Durham, Darlington, Teesside, Hambleton, Richmondshire & Whitby Sustainability Transformation Plan (STP) October 2016

Transcription

1 Durhm, Drlington, Teesside, Hmbleton, Richmondshire & Whitby Sustinbility Trnsformtion Pln (STP) October 2016 Footprint (CNE02) - Region: Cumbri nd the North Est Designted led : Aln Foster, Chief Executive, North Tees & Hrtlepool NHS Foundtion Trust Meeting our communities needs now nd for future genertions with consistently better helth nd socil cre delivered in the best plce 1

2 Contents Title Slide no Welcome to our pln 3 STP Popultion 4 Triple im gps (STP context) 5 Our Vision 6 Our delivery pln The Nine Must Do s Strtegic Pln on Pge Erly Intervention & Prevention Neighbourhoods & Communities Acute Hospitl Reconfigurtion Digitl Cre & Technology Delivery Pln Key Outcome Mesures Enblers Esttes Workforce Enggement Governnce Appendix 1 Finnce & Activity Assumptions Finnce Assumptions

3 Welcome to our pln In Durhm, Drlington, Teesside, Hmbleton, Richmondshire nd Whitby (DDTHRW), the NHS including specilised commissioning, locl Government nd the voluntry sector re committed to continuing our system wide working in order to further develop our mbitious plns to prevent ill helth, improve helth outcomes, improve qulity of cre nd deliver finncil sustinbility. The footprint is mix of urbn nd rurl communities which presents specific chllenges for the provisions of helthcre. In June 2016 we set out our vision of meeting our communities needs now nd for future genertions, with consistently better helth nd socil cre delivered in the best plce. This ws supported by cler rticultion of our chllenges ssocited with n overrelince on hospitl bsed services. This itertion of our pln rticultes how we will deliver trnsformtion t scle nd pce in order to deliver the requirements of the Five Yer Forwrd View. Building on the feedbck we received in July, this pln focuses on the following res; Detiling the yer on yer benefits of the trnsformtion progrmmes we pln to deliver including expected outcomes. Giving cler indiction of the enggement ctivities required to deliver the trnsformtionl chnges required. Continuing to mke connections with neighbouring STPs in order to understnd the shred opportunities nd wide impct of our respective plns. Including the development of regionl blueprint for n mbitious vision for future services with Northumberlnd, Tyne & Wer. To mke this vision success, North Durhm is now prt of the NTW STP reflecting ptient flows nd popultion centres round the three rivers. Further more, lignment with Humber, Cost nd Vle nd West Yorkshire STPs is currently being developed through forml enggement in our STP governnce rrngements. We re building on long history of working in prtnership to drive improvements in the helth nd wellbeing of our locl popultion. Where we hve collborted with others either outside of our boundries (e.g. Urgent nd Emergency Cre Vngurd) or within our footprint, the results hve been positive nd fr greter thn ny individul orgnistion could hve chieved lone. This is most evident with the Better Helth Progrmme nd lso Fit for the Future which re providing strong pltform for delivering system wide chnge. Trnsformtion cross the STP footprint will deliver shift towrds improving popultion helth - moving from frgmenttion to integrtion in cre delivery, but lso tckling the wider determinnts of the helth nd wellbeing of our popultion. Working together s Helth nd Cre system enbles us to focus on erly intervention nd prevention, integrtion, reconfigurtion of hospitl bsed services, nd technology. To do nothing is not n option. Our pln is mbitious, nd will deliver trnsformed system for our workforce nd locl popultion, delivering robust clinicl rots with ccess to full rnge of specilists, delivery of community hubs, speedy dignostics nd integrted tems. This will led to better ptient outcomes with shorter hospitl stys, improved ccess to GPs in finncilly sustinble system. Aln Foster STP Led 3

4 STP Popultion 4

5 Triple im gps - locl STP context 5

6 DDTHRW VISION 2020 Meeting our communities needs now nd for future genertions with consistently better helth nd socil cre delivered in the best plce 6

7 DDTHRW Vision 2020 An mbitious system wide cre strtegy hs been developed with full enggement of clinicins nd wider stkeholders to provide better qulity of cre nd outcomes for ptients in the longer term. This is rre exmple of whole system pproch underpinned by strong collective ledership by both Joint CCG Committee nd Joint NHS FT Committee to steer nd direct the pln nd implementtion. In order to deliver our vision we hve clerly described our delivery pln. In order to ensure the relistion of our pln we re relint on number of interdependencies cross our whole helth nd cre system i.e. Primry Cre, Locl Authorities, Public Helth, Voluntry Sector nd ll providers. It is cler tht services we provide cnnot continue in their present form. They re unble to ddress the key chllenges of helth nd wellbeing, cre nd qulity, nd finnce nd efficiency which we re currently fcing. The clinicl strtegy is system wide solution, (Figure 1) from effective screening nd prevention to more integrted community models of cre nd finlly hospitl bsed services trnsformed so tht more locl services re provided closer to home but ccess to specilist Consultnts is enhnced (Figure 2). Less vrition, with n ssocited improvement in qulity, would be key outcome t every stge of ptient s pthwy with services delivered in n extended dy, 7 dys per week. Figure 1. Figure 2. 7

8 DDTHRW Vision 2020 To dte we hve relied more on hospitl bsed cre thn other prts of the country. We wnt to strengthen cre outside of hospitl so tht neighbourhoods, communities nd individuls re ble to tke more control of their helth nd mintin independence for longer whilst preventing or delying the need for more services in cute nd community cre. We hve mbitious plns to strengthen services delivered in primry cre, ttrcting more GPs to the re nd growing the work force. Developing new roles tht cn support the primry cre tem to mnge their worklod, improve integrtion with socil cre nd expnd services tht were previously provided in hospitl setting. The new model will enhnce proctive cre plnning nd delivery for ptients t risk of hospitl dmission tht require wider service support. We will increse the number of services tht re delivered outside of hospitl settings. We will be developing helth nd socil cre hubs ech covering popultion of 30,000 to 50,000 people. Helth nd cre orgnistions will work together in developing new models of cre tking responsibility for the helth nd cre of the popultion budget. This new wy of working will enble us to reduce the number of people tht require dmission to hospitl. When people require hospitl dmission they cn often sty in hospitl longer thn is necessry so we re working closely s helth nd socil cre prtners to improve support for ptients leving hospitl, so tht they cn be dischrged quickly when it is mediclly sfe to do so. We recognise tht we need strong focus on creting sustinble nursing nd residentil cre provision. We pln to strengthen links between helth nd socil cre commissioners. Plns re being developed to integrte commissioning functions where it mkes sense to do so nd we wnt to build nd encourge the development of the voluntry sector so they cn support ptient cre in the community, ensuring helth nd socil cre services re used effectively. We will increse the number of ptients nd service users who hve ccess to Personl Helth Budget enbling greter choice nd control over their helthcre nd the support they receive. These principles pply for both physicl nd mentl helth nd service users with lerning disbility. The improvements in services in our neighbourhoods nd communities will impct on the wy tht our hospitl bsed services will be delivered. 8

9 DDTHRW Vision 2020 Stkeholders cross the STP geogrphy hve pproved strtegy nd set of qulity stndrds which set out the mbition to deliver person-centred outcomes bsed on four key principles within our neighbourhoods nd communities; Prevention Proctive cre Responsive nd ccessible cre Co-ordinted pproch Prevention Helth, wellbeing nd independence should be promoted Ptients will be supported to self-mnge their condition nd to mintin helthy lifestyle A directory of services to be implemented of helth, cre nd support services in their locl community Stndrds Responsive & Accessible Access to GP / Clinicin Access to socil cre support Rpid Response from community tem Approprite services vilble 7 dys week Outcomes Outcomes Proctive We will develop plns to dely or reduce the need for cre nd support Provide cre closer to home where sfe nd cost effective to do so to meet the wider needs of the popultion Connecting nd supporting people into their own community with voluntry sector support Principles Co-ordinted People will be ble to ccess the necessry cre nd support when it is required We will provide co-ordinted Helth nd Socil Cre delivery to meet peoples needs Stndrds 9

10 DDTHRW Vision 2020 The implementtion of community hub models will llow us to provide more services in the community. The community hub will deliver core components nd chieve greed stndrds cross our footprint however ech hub is expected to be tilored to meet the needs of locl neighbourhoods nd communities, in recognition of helth inequlities nd rurlity within our STP geogrphy. Below is n exmple of how this could work; Current Stte Future Stte 10

11 Level of Needs DDTHRW Vision 2020 We will move wy from trditionl model to new model of cre for chronic disese mngement, where self-mngement support, erly intervention nd dignosis is the responsibility nd n integrl prt of the Community Hub. Cre will be delivered by proctive workforce cross seven dys nd n extended dy, enbling ptients to move wy from being pssive recipients of cre to informed nd ctivted to selfmnge with n pproprite response in the event of escltion (identify, integrte nd co-mnge). Extended Primry Cre Tems: intensive cse mngement nd dvnced cre plnning for those people identified s very high risk. Typiclly >75 yers, 10+ GP ppointments per yer, multiple LTCs nd socil cre needs. Extended Primry Cre Tem + Wider Hub Network: prioritise clinicl res for improvement (i.e. MH & MSK), introduce more effective methods for delivery of IAG nd self-cre. Very High Risk (0.5%) High Risk (0.5-2%) Ongoing Support for Those Who l Need It Short-term Support to Help People Bck to Independence Secondry Prevention & Self-Mngement: supporting people to ddress lifestyle fctors tht increse the risk of ill-helth. Mking every contct count whole person pproch. Moderte Risk (2-20%) Help to Help Yourself Whole Popultion Primry Prevention: community-level cmpigns to improve helth behviours.. Low Risk (20-50%) Very Low Risk (>50%) Stying Well Proportion of Popultion 11

12 DDTHRW Vision 2020 A proposed outcomes frmework hs being developed which tkes whole (hub) popultion pproch nd ttempts to lign different outcomes with ech sector of Community Hub s segmented popultion (very high risk, high risk, moderte risk, low risk groups). Hub Inputs Hub Processes Trget Popultion Exmple Indictors / Mesures Outcome 1. Extended Primry Cre Tem Regulr risk strtifiction of popultion Regulr MDT & Advnced Cre Plnning Intensive Cse Mngement Very High Risk (0.5%) People dying in preferred plce of deth Reducing number of people dmitted to hospitl from cre home Emergency Admissions - reduction of interprctice vrince Ongoing Support for Those Who Need It Most 2. Primry Cre Tem + Wider Community Network Introducing more effective methods for communiction, dvice & guidnce, nd self-help Prioritising clinicl res for improvement, e.g. mentl helth, musculoskeletl High Risk (0.5-2%) % who know how to contct n out-of-hours GP service Reducing voidble emergency dmissions (BCF Composite) Delyed trnsfers of cre ttributble to dult socil cre per 100,000 ged 18 Short-term Support to Help You Return to Independence 3. Secondry prevention & self-mngement Supporting people to ddress lifestyle fctors tht increse the risk of ill helth Mking Every Contct Count tking whole person pproch in every interction Moderte Risk (2%-20%) Ptients (75+ yrs.) with frgility frcture treted with bone-spring gent Smokers (15+ yrs.) with record of n offer of support nd tretment (lst 24 months) Newly dignosed ptients w. dibetes referred to eduction progrmme within 9 months Help to help yourself 4. Whole Popultion Primry Prevention Community-level cmpigns to improve helth behviours Low Risk (20-50%) Very Low Risk (>50%) People tking up n NHS Helth Check Invite % of ll infnts due 6 to 8-week check tht re totlly or prtilly brestfed Prevlence of overweight (including obese) mong children in Reception Stying Well 12

13 DDTHRW Vision 2020 Chnges to services outside of hospitl will impct on the wy tht our hospitl bsed services will be delivered. At the front of house of ech of our hospitls would be resilient interfce with the community nd neighbourhood services to provide: Urgent cre services Fril elderly ssessment Short sty peditric ssessment Ambultory cre services Fst ccess to dignostic services Signposting nd trnsfer to the specilist hospitls, where pproprite The potentil reconfigurtion of the specilist hospitl bsed emergency services is best described by the illustrtion on the next pge, it demonstrtes system wide pproch underpinned by clinicl network of services with locl cre provided by the locl hospitls (this is under development nd subject to consulttion). 13

14 DDTHRW Vision

15 DDTHRW Vision 2020 Decision Mking Process Results A methodology to fully consider the long list of scenrios ginst the decision mking criteri ws greed, bsed on: Long term clinicl sustinbility Long term finncil sustinbility Successful implementtion The originl long list of scenrios ws reduced following the chnge to the STP footprint in August. The criteri to dte concludes tht four scenrios do not meet our strtegic im of better cre nd outcomes for ptients nd these re: Retining two district generl hospitls nd one Specilist Hospitl including mjor trum centre One single site for ll emergency cre services Three site nd two site inptient peditric services. The next stge is to pply the decision mking evlution (next slide) to determine the preferred option for:. The second specilist emergency hospitl b. The preferred scenrio for inptient peditrics nd locl short sty peditric ssessment. c. The preferred scenrio for consultnt led obstetric cre These re summrised on the next slide. Hospitls would work in prtnership to deliver new model of clinicl networks nd single services cross the system, where pproprite. A recommendtion to the NHS sttutory bodies nd the Joint CCG Committee is plnned. 15

16 DDTHRW Vision 2020 Potentil Service Scenrios The evlution criteri needs continued refinement nd professionl judgement to determine the second emergency hospitl site nd determine the preferred option for consultnt led obstetrics nd peditric services. * The key criteri highlighted bove should enble decision to be mde for the preferred second site. However, compelling difference between sites hs not yet been identified. Therefore further clinicl guidnce hs been sought. Plese refer to ppendix 1 which sets out in detil our finncil ssumptions mde in order to deliver our vision. 16

17 OUR DELIVERY PLAN 17

18 The nine must do s Across the STP historicl performnce in reltion to constitutionl stndrds hs been good. Recognising there will be individul vrinces which will be ddressed through locl plns nd performnce recovery mesures, where necessry, there is commitment cross the STP to ensure delivery. In prticulr ddressing our chllenges in reltion to; Cncer witing time A&E 4 hour stndrd Ambulnce response times 18

19 Digitl Cre & Technology Acute Hospitl Reconfigurtion Neighbourhoods nd Communities Erly Intervention nd Prevention Strtegic Pln on Pge CNE 02 Meeting our communities needs now nd for the future genertions with consistently better helth nd socil cre delivered in the best plce Trnsformtion Scheme STP Actions Enblers Efficiency Cncer Implementing the Cncer Allince, Mtching dignostic cpcity to expected demnd, Continuous improvement of ll pthwys, Increse Cncer wreness on prevention nd erly identifiction Helth & Wellbeing Gp Lifestyle, Erly Intervention nd Prevention Giving Every Child the Best Strt Reduce smoking rtes, Reduce obesity rte through incresed physicl ctivity, Focus on hrd to rech communities Improve perintl services including CCG mentl Schemes helth nd smoking. Reduce childhood obesity rtes through increse physicl ctivity, Focus on hrd to rech communities Esttes 9.6m Trnsformtion Scheme STP Actions New Models of Cre Enggement nd benchmrking of models of cre, Design nd gree models of cre t locl level, Commence implementtion phse including Dischrge to Assess models Primry Cre CCG investment into developing nd supporting Primry Cre, Delivery of extended ccess, Implement new models of cre Workforce 42.9m Qulity & Cre Gp Urgent & Emergency Cre Network Mentl Helth Re-procurement of 111 service (including clinicl hub), Delivery of IUC stndrds to support new models of cre, Reform pyment mechnisms nd metrics Implement plns regrding Erly Intervention into Psychosis (EIP), psychologicl therpies (IAPT) nd improvements to CAMHS, Develop community bsed services to support reptrition of out of re plcements, Implement enhnced system wide dementi support. Lerning Disbilities Co-production of new service model, Agree nd implement bed closures, Agree finncil flows Right Cre Implement rnge of clinicl thresholds for priority res, review pthwys in line with New Models of Cre, reduce vrition t prctice level. Enggement 110.7m Trnsformtion Scheme STP Actions Funding & Efficiency Gp Better Helth Progrmme Finlise options for public enggement, Undertke public consulttion, develop implementtion plns Trnsformtion Scheme STP Actions Governnce 100.8m Digitl Cre nd Continution of dt shring nd interoperbility, Progress the digitl mturity of secondry cre Technology providers, Implementtion of the Locl Digitl Rodmp with n emphsis on Remote /Self Cre nd Decision support 19

20 EARLY INTERVENTION AND PREVENTION 20

21 Lifestyle, erly identifiction nd intervention Must Do s Smoking Alcohol Lifestyle Implementing RightCre Implement the cncer tskforce report Support self cre nd prevention Mke progress in improving one-yer survivl rtes 16/17 17/18 18/19 19/20 20/21 Re-procure Fresh & Blnce Develop revitlised progrmme for obesity, tobcco nd lcohol Implement Smoke Free NHS (Acute nd MH) with holistic smoke free pthwy nd ccess to smoking cesstion services Develop holistic lcohol brief intervention nd tretment pthwys with improved community support services Develop 4 yer comprehensive prevention progrmme for Long Term Condition e.g. Crdiovsculr disese prevention progrmme nd COPD pthwys(using PHE Progrmme) Build on Helth t Work Awrd nd develop comprehensive workplce helth progrmmes nd pthwys to work progrmmes The Gp Why Chnge is needed The mjority of Locl Authority res report rtes tht re significntly worse thn the Englnd verge for Hospitl stys for lcohol relted hrm nd lcohol specific stys for under 18 s. Alcohol misuse contributes significntly to 48 helth conditions, wholly or prtilly, due either to cute lcohol intoxiction or to the toxic effect of lcohol misuse over time. Smoking is the single lrgest cuse of helth inequlities nd premture deth, within the STP, nerly 1 in 5 dult s smoke (19.6%). Smoking is the primry reson for the gp in life expectncy between those in the most deprived quintile nd those in the lest deprived quintile. Obesity rtes for the STP re 11.9% compred to ntionl rte of 9.0% nd the percentge of physiclly inctive dults is 31.0% compred to ntionl rte of 27.7%. Poor diet nd physicl inctivity re cusl fctors of obesity nd obesity disproportiontely ffects the most deprived communities. Key themes hve been identified through nlysis of right cre tht hs identified key res such s respirtory, CVD nd cncer. Themes identified to improve outcomes focus on preventtive interventions specificlly screening nd erly dignosis, lifestyle chnges, vccintions which ll require close working between public helth nd helth service providers with strong focus on primry cre s erly ction nd improved primry cre models will reduce spend nd mximise helth gin. Future Stte/Ambition for 2020/21 Improved support services for people dmitted with lcohol relted dmissions long with provision of brief dvice in primry nd secondry cre settings nd sustined enggement with high-impct users.. Refocus of locl tobcco control efforts nd smoking cesstion services on priority groups; the poorest 10% of our community, people with long term conditions including mentl helth illness nd smoking in pregnncy Hospitl liison services for drugs nd lcohol Implement Government Buying Stndrds for food nd ctering services (GBSF) cross rnge of public settings nd fcilitte the uptke of nutrition policy tools Integrte weight mngement nd mentl helth services Greter focus on screening inititives to improve effective erly detection nd mngement of long term conditions Cre pthwys will endure referrl to pproprite support services t key trigger points in the ptient journey nd where possible provide support proctive self mngement Secondry prevention in ll cute contrcts nd udited to monitor delivery Extending the use of personl helth nd socil cre budgets nd supporting people to use nd mnge these effectively to ensure people will hve incresed choice nd control over ll spects of their life. Scling up wellbeing / wellness progrmmes in the community nd expnding cpcity to deliver s prt of self cre s system defult building upon existing progrmmes with n equl focus on mentl helth Increse the role of physicl ctivity s prevention, erly intervention, pre-hbilittion nd rehbilittion for physicl nd mentl helth. Benefits A reduction in lcohol relted hospitl dmissions Reduce Alcohol Relted Hrm A reduction in the prevlence of smoking mong persons ged 18 yers nd over A reduction in directly stndrdised rte of smoking ttributble dmissions in people ged 35 nd over An increse in successful quitters t 4 weeks per 100,000 smokers Reduce Obesity nd Promote Helthy Diet Increse Physicl Activity Reduce Premture Deths Reduce Helth Inequlities Increse in the number of people ccessing personl helth budgets An increse in screening rtes An increse in vccintion rtes Support Self Cre &Prevention & Mking Every Contct Count Wht resources re required to deliver / wht cpcity nd cpbility do we need? A joined up trgeted public helth response cross the STP footprint Focused input to identify, nd work with, hrd to rech groups nd deprived communities Support for primry cre to mnge worklessness nd support people with LTC bck into employment A multi disciplinry workforce to ensure tht every contct counts underpinned by long term pln for workforce recruitment to the NE nd not bsed on individul orgnistions Continuous improvement nd wreness of pthwy developments cross the footprint through robust trining nd eduction pln Additionl resource through working prctice nd innovtion to improve secondry prevention in primry cre nd secondry cre 21

22 Providing every child the best strt in life Must Do s Childhood Obesity Integrted Services Brestfeeding Mternl Smoking Pthwys Implement the ntionl mternity services review Better Births, through locl mternity systems 16/17 17/18 18/19 19/20 20/21 Develop 4 yer comprehensive, childhood obesity progrmme to promote helthy diet, increse physicl ctivity & sport, improve tier two & community support services Develop integrted 0-19 or 0-26 services cross HV, SN nd Socil Cre to deliver Helthy Child Progrmme nd reduce LAC Expnd Brestfeeding Inititives such s Henry, Bbycler nd UNICEF Bby Friendly Inititive Expnd Trgeted Smoking Cesstion Inititives such s Henry, Bbycler nd UNICEF Bby Friendly Inititive Develop nd support the delivery of improved pthwys through existing networks The Gp Why Chnge is needed This remins priority for ll orgnistions with the mjority of Locl Authorities reporting bove the ntionl verge highlighted in the nnul Ntionl Child Mesurement Progrmme (NCMP) reports. Excess weight (overweight nd obese) for Reception yer (4-5 yers) of 21.9% nd for Yer 6 (10-11 yers) of 22.3% Dt from the NCMP 2012/2013 show us tht the most deprived 4-5 yer olds nd yer olds re twice s likely to be obese thn the lest deprived. Dt from PHE shows tht this footprint hs significnt child poverty nd severl worsening res of helth e.g. mortlity; MMR immunistions uptke ; levels of child development; rise in children in cre Future Stte/Ambition for 2020/21 All children nd fmilies to be ble to ccess improved services for ; mternl mentl helth, mentl helth, brestfeeding, mternl obesity, mternl smoking, prentl drug nd lcohol issues, prenting progrmmes, school rediness Support orgnistions to relise the benefits of physicl ctivity is n importnt component of erly brin development nd lerning. Communiction skills depend on well-developed physicl skills, such s effective movement nd eye contct; prenting progrmmes; Dily mile schools; Prk runs - communities Supporting ll children nd fmilies to ccess child heth prevention progrmmes All children nd fmilies to ccess - food in settings - hospitls, nurseries, schools, workplces All orgnistions to Helthy weight declrtion or sugr smrt city Implement prevention pthwys in mternity contrcts Improved poorly child pthwys Improved public mentl helth cross the life course. This could include cler offer for ll life stges in line with Future Minds/CAMHS trnsformtion Benefits Reduce the prevlence of overweight nd obese children t Reception nd Yer 6 Reduce the vrition of prevlence of overweight nd obese children t Reception nd Yer 6 with the STP footprint A reduction in mternl smoking Reduce mortlity rtes Reduce mentl helth of children Reduction in the top 10 childhood illnesses Increse in chid development Reduction in children in cre Reduction in A&E Attendnces for children Reduction in non-elective ctivity Improve School Rediness Improve Childhood Immunistion Rtes Increse Brestfeeding Rtes Reduce Teenge Pregnncy Improve Mternl Mentl Helth Improve the mentl helth of children A reduction in self hrm emergency dmissions nd suicide rtes. Wht resources re required to deliver / wht cpcity nd cpbility do we need? Increse in trining nd eduction of primry, community, 3 rd sector to be confident in recognising potentil problems nd being ble to signpost proficiently nd effectively Secondry prevention in primry cre nd secondry cre. E.g. Nicotine ddiction to be mnged s prt of routine cre not s n dd on. Delivering ginst NICE guidnce 22

23 Trnsforming cncer services Key Actions Must Do s Milestones 16/17 17/18 18/19 19/20 20/21 Implement Cncer llince Cncer witing times Dignostic cpcity Pthwys Stkeholder nd Ptient Eduction Implement the cncer tskforce report Mke progress in improving one-yer survivl rtes All ptients hve holistic needs ssessment nd cre pln t the point of dignosis First meeting of Allince nd greement of priorities Delivery of cncer stndrds in line with STF plns Agree increse in dignostic cpcity Continuous improvement of ll pthwys Bseline ssessment Deliver the NHS Constitution 62 dy cncer stndrd Reduce the proportion of cncers dignosed following n emergency dmission A tretment summry is sent to the ptient s GP t the end of tretment Implement BHP to ensure sufficient dignostic cpcity in the right loctions Secure dequte dignostic cpcity Ensure strtified follow up pthwys for brest cncer ptients A cncer cre review is completed by the GP within six months of cncer dignosis Deliver dignostic cpcity Implement ongoing progrmme of eduction with stkeholders nd public The Gp Why Chnge is needed Significnt gp between life expectncy cross the STP footprint nd tht of Englnd. Cncer is significnt contributor to this. Higher thn ntionl verge prevlence rtes for incidents of smoking, including smoking during pregnncy Significnt inequlity gp within communities cross our STP We hve too mny people dignosed t lte stge Too mny people die within 12 months of dignosis Future Stte/Ambition for 2020/21 Preventing cncer by ddressing cncer risk fctors especilly smoking; the STP will tke steps to reduce locl rtes by Dignosing more cncers erly, incresing the proportion of cncers dignosed t stge 1 nd 2. The STP will improve ll cncer pthwys s well s substntilly incresing dignostic cpcity (especilly imging/rdiology). These ctions will result in fewer cncers dignosed s n emergency, nd n increse in one nd five-yer survivl rtes. By 2020, everyone with suspected cncer should receive definitive dignosis or within 28 dys. By 2020, ll ptients will hve ccess to high-qulity modern therpeutic services, such s personlised tretment informed by moleculr dignostics. They will be cred for during nd fter their tretment, benefiting from incresed support to live well fter tretment. Ptients will hve better experience of their cncer cre, with less vrition cross the STP. Benefits Immedite Actions: Achieve cncer witing time stndrds Support NHS Improvement to chieve mesurble progress towrds the ntionl dignostic stndrd of ptients witing no more thn six weeks from referrl to test Agree trjectory for increses in dignostic cpcity required to 2020 nd chieve it for yer one Reduction in smoking rtes Incresed uptke in ll cncer screening progrmmes A demonstrble improvement in the proportion of cncers dignosed t stges 1 nd 2 Overll 2020 /21 gols: Deliver significntly improving one-yer survivl to chieve 75% by 2020 for ll cncers combined (now t 69%) with reduction in CCG vrition Ensure ptients re given definitive cncer dignosis, or ll cler, within 28 dys of being referred by GP Increse dignostic cpcity to meet identified need Continuous improvement in ptient experience with reduction in vrition An increse in the proportion of ptients prticipting in reserch for cncer cre Continuous improvement in long term qulity of life A mrked reduction in the proportion of dignosis through emergency presenttion Wht resources re required to deliver / wht cpcity nd cpbility do we need? The independent cncer tsk force report sets out how to chieve world clss cncer outcomes in Englnd by In response to this we will utilise the cpcity nd resources within the Allince to deliver the following; A joined up trgeted public helth response cross the STP footprint Focused input to identify, nd work with, hrd to rech groups nd deprived communities Incresed cpcity in cncer support services (including dignostics, welfre dvice, screening etc.) delivered through improved working prctice nd innovtions such s pooling clinicl cpcity cross the system. This will be undertken in prtnership with NHS, Independent Sector nd Voluntry Community Sector providers. A multi disciplinry workforce to ensure tht every contct counts underpinned by long term pln for workforce recruitment to the NE nd not bsed on individul orgnistions Continuous improvement nd wreness of pthwy developments cross the footprint through robust trining nd eduction pln 23

24 NEIGHBOURHOOD AND COMMUNITIES 24

25 New models of cre Key Actions Must Do s Ensure the sustinbility of generl prctice by implementing the GP Five Yer Forwrd View Delivery of the prevention nd self cre gend Robust provision of community cre to ensure those who re mediclly fit re dischrged in timely mnner Implementing the integrtion of helth nd socil cre s prt of community model System wide ccessible informtion Access to community bsed urgent cre Delivery of ccess to 7 dy services for primry, community nd socil cre People re cred for in the community nd only dmitted into hospitl where bsolutely necessry Milestones 16/17 17/18 18/19 19/20 20/21 Community Hub Actions: Enggement nd benchmrking Design Implementtion Phse 1 Implementtion Phse 2-5 D2A The Gp Why Chnge is needed A popultion with growing number of older people Our current helth nd cre system is not lwys co-ordinted well Mny ptients hve conditions which re not mnged s well s they could be nd so often go to hospitl when they could be better supported in community setting or t home. A growing number of people with complex medicl conditions coupled with communities with different needs. There re high levels of ill-helth nd disese prevlence in our re, we need to do more in terms of promoting wellbeing within the community. People tell us tht services feel frgmented nd tht informtion does not follow the individul round the system. People tell us they re confused bout how to ccess services in the community, prticulrly where people hve n urgent need. Frgile mrket in reltion to cre nd nursing home provision Under use of community ssets or voluntry sector cpcity Future Stte/Ambition A risk ssessment bsed proctive pproch to cre looking t whole popultion model (bsed on popultions of 30k-50k) Less relince on hospitl bsed cre through developing new innovtive models of cre with prtners Bringing together core primry medicl cre services with wider community-bsed NHS services nd, potentilly, socil cre (extending beyond primry cre t-scle) with focus on out-ofhospitl services bsed round registered popultions through development of community hubs Developing multi-specilty community providers ll essentilly working towrds the sme gol, qulity improvement, cost svings nd working together more efficiently. Expnded multi-disciplinry community-bsed tems Incorportion of some specilist services or support Enbling community ctivtion nd well being through neighbourhoods by working collbortively with Voluntry Community Socil Enterprise (VCSE) sector New contrcting nd funding pproches to mnge cpitted budget for ll out-of-hospitl cre Benefits Reduce fril elderly bed dys by 20% over the next five yers Reduction in A&E ttendnces Reduction in fril elderly emergency redmissions, prticulrly focussing on GP dmissions Reduction in emergency redmissions Reduction in permnent dmissions to cre homes (older dults over 65) per 100,000 popultion Increse in deths in the usul plce of residence Reduce delyed trnsfers of cre s percentge of occupied bed dys Wht resources re required to deliver / wht cpcity nd cpbility do we need? Implementing Community Hub Model Integrtion of providers within helth nd socil cre Integrtion of informtion systems A developed workforce tht delivers cre s prt of cre plnning pproch A cre model tht is bsed round tringle of needs, incorporting: Highest needs Extensivist model supported by strong multidisciplinry tem, with risk strtifiction to identify ptients who will benefit most from intensive support Ongoing cre needs Integrted primry nd community cre MDTs, bsed round popultion hubs, working closely with specilists, crers, other sectors nd with cre co-ordintor. GPs ensuring continuity of responsibility for ptients on their list, supported by stndrdised tools for LTC mngement. Implementing Dischrge to Assess A developed culture which hs trust in the system to dischrge into the community when mediclly fit An infrstructure ble to mnge needs within the community STP support for the New Models of Cre An ppliction for funds in order to support the spred of new cre models to deliver not-inhospitl services 25

26 Primry cre Must Do s Ensure the sustinbility of generl prctice by implementing the Forwrd View Investment in trining prctice stff nd stimulting the use of online consulttion systems Ensure locl investment meets or exceeds minimum required levels Extend nd improve ccess in line with requirements for new ntionl funding Tckle workforce nd worklod issues to increse the number of doctors working in generl prctice Support generl prctice t scle Themes 16/17 17/18 18/19 19/20 20/21 Investment CCG investment into developing nd supporting primry cre Recruitment nd retention inititives Trining cre nvigtors Medicl ssistnt roles Workforce Reform OOH/111 Pper free Worklod Infrstructure Cre Redesign Fund protected lerning New models of cre Extended ccess Propose MCP contrct The Gp Why Chnge is needed A new style of primry cre is required to strengthen the connections between helthcre professionls nd the people they cre for. Primry cre is pivotl in delivery in the NHS nd hs the bility to ensure erly intervention nd prevention. There is high use of services including A&E which could be delt with through erly intervention nd improved ccess to primry cre. Primry cre needs to chnge to meet the chllenges of n geing popultion nd to better serve those living with complex helth nd cre needs. This mens providing personlised, proctive cre to keep people helthy independent nd out of hospitl through risk bsed pproch nd reducing vrition in pproches to delivering cre. There is need to expnd nd chnge the skill mix of the workforce in primry cre s within our STP there is n geing workforce nd difficulty in recruiting GPs. Future Stte/Ambition Our vision for the future stte of Primry cre is tht new style of Primry cre intervention is delivered through integrted primry cre tems. An increse workforce in generl prctice supported by new roles beyond trditionl GP s such s mentl helth counsellors/therpists, physicin ssocites nd clinicl phrmcists Primry cre would be delivered t scle through the development of seven dy ccess model vi primry cre hubs. The hubs will need to be slightly different cross loclities but core components nd stndrds of ccess will be the sme cross ech with incresed ccess to primry cre through the provision of pre-bookble nd sme dy ppointments in evenings nd weekends Use of technology to introduce new wys of ccessing primry cre services introducing services providing lterntives to fce-to-fce contct including the use of phone nd online consulttions. Collbortive working between prctices work to cpture economies of scle, improve qulity, reduce vrition nd improve efficiencies supported by system wide prctice development progrmme. Primry cre records shred cross the locl helth economy, including community phrmcy, with the introduction of common stndrds, pperless trnsfer of notes nd digitl summry cre records. Implementtion of new model of cre tht integrtes provision of primry nd community to ensure whole popultion helth pproch to service delivery with the required infrstructure nd fit for purpose premises Introduction of Cre Nvigtion / Cre Co-ordintion roles to ensure semless ptient journey cross helth nd socil cre, enbling ptient to tell their story only once Benefits Increse in GP numbers nd skill mix with helthcre professionls Improved ccess times to primry cre Incresed 111 ccess to generl prctice ppointment systems Improved informtion shring nd dt flows cross helth services Incresed scope of services vilble in primry cre Improved stisfction rtes for ccess to primry cre Incresed funding in primry cre Increse inter prctice referrls nd greter use of technologies e.g. Skype nd telehelth Reduction in A&E ttendnces Wht resources re required to deliver / wht cpcity nd cpbility do we need? Access to nd utilistion of Esttes nd Technology Trnsformtion Funding Additionl investment to primry cre ccess through the sustinbility nd trnsformtion pckge of support from 17/18 to 18/19 Additionl workforce cpcity through working prctice nd innovtion nd incresed recruitment nd retention Trnsformtion resource to support the implementtion of new models of cre 26

27 Urgent nd emergency cre network Key Actions Must Do s Deliver the four hour A&E stndrd, nd stndrds for mbulnce response times Ensuring 24/7 integrted cre service for physicl nd mentl helth is implemented by Mrch 2020 Meet the four priority stndrds for seven-dy hospitl services for ll urgent network specilist services A reduction in mbulnce clls tht result in voidble trnsporttion to n A&E deprtment Implement the Urgent nd Emergency Cre Review Initite cross-system pproch to prepre for forthcoming witing time stndrd for urgent cre for those in mentl helth crisis Future Stte/Ambition The NEUCN im is to reduce unwrrnted vrition nd improve the qulity, sfety nd equity of urgent nd emergency cre provision by bringing together A&E Delivery Bords nd stkeholders to rdiclly trnsform the system t scle nd pce which could not be delivered by single A&E Delivery Bord lone. Our objectives: Delivering urgent cre centres in community nd primry cre fcilities providing ccess to urgent cre for the locl popultion 24/7 ddressing our popultion helth needs, blnced ginst requirements of personlistion Simple to ccess integrted cre pthwys, delivered s close to home s possible, provided cross full rnge of cre settings, enbling good choices by ptients nd clinicins Improved ptient experience nd clinicl outcomes delivered through cre in the right plce, t the right time, provided by those with the right skills Ensure people with more serious or life thretening emergency cre needs receive tretment in centres with the best expertise nd fcilities Milestones 16/17 17/18 18/19 19/20 20/21 Clinicl Hub Clinicl hub implemented Re-procurement of NHS 111 Directory of Services Digitl in-hours booking Behviourl nlysis roll-out Constitutionl stndrds Pyment reform & metrics Delivery of IUC stndrds Develop nd deliver new models of crisis cre for young people Strt the review of existing service Review existing DoS entries to ensure fir for purpose Technicl scoping & delivery pln greed Enggement & communiction Delivery of the A&E 4 hour stndrd nd delivery of the Ambulnce stndrds (in line with STF requirements Modelling work undertken Continue with procurement Technicl roll-out cross the region Lerning lessons nd continuous improvement Shdowing of revised pyment mechnism Implementtion of revised pyment mechnism nd system wide outcome metrics to understnd how the networked system is performing including chnnel shift Implementtion of the 8 key elements of integrted IUC stndrds ccessed through 111 Test out new models of cre nd dopt best prctice The Gp Why Chnge is needed Frgmented urgent cre services with multiple points of entry result in ptient contct dupliction nd ptient confusions cross the region, which is inefficient nd does not promote positive ptient experience nd is not delivering performnce stndrds. Benefits A reduction in hospitl dmissions A reduction in Accident nd Emergency ttendnces A reduction in 999 mbulnce disptches Redirection of ptients to phrmcies for minor ilments Increse see & tret nd her & tret Erly intervention in cre homes Ambulnce witing times (including response times & hndovers nd diverts) Delivery of the A&E 4 hour stndrd Ptients hve equitble ccess to specilist cre in order to mximise their chnces of survivl nd good recovery Reduction in DTOC Wht resources re required to deliver / wht cpcity nd cpbility do we need? Redesigned nd more ccessible, enhnced urgent cre services, delivering the eight commissioning stndrds tht: A single cll to get n ppointment out-of-hours (OOHs) Dt cn be sent between providers The cpcity for NHS 111 nd OOHs is jointly plnned The summry cre record is vilble in the clinicl hub nd elsewhere Cre plns nd ptient notes re shred between providers Appointments cn be mde to in-hours GPs There is joint governnce cross locl urgent nd emergency cre providers There is clinicl hub contining (physiclly or virtully) GPs nd other helth cre professionls Workforce development will include promoting helth, wellbeing, prevention nd self-cre All NHS providers re working towrds the better helth t work wrd 27

28 Lerning disbilities trnsformtion Key Actions Must Do s Deliver Trnsforming Cre Prtnership plns with locl government prtners &enhncing community provision Reduce over relince on inptient bed cpcity nd inpproprite dmissions Future Stte/Ambition Our mbition is for the footprint is to be s good s nywhere in the world to live for people with lerning disbility nd / or utism nd mentl illness or behviour tht chllenges. This vision ws developed by ll prtners nd stkeholders, including people with lerning disbility, fmilies nd crers. By developing community infrstructure, supporting workforce development, voiding crisis, erlier intervention nd prevention the North Est nd Cumbri will be ble to support people in the community so voiding the need for hospitl dmission. Co-Production Bed Closure Developing new service model Improve ccess to helthcre for people with lerning disbility Reduce premture mortlity by improving ccess to helth services, eduction nd trining of stff Milestones 16/17 17/18 18/19 19/20 20/21 The North Est nd Cumbri Lerning Disbility Trnsformtion Pln nd the Yorkshire Trnsforming Cre Pln ims include less relince on in-ptient dmissions, developing community support nd lterntives to inptient dmission, prevention nd erly intervention, voidnce of crisis nd better mngement of crisis when it hppens to crete better more fulfilled lives. Benefits Less relince on in-ptient dmissions, delivering reduction in voidble dmissions to inptient lerning disbility services nd delivery of commissioned bed reduction trjectory by Developing community services nd lterntives to inptient dmission Prevention, erly identifiction nd erly intervention Incresing the number of nnul helth checks nd helth promotion/prevention progrmmes Avoidnce of crisis nd better mngement of crisis when it hppens Better more fulfilled lives. Improved qulity of life Improved service user experience Funding Arrngements The Gp Why Chnge is needed The current experience for people with lerning disbilities within the footprint is very vried. This is, in prt, pprent by looking t the dt but lso by listening to the stories of service users, fmilies, providers nd commissioners. However, there re mny chllenges in understnding the true picture becuse of lck of consistent dt cross the whole system. We understnd pockets of ctivity such s for ptients inptient settings, but on the whole we hve poor visibility of wht people s needs re, how they re currently being met (or not), nd wht issues they re encountering. Dt shows tht lthough proportion of ptients in specilist lerning disbility inptient settings require this type of cre, mny of them could be mnged in the community. The dt lso shows tht people often sty in inptient settings for longer thn necessry, with some people dmitted for very long periods of time (up to 25 yers). The pce of trnsformtion in respect of the community infrstructure is prmount in fcilitting the sfe reduction in inptient beds cross the loclity. Without the mtched level of investment nd resource the demnd on inptient beds will continue to be pressure. This is further influenced by the chnges in commissioning cross NHSE Specilised Services, which will see less tretment progrmmes being delivered in secure settings nd more ptients being mnged in the community. The trnsfer of ptients through the rehbilittion pthwy will require the CCG to ensure tht the necessry settings re vilble to sfely respond to ptients with ssocited behviourl nd forensic needs. Wht resources re required to deliver / wht cpcity nd cpbility do we need? Locl implementtion Groups re ctive in every loclity, leding the delivery of loclity plns to implement the new model of cre. Regionl tsk nd finish groups tke forwrd delivery of the regionl strnds of work focusing on: Resources, cpcity nd cpbility re dependnt on ech specific loclities requirements. Focused workforce investment is required to ensure tht community bsed services re resourced with ppropritely trined stff. Closer working between Specilised Commissioners nd CCGs to better mnge the trnsition of ptients between services Joint working with LA prtners to increse resilience in the existing provider mrket nd lso develop new models of cre nd support is priority nd will require more detiled nd diverse co- commissioning to enble the physicl nd culturl shift in service delivery. The relese of recurrent investment from bed bsed services is crucil in order to support the development of more robust community services, dowries, nd the delivery of helth nd socil cre community. 28

29 Trnsforming mentl helth services Must Do s At lest 25% of people with common mentl helth conditions will get ccess to psychologicl therpies Increse ccess to individul plcement support for people with severe mentl illness in secondry cre services Deliver mentl helth ccess nd qulity stndrds including 24/7 ccess to community crisis resolution 60% of people with first episode psychosis treted with NICE concordnt therpy within 2 weeks of referrl 95% of children nd young people with eting disorders re seen within 4 weeks of referrl (1 week for urgent referrls) Comprehensive core 24 liison service in plce in cute hospitls (1 hour response in urgent cre, 24 hour response to inptient settings) Access to specilist perintl mentl helth services both community nd in ptient 25% of people with common MH conditions ccess psychologicl therpies Access to liison nd diversion services cross the criminl justice system Mentl helth ccess stndrds for crisis cre CYP trnsformtion pln 35% more children nd young people with mentl helth conditions will receive tretment Ensure tht 95% of children nd young people with n eting disorder receive tretment within four weeks Mintin dementi dignosis rte of t lest two thirds of estimted locl prevlence 16/17 17/ 18 50% 15.8% 16.8 % Refresh pln Ensure tht t lest 60% of people experiencing first episode of psychosis begin tretment within two weeks Reduce suicide rtes by 10% ginst the 2016/17 bseline Eliminte out of re plcements for nonspecilist cute cre by 2020/21 18/19 19/20 20/21 19% 22% 25% Future Stte/Ambition 24/7 urgent nd emergency helth response, n ll-ge mentl helth liison service in emergency deprtments nd in-ptient wrds, multi-gency suicide prevention pln in order to reduce suicides by 10% Mentl helth is everywhere nd the helth needs of our popultion re incresing. We re looking to build high qulity services nd highly skilled workforce tht not only delivers vlue for money nd re finncilly sustinble, but tht provide more of our popultion with erly interventions nd incresed ccess to tretment cross ll of our communities Wht resources re required to deliver / wht cpcity nd cpbility do we need? To deliver the 60% trget for first episode psychosis further workforce development nd trgeted funding is required to ensure ccess to the full rnge of NICE concordnt tretment. In order tht 35% more CYP with dignosble MH condition receive tretment from n NHS-funded community MH service, further trgeted investment in line with NHSE commitment needs to be mde vilble to support CYP IAPT progrmme, CAMHS crisis nd home tretment, specilist eting disorder nd tier 2 nd 3 CAMHS Development of growth nd investment plns for workforce development nd service cpcity so tht t lest 25% of people with common MH conditions get ccess to psychologicl therpies ech yer by 2020 Ensure tht commitment is sustined so tht ll of our cute hospitls hve in plce ll-ge mentl helth liison service chieving Core 24 service stndrd Continued support to community mentl helth services to eliminte out of re in ptient tretment for non-specilist cute mentl helth cre nd improve employment support. Develop opportunities for collbortive commissioning with prtners to deliver new models of cre for specilist mentl helth services nd integrted mentl nd physicl helth services Investment in workforce nd services is required to ensure ccess to specilist perintl mentl helth support in the community nd in ptient settings by 2020/21 Continued focus on memory clinics nd cross system dementi cre services to ensure mintennce of dignosis rte nd effective post dignosis support. Work with ll gencies to develop nd implement rnge of routine outcome mesures cross ll services. Incresed investment in individul plcement support in secondry MH services Ensure continued multi gency support to suicide tsk groups to mintin relevnce of suicide reduction plns Benefits The success of the improvement res under the Mentl Helth Five yer Forwrd View will men tht vstly more people, of ll ges, will hve ccess to high qulity, timely mentl helth tretment nd erlier intervention, specific to their needs nd improvements in helth nd wellbeing to increse opportunities for people ffected by mentl helth nd close the mortlity gp. Scheme specific benefits will be seen in terms of service improvements in: (1) Helth & Wellbeing, (2) Cre & Qulity, nd (3) Finnce & Efficiency. The Gp Why Chnge is needed Due to the prevlence of disese nd long term illnesses coupled with high levels of deprivtion individuls re more susceptible to developing mentl helth problems in our footprint. Recognising within our footprint there re significnt number of rmed forces personnel nd veterns nd fmilies who my require enhnced mentl helth support, therefore it is essentil more is done to ensure erly identifiction nd support to ccess cre is in plce. 29

30 Reducing vrition Right Cre Key ctions Must Do s Milestones 16/17 17/18 18/19 19/20 20/21 Delivery t STP level Delivery t locl level Demnd reduction mesures include: implementing RightCre; elective cre redesign; urgent nd emergency cre reform; supporting self cre nd prevention; progressing popultion-helth new cre models such s multispecilty community providers (MCPs) nd primry nd cute cre systems (PACS); medicines optimistion; nd improving the mngement of continuing helthcre processes. Continued work to further nlyse nd implement service chnge to deliver opportunities identified within the RightCre pproch. Continued work to further nlyse nd implement service chnge to deliver opportunities identified within the RightCre pproch. The Gp Why Chnge is needed Anlysis of the RightCre focus pcks (My 2016) t n STP level identifies n unwrrnted vrition cross service delivery nd qulity, spend nd outcomes in cncer, mentl helth, MSK, CVD, respirtory mternity nd erly yers, nd neurology. In ddition to this, more locl nlysis hs been undertken t CCG level which hs informed Commissioner level RightCre plns which re currently being progressed. Chnges to prevention, delivery of pthwys nd service integrtion s set out in the RightCre opportunities re criticl to the delivery of the key trnsformtion schemes. The STP recognises the importnce of implementing the RightCre pproch in order to deliver better ptient outcomes nd to free up funding to enble further innovtion. Future Stte/Ambition for 2020/21 For ptients better ccess to excellent cre, improved ptient experience nd greter involvement in decisions bout their cre. For commissioners proven pproch to unite prtners cross the helth economy nd prioritise investment to mximise vlue, whilst meeting the requirements of the new NHS Improvement nd Assessment Frmework. For primry nd community cre opportunities to redesign ptient cre with focus on prevention nd erly intervention. For secondry cre ctive involvement in the redesign of ptient journeys cross primry nd secondry cre. Plus, support to meet the requirements of the Crter Review to reduce unwrrnted vrition. For locl uthorities sound, trnsprent rtionle for how limited resources re prioritised, helping meet legl duties under the Helth nd Socil Cre Act 2012 to reduce helth inequlities. For professionl bodies prtnership working to develop common view of wht excellent looks like nd promote opportunities for clinicl enggement nd reform. For ntionl progrmmes n opportunity to embed proven pproch tht delivers better outcomes nd reduces vrition within ntionl work. For specil interest groups using vrition to trget helth economy support nd the opportunity to contribute to the design of optiml ptient experience. Benefits Cncer nd tumours: A reduction in mortlity from ll cncers: Under 75 Directly ge-stndrdised rtes (DSR) per 100,000 Europen Stndrd Reduction of expenditure cncer progrmmes of cre. Respirtory conditions: A reduction in mortlity from respirtory disese: Under 75 Directly gestndrdised rtes (DSR) per 100,000. Reduction of expenditure on respirtory progrmmes of cre. Reduction of expenditure on CVD progrmmes of cre. Reduction of expenditure on Primry Cre prescribing items where identified s pproprite. Musculoskeletl issues: An increse in % of ptients ged 75+ yers with frgility frcture treted with n pproprite bone-spring gent - Excludes Trum Mternity nd reproductive helth: A reduction in rte of hospitl dmissions cused by unintentionl nd deliberte injuries in children ged 0-4 yers per 10,000 popultion ged <5 yers Mentl Helth: Rte of recovery: An increse % of people who re "moving to recovery" of those who hve completed IAPT tretment Wht resources re required to deliver / wht cpcity nd cpbility do we need? Delivery of RightCre is dependent upon ll Providers nd Commissioners within the STP footprint being engged nd demonstrting buy-in to the principles. We need to ensure there is sufficient Business Intelligence support to understnd t n STP level the possible system opportunities vilble beyond those lredy identified. 30

31 ACUTE HOSPITAL RECONFIGURATION 31

32 Better Helth Progrmme Acute reconfigurtion Must Do s Improve qulity of cre Progressing popultionhelth new cre models Mesure nd improve efficient use of stffing resources to ensure sfe, sustinble nd productive services Improving the mngement of continuing helthcre processes Implement the ntionl mternity services review, Better Births, through locl mternity systems Milestones 16/17 17/18 18/19 19/20 20/21 Peditrics Neontes Urgent Cre Obstetrics Emergency Surgery A&E nd cute medicine Elective cre Rdiology Enbling progrmmes Milestones Decision mking process Investment Committee Locl Elections Public Consulttion Joint Committee Joint OSC Joint Committee decision Dec 16 Jn 17 Feb 17 Mr 17 Apr 17 My 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 The Gp Why Chnge is needed Hospitl Trusts re significntly short (68% met) in meeting over 700 stndrds set by the Royl Colleges, NCEPOD nd Emergency Cre Acdemy. As helthcre is becoming incresingly specilised it is becoming more difficult to hve tht level of expertise vilble in every hospitl for every service. The medicl evidence shows tht where ptients re dmitted to specilist centres with stff seeing high volume of ptients with similr problems, nd meeting high clinicl stndrds, the outcomes for ptients re much improved. Chnging ptterns of need; medicine is dvncing with revolutionry new tretments sving nd trnsforming lives. As well s living longer, the nture of illness is chnging with fr more ptients with chronic long term conditions rther thn brief cute illness tht resolves within dys Our chllenge is the vilbility of specilist workforce t consultnt nd senior doctor level. We need to ddress this so tht to ensure consistent specilist consultnt decision mking, 7 dys week, 16 hours per dy nd where this pplies to mjor trum centre 24 hours per dy. Our popultion nd our specilist consultnt medicl workforce re in blnce but spred over too mny hospitls to respond to the medicl dvnces now nd in the foreseeble future Benefits 100% delivery of the clinicl stndrds 7 dy consultnt presence 16 hours per dy Consultnt specilist ccess Over 75% of ptients ssessed by Specilist Consultnt on dmission nd 100% ssessed within 12 hours by Consultnt Less vrition in outcomes cross the system, e.g., Top 3 outcomes for ech service greed by Clinicl Ledership Group, for exmple, hyper cute stroke, 18 weeks, ptient cncelltions, obstetrics nd neontl services. Opertionl excellence in contributing to better vlue for money Better retention nd recruitment of highly skills consultnt nd clinicl stff with reduced spend on locum stff. Future Stte / Ambition See Vision 2020 sttement 32

33 DIGITAL CARE & TECHNOLOGY 33

34 Digitl cre nd technology Trnsformtion Progrmmes Must Do s Interoperbility between cre systems Infrstructure Plnning nd decision support A tretment summry is sent to the ptient s GP t the end of tretment Ensure the sustinbility of generl prctice Enble nd fund primry cre to ply its prt in fully implementing the forthcoming frmework for improving helth in cre homes Trnsfers of cre Technology enbled cre services Milestones 16/17 17/18 18/19 19/20 20/21 Communictions, enggement nd consent Northern Englnd Clinicl Network key priorities Anlytics Ntionl Inititives Stremline elective cre pthwys, including through outptient redesign nd voiding unnecessry follow-ups Investment in trining prctice stff nd stimulting the use of online consulttion systems Deliver reduction in the proportion of mbulnce clls tht result in voidble trnsporttion to n A&E deprtment Provider efficiency mesures include: implementing pthology service nd bck office rtionlistion All ptients hve holistic needs ssessment nd cre pln t the point of dignosis Mesure nd improve efficient use of stffing resources to ensure sfe, sustinble nd productive services. Interdependencies Develop Locl Digitl Rodmps to support delivery of Personlised Helth nd Cre 2020 to drive qulity, productivity nd ptient experience, trnsforming popultion helth from self-cre to vlue bsed service when needed. Linking with the STP workforce strtegy to promote recruitment, retention, role development nd the helth nd wellbeing of stff building upon good prctice within the NHS nd Locl Authorities including Mking Every Contct Count. This will enble semless pthwys of cre tht reduce unnecessry ressessment nd dmission. Leverge the multiple strnds of the Regionl Informtics Converstion - North Est & Cumbri Digitl Cre Progrmme, U&EC Network nd Connected Helth Cities Progrmme. Overly the excellent work being led by clinicl nd mngeril leders cross the footprint to implement the Gret North Cre Record, resulting in lsting contribution to the helth nd well-being of our popultion through the shring of informtion securely nd effectively. The Gp Why Chnge is needed Better use of dt nd digitl technology hs the power to support people to live helthier lives nd use cre services less. It is cpble of trnsforming the cost nd qulity of services when they re needed. It cn unlock insights for popultion helth mngement t scle, nd support the development of future medicines nd tretments. Putting dt nd technology to work for ptients, service users, citizens nd the cring professionls who serve them will help ensure tht helth nd cre provision in the NHS improves nd is sustinble. It hs key prt to ply in helping locl leders cross helth nd cre systems meet the efficiency nd qulity chllenges we fce. Future Stte/Ambition More ptients treted loclly preventing the need for cre outside of the locl community By 2021 we will mke lsting contribution to the helth nd well-being of our popultion through the shring of informtion securely nd effectively. By end 16/17 we will hve in plce criticl milestone to this shring of GP records cross ll providers. The Gret North Cre Record will mke informtion more widely vilble nd ccessible to support frontline cre, individul self-mngement, plnning nd reserch. Through the use of TECS ptients, crers nd citizens will use digitl technologies to be ble to feel more in control of their condition A significnt in crese in the level of digitl mturity of secondry cre providers Digitlly enbled helth nd cre system with move from isoltion to integrtion. A pper free system with informtion flowing semlessly between primry, secondry nd socil cre digitlly Benefits nd Outcomes Reduction in dmissions to hospitl through more informed clinicins t the point of cre A reduction in duplicte ssessments, investigtions nd dt entry Sved time clling other orgnistions GP prctices Sved time nd improvements in trige A reduction in medictions prescribed A reduction in unnecessry / inpproprite referrls to nother service Improved working prctices leding to greter efficiencies Mesured improvement in stisfction of service provision Wht resources re required to deliver / wht cpcity nd cpbility do we need? Instlltion costs for single cre record (popultion 3.6 million), plus hosting chrges where pplicble nd nnul running costs. Replcement nd upgrde of Electronic Ptient Record (EPR) Systems Funding to invest in infrstructure (Wi-fi, Virtul Desktop Infrstructure etc) Pltform nd technologicl solutions to support Technology Enbled Cre Services PMO resource to support delivery of the progrmme 34

35 Digitl cre nd technology (this is the Locl Digitl Rodmp summry, vision nd pthwy to deliver) 35

36 Delivery pln key outcome mesures Improvement nd Assessment Indictor Erly Intervention nd Prevention Neighbourhood nd Communities Acute Reconfigurtion Digitl Cre nd Technology At lest 5% reduction in A&E ttendnces Delyed trnsfers of cre s percentge of occupied bed dys Delivery of 7 Dy Stndrds Improvement in Smoking quit rtes (successful quitters) 16+ Improvement in urgent GP referrl hving first definitive tretment for cncer in 62 dys Improvement of Ambulnce witing times Improvement of one yer cncer survivl Improving Access to Psychologicl Therpies recovery rte Increse in estimted dignosis rte for people with dementi Increse in the number of ptients witing 18 weeks or less from referrl to hospitl tretment Increse of ptients treted within the 4 hour A&E stndrd Increse Personl Helth Budgets per 100,000 popultion Incresed cncer dignosis t n erlier stge Injuries from flls in people ged 65 nd over per 100,000 popultion People with 1st episode of psychosis strting tretment with NICE-recommended pckge of cre treted within 2 weeks of referrl People with long-term condition feeling supported to mnge their condition People with dibetes dignosed less thn yer who ttend structured eduction course Percentge reduction in permnent dmissions to cre homes (older dults over 65) per 100,000 popultion Percentge reduction in permnent dmissions to cre homes (older dults over 65) per 100,000 popultion Proportion of people with lerning disbility on the GP register receiving n nnul helth check Reduction in Bed Dys Reduction in delyed trnsfers of cre ttributble to the NHS nd Socil Cre per 100,000 Reduction in emergency dmission rtes Reduction in emergency dmissions for lcohol relted liver disese Reduction in emergency redmissions rtes Reduction in fril elderly emergency dmissions, prticulrly focussing on GP dmissions Reduction in fril elderly emergency dmissions, prticulrly focussing on GP dmissions Reduction in mternl smoking rte t delivery Reduction in out of re plcements for mentl helth inptients Reduction in percentge of overweight or obese children t Yer 6 Reduction in the number of emergency bed dys per 1,000 popultion Reduction in the percentge of deths which tke plce in hospitl Reduction of neontl nd still births 36

37 ENABLERS 37

38 Esttes Esttes is n enbler for the STP to deliver its service mbitions nd close the finncil gp. Ensuring delivery of improved Primry nd Community Cre estte to fcilitte cre in the locl community nd respond to popultion growth nd demogrphic pressures cross the STP re is essentil. A key component of this will be the delivery of the ETTF progrmmes in ech CCG re, to both trnsform individul prctices nd deliver integrted community, primry nd socil cre services t scle. Improved utilistion of core estte nd rtionlistion nd disposl of older not fit for purpose buildings is required to reduce poor qulity ccommodtion; eliminte bcklog mintennce, void nd excess running costs nd fcilities. This will llow us to mximise existing identified core sites nd buildings through incresing occupncy nd utilistion. Improved utilistion of core estte nd rtionlistion nd disposl of older not fit for purpose buildings to reduce poor qulity ccommodtion; eliminte bcklog mintennce; void nd excess running costs nd fcilities. This will llow us to mximise existing identified core sites nd buildings through incresing occupncy nd utilistion. Through current esttes strtegies we will ensure the retined estte is energy efficient nd properly mintined. As prt the Crter provider efficiencies, we will utilise technology to support reconfigurtion of bck office functions to mximise vilble clinicl spce. Within the greed governnce frmework we will enble greter collbortion cross the wider public sector through Cbinet Office s One Public Estte Progrmme to ensure we respond to housing growth, popultion nd demogrphic chnges cross the STP re. Estte Implictions of STP Plns: Requirement for cpitl expenditure on cute sites in order to crete effective ptient flow nd service efficiency in line with Better Helth Progrmme proposls. Additionl specilist resource requirement for delivery of Acute reconfigurtion including substntil cpitl progrmme cross multiple sites. Not in Hospitl cre model supported by GP community hubs nd primry cre led urgent cre evlution of esttes implictions required. Swet long-term core estte utilise existing PFI sites such s Jmes Cook University nd Bishop Aucklnd Generl Hospitls Review of Community Hospitls to support Not in Hospitl Cre scoping step-up, step down nd GP led requirement, my produce medium term consolidtion nd sving opportunities Opportunities to reduce footprint, relese cpitl nd contribute to housing trgets through previously plnned prt disposls business s usul nd no impct on service delivery Consolidtion of pthology t JCUH site, review estte implictions nd potentil for bck office consolidtion - identify opportunities cross the cute nd community estte Erdicte s much not fit for purpose estte s possible, remove bcklog libility cross sites Address Crter trget for non-clinicl spce proportion 35% or less The current estte: Performnce Mesures: Portfolio No. Properties Footprint Size (H) Size GIA (sqm) Estte Running costs p ( m) (rent, s chrge, FM) Bck-log*** Mintennce m GP premises ,230 ⱡ 19* 3.5 NHS PS 96-85, CHP 5-17, Provider estte** Mentl Helth Trusts** Public Helth Estte , , Totls , Current Estte Running Costs 353m p ( 603 m2) Non-Clinicl Spce 133k sq metres 35 % Unoccupied Spce 22k sq metres 5.65 % Plnned (April 2020) Reduce 5% - 18m ( 573 m2) Reduce to 30% Reduce to 2.5% 38

39 Esttes Key next steps towrds deliver: Key next step Chllenges Resources Indictive timeline Comments Acute Reconfigurtion Model options for rnge of site nd service scenrios Engge esttes tems Externl resource for helthcre plnning nd modelling By Nov 2016 Modelling to understnd cost nd deliverbility of chnge scenrios linked to public consulttion requirements Not in Hospitl Cre Understnd esttes implictions of not in hospitl proposls Work with CCGs to understnd hub proposls nd model cost nd delivery options By Mrch 2017 Modelling to understnd cost nd deliverbility of chnge scenrios Understnd impct of ETTF cpitl or other cpitl routes Generl Floor re dt on Primry Cre estte needs updting Work with CCG/DV to estblish floor res in HRW Within 3 months Better understnding of s-is position required in order to support business cse for hubs Community Estte Understnd the interction of Community estte with not in hospitl plns Esttes input to not in hospitl workstrem. Model bed numbers nd requirements cross helth economy By June 2017 Understnd long-term requirements cross community hospitls nd primry cre centres, feed into STP plns Administrtive Estte Detiled proposls for dministrtive consolidtion to reduce costs Project support to model dministrtive requirements linked to STP proposls By June 2017 Understnd dmin estte requirements nd opportunities to consolidte nd linked to lese events 39

40 Workforce The Gp Why chnge is needed Mny chllenges relte to the vilbility of clinicl specilist skills nd workforce to consistently ensure senior decision mking clinicins re vilble for n extended dy, seven dys week, supported by sufficient numbers of junior doctors, nurses, helth scientists, etc. For exmple, for person using A&E, this does not only men those doctors who work in A&E, but collegues in rdiology, medicine, surgery, etc. who my lso be required to help dignose nd tret the ptient. At regionl level, some medicl specilties re t risk such s Psychitric workforce, Emergency Medicine, Generl Internl \ Acute Medicine, Clinicl Rdiology, Community Sexul nd Reproductive Helth, Orl nd Mxilo Fcil Surgery, Immunology, s is generl prctice There re questions bout the sustinbility of specilty medicine rots including stroke nd crdiology given the smller number of these consultnts. Some shortges of middle grdes requiring dditionl consultnts to bckfill rots Insufficient workforce to sfely operte current numbers of sites i.e. mternity incresing speciliztion which is leding to the min chllenge in this re of providing sustinble workforce. There is high proportion of GPs over the ge of 50. This is risk in terms of the number of GPs expected to retire in the next 10 yers; the chllenge is in ensuring tht there re enough newly qulified GPs to replce this cohort. Nursing & midwifery will be effected by recruitment difficulties nd high vcncy rtes cross the nursing profession nd specilist nursing roles.; The effect of grdute-entry nursing on the skill mix, ttrition nd the number undertking undergrdute courses, which is s yet un-quntified in some res. Workforce Design Principles Robust, resilient nd productive tems working cross orgnistionl boundries with the sme vlues nd behviours so we hve n gile workforce to respond to ptient s needs Attrct, recruit nd retin the workforce so we cn fill vcncies with the people with the right skills nd behviours, reduce gency spend, nd increse stff stisfction to improve ptient cre Blnce specilist skills nd generlist skills both in cute cre settings, community nd primry cre to meet now nd future ptient needs. Culturl chnge nd different philosophy of cre t network level (orgnistions, services nd tems) nd viewing the workforce differently by using the voluntry sector. Wht resources re required/ cpcity nd cpbility do we need? Some of the ctions to dte, nd which will continue include: Investment in the primry cre workforce, this includes incresing the numbers of stff working in primry cre in substntive posts nd trining schemes, by rnge of recruitment, retention nd eduction inititives. This includes developing the entire primry cre workforce, including prctice nurses, phrmcists, helth cre ssistnts, prctice mngement stff Investment in the bnds 1-4 workforce to reflect their incresingly ptient fcing role. Including enhncing their competencies to ensure tht they cn deliver their current roles but lso, where pproprite, deliver dditionl roles trditionlly done by other stff. Introduce new roles \ chnge the skill mix nd expnsion of stff working in different roles, for exmple dvnced prctitioners nd helthcre scientists tking on roles previously done by medics nd physicin s ssocites, working cross secondry nd primry cre in vriety of services. Ensuring tht the continuing workforce development of stff is reflected in the investment by employers but lso by HEE NE. Continued work, including vi HEE NE, with cre homes, hospices nd the voluntry sector to understnd their eduction nd workforce issues. This includes mking eduction nd trining vilble to those working outside of NHS employment. Work collectively nd individully to reduce turnover nd increse retention of the workforce nd seek to deliver more efficient nd effective use of bnk nd gency stff. Benefits nd impcts We recognise tht the helthcre workforce needs to evolve nd chnge to deliver more efficient nd effective service, in nd cross rnge of different settings. The workforce will hve to be redesigned nd developed to ensure current gps re filled, nd use of locums reduced. At the sme time, the workforce requirements for the communities nd neighbourhoods model to be delivered need to be understood nd plnned for to enble the ssocited cute reconfigurtion. Some of these chnges cn nd will be with the skill set of the existing workforce, some will be the introduction of new nd lternte roles, whilst others will be where nd how stff re deployed. Some of these chnges will deliver ctul finncil svings from the py bill, others will deliver efficiency svings by more pproprite tretment in more pproprite settings. For greter detil relting to ssumptions mde on workforce projections plese refer to the seprtely submitted finnce nd ctivity templte.

41 Enggement - Progress to Dte Trnsforming our communities Better Helth Progrmme Enggement work so fr hs tken plce cross the footprint on locl plns, the Better Helth Progrmme nd Fit 4 the future - trnsforming our communities. These progrmmes hve undertken wide-reching nd informtive enggement using vriety of inclusive mechnisms nd chnnels where we hve imed to engge with people cross the DDTHRW re. The enggement strtegies ensure we hve ongoing stkeholder enggement, nd enbles the consulttion process, whilst continuing the informtion process for stkeholders. Our stkeholder groups hve been crucil prt of this strtegy, nd re fully involved in the pproch to public, ptient, stkeholder nd stff enggement. It is this communiction nd enggement with comprehensive rnge of people which hs prepred the pth to ddress the key chllenges cross the footprint. Progrmme Activity Mrket reserch Ptient nd public preenggement Stkeholder enggement Voluntry sector groups Pre consulttion Enggement Methods My 2015: including 1,000 telephone interviews nd 6 focus groups Ptient nd public enggement events cross the footprint Phse 1: Februry Wht cn we do better? Phse 2: My Future shpe of services Phse 3: July Wht s importnt in decision mking Phse 4: October cre outside hospitl, nd scenrios Better Helth Progrmme website nd digitl ctivities Stkeholder forum events Enggement with: Locl Authorities, Voluntry Sector Helthwtch CCG ptient prticiption groups Joint Overview nd Scrutiny Committee Helth nd Wellbeing Bords 100 converstions: Voluntry sector fcilitted discussion groups, including focus on specil interest groups nd protected chrcteristics (continuing until October 2016) Lets hve proper cht listening events, identifying key issues for the community round cre closer to home. Tlking to locl people bout chnges to community hospitl provision Consulttion To engge the locl community nd provide them with the informtion in order for them to influence decision mking on Fit 4 the future proposls. Forml consulttion July 2016 to September

42 Enggement - Feedbck nd next steps Feedbck from our enggement People support services outside of hospitl but these need to be fully resourced nd effectively integrted There re concerns tht the trnsport systems in the County re n issue in being ble to ccess some helth cre. It ws felt tht in order to ccess helth cre, then trnsport links would need to be improved nd strengthened Concern bout impct of incresed trvel/distnce on ptient outcomes nd on ptients, crers nd visitors People wnted to be cred for t home when t ll possible. On the occsions when it is not possible or prcticl to offer cre t home, people wish to receive tretment s close to home s possible Communiction nd public enggement objectives Our objectives re to ensure legl duties to engge nd consult re met whilst mintining public confidence in helth nd socil cre nd supporting sfe nd robust reconfigurtion of services. Communictions nd public enggement strtegy includes Public enggement Clinicl enggement Stff enggement Outline pproch Stge 1 Publiction nd enggement on the pln Stge 2 Use insights from stge 1 to inform the consulttion Stge 3 Forml consulttion Stge 4 Use insights from consulttion to inform the decision mking 42

43 Governnce Governnce Requires Nrrtive The drft governnce frmework hs been developed in prtnership with the CCGs, NHS FTs (All Providers) nd Locl Authorities. It demonstrtes fully engged nd whole system ledership pproch. A number of development sessions hve been held nd this emerging model will continue to develop vi Ledership Forum. The STP Progrmme Bord hs met on severl occsions supporting the development of system wide strtegy. The decision mking committees re pproved. The Joint CCG Committee (Better Helth Progrmme) pproved terms of reference re currently being refined s consequence of the trnsition from BHP to STP. These re subject to pprovl t the next CCG Governing Bodies. The NHS FT Committee in Common hs greed terms of reference subject to pprovl by respective Bords in November. The Locl Authority sttutory decision mking rrngements re cler nd will focus on co-design of strtegy development in the Progrmme Bord. To deliver the key purpose of the STP the Progrmme Bord will hve mjor delivery groups long with enbling work-strems. The emphsis is building on the positive Better Helth Progrmme brnd vi public enggement over the pst two yers nd ensuring sfe trnsition into system wide STP. System owners re in plce for ech of these Delivery Groups nd work-strems. The development of hndbook to set out the clrity of purpose tht dds vlue is the next criticl step in the work progrmme. 43

44 System mngement Governnce Finncil flows, Requires contrcting Nrrtive mechnisms nd commissioning Reshping how cre is provided, working through integrted pthwys tht incentivise the delivery of joined up services, single points of ccess nd system wide clinicl provider networks, will require n innovtive pproch to finncil flows tht incentivise system outcomes. We envisge the need to stremline the contrcting process nd reduce trnsctionl ctivity t individul provider nd commissioner level. Mnging finncil flows within the STP control totl nd recognising tht there re provider cost reductions tht re not picked up in PBR triffs, we re working towrds cpittion bsed pproch cross the system. This will require the development of pproprite finncil flows nd incentives to support delivery cross Acute, Community (including Socil Cre) nd Primry Cre pthwys. We will continue to explore the use of new contrcting models tht support the stremlining of our commissioning nd provider ctivities nd reduce dupliction, including the use of the Prime Contrctor, Prime Provider Contrct nd Allince contrcting models where pplicble to the service model being delivered. This pproch will lso require strong collbortive commissioning rrngements tht work cross current orgnistionl boundries. The CCGs re therefore working on rrngements to strengthen collbortive commissioning processes cross our footprint tht mtch proposed chnges to the provider lndscpe nd pproches to delivery. These rrngements re intended to deliver better outcomes for ptients, mximise the benefits of cliniclly led commissioning deliver mngement efficiencies tht will contribute to the system wide finncil chllenges. Building on longstnding North Est wide commissioning rrngements we re determining those ctivities tht will tke plce t ech level of cre nd cross different geogrphicl res including how we strengthen integrtion rrngements with socil cre These rrngements will be in plce in shdow form by the end of the yer nd will be further developed throughout 2017 so tht fully integrted commissioning pproches re in plce by the utumn of The grphic on the following pge represents this work. 44

45 System mngement Governnce Finncil flows, Requires contrcting Nrrtive mechnisms nd commissioning 45

46 APPENDIX 1 FINANCIAL & ACTIVITY ASSUMPTIONS 46

47 Finnce nd ctivity ssumptions Summry Solutions Activity Reduction Neighbourhoods nd Communities 17/18 18/19 19/20 Numbers % Numbers % Numbers % Pthwy chnges Consultnt led first outptient -87, , Elective , Non Elective -11, , Accident nd Emergency -37, , Rightcre Vrition Elective -8, Our mbitious pln supports direction of long term clinicl nd finncil sustinbility nd is bsed on these strtegic ssumptions; The underlying finncil position is bsed on 2016/17 finncil plns The cost nd triff infltion used when modelling the finncil gp is bsed on the 5 yer plnning guidnce, covering 2016/17 to 2020/21 The ctivity growth included in future yers modelling is bsed on NHS Englnd s growth percentges, issued to individul STP footprints Of significnt shift in ctivity from hospitl bsed services to community bsed provision There will be shift in fril older people currently dmitted for NEL purposes from cute to community bsed provision Current A&E ctivity will shift to urgent cre centres Potentil cpitl investment of 115m By nture of the complexity of the chnge this mkes delivery high risk. Arrngements re in plce through the governnce frmework to mitigte these risks. NB Whilst the slide demonstrtes the ctivity shift from cute cre (A&E nd fril elderly) it does not reflect how the ctivity into integrted community services (urgent cre centres & frilty units) will be counted Non Elective -4,