Council of Members - Southwark CCG...as Local Care Networks. •Set contracts on the basis of improving peoples’ outcomes. This means working very differently to engage patients,

Council of Members

14 October 2015

Minutes of last meeting:

May 2015

Dr. Richard Proctor, Council of Members Chair

Launch of Election Process:

Council of Members

Chair and Deputy Chair

Malcolm Hines, Chief Financial Officer

CoM Chair and Deputy Chair Elections

• The current terms of appointment for the Council of Members Chair and Deputy have

now expired.

• We need to agree an election process to enable the new Chair and deputy to be

elected for the January 2016 meeting.

• It is proposed this would be for a period of one year. This is for agreement tonight.

• Each practice will have one vote, giving 44 possible votes in total for each post.

• We will set up a simple but secure voting process online.

• The Chair and Deputy Chair will both be elected by gaining the greatest number of

votes cast, for that position.

• There will be a selection process, which will involve an interview with Southwark CCG

Governing Body Lay Members.

• We would request that colleagues wishing to be considered for these roles supply a

personal statement of no more than 500 words by the end of October 2015. The

process and format will be laid out on the members zone website shortly. Previous

post-holders may reapply.

• We will then run the voting process for those who have a satisfactory selection

interview, and announce the outcome of elections before Christmas.

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Questions and answers

Setting out our forward plan

and local commissioning

intentions

Mark Kewley, Director of Transformation and Performance

Dr. Jonty Heaversedge, Chair, Southwark CCG

1. Understand the

population and establish

priorities for action

2. Understand what

providers of services can

do to address those

priorities

3. Understand what effect

services have had on

making a difference to

people’s lives

Our job is to plan for our local population, support providers to

respond, and to monitor the overall effect on health outcomes

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We need a new plan

• Understanding what it is like now

• Prioritising areas for improvement

Section 1

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• On a daily basis the local system achieves amazing things, but the system as a

whole can and should improve

• There is definitely a real financial challenge but our desire for change is not driven by

‘cost saving’: we would need to radically improve the health and social care

system even if money was no object

• Part of the problem is the historic way that

we arrange budgets and the way we contract

with GPs, hospitals, social care services

and other providers in the system. This

makes it too hard for people to work together

and too often makes people think about what

they provide, rather than what a person needs

• Southwark CCG and Southwark Council are going to set out a plan to

change the way we use our resources so that these problems are reduced.

This will mean shaping our budgets and contracts around populations rather than

providers.

Great people work in health and care services but we need a new

plan of action to change how the system works as a whole

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• Bring together health and social care budgets with funding allocations based on

populations and their needs, rather than providers and historical arrangements.

• Commission contracts which cover all the health and care needs for ‘segments’ of the

population (e.g. people with serious mental illness). Stop commissioning healthcare

‘episodes’ or ‘activities’ from providers.

• Stop commissioning from individual providers and start commissioning from

groups/networks or multi-specialty (integrated) organisations. We are referring to these

as Local Care Networks.

• Set contracts on the basis of improving peoples’ outcomes. This means working very

differently to engage patients, specify the right outcomes and then collect the data to

monitor contracts – this is outcomes-based commissioning.

• Play a more active role in supporting the development of new organisations that

are capable of serving the health needs of defined population segments. This should

also stimulate greater innovation.

This means fundamentally changing how commissioners use

budgets and how providers and people work together

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Emphasize populations rather than

providers

Focus on total system value rather

than individual contract prices

Focus on the ‘how’ as well as the

‘what’

We are changing the way we work and commission services so that we:

Arranging networks of services

around geographically coherent

local communities

Moving away from lots of separate

contracts and towards population-

based contracts that maximize

quality outcomes (effectiveness

and experience) for the available

resources

Focusing on commissioning

services that are characterized by

these attributes of care, taking into

account people’s hierarchy of

needs

Key concepts: we will focus on delivering high value for the Southwark

population taking into account people’s hierarchy of needs

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Maslow’s hierarchy of needs

Biological and Physiological needs Air, food, drink, shelter, warmth, sex, sleep

Safety needs Protection from elements, security,

order, law, stability, freedom from fear

Social needs Friendship, intimacy, affection and love

Esteem needs Achievement, mastery,

independence, status,

self-respect, respect from others

Self

Actualization

needs

Key concept: Resourceful communities and high value health and social

care services help people to meet a variety of needs

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• Resourceful communities help people to

meet needs that are higher up the

hierarchy

• Meeting these needs creates wellbeing and

reduces the likelihood of many socially

determined health and social care needs

• This is how we can support people to

flourish

• Good health and social care services

recognise people’s various needs and

help to address all of them

• The best service also recognise people’s

esteem needs and help them to develop

independence and mastery, particularly

when dealing with long term conditions

In future funding will go to providers who work in integrated ways

• Co-designing specific

improvements

• Supporting providers

to implement them

Section 2

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Our local commissioning intentions are informed by national,

regional and sub-regional plans

National

England Regional

London Sub-regional

Southeast London

Commissioning intentions for Southwark CCG

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We are working towards a system that addresses the most basic

and the most specialist needs as one joined up care system

15

In practice we are focussing on six themes of work, each of which

have been co-produced with citizens and professionals

• Focus on accessible care, proactive care and coordinated care,

within Local Care Networks (taking into account the PMS review

and a move towards greater collaborative working)

• Focus on reducing variation, improving diagnostics, elective

care centres and pathway reviews in urology, neurosurgery,

nephrology, gynaecology and dermatology

• Focus on targeted wellness, assessment of risk and assignment

(to local community/LCN team or high risk team), access to acute

assessment, and better transitions of care

• Focus on primary prevention and wellness, integrated

community teams, extended GP hours, short stay units,

planned care pathways, and supported transitions

• Focus on London Quality Standards, access in primary care,

specialist advice and referral, improved 111 and LAS onward

referral, a single front door to ED, and better MH interface

• Focus on primary prevention and early detection, treatment

through networked centres, supporting survivorship and

ensuring consistent planning and coordination at the end of life

Transforming primary and

community care

Transforming

planned care

Transforming urgent and

emergency care

Transforming

maternity care

Transforming care for

Children and Young People

Transforming

cancer care

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Systems need disruption and support to make change

happen efficiently and effectively

Energy in:

Disruption in the

system

Catalysis:

Stabilise the transition:

• Federations and LCNs

• Sharing and learning (CEGs)

• Workforce development

(CEPNs)

• Informatics development

(LUCR)

• Funding (PMS / PHM etc.)

• Estates

This isn’t rocket science…it’s harder than that!

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Key concept: over time we are developing better ways to work

together which is good for citizens, care staff and commissioners

What this mean

for me as a… Traditional models [Small molecules] Working as isolated units

More integrated working [Small

cells] Working as small joined-up teams

Accountable care [Living system] Working as a dynamic and complex system

…service user • Sometimes services are good, sometimes

they are not, it’s a bit of a lottery

• I feel looked after in an emergency but at

other times I’m left confused and

disempowered

• I have to fit around the system and it’s

inconvenient

• I know more about what is going on

• Clinicians know more about what has

happened in my care

• People ask me about what I need

• I’m feeling more confident about how to live

well, and what to do when I start to feel like

I’m getting unwell

• I feel in control of my life and the care I

receive, and I know what’s going on

• Professionals work together to support me

• The little but important things are thought

about

…staff member • I’m isolated with little opportunity to work in a

team

• I’m frustrated at the lack of coordination

• There is little opportunity to sort things out

creatively, at the root of the problem

• I get help from others when confronted with

complex situations

• I’m developing new relationships and

connections

• I can sort out the things that count

• I feel part of a team and I am learning new

things that make me feel more confident in

what I do

• I feel I’m able focus on the things I’m good at

and let others do what they are good at

…commissioner • I try to take responsibility for detailed

pathway design

• I focus on the transactional rather than the

transformational

• I can spend more time thinking about what

people actually want from services

(outcomes) rather than just tracking inputs,

targets and expenditure

• I spend my time looking at whether we are

really delivering quality outcomes for people

for the funding we have. I can see the wood

for the trees

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Key concepts: we will align incentives across the system now, and use

2016/17 to develop a population-based approach for one client group

Developing additional contracts to cover other

populations

• The major contracts in the system include a

shared system-wide performance measure /

objective

• Available non-recurrent ‘transformation’ monies

are used to fund priority projects to integrate the

system

Making sure

different contracts

cohere

Q3

2015/16

Q4

2015/16

Q1

2016/17

Q2

2016/17

Q3

2016/17

Q4

2016/17

Q1

2017/18

Q2

2017/18

Q3

2017/18

Q4

2017/18 …

• For a defined population (e.g. people with

Severe Mental Illness) there will be a very

different capitated contract delivered through an

accountable network of providers

Developing a genuinely integrated contract and

service model for a chosen population

Developing better information systems and analytics to understand our population and value across the system

Over time all

sections of the

Southwark

population will

be covered by

these

arrangements

Developing additional contracts to cover other

populations

Developing additional contracts to cover other

populations

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Questions and answers

• We want to hear your thoughts about the outline commissioning

intentions

• On each table there is a more detailed description of the key

features of the models we are trying to commission

• You have a CCG lead on your table to facilitate discussions

1. What are the strengths of the proposed

approach?

2. Are there any significant gaps?

3. What are the main considerations to

keep in mind when commissioning

this pathway: how can we make it

work in practice?

Section 3

What do you think?

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Update on CCG

Financial Position

Malcolm Hines, Chief Financial Officer

Financial Performance Duties as at Month 5

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Notes:

1.The above duties correspond to those reported in Note 42 of the Annual accounts, and represent

the statutory duties of the CCG.

2.To support the delivery of the above, an in-year QIPP programme of £7,982k has been established.

QIPP monitoring information is included later in this report.

CCG Programme Budget Summary: M5 2015/16

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CCG Programme Budget Summary: M5 2015/16

• The acute position shows a slight favourable year to date (YTD) position that is forecast

to worsen slightly over the remainder of the year to a breakeven position. The worst

case scenario forecast for Acute is nearly £5m adverse and assumes the outturn for

King’s College Hospital NHSFT and Guy’s & St Thomas’ NHSFT will exceed the

contract tolerance and will therefore result in adverse variances.

• The running cost allocation is separate from the Programme budget and is monitored

separately. Running costs are currently underspent by £126k at Month 5. This mainly

relates to un-utilised budget for contract management. Contract variations that were

expected at the time of budget setting are now no longer expected to occur in the

current financial year.

• Programme Budgets are achieving overall planned levels at Month 5, achieving the

planned surplus level of £3,032k (expected to achieve £7,277k at year end).

• Total QIPP savings plans of £8,166k are in place for 2015/16. In order to achieve the

plans, an investment of £184k on Acute schemes has been made. This leaves the net

QIPP value at £7,982k which is forecast to be delivered in full in 2015/16.

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King’s College Hospital

CQC Inspection

Gwen Kennedy, Director of Quality and Safety

King’s College Hospital CQC Inspection

The CQC Inspection visits of KCH took place from 13 – 17 April 2015. The overall CQC

rating of KCH is ‘Requires Improvement’:

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Are services at this trust safe? Requires Improvement

Are services at this trust effective? Requires Improvement

Are services at this trust caring? Good

Are services at this trust responsive Requires Improvement

Are services at this trust well-led? Requires Improvement

Denmark Hill Requires Improvement

PRUH Requires Improvement

Orpington Hospital Good

Each individual KCH site has been given an overall rating:

King’s College Hospital CQC Inspection

Key CQC findings

• KCH was recognised as a caring organisation, strong on outcomes.

• The main concerns and challenges raised by the CQC were around:

– infrastructure.

– staffing & training.

– consistency of documentation, protocols and processes.

– access to records (PRUH).

– responsiveness to complaints.

These are all issues that the CCG are aware of through the CQRG and many of

these areas already have action plans in place.

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Question and Answers of

the CCG Governing Body

Dr. Richard Proctor

Any Other Business

Dr. Richard Proctor

Close