NHS NORTH CLINICAL COMMISSIONING GROUP ANNUAL REPORT 2018/19 WELCOME To the annual report summary of NHS Warwickshire North Clinical Commissioning Group for 2018/19.

This has been a really successful year for the CCG, building on the strong relationships and foundations that we’ve established over the last few years, so that together we can reduce health inequalities, and improve access and quality of services for local people. Dr Deryth Stevens Chair We are particularly proud of the work we have done to improve community and primary care services this year, working with our GP Members, Practice Managers and Practice Nurses. We have secured real improvements in the resilience of primary care and more patients than ever are able to access services. It has also been the first year of our new contract for out of hospital care, organising community staff to work more closely with general practice teams, to offer a more responsive and integrated service focused on an individual’s needs.

Citizens and patients remain the focus of everything we do, and this year we have continued to demonstrate our commitment to involving patients in our work. We have worked with our partners in the voluntary sector, local community leaders and colleagues at the local authorities to ensure that all of our population have the opportunity to have their voice heard.

In 2019/20 we will continue to build on the progress we have achieved, learn lessons from where things don’t go as planned, and renew our focus on how we can best improve care for our patients both now and in the future.

Andrea Green Accountable Officer

02 | Warwickshire North CCG Annual Report Summary 2018/19 WHO WE ARE AND WHAT WE DO

NHS Warwickshire North Clinical Commissioning Group (CCG) is responsible Our Values for the planning, organising and buying of NHS healthcare for around 192,728 In 2018/19 we refreshed our values, which underpin the people living in the boroughs of , and . way that the CCG commissions services. This includes most hospital and community NHS-funded services. In 2018/19 we continued to jointly commission Primary Care (General Practice) services with NHS . The CCG is made up of GP member practices which provide primary care services to Caring For Our Population First people in our area. The member practices have elected a clinical Chair and three locality • Putting our patients, carers and populations’ needs first, this GPs who, along with our Chief Nurse, Secondary Care Doctor, three Lay Members, Chief is why the CCG was established and at the heart of all we do. Finance Officer and Accountable Officer, make up our Governing Body. • Working together across all parts of the health and social care system to reduce inequality, improve access, remove In 2018/19 the CCG managed a budget of £272.719m for spending on a variety of duplication, unwarranted variation and wasted resources services including: so that we can best meet our communities and populations’ needs. Primary care services General practice services which provide the first point of contact in the healthcare system, Creating The Culture For Partnerships And Integration acting as the “front door” of the NHS. • Building and sustaining the most effective relationships, partnerships, and service integration that improves the care and Community health services outcomes for our population. Such as treatment by district nurses, advice from health visitors, rehabilitation, • Being objective, transparent and explicit with Partners about physiotherapy and occupational therapy to help people recover from illness and injury. potential barriers to improvement so that we can collectively Acute hospital services agree how these can be overcome. The main provider of acute and some community rehabilitation services across the CCGs area was Hospital NHS Trust (GEH). In addition to this, University Hospitals Respectful And Inclusive and Warwickshire NHS Trust (UHCW) and Heart of England NHS Foundation • Ensuring access to services by valuing everyone, being Trust (HEFT) are the main providers of acute care. mindful of others perspectives, needs and differences. • Respecting and including our staff, empowering Mental health services them through information, personal development and These include talking therapies for people with common mental health problems, and care engagement, so that they can be active advocates for delivering the CCG core objectives. from mental health teams for people with more complex needs. Coventry and Warwickshire Partnership Trust (CWPT) provides mental health and learning Striving For Excellence disability services for children, adults and older people. • Ensuring that our local population has access to evidence Medication based high quality, health and care outcomes. The medication which patients are prescribed by their GP, consultant or other • Being an excellent convener for system partnerships to NHS practitioner. achieve improved care outcomes. • Improving the sustainability of primary care, so that clusters/ Continuing Health Care networks can be active participants, place leaders and Personalised packages of care that include Continuing Health Care (CHC) and funded partners, in the future integrated care system. nursing care service from a number of nursing home and other care home providers.

03 Compared to England Better Similar Worse WARWICKSHIRE NORTH IN NUMBERS Warwickshire England North - CCG North Warwickshire Population Age breakdown MEDIAN Under 18 - 19.43% • Estimated dementia diagnosis rate age 65+ 59.0 67.6 Total - 64,100 AGE 18-64 - 64.67% • Male - 31,544 43 • Female - 32,525 65+ - 21.63% • Depression: Recorded prevalence (aged 18+) 7.7 9.1

Nuneaton and • Primary care mental health register with SMI with Age breakdown 12.9 13.4 Bedworth Population a comprehensive care plan MEDIAN Total - 128,700 AGE Under 18 - 21.57% 59.41% • Male - 63,259 40 18-64 - • People on primary care mental health register/ 81.6 79.0 • Female - 65,400 65+ - 18.97% with SMI with a comprehensive care plan

• Hospital admissions as a result of self-harm 525.1 417.4 (10-24 years) Compared with benchmark: Better Similar Worse Quintiles: Best Worst PERIOD: 2015 - 2018 • Prevalence of Diabetes QOF (17+) 7.4 6.7 NORTH NUNEATON WARWICKSHIRE & BEDWORTH MALE • Life expectancy at birth 78.6 78.0 • Hospital admissions caused by unintentional and 105. 0 99.9 deliberate injuries in children (aged 0-14) • Life expectancy at 65 17.9 18.0

• Inequality in life expectancy at birth 6.0 7.2 • Hospital admissions due to substance misuse 101.1 89.7 • Inequality in life expectancy at 65 1.5 4.9 (15-24 years)

• Gap in life expectancy at birth between -1.0 -1.5 each local authority and England as a whole • Infant mortality 5.8 3.9 FEMALE 82.9 82.4 • Life expectancy at birth • Persons, 60-74, screened for bowel cancer in last 30 60.4 59.1 months (2.5-years screening coverage) • Life expectancy at 65 20.6 20.3 • Inequality in life expectancy at birth 2.4 6.6 • Females, 50-70, screened for breast cancer in last 36 74.7 72.5 • Inequality in life expectancy at 65 1.7 5.2 months (3 year coverage)

• Gap in life expectancy at birth between -0.2 -0.7 each local authority and England as a whole • Females, 25-64, attending cervical screening within 73.0 72.1 target period (3.5 or 5.5 year coverage)

04 | Warwickshire North CCG Annual Report Summary 2018/19 Key: Target Actual met Actual not met MEASURING OUR Cancer waits – two-week wait Maximum two-week wait for first outpatient 93% appointment for patients referred urgently PERFORMANCE with suspected cancer by a GP 96.3% Maximum two-week wait for first outpatient 93% The CCG is working towards improving appointment for patients referred urgently with breast health outcomes, reducing health inequalities symptoms (where cancer was not initially suspected) 93.1% and improving the quality of the services it commissions. Cancer waits – 31-day wait In 2018/19, the CCG has continued to Maximum 31-day wait from diagnosis to first 96% perform well in our commissioned services against definitive treatment for all cancers 98.5% key constitutional requirements. The CCG has routinely met 9 of the 12 NHS Maximum 31-day wait for subsequent treatment 94% Constitutional Standards. where that treatment is surgery 95.6%

Key areas where performance has been less than Maximum 31-day wait for subsequent treatment 98% the NHS Constitutional standard are those where where the treatment is an anti-cancer drug regimen 98.7% performance nationally has commonly also been severely challenged in year, namely: Maximum 31-day wait for subsequent treatment 94% where the treatment is a course of radiotherapy • Referral to Treatment (RTT) - Patients on 97.1% incomplete non-emergency pathways waiting Cancer waits – 62-day wait no more than 18 weeks from referral Maximum 62-day wait from urgent GP referral to first 85% • A&E 4 hour waits definitive treatment for cancer 79.2%

• Cancer two week waits for first outpatient Maximum 62-day wait from referral from an NHS 90% screening service to first definitive treatment appointment for patients referred 90.2% urgently with breast cancer for all cancers Maximum 62-day wait for first definitive treatment following a consultants decision to upgrade the 88.0% priority of the patient (all cancers) – no operational standard set

05 Key: Target Actual met Actual not met

Referral to treatment waiting times for non-urgent 92% RTT – Patients on incomplete non-emergency pathways 84.4% waiting no more than 18 weeks from referral

Diagnostic waiting times <1% Diagnostic tests – Patients waiting less than 6 weeks from referral to having the test undertaken 0.5%

A&E waiting times 95% A&E waits – Patients should be admitted, transferred or discharged within 4 hours of their arrival at an 84.4% A&E department (GEH level)

A&E Performance has improved significantly over the same position of last year, but hasn’t been able to sustain this improvement over winter.

% Increase from Point of Delivery 2017-18 2018-19 2017-18

GP Referrals 40,812 47,384 16.1%

A&E Attendances 80,785 85,333 5.6%

Electives (Planned 25,065 27,061 7.9% Admissions)

Non-Electives (Emergency 17,587 19,513 10.9% Admissions)

First Outpatient 60,712 61,697 1.6% Attendances

06 | Warwickshire North CCG Annual Report Summary 2018/19 ,

WHAT THE MONEY £4,151,000 £3,602,000

IS SPENT ON £15,654,000 £2,260,000

£17,333,000

The CCG received an allocation of £272.719m. The chart shows the expenditure by category of care. £25,658,000

Acute Healthcare £145,849,000 Mental Health

GP Prescribing £32,132,000 Delegated Commissioning

Community Services

Continuing Healthcare £26,080,000 Other Non Acute

CCG Running Costs

Clinical Support

06 | Warwickshire North CCG Annual Report Summary 2018/19 07 MEMBERS OF THE CCG’S GOVERNING BODY March 2019

Dr Deryth Stevens Andrea Green Dr Godwin Igodo Dr Arshad Khan Rachel Robinson Chair (until Jan 2019) Accountable Officer Clinical Lead - elected Clinical Lead - elected Consultant in Public Health (Co-opted)

Dr Inayat Ullah Sue Turner David Allcock Graham Nuttall Practice Network Clinical Lead - Practice Network Lay Member – Audit Lay Member - elected, Clinical Lead and Governance Primary Care – North Warwickshire

Derek Pickard Dr Chris Pycock Jo Galloway Clare Hollingworth Lay Member – Patient and Public Secondary Care Consultant Chief Nursing Officer Chief Finance Officer Involvement (until March 2019) (until Jan 2019)

08 | Warwickshire North CCG Annual Report Summary 2018/19 HIGHLIGHTS

Throughout our full annual report there are details of the many pieces of work which we have done to improve services for our population. Below are some of our highlights from 2018/19. Signposting the way to improving wellbeing

We know that people’s wellbeing is not just could support them. All the support staff at determined by their physical health, but also the practice were also offered training on their mental state. Social, environmental how to start conversations with patients and economic pressures can all have a great and support them to see how they could influence on a person’s overall wellbeing, benefit from the advice and services on offer. which make it vital for us to treat patients in a holistic way and not just focus on their The signposts have so far included immediate physical health needs. This is information about various aspects of often known as social prescribing, where wellbeing including mental health, physical “Our receptionists felt the training made them more aware patients can be referred by their practices activity services, vaccination information and of the organisations available for patients and gave them the to a range of local, non-clinical services. where to go for help with housing/finances, confidence to suggest organisations and services that they Through this, patients can be supported to issues which we know are key for our previously did not know about. In particular they were take greater control of their own health. patients. The theme changes seasonally and amazed at all the different services offered by the Citizen’s there is also monthly information about local Advice Bureau.” We worked with Warwickshire Public events and initiatives. Health to deliver an innovative new pilot Liz Gilbey, Practice Manager Bedworth Health Centre which points the way to healthier lifestyles The signposts have been well received by for residents across north Warwickshire. both staff and patients, and staff report that The scheme saw signposts containing they feel more confident and empowered to information leaflets placed in GP practice make a difference, and give patients the help reception areas, giving local patients a way that they need. “We believe the signposting in an excellent addition to the to find their own way to local services which services we already provide as our trained signposter can work with the clinical team to enhance the patient’s journey and “The signpost in the practice has empowered and enabled me to direct knowledge in one place. We have also found that patients ask questions to the reception team without seeing a clinician, patients to services that they can access in our local community. This has been particularly around social issues, as a direct result of the rewarding and enhances my job satisfaction on a daily basis.” information on display.” Paula Collett, Receptionist, Chancery Lane Surgery Lynn Slater, Practice Manager, Manor Court Surgery

09 Addressing a commissioning gap on community dermatology

In April 2017, the community dermatology service which had previously been offered for Warwickshire North patients came to an end. This meant that patients that were historically seen in a community location were now having to be referred into secondary care which exacerbated the waiting times issues with local Acute Providers.

Working together with our member practices, as well as the Arden GEM CSU procurement team, we undertook a mini procurement exercise to identify and award a contract to the successful bidding organisation and develop a clinically agreed service specification for the successful provider to work against. Once a contract was awarded the service was mobilised quickly.

The successful provider has attended two of our members’ engagement meetings and one Protected Learning Time (PLT) since May 2018. At each of these sessions member practices were able to advise what would work well for this service and several suggestions from practices resulted in significant changes being made to the inclusion criteria for the service and several important process changes.

From April 2018 the consultant led, community based dermatology service has been operating from three locations in Nuneaton, Coleshill and . This has improved convenience for patients, who now need less travel time for appointments. The clinics offer shorter than average waiting times and patients are likely to experience less unnecessary follow up appointments as provider has been commissioned to follow a see, treat, and discharge policy where possible.

10 | Warwickshire North CCG Annual Report Summary 2018/19 Co-designing dementia services with carers, former carers and members of the public

Dementia is a long-term ongoing condition. The Panel met again in December 2018 and will The new developments in post-diagnostic care will While recent national focus has been on meet again in April and August 2019 to continue support carers and reduce health inequalities so that improving diagnosis of dementia, following developing and co-designing services for carers people with dementia and carers are supported to and for people with dementia. Taking on board access services and live full, independent lives for as input from members of our Patient Group the comments and views of those consulted, the long as possible. Forum, and local older people’s group, CCG revised the requirement (‘specification’) for an the CCG identified that there is more existing service in order to expand their geographical Following the initial meetings the CCG is working that also needs to be done to improve coverage, increase their partnership working with closely with Warwickshire County Council and other post-diagnostic support for those with other agencies, and enhance their training offer to providers to put in place the support that residents carers and professionals. The CCG also enhanced have asked for. By working closely with the County the condition. the community offer through the creation of an Council, the CCG ensures that all local support and additional post, to bring extra dementia-specific services – regardless of which agency commissions This will enable people with dementia to ‘live well clinical support into the community in 2019. them - are joined up and working together for the with dementia’ and remain independent and at benefit of patients and families. home for as long as possible, and enable carers to In October 2018, the CCG also visited a number of remain healthy, positive and resilient while carrying community venues to consult with current carers, out their caring role. Residents, carers and former family members and people with dementia. They carers have also told us that they want to be more fed back their views on how well they thought NHS involved with the development of services. services had supported them and what they would like to see in the future. To support co-production and development of “The [Panel] meeting was good in ideas to improve post-diagnostic care for carers of the respect of being updated to those with dementia and for people with dementia, Improving patient outcomes where the CCG is going with the CCG set up a Carer and Reference Panel for By consulting and engaging with carers, former Dementia. The Panel includes members of the public carers and an empassioned lobby group, the CCG Dementia…My group will continue and former carers as well as representatives from ensured that it listened to a group of residents who to attend as it is a topic that we the CCG. are not often heard. As dementia is an age-related condition, it also meant that the CCG consulted with feel very passionate about and I am Understanding patient needs older people for services that are predominantly for pleased that we have a doctor in The first Panel in August 2018 was a workshop older people. our practice that is taking the lead... which was attended by a number of providers, including the Alzheimer’s Society, Carers’ Trust Many carers are dedicated to looking after a Keep the good work up.” Heart of England, CWPT, SWFT, and Warwickshire loved one and do so out of choice, however they County Council. acknowledge that caring full-time can also be stressful, tiring and socially isolating.

11 Case study - Raising awareness of diabetes and support for member practices

We welcomed approximately 450 delegates including Improving patient outcomes GPs, practice staff and hospital clinicians to our first ever combined Coventry and Warwickshire Diabetes Following on from the Diabetes PLT, a number Protected Learning Time (PLT) event, on World of practices have changed their diabetes review Diabetes Day in November. The aim was to raise processes, and instead of medication management awareness about the local diabetes transformation are reviewing the patients’ lifestyle first. service and explain where to refer patients who have Some practices have started to change the way they been newly diagnosed with Type 2 diabetes. Also deliver diabetes care as a direct result of the event discussed were lifestyle transformation, diabetes that took place in November. Group patient sessions foot care, optimising insulin treatment, gestational focusing on lifestyle change have been introduced, diabetes and remission of Type 2 diabetes. during which patients are brought in as a group six Representatives from local provider services to nine months ahead of their annual review, and showcased information about their services, a range receive education around lifestyle changes, diet and of 20 local services attended on the day. This was exercise. Patients then receive their annual review followed by a comprehensive range of workshops as individuals where full annual review bloods and delivered by local and national health providers, biometrics are taken. The results are compared to GPs, Consultants, Fixing Dad (BBC acclaimed story) baseline and patient satisfaction, allowing us to family, practice nurses, dieticians and patients. ensure that changes are patient led and sustainable.

Events to promote learning and build relationships In December 2018, we held a Better Health, Better Care, Better Value workshop to explore the current diabetes pathways across Coventry and Warwickshire and asked questions from delegates about what is working well, what doesn’t work so well, and what pathways could look like moving forward. This group and the commissioning teams will work very closely with primary, secondary, community care and voluntary groups to develop diabetes services that are patient centred, delivered at point of need and make maximum use of resources both financial and staff. We will continue to inform clinicians of any changes.

12 | Warwickshire North CCG Annual Report Summary 2018/19

Supporting local communities to Stay Well This Winter

The winter months are always challenging for the local NHS, especially for urgent care services. Our winter health plan was designed to be delivered across a range of phases that targeted different audiences with different calls to action to help reduce these pressures.

This included messages about flu immunisation, staying well in winter, NHS 111, community pharmacy and extended GP hours. We consciously used simple language and information about the urgent and emergency care system, alternative healthcare services, encouraging self-help and care as and when most appropriate.

Our aim with this year’s winter health campaign was to avoid using the term‘ A&E’ and instead build people’s trust and confidence not only in the local health services available to them but also in themselves to treat minor conditions and ailments by visiting their local pharmacy, calling NHS 111 or seeing their GP.

Simplifying the message to support access

Understanding that some of our local communities might find it particularly difficult to access services, we undertook engagement in our local area to support residents to understand what services were available for them, and how to access them.

We also delivered a Nepalese community session with our Infection and Prevention Nurse at the CCG about winter health. The entire session was translated in Nepalese by a community leader.

14 | Warwickshire North CCG Annual Report Summary 2018/19 This community was very appreciative of the information and understood that keeping well during the winter months was important. 50 men and women took part in the session.

We ran winter health sessions with a variety of groups, focusing on those groups representing people with protected characteristics. These groups included the Sikh Community Association regarding the importance of the flu jab when they receive their letter from the GP. The Punjabi women in particular were receptive to the information and keen to hear about why the flu vaccination is important for those who have diabetes.

Service providers from the Family Information Services and a Community Development Worker from Warwickshire took information about NHS 111 and Your Guide to Local Health Services in Nuneaton. In total we ran or attended 11 sessions over the winter period, speaking to over 200 people.

Improving outcomes for patients

Through raising awareness of how to access services and information around infection control, vaccination and NHS 111 we have empowered local residents to be able to care for their own health and Stay Well This Winter. Feedback from the sessions was positive, with people assuring us that they Engagement with the Nepalese Community in Nuneaton would get their flu vaccinations and sharing that they felt more confident in using NHS 111.

We were able to share materials in different languages where appropriate, and many groups were pleased to receive materials to circulate more widely. The Wellbeing Warriors Calendar for 2019

Healthy Month

BNF Health Eating Week

16 | Warwickshire North CCG Annual Report Summary 2018/19 Wellbeing Warriors Supporting the health and wellbeing of our own a successful assessment against the Thrive at Work “I really think having sessions staff is a vital part of ensuring we continue to deliver toolkit to be awarded a Thrive Award which shows high quality services for patients. As part of the Year that the CCG is an exemplar employer. and workshops like this, and of Wellbeing in Coventry and Warwickshire, the CCG has committed to ‘Thrive at Work’, a workplace To understand what staff need, the Wellbeing highlighting important issues programme with criteria and guidelines on creating Warriors completed a short health survey to staff, at work is amazing. The a workplace that promotes employee health including questions about healthy eating, physical activity and mental health. monthly bulletin is a great and wellbeing. As a result of this a workplace wellbeing action plan read too.” The programme includes a supporting toolkit of was developed and a calendar of events has been available local and national resources, policies and published alongside a monthly healthy workplace services that support implementation by making it bulletin to all staff. clearer and easier for staff to raise awareness and take action to improve health and wellbeing in the CCG. Staff are also supported by managers to attend wellbeing events which address the issues raised A group called the Wellbeing Warriors has been in the health survey. This has included sessions on “I really enjoyed it and found it established to take this work forward and includes relaxation and better sleep and feedback from very beneficial.” members from all teams of the CCG. The aim of the staff has been very positive and this will continue group is to improve staff wellbeing and work towards to be evaluated.

Wellbeing activities in 2018/19 Mothers, families, carers and staff help shape the future of maternity and paediatric services

During 2018, the CCG engaged with over Access Communication, advice and guidance 700 mothers, mothers to be, families, People receive timely access to services and to be Communication to, with and from families should be carers, front line NHS staff and community given all the information they needed to make consistent, accessible and family-friendly; information informed choices about their pregnancy such as should be up to date, available in a variety of formats and voluntary sector representatives to help where and how best to give birth, breast vs bottle and languages; advice and guidance should be shape the future of maternity and paediatric feeding, and to be moved between services quickly consistent between professionals and organisations. services. We wanted people to tell us about and efficiently when required. their experiences of using, supporting or delivering these services; we also wanted Joined-up services to hear what people thought worked well Quality of care Providers need to work together across all and what they thought needed to improve The quality of care received by families, including organisations, including working more closely with and, finally, we wanted to understand what children and young people, is delivered safely and the independent and voluntary sector, to reduce mattered most for them for future delivery effectively in a way that meets their needs. duplication, ensure safety and deliver a seamless of maternity and paediatric services. service and reduce inequalities of service; patients should only need to tell their story once and there Through a series of face to face sessions, telephone should be some continuity of care where appropriate. interviews and workshops, participants helped us to Services and workforce co-design a set of “desirable criteria”, which were Staff to be well-trained and supportive, empowered The next stage will be to take these findings the things we would need to get right to make to work across specialisms and organisations, with back out to the people who took part to ensure sure services best met the needs of our population. a drive for recruiting and retaining staff, and to we interpreted the feedback correctly; that they We also developed a set of draft outcomes so that have greater integration with the community and are satisfied with how we have condensed their we could measure how successful services were in voluntary sector. feedback into these key themes and that it still meeting those needs: makes sense and feels right for them. The feedback will then be given to local providers to help them Person centred care plan future maternity and paediatric services with Care is delivered with compassion, empathy Environment patient needs at the heart. and understanding of the person’s needs Care is delivered in appropriate, safe and clean and circumstances. environments, including in the community where possible.

18 | Warwickshire North CCG Annual Report Summary 2018/19

HOW TO GET INVOLVED

Become a Health Champion Being a Health Champion is the best way to stay in touch with NHS Warwickshire North CCG. Anyone can become a Health Champion, and Health Champions can be involved in shaping the future of local healthcare in a number of ways, such as taking part in focus groups, reviewing new health information before it goes to the We want to hear your feedback general public, as well as receiving regular communications from the CCG. This gives our Health Champions a chance to have their say Both positive and negative – about your experiences on health services, as well as opportunities and issues affecting and the treatment and care you have received is their communities. welcomed by the CCG as we use this as one of our sources of intelligence for understanding Anyone can become a Health Champion patient experience. If you would like to join us and have your say about local health services, contact us by: You can often provide feedback anonymously and giving feedback will not affect your care or how you are treated. If a www.warwickshirenorthccg.nhs.uk family member or someone you care for is a patient and unable to provide feedback, you are encouraged to give feedback [email protected] about their experiences on their behalf. Feedback will help to improve NHS services for all. @WarksNorth You can feedback to Warwickshire North CCG through our 024 7632 4399 website, by phone or post using the contact details opposite.

NHS Warwickshire North CCG, Heron House, Newdegate Street, Nuneaton, CV11 4EL

This report is a summary version of our Annual Report and Accounts 2018/19. The full version of the report is available online at www.warwickshirenorthccg.nhs.uk

The information in this publication is available in a range of languages and formats such as large print or braille. Please contact us by post, email or telephone to request a hard copy, or a copy in a different language or another format.