NHS Trafford Clinical Commissioning Group Integrated Strategic Plan Commissioning for health outcomes

Transcription

1 NHS Trafford Clinical Commissioning Group Integrated Strategic Plan Commissioning for health outcomes

2 Trafford CCG: Integrated Commissioning Plan Foreword... 4 Executive Summary Our philosophy... 8 Who we are... 8 Our practices and our localities... 8 Constitution... 9 How we operate... 1 Membership Model Local joint working arrangements What We Want to Achieve How We Have Listened What We Will Do... 2 Patient Choice / Complaints Annual Health Check : Case for change Demography Health Need Mental Health... 3 Health needs outside the scope of the strategic plan The provider landscape Compliance with the operating framework in transition Performance The Economic Climate The NHS Constitution The NHS Outcomes Framework and our approach to quality Our approach to quality : Our key strategic priorities CCG QIPP transformation priorities Better Integrated Care Closer to Home Scheduled Care Development of Community Services End of Life Care (EOLC) Prevention and Staying Healthy Primary Care Maternity, Children and Young People s Health and Wellbeing Provider Performance, Quality and Safety Academic Health Science Networks (AHSNs)... 6 Workforce Key enablers for our strategy Linking the Population Conversation with the Contract Developing an Integrated Care System: A New Health Deal for Trafford Our challenges Internal analysis

3 Trafford CCG: Integrated Commissioning Plan External analysis... 8 Financial challenge and delivering QIPP Financial Scenario Planning and Assumptions 213/14 to 215/ Financial Scenario Planning Outputs Achieving our Vision Principles we will follow What we will achieve Over the next two years Over the next 3-5 years Our development through transition... 9 Authorisation... 9 Our management support system... 9 Senior clinical leadership Senior management leadership Commissioning support Running costs Managing the workforce through transition Organisational Development Focus on Equality Clinical Senates and Networks... 1 Local Area Teams Appendices Appendix 1: Resource and application statement Appendix 2: Assumptions within Scenario Planning Appendix 3: Base case scenario Appendix 6: Milestone trajectory action plans

4 Trafford CCG: Integrated Commissioning Plan Foreword Through the leadership of local GPs with the new Clinical Commissioning Groups, a radically new healthcare system will evolve which is far more patient centred, efficient and effective. In Trafford this will not be a recycling of PCT-based commissioning, as it will develop from an approach which has been more population based to one which is individual, personalised and pro-active; one focused on delivering integrated care solutions. As a CCG we are engaging early and influencing the commissioning process by understanding spend, where it is spent, and for what outcome. This will be key to our success as we begin to take responsibility for large swathes of commissioning resource and budget responsibility. The CCG accepts the role to establish and build relationships with new and different organisations and consider the full range of perspectives, including those of patients and the public. A new more strategic, yet business focussed relationship with Trafford Council is emerging, building on the strengths within the borough and the significant capabilities and altruism that exists between professionals from both social and health environments. There is a One Borough movement building across Trafford and the CCG wishes to see this develop further with the re-engineering of the Health and Wellbeing Board and joint commissioning functions. The ambition for healthcare described in the new White Paper proposals is clear. A radically new healthcare system which will combine improvements in patient experiences, better health outcomes for these patients from healthcare providers, and better use of the available NHS resources. Our local GPs will be at the centre of this system and will lead the changes necessary to deliver the future aspirations of the public. We believe that this new design will come from a shift of commissioning philosophy and practice from one which is geared around aggregated population-based services to one which is more individual, with personalised healthcare services as the norm. In the future scenario we envisage, patients will have far more personalised healthcare choices, support to navigate the system, access to 24/7 care at the appropriate level and location, pro-active management of their conditions, with greater support and guidance to self care. There will be no decision about me, without me where GPs and their practices will be the main patient advocate supporting and coordinating individualised care. This change is not about a mechanical or bureaucratic shift from the current PCT. It will not be about replicating what the PCT did, however it will build on the things that have been achieved, are of value and most significantly have been clinically led, such as the Trafford Clinical QIPP programme, incorporating the work on allocative efficiency via demand management. 4

5 Trafford CCG: Integrated Commissioning Plan However, we do believe that the well established commissioning cycle, which was explored through World Class Commissioning, is still a valid cycle for the technique of commissioning to take place. We envisage that the way in which technical, and largely management functions, take place will continue to employ this cycle of change. Within this document we outline, at a high level, the broad vision and principles of Trafford CCG and our intended strategy for the immediate years ahead; it ultimately represents our first integrated plan for Dr Nigel Guest Chief Clinical Officer Dr Kath Sutton Chair 5

6 Trafford CCG: Integrated Commissioning Plan Executive Summary The purpose of this integrated plan is to set out the principles, vision and decisions required to deliver an effective and sustainable CCG within Trafford. The plan aims to underpin and align with the accepted direction of travel as described and set out in national, regional and local strategies, introduced as part of the implementation of the Health and Social Care Act (212) and the accompanying NHS Operating Framework. For NHS Trafford CCG, this requires a transformation of the local health system to one that focuses on integrated care with much greater emphasis on knowledge systems, local clinical leadership and empowerment, and new service delivery and enhanced patient and clinical engagement. In developing this plan the CCG has considered the statutory functions that the CCG will deliver as it moves through the transition as a shadow organisation, through the authorisation process to become a statutory organisation. Clinical commissioning will enable doctors, nurses and other health and social care professionals in primary and secondary care to be become even more involved in achieving these aims. Our work will be led by senior clinicians, and will be based on principles of collaboration between commissioners, providers and the public, and between clinicians and patients across the healthcare system. Whilst rigorous contract negotiation and management will underpin the relationship between the CCG and its provider organisations, we believe that real and lasting improvement can only be achieved in partnership at both an organisational level and between clinicians. We will therefore seek to strengthen existing partnerships with providers, with our local authority partners, with other key stakeholders and the Third Sector to ensure that we recognise the needs of each organisation and the requirements upon them. We will work with the provider partnerships established to transform community care to ensure that our objectives are achieved, and will strengthen the clinical relationships between CCG and those partnerships. We will ensure that the views of patients and the public (all ages) are considered in every decision we make, with public and patient engagement embedded in our ways of working through, for example, all service redesign work involving patients, all CCG decisions explicitly considering how patients and the public have been involved in proposals, and expecting our providers to equally ensure engagement of service users in their plans. We will work with both Trafford Council and other partners to build strong mechanisms for working with the public. 6

7 Trafford CCG: Integrated Commissioning Plan All Trafford Practices listed in the CCG will be members of the CCG. Our ability as clinical commissioners to achieve change rests fundamentally on our ability to engage them in commissioning. We will build upon the achievements of practice based commissioning to develop collaborative working in which all local GPs have a voice. This plan has been developed in line with the priorities defined in the 212 refreshed Joint Strategic Needs Assessment (JSNA). This plan has also fed into, and informed, the Joint Health and Wellbeing Strategy (JHWS). We are confident of the alignment between our plan and the draft JHWS and the resulting priorities that the JSNA has guided us to. The local JSNA represents a summary of much more detailed work that has been undertaken in Trafford. It is underpinned by a core data set defined in statutory guidance, and by needs assessments which have been undertaken in relation to various client groups and localities. This will evolve and our use of the JSNA and other key intelligence sources will continually inform our planning, our priority setting and our commissioning. We will draw on our local specialist public health service within Trafford Council to build on this evidence based approach to commissioning. 7

8 Trafford CCG: Integrated Commissioning Plan Our philosophy Who we are 1.1 NHS Trafford CCG is comprised of 37 practices across the Trafford borough and is responsible for commissioning health services to the 233, residents as well as those who are not registered with a GP practice and those presenting for emergency care. Our practices and our localities 1.2 In Trafford, small groups of practices came together as early as 26 to take on new commissioning responsibilities promoted through the government policy of practice based commissioning. 1.3 With the introduction of clinical commissioning these groups recognised the need to form into a larger, more robust structure and in September 21, Trafford Commissioning Consortia (TCC) was formed. 8

9 Trafford CCG: Integrated Commissioning Plan We marked our establishment as a formal sub-committee of NHS Greater Manchester s Board on May By April 213, we aspire to be a statutory organisation in our own right. Constitution 1.5 Our constitution sets out the governing arrangements for the organisation including: I. A governing body that is chaired by a GP, includes two patient representatives (often referred to as lay members ), a nurse and specialist clinician from outside the area, a chief clinical officer, a chief finance and operating officer and six GPs from the local area; II. The governing body takes strategic decisions on behalf of the membership council and ensures that the governance arrangements of the Clinical Commissioning Group are robust; III. A membership council which is the representative body of each of the 37 member practices; IV. Four peer groups which are based in the four recognised neighbourhoods of Trafford and provide vital connection to our member practices; 9

10 Trafford CCG: Integrated Commissioning Plan V. A Clinical Policy Committee whose members include senior doctors, managers from local hospitals, a lay member, nurses, allied health professionals, adult and children s social care and public health. The Group advises the governing body, helping to drive the clinical priorities of the Clinical Commissioning Group. How we operate 1.6 We are clear as a GP leadership community, that the CCG cannot and should not replicate previous commissioning system regimes. It has to break new ground, be more radical, be more transformational, deliver better outcomes, be closer to the patients it serves; and be less expensive to operate, with less bureaucracy, less management and control health care spending better than anyone has ever achieved before. With those objectives in mind, it stands to reason that marginal changes to systems and structures will not suffice. 1.7 If we consider the core requirements from CCGs as we know them today (outlined in the diagram below), recognising they may well change in time and with new policy direction, we can reasonably deduce that a fundamental shift in thinking is required. 1.8 In order to prepare a new commissioning business model that meets the requirements stated above it is important to accept that change is required; a change to the typical leadership model as well as a change in the mindset of those held to account by it. 1

11 Trafford CCG: Integrated Commissioning Plan The UK health system has shown some significant improvement over the lifespan of the NHS Plan (2); however there are downsides that now need to be addressed. The contribution of professional groups who provide care as well as those who commit cash resources with every prescription or referral is far too variable. For many clinical programme areas within the Trafford health system there are still significant gaps between our outcomes (quality and cash control) compared to better performing health economies. 1.1 We believe that a new approach to GP-led commissioning requires a change in logic and approach to these challenges. The strength of clinical leadership locally will be a major asset to address these factors but it must and should be supported by high quality, capable and competent management talent, systems and support Ultimately we want to develop a radically new healthcare system which will combine improvements in patient experiences, better health outcomes for our patients from healthcare providers, and better use of the available NHS resources Therefore, our business model has several main features - ranging from the technical and structural changes required, through to how we propose that clinical programme management should be arranged and clinical contribution and variation management could be redesigned We also believe that the management support system needs to change its style and behaviour to support the CCG s clinical programme objectives Our business model is based on four main components: Membership Model 1.15 NHS Trafford CCG recognises that strong clinical leadership and engagement will be critical for its future success. 11

12 Trafford CCG: Integrated Commissioning Plan The CCG recognises that GPs will want different levels of engagement with the CCG and its work, ranging from understanding what it is doing and what difference it makes to leading work with is partners. Engagement of front-line, grass roots GPs is the critical success factor for the CCG. This is a really important part of the CCGs responsibilities and is being approached in a number of ways. Council of members 1.17 For NHS Trafford CCG this is a really important vehicle for gaining meaningful and real practice engagement in delivering the CCG s vision and objectives. The meetings are currently held quarterly, moving to bimonthly from April 213 and will continue to be constructive in enabling continued CCG involvement in decision making within commissioning. Neighbourhood peer groups 1.18 A system will be developed whereby each CCG GP member have been aligned with a number of constituent practices within a neighbourhood footprint, meeting with them bi-monthly to provide information and update them on CCG developments including the CCG strategy, vision and values, as well as to capture feedback and review pathways. This gives the practices the opportunity to have real input into local commissioning decisions and also feedback any issues currently affecting their practice population. It is hoped that this forum will strengthen communications between the CCG committee members and member practices and become the way forward to ensure meaningful engagement. Protected time for learning events 1.19 A number of events for GP s have been held which provides the opportunity for learning and sharing. Several of the events over the past 12 months have been used as a platform for updating the practices on the NHS reform both nationally and how this has affected the NHS locally. Alongside the key contact system, a bi-monthly newsletter is produced and distributed to all practices across Trafford. Clinical extranet 1.2 The CCG is also developing an electronic website for practices, which will enable a discussion forum between practices and provides a vehicle for regular updates. Practice manager and nurse meetings 1.21 This group have used dedicated part of their monthly meetings to discuss/debate CCG issues and developments. 12

13 Trafford CCG: Integrated Commissioning Plan Local joint working arrangements 1.22 In setting strategic priorities and prioritising the investment of NHS Trafford CCG commissioning resources, the CCG will continue to work closely with NHS Central Manchester and South Manchester CCGs particularly, as both CCGs are commissioning from the same providers to ensure alignment and clarity of expectations All three CCGs have established a joint governance framework which includes a joint commissioning committee (known as the South Sector Leadership Board). Lead commissioning arrangements across the three CCGs are clear and supported through the Greater Manchester Commissioning Support Service arrangements, which provides further checks and balances to ensure individual CCG decisions and priorities are shared to check for alignment. Trafford CCG is an associate commissioner for both CMFT and UHSM. The lead commissioning function is undertaken by Central Manchester CCG and South Manchester CCG. Joint working with other CCGs 1.24 We have a strong history of collective working with neighbouring NHS commissioners. All 12 Greater Manchester CCGs have committed to supporting the establishment of a Greater Manchester-wide Commissioning Network which aligns to the work of CCGs. We already have shared programmes in place across Greater Manchester CCGs and we are working with local authorities to consider what opportunities might accrue through developing a single approach to strategic planning across Greater Manchester through the Association of Greater Manchester Authorities (AGMA) We have recently been considering ways of further enhancing our collaborative working to build upon the work and engagement we have already been undertaking around Quality, Innovation, Productivity and Prevention (QIPP) and business planning during 211/12 and our shared contract team arrangement for negotiating 212/13 contracts The network will also provide a mechanism for collaboration with respect to our other important collective working arrangements, including GM-wide approaches, shared programmes and our partnership working within Greater Manchester There is a long history of collaborative commissioning across the geography of NHS Greater Manchester. This is principally driven by the shared reliance on provision of acute care from the major Foundation Trusts which serve the sub localities in broadly equally terms. Most recently this has been through the development of the Greater Manchester Clinical Strategy Board As commissioners all GM CCGs rely on the same providers and same pathways of care for much of their delivery of services to their constituent populations. Therefore a 13

14 Trafford CCG: Integrated Commissioning Plan unified approach to commissioning in these areas offers many benefits to CCGs in the delivery of their own visions and strategic objectives It is recognised that it is early days in the development of the CCGs and therefore the principles and arrangements set out will need to evolve as the CCGs develop and their needs change. What We Want to Achieve 1.3 This section sets out our vision, values and ambitions and how we have worked with different groups. Our vision 1.31 Our vision describes the long-term ambition of the organisation We want the Trafford population to have the best possible healthcare outcomes by commissioning high quality, equitable services and empowering the population to look after their health and wellbeing through health promotion and integrated care systems, the CCG want to deliver this in partnership with others. Our priorities 1.33 Our vision is supported by three high level goals which describe the changes we aim to make in the medium (two years) to longer term (five years), which are to: I. to improve population health; II. to improve the care provided and the healthcare experience of individuals; and III. to lower per capita costs of providing the above This is underpinned by introduction of an integrated care system, through more effective clinical decision making and by working closely with patients, the public, carers, providers and partners. Our strategic aims 1.35 I. Rebalancing the Health Economy We will target our resources on the major causes of ill health to improve outcomes for our patients but doing so at an appropriate cost so our resources across the health economy are deployed to deliver best value. II. Health Improvement We will utilise our own commissioning responsibilities and work with partners across the public, private and voluntary sector to protect good health and prevent ill health be ensuring evidence based practice at the appropriate scale. III. Communication / Relationships We will not achieve our goals without working closely with individuals, communities and other partner organisations. Fostering 14

15 Trafford CCG: Integrated Commissioning Plan and maintaining effective partnerships that improve outcomes for patients and communities is an essential and key component of our plan. IV. Effective Commissioning We will commission services that demonstrate value for money for our population and improve the quality of healthcare and outcomes and reduce inequalities. We will maintain a robust system of financial control with our clinical leads overseeing effective management of resources including the delivery of our QIPP programme. V. Integration We aim to commission and manage effective integrated care pathways in partnership via our local clinical senate, local health and wellbeing boards and other appropriate partnership structures. Our goal of developing integrated care is to reduce duplication, improve coordination across settings and to structure services so they are patient focussed to improve outcomes and the patient experience. Our Objectives Consistently achieving local and national quality standards. I. Strategic Goal 1: We will seek to consistently meet every commitment of the national NHS Constitution II. Strategic Goal 2: We will seek to ensure our providers, in all sectors, deliver excellent patient satisfaction levels 2. Delivering an increasing proportion of services from primary and community settings in an integrated way I. Strategic Goal 3: We will seek to ensure local people benefit from lower than average hospitalisation rates II. Strategic Goal 4: We will have shifted resources from tertiary and acute services to primary and community care. 3. Reducing the gap in health outcomes between the most and least deprived communities in Trafford I. Strategic Goal 5: We will have reduced the prevalence of harmful drinking II. Strategic Goal 6: We will improve mortality within our three priority disease areas cancer, CVD, COPD, mental health and alcohol. 4. Being a financially sustainable economy I. Strategic Goal 7: The CCG and all local providers will deliver financial balance and a small surplus Our values 1.37 It goes without saying that corporately, we will be mindful of and adhere to the Nolan principles of public life, but we have engaged with our staff, local member Practices and stakeholders, to identify a core set of values that we believe will have resonance and meaning within our own organisation. Therefore, our values signal what we 15

16 Trafford CCG: Integrated Commissioning Plan believe matter the most in the way we conduct ourselves and the values that we can be held to account for They are as follows: I. Compassion, respect and dignity II. Commitment to quality of care to improve lives III. Working together for patients IV. Selflessness and recognition that everyone counts V. Integrity, openness and honesty in all our interactions VI. Objectivity and accountability in all we do 1.39 Ultimately, Trafford CCG s major ambition is to develop an Integrated Care System, which we view as the primary delivery vehicle for our ambitious programme of change and reform. 1.4 This means that people requiring treatment and care will have it delivered by multiagency, multi-provider teams who together have the expertise to give the best holistic care for individuals. More care will be accessible within local GP Health Centres and practices with multiple providers inputting expert advice, support and treatment where required. This seamless care will be made possible by the implementation of a system which shares information between the multiple providers and sites. Data sharing and quality programmes will ensure accurate disease registers facilitate comprehensive patient participation. Using the latest telemedicine systems we will support highly trained clinicians to monitor and offer appropriate interventions particularly for people with long-term conditions such as Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Clinical experts will work together to advise on best treatment pathways and improved outcomes to the providers in the integrated care system (ICS) In summary, the QIPP model provides a useful organising framework for our strategy, to ensure that we can achieve the most effective services for our population within the available resources. For Trafford CCG this means: Quality Innovation Productivity We will work with providers to ensure that our residents receive high quality care through looking at the domains of safety, clinical effectiveness and patient experience. We will ensure that our patients have access to most effective leading edge technologies. For example, we are planning investment in remote monitoring technologies to support integration. In addition, we will ensure that we work in partnership with staff to unlock their potential to find the most effective way of providing and commissioning care. We will use tools such as Better care, Better value indicators to benchmark our services and commission to maximize value for 16

17 Trafford CCG: Integrated Commissioning Plan Prevention money. We will pursue prevention as a core component of all our work which will include identifying the high risk patients so that we can support individuals in making positive life choices to help them to lead healthy lives. How We Have Listened 1.43 In developing our strategic plan, we have discussed and agreed our priorities with the Trafford Health and Wellbeing Board and key stakeholders. This ensures the CCG plan: I. Aligns with and supports delivery of the Joint Health and Wellbeing Strategy (JHWS); II. Aligns with and supports delivery of other appropriate partnership plans including the Trafford Children and Young People s Plan and local health and wellbeing partnership plans; III. Reflects the Joint Strategic Needs Assessment for Trafford; IV. Contributes to the wider vision for communities shared with partner organisations including Trafford Council; V. Shapes other local commissioning plans to enable integration of services/ pathways Given that the need for change within the Trafford health system has been understood for some time, we, as a clinical group, started our work as far back as 28 with local stakeholders and communities to develop designs and options for securing the future stability and sustainability of the local health and care system. The table below outlines this chronology of public and stakeholder engagement activity. June - September 28 October 28 November 28 - February 29 February 29 Major large scale conversation with the local population to help shape and determine health priorities for the next five years. Responses from the local population used to build the design process for a clinical conversation. Major clinical congress to understand the views of local people and start the process to design a new model of integrated care. A series of population wide deliberative events to identify the appetite for integrated services and the public s values that should inform any future development. Open public meeting between the Board of NHS Trafford and local people. Heard the views of local people and debated and agreed the policy framework for integrated care with the public. Pilot work was confirmed to test the concepts of integrated care with 17

18 Trafford CCG: Integrated Commissioning Plan April 29 November 21 further public engagement. Community representatives (including members of Trafford LINk) formed a citizens panel, which met five times with the integrated care project leads to inform future clinical developments. 31 conversations were held with representatives of hard to reach groups to identify trends relating to their experiences of health services. 15 patients were recruited and trained to participate in clinical pathway design discussions with clinicians and health managers to inform proposed changes, and identify their perceptions of the benefits. Stakeholder Reference Group established to include the Trafford LINk in shaping the strategic discussions with Board level decision makers. Regular briefings with OSC and senior councillors and MPs were held. Public representatives involved in evaluating the acquisition bids for the running and management of THT services The major obstacle to progressing this work further came from national confirmation that that all NHS healthcare providers must achieve foundation trust status by April 214 something which could not be guaranteed within such a timeframe by Trafford Healthcare Trust Now having resolved the long-term future of the borough s acute provider, health service commissioners, Trafford Council s commissioners and social care team, Trafford s three major acute providers and community health providers have been able to join together to undertake the further design work needed to identify how they can collectively realise the ambition of delivering high quality, safe, accessible and sustainable services which are integrated wherever possible for the future Therefore, in November 211 clinically and publicly driven pre-consultation option development work was re-started, led by the clinicians of Trafford CCG. Our approach to arrive at a final model of care based on our strategic priorities has therefore, latterly been geared around three phases of implementation as below: 18

19 Trafford CCG: Integrated Commissioning Plan Broadly we have supported a period of engagement with stakeholders to seek their views and help develop the best possible options for service development in Trafford. This engagement phase took place from November 211 to March 212 to ensure that relevant stakeholders are firstly, involved in the development of options from an early stage and secondly, involved throughout the life of the remainder of the programme Our tactical approach has comprised six key components: Insights from patients, public, clinicians and local partners 1.5 Major Issues - In terms of the major issues identified by the public there is a real perception that there "is a lot of cancer about" compared to other areas as well as high rates of heart problems. Similarly, there is a real sense that there are lots of breathing problems some people attributed this to industry/environment while some attributed it to the low lying nature of the place Mental Health - There is a perception that there are a lot of mental health problems in the area. In particular, lots of work related stress as well as anxiety, depression etc. This is compounded by people's experience of very poor mental health services, e.g. very long waiting lists for poor quality services. Many people don't even bother trying to access bereavement, counselling services because there is a perceived real lack of understanding of what might be available (therapy etc as opposed to drugs). This perception triangulates the sense that mental health should be a priority for us and supports the clinical consensus on this issue Smoking - There is a real sense that the smoking ban is having a positive effect and some local sense that younger people see it as a lifestyle "choice". Overall people see it as a problem in deprived areas. 19

20 Trafford CCG: Integrated Commissioning Plan Barriers to health lifestyles - Barriers to healthy lifestyles are seen as practical in most cases (no time to cook and eat properly or to exercise). There was also some sense that people who needed it most could not afford proper food or gym membership. There are a lot of assumptions that "other people" needed educating about healthy lifestyles - in fact the thought that it was "other people that needed to change came out a number of times in the focus groups Inequalities - The issue of whether the NHS should concentrate on closing the gap between the least and most healthy is controversial. Some respondents said "I don't want my money spent on (poor) people who can't be bothered to live healthy lifestyles". This indicates that the CCG needs to make the case for tackling inequalities on business as well as moral grounds. It cannot be assumed that the population will view tackling inequalities is necessarily a "public good". Many people who didn't see closing the inequalities gap as a priority were covered by private health insurance and felt that they were paying twice and received no recognition for this. Others felt that focusing on deprived areas flew in the face of a universal service. What We Will Do 1.55 As part of our commitment the CCG will act on public and patient feedback throughout the life of this strategic plan. Our clinical priority areas provide the cornerstone for this plan, and this decision has been informed by their feedback. We will focus on these priorities applying evidence-based practice in order to achieve the best health for the people of Trafford We will be specific about what we can achieve and when we can achieve it within the resources that we have available Much of the work needed to achieve sustained health improvement lies in the remit of our partner agencies. We will not achieve our goals without working closely with individuals, communities and other organisations. Fostering and maintaining effective partnerships that improve outcomes for people and communities is an essential component of our plans We believe that we will deliver better outcomes for patients in this way and also improve value for money for taxpayers by removing duplication between organisations. We will work with a wide range of partner organisations, including Trafford Council; community, voluntary and faith sector organisations; our provider organisations; and other statutory organisations Much of the work needed to achieve sustained health improvement beyond 213 lies in the remit of the Health and Wellbeing Board partner agencies across Trafford. 1.6 It is estimated that 7% of determinants of health fall outside health services. Thus we will not achieve our goals without working closely with individuals, communities and other organisations. Fostering and maintaining partnerships and partnership activity 2

21 Trafford CCG: Integrated Commissioning Plan that measurably improve outcomes for people and communities are an essential component of our strategy The Trafford Health and Wellbeing Board (HWB) will be the vehicle for local authority to work in partnership with us. Priorities for the HWB include applying a series of priority shifts to the way in which organisations work together to achieve a shift in health and wellbeing outcomes We will collaboratively focus on three priority outcome areas which we see are aligned to and help deliver our plan. These are: I. Every child has the best start in life; II. A reduced gap in life expectancy; and III. Improved mental health and wellbeing We are actively contributing to the emerging Trafford HWB; sharing our priorities, engaging with the consultation on the draft health and wellbeing strategy and are helping further develop and deliver it. We will continue to contribute by working with it to: I. Jointly assess the health needs of the population to produce a health and wellbeing strategy, which our plans will be part of; II. Promote integration and partnership through joined up commissioning plans across the NHS, social care and public health; III. Support joint commissioning and integrated arrangements; IV. Improve the lives and futures of Trafford s citizens in bringing together health, wellbeing and social care. Our ambition is to improve outcomes for individuals through joint commissioning; V. Integrating health and social care commissioning around agreed priorities We understand a range of other partnerships where our engagement will be important and will work to develop these relationships, listening and learning as we do. We have identified a range of partnerships where participation from the CCG will be essential in both supporting achievement of partnership priorities focussed on improving health and wellbeing and the CCG s own priorities. These include, but are not limited to, the Trafford Children and Young People s Services (CYPS) and the various local strategic partnerships. Patient Choice / Complaints 1.65 GP referrals and the choices patients are making will be monitored regularly and this information will be used to inform future commissioning intentions. Complaints will be presented at the Finance, Quality & Performance Committee and a detailed action plan to ensure service improvements and inform commissioning decisions will be produced. This will be the responsibility of the Clinical Executive Lead for Finance, Quality and Performance. 21

22 Annual Health Check Trafford CCG: Integrated Commissioning Plan As part of our annual operating plans we will undertake annually an independent health check of the processes of the CCG. This will enable us to review and provide analysis of what NHS Trafford CCG activity is telling us about what is happening within our health economy. It will enable the CCG to identify areas where we need to specify changes to our routine business intelligence. This will be routinely provided by a commissioning support function, supported by the public health service as appropriate, and will allow and support the CCG to influence and determine its commissioning intentions for the following year. 22

23 Trafford CCG: Integrated Commissioning Plan : Case for change 2.1. This section sets out the factors driving our plans for change in healthcare in Trafford. These factors are both local, for example what our joint strategic needs assessment tells us and national, for instance the financial climate we are operating in In many ways NHS Trafford CCG follows the pattern of the country as a whole and many indicators of health and social care are comparable with averages for England. However, there are some issues of concern even where the CCG area is comparable to the average, this masks stark inequalities between areas and communities within the CCG. Demography 2.3. Trafford is an area of 4 square miles, made up of 21 electoral wards; NHS Trafford CCG is coterminous with Trafford Borough Council and covers a geographical patch of Greater Manchester stretching from Partington in the West, Sale Moor in the East, Old Trafford in the North and Hale in the South The population residing within Trafford s boundaries was estimated to be approximately 217,37 in 21 and is expected to have grown by 2% in 23 according to 21-based population projections The key characteristics of the population based on ONS mid-21 population estimates are outlined below: I. 49% of the population are male and 51% are female; 23

24 Trafford CCG: Integrated Commissioning Plan II. 21.8% of the population are over 6 and 16.2% over 65 years of age; and III. 12.% of the population are from Black and Minority Ethnic groups (based on mid-29 estimated resident population by ethnic group). The largest of Trafford s minority groups is Pakistani which makes up 2.4% of the total population. This is closely followed by people of Indian origin at 2.1%. All groups including black Caribbean, black African and Chinese are represented making Trafford a diverse population The age structure of Trafford s population is very similar to that of England and Wales however; the borough has a slightly higher percentage of older people than the profile for Greater Manchester as a whole. The borough has disparate socio-economic factors with some of the most affluent areas of the country situated alongside areas that are in the worst 5% nationally for deprivation and life expectancy in these areas varies greatly The most economically and socially deprived neighbourhoods in Trafford also have the greatest levels of health deprivation, with the worst being north of the borough within the ward of Clifford but also within pockets of Bucklow St-Martins and St Mary s. The map below indicates the areas with high levels of deprivation. 24

25 Trafford CCG: Integrated Commissioning Plan Health Need 2.8. Male life expectancy (28-1) is 78.8 years compared to an England average of 78.6 years and female life expectance is 83.1 years compared to the England average of 82.6 years. Number of years Number of years Life expectancy at birth - males Life expectancy at birth - males ENGLAND North West Stockport Bath and North East Somerset Trafford ENGLAND North West Stockport Bath and North East Somerset Trafford Compendium of Population Health Indicators (indicator.ic.nhs.uk or nww.indicators.ic.nhs.uk) Compendium of Population Health Indicators (indicator.ic.nhs.uk or nww.indicators.ic.nhs.uk) Number of years Number of years Life expectancy at birth - females Life expectancy at birth - females ENGLAND North West Stockport Bath and North East Somerset Trafford ENGLAND North West Stockport Bath and North East Somerset Trafford Compendium of Population Health Indicators (indicator.ic.nhs.uk or nww.indicators.ic.nhs.uk) Compendium of Population Health Indicators (indicator.ic.nhs.uk or nww.indicators.ic.nhs.uk) 2.9. Life expectancy is increasing in men and women, although many people are still dying earlier than necessary 2.1. There are health inequalities by gender, level of deprivation and ethnicity. For example, people in the more deprived parts of the borough live shorter lives than those in the more affluent areas as much as eleven years less for men and six years less for women Also, those with mental health problems and learning disabilities suffer much poorer physical health than the rest of the population For children and young people, there are average levels of physically active children and the proportion of obese children in the population is slightly lower than average. The hospital admission rate for alcohol specific conditions is similar to the national 25

26 Trafford CCG: Integrated Commissioning Plan average. The Health and Wellbeing of children in Trafford is generally better than the England average Overall, the health of Trafford is better, or similar to, the national average. A number of indicators are significantly better than the England average including deprivation, the number of adults who are obese or have road injuries. One measure is significantly worse than the national average; hospital stays due to alcohol related harm, though this significantly better than the North West average. Causes of death A major challenge for improving the health of the borough lies in tackling the 77% of deaths in Trafford attributable to three types of disease: cardio-vascular disease (CVD) equates to 35% of all deaths; cancer equates to 29% of all deaths and chronic obstructive pulmonary disease (COPD) equates to 13% of all deaths Premature mortality due to cancer and CVD declined in Trafford and is slightly higher than the national average, though not significantly. Mortality from COPD is above the England average. However mortality from these diseases is much higher in the deprived populations in Trafford with wide variations within the borough and is much higher in men than women. Within Trafford there is a focus now on prevention services which are responsive, individualised, tailored and efficient Public health evidence indicates: I. Cardiovascular disease is significantly higher in the Indian, Bangladeshi, Pakistani, and Black communities than the White population; II. Over the last few years there has been a slowing in the rates of early deaths from cancer and the need to improve awareness for earlier cancer is recognised together with faster, better treatments for improved survival rates; and III. Chronic Obstructive Pulmonary Disease (COPD a respiratory disease) is still a major cause of death in Trafford and is linked to smoking patterns. 26

27 Trafford CCG: Integrated Commissioning Plan Cardio-vascular disease Circulatory diseases are the largest cause of death in Trafford and apart from 26, mortality from CVD has been consistently higher for Trafford than the national average. However, in 28 Trafford was much closer to the national average and is still below the North West average. CVD mortality - Under 75 years CVD mortality - Under 75 years DSR per 1, population DSR per 1, population ENGLAND ENGLAND Trafford PCT Trafford PCT DSR per 1, population DSR per 1, population CVD mortality - Under 75 years CVD mortality - Under 75 years ENGLAND North West SHA Trafford PCT ENGLAND North West SHA Trafford PCT Coronary Heart Disease (CHD) mortality is highest in areas of deprivation in Trafford. Circulatory conditions continue to account for a significant proportion of the secondary care attendances in outpatients, emergency admissions and elective admissions. This suggests that improved community management would have significant gains on quality of life, and ongoing symptom management Using the NHS Health Check programme, we are confirming the risk status of patients without existing disease. With data collection covering 74% of the population, the estimates we currently have suggest the following stratification: I. High risk 2% or higher risk of developing CVD in next ten years: 5,732 (9%) II. Moderate risk 1-2% risk of developing CVD in next ten years: 14,78 24%) III. Low risk 1% or lower risk of developing CVD in next ten years: 41,95(67%) 2.2. Total population included: 168,428 of which 62,93 are eligible for Health Checks. By providing tailored services to engage our population with strategies to manage and reduce their risk status there is expected to be an increase in life expectancy and reduction in health inequalities. Cancer Cancer is the second largest killer in Trafford and the mortality rate for all cancers in persons of all ages is significantly lower than the North West and inline with the national average. Mortality rates from cancers are falling in Trafford. 27

28 Trafford CCG: Integrated Commissioning Plan DSR per 1, population DSR per 1, population Bronchitis, emphysema and other COPD mortality - all ages Bronchitis, emphysema and other COPD mortality - all ages ENGLAND North West SHA Trafford PCT ENGLAND North West SHA Trafford PCT DSR per 1, population DSR per 1, population Bronchitis, emphysema and other COPD mortality - all ages Bronchitis, emphysema and other COPD mortality - all ages ENGLAND 2 ENGLAND Trafford PCT 15 Trafford PCT Asthma mortality - all ages Asthma mortality - all ages 3 ENGLAND Trafford PCT 3 ENGLAND Trafford PCT DSR per 1, population DSR per 1, population The most common types of cancer are lung, colorectal, breast, and prostate, the figure below shows the top 6 causes of cancer mortality in Trafford. Other includes cancer of CNS, blood, bone, skin etc The most common risk factors for cancer are smoking, excess alcohol consumption, and obesity. A preventative strategy covering these risks is fundamental to reducing cancer incidence and mortality. The second annual report of the cancer reform strategy published in December 29 highlighted the need for early detection, and 28