Dr Nick Harding's first presentation at "SWB Connect" event held in West Bromwich, 28th June 2012.

1. Sandwell and West Birmingham CCG
Healthcare Without Boundaries
Our journey so far…
Dr Nick Harding
MBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)
26th June 2012
1

2. Overview
 NHS Changes
 An introduction to Sandwell and West Birmingham CCG
 Progress towards authorisation so far
 The wider context for delivery
2

3. Health and Social Care Act 2012
• Clinical Commissioning Groups to take over responsibility of
commissioning health services for local populations – abolition
of PCTs and Strategic Health Authorities by 2013
• Creation of NHS Commissioning Board
• Establishment of HealthWatch and local Health and Wellbeing
Boards to increase accountability for patients and the public
• Creation of Public Health England to improve the health of the
population
• Commissioning Support Services
3

4. Before Now Future
Department Department of Department of Department of
of Health Health Health Health
Strategic 10 SHAs 4 SHA Clusters NHS
Health West Midlands (Midlands & Commissioning
Authorities East) Board
151 PCTs 50 PCT Clusters 27? Local
Local Health e.g. Sandwell. e.g. Birmingham offices for NHS
Ecoonomy Heart of &Solihull, Black
Commissioning
Birmingham Country
Board
Local 230 CCGs 200? CCGs(tbc)
4

5. Delegating Responsibility
How things are changing
Delegated responsibility
► From 2013 new organisations will take on PCT responsibilities
Individual PCTs Transition to Cluster Flip Future
Public Health
Heart of Birmingham
Teaching PCT Commissioning Support Service
Clinical Commissioning Groups
Sandwell PCT Local Office (NHS Commissioning Board)
NHS Property Co.
Up to 2010 2011 April 2012 2012 and beyond
5

6. A phased approach
From 1st April 2012, as part of a phased approach for transition, after a
rigorous Board to Board Challenge pre-authorisation process, NHS
PCT Clusters started delegating some responsibility to CCGs such as:
Commissioning and monitoring of services
Delivery of improvements and savings (QIPP)
Improving quality and safety
Achieving financial balance
Hitting Key Performance Measures
Communications and engagement
..To help achieve a seamless transition for patient care
6

7. An Introduction to CCG
►We are passionate about improving the
healthcare for the people of Sandwell
and West Birmingham.
►Our vision is for transforming services
to ensure excellence for everyone and
in everything we do.
►Our aspiration is to create a new kind of
organisation really rooted in its membership,
relationships and local knowledge.
►We will be using local and clinical knowledge
for change and improvement in health for our patients.
7

8. Our health priorities
8

9. CCG area
9

10. Our health needs
• SWBH commissioning area is around 530,000
• West Birmingham ranked 10th most deprived Local
Authority in England with 68% BME population
• Sandwell ranked 12th most deprived Local Authority
in England with approx 20% BME population
• Health challenges against rising costs and demands
for healthcare
• Absolute commitment to improving quality of care
10

11. Who we are
Building on long standing foundation of partnership working through
Right Care Right Here between Sandwell and West Birmingham
NHS and local authorities.
“Serve a unique population - diversity unifies us”.
Bridging the health gap
Unsafe Journey © Amy Helene Johansson 11 11

12. The journey so far
2002 PCT arrives
2003 Right Care Right Here partnership forms
2007 Practice Based Commissioning
2008 Primary Care Collaborative
Clinical Commissioning Directors appointed
2009 Partnerships form: Vitality Partnership, ICOF
10 Strategic Models of Care and clinical strategies agreed
2010 GP Consortia HealthWorks, ICOF, Black Country Alliance and
Pioneers for Health
22 Care Pathway Reviews agreed across health economy
2011 Sandwell and West Birmingham Clinical Commissioning Group
September - agree vision values with clinical leaders
2012 Interim Board is formed with five CCGs
12

13. Our role
By April 2012 - shadow form as a CCG in readiness for 2013.
We want to:
1. Be clear on the health needs of our population and how we are going to
improve their health
2. Get the balance right between local and strategic decisions
3. Show real clinical leadership and development across the health
economy
4. Do this new role in the most effective way we can
5. Create a Clinical Commissioning Group that leads by example
6. Be effective in communications within our organisations and the people
we serve
7. Be ready to lead and manage the NHS as a system by April 2013.
13

14. Our Clinical Commissioning Group
Local Commissioning Groups Chair Practices Population
Black Country Dr George Solomon 20 112,228
HealthWorks Dr Nick Harding 22 132,985
ICOF Dr Samar Mukherjee 27 106,953
Pioneers for Health Dr Vijay Bathla 10 46,151
Sandwell Health Alliance Dr Basil Andreou 31 127,519
Clinical Commissioning Group Chair Practices Population
Dr Nick Harding
Sandwell and West Birmingham 110 525,836
(Interim Chair)
14

15. Our vision and values
Mission Healthcare without boundaries
Working together, to improve health and care in our
Vision communities.
We will:
• be the type of organisation that listens to and appreciates
its staff and member Practices be supportive, fostering a
no blame culture, ensuring that everyone is
knowledgeableandwell informed, communicating well
Values at all times
• set out what we intend to do with clarityin order to ensure
that we deliver
• be inclusiveand delegateresponsibilities where we can
and be transparentin all our duties and we will go the
extra milefor our staff, member Practices and partners.
15

16. A Different Approach “Membership organisation”
- Delivery by Local Commissioning Groups
• Develop commissioning priorities
• Develop Clinical Pathways
• Primary Care Quality including Medicines Management
•QIPP Delivery
• Membership
• Patient Participation Groups/Patient Networks
• Engagement: members, stakeholders e.g. local authority, public
• Primary Care Demand Management
Black Country HealthWorks ICOF Pioneers 4 Health Sandwell Health
Alliance
16

17. At CCG level - preparation for authorisation & future
Phase I Preparation for Organisation readiness: Organisational strategy: vision & values;
authorisation Commissioning plan, Financial Strategy, Risk register, OD and HR plan,
Partnerships Agreement, Membership Agreement, Board Development
and comms and engagement plan.
Setting up robust governance and processes to ensure quality and safe
care within financial limits.
Phase 2 Shadow year – Commissioning
until April 2013 Assurance – relationship mgmt with Clusters/SHA/DH
Performance managing contracts with wide range of providers
QIPP plan – efficiencies, improvements, managing new system risks
Forming effective partnerships for delivery CCGs/LAs
Engagement – communicating the big changes
Systems – establishing new systems, ICT/information, reporting
Phase 3 As a statutory Commissioning contract and performance across providers: SWBH,
body Dudley, BCHC, BCH, BWH, BSMHT, ROH
Patient and public consultation & events on major changes
Strategic partnerships e.g. HWBBs, OSCs, RCRH
Primary care strategy and development
System management inc emergency planning 17

18. Achieving the right balance - Localism
Big and small…
Clinical Commissioning Group Local Commissioning Group
Robustness at scale Local ownership
Resilience Ideas into action quickly
Strong voice in the health economy Relevance
and contracts
Ability to deliver through major Patient representation and
partnerships involvement
Overview of system Ability to respond to feedback,
deliver improvements and
efficiencies at practice level
“As a membership organisation we would like to build ways of working
that are not bureaucratic with the right safeguards for all.”
18

19. Our interim Board Structure
Chair Vice Chair
(GP Director) (Lay Director)
GP Directors Executive Directors Clinical Directors Other Board Members
Lay Directors (Non Voting)
Chair and Vice Chair of Lay Director Managing Director Secondary Care Independent Committee
Black Country (Vice Chair) (Accountable Officer) Specialist Members x2
GP Directors GP Directors GP Directors
Chair and Vice Chair of Lay Director Finance Director GP Directors
Nurse Senior Officers x3
HealthWorks (Chair of Audit) (Chief Finance Officer)
Chair and Vice Chair of
Public Health Member
ICOF
Chair and Vice Chair of
Pioneers 4 Health
Notes
Chair and Vice Chair of •Directors are voting members
•Other Board members are non voting members
Sandwell Health Alliance •The Chair will be one of the GP Directors from the LCGs, not an additional post
•Vice Chair will be one of the two Lay Directors, not an additional post
One GP Directors to be Chair
19

20. Our governance
Remit: To determine
OD Sub
Main Remit: To determine pay
and implement the Remuneration Sub- and remuneration for
OD strategy for the Group SWBCCG Committee employees (likely to meet on
CCG Board an ad hoc basis)
Strategic
Finance &
Quality & Safety Commissioning & Audit Sub-
Performance Sub- Partnerships
Sub-Committee Redesign Sub- Committee
Committee
Committee
Remit: To have on-going Remit: To regularly Remit: To consider Remit: To help with Remit: To work with and
responsibility for the review providers to service provision and discharging financial lead partnerships,
affordability of the local ensure that services are ensure that services are functions. Statutory and putting resources where
healthcare system, and safe, and that outcomes commissioned for shorter legal obligations, challenges lay. Working
to receive monthly are monitored. pathways, better value working with accountable and delivering on two
monitoring reports. This for money and that officer. evolving agendas with
group will highlight provision is appropriate LAs, Health & Well-being
concerns to the Board. and adequate. Boards, HealthWatch
and RCRH.
20

21. Organisational Structure
CCG Board Black Country LCG
•Chair Dr George Solomon
•Accountable Officer Senior Commissioning Manager
HealthWorks LCG
Quality & Safety Sub- Sub-Committee Chief Officer
Independent Dr Nick Harding
Committee Committee Senior Commissioning Manager
Chair (Quality)
Member
ICOF LCG
Dr Sam Mukherjee
Independent Senior Commissioning Manager
Finance & Performance Sub-Committee Chief Finance Committee
Sub-Committee Chair Officer Member
Pioneers for Health LCG
Dr Vijay Bathla
Senior Commissioning Manager
Service Strategy &
Independent
Primary Care Sub- Sub-Committee Chief Officer
Committee
Chair (Operations) SHAC LCG
Committee Member
Dr Basil Andreou
Senior Commissioning Manager
Partnerships & Independent
Sub-Committee Chief Officer
Collaboration Sub- Committee
Chair (Partnerships)
Committee Member
21

22. 22

23. Continuously improving quality
Build feedback and
Annual
improvement into
Quality and
annual commissioning
Safety Plan
intentions
Monitor effective delivery of
quality and safe care through :
information at Quality & Safety Committee,
Local Commissioning Groups feedback
23

24. Progress so far
What we have done for authorisation
 Membership – we have a fully signed up practice membership and risk
sharing agreements in place
 Agreed priorities and focus for commissioning for 2012/3
 Setting out monitoring processes for quality and safety
 Developed plans to demonstrate how we will operate including financial,
OD and transition plan, comms and engagement
 Setting out our arrangements how we will work with others
(collaborative working/partnership plan, risks)
 Joint authorisation with Black Country & BSOL
24

25. A Constitution – good governance
Clear and comprehensive constitutions – to ensure effective structures,
strong governance systems and good relationships with practices.
• Describes our statutory responsibilities as a commissioning body
• Set out who and how you can be a member of the CCG, how to leave
• Our internal structures
• Our Elections and appointment processes, and removal from office
• How we can demonstrate transparency in how our decisions are taken
• Accountability to our patients, the wider local community, local council
and health and well being board
• Engagement with our membership, the wider profession
25

26. Timetable
Key dates
We are moving at a good pace and to move into the first wave of
authorisation we have an ambitious timetable of key deadlines which
need to be met:
Date Activities
April 18th April  CCG Board meeting
19th April  Resubmission of full set of authorisation documents
May 3rd May  Members engagement event
16th May  30 day consultation for proposed structures
commences
 CCG Board Meeting
June  Recruitment to structures of CCG
 Process for appointment to Chair, Accountable
officer and Chief Finance Officer
July  Authorisation assessment
October  Outcome authorisation
26

27. What we have learned from
board to board process
27

28. 28

29. Sandwell and West Birmingham CCG
Our approach to commissioning
Dr Nick Harding
MBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)
26th June 2012
29

30. Our health priorities
30

31. Our health needs
31

32. Our health needs
Health without boundaries - November 2011 32

33. A wide range of services available to
commission from
Complex range of providers for
healthcare:
Hospitals
Heart of England (3 hospitals),
University Hospitals Birmingham, Sandwell West
Birmingham, Birmingham Children’s Hospital, Royal
Orthopaedic, Birmingham Women’s Hospital and
Birmingham Dental Hospital
Birmingham
Specialist
Birmingham and Solihull Mental Health Trust
Community
Birmingham Community Healthcare
Acute & Urgent
West Midlands Ambulance Service; Range of
urgent care, walk-in and other providers – Assura,
Care UK etc
Third Sector – a wide range of provision e.g.
over 40+ alcohol/drug dependency services
33

34. RCRH Comms and Engagement
Chair and
RCRH Partnership Board Rep
Birmingham Birmingham
Black
Sandwell and City Council and Solihull
Country NHS Black Sandwell
Cluster Country Metropolitan West NHS Cluster
(Sandwell Partnership Borough Birmingham (Heart of
PCT) (NHS) Trust Council Hospitals Trust Birmingham
tPCT)
Birmingham Birmingham
Community and Solihull
Healthcare NHS Mental Health
Trust Trust (BSMHT)
34

35. Our strategic priorities
► Instigate – intervening early to prevent problems before
they occur
► Integrate – putting the patient at the centre of their care
► Innovate – changing the way we do things to deliver more
with less
► Improve – focusing on the quality and safety of services in
all parts of the system
► Influence – playing a full role in local partnerships,
affecting the determinants of health
35

36. Our plans are to:
► Increase the capacity and capability of primary care, using it as
a foundation for system change
► Focus on the frail elderly, supporting independence and dignity
in old age
► Accelerate the Right Care Right Here programme - providing
care in the community and treating hospitals as specialist
providers
► Treat mental ill health and promote wellbeing, viewing good
mental health as a precondition to better physical health
► Work in partnership to improve maternity and early years,
giving every child the best start in life
36

37. 37

38. Our quality priorities
Our priority How we monitor this
Safety Population health is improving
Effectiveness Treatments are effective
Population is satisfied with their
Patient experience
treatments
38

39. Continuously improving quality
Build feedback and
Annual
improvement into
Quality and
annual commissioning
Safety Plan
intentions
Monitor effective delivery of quality and safe care through :
information at Quality & Safety Committee,
Local Commissioning Groups feedback
39

40. How we will ensure high quality in
Primary Care
► We want to be able to use information in a way that continuously
improves services – as close to ‘real time’ as possible
► Our plan is to use same data as before – but in a smarter, more
user friendly way so you can react more quickly to feedback – we
can control this
► Reflected in improvements in GP dashboard
► National GP quality dashboard
► If we get the information reporting right at practice level, this will
make the job easier and create a more accurate bigger picture
40

41. 41

42. Getting the best out of services - diabetes
Patients
•Regular follow up
•Easy physical
access
•Close to home
SWB CCG
•Managed care •Patients
•Professional opinion managed safely
•Costs covered •Upstream
interventions
•Value for money
42

43. End of life – from pilot to rollout 2012/13
►Award winning pilot with experience-led commissioning
– patients driving the process
Range of events to inform strategy development
e.g. Planning Alternative Tomorrows with Hope (PATH)
stakeholder event (55) to agree shared vision for end of life care;
review of all existing strategies, documentation and initiatives;
public health and service cost data and statistics pulled together;
two experience co-design events held with third sector; one to
one filmed interviews with front line professionals, managers and
people living with dying and carers transcribed by University of
Oxford for emerging themes
►Strategy co-created with patients, carers and stakeholders
►Our strategy:
“in three years time, 90% of people will
die in a place they choose.”
43

44. End of life –CCG rollout 2012/13
5 improvement workstreams have been established February
2012 supported by 2 underpinning foundation programmes:
► Theme 1 Tell my story – helping people to articulate
end of life to be
► Theme 2 Hospice everywhere
► Theme 3 24:7 coordinated care
► Theme 4 Keeping carers well
► Theme 5 Compassionate communities – changing the
culture towards dying
Programme team established with wide range of clinicians,
commissioners, carers, third sector delivering the workstreams to
achieve improvements – with shared ownership.
44

45. Maternity and Children’s Strategic Model of Care
Experienced clinical group developed vision for Maternity and
Newborn Services – October 2009:
►120,000 women aged 15 to 44 in catchment area
►Share epidemiological and economic characteristics such as high
levels of deprivation
►Issues: High levels of still births and infant mortality compared to
England and Wales average
►Strong evidence impact quality maternity services can make to
improve health and well being of teenagers and their babies
increasing number of children on path to success
►Teenage pregnancy is a key issue in Sandwell and West
Birmingham
45

46. So who will overview new world
Commissioners: Providers
National
NHS Commissioning Provider • Support &
Board Development develop
Authority
• Set maximum
prices
• Maintain
Overview and Monitor continuity of
Scrutiny care
Committees
• Quality
CQC • Safety
HealthWatch
Any Willing Provider
Foundation Trusts
Private Sector
3rd Sector
Primary Care 46

47. The RATAR model
• Access to a Referral, Assessment, Treatment,
Advice and Recovery model through a single
point.
• Provision of Care Closer to Home
• A service based on outcomes with patients,
families and carers at the heart
• Integrated Care Pathways
• Collaborative Care
47

48. • The CCG will have as a priority the ongoing
commissioning and further development of
mental health and well being services.
• Developments will focus on an integrated
mental health service and the development of
Primary Care mental health and wellbeing in
the community to meet the needs of the
population.
48

49. Some successes already
► Reduction in A&E attendance by 6%
► Promotion of effective medicines management
► Good examples of GPs working together
► Defining agreed patient experience standards
► End of life pilot - being rolled out across CCG
► Dermatology – reductions in hospital attendances
► Improved access – radiography available in community
► Award winning patient consultation processes
► Approval to go for first wave authorisation…
49

50. How we currently invest in secondary
healthcare
Provider BSOL Sandwell Total
£000's £000's £000’s
SWBH 77,936 157,260 235196
BSMHT 23,724 1,443 25,167
BCPFT 230 33,915 34,145
Birmingham 634 5,065 5,699
Children’s
SCHS 8,804 34,553 43,357
BCHS 27,409 3,628 31,037
TOTAL 374,601
50

51. How we work with other CCGs
► Leadership /advice – clinical senate?
► Clinical leads for commissioning for contracts?
► Nominated contract leads – how this will work:
“hosted by a CCG but ensuring those CCGs with
‘significant interests’ are represented around the
discussion table’ e.g. urgent care, BCHC
► Health and Well-being boards – shared strategy for
city
51

52. Quality Priorities 2012/13
• Developed draft CCG Quality and Safety Plan – out for
consultation to members (issue 2) www.swbcg.link ]
• Putting quality into all our contracts – ensuring we are
commissioning for quality e.g. alcohol CQUIN
• Monitoring delivery of quality and safety through
Quality and Safety Committee and formal Clinical
Quality Reviews (e.g. meetings, reviewing
incidents/never events, visits)
• Provider development
• Primary Care development
52

53. Thank you
► Have learned a great deal already and much
to build on
► Remain committed to what its all
about….patients and quality of care
► Committed to working with the third sector,
patients, carers to develop together the best
healthcare Questions?
53

54. 54

55. 12 months on…
 Shared vision and strategy - We have an integrated
plan which has involved all health and local authority
partners
 Shared way of working through the Compact - for
shared leadership across the NHS and local authorities
 Resources - Good progress has been made - a
coordinated structure was established pooling the
resources of four PCTs
 Results so far - Delivery is good - moving from forecast
£50.5m deficit to £2m planned surplus; key quality and
performance targets achieved
55

56. Integrated Plan
 Greater push on transformation and delivering
improvements
 Greater emphasis on quality and improving
primary care
 Supporting development of future organisations
 More integrated working
→ specialised service pathways and joined up services
→ Councils working with health on care for older people
 Financial planning - Still heading off increasing
financial pressures for years ahead
56

57. Brief
• Support the Frail Elderly Programme
Signed off by CEO Compact
57

58. Patient/Clinician Journey
Dr S Mr/s D
58

59. A constitution – why?
Clear and comprehensive constitutions – to ensure effective
structures, strong governance systems and good relationships
with practices.
►Describes our statutory responsibilities as a commissioning body
►Set out who and how you can be a member, how to leave
►Our internal structures
►Our Elections and appointment processes, and removal from office
►How we can demonstrate transparency in how our decisions are taken
►Accountability to our patients, the wider local community, local council
and health and well being board
►Engagement with our membership, the wider profession
59

60. The journey to authorisation
► Approval to go for first wave authorisation
► What we need to demonstrate:
→ Examples of how member practices are involved in decision
making within the CCG/LCG
→ How we work together - constitution
→ Election process – competency and
representation
60

61. New NHS Parliament
Key:
Accountability Department of
Funding Health
Right Care Right
Here partnership
NHS Commissioning Monitor CQC
Board Licensing
Providers
SWB CCG Contracts
BSMHT, BCP, BCHC,
SWBH
Partnership
Local Authorities
Other providers BCH,
Local HealthWatch BWH, ROH, DGH, RW,
SWB, WM, and I/C.
Birmingham HealthWatch
Patients & Public
Sandwell HealthWatch 61

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