SUMMARY REPORT Meeting Date: 17 July 2014 Agenda Item: 9.1 Enclosure Number: 7 Meeting: Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Trust Board CCGs 5 Year Strategic Plan The attached presentation has been provided on behalf of the Clinical Commissioning Groups and will be presented at the meeting by a CCG senior officer (Summary Report: Julie Thornby, Director of Governance and Strategy) Committee Date Reviewed Key Points/Recommendation from that Committee Purpose of the report To provide the Board with an overview of the joint strategic plan of both local CCGs ie shared by Telford and Wrekin Clinical Commissioning Group and Shropshire Clinical Commissioning Group. A senior officer of Shropshire Clinical Commissioning Group will attend the meeting to present the strategic plan. The presentation is attached. Strategic Priorities this report relates to: To exceed expectations in the quality of care delivered 1 Board Meeting: 17 July 2014 To transform our services to offer more care closer to home more productively. To deliver well co-ordinated effective care by working in partnership with others. Consider for Action Approval Assurance Information x To provide the best services for patients by becoming a more flexible and sustainable organisation x x x x Summary of key points in report In June 2014, all Clinical Commissioning Groups (CCGs) submitted a draft five year strategic plan to NHS England This is a joint strategic plan shared by both the Shropshire CCG and Telford and Wrekin CCG The plan describes in some detail the system vision for the next 5 years and has been developed in consultation with the main local provider organisations In common with the Community Trust s own 5 year plan, the CCGs plan recognises that as it has been developed at a point in time, and noting the longer timescales for the Future Fit Programme, it does not describe in detail the transformation of service models. Further information can be found on the Shropshire CCG and Telford and Wrekin CCG
websites http://www.shropshireccg.nhs.uk/resources http://www.telfordccg.nhs.uk/publications Key Recommendations 1. To note the joint CCG 5 year strategic plan and consider if any Trust action is required, recognising that the Trust s own recently submitted 5 year plan reflected the CCGs Plan. Is this report relevant to compliance with any key standards? YES OR NO CQC N NHSLA IG Governance Toolkit N N State specific standard or BAF risk Board Assurance Framework Y BAF Risk on sustainability Impacts and Implications? YES or NO If yes, what impact or implication Patient safety & experience Y Sets commissioner context for Trust plans Financial (revenue & capital) Y Sets commissioner context for Trust plans OD/Workforce Y Sets commissioner context for Trust plans Legal N 2 Board Meeting: 17 July 2014
NHS Shropshire and NHS Telford and Wrekin Clinical Commissioning Groups A summary of our 5 Year Strategic Plan 2014/15 through to 2018/19
An overview of our five year strategic plan In June 2014, all Clinical Commissioning Groups (CCGs) submitted a draft five year strategic plan to NHS England This is a joint strategic plan shared by both the Shropshire CCG and Telford and Wrekin CCG The plan describes in some detail the system vision for the next 5 years and has been developed in consultation with our main provider organisations
An overview of our five year The strategic plan is based on three core areas of activity NHS Future Fit A review of hospital services Better Care Fund strategic plan Joint service development and planning across health & social care Mental Health Modernisation The operational plan is the detailed document that contains the actions that will deliver the three core areas of CCG business over the first 2 years of the 5 year plan
National challenges Our population is getting older People with long term health problems, such as diabetes and cancer, are living longer Quite rightly, our population wants the highest quality healthcare
Our local challenges We celebrate the fact that the life expectancy of older people has improved markedly In Shropshire, Telford and Wrekin the population of over 65 s has increased by 25% in just 10 years! We have one of the largest and most rural inland counties of England And a high population of older people spread across a large rural area with long travelling distances to hospitals So we need to develop a comprehensive range and increased scale of community based health services
Specific healthcare challenges After the Francis Inquiry into failings at Mid Staffordshire Hospital we have placed quality firmly at the top of our agenda This means we will ensure quality is built into every aspect of the local healthcare system The clinical and financial sustainability of our local acute hospital services is a concern The capacity of our community based services needs to be developed Parity of Esteem mental health needs to be a focus in everything we do
Workforce challenges There is a national recruitment challenge for the NHS in recruiting and retaining doctors and nurses Doctors training is now more specialist and advances in medical technology mean that there are less people with the right skills for every specialism This is combined with an ageing workforce and the need to establish a more community centred workforce Our rural profile and issues of access and travel distances also adds to the challenge We have shortages of medical staff in A&E services, stroke, medicine, critical care and anaesthetics
NHS England resource vs demand
Financial challenges The need for investment in the latest equipment, medicine and staff with the right skills and experience Rising inflation so services cost more Diminishing availability of specialists Question over viability of sub specialisms Greater demands on services from ageing population, health problems and lifestyle
Our system vision We envisage a system where, through working together, we have created a pattern of services that offer excellence in meeting the distinctive and particular needs of the rural and urban populations of Shropshire and Telford & Wrekin
Delivering the vision
Call to Action Conference Nov 2013 Patients, doctors, nurses and NHS staff agreed Hospitals can and should be used differently Opportunities for more people to manage their own health or receive care closer to home It is possible to redesign and enhance services that can offer excellence in meeting the different needs of the rural and urban populations of this area Change is needed to improve health outcomes, experience and safety for patients Any changes should be led by clinicians with full involvement of patients and communities
A review of all hospital services acute and community based Led by clinicians with patient involvement throughout Final clinical model developed by more than 300 clinicians and patients approved in June 2014 Governed by a programme board that involves all key stakeholders
Acute Care LTC / Frailty Planned Care Prevention Make every contact Targeted prevention Information / Self care count Whole economy long term strategic prevention programme Patient Access to reliable info Self management. Access to reliable info Empowerment about signposting Care and EOL plans re self care, local and self care. with shared decisions. services and direct access Advocacy and Integrated care record Key worker Pathway navigation Continuity Partnership Timely specialist GP led care with Tiered pathway driven Care support to generalist specialist support care with GP and specialist in Urgent Care Centre and education at defined points. Feedback and education as the norm Levels of Care One Emergency Centre Low, medium and Single Diagnostics and (see diagram) Some Urgent Care high medical input Centre for medium and Centres care settings high level procedures Integrated SPA to access integrated Integrated Teams integrated around Teams community services multi disciplinary teams service Whole system synergies
Better Care Fund The Better Care Fund is an opportunity to transform the local health and social care landscape. Committed to focus on four overarching principles: Prevention Early intervention Building community resilience Independent living An opportunity to develop the capacity of services in the community
Mental Health Modernisation No health without mental health delivering high quality services with a focus on recovery establishing clear waiting time limits tackling inequalities in access. We are committed to developing parity of esteem to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole (Department of Health, November 2013) to ensure that mental health services are given the same focus as physical health services The aim of which is to ensure that local agencies work together to improve care provision for those experiencing a mental health crisis.
Quality Improving quality and outcomes We have effective systems in place to monitor the quality of health services across Shropshire, Telford and Wrekin but there is still much to do and we need to work in partnership to deliver positive patient experiences Health Inequalities Tackling health inequalities is a priority for both CCGs each has it s own challenges whether that is urban deprivation or rural isolation we need to work together to challenge these inequalities and improve patient care Working in partnership Both CCGs have a robust and resilient approach to partnership working with the local councils and voluntary sector organisations and they are committed to continuing these positive relationships to enhance the necessary work to continuously improve patient care Engagement Both CCGs have mechanisms for engaging with their member GP practices and ensuring clinical expertise is at the heart of decision making this is combined with a dedicated approach to bringing patients and public into the shaping of healthcare for the whole of Shropshire, Telford and Wrekin.
Our strategic plan in summary We envisage a system where, through working together, we have created a pattern of services that offer excellence in meeting the distinctive and particular needs of the rural and urban populations of Shropshire and Telford & Wrekin. System Objective A service pattern that will attract the best staff and be sustainable clinically and economically System Objective A coherent service pattern that delivers the right care in the right place at the right time, first time, co-ordinated across all care provision System Objective A service which supports care closer to home and minimises the need to go to hospital System Objective A service that meets the distinct needs of both our rural and urban populations and which anticipates changing needs over time. System Objective A pattern of service which ensures a positive experience of care System Objective A service pattern which is developed in full dialogue with patients, public and staff and which feels locally owned Delivered through: Clinical models Whole system models of care describing whole patient journeys. Clinically led design with strong patient engagement. Delivered through: Workforce Workforce engagement, support and development central to our change programmes. Redesigning roles to meet the needs of new patterns of service delivery with staff working across different care settings. Delivered through: Change Management Using change management methodology for system and process improvement, which support continuous learning and development. Delivered through: Shifting finance, shifting focus Commissioning and contracting models which support the delivery of new clinical models and patterns of service delivery and which reflect the whole patient journey and support a re-focus of care away from a hospital based model100 Delivered through: Managing risks/working together Taking collective responsibility for making progress towards our shared strategic vision Overseen through the following governance arrangements FutureFit Health & Wellbeing Boards (Better Care Fund) Planned Care Working group Urgent Care Working Group Possible development of a clinical senate System Resilience Group Measured using the following success criteria 3.2% improvement in PYLL Improving the health related quality of life for those with LTC 15% improvement in unplanned hospital admissions Increase the number of people entering IAPT services by 15% by March 15 Increase the level of recovery for those accessing IAPT services to 50% by March 15 10-15% improvement in patient experience of Hospital care Increase by 20% people with COPD referred into a rehabilitation programme Increase the dementia diagnosis rate to 67% by March 15 Reduce permanent admissions of older people to residential and nursing care Increase the proportion of older people who are still at home 91 days after discharge Most effective use of resources Equitable access to the full range of services Improved staff recruitment, retention and satisfaction System values and principles We value above all else the extent to which our collective efforts will achieve real improvements in services for the people we serve. We recognise that everything we do will be achieved through our staff, stakeholder partners, with the help and support of patients, their carers and the general public and volunteers. We will demonstrate the high esteem in which we hold people, and the respect we have for them, by leading in accordance with the principles set out in the Concordat we have collectively signed up to. In particular, we will make sure that there is. a clear clinical vision for change that inspires those involved in delivering it. Principles: Home is normal. The level of care should match the level of need and unnecessary escalation of care should be avoided. A commitment to 7 day working as part of an integrated local health economy approach. Recognition that a commitment to quality and safety is paramount for clinicians. The need to get the system right for the next 10-20 years.
System Objectives System Objective A service pattern that will attract the best staff and be sustainable clinically and economically System Objective A coherent service pattern that delivers the right care in the right place at the right time, first time, co-ordinated across all care provision System Objective A service which supports care closer to home and minimises the need to go to hospital System Objective A service that meets the distinct needs of both our rural and urban populations and which anticipates changing needs over time. System Objective A pattern of service which ensures a positive experience of care System Objective A service pattern which is developed in full dialogue with patients, public and staff and which feels locally owned
Delivering the system objectives Delivered through: Clinical models Whole system models of care describing whole patient journeys. Clinically led design with strong patient engagement. Delivered through: Workforce Workforce engagement, support and development central to our change programmes. Redesigning roles to meet the needs of new patterns of service delivery with staff working across different care settings. Delivered through: Change Management Using change management methodology for system and process improvement, which support continuous learning and development. Delivered through: Shifting finance, shifting focus Commissioning and contracting models which support the delivery of new clinical models and patterns of service delivery and which reflect the whole patient journey and support a re-focus of care away from a hospital based model100 Delivered through: Managing risks/working together Taking collective responsibility for making progress towards our shared strategic vision
Delivery governed by Overseen through the following governance arrangements FutureFit Health & Wellbeing Boards (Better Care Fund) Planned Care Working group Urgent Care Working Group Possible development of a clinical senate System Resilience Group
Success Criteria Measured using the following success criteria 3.2% improvement in PYLL Improving the health related quality of life for those with LTC 15% improvement in unplanned hospital admissions Increase the number of people entering IAPT services by 15% by March 15 Increase the level of recovery for those accessing IAPT services to 50% by March 15 10-15% improvement in patient experience of Hospital care Increase by 20% people with COPD referred into a rehabilitation programme Increase the dementia diagnosis rate to 67% by March 15 Reduce permanent admissions of older people to residential and nursing care Increase the proportion of older people who are still at home 91 days after discharge Most effective use of resources Equitable access to the full range of services Improved staff recruitment, retention and satisfaction
System values and principles We value above all else the extent to which our collective efforts will achieve real improvements in services for the people we serve. We recognise that everything we do will be achieved through our staff, stakeholder partners, with the help and support of patients, their carers and the general public and volunteers. We will demonstrate the high esteem in which we hold people, and the respect we have for them, by leading in accordance with the principles set out in the Concordat we have collectively signed up to. In particular, we will make sure that there is. a clear clinical vision for change that inspires those involved in delivering it. Principles: Home is normal. The level of care should match the level of need and unnecessary escalation of care should be avoided. A commitment to 7 day working as part of an integrated local health economy approach. Recognition that a commitment to quality and safety is paramount for clinicians. The need to get the system right for the next 10-20 years.
To find out more. http://www.shropshireccg.nhs.uk/resources http://www.telfordccg.nhs.uk/publications