NHS Leeds West CCG Clinical Commissioning Strategy. 2013/14 to 2015/16

Transcription

1 NHS Leeds West CCG Clinical Commissioning Strategy 2013/14 to 2015/16 Working together locally to achieve the best health and care in all our communities 1

2 Contents Section 1: Summary Page 3 Section 2: Drivers for Change Page 8 Section 3: Strategic Objectives Page 24 Section 4: Priority Health Goals - Ensuring quality and safety in commissioning for priority health goals - Ensuring value for money in commissioning for priority health goals Page 26 Page 41 Page 45 Section 5: Organisational Development Goals Page 48 Section 6: Financial Plan Page 53 Section 7: Governance and Risk Page 59 Appendix 1: Plans on a page - Priority health goals - Delivery through member practices Annex 2: Delivery Plan - Annex 2a Priority health goals - Annex 2b Organisational development goals Page 63 Page 63 Page 64 Page 65 Page 66 Page 71 Appendix 3: Leeds Children s Trust Board CYP plan Page 73 Appendix 4: Resource Plan Priority Health Goals Page 74 2

3 Section 1: Summary 1.1. NHS Leeds West Clinical Commissioning Group (LWCCG) is a newly established organisation serving a diverse population of approximately 350,000 people living in West Leeds The purpose of the organisation is to work for member practices to improve the health of our populations through effective commissioning, collaboration and primary care development The largest of three Clinical Commissioning Groups in the city, and one of ten CCGs in West Yorkshire, LWCCG is a membership-led organisation committed to commissioning the best health and care possible within available resources. Working with our members and patients, we have set out the following vision which captures our ambition to involve local stakeholders in the commissioning decisions we take. Working together locally to achieve the best health and care in all our communities. Principles and values 1.4. LWCCG has committed to uphold the core values set out in the NHS Constitution and has identified the following local values to underpin the organisation: 1.5. Our values: Our values are at the heart of the decisions we make. They will guide us when we develop our plans for health services, what we think we need to do first, any changes we may need to make and how we tackle the challenges we face. Our values are: Respect and dignity Commitment to quality of care Compassion Improving lives Working together for patients Everyone counts 1.6. We will aim to: ensure that local people are at the centre of our commissioning decisions; commission services based on what we would want for our own families and friends; commission services which are the best possible value for money; 3

4 work in collaboration with our partners to make sure we achieve the best possible health and care for all our communities; and be an organisation where our staff are valued and where everyone counts The LWCCG strategy is focused on the key priorities identified for our population but is interdependent with and supportive of a range of strategies across the wider partnership agenda. Drivers for Change 1.8. In developing this strategy the organisation recognises the need to respond to a range of internal and external drivers for change including: The priorities identified by patients and members The Joint Strategic Needs Assessment (JSNA) The Leeds Joint Health and Wellbeing Strategy The NHS England Operating Framework: Everyone Counts The NHS Constitution The NHS Mandate. The Need For Change Our Population 1.9. The health of the c.350,000 population of West Leeds is characterised by a scattered pattern of need with some highly affluent areas and some of the most deprived in the country. Areas of high deprivation have amongst the lowest average life expectancy in the city, whilst variation in average life expectancy across the CCG population (the life gap ) equates to 10.9 years 1. The LWCCG population also includes diverse communities with specific need including offenders, gypsies and travellers and a high student population. The Need For Change Our Services LWCCG, along with commissioner and provider partners, must continue to ensure the safety, effectiveness and good quality of services provided in the local health economy. This is a particular priority in the current financial climate of limited resources, and in context of the need to transform services to sustain a response to growing demand for health and social care Performance in relation to key national pledges, including Referral to Treatment Times (RTT) and the Emergency Care Standard needs to improve and this strategy will address the organisational actions to support this In delivering change, the organisation will also take account of standardised access rates which indicate that, although there is a relatively good choice of providers for elective surgical care in particular, elective access to hospital 1 based on MSOA level data aggregate LE from birth 4

5 services is at a lower rate than could be expected for the population, whilst emergency access is higher. Strategic Objectives Towards delivering the organisational vision, and in response to the drivers set out below, LWCCG has identified four strategic objectives in order to build a highly effective organisation and tackle the health and care needs of our communities. These are discussed in more detail in section 3. Strategic Objective 1: Priority Health Goals - To tackle the biggest health challenges in West Leeds, reducing health inequalities. Strategic Objective 2: Quality & Safety - To transform care and drive continuous improvement in quality and safety. Strategic Objective 3: Best use of Resources - To use commissioning resources effectively. Strategic Objective 4 Organisational Development - To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can. Priority Health Goals Underpinning delivery of this strategy and aligned to the objectives above, the organisation will focus on eight priority health goals as follows: A. Promoting healthy living to tackle the wider determinants of health. B. Improving the sexual health of the population. C. Proactive management for people with long term conditions. D. Improving the mental health of the population E. Improving outcomes for those diagnosed with cancer. F. Improving access to elective care services. G. Commissioning an effective response to urgent care needs. H. Improving end of life care. 5

6 Quality and safety Effective use of resources Patient feedback and public involvement Best developed clinical commissioners and workforce Priority Health Goals Effective partnerships Organisational Development Goals In support of the priority health goals, and to ensure fitness for purpose in delivering the strategy, the organisation will also focus on three key organisational development goals: A. Build commissioning capacity and capability at member practice level. B. Develop the workforce, embedding clinical leadership in commissioning. C. Continue to collaborate with partners, ensuring system efficiency. Outcomes In delivering the strategic objectives over the next 3 Years, the organsiation aspires to achieve the following strategic population health outcomes in line with the Joint Health and Wellbeing Strategy for the city: Improved life expectancy at birth 6

7 Reduced differences in life expectancy (at birth) between communities (through greater improvements in more disadvantaged communities) In delivering this strategy, impact to the health economy is expected to be defined in terms of: More care delivered in primary and community care settings. More proactive care, co-created with patients on an individual basis. More integrated care pathways, regardless of organisational boundaries. A reduction in hospital based care, particularly in relation to emergencies. 7

8 Section 2: Drivers for Change What is important to patients and members of the public? 2.1. LWCCG have worked with local stakeholders in determining local priority health goals. Feedback from members of our population is on an ongoing basis and our member practices are vital to providing some of this rich intelligence via their close relationships with their registered patients and their families During 2012 LWCCG held a number of public events and distributed a questionnaire to our involvement network asking: if you could change one thing about your, a friend s or a family member s most recent experience of the NHS what would it be?. Responses highlighted that being treated with dignity and respect was very important to a high number of people, as was being better informed (see figure 1). Figure 1: Summary of responses from patients from 2012 events Chart Title 1% 1% Accessibility Consistency of practice 16% Time spent waiting 6% 22% 5% 17% Dignity Flexibility of appointments and access Quality and safety Equality 18% 8% 6% Customer service and communication Choice of services Partnership 2.3. In January 2013 the organisation held a prioritisation event for members of the public to look in detail at the information from the JSNA, the Health and Wellbeing Strategy, the NHS Constitution and Mandate and local benchmarking information. Attendees at the event felt that mental health, long term conditions and alcohol should be the priority areas for the CCG to focus on (see figure 2). 8

9 Figure 2: Results of public prioritisation event January 2013 Chart Title 7% Long term conditions 13% 12% 38% Mental health Cancer Alcohol 30% Hospital acquired infections 2.4. Our member practices reiterate these priorities and additionally have identified a range of health and service issues locally which they are concerned about on behalf of their patients. Like the general public, they are concerned about the experience of local patients with mental health problems as well as the experience of those requiring community nursing services, and in general the impact of alcohol on the health of the population, and the healthcare system and wider economy In 2012 all member practices received practice level JSNA reports and have developed individual plans in response. Themes identified through practice level plans included the prevention agenda, screening for cancer and alcohol misuse, weight management and proactive management of chronic conditions. Population Health Needs (JSNA) 2.6. The Leeds Joint Strategic Needs Assessment (JSNA) published in 2012 tells us that the population of Leeds is growing and changing and in general, people are living longer. According to the latest data from the Office for National Statistics (2011) there are 751,000 people living in Leeds. The birth rate has been increasing and the number of very elderly people is expected to double by Migration (both internal and international) continues to be a major influence on our population growth and is helping to increase the diversity of the city which is now home to over 140 different ethnic groups NHS Leeds West Clinical Commissioning Group (LWCCG) comprises 38 GP practices spread across an area over 45 square miles and commissions services for a population of approximately 350,000 people. The population extends from some of the most affluent neighbourhoods in Leeds to some of the most deprived. The map below at figure 3outlines the area covered by LWCCG 9

10 (green). Areas (Lower Super Output Areas) of relative deprivation within LWCCG area are highlighted in red. Figure 3. Source: Public Health Intelligence, Leeds City Council 2.8. Deprivation in LWCCG Lower Super Output Areas (LSOAs) are geographical areas designed to improve the reporting of small area statistics in England and Wales. Approximately 20% of the Leeds population live in the 10% most deprived LSOAs in the country and the scattered pattern of high deprivation within the LWCCG boundary can be clearly seen shaded in red. Approximately 25,000 people in LWCCG population live within the most deprived 10% LSOAs in the country and of these approximately 3000 live in the most deprived 3%. These areas are found in the inner west and inner north west areas of the city. It should be noted that there are additional populations who are vulnerable to health inequalities due to other factors than where they live such as 10

11 their ethnicity, or the stigma they experience from a health condition. 2.9 Age Profile in LWCCG The age profile in Leeds West CCG in 2011 shows that there is a greater proportion of year olds than the Leeds population, this is focused within localities with high student populations. Figure 4: NHS Leeds CCG age profile compared to Leeds average profile The numbers of births in LWCCG has been slowly increasing in recent years as shown in the chart at figure 5 below, and was about 4,000 per year in The overall birth rate is expected to plateau in

12 Figure 5. Source: LCC Public Health Intelligence The trends in the age structure of the population over time are shown below at figure 6. The population age under 14 is slowly increasing as is the older age population. Geographical registered population trends LWCCG and Over Figure 6. Source: LCC Public Health Intelligence 2.9. Safeguarding in Leeds Leeds West CCG is working with the citywide safeguarding partnerships and is a key member of both the Leeds Safeguarding Children Board (LSCB) and the 12

13 Leeds Safeguarding Adults Board (LSAB). Work is underway to ensure that all the services we commission are alert to issues of child and adult protection and that we work towards preventing abuse by ensuring support for families under stress and that services are alert to where abuse maybe perpetrated by staff. Further work is planned around understanding the impact of abuse on our local children's population Both the LSCB and the LSAB, working with the Leeds Safety Partnership Board will be taking forward work around the impact of Domestic Abuse on families. Leeds West CCG will be engaged in this work Ethnicity The chart below at figure 7 shows the ethnicity of the LWCCG population in January 2012 based on GP recording. A large proportion are not recorded, not stated, or unknown: however of those recorded, 57.7% were White British, and compared to the Leeds average there is a smaller proportion of other white background, Pakistani or British Pakistani and Black African ethnic groups. Figure 7 13

14 Additional heath intelligence In addition to the intelligence above, a range of information and intelligence including the Joint Strategic Needs Assessment (JSNA), the indicators measured for the Joint Health and Wellbeing Strategy, and additional local health assessment activity and national benchmarking indicate the following health needs. It should be noted that aggregated data to CCG level hides the distribution of need within the population. The differences in life expectancy within the LWCCG population are wide. The gap in a person s life expectancy is 10.9 years (based on MSOA level data). This illustrates the significant inequalities in health within the LWCCG population. LWCCG benchmarks poorly against the national average for smoking rates in adults. The percentage of adults who smoke in our area is 22.34% against a national average of 20%. This is reflected in the HWBS priority of supporting people to choose healthy lifestyles. LWCCG benchmarks poorly against other areas of the city for rates of alcohol related admissions to hospital. We have a rate of 1, per 100,000 population which is the highest in Leeds. This is reflected in the HWBS priority of supporting people to choose healthy lifestyles. LWCCG benchmarks poorly for excess weight in year olds. The percentage of year olds with excess weight in our area is 34.12% compared to the national average of 33.4%. This is reflected in the HWBS priority of supporting people to choose healthy lifestyles. LWCCG benchmarks poorly for rate of early death from cardiovascular disease. We have a rate of deaths per 100,000 population against a national average of 62.0 per 100,000 of population. This is reflected in the HWBS priority of ensuring people have equitable access to screening and prevention services to reduce premature mortality. LWCCG also benchmarks poorly for rate of hospital admissions for care that could have been provided in the community. We have a rate of 1238 per 100,000 population against a national average of 1037 per 100,000 population. This is reflected in the HWBS priority of increase the number of people supported to live safely in their own home. Leeds is currently experiencing: - a yearly increase in Human Immunodeficiency Virus (HIV) diagnoses in men who have sex with men -a yearly increase in diagnosed sexually transmitted infections (STIs) - teenage conception rates that remain higher than the national average but recently have been decreasing in Leeds 14

15 The Leeds Suicide Audit (July 2012) found pockets of higher level of suicide within the city was within our most deprived area. This supports JSNA data showing higher rates of mental health problems and substance use within Inner West Leeds. Risk stratification of the LWCCG population for future hospital admission risk tells us that: 8,475 people are at very high risk 15, 192 people are at high risk 26,880 people are at medium risk 58,503 people are at low risk 246, 137 people are at very low risk Figure 8 As well as inequalities in health between geographical communities within the LWCCG population, there are also communities with specific needs e.g. offenders, students and gypsies and travellers. Health and Wellbeing Strategy for Leeds LWCCG is part of the wider Leeds Health Economy and relies on a number of key partnerships to ensure that it achieves its objectives. 15

16 2.14. One such key partner is the Leeds Joint Health and Wellbeing Board, a statutory partnership between Leeds City Council, Leeds Clinical Commissioning Groups and voluntary organisations For Leeds to be the best city for health and wellbeing, it means making sure that people can access high quality health and social care services: but it also means that Leeds is a Child Friendly city, a city that creates opportunities for business, jobs and training: a city made up of sustainable communities and of course a great place to live. In short, the vision of the Joint Health and Wellbeing Board is that Leeds will be a healthy and caring city for all ages, where people who are the poorest, improve their health and wellbeing fastest. The Joint Health and Wellbeing Board will focus on five outcomes: o People will live longer and have healthier lives o People will live full, active and independent lives o People will enjoy the best possible quality of life o People are involved in decisions made about them o People will live in healthy and sustainable communities The Joint Health and Wellbeing Board will oversee how we continue to improve the health and wellbeing of the people of Leeds. The Joint Health and Wellbeing Strategy is vital to how Leeds City Council, Leeds Clinical Commissioning Groups and local voluntary organisations will work together to make it all happen LWCCG are committed to delivering the Joint Health and Wellbeing Strategy with our partners and the strategic direction of our Clinical Commissioning Strategy reflects the citywide priorities The Leeds Health and Wellbeing Strategy is outlined in table 1 below: Table 1: The Leeds Health and Wellbeing Strategy Outcomes Priorities Indicators 1. People will live longer and have healthier lives 1. Support more people to choose healthy lifestyles 2. Ensure everyone will have the best start in life 3. Ensure people have equitable access to screening and prevention services to reduce premature mortality 1. Percentage of adults over 18 that smoke. 2. Rate of alcohol related admissions to hospital 3. Infant mortality rate 4. Excess weight in year olds 5. Rate of early death (under 75s) from cancer. 6. Rate of early death (under 75s) from cardiovascular disease 16

17 Outcomes Priorities Indicators 2. People will live full, active and independent lives 3. People s quality of life will be improved by access to quality services 4. People will be involved in decisions made about them 5. People will live in healthy and sustainable communities 4. Increase the number of people supported to live safely in their own home 5. Ensure more people recover from ill health 6. Ensure more people cope better with their conditions 7. Improve people s mental health & wellbeing 8. Ensure people have equitable access to services 9. Ensure people have a positive experience of their care 10. Ensure that people have a voice and influence in decision making 11. Increase the number of people that have more choice and control over their health and social care services 12. Maximise health improvement through action on housing, transport and the environment 13. Increase advice and support to minimise debt and maximise people s income 7. Rate of hospital admissions for care that could have been provided in the community 8. Permanent admissions to residential and nursing care homes, per 1,000 population 9. Proportion of people (65 and over) still at home 91 days after discharge into rehabilitation 10. Proportion of people feeling supported to manage their condition 11.Improved access to psychological services 12. Improvement in access to GP primary care services 13. People s level of satisfaction with quality of services 14. Carer reported quality of life 15. The proportion of people who report feeling involved in decisions about their care 16. Proportion of people using NHS and social care who receive selfdirected support 17. The number of properties achieving the decency standard 18. Number of households in fuel poverty 19. Amount of benefits gained for eligible families that would otherwise be unclaimed 17

18 14. Increase the number of people achieving their potential through education and lifelong learning 15. Support more people back into work and healthy employment 20. The percentage of children gaining 5 good GCSEs including maths & English 21. Proportion of adults with learning disabilities in employment 22. Proportion of adults in contact with secondary mental health services in employment Local Services Access and Choice The LWCCG population will access health and prevention services commissioned directly by NHS England, Public Health England, Leeds City Council and by LWCCG itself. LWCCG commissions health services from a wide range of NHS and independent sector hospital and community providers including: Leeds Teaching Hospitals Trust, Leeds and York Partnerships NHS Foundation Trust and Leeds Community Healthcare NHS Trust NHS England commissions more specialist hospital care, along with primary care provided by GP practices, dentists and optometrists Table 2 below uses Standardised Access Rates (SAR) to provide an analysis of access to hospital services for the West Leeds population Area Pop Admissions Expected SAR Elective Leeds Leeds West Non Elective Leeds Leeds West Table 2: Standardised Access Rates using AP / In general for Leeds as a whole and for Leeds West CCG in particular, elective access to hospital services is at a lower rate than expected based on age and deprivation profile, whilst emergency access is higher. This suggests a need for the CCG to explore more preventative and proactive care, particularly in relation to primary care and community services Patients in Leeds West CCG have a relatively good choice of NHS and independent hospital service providers within travelling distance. Table 3 below illustrates the spread of the CCG s activity across 4 key providers. The extended choice offer has resulted in notable growth in the independent sector in recent 18

19 years particularly in relation to orthopaedics, general surgery, gynaecology and urology. GP Referred Outpatient Leeds TH HDFT MYHT Nuffield Other Leeds 73.90% 7.10% 3.70% 5.60% 9.70% NHS LWCCG 74.10% 2.10% 4.10% 6.50% 13.20% Table 3: Proportion of activity undertaken at main hospital providers Between 70 and 75% of patients in LWCCG still receive their elective care at the city s main hospital provider, the Leeds Teaching Hospitals NHS Trust and more choice is exercised in relation to surgical procedures rather than medical or maternity services. 71.8% of GP referred surgical outpatients are provided by the Leeds Teaching Hospitals Trust in comparison to 83.9% of medical outpatients This suggests that there is an as yet untapped potential to increase choice in medical specialities in line with ambitions to provide care closer to home for patients with long term conditions in particular, however this will need to be developed in context of the drive towards seamlessly integrated service pathways across providers There is currently limited choice of mental health or community service providers in Leeds, with one NHS provider of community nursing services and one Foundation Trust provider of acute mental health services. There is also a thriving economy of independent and third sector providers who have historically been underutilised by the NHS. This suggests further opportunity to increase choice for patients, looking more widely beyond traditional NHS healthcare providers. NHS Constitution Table 4 below outlines year-end performance (2012/13) in relation to key NHS Constitution pledges and an assessment of risks to delivery in 2013/14. Table 4: 2012/13 Performance against targets enshrined within the NHS Constitution. Pledge 2012/13 Delivery Risk to Delivery 2013/14 Referral To Treatment times for non-urgent consultant-led treatment 90% of admitted patients start treatment in 18 Red Amber weeks. 95% of non-admitted patients start treatment in 18 Green Green weeks. 92% of patients on incomplete pathways waiting no Green Green more than 18 weeks. Zero tolerance of over 52 week waiters New in Amber 19

20 Pledge 2012/13 Delivery Diagnostic Waiting Times 99% of patients should wait less than 6 weeks for a diagnostic test. Green Cancelled Operations Non clinical cancellations to be re-booked in 28 Green days. No urgent operation is cancelled for the second time. New in Emergency Care Standard 95% of patients admitted, transferred or discharged in 4hours of arrival at an A&E department No waits over 12 hours from decision to admit to admission (trolley waits) 2 Week Cancer Waits 93% of patients wait less than 2 weeks for 1st outpatient following urgent referral by a GP for suspected cancer. 93% of patients wait less than 2 weeks for 1st outpatient following urgent referral with breast symptoms (where cancer not initially suspected) 31 Days to Cancer Treatment 96% of patients wait less than31 days to first definitive treatment for all cancers. 94% of patients wait less than 31 days for subsequent surgery. 98% of patients wait less than 31 days for subsequent anti-cancer drug regimen. 94% of patients wait less than 31 days for subsequent course of radiotherapy. 62 Days to Cancer Treatment 85% of patients wait less than 62 days from urgent GP referral to first definitive treatment for cancer. 90% of patients wait less than 62 days from NHS screening referral to first treatment for cancer. Maximum 62-day wait for first treatment following consultant decision to upgrade patient s priority. Category A ambulance calls 75% of Category A calls result in emergency response arrival within 8 minutes. (Red 1 & Red 2calls separately) 95% of Category A calls result in an ambulance Red New in Amber Green Green Green Green Green Green Amber Amber Green Green Risk to Delivery 2013/14 Green Green Green Amber Green Green Green Green Green Green Green Amber Amber Amber Green Green arriving at scene within 19 minutes. Ambulance Handovers Handovers between ambulance and A&E take place New in Amber 20

21 Pledge 2012/13 Delivery Risk to Delivery 2013/14 within 15 minutes with crews ready to accept new calls in a further 15 minutes. Mixed Sex Accommodation Breaches Minimal breaches Green Green Mental Health 95% of people under adult mental illness specialties on Care Programme Approach (CPA) followed up in 7 days of discharge from inpatient care. Referral to Treatment Times (RTT) Green Green The sustainable delivery of referral to treatment times across every specialty and subspecialty whilst reducing the backlog of patients waiting over 18 weeks remains a complex challenge for the health economy although significant progress in recent years and most standards are now consistently achieved The CCG will ensure that strategic plans take account of the reasons for poor RTT performance in some specialties, develop options to improve provider capacity and efficiency, increase choice, support providers to manage increases in complexity and co-morbidity, reduce variation in demand for highly specialist work and ensure that GP referrals are consistent with peers and meet the needs of the population. Emergency Care Standard The city s A&E departments continue to face significant challenges in relation to the national availability of medical workforce reducing flexibility to respond to peaks in demand. In there are further potential risks in relation to the implementation of the Major Trauma Centre at Leeds General Infirmary and the mobilisation of the national 111 urgent care number CCG plans will consider the strategic options for a sustainable urgent care service for Leeds, including the critical role of primary care in responding to urgent needs. NHS Mandate LWCCG is committed to delivery of the NHS Mandate. Table 5 summarises the CCGs assessment of position on key measures within each domain and ability of plans to make progress. Table 5: LWCCG assessment of position on NHS Mandate 21

22 Domain Bench Mark Domain 1: Preventing people from dying prematurely Delivery 2013/14 Potential years of life lost (PYLL) from causes considered amendable to healthcare Under 75 mortality rate from cardiovascular disease Under 75 mortality rate from respiratory disease Under 75 mortality rate from liver disease Emergency admission as proxy measure) Under 75 mortality rate from cancer 2. Enhancing quality of life for people with long term conditions Proportion of people feeling supported to manage their condition Health-related quality of life for people with longterm conditions Unplanned hospitalisation for chronic Ambulatory care sensitive conditions (adults) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Estimated diagnosis rate for people with dementia 3. Helping people to recover from episodes of ill health or following injury Emergency admissions for acute conditions that should not usually require hospital admission Emergency readmissions within 30 days of discharge from hospital Total health gain assessed by patients i) Hip replacement ii) Knee replacement iii) Groin hernia iv) Varicose veins Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) 4. Ensuring that people have a positive experience of care Patient experience of primary care i) GP Services ii) GP Out of Hours services Patient experience of hospital care Friends and family test 5. Treating and caring for people in a safe environment and protecting them from avoidable harm Incidence of healthcare associated infection (HCAI) i) MRSA ii) C.difficile The QiPP Challenge The LWCCG strategy must be delivered within an environment where resources are constrained. Nationally it is estimated that the NHS must deliver productivity 22

23 savings of 20 billion in order that it can continue to meet demand for services whilst maintaining and improving quality The growth funding provided through the comprehensive service review is insufficient to accommodate the costs of increased demand on services from inflation, population growth and increasing patient expectations as a result of changes in medical technology. In 2011/12 a local assessment of the gap between available growth monies and the increasing cost was 260m per year by 2014/ Meeting this challenge will require priorities to be addressed through transformational changes in models of service provision across primary and secondary care rather than an unsustainable incremental investment in existing services In 2011/12 all health partners in Leeds agreed the financial goals associated with a QIPP programme for the city to 2014/15 including provider cost improvement programmes and the scale of transformational change required. Table 6 below outlines the understanding with regards to savings to be delivered at that point. Table 6: Leeds health economy agreement with regards to projected QiPP savings QIPP 000's 3 Leeds CCGs Leeds Teaching Hospitals NHS Trust Leeds Community Healthcare NHS Trust Leeds Partnership Foundation Trust Totals 11/12 22,949 39,400 5,185 7,062 74,596 12/13 6,751 52,435 5,712 3,836 68,734 13/14 5,967 41,421 4,849 4,611 56,848 14/15 6,000 41,668 4,810 4,600 57,078 Totals 41, ,924 20,556 20, , The local health system has been extremely successful over the past three years in reducing activity growth whilst maintaining financial balance through transformational change and provider based efficiencies LWCCG will continue to participate in arrangements to deliver QIPP through a combination of provider efficiency schemes and commissioner-led transformational change at a citywide level A citywide Health & Social Care Transformation Programme Board has been established for three years to provide a strategic framework for innovation and implementation at CCG and member practice level and to co-ordinate and translate practice level innovation into coherent citywide change at scale. 23

24 Section 3: Our Strategic Objectives Strategic Objectives 3.1. In response to the range of strategic drivers described in section 2 above LWCCG has identified four strategic objectives towards achieving its vision, responding to the health needs of the population, improve health and build a highly effective member-led organisation The four strategic objectives together address the primary functions of the CCG, namely: Improving the health of the population. Improving the quality and safety of health services in a sustainable way. Developing the organisation The four strategic objectives are: Strategic Objective 1: Priority Health Goals - To tackle the biggest health challenges in West Leeds, reducing health inequalities In line with the Health and Wellbeing Strategy for this city and from JSNA and other information above the CCG knows that it needs to respond to the priority health goals outlined from section 4 below. As a commissioner of health care improving the health of our population is our primary function. We recognise that we need to focus on the most urgent and important health needs in order to ensure that we tackle the biggest health challenges in our area and we have used the information in section 2 above to help us identify what are priorities are. Strategic Objective 2: Quality and Safety - To transform care and drive continuous improvement in quality and safety 3.5. In context of NHS Constitution, Mandate, Mid Staffs, QiPP Challenges etc. and in order to respond to the health challenges above, the CCG will commission a range of services. Additionally, our member practices provide a range of services in their core role as primary care providers. Our patients tell us that the quality and safety of these services is critical and in context of finite resources we have to make sure that this is maintained 3.6. LWCCG recognises the critical importance of working in partnership with local providers to deliver the pledges of the NHS Constitution, improving the quality of services and ensuring that patients have the best possible experience of care. Strategic Objective 3: Best use of resources To use commissioning resources effectively and responsibly 3.7. In the context of the QiPP Challenge outlined above, the recognised growing population and as a public body the CCG is committed to using its scarce and 24

25 finite resources effectively and responsibly. To achieve this we recognise the need to deliver financially sustainable change, to transform services to ensure that our health services are maintained and sustained for future generations. Strategic Objective 4: Organisation Development To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can We are committed to continuing to develop our organisation so that our team is fit for purpose to meet the challenges ahead As a new members-led organisation and to unleash the full potential of clinical commissioning with practices and patients at the centre of our work the CCG recognises the imperative need to engage, develop, involve primary care in our core business and to empower practices to lead and shape future transformation of health services Key to achieving this is our team of core staff who are committed to underpinning through supporting, leading and directing our clinical commissioning business. We want to have the best developed workforce we possibly can and we will do this by ensuring that our teams are supported to deliver their objectives through a range of mechanisms including quality training and development programmes and highly effective leadership. 25

26 Section 4: Our Priority Health Goals Three Year Priority Health Goals Strategic Objective 1: Priority Health Goals - To tackle the biggest health challenges in West Leeds, reducing health inequalities In response to the strategic objective above and the priorities of the Health and Wellbeing Board LWCCG will focus on the delivery of eight priority health goals for the CCG. The CCG has a responsibility to improve the health of the local population and has identified the following priority health goals for the population of West Leeds: 4.2. Please see the Year One Delivery Plan at Annex 2a for detail around how our goals will be achieved and how we will be measure our success through selected indicators. A: Healthy Living 4.3. As outlined in section 2, reducing smoking and obesity rates remains a priority in Leeds and in LWCCG. Both smoking and obesity rates are better than the Leeds average but both are strongly related to health inequalities and social deprivation. It is known that unhealthy lifestyles cluster together in areas of deprivation and then lead to the development of long term conditions which in turns leads to clusters of multimorbidity and reduced life expectancy in areas of deprivation We need to work in partnership with the Health and Wellbeing Board and local partners including the Leeds City Council WNW Area Leadership Team and WNW Health and Wellbeing Partnership and Public Health colleagues to improve the wider determinants of health in our population which in turn will help to promote healthy lifestyles and reduce inequalities Member practices have a pivotal role in improving healthy lifestyles, identifying people at risk of current and future harm, offering brief interventions and referral into healthy living services. Priority Health Goal a: Healthy Living In three years we will have Decreased the number of emergency admissions to hospital as a result of alcoholic liver disease. / alcohol related admissions to hospital Reduced percentage of adults over 18 that smoke Worked with member practices, public health commissioners and local partners to implement programmes to tackle childhood and adult overweight 26

27 Priority Health Goal a: Healthy Living Outcomes Joint Health and Wellbeing Strategy outcomes in bold Member practice actions by March 2014 and obesity. Continued to support and deliver NHS Health Checks and Making Every Contact Count commissioned by Public Health including onward referral for those needing to adopt healthier lifestyles. Supported more people to choose healthy lifestyles Ensured people have equitable access to screening and prevention services to reduce premature mortality People will have longer and healthier lives People s quality of life will be improved by access to quality services People will live in healthy and sustainable communities Support people to choose more healthy lifestyles Ensure everyone will have the best start in life Ensure people have equitable access to screening and prevention services to reduce premature morality Improved life expectancy at birth Reduced differences in life expectancy (at birth) between communities (through greater improvements in more disadvantaged communities) 5 LWCCG member practices have selected to develop plans aiming to reduce harmful effects of alcohol intake 1 LWCCG member practices have selected to develop plans to manage Number of NHS Health Checks offered in primary care increases. Healthy living services at practice and local level for communities in need. Primary care professionals trained to identify individuals at high risk from alcohol. patients identified as having obesity- 27

28 Priority Health Goal a: Healthy Living Health economy actions by March 2014 (Strategic approach) Health and Wellbeing Strategy health goals implemented locally Work in partnership with WNW Area Leadership Team and WNW Health and Wellbeing Partnership of Leeds City Council Healthy living programmes implemented locally. Children s obesity strategy implemented locally. Interventions and actions concentrated around key practice populations (JSNA information) Maintain link with and support of services linked to wider determinants of health through Health and Wellbeing Board B: Sexual Health 4.6. The main sexual health needs of the population are outlined in section 2. Five of our practices have a large proportion of students registered and it is important to them that we reflect the sexual health needs of this specific population within our key priority areas. This also supports the health and wellbeing strategy key priority to support people to choose healthy lifestyles LWCCG recognises that Leeds City Council are the lead commissioner for sexual health services and are committed to working in partnership with them on this agenda. Priority Health Goal b: Sexual Health In three years we will have Worked with the Local Authority who will take on the main commissioning responsibility for open access specialist sexual health services, LARC, pharmacy enhanced sexual health services and preventative sexual health programmes, LWCCG will have contributed to the improvement of sexual health with a particular focus on populations with high STI rates and unplanned conception Supported and engaged in new joint arrangements for commissioning sexual health services 28

29 Priority Health Goal b: Sexual Health Outcomes Joint Health and Wellbeing Strategy outcomes in bold Member practice actions by March 2014 Health economy actions by March 2014 Worked with member practice to Improve uptake of sexual health services through primary outcomes People will have longer and healthier lives People s quality of life will be improved by access to quality services Support people to choose more healthy lifestyles Ensure people have equitable access to screening and prevention services to reduce mortality Increased Chlamydia diagnosis in year olds Increase the uptake of HIV testing in areas of high prevalence to reduce the late diagnosis of HIV Reduced teenage conception rate Increase access and uptake of contraception, especially LARC Increase of Chlamydia screening in years through primary care (1 practice has selected this through clinical commissioning scheme) Increase the uptake of HIV testing in areas of high prevalence to reduce the late diagnosis of HIV Increase access and uptake of contraception, especially LARC Review of contraceptive pill prescribing Work in partnership with the Local Authority who will take on the main commissioning responsibility for open access specialist sexual health services, LARC, pharmacy enhanced sexual health services and preventative sexual health programmes C: Long Term Conditions 4.8. The improved care and management of long-term conditions is a key shared priority with significant work being undertaken through the transformation, integrated health and social care boards and health and wellbeing board. It is also a key local priority for LWCCG as the CCG also benchmarks poorly against 29

30 national data for unplanned hospital admissions for patients with long term conditions Locally the management of long term conditions has been highlighted by our member practices and members of the public as a priority. Practices are keen to develop their own specific plans to proactively manage patients who have long term conditions. Practice level JSNA data has highlighted diabetes as a major cause for concern We need to use the process of and outputs from risk stratification as described in section 2 to address both the immediate needs of those at high and very high risk of future hospital admissions as well as develop proactive planned approaches to those at emerging high risk through a strategic approach to managing long term conditions in the population. Priority Health Goal c: Long Term Conditions In three years we will have Developed a strategic and preventative approach to LTC management including: Implemented early identification in primary care and commissioning community based pathways for respiratory cases. Systematically integrate primary and secondary prevention initiatives into routine practice delivered through member practices such as weight management, brief interventions, NHS Health Checkslink to priority health goal A. Implemented a strategic approach to shared decision making and supported self-care Implemented proactive population based approaches to LTC management including the management of multi-morbidity and the use of risk stratification Improved disease specific LTC management through clear models of care, including primary care quality, for all LTC including diabetes, exploiting the benefits of information technology in improving chronic care ensuring LTC care is integrated ensure longer term strategic investment in primary 30

31 Priority Health Goal c: Long Term Conditions Outcomes Joint Health and Wellbeing Strategy outcomes in bold care and workforce fit for future Ensure lifestyle and behaviour change initiatives are integrated into LTC primary and secondary prevention initiatives Ensure carers support integrated into LTC care People will have longer and healthier lives People will live full active and independent lives People s quality of life will be improved by access to quality services Ensure people have equitable access to screening and prevention services to reduce premature mortality Increase the proportion of people supported to live safely in their own home Member practice actions by March 2014 Health economy actions by March 2014 Proactive management of LTCs Diabetes treatment (23 practices) Increase referrals to alcohol services (5 practices) Respiratory disease management (3 practices) Increase early diagnosis of cancer (3 practices) Prevention of CVD (2 practices) Stroke review 6 months post discharge (QP) Preconceptual advice for diabetes (QP) Prophylactic prescribing for COPD (QP) Self management programmes (QP) Every Contact Counts training (QP) Medicines review for those in care homes Embed risk stratification and integrated health and social care teams through citywide transformation programmes D: Mental Health 31

32 4.11. Member practices have reported widely that patients with mental health issues are an area of concern in terms of rising levels of demand, complexity of need and access to services. CCG public engagement events have also identified mental health and wellbeing as a priority, as has the Leeds Health and Wellbeing Board Improving people s mental health and wellbeing is a key priority for Leeds Health and Wellbeing Board Nationally there is a recognition of the significant demand on the system created by those with dementia and the anticipated benefits of a more holistic and community based approach to care. Priority Health Goal d: Mental Health In three years we will have Implemented proactive management of high risk groups in primary care Commissioning additional mental health support services Develop whole system approach to mental health accommodation and rehabilitation Enabling member practices to work closely with the third sector to offer holistic care to patients which address the wider determinants Improved access to IAPT services in our area and developed alternative services Procured mental health information line for professionals and patients LWCCG aims to contribute to a reduction of the suicide rate in LS12 and LS13 through increasing access to primary care at moments of crisis and increasing referrals to services to support high-risk groups Proactively supported the development of a citywide Dementia Strategy Worked with acute providers to improve early identification and additional service offerings for patients with dementia. Increased the number of people who recover following 32

33 Priority Health Goal d: Mental Health Outcomes Joint Health and Wellbeing Strategy outcomes in bold Member practice actions by March 2014 Health economy actions by March 2014 psychological therapy Carried out and implemented review of safe prescribing for people with depression People will have longer and healthier lives People s quality of life will be improved by access to quality services Support more people to choose healthy lifestyles Ensure everyone has the best start in life Ensure people have equitable access to screening and prevention services to reduce premature mortality Improve mental health and wellbeing Support more people back into work and employment More people being treated in IAPT services Timely diagnosis for people with dementia Receive ASIST training in suicide prevention in identified practices and refer in to appropriate services Review of dementia prescribing in primary care Implement dementia strategy for Leeds Improve access to IAPT services Develop specifications for new mental health services which supplement IAPT and offer and alternative Third sector support for vulnerable people Develop citywide mental health information line for professionals and patients Develop peer support and self-management strategies. E: Cancer section 2 shows cancer early mortality rate. Practice level JSNA information has indicated that cancer is an issue concentrated around certain practice populations. Members of the public have also told us that this is one of the issues 33

34 most important to them. Additionally this priority also responds to one of the key priorities in the health and wellbeing strategy around reducing premature mortality There are a range of initiatives to increase uptake of national screening programmes and to develop service capacity in response. National screening programmes including those for breast, cervical and bowel cancer transferred to the West Yorkshire Local Area Team (NHS England) on April 2013 however LWCCG recognises the critical role that primary care and CCG commissioners will continue to play in the success of screening programmes. Capacity to Screen - As lead commissioner for acute providers on behalf of the Leeds CCGs, LWCCG will continue to work closely with national screening programmes and the Yorkshire and Humber Strategic Clinical Network, hosted by the South Yorkshire Local Area Team and the West Yorkshire Local Area Team to support effective planning and commissioning of service capacity at acute providers Uptake Rates - LWCCG is also leading work with Public Health to improve uptake rates for bowel screening by practice through the Leeds Cancer Locality Group. Cancer Awareness Building on the recent successes of an NHS Leeds NAEDI lung campaign in relation to early signs of lung cancer, LWCCG will proactively support the development of further Be clear on Cancer campaigns. NHS England, Public Health England and the Department of Health will set the programme for the forthcoming year in July The Local Authority are identifying areas of greatest need to focus on raising awareness. Cancer Pathways LWCCG has identified whole cancer pathways as a key commissioning priority, potentially including improving uptake for screening, peer review and practice MOT to understand concordance with two week wait pathways and macro commissioning activity to secure appropriate diagnostic and surgical capacity to deliver national targets. In this way LWCCG will use patient experience and outcomes to understand the effectiveness of its commissioning processes Priority Health Goal e: Cancer In three years we will have Outcomes Joint Health and Wellbeing Strategy outcomes in bold Increased early diagnosis rates for cancer Decreased the number of people being diagnosed with cancer in A&E People will live longer and have healthier lives People s quality of life will be improved by access 34

35 Priority Health Goal e: Cancer Member practice actions by March 2014 Health economy actions by March 2014 to quality services Ensure people have equitable access to screening and prevention services to reduce premature mortality Ensure people have equitable access to services Improved rate of early death (under 75) from cancer Increase early diagnosis of cancer (3 practices) Increase bowel cancer screening (QP) People will have access to quality services and will have a choice of providers 18 weeks RTT will be sustainably delivered F: Elective Care Growth in elective activity has averaged around 2.6% per annum with much of this growth occurring outside of our main provider i.e. in Harrogate and the Independent Sector related to increasing awareness of choice options and a national focus on speciality level referral to treatment times The impact of more proactive and preventative care, for example cancer screening together with advances in medical technology is likely to be accelerate growth in elective activity. The CCG has planned for an increase of 3% in 2013/14 compared to 2012/13 outturn A key driver for prioritising elective care is the 18 week referral to treatment (RTT) target as enshrined within the NHS Constitution Specific outcomes are identified against work programmes below, however high level outcomes include the sustainable delivery of national performance and quality standards, improved choice and care closer to home In addition we know there is inequality of access to elective care across the CCG area. A review of relative access rates across practices has identified the need to work with practices to address variances in levels of access experienced Through addressing these anomalies we anticipate that overall levels of elective access and outpatients will increase as those with poorer access and greater need are identified and referred for treatment. We anticipate access will 35

36 especially improve for a range of long term conditions and for earlier identification and treatment of cancer Our approach to improving access to services electively will in the long term reduce demand for urgent and non-elective care as patients are treated earlier and more proactively for a range of conditions LWCCG will commission sufficient activity to ensure that the requirements of the NHS Constitution in relation to waiting times are met. This will continue to involve working closely with all main providers to model demand, assess the likely impact of choice and plan capacity effectively. Investment will continue to focus on specialty level access, reducing outstanding backlogs of very long waiters and managing growth in demand where applicable Key transformation programmes to support the sustainability of this agenda include. Acute Provider Management Work Programme Developing Choice and Competition Bring Care Closer to Home (AQP) The following schemes aim to mitigate against growth in demand for outpatient activity. At a member practice level, the CCG operates a peer review process to ensure that GPs respond to abnormal variation in referral rates, validate adherence to NICE guidance, and concordance with local pathways. LWCCG leads citywide work to review current clinical pathways for MSK, Endoscopy, Urology and Colorectal Surgery ensuring that referral guidelines are adhered to and hospital pathways are efficient. LWCCG leads citywide work to identify unwarranted variation in hospital based follow up rates, investing in innovative approaches to manage long term follow up care in primary care. Priority Health Goal f: Elective Care In three years we will have Sustainable delivery of national access standards for elective care Sustainable delivery of local standards for elective care Implement acute provider transformation programme Peer review of referral behaviours at practice level to normalise rates 36

37 Priority Health Goal f: Elective Care Outcomes Joint Health and Wellbeing Strategy outcomes in bold Member practice actions by March 2014 Health economy actions by March 2014 Established partnerships with the National Trust Development Agency, CQC etc Procure GP signposting system Complete baseline review of current AQP programme People will live longer and have healthier lives People s quality of life will be improved by access to quality services Ensure people have equitable access to services People will have access to quality services and will have a choice of providers 18 weeks RTT will be sustainably delivered across the health economy Peer review Implementation of clinical pathway guidance for MSK and dyspepsia. Member practices have adopted newly designed referral pathways and technologies to facilitate a range of newly agreed musculo-skeletal and gastro pathways into secondary and community providers. Review of urology, colorectal and ENT pathways into secondary care using feedback from practice level peer review of referral practice and identified blocks. Reducing outpatient follow up activity. Development of Primary Care Access Line (PCAL) Implementation of improved access to assessment and hot clinic functions in secondary care. G: Urgent Care Urgent Care remains a priority for the CCG due to pressures on our A&E departments, access to primary care and feedback from member practices that demand on their services are increasing. Patients have also told us that the system is confusing so we are committed to local actions as well as citywide strategies that address these issues. 37

38 4.27. LWCCG has a number of schemes aimed which will reduce emergency admissions: LWCCG is actively enabling proactive management of patients with long term conditions through the deployment of the risk stratification tool across practices and integrated health and social care responses. It is anticipated that this will reduce the number of emergency admissions to hospital for those with Long Term Conditions. The CCG will focus proactively on identifying those suspected of having cancer through uptake of national awareness and screening campaigns. In the immediate term this will increase demand for outpatient activity, but will ultimately reduce demand for emergency admission and radically improve patient outcomes. LWCCG leads citywide work in relation to developing Ambulatory Emergency Care (AEC) pathways. The AEC programme aims to build capacity to respond to urgent assessment needs in a planned way through the development of more responsive diagnostic services, hot clinics and the development of hospital assessment functions as an alternative to admission. Historic growth in recorded activity to 2011/12 is around 6% per year (5 year average). However much of this activity relates to very short stay admissions or assessment activity. Underlying growth in patients actually requiring emergency admission (excluding assessment) shows real growth at around 2.6% per year in line with elective activity. As a result LWCCG has planned for a limited growth in emergency admissions of 1.3% in 2013/14 compared to outturn. This constitutes a significant reduction in non elective demand as compared to adjusted trend (2.6%). Priority Health Goal g: Urgent Care In three years we will have Outcomes Joint Health and Wellbeing Strategy outcomes in bold Created an urgent care system which is seamless and simple for patients to understand and use Managed emergency care demand into secondary and primary care through system transformation Facilitated and emergency care system where performance is sustainable People will live longer and have healthier lives People s quality of life will be improved by access to quality services 38

39 Priority Health Goal g: Urgent Care Member practice actions by March 2014 Health economy actions by March 2014 Ensure people have equitable access to services Sustainable achievement of 4 hour emergency care standard Seamless system which is easy for patients to navigate Demand for urgent care is managed and sustained Expand proactive management of long term conditions to reduce emergency care demand Continue to offer extended hours and work flexibly 111 Urgent Care implemented at West Yorkshire level. Leeds Urgent Care strategy reflects specific needs of West Leeds. Recovery plan for LTHT A&E performance delivers sustained improvement in performance. Impact of Mid Yorkshire and Major Trauma reconfiguration on Leeds Urgent Care are understood and mitigated. H: End of Life Care This is an issue which is important as a priority to both our member practices and members of the public in terms of dignity and respect. This is also a citywide transformation priority and LWCCG is committed to working with those citywide programmes and implementing locally The end of life goal builds on work undertaken in recent years to raise clinical awareness of need to improve attitudes in providing choice for patients as to care towards the end of life. This builds on increasing investment in hospice care in the last two years. The key elements of this goal are to: Undertake a health needs assessment and review of end of life pathways to ensure that patient have increased choice at end of life. Increase the number of patients registered on the electronic palliative care coordination system (EPCCS) Ensure providers comply with NICE standards for end of life care. 39

40 Priority Health Goal h: End of Life In three years we will have Outcomes Joint Health and Wellbeing Strategy outcomes in bold Member practice actions by March 2014 Health economy actions by March 2014 Minimised people dying in hospital and maximised people being able to die in their own homes. Embedded NICE standards in all providers Implemented review of existing medications for those who become identified as needing palliative care People s quality of life will be improved by access to quality services Ensure people have equitable access to services More people dying in their own homes Best quality provision of services Fully integrated seamless services for patients Continue to register as many patients as possible on palliative care register EPCR Participate in training programmes Continue to fully integrate as part of whole system Ongoing training for practices around palliative care prescribing Carry out Health Needs Assessment for palliative care during 2013 with a view to developing a strategy for the city Identify programmes of work for EPCCS, NICE and primary care education. Continuation of roll out of palliative care drugs scheme Priority Group Children and Families In response to feedback from stakeholders LWCCG have identified children and families as a priority group and in response we will work closely with our commissioning partners to deliver a number of workstreams To support this we have appointed a GP clinical lead for children and families who will lead our local strategy and in partnership around citywide workstreams. 40

41 4.32. Children and Young People s Plan: Leeds CCGs will work collaboratively with the Leeds Children s Trust Board to ensure that children and maternity commissioning programmes support the delivery of the outcomes set out in the recently published Children and Young People s Plan which is summarised at Appendix Our approach will be to ensure robust collaborative commissioning and planning. This is necessary in the context of increased numbers of commissioners of children s services in the system (CCGs, NCB, LA) Our commissioning plans include continuation of Best Practice Tariff (Year of care) for paediatric diabetes Health Visiting and Family Nurse Partnerships: Leeds CCG are supportive of the continued investment and expansion of Health Visiting and Family Nurse Partnership (FNP) services in line with nationally agreed trajectories. Although from April 2013 the National Commissioning Board is responsible for the commissioning of FNP Leeds recognises the need to work closely to ensure effective recruitment from maternity services and for delivery of joined up pathways for vulnerable young people in the community In addition we will support the continued implementation of the integrated Early Start Service (health visiting and children centre workforce working closely with children s social workers) and development of integrated pathways. This supports the Government s ambition, as set out in the Mandate, to help give children the best start in life Services for Acutely Ill Children: Leeds CCGs have worked with partners to review pathways for acutely ill children. Redesign is underway to ensure senior paediatric expertise is in place in A&E and the Paediatric Assessment Unit at times of peak demand, the development of the Primary Care Access Line for children pathways, there is timely access to Rapid Access clinics, and an improved interface between Child and Adolescent Mental Health Service (CAMHS) and A&E. Ensuring Quality and Safety in Commissioning for Priority Health Goals Strategic Objective 2: Quality and Safety - To transform care and drive continuous improvement in quality and safety Patient Involvement and Patient Experience Leeds West CCG aims to put our patients first in everything we do. We are committed to ensuring that they are fully engaged in developing priorities, in charge of decisions which gives them greater control and have more choice regarding their care. We aim to ensure that in all we do we adopt the principle No decision about me, without me. 41

42 4.39. We have a wide range of informal and formal mechanisms through which we ensure we obtain information and insight regarding patient experiences of services and their expectations of how services should develop A key aim of collecting and monitoring patient experience is in response to the recommendations in the Francis Report on the failings at Mid-Staffordshire hospital. Triangulated with a range of quality monitoring mechanisms, patient experience will help us to identify early warning signs of a failing provider or service in our area Our GPs and member practices are one of our key mechanisms for obtaining feedback and views of patients. GPs, and practice staff, through their day to day contact with patients, obtain valuable insights to their experience of using the NHS services We will ensure that we systematically engage with all of our member practices to understand the issues and concerns of patients and their experiences good and bad of the services we commission For example, most of our GP practices have Patient Reference Groups and feedback gathered at these groups feeds into the CCG on a regular basis. We work closely with these patient reference groups and often set agenda items for discussion and facilitate occasional wider meetings where groups from different practices can meet each other around specific topics Patients are also involved and engaged through a range of face-to-face networks and forums including using a range of pre existing major channels within the voluntary and community sectors. The purpose of our engagement and involvement events range from information giving to raise the profile of the CCG, through Q&A sessions and specific consultations to strategic priority setting with members of the public We already undertake a range of face-to-face channels which include specific events that have been used to support the development of our priorities and informing how we invest in services. As we develop we will build on the use of such events to assist in forming and developing our plans Leeds West CCG also uses a range of innovative approaches for engaging people. These include use of social media (such as Facebook and Twitter), SMS, webcasts, webchats, animation, and publications. We aim to continue using technology and technological advances to ensure that our communications channels remain up-to-date, contemporary and accessible to different audiences. We aim to use all available channels to ensure that as far as possible no individual or section of the community is left out We also learn about patients experience from a wide range of sources through productive relationships with the local Healthwatch and the GP practice patient reference groups, which provide us with feedback about specific topics on a regular basis. 42

43 4.47. In addition we also look at information available through patients surveys (to include the new patients and family tests), PALS reports, complaints and feedback received via NHS Choices, Patient Opinion and our own web feedback options. We have also developed and invested in systems to collect and collate feedback from patients visiting our GP practices on all services they have used. We have established a Patient Insight Group to oversee our patient experience work and identify areas of good practice to share, as well as alerting us to any trends of poor care or practice We have established a patient voice standing item at our Governing Body meetings using patient videos to explain their experiences of services Finally we work closely with all of our major service providers and other statutory commissioning organisations both locally and regionally to ensure that planned service developments and changes are undertaken with appropriate engagement and consultation of patients and the public Overseeing this system we have a Patient Assurance group who review and scrutinise each service change and commissioning business case under consideration by the CCG. They identify whether appropriate levels of involvement, engagement and consultation both planned and take place with members of the public and make recommendations to the Governing Body regarding whether a case should be supported or deferred on that basis. Quality and Safety Leeds West CCG along with other CCGs in Leeds have put in place robust mechanisms to ensure ongoing review of service quality and safety in our providers We have a range of formal mechanisms that we use to monitor and track quality and safety. These include regular meetings undertaken between Medical and Nursing Directors and their counterparts in our main providers that are used to review current quality and safety and to assess any proposals for developments within the providers to ensure that these will not negatively impact on service quality and safety The CCG and its medical and nursing directors also use a range of mechanisms to support ongoing improvement in service quality. The key mechanisms include: Contract Management: The standard NHS Contract for providers embeds a wide range of nationally and locally defined clinical and service quality metrics. LWCCG regularly reviews these metrics and monitors performance via regular quality meetings held with the provider. Where quality is not provided at the requisite/expected level and not being adequately addressed we work with providers to understand the issues and agree appropriate remedial actions in accordance with the requirements of the contract. Where appropriate We will use 43

44 the sanctions and levers available in the contract to to support resolution and improvement CQUIN: commissioning for quality and innovation. The CQUIN framework ties 2.5% of the total contract value to the achievement of agreed quality and safety standards over and above those expected as a minimum. CQUINs are required to address four domains of quality i.e. safety, effectiveness, patient experience and innovation. LWCCG approach to CQUIN ensures that incentives for providers are tied to standards, which support each of these domains. As an example all contracts contain minimum expectations on reporting on safety and quality standards including serious untoward incidents, never events and complaints NICE Guidance: We work with all our providers to ensure that health care professionals make clinical decisions based on evidence-based practice and there are processes in place to monitor compliance with nationally agreed best practice as published by NICE. We seek assurance from all providers through receipts of evidence of compliance status on a quarterly basis Application of NICE guidance is monitored through local quality requirements, which states that Providers demonstrate full compliance with NICE guidance, as follows: Quality Report: Compliance target is 95% with all relevant published guidance within 12 months of publication and 100% for Technology Appraisal Guidance within 90 days of publication Monthly activity performance report (Should a Provider breach this quality requirement then they are required submit a report to the commissioners) Clinical Audit: Participation with relevant National Clinical Audits are monitored through a local quality framework, which requires that Providers demonstrate full compliance with all relevant National Clinical Audits and that these are reported upon through the Clinical Quality Report and annual Quality Accounts / Report. Monitoring of this requirement includes the following: The Provider will submit to the commissioner an annual Clinical Audit Programme by 31st of March each year and an annual Clinical Audit Report by the 30th September each year. These reports will demonstrate that: The provider has set out their clinical audit programme and completed all planned clinical audit projects using appropriately methodology, measuring standards and setting out recommendations in a clinical audit project action plan. All action plans are monitored to ensure recommendations for clinical practice are acted upon; The provider has undertaken all relevant national clinical audits including those listed on the National Clinical Audit and Patient Outcomes Programme 44

45 (NCAPOP), and set out participation rates within their annual Quality Accounts; The provider, on publication of each national audit report, assesses the benchmark data including any instances of outliers and act upon all relevant recommendations The provider will also submit national benchmark and outlier datasets and local action plans for each relevant national audit within 3 months of publication Response to the failing at Mid-Staffordshire Hospital Leeds West CCG along with other commissioning partners have fully reviewed the finding of the Mid Staffs review and are working closely with Leeds Teaching Hospitals Trust and other providers to ensure that high standards of service quality and safety are maintained. We monitor standards of care through regular review of key quality metrics via the mechanisms outlined above and through visits to providers to see quality of care first hand Winterbourne View Leeds CCGs and the Local Authority are also undertaking a full scale review of Learning Disabilities services across the NHS in Leeds. The review will conclude during 2013/14, with recommendations beginning to be implemented that year. It is likely that development of the services will respond to a number of factors, including but not exclusively focused on: The Department of Health s assurance requirements following the enquiry into abuses at Winterbourne View: A large increase in the number of people becoming eligible for Continuing Healthcare funding The need to consider the cities demographics and increasing population, and how partners develop strategies to meet needs The question of whether services are configured to meet future demographic changes Equality and Diversity LWCCG believes that access and equality issues are central to creating fair and modern health and social care services and are committed to establishing values and policies that promote equity of access to health care and address inequalities in health status between communities and neighbourhoods in West Leeds and across the city We work collaboratively across the Leeds NHS economy with Leeds NHS Equality Advisory Panel, who provide useful community voice evidence, which supports the effective commissioning of local services with improved access and experience for all local people. We use the NHS Equality Delivery System as a framework to drive up our equality performance. 45

46 4.63. Meaningful and sustained involvement of local people, the effective use of evidence, both quantitative and qualitative, a focus on outcomes with transparent reporting of progress and the integration of equality and diversity considerations into our mainstream strategy and operational work are out four key principles that underpin our equality and diversity work. Ensuring Value for Money in Commissioning for Priority Health Goals Strategic Objective 3: Best use of resources To use commissioning resources effectively and responsibly Leeds West CCG are operating in an challenging economic environment. The NHS is dealing with an aging population and growing expectations with regards to access to treatments and services as new and better treatments. At the same time the growth in available resources is not keeping pace with the demand and inflationary costs associated with healthcare. Nationally the process of meeting this challenge is known as QiPP (Quality, Innovation, Prevention and Productivity) There are a number ways in which, through commissioning, we aim to achieve this Driving down transactional costs (providing services for less). This includes initiatives such as effective procurement, efficient prescribing, reducing waste through adopting sustainable practices (energy, cost of stationary, reducing travel), and minimising administration costs through encouraging use of electronic referrals, e-prescriptions and use of electronic communications between healthcare systems and professionals. *It should be noted that the vast majority of transactional efficiencies are achieved through national frameworks such as implementation of the tariff system which restricts inflationary cost of provision, pay freezes and initiatives such as negotiation of generic drug prices Reducing the burden of ill health (Prevention): through focussing resources on prevention i.e. encouraging and supporting people to adopt healthy lifestyles. This includes supporting and encouraging people to stop smoking, eat healthily and reduce alcohol consumption. We will use our commissioning processes to encourage our members and all service providers to work with us to use every opportunity to engage with patients and public to adopt health behaviours, for example weight management and smoking cessation. Early diagnosis. Initiatives include early diagnosis and treatment of a range of conditions including diabetes, dementia, cancer and respiratory disease. Early diagnosis reduces the burden of disease and associated costs of looking after patients that will go on to develop disabilities and chronic conditions as a result 46

47 Better supporting older people and those with Long Term Conditions through improving access to community and primary care services. This will enable them to receive care in community settings and take greater control of their own health. This will in time reduce the demand for hospital attendance and admissions Redesigning Services: We will work with partners across sectors to ensure that we minimise the number of processes and contacts required to treat disease and manage care. This will include redesigning elective care and urgent care systems to ensure that patients receive the right care, first time in the most appropriate settings and that the time spent receiving that treatment is minimised where appropriate. This may include a range of technical innovations such as deployment of telecare and e-consultations to reduce administration, travel and capital costs We undertake the above through a mix of city wide and local initiatives. Local initiatives are deployed wherever possible however many initiatives are required to be undertaken on a city wide basis where they impact on the way that services are provided across the city All local and city wide commissioning proposals are subject to a robust business case and prioritisation process that ensures to ensure that they address local priorities that there is clarity about how they will deliver desired outcomes alongside analysis of how they will deliver value for money. Medicines management Specialist pharmacists, technicians, community matrons, adult social services and care home staff are working in partnership with patients' GPs to optimise patients' medicines in their home environment, and on discharge from hospital and in primary care. Key developments include Shared Management of Medicines Health economy wide uptake of new Leeds Traffic Light System for drug classification and netformulary, reducing the use of medicines of little or no clinical value. Enhanced Care - Improve quality of care around medicines use for patients in a care home setting, reducing amount of wastage and unnecessary medication Procurement - Central clinical verification of specific groups of medicines including 'specials', wound dressing, catheters and sip feeds. Develop alternative approach to supply of some of these groups of medicines Cross Sector Review medication at the patient interface, focusing on those patients who fall outside current pathways and those with mental health/learning disabilities 47

48 Section 5: Organisational Development Goals Strategic Objective 4: Organisation Development To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can In response to the strategic objective above and to ensure fitness for purpose in delivering the strategy, the organisation will also focus on three key organisational development goals as follows A. Build commissioning capacity and capability at member practice level. B. Develop the workforce, embedding clinical leadership in commissioning. C. Continue to collaborate with partners, ensuring system efficiency For the detailed year one delivery plan for organisational development goals please see Annex 2b. A. Build commissioning capacity and capability at member practice level 5.3. LWCCG is working with member practices to develop an environment which supports innovation and proactive change. Goals include: aligning a commissioning development scheme to the priorities identified in the CCG strategy, information and best practice sharing at Locality Development Sessions, a business case review process to prioritise practice level goals against strategic priorities and a peer review process which encourages information sharing between members Work Programmes: 5.5. Outcomes: Developing locality infrastructure. Delivering commissioning information at practice level. Implementing a member practice engagement and development strategy. In 3 Years all member practices will feel enabled to make commissioning decisions and where possible these will be taken at practice level. The Clinical Commissioning Committee will be fully representative of all member practices. The clinical leadership within the organisation will be fully functioning and there will be a robust succession plan in place. B. Developing the workforce, embedding clinical leadership in commissioning 48

49 5.6. LWCCG are committed to ensuring that we have the best developed workforce to enable us to meet the challenges ahead of us. We will do this through offering quality training and development programmes to staff and through highly effective leadership Work Programmes: 5.8. Outcomes: HR systems, processes and procedures. Development of a clinical leadership strategy to embed clinical leadership in delivery of strategic objectives Staff engagement Personal, Team and organisational development, aligned to organisational strategic objectives Training and development programmes to support our member practices In three years we will have high levels of staff retention and low levels of sickness absence Clinical leadership embedded in work programmes Our staff will report high rates of satisfaction in staff surveys Our staff will be up to date with all statutory and mandatory training and will also have access to personal and vocational training which supports them to carry out their role as best they can. 100% of our staff will be working to personal development plans with individual objectives aligned to LWCCG s organisational objectives. LWCCG will have supported the implementation of a training and development programme for member practices. C. Continue to collaborate with partners, ensuring system efficiency 5.9. LWCCG are committed to working with our partners to deliver citywide priorities and to safeguard and make sustainable our local health economy Work Programmes our partners: 49

50 Leeds Health and Wellbeing Board Leeds Health and Social Care Transformation Programme CCGs and Clinical Commissioning Networks Integrated Commissioning Executive Provider Management Groups (Contracts) Figure 9 Health & Wellbeing Board We are working with the health and wellbeing board to deliver our mutual priority health goals described above in section We will work with and as a member of the HWBB to ensure that the health needs of the city are addressed and outcomes improved, and we will ensure that our own strategies and plans reflect the HWBS for the city. We will work with our Public Health colleagues to ensure the CCG has a voice and contributes to both the Area Leadership Team and to local health and wellbeing partnerships. Leeds Health & Social Care Transformation Programme The Leeds Health and Social Care Transformation Programme Board is an established forum for senior leaders from across the health and social care economy. Members include senior leaders from Clinical Commissioning Groups, Local Authorities and all major NHS providers The purpose of the Transformation Programme is to create the conditions in which clinicians can innovate to deliver transformational change, in particular where joint action and ownership from all partner organisations is required The Transformation Board has, through involvement and engagement of clinicians from across primary, community and secondary healthcare and through and social care professionals, identified the high level impact, crossorganisational changes required to secure a sustainable health economy In addition to establishing vision and providing direction, the Transformation Programme will oversee delivery of the enabling programmes which will enable innovation and change at patient level, for example IT strategy for the city. Clinical Commissioning Networks (Provider Management Groups) 50

51 5.17. The three Leeds CCGs collaborate across a number of Clinical Commissioning Networks (Provider Management Groups) to increase their collective influence as commissioners in relation to large providers, to share their expertise across the city and to ensure that strategies are aligned and coherent. Clinical Commissioning Networks are established in relation to: Acute Providers Community Healthcare Mental Health Children Clinical Commissioning Networks oversee the delivery of internal provider cost improvement plans on behalf of the Transformation Board, reviewing quality impact assessments as part of this process, for: Leeds Teaching Hospitals Trust Leeds and York Partnership Foundation Trust Leeds Community Healthcare In addition, the Clinical Commissioning Networks lead citywide transformation schemes across providers on behalf of the three CCGs as follows: Elective and Ambulatory Care Integrated Health & Social Care Dementia Access to Psychological Therapies Reconfiguration of Maternity and Neonatal Services. Urgent Care In developing local delivery plans, LWCCG has drawn on the expertise, strategic approach and established best practice provided by the Clinical Commissioning Networks, ensuring that local actions are aligned to citywide transformation programmes and coherent at provider level, whilst targeted to meet the needs of the local population. Contracts with Providers NHS Leeds West CCG has relationships with a wide range of providers for the provision of healthcare services through established contracting arrangements, acting either as lead commissioner or as an associate to the contracts The services include: General and acute provision from NHS Acute Hospital Trusts, NHS Foundation trusts and the Independent Sector. Acute Services provided in the community by GPWSIs and providers procured via the Any Qualified Provider (AQP) route Local enhanced services for Cataracts and Community Bloods Community Services 51

52 Ambulance and Patient Transport. Mental Health and Counselling Voluntary Sector provision Hospices and palliative care The National Standard Contract is used for most contracts which ensures a robust contract which gives a consistent structure for providers to adhere to and promotes quality of provision. For smaller contracts, service level agreements provide the framework Commissioners work with the providers to set the contracts each year negotiating not only the finance and activity schedules but also those for quality and Care Quality Indicators (CQUINS), information and Service Development Improvement plans which are aligned to the transformation Programme The West and South Yorkshire and Bassetlaw Commissioning Support Unit plays a key role in supporting these arrangements through the business intelligence and provider management offer Outcomes: In three years we will have built effective relationships with our partner organisations and successfully delivered our shared goals. We will have broken down traditional organisational barriers and found innovative ways of working together and this will benefit our population. 52

53 Section 6: Financial Plan 3 Year Financial Planning Assumptions 6.1. Dependant on the delivery of ambitious QIPP targets outlined above, LWCCG will continue to deliver a balanced financial plan, including delivery of a 2% surplus plus 2% headroom available for future investment. The plan will also include 1% contingency Financial plans and proposed annual budgets are based on our current understanding of available resources, risks and developments known at this time and are subject to change pending management and mitigation of risks associated with contract negotiation plus impact of any PbR tariff changes. Underpinning Financial Plan Plans will underpin identified strategic priorities and have been updated to reflect: New commitments identified within the Everyone Counts and the Commissioning Outcomes Indicator Set. Resource requirements that support delivery of transformational change with partners, across provider organisations and with member practices The following financial assumptions detailed below in table 7, which are consistent with contract agreements, have been applied: Financial assumptions 2013/ /15 & 2015/16 (local assumptions) Allocations (growth) +2.3% +2% Tariff change -1.3% -1% Non-tariff price change -1.3% -1% Prescribing / enhanced services /OOH +1.8% +2% CQUINs +2.5% +2% Table 7 Available Resources 6.5. LWCCG has a recurrent underlying surplus of 7.6 million (2% of commissioning budget) and will receive an additional 2.3% in growth funding in from the NHS which equates to 8.6m LWCCG will therefore have a total of 15m of additional available resources in 2013/14 of which 7.6m (2% headroom) is to be used to support non-recurrent investments. 53

54 Commitments 6.7. Against these resources LWCCG will take account of cost pressures and precommitments resulting from previous investment decisions. Cost pressures and pre-commitments include an allowance for demand growth pressures, the increased costs of prescribing, Continuing Care and Learning Disabilities and delivery of key national targets including IAPT Offsetting these pressures, the CCG has the opportunity to reinvest the net tariff deflation benefit of -1.3%PbR and Non PbR activity. Additionally, in LWCCG is planning to make efficiency/qipp savings of 6.9m Tables 8 and 9 below show the financial starting position for LWCCG for 2013/14, and a summary financial plan for future years: Financial Plan 2013/ /14 '000 '000 Growth (2.3% on commissioning element) 8,569 Running costs adjustment 1,238 Underlying recurrent position 7,623 Return of surplus & SIF (including pass through monies) 9,472 Resources Available 26,902 Inflation/Deflation Tariff & non tariff (net of inherent CIP) -3,872 Prescribing 1,008-2,864 Cost Pressures, precommitments & investments Acute Services 4,191 Mental Health (including IAPT) 741 Community Health 628 Continuing Care 177 5,737 Demand Growth 4,526 Application of tariff deflator to fund developments & pressures 3,871 2% Transformational Projects 7,623 Planned Incremental Spend 18,893 Contingency and Reserves (including pass through monies) 7,306 Planned Spend and Reserves 26,199 Planned Commissioner QIPP (excludes inherent CIP) -6,920 Total Spend Net of QIPP 19,279 Planned Surplus 7,623 Table 8 54

55 Summary Financial Plan for future years 2014/ /16 '000 '000 Recurrent allocation 389, ,882 Non recurrent allocation 7,623 7,466 Total income 396, ,348 Planned expenditure 379, ,095 2% transformation fund 7,466 7,615 Contingency 2,940 3,023 Total expenditure 389, ,733 Planned surplus 7,466 7,615 Table 9 Investment Planning (Recurrent and Non Recurrent Resources) LWCCG has identified a range of potential investment areas based on proposals from providers, commissioning partners and member practices to support delivery of the organisation s strategic objectives in In addition LWCCG will participate in discussions with commissioning partners to collectively prioritise and invest in support of citywide transformational schemes ensuring collective ownership and understanding of the savings that underpin the financial sustainability of the health economy Support for these proposals will be finalised following contract sign off and a review of forward planning risks. At this stage, CCGs across Leeds have collectively identified 19m to invest in non recurrent schemes (of which LWCCG element is 7.6m). An outline of likely investment plan is shown below in table 10. Use of 2% Transformational Funding 2013/14 '000 '000 Citywide (reference only) LW CCG plan Programme costs: Elective & Ambulatory Care Transformation Use of Medicines Integrated Health and Social Care 1, End of Life Long Term Conditions Dementia Transformation Enablers: IMT 1, Provider support 5,550 2,244 Provider Service Development: 55

56 Use of 2% Transformational Funding 2013/14 '000 '000 Mental Health Community Health Other (including Local Authority) Local Schemes: Citywide pot 4,500 Leeds West schemes: Improving alcohol services 350 Mental Health services 350 Long Term Conditions 350 Early detection of cancer 350 Use of Medicines 284 Other 127 TOTAL 19,071 7,623 Table 10 Impact for Providers The anticipated impact of investment plans on provider s income is as follows. Leeds Teaching Hospitals: Increase in recurrent investment of 3%. The investment supports a 3% increases in outpatients, diagnostic and elective activity and 1.3% growth in non electives. Investment also supports development for some non-pbr activities. In addition LTHT will receive some non recurrent transitional support to help with their own transformation programmes Leeds Community Healthcare: No increase in recurrent investment planned. However it is envisaged that LCH will receive some non recurrent investment to support new ways of working. Leeds and York Partnerships Foundation Trust: No increase in recurrent investment planned. However it is envisaged that LCH will receive some non recurrent investment to support new ways of working. Provider Efficiency Plans 56

57 6.14. The provider efficiency attributable to the LWCCG QIPP is outlined in table 11 below. Provider Efficiencies ( 000s) 2013/ / /16 LTHT LYPFT LCHS Other NHS Trusts Independent sector YAS Urgent Care Mental Health/LD Continuing Care Community / LTC Total Table Our providers have developed efficiency programmes to underpin their forward service and financial plans. The following provides a brief summary of our main providers approach. Leeds Teaching Hospitals Managing For Success A significant proportion of total QIPP savings will be delivered by Leeds Teaching Hospitals through the Managing for Success change programme which will result in more efficient, high quality care. Managing for Success is expected to result in 60-70m being saved over 3 years largely through reducing lengths of stay and improved utilisation of staff to reduce the unit costs of treatment The programme has multiple projects including: Workforce skill mix Review Care pathways and service redesign Estates Procurement Corporate Other Providers Leeds and York Partnership Foundation Trust and Leeds Community Healthcare have both developed robust provider efficiency plans to remain financially stable over the planning period. Delivery will centre around ensuring the most efficient use of resources to absorb activity and develop services in line with best practice. 57

58 This will include seeking to improve utilisation of estates, procurement and workforce development. Quality Assurance & Workforce Planning In such a challenging environment it is critical that providers and commissioners collectively understand the impact of finance and activity plans on workforce plans, identifying a strategic response to risks from the outset and assuring themselves of the quality and safety of services through a period of sustained change LWCCG is working with main providers to ensure that efficiencies can be achieved without impacting on quality, safety and capacity for service delivery QIPP plans have been reviewed and approved by both Medical and Nursing Directors at each provider and by the CCG. Medical and Nursing Directors at LWCCG regularly review and assess the providers plans through a range of informal and formal mechanisms to assure themselves that those plans can be implemented in such a way as to not impact on quality of services On an ongoing basis, the CCG will use a number of mechanisms to assure itself that the changes planned do not adversely impact on the quality of services provided including: CQC reports National reporting on quality standards, complaints Feedback from PALs Outcome of audits National workforce benchmarking data Staff surveys Dr Fosters (e.g. standardised mortality) LWCCG also regularly reviews information available publicly such as provider board reports, annual plans and annual reports that provide information on a range of workforce metrics including, establishment, sickness and absence rates and use of agency staff. 58

59 Section 7: Governance & Risk Performance Management 7.1. The NHS Leeds West CCG Governing Body is responsible for overseeing the development and delivery of the organisations strategy and associated priorities The Governing Body is Chaired by Dr Gordon Sinclair. The Governing Body membership is constituted of the CCGs Executive Team, 4 GP Locality Chairs, Public Health Consultant and 3 Lay Members The Governing Body is responsible for agreeing all Strategic and Operational Plans and ensuring their delivery through obtaining assurance from the organisations governance processes 7.4. Leeds West has agreed a wide range of organisational objectives. Each of these objectives have been allocated to an Executive Director who is responsible to the Governing Body for ensuring its delivery Leeds West CCG works in a complex commissioning environment whereby delivery of these objectives is achieved through a range of local and city wide processes In recognition of this LWCCG has developed a robust governance framework that reflects the need to distinguish between objectives that can be delivered through local action alone and those that require a city wide partnership approach Figure 10 below describes the governance structures that have been established to secure delivery 59

60 Transformation Board City Wide Partnerships Health and Wellbeing Board Integrated Commissioning Executive Leeds West CCG Governing Body Clinical Commissioning Executive Assurance LWCCG Governing Body Sub Commities Audit Remuneration Figure Role of each sub committee Health and Wellbeing Board: Membership is Local Authority, NHS England and all Leeds CCG. Role is to oversee development of city-wide health and wellbeing strategy that outlines key priorities to be delivered by all partners and to track delivery. LWCCG plans have been developed to address agreed shared priorities. Transformation Board: Membership of all Leeds CCGs, Local Authority and Major Healthcare Providers that develops plans for service change that require engagement and ownership of all partners to ensure delivery. The Board oversees delivery of number of city wide projects including: Integrated Health and Social Care, Urgent Care, Dementia, End of Life and Prescribing Integrated Commissioning Executive: Membership of Local Authority and Council coordinated developments of commissioning to ensure that programmes are integrated cross city where necessary e.g. delivery of alcohol strategy Clinical Commissioning Committee: Oversees development and delivery of Leeds West CCG commissioning initiatives Assurance Committee: Ongoing review of performance and delivery of corporate objectives and manages associated risks 60

61 Audit: Responsible for ensuring that the organisation operates within regulatory framework. Functions include undertaking audits of governance and risk processes to ensure that they are fit for purpose and monitoring plans to improve where required and signing off annual accounts. Remuneration: Statutory function that reviews remuneration and rewards for Executive members of Governing Body 7.9. Members of the CCG Governing Body sit on all local and city wide sub committees and provide regular formal reports and informal updates on delivery of objectives and outputs of committees where appropriate This reporting process is designed to ensure that the Governing Body through local and subcommittee reporting structures receives adequate assurance that enables it to support, advise and intervene where necessary to secure the delivery of the organisations objectives. Key Risks The Governing Body regularly reviews the key risks associated with delivery of the strategic objectives and reviews and approves actions required to address where necessary The table below outlines the current key risks to the organisation in the ongoing delivery of its Strategic Plans and the current RAG rating associated with each Risks and controls are subject to further consideration by the Governing Body and this section with be refreshed in September

62 Leeds West CCG Assurance Framework 2013/14 Contents Page 1 Risk CCGW01 Sub-optimal Quality Diane Hampshire Updated 28 May 2 Risk Score RISK DESCRIPTIONS ASSURANCE P There is a risk to Leeds West CCG that the requirement to demonstrate continuous improvement in standards of care in provider organisations may not be met. This would be due to competing priorities, financial pressures and insufficient workforce 12 capacity within and across providers. This could result in suboptimal care, poor health outcomes, compromised access and service quality for our patients and a failure to achieve financial sustainability. 2 3 CCGW02 Transformation (QiPP) for Financial Sustainability Leaf Mobbs/Visseh Pejhan-Sykes CCGW03 Commissioning Support Visseh Pejhan- Sykes 12 4 There is a risk of non acheivement of transformation and cost improvement (QIPP) programmes. This would be due to identified schemes not being able to realise the CIP within required timescales. This could result in the need to identify reactive cost improvement and compromising decommissioning schemes impacting on services for patients. There is a risk that the WYCSU is not able to meet the requirements of the CCG specification for commissioning support. This would be due to a failure to mobilise new systems and processes on time and within budget, or through gaps in skills and capacity. This could result in LWCCG being unable to commission effectively and significant duplication of activity across CCG and CSU organisations. 4 CCGW04 Partnership & Collaboration Gordon Sinclair/ Philomena Corrigan 8 There is a risk that the new governance arrangements for collaboration, partnership working, risk sharing and commissioning across the Leeds CCG network, Local Authority, NHSE and other partner agencies are not robust. This would be due to more complex governance arrangements, increased time commitments and reduced workforce capacity in the new system. This could result in a failure to co-ordinate action around shared priorities, duplicated activity and weak commissioning engagement with providers. This will weaken NHS Leeds West CCG's ability to commission effectively. 5 CCGW05 Member Practice Engagement Simon Stockill NEW RISK** There is a risk that Leeds West CCG member practices do not engage adequately as clinical commissioners. This would be due to time constraints, capacity and capability. This could result in the organisation being unable to fulfil its purpose of working for members to improve the health of the local population 6 CCGW06 Emergency Planning Leaf Mobbs NEW RISK** There is a risk of serious disruption to ongoing delivery of commissioned services. This would be due to a lack of clarity regarding LWCCG role in emergency planning, resilience and response arrangements across the new commissioner landscape. This could result in the population of Leeds West CCG not receiving the healthcare that is required and potential patient harm. Table 12 62

63 Healthy living programme - children Healthy living programme - adults Sexual health projects LTC self management Practice Initiatives - LTC Integrated H&SC teams Risk stratification of people with LTC Mental health initiatives Access to IAPT Dementia pathways Early detection and diagnosis of cancer Improving cancer pathways Clinical value in elective care Prescribing AEC pathways Implement End of life programme APPENDIX 1 - PLAN ON A PAGE: PRIORITY HEALTH GOALS Our Vision Working together locally to achieve the best health and care in all our communities Our Purpose To work for members to improve the health of our populations through effective commissioning, collaboration and primary care development PRIORITY HEALTH GOALS To tackle the biggest health challenges in west Leeds, reducing health inequalities USE OF RESOURCES To use commissioning resources effectively Our Strategic Objectives QUALITY AND SAFETY To transform care and drive continuous improvement in quality and safety ORGANISATIONAL DEVELOPMENT Members can meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can Leeds West CCG Priority Health Goals Organisational Development Goals Reduce the gap in life expectancy in west Leeds Sexual health Long term conditions management Improve mental health support / services Improve cancer services Choice and access for elective care services Improve urgent care services Increase choice and control at End of Life 63 Children and Families Adults Older People

64 Priority Health Goals Practice Actions PRIORITY HEALTH GOALS DELIVERY THROUGH MEMBER PRACTICES LWCCG Clinical Commissioning Scheme Local QP Indicators (QOF) DES Schemes (examples) Diabetes treatment (23 practices) Increase referrals to alcohol services (5 practices) Respiratory disease management (3 practices) Increase early diagnosis of cancer (3 practices) Prevention of CVD (2 practices) Increase referral to weight management services (1 practice) Stroke review 6 months post discharge Preconceptual advice for diabetes Prophylactic prescribing for COPD Self management programmes Every Contact Counts training Increase bowel cancer screening Peer reviews for: - Outpatient referral data - Emergency admissions - A&E attendances Develop action plan for frequent attenders at A&E Alcohol related risk reduction scheme Risk profiling and care management scheme (risk stratification) Timely diagnosis for people with dementia Remote care monitoring prep scheme Learning disabilities health check scheme Shingles Rotavirus Patient participation Extended hours Reduce the gap in life expectancy in west Leeds Sexual health Long term conditions management Improve cancer services Improve mental health support / services Choice and access for elective care services Improve urgent care services Increase choice and control at End of Life 64