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Patients’ Congress 6 February 2014 1. 30 pm-4 pm Catterick Leisure Centre Patients’ Congress 6 February 2014 1. 30 pm-4 pm Catterick Leisure Centre

Welcome Henry Cronin Lay Chairman Jane Ritchie HEN representative for Richmondshire Welcome Henry Cronin Lay Chairman Jane Ritchie HEN representative for Richmondshire

CCG news update Dr Mark Hodgson GP and CCG Governing Body Member CCG news update Dr Mark Hodgson GP and CCG Governing Body Member

Ambulance times • GP Urgent Pathway – GP Urgent patients to travel on non-emergency Ambulance times • GP Urgent Pathway – GP Urgent patients to travel on non-emergency ambulance transport allowing more A&E vehicles to respond to 999 calls • GP “In Hours” Triage Pathway – Ambulance staff send patients to the GP practice from the scene, or the GP visits them at home as an alternative to sending to A&E, retaining ambulances in the local community • Paramedic Practitioners working in GP practices in Sleights/Sandsend and Harewood – they “see and treat” in the community and respond to emergency calls in the local area • New Ambulance ‘Stand By’ points are now working at locations in Catterick (GP Practice) and Richmond (Co-Op) with an additional point in Bedale (Health Centre) due to “go live” early in 2014 • Additional Static Defibrillator Points (e. g. Northallerton Civic Centre and Osmotherley) and a new C-Pad scheme (community defibrillator) scheme in Borrowby

Ambulance Response Times across the area Month Red 1 Response Month Red 1 Response Ambulance Response Times across the area Month Red 1 Response Month Red 1 Response YTD *April 55. 2% *May 50. 0% 52. 5% 47. 8% 51. 2% July 69. 0% 57. 1% August 79. 7% 65. 5% September October 79. 0% 68. 7% 84. 0% 71. 0% November 62. 9% 70. 2% *June * Pre new initiatives

Out of Hospital Contract Out of Hospital Contract

Plans for the future… • Introduce more community initiatives to improve ambulance response times Plans for the future… • Introduce more community initiatives to improve ambulance response times • More investment in nurses and therapists in the community to keep care closer to home and achieve maximum potential • Closer working with the Voluntary sector and community support groups to reduce social isolation and give greater support to carers • Better identification of patients at high risk of repeat hospital admissions and targeting the right care • Speed up access to intensive support towards the end of life • Based on what you tell us, to redevelop services in the community to deliver care closer to home • New treatments and services in the community, e. g. IV antibiotics

Financial update Alison Levin Head of Finance, Governance & Support Services Financial update Alison Levin Head of Finance, Governance & Support Services

Review of 2013/14 – Good News ! • CCG’s overall delegated budget for commissioning Review of 2013/14 – Good News ! • CCG’s overall delegated budget for commissioning services in 2013/14 is £ 169 m. • Repaid our share of the PCT brought forward deficit £ 1. 8 m • We are still planning to deliver a 0. 45% surplus (£ 752 k) at the 31 st March 2014 (Note: below the 1% identified in the national planning guidance). • This has given us a platform to have a balanced financial position to start 2014/15 with.

Where do we spend the money? Where do we spend the money?

Delivering our Financial Strategy What we have to do in 2014/15: Planning Guidance states: Delivering our Financial Strategy What we have to do in 2014/15: Planning Guidance states: Buy safe and sustainable services Plan for Non Recurrent Spend 1. 5% - £ 2. 6 m Create a Transformation Fund 1% - £ 1. 7 m Plan for a contingency of 0. 5% - £ 0. 9 m End the year with a 1% surplus - £ 1. 7 m In 2015/16 Create the Better Care Fund £ 5. 2 m

How much money have we got? 2013/14 £’ 000 2014/15 2015/16 £’ 000 CCG How much money have we got? 2013/14 £’ 000 2014/15 2015/16 £’ 000 CCG Programme Budget 165, 573 169, 381 173, 028 Uplift for growth 3, 808 3, 647 2, 941 Amount available to spend 169, 381 173, 028 175, 969 Growth 2. 15% 1. 70% 2. 30%

How do we agree the budgets? £’ 000 What we spent in 2013/14 (recurrent) How do we agree the budgets? £’ 000 What we spent in 2013/14 (recurrent) Efficiencies on provider contracts (-4. 0%) 165, 603 -6, 182 Inflation on provider contracts (+2. 8%) 5, 673 Demographic Growth (+1. 4%) 2, 315 Other growth and cost pressures 1, 975 QIPP TOTAL EXPENDITURE FORECAST FOR 2014/15 -2, 529 166, 855

What does the bottom line look like? 2014/15 £’ 000 20/15/16 £’ 000 How What does the bottom line look like? 2014/15 £’ 000 20/15/16 £’ 000 How much money have we got 173, 028 175, 969 How much are we spending 166, 855 168, 110 6, 173 7, 859 752 1, 730 Non recurrent Spend 1. 5%/1. 0% -2, 595 -1, 760 Transformation Fund 1% -1, 730 0 What have we got left What will we use this for? Receive CCG 2013/14 Surplus Better Care Fund 0. 5% contingency Balance 1. 0% surplus -5, 171 -865 -880 1, 730 1, 778

Risks to the financial plan • Demographic growth increases more than expected • Providers Risks to the financial plan • Demographic growth increases more than expected • Providers cannot meet their efficiency targets • QIPP programme is not fully delivered • Unexpected pressures emerge throughout the year • Investing the Non Recurrent Spend or Transformation Fund does not reduce the number of people being admitted to hospital as an emergency, which we need to do to help us create the Better Care Fund in 2015/16

Delivering our Financial Strategy • With the application of growth the CCG’s overall delegated Delivering our Financial Strategy • With the application of growth the CCG’s overall delegated budget for commissioning services in 2014/15 is £ 173 m. • This equates to £ 1, 211 per head of population to spend on commissioning services for its population. • Deliver the QIPP • Implement the service change needed to help create the Better Care Fund in 2015/16. • The CCG is planning to deliver its full 1. 0% surplus (£ 1. 7 m) at the 31 st March 2015.

Questions Questions

CCG planning 2014/15 • • • National and local context A Call to Action CCG planning 2014/15 • • • National and local context A Call to Action Fit 4 the Future Our priorities Group discussion

National Context • Changes to the NHS • Need for better quality and transparency National Context • Changes to the NHS • Need for better quality and transparency • Integrated health and social care • Improve outcomes • Prioritise prevention and early intervention • Providing more personalised care

Our Local Context • Ageing population • Resources are under-utilised and acute care focussed Our Local Context • Ageing population • Resources are under-utilised and acute care focussed • Community hospital estate needs investment • GPs want greater input in local care and services available 7 days a week • Innovation in healthcare e. g. telemedicine • Health economy is changing

National impact – A Call to Action • • • Every day the NHS National impact – A Call to Action • • • Every day the NHS saves lives and helps people stay well. However, the UK still lags behind internationally in some important areas, such as cancer survival rates. There is still too much unwarranted variation in care across the country, increasing health inequalities. But improving the current system will not be enough. Future trends threaten the sustainability of our health and care system: an ageing population, an epidemic of long-term conditions, lifestyle risk factors in the young and greater public expectations. Combined with rising costs and constrained financial resources, these trends pose the greatest challenge in the NHS’s 65 -year history.

National impact – A Call to Action • The NHS is on track to National impact – A Call to Action • The NHS is on track to find £ 20 billion of efficiency savings by 2015. • But this alone is not enough to meet the challenges ahead. Without bold and transformative change to how services are delivered, a high quality yet free at the point of use health service will not be available to future generations. • Not only will the NHS become financially unsustainable, the safety and quality of patient care will decline. • Fit 4 the Future is a major piece of work that we are carrying out locally to transform services and ensure local health services will meet current and future needs.

What is Fit 4 the Future? A large-scale initiative to seek the views of What is Fit 4 the Future? A large-scale initiative to seek the views of local people and organisations about how the NHS and its partners can start to prepare for an increase in demand for services arising from an ageing population. 5 public pre-engagement events attended by +270 people in spring/summer last year. Further engagement already this year in Whitby, lots to come in Richmondshire and Hambleton in the coming months. Please look out for this information. We were particularly interested in views on the following four key areas: • Staying healthy • Mental health/dementia • Long term conditions • End of life care

What we were told Keep people in their own homes for as long as What we were told Keep people in their own homes for as long as possible Provide better patient transport Provide more information for patients and their carers Provide more support for carers Facilitate social interaction A role for technology

Our Priorities 1. Transforming the community system – to create effective, integrated community services Our Priorities 1. Transforming the community system – to create effective, integrated community services that enable patients to be cared for as close to home as possible. 2. Mental health and dementia care – to meet the challenge of providing the best possible care for the rising numbers of patients with dementia. 3. Clinically appropriate planned care – to ensure care pathways and referrals across all specialties are as clinically efficient and effective as possible.

Our Priorities 4. Children’s health – to ensure that urgent care services are safe Our Priorities 4. Children’s health – to ensure that urgent care services are safe and sustainable and we build improved services in the community for vulnerable children and those with complex needs. 5. Patients with long term conditions – to improve patient’s ability to self-care and achieve their own goals, supported by earlier diagnosis and better identification of patients who are at risk. 6. Prevention of ill-health – to work with the North Yorkshire Health and Wellbeing Board to take forward plans and projects to improve the health of the local population. 7. Productivity in primary care

What we have done so far • Reduced the need for people to go What we have done so far • Reduced the need for people to go into hospital by extending the range of services available at night and weekends in Hambleton and Richmondshire • Brought professionals from different organisations to work more closely together to provide better coordinated care • Reduced the amount of time people need to spend in hospital • Introduced advanced technology that people can use confidently in their own home to manage their illness • Funded more Community Nurses • Funded additional consultant cover in Friarage A&E to cover the winter period • Diagnose more illnesses so serious problems can be prevented

Planning for 2014/15 Over the past three years, North Yorkshire County Council and the Planning for 2014/15 Over the past three years, North Yorkshire County Council and the PCT/CCGs have been working together to jointly agree and deliver proposals using Health and Social Care (H&SC) monies for integrated solutions, based on reablement, that will help to keep people out of hospital and long term social care. 2014/15 is the final year of spend using these monies. In October 2013, the CCG's Governing Body held a workshop to look at emerging proposals. Based on these proposals the CCG management team has developed formal proposals for 18 schemes.

Group discussion Your views on our priorities. Each member will have a print out Group discussion Your views on our priorities. Each member will have a print out of the CCG’s priorities for the coming year. On your tables, please consider: • Choose three or four from the list that you think are the most urgent priorities. Why do you think this? Please discuss in your group. • Do you think anything is missing? What other issues matter to you? Again, please discuss in your group.

Feedback and next steps Feedback and next steps

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