Melanie Craig NHS Great Yarmouth and Waveney CCG Chief Officer. Rebecca Driver, STP Communications and Jane Harper-Smith, STP Programme Director

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1 Agenda Item: 9 Governing Body Thursday 25 January 2018 Subject: Presented By: Prepared By: Submitted To: Purpose of Paper: Norfolk and Waveney Sustainability and Transformation Partnership Update Melanie Craig NHS Great Yarmouth and Waveney CCG Chief Officer Rebecca Driver, STP Communications and Jane Harper-Smith, STP Programme Director NHS Great Yarmouth and Waveney CCG Governing Body Thursday 25 th January 2018 For information and discussion Summary: The purpose of this report is to update members of the Governing Body on the Norfolk & Waveney Sustainability and Transformation Partnership (STP), with a focus on progress made on STP delivery since the last report in November This report outlines the main transformation deliverables that the STP workstreams are focused on and the key challenges faced by system partners in delivering these changes. Recommendation: The Governing Body is asked to: Consider and comment on the report; Identify actions that the Governing Body could take to accelerate progress on delivering the changes necessary to deliver sustainable services.

2 Norfolk and Waveney Sustainability and Transformation Partnership (N&W STP) Update 1. Background 1.1 The Governing Body considers a report on the progress made by the N&W STP at each of its meetings. 2. Highlights 2.1 Joint Strategic Commissioning Committee The CCGs have agreed to work more closely together on commissioning those services which are more effectively commissioned on a collective basis. This work will be coordinated through the new Joint Strategic Commissioning Committee which comprises all five CCGs and which will have full delegated authority for strategic commissioning decision making. This new committee is currently running in shadow form, and will meet formally in public from April This key development for the Norfolk and Waveney system will ensure consistency in commissioning decision making, and represents a very significant step forward in the work of the wider STP. With the CCGs continuing as statutory bodies, this will also ensure that the vital locality focus is maintained, with local delivery a priority for individual CCGs. 2.2 Links with Waveney Continuing to develop and enhance STP links across Waveney and Suffolk is a priority for the STP. In support of this, the Chief Executive Officer of Suffolk County Council and the Director of Adult and Community Services have been invited onto the Norfolk and Waveney STP Executive monthly meeting. In addition to this, the Chair of the Suffolk Health and Wellbeing Board has been invited to become a member of the STP Chairs Oversight Group. 2.3 Accountable Care Systems In November, NHS England met with STP Leaders across the Midlands and East to discuss the development of STPs across the region and the direction of travel from central government on STPs and emerging accountable care systems. At the STP Executive meeting in December, John Webster, Chief Officer in West Norfolk CCG, shared his experiences of developing the plan for an accountable care system in Bedford, Luton and Milton Keynes, which was a first-wave accountable care system. This is being followed by a joint workshop between the Executive Group and Chairs Oversight Group in January to discuss this further, with a view to creating a vision for the future for wider discussion by the end of March STP Delivery There has been slippage on a number of programmes over winter due to capacity, inability to recruit to some posts and delays in receiving National cancer funding. Plans are in place to bring programmes back on track in February. Page 2 of 5

3 2.5 STP Finance Many individual organisation financial positions, especially amongst providers in the Norfolk and Waveney system are under pressure. Various options are being explored to address increasing CCG and Trust savings plans and to secure as much external transformation funding as possible into the system. 3. STP Delivery 3.1 Primary and Community Programme Board The new STP Primary and Community Care Programme Board was successfully relaunched on the 5 December There were twenty-five attendees from across health and social, primary and community care and the voluntary sector at the first meeting. Progress is rapidly being made to establish five Local Delivery Groups which will be coterminous with the CCGs. The overall purpose of each Local Delivery Group will be to implement local new models of care, provider development, access and resilience, prevention and self-care. These new local models will align with the strategic direction set by the STP and is in line with the Five Year Forward View and the General Practice Forward View and is essential to meet patient need. A significant amount of work is already underway including: Active signposting and self-care: Across the STP, our aim is to have all practices with members of staff trained in sign-posting skills, with the ability to promote self-care and responsible health seeking behaviours from the public. Social prescribing: This is about developing a holistic approach to support the health and wellbeing of patients and carers to live well for longer at home. It lines up with the national Five Year Forward View and the new STP Prevention workstream. There are social prescribing projects already running across Norfolk and Waveney, with the lessons learned from each being used to plan for STP wide implementation. Improved access: Across the STP, the five CCGs have been working together to develop a consistent and robust approach to extended access for patients to GP services. Workforce: The STP Primary Care Workforce Strategy and delivery plan sets out how Norfolk and Waveney CCGs will support and enable primary care providers to develop a multi-disciplinary workforce providing high quality primary care for the residents of Norfolk and Waveney. Workforce Development and Productivity: We are active participants in national programmes which support practice level resilience and organisational development. A number of practices across the STP are already actively taking part in workflow optimisation, essentially streamlining day to day work to make practices more efficient. 3.2 Acute Care Workstream update Acute Services Review The acute services review of cardiology, radiology and urology services is the key piece of work underway at the moment and is progressing well. Attain is completing the second phase of its work before moving on to propose options for the future. Work also continues on opportunities at scale including procurement. A series of engagement workshops were held before Christmas to inform this work. Section has more details Maternity and Children Page 3 of 5

4 The final Local Maternity System (LMS) plan was submitted on 30 October 2017 to NHSE, as well as a detailed LMS Communications and Engagement plan. 3.3 Cancer This programme is focussed on delivering the National Cancer Task Force Strategy recommendations and the Five Year Forward View for cancer (in alignment with the East of England Cancer Alliance) to: Improve cancer outcomes, safety and patient/carer experience Reduce variation in cancer pathways Improve and sustain system performance re national cancer waiting times standards. The STP Cancer Locality Group has agreed a work programme to deliver these outcomes. Good progress is being made with a focus on the lung and prostate cancer pathway redesign and prevention. 3.4 Mental Health Workstream The Norfolk and Waveney STP is working closely with the Suffolk part of the North East Essex and Suffolk STP on mental health matters. This is essential to ensure our strategic plans for mental health services are coordinated, given we have a single primary provider across both geographical areas. A new go live date of October 2018 is being worked to for the first crisis or wellbeing hub for Norfolk. Work continues on developing a business case for access to psychological services. The A&E psychiatric liaison service is preparing to go-live at the Norfolk and Norwich Hospital in January Looking ahead, an engagement event is under consideration to co-create a new vision for mental health services. 3.5 Urgent and Emergency Care Workstream The priorities agreed by the Urgent and Emergency Care Board are: Developing an STP urgent and emergency care predictor tool Developing a single frailty assessment tool Extended health in care homes Reducing variation in access to urgent and emergency care services Rolling out discharge to assess Reducing delayed transfers of care Developing an integrated urgent and emergency care service across the STP. 3.6 Prevention Workstream It has been agreed to establish a separate workstream on prevention to ensure this has a greater focus in the overall plan and to increase the pace of work around a range of prevention initiatives. Dr Louise Smith, Director of Public Health, will chair the Programme Board and be writing to key members regarding the first meeting in February. The priorities of this work programme include implementing a new model for social prescribing, further rolling out the National Diabetes Prevention Programme and implementing the suicide prevention strategy, plus self care, healthy lifestyles (including alcohol reduction, smoking cessation and weight management and exercise) and population health management. 3.7 Enabling Workstreams Further workstreams have also been established to ensure that the delivery of the STP is supported by system-wide approaches to Workforce, Estates, ICT and Communications Communications and Engagement Page 4 of 5

5 Chris Williams and Sharon Jarvis started work in the STP communications and engagement team in January, supported through central funding secured to March These two posts will improve resilience and effectiveness in this critical area of our work. A work plan for the year will be published at the end of January, with a focus on staff engagement across the STP. Healthwatch Norfolk organised a series of public events in November and December to discuss the Norfolk and Waveney STP, with particular focus on primary care, cardiology, urology and radiology services. This was a key part of our engagement work linked to the ongoing acute services review. These events will be mirrored in Waveney in March, and we are currently developing a detailed programme with key stakeholders in the Waveney area. Key themes we heard at these events included: People value the NHS and NHS staff, but they are concerned that there are not enough staff, that some are overstretched and that there are difficulties recruiting staff. People said they were worried about transport and they are concerned about services being moved around and patients having to travel further for treatment. People were concerned about, and critical of, mental health services. A few people were sceptical about the STP, were concerned that it is about cutting or privatising services, and they disagreed with setting-up accountable care organisations in England. More engagement with staff and unions was seen to be needed and would be worthwhile People who came generally appreciated the chance to find out more about the STP and have their say. They would like more follow up events and would like to see more people at these events. They want to be kept informed about our work and progress Workforce ICT The STP Workforce Strategy has been submitted to NHS England and Health Education England for approval and funding has now been released. This will fund a full time STP Workforce Lead and delivery of the programme of work. Detailed workforce planning has now begun, led by Roisin Fallon-Williams as SRO and supported by Emma Wakelin from Health Education England. A very helpful presentation was given on this critical topic to the STP Stakeholder board on 9 January. Mark Avery from the East Anglian Health Science Network has supported the STP for two days a week until the new Chief Information Officer starts in post in January Estates John Green, Chief Executive Queen Elizabeth Hospital, has now taken over as the SRO for this work stream. A meeting has been held with NHS Property Services to explore how they could support this work and there are plans for a workshop to focus on all estates issues. 4 Key Risks and Challenges 4.1 The key risks and challenges for all system partners are: Achieving the scale and pace of change within the available resources Implementing the changes to ensure a sustainable workforce Developing our digital maturity across Norfolk and Waveney as a key enabler to change. Page 5 of 5