Haringey CCG Governing Body 9 November STP 6 month progress report

Transcription

1 Haringey CCG Governing Body 9 November 2017 STP 6 month progress report Helen Pettersen Accountable Officer & STP Convenor Will Huxter Director of Strategy North Central London CCGs

2 Ambition of the STP Achievements and challenges System-wide working including style Clinical and managerial leadership Urgent and Emergency Care Adult Social Care Finances Priorities to 31 March 2018

3 AMBITION OF THE STP

4 Ambition of the STP Ambition for the STP is built on existing CCG values and strategy: to improve the health of the local population, maximise care outside hospital, and reduce health inequalities 4 key elements to the plan: prevention, service transformation, productivity, enablers A partnership of the NHS and local authorities, working together where it s the most efficient and effective way to deliver on the shared ambition; and working together with the public, patients and Healthwatch.

5 ACHIEVEMENTS AND CHALLENGES

6 Examples of recent achievements (1) Strengthened relationships, visibility and understanding Sharper view of priorities Development of 2018/19 system intentions CC2H: each CCG producing local road map aligned to NCL strategic approach Planned care: MSK, urology and neurology pathway work underway

7 Examples of recent achievements (2) Digital: agreement to progress to Health Information Exchange as route to ICDR and population health management Mental health: specialist community perinatal service now live UEC: general surgery ambulatory care pathway pilot up and running POLCE: Enfield GB agreed changes postconsultation; consultation to be rolled out across remaining CCGs

8 Challenges this year CCG, provider and local authority financial positions/pressures Capped Expenditure Process Timetable and capacity for delivery of transformation alongside business as usual Communication and engagement Strengthening connections within the STP between CCGs and workstreams, providers, local authorities, and patient representatives

9 SYSTEM-WIDE WORKING

10 System-wide working Big cultural change to focus on the system not on individual organisations/institutions Providers agreeing joint programme of work they can do together on productivity, over and above individual CIP plans (eg patient transport, facilities) Commissioner lead from one CCG co-ordinating input from all CCGs on individual workstream initiatives gains in consistency, efficiency, and professional development

11 NCL CCGs SMT Role Accountable officer, NCL CCGs and STP convenor CFO, NCL CCGs Director, Acute and Performance, NCL Director of Strategy, NCL CCGs COO, Barnet CCG COO, Camden CCG COO, Enfield CCG COO, Haringey and Islington CCGs POD Director, NELCSU Name Helen Pettersen Simon Goodwin Paul Sinden Will Huxter Kay Matthews Sarah Mansuralli John Wardell (starting December) Tony Hoolaghan Eileen Fiori 11

12 CLINICAL AND MANAGERIAL LEADERSHIP

13 Clinical leadership and engagement Fundamental to development and implementation of every aspect of the STP Input into each workstream essential leadership across CCGs Challenge and assurance of STP initiatives via Health and Care Cabinet STP Advisory Board includes Chairs of all CCGs Looking at systematic approach to quality improvement across all of the STP, with initial focus on CC2H

14 Workstream SROs and Clinical Leads STP Workstream SRO(s) Clinical Lead(s) Prevention Dr Julie Billett, Director of Public Health, Camden and Islington Dr Karen Sennett, GP, Islington Dr Tom Aslan, GP, Camden Health and Care Closer to Home Tony Hoolaghan, COO Islington and Haringey CCGs Dr Katie Coleman, GP, Islington Urgent and Emergency Care Sarah Mansuralli, COO/Local Executive Director, Camden CCG Dr Samit Shah Mental Health Paul Jenkins, CEO Tavistiock and Portman Foundation Trust Dr Vincent Kirchner, Medical Director, C&I Dr Jonathan Bindman, Medical Director, BEH Dr Alex Warner, GP, Camden Cancer Professor Kathy Pritchard-Jones, Chief Medical Officer Dr Clare Stephens, GP Barnet CCG Professor Geoff Bellingan, Medical Director, UCLH Planned Care Marcel Levi, CEO UCLH NHS Foundation Trust Dr Richard Jennings, Medical Director, Whittington Health Dr Ahmer Farooqi, GP Barnet Maternity Rachel Lissauer, Director of Commissioning, Haringey CCG Professor Donald Peebles, Clinical Director Mai Buckley, Director of Midwifery Children and Young People Charlotte Pomery, AD Children s Services, Haringey Council Dr Oliver Anglin, GP, Camden Estates Simon Goodwin, NCL CCGs Chief Finance Officer TBC Digital David Sloman, CEO Royal Free London NHS FT Dr Katie Coleman, GP/Primary Care Lead Professor Stephen Powis, Group Medical Director, RFH Dr Cathy Kelly, Chief Clinical Information Officer, UCLH Workforce Maria Kane, CEO BEH Mental Health NHS Trust Dr Jo Sauvage, GP, Islington Communications and Engagement Paul Jenkins, CEO Tavistock and Portman NHS Foundation Trust TBC Provider productivity and service sustainability David Stout, Senior Programme Director, STP TBC 14

15 Managerial leadership Refresh of SROs and governance for major workstreams (UEC, Planned Care, CC2H, Digital) Dedicated programme management support appointed for all the workstreams with major savings target Workstream leads brought together to understand interdependencies, and priorities for joint working

16 URGENT AND EMERGENCY CARE

17 Summary of progress on programme commitments and deliverables Considerable progress on urgent integrated care developments with current focus on streaming and redirection being implemented. Simplified discharge (Discharge to Assess) is ahead of schedule and live from October 2017 Engagement with stakeholders for last phase of life is having a positive impact and a business case is in development to ensure investment to support the model of care is available. Majority of work streams are on track and work is in progress to strengthen relationships between STP work stream leads and UEC CCG/provider leads Dashboard to measure impact through activity and finance by CCG is in development, taking into consideration planned impact from DTOC and CHC trajectories submitted to NHSE Delivery plan for 2018/19 being reviewed and refreshed with aim of ensuring specific deliverables are prioritised including the establishment of a communications work stream Programme governance to be revised to be less intensive, accelerate delivery and focus on monitoring impact across NCL 17

18 Current status of programme Work stream resourcing and programme governance structure being reviewed to improve capacity Strengthening engagement and involvement of CCG UEC leads and A&E Delivery Boards to maximise capacity and reduce duplication Patient engagement and co-production events taking place throughout the autumn to ensure patient input to design of new services Accelerating progress of national must do s to enable improved performance over winter, e.g. simplified discharge and a consistent approach to admission avoidance Ensuring monitoring of impact against finance and activity metrics for all work streams within UEC, as well as qualitative performance indicators Increasing multi-agency involvement in programme team and working through Transforming Care and Systems Leadership programme (NHSI) to address barriers to change Developing implementation plans for new initiatives for 18/19 18

19 Current status of programme - finance The position reported reflects a CCG assessment of YTD (month 5 based on M4 SLAM) and FOT, with material adjustments made to the FOT for Critical Care, Marginal rate and QIPP delivery The activity data needs further validation before conclusions can be drawn, but is subject to this, at an NCL wide level. Based on month 4 actuals, there appears to be over-performance in A&E, nonelectives and out-patients, and under- performance in elective care. As per caveats above, contract performance in all Trusts for NCL CCGs indicates that: A&E attendances -activity YTD 4% above plan, finance YTD 6.1% above plan NEL spells- activity YTD 0.1% above plan, finance YTD 2.2% above plan UEC work stream interventions: YTD - 0.9m achieved v. 1.5m plan, adverse variance 0.6m (40%) FOT- 7m forecast v. 8.9m plan, adverse variance of 1.9m (21%) 87% of delivery forecast to be in months

20 Delivery Goals Work stream Integrated Urgent Care Ambulatory Care and Admission Avoidance Simplified Discharge and Early Supported Stroke Discharge Last Phase of Life Communications Delivery Goals Fornt door Streaming and Redirection live across NCL A&E departments Business case to secure funding for 24/7 GP in the Hub (currently piloted) enabling continuation of the * 567 lines Business case to develop a business intelligence platform to monitor effectiveness of 111 services and IUC Hub Extend direct booking functionality to weekdays NHS 111 online application live across NCL Standardise the facilities and functions available across all of the NCL UCCs Consistent offer and tariff for ambulatory care across NCL Increased ambulatory care volumes across NCL, and hence reducing non-elective admissions Consistency of in- & out- reach admission avoidance services across NCL Single referral process for all admission avoidance services across NCL Discharge to assess pathways 0-3 implemented consistently across NCL, including a single referral form for rehabilitation services Business case for Early Supported Stroke Discharge approved and implemented Trusted assessor model is developed, implemented and embedded Agreed model of care for last phase of life across NCL Business case and investment to implement model of care approved and delivering Stakeholder analysis of key stakeholders and actions required to change behaviours and perceptions Improved engagement with key stakeholders to enable system changes required 20

21 ADULT SOCIAL CARE

22 North London Councils Adult Social Care Programme Progress Date Key Milestones Jan 2017 Feb Mar 2017 Apr 2017 May 2017 Jul 2017 Aug 2017 Programme Lead seconded to develop the approach to involvement of Camden, Islington, Haringey, Barnet and Enfield London Borough Councils in ongoing shaping of STP. Initial workshop held with Directors of Adult Social Services (DASS) to formulate approach. EY commissioned to do high level analysis of financial challenges facing local authorities and areas for further engagement and involvement. Results highlighted particular challenge in adult social care and need to scope opportunities for 5 Councils to develop joint solutions to shared problems. STP updated to reflect growing engagement with adult social care. Areas of focus for Councils confirmed as: 1. Hospital admission avoidance and discharge 2. Market management 3. Workforce 4. Learning disabilities DASS workshop held to feed back EY work and decide on next steps. Agreement reached to jointly fund project team for rest of 2016/17 to fully scope the four areas. Agreement on approach to developing business cases on the four areas New team starts work on scoping four areas Oct 2017 DASS workshop held project leads feed back on progress so far and prioritise areas for deeper analysis. Shortlist of 16 specific areas for collaboration produced and prioritised to 5: 1. Improving consistency in the social care element of the hospital discharge process across NCL 2. A joint approach to recruitment and retention of staff in health and social care, focusing on nursing and the independent sector 3. Building more capacity in the nursing home sector looking at options for joint-capital investment to build more homes 4. Joint brokerage of health and social care packages of care, looking at options to combine the existing operations run by Councils and CCGs 5. Looking to develop a stronger provider market to support people with complex LD needs, focusing on prevention of needs escalating into the transforming care cohort and those transitioning from children to adulthood Nov 2017 Jan 2018 Business case development on five areas takes place, including design workshops to engage wider partners.

23 FINANCE

24 Executive Summary month 5 financial position The year to date deficit reported across NCL is 61.6m, an adverse variance to plan of 16.7m, with 10 organisations (4 CCGs plus 6 Trusts) reporting year to date variances to plan, and 8 of these forecasting recovery in months A straight line extrapolation of the YTD position would be a deficit of 148m, compared with the 70m reported, demonstrating the degree of recovery required. The month 5 forecast outturn is a deficit of 70.5m (increased from 62.2m at month 4), a 18.5m variance to plan ( 10.2m at month 4), and 105.1m adverse variance to control total ( 96.8m at month 4). The 8.3m movement reflects the outturn deficit reported at month 5 by Barnet CCG. Trust CIP delivery has an adverse YTD variance of 8.3m (c17%), with a forecast outturn projection of 9.8m (c6%) under-achievement. c72%% of achievement is profiled into months The net CCG risk position has reduced from 26.4m at month 4 to 18.1m at month 5, largely reflecting that Barnet risk has now crystallised in a forecast outturn deficit. On QIPP, there are both YTD and FOT adverse variances reported of 7.6m (c33%) and 23.2m (c27%) respectively. c75% of total QIPP achievement is profiled into months An updated overall NCL risk assessment has been undertaken and suggests total risks of c 75m over and above the current forecast outturn. Subsequent to month 5 reporting, a revised control total has been agreed by NHSI for the Royal Free, which is based on the Trusts plan (excluding STF) of 27.5m deficit, plus a potential STF due in Q2-4 of 16.3m, resulting in a 11.2m deficit revised control total, (compared to 23.9m surplus previously). A revised 17/18 control total has also been agreed for RNOH, which will eliminate the 5.4m gap to control total ( 3.4m via a change in control total, 2m via a change in plan, including 1m of STF). All other things being equal, these changes will have the impact of reducing the NCL plan to 33.8m deficit, changing the control total to 3.9m deficit, and reducing the FOT gap to control total to 48.4m when incorporated into reporting at month 6. However the 18/19 control total for the Royal Free has been increased as part of this change to 58m surplus, increasing the challenge in 18/19. 24

25 PRIORITIES TO 31 MARCH 2018

26 Delivery of existing 2017/18 workstream plans Development of 2018/19 workstream plans 2018/19 contracting round alignment of CCG, provider and workstream plans Enhancing communications and engagement public, patients, and within STP partners Explore scope for more NCL-wide working where appropriate

27 18/19 STP workstream/ccg QIPP plan development October December 2017 Week of 2 6 Oct QIPP Oversight Meeting 1 (3 Oct) - Review and signoff process Week of 9-13 Oct Week of Oct Week of Oct QIPP Oversight Meeting 2 (24 Oct) Week of 30 Oct 3 Nov Stage 1 Stage 2 Week of 6 10 Nov QIPP Oversight Meeting 3 (7 Nov) Week of Nov Week of Nov QIPP Oversight Meeting 4 (21 Nov) Week of 27 Nov 1 Dec Final plans complete Week of 4-8 Dec QIPP Oversight Meeting 6 (5 Dec) (28 Nov) Stage 3 Stage 4 Week of Dec Week of Dec Final plans complete (15 Dec) Week of Dec CCGS to each develop local, non-acute QIPP plans CCGS to each develop bottomup acute QIPP plans UEC, PC, HCCH to update their delivery plans to include draft plans for 18/19 Alignment meetings between 3 workstreams and 5 CCGs Other workstreams to update and finalise detailed plans Pull together aggregated CCG plan UEC, PC, HCCH finalise w.stream plans Approval of individual CCG QIPP plans Approval of workstream delivery plans: Workstream Boards, HCC, FAM and PDB Outputs: 5 initial draft CCG QIPP plans + 3 draft workstream plans Outputs: 5 final draft CCG QIPP plans; final workstream plans 27

28 CONCLUSION

29 Good progress on existing workstream plans, although further to go Strong team in place working together across the CCGs, providers and local authorities Good relationships between all STP partners More to do on patient and public involvement, working with Healthwatch Finance positions very challenging across NCL Need to focus relentlessly on delivery.