1. Merton CCG Annual General Meeting 24 September 2015

2. Agenda Welcome and Chair’s Introduction The Annual Report Our accounts The challenges ahead Questions Mental health in Merton Questions 2 AGM slides 24 September 2015

3. Introduction Dr Andrew Murray, Chair

4. The Annual Report Adam Doyle, Chief Officer

5. Who we are We are: a GP-led membership organisation responsible for planning, buying and monitoring local health services Our GP practices work in partnership with hospitals, community services, mental health services, pharmacists and dentists, Merton Council and our local community 5 AGM slides 24 September 2015

6. Merton’s Health Need Merton’s population expected to increase by over 21% by 2021 We have an increasing and high birth rate and at the same time an aging population Levels of deprivation are much higher in wards in East Merton than West Merton Our population is increasingly diverse with BAME rising to 39% by 2017 6 AGM slides 24 September 2015

7. Our aims in 2014-15 To improve the health outcomes for the people of Merton by buying services tailored to their needs while addressing the diverse health needs of our population Everyone in Merton should be able to receive the care they need, at the right time, in the right place and from the right health care professionals, bringing the right outcomes 7 AGM slides 24 September 2015

8. How we operate We have strong clinical input via the work of our localities, our Practice Leads Forum, the Practice Nurse Forum and our Clinical Reference Group (CRG) We have in place a strong executive leadership team We work in partnership with Merton Council and Healthwatch 8 AGM slides 24 September 2015

9. Our structure 9 AGM slides 24 September 2015

10. Delivering Our Priorities We agreed a set of priorities for 2014-15 which we believed would make a real difference to the quality of care in Merton Many of these initiatives aimed to tackle the most common diseases which affect local people and their quality of life 10 AGM slides 24 September 2015

11. Older Adults Expanded the community prevention of admission team (CPAT) Developed a new tool to support homes in identifying the best service Provided ‘in-reach’ nursing at St. George’s Hospital to support patient discharge Launched the Dementia Hub Developed a falls prevention pathway 11 AGM slides 24 September 2015

12. Children and Maternity Target time achieved for the provision of initial health assessments for children looked after away from home Review for children with complex health needs commissioned from the Royal College of Paediatrics and Child Health Maternity Clinical Network created to review and improve maternity services 12 AGM slides 24 September 2015

13. Mental Health and Learning Disabilities Mental Health Needs Assessment (HNA) commissioned The Improving Access to Psychological Therapies (IAPT) programme re-procured New complex depression and anxiety service launched to improve service provision 13 AGM slides 24 September 2015

14. Engagement Established the Merton Better Healthcare Closer to Home group Worked with Healthwatch, the public and patients to ensure local people have a voice in everything we do Greater use of digital and social media Ran Engage Merton and Mitcham Carnival ‘health hub’ 14 AGM slides 24 September 2015

15. Keeping Healthy and Well Developed a joint weight management pathway and GP pilot in the more deprived areas of Merton Merton CCG and East Merton GP locality group began to develop a Model of Care for East Merton 15 AGM slides 24 September 2015

16. Early Detection Increased provision of cardiac rehabilitation - in particular targeting hard-to-reach groups Clinical health coaching telephone service pilot launched for patients with chronic obstructive pulmonary disease Macmillan GP recruited Invested in enhanced musculoskeletal service 16 AGM slides 24 September 2015

17. Urgent Care Urgent Care Centres incorporated into A&E departments at St. Helier and St. George’s Hospitals - ensured appropriate assessment and reduced pressure on A&E departments ‘Not Always A&E’ communication campaign helped raise awareness of the range of services available to local residents in addition to A&E 17 AGM slides 24 September 2015

18. Planned Care Opened the state of the art Nelson Centre on 1 April 2015, allowing patients to be diagnosed and treated closer to home 18

19. The Nelson Health Centre Community services well utilised Diagnostics working well Patient numbers are increasing steadily month on month Waiting times for many services are very short The pharmacy service opened this week 19 AGM slides 24 September 2015

20. New Health Centre for Mitcham Wilson Hospital site agreed as the preferred location Approval request submitted this month to NHS Property Committee to proceed Engagement with local people and groups begins in November Site and facility design to begin November/December 20 AGM slides 24 September 2015

21. Our performance 2014-15

22. 2014-15 Performance Merton achieved the following key performance targets helping to get people seen, diagnosed and treated – often more quickly: Diagnostics Cancer 2 weeks / Cancer 31 days IAPT (Improving Access to Psychological Treatment) Diagnosis rates for dementia 22 AGM slides 24 September 2015

23. 2014-15 Performance Targets not achieved: A&E 4hr waiting time (93.6%) - St Georges (92.4%) Kingston (94.4%). Lack of beds/staff Cancer 62 day wait (83.8%) – still ranked 8th of 32 London CCGs Ambulance red response times – not achieved across London, significant investment in 2015-16 from CCGs 23 AGM slides 24 September 2015

24. A&E 24 AGM slides 24 September 2015

25. Diagnostics 25 AGM slides 24 September 2015

26. Cancer – Two week wait 26

27. Cancer – 31 days 27 AGM slides 24 September 2015

28. Cancer – 62 days 28 AGM slides 24 September 2015

29. Cancer – 62 days screening 29 AGM slides 24 September 2015

30. Improving Access to Psychological Therapies 30 AGM slides 24 September 2015

31. Dementia 31 AGM slides 24 September 2015

32. Our Accounts Cynthia Cardozo, Chief Finance Officer

33. 2014/15 Financial allocation We were given £208m (c.£940 per head of population) 4.92% increase from 13/14, 7.67% below target A running cost allocation of £5m In-year extra funding of £4.7m (incl. 13/14 carry forward surplus of £2.1m and £1.1m for winter resilience) This created a total allocation of £218m 33 AGM slides 24 September 2015

34. 2014/15 Financial requirements We achieved: A surplus of £2.7m (1.2% of resource allocation) against the budget of £218m Met our running cost target of £5m Achieved the Better Payment Practice Code - 97% in terms of invoices and 99% in terms of invoice value (Target 95%) Met the target for Capital expenditure (£0.8m) 34 AGM slides 24 September 2015

35. How we spent our money on NHS care 35 AGM slides 24 September 2015

36. Acute Activity Performance Acute spend of £128m (59%) covers detailed activity Overall activity has increased from 2013/14 Large increases in emergency and GP referred activity 36 AGM slides 24 September 2015

37. External Audit Conclusions The CCG fully met the relevant conditions and requirements on its 2014/15 annual accounts Specifically: Unqualified opinion on financial statements Unqualified regularity opinion Unqualified opinion on remuneration report No issues on value for money review 37 AGM slides 24 September 2015

38. 2015-16 and beyond: the challenges ahead Dr Andrew Murray Chair

39. Allocations for 2015-16 An 8% increase in programme cost allocation (£226m), to buy services for an estimated population of 226,559 This gives us £997 per head of population, however still 4.77% below target for our population A running cost allocation of £4.5m (reduction of £0.5m from 2014/15) 39 AGM slides 24 September 2015

40. Financial Plan for 2015-16 To deliver 1% surplus (£2.3m) Invest £11.3m in Better Care Fund Invest 8% more in Mental Health services to deliver parity of esteem Invest in capacity at St George’s Hospital FT deliver A&E four hours wait Deliver QIPP plans of £4.9m (2.1%) to offset growth in demand for services 24 September 2015 40 AGM slides

41. Priorities going forward Whole Merton Model: Engagement and communications Culture and workforce Technology Partnerships 41 AGM slides 24 September 2015

42. Priorities going forward Planned care – review of referrals Taking forward the Mitcham development Delegated commissioning Working with other CCGs on the South West London Collaborative Commissioning (SWLCC) on our five-year plan 42 AGM slides 24 September 2015

43. SWLCC – ‘The Issues Paper’ In June 2015, six south west London CCGs published an Issues Paper, summarising the challenges and emerging solutions set out in the strategy and putting forward questions for local people to respond to. You can read and respond to the Issues Paper online http://www.swlccgs.nhs.uk/issues-paper/ http://www.swlccgs.nhs.uk/issues-paper/ 43 AGM slides 24 September 2015

44. Any questions? 44 AGM slides 24 September 2015

45. Mental health services in Merton Dr Andrew Murray, Clinical Chair and Emma Gennard, Mental Health Commissioning

46. Our population Total CCG population in 14/15: 217,802 No. of GP practices: 26 (now 24) One in four adults will experience mental health problems One in six adults has a mental health problem at any given time 46 AGM slides 24 September 2015

47. Merton Community Mental Health Profile (2014) The profile for Merton looks at 3 areas; Mental Health and Illness, Treatment and Outcomes and then compares us with the rest of England using 26 indicators It helps us to understand better where we are doing well and if we need to review something 47 AGM slides 24 September 2015

48. There are five indicators Merton has significantly lower figures than England across all five measures tested and compared to the rest of England This could indicate that depression and anxiety may be lower than other places Or could mean there is under-diagnosis and under-recording in general practice 48 Mental Health and Illness AGM slides 24 September 2015

49. Example: Depression Prevalence 49 Merton = 4.7 National=5.8 Category=Significantly Lower Recording people with depression AGM slides 24 September 2015

50. Key points on Mental Health and Illness We need to understand better the variation between GP practices This will help us make better decisions about what services are needed 50 AGM slides 24 September 2015

51. Treatment 51 There were 14 Indicators How does Merton compare? AGM slides 24 September 2015

52. Key Points on Treatment Where a patient has been diagnosed we are good at keeping a record of this We are ensuring carers are offered assessments Our patients spend less time in hospital and don’t use A&E for mental health We need to get better at ensuring people can access mental health services when needed 52 AGM slides 24 September 2015

53. Outcomes There were 7 indicators for outcomes How does Merton compare? 53 AGM slides 24 September 2015

54. Key Points on Outcomes We have more adults on CPA in settled accommodation than the England average We have lower emergency admissions for self harm and unintentional and deliberate harm (Good Home Treatment Teams) We need to help more people to recover during talking therapy treatment 54 AGM slides 24 September 2015

55. What the CCG buys In 14/15 we spent £20.6m on mental health services That money helped provide mental health services (clinical assessment and treatment) provided by: Talking Therapies (IAPT) Secondary Mental Health Services (SWLstG) Specialist Mental Health Services (SLAM) 55 AGM slides 24 September 2015

56. Mental health priorities 2014-15 We developed six aims to help us start to better meet the needs of our local population: Improve mental health and well-being Reduce rates of admission and re- admission Improving crisis services Integrating mental and physical health Improving quality of life Improving access to community services Improving access to community service AGM slides 24 September 2015

57. What did we do? Moved some specialist services locally Invested more money in talking therapy services and retendered the contract to help more prevent severe mental health problems Created a new local service for patients suffering complex depression and anxiety Developed a local crisis care concordat action plan AGM slides 24 September 2015

58. What did we achieve? We made progress against five out of the six aims –Improving mental health and well-being –Reduce rates of admission and re-admission –Improving crisis services –Improving quality of life –Improving access to community services We did not make good progress on integrating mental and physical health We still have a lot of work to do to make sure these aims are met across all our mental health services AGM slides 24 September 2015

59. Our priorities for 2015-16 Getting the new IAPT service up and running (begins 1 October) Creating a new Step Down service (ready to launch 1 April 2016) Making sure alcohol detoxification services are fully integrated and more local to Merton Getting a better understanding of patient/carer experience AGM slides 24 September 2015

60. Measuring our progress We have set some key performance indicators for all our priorities to make sure we make good progress We will work with the providers to ensure they are able to meet the performance we agreed We will report to our Executive Management Team on progress 60 AGM slides 24 September 2015

61. Where do we need to do more Establish the best way to work with patients, carers, mental health service providers and employers Work with patients, their families and carers to review services to help us make it work better Monitor and review the number of urgent admissions and re-admissions Develop more local support services for patients with long term conditions Offer more services via GP practices AGM slides 24 September 2015

62. Any questions on our mental health work? 62 AGM slides 24 September 2015

63. THANK YOU 63 AGM slides 24 September 2015