Isle of Wight Clinical Commissioning Group OPERATIONAL PLAN FINAL FOR SUBMISSION 23 DECEMBER 2016

Transcription

1 Isle of Wight Clinical Commissioning Group OPERATIONAL PLAN FINAL FOR SUBMISSION 23 DECEMBER

2 Contents 1. Plan on a Page Executive Summary Our Challenges Isle of Wight System Vision for our New Care Model Delivery of the STP and Local IOW Delivery of Programmes Delivering the Five Year Forward View Must Dos for Finance Contracting Performance Quality Better Care Fund Delivery and Risks References

3 Operational Plan on a Page OUR VISION: OUR AIMS (Our long term goals) COMMISSIONING HIGH QUALITY, SUSTAINABLE AND INTEGRATED SERVICES Work with partners to improve health and wellbeing for patients, carers and communities. Ensure that when patients need healthcare, their experience is positive. Ensure that when the need arises, our patients will access high quality, safe services. Reduce the difference in life expectancy and burden of disease that exists between our most advantaged and most disadvantaged communities. Embed patient and public involvement in our work. Ensure our practice members value their role within the CCG. Ensure the healthcare we commission is effective, efficient and financially sustainable. Health and Wellbeing Gap Care and Quality Gap Funding and Efficiency Gap Challenges By 2024/25 one third of the Island s residents will be over 65. With an older ageing population there will be a higher incidence of long term conditions. If we do nothing, we expect to see a 19% increase in A&E admissions, 10% increase in demand for GPs and a 10% increase in demand for community care. We expect the complexity of residents needs to also increase as people live longer, but live longer with poor health. Key Deliverables Renewed focus on prevention, self-management and building strong community support. Improved management and support of long term conditions. Supporting mental health and wellbeing. Early intervention and diagnosis. More choice of appropriate urgent care services. Delivery of the 5 Year Forward View for Primary Care. Outcomes Improved support for vulnerable people and reduced health inequalities. Improved wellbeing planning and reduced preventable conditions. Reduced mortality and morbidity. People are more empowered to care for themselves and remain independent and well. More years of healthy life. Performance needs to improve; access levels to local services have been unacceptable for A&E, Ambulance, Cancer and Elective Care. Some of our Island services are clinically unsustainable and we struggle to get the people with the right skills to deliver treatment and care. There is a shortage of GPs now, and within the next five years the number of GPs due to retire amounts to 12 whole time equivalents. With increased demand for services and shortages of staff it is difficult to maintain quality and patient safety in all areas. Integrated locality services with proactive case management. Delivery of the 5 Year forward View for Mental Health. Reconfiguration of unsustainable acute services. Increased community capacity to avoid the increasing delays in hospital. Less deterioration of patient conditions due to better access across all services. Minimal delays in flowing through the system. Appropriate specialist support. Best possible clinical and health outcomes. Proactive workforce with improved skill mix. Improved quality and safety indicators. Better experience of care. If we do nothing, by 2018/19 there will be a gap of 21m and this will significantly increase each year, due to decreasing funding levels and increased demand. To avoid a significant deficit, the IOW NHS Trust must make significant savings. By 2024/25 growth in social care is set to rise requiring an increase in Social Care spend of 46m. New Model of Care with a person centred community care system, and acute care provided through an Urgent and Planned Care centre through the Acute Alliance. Mental Health services provided on-island but with clear pathways to specialist Mental Health NHS services off-island. Integrated services to increase efficiency, with technology as a key enabler to drive efficiency. Implementing the NHS RightCare Programme. Reduced care activity through preventing duplication & eliminating activity with no clinical value. Appropriate use of resources in accordance with need. Economies of scale through alliance partnering. Clinical and financial sustainability across the system. 3

4 2. Executive Summary The CCG Operational Plan sets out how the CCG will meet its strategic priorities and implement the Hampshire and IOW Sustainability and Transformation Plan (HIOW STP). CCG IAF QIPP / Turnaround Plans HIOW STP IOW CCG Operational Plan MLAFL Programme 5YFV The Plan takes into account the national guidance to deliver the Five Year Forward View (5YFV), the Primary Care 5YFV, the Mental Health 5YFV, the IOW My Life a Full Life Programme (MLAFL), the CCG Improvement and Assessment Framework (CCG IAF), RightCare, and IOW QIPP and Turnaround plans. Due to minimum growth in its funding allocation and increasing demand for healthcare services, from the beginning of 2016/17 to the end of 2018/19 the CCG will have to achieve savings of 26m in order to remain within its legal financial duties. This level of savings is three to four times the historic level achieved by the CCG. The CCG is therefore facing its greatest ever challenge to balance its financial position. As the Island s health and care services serve a small population, there are diseconomies of scale, where the allocation received by the CCG, which is based on an amount per head, is not sufficient to cover the cost of providing a service. Although the CCG receives a financial allocation (c 5m per annum) to recognise this in relation to some emergency services, there are other affected service areas for which this is not the case. Right Care Primary Care 5YFV Through service transformation, reviewed care pathways, reduction in services mainly by raising thresholds and avoiding activity with low or no clinical value, the CCG has put together an ambitious programme of delivery as set out at high level in this document. Mental Health 5YFV Our aim is to work in partnership with our Local Authority, our providers and other organisations across the STP. The scale of change is such that single organisations cannot deliver the transformation requirements alone and it will be the planning, commissioning of services and drive for delivery of schemes at different appropriate levels that will be critical to ensure we deliver our plans. 4

5 EXECUTIVE SUMMARY FINANCE The CCG s financial plan is based on the national and local (Wessex) planning rules, including: Financial control total: 17/18 = breakeven; 18/19 = 0.5% surplus 0.5% contingency 1% non-recurrent expenditure reserve, with only 50% committed Tariff changes: o Acute : 17/18 = 1%; 18/19 = 1% o Non-acute: 17/18 = 2.5%; 18/19 = 2.7% Demographic growth: 17/18 = 0.6%; 18/19 = 0.6% Growth funding: 17/18 = 0.3m (0.2%); 18/19 = 0.1m (0.1%) The plan is still to be updated for any changes brought in by the Better Care Fund technical guidance, due out in January In order to meet the financial control totals, the CCG will need to achieve the following level of savings: 17/18 = 11.8m (5.1%); 18/19 = 8.8m (3.8%). This is three to four times the historic level of savings achieved. The CCG has yet to identify schemes to this value and has therefore shown the gap as an unmitigated risk of 17/18 = 4.3m and 18/19 = 4.3m. STP DELIVERY & MLAFL VISION The operational plan supports the delivery of the STP and our MLAFL Vision. Our vision is as follows: Integrated health & care provided as close to home as possible by shifting many services traditionally provided in a hospital setting to out of hospital/community based care. This will enable a person-centred community care system with diverse, multidisciplinary services to deliver non-specialist support that embraces digital access, self-care and self-management by default. Our future acute model of care will be through an Urgent and Planned Care Centre where appropriate care will be delivered on the Island with links to services across the Solent. Mental health services will continue to be provided on island where appropriate but with clear pathways to off island services. PERFORMANCE The CCG performance plans are based on the assumption that the current A&E improvement plan will deliver a trajectory of 92% from April 2017, achieving 95% by March The remaining constitutional targets will be achieved and maintained. There are risks that if the RTT target is not achieved in 2016/17, this will change the baseline position. The CCG is ensuring the activity modelling: Takes place with the IOW Trust Has clear assumptions to deliver performance trajectories Takes into account planned change Is aligned to capacity plans. The impact of QIPP schemes has been taken account of in financial assumptions. The modelling of the activity impact in the demand plan is being finalised and agreed as part of contract negotiations. QUALITY Improving the quality and patient safety is a key CCG Priority. We will do this by: Supporting the IOW Trust in delivery of the CQC Improvement Plan. Having robust quality assurance processes. Ensuring workforce planning is improved to enable appropriate levels of provision by a provider workforce with the right skills. Ensuring patient safeguarding is a key component of our contractual requirements. Measuring quality impact of our transformation schemes. Having a clear improvement plan for our quality priorities. 5

6 3. Our Challenges We need to change because of all the pressures the statutory sector is facing: PATIENT NEEDS ARE INCREASINGLY COMPLEX As people get older the number of long term conditions (LTC s) they are likely to have increases. By the age of 75 they are likely to have 3 or more long term conditions. DEMAND FOR HEALTH AND CARE IS INCREASING The Island has a much higher older population compared with the rest of England. 26% of the Island s population is over 65 compared with 16.6% in England. Demand for health and care is growing at an unsustainable rate as people are living longer, increasingly spender longer in poor health, with multiple chronic conditions. The Island s over 65 population is how the rest of England will look in 20 years time. 1 person in 10 now acts as a carer to someone else on the Island. People need our support. OUR CITIZENS WANT CHANGE People have told us they want services and organisations to work more closely together so that they don t The graph above always shows have how to the explain numbers their of LTC s needs grow with age for our Island s population over using and our over risk again. stratification People also tool. want We know mental better health quality and wellbeing and improved is also choice. influenced by levels of physical health, and vice versa. OUR SYSTEM ISN T COPING Many of our critical health and social care services are under severe pressure. Too many people are admitted to hospital and stay in hospital longer than they need to. About 70% of hospital beds are currently occupied by people over the age of 65. Some of these people could be better cared for by integrated services in the community. We are over-reliant on institutional care in 2015/16, 55% of Adult Social Care s total budget was spent on residential and nursing care, making us a national outlier. We have the highest rate of admissions into residential/ nursing care for adults aged under 65 in 2015/16 of all our comparator group of local authorities. Only 2.1% of older people received rehabilitation/ reablement after discharge from hospital, but 92.8% of older people who received rehabilitation/ reablement were still at home 91 days after discharge. Further information can be found in the MLAFL Case for Change and BCF 2015/16 WORKFORCE In most sectors we struggle to recruit and retain sufficient staff. OUR CITIZENS WANT CHANGE People have told us they want services and organisations to work more closely together so that they don t always have to explain their needs over and over again. People also want better quality and improved choice. FINANCIAL PRESSURES Over the past few years, the financial position of the Island s health and care system, which includes IOW NHS Trust and IOW Council, has significantly deteriorated, contributing to the Hampshire and Isle of Wight STP projected funding gap of 577m by 2020/21. Due to the CCG s distance from target (DFT) allocation, which is by the end of 2016/17, 11.9% c 25m, minimum growth funding will be received, until the CCG reaches 5% (DFT). On average, the CCG will receive 2m per annum less than the national average growth funding. This is insufficient to cover inflation and the growth in healthcare demand. The CCG has also received 1.2m less non-recurrent (2 year) funding support to pay the new acute new tariff (HRG4+) than it will cost. Reduced funding and increased costs in essential services which consume 58% of the Council s controllable spend, has required the IOW Council to make over 60m in savings over the past five years. Over the next four years, a further 24m of savings are required to balance the budget. 7.5m of the total savings target is required to be found in

7 Isle of Wight System Vision for our New Care Model My Life A Full Life (MLAFL) is an IOW system wide programme established in 2012 and is a collaboration of health, care and voluntary sector organisations looking at new ways to deliver health and care services on the Isle of Wight. As part of this programme in 2016 we have undertaken a Whole Integrated System Re-design (WISR), the outcomes of which have influenced the HIOW STP in order to support the changes we need to see on the Island. Our vision for our placed based system of integrated care is: Integrated health & care provided as close to home as possible by shifting many services traditionally provided in a hospital setting to out of hospital/community based care. This will enable a person-centred community care system with diverse, multi-disciplinary services to deliver non-specialist support that embraces digital access, self-care and self-management by default. Our future acute model of care will be through an Urgent and Planned Care Centre where appropriate care will be delivered on the Island with links to services across the Solent. Mental health services will continue to be provided on island where appropriate but with clear pathways to off Island services. Emerging Care Model Levels of Care 7

8 Emerging Care Model Care setting 8

9 Care Model by Care Setting Self-Care Prevention Shift care significantly towards prevention and early intervention, self-help, with the aim of reducing health inequalities and the health and wellbeing gap. Integrate services to improve quality and increase system efficiencies using technology as the key enabler. Create self-management and preventative services that are based in the community / at home. Support mental health wellbeing to avoid intervention. Provide technology for independent and supported living. Service user coaching for management of long term conditions. Integrated Community Care Transform community services, including Primary Care to deliver co-ordinated multidisciplinary working for those in need. Provide person-centred health & wellbeing that promotes prevention and self-care. Proactive case management of vulnerable and at risk people to enable them to stay safe and well within their communities. Ongoing treatment and care will move to community based care where appropriate. Urgent care needs are met closer to home without default to a hospital setting. Prevention of mental health crisis through local safe haven services. Management of Long Term conditions in the community, supported by service user coaching. Proactively pull ongoing care back to the community from acute settings. Urgent and Planned Care Centre Urgent Care Access to specialist clinical & diagnostics providing rapid assessment, stabilisation, diagnosis, including A&E. Co-ordinated triage at the front door to direct service users to the right care setting. Care planning and discharge for ongoing treatment (in community or for more complex needs off Island). Planned Care Access to day case and inpatient surgery. Rehabilitation support and follow up provided in community settings. Access to networks of support across clinical pathways on and off Island. Active outreach to support local community based services. Access to acute non specialist MH services on-island. 9

10 The key changes and outcomes we will see are: Self-care/prevention Integrated Community Care Urgent and Planned Care Centre Key Changes Build on assets and mobilise social capital to help reshape care delivery to meet people s Service User outcomes Service/Clinical outcomes Create a cross-sector integrated care service. St. Mary s hospital will evolve into an Urgent and Planned Care (U&PC) Centre. changing needs. Provide a range of services More complex & specialist activity off- Reduce reliance on statutory services where traditionally provided in hospital Island, when clinically appropriate. they are not required and/or not the most settings. Support for multi-site care pathways. appropriate solution to an individual s own need. Routine management & support for people with Long Term Conditions, Triage service users with mental health conditions at A&E to avoid unnecessary Enable the increased use of individualised including non-medical coaches. admissions. personal health & care budgets. Risk based case management. Triage to urgent care using 111/ The Hub Increase Technology Enhanced Care (TEC) monitoring. Development of community resilience and community assets in each locality Increased use of cross-solent specialist alliances. Increase care co-ordination and use of Care Navigation/Local Area Coordinators. Create mental health single point of access. Rapid diagnostics provided by a shared Hampshire centre. Support social prescribing. Integrated working with mental health community groups. Improved support for vulnerable people and Better access right care, right time, Less deterioration of patient conditions reduced health inequalities. right place. due to reduced wait times for procedures. People are able to self-direct the services they Improved wellbeing planning. Improved access to non-ed services that need to live independently. Services delivered locally around the are closer to home. More people recover and are empowered to person. Safer procedures for all specialties. maintain their emotional wellbeing. Improvements in self-control of care. Best possible clinical outcomes for People are supported into work, volunteering Reduced mortality and morbidity patients. or training. rates. Greater choice of care for urgent needs. Communities become more resourceful, Reduced number of DNAs in all care Improved specialist support. resilient and inclusive. settings. Economies of scale through use of alliance Reduced dependency on statutory services. Increased advice and support activity. partnering from the mainland. Prevent increase in demand through increased Proactive workforce with improved Reduced cost and increased turnaround utilisation of resources (informal) within skill mix able to deliver care in the time for diagnostic services. communities. right place at the right time. Improved service quality and safety Specialist and statutory care only delivered Reduced reliance on default specialist indicators. when it is needed. advice. Reduced duplication of care activity. 10

11 4. Delivery of the STP and Local IOW Delivery of Programmes The following pages set out the key priority areas from the STP and our local delivery of the STP Plan. The first two pages are extracts from the HIOW STP and the subsequent pages are the IOW implementation plans. To deliver our shared priorities we are working together across Hampshire and the Isle of Wight in ten delivery programmes: six core programmes focused on transforming the way health both physical and mental health and care is delivered (summarised below), and four enabling programmes to create the infrastructure, environment and capabilities to deliver successfully (summarised overleaf). This portfolio of programmes is our shared system delivery plan for the STP. Core Programme Programme Objective Expected Impact and benefits for patients, communities and services ❶ Prevention at scale ❷ New Care Models ❸ Effective Patient Flow and Discharge ❹ Solent Acute Alliance ❺ North & Mid Hampshire configuration ❻ Mental Health Alliance To improve healthy life expectancy and reduce dependency on health and care services through a radical upgrade in prevention, early intervention and self-care: a sustained focus on delivering prevention at scale in HIOW. To improve the health, wellbeing and independence of HIOW population through the accelerated introduction of New Models of Care and ensure the sustainability of General Practice within a model of wider integrated health and care. This will be delivered through the Vanguard programmes and local health system New Care Models delivery arrangements. To ensure no patient stays longer in an acute or community bed based care than their clinical condition and care programme demands and as a result reduce the rate of delayed transfers of care by improving discharge planning and patient flow, and by investing in capacity to care for patients in more appropriate and cost effective settings. To deliver the highest quality, safe and sustainable acute services to southern Hampshire and the Isle of Wight. To improve outcomes, reduce clinical variation & cost through collaboration between UHS, PHT, IOW NHST & Lymington Hospital. Provide equity of access, highest quality, safe services for the population. To create a sustainable, high quality and affordable configuration of acute services for the population of North & Mid Hampshire and the out-of-hospital services to support that configuration (linking with the New Models of Care programme). To improve quality, capacity and access to MH services in HIOW. Achieved by the four HIOW Trusts providing mental health services (SHFT, Solent NHST, Sussex Partnership FT and IoW NHST), commissioners, local authorities, 3rd sector & people who use services, working together in an Alliance to deliver a shared model of care with standardised pathways. Improving Health and Wellbeing, with more people able to manage their own health conditions reducing the need and demand for health services. More people supported to give up smoking, achieve a healthy weight and drink sensibly (reducing lifestyle related diseases). Efficiencies of 10m by 2020/21. Improved outcomes for people with long term conditions/multiple co-morbidities. Reduced A&E attendances/hospital admissions for frail older people and people with chronic conditions. More people maintaining independent home living. Sustainable General Practice offering extended access. Efficiencies of 46m by 2020/21. Patients supported in the setting most appropriate to their health and care needs. Improvements in LOS for patients. Reduced requirement for hospital beds of up to 300 beds across HIOW. Efficiencies of 15m by 2020/21. All patients able to consistently access the safest acute services offering the best clinical outcomes, 7 days a week & delivery of the national access targets for the Southern Hampshire/IOW population. Reduced variation and duplication in acute service provision. Efficiencies of 165m by 2020/21. Sustainable access to 24/7 consultant delivered acute care for North & Mid Hampshire population, improved outcomes through care closer to home & delivery of the national access targets. Efficiencies of 41m by 2020/21. Improved quality and performance targets. All people in HIOW will have early diagnoses to enable access to evidence based care, improved outcomes and reduced premature mortality Enhanced community care & improved response for people with a mental health crisis. Reduced out-of-area placements for patients requiring inpatient care. Efficiencies of 28m by 2020/21. 11

12 The table below summarises the objectives and expected impacts of our four enabling programmes to create the infrastructure, environment and capabilities to deliver successfully. A plan on a page summary of each core and enabling programme is set out on the following pages of this document. Enabling Programme Programme Objective Expected Impact and benefits for patients, communities and services ❼ Digital Infrastructure ❽ Estate Infrastructure rationalisation ❾ Workforce ❿ New Commissioning Models To give patients control of their information and how it is used, allowing patients to manage their long term conditions safely and enable patients to access care at a time, place and way that suits them. To build a fully integrated digital health and social care record, and the infrastructure to allow staff to access it from any location. To provide the estate infrastructure needed to deliver the new models of care and to deliver savings by rationalising the public sector estate in Hampshire and the Isle of Wight. To ensure we have the right people, skills and capabilities to support the transformed health and care system by working as one HIOW to manage staffing, development, recruitment and retention. To adapt our methods, tools, resources and architecture for commissioning health and care, to reduce unnecessary duplication of commissioning work and facilitate the delivery of the STP. To generate cost reductions in expenditure on Continuing Health Care and Prescribing through working at scale. An integrated care record for all GP registered citizens in Hampshire and IoW. Flexible IT systems enabling care professionals to work from any location, with access to citizens health and care records. Citizens able to self-manage their health and care plans e.g. managing appointments, updating details, logging symptoms. Real time information to support clinical decision making. Improved collaboration & co-ordination of HIOW estates expertise and information will mean that we can improve our planning capability at STP and local level. Providing estate that can be used flexibly and enable new ways of working. Reducing demand for estate will generate efficiencies and savings through reduced running costs and release of land for other purposes. Improving the condition and maintenance of our estate will mean that citizens can access services in fit for purpose facilities across Hampshire and IOW. Release surplus land for housing and reducing operating costs in our buildings across HIOW. A flexible workforce shared across geographical and organisational boundaries, working in new ways with extended skills to deliver the workforce transformation that underpins STP core programmes. Health and care roles that attract local people, to strengthen community based workforce. Significant reduction in the use of temporary and agency workers. Increasing the time our staff spend making the best use of their skills/experience. No overall growth in the workforce over the next five years. Collaboration across five Hampshire CCGs and the establishment of single leadership across four CCGs, strengthened integration with Hampshire County Council, increasing the ability to unlock savings and reducing unaffordable infrastructure. Single approach and shared infrastructure for the commissioning of hyper-acute and specialised physical and mental health services for the population of HIOW - driving improved outcomes, service resilience and delivering organisational inefficiencies. Capitated outcomes based contracts procured for at least three places by 2019/20. Efficiencies of 36m in CHC, 58m in prescribing costs and reduced system infrastructure costs by 10m. 12

13 PREVENTION AT SCALE STP Programme Objective: To improve healthy life expectancy and reduce dependency on health and care services through a radical upgrade in prevention, early intervention and self-care: a sustained focus on delivering prevention at scale in HIOW. Programme Description Working across the system we will deliver initiatives to prevent poor health consistently and at scale, integrating with public health, CCG and vanguard agendas. On the Isle of Wight the Prevention at scale agenda will be addressed through MLAFL: Implementation of the Island Prevention Strategy through My Life a Full life workstreams. Family Wellbeing Platform, which includes wellbeing service, weight management pathway and digital front door for lifestyle services platform. Local Area Coordination. IOW is part of the second wave national diabetes prevention programme to be rolled out from April 17. Public Health is leading local implementation with support from CCG primary care team. Continue roll out of Making Every Contact Count (MECC) throughout 17/18. Emphasis on preventative interventions to tackle levels of alcohol related harm by improving alcohol pathway and reducing impact of alcohol related liver disease on the system. PH and CCG to lead on tackling Opioid Analgesic Dependency. Outcomes and benefits to be delivered STP - By 17/18 more people will have: given up smoking prior to surgery, been screened for cancer; access to lifestyle behaviour change support. 1. A culture shift of thinking prevention first across all MLFL work streams. 2. Wellbeing Service will deliver behaviour change outcomes for individuals Reduction in risk factors for diabetes and other Long Term Conditions. Increase individuals capacity to self-manage. 3. Local Area Coordination will deliver outcomes across three layers, individual, community and system wide: individuals being in better control of their health and social care support, Improved individual and community resilience, Increase in selfconfidence to self-advocate, supporting existing and creating new social capital. 4. Increase in health and care staff who have attended MECC training- Increase in critical mass of staff trained to enable cultural/workforce shift to prevention. 5. Local implementation of National Diabetes Prevention Programme will reduce risk of cohort of patients identified as pre-diabetic going on to develop type 2 diabetes. 6. Increased levels of prevention interventions for alcohol in the community through AUDIT C, in schools through PSHE network and across community safety partnership (Night time economy, Community Alcohol Partnership for example). 7. Reduction in alcohol related harm and anti-social behaviour from 2018/ Reduction in costs of prescription for opioids for CCG. Local Projects Timescales Projects 2017/ /19 Family Wellbeing Platform Family Wellbeing Service taking referrals for individual behaviour change ( Tier 2 weight management/smoking cessation/physical activity National Diabetes Prevention Programme Local Implementation Local Area Coordination (LACs) Local Area Coordinators taking introductions in 9 neighbourhoods 12 month evaluation (externally validated) Make Every Contact Count (MECC) 9 trainers to deliver 12 day MECC training throughout Weight Management Integrated tier 1-4 Weight Management pathway Childhood Obesity School based programmes including Chartwells healthy meal plans, National Child Measurement Programme to support obese children, EDUMOVE to increase activity, and Change for Life campaign Working with trading standards and planning around location of fast food outlets Falls Refreshed Falls Prevention Strategy agreed Falls Prevention Strategy implementation plan commenced. Cancer Early Diagnosis Improved Access to diagnostics Support PHE national screening programmes by ensuring requirements are reflected in local drivers Work Place Health Charter Self-assessment to have been completed Implement action plan 13

14 NEW MODELS OF INTEGRATED CARE STP Programme Objective: To improve the health, wellbeing and independence of HIOW population through the accelerated introduction of New Models of Care and ensure the sustainability of General Practice within a model of wider integrated health and care. This will be delivered through the Vanguard programmes and local health system New Care Models delivery arrangements. Programme Description The programme will deliver place based integrated care in each locality in HIOW, with 5 big ticket interventions consistently implemented. Foundation for Independence & Self-care Fully Integrated Primary Care Care Coordination including Care Navigators & LACs Community Asset Development Patient Activation & Health Coaching Primary care working at scale to deliver urgent care across 7 days. Joined up, enhanced multi-professional primary care teams with extended skills and extended access care hubs in localities Local Projects Timescales Projects 2017/ /19 Transforming Community Services Integrated Locality Working including market development, facilitated discharge& interim support, care navigation, end of life and locality governance Case Management of those most at risk (inc. MDT) Integrated Intermediate Care Complex & End of Life Care Integrated Health and Social Care Services in the Localities Community beds in Nursing Homes Integrated Rehabilitation & Reablement Dedicated support from the multi professional team for those patients at greatest risk, including the 0.5% of patients with the most complex needs and those at end of life Prevention and Early Intervention including Family Wellbeing, LAC, Asset based Community Development and Big White Wall Coordinated Access to all Island Provision, including Access Blueprint, Hardware & Networks and Isle Help MH Serenity Safe haven LTCs: Diabetes& Respiratory Outcomes and benefits to be delivered Greater Shift from Acute to Community Provision As part of MLAFL and the implementation of WISR, the Island has a Transforming Community Services Delivery Programme. The Better Care Plan supports delivery of elements of this programme and the Primary Care Strategy supports the primary care contribution to integrated care, whilst delivering specific aspects of primary care transformation. STP - By 17/18-75% of integrated primary care hubs operational. National diabetes pathways fully implemented 1. Improved outcomes for people with long term conditions/multiple co-morbidities. 2. Reduced A&E attendances/admissions for target conditions. 3. More people maintaining independent home living. 4. Extended primary care access and increased GP capacity to manage complex care due to improved skill-mix in wider workforce. 5. More sustainable Island health and care economy. Rehabilitation, Reablement, Recovery Alliance Contracting Primary Care Strategy subject to outcome of Primary Care Strategy Consultation Improved Access Urgent Care inc. OOHs Chronic Disease Management/Wellbeing Planning Workforce/ Workload Digital Enablement Future Estates 14

15 EFFECTIVE PATIENT FLOW AND DISCHARGE STP Programme Objective: To ensure no patient stays longer in an acute or community bed based care than their clinical condition and care programme demands and as a result reduce the rate of delayed transfers of care by improving discharge planning and patient flow, and by investing in capacity to care for patients in more appropriate and cost effective settings. Programme Description To address the issue of rising delayed transfers of care in HIOW we will deliver 4 workstreams focused on the underlying causes as detailed in the HIOW STP. The Isle of Wight System Resilience Group (A&E Delivery Board) Improvement Plan 2016 has identified five discharge pathways, with actions agreed to improve admission, patient flow and discharge processes: Simple Discharge. Reinstating/ restarting care packages (easy access care, including simple reablement). Self-funding ongoing health and social care. Complex ongoing social care or complex reablement (including Dementia). Complex ongoing NHS care including Continuing Health Care (CHC). The Transforming Acute Services (TAS) workstream will deliver the improvements through Urgent and Emergency Care Operational Improvement plans, which are formally mapped to the nationally mandated urgent and emergency care initiatives. Ambulance Front Door ED Flow The CCG, with the LA, will commission sufficient capacity in the system to ensure that effective patient flow and discharge is maintained. Outcomes and benefits to be delivered Ambulatory Care Internal Flow STP - By 17/18 - Implementation underway of a collective approach to grow the domiciliary care workforce and capacity. Discharge 1. Patients supported in the setting most appropriate to their health and care needs, leading to improvements in Length of Stay for patients currently residing in acute and community hospital beds. (Patient Navigation Team and Voluntary sector home from hospital support were implemented in 2016/17). 2. Improvements in LOS for patients staying 7-30 Days through multi-agency stranded patient review. 3. Improvements in LOS for episodes of 2-7 Days through SAFER effective flow management, removal of internal delay and 7 day services. (SAFER implemented in 2016/17). 4. Improvements in LOS for episodes of 0-2 days though the implementation of ambulatory care front door turnaround teams. Local Projects Timescales Projects 2017/ /19 Discharge Planning System wide admissions and discharge policy implemented Every patient has a discharge plan Focus on simple discharge ( <6 days) Criteria led discharge Community notifications are automated Care Plans shared across community & acute Multi-disciplinary teams are established Effective management of patient flow 7 day services Live bed state system Adopting principles of NHS Enhanced Recovery for surgical services to reduce LOS Workforce Development Implement outcomes of LGA / ECIST flow and discharge audit Complex Discharge Roll out of Care Act Compliance Discharge to assess and trusted assessors Revision of CHC Processes Increased use of the voluntary sector support discharge Development of onward care Care and Nursing Home development programme Domiciliary care services development Health coaching and Service User Activation models Co-produced wellbeing planning 15

16 SOLENT ACUTE ALLIANCE STP Programme Objective: To deliver the highest quality, safe and sustainable acute services to southern Hampshire and the Isle of Wight. To improve outcomes, reduce clinical variation and lower cost, through collaboration between UHS, PHT, IoW NHST & Lymington Hospital. To provide equity of access to the highest quality, safe services for the population. Programme Description The IOW has a number of clinical services which are not clinically sustainable without a strong Solent alliance which facilitates multi-professional networks of clinicians delivering best available acute care. The IOW has already undertaken a cancer oncology review and urology review and these will continue to be implemented across the alliance. The Island is committed to driving this work forward to deliver improved outcomes and reduce costs by reducing the use of locums, reducing clinical variation and ensuring continued local access to services where clinically appropriate. Core services will be provided at each centre with speciality collaborations using a hub and spoke model to ensure safe 24/7 provision. The clinical service reviews will be undertaken concurrently, starting in January As the review is completed a detailed implementation plan will be developed with timelines for delivery. The blueprint for redesigned pathways will be completed by May Outcomes and benefits to be delivered STP - By 17/18 - Implementation underway of transformation plans in back office services, pharmacy, pathology, radiology and outpatients. 1. Sustainable acute services for the IOW. 2. Reduced clinical variation and improved outcomes. 3. Reduction in outpatient attendances and follow ups. 4. Improvement in IOW delivery of national standards (RTT, 7 Day service). 5. Developing arrangements for consultant rotations and cross-cover arrangements to ensure improved access to expert clinical support. Local Projects Timescales Projects 2017/ /19 Pathology consortia (re-visited) Implementation of redesigned services Clinical Services Review Agreement of final blueprints of service models with UHS/PHT to include finance, HR, IT, focusing on agreed outcomes from scope. Discussions and sign off of proposals and consultation plan with Trust/CCG Boards Engagement with public on key changes to service as appropriate Implementation Outpatient Digital Implementation of OP Digital pathways Commence delivery of transforming outpatient services Deliver reduction in overall follow up appointments 16

17 MENTAL HEALTH ALLIANCE STP Programme Objective: To improve the quality, capacity and access to working age and older adult mental health services in HIOW. This will be achieved by the three HIOW Trusts providing mental health services (SHFT, Solent NHST and IoW NHST), commissioners, local authorities, third sector organisations and people who use services, working together in an Alliance to deliver a shared model of care with standardised pathways. Programme Description In order to achieve parity of esteem we are committed to ensuring that support for mental health is embedded holistically across the system and not seen in isolation. We will ensure that people experience a seamless, coherent pathway that incorporates the key principles of prevention, risk reduction, early intervention and treatment through to end of life care. The Five Year Forward View for Mental Health, the Dementia Implementation Plan and the Wessex Clinical Network Strategic Vision provide us with a blueprint for realising improvements and the mechanism for mobilising the system by 2020 /21. We will achieve this by working at scale through the IOW MH Reconfiguration Programme Board, linking with STP to deliver 5YFV and locally clinically and financially sustainable services including: Local Projects Timescales Projects 2017/ /19 Acute and community mental health pathway review and redesign, in line with constitutional standards. Review and redesign of the HIOW Mental Health Rehabilitation Pathway - including reconfiguration of IOW provision. Coproduce Alliance wide recovery based pathways and care models. o o o Review and redesign of MH rehabilitation service Implementation of MH Safe Havens Cluster 8, complex care and IAPT plus o o o Financial Envelope review Community Mental Health Services improvement 24/7 Single Point of Access Development of STP wide pathways and protocols and Crisis prevention strategy to reduce crisis and de-escalate effectively. Recommission IOW Dementia assessment and treatment service. Outcomes and benefits to be delivered STP - By 17/18 - A local recovery based solution replacing high cost out of area residential long term rehabilitation will be in place 1. 24/7 all age Crisis Response in place. 2. Reduce suicides by 10% with local government and other partners. 3. Treatment within 2 weeks for 53% of people experiencing a first episode of psychosis. 4. Reduction in high cost out of area placements. Implementing MH Safe Havens. Fully implement Single Point of Access 24/7 for all ages. Improve services for people in need of complex care, including IAPT plus. 17

18 DIGITAL INFRASTRUCTURE STP Programme Objective: To give patients control of their information and how it is used, allowing patients to manage their long term conditions safely and enable patients to access care at a time, place and way that suits them. To build a fully integrated digital health and social care record, and the infrastructure to allow staff to access it from any location. Programme Description This workstream is designed to increase the quality of service provision, reduce the pressure on care services and improve efficiency. The programme delivers the capabilities required to deliver our visions for the STP and the islands MLAF strategies by providing the enabling platform. The CCG has aligned its IT strategy and Local Digital Roadmap to that of the STP in recognition that the island shares the same aspirations as our regional colleagues and that ultimately wider integration of systems will be better for our patients. This will ensure best access to appropriate funding. Our local IT subject matter experts in health and social care are formally engaged and have local delivery groups established to drive through change. They will be guided and reliant on the STP programme management but cognisant that local implementation will be reliant on funding from existing local income or funding opportunities. The table to the right highlights the key programmes aligned to the STP strategy. A strategic roadmap (Local Digital Roadmap) for the delivery of the programme has been developed and agreed. Outcomes and benefits to be delivered By 17/18 Made Wi-Fi available across all care settings, rolled out e-consultations to GP Practices, deployed the infrastructure to support the care coordination centre. This programme is designed to: The ambitions of this programme are to: Increase the quality of service provision. Provide an integrated digital health and care record. Reduce the pressure on care services Unlock the power of data to inform decision making Improve efficiency. at point of care. Deliver the technology to shift care closer to home. Establish a platform to manage Population Health. Drive up digital participation of service users. Drive up digital maturity in provider organisations. Local Projects Timescales Projects 2017/ /19 HIOW Technical Strategy Implemented 2016/17 Patient Data Sharing Initiative (Phase 1) Patient Portal E-Prescribing & Medicine Reconciliation Digital Communications across Care Providers Wi-Fi for HIOW & Cyber Security Channel Shift (Phase 1 - e-consultations) Care co-ordination centre infrastructure Optimising intelligence capacity National Must Do s (NHS England Universal Capabilities) A: Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions. B: Clinicians in U&EC settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC). C: Patients can access their GP record. D: GPs can refer electronically to secondary care. E: GPs receive timely electronic discharge summaries from secondary care. F: Social care receives timely electronic Assessment, Discharge and Withdrawal Notices from acute care. G: Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly. H: Professionals across care settings made aware of end-of-life preference information. I: GPs and community pharmacists can utilise electronic prescriptions. J: Patients can book appointments and order repeat prescriptions from their GP practice 18

19 ESTATE INFRASTRUCTURE RATIONALISATION STP Programme Objective: To provide the estate infrastructure needed to deliver the new models of care and to deliver savings by rationalising the public sector estate in Hampshire and the Isle of Wight. Programme Description Local Projects Timescales The Estates programme has two core and interdependent objectives: 1. To enable delivery of the STP core transformational workstreams and 2. To drive improvement in the condition, functionality and efficiency of the IOW estate, ensuring that the quality of our estate, particularly in community settings supports new ways of working across localities. Projects 2017/ /19 Develop business case for Newport Hub Identify potential funding routes Development of a Newport locality Hub, re-providing two GP surgeries and a number of existing community buildings that are not fit for purpose. Refurbishment of barracks building in Sandown to provide for a south locality hub as part of the One Public Estate project with Isle of Wight Council. To redevelop a new primary care surgery in Brighstone providing for the surrounding rural population and offering greater choice in the West Wight area. To identify a hub solution for the Ryde area, re-providing for two GP surgeries. To make progress implementing the primary care strategy estates plan aimed at ensuring that neighbourhood surgeries are fit for purpose. This involves bidding for and investing capital in practices and supporting practices to maximise efficiency in the use of their estate. NB. The IOW Primary Care Hub, as referred to in the HIOW STP Plans, is St. Mary s Hospital, run by the IOW NHS Trust. Primary Care Committee/Governing Body to make decision on case If approved, building work to commence Develop business case for Sandown Hub Identify potential funding routes Primary Care Committee/Governing Body to make decision on case If approved, building work to commence Develop business case for Brighstone Rural Hub Work with current practice to identify funding Primary Care Committee/Governing Body to make decision If approved, building work to commence Outcomes and benefits to be delivered STP - By 17/18 Implementing plans to ensure that the quality of our estate, particularly in community settings, will support new ways of working across localities. 1. Reduced reliance on old and poor quality buildings to deliver healthcare. 2. Physical home for each locality developed providing a focus for transformation work programmes. 3. Realisation of locality model and infrastructure in place to support movement of services from the hospital site into the community. Secure resource to dedicate to developing strategy for Ryde Hub Development of strategic approach to Ryde hub Development of business cases Develop Plan for investment of available capital in primary care Secure agreements with practices Modifications to be completed 19

20 WORKFORCE STP Programme Objective: To ensure we have the right people, skills and capabilities to support the transformed health and care system by working as one HIOW to manage staffing, development, recruitment and retention Programme Description Local Projects Timescales To work as one system to develop the right people, skills and capabilities to support the transformed health and care system. By working as one we will ensure we remove organisational and professional boundaries and make better use of resources across the system. We will exploit the potential of new technology and reduce unnecessary competition for limited staffing resources. We will have an Isle of Wight system recruitment strategy which targets our hard-torecruit posts and which will include initiatives such as a Gateway to the Island recruitment portal attracting people to work on the Island, rather than recruiting through separate organisational processes. We will have an Isle of Wight system workforce plan, providing clarity of both short and longer term workforce needs for the Island. We will train and educate our workforce as one wherever possible, through an Isle Learn integrated learning management system. Working with the Solent Acute alliance we will minimise the use of temporary staff and make best use of expert resources by planning and utilising our workforce across a wider geography (e.g. Southampton, Portsmouth and the Isle of Wight). Outcomes and benefits to be delivered STP - By 17/18 - Implementation underway of workforce transformation plans to deliver the STP core programmes and the HIOW system approach to staffing 1. Flexible workforce shared across geographical and organisational boundaries, working in new ways with extended skills to deliver the core STP programmes. 2. Health and care roles which are more attractive to local people, enabling the development of a stronger community based workforce. 3. Significant reduction in the use of temporary and agency workers. 4. Increasing the time our staff spend making the best use of their skills and experience. Projects 2017/ /19 Workforce planning and Information Workforce planning and Information Recruitment and Retention Strategy Recruitment hot-spots System wide use of resources Workforce Corporate back office functions Technology Technology Education and Development Making best use of our resources Ensuring our staff are best equipped for the future Engagement and Organisational Change Engagement and Organisational Change 20

21 NEW COMMISSIONING MODELS STP Programme Objective: To adapt our methods, tools, resources and architecture for commissioning health and care, to reduce unnecessary duplication of commissioning work and facilitate the delivery of the STP. To generate cost reductions in expenditure on Continuing Health Care and Prescribing through working at scale. Programme Description Local Projects Timescales The Programme aims to align commissioning intentions and planning for the future form and function of commissioning across HIOW: Commissioning activities orientated around tiers. Closer integration of health and social care commissioning around place-based solutions. Contracting and payment approaches that support the implementation of new models of care & alliance / MCP / PACs or ACO contracting. Additionally, the Programme aims to improve the delivery of CHC processes and reduce inappropriate variation in Primary Care prescribing. CHC processes will be reviewed to ensure consistency in contracting and decision making across the STP footprint, that CHC pathway timeframes are adhered to, and that referrals are appropriate. Prescribing programmes, systems, processes and formularies will be reviewed to ensure contracts and services are aligned to improve the quality of care they deliver while making efficiency savings. o Care Home Medication Review service to be reviewed to support multi-disciplinary review of patients living in care home or receiving social care in the community in line with NICE Guidance. o Reduce variation and waste in primary care prescribing by supporting engagement with IT system tools. Outcomes and benefits to be delivered STP - By 17/18 - Common approach to contracting STP - By 18/19 - Place based solutions Alliance Contracting Projects 2017/ /19 IOW Community Alliance Contract IOW Community Alliance Contract Collaborative Commissioning with other CCGs Integrated Commissioning with IOW LA Integrated Commissioning with IOW LA Development of MCP Contract Population based Contract Continuing Healthcare Processes Robust business processes established including improvement in referrals to CHC assessment processes for the Island. Processes implemented to ensure CHC Pathways DoH timeframes adhered to Robust frameworks and commissioning/contracting arrangements developed with HIOW STP to ensure consistency across the system Personal Health Budgets Increase local offer of PHBs to 143 people by 2020 Reduce Inappropriate Variations in Primary Care Prescribing Prescribing programmes to support HIOW STP Prescribing Programme where being addressed at scale will be beneficial at a local level 1. Effective commissioning at scale for acute services. 2. Local placed solutions facilitating delivery of new models of care. 3. Outcomes based commissioning with aligned incentives across the system. 21

22 5. Delivering the Five Year Forward View Must Dos for Summarised requirements from the Planning Guidance. FINANCE Deliver Control Totals Implement local STP plans and achieve targets Demand reduction measures SUSTAINABILITY AND TRANSFORMATION PLAN Implement agreed STP milestones Achieve agreed performance trajectories URGENT CARE Deliver A&E Improvement Plan 7 Day services (4 Priority Actions) Improve Waiting Time Standards for those in MH Crisis. PRIMARY CARE Implement the Five Year Forward View REFERRAL TO TREATMENT TIMES & ELECTIVE Streamline pathways Reduce unnecessary outpatient follow ups Implement Better Births CANCER Stratified pathways for Breast Cancer and roll out of other areas Ensure all elements of the Recovery Package are commissioned MENTAL HEALTH Improve access to Psychological Therapies (IAPT) Improve access to Children and Young People s Psychological Therapies (CYP IAPT) EIP increase in access and efficiency Improvement in employment support Improve access to eating disorder services for children and young people Reduce suicide rates LEARNING DISABILITY Reduce premature mortality by improving access and making reasonable adjustments for peole with LD and/or autism. Improve access to health services QUALITY Commissioning safe, sustainable and productive services Key activities relating to the Must Do s are detailed on following pages. See separate sections for: STP Section 5 FINANCE Section 7 QUALITY Section 10 22

23 Primary Care The CCG will focus on the implementation of the GP 5YV and the locally agreed primary care strategy. This starts a period of transformation in primary care which will result in larger more sustainable practices operating across localities and neighbourhoods. The plans will support the development of new workforce alongside securing GPs for the Island. A key focus is the development of a digital offer in primary care reducing reliance on face to face contact and supporting better access to advice and support. New models of care across urgent services and chronic disease management will be developed supporting the vision developed by My Life a Full Life of integrated community services focused around the needs of the patient. Key Activities Level of Ambition IMPROVED ACCESS AND 7 DAY SERVICES Continued improvement in access in core hours. Provision of practice based extended hours. primary care on a 7 day basis. Improvement in MORI survey patient satisfaction with opening Implementation of 7 day services. WORKFORCE AND WORKLOAD Workflow optimisation projects. Continue to roll out 10 high impact actions. Continued involvement within General Practice Improvement Programme. Recruitment programme for GPs, Nurses and pharmacists for island. Develop urgent care offer. Develop case for and commission acute visiting service. DIGITAL TRANSFORMATION Roll out of Wi-Fi for practices (Estates and Technology Transformation Fund funded project) and mobile working. Implementation of e-consulting package. Refresh E-referral and work towards paperless referrals. Expand online access for patients. Accelerate roll out of Repeat E-dispensing. Implementation of the Hampshire Health Record (HHR) (TBC). CARE NAVIGATION AND SIGNPOSTING Review and refresh of care navigation within GP practices. Investment of non-recurrent funding to support training of reception and clerical staff. By September 2017, 100% of Island residents able to access routine hours to reach 84% satisfaction rate equivalent to high of July All 16 practices to offer extended hours extended service. Release approximately 15% clinical time through workflow redesign by December In hours urgent care offer in one locality by December Acute visiting service in place by March Recruitment programme in place by May Wi-Fi in all practices by March 2018 (baseline zero). E-consulting available in 7 day service by September 2017 and practices by March Achieve 100% of use of e-referrals by no later than April 2018 in line with the 2017/18 CQUIN and payment changes from October This target is ambitious and requires the delivery of an intense implementation project by the Trust with the support of the CCG. The current level of achievement is only c8%. The project has been initiated. Increased online access by minimum 10% per year for each year of this plan (from a baseline of 3%). 30% patients receiving repeat e-dispensing by March HHR rolled out by September 2017 (TBC). Development of training programme. Delivery of training programme. 23

24 PRIMARY CARE TRANSFORMATION Continued support to GP Federation. Development of programme to create Standard Operating Procedures for Island GP practices. Development of patient champions supporting change. Coaching for LTC proof of concept. Reduced bureaucracy programme of work. DIABETES The CCG aims to deliver the national diabetes priorities for type 1 and type 2 diabetes patients, improve delivery rates for NICE recommended processes and the uptake of structured education, and achieve improvement in cholesterol and blood pressure, by incentivising GPs under LIS. All practices will participate in the National Diabetes Prevention Programme alongside their existing commitment to health checks. The CCG work with public health in the local authority and the GP federation to develop a referral pathway which includes taking advantage of the GP single system enabling central generation of patient lists. Treatment targets: Through the Diabetes Local Incentive Scheme (LIS) a practice visit will be held with the Secondary Care Diabetes Centre to review newly diagnosed patients in the previous 12 months, who have not achieved an HbA1c of <7% (<53 mmol/mol) and appropriate treatment plans put in place. Structured Education: Through the Diabetes LIS there is a requirement for 90% of newly diagnosed Type 2 patients to be referred to the structured education programme. Commission public engagement to understand barriers to the uptake in structured education. Work with GP Practices to improve record keeping in relation to structured education courses. Cholesterol and blood pressure Action plan to be developed by Localities to ensure GP Practices are reaching 40.2%. As part of the Diabetes LIS, practices will aim to risk assess patients diagnosed with diabetes for use of a statin, using the Q Risk Tool. SCREENING AND IMMUNISATION We will continue to work with Public Health England to increase the uptake of screening and immunisation programmes and in particular: Share information - benchmark information with practices to encourage peer review to consider how better to target patients. Work with the primary care team to ensure that practices are signed up to services and reporting data accurately. Support practices to ensure that they specifically consider the issues associated with people with learning disability. Ensure that prevention messages are included in the system resilience programme. OTHER Commission Leg Ulcer pathway. Finalise commissioning arrangements for phlebotomy service. SOPs covering safeguarding and key CQC matters by September Recruitment of patient champions by June Business case for coaching approved by June 2017 for roll out on pilot basis September 2017 proof of concept by September Use of TPP to support contract management by March Treatment targets: Improve achievement of the three NICE-recommended treatment targets ((HbA1c <=58mmol/mol (7.5%); Cholesterol <5mmol/L; Blood pressure <=140/80 mmhg) for adults and one (HbA1c) for children with diabetes. GP practices to maintain or improve performance to 40.2% (current national median). Structured Education: Increase the percentage of people with diabetes (diagnosed less than a year) who attend a structured education course. An additional 10% of newly diagnosed people with diabetes attending structured education. National screening Programme Data to be shared with GP Practices throughout to encourage improved performance. Encourage GP Practices to improve the National Cervical Screening Programme uptake to 80% by March Maintain or improve above national average uptake of all other national screening programmes, with particular consideration to people with learning disabilities. Encourage wider dissemination of National Screening Programme Literature. Leg ulcer pathway rolled out by June Phlebotomy service mobilised by September

25 Urgent and Emergency Care The IOW System Resilience Group (A&E Delivery Board) is committed to ensuring that key targets for A&E and Ambulance are delivered through the 5 key elements of the A&E Improvement Plan, which they will ensure are consistently delivered in 2017/18. As part of the WISR process the IOW has been redesigning its urgent care pathways, which it will implement over the next 2 years. This will lead to appropriate utilisation of resources across the whole of the urgent care pathway, with plans reflecting the 9 key building blocks to deliver the priorities from the Urgent and Emergency Care Review. Plans detailing how these service improvements will be delivered have been developed within the Transforming Acute Services (TAS) workstream and are within the TAS Urgent Care Improvement Project Plans. We are a member of the Wessex Urgent and Emergency Care Network, fully utilising the resources of the network to enable local delivery of the Urgent and Emergency Care Strategy, aligned with best practice and using the national toolkits. Key Activities Level of Ambition SELF MANAGEMENT AND SUPPORT Promotion of alternative provision, including digital support and pharmacy first. PRIMARY CARE Redesign of in hours urgent care to support practices to manage workload, including in-line decision making and ensuring patients same day primary care needs are met and managed within localities. CLINICAL COORDINATION HUBS Continue to commission the Integrated Urgent Care Hub that supports NHS 111, 999 and out of hours calls, with further development of the directory of services and implementation of Integrated Clinical Advisory Services. 111 call centre development to enable phone first digital and online clinical triage and treatment. AMBULANCE Continue to commission and sustain hear and treat and see and treat activity, benchmarking in top quartile. Redesigned processes including web-enabled transfers, to improve Ambulance handover. FRONT DOOR Implementation of all Ambulatory Emergency Care (AEC) pathways to deliver default AEC service. Development of Urgent Care Floor, as detailed in Transforming Acute Services (TAS) plans, combining ED, GP OOHs, AEC and the Medical and Surgical Assessment Units, creating a multi-disciplinary clinical urgent care team. Paediatric Assessment Unit to ensure children are observed, assessed rapidly to ensure that they receive a service appropriate to their needs in the least restrictive environment as close to home as possible. It is linked to Transforming Community Services (TCS) to ensure services for children are provided in community settings by outreach paediatric staff. Commission new OOHs primary care contract to ensure delivery of integrated urgent care standards. Commission continued delivery of MH single point of access and ensure liaison psychiatry support to deliver waiting time standards for urgent care for those in MH crisis. HOSPITAL SERVICES Ensure the four priority standards for seven day hospital services are met: 2 - Time to Consultant Review 5 - Access to Diagnostics 6 - Access to Consultant-directed Interventions 8 - On-going Review. Monitor delivery of improvement plans to ensure hospital flow is improved. DISCHARGE Improve discharge to home by implementing default Discharge To Assess. Trusted assessors. Complex discharges. Increased community capacity Domiciliary Care, Nursing Home beds and rehabilitation/ reablement. Integrated Access Blueprint aligned with MLAFL workstreams by March Implementation during 2017/18 Deliver improved access to Primary Care in and out of hours: o 7/7 to reach 100% of the population during 2017/18. Deliver access to integrated urgent care, to reach a further 20% of the population during 2017/18. Maintain achievement of 95% of calls answered within 60 seconds. Category A calls (Red1) and also (Red2) within 8 minutes, 75%. Category A calls within 19 minutes, 95%. All Handovers between ambulance and A&E within 15 minutes. Step change improvement in A&E to 92% by the end of March Further improvement to 95% over the course of 2017/18 will be agreed. Default Ambulatory Care fully operational by Sept Implementation timeline subject to outcomes of WISR Public Consultation. Paediatric pathways fully operational across Solent Alliance during 2018/19. Reduction in number of children admitted to Acute hospital. Integrated OOHs primary care contract procured by September 2018 Continue to commission MH support required to meet A&E targets and extend the provision to Children. As detailed in the TAS Urgent Care Improvement Plans, all patients admitted via the Urgent and Emergency care pathway will have access to acute hospital services that will comply with the four priority standards, 7 days per week, by November Every patient will have an Automated Care Plan, by end of 2017/18. In 2017/18 Capacity, demand, acuity, utilisation, efficacy of every care space in the Acute and Community sector will be accurately and consistently understood. Medically fit patients will spend less than 14 days in a hospital setting, unless it is deemed by the MDT that hospital is the most appropriate care environment. See Performance section 8 for trajectories. 25

26 Referral to Treatment Times and Elective Care The delivery of the RTT constitutional target has not been achieved during 2016 mainly due to capacity pressures throughout the health and care system. The Isle of Wight System Resilience Group (A & E Delivery Board) Improvement plan outlines the key actions - demand management, improvement of flow and discharge to enable the delivery of routine elective activity. The CCG has continued to actively promote increased activity at mainland trusts and the independent sector to help alleviate the pressures on the IOW NHS Trust waiting list. Throughout the next year we will continue to actively promote patient choice, and demand plans have been developed with all our major providers to ensure sufficient activity levels are commissioned, including ongoing commissioning of mainland independent sector capacity. The IOW CCG is a member of the Southampton, Hampshire, Isle of Wight and Portsmouth (SHIP) collaborative of CCGs and providers as a Maternity Pioneer Board which aims to deliver maternity services improvements in in line with the recommendations in the national maternity review, Better Births. Key areas of focus are: a single point of access, an individualised pathway and a named midwife. Key Activities Level of Ambition CONSTITUTION STANDARDS To ensure sufficient activity levels are commissioned, develop robust demand and capacity plans with the IOW and mainland Trusts, to be monitored throughout and updated in year for Ensure there is capacity in the system to deliver routine elective activity and achieve constitutional targets. Release capacity through effective demand management including the introduction of new thresholds through procedures of limited clinical value QIPP scheme. Proactive participation with the HIOW Solent acute alliance to streamline elective care pathways, including through outpatient redesign and avoiding unnecessary follow-ups, elective demand control in line with best practice guidance, and clinical services review. Key activities from WISR Business case for outpatient redesign will also be continued in , including: o Ceasing or reducing default outpatient follow ups where appropriate. o Providing services virtually using digital support. o Delivering care by other care providers. o Preventing unnecessary referrals. A key influence on activity is the introduction of more procedures of limited clinical value, the phase aligning our policies to that of our STP colleagues has been approved and being implemented. PATIENT CHOICE To ensure delivery of patient choice, ensure sufficient levels of activity are commissioned with mainland Trusts and independent sector. Implement e-referrals. Deliver the NHS Constitution standard by April 2017 that more than 92% of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment. The CCG aims to significantly reduce the numbers of unnecessary follow Ups. Our QIPP aims to align ratios to that of the upper decile in comparative areas in 17/18 and aims for further reductions in 18/19 through jointly planning improved pathways. Deliver patient choice of first outpatient appointment. Achieve 100% of use of e-referrals by no later than April 2018 as described within Primary Care section. MATERNITY Key areas of focus are: a single point of access, an individualised pathway and a named midwife. Neonatal mortality and stillbirths, and local implementation of Saving Babies Lives care bundle. 3 year pilot will be undertaken to expand specialist perinatal MH Community Services across Hampshire and the Isle of Wight. Access will be 100% by 2020/21. Women and families will receive specialist perinatal care from February By 2019/20 approximately 63 IOW women will be able to access the service each year. 26

27 Cancer More than half the people receiving a cancer diagnosis are predicted to now live 10 years or more. Nationally the numbers of individuals diagnosed with cancer is growing by 2% per year, with the rise partly due to ageing, growth of population, shifts in lifestyles increasing age-standardised risk, and individuals being less likely to die early from other conditions. Survival nationally is low in lung, pancreas, oesophageal and brain cancers, for which IOW residents require access to a number of providers in local Cancer Unit and mainland Cancer Centres. The CCG is committed to work with local and regional partners as part of a Cancer Network to drive improved outcomes for person centred cancer care. Key Activities ACHIEVING WORLD-CLASS CANCER OUTCOMES AND CANCER ALLIANCE Prevention Ensure GPs are appropriately prescribing the chemo-preventative agenda to reduce the risk of invasive breast cancer. Early detection - All GPs should be required to undertake a Significant Event Analysis for any patient diagnosed with cancer as a result of an emergency admission. Patient Experience By 2020 all consenting patients should have ability to access test results and communication online. End of Life CCGs commissioning appropriate integrated services for palliative and end of life care, in line with NICE Quality Standard (2011). NHS CONSTITUTION CANCER STANDARDS Identify disparity in achievement of targets between providers and ensure improvements are progressed via the Solent Acute Alliance and Cancer Alliance. CCG will continue to work with the Network and Wessex Cancer Alliance to identify system wide opportunities to secure additional diagnostic capacity. The CCG will work with specialised commissioning and tertiary providers to ensure diagnostics and pathways of care are commissioned to meet 62 day standard. The Cancer alliance is the lever to improve MDT Cancer Peer review compliance and improve capacity for Island residents. Formalise Cross-Solent Cancer local alliance via Memorandum of Understanding between providers, including NHS Trusts in Portsmouth, Southampton and the IOW, and Wessex Specialised Commissioning. Developing a local Alliance Agreement based on MOU and patient outcomes by 31st March IMPROVING ONE-YEAR SURVIVAL RATES AND EMERGENCY ADMISSIONS All new 2 week wait forms are now rolled out on the GP system and in use. Implement any further suspected cancer referral forms as developed and improved by the Wessex Cancer Strategic Clinical Network. Continue clinical leadership programme within primary care supporting symptom recognition and early diagnosis. Commission to improve access to diagnostic services for both non-malignant and cancer including CT and ultrasound, and drive improvements in one year survival rates and evaluate diagnostic direct access pilot. CANCER RECOVERY PACKAGE AND STRATIFIED FOLLOW-UP Review outcomes of Macmillan colorectal pilot and scope funding opportunities for embedding as core service delivery. Implement and roll out stratified follow up pathways to other tumour sites. 75% of IOW patients with colorectal or breast cancer to receive holistic needs assessment and treatment summary. Level of Ambition Milestones and key dates will be developed following further chemopreventative guidance from NICE. Compliance data to be agreed. Online access being increased by 10% per year. Delivery of Isle of Wight End of Life Care Strategy Implementation Plan milestones. Cancer waits - 2 week wait: Maximum wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP; or referred urgently with breast symptoms, 93%. Cancer waits 31 days: Maximum wait from diagnosis to first treatment all cancers, 96%. Maximum wait for a subsequent treatment (surgery), 94%, (anti-cancer drug), 98%, (radiotherapy), 94%. Cancer Waits 62 days: Maximum wait from urgent GP referral to first definitive treatment for cancer, 85%; maximum wait following a consultants decision to upgrade the priority of the patient (all cancers), 86%. Maximum wait from referral from an NHS screening service to first definitive treatment for all cancers, 90% Improve on current [based on 2013 figures] one year survival rates Continue to perform above the national average for Stage 1 and 2 diagnosis rates currently 54.7% against national average of 50.7% as at 2014 data Support Cancer Alliance application to National Transformation Fund to support early detection. Building on colorectal pilot, plan to implement recovery package for breast cancer as part of Outpatient redesign during 2017/18 Target to be achieved by 31 st March

28 Mental Health The IOW Mental Health Reconfiguration Programme Board is linking with Hampshire IOW STP to deliver the Mental Health 5YFV and local clinically and financially sustainable services as well as to ensure that Parity of Esteem is achieved. A number of task and finish groups have been set up to review and redesign the whole of the Island s mental health services within a revised financial envelope, working with other partners in the alliance and the third sector. The task and finish groups which have been developed to take work forward in include: - Financial Envelope review - Community Mental Health Services - Cluster 8, complex care and IAPT plus Key Activities Review and procurement of Woodlands rehabilitation 24/7 single point of access (all age, possibly through an alliance) Implementation of Mental Health Safe Havens IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES (IAPT) In , to ensure delivery of the mental health access and quality standards, we will: Commission services to ensure current IAPT Access standards are maintained and increased using e-technology and linking to Primary care plans for implementing Improved Access to Psychological Therapies (IAPT) and physical health provision. Commission to receive and be assured that plans are in place for delivery of workforce training to deliver improved access to Children and Young People IAPT. SINGLE POINT OF ACCESS Working with Acute and Emergency Care Commissioners, commission 24/7 urgent and emergency mental health service for children and young people and integrate with adult services from April EARLY INTERVENTION PSYCHOSIS Commission to receive and be assured that action plans are in place to ensure that: o People experiencing a first episode of psychosis begin treatment with a NICE-recommended package of care within two weeks of referral. o Workforce training schedule is in place to ensure Early Intervention Psychosis (EIP) team will meet CCQI self-assessment. Commission an early intervention service that provides NICE-concordat care to people aged years meeting the relevant access and waiting time standards. EMPLOYMENT SUPPORT Develop plans for improving access to Individual Placement Support (IPS) employment. Transformation Funding Bid to be submitted in 2016/ 2017 and plans to be implemented in 2017/18 pending outcomes of bid. Level of Ambition Maintain 22% current IAPT access, and plan to increase to 23% in 17/18 and 24% in 18/19, to achieve 25% by All areas to be included as part of Children and Young People Improving Access to Psychological Therapies (CYP IAPT) by By 2018/19 we will have an all-age MH liaison service achieving core 24 service standards. By 2018/19 83% of the population will have access to liaison and diversion, all age. 1 hour ED liaison response times. 4 hour MH Act Assessment response times (for non-injury). Maintain current levels of 75% of people experiencing a first episode of psychosis begin treatment with a NICE-recommended package of care within two weeks of referral. EIP team to meet CCQI self-assessment by 2018/19. At least 25% of EIP teams should meet the rating for good services in the CCQI self-assessment by 2018/19. Increase access to individual placement support (IPS) for people with severe mental illness in secondary care services by 25% by April 2019, against 2017/18 baseline. Baselines for HIOW CCGs will be established in 2017/18 and trajectories then set for improving access to IPS Employment support for people with Serious Mental Illness by

29 EATING DISORDER Commission dedicated eating disorder teams, jointly with Southampton and Portsmouth, in line with the waiting time standard, service model and guidance in SUICIDE PREVENTION Continue to implement and monitor, through the Health and Wellbeing Board, the IOW suicide prevention strategy and action plan, delivering a multiagency suicide prevention plan that complies with the latest evidence and PHE guidance. Implement development plans to ensure that adult liaison mental health services in local acute hospitals are staffed to deliver a minimum Core 24 standard. Assess and monitor access and waiting times for liaison service. Transformation Funding Bid to be submitted in 2016/ 2017 for implementation in 2017/18, if successful. DEMENTIA DIAGNOSIS Commission services to ensure current dementia diagnosis rates are maintained and increased by regular monitoring and reporting of referral to treatments times using Mental Health Standard Data Set (MHSDS) data and self-report data from the new CCQI tool. Implement forthcoming NHS guidance on dementia, focusing on post-diagnostic care and support. RECOVERY AND REHABILITATION Reduce/eliminate the number of Out Area Placements (OAP), as part of HIOW STP, and establish a mental health rehabilitation pathway that has a managed functional network of services across a wide spectrum of care. PERINATAL SERVICES Commission additional specialist perinatal mental health community services to deliver care to more women within the locality. Provision of specialist services community services will be monitored through MHSDS and NHSE finance tracker. 95% of children and young people receive treatment within four weeks of referral for routine cases, and one week for urgent cases. Waiting time and access will be measured through UNIFY from 2016/17 and the Mental Health Standard Data Set (MHSDS) from 2017/18. Reduce suicide rates by 10% against the 2016/17 baseline. Suicide prevention action plan, informed by Public Health guidance, to be developed by April Maintain current dementia diagnosis rate of the national rate of 66.7% or higher. Set trajectory of 5% increase on established baseline for starting treatment within 6 weeks of referral for people diagnosed with dementia. Eliminate out of area placements for non-specialist acute care by 2020/21 by delivering a 20% reduction in each year against the 2016/17 baseline. Increase access to evidence-based perinatal mental health care as follows: Trajectory for 2016/17 4 women Trajectory for 2017/18 Trajectory for 2018/19 Trajectory 2019/20 onwards 28 women 43 women 63 women 29

30 People with Learning Disabilities The IOW CCG is an active member of the Hampshire and IOW Transforming Care Board and subgroup through which we will be ensuring implementation of the Transforming Care Partnership Plans with local government partners, enhancing community provision for people with learning disabilities and/or autism locally throughout , in partnership with the IOW Learning Disability (LD) Partnership Group. The CCG is also involved in the Wessex Learning Disability Mortality Review Programme (LeDeR) pilot and we will work with providers to ensure lessons learnt are implemented; all deaths occurring in a person with LD are monitored via the Clinical Quality Review Meetings (CQRM). Progress is regularly reported to the LD Partnership Groups, Joint Commissioning Board (JCB), CCG Clinical Executive, CCG Governing Body and HWB to ensure adherence to the national Care and Treatment Review (CTR) guidance. There are six subgroups of Transforming Care Board which are ensuring delivery of the must dos for people with learning disabilities: 1. Housing 2. Workforce development 3. Developing community services Key Activities 4. Early intervention and prevention 5. Personal budgets 6. Communication and engagement. HOUSING Improve access to independent living by enabling more people to leave residential care and increase independent living opportunities for young people in transition. Through increase of accommodation options locally, enable less people to be in out of area placements unless specialist support is required. Ensure fully worked up housing scheme is available should more funding become available through NHS Capital funds. Level of Ambition Maintain zero patients in hospital beds where clinically appropriate. Increased uptake of assistive technology Reduction in number of people living in residential setting EARLY INTERVENTION AND PREVENTION Improve access to healthcare for people with a learning disability and ensure annual health checks are prioritised and implementation plan is delivered. Ensure through contracts that providers are supporting the education and training of staff to make reasonable adjustments. PERSONAL BUDGETS Continue to promote and increase take up of personal budgets, including consideration of jointly funded packages of care. Trajectory will be set on current baseline of 36.75% such that: o 55% on a GP register are receiving an annual health check by March o 65% on a GP register are receiving an annual health check by March o 75% on a GP register are receiving an annual health check by Currently 12 out of 13 fully funded Continuing Health Care clients have a personal health budget. COMMUNICATIONS AND ENGAGEMENT Undertake LD Peer Review through LGA which will inform our future key activities and priorities for our residents who have a learning disability. Peer review will take place in January

31 6. Finance Revenue Resource Limit / / /19 Recurrent 229, , ,195 Non-Recurrent 4,368 3,558 3,615 Total In-Year allocation 233, , ,810 Income and Expenditure Acute 108, , ,407 Mental Health 23,390 21,747 20,990 Community 25,798 22,291 20,890 Continuing Care 15,229 15,517 16,501 Primary Care 28,921 28,760 29,455 Other Programme 12,887 7,029 5,814 Primary Care Co-Commissioning 20,698 21,040 20,611 Total Programme Costs 234, , ,668 Running Costs 2,938 2,938 2,938 Contingency 0 1,166 1,170 Total Costs 237, , ,776 Surplus/(deficit) In-year movement (4,532) 0 1,034 Brought forward surplus/(deficit) 4, Balance c/f surplus/(deficit) 7 7 1,041 Risk adjusted position Net Risk/Headroom (4,330) (4,228) Risk Adjusted surplus/(deficit) (4,330) (3,194) Underlying position Underlying position - surplus/ (deficit) (1,961) (15) 21 Underlying position - surplus/ (deficit) % -0.86% 0.0% 0.01% Running costs Notified Running Cost Allocation 3,100 3,090 3,081 Running Cost 2,938 2,743 2,743 Under / (Overspend) /17 is the first year in which the CCG is unable to deliver an in-year break-even position, due to receiving a minimum level of growth that was insufficient to off-set the cost of inflation and increased demand. This is a theme which continues. In order to deliver the STP set financial control totals of a break-even in 2017/18 and a 0.5% surplus in 2018/19, the CCG must deliver a savings programme of 11.8m (5.1%) in 2017/18 and 8.8m (3.8%) in 2018/19, which is 3 to 4 times the level the CCG has historically achieved. There is an exceptionally high risk around non-delivery of the full amount. At present, the CCG has unmitigated risks of 4.3m in 17/18 and 4.3m in 18/19. However, the CCG is working with its Turnaround Director to ensure that all high impact and deliverable savings opportunities are identified and taken forward. Despite significant savings and redesign programmes around acute services to reduce unnecessary activity, from 17/18 the services are costing more, mostly due to the impact of HRG4+ ( 3.9m). It should be noted that the CCG has only received 2.7m, for 2 years, towards this cost pressure. Both Mental Health and Community Services are showing a lower cost over the next few years. This is for two reasons. Firstly, the price paid for services is high when benchmarked nationally, and therefore the CCG will be re-basing its contracts to ensure value for money. Secondly, as part of the Island s My Life a Full Life/Whole Integrated System Redesign programme, both services are being redesigned. Due to the age profile of our population, Continuing Health Care remains an area of increasing cost. The CCG s Turnaround Director is focusing on developing further savings programmes in this area. The CCG s financial position means that it is unable to invest in any service areas, whether non-recurrently or recurrently, without identifying savings to off-set the costs. A significant proportion of the CCG s savings (QIPP) programme is reliant on receiving New Care Models funding to support the necessary service transformation. CCG running costs remain within the allocation envelope and have savings plans to deliver. Note: The CCG is still awaiting information on any financial impact from the revised Identification Rules (allocation of commissioned services between specialised commissioning and the CCG). 31

32 Risks based on probability of occurrence Savings (QIPP) Programme (cumulative) some 17/18 savings are FYE of 16/ / / /17 (Recurrent) 2017/ /19 Acute SLAs Reduction in A&E attendances & non-elective admissions 120 1,112 1,789 Mental Health SLAs Urgent Care redesign 300 1,000 1,000 Continuing Care SLAs Planned care: PLCV & outpatient reduction/redesign 629 2,608 3,758 Savings (QIPP) under-delivery 4,000 4,000 Medicines management: drugs, dressings, healthcare at home 1,150 2,739 4,265 Prescribing Cost pressure management: thresholds & service redesign Total Risks 5,400 5,300 Community services contract re-basing & redesign 3,719 5,593 Mitigations Mental Health services contract re-basing & redesign 2,000 2,607 Contingency held 1,067 1,072 Continuing healthcare Net Risk 4,333 4,228 CCG wide schemes including running costs 1,886 2,076 2,076 The CCG is managing a number of key financial risks, as shown in the table above. Unidentified savings/schemes with further work required Total savings 4,725 16,495 22,329 % of allocation 2.54% 5.12% 3.84% In relation to acute activity, in 2016/17 the CCG has seen an increase in both the number and complexity of non-elective cases treated on the mainland. There is little that can be done in relation to mitigating such cases. In addition, the CCG is actively managing the balance of elective activity between the IOW NHS Trust and private/independent mainland providers, who currently have much shorter waiting times. Should the IOW NHS Trust s RTT recovery plan not be effective, there could also be a backlog of elective activity to pay for next year. The CCG is working closely with the STP Mental Health Alliance & the IOW NHS Trust to mitigate the risk and cost of high cost placements, through better contract arrangements and pathway re-design. In relation to Continuing Healthcare, this is a key area of focus for the CCG s Turnaround Director, who is identifying opportunities around policies, processes and price. The most significant risk is around the non-delivery of the savings (QIPP) programme. More detail is provided in the table and paragraph to the right on this. Over the next few years, the CCG has an unprecedented level of savings to achieve, if it is to achieve its statutory financial duties. The CCG s savings plans take into account CCG developed schemes, those from the My Life a Full Life programme and opportunities identified as part of the turnaround process. Only the schemes which have been worked up in sufficient detail to quantify outcome with some certainty, have been listed as identified. The schemes have several major themes: Reducing demand through prevention and early intervention schemes. Reducing procedures of limited clinical effectiveness, unless exceptional criteria met e.g. cosmetic surgery. Stopping or providing in other ways activity that doesn t add clinical value e.g. some follow up out-patient appointments. Redesigning the way in which services are delivered, to achieve good outcomes for less cost e.g. Mental Health. Prioritising services and reviewing access thresholds. To deliver these schemes relies on strong partnership working, both on the Island and as part of the Hampshire and Isle of Wight STP. 32

33 7. Contracting OBJECTIVE: To set in place well planned, effective contracts with providers to deliver the health needs of the Island population, meet constitutional targets and support delivery of the national must dos whilst recognising the financial challenges. Contracting Approach Whilst improving quality of care, the IOW health & care system also continues to face a period of unprecedented change, and increasing financial challenge for all organisations. This focuses the need on innovation, productivity and performance within our agreements with providers to ensure that all of our resources are targeted effectively to maximise patient treatment and care, and to ensure the transparency of coding and charging across the health economy. We recognise that this will mean greater co-operation and collaboration across organisations to identify initiatives which will bring greatest benefit. Some key features for the forthcoming contract include: Aligning acute provider standards, requirements and policies across the Wessex area. Ensuring that our mainland contracts indicate appropriate activity to facilitate patient choice. Working with providers to understand true costs of services. Ensure we are confident regarding our providers capacity to deliver our plans. Having robust improvement plans / performance trajectories in place where required. Engagement in new models of care and integrated ways of working. New Models of Care The CCG wholly support the models of care developments by the IOW health & care system through the Vanguard program - MLAFL Over the next 2 years the contract will facilitate the development of the outcomes of key initiatives and change accordingly. Our key contracts Providers Main Island NHS Provider (IOW Trust) Acute Community Mental Health Ambulance Mainland NHS Contracts Portsmouth HT University Hospital Southampton Salisbury Foundation Trust Independent Private Sector Southampton Treatment Centre Spire Hospital Portsmouth Spire Hospital Southampton Non-Hospital Healthcare Care Homes, Nursing Homes Domiciliary Care, Hospices Primary Care GP Practices Pharmacies, Opticians Type of Contract Lead CCG Contract with block financial arrangements on NHS Terms and Conditions Associate Contracts alongside a mainland NHS CCG on a payment by results basis and on NHS Terms and Conditions Associate Contracts alongside a mainland NHS CCG on a payment by results basis and on NHS Terms and Conditions CCG Contract on NHS Terms and Conditions CCG Contract on NHS Terms and Conditions Whole Integrated System Redesign Community Alliance Contracting Mental Health Regional Alliance Learning Disability Transformation Whole Population budgets Outcomes based contracting Sustainability Transformation Plans Better Care Fund Contracting Risks The CCG has agreed the 2017/18 to 2018/19 contract with the IOW NHS Trust. It will be a block contract for all services, with a 10.8m risk share around the delivery of a programme of savings schemes. The CCG s share of the risks is c 4.3m. 33

34 8. Performance Objective: A Performance Management Framework that delivers a robustly planned contract baseline and provides assurance through monitoring compliance and improvements to targets and standards. Performance Approach Demand Planning A structured approach to demand and capacity planning with consideration of planning targets set for CCGs by NHS England and the Five Year Forward View. Initial Demand plan forecasts for 2017/18 have been developed at point of delivery (POD) and specialty level. Forecasts are for remainder of 2016/17. The focus is on assurance regarding delivery of the predicted activity within financial envelopes to the required quality standards. What we report (Key areas): NHS Constitutional targets and standards Improvement plans and trajectories CCG assurance outcomes indicator sets RightCare commission for value benchmarking Quality premium schemes Better Care Fund indicators Where we report it Reports are provided to our governing and supporting bodies on a regular basis along with our staff, partners and public where appropriate including NHS England, Governing Body, Clinical Executive, System Resilience Group (A&E Delivery Board), and Transformation Boards. Demand and Capacity Planning The CCG and the Provider undertake joint demand planning meetings. A structured approach is taken to ensure that activity modelling has clear assumptions, takes into account planned change, is aligned to capacity plans and built around achievement of performance trajectories. Weekly impact of changes through the presentation of a demand plan journey illustration is shared for agreement and the risks are outlined and discussed. There are currently a number of these factors and scenarios being worked through and validated for agreement that may materially change activity profiles before contract signature. These in particular include the impact of the required level of QIPP schemes to achieve financial balance, capacity validations and final modelling of RTT based on forecast outturn. Bridges have been used to link forecast lines, these include:- o Referral trends and dropout rates. o Outpatient New to Follow-Up ratios. o % Day Case rates. o Elective to Emergency ratios. Activity trends data back to Apr 13 have been examined. Growth due to population change has been included using Indicative Hospital Activity Model (IHAM) as a starting point. The baseline has been adjusted to take account of local commissioning and/or agreed Provider intentions, transformation programmes including the STP assumptions and QIPP schemes ensuring consistency and delivery of national and local targets along with adjustments to reflect impacts of the improvement schemes. Elective activity is modelled around capacity constraints, waiting list size targets and profiling the achievement of RTT by speciality. Capacity Planning We assess assumptions that are embedded in the models such as bed numbers, theatre capacity, resourcing levels including sickness, non-attendance rates, booking efficiency, seasonal fluctuations such as winter pressures and implications of planned health campaigns. We take into effect assumptions on volumes of referrals going to mainland providers, bed capacity in the wider system to enable patient flow and the impact of investment into community based services. The CCG have made arrangements with local mainland providers for particular procedures where there may be a shortfall in capacity at the IOW NHS Trust. 34

35 Demand Assumptions The graphs illustrate a summary of the current activity levels that have been included in our plans for both non Elective and Elective demand. This follows the methodology described on the previous page. The activity numbers represented in red highlight increases e.g. due to population growth. The green boxes highlight the reductions in activity e.g. the STP alignment. Planned numbers reflect latest modelling, capturing the impact of our latest considerations and scenarios including: Further scenario testing in respect of referrals/waiting list sizes and RTT. Implication of QIPP schemes including PLCV and follow up ratios. Further analysis of non-elective activity based on recent growth trends and the application of extensive change plans to improve urgent care. Transformation projects and their impact. Best practice / final HRG4+ tariff implications. 35