Sussex & East Surrey Sustainability & Transformation Partnership Papers for the STP Programme Board meeting 19 September 2017 The following papers from this meeting follow: Agenda Page 2 Item 2 Minutes and action notes of the meeting on 8 August 2017 Page 3 Item 4 Clinically effective commissioning Page 9 Item 5 Urgent and emergency care update Page 20 Item 5 NHS 111 transformation programme update Page 28 Item 5 NHS 111 paper for CCG governing bodies Page 56 Item 6 STP update for HOSC chairs Page 105
Sussex & East Surrey Sustainability & Transformation Partnership Sustainability & Transformation Programme Board AGENDA Tuesday 19 September 2017 Lindfield Room, Charis Centre, Town Barn Road, Crawley, RH11 7EB 17:45 19.30 Time Item Description Attachments Presenter 1. 17:45 Welcome and Introductions 2. 17:50 3. 18:00 4. 18:10 5. 18:25 Action notes Matters Arising Mental Health Delivery Plan Update STP Update Feedback from STP Oversight Group workshop Enc 2 Clinically Effective Commissioning Enc 4 Urgent & Emergency Care Winter plans NHS 111 update 6. 19:05 STP Update for HOSC chairs (for information) Enc 6 7. 19:10 AOB Enc 5.1 5.3 Michael Wilson Michael Wilson/ Sam Allen Michael Wilson/ Dena Marshall Geraldine Hoban/ Katie Armstrong Maggie Keating/ Colin Simmons Dan Wood Michael WIlson Page 1 of 1
Sussex & East Surrey Sustainability & Transformation Partnership Sustainability & Transformation Programme Board ACTION NOTES Tuesday 8 th August 2017 17:45-19.30 Charis Centre, Crawley Present: Michael Wilson, STP Chair & CEO SASH Paul Simpson, Chair STP Finance Group & CFO SASH Sam Allen, SRO STP Mental Health Work stream & CEO SPFT Siobhan Melia, SRO Workforce & Estates STP Work streams & CEO SCFT Mark Watson, STP Digital Programme Director Jayne Phoenix, Director of Strategy, SECAMB Maggie Patching, Programme Manager - Workforce, HEE Richard Boyce, NHS Improvement Sarah Billiald, CEO, First Community Richard Brown, Medical Director, Surrey & Sussex LMCs Katrina Broadhill, Healthwatch West Sussex Wendy Carberry, STP SRO & AO HWLH CCG Dominic Wright, AO East Surrey CCG Steve Jenkin, CEO, QVH Rachel Harrington, HMS CCG Pennie Ford, Director of Delivery & Assurance, NHS England Dena Marshall, Programme Director Andy Gray, Director or Corporate Services, BSUH & WSHT Katie Armstrong, AO, Coastal CCG Amanda Philpott, AO EHS & H&R CCGs Sadie Leack AHSN Sally Flint, DoF, Sussex Partnership FT John Childs, COO, Brighton & Hove CCG Kerry Moody, Leadership Academy Anne-Marie Archard, Leadership Academy David Liley Healthwatch Brighton & Hove Adrian Bull, CEO ESHT Nick Lake, Sussex Partnership FT Rick Fraser, Medical Director, Sussex Partnership FT Caroline Huff, Programme Director, STP Clinical Board In attendance: Hannah Farrar, May Li, Phil Livingstone (Carnall Farrar) Apologies: Adam Doyle, Keith Hinkley 1
Item By whom By when 1. Welcome & introductions Michael Wilson welcomed everyone to the meeting and a round of introductions was made. 2. Action notes The action notes on Tuesday 27 th June were agreed as a correct record. The following matters arising were discussed: 2.1 CEP submission Paul Simpson reported that the STP had not yet received any formal feedback from regulators following the submission made on 15 th June 2017. Richard Boyce (NHS I) and Pennie Ford (NHS E) commented that they had nothing further to add on behalf of the regulators. 3. STP update Michael Wilson advised that an announcement regarding the Executive Chair appointment was expected late August/ early September 2017. MW reported that he would continue to chair the STP Executive Group and Programme Board until an appointment was made. 4. Place based plans Hannah Farrar provided a very detailed update on the work Carnall Farrar has been supporting since April 2017, speaking to the slide deck circulated with the agenda. A summary document was provided on tables and this would be circulated with the notes of the meeting. As the Carnall Farrar support is ending the place based leads provided an update on how the outputs would be implemented locally. North CSESA Michael Wilson advised that a clinical engine room would be established either by re-purposing an existing group/s or setting up a new group. MW reported that an ACS leadership group was being established of CEOs and AOs and that the first meeting would be externally facilitated. Governance of the leadership group will need to align with the existing SASH Transformation Board and the clinical group. MW advised that there was further 2
work underway to understand the financial challenge across the system and how to address this. Coastal Katie Armstrong explained that the Carnall Farrar support had enabled Coastal Care to take the business case to the next level of detail. She reported that they had clarified their priority areas and the work that needs to be done and had appointed managerial and clinical leads for each work stream. She reported that she anticipated that the Coastal Care Delivery Plan would be signed by all partners at the end of August 2017. The CCG had now aligned dedicated resource to develop the partnership. She reported that the partnership was working towards a single operating plan and single leadership team. South CSESA Wendy Carberry reported that alignment between partners had been achieved on the focus for 2017/18 and that this would be on reducing delayed transfers of care and on engaging GPs to plan pro-active care. She reported that partners would be developing a single operating plan. They had agreed to revisit the number of localities. They had also agreed to standardise delivery mechanisms across the place which would mean bringing Caring Together and Connecting 4 You into one plan. A tripartite SRO (WC/ MG/ AD) had been agreed and would come into immediate effect. A PMO structure would need to established. Paul Simpson advised that the outputs from this work in terms of potential savings were being reviewed by the STP Finance Group in pursuit of understanding these could support the STP Strategic Financial Framework. There was discussion about the evidence base for a 35% reinvestment in services to deliver the place based plans. Hannah acknowledged that the evidence was weak and that this would need to be considered on an intervention by intervention basis. 4. Mental Health Case for Change Sam Allen, joint SRO Mental Health, opened the session highlighting the prevalence of mental health issues across the STP and welcoming the focus the STP had decided to give to mental health services. Hannah Farrar talked to the summary of the larger case for change document circulated with the agenda which was available on each table and will be circulated with the notes of the meeting. Following Hannah s overview, smaller discussions took place on each table and the following key issues were reported back to the plenary following these smaller discussions: 3
Programme Board members were surprised at the prevalence of mental health conditions across the STP and also at the apparent variation in funding/ service provision; The case for change suggests that there are issues for both commissioners and providers to address; There needs to be more information about outcomes linked to current spend in order to inform decision making; The fragmentation of crisis services is stark; The case for change resonates for clinicians; The case for change suggests a potential investment requirement in mental health services which will be difficult in the context of no new money; The case for change points to the need for be better integration between physical and mental health services; Crisis, early intervention, dementia, raising awareness/ reducing stigma all priority areas; Greater engagement with workforce required so as to codesign new models of care; There was a discussion about the linkages between the mental health case for change and the place based plans. Hannah explained that the Mental Health Strategic Framework would seek to make these linkages in terms of the optimal size of population for the design of each intervention. Sam and Hannah advised that they would be sharing the Strategic Framework at the next meeting on 19 th September 2017. SA 19 th September 2017 5. Clinically Effective Commissioning Katie Armstrong spoke to the paper circulated with the agenda for the meeting. KA explained that Clinically Effective Commissioning (CEC) was about best practice commissioning, ensuring that all eight commissioners had a consistent approach to commissioning policies in order that they could ensure the public of consistent care and value for money. KA explained that in the first instance CEC involved developing a common set of policies to be considered by CCG Governing Bodies in September 2017. In some cases this would involve clarifying existing guidance and ensuring consist application across all commissioners and in other cases this involved recommending thresholds for surgical interventions. KA explained that in terms of the latter workshops were being organised for September involving clinicians. 4
KA explained that given the financial positions of commissioners this work would also have to include thinking the unthinkable. KA explained that Clarity (the external consultants supporting this work) was drawing together a long list for discussions with clinician and the public in due course. KA commented that ownership and engagement were both key to successful implementation. A further update will be provided at the next meeting. KA/ GH 19 th 6. Proposal to share Programme Board papers Dan Wood spoke to the paper circulated with the agenda. September 2017 8. AOB Programme Board members approved the proposal that Programme Board agendas, papers and minutes would be made available to the public through the development of an STP website and that they should be made available through partner websites in the meantime. Dan Wood agreed to action. No further business. DW ASAP Date & time of next meeting: Tuesday 19 th September 2017, 1745-1930 5
ACTION LOG 8 th August 2017 Action By Whom By When 1. Mental Health Strategic Framework presentation to Programme Board Sam Allen 2. Update on Clinically Effective Commissioning Geraldine Hoban/ Katie Armstrong 19 th September 2017 19 th September 2017 6
Clinically Effective Commissioning (CEC) CEC Programme Team September 2017
How do we address waste and achieve best value? CEC focussed on planned care (rather than urgent care) In order to help the whole system balance resources and demand there is a need to: 1. Decide what the system will and won t do (e.g. medicines, procedures or other treatments) based on a defensible and clinically led decision making process 2. Enact those choices in formal policies, embed them in systems and communicate our decisions widely 3. Keep those policies up to date and under continuous review to ensure they reflect clinical evidence as it emerges and the needs of our local populations 4. None of these discussions undermine the hard work of clinical redesign which is also required, but these hard decisions will create the space in which redesign can occur 2
Releasing resources Key assumptions: As a system we will identify all areas of waste and address them via savings schemes if examples of pure waste are located these must be addressed as an absolute priority We recognise that there is no new money likely to be forthcoming we need to manage within the resources we have been allocated Managers can do a lot to implement change and identify the issues and challenges, but ultimately as a clinically led organisations, it is the membership of the CCG which need to decide the priorities for the local population led by our clinical leaders 3
Why this is good practice, even if there weren t financial challenges Resources required for the innovation Implementation of high value innovation e.g. troponin in heart disease funded by reduced spending on lower value intervention in the cardiovascular programme budget and control of innovation of uncertain value. Innovation adopted Resources freed by reducing lower value activity 4
Programme Governance CCG commissioned, STP oversight There are 8 CCGs in the STP they commissioned the work as it is core business for CCGs, but ultimately as the implementation needs the whole system to play a role, so CEC is a key work programme for the STP CEC Programme is governed as follows: Decisions to change must be made by the CCGs clinical policies are owned by each CCG so each must come to their own decision, but work in common to arrive at the same result by: Overseeing the work via the CEC Programme Board (all 8 CCGs are represented) Reporting weekly and monthly progress and issues STP oversees and reviews STP executive monthly highlight report STP clinical board advises on clinical issues which may have wider system impacts 5
East Surrey special considerations Situation: East Surrey CCG is a member of the STP and is playing an active role in the programme East Surrey CCG is a significant commissioner of services at SaSH (as is Crawley and Horsham & Mid Sussex CCGs), so there is a clear benefit in all the CCGs working together to develop common policies and approaches to compliance around the trust Complication: East Surrey CCG is a member of the well established Surrey-wide policy development forum which has driven common threshold policies across Surrey these are not consistent with existing Sussex policies and may differ from the new Sussex-wide policies in development East Surrey CCG shares a number of compliance support services from other Surrey CCGs. Surrey systems and processes are well regarded nationally and again differ from those currently in place in Sussex Resolution: Sussex and Surrey policies will be harmonised as far as possible. To minimise the differences recent Sussex common policy proposals will be shared with Surrey forum and Surrey forum representatives have been invited to September clinical workshops. There is an opportunity for the future sustainable Sussex policy review mechanism to be linked (or common) with Surrey Opportunities to learn from Surrey compliance approaches to be actively take a leadership role in helping Sussex CCGs adopt better practice pursued East Surrey to 6
Three CEC Objectives 1. Common Policies - Objective There are 8 CCGs in the STP and there are at least 5 main versions of each clinical policy (this means that Patients referred to the same hospital for the same treatment are subject to different threshold policies). The different policies mean that patients get different access and outcomes. If a common, revised policy can be established there will be: Greater equality of access to treatments across the whole STP footprint It will be cheaper for CCGs to maintain currency of common policies All policies are being reviewed and detailed assessment of evidence supporting the policy and the degree of difference between each policy is being assessed. Latest information on what the 8 CCGs spend with local acute hospitals indicates that there is substantial variation in numbers of treatments per 100k population which indicates that there is non-clinical variation which could be addressed to release resources. In other locations, improved policies and increased effort on end-to-end processes and compliance has stopped 5-15% of the activity, which could release 3-6m in a full year after implementation of the total programme 7
Three CEC Objectives 1. Common Policies Progress A first group of policies are being finalised these are policies where most CCGs already had an existing policy and there is strong evidence body of clinical evidence exists to support a common policy which will set a threshold for treatment. STP clinical board has agreed that most of the policies are uncontroversial all CCGs have had multiple rounds of drafts to review. Final drafts to be provided to CCGs in August for decision making within CCG processes A second group of policies is being reviewed and developed. These are more complex, as CCGs have different existing policies, or there is more clinical debate required to find the appropriate standard. Four clinical evidence review workshops were held in September bringing together acute providers, GPs, public health and lay members to discuss the evidence base and as far as possible agree on an outline common policy If new policy proposals represent a significant change, then engagement and consultation processes will follow to ensure CCGs involved and engage all relevant 8 stakeholders
CEC Objectives 2. Improved processes - Objective There are 8 CCGs in the STP each of which have differing approaches to ensuring end to end compliance with existing policies. This leads to differing effectiveness of the thresholds as in some cases there is evidence of significantly differing use of medicines and procedures, despite similar or identical policies. There are significant advantages in the CCGs working together to develop best practice approaches and in some cases co-developing new processes and systems to aid compliance. ECI Policies 1. Review for currency 4. Computer system to automate good referral practice 2. Confirm referrers know the policies Referral sources: GP C2C Optom. 5. Process and system to help referrers decide on need for referral 7. Patient choice do patients really understand the alternatives? 6. Referral Management to check compliance Compliance, monitoring, enablement system Acute Care Depts 3. Confirm Providers know the policies and will reject noncompliant referrals 9
CEC Objectives 2. Improved processes - Progress Each stage of the process has been analysed for each CCG. The CEC programme has developed project outlines for 12 initial projects to improve each step of the process. Not yet been approved for implementation as there are key stakeholders who have yet to be involved. PID 1: Set up STP wide process to update, maintain and upload policy changes onto GP systems. PID 2: Help referrers work within the process (link to the introduction of supporting software e.g.. DXS) PID 3: Implement decision support tools to standardise GP referral PID 4: Harmonise uptake of E-referral (ERS) across Provider Trusts and support GPs to adopt PID 5: Standardise GP dashboard to review variation in GP referral patterns PID 6: Shared decision making and PDA processes to help patients make more fully informed decisions about their care PID 7: Align IFR processes to harmonise with prior approvals arrangements at Trusts PID 8: Advice & Guidance Secondary care assistance to GP referrers opportunity for common approach PID 9: Promote common approach to referral hub function for validation of prior approvals. PID 10: Implement easy to use prior approval system in the four principal acute Trusts (BSuH, SaSH, ESHT, WSHFT). Capture C2C referrals. PID 11: Coding and costing optimisation supporting standardised reporting and compliance processes PID 12: Audits to demonstrate quality and compliance 10
CEC Objectives 3. Accelerating savings There are 8 CCGs in the STP and an emerging cost pressure in 2017-18 for the Commissioners budgets Working across the CCGs, we aim to identify a range of opportunities which can be rapidly assessed and put in place across the system to improve the financial position. This work takes place in the context of the Capped Expenditure Process, which required the whole system to demonstrate that all possible options has been considered then prioritised for further development based on criteria also developed in the project. There are a small number of options which CCGs believe could be pursued in 2017-18 most of which involve the 8 CCGs working more closely together to share best practice and take advantage of the scale offered by the STP. Further work to take place to gather more options, quantify the opportunities and examine the timescales for delivering sustainable change. 11
Sussex & East Surrey Sustainability & Transformation Partnership Urgent and Emergency Care Update Winter Planning Update Tuesday 19 th September 2017
Sussex & East Surrey Sustainability & Transformation Partnership Content 1. Winter Plans 2. Winter Planning: STP Wide Interventions 3. NHSE Transformation Funding 4. UTC Update
Sussex & East Surrey Sustainability & Transformation Partnership Winter Plans Broad focus areas: 1. 2016/17 Review and lessons learnt 2. System wide planning; collaboration and partner working 3. High risk groups; admissions avoidance 4. Demand and capacity planning; surge management 5. Streaming at the front door 6. Improved discharge and flow 7. Governance and leadership; escalation protocols AEDB Urgent Care Leads asked to provide an update to the board focussing on: What is due to come on line in next 6 months in relation to UEC delivery plan / A&E improvement plan? What is specifically being done in preparation for winter (e.g. bed capacity, immunisation etc.)? What surge plans are in place to manage expected and unexpected peaks? Update regarding NHSE CHC assessment process ask Status: ESBT detailed plan produced; tangible targets in place BSUH milestone plan developed based on narrative (AEDB action) SaSH - plan needs further development to set out specific targets and milestones against published narrative (AEDB action to resolve) Coastal plan needs further development to set out specific targets and milestones against published narrative
Sussex & East Surrey Sustainability & Transformation Partnership Winter Planning: UEC STP Wide Interventions DTOCs Continue to impact flow and work is ongoing across the STP to address this in advance of winter, moving towards national target of 3.5% occupied bed days; 50:50 responsibility to achieve this between NHS and local authorities. A reduction in CHC assessments taking place in acutes will be a key contributor to this alongside ensuring alignment with BCF plans CCGs [reporting >30% CHC assessments taking place in acute] are required to submit a plan for improving this to less than 15% by March 2018 DoS Optimisation Sussex DoS lead appointed Priority to be given to: Completing service profiling for urgent care settings Ensuring services are profiled fully e.g. where they are available via SPoA (HSCC, Onecall) or GP surgeries (nurses, therapists etc.) Clinical profiling to support MiDoS rollout (transformation fund bid) Provider interventions to change working practices (NHS111 / SECAmb / GPs)
111 calls being handled by clinicians Contract variation being implemented for 17/18 priority projects: Sussex & East Surrey Sustainability & Transformation Partnership Winter Planning: UEC STP Wide Interventions 1. Validation of green non-emergency ambulances - to drive down inappropriate ambulance despatch. 2. Validation of ED referrals initially focused on 4 hour dispositions (c. 1100 per month) - to reduce pressure on ED (used in conjunction with RAIDR delivery to confirm attendances) 3. DoS optimisation by 111 - aligned to DoS improvement programme to increase utilisation and improve working practices (following ranking strategies; selecting valid rejection codes 4. Introducing more pharmaceutical support in NHS111 service Providing professional advice and assurance regarding medication queries and dosage / frequency risk Reducing demand on OoH for those callers who don t need an immediate prescription. Pharmacies Rollout of NUMSAS reducing demand on OoH for callers who do need a prescription Significant acceleration approaching August bank Holiday (and in advance of Winter) DoS searches to support presentation of NUMSAS ahead of any other alternatives (e.g.ooh) 111 working practices to support ED Streaming Ability to stream patients to services appropriate to acuity National target for implementation - October 2017 Systems largely on target (some work force / contractual issues?) Detail held within place based plans
NHSE Transformation Funding Sussex & East Surrey Sustainability & Transformation Partnership 2m ring fenced to support priority areas DoS optimisation and clinical access (MiDoS) Primary Care Appointments solution Channel Shift modelling support Further 4.6m available subject to business case Investment funding proposal form submitted to develop solutions for increasing care plan volumes and visiblity Across 3 STP footprints Business case predicated on 20% drop in conveyance to A&E for complex patients (2% population), if a management plan for the patient can be made available to front line ambulance staff Taking this IBIS data and comparing with tariffs shows that for acute hospitals with an activity based tariff for ED, the expected QIPP saving per plan is 260 saved by both avoiding: admitting the patient into ED, and avoiding onwards admission deeper into the hospital
UTC Update: Timeline Sussex & East Surrey Sustainability & Transformation Partnership Deliverable Identify sites we already know we want to designate as a UTC and can achieve the required standard by December 2017 If the CCG/Local Delivery System have no facilities that will meet this initial cohort then this position also needs to be confirmed to NHSE Assurance Due date 25 th August 2017 Undertake analysis across the STP to identify sites that will be designated UTCs Whilst the pro-forma is for each site we do need to sit down across wider footprints (place and STP) to agree the best placement of services that will support our patient base as a whole Workshop held 5 th September to ensure plans are strategically aligned across STP 25 th September 2017 Plans in place to uplift designated sites to meet standards March 2018 Standards achieved across all designated sites December 2019
UTC Update: Key Messages Sussex & East Surrey Sustainability & Transformation Partnership CCGs should consider the need for UTCs within a wider urgent care strategic framework that may extend beyond the timelines set out &/or CCG boundaries, dictated by evolving local development opportunities, partnerships and patient demographics and needs. CCG returns should be supported by a covering letter that provides narrative and the rationale behind the given responses, the context within the strategic direction of the CCG, local place based plans and the overarching STP plans for the delivery of urgent care. A template will be produced to provide some guidance and consistency regarding this cover letter and some commentary regarding some of the overarching STP issues that are common to all, to include: Estates; Work force; STP Transformation fund initiatives / impact Unknown effect of parallel urgent care intervention i.e. channel shift; Dependencies on change management and patient / provider behavioural change; and General UEC strategic context.
Sussex Integrated Urgent Care Transformation STP Programme Board 19 th September 2017
The nine key outcomes of Integrated Urgent Care 1. A single call to get an appointment during the out-of-hours period. 3. The capacity for NHS 111 and urgent multidisciplinary clinical services need to be jointly planned. 5. Care plans and special patient notes are visible to the Clinicians in the IUC and in any downstream location of care. 7. There is joint governance across Urgent and Emergency Care. 2. Data and Information can be shared between providers. 4. The Summary Care Record (SCR) is available in the Clinical Assessment Service (CAS) and elsewhere. 6. Appointments can be made to in-hours and extend access primary care services - offering services in the evening and at weekends. 8. Suitable calls are transferred to a Clinical Assessment Service containing GPs and other health care and social care professionals. 9. The Workforce Blueprint products and guidance are implemented across all providers.
National NHS 111 Hear and Treat / See and Treat
NHS England The national specification requirements This service specification supersedes the previous commissioning standards, moving from an advisory set of recommendations to mandatory requirements, to ensure a consistent service across the country. GP Out of Hours and NHS 111 services will be combined, and multidisciplinary clinicians added to the integrated working model.
A Clinical Assessment Service SPECIALIST SERVICES HEALTH CARE PROFESSIONALS IN THE COMMUNITY EMERGENCY DEPARTMENTS 999 Health Advisor Clinical Advisor ALLIED HEALTH PROFESSIONALS GENERAL PRACTITIONER DENTAL NURSE PHARMACIST ADVANCE NURSE PRACTITIONER THE CLINICAL ASSESSMENT SERVICE SPECIALIST & ADVANCED PARAMEDICS MIDWIFE COMMUNUTY PSYCHIATRIC NURSE ED CLINICIANS PAEDIATRIC NURSE PALLIATIVE CARE NURSE SPECIALIST SUB-GROUPS RENAL SPECIALIST PATHOLOGY SPECIALIST CANCER SPECIALIST PSYCHIATRIC SPECIALIST TRANSPLANT SPECIALIST FACE TO FACE OUT OF HOURS GENERAL PRACTICE DENTIST MENTAL HEALTH CRISIS TEAM COMMUNITY PHARMACIST DIRECT APPOINTMENT BOOKING VIDEO CONSULTATION SELF CARE
Seven Clinical Commissioning Groups & 188 GP Practices
NHS Local Providers
What do we already know? Calling NHS 111
What do we already know? GP Out of Hours
What do we already know? Peak call times
The Recommendations Recommended Procurement Process: Due to time and resource limitations we are proposing a Pre Qualification Questionnaire (PQQ) and Invitation To Tender (ITT) Procurement process with this procurement. Recommended Contract Length: Following the feedback from our first soft market testing event we are proposing a longer contract option than is normally considered. For this service we are recommending a five year contract with a two year extension option. Cost: We are looking at a contract value of approx. 17 to 19million per annum for the whole of Sussex. This figure currently includes the face to face element of Out of Hours
Digital Principles Access to appropriate Patient Information Call handling tools and information Directory of Services Direct Booking into appropriate settings Remote access and virtual working Online Information Symptoms and Services Workforce management Clear reporting demand management and measurement of outcomes
Workforce Principles Workforce blueprint Use of all types of clinicians not just GP s 111 / CAS Career Framework to develop HCP Avoiding duplication in the system and using existing resources Allowing flexibility especially to address demands Indemnity Insurance Clinical Governance for Quality and Development
This summers engagement activity Soft Market Testing Event 26 July 2017 We shared our initial thinking for the pan-sussex NHS 111 / Clinical Assessment perspective providers and the aim of integrated Urgent Care services across Sussex The Sussex wide NHS 111 Survey Service with We ve ran a survey online and printed in newspapers across Sussex throughout July and August to get peoples views and to use them to inform the service we are looking to buy PPG and Public Engagement Events Throughout August we attended a range of PPG meetings and public engagement events through the seven Sussex CCG s engagement teams. Staff and Clinical Engagement Throughout July and August we have been updating and engaging with CCG staff and their clinical membership on the progress programme.
Our survey said The survey was run from 17 July to 20 August 2017. We received 1062 response to the survey in total 650 were completed online and 412 were completed from the local newspaper insert. We asked people a range of questions about the current service and their experiences. We also asked what people would like to see change to help inform the new services we are looking to procure for 1 April 2019.
Who did we hear from? 1% 30% 69% Female Male Prefer not to say 350 300 250 200 150 100 50 0 17 24 25-34 35-44 45-54 55-64 65-74 75+ Prefer not to say 71 43 178 A child or children over 5 years A child or children under 5 years An adult or adults 728 None of these
The postcode breakdown into CCG footprint 500 450 400 350 300 250 200 150 100 50 0 Brighton & Hove CCG Coastal West Sussex CCG Crawley CCG Eastbourne Hailsham and Seaford CCG Error Hastings and Rother CCG High Weald Lewes Havens CCG Horsham Out of Area Mid Sussex CCG (blank)
Feedback on the current NHS 111 service Have you used the NHS 111 service? No Yes 33% Have you heard of the NHS 111 service? 1% 4% no yes 67% If you have used the service how satisfied were with the experience? 10% 16% 16% 32% 26% Extremely satisfied Satisfied Neither satisfied nor unsatisfied Unsatisfied Extremely unsatisfied 95%
Existing services rated on importance 7000 6000 5000 4000 3000 2000 1000 0 Dental health Help and advice for carers and young carers Information about local health services Pharmacy and medicines enquiries Mental Health Advice on treating and managing your condition yourself Access to a GP Advice on whether you need to go to a hospital Least Important Most Important
Feedback on ideas for the future service Elements to be considered as part of the future design of NHS 111 To reduce the number of questions you get asked when you first speak to an adviser To have a telephone filtering system that gives you direct access to a clinician, for example - press 2 if you re over 75, press 3 if you re calling for child under 5yr old To have a shorter window of time for call backs. 4 hours is too long To be able to use a smart device/ smartphone to Skype or FaceTime a clinician To be able to talk to a medical professional, for example a Nurse, GP or Pharmacists sooner than you currently do Access to other services, such as social care 0 100 200 300 400 500 600 700 800 900 1000
Feedback on ideas for the future service Would you like the idea of NHS 111 effectively becoming the only number you need to make contact with any local health service or health team, such as the District Nurses or your GP? Still need to contact GPs separately otherwise it would clog system up Only if it is more effective. Seems to me it would increase wait times and load on GPs Yes 28% Yes. If properly staffed No 72%
Feedback on ideas for the future service Only clinicians, not the person who answers the phone Would you be happy for NHS 111 staff to be able to access and update your medical records, to help make informed decisions about the care you may need? Anything to give more information to those advising is a good idea. Sharing medical info is vital No 27% Yes. It can only make the service more effective Yes 73%
Feedback on ideas for the future service Would you be happy for NHS 111 staff to book appointments directly with your GP or other local NHS service? Yes. Only under certain circumstances not as a matter of course Yes. with a text/email service confirming the appointment Yes - appointment booking would be a helpful service Yes 73% No 27%
Next Steps and Proposed Timeline
Timeline September 2017- July 2018 Governing Body sign off Patient focus groups Internal engagement Contract awarded - mobilisation starts Stakeholder Event Public Campaign - you said, we re doing Clinical Engagement Second soft market testing event PQQ process runs ITT Process runs
Next Steps Agreement of approach by all 7 CCG s Governing Bodies and Assurance committees Need to review governance Need to understand the Urgent and Primary Care landscape ie extended access and OOH bases linked or not Locations for UTC s Finance modelling finalise Clinical lead interim and appointment Preparation and planning for procurement
Questions?
Transformation Programme Team Colin Simmons, Programme Director Sussex 111 Transformation Programme Kerry Exley, Senior Project Manager Sussex 111 Transformation Programme Nicola Kemp, Senior Communications & Engagement Manager Sussex 111 Transformation Programme Morven Banks, Senior Commissioning Manager Sussex 111 Contract Team Dawn Fourniss, 111 Programme Support Officer Sussex 111 Transformation Programme Vinny Hanley, Directory of Services & Project Manager Sussex 111 Contract Team You can contact the team on: cwsccg.sussex111transformation@nhs.net
Governing Body Paper xx/xx September 2017 Paper Author Colin Simmons, 111 Programme Director Lead Executive 111 Programme Board Date paper completed 11/09/2017 Purpose For information For discussion For decision For procurement decision This paper provides a further update on the 111 Transformation Programme. It outlines the revised approach and timescales for the pan-sussex procurement, the model and the key next steps for Governing Bodies to be aware. Additionally, this paper outlines the decisions required for the Sussex NHS 111 Programme to progress to procurement. Paper summary Governing Boards are asked to: Update: Note the outcome from and feedback gathered at the Sussex NHS 111 Soft Market Testing Event held on 26 th July 2017 and the output from the Sussex NHS 111 public survey carried out in August 2017 Update: Note the programme s response to points raised by previous Governing Bodies across Sussex and the lessons learned from previous large procurements (particularly PTS and MSK) Update: Note the update around the National Integrated Urgent Care (IUC) Specification, IUC Digital Specification and NHSE IUC Workforce Blueprint Decision: Approve the proposed timetable and approach for procurement and transition to new model Decision: Endorse the commitments for the resources required for the procurement, evaluation and contract award activity Decision: Approve and follow the National Integrated Urgent Care Service Specification Decision: Approve the contract value and length Decision: Delegate authority for Accountable Officers to make minor amendments after decisions have been made at seven CCG Governing Bodies Associated papers Appendix A: Governing Body Paper 4 th July 2017 Appendix B: Sussex NHS 111 Survey Appendix C: Summary of Sussex NHS 111 Survey Appendix D: Lessons Learned Log CWS Business Domain work associated with: Management of conflicts of interest Governing Body member interests can be found here How does this work support the NHS 1. Today s care 2. Tomorrow s services 3. Patients at the centre 4. Improving our population s health and wellbeing 5. Live within our means and create a sustainable future 6. An environment where people deliver success No conflicts of interest have been declared in relation to this item. Approved by Head of Corporate Business The NHS aspires to the highest standards of excellence and professionalism in the provision of high quality care that is safe, effective and focused on patient experience.
Governing Body: Clinical Commissioning Executive Date Paper XX Constitution: Patient and Public engagement to date: Equality and Diversity assessment: Legal implications The Sussex wide NHS 111 Survey - We ve ran a survey online and printed in newspapers across Sussex throughout July and August. This provided us with people s views that have informed the service we are looking to procure. Patient Participation Groups (PPG) and Public Engagement Events - Throughout August we attended a range of PPG meetings and public engagement events. This was coordinated through the seven Sussex CCGs engagement teams. No obvious impact on equality and diversity identified Advice and support from procurement services is part of this transformation programme 111/Integrated Urgent Care Transformation Programme 1. Background The redesign of urgent and emergency care services in line with the Five Year Forward View (5YFV) is developing across the Sussex CCGs to provide a more integrated service for patients. The focus is on ensuring those with urgent care needs get the right care in the right place, the first time. An Urgent and Emergency Care Route Map was published in November 2015 as part of the Keogh Review and included deliverables for NHS 111. The report highlighted five areas for the future of urgent and emergency care: Provide better support for people to self-care Help people with urgent care needs to get the right advice in the right place, first time Provide highlight responsive urgent care services outside of hospital so people no longer choose to queue in A&E Ensure that those people with more serious or life threatening emergency care needs receive treatment in centres with the right facilities and expertise in order to maximize the chances of survival and a good recovery Connect all urgent and emergency care service together so the overall system becomes more than just a sum of its parts The development of a Clinical Assessment Service (CAS) is seen as pivotal to bring urgent care services together with an Integrated Urgent Care model (IUC) and has been mandated by NHS England (NHSE) through the 5YFV, the Urgent and Emergency Care Delivery Plan (April 2017) and the National Integrated Ur gent Care Service Specification (August 2017) CCGs are required to commission a service that delivers against the nine key elements of the IUC service:- 1. A single call to get an appointment during the out-of-hours period 2. Data can be shared between providers 3. The capacity for NHS 111 and urgent multidisciplinary clinical services needs to be jointly planned 4. The Summary Care Record (SCR) is available in the CAS and elsewhere 5. Care plans and special patient notes are shared 6. Appointments can be made with in-hours GPs 7. There is joint governance across Urgent and Emergency Care 8. Suitable calls are transferred to a Clinical Assessment Service containing GPs and other health care and social care professionals 9. The Workforce Blueprint and guidance are implemented across all providers. The current contract for NHS 111 covers the geographical area of East Kent, Medway, Sussex and Surrey (KMSS) as a regional contract covering 17 CCGs. The NHS 111 KMSS service is provided by South East Coast
Governing Body: Clinical Commissioning Executive Date Paper XX Ambulance service (SECAmb)who subcontract parts of the service to Care UK. Sussex CCGs are currently in a two year service extension until 31st March 2018 with all CCGs recently approving an additional 12 months extension to the current contract until March 2019 at the latest. This contract variation incorporates a number of elements that require the incumbent provider to deliver projects against the Urgent and Emergency Care Delivery Plan. This activity is being managed across the KMSS footprint. This Sussex NHS 111 re-procurement is a pan-sussex Transformation Programme, requiring collaboration across seven CCGs which will need to reflect local requirements. The paper submitted to the Pan Sussex Governing Bodies in July 2017 can be found in Appendix A. 2. Update 2.1 Soft Market Testing On 26 th July the 111 Transformation Programme Team held a soft market testing event. Representatives from nine providers and fifteen commissioning organisations (including HEE and NHSE). The morning session gave an oversight of progress so far, requirements for the new service that have been provided and some headline information about the CCGs involved in the procurement. The afternoon session consisted of three workshops, offered in rotation to allow all attendees to take part in each. The workshops covered:- Finance, performance and contracting Workforce and quality Digital / Technology Finance, Performance and Contracting Workshop Feedback Contract Length: Common theme across all three workshops, but specifically discussed at this workshop by all three rotations. Providers felt very strongly that the standard contract length of 3+2 (previously 3+1+1) was not sufficiently long for them to be interested in bidding. Four providers explicitly stated that they would not put forward a bid for a contract of this length. Procurement Process: Preference was expressed for a competitive dialogue approach, particularly given the lack of clarity around the national Integrated Urgent Care (IUC) service requirements at present and the digital / technology requirements that would require substantial negotiations across partner agencies Mobilisation Timeframe: Several providers raised concerns with regard to the timescale required for mobilisation. Preference was expressed around a phased approach, particularly around the pressure that will be created by a Go-Live happening at the same time as shifting requirements of IUC from NHSE Physical Infrastructure Investment: With no physical call centre in Sussex (for the KMSS contract these are currently in Dorking, Surrey and Ashford, Kent), there will need to be a level of investment to create a call centre / Clinical Assessment Service (CAS). This investment requirement links back to the concerns around the contract length. Workforce and Quality Workshop Feedback IUC Workforce Blueprint: Concern that the requirements of the IUC Workforce Blueprint have not been finalised and that this will have an impact on both the specification and the bids. Recruitment, retention and training and development strategy will need to be demonstrated and aligned with both the specification and the requirements of the blueprint. Indemnity: Indemnity cover for Out Of Hours / 111 staff is currently an issue. Thus is being looked at by NHSE, however this has been ongoing for quite some time with no resolution. Solution will need to be defined as part of the service specification and bidding process as currently the cost implications of
Governing Body: Clinical Commissioning Executive Date Paper XX indemnity mean that it is often not viable for clinicians to work the shorter shifts and services that will be required. Contract Length: Concern was raised in this workshop that the contract length of 3+2 would be an issue for them and may impact on the likelihood of submitting a bid Digital and Technology Workshop Feedback Information Governance and Data Sharing: Given the number of organisations potentially involved with IUC and the requirements coming out of the (currently) draft IUC Technical Specification, concern was noted among the groups that IG agreements could be challenging to get in place. Equally challenging will be the impact of setting up data sharing processes, the technological solution required to deliver this and how existing systems across the IUC environment will be incorporated Caller Consent: Will need to establish how far initial consent to share information will go along the patient journey and how this consent will be obtained Contract Length: All rotations expressed significant concern around the contract length and the requirement for investment both in hardware, but time and effort to develop software solutions that support the integration and data sharing currently being outlined in the draft service specification and technical specification 2.2 Citizen Engagement Survey The Sussex 111 Transformation Team launched a pan- Sussex public survey on 17 July 2017. The survey has been made available via the existing communications and engagement channels for the: Seven Sussex CCGs Five Acute Trusts Two Mental Health Trusts Two Community Health Trust Three Local Authorities Healthwatch across Sussex The channels used ranged from: website promotion, news items, newspaper article social media channels (Twitter and Facebook) email to e-panel members (CCGs and Local Authorities) Survey live on the County Councils - Have Your Say pages The survey approach was approved by Sussex 111 Transformation Board on the 18 May 2017 and received IG approval on 20 July 2017. The survey can be found in Appendix B. Overview of the survey Before any new contract is finalised, we wanted to explore with local people, what their priorities are for this service, to ask questions that will give us a clearer idea about what the service is that we need to buy for our local population. The survey was run from 17 July to 20 August 2017. We received 1062 response to the survey in total 650 were completed online and 412 were completed from the local newspaper insert. We asked people what the like the new NHS 111 service to do that is different to the current service as it would help to inform the new services we are looking to procure for 1 April 2019.
Governing Body: Clinical Commissioning Executive Date Paper XX It is worth noting that since the survey was run NHS England has published the new national service specification for Integrated Urgent Care 1. This specification has moved from previously being an advisory set of recommendations to mandatory requirements. We will be following the mandated specification but the insight and feedback from the survey will be used to inform our local service offer. It is clear from the findings that many people think that NHS 111 is only for out of hour s services. And that many of the comments we have received have been around accessing a GP out of hours and delays around call backs and visits. Following NHSE national specification - it provides a clear steer that these services should be procured as one. Looking at an NHS 111 Clinical Assessment Service (CAS) for Sussex, what people have said is: They want to retain local numbers where possible and not have a single number to access local health and care services; They are happy for their medical records to be accessed if it will make their journey quicker and seamless - but only by a clinician within the 111-CAS service; They like the idea of the 111-CAS service being able to book appointments into in-hours, extend access and out of hour s primary care services - offering services in the evening and at weekends. A summary of the finding can be found in Appendix C. 2.3 Feedback from Previous Governing Bodies and Lessons Learned from Previous Procurements The programme was tasked by the various governing bodies to evidence learning from large procurements that had previously been undertaken by the CCGs. The programme had already collated lessons learned from the following procurements Patient Transport Service MSK East Kent procurement of 111 and Out of Hours Coastal West Sussex CCG Out of Hours NHS 111 Lessons Learnt & Shared Understanding The collated list of identified lessons learned and the associated risks can be found in Appendix D. This document also contains the actions the programme have taken to respond to the lessons. In summary, there are shared themes across the lessons, covering:- Pre procurement planning Procurement and contract content Mobilisation planning / mobilisation timescales Resourcing of programme office The programme is confident that a response / action is in place to address the lessons learned and this document will continue to be reviewed alongside the risks and issues log (RAIDD Log) and used to inform the governance of the programme. 2.4 Update from NHSE: National Specifications and Workforce Blueprint the model 1 https://www.england.nhs.uk/wp-content/uploads/2014/06/integrated-urgent-care-service-specification.pdf
Governing Body: Clinical Commissioning Executive Date Paper XX The scope of the NHS 111 procurement has now been reconfigured by NHSE to be a procurement of an Integrated Urgent Care Service. This initially included the clinical triage component of the existing GP OOH, but has now been further expanded to require delivery of a Consult and Complete model of Integrated Urgent Care 2. The central challenge to this work is the alignment of GP OOH face to face within this model. Whilst the NHS 111 Transformation was initially intended to focus on the clinical telephone triage aspect the face to face procurements will need to be incorporated to ensure that patients receive a complete episode of care, concluding with either:- o o o o o o Advice - better support for people to self-care A prescription An appointment for further assessment or treatment - helping people with urgent care needs to get the right support in the right place, first time Provide highly responsive urgent care services outside of hospital so people no longer choose to present at A&E Ensure that those people with more serious or life threatening emergency care needs receive treatment in centres with the right facilities and expertise in order to maximize the chances of survival and a good recovery Connect all urgent, same day and emergency care service together so the overall system becomes more than just a sum of its parts There are three components that need to be considered in the reprocurement of IUC Services. 111 Clinical Assessment Service Consult and Complete Out of Hours face to face, including home visiting Extended Access to Primary Care While all three elements need to be considered in the procurement, Extended Access to Primary Care sits outside the national service specification for IUC. The pathway for patients ringing 111 is shown below:- 2 https://www.england.nhs.uk/wp-content/uploads/2014/06/integrated-urgent-care-service-specification.pdf
Governing Body: Clinical Commissioning Executive Date Paper XX Four options were considered with regard to how procurement elements could be delivered:- 1. Fully Combined: All three elements procured together across Sussex- one provider or lead provider for all three elements 2. Totally Separate: All elements procured separately 111 across Sussex, extended access and OOH face to face by each place based area / CCG 3. NHS 111 and OOF F2F Only: Extended access procured locally in a separate exercise 4. Extended Access and OOH Only: Sussex NHS 111 procured in a separate exercise Each of the four options to procure these different elements is complex and comes with its own risks. Each CCG / place based area has a different mix of rural / urban and young / elderly which means the provision of services becomes complicated based on local need. Lessons learned from recent pan Sussex procurements have indicated the need for phased go live. We also need to consider the impact of different providers competing for the same workforce at a time of whole scale urgent care transformation. The high potential of providers seeking to outbid each other could result in the workforce following the best terms and conditions. This is particularly pertinent for GP OOH provision which has been provided by one provider across the four contracts for the last four years who have reported increasing costs year on year. The best option for this procurement would be to have 111 / CAS procured with the Out of Hours face to face (option 3). The Out of Hours face to face would be delivered from a base 8pm to 8am and home visiting service from 6.30pm to 8am. The location of the bases would need to consider the use of existing care provision settings where possible the use of local services should be preferable and the delivery of these services should cover the areas that do not have easy access to such services. Patients should be referred to the extended access services, UTC or A&E delivery hubs for those areas that have them. This aligns with the new national specification. It should be noted that there is still scope for the requirements to change and this potentially creates a significant risk to the programme. This risk has been recorded in the programme risk and issue log which is escalated to Programme Board and to the Urgent Care STP forum.
Governing Body: Clinical Commissioning Executive Date Paper XX In addition to the nationally set outcomes, there are outcomes that are defined as needing to be considered on a more local footing. These are dependent on local demographics and need and are as follows:- To provide consistent clinical assessment of patient needs at the first point of contact Meeting the urgent care needs of patients and referral back to Primary Care if clinically appropriate Ensure that specific health needs such as palliative care, mental health and long term conditions are properly met Co-ordination of care with:- o Community pharmacy services for repeat prescriptions and pharmacists o Hear and Treat and See and Treat for minor illnesses o Mental health services providing care for people with mental health conditions o Urgent dental care services o Co-ordination of specialist palliative / end of life care including statutory and voluntary care sectors o Social Care The programme is currently working with Version 0.23 of the final National Integrated Urgent Care Service Specification. The NHSE IUC Workforce Blueprint is also yet to be finalised, but the publication date is reported to be April 2018. This document will be a key resource for commissioning the workforce. The Provider will be expected to implement the products detailed in the Blueprint as a key element of the IUC service. The Blueprint will include the following products: 1. Career Framework; competency based job descriptions Skills for Health Levels 2-7 2. Core and specialist competencies Skills for Health Levels 7-9 3. Apprenticeship scheme 4. Workforce Governance Guide 5. Workforce Mental Health and Wellbeing 6. Accreditation of education and training 7. Leadership development 8. Workforce modelling 9. Career of Choice 10. Workforce Survey Recommendations Report NHSE and HEE have been working with Commissioners and Providers to develop the Workforce Blueprint, indeed the workforce survey was undertaken with the staff of existing providers. The requirements have been and will continue to be widely consulted on and should not come as a surprise to any providers currently in the market. New providers should be expected to have explored the Blueprint as part of their due diligence.
Governing Body: Clinical Commissioning Executive Date Paper XX 2.5 Financial Modelling Financial modelling was undertaken in May 2017 for a Clinical Assessment Service covering a population of 1.6 million. The financial modelling considered three scenarios against an agreed baseline. Baseline 23% of cases go to clinicians As Is dispositions / patient outcomes Scenario 1: Half Way House CAS 40 % of cases going to assessment by a clinician modest change in end dispositions / outcomes 2 physical bases / hubs Scenario 2: Full CAS Capability 60% of cases go to clinicians Significant change in end dispositions / outcomes 2 physical hubs / CAS Scenario 3: Full CAS capability 60% of cases go to clinicians Significant change in end dispositions / outcomes Single entity - Integrated 111 / CAS linked to remote services In terms of cost, Scenario 3 shows to be most cost effective. The indicative cost for the model is the following table based on key assumptions from the financial modelling. The new service should not cost more than the combined cost of the two existing services plus uplift. However this can only be confirmed after the procurement. This will be further validated for assurance. Element Indicative Cost % split Call Handling 2902800 15% Clinical Assessment Service 4257440 22% Incentivisation (to be agreed) 2098760 11% OOH Face to Face 10093000 52% 19352000 2.6 Benefits of model The benefits to procuring 111 / OOH together as one Integrated Urgent Care / Clinical Assessment Service are as follows :- Commissioning at scale presents a bigger commercial opportunity for providers with fewer overheads and as such presents a lower cost option than smaller block contracts would facilitate; Improved patient journey from start to finish with them reaching a clinician as soon as possible to meet their health or care need; Multiple handoffs across different providers being managed under different contracts introduces more complex performance management, MI requirements and potential issues with IG and data sharing; High overhead cost to CCGs of separate procurement exercises running in parallel; Trusted assessor protocols essential to avoid re-triage at the point of handover complicated where different contractual arrangements exist; Multiple block contracts introduce competition across geographic boundaries increasing risk and cost in ability to fill rotas;
Governing Body: Clinical Commissioning Executive Date Paper XX Standardising services across the STP becomes more complex when being delivered by different providers under different contractual arrangements. (Note: this is not the same as different services being commissioned due to variances in local need) Timescales are a risk for Commissioners with the current OoH contract due to expire March 2019. Whilst this is positive in so much as it aligns with the NHS 111 contract, starting new procurement processes from scratch at this stage will put that date at risk; Aligning different technologies to deliver consistent patient outcomes and data flows becomes more complex across different contractual arrangements; Whilst CCG and place based footprints establish boundaries, these are not recognised by patients. Strategic operating models, including the logical placement of services, need to be set to reflect patient demographics across the widest possible footprint; The desired outcomes for delivering urgent and emergency care across the STP are common and therefore service specification and best practice models will also be common; Work force rotas are often difficult to fill due to competition across boundaries across different providers; The GP resource pool is the same across a wide range of settings to support urgent care and cannot be considered in isolation. 2.7 Procurement Approach Following the publication of the national specification, and feedback from soft market testing it is recommended by procurement to follow a Pre-Qualification Questionnaire (PQQ) / Invitation To Tender (ITT) route. This would allow the largest mobilisation window October 2018 to April 2019 and help ensure we have the appropriate planned in resources to support the procurement. This would also allow programme to go back to the governing body(s) (part 2) in April for information on progress after PQQ (confidential and not naming providers) and then also in July / August to ratify the decision before award of contract and standstill. A key focus of this procurement will be quality and this will need to be clear in the evaluation criteria.
Governing Body: Clinical Commissioning Executive Date Paper XX 3 Risks Risks Resourcing: Risk Detail: (i) Overall project / programme resourcing has significant gaps / resource still to be secured. These areas include project management across the CCGs, Legal, HR, Procurement and IT&M. (ii) Specific concerns around IT&M resource as programme is highly dependent on technical solution to deliver - unclear at present whether Technology Solution will be procured with Service as a single entity or as a separate entity. Impact: (i) Delay in development of key information / documents - programme may slip further (ii) Quality of outputs may not be sufficient as required expertise has not been available to develop outputs (iii) Lack of quality / timely delivery may impact reputation of organisations (iv) Lack of quality / timely delivery may impact final product / service Mitigating Actions in Place Ongoing problems around recruitment of Clinical Lead for the programme. Risk has been escalated to programme board for endorsement of extension of recruitment period for this post. Agreement that Clinical Lead recruitment will be recommenced after 24/08/2017. Support has been utilised from NHSE via informal approach to NHSE Clinical lead(s). Recruitment to Lay Member post is complete. Increased risk around Digital / Technology resource as current STP level post holder will be leaving the post in September 2017 Increased risk around SRO for programme as previous SRO has now left NHS Coastal West Sussex CCG. Issue has been escalated to STP / across the seven Sussex CCGs.
Governing Body: Clinical Commissioning Executive Date Paper XX Integrated Urgent Care / 111 Technology Risk Detail: Lack of clarity around how the technology solution for 111 will be secured and how this will work with (a) the local services for OOH / Urgent Care / Same Day Care and (b) the overarching STP Digital Roadmap requirements Risk Impact: (i) Wrong solution may be pursued leading to poor quality / expensive outcomes (ii) Solution may be temporary in an unplanned manner (a temporary / stepped solution may be an appropriate decision but this needs to be an active and planned approach) (iii) Unclear approach to technological requirements may reduce bidder pool, removing the best solution from programme options (iv) Increased costs if technological requirements are unclear and ad-hoc amendments or reworking of solution is required (v) Programme may not end up with a technological solution that delivers the required outcomes and may have no options to resolve within the contract lifespan (vi) Lack of clarity around requirements may lead to the programme slipping and an extension of the existing contract being required, leaving the CCGs in a weak position with existing provider Ability to Let Contract / Lack of Bidder Interest Risk Detail Bidder pool interested in bidding for contract is potentially restricted by elements of the specification Length of contract investment and movement within the national requirements of IUC resulted in bidder feedback that a 3+2 contract length is very unattractive and several providers advised they would not submit a bid for a contract of this length. Variable service elements - movement of elements in and out of the contract may make service a challenge to contract for and contract manage. Lack of base in Sussex and associated increase in startup costs create a challenge for potential bidders. Still awaiting final Technology Specification from NHSE / NHS Digital. Concern at programme level that funding will not be allocated to CCGs to tackle any potential future costs - two possible risks [a] No funding at all is available and costs of overall programme need to increase [b] Funding is made available pan STP and pan programme so funding must be shared - this will add additional constraints that the programme will have no control over. This risk to be escalated once the Technology Specification has been received and analysed and the risks confirmed. While the overarching IUC Service Specification has been received, the Technology Specification embedded in this document has not been updated since March 2017. Additional concern around this risk is that STP Technology Lead is due to leave the organisation in September 2014 and there may not be a resource to support this element from this date. Programme is required to work with the seven CCGs to ensure requirements are understood and accepted. Service Specification is mandated and will form basis for NHS Sussex 111 Service Specification. Noted that Technology requirements are still not reflecting recent NHS Digital discussions - this has been escalated by Wilson Sharpe to NHSE. Risk compounded by fact Wilson Sharpe is leaving the programme and no replacement resource has been identified to undertake technology / digital activity. Escalated to STP Digital Steering Group Request for decision from Governing Bodies for a decision to contract for 5+2 years. Liaison with other local commissioning groups to develop a regional approach to contract length to ensure Sussex are not outliers in a manner that would disadvantage our ability to let the contract. Active Soft Market engagement to ensure voice of bidder is understood and factored into decision making. Additionally ensuring engagement is with multiple providers (within the procurement rules) to ensure that Programme understands wider provider voice. Risk Impact: May not be able to let contract - will mean incumbent provider will have an extremely strong position should an additional extension be needed - will have cost and legal implications
Governing Body: Clinical Commissioning Executive Date Paper XX 4 Decisions 4.1. Proposed Timetable for Future Decisions, Procurement and Transition to New Model Governing body is asked to approve the timetable of activity set out in the tables and graphic below: Decision Activity Timetable Date Update and Approval of Procurement Timetable and Resource NHS Horsham and Mid Sussex CCG 21 st September 2017 NHS Crawley CCG 21 st September 2017 NHS Coastal West Sussex CCG 26 th September 2017 NHS Brighton and Hove CCG 26 th September 2017 NHS Eastbourne, Hailsham and Seaford CCG 27 th September 2017 NHS Hasting and Rother CCG 27 th September 2017 NHS High Weald Lewes Haven CCG Governing Body 27 th September 2017 Procurement Activity Timetable Date Specification and procurement approach approval September 2017 Procurement readiness September 2017 to December 2017 Procurement January 2018 to August 2018 Information to Part 2 Governing Bodies Complete PQQ April 2018 Ratification of provider at Part 2 Governing Bodies and Contract July / August 2018 Award Contract Award Contract Go-Live Feedback from providers at both the Sussex NHS 111 soft market testing event and the Surrey NHS 111 soft market testing event and lessons learned from the previous procurement activity strongly supports:- A minimum of six months mobilisation (longer if at all possible) A six month period of stabilisation post contract go-live to allow the service to bed in before any planned innovation and development is undertaken. See Appendix E for High Level Procurement Plan 4.2 Resource Commitments for Procurement Activity Including Evaluation Any procurement exercise undertaken will require a significant level of resource to deliver and ensure a quality product is secured. The programme is seeking a commitment from Governing Bodies that resource from the seven CCGs is available to support and deliver the procurement activity. Broadly, we are seeking the following type of resource from each CCG:- Clinical representation Digital / Technology representation Quality Assurance resource Urgent Care Commissioning Resource
Governing Body: Clinical Commissioning Executive Date Paper XX Our expectation is that any resource allocated to the programme will have the skills, capacity and seniority to allow them to make decisions to develop the procurement document set and around evaluating responses from bidders and coming to a final recommendation for contract award. We are seeking resource to support: Activity Development of PQQ document set:- Sussex NHS Service Specification PQQ Compliance Documentation PQQ Questions and Evaluation Criteria Supporting documents Timeframe December 2017 [Programme Team and SOEPs to complete bulk of documentation however SME will be required to ensure documentation meets required standards and content] Evaluation and moderation of PQQ responses March 2018 Development of ITT Document set To be completed by April 2018 ITT Volume 1 - Bidder Instructions ITT Volume 2 - Service Delivery Template ITT Volume 2 - Section A: Commercial and Legal Requirements ITT Volume 2 - Section B: Service Delivery ITT Volume 2 - Sussex NHS 111 Service Specification (including supporting documents) ITT Volume 2 - Sussex Safeguarding Standards (Guidance) ITT Volume 2 - Sussex Safeguarding Standards (Self -Assessment) ITT Volume 3- Commercial Offer Document ITT Volume 3 - Finance Template ITT Volume 4 NHS Standard Contract Cover Document ITT Volume 4 - NHS Standard Contract 19/20 (Date TBC) Evaluation and moderation of ITT responses July 2018 [Programme Team and SOEPs to complete bulk of documentation however SME will be required to ensure documentation meets required standards and content] 4.3 Decision: Approve and follow the National Integrated Urgent Care Service Specification [Page 11, NHSE Integrated Urgent Care Service Specification] This service specification supersedes the previous commissioning standards, moving from an advisory set of recommendations to mandatory requirements, to ensure a consistent service across the country. [Page 18, NHSE Integrated Urgent Care Service Specification] GP OOH and 111 services will be combined, and multidisciplinary clinicians added to the integrated working model. In addition, the future NHS111 IUC will book people into urgent face-to-face appointments where needed. The National Integrated Urgent Care Specification mandates the need to bring 111 and OOH together to form an Integrated Urgent Care / Clinical Assessment Service 4.4 Decision: Approve the contract value and length The contract length should be five years with a possible two year extension. The contract will have the necessary break clauses should they be needed.
Governing Body: Clinical Commissioning Executive Date Paper XX The contract value should cost no more than the current 111 and OOH budgets combined. The Governing Body is asked to approve this indicative value. The final cost of the procurement will be ratified in July / August 2018 on award of contract 4.5 Decision: Procurement Approach The procurement will follow the standard PQQ (Pre-Qualification Questionnaire) and ITT (Invitation To Tender) route. 4.6 Decision: Delegate authority for Accountable Officers to make minor amendments after decisions have been made at 7 CCG Governing Bodies As the decisions will need to be passed by seven CCG s, authority is sought to delegate to Accountable Officers of the seven CCG s should minor alterations be needed to the procurement. These will then be communicated back afterwards.
Governing Body: Clinical Commissioning Executive Date Paper XX Appendix A Paper Author Colin Simmons, 111 Programme Director Lead Executive Marie Dodd, SRO Date paper completed 5 th June 2017 Purpose For information For discussion For decision For procurement decision This paper provides an update on the 111 Transformation Programme. It outlines the revised approach and timescales for the pan-sussex procurement, the model and the key next steps for Governing Bodies to be aware. Paper summary This paper describes the work that has been undertaken on the 111 / OOH reprocurement so far and the work needing to be completed prior to a new contract for a 111 and Out of Hours service. Coastal West Sussex Clinical Commissioning Group (CWS CCG) took the lead of the procurement of 111 pan-sussex and East Surrey in July. Associated papers CWS Business Domain work associated with: Management of conflicts of interest Governing Body member interests can be found here How does this work support the NHS Constitution: Patient and Public engagement to date: Equality and Diversity assessment: Legal implications Governing Boards are asked to: Note the approach for the 111 transformation and the development of the model Note the plans to deliver and to consider any additional steps or requirements for the programme None 7. Today s care 8. Tomorrow s services 9. Patients at the centre 10. Improving our population s health and wellbeing 11. Live within our means and create a sustainable future 12. An environment where people deliver success No conflicts of interest have been declared in relation to this item. Approved by Head of Corporate Business The NHS aspires to the highest standards of excellence and professionalism in the provision of high quality care that is safe, effective and focused on patient experience. Public engagement events have taken place and an urgent care survey with the public. No obvious impact on equality and diversity identified Advice and support from procurement services is part of this transformation programme
Governing Body: Clinical Commissioning Executive Date Paper XX 111/Integrated Urgent Care Transformation Programme 1. Background The redesign of urgent and emergency care services in line with the Five Year Forward View is developing across the STP footprint to provide a more integrated seamless service for patients. This is focused around ensuring those with urgent care needs get the right care in the right place, first time. An Urgent and Emergency Care Route Map was published in November 2015 as part of the Keogh Review and included deliverables for 111. The report highlighted five areas for the future of urgent and emergency care: Provide better support for people to self-care Help people with urgent care needs to get the right advice in the right place, first time Provide highlight responsive urgent care services outside of hospital so people no longer choose to queue in A&E Ensure that those people with more serious or life threatening emergency care needs receive treatment in centres with the right facilities and expertise in order to maximize the chances of survival and a good recovery Connect all urgent and emergency care service together so the overall system becomes more than just a sum of its parts The development of an Integrated Clinical Assessment Service (ICAS) is seen as pivotal to bring urgent care services together with an Integrated Urgent Care model.
Governing Body: Clinical Commissioning Executive Date Paper XX The current contract for NHS 111 covers the geographical area of Kent, Medway, Sussex and Surrey (KMSS) as a regional contract, historically 21 CCGs. The NHS 111 KMSS service is provided by South East Coast Ambulance service (SECAmb)who subcontract some parts of the service to Care UK. This contract expired on March 31st 2016 with 17 remaining CCGs under taking a two year extension, included in the original contract. Sussex CCGs are currently in a two year service extension until 31st March 2018 with all CCGs recently approving an additional 12 months extension to the current contract until March 2019 at the latest. This 111 re-procurement is a pan-sussex Programme, requiring collaboration across 7 CCGs which will need to reflect local requirements spanning the clinical model at the front door of Accident and Emergency (A&E), Urgent Care and other services that require access on the same day. NHS Coastal West Sussex CCG took on the lead for the pan Sussex re-procurement in July 2016. 2. Update 2.1 Programme Objectives The objectives of this programme are: To re-procure NHS 111 supported by an Integrated Clinical Advice Service (ICAS) with all seven pan-sussex CCGs. To detail the options for the design and locations of face to face urgent and emergency care services and procure services as part of the wider urgent care model in line with the national recommendations, best practice and local need Ensure that our patients and public, providers, voluntary sector and social care partners are co-designers and formally consulted (as required) on the service model options Agree and seek the relevant approval to the chosen service model Decommission current services as appropriate Procure and implement the new service model Ensure the CCGs and local health economy remains on a sound financial footing in the future Ensure that the urgent and emergency care model compliments and aligns with the aspirations for the Sustainability and Transformation Plan (STP).
Governing Body: Clinical Commissioning Executive Date Paper XX Ensure key lessons learned from other large scale procurements in Sussex (for example Patient Transport Services, but also around the country are followed :- Do not allow the programme to become isolated from the business / services / organisations (need to ensure all stakeholders are aware, understand and support the proposed approach). No surprises. Communication with decision makers is important and these individuals should be identified early in the project A phased rollout rather than a big bang approach will be the approach for the go live of this service Transition planning is key and should be tested and robustly challenged As part of the transition planning, there should be specific planning around transfer of key data between the old and new providers. Business critical data should be identified and failure to transfer should be a go / no go issue. Resourcing for procurement should not be underestimated. Key roles should be identified and filled with clear understanding of the requirements for each role and the time commitment required to deliver. The programme will use external sourcing for specialist roles where this cannot be met appropriately from within the organisation(s). 2.2 Redesign Principles In aligning to the national recommendations, a number of principles are suggested: The 111 service will be part of an urgent and emergency care system that is able to meet the needs of the whole population, within the resources available, delivering improved quality and patient experience. The patient will experience a service that is working as one integrated and whole system although provided by multiple agencies The patient will be seen at the right time, by the right person with the right skills to manage their needs, in the right place The patient will not experience any delay in receiving the most appropriate interventions through the whole pathway being able to respond to unpredictable fluctuations in demand Provide highly responsive urgent care services outside of the Accident and Emergency Department (A&E) so people no longer choose to attend A&E when they do not need to A single point of access to urgent care services Provide improved access to GPs or nurses working from community bases equipped to provide a much greater range of tests and treatments Empower ambulance services to make more decisions to treat more patients and allow them to make referrals in a more flexible way Provide better support and education for people to self-care and to enable a greater use of pharmacists Improved utilisation of the voluntary sector All patients have equitable access to services Key Principles of the new model Contract Current model Proposed model One organisation providing NHS111 for all of Kent, Surrey and Sussex OOH services for Sussex and East Surrey - IC24 Area 1: Coastal West Sussex CCG Area 2: Brighton & Hove CCG Area 3: Hastings & Rother CCG, Eastbourne, Hailsham & Seaford CCG and High Weald Lewes & Havens CCG Area 4: Crawley CCG, Horsham & Mid Sussex CCG and East Surrey CCG A single contract with responsibility for 24/7 integrated service for NHS111 across Sussex, and possibly larger. This may be delivered by a single organisation or (more likely) by a group of organisations working together. Face to face would be delivered locally. A single contract, with a clearly designed specification, would make it easier for CCGs to hold providers to account for delivering the right outcomes and care for patients.
Clinical support Heavily reliant on GPs for clinical support. Recruitment of GPs is increasingly difficult as there is a shortage of GPs nationally. Assessment People who require a GP urgently have to speak to at least two people (typically more) before they can get definitive clinical advice or an appointment. Appointments Some direct bookings but patients usually need to hang up and call a different number to make an appointment with the appropriate service Medical history Services have limited access to special patient notes for people with complex health and/or social care needs, and no access to routine medical history for NHS111 or OOH Equity of access Professional contact Signposting Access to OOH services is different depending on where people live Currently unclear and inconsistent access to clinicians and other professionals Currently signposting to information or appropriate services is limited (5%) Governing Body: Clinical Commissioning Executive Date Paper XX A range of clinical skills is available (nurses, paramedics, pharmacists and GPs) who could be used flexibly to provide clinical support. This means callers would be directed to the most appropriate clinician for what they need. People would be directed to the most appropriate service; usually by the first person they speak to. Direct bookings for appointments for identified services. Primary care dispositions for see GP (in hours) will be warm transferred to the GP surgery reception and then use the processes of the practice to arrange an appointment Those involved directly in patient care would have consistent access to special patient notes and routine medical history for patients using the service Access to OOH services would be the same, regardless of where people live and patients would have more choice One place for all professionals to go to request advice, information and contact Increase of signposting (where appropriate and safe) and advice lines with existing conditions eg diabetes, cancer
Governing Body: Clinical Commissioning Executive Date Paper XX 2.3 Model Plans for achieving the vision of an integrated urgent care system will be achieved by progressing procurement of NHS 111 as a single point of entry supported by an Integrated Clinical Advice Service (ICAS). A wider, joinedup approach to designing NHS 111 and the ICAS will provide a more integrated, effective approach to these services. This diagram depicts the components of integrated urgent care, at a high level. The ICAS will provide clinical advice to patients contacting NHS 111 or 999, GP speak to services as well as providing clinical support to clinicians, such as ambulance staff and emergency technicians so no decision is made in isolation, as detailed within the Integrated Urgent and Emergency Care Commissioning Standards. This system will be supported by being functionally integrated with all the local urgent care models that are in development with further support of the model to be achieved by the technical integration of IT systems enabling the sharing of single patient records and the warm transfer of calls to available services to avoid retriage at each step. The procurement will include the telephone triage aspects of the current Out of Hours service. The face to face OOH will be delivered locally but will be informed by the outputs from this model. The model was developed in order to support navigation of patients away from ED, when attending with symptoms appropriate for primary care intervention. It should be noted that although emergency services within the A&E departments are not part of this review, they should be positively affected by the programme, as patients attending these departments that do not require this level of expertise should be directed and treated elsewhere within the urgent care system.
Governing Body: Clinical Commissioning Executive Date Paper XX The component parts of the Integrated Urgent Care Service are shown below, aspects of this will be delivered through the 111 / IUC procurement and other functions will be delivered locally. Financial modelling has reviewed three different scenarios against an agreed baseline Financial modelling considered 3 scenarios against an agreed baseline a. Baseline i. 23% of cases go to clinicians ii. as is dispositions / patient outcomes b. Scenario 1: half way house CAS i. 40 % of cases going to assessment by a clinician ii. modest change in end dispositions / outcomes iii. 2 physical bases / hubs c. Scenario 2: Full CAS capability i. 60% of cases go to clinicians ii. Significant change in end dispositions / outcomes iii. 2 physical hubs / CAS d. Scenario 3: Full CAS capability i. 60% of cases go to clinicians ii. Significant change in end dispositions / outcomes iii. Single entity - Integrated 111 / CAS linked to remote services
Governing Body: Clinical Commissioning Executive Date Paper XX The suggested model based on this is scenario three which fits within the current financial envelope for 111 and OOH. This will be further review at the soft market testing at the end of July. e. Conflicts of Interest The CCG recognises the need to manage conflicts of interest appropriately throughout the commissioning cycle. Governing Body member, committee member and employee interests are recorded on the Register of Interests. The relevant interests of all 111 Programme Board and Working Group members will be identified and arrangements put in place to manage any conflicts of interests as necessary. f. Communication and Engagement The communications and engagement plan, for the programme, aims to consult, engage and fully communicate the 111 programme. It will build people s trust and confidence not only in the 111 service but also in integration of urgent care services. It will ensure the appropriate information and guidance is available in the right place, at the right time for both internal and external audiences.
Governing Body: Clinical Commissioning Executive Date Paper XX Objectives 1. To communicate and engage with patients and the public around the re-procurement of the pan- Sussex 111 service - Public 2. To raise positive awareness of the 111 re-procurement and the changes GPs, Partners and Providers will see Clinical Services 3. To communicate and engage internally with staff across the seven CCGs, five acute trusts, three community trusts and two mental health trusts about their role to support the 111 communications and engagement activity Internal chairs, execs, managers and staff 4. To enhance patients confidence and engagement with the 111 service - Lay Members, Patients and Public 5. To ensure patients have the information and support to make informed choices about their health care and to encourage patients to use the appropriate services depending on their health care needs Public 6. To increase positive awareness and understanding of the NHS 111, pharmacies and the minor injuries unit - Public Key Stakeholders Internal NHS Brighton & Hove CCG NHS Coastal West Sussex CCG NHS Crawley CCG NHS Eastbourne Hailsham and Seaford CCG NHS Hastings & Rother CCG NHS High Weald Lewes Havens CCG NHS Horsham and Mid Sussex CCG External HASC / HOSC Local Authorities Acute Trusts Sussex Partnership Foundation Trust Sussex Community Foundation Trust SECAMB 999 Operations NHS England (Pharmacy/Dental) g. Risk
Governing Body: Clinical Commissioning Executive Date Paper XX Risks Procurement Process [Approach and Timescales]: The deadline for delivery of the 111 re-procurement is challenging. The development of a service specification, links with the new model of provision for OOH and Urgent Care and procurement documentation was behind time leaving a very compressed timescale to deliver these key documents. An additional area of pressure is the fragmented approach across the STP footprint to the development of OOH and Urgent / Same Day services that the 111 service will need to refer in to. A decision in principle was taken to extend the contract for 111 and OOH for an extra year in order to develop the model across Sussex and align it to the key developments within Coastal Care, however until the agreement is reached on the extra cost, this extension will not been signed off. If the extension to the project is not signed off there is a risk that its output will not be fit for purpose. The new IUC specification, technical and workforce specifications are in development - published post purdah by then end of June. This could have an impact on the development work for the model and also soft market testing Mitigating Actions in Place Swale CCG who are the lead CCG have negotiated an extension and will deliver a number of projects so that it increases clinical input, 999/111 integration, Green ambulance/ ED disposition validation and develop a mini clinical hub. The details of these are being developed with the provider. Once the extra work has been agreed with clear timescales, deliverables and measures, the final sign off is the agreement of any additional funding for this work. The agreement in principle to extend has allowed the project to develop an achievable plan for delivery, until the agreement is reached on the extra cost however, this extension has not been completed. Waiting for the new specification s which comes out at the end of June. reviewing the delivery plan which could be linked, will not be clear on impact until published h. Next Steps and Recommendations The timescales for the programme are as follows:- Stage 1: Service Redesign Soft market testing and development of technology options Process mapping and pathways Business analysis & Financial modelling Agreement of operating model and blueprint Completion of Project documentation PID, QIA Business case and service design signed off Stage 2: Procurement Readiness Patient engagement Approval of service specification Procurement Documentation Clinical engagement Stage 3: Procurement Commencement of PQQ / ITT process Decision regarding appropriate procurement process (most capable provider, open tender) November 2016 September 2017 September 2017- December 2017 January - August 2018
Stage 3: Deployment Development of deployment and mobilisation plan, stakeholder list & benefits realisation plan Engagement of incoming and outgoing providers in order to facilitate seamless transfer Management of go-live activities, floor walking support, bug-fix and post golive evaluation Management of deployment to steady state and withdrawal, based on agreed criteria Production of a project exit report detailing actions, issues and lessons learned Governing Body: Clinical Commissioning Executive Date Paper XX September April 2019 Go Live 1 April 2019 The 111 Transformation Programme is complex and has a number of tight deadlines. This paper seeks to update governing bodies on the progress made so far, update with the thoughts and ideas of the approach and also to clarify the process of the sign off of the specification in September. The sign off documents will come to each governing body for sign off.
Governing Body: Clinical Commissioning Executive Date Paper XX Appendix B NHS 111 Service Welcome to NHS 111 Survey The NHS 111 service is available 24 hours a day, 365 days a year and is free to call. Locally across Sussex, there are more than 7000 calls made to NHS 111 every single week - clearly it is a key part of the NHS in this area, and we all need it to work as effectively as it possibly can. The 111 phone service is vital not only in terms of providing advice and support for people with urgent, but not life-threatening, health concerns, but it also plays a central role in managing demands on other parts of the local health service - especially A&E, and GP surgeries. By autumn 2018, we must award a new contract for the running of the local NHS 111 service and go-live with the new service in April 2019. Before any new contract is finalised, we want to explore with local people, what their priorities are for this service, to ask questions that will give us a better idea about what the services we need to procure should look like. Please take just a few minutes to let us know your views about the future of the NHS 111 service across Sussex. You can do this by completing our online survey. If you want to receive a paper copy, please contact the 111 Transformation Team on 07711920424 or email: cwsccg.sussex111transformation@nhs.net Please can we ask that you do not include any personal information in any comments you make within the survey.
Governing Body: Clinical Commissioning Executive Date Paper XX About the NHS 111 Service: Q1. Have you heard of NHS 111? o o Yes No o Yes Q2. Have you used the NHS 111 service? o Yes o No Q3. How satisfied were you with the experience? o extremely satisfied o satisfied o neither satisfied nor unsatisfied o unsatisfied o extremely unsatisfied Q4. Would you recommend NHS 111 to friends and family? o o Yes No Q5. Please share with us your experience of the NHS 111 service. Please can we ask that you do not include any personal information in any comments you make. Q6. What are the most important existing NHS 111 services? Please rank them from 1 being the most important and 8 being the least important. Service 1 2 3 4 5 6 7 8 Mental Health Dental Health Pharmacy and medicine enquiries Access to a GP Advice on treating and managing your condition yourself Advice on whether you need to go to a hospital Information about local health service Help and advice for carers and young carers
Governing Body: Clinical Commissioning Executive Date Paper XX Q7. If you could influence future changes to how you access care from NHS 111, which of the three suggestions would be most important to you. Please circle your three choices. To reduce the number of questions you get asked when you first speak to an adviser To be able to talk to a medical professional, for example a Nurse, GP or Pharmacists sooner than you currently do To have a shorter window of time for call backs. 4 hours is too long To be able to use a smart device/ smartphone to Skype or FaceTime a clinician To have a telephone filtering system that gives you direct access to a clinician, for example - press 2 if you re over 75, press 3 if you re calling for child under 5yr old Access to other services, such as social care Q8. Would you like the idea of NHS 111 effectively becoming the only number you need to make contact with any local health service or health team, such as the District Nurses or your GP? Please can we ask that you do not include any personal information in any comments you make o Yes o No Comment: Q9. Would you be happy for NHS 111 staff to be able to access and update your medical records, to help make informed decisions about the care you may need? Please can we ask that you do not include any personal information in any comments you make o Yes o No Comment:
Governing Body: Clinical Commissioning Executive Date Paper XX Q10. Would you be happy for NHS 111 staff to book appointments directly with your GP or other local NHS service? Please can we ask that you do not include any personal information in any comments you make o o Yes No Comment: 11. What else could the NHS 111 service offer or do? Q12. Is there anything you think the NHS 111 service shouldn't do?
Governing Body: Clinical Commissioning Executive Date Paper XX About you: We want to make sure that everyone is treated fairly and equally. We would like some information about you so that we can make sure we are seeking the views of everyone in society from across our area. Your responses will be anonymous. Q13. Are you Male Female Prefer not to say Q14. What is your age? Under 16 years 35-44 65-74 17-24 45-54 75+ 25-34 55-64 Prefer not to say Q15. Are you caring for? A child or children under 5 years An adult or adults A child or children over 5 years None of these Q16. Do you consider yourself to have a disability or long term illness? Physical impairment Mental health issue Sensory impairment (hearing, sight) Learning Disability Long-term illness None of these Prefer not to say Q17. How would you describe your ethnic origin?
Governing Body: Clinical Commissioning Executive Date Paper XX White British Black/African/Caribbean/Black British White Other Gypsy/Irish Traveller Mixed/multiple ethnic groups Prefer not to say Asian/ Asian British Other (please specify) Q18. What is your religion? Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Jewish Buddhist Muslim No religion Hindu Sikh Prefer not to say Other (please specify) Q19. Which of the following best describes your sexual orientation? Bisexual Gay man Prefer not to say Heterosexual or straight Gay woman or lesbian Other Q20. Does your gender identity match completely the sex you were registered with at birth? Yes No Prefer not to say Q21. Are you completing this survey as
Governing Body: Clinical Commissioning Executive Date Paper XX Patient/ member of the public Member of an interested organisation (e.g. voluntary, community or Local Authority) Member of NHS staff Prefer not to say Q22. Please tell us your Postcode (first 4 digits only) When you have completed this survey you can either hand it in to your GP practice, or use our freepost address: Freepost RTKY-LXHA-BATT, Coastal West Sussex Clinical Commissioning Group, The Causeway, Goring-by-sea, Worthing, BN12 6BT. Thank you for taking the time to complete our survey.
Governing Body: Clinical Commissioning Executive Date Paper XX Appendix C - NHS 111 survey Sussex Overview NHS 111 is the non-emergency number that people should call if they need medical help or advice but feel it's not a life-threatening situation. With experienced call handlers and clinicians available to assess a person s needs and situation they can direct you to the best local services for the care that you need. The service is available 24 hours a day, seven days a week, 365 days a year. Locally across Sussex, there are more than 7000 calls made to NHS 111 every single week - clearly it is a key part of the NHS in Sussex and we all need it to work as effectively as it possibly can. The seven CCGs in Sussex have come together to work collaboratively and award a new contract for the running of the local NHS 111 Clinical Assessment Service for all of Sussex by April 2019. Before any new contract is finalised, we wanted to explore with local people, what their priorities are for this service, to ask questions that will give us a clearer idea about what the service is that we need to buy for our local population. The survey was run from 17 July to 20 August 2017. We received 1062 response to the survey in total 650 were completed online and 412 were completed from the local newspaper insert. We asked people a range of questions about the current service and their experiences. We also asked what people would like to see change to help inform the new services we are looking to procure for 1 April 2019. It is worth noting that since the survey was run NHS England has published the new national service specification for integrated urgent care, which NHS 111 and Out of Hours are included. This specification has moved from previously being an advisory set of recommendations to mandatory requirements. We will be following the mandated specification but the insight and feedback from the survey will be used to inform our local service offer. Summary of the findings - Who did we hear from? Gender Profile: 1% 30% 69% Female Male Prefer not to say
Governing Body: Clinical Commissioning Executive Date Paper XX Age Breakdown: 350 300 250 200 150 100 50 0 17 24 25-34 35-44 45-54 55-64 65-74 75+ Prefer not to say 17 24 25-34 35-44 45-54 55-64 65-74 75+ Prefer not to say The postcode breakdown into CCG footprint: 500 450 400 350 300 250 200 150 100 50 0
Governing Body: Clinical Commissioning Executive Date Paper XX Summary of the findings Feedback on the ideas for the new NHS 111- Clinical Assessment Service Elements to be considered as part of the future design of NHS 111 To reduce the number of questions you get asked when you first speak to an adviser To have a telephone filtering system that gives you direct access to a clinician, for To have a shorter window of time for call backs. 4 hours is too long To be able to use a smart device/ smartphone to Skype or FaceTime a To be able to talk to a medical professional, for example a Nurse, GP or Pharmacists Access to other services, such as social care 0 100 200 300 400 500 600 700 800 900 1000 Would you like the idea of NHS 111 effectively becoming the only number you need to make contact with any local health service or health team, such as the District Nurses or your GP? Yes 28% No 72% Comments: Still need to contact GPs separately otherwise it would clog system up Only if it is more effective. Seems to me it would increase wait times and load on GPs Save going through all the other services to get the health care you want Yes. If properly staffed Prefer to have personal access to different parts of the NHS
Governing Body: Clinical Commissioning Executive Date Paper XX Would you be happy for NHS 111 staff to be able to access and update your medical records, to help make informed decisions about the care you may need? No 27% Yes 73% Comments: Anything to give more information to those advising is a good idea. Sharing medical info is vital Yes. It can only make the service more effective It would give them a better idea of your history immediately Must be better to have all medical history To access yes - to update no. If confidentiality and security can be assured Only if medically qualified to a good level But only clinicians, not the person who answers the phone Would you be happy for NHS 111 staff to book appointments directly with your GP or other local NHS service? No 27% Yes 73%
Governing Body: Clinical Commissioning Executive Date Paper XX Comments: If they have access to book faster/sooner appointments It would be helpful Some people find it difficult to make an appointment so it would certainly help them. Yes this would make life easier when at weekends and appointment needed urgently Yes. with a text/email service confirming the appointment Yes. Only under certain circumstances not as a matter of course. Yes - appointment booking would be a helpful service Yes, following discussion on my availability and ideal location. Outcome and next steps: Further detailed analysis of the survey data is being completed over the next few weeks. The initial findings from this survey have provided the NHS 111 Sussex Transformation Team with information that we will use to help inform and shape the new NHS 111 service and the development of the pan-sussex integrated urgent care services for our local population. As stated above we will be following the national service specification from NHS England but will ensure we listen to local people throughout this procurement and transformation programme to ensure that the local patient and public voice is heard. There are some key community groups and age groups that we didn t reach with our survey. We want to engage with as many people as we can, so we are making arrangements to work with the local Healthwatch and together with our new Public Member try to reach and engage with them.
Paper xx/xx Appendix D Lessons Learned from Previous Procurement: Extract from 111 Transformation RAIDD Log Ref Date Lesson Identified LL1 01/02/2017 01/04/2016 Nov-16 LL2 01/02/2017 Nov-16 Source (s) East Kent: Output of Workshop held after Mobilisation NHS Coastal West Sussex CCG OOH Procurement Patient Transport Service East Kent: Output of Workshop held after Mobilisation Patient Transport Lesson Category / Area of Impact Governance Procurement / Resourcing Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned Robust, well led governance structure and clearly identified lead commissioner are vital to the successful delivery of the programme. This governance must be sighted on and understanding of the Risks identified by the programme and their role in managing them Development of specification and implementation of new service will require subject matter expertise (SME) to be available to the programme at Decisions cannot be made Decisions have not authority Scrutiny of approach and decision making is not possible Service specification will be incorrect / inaccurate Service procured will not deliver the required outcomes and callers will be put at risk of Lead Commissioner is NHS Coastal West Sussex Accountable Officer for Lead Commissioner is Marie Dodd Governance structure and terms of reference are in place and have been approved at STP level Sussex NHS 111 Programme Team ensuring Governing Bodies are engaged with and appropriate approvals are sought Reporting lines are clear and the programme has identified Sussex wide Governing Bodies, scrutiny groups and interested parties. Plan is in place to engage with these groups to ensure maximum oversight and understanding in particular with regard to decisions and risk management Clinical resource requirements have been identified and action commenced to ensure these are met Clinical Oversight group has
Ref Date Lesson Identified LL3 01/02/2017 01/04/2016 Nov-16 Source (s) Service East Kent: Output of Workshop held after Mobilisation NHS Coastal West Sussex CCG OOH Procurement Patient Transport Service LL4 01/02/2017 East Kent: Output of Workshop held after Mobilisation Lesson Category / Area of Impact Data and Information Procurement and Resourcing Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned all times. This to include during mobilisation and post go-live. Consideration should be given to bringing in additional mobilisation expertise in good time. Data to support the development of specification and service solution should be collected, analysed and quality assured Need to ensure that SME resource is secured for the entirety of the programme activity to ensure expertise is appropriate to needs to harm Sussex NHS 111 will not be compliant with national directions Service model may not meet the needs of the population (both for 111 or for other Urgent Care services) Contract value may be over / underestimated creating financial risks for the Sussex CCGs Providers may perceive the contract activity to be too low / high to be of interest and not bid See LL2 been recommenced Specialist procurement resource has been engaged (SOEPs) SME representatives from Quality & Safeguarding, Digital, Finance, Comms and Engagement have been secured and where appropriate now sit on programme board Requirement for SMEs flagged to programme board and logged as a risk on the Sussex NHS 111 RAIDD Log. Two years worth of raw data received from SECAmb (incumbent provider), collated data for same period for OOHs Detailed analysis carried out by performance teams sense checked across the seven CCGs and reference to national data to check for outlying issues See LL2
Ref Date Lesson Identified Source (s) LL5 01/02/2017 East Kent: Output of Workshop held after Mobilisation LL6 01/02/2017 Nov-2016 East Kent: Output of Workshop held after Mobilisation Patient Transport Service Lesson Category / Area of Impact Procurement and Evaluation Programme Management Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned programme Adequate and appropriately skilled resource needs to be secured to carry out the evaluation and scoring of the tender documentation for the entirety of the procurement process. Ensure that the programme office is adequately resourced to deliver the programme and its implementation Bids submitted will not be appropriately scored Contract may be awarded to provider who is not able to deliver service to expected levels or may need additional support or funding to deliver Procurement may be at risk of legal challenge if evaluation does not comply with standards Key tasks to ensure the procurement happens will not be delivered or will be of poor quality Risk that the procurement will be delayed Risk that requirements set out by NHSE or other directive organisations will not be built in to procurement Resource requirement flagged to programme board Resource requirement referred to SOEPs for expert opinion around FTE, skills and timescale resource will be required for Requirement for procurement resource flagged to programme board and logged as a risk on the Sussex NHS 111 RAIDD Log. Programme team recruited and hosted by Lead Commissioner MOU in place to ensure programme team have a shared responsibility to all seven CCGs Team members include:- o Programme Director o Senior Project Manager o Senior Communications Manager o Senior Commissioning Manager o DoS Lead / Project Manager o Programme Support
Ref Date Lesson Identified Source (s) LL7 01/02/2017 East Kent: Output of Workshop held after Mobilisation LL8 01/02/2017 Nov-16 LL9 01/02/2017 Nov-16 East Kent: Output of Workshop held after Mobilisation Patient Transport Service East Kent: Output of Workshop held after Mobilisation Patient Transport Service LL10 01/02/2017 East Kent: Output of Workshop held after Mobilisation Lesson Category / Area of Impact Resourcing Planning / Timescales Mobilisation Procurement and Evaluation Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned Identified the need to ensure that SMEs are involved in the development of the mobilisation plan and activity Ensure that adequate time in planned in to carry out required activity such as specification sign off, formal sign off for contract, mobilisation etc. Programme plan should also include appropriate gateway / decision points and have a strong communication and engagement element. We must ensure that engagement is ongoing throughout the process and that positive messages are reported. Ensure that TUPE position is clear as early as possible Identify whether a provider is a new entrant to the market and assess what additional support might be needed this may See LL2 Risk that required activity is not completed in time and the contract go-live date has to be slipped Risk that required activity has to be completed in an inappropriately compressed timescale and tasks are not completed to an appropriate standard, insufficient scrutiny is applied or key tasks are missed out Risk of legal challenge to Commissioners, outgoing and incoming provider Financial risk if TUPE challenged If TUPE position is unclear, may impact of bidders coming forward to bid for contract Provider may not have the capacity to commence the contract in a timely manner Provider may underestimate See LL2 Officer Analysis of Lessons Learned from previous procurement to give idea of timescale required Feedback from soft market testing event with providers and other commissioners Expert advice sought from procurement SMEs (SOEPS) Communication and engagement plan in place and signed off by Programme Board events on plan have already commenced Requirement to identify potential TUPE position logged as a risk on the Sussex NHS 111 RAIDD Log Requirement to identify providers new to the market bidding on the contract logged as a risk on the Sussex NHS 111
Ref Date Lesson Identified Source (s) Lesson Category / Area of Impact Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned best form part of the evaluation the requirements of the service RAIDD Log process. and fail to deliver the service levels required Requirement to build in experience in the market and The provider may withdraw from the contract implementation plan for mobilisation, go live and ongoing resilience for the service to form part of the evaluation criteria LL11 01/02/2017 East Kent: Output of Workshop held Specification The national picture around Integrated Urgent Care is Contract will not deliver to national requirements Programme team securing clinical input into the after Mobilisation subject to change and respecification. The programme will need to ensure new May be financial implications either through central funding not being received as a result programme to ensure national clinical requirements are understood national requirements are built into the specification and contract. These requirements will include the IUC Digital of lack of compliance or additional costs if contract needs to be varied to deliver national requirements Programme engaging with regional IUC team and NHSE to ensure sight of national requirements as soon as they Specification and the Workforce Elements of the service may are released Blueprint not align with other urgent care services that do meet the national model creating a poor Programme team and Urgent Care team attending NHSE and regional events around IUC experience for the patient, increased risk for the patient, potential increased costs Programme team building stakeholder engagement programme to develop Sussex Footprint wide understanding of the national requirements Specific programme resource to support the digital requirements has been identified LL12 01/02/2017 East Kent: Output Mobilisation Ensure that demonstration of Provider may front load Requirement to demonstrate
Ref Date Lesson Identified Source (s) of Workshop held after Mobilisation LL13 01/02/2017 East Kent: Output of Workshop held after Mobilisation LL14 01/02/2017 East Kent: Output of Workshop held after Mobilisation Lesson Category / Area of Impact and Go-Live Evaluation and Post Go-Live Programme Planning Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned and evidence of operational capacity of provider post go-live forms part of the evaluation process. Ensure data collection and reporting capacity is built in to specification and contract and available from day one. Wider impacts of the new service need to be understood, not only for the service itself, but for associated services procurement activity in order to win contract with service failing to match promised performance once contract has gone live Provider may require additional support during early days of contract will have a financial and quality impact Provider may fail and contract be handed back to commissioner Provider may not be able to deliver requirements some of which are nationally mandated Commissioners will not be able to monitor performance of new provider Other services such as ED and local primary care services may be impacted by a surge or drop in patients and evidence operational capacity post go-live to form part of the evaluation criteria Risk to contract post go-live from provider lacking operational capacity noted as a risk on the Sussex NHS 111 RAIDD Log. Programme will ensure that data collection and reporting requirements are built in to the contract and service specification and that the commissioner and provider have a shared understanding of when data / reports are expected from the outset of the contract. Commissioner and provider will negotiate performance requirements and compliance with KPIs around contract go live The programme has developed an engagement strategy for partner organisations this includes a stakeholder event
Ref Date Lesson Identified Sept-2011 Source (s) NHS 111 Lessons Learnt & Shared Understanding LL15 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement LL16 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement LL17 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement LL18 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement 03/12/2015 MSK Lesson Category / Area of Impact Resourcing Resourcing / Procurement Data Engagement / Stakeholders Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned down and up the line who may be impacted by changes For any future pan Sussex procurement, ensure a range of expertise is in place that may not be available at CCG level Expertise of the CSU procurement team was invaluable Ensure that activity data used to inform specification and procurement is robust Programme needs to ensure that engagement with internal and external stakeholders is robust Other services such as ED and local primary care services may be impacted by changes in way and times patients present themselves or in the way referrals are received See LL2 See LL6 Lack of expertise may cause the procurement to fail See LL3 See LL3 See LL1 See LL14 and briefing packs for accountable officers the aim of this information is to ensure the new Sussex NHS 111 service is understood and partners are given the opportunity to identify areas of impact The programme reports in to the STP board this forum includes representatives from partners who may feel an impact from the new service See LL2 See LL6 Programme is using expert procurement resource via the commissioned service supplied by SOEPs See LL1 See LL14 Soft Market Testing completed Public consultation / survey Stakeholder engagement session (to include MPs, Chief Officers, Leaders etc) planned
Ref Date Lesson Identified Source (s) LL19 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement LL20 01/04/2016 NHS Coastal West Sussex CCG OOH Procurement LL21 Nov-16 Patient Transport Service LL22 Nov-16 Patient Transport Service Lesson Category / Area of Impact Procurement / Contract Award / Mobilisation Procurement Mobilisation / Go Live Contract Management Governing Body: Clinical Commissioning Executive Date Paper XX Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned Mobilisation period needs to be set and adhered to timescale needs to be realistic. Award process needs to be adhered to Providers fed back that a Bidder Day with case scenarios was more helpful than just written bids Ensure that options around data transfer are fully explored suggestion from PTS team is that shadow running of the service is considered CCGs need to consider a longer term view of services and stop managing from contract to contract in See LL8 See LL8 Potential risk that not all bidders who could provide the services engage with the procurement Programme will explore how bidders would prefer to engage with the procurement Programme has already undertaken a Soft Market Testing event and will be offering a second event later in the year Action may not be possible Explore this option with both the incumbent provider and the potential providers Providers may not be interested in bidding for contract if CCG approach is too short term. Investment requirements may be too much for providers if contract is too short term / service view is too short term. This may mean providers either do not submit bids or there is a need for CCGs to pump prime / offer financial incentives or support Programme has raised the issue of contract length and need to move away from short-termism with the providers during the soft market testing feedback was that a 3+2 contract would not be of interest
Governing Body: Clinical Commissioning Executive Date Paper XX Ref Date Lesson Identified Source (s) LL23 Nov-16 Patient Transport Service LL24 Nov-16 03/12/2015 Patient Transport Service MSK LL25 Nov-16 Patient Transport Service Lesson Category / Area of Impact Procurement Process Procurement Process Contract Management LL26 03/12/2015 MSK Organisational Capacity Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned Commissioner should consider offering visits to incumbent provider sites as part of ITT process Commissioner should have a planned response in place should the procurement process result in only one or no bidder coming forward Commissioner should have plan in place to deal with exiting from the contract should the need arise The programme needs to factor in and respond to the bandwidth of partner organisations to deal with change, particularly given the ongoing organisation change and development around STPs / Place Based Care, Legal Directions and Special Measures. The programme must ensure that it does not Programme to explore this as o Incumbent provider may not permit this o Bidders may not be interested in this offer If a plan is not in place and this Risk of no bidder or only one eventuality comes to pass, bidder submitting noted as a response will be delayed while risk on the Sussex NHS 111 situation is analysed and RAIDD Log response formulated. Risk of no award of contract being possible to be incorporated into Sussex NHS 111 RAIDD Log Financial risk additional costs Programme to develop exit should early exit be required strategy and plan and costed plan not be in place Reputational risk CCGs will generate adverse publicity if an early exit is required. A plan will minimise this risk Risk that organisations do not have full understanding of the programme activity and what they might be committing to Risk that organisation rejects the final model / procurement approach / contract award as a result of lack of full understanding Programme to ensure that exit and break clauses are built in to the contract and specification. Risks acknowledged in Sussex NHS 111 RAIDD Log Escalation route for programme concerns formally agreed in the Programme Board Terms of Reference Communication and Engagement plan in place this includes Accountable Officer briefing packs
Governing Body: Clinical Commissioning Executive Date Paper XX Ref Date Lesson Identified Source (s) Lesson Category / Area of Impact Description of Lesson Risk if Lesson not Learned Programme Action as a result of Lesson Learned become isolated from the commissioning organisations
Appendix E High Level Procurement Plan Governing Body: Clinical Commissioning Executive Date Paper XX
Sussex & East Surrey Sustainability & Transformation Partnership Sussex and East Surrey Sustainability and Transformation Partnership HOSC Chairs Update, September 2017
STP governance Sussex & East Surrey Sustainability & Transformation Partnership MoU agreed and with NHS partner boards for signing All four councils committed to working in partnership to improve health and social care outcomes. Recognition of different democratic accountability for councils Principle of place is fundamental to integrated working and formal agreements need to be built around places and their populations NHSE and NHSI to confirm STP leadership arrangements and any other national support
Winter planning Sussex & East Surrey Sustainability & Transformation Partnership Preparing for winter is a key priority with ensuring local resilience and surge plans are in place and aligned across the STP DToCs continue to impact flow and work is ongoing across the STP to address this in advance of winter, moving towards national target of 3.5% occupied bed days; 50:50 responsibility to achieve this between NHS and local authorities. A reduction in CHC assessments taking place in acutes will be a key contributor to this alongside ensuring alignment with BCF plans Coordinating work to improve urgent and emergency care in line with the 5YFV. Will provide strong basis for this winter and foundation for longer-term improvements for more integrated and seamless services Directory of Services (DoS) optimisation to ensure all services have up-to-date information on the care options available, including urgent and out of hours care In preparation for procurement of new NHS111 integrated urgent care service, contract variations projects are being developed start the move from an assess and refer to a consult and complete service
Development of place based plans ESBT already well developed. ESBT Alliance working in shadow form in 2017/18, creating conditions for single health and care entity Work on other three places progressing locally This work is underpinned by the identification of: 11 key interventions that will have the greatest impact for local people, based on best practice and evidence 7 enablers required to deliver integrated care models Sussex & East Surrey Sustainability & Transformation Partnership (See the following slides for more detail on the interventions and enablers)
11 key interventions Sussex & East Surrey Sustainability & Transformation Partnership
7 enablers Sussex & East Surrey Sustainability & Transformation Partnership