1. ‘The right healthcare, for you, with you, near you’ Wiltshire Clinical Commissioning Group Stakeholder Event

2. ‘The right healthcare, for you, with you, near you’ Welcome Dr Peter Jenkins Chair

3. ‘The right healthcare, for you, with you, near you’ Agenda National Financial Picture The Task for Commissioners New Models of Care The Local Financial Picture The Local Solutions Question time with the panel Refreshments We need your help! Lunch

4. ‘The right healthcare, for you, with you, near you’ Deborah Fielding, Accountable Officer

5. ‘The right healthcare, for you, with you, near you’ Biggest financial squeeze in its history Budget ring-fenced but frozen at 2010 levels plus 1.7% growth Social Care and Public Health funding in local authorities squeezed 30 billion required to keep pace with growth by 2020 £2.2 billion to come from efficiencies 8 billion to come from treasury National Financial Picture

6. ‘The right healthcare, for you, with you, near you’ How do we achieve these efficiencies without effecting quality of care?

7. ‘The right healthcare, for you, with you, near you’ 1. More systematic and proactive management of chronic disease - improve health outcomes, reduce inappropriate use of hospital and impact on health inequalities 2. The empowerment of patients 3. Better integrated models of care 4. Population based approach to commissioning Commissioners need to drive the following

8. ‘The right healthcare, for you, with you, near you’ 1.More systematic and proactive management of chronic disease 1.Primary Care Based 2.Multidisciplinary Teams wrapped around patients 3.Early systematic identification 4.Patient led care plans based on outcomes

9. ‘The right healthcare, for you, with you, near you’ 2. The empowerment of patients Support for Self Management; Patient and carer education programmes Meds management advice and support Support for diet and exercise Use of telecare and telehealth Psychological interventions Telephone based health coaching Pain management Access to records

10. ‘The right healthcare, for you, with you, near you’ 3. Better Integrated models of care Five Year Forward View – New Models of Care 1.Multi-Speciality Community Provider (MCP) with population based (placed based) commissioning at its heart centred around General Practice. (Horizontal Integration) 2.Primary and acute Systems (PACS) Managed by Acute Sector includes primary care (Vertical Integration)

11. ‘The right healthcare, for you, with you, near you’ The Case for Outcome Based Commissioning Funding can be linked to activity (inputs), or achievement of targets (outputs). However, it can also be linked to outcomes for individuals and groups. The ultimate aim is to reward impact, but impact is usually the result of the work of many agencies – better quality of life may be influenced by health care, finance, education, environment etc. Inputs/activityOutputs/targetsOutcomes Number of patients treated for hypertension Mean blood pressure achieved Number of strokes prevented

12. ‘The right healthcare, for you, with you, near you’ Multi-year capitated contracts Place the individual centre stage with a comprehensive anticipatory care plan. Providers must have; 1.The ability to coordinate the care of individuals along pathways and across settings 2.The ability for population health management (can incentivize primary prevention)

13. ‘The right healthcare, for you, with you, near you’ The Financial Outlook for the Wiltshire Health Economy Simon Truelove Chief Finance Officer

14. ‘The right healthcare, for you, with you, near you’ Wiltshire CCG receives £540m for commissioning healthcare services for the population of Wiltshire. Does not include core contract for primary care, public health, specialist services and army personnel health. How much funding does WCCG receive

15. ‘The right healthcare, for you, with you, near you’ Set to overspend by £2.4m or 0.5% of its funding. We have to produce a Financial Recovery Plan (FRP) to improve the CCG’s position by £4.8m The CCG’s Financial Position for 15/16

16. ‘The right healthcare, for you, with you, near you’ What does the health system look like SFT £6m deficit GWH £14m deficit RUH £1m deficit AWP breakeven

17. ‘The right healthcare, for you, with you, near you’ How much money will we get in 2016/17 We are assuming a 1.7% growth on the 15/16 Baseline £9.7m

18. ‘The right healthcare, for you, with you, near you’ Impact of Growth £11.7m Impact of Inflation and National Insurance increases £18.7m What could our expenditure look like if we do not change

19. ‘The right healthcare, for you, with you, near you’ Income stopping, known cost pressures – ( £6.8m ) Re-create mandated 1.5% uncommitted reserves ( £8.3m ) What could our expenditure look like if we do not change

20. ‘The right healthcare, for you, with you, near you’ Efficiency will be set at 4% £17.7m What Efficiency will we require from our Providers

21. ‘The right healthcare, for you, with you, near you’ £m Total Funding to Wiltshire CCG 2016-17(560) Existing Expenditure & Reserves568 Anticipated Growth for 2016/1712 Inflation and National Insurance increases18 Provider Efficiency(17) Total Expected Expenditure and Reserves583 Recurrent Savings to be Found23 What does this add up to for 2016/17

22. ‘The right healthcare, for you, with you, near you’ This is before Provider Overspends Providers will have to deal with £18m of efficiency savings Deal with Underlying deficits Manage new costs in 2016/17

23. ‘The right healthcare, for you, with you, near you’ What is the Financial Gap The financial gap across the whole of the health economy could be in excess of £40m. – CCG Savings Requirement £23m – Provider Efficiency Requirement £18m – Historical Provider Deficits £???

24. ‘The right healthcare, for you, with you, near you’ What are we going to do? We cannot afford the levels of health intervention that we currently provide – we need a local debate on what should we stop / reduce We have to ensure the sustainability of the 3 acute hospitals through better efficiency and reducing the number of patients entering the acute system We can only do this by working together across the health system

25. ‘The right healthcare, for you, with you, near you’ Debbie Fielding Accountable Officer

26. ‘The right healthcare, for you, with you, near you’ The Local Solution Out of Hospital Care Emergency Dept. Admitted care/discharge Wiltshire CCG Co- commissione rs GP community Providers Our 2016/17 plan needs to address underlying system pressures. Our strategy has already set the direction of travel for the system System pressures can only be resolved through agreed integrated action across the whole care system Our plan will need to demonstrate financial balance and progress in implementing our strategy, which can be achieved through commissioning less acute activity and shifting care into out of hospital settings

27. ‘The right healthcare, for you, with you, near you’ Our four key themes for 2016/17 Managing down demand in both elective and emergency care Restricting growth and investment Changes to funding arrangements Internal cost reduction within the CCG and its support services Our 2016/17 planning will be grouped around four key themes We have formulated a structured programme to work with partners across the health system to: Develop plans that are aligned and with agreed outcomes Get buy in at an operational level Create joint delivery teams so we can actively support and contribute to implementation of more complex change projects The plans to manage down demand and restrict growth/investment will require difficult decisions and not be straightforward to agree with our system partners We will also need to make the right use of contractual levers to facilitate action acroiss the health system These themes will be managed at CCG level and are likely to require a lower level of external engagement. They will release a much lower level of cashable savings than the other two themes identified These will be the two key themes around which we will engage with Co- commissioners, our GP members and Providers. They should also release the greatest level of cashable savings to help us achieve our financial plans

28. ‘The right healthcare, for you, with you, near you’ Estates - exploit opportunities emerging from the One Wiltshire devolution proposal Workforce - progress with integrated workforce planning and improved leverage in Local Education Training Board (LETB) Acute Care – managing acute care bed capacity for the system Out of Hospital Care – a new provider of integrated community services to form the platform for further integration Seven Day Working - continued support with developments such as Urgent Care Centres – particularly in Devizes Prevention and Early Diagnosis - develop closer working relationships with Wiltshire Council and the One Wiltshire devolution agenda Supporting our future

29. ‘The right healthcare, for you, with you, near you’ Please wait for the microphone before asking your question

30. ‘The right healthcare, for you, with you, near you’ Refreshment Break 15 minutes

31. ‘The right healthcare, for you, with you, near you’ We need your help!

32. ‘The right healthcare, for you, with you, near you’ Table top session Red Table – Prescribing Yellow Table – Sharing People’s Information Light Blue Table – Winter Planning Orange Table – Commissioning for Value Green Table – Crisis Management in Community Settings Dark Blue Table – Prevention/Self-Responsibility

33. ‘The right healthcare, for you, with you, near you’ Feedback from tables

34. ‘The right healthcare, for you, with you, near you’ Thank you for coming