Transformation update January 2018 Purpose 1. The purpose of this paper is to provide the Joint Working Board (JWB) with an update on the transformation and change activities across the three Trusts since the last JWB meeting. The dashboards for the portfolio of change activities and the programmes more generally is included as an annex to this report. Public consultation update and PCBC model 2. Public consultation activities continue in month, with public meetings commencing in January across mid and south Essex, January dates are shown below: 9 th January 2018 / 18:30-20:30 / Chapter House, Chelmsford 16 th January 2018 / 18:30-20:30 / Wick Community Centre, Wickford 17 th January 2018 / 13:30-15:30 / Chantry House, Billericay 24 th January 2018 / 18:30-20:30 / Civic Hall, Blackshots, Grays 31 st January 2018 / 13:30-15:30 / Michael Ashcroft Building, ARU, Chelmsford 3. We are also arranging a number of smaller focus groups which we will give you further details on in our next update. 4. Staff briefings have been undertaken across all sites and will continue to be undertaken during the consultation period, this is now being completed through a periodic bulletin which is being circulated to hospital leaders and governors/patient council members, this includes a frequently asked questions which is being regularly updated based on feedback and questions that are being received during the consultation process. 5. Preparatory work has commenced to pull together the required material for the clinical senate stage 2 submission as required in all proposed service changes. Change management office, governance, resourcing 6. Recruitment to fill the remaining vacancies within the CMO is underway, this includes the introduction of apprenticeship scheme for the Band 5 roles. The CMO team have also been supporting the recruitment for other sections within the PMO. 7. Gateway process has been agreed and is in place, Communication session held with the Clinical Re-design Team, further sessions are to be scheduled with the Clinical Support and Corporate Support Programme Level Teams. Note that document templates continue to be refined during this process. 8. Review and agreement of business case process to include an initial outline business case is underway. Page 1 of 9
9. CMO working alongside the recently appointed Group Director, Owen O Sullivan to review and re-align the Radiology programme within the Clinical Support Programme. 10. Review of risks has been undertaken for Group Portfolio programmes/projects and work continues to rationalise these to ensure appropriate risk management is in place. 11. At a local level, the local programme board for SUHFT is now up and running, with the first meeting held in December 2016. CMO teams are also supporting the development of the local CIP plans and work is underway to align these across the MSB. 12. Revision to the Quality Impact Assessment process to include impact on staff is underway, aligning the approach to QIA across the 3 Acute Trust s is also underway. 13. Work continues on bringing the information together for all projects at both group and site level to enable easier prioritisation and support resourcing planning. Clinical reconfiguration and redesign 14. The overall RAG rating for the clinical programme board is Amber, with good clinical engagement across the three sites in developing the future vision for services, there is, however, significant detailed work to be undertaken in a range of areas to ensure that projects move through the correct governance channels, and into operational implementation phase. As shown on the dashboard there were 7 projects Red RAG rated in November. A number of these projects were Red due to small delays, and have since recovered in December. Projects with ongoing delays are detailed below 15. Vascular: This project remains RAG rated Red, as the business case was not complete for approval at clinical programme board. A draft business case was presented however, the draft presented now needs to link to the demand and capacity analysis work, and costed by finance. The project is aiming to get the business case finalised for the clinical programme Board in January, however, this is challenging due to the Christmas break. 16. Renal: This project has been Red RAG rated in November due to slow progress and remaining at gateway one. The project proposal form is to be presented in January to formalise the project to the next gateway, and to move forward to business case. 17. OMFS: This project is RAG rated Red in November, due to ongoing operational resource issues. The full implementation of this is now likely to be delayed until April. 18. Clinical Programme Board approved the mandate document for the Emergency Treat and Transfer project to go into a live phase, with a clinical lead to be appointed in December. Stroke project proposal form was also signed off and approved in December, with the next key governance milestone being business case. 19. A key area of risk highlighted at the clinical programme board in December was concerns as an increasing number of projects progress to business case stage that there is insufficient resource at an appropriate skill level within the analytics and finance work to support the business development. This risk has been escalated through to the Joint Executive team, who are working on resourcing plans to ensure that this risk is mitigated. Page 2 of 9
20. Quality Impact Assessments and Equality Impact Assessment templates have now been agreed and will be populated for projects over the next 8 weeks. 21. Clinical Reconfiguration roadmap was presented at clinical programme board, and will form part of a regular update for the group portfolio meeting. The roadmap will remain a live document however, outlines the in-hospital (inpatient) fast-track projects that are likely to begin implementation in 2018/19 (subject to public consultation) to be: - Vascular - Cancer - Stroke - Interventional Radiology - Urology - Trauma & Orthopaedics - Emergency Treat and Transfer 22. Other live projects will continue to be scoped (and where possible begin implementation), teams will continue to meet regularly and be support by the clinical redesign project team, to ensure a smooth pipeline of implementation throughout of the reconfiguration programme. 23. An in-hospital environment and infrastructure project has now also been developed to ensure alignment of plans between clinical reconfiguration and the alignment of capital funding. 24. Preparation is commencing now to ensure that the required information for the next clinical senate in April 2018 is in place. Corporate support 25. Work continues to prepare proposals for transactional services and helpdesk to be presented to the Joint Working Board in February. Clinical support 26. Progress has been made in sterile services as its business case was approved at Group Portfolio Steering Group. It recommends the consolidation of Orsett sterile activity at Mid Essex (60%) and Southend (40%) with an estimated first year savings of > 400k and subsequent years savings of > 500k. The Southend site management team supported the principle but require further assurance from the site operational team. Significant progress on standardising working practice has also been made as the packing processes have been mapped, aim to present final case to JWB February. 27. The Pharmacy work-stream is now progressing as a business case was approved to create an MSB medicine information service at Mid Essex with an annual savings of ~ 80k. In addition, the proposal to make Basildon the prepacking and over labelling site and close the old pharmacy aseptic production unit, whilst consolidating the aseptic production activity at Mid Essex and Southend, was well received at the Page 3 of 9
clinical reference group. This approach eliminates the need to replace the old aseptic unit at Basildon (at a cost between 150-250k) whilst it also reduces the aseptic production cost per unit. Initial analysis of the wholly subsidiary outpatient dispensing savings shows that the new proposal payment for NHSE drugs of 40 per unit for 2 years and 30 per unit thereafter is not viable and this has to be renegotiated. 28. Radiology out of hours reporting went live in Basildon (end of Oct 17) and Southend (end of Nov 17) with estimated savings of 5k already, whilst work is on-going to implement an interim solution to enable Mid Essex go-live in Jan 2018 to yield a potential savings of > 40k (for Mid Essex alone) to the end of 2017/18 financial year. Image sharing has gone live in Basildon and Southend. There is a plan to replace the Mid Essex firewall which has delayed its go-live, and this will enable Mid Essex to start sharing image with other MSB sites by the end of March 2018. 29. The business case to support the rebranding of Microbiology to become the MSB Infection Service has been drafted. This project aims to develop the service by focusing on: research and development; new diagnostic methodology; creating robust pharmacy antimicrobials to support the hospital at home; and, OPAT to reduce length of stay and free up beds to do more elective activity. 30. The inability to move budget around within MSB is affecting the implementation pace of the Clinical Support Programme because every site has to approve the transfer of vacancy posts from one site to another e.g. pharmacy medicine information implementation requires a vacancy post to be transferred to Mid Essex. Above all, additional resources such as project implementation managers will be needed to implement a large proportion of the pharmacy work and the MSB infection Service. Individual trust programmes Basildon (Stepping Up Programme) 31. The overall portfolio has been rated AMBER for November performance with five projects RAG (Red/Amber/Green) rated Red. 32. Five projects are Red rated, which is a deterioration from the four projects rated Red in October. 33. E-Referrals There continued to be delays in the opening up of slots on the E Referrals Service system for identified clinics, due to capacity issues within the Electronic Patient Records team to be able to process these changes. There is also a significant risk to achievement of the CQUIN element relating to delivering an improvement trajectory for reducing Appointment Slot Issues (ASIs) to 4% by the end of quarter 4. Most recent performance at the trust is at 36%. The paper switch off poses 5.5million pounds worth of activity at risk if not completed by October 2018. Page 4 of 9
34. Radiology Utilisation project remains Red rated in November due to lack of progress and issues with resourcing the project both operationally and divisionally. The project continues to be impacted by a lack of informatics support to undertake demand and capacity analysis within the service. 35. Cost Improvement Programmes remains Red rated in September as there is limited assurance of delivery of the overall 16.3m. As at 4th December, the pipeline of schemes is at 17.28m, however, approximately 4.0m of this is still in the early stages of the maturity index and as yet does not have robust implementation plans in place. Quality Assurance Group (QAG) is continuing to sign off schemes with 9 schemes ( 518k) signed off in October. Four Eyes Insight projects are yet to be formally approved by QAG as the finances have not been agreed. It is anticipated that this can be completed in December. As at 4th December M8 reported 7.14m YTD of CIP delivery against planned 10.52m. 36. Pressure Tissue Damage project remains Red rated due to lack of progress in delivering milestones caused by capacity issues with the Tissue Viability Team. The project is focussing on delivering the E-Observations package, while there are plans to recruit a new member of the Tissue Viability Team. 37. VTE project is Red rated due to slippage against plan of milestones, particularly slippage in relation to completion of processing changes agreed following the data cohorting meeting from the original plan. 38. At SUB it was noted that progress on the processing of the exclusion criteria has shown an improvement in compliance to above 95%. The rating of the project is likely to move to a Green rating in December based on this improvement. 39. The Portfolio Risk Register was reviewed at Stepping Up Board. The highest risk affecting delivery of the portfolio projects and achievement of the identified outcome measures is in relation to the impact of the projects upon achieving the key performance standards and a lack of capacity within the informatics team to support projects within the Stepping Up Portfolio. A new candidate risk was added to the risk register this month highlighting the risk that lack of capacity within Patientrack to deliver requested new modules to the EObservations system may delay the implementation of projects within the Stepping Up portfolio. This may affect, Deteriorating Patient, VTE, Infection Control and Pressure Tissue Damage. The impact on projects is being assessed. Mid Essex (Transformation Steering Group) Page 5 of 9
40. The MEHT 2017/18 Transformation Programme has now been agreed and with leads at all levels of the organisation assigned (as shown in the dashboard). The meeting structure and meeting governance have been refreshed with the new meeting structure in diaries and to commence from the first week in January. Key risks to the programme is around operational staff time to engagement in the new programme, whilst experiencing winter capacity pressures. Substantive recruitment to the improvement team at MEHT has been underway and a Programme Director has now been appointed to and due to start in post in early 2018 with ongoing recruitment of substantive improvement specialists. Southend 41. Focus continues on existing projects with significant focus now being placed on 2018/19 CIP planning. 42. Issues have been identified in respect of resourcing within the core site change team at Southend, relating to securing the necessary authorisations. This has been escalated for resolution to the relevant Finance and HR teams. People and organisational development 43. MSB Core Leadership Programme: A Core Management Development Programme has been designed to support collaborative working across the 3 sites, titled MSB Core Leadership Skills Programme designed to support first time managers. Following completion of the first programme this has been evaluated and updated with three cohorts planned for 2018 commencing February. It complements the NHS Leadership Mary Seacole Local Programme with Alumni from both programmes supporting future delegates. 44. MSB Corporate Induction: A review of the Corporate Induction Programmes for all three sites has taken place. Work has commenced to design and develop an MSB Corporate Induction Programme with a planned timeframe for commencement as April 2018. 45. MSB Appraisal Process: Work has commenced on the option appraisal paper for the MSB Performance Appraisal Process. To be presented to JEG in March 2018 46. MSB Clinical Engagement: A clinical / medical engagement action plan has been developed following the medical engagement survey undertaken in Spring 2017 47. Organisational Culture assessment: An exercise will be undertaken to understand and assess the organisational culture of the three Trusts. 48. MSB Statutory and Mandatory Training: Review of the Statutory and Mandatory policies across group has commenced with the plan to move compliance reporting on the Core Skills Training Framework to all boards Page 6 of 9
Digital spend Digital Payments UNRESTRICTED 49. People strategy: development is ongoing through staff workshops, evening sessions have been arranged for non-executive directors to feedback on the work and findings so far. Apprenticeship levy update Apprentice Levy Digital Payments received (April to November 2017) Apprenticeship Levy Payments received- MSB April - November 2017 600,000 580,000 560,000 540,000 520,000 500,000 480,000 460,000 Mid Essex Southend Basildon Predicted Apprentiecship Levy spend Quarter 4 Predicted Apprenticeship Levy spend - MSB 50,000 48,000 46,000 44,000 42,000 40,000 38,000 36,000 January February March Quarter 4 Additional monthly spend for April October 2018 50. With the current interest in uptake of an apprenticeship programme the final table shows the forecasted predicted spend per month and a final total for twelve months. There will be additional spend as further healthcare apprenticeships become available and additional leadership and management opportunities are taken-up. Page 7 of 9
Integrated Care Operations Executive MBA 30 places 33,750.00 Top up to Registered Nurse 30 places 16,500.00 HND Assistant Practitioner 20 places 9,166.66 Software Development Technician 1 place 1,000.00 Digital Marketer 1 place 800.00 HR/CIPD 3 places 833.31 Healthcare Associate Level 4 1 place 375.00 Healthcare Science Practitioner Level 6 3 places 1,687.50 Electrical 1 place 375.00 Carpentry 1 place 500.00 Forecasted spend 64,987.47 Continuation of Jan - March spend 49,309.63 Total spend per month 114,297.10 Total spend for 12 months 1,371,565.20 51. The Integrated Care Operations team continue to progress the mobilisation and operation of a number of services supported through both Better Care Fund and the additional winter monies allocation, these include: Afflets Sheltered Housing Project which remains on track for mid-february start. Domiciliary Care Bridging in Essex which is coming on stream as recruited staff commence work. Support for mid Essex with the mobilisation of the Chelmer Valley nursing home beds which commenced 2 nd January 2018. 52. Recruitment for the Hospital at Home service at Broomfield, alongside the recruitment for the expansion of the Basildon service has concluded and is coming on stream as recruited staff commence work. Strategy and joint working 53. New Care Models: We were asked to present at the national Acute Care Collaborations community of practice for the vanguards and were subsequently asked to provide some additional information used in our clinical service strategy to the Nuffield Trust. Useful learning for us from other systems around the country. 54. Innovation: We were invited to judge the NHS Hack day to uncover the future innovative solutions to NHS problems using digital applications. Also invited to an event as a host of the NHS Clinical Entrepreneurs Programme, where the STP was personally thanked by Professor Sir Bruce Keogh, who is the national lead for the programme, who said that we were really stepping up as a system to support young innovators. We will launch the msb Innovation Fellowship in January. The hospital group in Essex also got a mention by Professor Tony Young on BBC Breakfast on 28 December when talking about new digital innovations in the NHS, specifically in Page 8 of 9
reference to being the first UK site for a trial of the Upright Sensor aimed to reduce back pain. 55. Improvement: The trusts have been successful in our bid to participate in the UCLPartners Human Factors Programme, a ten-month course to help organisations grow capacity in addressing and reducing ways care is delivered which influence behavior and can impact on patient safety. Only five organisation slots were available for the whole AHSN area. In order to accommodate all three trusts, we have been offered an additional place in the cohort. STP team 56. We are currently working with regulators and commissioners on the longer term programme management and communications arrangements to replace the existing temporary programme and communications leadership roles for the new financial year. These arrangements will be reported to the next meeting of the Joint Working Board in February. Summary and conclusions 57. The Joint Working Board are invited to: Note the report. Annexes A. Programme dashboards. January 2018 Page 9 of 9