Agenda item

Purpose of the report:  Scrutiny of Services and Budgets/Performance Management

 

This paper sets out a Better Care Fund Position Statements for each of the six Local Joint Commissioning Groups across Surrey.

Witnesses:

Dave Sargeant, Strategic Director Adult Social Care

William House, Strategic Finance Manager

Helen Atkinson, Director of Public Health

Richard Bates, Chief Finance Officer, East Surrey CCG

Karen Parsons, Chief Operating Officer, Surrey Downs CCG

Sonya Sellar, Mid Surrey Area Director, Adult Social Care

Elaine Newton, Director of Governance and Compliance, Guildford and Waverley CCG

Shelley Head, North West Area Director, Adult Social Care

Lisa Compton, Operations Director, Locality Hubs, North West Surrey CCG

Sue Robertson, Head of Collaborative Programmes and Partnership, North West Surrey CCG

Sarah McBride, Director of Delivery, North East Hampshire & Farnham CCG

Jean Boddy, Surrey Heath and Farnham Area Director, Adult Social Care

Nicola Airey, Director of Strategy, Surrey Heath CCG

 

Mel Few, Cabinet Member for Adult Social Care, Wellbeing and Independence

Helyn Clack, Cabinet Member for Wellbeing and Health

Tim Evans, Cabinet Associate for Adult Social Care, Wellbeing and Independence

 

Key points raised during the discussion:

 

East Surrey LJCG

 

1.    The Board were advised that there is a plan to develop Health and Social Care hubs across East Surrey to breakdown barriers to see improvements in number of patients ready for discharge. The Chief Finance Officer noted that the LJCG members are beginning to learn how they work and that the 2015/16 year will hope to see how the progress goes with the challenge of measuring delivery benefit of individual schemes. The first-quarter results of their work have been released and have started to show evidence of delivery of the BCF metrics.

 

2.    East Surrey CCG is financially challenged and not currently assured by NHS England therefore it is under increased scrutiny. The CCG’s recovery plan indicates a return to financial balance in 2016/17. The financial challenge has been a catalyst for a stable health and social care system and the development of a pragmatic relationship with the Area Director, Surrey and Sussex Healthcare NHS Trust (SASH), the Ambulance Service and the First Community Health and Care.

 

 

3.    The Scrutiny Board Chairman asked for confirmation of the financial challenge faced by East Surrey CCG. It was stated that this was £20 to £25 million in savings by the end of the 2015/16 with the target of decreasing the annual budget from £180 million to just under £120 million in 2017.

 

4.    The aim for the LJCG is to develop hubs including primary care and social care to provide support for early discharge and to reduce inappropriate admissions. East Surrey has seen a reduction in the number of non-elective admissions and progress is being made with SASH on patient flow and discharge. The Chief Finance Officer emphasised the need to focus on overcoming the barriers to integration and they are considering how to integrate the separate commissioning teams through co-location and join procurement and the challenge of measuring the benefits of individual schemes.

 

Guildford & Waverley LJCG

 

5.    The Director of Governance and Compliance advised that the CCG is assured with support and has a challenge savings programme. It has agreed a variable base contract with its acute hospital – Royal Surrey County Hospital – which puts a cap on their overall risk. The CCG have forged links with the Adult Social Care Area Director who is now part of the CCG’s executive management team.

 

6.    There are five General Practitioner hubs titled ‘My Care, My Choice’ with a multi-disciplinary team to provide for high risk patients and there is a pilot in East Waverley underway. A challenge exists around measuring benefit necessitating constant monitoring and review.

 

7.    The LJCG have developed a discharge response strategy and has identified a core group of residents to test the model which is set to begin in autumn with a review across the winter period to provide proof of concept and build schemes based on evidence.

 

Surrey Downs LJCG

 

8.    The Board were informed that the Surrey Downs CCG has a financial recovery plan under the direction of NHS England. The CCG’s financial challenge is saving of £18 million in year one to break even in  2017/2018. Of the CCG’s budget, £16.4 million is part of the Better Care Fund with £15.2 million closely monitored.

 

9.    The CCG faces three health economies including three Acute Hospitals – Epsom and St.Helier, Kingston and SASH. The local partners actively engage and work through the Transformation Boards. They have developed a strategy that focuses on out-of-hospital care. The Epsom General Practices have been successful in gaining funding from The Prime Minister’s Challenge Fund to invest further in primary care and as a result, they have developed an enhanced GP service. This work aims to decrease the amount of hospital admissions and improve the discharge process.

 

10.  The Area Director for Mid-Surrey noted that a community hub model has been developed. This provides an integrated approach to deliver Health and Social Care, initially focusing on people over 75 years. This will then be rolled out to support adults over 65 and adults with long term conditions.  The enhanced GP services will provide dedicated medical support to the hubs. The Elmbridge Hub has been launched with the Epsom and Dorking Hub soon to follow.

 

11.  The Adult Social Care Commissioning Managers work closely with Surrey Downs CCG and have a base in the CCG offices. This has helped to develop local joint working and has for example, last year helped to secure the nursing places to respond promptly with pressure on the system over winter.

 

12.  The rapid response model has now evolved into a GP led, Community Assessment and Diagnostic Unit (CADU), based at Epsom Hospital. This will provide a seven day GP led service, with same day diagnostics being available and support from Social Care and Community Health to respond quickly and help to prevent people needing admission to hospital.  We have planned a simulation event with local residents to test the model, prior to implementation and will be continuously revising the effectiveness of the approach throughout winter.

 

13.  Enhanced GP services will provide more medical support to hubs to deal with complex cases and provide medical services in a community setting. The rapid response model aims to provide community assessment and diagnostics following GP referral to avoid admissions and will operate seven days a week. The Adult Social Care Commissioning Managers work closely with Surrey Downs CCG often in the CCG offices. This helped to secure the nursing places to cope with the winter pressures in a quick manner.

 

14.  The Adult Social Care Commissioning Managers work closely with Surrey Downs CCG and have a base in the CCG offices. This has helped to develop local joint working and has for example, last year helped to secure the nursing places to respond promptly with pressure on the system over winter. 

 

North West Surrey LJCG

 

15.  North West Surrey is the largest area in the county encompassing more than 300,000 residents, four boroughs, 42 general practices and the Ashford & St. Peter’s Hospitals Foundation Trust. The CCG has had issues achieving a stable senior management structure and there were lots of lessons learnt and knowledge developed that had come from the winter pressures faced by the system in 2014. The savings target for 2015/16 is £15.9 million.

 

16.  The LJCG has identified six transformation areas: Planned Care, Children and Young People, Mental Health, Urgent Care, Integrated Care (for the age 75 plus cohort) and Targeted Communities. The latter three relate to the BCF. To deliver the BCF metrics three locality hubs are being created with a Woking hub up that will be running before Christmas and the other two hubs operating in 2016.

 

17.  The LJCG’s key development is these Locality Hubs and sourcing three buildings for the hubs has been a significant challenge as has information governance. The main aims of the hubs are preventing increased frailty and hospital admissions. The hubs focus on a specific cohort (aged 75 plus) but the model is scalable. The hubs will include new staff roles that fall between primary and secondary care and GPs to offer a joined-up approach. They will also include the voluntary sector to offer social prescriptions such as exercise classes and to offer transport to patients to become a ‘one stop shop’ to break the cycle of hospital admissions.

 

18.  A question was raised regarding the locality hubs of the NW Surrey group and how these would provide for mental health. The response was that they have a scalable model and are working closer with colleagues when the service is up and running to take referrals for different age groups and needs as well as providing services to those groups .

 

Surrey Heath LJCG and North East Hampshire & Farnham LJCG

 

19.  Both Surrey Heath and North East Hampshire & Farnham LJCG share acute and community provider systems. North East Hampshire & Farnham work with two County Councils and consist of 24 member practices. The CCG have been chosen as one of the national vanguard sites to accelerate progress towards integration and reducing hospital admissions.

 

20.  Surrey Heath CCG is the second smallest group in England and the Director for Strategy outlined the positives of that size to the board being that they are able to take decisions quickly, promote innovation and have been encouraged to work collaboratively to achieve economies of scale.

 

21.  Surrey Heath has integrated teams with GPs and Community Nurses working 8am to 8pm, seven days a week. The CCG will deliver is a budget surplus this year but the same challenges are prevalent such as non-recurrent funding and demand at acute level that will put the CCG into deficit in the year 2016/2017. It was noted that the relationships with providers are well established which allows for more mature conversations regarding change.

 

22.  The Director of Strategy outlined three key challenges for Health and Social Care systems for the board:

 

·         How to allow money to follow people, the current system needs to go further in its encouragement of joint working.

 

·         Health and Social Care Systems need to build on the successes of BCF to share risks and successes beyond the established boundaries to break down cultural assumptions.

 

·         How to include the economic determinants of healthcare in prevention plans and achieve a balance between centralism, localism and engaging communities in the development of services.

 

23.  Adult Social Care he Surrey Heath CCG’s Inner Area Director has been covering both Surrey Heath and North East Hampshire &  Farnham CCGs. The NE Hampshire and & Farnham CCG’s annual budget is £246 million and have introduced a new vanguard system with 24 member practices. The Chairman raised concern of the finance and asked the question of enforced reductions. Their savings target is £7.5 million this year. Further to this, the CCG will deliver a budget surplus this year but the same challenges are faced. The non-recurrent funding and demand at acute level that will be put the CCG into deficit in 2016/17.

 

24.  It was noted that as well as to get budgets separately, sharing risks and success within the CCG as well as the implementation of devolution is both important to health and social care. The Surrey Heath CCG is also looking into a collaborative, joint commissioning as well as encouraging members to be active locally by offering an open invitation to members.

 

25.  The Director of Public Health noted how the Social Care Services Board could use the BCF metrics to ensure the board scrutinise evidence-based outcomes of the LJCG’s plans.

 

 

26.  The Chairman of the Surrey Coalition of Disabled People sought to remind the Health and Social Carer Commissioners of the importance of the inclusion of mental health services in their hub models as well as to consider the needs of young carers as there was a feeling that they can be missed by the NHS and both Social Care and Health support. It was additionally noted that patients and carers more widely should be at the centre of plans for the Better Care Fund.

 

Recommendations

 

The Board:

 

·         That the Cabinet Members for Adult Social Care and Health and Wellbeing write to the Secretary of State for Health to outline the Government’s rationale for asking Surrey CCG’s to make 5% savings in their budgets this year as well as proposed reduction to ASC and Public health funding

 

Actions / further information to be provided:

 

·         The Board encourages Local Joint Commissioning Groups to involve Local Committees in the development of health and social care integration in their areas.

 

 

Board Next Steps:

 

·         A joint session is convened with the Wellbeing and Health Scrutiny Board in early 2016 to consider the outcomes of the six local plans outlined at this meeting.