NW London Sustainability & Transformation Plan. STP Highlight Report

Transcription

1 NW London Sustainability & Transformation Plan STP Highlight Report November 2017

2 Contents 2 Executive Summary (pages 3-6) STP NW London STP Programme Lifecycle (page 7) Risk Framework (page 8) Issue Framework (page 9) Delivery Area 1 report: Improving health and wellbeing (pages 13 & 12) Delivery Area 2 report: Better care for people with long term conditions (pages 13-17) Delivery Area 3 report: Better care for older people (pages 18-20) Delivery Area 4 report: Improving mental health services (pages 21-24) Delivery Area 5 report: Safe, high quality and sustainable hospital services (pages 25-28) Workforce workstream update (pages 30-32) Digital workstream update (pages 33 & 34) Business Intelligence (pages 35 & 36) Estates workstream update (pages 37-42) Glossary (page 43) Contents and key messages for NWL project work book updates (page 44) NW London project work book Risk framework (page 45) NWL project updates ( DA1ai, DA1di, DA5b, DA5ci & DA5ciii)

3 Executive Summary: 3 DA DA1 DA2 DA3 Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can share) Making Every Contact Count programme continues to be rolled out across NW London- with particularly strong engagement across probation services, the voluntary sector and primary care. Discussions are progressing well at an STP level regarding the approval fro the alcohol business case Reducing Harmful Drinking will report via the NWL workbook (DA1ai) MECC training has commenced in Hounslow- Making Every Contact Count will report via the NWL workbook (DA1di) Primary Care Access Harrow CCG are now offering full extended Access in to their hubs Provider Maturity First provider maturity evaluation held Ealing and dates for other CCG launch events and evaluation also arranged for H&F and Brent. 30 Expressions of interests made by NW L for international GP recruitment programme NW L Diabetes Programme : Winner of 3 awards at the Quality in Care Diabetes Self Care PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over 12,000 Received approval to proceed with mycopd digital project from DA2 Programme Board. Cancer Recovery: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds IAPT-LTC 200 practitioners (50 from NWL) have registered for the PWP/ counsellors online training on LTCs. Online training to be reviewed by the IAPT Education Expert Reference Group (Skills for Health) with a view to recommending the resource nationally. Long Term Conditions/IAPT service staff recruited and the service launched across 7 Boroughs (DA2c) Integrated commissioning-the project team has focussed on providing clarity to local areas about which deliverables can occur across all local areas. Enhanced care in care homes- Consultation on the leadership care home manager programme was completed. Local delivery groups were established for the roll out of the red bag scheme in Brent, Ealing, Hillingdon with implementation initiated. Intermediate care & rapid response- An London Ambulance Service (LAS) training session on accountable care partnerships (ACPs) was delivered at the Brent Ambulance Station, attended by 50+ paramedics on 04/10 to increase referrals and reduce Accident & Emergency (A&E) conveyances. Response at time of crisis- At Northwick Park Hospital a fully staffed and operating Multidisciplinary Team (MDT) model was agreed for w/c 30/10. Home first- 501 patients have been discharged on the Home first pathway across North West London (NW London) (as of 23/10). Last phase of life-telemedicine- Three business cases were developed on time and localised to each individual CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10-24/10, Brent CCGs business case was approved. Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act as lever/ note) Reprioritise and refocus the DA1 Prevention workstream. Support in obtaining commitment from key stakeholders across health and care to the programme. Ealing, Brent and Harrow CCGs to agree to fund the alcohol business cases and the JHCTG to act as a lever to prioritise alcohol prevention work and support this decision making progress (DA1ai) Further recruitment drive needed to fill spaces as there has been reduced appetite in some of the boroughs (DA1di) DA2 is the most diverse delivery area and therefore it is not possible to pull out one main action common to all areas. Work across the system to promote patient behaviour change away from UCCs to available capacity that can meet their requirements within the primary care centres where utilisation averages 57%. Support in engaging with CareUK in relation to direct booking roll-out and alignment with NW London timelines. Joint working to promote work and ensure enduring clinical pathway change on diabetes and other right care areas of focus. Integrated commissioning- The project team aim to work with each local area, however, may need some direction on whether to prioritise support to local areas that are fully engaged or those areas needing further persuasion. Enhanced care in care homes- Local CCGs need to identify named support and the capacity to implement the schemes. Home First- The project team will need to engage with local authorities to validate the financial model. Last phase of life-telemedicine- Harrow and Hillingdon CCGs business cases will go to executive committee for approval.

4 Executive Summary: continued 4 Enabler Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can share) Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act as lever/ note) DA4 DA5 PCMHT Evaluation, jointly run with HLP, is on track to go to procurement on 13/11 (DA4a). Out of Hospital Contract for GPs, to provide enhanced physical health care for people with Serious Mental Illness (SMI) is on track to be implemented across NWL in 18/19 (DA4a) Early Discharge Planning tool is gaining traction and having desired effect across CNWL; similar DTOC-reducing initiatives are bringing results in WLMHT. Service spec and Service Operating Procedure for WLMHT Rehab presented with minor queries to be endorsed over . Agreed investment in detailed flow modelling, bed modelling, and implementation decision-making analysis to take place across NWL (DA4a). NWL is on course to achieve 5 years plus inpatient discharges for people with learning disability/autism and challenging behaviour (DA4b). Children and Young People Transformation Plan has been refreshed and new priorities for 2018/19 have been set. The new crisis pathway and community outreach service has been launched to provide support in the community (DA4c) Official opening of the North West London Ultrasound Academy is due on 01/11/2017; this will take in a cohort of five sonographers. A paper was produced to show how seven successful pilots have demonstrated clear evidence of length of stay reduction, and have been implemented in various hospitals. Radiology and diagnostics/ inpatient model of care will report via combined the NWL workbook (DA5bi & DA5bii) Assurance of SOC 1 continues - SOC 1 will report via the NWL workbook (DA5ci) New pilot models implemented at Hillingdon. Launch of personalised postnatal care plan at all sites - Early Adopters will report via the NWL workbook (DA5ciii) Paediatric review was taken to Ealing Health and Adult Social Services Scrutiny Panel (HASC) meeting on 24/10. Project is now officially closed (DA5c) Successful proof of concept of added value of new renal pathway supported by STP Clinical Board. Project team is in place to deliver outpatient transformation. There is good progress and clinical engagement for cardiology and MSK (DA5a&d) Can we agree the principle across the system that services likely to yield return on investment and reduction in need for beds, may be funded for 6-12 months using transformation funding as a bridging fund; until such time as the service is self-sustaining. (DA4a) Urgent and crisis care pathway integration discussions to begin requiring input from all agencies. Partners are encouraged and asked to participate and prioritise. (DA4c) The funding flow model for specialised commissioning patients will be shared by NHSE through ADASS forum which require system level response from health, social care and housing stakeholders. DASS s and Director of Corporate Resources/Finance to engage in the debate. Support in implementing the development of outline business cases for both hubs and Trusts as far as possible without confirmed funding (DA5ci). DA5a & d A formal agreement of Business Principles has been agreed by CFOs and is being discussed by Provider Board and CCG Collaboration Board. This is a key enabler to transformation by removing the current payment system which acts as a disincentive to improving care and reducing costs.

5 Executive Summary: continued 5 Enabler Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can share) Workforce HEE Workforce Observatory now in operation; the Observatory will provide workforce intelligence and planning support to the 5 London STPs, making more effective and efficient use of existing data sets, participate in new collections and will have the capacity to assist in appropriate workforce modelling approaches. Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act as lever/ note) There is a need for a NWL-wide Organisational Development plan to support the delivery of the STP. This will require a significant amount of engagement from the outset to identify needs, establish ownership and gain buy in from the sector. NW London response to the national Mental Health Workforce Plan will be shared for agreement at the Mental Health Transformation Board on 24th November. The first draft report of analysis of pay rates for substantive and bank clinical staff at WLMHT and CNWL has been produced, to enable greater transparency around pay and incentives and understand where there could be opportunities to create a coherent pay strategy. Revised savings target for NW London staffing project have been agreed at 1.9m for 17/18 and 6.7m for 18/19. Digital Continued good progress with Primary Care Digital Programme (already funded through Estates & Technology Transformation Fund ETTF). CCGs and Trusts working well together on existing project initiatives (e.g. e-referrals) Improved progress with interoperability in some areas, but full realisation of the digital vision for shared records to support integrated care will require capital funding. NHSE have confirmed that no STP/LDR funding will be received during 2017/18; details of funding 2018/19 to 2020/21 will be confirmed after the Budget. The transformational step change required to fully automate clinical operations and build shared care records, as set out in the STP and LDR vision, will not occur without the required capital funding, especially in LNWHT and THH. NHSE have recognised that the Five Year Forward View target of Paperless by 2020 is no longer achievable. Prioritisation of investment will occur at Technical Design Authority and Digital Portfolio Board once funding amount and guidance are confirmed. JHCTG should consider alternative sources of funding for STP digital enablers. Business Intelligence (BI) Estates Recruitment to 2 substantive transformational informatics roles in BI team progressing well. OPE expression of interest submitted across the WLA supported with follow up information provided by 3 November deadline. The NHSE London Capital Committee confirmed partial funding for Parson s Green (the relocation of Lilyville practice) and for the reconfiguration of the first floor at Belmont Health Centre, Harrow. Heston OBC submitted to NHSE for approval. Positive meeting held with NHSE London Region Finance team and PAU to discuss progression of pipeline of scheme. Joint review of Heston OBC to take place in Nov. Brent joint public sector asset review completed and due to report imminently. To try to get reliable feeds for project related data, either from social care, or other parts of the health sector. Reaffirming partner support and engagement with delivering the NWL Hub strategy

6 Executive Summary: continued 6 Delivery Area DA1 DA2 DA3 DA4 Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can JHCTG help? Key stakeholders have not committed to the prevention agenda as previously stated in the STP, due to lack of strong financial modelling and ROI evidence. There is still a resistance to commitment in the presence of strong and robust evidence. IMPACT: focus gets shifted/momentum drops meaning we cannot complete planned projects, we are unable to make detailed plans/fund projects, and/or we are unable to realise any predicted savings. Note: Alcohol Prevention (DA1ai) - key issue is the on-going uncertainty of funding for the alcohol work and the consequential delays in implementation. Risk of causing damage to relationships between the STP and funding providers due to being overly ambitious in project development and setting unachievable targets (DA1di) No risk to escalated this period There is a risk that the pace of implementation for the DA3 Programme is compromised due to significant dependencies on other delivery areas, such as DA5, e.g. re-investment into community services is dependent on shifting resources from other areas in the system. Staffing Staffing constraints are delaying the implementation of an emergency frailty model at Ealing hospital. Similar constraints are likely to be encountered at other sites. There is a risk across the programme that significant transformation required across multiple workstreams does not have sustainable funding streams, and that we are unable to generate re-investable savings from benefits realised elsewhere in the health and care system. JHCTG is asked to support developing views on where our priorities should lie and what has most impact. There is a risk that there is an unknown financial exposure as individuals with learning disability/autism and challenging behaviour are discharged from NHSE funded care to locally funded care and no confirmation has been received of funding flows. JHCTG is asked to continue to support efforts to understand the financial impact with particular support needed from CFOs. DA5 Workforce Digital BI Estates Clinical Decision Support (CDS): there is an issue with the integration of CDS with ICE. The delay is because of Sunquest, who have integrated the wrong version of ICE into CDS (DA5b). Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not considered for autumn capital announcement. Trusts OBCs are also on hold until the approval of SOC Part 1 and funding being available to commence the necessary work. (DA5ci). Some delays to programme due to accessibility of data sets. Delays in advertising / recruitment to CW and Imperial teams has resulted in a risk to launch in Jan '18 (DA5ciii). Need financial models to support programmes with system benefits but where there are interim provider stranded costs. CFOs have developed business principles and this work should be supported by JHCTG (DA5a&d). There is a risk that the GP targets (set out in the GPFV) may hamper innovative workforce planning for new models of care. Primary care transformation initiatives and programmes are more focused on retaining and developing existing staff and ways of working to build resilience in the primary care workforce, than recruitment alone. Further delay and reduction in NHSE STP/Local Digital Road map (LDR) funding will impact on many of the digital enabling projects for the STP. Funding will be at a much lower level than required to enable the STP and national clinical objectives. Digitisation of provider records, and automated transfers to support integrated care, will be delayed. Access to Whole Systems Integrated Care (WSIC) data is key to progressing many Business Intelligence Unit (BIU) development projects. Risk to delivery of Hub programme if external consultancy support cannot be secured. Lack of resource internally to deliver the programme of work within the timescales required and subsequent risk to delivery of SoC 1. Following delays to reconfirming funding for support and the associated governance processes that need to be followed there is an expected two three month delay to the programme.

7 NW London STP Programme Lifecycle 7 Our portfolio management approach creates an environment in which teams, resources and activities are optimised to best achieve our clinical, operational and financial goals and identify and manage our key risks. It is supported by the Strategy & Transformation Project Management Framework. It is designed to be a scalable framework suitable for all audiences. The Framework has been designed to ensure that projects and programmes: remain aligned in their approach to delivering transformation activity can easily access and learn from best practice and experience from across the sector follow a structured and proven methodology for delivering projects and programmes. To ensure consistency in our approach to delivery and assurance, each of our transformation initiatives is based upon an agreed project lifecycle which takes a gated approach. Gateway reviews will be undertaken by an independent panel composed of: Clinicians Lay partners Technical experts from within the sector Note: There will be a minimum of two gateway reviews for each programme, however depending on the scale of change, additional gateway reviews may be added. NWL STP programme lifecycle Implementation of all solutions; troubleshooting, monitoring and reporting

8 Risk framework 8 Risks are score as a multiplication of the risk likelihood and risk severity (1-25)

9 Issues framework 9 Severity Extreme Incapable to deliver service Rating 5 Major Significantly impairs ability to deliver service 4 Moderate Impairs ability to deliver service 3 Minor No effect on critical path (within float) Some effect on ability to Minimal No effect on critical path (within float) Minimal effect on ability 2 1 Issues are scored only on severity (1-5)

10 10 STP Highlight Report Delivery Area 10

11 Delivery Area 1 report 11 IMPROVING HEALTH AND WELLBEING RAG key: delay immediate action required HEADLINES NHSE target to double IPS for SLTMH by funding to be released in Jan 2018 to enable the expansion of our existing Individual Placement Support schemes, with funding to develop new models released in (DA1b) Delivery in schools of parenting programme training started in November (DA1c) PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Supporting local people to live healthier lives (DA1a) Reducing harmful drinking (DA1ai) Report via NWL workbook see section below Promoting mental wellbeing and reducing loneliness (DA1b) Health benefits of employment (DA1bi) Project identification Jan 2018 (Due to slippage) IPS for Substance Misuse Project to receive 46% match funding from Life Chances fund assuming we can agree remaining 54% funding from CCGs and LAs. Continuing to work with Social Finance to develop a payment by health outcomes model that reduces risk for CCGs. NHSE target to double IPS for SLTMH by future funding to be released in Jan 2018 Continue to work with Social Finance to agree payment by health outcomes model. Continue to liaise with NHSE for updates and information on funding application process for SLTMH IPS models. Helping children get the best start (DA1c) Parenting Programme/ Conduct Disorder (DA1ci) Implementation Mar 2018 GREEN (on track) 7 Recruited schools in Ealing have been matched to health supervisors. Training for multidisciplinary teams began in September. Initial data collection with schools taking place. Continue implementation and evaluation. Roll out of the National MECC Programme (DA1d) Making Every Contact Count (DA1di) Report via NWL workbook see section below

12 Delivery Area 1 report (continued) 12 IMPROVING HEALTH AND WELLBEING RAG key: delay immediate action required KEY OUTSTANDING ISSUES THIS PERIOD DA Issue Score Mitigation (latest progress) Score DA1 There is an issue that there is insufficient resource within the DA1 STP team available to progress work within DA1 IMPACT: unable to complete/continue planned projects/ existing work 4 Interim measures have been put in place however there is currently no longer term plan. 4 DA1 Programme wide - we are unable to obtain sufficient support and buy in from the system to take forward prevention at a NWL wide level 4 The DA1 Programme Board is revising its function, and has been exploring alternative ways of working for the Programme. The programme is currently looking to review the level of commitment to prevention across NWL, asking for revised commitment to prevention from the NW London system. 4 DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score DA1 Key stakeholders have not committed to the prevention agenda as previously stated in the STP, due to lack of strong financial modelling and ROI evidence. There is still a resistance to commitment in the presence of strong and robust evidence. IMPACT: focus gets shifted/momentum drops meaning we cannot complete planned projects, we are unable to make detailed plans/fund projects, and/or we are unable to realise any predicted savings. Note: Alcohol Prevention work and the significant delay to progress. 20 Looking to source match funding from Social Investment Bond to reduce cost and risk to CCGs. Reviewing the DA1 programme and representation, challenging system commitment to the prevention agenda. Concerns that national published guidance is misleading in terms of RoIwill be cautious to fully review and explore figures in relation to all project work. 16 KEY AREAS FOR DISCUSSION none 12

13 Delivery Area 2 report 13 BETTER CARE FOR PEOPLE WITH LONG TERM CONDITIONS HEADLINES RAG key: GPFV: Full extended access in to hubs available in Harrow; National guidance on Online Consultations has been released and shared with primary care leads (DA2ai) Progress made across all project outcomes individual practices now receiving practice resilience support. (DA2aii) Expressions of interest have been received from NW L across all 8 CCGs for the International GP recruitment drive (DA2aiii) Cancer: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds (DA2b) Mental Health: 200 practitioners (50 from NW L) have registered for the Psychological Wellbeing Practitioner/ counsellors online training on LTCs (DA2c) Diabetes: Diabetes programmes won 3 Quality in Care awards (DA2d) Self Care: PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over 12,000 (DA2e) PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Primary Care DA2ai Primary Care Access - Hubs Implementation Evaluation (Jan 2019) GREEN (Running to Plan) Harrow CCG is now offering full extended access in to primary care hubs. Ealing have been successful with direct booking in to hubs and all 5 inner CCGs expected to be offering this in the next fortnight. Current efforts are now on IT and Integration to install direct booking in to UCCs in time for winter pressures. Implement direct booking IT solution in place across all Access Hubs and UCCs to enable direct booking and progress patient redirection. Create outcomes and metrics dashboard for all 8 CCGs. Investment and support for GPs and their teams - delivering the national GP Forward View (DA2a) DA2aii Provider Development Solution Design Implementation Planning (TBC) GREEN (Running to Plan) Progress made across all project outcomes individual practices now receiving practice resilience support. Groups of practices working at scale are beginning to participate in the Provider Maturity Evaluation. Ealing and H&F have both had provider maturity launch events with a very good response. Roll out of additional Provider Maturity evaluations in at least two more CCGs, likely to be Hammersmith and Fulham and Brent. Pull together the tools and guidance that support transformation in the commissioning of primary care at scale. Hold workshops/sessions with primary care leads and NHS E. Start to look at how we will measure impact of 3ph investment. DA2aiii Workforce Solution Design Implementation planning (Jan 2018) GREEN (Running to Plan) Primary care workforce strategy is close to completion and the process for reviewing and taking the strategy through CCGs governance is underway. International GP recruitment programme is underway and guidance has been shared by NHS E. 30 Expressions of interest have been received from NW London across all 8 CCGs. Develop project plans aligned to the primary care workforce strategy. Progress review of workforce and strategy with CCGs. Undertake thorough gap analysis of current CCG PC workforce work. Confirm final number for expressions of interest post 10 th Nov deadline.

14 Delivery Area 2 report (continued) 14 BETTER CARE FOR PEOPLE WITH LONG TERM CONDITIONS RAG key: PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Investment & support for GPs & their teams - delivering the national GP Forward View (DA2a) DA2aiv Practice Infrastructure Implementation Planning Implementation (TBC) (Way forward to be determined following decision to halt pilot with Babylon) Online Consultations National guidance for online consultations released and discussed with primary care leads. Online consultation planning meeting held with leads, from across NW London to agree recommended approach. Two small GP engagement workshops held by ICHP to gain GP views. Practice Infrastructure - Digital IT exhibited several stalls at the Transforming Primary Care conference in Brent on 19th October. Feedback from GPs was very positive and due to the high level of interest this roadshow may be rolled out to other CCGs. Identify project team and set up online consultations project delivery group. Develop plans for and begin GP and patient engagement. Commence development of plans for pan-nw London approach to be submitted to HLP on 1st December. Complete mapping of digital programme to DA2a delivery areas. Saving lives by Improved cancer outcomes (DA2b) Improving cancer outcomes Diagnostic Solution Design (TBC) (Concentrated efforts on 62 day standard & less assurance on STP priorities in primary care. However, now transformation funding has been released, planning is developing at greater pace) Hillingdon went live with Prostrate pathway. Safety netting tool to enable identification of at risk patients and earlier diagnosis and prevention of emergency presentations in A&E will be rolled out across practices in Q4. Transformation funds released to Hillingdon; ChelWest; Imperial and London NW Trust to implement optimal lung, prostate and colorectal performance to enable sustainable approach. Governance still to be agreed regarding reporting lines and accountability to STP for acute standards. Confirm achievement of 62 day standard. Agree governance and reporting lines to STP for acute standards.

15 Delivery Area 2 report (continued) 15 BETTER CARE FOR PEOPLE WITH LONG TERM CONDITIONS RAG key: PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Long term conditions and mental health (DA2c) Implementation Monitoring (Mar 2018) GREEN IAPT LTC service promotion amongst physical health clinicians continue. Clinical models have been developed. The intention is to standardise the model across NWL. Evaluation framework methodology and proposed KPIs are being developed. NWL clinical model to be agreed between the two Trusts. Co-location discussions to begin. Evaluation framework to be shared with physical health commissioners and Acute Trust to gain consensus on KPIs. Providing the right care every time to prevent serious illness (DA2d) Implementation Evaluation (Jan 2022) GREEN (Running to plan) The NW London STP Diabetes Transformation programme won 3 awards at the Quality in Care Diabetes Successful engagement event took place on October 19 for the Diabetes Footcare delivery group. Commenced developing baselines and dashboards for effective measurement of the AF/Hypertension programme. Launch of the Know Diabetes website. Hold digital interoperability workshop for call centre launch in April Meet with British Heart Foundation Strategic Engagement Lead to discuss partnership working re: AF and Hypertension. Supporting people to take control of their own health (DA2e) Implementation Evaluation (Jan 2019) GREEN (Running to plan) PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over 12,000. PAM activity presented at Virtual Primary Care meeting to promote best practice and encourage CCGs with low activity (H&F, Ealing, Central London and Hillingdon). Received approval to progress with mycopd digital project from DA2 Programme Board. Successful kick off workshop held with leads from across NW London to establish mycopd workstream. Four CCGs developing business cases for DoH fund on Social Prescribing supported by HLP. Establish plan to determine trial for mycopd. Identify and support CCG expressions of interest in DoH Social Prescribing fund. Hold Carer PAM workshop to establish Harrow project. Increased PAM activity following targeted support.

16 Delivery Area 2 report (continued) 16 BETTER CARE FOR PEOPLE WITH LONG TERM CONDITIONS RAG key: KEY OUTSTANDING ISSUES THIS PERIOD DA Issue Score Mitigation (latest progress) Score DA2ai Primary Care Hubs Regional team have asked that CCGs use part of their allocation to fund London-wide communications. CCGs access fund has been fully committed & they are unlikely to be able to meet this ask. 4 This has been escalated to the NHSE regional team for solution. N.b. other STP areas have also raised a similar issue. 3 DA2aii Provider Development Primary care providers across NW London have different levels of readiness & capacity to work at scale or deliver new models of care. The change programme underway is resource & time intensive. 4 Substantial work underway on the development of at scale providers. A number of CCGs have clear & well developed primary care strategies which outline their journey to delivering primary care at scale. Many CCGs have used some of their 3ph investment in 17/18 & 18/19 specifically to support at-scale provider development. Specific Local Services resource is available to support CCGs directly. 3 DA2aiii Workforce CCGs do not have a consensus/agreement on what the workforce priorities are for NW London. 3 Strategy in development and close to being finalised. Mapping activity to showcase gaps in workforce activity is also underway and once completed will inform some of the priorities. 2 DA2d Right Care AF - There is a lack of resource to ensure programme rollout at pace and scale, and to take advantage of potential opportunities. Business case shows cost pressure due to anticoagulation medicines cost, and savings will mainly be made in social care therefore CCGs are keen to identify opportunity for programme wide resource. 3 Request made for extension of funding. Learn lessons from diabetes programme and develop case for resource based on potential savings across the whole health economy. 3 DA2d Right Care CCGs all engaged on AF activity but not yet pursuing hypertension. 3 Use Size of the Prize to reinforce need for addressing hypertension. Work with Cardiac & Stroke Transformation Board on pan London Stroke Prevention plans which align with AF/Hypertension/Cholesterol. 3 KEY AREAS FOR DISCUSSION DA2c: How can we promote an integrated shared agenda of mental & physical health commissioners? DA2d: How we can encourage and gain traction with CCGs to pursue Hypertension?

17 Delivery Area 2 report (continued) 17 BETTER CARE FOR PEOPLE WITH LONG TERM CONDITIONS RAG key: DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score DA2ai Primary Care hubs There is a risk that Brent, Hillingdon and Harrow will not have direct booking from 111 in place by 1-Nov as CareUK 111 are only agreeing to go live with Ealing hubs and 1 Hounslow Hub by 1 Nov This has been escalated to NHS England National as this is a national issue and conversations with Care UK are on-going. 16 DA2b Cancer There is no administration or project management resource for the programme from within NW London; without managed timelines & plans, there will be slippage in delivery or the desired outcomes may not be achieved. 15 Resource from NW London still to be secured; Vanguard are providing project management for most of the primary care programmes but requires support for NW London governance & to support delivery within each CCG. 12 DA2b Cancer There is a risk that the increased national scrutiny on delivery of 62-day target, by end Q1, in addition to delivery of cancer transformation commitments may result in significant system overload. 15 Revision of secondary care cancer board membership to ensure executive engagement across NW London. Regular communication underway between Vanguard, NW London & NHS E regarding scope & deliverability of key programmes. Increased input & oversight for any Trusts at high risk of non-delivery. 12 DA2c Long Term Conditions and Mental Health The fragmented way of working between physical health and mental health commissioning and delivery minimises opportunities for better utilisation of resources and improved outcomes for vulnerable people. 20 Creating opportunities for commissioners and clinicians to come together to change practice and encourage joint working and colocation. Identifying referral points in pathways to develop joint practices. 16 DA2c Long Term Conditions and Mental Health The cultural shift in physical health environment required is significant and is being slowly addressed which may impact on longer term benefit realisation. 12 Discussions between physical health and mental health commissioners to encourage joint/integrated commissioning as well as integrated delivery. 8 DA2d Self Care Lack of investment in social prescribing prevent sustained roll out across NW London. 12 Scoping of social prescribing across NW London to identify gaps has commenced and the Roll out of i5health tool will support economic case. Also Identifying additional funding opportunities beyond CCG and LA. 12 DA2d Self Care H&F, Hillingdon, Hounslow, Central London and Ealing PAM activity within 2 nd quarter highlights risk to CCG PAM targets. 12 CCGs engaged via NW London PAM Working Group to identify support requirements. Monthly reporting provided. Number of CCGs embedding PAM within local primary care contracts. Engagement with community, acute and local authority to expand use beyond primary care. 9

18 Delivery Area 3 report 18 BETTER CARE FOR OLDER PEOPLE RAG key: PROJECT AREA Commissioning high quality and effective care for older people Getting the whole health and care system working together for older people HEADLINES Integrated commissioning (DA3ai) Enhanced care in care homes (DA3aii) Improved Intermediate Care Services (IC) and Rapid Response (RR) (DA3ci) LIFECYCLE Implementation planning Implementation planning Solution Design/ Implementation Planning (various workstreams are at various stages). DATE DUE TO ENTER NEXT Implementation (April 2018) Implementation (Dec 2017) Implementation Planning/ Implementation (various workstreams are at various stages). RAG RATING PROGRESS NEXT STEPS GREEN (Due to deliverables running to time and to scope) (Due to delays in agreeing CCG specific approach) (Due to review of IC&RR working group priorities underway) A project plan and implementation brief have been prepared. Senior stakeholder engagement has been completed. There was positive feedback on the draft care home managers leadership programme specification from care home managers, NW London CCG/Local authority (LA) commissioners, Care Quality Commission(CQC) and Health watch. A test comprehensive NW London care home dashboard has gone live with CCG and LA commissioners. Local delivery groups were established to progress the red bag scheme in Brent, Ealing and Hillingdon. Implementation has commenced. Discussions were initiated with London North West Healthcare NHS Trust (LNWHT) and Hillingdon Hospital Trust to develop internal processes regarding the transfer pathway. An LAS training session on ACPs was delivered at the Brent Ambulance Station, attended by 50+ paramedics on 04/10 to increase referrals and reduce A&E conveyances. Urgent & emergency care (UEC) conditions data has been refined to focus on rapid response (RR) top referral reasons. A decision was made by RR providers and commissioners to focus on falls and urinary tract infections (UTIs) as an opportunity identified to reduce <2days admissions (65yrs+). The intermediate care and rapid response (IC&RR) working group decided to review medical accountability variation across the eight NW London boroughs to mitigate risk. Providers and commissioners agreed to consider accepting RR referrals directly from the LAS control centre. The LAS protocol communications strategy was developed to ensure wider communication engagement by the LAS crew. The project team has focussed on providing clarity to local areas about which deliverables can occur across all local areas (DA3a). Consultation on the leadership care home manager programme has been completed, local delivery groups have been established for roll out of the red bag scheme in Brent, Ealing and Hillingdon (DA3a). A London Ambulance Service (LAS) training session on accountable care partnerships (ACPs) was delivered at the Brent Ambulance Station and was attended by 50+ paramedics on 04/10 to increase referrals and reduce A&E conveyances (DA3c). At Northwick Park Hospital a fully staffed and operating multi disciplinary team (MDT) model was agreed for w/c 30/10 (DA3c). 501 patients have been discharged on the Home first pathway across North West London (NW L) (as of 23/10) (DA3d). Three business cases were developed on time and localised to each individual CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10-24/10, Brent CCGs business case was approved (DA3e). Senior responsible officers (SROs) need to agree the project plan and implementation brief. Local implementation project teams are to meet on a regular basis. Local areas are to all agree on work that can be delivered once across the eight areas e.g. pricing. Roll out of the joint intelligence working guidance and a NW London care home dashboard. Undertake procurement of the training provider (Nov Dec 2017). Engage stakeholders on the development of the standardised hospital transfer pathway. Audit compliance against joint intelligence working guidance. Sign off the RR dashboard prototype with the IC&RR working group. Agree triggers and mitigating actions for rapid response services pan NW London to continue to meet demand at times of low capacity. Deliver the LAS protocol communications strategy.

19 Delivery Area 3 report (continued) 19 BETTER CARE FOR OLDER PEOPLE RAG key: PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Getting the whole health and care system working together for older people (DA3c) Response in time of crisis (DA3cii) Implementation Planning Implementation (March 2018) (Due to variation in uptake of the model across the different sites) There was a soft launch of the Northwick Park hospital project with an extension of locum geriatrician post whilst substantive recruitment continues. An extension till the end of November was agreed for occupational therapist input to the project at the Ealing site. Agree metrics and evaluation processes, staff resources and governance structures at Northwick Park hospital. Determine a plan of action and implementation in the Hounslow frailty conversation on the 25/10. Agree to increase hours of operation for the Ealing pilot. Home from Hospital (DA3d) Home first (DA3di) Implementation BAU (March 2018) (Due to variation in uptake of the model across the different sites) 501 patients have been discharged on the Home first pathway across NW London (as of 23/10). A Memorandum of Understanding (MoU) was agreed in principle between health and social care partners in Hillingdon to enable the full roll out of Home first. Validation of financial model. A communication plan to include all pathways out of hospital (including front door discharges) aligned to Home first s ethos. Continued delivery and spread of Home first pathways. Last phase of life (DA3e) Telemedicine (DA3ei) Implementation Planning Implementation (Dec 2017) (Due to the delays in awarding the contract) Brent, Harrow and Hillingdon (BHH) chairs and managing directors (MDs) have agreed in principle to participate in the programme with Executive Committees to review and approve the business case in October. Three business cases were developed on time and localised to each individual CCG area (Brent Harrow and Hillingdon). The Brent business case was presented and approved at executive committee. Sign funding agreement between Central London, West London, Hammersmith & Fulham, Hounslow and Ealing (CWHHE) CCGs and Social Finance. Pre-mobilisation to commence with Provider Alliance and Social Finance. Harrow and Hillingdon CCGs business cases will go to executive committee for approval.

20 Delivery Area 3 report (continued) 20 BETTER CARE FOR OLDER PEOPLE RAG key: DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score DA3b DA3b DA3b DA3c DA3c DA3c DA3d DA3d There is a risk that constraints from CCGs/LAs to prioritise capacity and funding to support initiatives will restrict the Strategy & Transformation s team ability to transform care delivered in care homes. There is a risk that there will be resistance to implement standardised approaches across a diverse spectrum of care home providers (140 providers) across the sector. There is a risk that the pace of implementation for the overall project is compromised due to significant dependencies on other sector and local projects e.g. setting up of ACP, transforming primary care, market management and telemedicine. There is a risk that the proposed model of care will be resourced using existing staff groups with known supply shortages. The counting, coding and financial impact that this change will have on all organisations, will present a barrier to the model going live or moving from pilot stage to business as usual. There is a risk that RR teams do not have sufficient capacity to expand to the numbers of patients required. There is a risk that the rapid assessment function required to support the Home first model does not have sufficient capacity to expand to the numbers of patients required. There is a risk that the required care provision to support discharge to assess pathways can not be provided, particularly due to reductions in social care funding, which will delay progress and increase scale in implementation Work with local CCGs/LAs to influence prioritisation of efforts for 2017/18 and alignment with business planning for 2018/19. Work with a spectrum of diverse care home representatives to agree standardised approaches. Maintain close links with linked projects via regular meetings DA3 team level, DA3 board level, NW London S&T local services team, long term needs clinical reference group (CRG), Older Peoples CRG, workforce transformation group and any other key meetings. Seek support from providers and CCGs to identify resources which could be reallocated and look at alternative staffing options. Up front conversations to ensure that all providers are operating with the same expectations and that there is a plan to address these issues prior to moving to a sustainable model. Early evaluation to understand the baseline capacity within services. Early sector wide modelling to understand requirements and investment decisions. Sector-wide conversations throughout. Initial phase of pathway testing is designed specifically with comprehensive evaluation to understand the baseline capacity within services early. Sector wide modelling then allows scaled up values to be understood and investment decisions to be made early. Local A&E Boards and CCGs are involved throughout the process to increase likelihood of investment. Evaluation process of the initial phase gives evidence for on-going care needs and the new NW London Home. The first activity model will enable translation of the evidence to "at scale" values. Work is also on-going with LA colleagues to improve data quality in order to test KEY AREAS FOR DISCUSSION None

21 Delivery Area 4 report 21 IMPROVING MENTAL HEALTH SERVICES RAG key: HEADLINES Investment in detailed flow modelling and implementation decision-making analysis has been agreed, which will take place across NW London (DA4a) Review of selected inpatients cohort has been completed to inform future model development (DA4b) Urgent care evaluation recommendations are being taken forward by Trusts (DA4c) Refresh of the NWL Children and Young People s Transformation plan submitted to NHSE 31 October, will be used to agree work plan and priorities (DA4d) PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Supporting adults with serious and long term mental health needs (DA4a) New Model of Care for SLTMHN (DA4ai ) Implementation Planning Implementation Jan 2018 (due to slippage) Needs mapping at a local level has been completed with information gleaned from GP Clinical Leads, MH Commissioners, Trust management and Trust clinical staff; and presented to Programme Exec. An investment plan was not endorsed as funding specific services is not in the remit of transformation. Agreed investment in detailed flow modelling and implementation decisionmaking analysis to take place across NW London. Out of Hospital services on track to be implemented across NWL in 18/19. Progressing with bed modelling; PCMHT Evaluation and Out of Hospital across-nwl roll-out. Commencing a review and optimisation of Community Mental Health Teams, together with HLP Embedded Resource. Targeted support for specific groups of people (DA4bi) Supporting people with learning disabilities and/or autism with challenging behaviour (DA4bi) Diagnostics Mar 2018 (delays in receiving funding model and in completion of forensic patient reviews) NWL is on track to achieve its discharge trajectory for CCG patients. Review of selected inpatients cohort has been completed to inform future model development. Development of options for community forensic services has began. Meetings have taken place with specialist assessment and treatment inpatient unit in to discuss NWL bed usage and future need. Meeting with NHSE, SRO, CFOs and TCP took place on 20/11 to review and test the assumptions made in finance submissions including transition costs, future costs of care packages and assumptions surrounding block contracts. Development of the future operating model to inform commissioning intentions. Recommendations for future Community Forensic Service for NWL to be discussed. Local engagement and possible workshop to be set up to discuss Autism Spectrum Disorder pathways and services for diagnostic and diagnostic support. Further roll out of behaviour support to begin in December. Additional training sessions to be confirmed. Social Supervision Training to begin in Jan, Feb 2018.

22 Delivery Area 4 report continued 22 IMPROVING MENTAL HEALTH SERVICES RAG key: PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Targeted support for specific groups of people (DA4bi) Mental health support for new mothers during and after pregnancy (perinatal) (DA4bii) Now closed - reported within Trusts and in BAU N/A GREEN (on track) (BAU) BAU BAU Section 136 Pathway (DA4ci) Planning December 2017 GREEN (on track) Availability of capital funding for S136 related initiatives/ innovations has been launched. Conversations underway to determine local interest for developing a bid. In order to continue local discussions and develop a business case for reconfiguration of health based places of safety, further data and analysis of demand and patient flows are required. Healthy London Partnership to progress with the data analysis. Develop costed capital bid application. Crisis Care (DA4c) Liaison Psychiatry Service (DA4cii ) Now closed - reported within Trusts and in BAU N/A GREEN (on track) (BAU) LPS is now managed by the Trusts and the S&T team no longer manages this workstream. BAU Urgent Care Pathway (DA4ciii) Phase1- Evaluation Phase 2- Feasibility November 2017 GREEN (on track) Phase 1 Trusts and CCGs have developed plans to address areas of concern as part of the crisis care concordat Evaluation recommendations are being taken forward by Trusts. Phase 2 Scoping work started to define an integrated approach to urgent and crisis care across NWL. This will feed into the development of the new programme of work that manage demand in ED. Meeting is taking place in early December to agree and implement Crisis Care Concordat plan. An approach to redesign of the urgent and crisis care to be developed and discussed with MH and Acute stakeholders. Governance to be established to oversee this new work programme.

23 Delivery Area 4 report (continued) 23 IMPROVING MENTAL HEALTH SERVICES RAG key: PROJECT AREA LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Vulnerable groups (DA4di) Project identification March 2018 (Due to slippage) Mapping of Autism and LD completed across NW London. The recommendations have been discussed between commissioners and clinicians, both mental health and paediatrician. Further discussions to determine local level work vs the work that can be completed across NWL as Autism and LD landscape is complicated due to different social care and education infrastructure. Short listed ideas to be discussed and prioritised for delivery in 2018/19. Children and young people (DA4d) Specialist community eating disorder (DA4dii) Crisis and urgent care (DA4diii) Evaluation/ BAU Phase 1- Implementation Planning Phase 2- Scoping BAU Jan 2018 Dec 2017 (Due to slippage) GREEN (on-track) Service evaluation is underway. Collation of data has been problematic due to Trusts reporting systems and resulting in the delay of completion of the evaluation. Phase 1 New NWL CAMHS Crisis and Liaison Team across both MH Trusts have now been launched to provide intensive support for young people in mental health crisis. Phase 2 Work began to develop and agree a long term crisis pathway with representatives from young champions, the Metropolitan police, clinicians and commissioners. Provider/commissioning event planned for Dec to identify quality of service, action plan to address issues and adapt to ensure service meets local needs. Phase 1 Governance for service monitoring and evaluation framework to be developed. Phase 2 Following the workshop work to begin to define the new pathway. Redesigning the system (DA4div) Diagnostics March 2018 GREEN (on-track) The refresh of the Local Transformation Plan gave an opportunity to review local and NWL priorities to develop a new work programme. Priorities and work plan to be agreed specifying which elements will be carried out at local level and which will be carried out at system level.

24 Delivery Area 4 report (continued) 24 IMPROVING MENTAL HEALTH SERVICES DELIVERY RISKS FOR NEXT PERIOD RAG key: DA Risk Score Mitigation (latest progress) Score DA4a Fidelity to the ambition of the model is compromised given the non-availability of the significant funding required. 20 Ongoing commitment to optimising existing elements of the model; and in addition focussing our limited resource on the most significant blockage, CMHT, should enable flow and better delivery of the model s aims. 15 DA4b Specialised commissioning funding following the patient upon discharges will be subject to bed de-commissioning. NHSE has not yet confirmed how this is to be achieved. IMPACT; CCGs not receiving the funding required for community packages therefore LAs and CCGs having increase in their operating costs. 25 Conversations have been held with NHSE regarding funding, following the de-commissioning of beds in London. NHSE to provide clarification on funding specific to London. This will help determine impact on cost of services and investment requirements to manage demand for inpatient beds. 20 DA4b Lack of housing availability for the TCP cohort may result in our inability to reduce overall need for inpatient beds. 25 Review the needs of this cohort and the range and scope of existing services, specifically for people with complex and challenging behaviour across residential care. Engage with social care and housing departments of LAs and provider sector to identify opportunities. 20 DA4c Fragmented approach to pathway redesign will result in missed opportunities to better utilise resources to reduce demand in ED and specialist services. 20 An integrated urgent and crisis pathway has been proposed to key stakeholder group. A proposal is being developed to be shared with Acute stakeholders. Joint governance will be in place to minimise fragmentation and promote integration. 8 DA4d Insufficient workforce to meet the new service delivery CYP roles (volume and skills/ capability) within the new service delivery framework may result in delays in implementing new services 16 A workforce strategy is in development which sets out the plans to ensure the wider CYP workforce have the right skills to deliver the right intervention at the right time. We are aligning to National HEE education and training directives and implementing designated initiatives across NW London. 9 DA4d Fragmented crisis service commissioning with numerous interdependent services being developed by different agencies (Crisis pathway, Forensic London CAMHS Service, New Models of Care). 12 Linking up the various system components and agencies will ensure there is seamless pathway in place enabling children to access the right help at the right time. 9 KEY AREAS FOR DISCUSSION None

25 Delivery Area 5 report 25 SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL SERVICES RAG key: HEADLINES Ongoing work around Renal, HIV and early exploratory work around Cardiac (resource constrained) No strategic plan to close forecast 188m gap (DA5a) Outpatients secured mandate in STP Clinical Board for the work, with a view of starting clinical working groups in November (subject to funding/resourcing agreements and mandate at Collaboration Board) (DA5d) PROJECT AREA LIFE CYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Improving commissioning of specialist services (DA5a) Improving commissioning of specialist services (DA5a) Solution design TBC RED ( no strategic mitigating plans for 188m gap) Renal: successful proof of concept of added value of new renal pathway supported by STP Clinical Board. HIV: ICHP supporting multi-trust discussions around consolidation opportunities. Cardiac: Good progress bringing together CCGs and NHSE and providers to develop a cardiology transformation programme. Successful launch workshop on 2 nd November. Clinical leads identified and priorities identified. Dates set for redesign workshops January-March. Renal: model and agree new funding flows to accelerate adoption for all renal patients. HIV: Multi-stakeholder event to be held and proposal developed. Cardiac: agree tertiary redesign priorities with NHSE mid November. Overall:. Only 0.5 post dedicated to support specialised commissioning despite 188m forecast gap. Radiology and Diagnostics (DA5bi) Getting hospital patients better, quicker (DA5b) Report via NWL workbook see section below Inpatient model of care (DA5bii)

26 Delivery Area 5 report (continued) 26 SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL SERVICES RAG key: PROJECT AREA LIFE CYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Organising Hospital services (DA5c) Capital business cases to support clinical improvements (DA5ci) Planning Report via NWL workbook see section below Improvements to children services (DA5cii) Transition to BAU N/A CLOSED Paediatric review was taken to Ealing Health and Adult Social Services Scrutiny Panel (HASC) meeting on 24/10 Project is now officially closed. N/A Organising Hospital services (DA5c) Improvements to women s services (DA5ciii ) Development of local hospital models of care (DA5civ) Planning Planning Report via NWL workbook see section below TBC depends on ImBC approval?q1 2018/19 (due to dependency with SOC approval) Engagement around developing older people s care services in Ealing started on 1 August 2017 and is expected to run until November Ealing Transformation Steering Group on 10/11/17 On-going work to develop frail elderly model of care. The following areas have been agreed as priority work packages : 1. ambulatory care sensitivity map for LNWHT; 2. outpatient activity analysis by age group; 3.diabetes as well as respiratory activity analysis by age group. The next step with the estate feasibility study is to consider whether this is a viable option worthy of further investigation to OBC level.

27 Delivery Area 5 report (continued) 27 SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL SERVICES RAG key: PROJECT AREA LIFE CYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS Muscular Skeletal (MSK) (DA5di) Rolling programme N/A because of rolling programme (due to funding flows causing blocks to progress) Programme has been reprioritised to deliver most savings in 18/19 and to fit within 0.5 support post. MSK is a priority for the outpatient programme, clinical leads have been identified. Identified that model of care for fracture clinics needs to offer higher value. Agree new model for fracture clinic. Set up redesign groups for outpatients. Identify overlap between Harrow CCG MSK work and sector work. Identify facilitator for community MSK pathway. Procurement (DA5dii ) N/A N/A (due to Resource demands) NWL Procurement Director started this month: market activity around Continence and Advanced Woundcare, evaluating the opportunities to aggregate demand, standardise products and swap to clinically equivalent products. Invitation to tender (ITT) to be finalised to identify expertise to support procurement opportunities in specialist technical areas. Hospital productivity programme (DA5d) Staffing (DA5diii) N/A N/A (Based on the fact that the agreed 3.1m benefits will not be realised in 17/18 and we do not yet know how much will be saved in 17/18) Pan London Medical Locums: Break glass ceiling rates for medical locums have gone live and monitoring process put in place. Occupational Health Baseline of current OH services at each of the trusts carried out to identify opportunities. Deep dive into Imperial OH service with action plan to address 390k 2016/17 overspend. A lead HR director is to lead the Shared Bank - Options Appraisal/ Business Case on behalf of the sector Medical Locums: Plan to extend break-glass ceiling rates to medical bank 1st April Team working with NWL Trusts to calculate savings for each Trust. Occupational Health: Cost savings for Imperial in 2017/18 and for all Trusts in 18/19 (savings targets are being calculated). Plan process mapping workshops to develop standardised processes for sickness absence an pre-employment checks. Shared bank: Develop Business Case to evaluate options for temporary staffing in-house vs. outsourcing vs. shared service vs. virtual bank and identify financial savings. Develop break-glass ceiling rates for nursing bank staff in NW London (building on pan-london medical locum methodology). Develop work to consider priorities for 18/19. DA5div Outpatients (DA5div) Project Identification N/A (due to start delay in securing Resource) Developed business case with specific work plan. Programme mandate from Outpatient Board, STP Clinical Board. Agreed five priority specialties. Identified clinical lead s on all five specialties. Should have permanent band 5 administrator in post March Chief Transformation Officer (CTO) drafted business rules for discussion with CFOs on financial models which incentivise providers and deal with stranded costs. Identification of resources and funding to carry out the work from November. Brief clinical leads on their role. Set up all clinically led meetings. Agree change process to facilitate radical solutions. Work with FRG to explore how this transformation programme fits with CCG CIPs for 18/19. Identify two further facilitators. Take business rules to Nov/Dec Provider Board for discussion and agreement. 27

28 Delivery Area 5 report (continued) 28 SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL SERVICES RAG key: KEY OUTSTANDING ISSUES THIS PERIOD DA Issue Score Mitigation (latest progress) Score DA5d Financial systems to support system transformation, to incentivise providers during transition of interim stranded costs and to identify investment where there is a strong ROI. 4 Chief Transformation Officer (CTO) drafted business rules for discussion and agreement with Provider Board and with CCG Collaboration Board. 3 DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score DA5a This programme has limited NWL and NHSE resources, over and above BAU within providers. Successful delivery requires engagement and prioritisation across a range of stakeholders. 20 The risk of the forecast 188m gap has been accepted for now. CTO working with CFOs to develop options for November provider Board to agree. 20 DA5d Outpatients: 2/5 pathways delayed as we have not yet identified facilitator of clinical redesign groups. 8 Outpatient: Discussions with CLARC and other stakeholders 6 DA5d Procurement: Resources within procurement departments are limited, driven by the demands of BAU, local CIP and Collaboration. There is limited capacity to undertake work in non-traditional opportunity areas. 8 Procurement: ITT being developed for approval by CFOs which would support additional specialist resource to focus on nontraditional opportunity areas. Appointment of NWL Procurement Director will also support this activity. 6

29 29 Enabler workstream 29

30 Enabler workstream report: Workforce 30 RAG key: HEADLINES As of October the new HEE Workforce Observatory is in operation and is starting to organise its operating model with the aim of providing workforce intelligence and planning support for the 5 London STP's. This team will work closely with the HEE central team and Information Development to make more effective and efficient use of existing data sets, participate in new collections and will have the capacity to assist in appropriate workforce modelling approaches. Mental Health: Initial meeting held to agree approach to agreeing the NW London response to the national Mental Health Workforce Plan. First draft report of analysis of pay rates for substantive and bank clinical staff at WLMHT and CNWL produced, to enable greater transparency and understand where there could be opportunities to create a coherent pay strategy. There can be seen significant differences in the overall approaches to both the way that staff banks operate and approaches to bonus schemes and other initiatives across both trusts. Change Academy: Provider has been appointed for the Change Coach Development programme, 36 strong applications were received, the programme is due to launch in December. Organisational Development: Scoping meeting held on 7/11 to agree approach to develop a NW London-wide Organisational Development Strategy across health, social care and voluntary sector to support delivery of the STP. Staffing project: Revised savings target for NW London staffing project has been agreed: 1.9m for 17/18 and 6.7m for 18/19. PROJECT AREA/ WORKSTREAM LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS 1 STP Delivery Area 1: Health coaching Self care Implementation Evaluation Q3 GREEN (on track) Evaluation report for the carers programme in development. Held first leaders and champions event in October inviting past participants of our training who are currently integrating Coaching for Health into systems. Completion and review of evaluation report of Health Coaching for Carers Agree the on-going provision of embedding activities for around 300 people already trained as well as other approaches for shared learning. 2 STP Delivery Area 2: Primary Care Transformation projects Project initiation & start-up Diagnostics Q3 GREEN (on track) Medical Assistant training (Correspondence Management and Signposting) delivered via 8 local pilots to over 600 existing members of practice staff. 70 GP Practices are participating in the pilot across NW London. NWL currently has 13 Partnership Innovative Education (PIES) projects, to increase sustainability and address current issues in the workforce. PIEs bring together health & social care service providers, community groups and education providers to create innovative educational models to support local workforce transformation. The funding for 7 of these has just been awarded. Joint workshop with CLAHRC planned for early November to discuss challenges of PAs in primary care. Activity and capacity benchmarking launch of initiative to provide support to practices to understand their future capacity issues and subsequent workforce requirements. Locum booking platforms exploring potential NW London roll-out of locum booking platforms, this is designed to release similar benefits to staffing banks with considerably reduced costs. Action on indemnity dependent on progression of national work, this aims to reduce the financial burden of indemnity on GPs through e.g. helping GPs to shop around and target training to address specific factors driving up indemnity costs. Sharing best practice - We are identifying areas of best practice locally that will benefit from dissemination across North West London and action scaling of these interventions. These will potentially include such examples as e.g. the Brent and Ealing digital training platforms, and the H&F practice support teams.

31 Enabler workstream report: Workforce 31 RAG key: PROJECT AREA/ WORKSTREAM LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS 3 STP Delivery Area 3: Achieving better outcomes and experiences for older people Initiation Diagnostics Q3 (funding secured, identifying sites) Agreed the workforce support for Acute Frailty teams. Analysis of consultant geriatrician workforce across NW London and identify opportunities to use the workforce more effectively to support strategic priorities. 4 STP Delivery Area 4: Improving outcomes for children & adults with mental health needs Diagnostics for SLTMHN Identification for collaborative programmes Initiation Q3 (Due to being in scoping phase) Held initial meeting 6/11 to discuss and agree the NW London approach and response to the HEE the Mental Health Workforce Plan, and alignment with Workforce delivery plans to support DA4. First draft report of analysis of pay rates for substantive and bank clinical staff produced. This will help WLMHT and CNWL to have greater transparency and understand where there could be opportunities to create a coherent pay strategy. Findings and recommendations report from pay rate review to be presented at CNWL and WLMHT board meetings in November. Begin developing STP level response to inform regional plan and approach. This will be presented at the Mental Health Transformation Board meeting on 24/11. Continue development of workforce delivery plans. 5 STP Delivery Area 5: NW London Staffing Project Project initiation & start-up Diagnostics Q3 (not all 8 priorities have traction) The project board have agreed the savings targets for agreed areas of focus and identified additional opportunities for further savings to be quantified. Local London rates have been live since 2 October, intelligence to date across London suggests these rates are reducing very high cost medical locum shifts. Provider appointed to support collaborative process improvement for occupational health services. Develop work plan and resource requirements for 18/19 to deliver programme Commence planning to introduce local London rates for medical bank staff from 1 April 2018 Set up process improvement workshop to be ready to implement new processes by 1 April 2018 Agreement from trust on collaborative bank working scope for agreement at next project board, 4 December. 6 Recruitment and Retention Project initiation & start-up Diagnostics Q3 (strategy to meet GPFV targets required) GPFV targets to increase GP numbers for NW London by 218 currently confirmed (targets are not yet fully fixed and could potentially be modified). GP international recruitment programme established participation is mandatory, a single London-wide application is due for 30 th November, it will include a NW London chapter. Formal guidance has still not been released. PC retention workshops/focus groups completed alongside draft retention strategy initial meeting of retention T&F group met to set the agenda and prioritisation for delivery moving forwards. PC workforce strategy initiatives including activity and capacity benchmarking & locum booking platforms scoping is underway. S&T coordinating NW London approach to GP International Recruitment CCGs have sent EOI forms and outline communications to practices, follow-up engagement planned. Retention T&F group currently being formed, with ToR, membership and key work streams currently under review.

32 Enabler workstream report: Workforce (continued) 32 RAG key: PROJECT AREA/ WORKSTREAM LIFECYCLE DATE DUE TO ENTER NEXT RAG RATING PROGRESS NEXT STEPS 7 HEE NW London - supporting future workforce growth Implementation Evaluation (various) GREEN (on track) Capital Nurse Programme - recruitment to rotation programmes for September has been concluded with a lower uptake than anticipated. CEPNs have taken up an extended role to develop relationships with education providers and work collaboratively to increase placement capacity in primary care. Discussion needs to happen around the impacts of lower numbers recruited to the Capital Nurse Programme in NW London. Participation in London-wide bid for international GP recruitment. Currently engaging with practices to obtain expressions of interest. 8 Change Academy High Performing Care (HPC) & Leading Transformation programmes (LTP) Commissioning for Outcomes programme (C4O) Implementation Evaluation Q4 (tailoring coproduction to readiness) Cohort 2 (6 teams) of Commissioning for Outcomes and Integration programme completed their third workshop on 31/10. HPC Change Coaches are being flexible in their approach and support offers to meet needs of the 9 project teams. Final preparation for the Change Coach Development programme to launch in December with a cohort of approximately 40 Change Coaches, who will use their training to support local transformation projects. Change Coach programme launch in December. C4O programme; final workshops to be held and follow on support to be agreed. HPC nd LTP programmes to continue. evaluation report will be completed this month to show progress. KEY OUTSTANDING ISSUES THIS PERIOD DA Issue Score Mitigation (latest progress) Score All Relationships with local government colleagues needs be maintained and strengthened to address social care workforce challenges and improve integration. 3 Workforce strategy encompasses workforce challenges and implications. Health and Social Care Workforce Lead role to be re-advertised for permanent recruitment. 2 DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score 2 There is a risk that the GP targets (set out in the GPFV) may hamper innovative workforce planning for new models of care. Primary care transformation initiatives and programmes are more focused on retaining and developing existing staff and ways of working to build resilience in the primary care workforce, than recruitment alone. 9 Work with Local Services Team and forums including the Workforce & Provider Development Delivery Group, Workforce Transformation Delivery Board and Advisory Council to develop a Primary Care Workforce Strategy and Delivery Plan to address the challenges. Dedicated resource in place to lead on the strategy. 6 KEY AREAS FOR DISCUSSION None

33 Enabler workstream report: Digital 33 RAG key: HEADLINES STP/ Local Digital Roadmap no funding will be received during 2017/18; funding 2018/19 to 2020/21 likely to be announced after the Budget in November; NHSE guidance will follow. This will delay paperless records in providers, and shared digital records to support better integrated care. NHSE has accepted that the FYFV target of Paperless by 2020 will not now be achieved. Digital Portfolio/ Primary Care/BI good progress against agreed plan Provider Digital Projects continued progress with Care Information Exchange, but slow Digital CQUINs work on e-referrals and Advice & Guidance CQUINs under way in all Trusts PROJECT AREA/ WORKSTREAM RAG RATING PROGRESS NEXT STEPS 1 STP/ Local Digital Roadmap RED (due to delay and reduction in STP/LDR funding) NHSE have confirmed that no STP/LDR digital funding will be received during the current FY. NHSE will ask the Treasury in November 2017 for 800m of funding over 2018/19 to 2020/21. This is expected to be distributed to STP footprints on a capitation basis, suggesting an allocation to NWL of 32m (4% of 800m) over three years, which compares with the original LDR request for 146m over five years (based on the Secretary of State s announcement in February 2016 of a 4.2bn technology fund) and the previous planning assumption of 32m in the first two years, with more in the subsequent two years. However, NHSE have stated that the allocation will be reduced to reflect the Global Digital Exemplar funding already awarded to Imperial ( 10m) and Chelwest ( 5m) so the final number will be less than 32m. Existing projects are proceeding, but the step change required to fully automate clinical operations and build shared care records, as set out in the STP and LDR vision, will not occur without the required capital funding. This will impact LNWHT and THH especially, since their clinical processes remain paper-based and the funding will be insufficient to implement systems such as Electronic Prescribing and Electronic Document Management. The Five Year Forward View target of Paperless by 2020 is no longer achievable and this has now been explicitly recognised by NHSE (Will Smart, CIO, speech at EHI, 31 Oct). Projects will need to be re-prioritised once final guidance has been received from NHSE. Final funding guidance to be received from NHSE LDR Digital Programme Plan to be developed for high priority projects likely deadline is Feb Digital Portfolio/ Primary Care/BI GREEN (proceeding as planned) Planning for 17/18 GP Practice Hardware Refresh is under way, with the bids submitted to NHS England. Approval from the London Capital Committee is expected early November. Video Conferencing project is under way, reviewing As-Is and To-Be. Health Help Now patient application has been assured as being SCCI0129 compliant and is now included in the NHS app library. Working with the Cabinet Office, NHSD, LCIE on patient verification authentication by Feb Patient Online making good process with the patient facing campaign. Target is 85% of practices to have 20% of patients with an on-line account by end October. GP practice Wi-Fi: pilot practices have been established, testing the capacity to manage network traffic and additional infrastructure resilience. Phase 1 of the deployment is now under way. Whole Systems Integrated Care continues to make good progress with GP sign up, deployment, training and establishing GP data flows and release 11. Diabetes population health RADAR pilot completed. Population health views development work started. Personalised Integrated Care Planning Standards carried out its expert group review, draft 3 of the design standards is now the focus. Data Quality Framework is progressing defining local standards and local tools. SNOMED planning work continues on governance, stakeholder engagement and resource review. The E-Learning Hub - the system is on track to be procured in October, with deployment plans now being developed. BI Re-procurement NWL CCGs working with London LPF team to procure a BI system for 32 CCGs to include population health functionality. Sep 17 ITT date has been delayed, but the London programme reports that mobilisation for Sep 18 is still on target NHSMail2 work is well underway with communications being released, deployment and support being made available for the migration. Work is progressing well for Infrastructure & IT Operations, disaster recovery testing, moving databases to the NWL environment, developing the business case for the Data Centre. Continue with planning and deployment phases Development of the Corporate Infrastructure Strategy

34 Enabler workstream report: Digital continued 34 RAG key: PROJECT AREA/ WORKSTREAM RAG RATING PROGRESS NEXT STEPS 3 Provider Digital Projects and Digital CQUINs: GREEN (proceeding as planned) Continued progress with NW London Care Information Exchange development of further interfaces (see above), but deployment to clinicians has been slow (e.g. care planning pilot in Hillingdon delayed again pending EMIS interface) and there is no agreement on funding for the CIE beyond March 2018 though Imperial s Charity, which has funded the CIE to date, may be prepared to fund it for a further year if the care community as a whole is supportive. NWL Digital Programme is providing support for the digital elements of national clinical CQUINs for 2017/18 (e-referrals, Advice & Guidance): planning is under way in all acute Trusts, being managed by lead CCGs as a commissioning and contracts issue since digital enablement via e-rs is in place. Providers are participating strongly in Digital governance, with partners working together on core system-wide plans and capabilities, though delivery is dependent on STP/LDR funding (see above) Current resourcing for PMO is not sufficient to collate Provider project progress for STP reporting purposes. Care Information exchange (CIE) options analysis Ongoing support of e-rs and Advice & Guidance CQUINs Continued work between CCGs and providers through joint governance KEY OUTSTANDING ISSUES THIS PERIOD No Issue Score Mitigation (latest progress) Score 1 STP/LDR funding has been delayed and will be insufficient to fully automate clinical operations and build shared care records, as set out in the STP and LDR vision. It is unlikely that there will be funding for an overall Digital PMO for NWL so it will be difficult to report consolidated progress. 5 JHCTG to consider alternative sources of funding for STP enablers Prioritisation of investment at Technical Design Authority and Digital Portfolio Board re priorities, once funding amount and guidance are confirmed. 4 2 Integrated care requires shared patient records but currently our GP and community systems (SystmOne and EMIS) do not have open interfaces and progress towards interoperability is slow. NHS Digital s GP Connect interfaces will fill this gap, but are still in pilot stage. 3 Extracts from EMIS and SystmOne to WSIC implemented using third party product (Apollo). EMIS interfaces are improving (primary/community sharing pilot in Hillingdon, links to Care Information Exchange being tested, CMC interface now in place). Positive news Technology partnerships TPP has announced it plans open interfaces for SystmOne (details of scope and timescales are awaited). 3 DELIVERY RISKS FOR NEXT PERIOD No Risk Score Mitigation (latest progress) Score 1 The further delay in NHSE STP/LDR funding will impact many of the digital enabling projects for the STP. Funding will be at a much lower level than required to enable the STP and national clinical objectives. 20 JHCTG to consider alternative sources of funding for STP digital enablers Prioritisation of investment at Technical Design Authority and Digital Portfolio Board, once funding amount and guidance are confirmed. 16 KEY AREAS FOR DISCUSSION JHCTG to consider alternative sources of funding for STP digital enablers In meantime, be aware that existing projects will continue, accepting that there will be delays in digital enablement of STP Delivery Areas, especially automation of clinical operations and shared care records

35 Enabler workstream report: Business Intelligence 35 RAG key: HEADLINES GREEN S&T team now taken on reporting from previous interim staff (DA2) Development of prototype programme, rapid response and frailty dashboards (DA3) Continued working on MH dashboard previously identified as risk by DA4 programme (DA4) Produced datasets and doing continued work to support GE Healthcare in their assurance of SOC1/SaHF (DA5) Supporting Delivery Areas to produce OATs for QIPP schemes across NWL (QIPP) PROJECT AREA/ WORKSTREAM RAG RATING PROGRESS NEXT STEPS DA2 DA2e - Supporting people to take control of their own health GREEN Handover of BAU reporting on PAM measures routine report now complete. Automate labour intensive process and provide second line cover to produce each month. Request for new Atrial Fibrillation and Hypertension dashboard. Work in progress to understand requirements. Further developed opportunity analysis for Rapid Response services using Ambulatory Care Directory and activity in low acuity ED attendances Work up routine Low Acuity ED analysis and Ambulatory analysis for Falls and UTI pathways to help group better understand cohort. DA3 DA3 Better care for older people GREEN Taken a version of the programme dashboard to the DA3 programme board. Featured context data for older peoples urgent care usage in NWL, and SPC charts to show progress against outcome metrics. A live data feed has been requested for Care Home activity and is currently being developed by Kavitha S in BIU. Combine ASCOF data and data available from WSIC to include in programme dashboard. New request for a frailty dashboard to cover Northwick Park and Ealing Hospitals DA4 DA4a - Supporting adults with serious and long term mental health needs DA4 Improving mental health services (Previous identification of BI resource has delayed development) Resource now in place to develop dashboard. Some revision to original data requirements but good engagement with WLMHT Routinely producing Grenfell attempted suicide and selfharm reporting. Review options for additional datafeeds for workforce and quality data. Will need similar conversations with CNWL. Looking into how we could identify where patients may now be in other localities. DA5 DA5 - Acute Transformation GREEN GP Hubs and 111 dashboard development continues with some additional requirements identified Developed further areas of potential QIPP and produced materials to facilitate and engage providers. Working closely with WLCCG colleagues and provider transformation team. Incorporate UCC capacity and staffing grades into current report. On-going work with stakeholders to determine true QIPP potential QIPP Opportunity assessment templates GREEN Some initial work on MSK, admissions from care homes / end of life, emergency ED attendances, BI support as necessary to support production of OATs for dermatology, ENT/audiology, gastroenterology, ophthalmology, cardiology, mental health prescribing and diabetes.

36 Enabler workstream report: Business Intelligence (continued) 36 RAG key: DELIVERY RISKS FOR NEXT PERIOD DA Risk Score Mitigation (latest progress) Score Unexpected complexity in backend SQL server tables causing delay in being able to use WSIC data to support S&T 6 Discussions with WSIC team about data structures and run through of tables 6 KEY OUTSTANDING ISSUES THIS PERIOD DA Issue Score Mitigation (latest progress) Score Delay to development of MH dashboard 6 Dedicated analyst capacity identified, risk with providers ability to provide necessary data fields. Meeting arranged with WLMHT. 3 KEY AREAS FOR DISCUSSION None

37 Enabler report: Estates 37 HEADLINES RAG key: BRENT NHS Property Services review of occupation being undertaken to feed in to proposed One Public Estates project. CENTRAL LONDON Refresh of current space /demand is being undertaken EALING Mattock Lane PID drafted for submission to F&P in November HAMMERSMITH & FULHAM PID for Phase 1 redevelopment at Parsons Green was approved by NHSE London Capital Committee in October HARROW NHSE London Capital Committee has approved funding for improvement works to first floor of Belmont Health Centre HILLINGDON PIDs for both the North Hillingdon Hub and Uxbridge and West Drayton Hub approved by F&P and GB HOUNSLOW Community Health Partnerships (CHP) approved capital funding PID for 400k for improvements/reconfiguration at Heart of Hounslow. Heston OBC approved by F&P and GB in September WEST LONDON ETTF funding secured to the value of 4.4m relating to the South Hub CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAME FOR DELIVERY PROGRESS Wembley Centre for Health and Care Hub increase utilisation and reduce voids NHS Capital 2.45 Year 1 7 (Aligned to CMH) Work continues to commission out of hospital services from the site and work is starting on looking at the possibility of reducing HQ costs at Wembley by consolidating the CCG space to reduce the cost of the accommodation. The opportunity to co-locate the CCG HQ with Brent Council is also being explored. NHS Property Services (PS) is leading a review of the current occupation of the site to establish the future clinical space required to support Hub delivery. This information will feed into a proposed OPE project to establish the potential mixed use development opportunity of the site with Brent Council and other adjacent land owners. This will also identify potential capital to be generated from land release. Brent Willesden Centre for Health and Care Hub increase utilisation and reduce voids NHS Capital 4.46 Year 1 7 (Aligned to CMH) Work continues to introduce new providers to deliver out of hospital services from the site. An improvement grant bid to relocate Burnley Practice to larger vacant accommodation was successful and the project has been initiated and work is underway to complete NHSE due diligence. The CCG is working with providers and the Council to develop a long term strategy for the use of the site linked to the emerging plans for Central Middlesex Hospital. Central Middlesex Hospital PC Hub increase utilisation and reduce voids ETTF 1.90 Year 1 The ETTF bid to create a primary care facility at Central Middlesex Hospital was successfully funded and due diligence has been completed. The London Capital Committee approved the enhanced PID in July and the CCG received national sign off in August and work has commenced on site. NHSE has completed the procurement of a new APMS practice with a new contract awarded. Some internal LNWHT delays has pushed back completion of the works to 1 Feb Central Westminster Hub New build NHS Capital 4.92 Year 3-4 Hubs and Spoke Workshops have been undertaken to test the original assumptions and re-focus models of care that are deliverable. The CCG is now exploring alternative options for a Central Hub. Central Church Street Hub New build NHS Capital/ Westminster City Council Year 5+ Dialogue continues with Westminster City Council to develop a community hub on a site at Lilestone Street as part of the Church Street regeneration. Phase 1 works to create new housing units at Lisson Arches has been delayed and this is having a knock on effect to vacating the Lilestone Street site. Alternative options are being considered

38 Enabler report: Estates (continued) 38 RAG key: CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAM E FOR DELIVERY PROGRESS Ealing East Hub New build LIFT ( 23m) Year 2 The PID and Options Appraisal (OA) have been approved by the CCG and following NHSE approval of the PID the OA has been submitted to NHSE for approval. The preferred option is to rebuild Acton Health Centre which is a LNWHT owned site. Work now to commence on OBC. Ealing Ealing North Hub New build 3PD m Year 2 The PID and Options Appraisal (OA) have been approved by the CCG and following NHSE approval of the PID the OA has been submitted to NHSE for approval. The preferred option is a new health centre on the former Glaxo (GSK) site. The GSK developer has successfully obtained planning consent for the scheme which includes a 2,000 m2 of health facility (subject to commercial terms and necessary approvals being in place). Work now to commence on OBC. Mattock Lane Non-Hub New build TBC TBC Year 3-5 Proposal to develop Mattock Lane as a large primary care centre for central Ealing to serve a registered patient list of circa 50,000, plus community services. A feasibility report was commissioned to demonstrate how the site could potentially be redeveloped to provide a health facility of between 2,000 and 2,500 m2. Several local GP practices have expressed an interest in collaborating to consolidate primary care services on this site. The recommendation from the feasibility report is now informing the development of the PID which is due to be submitted to the Finance Committee in December 2017 Hammersmith and Fulham Parsons Green Health Centre Bridge House Hub Reconfiguration of existing site Non-hub Reconfiguration NHS Capital/ ETTF NHS Capital 4.81 Year Year 1 Partial funding of 794k via ETTF was expected to be confirmed at London Capital Committee in July 2017 to support the relocation of Lilyville Surgery, however this decision was not confirmed until the LCC in October Work will now progress on completing the due diligence required for the project. ICHT are now delivering Cardiology and Respiratory services from the newly reconfigured accommodation and ICHT has also agreed to facilitate a new IAPT pilot service from this space. Minor works to convert two void rooms on the ground floor as accommodation for the IAPT Service displaced from Charing Cross has completed. IAPT due to move in during November.

39 Enabler report: Estates (continued) 39 RAG key: CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAME FOR DELIVERY PROGRESS The Pinn Medical Centre Hub increase utilisation and reduce voids NHS Capital 0.68 Year 1-2 A utilisation review of the site has been undertaken and further opportunity to accommodate services was identified. The site houses a practice with a patient list of 23,000 and a walk-in centre (WiC). This is an operational Hub offering a range of OOH, community and primary care services. X-ray and ultrasound services are also offered from the site. The opportunity to reorganise some space at the site to create additional clinical capacity will now be explored.. Harrow East Harrow Belmont Health Centre Hub New build Non-hub Reconfiguration NHS Capital NHS Capital ( 2.9m- 7.8m) Year Year 1 The PID for this scheme has been approved by the CCG and NHSE. The Options Appraisal (OA) has been completed for the scheme and has identified the preferred option as the redevelopment of the existing Belmont Health Centre. CCG F&P and GB approval was obtained in August The project has also been Identified as a possible One Public Estate scheme to maximise development potential with Harrow Council and release surplus public sector land for residential development. NHSE operational capital had been approved to convert the void first floor office accommodation into clinical space to address overcrowding a lack of capacity at the site. NHS PS has undertaken the tendering for the detailed design for the work and engagement with the existing tenants and PPG continues. Concept design ready is being reviewed with the tenants week of the 13 November. Alexandra Avenue Hub increase utilisation and reduce voids LIFT 2.70 Year 1-2 Following a space utilisation review and a piece of targeted work all admin and clinical space on the lower ground floor is now occupied and void space at this site has been reduced to less than 3%. Utilisation has increased from 44% in 2016 to a current rate of 75%. Minor works to meet current Infection Control requirement is currently underway and once completed Tissue Viability will commence from this site. Alexandra Avenue currently provides most of the core services identified in the OOH hub strategy.

40 Enabler report: Estates (continued) 40 RAG key: CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAM E FOR DELIVERY PROGRESS Hesa Health Centre Hub increase utilisation and reduce voids NHS Capital TBC Year 1-3 The re-procurement of primary care services at the site has triggered a requirement to look at the primary care space at the site. This may also create an opportunity to release further space for the delivery of out of hospital services at the site. Yiewsley Health Centre Non-hub Reconfiguration of existing site ETTF 0.5 Year 1 The ETTF scheme to convert void space into clinical space is progressing with the design agreed. Practices have agreed the allocation of space and will now enter into lease negotiations with NHS PS in order to satisfy NHSE due diligence. The ETTF investment will negate any revenue increase. There remains a significant risk with respect to the delivery of this scheme, and all ETTF schemes in NHS PS properties as currently there is no mechanism for NHSE to transfer capital to NHS PS. This matter has been escalated and is being dealt with by DH. Tender for works has commenced with tenders due 21 November. Additional s106 funding sought to improve entrance, lobby and reception areas. Hillingdon North Hillingdon Hub New build NHS Capital 5.67 Year 2-3 Discussions continue with THH to include the provision of the Hub space requirement in its new build skin clinic on the Mount Vernon site. An alternative scheme has been worked up with NHSPS for the combined Northwood & Pinner Community Hospital and Northwood Health Centre sites. These two site options will be analysed at Options Appraisal. The PID was approved by F&P in August and GB in September 2017 and has been submitted to NHSE for approval. The PID was approved by F&P in August and GB in September 2017 and has been submitted to NHSE for approval. Uxbridge and West Drayton Hub New build 3rd party developer / NHS Capital Year 3-4 Having been unable to secure a site on the St Andrews site with St Modwen, the redevelopment of the Uxbridge Health Centre is being assessed with CNWL. A feasibility study has been undertaken for input to the Options Appraisal. The PID was approved by F&P in August and GB in September 2017 and has been submitted to NHSE for approval.

41 Enabler report: Estates (continued) 41 RAG key: CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAME FOR DELIVERY PROGRESS Heart of Hounslow Hub increase utilisation and reduce voids LIFT 1.72 Year 1-2 CHP has secured 400k capital funding for 17/18 to reconfigure space that will lead to further improvement in utilisation, including bringing void space back into use. A PID for the additional work has been approved and the project is due to commence shortly with works expected to complete by end of the financial year. Heston Hub New build LIFT ( 1.9m) Year 2-3 Stage 1 (OBC) document approved by Hounslow GB on 14 March 2017 subject to further cost reduction measures being explored as part of design development. Stage 1 (OBC) document was approved by Hounslow F&P and GB in September. Due to the six month delay, due to affordability concerns and logic model requirements, the FBC is now expected to be completed in May Hounslow Chiswick Health Centre Hub Reconfiguration of existing site ETTF 1.00 Year 1-2 ETTF PID for Chiswick Health Centre has been submitted to London Capital Committee and approved. The proposed scheme has been represented to GP practices, HRCH and NHS PS to ensure that key stakeholders are engaged. All parties are positive about the proposed scheme that will deliver additional clinical space through an internal reconfiguration/refurbishment. NHS PS has completed a competitive procurement process and has appointed a design consultant to progress the scheme. The CCG and NHS PS is considering the shortterm opportunity versus the medium-term redevelopment option and in parallel with the Brentford approach NHS PS has appointed a design team who have recently completed a feasibility and viability study. This approach was discussed with NHSE at the recent ETTF Surgery held on 3 October A draft paper is being prepared collaboratively with NHS PS that will re-state the consistent objectives and benefits Brentford/ West Middlesex Hub New build NHS Capital Year 3-4 Early discussions with West London Mental Health Trust have identified an opportunity for a collaborative redevelopment of the site, which could include both Brentford Lodge and the Brentford Health Centre. This is being explored further with WLMHT and NHS PS who have appointed a design team who have recently completed a feasibility and viability study. Draft PIDs have been prepared for both sites and are expected to be presented to F&P in November. OA list from NHS PS still awaited.

42 Enabler report: Estates (continued) 42 RAG key: CCG PROJECT PROJECT TYPE FUNDING TYPE ESTIMATED INVESTMENT ( m) TIMEFRAME FOR DELIVERY PROGRESS West South locality Hub Refurbishment and extension 3 rd party developer/ NHS Capital/ ETTF ( 10.4m) Year 2-3 Dialogue continues with The Cadogan Estate with respect to the refurbishment and extension of the Violet Melchett Clinic to determine how the scheme can be taken forward and the associated costs/delivery route. Cadogan has commenced pre-application discussions with the Local Authority and Cadogan have recently advised that a planning application is unlikely to be submitted before January The Options Appraisal (OA) was approved by CCG GB in March 2017, subject to financial alignment with SOC1, which was completed in June The OA has now been submitted to NHSE for approval. Partial funding of 4.4m via ETTF was confirmed at London Capital Committee (LCC) in July St Charles reduced Hub Reconfiguration of existing site and reduce voids NHS Capital 3.95 Year 2-3 Initial discussions have commenced with NHS PS relating to options to utilise space at St Charles Centre for Health and Care. CNWL has withdrawn its interest in leasing space in Courtfield House due to the poor general condition of the building and thus overall scheme viability. A workshop is being planned for Nov 2017 to allow the CCG to define its commissioning intentions for the site. KEY AREAS FOR DISCUSSION Reaffirming partner support and engagement with delivering the NWL Hub strategy 42

43 Glossary 43 Acronym Term in Full Acronym Term in Full A&E Accident & Emergency ibcf Improved better care fund ACP Accountable care partnership IC Intermediate care ADASS Association of Directors of Adult Social Services ICHP Imperial college health partners APMS Alternative provider medical services ITT Invitation to tender ASD Autism spectrum disorder JHCTG Joint Health Care Transformation Group BAU Business as usual LAS London Ambulance Service BHH Brent Hillingdon and Harrow LA CYP Local authority children and young people BI Business Intelligence LDR Local digital road map BIU Business Intelligence Unit LNWHT London North West Healthcare NHS Trust CAMHS Child and adolescent mental health services MSK Muscular Skeletal CEPNS Community Education Provider Networks (CEPNs) NHSE National Health Service England CIPs Continuous improvement process NHSI NHS Institute for Innovation and Improvement CFO Chief Finance Officer OPE One Public Estate CLARCH CLAHRC - Collaboration for Leadership in Applied Health PAM Patient Activation Measures Research and Care CNWL Central and North West London NHS Foundation Trust PBS Positive behavioural support COOs Chief Operating Officers PID Project Initiation Document COPD Chronic obstructive pulmonary disease QIPP Quality innovation productivity prevention CQUINs Commissioning for Quality and Innovation ROI Return on investment CRG Clinical reference group RR Rapid response CTO Chief Transformation Officer SLTMHN Supporting adults with serious & long term mental health needs CTPLD Community team for people with learning disabilities SNOMED Systematised nomenclature of medicine EMIS (Egton medical information system) a supplier of electronic patient SOC Strategic outline case record software systems for primary care EOI Expression of interest SQL Structured query language F&Ps Finance & Procurement STARRS Short-term assessment, rehabilitation & reablement service GPFV General Practice Forward View THH The Hillingdon Hospitals NHS Foundation Trust HASC Health & Adult social care select committee TPP The Phoenix Partnership a Government accredited clinical computer system used in Primary Care HEE Health Education England UCC Urgent Care Centre HEENWL Health Education England North West London WLA West London Alliance HLP Healthy London Partnerships WSIC Whole Systems Integrated Care IAPT-LTC Improving Access to Psychological Therapies (programme) - long WTAC Workforce Transformation Advisory Council term conditions IAPTUS Improving Access to Psychological Therapies a Clinician online patient management system WTDB Workforce Transformation Delivery Board

44 Contents for NWL work book updates 44 NWL project workbook- Risk Framework Supporting local people to live healthier lives (DA1a) - Reducing harmful drinking (DA1ai) Roll out of the National MECC Programme (DA1d) - Making Every Contact Count (DA1di) Getting hospital patients better, quicker (DA5b) - Radiology and Diagnostics (DA5bi) & Inpatient model of care (DA5bii) Organising Hospital services (DA5c) Capital business cases to support clinical improvements (DA5ci) Organising Hospital services (DA5c) - Improvements to women s services (DA5ciii) Key messages for NWL work book updates Transition to using the NWL project workbook is underway across S&T The workbooks presented in this section are the first projects to transfer and are being developed We are awaiting the development of programme level work books This is the GANTT chart key used in the workbooks GANTT Chart Completed milestones: Completed tasks: Incomplete milestones: Key Incomplete tasks: 6

45 NWL project workbook - Risk framework 45 Taken from CWHHE policy (CWHEE/GOV/003-(Source: National Patient Safety Agency)