NHS Southwark CCG Operating Plan : 2018/19 refresh. March 2018

Transcription

1 NHS Southwark CCG Operating Plan : 2018/19 refresh March 2018

2 Operating Plan : contents Section Introduction and context: 1. What is an operating plan? 2. National and regional planning and strategic context Page Integrated system working 7 NHS Southwark CCG Five Year Forward View 10 Emergency care and referral to treatment times 14 Financial framework 19 Delivery of next step priorities 25 Additional operational and activity plans 49 2

3 Introduction and context

4 What is an Operating Plan? The Operating Plan is an assurance document which sets out how the CCG plans to improve the health and wellbeing of people living in our borough by meeting mandatory requirements set by NHS England. The requirements set for CCGs originate from the government s annual Mandate to NHS England. This Operating Plan sets out our locally-defined response to national requests. It can be read as a declaration of the CCG s commitment to meet national requirements; establish the extent of our ambition for the improvement of certain performance and outcome indicators; and provide a view of the programmes of work underway and planned to ensure these improvements happen. The Operating Plan also summarises the CCG s financial plan, full details of which are provided in the CCG s Budgetary Framework 2018/19. Both the CCG Council of Members and NHS England are responsible for reviewing and approving CCG operating plans and the CCG submits detailed planning templates to NHS England first in early March and finally at the end of April to indicate its compliance (or otherwise) with the national requirements. This document summarises the detailed submissions made by the CCG to NHS England on 9 March 2018, and supplements this information with a further description of the key actions and activities the CCG plans to complete in 2018/19 to deliver an improved NHS in Southwark. The over-arching purpose of CCG operating plans is for the NHS in aggregate (through commissioner, provider and STP plans) to set out a clear trajectory to implement the national Five Year Forward View; drive improvements in health and care; restore and maintain financial balance; and deliver core access and quality standards. Refreshing year two of the CCG s two year Operating Plan NHS Operational Planning and Contracting Guidance (published September 2016) and Next Steps on the NHS Five Year Forward View (March 2017) established a requirement for CCG s to set a two year operating plan covering the two year period It also mandated CCGs to set contracts with their main providers to cover the same time period. The CCG s Council of Members approved the current CCG s operating plan in March In February 2018 NHS England and NHS Improvement published Refreshing NHS Plans for 2018/19, which set out the additional resources made available by HM Treasury to the NHS at the November 2017 Budget, and outlined the expectations to commissioners and providers for how these additional resources would be allocated across England and how they should be targeted. CCGs were asked to refresh their CCG Operating Plan in line with these requirements, addressing the 2018/19 deliverables described in the Next Steps on the NHS Five Year Forward View. 4

5 National planning and strategic context Next Steps On The NHS Five Year Forward View (March 2017) The NHS Five Year Forward View set out a vision for how the health service in England needs to change over five years from 2015/16. This document was supplemented in March 2017 by Next Steps, which set out the NHS main national service improvement priorities over the two year planning period in acknowledgement of the need for the service to confront some of the choices raised by the challenging context. The following priorities in Next Steps form the basis of CCGs operating planning requirements: urgent and emergency care 24 hours a day, 7 days a week; working with partners to free up hospital beds; more convenient alternatives to A&E: Urgent Treatment Centres, GP appointments, NHS 111. ensure patients can get a convenient and timely appointment with a GP; enhance primary care clinical recruitment and professional development; and extend out-of-hours access. speed up and improve diagnosis, increase current capacity and open new Rapid Diagnostic and Assessment Centres to treat patients with suspected and/or diagnosed cancer substantially increase investment in mental health services; improving access to talking therapies, specialist perinatal mental health teams and community services for children an young people; rebalancing of specialist beds around the country; 24-hour mental health liaison teams in A&Es; investing in crisis response and home treatment teams; and placing more therapists in primary care. accelerate integrated working through partnerships of care providers and commissioners via Sustainability and Transformation Partnerships. deliver more value through delivery of the NHS 10 Point Efficiency Plan; and leverage the potential of technology and innovation to improve patient outcomes and operational efficiency. 5

6 2018/19 deliverables: Next Steps Priorities The NHS is already working to the two-year priorities set out in last year s planning guidance and on the Next Steps priorities. The February 2018 Refreshing NHS Plans for 2018/19 guidance builds on the Next Steps document and sets out the deliverables for CCGs and providers in 2018/19. The CCG s response to these deliverables or next step priorities is summarised below and detailed in the remaining sections of this document: Mental Health: Progress with the delivery of recommendations published in the Implementing the Mental Health Forward View and Stepping Forward to 2020/21. Taking steps towards providing equal status for mental and physical health. Cancer: Advance delivery of the National Cancer Strategy to promote better prevention and earlier diagnosis and deliver innovative and timely treatments to improve survival, quality of life and patient experience by 2020/21. Primary Care: Stabilise general practice today and support the transformation of primary care and for tomorrow, by delivering General Practice Forward View and Next Steps on the NHS Five Year Forward View. Urgent and Emergency Care: Redesign and strengthen the urgent and emergency care system to ensure that patients receive the right care in the right place, first time. Transforming Care for People with Learning Disabilities: Transform the treatment, care and support available to people of all ages with a learning disability, autism or both so that they can lead longer, happier, healthier lives in homes not hospitals. Maternity: Continue to make maternity services in England safer and more personal through the implementation of the Better Births. 6

7 Integrated system working

8 Integrated System Working: south east London perspective NHS Southwark CCG is participating fully as a member of Our Healthier South East London (OHSEL), which is the Sustainability and Transformation Partnership for South East London (SEL STP) comprising six clinical commissioning groups, three acute provider trusts and two mental health trusts. OHSEL published the SEL STP plan in October 2016 setting out a five year vision of how the NHS organisations and local authorities in south east London will work together to establish sustainable services for the local population which are safe, affordable and of consistent high quality. Specifically, OHSEL is focusing on the following objectives: Developing community based and primary care services targeted at prevention Reducing variation / improving the quality of both physical and mental health services Changing how we work together through an programme of transformation in the delivery of clinical services Developing sustainable specialised services Reducing cost and increasing productivity through provider productivity collaboration South east London faces some significant challenges to deliver on its objectives, meet national targets and secure capital to invest in services in the light of physical constraints imposed by existing estates and against a backdrop of unprecedented financial pressure and rising demand for services. The SEL STP represents an ambitious programme of clinical transformation and provider productivity initiatives with partners working both individually and in collaboration to deliver change. Further information about OHSEL case-for-change; financial strategy; governance; and publications and resources is available at 8

9 Integrated System Working in south east London 2018/19 In 2018/19, STPs are expected to take an increasingly prominent role in planning and managing systemwide efforts to improve services. Following a review of the leadership and programme support resources across OHSEL and south east London CCGs, the SEL STP appointed a single Accountable Officer, Executive Leadership Team, and dedicated resource working at a south east London level to coordinate planning and system management across all partners in the STP area. Under this arrangement, the STP in south east London will in 2018/19 undertake action to: ensure a system-wide approach to operating plans that aligns key assumptions between providers and commissioners which are credible in the round; work with local clinical leaders to implement service improvements that require a system-wide effort as per that set out in the SEL STP plan (October 2016); identify system-wide efficiency opportunities such as reducing avoidable demand and unwarranted variation, or sharing clinical support and back office functions; undertake a strategic, system-wide review of estates, developing a plan that supports investment in integrated care models, maximises the sharing of assets, and the disposal of unused or underutilised estate; take further steps to enhance the capability of the system including stronger governance and aligned decision-making, and greater engagement with communities and other partners, including where appropriate, local authorities. take steps to resource the STP infrastructure. 9

10 NHS Southwark CCG Five Year Forward View

11 Local strategic vision: Southwark s Five Year Forward View Building on the national Five Year Forward View, the CCG and Southwark Council in 2015 developed a local vision for health and social care in Southwark: 2016/17 to 2020/21 to transform local NHS and care services in the borough. Both the CCG and Council together with local stakeholders agree that we should be working toward establishing a health and care system that works to improve health and social care outcomes for Southwark people, instead of simply focusing on maintaining current service arrangements. Our local ambition is to create a much stronger emphasis on prevention and early action as well as deeper integration across health and social care, and wider council services (including education). To support this change we have joined together some commissioning arrangements (as a Partnership Commissioning Team) and have worked to set-up contracts that incentivise system-wide improvement. Our work focuses on specific populations, including particularly vulnerable groups and we will continue our work with ever greater emphasis on the outcomes achieved in addition to the quantity of activity delivered. The implication of our Southwark Forward View strategy is a movement away from a system with lots of separate contracts and towards inclusive contracts for defined segments of the population which cover all of the various physical health, mental health and social care needs of people within that group. These contracts will be available to providers who can bring together the skills required to meet these needs. Our aim is to empower the development of multi-specialty community providers Local Care Networks - serving populations of 100, ,000 people, with access to excellent specialist networks when required. 11

12 The progress we made in 2016/17 We are trying to maximize the total value of health and care for Southwark people, ensuring that commissioned services exhibit positive attributes of care (services respond to a person s mental and physical health needs; they are proactive, preventative, and empowering; and they are well coordinated) 1 We have begun to address the 2 We have begun to address the 3 fragmented arrangements of fragmented arrangement of commissioning & contracting, by: organisations and professions, by: We have begun to address the need to empowering residents and service users, by a) Establishing joint population-based commissioning development groups (CDGs) and a Joint Committee b) Creating fully assured BCF plans c) Recruiting to an Assistant Director for Joint Commissioning, and launching consultation on the joint commissioning team structure d) Establishing a shared system incentive (with alternative arrangements for general practice) e) Starting formal options appraisal and engagement to determine if we will submit an application for delegation f) Establishing two Local Care Network Boards in Southwark, with consistent multi-agency representation, and funded LCN chairs additional resources are being agreed to support further development g) Putting into practice two at scale Extended Access Hubs, developing GP federations, and orienting adult social care around neighbourhood and LCN geographies h) Agreeing our local Sustainability and Transformation Plan (STP) and launching a consultation on an elective orthopaedic centre model i) Holding public meetings about our GP contracts (the PMS Review), and involving local residents in the development of a new pathway of care for people with complex needs (through ethnographic research, patient stories and experience-based co-design) j) Successfully bidding to be a pilot site to embed Patient Activation Measures in our local services k) Requiring providers to include collaborative care planning and selfmanagement in the pathways for people with chronic conditions 4 We have established a local Strategic Partnership of commissioners, statutory providers and residents to ensure alignment of organisational strategies and to coordinate and enable the delivery of our shared transformation programme 12

13 The progress we plan to make in We are trying to maximize the total value of health and care for Southwark people, ensuring that commissioned services exhibit positive attributes of care (services respond to a person s mental and physical health needs; they are proactive, preventative, and empowering; and they are well coordinated) 1 We will continue to address the 2 We continue to address the 3 fragmented arrangements of fragmented arrangement of commissioning & contracting, by: organisations and professions, by: We continue to address the need to empowering residents and service users, by a) Using our CDGs to develop plans that support population-based and outcomes-focused contracting for CYP, adults and SMI groups b) Fully utilising BCF opportunities, moving towards a thematic approach to H&SC funding within the scheme c) Deepening our joint working with the Council by establishing a more integrated approach to commissioning, underpinned by our Partnerships Commissioning Team d) Making the most of our commissioning opportunities to simplify GP contracting and support collaboration with the wider health and care system f) Building greater capacity and purpose within our Local Care Networks investing in an engine room to drive a wider programme of activity (covering aspects of neighbourhood working and more integrated Community Based Care) g) Continuing to implement the GPFV, ensuring that our Extended Access Hubs meet the London Access Specification (including offering routine pre-bookable appointments) h) Beginning to deliver projects within our local STP, including sharing corporate functions and the further development of the Local Care Record and analytics i) Holding public meetings to inform our approach to local contracting (including creating a local outcomes framework) j) Involving local residents in the development of a new pathway of care (through ethnographic research, patient stories and experience-based co-design) k) Building on the PAM pilots so that self-management is more effectively supported in Southwark; and that service users and staff to make the most of collaborative care planning l) Exploring approaches to develop flourishing communities 4 We will continue to work within our local Strategic Partnership of commissioners, statutory providers and residents to ensure alignment of organisational strategies and to coordinate and enable the delivery of our shared transformation programme 13

14 Emergency Care and Referral to Treatment Times

15 Emergency Care and Referral to Treatment Times The CCG s original (submitted for two years in 2017) plans have been revised to reflect updated financial allocations for 2018/19 and the requirement to use additional resources to support a locally-determined contribution to the national ambition of a 2.3% growth in non-elective admissions and ambulance activity and 1.1% growth in A&E attendances; 4.9% growth in total outpatient attendances; and up to 3.6% growth in elective admissions. Revisions to the CCG s budget and performance trajectories will be finalised with trusts as part of the ongoing negotiations on variations to agreed two year contract. Growth for Southwark has been modelled using current contractual assumptions around levels of growth and RTT, and the potential impact of CCG QIPP schemes. The following pages set out the A&E, RTT and diagnostics activity and performance trajectories for Southwark CCG for 2018/19. Plans are forecast from actual performance in 2017/18 (forecast year end) and have been developed with reference to the South East London STP, provider plans; the CCG s financial and QIPP plans; the Southwark BCF plan and to the contracts agreed with providers for (subject to final agreement). 15

16 Urgent and emergency care performance The data below is for all patients attending King s College Hospital (KCH) emergency department (both at Denmark Hill and PRUH sites). Southwark CCG is the coordinating commissioner for King s and so is required to submit this trajectory. The CCG is committed to work with the trust to implement at a local level the commitments made as part of the STP. The local approach to implementing key deliverables for 2018/19 is described on pages 4 and 5. A&E waits at KCH Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Number waiting > 4 hours 4,717 4,523 4,218 3,914 3,435 3,318 3,223 2,917 2,596 2,395 1,948 1,799 Total Attendances 34,084 34,821 34,744 34,665 32,905 33,183 35,183 35,063 34,705 36,069 33,588 35,992 Percentage < 4 hours 86.2% 87.0% 87.9% 88.7% 89.6% 90.0% 90.8% 91.7% 92.5% 93.4% 94.2% 95.0% NHS England has set a national ambition for 2018/19 to achieve above 90% in September 2018 and for the majority of providers to achieve the 95% standard for the month of March The trajectories above show that King s College Hospital has planned to meet these ambitions for 2018/19 16

17 Referral to treatment times and elective care A more significant annual increase in the number of elective procedures compared with recent years means commissioners and providers should plan on the basis that their RTT waiting list, measured as the number of patients on an incomplete pathway, will be no higher in March 2019 than in March 2018 and, where possible, they should aim for it to be reduced. Percentage waiting to start treatment who have been waiting less than 18 weeks Incomplete pathways Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Incomplete Pathways < 18 weeks 18,944 19,025 18,980 19,017 19,015 19,046 19,057 19,067 19,059 19,082 19,083 19,104 Total Incomplete Pathways 22,147 22,104 21,929 21,859 21,751 21,666 21,530 21,391 21,268 21,155 21,040 20,926 Percentage 85.5% 86.1% 86.6% 87.0% 87.4% 87.9% 88.5% 89.1% 89.6% 90.2% 90.7% 91.3% The national 2018/19 ambition is to sustain the waiting list at March 2018 levels in March The trajectories above show a reduction in the number of people on the waiting list Number of patients waiting more than 52 weeks for treatment 52 weeks Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Pathways >52 Weeks The national 2018/19 ambition is for the number of patients waiting more than 52 weeks for treatment at March 2018 be halved by March The trajectories above show that the CCG has planned to surpass this ambition, with no patients waiting more that 52 weeks by March

18 Referral to treatment times and elective care Utilisation of e-referrals to deliver patient choice at first outpatient appointment E-referral coverage Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Total number of patients referred to 1st Outpatient Services via e-rs Overall number of patients referred to 1st Outpatient Services 5,503 5,933 6,277 6,878 7,566 8,168 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 8,598 Percentage 64.0% 69.0% 73.0% 80.0% 88.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NHS England has set a national ambition for 2018/19 to achieve 100% coverage by Quarter 2 of 2018/19. The trajectory above shows the plan to achieve this ambition by October Diagnostics E-referral coverage Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Total number of patients waiting >6 weeks for diagnostics Total number waiting 5,005 5,255 5,255 5,505 5,505 5,005 5,756 5,505 4,755 5,505 5,005 5,255 Percentage 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 0.9% 1.0% 1.0% 1.0% 1.0% 1.0% NHS England has set a national ambition for a maximum of 1% of patients should wait 6 weeks or more for a diagnostic test. The trajectory above shows the plan to achieve this throughout 2018/19. 18

19 Financial Framework

20 Financial Framework The financial scenario facing the CCG for and future years is increasingly tough and has tightened further since last year. The CCG anticipates closing its accounts for having achieved a 2.3% surplus, equivalent to c. 9.7m and in line with plan. The CCG is continuing to invest more in mental health services. The Five Year Forward View requires CCGs to demonstrate that we are investing an amount equivalent to the growth in their allocation. Southwark received 2.5% growth in the original allocation plus a further c 0.8% ( 3.28m) in the Autumn Budget (i.e. total 3.3%). The current planned growth for Mental Health for 2018/19 is 3.5%, which is made up of planned investment in Older Adults and Adults Mental Health, Children & Young Peoples Mental Health, Crisis Services and Mental Health Liaison with acute hospitals, as well as IAPT. This investment totals an additional 2.16m. For the coming year we will continue to invest in improving the quality of community and primary care services, and achieve safety and quality improvements in all our contracts. We are working closely with our local GP Federations, to deliver improved quality and consistency of services to all residents on a population basis. The CCG has had significant cost pressures to deal with in the past few years, most significantly the growth in acute activity. 2.1m of the extra 0.8% allocation is assigned to acute services. The current envelopes include an assumption of funds being set aside for the acute sector, for outturn, tariff uplift, forecast future growth and other pressures such as the investment in the SEL Integrated111/Urgent and Emergency Care Service. The two year control totals for CCG s issued last year by NHSE give additional pressure in , as the SEL CCG s are required to increase their surplus position by 3,250k collectively in year. At present this assumes that Southwark will make a share of that surplus, giving an additional target of 650k surplus in 2018/19. 20

21 Financial Framework The CCG has determined that it will need a net QIPP saving programme of circa 16.5m in the year comprising a gross saving of 17.7m enabled by a small investment of 1.2m. This is higher than has been set in previous years. As a result of known pressures and the QIPP requirement, the CCG is unable to maintain contingency and reserves at the same level as previous years. National business rules have been revised to require the CCG to hold only a minimum 0.5% contingency in reserves that can be used to meet in year pressures. We are no longer required to hold a separate 0.5% for non-recurrent spend in 2018/19. The CCG s 0.5% general contingency is 2.4m and the CCG holds other reserves of 3.1m. Financial balance and the delivery of the CCG s planned financial position is a core priority and a statutory requirement for NHS Southwark CCG. The financial position is reviewed regularly by the CCG s Governing Body and the Integrated Governance & Performance Committee. The committee is accountable for: overseeing a robust organisation-wide system of financial management, including QIPP delivery; ensuring that budgets are set in an appropriate and timely manner and that the Governing Body is fully aware of any financial risks which may materialise throughout the year. The annual budget and operating plan are approved by the Council of Members in March 2017, and they receive updates throughout the year. The CCG has a key role as the lead commissioner of King s NHS Foundation Trust, in working with partners, and the Trust, on the delivery of their Financial Recovery Plan. This involves regular discussions and agreement of targets for the recovery plan with all parties, including NHS Improvement. 21

22 Opening Budgets and 2019/20 (indicative) Opening Resources ( 000) Recurrent Allocation 446, , ,276 NHSE transformation funds- NR 2, Access funds Running Costs allocation 6,496 6,533 6,565 Total Resources 455, , ,791 Target surplus for the year 9,743 10,393 To be agreed The CCG is facing a tougher period over the next two years with lower allocation increases and ongoing pressures in the provider sector. The CCG has increased the surplus to 9,743k in 2017/18 and to 10,393k in 2018/19 and which is above the 1% surplus business rules requirement. 22

23 QIPP Programme and 2019/20 (indicative) Net QIPP programme and ( 000) Acute services and Community services 6,355 7,155 7,700 Mental health /client groups 3,045 2,500 2,600 Corporate services 155 1, Continuing Care/ transformation 2,000 1, Primary Care inc. Delegated Community services Transformation Prescribing 1,700 2,112 1,438 Unidentified/Wave 2 balance to find 0 1,072 2,000 Total gross savings 13,255 17,718 15,428 Investment to achieve QIPP in acute /MH 862 1,168 TBA Total QIPP programme- net of investment 12,393 3% 16, % Due to known/likely cost pressures we face, and a reduced level of uplift to the allocation, QIPP planning is based on a 3.6% net saving of 16,550k in 2018/19 and 3.2% net saving of 15,428k in 2019/20. This compares to a QIPP net saving value of 12,393k (2.7%) in 2017/18. 15, % Such a level of QIPP will inevitably be challenging and will need close monitoring of both planning and implementation to ensure it is successful. 23

24 Reserves and 2019/20 (indicative) Overall planned level of reserves ( 000) Set aside for Non recurrent pressures 2, General contingency ½ % 2,038 2,350 2,400 Winter Resilience General risk reserve and HLP ,352 1,532 Return of non-recurrent resource from NHSE 2,000 0 NR drawdown of historic underspend Total Reserves available 6,878 5,402 4,632 % of total budget 1.51% 1.20% 0.97% The financial plan meets national business rules with regard to holding a 0.5% contingency. We are no longer required to hold a separate 0.5% for non-recurrent spend in 2018/19. 24

25 Delivery of next step priorities detailed in the 2018/19 planning guidance refresh

26 1: Mental Health NHS England published Implementing the Mental Health Forward View in July 2016 to set out clear deliverables for putting the recommendations of the independent Mental Health Taskforce Report into action by 2020/21. The publication of Stepping Forward to 2020/2025 in July 2017 provides a roadmap to increase the mental health workforce needed to deliver this. Making parity a reality will take time, but this is a major step on the journey towards providing equal status for mental and physical health. The following slides show the operational and activity plan requirements for the CCG to deliver during 2018/19. NHS England have highlighted the key deliverables for the CCG (some in partnership with the STP) for 2018/19. These objective also align with the recently published joint Southwark CCG and Council Mental Health Strategy: Meet the Mental Health Investment Standard (MHIS): The Southwark 2018/19 investment in mental health rises at a faster rate than their overall programme funding. This will be validated at year end by the CCG s auditors. Contribute to the national ambition for an additional 49,000 children and young people receive treatment from NHS-commissioned community services nationally, towards the 2020/21 objective of an additional 70,000 additional children and young people: The joint agency Local Transformation Plan is aligned to the SEL STP and regularly refreshed and published on the CCG website. Progress further towards delivering the 2020/21 waiting time standards for children and young people s eating disorder services of 95% of patient receiving first definitive treatment within four weeks for routine cases and within one week for urgent cases. The plan to continue to achieve 100% for this standard is detailed on page

27 1: Mental Health (continued) Ensure that 53% of patients requiring early intervention for psychosis receive NICE concordant care within two weeks: The plan to continue to meet the EIP waiting time standard is detailed on page 30. Deliver against regional implementation plans to ensure that by 2020/21, inpatient stays for children and young people will only take place where clinically appropriate, will have the minimum possible length of stay, and will be as close to home as possible to avoid inappropriate out of area placements: Close working between partners in the South London Partnership (SLP) has been established with a plan established to place south London adolescents in south London beds. This has resulted in a shift towards the use of SLP beds for south London children and young people and reduction in tier 4 out of partnership bed days. Young people in tier 4 placements are closer to their families and social networks. Continue to increase access to specialist perinatal mental health services: During 2018/19, Southwark CCG will develop a new perinatal mental health service model. We aim to have a service that deals with patients who need expert care, but also to provide a consultancy service to other clinicians on how to support existing patients. Continue to improve access to psychology therapies (IAPT) services: IAPT will be expanded into primary and physical healthcare pathways and Southwark will maximise the potential for primary care to support people with mental health issues in the community, shift towards GP-led healthcare. Continue to work towards the 2020/21 ambition of all acute hospitals having mental health crisis and liaison services: In conjunction with SLaM we have implemented the Core 24 model for our psychiatric liaison services at KCH and GSTT. This improves psychiatric support for A&E and the hospital wards and enables hospital staff to have access to specialist advice about managing people in crisis. In 2018/19, we will assess the impact of Core 24 services with a focus on improving in-hospital and community-based solutions. 27

28 1: Mental Health (continued) Support delivery of STP-level plans to reduce all inappropriate adult acute out of area placements by 2020/21: Southwark will review residential provision and develop alternatives to in-patient wards. Development of new community-based models of support is a deliverable for Southwark included in Joint Mental Health and Wellbeing Strategy ( ). Contribute to the ambition to provide a 25% increase nationally on 2017/18 baseline in access to Individual Placement and Support services: Plans are in place and included in Joint Mental Health and Wellbeing Strategy ( ) delivery planning Maintain the dementia diagnosis rate of two thirds (66.7%) of prevalence and improve post diagnostic care: The plan to continue to meet the dementia diagnosis standard is detailed on page 33. Deliver the CCG s contribution to the mental health workforce expansion as set out in the HEE workforce plan, supported by STP-level plans: Commissioners across the sustainability and transformation plan (STP) area are developing a multi-agency workforce plan in South East London with key actions to be completed by March Deliver against multi-agency suicide prevention plans, working towards a national 10% reduction in suicide rate by 2020/21. Southwark has committed to delivering against targets in the Southwark Suicide Prevention Strategy and Joint Mental Health and Wellbeing Strategy ( ) delivery plan. Deliver liaison and diversion services to 83% of the population. Additional mental health crisis and liaison services are in place and the SLaM Crisis Assessment Team pilot will be reviewed during 2018/19. Ensure all commissioned activity is recorded and reported through the Mental Health Services Dataset. 28

29 1: Mental Health: IAPT Access and Quality Standards IAPT Waiting times Quarter 1 Quarter 2 Quarter 3 Quarter 4 The number of ended referrals that finish a course of treatment in the reporting period Percentage who received their first treatment appointment within 6 weeks of referral 75.0% 75.0% 75.0% 75.0% Percentage who received their first treatment appointment within 18 weeks of referral 95.1% 95.1% 95.1% 95.1% CCGs are required to ensure that 75% of people referred to the Improved Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral. This standard applies to adults. The above trajectory refers to Southwark patients accessing services at all providers. The CCG is currently planning to meet this target for its patients throughout IAPT Recovery Rate Quarter 1 Quarter 2 Quarter 3 Quarter 4 The number of people who completed treatment having attended at least two treatment contacts and are moving to recovery The number of people who finish treatment having attended at least two treatment contacts, excluding those not at clinical caseness at initial assessment Percentage who finish treatment having attended at least two treatment contacts, excluding those not at clinical caseness at initial assessment % 50.0% 50.0% 50.0% CCGs are required to ensure that at least 50% of people completing treatment are moving to recovery. The above trajectory refers to Southwark patients accessing services at all providers. The CCG is currently planning to meet this target for its patients throughout IAPT Roll-out Quarter 1 Quarter 2 Quarter 3 Quarter 4 Number of people who receive psychological therapies 1,991 1,991 1,991 1,992 Number of people who have depression and/or anxiety disorders 41,930 41,930 41,930 41,930 Percentage of people who have depression and/or anxiety disorders receiving psychological therapies 4.7% 4.7% 4.7% 4.8% CCGs are required to ensure that at least 19% of people with anxiety and depression access treatment by Quarter 4 of The CCG is planning to meet this target. 29

30 1: Mental Health: early intervention psychosis EIP Psychosis treated with a NICE approved care package within 2 weeks of referral Number of referrals to and within the Trust with suspected first episode psychosis or at risk mental state that start a NICE-recommended package care package in the reporting period within 2 weeks of referral. Quarter 1 Quarter 2 Quarter 3 Quarter Number of referrals to and within the Trust with suspected first episode psychosis or at risk mental state that start a NICE-recommended care package Percentage that start a NICE-recommended package care package in the reporting period within 2 weeks of referral. 55.0% 55.0% 55.0% 55.0% The above table shows the trajectory for expansion of EIP services in line with the Mental Health Five Year Forward View so that more than 53% of people experiencing a first episode of psychosis begin treatment with a NICE-recommended package of care within two weeks of referral 30

31 1: Mental Health: community eating disorder teams Children accessing eating target - routine Quarter 1 Quarter 2 Quarter 3 Quarter 4 Number of CYP with ED (routine cases) referred with a suspected ED that start treatment within 4 weeks of referral /19 Plan Number of CYP with a suspected ED (routine cases) that start treatment Percentage starting within 4 weeks of referral 100.0% 100.0% 100.0% 100.0% Children accessing eating target - urgent Quarter 1 Quarter 2 Quarter 3 Quarter 4 Number of CYP with ED (urgent cases) referred with a suspected ED that start treatment within 1 week of referral /19 Plan Number of CYP with a suspected ED (urgent cases) that start treatment Percentage starting within 4 weeks of referral 100.0% 100.0% 100.0% 100.0% CCGs are required to commission community eating disorder teams so that 95% of children and young people receive treatment within four weeks of referral for routine cases; and one week for urgent cases; and reduce suicide rates by 10% against the 2016/17 baseline. The trajectories above show the CCG meeting urgent and routine case targets. Evidence based eating disorder services are effectively provided locally and cited in the guidance. As the main provider of services in South East London, South London and Maudsley NHS Foundation Trust have developed a seven borough proposal. This includes how local community eating disorders services will be enhanced in line with new guidance to meet waiting and access standards for eating disorder services for children and young people. We have supported further the development of the already established community-based eating disorder service, by enhancing existing provision and opening the service to self- referrals and online resources for early assessment. 31

32 1: Mental Health: children services Children accessing rate roll out 17/18 CCG Revised Estimate* Q1 18/19 Q2 18/19 Q3 18/19 Q4 18/19 Annual 18/19 Total number of individual children and young people aged 0-18 receiving treatment by NHS funded community services in the reporting period. 1, ,830 Total number of individual children and young people aged 0-18 with a diagnosable mental health condition. 6,196 6,196 6,196 6,196 6,196 6,196 Percentage of children and young people aged 0-18 with a diagnosable mental health condition who are receiving treatment from NHS funded community services. 21.1% 7.7% 7.3% 7.3% 7.3% 29.5% CCGs are required to ensure there are more high-quality mental health services for children and young people. The CCG has modelled that 1,830 children with a diagnosable condition will access evidence-based services by April 2019, including all areas being part of Children and Young People Improving Access to Psychological Therapies (CYP IAPT) by This represents 29.5% of the total number of individual children and young people aged 0-18 with a diagnosable mental health condition, and an increase of 535 compared to the 17/18 estimated position. The national ambition is that at least 32% will access services during 2018/19. Southwark are not expecting to meet this target within the timeframe set out in national guidance. The CCG will work closely with providers and other stakeholders to set a trajectory to increase access to the national standard within the financial year 2019/20. 32

33 1: Dementia access standards Dementia diagnosis APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Number of People diagnosed (65+) 1,026 1,026 1,026 1,026 1,026 1,026 1,026 1,026 1,026 1,026 1,026 1, Plan Estimated dementia prevalence (65+ Only (CFAS II)) 1,537 1,537 1,537 1,537 1,537 1,537 1,537 1,537 1,537 1,537 1,537 1,537 % 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% 66.8% A national dementia tool provides the CCG and each general practice member with a predicted number of people on registered lists estimated to have dementia. CCGs are required to maintain a dementia diagnosis rate of at least two thirds of estimated local prevalence, so that those thought to have dementia are referred for diagnosis, diagnosed, and then added to their registered practice s dementia register for on-going management and care planning. Building on strong performance and significant investment over previous years, the trajectories above show this being met throughout 2018/19. 33

34 2: Cancer The NHS s goal for is to advance delivery of the National Cancer Strategy to promote better prevention and earlier diagnosis and deliver innovative and timely treatments to improve survival, quality of life and patient experience by 2020/21. The CCG continues to work with the trusts, the Accountable Cancer Network and Transforming Cancer Services Team to promote earlier identification of and treatment for cancer. The following slides show the operational and activity plan requirements for the CCG to deliver during 2018/19. The planning guidance highlights the following deliverables for 2018/19: Ensure all eight waiting time standards for cancer are met, including the 62 day referral-totreatment cancer standard. The 10 high impact actions for meeting the 62 day standard should be implemented in all trusts, with oversight and coordination by Cancer Alliances: The South East London 62 Day Group lead delivery of the 62 day standard. Plans to achieve the 2 week, 31 day and 62 day standards are detailed on page 36. Ensure implementation of the nationally agreed rapid assessment and diagnostic pathways for lung, prostate and colorectal cancers, ensuring that patients get timely access to the latest diagnosis and treatment: This will be taken forward via the Lambeth, Southwark and Bromley Cancer Locality Group. South East London Cancer Alliance will develop the GP role in the 2WW pre-hospital pathway Progress towards the 2020/21 ambition for 62% of cancer patients to be diagnosed at stage 1 or 2, and reduce the proportion of cancers diagnosed following an emergency admission: A Macmillan GP operates in Southwark and will work with primary, community and specialist clinicians and colleagues in public health to lead improvements in screening and early diagnosis of cancers in the local population. 34

35 2: Cancer (continued) Support the rollout of FIT in the bowel cancer screening programme during 2018/19 in line with the agreed national timescales: Southwark and the wider Cancer Alliance will support Public Health England to achieve the ambition for at least 10% of all bowel cancers diagnosed through the screening programme are detected at an early stage, increasing to 12% in 2019/20. Progress towards the 2020/21 ambition for all breast cancer patients to move to a stratified follow-up pathway after treatment. The Alliance Cancer Network Breast Tumour Group will lead the development of clinically agreed protocols for stratifying breast cancer patients and a system of remote monitoring by the end of 2018/19. Ensure implementation of the new cancer waiting times system in April 2018 and begin data collection in preparation for the introduction of the new 28 day Faster Diagnosis standard by 2020: There is a commitment to implement industry leading cancer management software (Somerset) across south east London. This will support implementation of the new cancer waiting times system and Faster Diagnosis standard. 35

36 2: Cancer (continued) Cancer waiting times: 2 week wait Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Number waiting < 2 weeks Total number waiting Percentage 93.1% 93.0% 93.0% 93.1% 93.1% 93.1% 93.1% 93.1% 93.0% 93.1% 93.1% 93.0% The above trajectory refers to Southwark patients accessing services at all providers. The CCG is currently planning to meet the 93% target for its patients throughout Cancer waiting times: 31 day first treatment Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Number waiting < 31 days Total number waiting Percentage 97.1% 97.2% 97.2% 97.3% 97.3% 97.1% 96.2% 97.3% 96.9% 97.3% 97.1% 97.2% The above trajectory refers to Southwark patients accessing services at all providers. The CCG is currently planning to meet the 94% target for its patients throughout Cancer waiting times: 62 day GP referral Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Number waiting < 62 days Total number waiting Percentage 84.6% 87.5% 88.6% 87.2% 87.9% 86.7% 88.4% 89.7% 87.9% 88.9% 88.9% 88.9% The above trajectory refers to Southwark patients accessing services at all providers. The CCG is currently planning to meet the 85% target for its patients from May In addition to the trajectories included above, the CCG is planning to deliver all national Cancer Waiting Times targets for treatment-specific pathways and for patients referred via national screening programmes. 36

37 3: Primary Care The NHS s goal for is to stabilise general practice today and support the transformation of primary care for tomorrow by delivering General Practice Forward View and Next Steps. The CCG explicitly wants to encourage stable, sustainable and transformed general practice, working at scale and as the foundation of emerging Local Care Networks. This is in anticipation of commissioning changes (over the next 12 to 24 months) that will reimagine existing primary and community care contracts. As such, the CCG is committed to the following deliverables in 2018/19: Commission extended access to GP services, including at evenings and weekends, for 100% of our population. Plan showing that this is being achieved is detailed on page 40. Work with our local NHS England teams to agree our contribution and wider workforce planning targets, as part of a national commitment to have an extra 5,000 doctors and 5,000 other staff working in primary care: Southwark now has clinical pharmacists working at a federation level across GP practices which will contribute to this target. Invest 1.50 per registered population for general practice transformation support: This is the balance of the 3 per head investment commitment across 2 years. This investment will ensure the support of: o o o o o Specific neighbourhood development projects aligned to the LCN programme agenda (and the STP s CBC plans) Commitment from federations to work with the CCG to nurture patient participation in member practices and within neighbourhood projects Participation of federations and member practices within the LCN Programme Clear commitment from federations to develop close practical collaborations with foundation trusts Continued regular dialogue with the CCG through quarterly board-to-board discussions. 37

38 3: Primary Care (continued) Actively encourage every practice to be part of a primary care network: Federations in the North and South of the Borough have begun to organise practices around coherent geographies with populations of 35,000-75,000 Investing in upgrading primary care facilities, ensuring completion of the pipeline of Estates and Technology Transformation schemes: NHS Southwark CCG have two estates projects where NHS England have agreed to funding from ETTF: o o Dulwich: This is a LIFT project so the ETTF funding will cover project costs, transition costs, ICT and some furniture, fittings and equipment. This project is scheduled to reach financial close at the end of 2017/18 and will progress to construction in early Occupation is scheduled for the end of Peckham premises rationalisation (Gaumont): This is a practice led scheme which forms phase 2 of a premises rationalisation process allowing the disposal of some very poor quality premises and the utilisation of some void space. This scheme is awaiting the publication of the new Premises Cost Directions (PCD) scheduled for April/May It consists of the refurbishment and conversion of existing office space into clinical rooms. The project will be 3-4 months in duration and so subject to the new PCDs and appropriate lease arrangements with NHS Property Services being in place we expect this project to be completed in

39 3: Primary Care (continued) Ensure every practice implements at least two of the high impact time to care actions: This work has been led by the two federations in Southwark: Quay Health Solutions (north Southwark) and Improving Health (south Southwark). Both have implemented a number initiatives which support the rollout of high impact time to care actions across member practices. These include: o o Developing staff capability through the Releasing Time Programme across Southwark General Practice aimed to reduce workload and free up time for GPs and staff Developing the team through employing staff to support the delivery of holistic assessment and care planning across our 20 GP practices as part of the PHM contract Staff development programmes will continue to be rolled out during 2018/19, supporting practices to manage workload and to release capacity in primary care. Provide assurance that statutory primary medical services functions are being discharged effectively: The Southwark Primary Care Commissioning Committee makes collective decisions on the review, planning and procurement of primary care services in Southwark, under delegated authority from NHS England. This committee is chaired by a Lay Member of the CCG and is held in public. Roll out online consultations during 2018/19: The CCG has led a procurement for an online consultation software to support practices. Implementation will start before 31 March 2018 and continue in to 2018/19. 39

40 3: Primary Care: Extended access 100% of Southwark CCG s population benefit from extended access services commissioned 365 days a year for each day of the week by the CCG. Appointments are delivered from two locations in Southwark: Spa Medical Centre and Lister Primary Care Centre. Opening times are 8am-8pm seven days a week (including bank holidays) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CCG weighted population benefiting from extended access services commissioned 365 days a year 331, , , , , , , , , , , ,683 CCG weighted population 331, , , , , , , , , , , ,683 Percentage of population benefiting from extended access services commissioned 365 days a year 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 40

41 4: Urgent and emergency care The NHS s goals for are to redesign and strengthen the urgent and emergency care system to ensure that patients receive the right care in the right place, first time. The CCG will work with partners across the system on the key deliverables identified for 2018/19 by NHE England: Ensure that aggregate performance against the four-hour A&E standard is at or above 90% in September 2018, that the majority of providers are achieving the 95% standard for the month of March 2019 (see pages 14-18) NHS 111 online is operational and available to 100% of the population. Patients calling NHS 111 currently hear a recording telling them they can access the online website. Access to enhanced NHS 111 services to 100% of the population, with more than half of callers to NHS 111 receiving clinical input during their call: The new Integrated Urgent Care service will go live in October It will provide a Clinical Assessment Service (CAS). GP out of hours services, Urgent Treatment Centres and GP hubs will all be linked into the new integrated model. Ensure that direct booking from IUC CAS into local GP systems is delivered: NHS 111 can book directly into the two GP hubs and is able to book into SELDOC for out of hours. UTCs meet the new standards and operate as part of an integrated approach to urgent and primary care: GSTT and KCH have been declared as meeting the new standards for a Urgent Treatment Centre. Deliver a safe reduction in ambulance conveyance to emergency departments: The CCG is running local programmes to reduce demand on LAS via the SEL Demand Management programme. In Southwark, successful work over the last year has focused on reducing frequent callers to LAS and educating care homes on when to call LAS versus other local services. 41

42 4: Urgent and emergency care (continued) Continue to improve patient flow inside hospitals through implementing the Improving Patient Flow guidance: KCH is implementing the SAFER bundle across the Denmark Hill site. This includes running Multi Agency Discharge Events scheduled through December 2018 to help facilitate and improve patient flow in the hospital. Focus specifically on reducing inappropriate length of stay for admissions, including specific attention on stranded and super stranded patients who have been in hospital for over 7 days and over 21 days respectively: KCH is holding weekly meetings around stranded and super stranded patients to reduce the number of patients in these categories to under 40% of the bed base. Southwark CCG will continue to participate in weekly meetings with KCH to help facilitate any DTOC delays Continue to improve patient flow inside hospitals through implementing the Improving Patient Flow guidance: KCH is implementing the SAFER bundle across the Denmark Hill site. This includes running Multi Agency Discharge Events scheduled through December 2018 to help facilitate and improve patient flow in the hospital. Focus on reducing inappropriate length of stay for admissions, including specific attention on stranded and super stranded patients who have been in hospital for over 7 days and over 21 days respectively: KCH is holding weekly meetings around stranded and super stranded patients to reduce the number of patients in these categories to under 40% of the bed base. 42

43 4: Urgent and emergency care (continued) Continue to work towards the 2020/21 deliverable of all acute hospitals having mental health crisis and liaison services that can meet the specific needs of people of all ages including children and young people and older adults: There is a well-established psychiatric liaison team at King s College Hospital and a comprehensive well utilised Paediatric Liaison service at King s College Hospital and as such presentations at the emergency department (ED) are responded to appropriately. Core 24 has been implemented at KCH and is fully funded on a recurrent basis in the SLaM contract baseline from 2018/19 onwards. Ensure that fewer than 15% of NHS continuing healthcare full assessments take place in an acute setting. Southwark CCG achieved this target across quarter 4 of 2017/18. Work will continue to maintain this throughout 2018/19 Continue to progress implementation of the Emergency Care Data Set in all A&Es (Type 1 and Type 2 by June 2018; and Type 3 by the end of 2018/19): KCH is currently working on implementing the Emergency Care Data set across PRUH and KCH. Implement a proprietary appointment booking system at particular GP practices, integrated urgent care services and UTCs, supported by improved technology and clear appointment booking standards: NHS Digital is currently helping SEL with technical issues that surround linking different IT systems together. GP hubs and out of hours services in Southwark are already available for appointment bookings. Continue to rollout the seven-day services four priority clinical standards to five specialist services (major trauma, heart attack, paediatric intensive care, vascular and stroke) and the seven-day services four priority clinical standards in hospitals: Both GSTT and KCH have been working on extended 7 day clinical services to many of their speciality areas. This involves extensive job planning and consultations with staff. 43

44 5: Transform care for people with learning disabilities, improving community provision NHS Southwark CCG, as part of the South East London Transforming Care Partnership (TCP), will continue to work with partners to deliver NHS England's Transforming Care Programme. The partnership will jointly deliver the three programme outcomes in their sub-regional areas: 1. Reduced reliance on inpatient services (closing hospital services and strengthening support in the community) 2. Improved quality of life for people in inpatient and community settings 3. Improved quality of care for people in inpatient and community settings. The NHS s goal for is to transform the treatment, care and support available to people of all ages with a learning disability, autism or both so that they can lead longer, happier, healthier lives in homes not hospitals. The following deliverables are identified for 2018/19: Continue to reduce inappropriate hospitalisation of people with a learning disability, autism or both, supporting a national reduction in hospital at a national aggregate level by 35% to 50% from March 2015 by March This involves placing a particular emphasis on making a substantial reduction in the number of long-stay: Pre-admission Care Treatment Reviews are implemented as soon as a client at risk of an admission. At Risk of Admissions Registers are in place to identify both adults and children and young people at risk of an admission or readmission. Timely discharge of patients who are clinically ready to move from an inpatient setting, achieved by: ensuring a robust case management; two-weekly reviews and reporting of all inpatients; Care Treatment Reviews for all inpatients within two weeks of admission and monitoring of resulting action plans. 44

45 5: Transform care for people with learning disabilities, improving community provision (continued) Continue to improve access to healthcare for people with a learning disability, so that the number of people receiving an annual health check from their GP is 64% higher than in 2016/17. The South East London TCP will support the CCG to increase both the number of people with a learning disability recorded on the GP Learning Disability Register, and by improving the proportion of people on that register receiving a quality health check. Make further investment in community teams to avoid hospitalisation South east London wide initiative is in place to work with the South London (Mental Health) Partnership to develop a community-based model of care, starting with commissioning high quality acute mental health care for the adult non-forensic Transforming Care cohort. Ensure more children with a learning disability, autism or both get a community Care, Education and Treatment Review (CETR) to consider other options before they are admitted to hospital, such that 75% of under 18s admitted to hospital have either had a pre-admission CETR or a CETR immediately post admission: South east London wide Care, Education and Treatment Review training has been undertaken, and a SEL-wide CYP scoping and planning workshop has identified initiatives that need to be taken across south east London. Continue the work on tackling premature mortality by supporting the review of deaths of patients with learning disabilities, as outlined in the National Quality Board 2017 guidance. 45

46 5: Transform care for people with learning disabilities, improving community provision (continued) Improving access to health care for people with Learning Disabilities Improving access to health care for people with Learning Disabilities Q1 Q2 Q3 Q4 Patients aged 14 or over on the GPs Learning Disability Register receiving a health check within the quarter Population on the GPs Learning Disability Register (18+ only) % 12.8% 15.1% 17.4% 19.8% The national ambition is for an increase in the number of Annual Health Checks delivered by GPs compared with 2016/17 by 64%. The above trajectory shows the CCG plan to reach the quarterly equivalent of this ambition for Quarter 4 of Reliance on inpatient care for people with LD or autism Reliance on inpatient care for people with LD or Autism Q1 Q2 Q3 Q4 NHS England commissioned inpatients Inpatient Rate per Million GP Registered Adult Population NHS England commissioned Total No. of Inpatients with learning disabilities and/or autism (TCP level; and by TCP of origin) Total Inpatient Rate per Million GP Registered Population The national ambition is that by March 2019 no area should need more inpatient capacity than is necessary at any one time to cater to: inpatients in CCG commissioned beds (such as those in assessment and treatment units) per million population; inpatients in NHS England-commissioned beds (such as those in low, medium or high-secure units or CAMHS Tier 4 units) per million population. The trajectories above are on a Transforming Care Partnership (TCP) basis. The reduction in inpatient numbers is a proxy measure for a reduction in the number of inpatient beds. The above trajectory shows the TCP plan to achieve this ambition. 46

47 6: Maternity The NHS s goal for is to continue to make maternity services in England safer and more personal through the implementation of Better Births. Better Births sets out the Five Year Forward View for NHS maternity services in England. In south east London the development of the local Better Births Delivery Plan has been led by the Local Maternity System, facilitated centrally by the STP programme team. The development of this plan has been overseen by the STP maternity workstream s Senior Responsible Officer and Clinical Lead and co-chair of the Local Maternity System (LMS). The refreshed operating planning guidance identifies the following deliverables for 2018/19, which will be addressed by the LMS in south east London: Deliver improvements in safety contributing to the national 2020 ambition to reduce stillbirths, neonatal deaths, maternal death and brain injuries by 20% and by 50% in 2025, including full implementation of the Saving Babies Lives Care Bundle by March 2019: All trusts in SEL have a Saving Babies Lives plan for implementation of the bundle s aspects as per gap analyses conducted in April Achieving the halve it ambition is a key theme of the local Better Births delivery plan, and a 50% reduction in stillbirth rates by 2025 is identified as one of the 9 key outcomes of the plan. Continue to increase access to specialist perinatal mental health services, ensuring that an additional 9,000 women access specialist perinatal mental health services and boost bed numbers in the 19 units that will be open by the end of 2018/19 so that overall capacity is increased by 49%: Lambeth, Southwark and Lewisham together with SLaM gained funding to develop perinatal mental health services. Staff have been recruited including 5 WTE Specialist Nurse Practitioners, 1 WTE B6 Nurse and 1 WTE Consultant Psychiatrist in Lambeth, Southwark and Lewisham. This has enabled a daily consultant emergency slot to be available. Patients who are relapsing or require urgent mental health review are now being seen either on the same day or next day. 47

48 6: Maternity (continued) Increase the number of women receiving continuity of the person caring for them during pregnancy, birth and postnatally, so that by March 2019, 20% of women booking receive continuity nationally All three trusts currently provide a number of continuity teams. In recognition of the need to comply with national requirements, under which most women must be offered continuity of carer in the future, the Local Maternity System has agreed the following phases in expanding the offer of continuity of carer within the region: All vulnerable women to be offered full continuity of carer. All vulnerable women to be offered full continuity of carer, and other women to be offered antenatal and postnatal continuity of carer. All vulnerable women to be offered full continuity of carer, some other women to be offered full continuity of carer, and other women to be offered antenatal and postnatal continuity of carer. Vulnerable women have been selected as the first cohort to consistently receive continuity of carer within South East London as it is felt that they will benefit from receiving continuity more than other women may do. By June 2018, agree trajectories to improve the safety, choice and personalisation of maternity In conjunction with other LMS areas in London, the SEL LMS is working with NHS England to understand the trajectories that are required and the methods of measurement that will be used in assessing progress. In addition the LMS is setting up a selection of working groups that will support the broader system in setting and reporting on these trajectories. 48

49 Additional Operational and Activity Plans

50 Other commitments Personal Health Budgets Q1 Q2 Q3 Q4 Personal health budgets in place at the beginning of quarter New personal health budgets that began during the quarter Total number of PHB in the quarter (new plus those in place at the start of the quarter) GP registered population (total number per CCG) 325, , , ,127 Rate of PHBs per 100,000 GP registered population The above trajectories show the plan for there to be 79 personal health budgets across Southwark CCG by quarter 4 of 2018/19. By 2020/21, NHS England s ambition is for there to be a total of 100 to 200 Personal Health Budgets over the course of a year for every 100,000 of population. Children Waiting more than 18 weeks for a wheelchair Q1 Q2 Q3 Q4 Number of children whose episode of care was closed within the reporting period where equipment was delivered in 18 weeks or less of being referred to the service Total number of children whose episode of care was closed within the quarter where equipment was delivered or a modification was made Percentage 93.8% 93.8% 93.8% 100% The trajectory above shows the plan to meet the national ambition for 100% of children waiting less than 18 weeks for a wheelchair by quarter 4 of 2018/19 50