Governing Body - Crawley CCG and Horsham and Mid Sussex CCG Paper Title

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1 Meeting Governing Body - Crawley CCG and Horsham and Mid Sussex CCG Paper Title Operating Plan Item number 58 i /15 Paper Author Sharelle Barber (Alison Hempstead) Lead Executive Dr Amit Bhargava for Crawley CCG Geraldine Hoban for Horsham and Mid Sussex CCG Date completed 8/3/16 Paper summary For Information For discussion For Decision The GB previously received updates on the emerging national guidance and the work in progress. The broad strategic direction has been approved by the Governing Body. The attached working draft Operating Plan represents year 1 of the CCGs contribution to the Strategic Transformation Plan (STP), which is a five year plan, compiled over the whole Sussex and East Surrey footprint. The STP is due to be submitted to NHS England by the end of June The CCG recognises that both a clear focus on our very local place based commissioning, alongside the broader system sustainability to be articulated in the STP, are complementary and necessary for improving outcomes for our population. The attached plan is work in progress and has been developed bottom up from the programme teams led by our clinical directors. GB members should note that the final submission date is 11 April 2016, and therefore some areas of our narrative require further work and are still being finalised. Purpose Governing Body Members are asked to approve this working draft version of the operating plan narrative, with the caveats outlined above. Governing Body are asked to delegate to the Accountable Officer, authority to sign off the final version to be submitted to NHS E on 11 April Further updates will be provided at the May GB meetings alongside progress with development of Sustainability and Transformation Plans. Associated papers Associated Committees Attached DRAFT operating plan narrative Previously work in progress considered by Executive/Delivery Groups and CRG/Locality Groups. Key themes and ideas with executive summary presented to both CCG CPRGs. How does this work link to the CCG Operating /Strategic plans? How does this work support the NHS Constitution/NHS Outcomes framework /KPIs Patient and Public Engagement to date Equality and Diversity Assessment Legal Implications Risk Register implications This is the CCG operating Plan The plan incorporates achievement of all targets and standards. NHS E specifically challenged the CCG in this are to demonstrate compliance. Key themes and ideas with executive summary presented to both CCG CPRGs. Individual project and programme level engagement is specific to each topic. The Plan includes awareness of health inequalities and measures required to reduce them. Each project has a specific equality impact assessment. None identified currently. Executive/Delivery Group will re-assess strategic risks at the start of the year against the agreed plan.

2 16/17 Operating Plan Working draft for discussion and review

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4 Contents Executive Summary Introduction Understanding the context for our work Health needs of our local population Ensuring sustainable health and social care locally Ensuring sustainable health and social care across Sussex Developing our vision and strategy for the next 5 years Our planning process Vision and strategic aims Delivering our vision in Crawley Delivering our vision in Horsham and Mid Sussex Patient and public engagement Our commissioning plans for Our approach to commissioning Sustainable General Practice and integrated community services Pathways of care Urgent and responsive services Ensuring parity of esteem in our mental health commissioning Ensuring the quality of services we commission Optimising medicines management Jointly commissioning services with social care Childrens services Learning disability and autism Dementia EoLC Better Care Fund Delivering our commissioning plans Managing our finances Demand management and capacity planning Delivery assurance and programme management CCG governance and risk management Developing our resources and infrastructure Workforce planning IM&T infrastructure Estates utilisation and development Next steps

5 Executive Summary [Draft Exec Summary once final draft is available] 4

6 1 Introduction This document summarises the key features of the 2016/17 Operating Plan for Crawley CCG and Horsham and Mid Sussex CCG (CHMS CCGs). It sets out our vision, and provides an overview of how we are working to transform our services, consistent with Delivering the Five Year Forward View, the NHS Mandate and NHS Constitution. During this time, we will focus on improving the health and wellbeing of our populations by: Delivering preventative and pro-active care, to help people keep themselves well and encourage access to services which improve their wellbeing. Strengthening the way we work in our communities, to deliver new models of care which are better able to meet their health needs. Integrating health, social care and voluntary sector services, to provide better joined up care across the services we commission. Improving our pathways of care, to deliver better clinical outcomes and choice for patients, meet the Constitutional Standards and improve the overall patient experience. Providing more integrated urgent care in our communities, so that people can be treated locally and do not have to travel to hospital unless it is clinically necessary. Achieving parity of esteem across our mental health services, to deliver the new access standards, diagnosis rates for dementia and transform care for people with learning difficulties. Ensuring the financial sustainability of our CCGs and contributing to the aggregate financial balance of our local health system. Our Operating Plan is aligned with the Sussex Sustainability and Transformation Plan (STP), and will deliver the agreed STP Year 1 actions locally for the population of Crawley, Horsham and Mid Sussex. [Check comment and expand using draft STP April submission] 5

7 2 Understanding the context for our work 2.1 Health needs of our local population [Work in progress. Identify scope health needs/ pockets of deprivation/ poor outcomes etc. Need to work with both CCGs to develop golden thread through section 2 & priorities in the logic models etc in section 3.] Crawley health needs and key priorities [To follow] Horsham and Mid Sussex health needs and key priorities [To follow] 2.2 Ensuring sustainable health and social care locally Our CCGs work across Crawley, Horsham and Mid Sussex, and jointly with other neighbouring CCGs, to commission effective services for our population. This enables us to understand potential issues in more detail and develop a greater awareness of the knock-on effects across the wider geography. It also allows us to strengthen our approach to system resilience planning, and identify/ mitigate risk by drawing on a wider range of resources. However our CCGs face particular challenges because our population is served by two large acute providers. Crawley and Horsham look towards Surrey and Sussex Healthcare Trust (SASH), while Mid Sussex is served by Brighton and Sussex University Hospitals Trust (BSUH). Additional local community medical care and specialist services are provided by Queen Victoria Hospital (QVH). Our staff work closely with all our providers through our existing collaborative arrangements as follows: Central Sussex Collaborative We are working through a formal arrangement with our neighbouring CCGs, in Brighton & Hove and High Weald Lewes Havens, to better understand and manage the demand and capacity required by the BSUH catchment population. This builds on work undertaken by Ernst & Young (E&Y) in 2015/16. Key collaboration programmes include: Reviewing the criteria for interim care beds to ensure capacity is optimised across the patch. Rolling out the integrated MCP model across the area built around clusters of general practice as described in section 4. Prioritising the interoperability of patient records across the footprint to enable integration. Managing demand strategically, stimulating capacity where required and developing new pathways for urgent care. Redesigning our collective response to elective needs through the development of one-call and the clinical hubs (incorporating reprocurement of OOH, NHS111 and integrating responsive services. Horsham and Mid Sussex CCG also recognise the importance of strengthening existing collaboration around SASH for their population in Horsham. In particular, we are working 6

8 through the newly established SASH Commissioning Board to conduct a demand and capacity exercise with E&Y. This would extend the BSUH benchmarking across our whole geography, identify opportunities for commissioning new pathways of care and optimise current capacity Horsham and Mid Sussex Local Transformation Board Our CCG is an active member of the Local Transformation Board which is led by Sussex Community Trust, and has representation from primary care in our towns, Queen Victoria Hospital, Brighton and Sussex University Hospitals Trust and West Sussex County Council. Current priorities for the Transformation Board include developing new models of care in our communities and supporting the development of the infrastructure required to deliver these new ways of working SASH Commissioning Board We are working through a partnership arrangement with Crawley, Horsham and Mid Sussex and East Surrey CCGs (the SASH Local Commissioning Board) to better understand and manage the demand and capacity required across the SASH catchment population. We have initiated a review with E&Y (similar to the one undertaken for the BSUH economy) to establish the baseline upon which we can build our collaborative programmes of transformational work Crawley Integrated Community Services Board (CICSB) We will be working with our partners Sussex Community Trust, Sussex Partnership Foundation Trust and West Sussex County Council to integrate community services on a Crawley Borough footprint. The CICSB will agree new models of community care building on our earlier Pro-active Care Programme, and start to implement service improvements and workforce integration based around two Communities of Practice in Crawley from the second quarter of 2016/17. We will ensure that our place based plans fit coherently and align with the Sussex and East Surrey STP described below. 2.3 Ensuring sustainable health and social care across Sussex [Update using draft STP April submission when available] We are working with our health and care system to identify the most appropriate footprints for the Sustainability and Transformation Plans (STP) across the Sussex geography. Our CCGs understand the importance of delivering robust place-based planning for our local population, and the significant benefits of achieving effective system leadership across commissioners and providers. The move towards a shared and open-book approach to operational planning, in particular integrated activity, demand and financial planning, is welcomed. We have worked with our neighbouring CCGs, providers and councils to identify and agree the most appropriate STP footprint - covering Sussex and East Surrey. The footprint includes eight CCGs, four Acute Trusts, four County Councils (coterminous Health and Wellbeing Boards), two Community Trusts, a Mental Health Trust and an Ambulance Trust. In addition to the many primary care providers, smaller providers and District Councils that will need representation within the structure. [Update table with list of all partner organisations in new footprint information requested] 7

9 CCGs NHS Brighton & Hove CCG NHS High Weald Lewes Havens CCG NHS Horsham and Mid Sussex CCG NHS Crawley CCG NHS East Surrey CCG NHS Coastal Local Councils County Council Surrey West Sussex County Council Brighton & Hove City Council (Unitary) East Sussex County Council Providers Brighton and Sussex University Hospitals NHS Trust Sussex Community NHS Trust Sussex Partnership NHS Foundation Trust Surrey And Sussex Healthcare NHS Trust Queen Victoria Hospital NHS Foundation Trust South East Coast Ambulance Service NHS Foundation Trust Surrey And Borders Partnership NHS Foundation Trust Third sector First Community Health and Care Virgin Community Services Limited Relevant District and Borough Councils Relevant Health and Wellbeing Boards Third Sector 8

10 3 Developing our vision and strategy for the next 5 years 3.1 Our planning process [Add text outlining bottom up approach to Op Plan development] We have worked across our CCGs and partner organisations to develop our shared vision, commissioning strategies and work plans. These take into account the specific health needs of our local populations and reflect the particular commissioning issues facing each CCG. They are designed to deliver the Five Year Forward View, the NHS Constitution and NHS England s Mandate. They reflect best practice approaches to commissioning, and are consistent with national guidance. Our Programme teams and clinical directors have worked together to identify their planning priorities for both the strategic planning period (2016/17 20/21 to inform the Sussex Sustainability and Transformation Plan. see Appendix1) and for 20/16/17. The outputs from this process are summarised in section 4. [check ref] 3.2 Vision and strategic aims We have worked across our CCGs with clinicians, staff and patients to understand how we should shape our services for the future. This work is ongoing and continues to evolve as we develop our transformation plans and work with our health and social care partners locally. Our current draft vision is set out below: By 2020/21 we will have transformed our care so that you can access: Help to care for yourself, keep you well and meet your day to day health needs. This will be provided close to home, with more services available in the local community. If you do become ill, we will treat you in your community where possible, rather than referring you to hospital unnecessarily. High quality pathways of care for when you require specialist care appropriate to your healthcare needs. These are designed to meet nationally recognised standards, and aim to deliver best clinical outcomes for patients. We will deliver this care in a variety of places across our communities, such as GP practices, community facilities and hospitals. Urgent and responsive care for when you need healthcare in a hurry. Clinical staff will care for you when you have an urgent healthcare need, an accident that requires medical attention or a healthcare emergency. These services will be located in our communities as well as in hospital. [ 9

11 Looking after the health and wellbeing of our population in Crawley, Horsham & Mid Sussex Caring for yourself For your day to day needs Enabling your physical health & mental wellbeing Pathways of care When you need specialist care Urgent & Responsive care When you need healthcare in a hurry We will ensure that you receive high quality, sustainable care where ever it is delivered. We will provide as many services as possible in our five communities Crawley, East Grinstead, Horsham, Haywards Heath and Burgess Hill by working closely with our local health and social care partners. 3.3 Delivering our vision in Crawley [Add logic model or some such from Amit and David. Meeting arranged for 15 th and 22 nd March] 3.4 Delivering our vision in Horsham and Mid Sussex [Add logic model. Meeting with Minesh on 15 th March to understand model and confirm content] 3.5 Patient and public engagement [Text requested from Sue Lin] 10

12 4 Our commissioning plans for [Update all text and tables with information from 3 rd planning round] 4.1 Our approach to commissioning We use a number of specific tools and techniques such as Right Care, (including Commissioning for Value and the Atlas of Variation) and the CCG Outcome Indicator set to inform our commissioning. These enable us to benchmark the care provided, review potential outliers and unwarranted variation in comparison with national and peer group comparators. [Work in progress to outline use of Right Care as an integral part of our approach to commissioning to be informed by discussions at March Exec and Delivery] Our CCGs are also participating in wave 2 of the Right Care programme. 4.2 Sustainable General Practice and integrated community services We recognise that our current model of service delivery is not sustainable demand for health and care services is growing as our population lives longer and we know that the cost of meeting this demand is rising more quickly than we can afford. Patients, and in particular those with long term conditions, often find their experience of care disjointed and uncoordinated. Whilst the health and wellbeing of local people overall is better than the national average, there are local areas of deprivation where people have poorer health and lower life expectancy which need to be addressed. Looking to the future in Horsham & Mid Sussex and Crawley we know we will have a larger population and one that is living longer with complex needs. At the same time locally our general practices and community services are increasingly struggling to meet the current demands. We have focused our vision for primary and community care services to around addressing the three gaps highlighted in the Five Year Forward View by: 1. Health & wellbeing gap: having a much stronger focus on empowering and supporting patients to give them the knowledge, skills and confidence to manage their own condition and on prevention through for example participation in wave one of the National Diabetes Prevention Programme; 2. Care & quality gap: working with clinicians to develop a new model of high quality integrated care with sustainable general practice at the core, bringing in wider groups of community-based professionals to provide joined up patient-centred care, tailored to the needs of the local community; and 3. Funding & efficiency gap: focusing on better management and support in primary and community services for the relatively small numbers of the most complex patients but that have a disproportionate cost to the health and care system and increase pressure on the system as a whole. Our aim is to deliver high quality, accessible care to our population, and move from a service that is primarily reactive and bed based, to one that focuses on keeping people well and treating them proactively in the community when they do become ill. We believe the best way to do this is to build on the strength of general practice and community providers. Both play a pivotal role in coordinating care and preventative interventions for the most vulnerable patients, particularly for people with long term conditions. 11

13 We aim to do this by creating a new model of high quality integrated care with general practice at the core, bringing in wider groups of community-based professionals to provide joined up care, tailored to the needs of the local community. This will include: Groups of practices working together to provide a much wider range of services, and in close partnership with community services to provide many more services out of hospital. In 2016/17 we will look to develop enhanced primary healthcare teams, bringing together community nursing teams & multi-disciplinary proactive care teams into one integrated team based around groups of general practice in the communities across Horsham & Mid Sussex and Crawley. Targeting services for different groups of patients. Care will be designed around complex patients supported by the enhanced multidisciplinary teams and focused on early intervention, living well at home and avoiding unnecessary use of the hospital with specialist care in the community. Testing and widening new skills and roles for enhanced primary care teams, including for example increased use of pharmacists, community paramedics and advanced nurse practitioners. Working more closely with the third sector. A much stronger focus on empowering and supporting patients and their carers, to give them the knowledge, skills and confidence to manage their own condition. We have recently been successful in our bid to become a Primary Care Home pilot site in one of our localities East Grinstead working with the National Association of Primary Care and the national Vanguards programme. We will work as part of this programme to develop this new model of care at pace in 2016/17, ensuring that the learning is shared across our CCGs with the other 4 localities to inform the development of their own plans. The transformation of primary care and the development of new models of self and supported care, will enable us to deliver on the prevention agenda (most importantly on secondary prevention).the work we are doing to establish the Crawley social prescribing programme will help to improve pathways which connect individuals and communities to services and community resources. We will build on our experience of developing social movement approaches, such as creating Dementia friendly Crawley, and apply this approach to improving health outcomes in other areas, such as childhood obesity. This in turn will help us to: Develop a new focus on health inequalities. Establish effective partnerships between primary care, the voluntary sector, local government and business (businesses have much to offer including health and wellbeing facilities, sponsorship and expertise of staff). Work with partners to encourage community engagement and volunteering to improve health and wellbeing. During 2016/17 we will focus on delivering the following key projects: [Work in progress] Key projects Main activities Milestone dates 12

14 Key projects Main activities Milestone dates 4.3 Pathways of care Our programme teams are working across both CCGs and with our partners to review our existing pathways of care. This ensures that we are commissioning services which deliver better outcomes for our patients, best value and are agreeing where necessary trajectories for improvement with our providers. A summary of our performance against the NHS Constitutional standards and other access and performance targets is provided in section 6.2. [Check] Cancer Cancer was flagged up as a clinical priority in the Five Year Forward View and an independent Cancer Taskforce was convened in January 2015 to define a new cancer strategy for the healthcare system. Achieving World-Class Cancer Outcomes: A Strategy for the NHS was published on 19 July 2015 and sets out a proposed new five-year cancer strategy for the NHS. The new strategy builds on the themes of previous cancer strategies and makes the case for a much greater emphasis on earlier diagnosis and living with and beyond cancer. The Cancer Taskforce has estimated that implementation of the Cancer Strategy could deliver around 30,000 additional patients surviving cancer every year and a step-change in patient experience and quality of life. Additionally, in June 2015 new guidance on the referral of patients with suspected cancer was released by the National Institute for Care and Clinical Excellence (NICE). Suspected cancer: recognition and referral lowers the threshold for referral to investigations or to a cancer specialist and has significant implications for commissioners. New commissioning arrangements introduced in April 2013 mean that currently CCGs are responsible for commissioning common cancer services, early diagnosis, and services for patients living with and after cancer and end of life care approximately 60% of the cancer patient s journey; NHS England remains responsible for the direct commissioning of specialist cancer services. Ensuring that patients have rapid access to diagnostic and treatment options will improve their earlier diagnosis, one-year survival and quality of life and will reduce the proportion of cancers diagnosed following an emergency admission. During 2016/17 we will focus on delivering the following key projects as our first step to full implementation of the national cancer strategy: Key projects Main activities Milestone dates Prevention and Analysis of practice screening data and Macmillan GP 13

15 Key projects Main activities Milestone dates awareness Earlier diagnosis (Improving 1-year survival & delivering year-onyear improvement in the proportion of cancers diagnosed at stage 1 & 2.) Deliver the 62-day cancer waiting standard. (Inc. ensuring diagnostic capacity) Reduce diagnosis of cancer as a result of an emergency presentation. Patient experience, and living with and beyond cancer. Modernising cancer services Commissioning accountability and provision practice visits commenced. (Crawley) Work with CRUK to raise awareness of the opportunities for screening through GP practices. (Crawley) Raised awareness of the importance of screening through a CRUK/Macmillan presence at local events. (Crawley) Completion of the ACE lung pilot projects: Pathway evaluation. (Crawley) Implementation of best practice pathway.(hms) Pathway evaluation.(hms) Distribution of NG12 proformas for a suspicion of cancer, with related communications and GP education. (Both CCGs) Gap analysis and agreement of future commissioning arrangements to provide full implementation of NG12. (Both CCGs) Implementation of alliance approved timed pathways, starting with Digestive Diseases streamlining. (Crawley & Horsham) Improve delivery of DD services, ensuring that patients are able to meet NHS Constitutional Standards. (Mid Sussex) Targeted approaches on awareness of cancer to local communities and groups. (Crawley) Scoping the impact of emergency presentations for cancer as an impact on the system as a whole. (Crawley & Horsham) Improve use of end of treatment summaries by primary care. (Crawley) Implement commissioned health and well-being days for patients with and after cancer. (Crawley and Horsham) Improve use of holistic needs assessments and cancer care reviews. (Both CCGs) Ensure fax referrals are replaced by /e-referral.(both CCGs) Identify workforce implications for delivery of 62 day cancer standards in the implementation of timed pathways.(both CCGs) Develop CCG strategic plans that reflect the processes and arrangements for the future commissioning of cancer. (Both CCGs) Q2 2016/17 Q3 2016/17 Q3 2016/17 Q1 2016/17 Q1 2016/17 Q3 2016/17 Q1 2016/17 Q3 2016/17 Q4 2016/17 Q2 2016/17 TBA Q2 2016/17 Q2 2016/17 Q4 2016/17 Q4 2016/17 Q /17 Q4 2016/17 Q3 2016/ CHD and Stroke [Stroke to follow] Stroke is the leading cause of disability and third largest cause of death in England. There are 110,000 strokes in England each year, and at least 900,000 stroke survivors are living in England, a third of whom live with moderate to severe disability. The cost to the economy is estimated at around 7 billion per year, of which at least 2.8bn is direct cost to the NHS (National Stroke Strategy, 2007). 14

16 Last year there were a total of 1180 admissions for stroke across both CCGs, with 51% diagnosed as stroke (Cerebral Infarction) and 16% diagnosed as TIAs or head injury. For the Crawley CCG population: The prevalence is 3.22 people per 1000 admitted each month with a diagnosis of stroke. The number of admissions for people with a diagnosis of stroke was 319 and 392 for ABIs, with an average spend of 1,445 and 1,357 respectively. For the Horsham and Mid Sussex CCG population: The prevalence is 2.14 per 100 people per 1000 admitted each month with a diagnosis of stroke. The number of admissions for admissions people with a diagnosis of stroke was 861, and 759 with ABIs, with an average spend of 2,261 and 1,563 respectively. Expenditure of cardio vascular disease in the CCGs is [??? check] than the national average. Stroke is unique amongst cardiovascular conditions in the complexity and diversity of the possible sequalae, which for most survivors which include a combination of physical, cognitive and emotional changes. Estimates indicate that about a third of stroke survivors are left with long-term residual disabilities and needs which can persist for many years following the acute stroke event, implying that there are over 393 people per year added to the population of stroke survivors in the area that will require some sort of on-going support. During 2016/17 we will focus on delivering the following key projects: Primary prevention with Locally Commissioned Service (LCS) focused initiative to ensure that those patients who are not optimally anticoagulated receive a holistic assessment of their needs and appropriate medication to the new NICE standards. Commissioning the implementation of the SEC Service Specification enabling providers to work together as an inter-disciplinary stroke network across South East Coast in order to fully integrate stroke care and provide seamless transition of care between providers. Timely access to Hyper Acute and Acute pathway specialist Services through the reconfiguration of current pathways in line with the South East stroke service reconfiguration work and recommendations, to ensure best possible outcomes for patients and the most effective use of resources across the health economy Provide clear commissioning intentions for providers of specialist neurorehabilitation pathways within acute and community care to ensure clear pathways are applied which meet the needs of patients following a stroke. Provide SEC Service Specifications which meet professional clinical and NICE guidelines on the Stroke pathway The following outcomes are anticipated: Improve the outcomes for stroke patients by reducing mortality and levels of dependency following an acute stroke. Reduce the length of stay of stroke patients in bed based services. Improve patients experience and to enhance their recovery following a stroke. Reduce readmission rates for stroke patients. Improve patient access and experience of specialist stroke care. Provide services based on an accepted international and national evidence base. Provide services which are sustainable and value for money. [Workplan under review] 15

17 Key projects for stroke and CVD Main activities Milestone dates Primary prevention through the AF LCS - optimal anticoagulation of patients with known AF (HMS) Identification of patients with undetected AF (HMS) Identification of patients with undetected AF and management of patients with AF in Crawley Develop an overarching stroke strategy in line with the Sussex and Surrey Stroke review Implementation of the LCS Review and monitoring (BAU) Audit of outcomes April 2016 Q4 2016/17 Agree the strategic approach and develop year 2 of the LCS Q3 2016/17 Develop the approach and strategic direction Q2 2016/17 Public consultation on potential stroke models. Review Stroke Association contract and integration with new models of community care. Begin alignment of services for a move to an agreed HASU / ASU model. Begin alignment of services for a move to an agreed HASU / ASU model. Q2 2016/17 Q2 2016/17 Q4 2016/17 Q4 2016/ Diabetes During 2016/17 we will focus on delivering the following key projects: Implementing the NHS diabetes prevention programme (NDPP) wave 1. This was announced in the NHS Five Year Forward View which set out the ambition to become the first country to implement at scale a national evidence-based diabetes prevention programme modelled on proven UK and international models, and linked where appropriate to the new NHS Health Checks. The NDPP aims to deliver at a large scale services for people already identified with non-diabetic hyperglycaemia, and who are therefore at risk of developing type 2 diabetes. High risk individuals will be offered a behavioural intervention to enable them to reduce their risk of developing type 2 diabetes through weight loss, improved diet and increased levels of physical activity. Review of our primary care locally commissioned service (LCS). This aims to review the provision of services locally for people diagnosed with diabetes to ensure the eight care processes are implemented across primary care in an equitable way in line with current NICE guidance and best practice. A review of the investment we make across the diabetes pathway to consider whether we are getting the best value for our investment, considering where there might be gaps and focusing on those areas where we need to improve the quality of services for local people to inform our future commissioning intentions. 16

18 4.3.4 Planned care [Draft text to be reviewed] Business As Usual For 2016/17 the planned care team will be supporting the contracting team in managing over 30 contracts in over 8 specialities. This involves as a minimum bi-annual meetings, monitoring of performance and quality, as well as managing issues as they arise such as complaints and incidents. The team also schedule into the programme plan any procurement processes required for projects. For 2016/17 this will be around tier 3 weight management services. The monitoring of the MSK contract continues to be resource and time intensive as Horsham and Mid Sussex are the lead Commissioner, although it will be our intention to make this business as usual in time. Future developments The planned care team support the local acute Trusts with programmes of work including pathway redesign, market development and managing growth. These focus on specialities, initially, where patient pathways are not aligned to the NHS Constitutional mandates due to demand. This involves building on and developing already established community services such as ENT and urology and direct discussions with Independent sector providers around pathways affording greater patient choice of provider and being seen an treated in a timely way, such as gall bladder pathway, rectal bleeding pathways. The planned care team are also scoping alternative services and providers in the community -such as for the management of referrals and treatment of patients with digestive disease conditions. In developing such pathways the team are working closely with the cancer team to incorporate the NICE cancer guidance. In 2016/17 there will be a focus on diagnostics and direct to test. Throughout the development of such projects the planned care consider the outcomes from reports such as Right Care variation, public health JSNA, and ability to benchmark against other similar services in England. The challenges The planned care programme plan schedules activities on an annual basis and the plan is discussed at the bi-monthly planned care programme board. An increase in staff establishment has been agreed for 2106/17 and workload apportioned accordingly. However the challenges are often as a response to events that happen such as closure of services, quality issues within a service, monitoring of performance, liaison with providers when issues arise, and the resource and time required to deal with these whilst trying to maintain traction with projects. The establishment of workstreams/ task and finish groups in year to support other local CCGs and development of services; to support local Trusts with service redesign; to consider the impact and implement NICE guidance; to manage primary care services and demand; are considered by the programme board and prioritised accordingly. During 2016/17 we will focus on delivering the following key projects: Key projects Main activities Milestone dates NHS Constitution capacity and demand modelling Shaping and modelling based on Intensive Support team work with BSUH. Horizon scanning other health economies where pathways effective, lessons learnt Building support from March 2016 Meeting with IS providers to create pathways from March

19 Key projects Main activities Milestone dates Embed MSK into BAU Support for BSUH/ CCG planned Care programme board DD and diagnostics (working with cancer programme) Monitoring and support for SaSH in delivering NHS Constitution standards. Move of services from specialised tier 4 weight management/ neurology Working with Independent Sector to create pathways for effective use of all capacity Implement a strategy which supports MSK embedding into BAU with reduction in commitment and resource to monitor progress Key areas for CCGs to work with BSUH on DD, neurology, ENT, gynaecology, T&O (including pain) Diagnostic pathway- capacity and demand, impact of guidance, pathways post diagnosis. Project mandate/ BC/ Service modelling and specification, stakeholder engagement Focus with wider health economy Attendance at planning meetings Work with East Surrey CCG Understanding specification and monitoring of tier 4 services- SaSH will want to apply Links for neurology into RTT poor performance and through BSUH planned Care Programme Board Scoping additional capacity for DD clinic activity by May 2016 By March 2017 Programme Boards monthly. Key area focus monthly deep dive Actions for CCGs/ BSUH monitored and progress reported at meetings Initial scoping work by April 2016 Formal project plan June 2016 Ongoing April- June and ongoing monitoring October March with plan for resource management Maternity By 2020/21 we will have transformed our care so that women can access high quality maternity care locally. This will enable women to be supported to create an individually tailored care plan empowering them to give birth in a care setting of their choice. Top priorities for strategic planning period include: Improve perinatal mental health. To improve support and provision from pre-pregnancy advice - for women with existing MH issues - through to the first 18 months of a baby s life. Implement the Quality standards issued on 18 February 2016 across our geography. This includes Implement the recommendations of the by Baroness Cumberledge s report Better Births: Improving outcomes of maternity services in England (23 February 2016). Implement NICE guidance on low weight/still births. Improve safety and increasing personalisation and choice in maternity services. 18

20 During 2016/17 we will focus on delivering the following key projects: Key projects Main activities Milestone dates Milk Formula Review Perinatal Mental Health Normalising Birth Programme Review of the current prescribing practices. Identify best practice. Agree formula/pathway for reflux/cow s milk intolerance. Deliver education events. Agree and implement pathway. Work to be led by the Clinical Advisory Group. Work with acute hospitals to agree a programme of work and milestones to improve the number of normal births. To include best practice on decision making to improve outcomes for women and their babies, the implementation of the Better Births report and NICE guidance on low weight/still births. Q2 2016/17 Q2 2016/17 Q3 2016/17 Q4 2016/17 Q3 2016/17 Q2 2016/ Urgent and responsive services We are working with actively across our two System Resilience Groups (SRGs) and the new Urgent and Emergency Care Network to transform our urgent and responsive services. Our aim is to implement an integrated, 24/7 urgent care pathway, which is accessed and navigated through the NHS 111/ Twin (Clinical) Hub. This will be designed to treat people in the most appropriate environment, depending on their condition as follows: People who have an urgent but non life-threatening need will receive care closer to home. This will be delivered by a range of clinical teams and services including GPs, pharmacists, minor injury units (MIUs), the urgent treatment centre (UTC) and clinical assessment unit (CAU). We are also consolidating our community teams into a single Responsive Service to minimise handoffs and reduce confusion. We will change the way we work to improve access to appointments locally, so that our population do not have to travel to emergency departments in hospitals unnecessarily. People with a life-threatening condition who need emergency and specialist care, will be treated in the emergency departments and specialist services of acute hospitals. People who have an urgent but non life-threatening need and make a 999 call for an ambulance, will be treated on site by a paramedic where clinically appropriate. This will reduce the number of people who are taken to hospital unnecessarily and will enable our emergency services to concentrate on patients who require their specialist expertise Transforming our care pathway will enable us to better integrate the services which provide urgent and responsive services, and provide patients with the right advice in the right place as shown below. 19

21 Hosp to home Take home & settle 2016/17 Operating Plan V1.6 Working Draft Brighton and Sussex University Hospitals OOH Urgent Care Summary Burgess Hill Community Princess Royal Hospital Urgent (inc. Acute Physician) Haywards Heath RAMU / OOH SRC/DAY Hosp Social Care (inc. Carer, Safeguarding and Advocacy) East Grinstead HRDT AMU A&E Daytime GP Discharging MRD Horsham Responsive Services PTS MH Urgent Crawley Kleinwort Crawley Hosp Beds / UTC Surrey and Sussex Hospital QVH MIU Horsham Hospital Beds / MIU Care Home LCS CHIRT DIRT Telecare EOLC Co-ordinator St Catherine's Hospice St Peter & St James Hospice Self Care Single Pathways 111 Pharmacy The implementation and delivery of the new integrated urgent care pathway is a major undertaking. It will be managed through our SRGs, and phased over the next 5 years. Key milestones for this transformation comprise: Responsive services - Finalising the service specification by March Twin hub - Confirm clinical hub design to integrate 111 model by June Front door provision - Scoping and phasing in the networking of MIUs/ UTCs/ Acute front doors by March Twin hub - Confirm and beta test Phase 2 clinical hub (Twin Hub) by April Twin hub - Implement Phase 3 of clinical hub, with integrated and transformed 111 and OOH services. NHS Re-procurement aligned with Twin Hub development by March Integrated primary & community service model - Fully embed Target Operating Model 3 by March Integrated hospital discharge - Fully embed Target Operating Model 4 by March Key projects Main activities Milestone dates Twin Hub TUCC & Sub Acute Ward Responsive Services & Front Door Provision Define vision for Urgent Care Pathway (NHS 111 and OOHs role). Contract extension negotiation if applicable. Develop clinical hub. Finalise business cases. Recruitment. Communications strategy. Opening. Finalise service specification.* Consolidate existing teams. Scoping and phasing in networking of MIUs/UTCs/Acute March 2016 July 2016 March 2016 Jan - April 2016 July Sept 16 October 2016 March 2016 June 2016 March

22 Key projects Main activities Milestone dates Front Door PRH Front Door SASH Care Home Services Front Door.* Finalise and implement primary care model. Embed HRDT. Implement HRDT model. Scope primary care model. Finalise and implement primary care model. Scope and evaluate all services. Engagement exercise with providers. De-commission/commission. Community Beds Fully implement SAFER. Shift from purely step down to step down/step up model. Prioritise cohorting. *Indicates key milestone in the on the Urgent Care transformation pathway. July 2016 July 2016 March 2017 July 2016 March 2017 June 2016 Summer 2016 September 2016 July 2016 March 2017 March Ensuring parity of esteem in our mental health commissioning Our CCGs remain firmly committed to closing the health gap between people with mental health problems, learning disabilities and autism, and the population as a whole. Our work is delivered through a number of different programmes, each targeting different needs within our communities: Adult mental health through the work set out in this section. Child mental health jointly commissioned with social care through the Children and Young People Mental Health Transformation Plan. (see section 5.1?) Perinatal mental health through our maternity programme. (see section 4.2.5?) Dementia care jointly commissioned with social care through our Dementia Framework for West Sussex (see section 5.3?) Learning disabilities and autism - jointly commissioned with [social care] through our [check what] workstream which is lead by Brighton CCG (see section 5.2?) We are continuing to transform and develop the way in which adult mental health services are delivered locally by our providers. Our aim is to transform services so that people can: 1. Get help early when mental health difficulties emerge or reemerge. 2. Get help quickly when mental health problems become urgent. 3. Expect to access physical health care services that also address the psychological impact of the illness/ condition. 4. Expect to receive mental health support that is recovery focus. During 2016/17 we will focus on delivering the following key projects: Key projects Main activities Milestone dates Crisis Care Concordat Enhanced MH liaison service at PRH and ESH. Increasing access to MH support for wider range of statutory and voluntary services. April 2016 March

23 Key projects Main activities Milestone dates Pathways, Clustering and Currency development Implementation of new Tier 2 service Improve physical health of patients with SMI Increasing access to psychological therapies Cluster based pathways linked to Carenotes. Strengthen data reporting and assurance. Clustering training for clinicians. March 2017 New service commences. June 2016 Develop holistic service providing targeted physical health care. March 2017 Increase to 16% for both CCGs. March 2017 We are already meeting the new national 2016/17 access standards for 50% of people experiencing a first episode of psychosis to access treatment within 2 weeks, and providing access for 75% of people with appropriate conditions to talking therapies. Currently we achieve 90% access within 6 weeks and 100% within 18 weeks. 4.6 Ensuring the quality of services we commission Our approach to improving quality and patient safety places the NHS Constitution at the heart of our work, ensuring that we monitor and make efforts to improve, the quality of healthcare we commission. Our aim is to drive up the quality of care, treatment and overall patient experience of the services commissioned for our population. This includes working to close known gaps in equality and access across our communities, within a framework of continuous quality improvement. Our approach is aligned to three domains of quality within the NHS: Patient safety - commissioning services that are safe and continually improving. Patient experience - engaging effectively with our stakeholders, local communities and patients where we anticipate changes to services offered. Clinical effectiveness - monitoring patient outcomes and taking remedial contractual action where proportionate and appropriate. Our quality assurance and improvements process feeds into the CCGs Quality Assurance Framework, which is in use with all our commissioned providers. This enables us to measure 22

24 and benchmark providers against best practice, identify gaps in quality and ensure provider accountability. We work in close collaboration with our providers focusing on: Delivering continuous quality improvement which enhances quality and patient experience. Extracting and embedding learning from incidents, complaints, safeguarding, soft intelligence, clinical reviews and audits. Incorporating learning and outcomes in our contractual schedules and processes. Promoting openness, transparency and candour throughout the local system to aid learning, in line with best practice and national guidance. Assurance is undertaken through formal quality review meetings, qualitative and quantitative data and provider site visits. We are working with the Programmes teams in the CCGs to support transformational change, and ensure that the care is provided in the most efficient way possible in line with consistent quality standards. Particular issues include: Redesign of community/primary care nursing models of care. Population health focusing on the wider lifestyle determinants of ill health. Supporting integrated systems of out of hospital care. In addition to our regular quality assurance work, we will also focus on delivering the following key projects in 2016/17: Key projects Main activities Milestone dates Develop Quality strategy for CCGs Develop a quality approach and strategy for our CCGs. Embed approach within our programmes and organisation to reinforce the importance of delivering continuous improvement. Qtr /17 Quality support for commissioning Agree an ongoing programme of quality improvement and monitoring with providers, designed to meet national targets and standards. Identify programmes support requirements for 2015/16. eg Cancer: improving outcomes. Dementia: address cultural issues. Primary Care transformation/ communities of practice. Stroke: support providers to meet national targets. Rightcare outcomes findings across all Programmes. Develop generic templates to support Programmes with: Quality criteria for service reviews/ specifications. Care setting base requirements. Identify and refine programmes requirements for 2016/17. Qtr /17 Qtr /17 Qtr /17 Qtr /17 Quality support to Primary Care & General Practice Identify support required by practices to: Reduce primary care associated infections. Prepare for CQC inspections. Support practices identified by CQC as needing to improve. (Quality team to work collaboratively with Primary care team to make best use of resources.) Raise awareness of Sepsis, in conjunction with KSS Patient Safety Collaborative. Qtr /17 23

25 Key projects Main activities Milestone dates Super CQUINs and CQUINs Learning Disabilities/ autism Sign off Super CQINS with providers. Develop a methodology for evaluating the impact, effectiveness and outcome. Map process for developing CQUINs for 2016/17. Develop and agree CQUINs with providers Transform care and address the health gap, in conjunction with the Transforming Care Partnership (see section 5.2 check) Qtr /17 Qtr /17 Qtr /17 Qtr / Optimising medicines management Medicines play a crucial role in maintaining health, preventing illness, managing chronic conditions and curing disease. However it has been estimated that between 30-50% of medicines prescribed for long-term conditions are not taken as intended. (WHO 2003). Clearly it is vital that patients get the best quality outcomes from their medicines 1, and the NHS is actively seeking to ensure this through the use of medicines optimisation. This approach seeks to maximise the beneficial clinical outcomes for patients from medicines, with a focus on safety, governance, professional collaboration and patient engagement. Effective medicines optimisation is underpinned by four key principals, as outlined by The Royal Pharmaceutical Society: In we will continue to focus on initiatives which use the medicines optimisation approach to realise quality improvement and efficiency savings in medicines management and prescribing. These fall in to three broad categories: Incorporating medicines optimisation in all aspects of commissioning. Supporting medicines optimisation in primary and community care. 1 RPS Medicines Optimisation: Helping patients to make the most of their medicines. 24