to 5YFV Radical upgrade in prevention and public health – children, workplace, sickness rates, FBB Personal health and social care budgets Carer support Better working with voluntary sector GPs-hospitals, physical-mental, health-social care, complexity-disease Multi-Speciality Community Providers, Primary-Acute Care Systems Urgent care design and role of smaller hospitals Maternity care and midwifery List-based care, increasing investment in 1ry care, more GPs in training

18. www.5communitieswestsussex.nhs.uk Health and Wellbeing Board During 2014-15 the Health and Wellbeing Board have refreshed and updated the Joint Strategic Needs Assessment (JSNA). This has identified three priority focus areas which have been developed and refined through a series of workshops with stakeholders. The identified areas and how the CCG will be contributing to these in 2015-16 are outlined below. Children 0 to 2 Normalising births Children & family Act / SEND Children’s community nursing & therapies Personal health Budgets Emotional health & wellbeing services including pre pregnancy services Joint commissioning of targeted family services Transition to adults Improve Urgent care pathways (Paediatric area in UTC) Primary Care Hubs Workforce WSCC Health and Wellbeing Board – Workforce project SCDT workforce development Working with Health Education Kent Surrey and Sussex to highlight the House of Care Model and the future changes both in ways of working (collaborative care planning, shared decision making, motivational styles, person centred care) and new models of working (Multi-Speciality MDTs). Wellbeing and Resilience Developing person centred care: Tailored health coaching HWB introduced to secondary care settings HWB Champions Primary Care Co-Ordinators project 12 Population Health Needs 4 Cross cutting all CCG programmes is the need to reduce health inequalities and this is built into the JSNA priorities and CCG outcomes aspirations on slides 10 and 11. The 2014 PHE Health profile 2014 shows a life expectancy gap of 5.5 years for men and 7.1 years for women in Horsham District. Crawley Borough area shows a wider gap for men at 7.9 years and for women 5.2 years.