Cornwall Health & Care System Operational Planning for 2019/20

Transcription

1 10/1/19 : Final Using NHS England / NHS Improvement Initial Operational Planning Guidance 21/12/18 and NHS Long Term Plan 7/1/19. Cornwall Health & Care System Operational Planning for 2019/20 A system approach to developing 2019/20 plans Transformation Board 17 th January 2019

2 2 Contents CIoS Strategic Objectives & Emerging System Priorities CIoS Operational Planning Appendices: 1) NHS Long Term Plan Key Messages 2) Local System Governance 3) Initial Operational Plan Guidance (Pending update from Final Guidance) 4) NHS Planning Timetable & System Requirements

3 CIoS Operational Planning

4 4 Ambitious Plans to Reshape Health & Care Services in Cornwall An ambitious system plan, more than an aggregation of organisational plans, setting out: System objectives and priorities within the context of the NHS Long Term Plan and regional priorities (and review of publication of full planning details); The differences plans will make for local people informed by ongoing engagement; The changes in 2019/20 that will bring about a shift in activity from in-hospital to out of hospital services; Changes to the existing model of planned and outpatient care recognising people need to be treated locally where appropriate, and travel less; Changes and priorities for services which are evidence based; Robust quality, financial and workforce plans; Clarity over terms of integration between all partners across the health and care system. Four core system work programmes with clear system leadership: Urgent and emergency care Planned care Integrated community care (including mental health, primary care, integrated community services) Children and young people (One Vision Children s programme) Deliver on intentions in respect of Prevention in 2019/20. Supported by enabling strategies including workforce, estates, digital and finance.

5 5 Our Ambition Leading to care closer to home and moving away from care based around beds From Heavy reliance on acute and costly hospital care A major shift To Prevention Supporting Self-care Out of hospital, integrated care centred around local community provision including networks of GP practices and multi-disciplinary teams Dependent on developing our workforce as a priority and embracing cultural change

6 Planning Approach as a System for 2019/20 An agreed single set of strategic objectives to inform all plans; 6 A single system operational plan narrative & summary plan: An overview setting out how the system will use its overall financial resources to meet the needs of its population and what the system will deliver in 19/20; reflecting joint strategic commissioning priorities and underpinned by organisational operational and delivery plans aligned technical submissions (activity, finance, workforce) Priorities and opportunities within Integrated Care Areas developed as a key feature of our approach to planning; Supporting and developing our workforce; Year 2 of the NHS CIoS System Financial Framework to support planning approach; System approach to demand and capacity planning, efficiencies and investment prioritisation ensuring all plans aligned; System efficiency programme to demonstrate explicit system improvement; Alignment between NHS and Council Plans for 2019/20 underpinned by an agreed financial framework.

7 7 CIoS Strategic Objectives & Emerging System Priorities

8 8 System strategic objectives People living healthy lives in healthy communities, preventing illness and improving wellbeing. Improve health and wellbeing and reduce inequalities by working in partnership and creating opportunities for our citizens Provide safe, high quality, timely and compassionate care and support in local communities whenever possible When care is needed it will be safe, high quality and mainly provided close to home. Attract and maintain a motivated, talented and caring workforce. Make Cornwall and the Isles of Scilly a great place to work in health and social care Working efficiently so health and care funding give maximum benefits Available money will work harder and savings will result from more joined up services. Create the underpinning infrastructure and capabilities that are critical to delivering high quality care and support. Ensure all our nonclinical services work together to support our teams in providing high quality care and support

9 Emerging Strategic Commissioning Priorities Aligned to the NHS Long Term Plan 9 Making sure everyone gets the best start in life Reduce smoking in pregnancy; Improve child and adolescent mental health; Reduce childhood obesity. Delivering world-class care for major health problems Improve early detection and management of risk factors for cardiovascular disease; Reduction in self-harm and suicide; Improve diagnosis of cancer at an early stage; Improve mental health outcomes. Supporting people to age well Improve dementia diagnosis and support; Help more people to live independently at home for longer; Empower people to make healthy choices.

10 Mapping Our Priorities Long Term Plan Delivering for People Making sure everyone gets the best start in life Delivering worldclass care for major health problems Supporting people to age well Delivering the ambitions Doing things differently Preventing illness and tackling health inequalities Backing our workforce Making better used of data and digital technology Getting the most out of taxpayers investment in the NHS Local Transformation Programmes Children and young people Urgent and Emergency Care Planned Care Integrated Community Care Local Priorities Improve system working for urgent care A different way of providing outpatient services Tackling major health problems: Circulatory Cancer Joints and bones Respiratory / Gastrointestinal Integrated care Primary Care 10 Improving children s health and wellbeing Mental Health / Learning disabilities Enablers Enabling Services, Workforce & OD, Estates, Digital An Integrated Care System delivered through Integrated Care Areas

11 Emerging System Priorities & Strategic Ambition 11 Urgent & Emergency Care Help people stay safe, well & independent at home; Provide rapid assessment and advice or treatment of urgent care needs; Make Ambulatory Care our default, with bed based care only when clinically indicated; Get people back home quickly if they are admitted to hospital; Maintain planned levels of access to elective care; Maintain safety & standards & people s experience of care 24/7; To deliver on the Long Term Plan for urgent & emergency care; To deliver on national standards and nationally determined trajectories for ED 4hr standard; Delayed Transfers of Care. Examples Provision of alternatives to people attending emergency department(s); Improvements in the operation of the Emergency Department in acute hospitals through implementation of a mixed model of urgent care services (incl. urgent treatment centres, minor injury services, improved access to general practice services and community pharmacy support); Reducing length of stay by improvement to patient flow; Implementing best practice discharge and flow processes; Implementation of the 3 agreed urgent treatment centres; Best use of acute capacity with community settings and community based alternatives; A comprehensive prevention and reablement model across the system.

12 Emerging System Priorities & Strategic Ambition 12 Planned Care People will be offered safe, high quality planned care, in the right place, at a time which is right for them; Adopt whole system prioritised pathways to shift to more preventative care and support, and enable people to self care with less intervention (MSK, CVD, Falls, Respiratory) Transform outpatient care - address the quality of referrals, implement new models of delivery, promote self care and patient initiated follow up; Achievement of the referral to treatment standards; Deliver national cancer standards; Improve the 3 core elements to achieve NHS national standards ( Outpatients, Diagnostics, inpatient / day-case care), and develop the blue print for the future service ; As part of the Peninsula Pathology Network, modernise services aligned with our new pathways of care Be creative with our workforce and to maximise skills and develop a comprehensive plan for the future. Examples Use technology to reduce appointments and travel time and link practitioners; Build skills and capacity to offer more specialised care as appropriate in communities with a geographically mobile workforce; Implement patient initiated follow up and enable more self care, seek to eliminate un necessary follow ups; Whole service reviews and reset to create community base e.g. respiratory, dermatology and ophthalmology; Ensure sufficient diagnostic capacity to meet the requirements of urgent, elective and cancer services.

13 Emerging System Priorities & Strategic Ambition Integrated Community Care Integrated Care Areas: Aligning people, systems and processes to the three geographical areas to better manage population health; Personalisation and personal health budgets: Giving people more say about the care they receive and where they receive it and sharing what is important to them, particularly towards the end of their lives; Rapid community response: Redesigning integrated health and social care rehabilitation and re-ablement care services to provide rapid community response when people need urgent care at home; Dementia: Improve awareness, earlier diagnosis, intervention and higher quality of care to achieve of Dementia diagnosis standards; Suicide prevention: Reduce the suicide rate and provide support for those bereaved or affected by suicide; Care homes: Increase care home resilience matching capacity to demand; Ensure there is a sustainable primary care service and infrastructure across CIoS and improve the resilience of General Practice; Deliver the mental health investment standard and Learning Disability Transforming Care plan. Examples Implementing a person-centred integrated care record system that includes an end of life care record; Social prescribing: Continued roll-out and evaluation of social prescribing schemes; Integrated Care Teams and Local Points of Access: Bringing together different primary, community, mental health and social care practitioners into integrated care teams to co-ordinate care better; High Intensity User service: Delivery and evaluation of High Intensity User service to provide better support to people who frequently call NHS 111, 999 and attend the Emergency Department; Working with the voluntary sector: Improve place-based coordination and collaboration of the voluntary sector to increase social capital, develop caring neighbourhoods, villages and towns in order to enhance individual and community resilience; Care at home: Increase care at home capacity; GP appointments: Creating the environment and resource to have primary care access in evenings and weekends. 13

14 Emerging System Priorities & Strategic Ambition 14 Children and Young People Work jointly to develop locality based Children's services; Streamline the way in which children and families access secondary healthcare to ensure the right assessment and resource allocation is in place; Co-design the pathway and service offer to ensure the most effective resource across secondary specialist healthcare and mental health services; Develop a Joint commissioning framework for children s services. Deliver integrated Place Based Children's Services; Examples Neurodevelopmental Pathways aimed at integrated pathways to reduce waiting times and get the right help to children and families; Implement the Children's and Young People Mental Health Local Transformation Plan aimed at developing an integrated and comprehensive service offer to meet rising needs. Integration of Public Health nursing service; Residential Short Breaks aimed at providing an integrated offer and promoting the enablement of children and young people;

15 Emerging System Priorities: Integrated Care Areas (ICA s) 15 West Integrated Care Area Developing a plan for integrated care in Penwith to inform the future of Edward Hain Community Hospital; Building compassionate communities; Providing better care and support for people with dementia; Providing better care and support for people with respiratory conditions; Continuing to test out pilots for frailty with West Cornwall Hospital and the ambulance service; Implementing Care Coordinator posts to work with some of the most vulnerable people in the community; Central Integrated Care Area Developing a plan for integrated community services in the south mid area to inform the future of Fowey Community Hospital; Improving care and support for people with dementia; Prescribing initiatives; Improving care home resilience and quality; North and East Integrated Care Area Developing a plan for integrated community services in Saltash and St Germans to inform the future of Saltash community hospital; Work towards interoperability starting with an agreed move to a preferred GP IT system; Testing population health management with two practices; Resilience, integration and efficiency of service; Continuing to support practices with a wider range of workforce including first contact physiotherapists; Continuing to review pathways for diabetes, dermatology, cardiology and musculoskeletal services with community based and secondary care providers; Community based geriatrician to work with GPs, community teams and local people.

16 16 Appendices: 1) NHS Long Term Plan Key Messages 2) Local System Governance 3) Initial Operational Plan Guidance 4) NHS Planning Timetable

17 NHS Long Term Plan Published 7 th January

18 NHS Long Term Plan Priorities: Delivering for Citizens (i) 18 Making sure everyone gets the best start in life Including reducing stillbirths and mother and child deaths during birth by 50% ensuring most women can benefit from continuity of carer through and beyond their pregnancy, targeted towards those who will benefit most providing extra support for expectant mothers at risk of premature birth expanding support for perinatal mental health conditions taking further action on childhood obesity increasing funding for children and young people s mental health bringing down waiting times for autism assessments providing the right care for children with a learning disability delivering the best treatments available for children with cancer, including CAR-T and proton beam therapy.

19 NHS Long Term Plan Priorities: Delivering for Citizens (ii) 19 Delivering world-class care for major health problems Including preventing 150,000 heart attacks, strokes and dementia cases providing education and exercise programmes to tens of thousands more patients with heart problems, preventing up to 14,000 premature deaths saving 55,000 more lives a year by diagnosing more cancers early investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital spending at least 2.3bn more a year on mental health care helping 380,000 more people get therapy for depression and anxiety by 2023/24 delivering community-based physical and mental care for 370,000 people with severe mental illness a year by 2023/24.

20 NHS Long Term Plan Priorities: Delivering for Patients (iii) 20 Supporting people to age well Including increasing funding for primary and community care by at least 4.5bn bringing together different professionals to coordinate care better helping more people to live independently at home for longer developing more rapid community response teams to prevent unnecessary hospital spells, and speed up discharges home. upgrading NHS staff support to people living in care homes. improving the recognition of carers and support they receive making further progress on care for people with dementia giving more people more say about the care they receive

21 Delivering the Ambition of the NHS Long Term Plan Doing things differently: we will give people more control over their own health and the care they receive, encourage more collaboration between GPs, their teams and community services, as primary care networks, to increase the services they can provide jointly, and increase the focus on NHS organisations working with their local partners, as Integrated Care Systems, to plan and deliver services which meet the needs of their communities. 2. Preventing illness and tackling health inequalities: the NHS will increase its contribution to tackling some of the most significant causes of ill health, including new action to help people stop smoking, overcome drinking problems and avoid Type 2 diabetes, with a particular focus on the communities and groups of people most affected by these problems. 3. Backing our workforce: we will continue to increase the NHS workforce, training and recruiting more professionals including thousands more clinical placements for undergraduate nurses, hundreds more medical school places, and more routes into the NHS such as apprenticeships. We will also make the NHS a better place to work, so more staff stay in the NHS and feel able to make better use of their skills and experience for patients. 4. Making better use of data and digital technology: we will provide more convenient access to services and health information for patients, with the new NHS App as a digital front door, better access to digital tools and patient records for staff, and improvements to the planning and delivery of services based on the analysis of patient and population data. 5. Getting the most out of taxpayers investment in the NHS: we will continue working with doctors and other health professionals to identify ways to reduce duplication in how clinical services are delivered, make better use of the NHS combined buying power to get commonly-used products for cheaper, and reduce spend on administration.

22 System Governance 22

23 Agreed Governance for Approval of Strategic and Operational plans 23 Priorities informed by Strategic Commissioning Urgent care Planned care Mental health & Learning Disability Integrated care in the community Children s Services Enablers Workforce & OD development Digital Strategy Estates Strategy Financial plan Approval by system boards A&E Delivery Board Planned Care Board Integrated Community Services Design Board One Vision Workforce Strategy Board Digital Board Estates Board ICP Mobilisation Transformation Board / Health & Care Leadership Board ICP Mobilisation Group Strategic Plan Year /20 System Plan Clinical Practitioner Cabinet Combined in plans Council Governance Council plans have separate governance arrangements (e.g. Medium Term Financial Plan and Budget for Adult Social Care and Public Health) Royal Cornwall Hospitals Trust Plan Royal Cornwall Hospitals Trust Board Cornwall Foundation Trust Plan Cornwall Foundation Trust Board Organisations sign off Shaped by each local area West Integrated Care Area Central Integrated Care Area Devon Trusts North & East Integrated Care Area NHS Kernow Plan NHS Kernow Governing Body Organisational plans

24 Overview of the Approach and Progress made in CIoS System Planning 24 National Planning Update NHS Long Term Plan published 7 th Jan 2019; Full plan Guidance published 10 th Jan (pending full technical guidance) requirements for submission of the system operational plan (first part of the national planning guidance published on 21 st Dec 2018; Full financial framework including allocations published 10 th Jan, however, NHS system control totals will be to be set which will be the sum of the individual organisation control totals there will be the opportunity to propose net-neutral changes. Approach to System Operating Plan 2019/20 System wide Planning Oversight Group established and meeting regularly to develop System plan, with fortnightly planning meetings in place; Activity and Finance plan is being coordinated by System CFO led through Finance Directors, managing efficiency, approach and plan assumptions; Draft System plan 19/20 suggested outline developed and to be agreed with Chief Officers. System plan framework and draft narrative to be developed for February requirements; Detailed workforce plans required. Progress to date The system wide planning group have met for initial meeting in early November and regularly since early December; Agreed the approach and draft system strategic ambitions for four core system transformation work programmes; Initial Information Pack for emerging system priorities under development to support System operating plan; Full planning guidance will be assessed to update this planning information as appropriate.

25 28 Initial Operational Plan Guidance Published 21 st Dec Pending Update from Final Planning Guidance 10 th Jan 2019

26 National Guidance Key Points Produce a system operating plan for 2019/20, which is year 1 of a local system 5-year plan and will deliver year 1 of the NHS Long-term Plan 2. An open book approach with shared capacity and activity assumptions providing a single framework for organisational activity plans 3. A system financial control total, but within that we can propose net-neutral changes, agreed by all parties, to organisational control totals 4. If all parties agree, STPs can link a proportion of their Provider Sustainability Fund and any applicable Commissioner Sustainability Fund to delivery of the system control total seen as an important marker of system maturity/ readiness to develop as an Integrated Care System 5. Market Forces Factor updated changes to be implemented over 5 years 6. Continued commitment to increase investment in mental health services 7. CCGs are asked to deliver a 20% real terms reduction in 2020/21 against their 2017/18 running cost allocation (adjusted for recent pay award) 8. CQUIN schemes reduced by 50% with corresponding increase in core prices 9. STPs/ICSs must have a Primary Care Strategy in place by 1 April 2019 and CCGs will be required to commit a recurrent 1.50/head (cash) to developing and maintaining primary care networks 100% coverage by 30 June 2019

27 National Guidance - Key Points Increased focus on workforce plans including a move towards a bank first temporary staffing model, new roles and/or new ways of working, securing cost reductions compared to 2018/19 outturn and improving health and wellbeing; 11. Enable greater staff productivity by investment in new digital technology, investment in the wider infrastructure and transformative service models; % uplift in the national tariff (subject to consultation) and a minimum efficiency ask of 1.1% per year for the next 5 years, looking for efficiencies that can be delivered collectively and at the cost-effectiveness of the whole system; 13. Realistic phasing of non-elective and elective activity across the year, so as much as possible of inpatient elective activity occurs before winter; 14. Tackle variation working with NHS Right-Care to implement national priority initiatives (cardiovascular and respiratory) and at least one other pathway; 15. CCGs yet to implement a High Intensity User support offer for demand management in urgent and emergency care required to establish a service; 16. Commissioners and providers work together to simplify contracting processes and reduce the costs of transactional services e.g. through automation; 17. Start to include priorities for specialised services in our 2019/20 plan.

28 28 NHS Planning Timetable & System Requirements

29 A list of the plans we are required to produce 29 A system operating plan for 2019/20 comprising a system overview and system data aggregation it is year 1 of a local system 5-year plan including deliverables for year 1 of the NHS Long-term Plan including agreed local specialised service priorities (further opportunities to integrate specialised services for a whole pathway-based approach will be explored during 2019/20) Organisational operational plans for 2019/20 STPs/ICSs must have a Primary Care Strategy in place by 1 April 2019 A local system 5-year plan (2019/20 to 2023/24) Autumn 2019 Improving quality Achieving sustainable balance Delivering the NHS Long Term Plan

30 Process and Timescale 30 1 Year Plan (2019/20) Planning Approach Joint Letter October /20 Initial Operational Guidance 21 Dec 18 5 Year Plan Summer 2019 Final Op Guidance and Long Term Plan Published Jan 19 NHS 10 Year Plan 14 Jan 19 Initial Plan Submission Activity and Efficiency 12 Feb 19 Draft 19/20 Plan Submission 19 Feb 19 Draft System 19/20 Plan and Narrative 5 Mar 19 Contract Alignment 21 Mar 19 Contract Signing 1 Year (2019/20) Operational Timelines 4 Apr 19 Final 19/20 Plan 11 Apr 19 Final 19/20 System Plan Dec/Jan/Feb 2019 Mar/Apr