Agenda Item No. Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY Date Title of Report Purpose of the Report CCG strategic objectives, priorities, and commissioning intentions The report is a short round up of several topics for discussion and agreement by the Governing Body. The purpose of this paper is to provide members with an update on the work that is ongoing to develop the detail on a range of commissioning intentions for 2017/18. A refined list of commissioning intentions will be proposed, with an outline of how the work will be taken forward. Actions Requested Decision X Discussion X Information Strategic Objectives Supported by the Report Recommendations 1. Consistently achieving local and national quality X standards. 2. Delivering an increasing proportion of services X from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the X most and least deprived communities in Trafford. 4. To be a financial sustainable economy. X The Governing Body is asked to: i. Agree on rephrasing strategic objectives and confirming 2017/18 objectives. ii. Agree the commissioning intentions for 2017/18. I. Support the refined proposed 2017/18 Commissioning Intentions. Note the next steps to take forward the detailed work up. Trafford Coordination Centre Implications One of the proposed corporate objectives for 2017/18 is maximising the utilisation and potential of the co-ordination centre A number of the Commissioning Intentions will have a direct positive influence maximising the utilisation and potential of the co-ordination centre
Discussion history prior to the Governing Body Financial Implications Risk Implications Equality Impact Assessment Communications Issues Public Engagement Summary The strategic objectives, priorities and commissioning intentions have been discussed in SMT and Clinical Directors. The refined Commissioning Intentions have been discussed and agreed at a dedicated CCG session, prior to be presenting on this paper There are no financial implications associated with the strategic objectives and priorities. The commissioning intentions will have financial implications and they are in the process of being quantified as part of the ongoing commissioning process. By implementing effectively the commissioning intentions this will mitigate performance risks. There are no equality risks associated with the objectives and priorities as the CCG will be commissioning services equitably for all residents. In implementing the commissioning intentions once agreed then there will be individual equality impact assessments undertaken for each service change. The priorities and commissioning intentions will be discussed in PRAP and other fora with the public. The priorities will be shared with the public and will form part of a process for future priority setting. There will be discussion and engagement on commissioning intentions as they are progressed during the course of the year. We will be engaging PRAP and Healthwatch initially in these discussions. Prepared by Responsible Director Cameron Ward, Interim Accountable Officer Cameron Ward, Interim Accountable Officer
Strategic objectives, priorities, and commissioning intentions 1.0 INTRODUCTION AND BACKGROUND Within the context of reviewing the organisation as an incoming Accountable Officer the approach has been to consider all aspects of CCG business. Whilst this progresses there are several key aspects CCG business where initial proposals should be considered. These are intended to provide clarity on immediate priorities whilst working through the longer term changes. 2.0 STRATEGIC OBJECTIVES AND PRIORITIES It is good organisational practice to periodically debate and fine tune strategic objectives as well as agreeing set of in-year priorities. The latter to be based on supporting the delivery of strategic objectives including national, regional and local priorities. They all need to be considered in the light of finance and capacity for delivery as well as forming part of individual staff appraisal. Contained in appendix 1 is the revised list of CCG strategic objectives and proposed list of priorities for 2017/18 with their respective lead officer. These have been discussed with CCG clinicians and staff. 3.0 COMMISSIONING INTENTIONS FOR 2017/18 3.1 On an annual basis the organisation needs to prepare a series of commissioning intentions to support the delivery of the commissioning plan. They are intended to cover all aspects of national, regional and local requirements. A long list of intentions has been prepared and discussion taken place to refine the list below. 3.2 Whilst considering the intentions there will also need to be an assessment of delivery both from a financial and staffing capacity perspective. Bearing in mind the significant financial challenges of the CCG it will be important to ensure any investments provide a return and value for money. 4.0 REFINED COMMISSIONING INTENTIONS 4.1 An exercise has been completed to review the original long list of commissioning intentions. A meeting of members of commissioning staff and clinicians took place on Tuesday 13 June. During the meeting each intention was reviewed and discussed against the CCG strategic objectives, national 9 must do s, value for money and also ongoing work programmes. The conclusion was an agreement of a refined list, which is illustrated in the table below.
Table one Commissioning intention Unscheduled Care (reduction of activity) Work stream A&E attendances/ non elective admissions Length of stay Delayed transfer of care (DTOC) Deaths in hospital (CCG has higher than average deaths rate than its peers) Falls (CCG has higher than average rate of falls than its peers) Description Through the contract outcome work (in development) measure the success of existing services which are commissioned to avoid attendance and admissions at acute hospitals. Establish further work streams with schedule care in the development of influenza and pneumonia pathways Ensure that existing commissioned services are supporting discharge at the earliest clinically appropriate time. Including Ascot House and discharge to assess facilities. In collaboration with the UHSM length of stay programme undertake deep dive of Trafford activity to identify priority services/pathways that need to be reviewed. DTOC work programme to be reviewed to assess what areas of work will directly inform the 2017/18 commissioning intentions. Starting with integrated health and social care discharge team/processes Linked to NHS Right Care and CCG Improvement and Assessment Framework (IAF) undertake deep dive to ascertain trends in activity and identify opportunity of change to be included within a work programme which will focus on service provision and clinical practice Linked to NHS Right Care, CCG IAF and public health undertake mapping exercise to review existing services, capacity and gaps in provision. With the aim of developing a Falls Prevention work programme. Scheduled Care Respiratory Right Care Deep Dive Complete review of respiratory services. Stroke neuro rehab (requirement to significantly reduce waiting times) Development of influenza, pneumonia and lower respiratory pathways. Redesign of local community stroke and neuro rehab services in partnership with Manchester CCG would support the performance of the inpatient services and reduce bed days. Further financial modelling required. Review current service provision to
Cardio vascular disease (CVD) Diabetes assess capacity and appropriate clinical workforce to manage existing and future demand. With the view of working alongside the development GM single operating model Right Care Deep Dive Review and prepare an action plan to cover: Increase prevalence rate Access to diagnostics Improved RTT performance Explore more elective care being provided as day cases Reduction in length of stay Links to strongly to high stroke nonelective spend Review existing workstreams including: Upskill primary care including delivery of Warwick programme to GPs and nurse practitioners and delivery of virtual clinics Deliver 9 care processes (NICE guidance) including IAF performance targets Delivery of structured diabetes education programmes Must do: delivery of National Diabetes Prevention Programme (NDPP) in conjunction with Public Health draft local delivery plan to roll out Work with secondary care and Manchester commissioners to develop integrated pathways Refresh Trafford Diabetes Strategy in light of above workstreams. Phlebotomy Dermatology End of life Identify further areas of work from Rightcare data e.g. Type 1 non-elective spend Continue ongoing review of existing community and acute service; introduce booking system Full review of existing dermatology contract Undertake a mapping exercise to review existing services, capacity and gaps in provision to ascertain why Trafford is currently the worst performing area for patients dying in their usual place of residence and to identify areas of improvements.
Continuing health care (CHC) Personal health budgets CHC market commissioning and finance review Supporting hospital discharge scheme Implementation of the Local and GM Personal Health Budget programme Linked to Right Care and CCG IAF and the Deaths in Hospital work stream within unscheduled care. Work programme to focus on service provision and clinical practice and with links to other identified priority disease programmes. Delivery of a blended tariff model for CHC placements and establish approved provider list for nursing homes Refresh of the approved provider list for CHC and end of life homecare providers Implementation of homecare commissioning process Establishment of the discharge to assess model and revised fast track process Establish expanded and revised Brokerage and Managed Account Approved Provider Framework Establish Finance processes for PH Budgets not held by the CCG Procure and Deliver commissioned PHB Training programme Deliver Programme support to all Community Teams offering the PHB Local Offer to achieve QAF targets Delivery of the PHB Joint Working Principles with Trafford Council Implementation of the GM wide PHB Programme for the LD Transformation programme Procure and Deliver support systems for training and supervising Personal Assistants with 3 rd Sector organisations Delivery of one stop point of contact for PHBs and Directory of Services for PHB users. Delivery of the GM wide PHB programme conference and action plan 4.2 It is acknowledged that other programmes of work such as the Transformation Fund bid - mental health, primary care and new models of care, would work alongside the commissioning intentions work stream, where appropriate. 4.3 At this stage the refined list illustrates broad headings, includes high-level detail, which cover a spectrum of clinical areas and services. Further work up is now required to clearly outline the level of detail and work involved. Part of this work will include a look back over previous years to understand and reflect on relevant work that may have taken place in the past. 5.0 NEXT STEPS
5.1 To assist with the further work up of each of the proposed commissioning intentions it is proposed that Task and Finish Groups are establish to cover the four areas: Unscheduled care Schedule care Continuing health care 5.2 Initially the purpose of these groups will be to undertake a mapping exercise to understand what the current position is for each of the work streams. This will include where appropriate: Contract status Finance Data Local intelligence Other related work programmes, including GM and national. Previous work undertaken 5.3 A commissioning intentions work programme will be developed to illustrate how the work up of each commissioning intention will take place. This will include clear tasks, lead/s and resources that will be required. In addition, it will reconcile where there is a clear link to other work programmes within the CCG to ensure there is no duplication and programmes are working alongside each other. Once this has been confirmed comprehensive project initiation documents (PIDs) will be developed through the Task and Finish Groups. 6.0 RECOMMENDATIONS The Governing Body is asked to: i. Agree on rephrasing strategic objectives and confirming 2017/18 objectives. ii. Receive the commissioning intentions noting the work required for the Governing Body meeting on 20 June. iii. Discuss and agree to the proposed changes to the committee structure. Cameron Ward Interim Accountable Officer 19 June 2017
Appendix 1 Vision - A fully integrated and efficient health and social care system, which has the people of Trafford at its heart. Strategic objectives suggested changes noted in italics 1. Continually improve engagement with member practices, patients, the public, carers, providers, our staff and other partners to effectively contribute to and influence the work of Trafford CCG. 2. Working with health and social care partners deliver the transformation plan for Trafford including an increasing proportion of services from primary care and community services in an integrated way. 3. Through effective integrated commissioning improve the quality of services and reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a sustainable economy both in terms of clinical services and finances. 2017/18 priorities 1. Design, plan and begin implementation of the Transformation Plan including New Models of Primary Care, integration with Trafford MBC, Local Care Organisation and maximising the Trafford Co-ordination Centre lead interim Accountable Officer 2. Attain delayed transfers of care targets (DTOCs) lead Director of Commissioning. 3. Meet waiting time standards in urgent care, cancer, mental health and planned care lead Director of Commissioning. 4. Achieve financial plans lead Chief Finance Officer a. Enhance CRES scheme delivery b. Prepare a medium term financial plan. 5. Implement delegated primary care commissioning including the GP Forward View lead Medical Officer. 6. Prepare a Trafford wide integrated estate and service plan including Altrincham and Limelight - lead Chief Finance Officer 7. Enhance engagement with communities, providers, and primary care lead Chief Nurse 8. Progress organisational development throughout the health and social care sector lead Associate Director Corporate Services 9. Progress commissioned service changes eg end of life, diabetes lead Director of Commissioning