Service Update Clinical Services System Resilience and Commissioning Update Agenda Item: 17 Reference: WCT14/15-309 Meeting Name: Trust Board Meeting Date: 4 March 2015 Lead Director: Sandra Christie Job Title: Director of Nursing and Performance Link to Business Plan: Has an Equality Impact Assessment (EQIA) been undertaken & attached? Have the Public & Stakeholders been consulted? Yes No N/A Yes No N/A To Approve To Note To Assure Financial Implications: E.g. What is the Impact on the Trust? Does it provide Value for Money? All costs should be clearly explained in the section below. The Trust has secured short term funding via System Resilience for the introduction of Rapid Response. Future funding is via the Better Care Fund. Overall Cost / Pressure: Additional Funding Required: Identified Risks: TBC Overall Income: n/a n/a Funding Already Ring Fenced: n/a Assurance to Board: The Trust is fully engaged in the integration and commissioning agenda that will ensure that service delivery is integrated and that the patient care is optimised and patient experience is enhanced. Publish on Website: Yes No Private Business: Yes No Report History Submitted to Date Brief Summary of Outcome No history
Wirral Community NHS Trust Service Update Clinical Services System Resilience and Commissioning Update Purpose 1. This monthly paper will update the Trust Board on developments within trust services which support the delivery of the trusts strategic objectives and integrated business plan, support the commissioner s commission intentions, wider system resilience and ensure that service delivery is integrated and that the patient care is optimised and patient experience is enhanced. Executive Summary 2. Care delivered in primary and community settings accounts for the majority of patient contacts in the NHS. Community services help support people's health and wellbeing at every stage of their lives. They include child health and well- being services, crucial to getting the right start in life; support for people with complex long-term conditions to help manage their disease; and services such as community nursing and therapies) to help frail older people live independently at home for longer. 3. Greater integration of health and social care services is needed to mitigate the impact of fragmented health and care provision on patient experience. Patients can often experience gaps in service provision, poor transitions between care settings and failures in communication. The Health and Social Care Act places a duty on providers to work more closely together to address these issues. 4. Rapidly available community services offer a system of care that is not only responsive and coordinated, but that is also sustainable, shifting the emphasis onto prevention to reduce demand and making the most of the NHS s already stretched resources. Developing what health and social care will look like by 2018 5. A draft model of how health and social care will be delivered in 2018 has been developed by the Vision 2018 partners and approved by the Strategic Leadership Group. Based on the Integrated Care Coordination Teams (ICCTs) - which bring health and social care staff together to provide an integrated service with pooled budgets this will mean that patients don t need to be referred on to multiple services. Further details on this work can be found in the Vision 2018 bulletin (Appenidx1). Current Vision 2018 Development Work Streams Integration 6. The model to establish four integrated community care teams (ICCT) across Wirral has been developed by the Integration work stream of the Vision 2018 programme. 7. Four local teams, geographically based within the parliamentary constituencies in South Wirral, Wallasey, Birkenhead and West Wirral have been agreed. 8. The bases for the teams are being finalised but are likely to be Eastham, VCH, St Caths and Marine Lake/Concourse, utilising the existing structure of the Multi-disciplinary Team (MDT) Co-ordinators and ICCT meetings and developing integrated, co-located health and social care teams.
9. The implementation of the service is being project managed, using Eastham as the first pilot site. The timescales for full implementation is by September 2015. 10. The divisional restructure supports this plan, with four hubs for each division based in these geographical locations. 11. Understanding the demand and care needs in each of the localities is vital so that Community matron, community nurses and therapists can be allocated to each ICCT 12. The specification for how this service will be delivered has been outlined in a draft service specification which will be developed and refined by the teams between now and September 2015. This will be used alongside the current service specifications for Community Nursing, Community Matrons and Therapies, and will be implemented fully when all teams are properly established. During the implementation phase a Task & Finish Group of operational managers including the recently appointed ICCT Manages will work to implement a detailed project plan. 13. Specific projects for the 4 ICCT s have also been identified and the newly appointed ICCT Managers are working on the following: Wallasey patient risk stratification, supported by the successful bid for the Integrated Care Demonstrator site fund, employing social workers to support people with social care needs who have been highlighted as at risk of unplanned admission on the test sites for risk stratification. South preventing patient re-admissions, targeting patients who have high re-admissions rates to the older people wards, supported by the Community Geriatricians and End of Life teams. Birkenhead care homes, identifying a care home in the Birkenhead area and looking at models of enhanced support from the ICCT to prevent unplanned admissions to hospital. West there is the opportunity to develop a healthy living hub, working with the redevelopment of the Concourse and Marine Lake site to provide support to people to a healthy lifestyles using the leisure services, to managing complex needs via the ICCT and the services required in the new GP centre (longer term project) 14. Developing a performance management framework by which the integrated teams can measure performance is being developed using a single data set. Having robust evidence which demonstrates the impact that integrated working can have on unplanned admission is a key aspect of the Vision 2018 programme. Rapid Community Services 15. The aim of the Rapid Community Service is to increase the number of referrals to community based services through proactive engagement with GPs and other professionals. 16. The commissioning intention is for a partnership approach to an integrated MDT coordinating the care of people requiring an urgent response. This aims to bring the functions of the Pull Team, Admissions Prevention and A2H services, Community Trust nurses and IMC team and other identified schemes in the Better Care Fund together into one multidisciplinary team responsible for responding to: Patients who require a rapid response in the community in order to prevent admission to hospital Patients, who are being discharged from hospital to home, but need intermediate or transitional care before they can live at home. 17. The MDT will be part of the wider step up and down MDT service but focus on rapid support in peoples own homes.
18. The intention is to expand the current step up down bed based service to a service that includes support in peoples home where a bed is not necessary. 19. The service will provide an urgent (within 4 hours) response for GP's and support developments with North West Ambulance Service divergence and IV antibiotics at home. 20. The MDT will include nursing support, therapists, and social workers with access to domiciliary care and reablement and mobile nights and 72 hour on support as required. 21. This development is a key element of the systems admission avoidance strategy. 22. System Resilience funding had been used to expand the current services, of which the Community Trust has received to increase capacity in community nursing between December 2014 and April 2015. 23. A model for Rapid Community Services (Appendix 2) and briefings for GPs have been developed to explain the options available and other redesign work such as the discharge pathway. 24. The model includes a number of other services that the Community Trust is an integral part of for example integrated discharge and the early supported discharge schemes, where nurses and therapist are key to whole system working. Contract Negotiation Update Service Specifications, quality requirements, Commissioning for Quality and Innovation (CQUIN) and Service Development and Improvement Plans (SDIP) 25. The NHS standard contract is the basis on which NHS services are commissioned. It comprises service conditions, general conditions and particulars. Service specifications, quality requirements, including Commissioning for Quality and Innovation (CQUIN) schemes, and Service Development and Improvement Plans (SDIPs) appear within the particulars section. The national quality requirements and operational standards cannot be changed by local commissioners. Local quality requirements, CQUINs and SDIPs may be varied by commissioners (NHS England and Clinical Commissioning Groups) in order to address local priorities. 26. Good progress has been made on reviewing the 2014/15 service specifications to ensure that any required changes for 2015/16 have been included and that the contracts reflect the changes to services as part of the Vision 2018 work. 27. The quality schedule of the contract has been reviewed and any reporting requirements which are no longer valid or required removed. 28. The Commissioning for Quality and Innovation (CQUIN) payment framework enables commissioners to reward providers for delivering specific quality and innovation improvement goals, above the baseline requirements set out in the NHS standard contract, by linking a proportion of providers income to their achievement. National and local CQUINs appear in the particulars section of the contract under the national and local quality requirements. 29. CQUIN funding is currently earned by providers within a financial year and the monies remain non-recurrent. The national element - 0.5% of contract value - includes the Friends and Family Test and patient safety (which focuses on pressure sores, healthcareassociated infections, medication errors, and maternity safety. The remainder - 2% of contract value - is linked to local commissioning priorities and strategies. 30. Negotiations are on-going in relation to local CQUINs.
31. The draft SDIP plan is being developed with the commissioners and will support developing the services which are required as part of the Vision 2018 programme and wider system resilience. These include the single front door model, care navigation, the introduction of integrated care teams, implementing Percutaneous Tibial Nerve Stimulation (PTNS) for overactive bladder syndrome, botox follow up for overactive bladder syndrome, a review of the Looked After Children service and implementation of the revised specification for the Specialist Palliative Care team. Service Update Urgent and Primary Care Services 32. Following the paper and discussion about GP OOHs last month a task and finish group has been established to create a positive work environment for GPs within the service and to explore alternative models of care delivery which will support both Primary Care and the wider system in delivering urgent care services. Conclusion 33. There is a great deal of work taking place to support delivery of the trusts strategic objectives and integrated business plan, to support the commissioner s commission intentions, Vision 2018 and wider system resilience. 34. Wirral Community Trust is in an ideal position to influence and lead on some of the major projects, ensuring that service delivery is joined up and that the patient experience is enhanced Board Action 35. The board is asked to note the paper to be assured that the Trust is fully engaged in the integration and commissioning agenda that will ensure that service delivery is integrated and that the patient care is optimised and patient experience is enhanced. Sandra Christie Director of Nursing and Performance Contributors: Val McGee, Interim Director of Development/Interim Deputy Director of Performance
Appendix 2. Rapid Community Services
ISSUE 5 To ensure the residents of Wirral enjoy the best quality of life possible, being supported to make informed choices about their own care, and being assured of the highest quality services. Vision 2018 bulletin Issue 5 Feb 2015 Contents 1. General Update... 1 2. Developing what health and social care will look like by 2018.... 1 3. Transforming our current health and social care system to make it suitable for 21 st Century. 1 4. Bigger Projects... 2 5. Faster Projects... 3 6. Culture and Workforce Domain... 4 1. General Update In the last bulletin we launched the three guiding principles that underpin Vision 2018: 1. We will improve Health and Wellbeing outcomes 2. We will improve patients and service users experience 3. We will reduce the cost of health and social care These guiding principles (the triple aim ) have then been further defined in a set of Strategic Outcomes that we are striving to achieve through Vision 2018, including reducing emergency hospital admissions, providing care closer to people s homes and improving health and social care outcomes for young children. The full list of strategic outcomes is available on the Vision 2018 webpages. Work is now underway to achieve these. 2. Developing what health and social care will look like by 2018. A draft model of how health and social care will be delivered in 2018 has been developed by the Vision 2018 partners and approved by the Strategic Leadership Group. Based on the Integrated Care Coordination Teams (ICCTs) - which bring health and social care staff together to provide an integrated service with pooled budgets this will mean that patients don t need to be referred on to multiple services. Feedback from a recent Unplanned Care redesign event (see p3) has also been incorporated. The aim is now to take this approach further to create better links between the ICCTs and secondary and primary care, using IT to enable more seamless care. The draft model will next be presented to staff, patients, carers and local community groups for further development, to ensure this is the right way to go for Wirral. Your view really matters, so we ll bring you more in the next bulletin about how to get involved watch this space! 3. Transforming our current health and social care system to make it suitable for 21 st Century. The Innovation Unit is an independent social enterprise that works with public sector organisations. They are innovation experts that help to create radically different solutions to complex social 1
challenges. The Innovation Unit has published 10 Ideas for 21 st Century Healthcare ; we are reviewing these ideas with groups of staff, patients and carers to see if and how we could incorporate them into Vision 2018. Some key themes emerging are: A single contact point for advice and support: including a directory of community and statutory services available in a number of different formats; A social prescribing scheme: where people are prescribed an activity or group that would help improve their health. Accessed via GP surgeries, libraries or community venues, with the increased use of volunteers / peer mentors etc; Maximising use of digital technology: e.g. YouTube, Skype, Puffell; Asset Based Community Development: e.g. wellbeing drop-in centres, creating links in the community, accessing health in community venues; Communications: discussions with local people about changes to health and social care, so they can inform plans. Support individuals to manage their own condition better As we receive more feedback via group work the themes will be refreshed and then will be developed into projects to take forward more information will be shared in future bulletins. 4. Bigger Projects In the last bulletin we explained how the Vision 2018 work programmes have been identifying the priority projects that will help achieve the strategic outcomes. Bigger Projects are longer term transformational projects that will be co-designed with staff and the public and take longer to develop. Value Stream Analysis (VSA) is an approach taken to develop plans for these projects, current priorities include Unplanned Care, Respiratory and Musculoskeletal (described below). Value Stream Analysis (VSA) Events These events focus on mapping out how the system currently works for a particular area and then identifying how we can improve the patient / carer journey by removing wasteful steps, and enabling services to work together to avoid duplication. The events start by looking at what patients, carers and staff say already works well and what they think could be improved. Data is collected in relation to the numbers of patients accessing services and what current quality standards and outcomes for patients are. After reviewing all this information and mapping out the current pathways, the focus is then to think about out the ideal future pathway and develop an action plan to achieve it. By the end of the event we aim to have developed a draft 12 months redesign programme. Staff involvement (across all health and social care providers) and patient/carer input is central to the effectiveness of these events. Prior to the events being held we carry out research, interviewing patients that have used the service, as well as a range of clinicians and managers involved in the delivery of the service. This data provides invaluable insight to develop and improve pathways. 2
The Unplanned Care & Respiratory 'Value Stream Analysis event was held in December, including representatives from Primary Care, Secondary Care, Community, Social Services and North West Ambulance Service. Key themes to be taken forward are: 1. Care navigation system redesign of the central access to care services 2. Access to opinion and assessment in a community setting as an alternative to hospital for patients with respiratory conditions 3. Self-management and support for patients with a respiratory condition 4. End to end respiratory pathway developed through respiratory Vision (formerly QIPP) A Musculoskeletal 'Value Stream Analysis event is planned later this month to review and redesign elective hip and knee care pathways. Orthopaedic activity across Wirral has increased over the last 3 years and hip and knee care account for the highest levels of expenditure. Our population is ageing and we want enable people to live independent lives for as long as possible, so it is important that we ensure that the right care pathways for people with hip and knee joint problems are delivered at the right time to enable them to function as well as possible. 5. Faster Projects These are quicker to develop because staff and patients are already involved in development, or because they won t have a significant impact on services or staff. Projects already underway include: Virtual Fracture Clinic - redesign of pathways for appropriate patients who have attended the Emergency Department with a fracture or a suspected fracture. Virtual pathways will be delivered by a Consultant with access to results and X rays. Ear Care following a review of the drop in ear care clinic at Arrowe Park, new pathways will include bookable appointments, advice and intervention and appropriate discharge back to the patient s GP. Percutaneous Tibial Nerve Stimulation (PTNS) / Botox (overactive bladder syndrome) appropriate care will be available closer to home, utilising existing expert community services. This will create capacity within secondary care for more specialist intervention. One Stop Surgery identifying opportunities to provide a one stop approach for surgical procedures where it is clinically appropriate based on success of one stop Hernia service at Arrowe Park. This pathway is well liked by patients and there is an intention to build on this success. Integrated Record of Care (IROC) - single care plan for people with long term conditions and complex needs, to be used across all health and social care services. Being developed with input from patients, carers and professionals. Think Pharmacy launch of a minor ailments scheme within pharmacies to enhance selfcare and reduce the number of minor ailment cases being seen in GP practices and A&E (to include free prescriptions for those that qualify). 3
GP Acute Vising Scheme (in collaboration with North West Ambulance Service): provide a rapid response by GP practices to take over the care of patients that have called an ambulance but do not need to be admitted to hospital (available 24/7). Street Triage: collaborative scheme (between North West Ambulance Service, local police and Cheshire and Wirral Partnership mental health team) to rapidly assess people on the street who have been identified by police or ambulance service as possibly having mental health and substance misuse issues and ensure they are directed to the most appropriate support service (rather than being taken to A&E by ambulance if not appropriate). Intravenous (IV) Antibiotic Service: development of a specialist service to allow patients to receive antibiotic therapy in the community to prevent unnecessary admission to hospital and allow patients to be discharged earlier and receive ongoing specialist treatment at home Other projects in development are focusing on children s integrated care, integrated coordination teams and projects to support people to self-care. 6. Culture and Workforce Domain The Culture and Workforce group (including human resources, managerial representatives and trades union / professional body colleagues) meets regularly to look at how employees within each of the main partner organisations might work differently or more closely together to improve service quality whilst budgets are being squeezed. If you have views on ways in which current practices for joint working could be improved, or ideas about how we could increase staff engagement to help make changes happen, the group would be delighted to hear from you. Please contact roger.nielsen@cwp.nhs.uk Job vacancy clearing house Senior leaders of the main Vision 2018 partner employers have agreed to implement a temporary Local Clearing House procedure (applying only to those partners) in filling job vacancies. The aim is to ensure that all employees who may be deemed at risk as a result of restructuring within their home organisation are given maximum opportunities to secure continuing employment and the retention of skills is maximised. It is intended that the scheme will be introduced within the next month, covering all NHS partner organisations initially and being extended to include the Council as soon as possible after that. Integration demonstrator site funding It has just been announced by Health Education North West that two Vision 2018 bids for demonstrator funding have been successful. One of those will enable the programme to run a highly regarded one day managing complexity workshop for all leaders of professional / clinical teams and also help bolster work on building team effectiveness within Integrated Care Coordination Teams. More information will follow in future bulletins. If you have any questions about Vision 2018, or would like to get involved, please contact WICCG.InTouch@nhs.net or 0151 651 0011 4
Appendix 2. Rapid Community Services
Foundation Trust Programme Update Agenda Item: 18 Reference: WCT14/15-310 Meeting Name: Trust Board Meeting Date: 4 March 2015 Lead Director: Alison Hughes Job Title: Trust Board Secretary Link to Business Plan: Has an Equality Impact Assessment (EQIA) been undertaken & attached? Have the Public & Stakeholders been consulted? Yes No N/A Yes No N/A To Approve To Note To Assure Financial Implications: E.g. What is the Impact on the Trust? Does it provide Value for Money? All costs should be clearly explained in the section below. Dependant on achieving Foundation Trust status. Overall Cost / Pressure: Additional Funding Required: Identified Risks: n/a Overall Income: n/a n/a Funding Already Ring Fenced: n/a Ability to deliver the organisational change to meet NHS policy within the financial envelope and timescales set by Department of Health. Assurance to Board: Programme management arrangements, overall timetable and risks to achieving FT status determined, as set out in this paper. Publish on Website: Yes No Private Business: Yes No Report History Submitted to Date Brief Summary of Outcome Regular report submitted each month
Wirral Community NHS Trust Foundation Trust Programme Update Purpose 1. The purpose of this paper is to provide an update with regard to the trust s progress with its application for Foundation Trust status. General Programme Update 2. The TDA has confirmed that the trust s FT application will be considered by the TDA Board on 19 March 2015. If approved, the trust is required to formally apply to Monitor in writing providing the trust s proposed FT constitution and IBP. Once those documents have been received Monitor will conduct a batching exercise confirming when the assessment phase will formally commence. 3. The IBP (Integrated Business Plan) and LTFM (Long Term Financial Model) were submitted to the TDA at the end of December 2014 and are currently being refreshed to reflect the latest position. 4. The TDA visited the trust in mid-february 2015 to conduct a further review of the trust s CIP plans for 2015/16 and 2016/17 including interviews with selected CIP scheme leads, following the detailed reviews completed in December 2014. 5. The trust s quality governance processes and the QGAF action plan continues to be closely monitored and reviewed by the Quality & Governance Committee on a monthly basis with quarterly reporting to board; last reported at public board on 14 January 2015 (WCT14/15-240) with the next report due in April 2015. 6. The CQC comprehensive inspection action plan following the CQC Chief Inspector of Hospitals inspection in early September continues to be monitored by the Quality & Governance Committee on a monthly basis with quarterly reporting to board; see agenda item WCT14/15-306. 7. The Trust has considered its FT constitution, in readiness for the Monitor assessment, and in particular the appointed governors to sit on the Council of Governors. A series of governor information sessions for public and staff have also taken place during February 2015. Work stream updates Business planning work stream 8. Following submission to the TDA in December 2014, the refreshed versions of the five year IBP and LTFM were presented to the Trust Board in private session in January 2015. The IBP and LTFM are currently being reviewed to include further detail on the new executive structure, the subsequent divisional restructure and key service developments. The TDA has confirmed that the trust will not be required to submit the refreshed versions to them but has advised that Monitor will require them at the start of their assessment phase. 9. Further information requested by the TDA including the draft Commercial Development Strategy, and further information on the divisional restructure was submitted on 16 February. The final Commercial Development Strategy has also been submitted to board, in private session, for final approval. 10. Letters of support from the Trust Chief Executive, Chairman and from the CCG have also been provided to support the Trust s application to Monitor.
Quality work stream 11. The trust continues to monitor both the Quality Governance Assurance Framework (QGAF) and CQC action plans. 12. The CQC identified several areas for improvement and an action plan to address both the must do and should do actions is monitored by the Quality & Governance Committee on a monthly basis. All actions are due to be completed by the end of March 2016. 13. The QGAF action plan is also monitored by the Quality & Governance Committee on a monthly basis. 14. To be authorised as an FT, the trusts needs to have a QGAF score of less than 4 with an overriding rule that none of the four categories of the Quality Governance Framework are entirely amber-red rated. 15. Monitor highlighted two areas of the QGAF as amber/red (partially meets expectations but some concerns on management's capacity to deliver green performance within a reasonable timeframe): 1B is the board sufficiently aware of potential risks to quality 4C is quality information used effectively 16. At a board development session in January 2015, members of the board considered the current QGAF action plan and assurance against the four areas of quality governance. Based on the evidence presented a revised QGAF score of 3.5 was recommended and supported by the committee. 17. The board agreed for a further development session to be scheduled (tentative 8 April 2015) to consider the on-going reduction of scores beyond 3.5 and the required actions. Finance and performance work stream 18. As described above, the trust s five year financial plans were submitted to the TDA in December 2014 and are being refreshed to reflect current service developments. 19. These plans show, subject to the delivery of challenging CIP savings each year of 4-5%, the Trust achieving a relatively small surplus in year 1 of 0.25% rising to 1.25% in year 2 and remaining above 1% for the latter 3 years of the model. This represents a healthy base position in the long term and a continuity of services risk rating of four is maintained for each of the five years of the planning period. 20. The plans are sensitive to assumptions on the delivery of CIP, the annual NHS tariff deflator and pay inflation, however the assumption made in the plans are robust and prudent. 21. Under a so called downside scenario the trust would be able to maintain its surplus, cash balance and risk rating through the delivery of identified mitigating actions. 22. The TDA conducted a review of CIP plans for 2015/16 and 2016/17 in December 2014 and subsequently in February 2015. As follow-up to these reviews, the trust submitted detailed plans including full Project Initiation Documents (PID) and Quality Impact Assessments (QIA) for both financial years. 23. At an extended SMT session in January 2015, the QIA process including an approach to confirm and challenge and a draft CIP policy were also discussed in detail. 24. The trust has undertaken to recover YTD slippage of CIP savings and at the end of M10 YTD savings remain on target achieving 2,586k against the plan of 2,583k, representing 100% delivery of the plan.
25. The trust will be required to complete a refresh HDD2 assessment and it is expected that this will be completed in parallel with the Monitor assessment process. Engagement work stream 26. In readiness for the Monitor assessment the trust is revisiting its FT constitution including plans for the election of governors. 27. Five governor information sessions have taken place during January and February 2015 with good attendance from both staff and public members. 28. The board has also reviewed the proposals for appointed governors to sit on the Council of Governors, giving consideration to statutory requirements and links with local health, social care and voluntary organisations. 29. Given the revised timelines for the TDA assessment of the trust s FT application, it is anticipated that the notice of election will be no earlier than April 2015. The Trust Board Secretary s team continues to stay in touch with the election provider to regularly review the timelines. TDA reporting 30. The trust has submitted its monthly TDA self-certification for January 2015. These were reviewed and approved at the meeting of the Finance and Performance Committee in February 2015 and relate to the month of January 2015. Board action 31. The board is asked to confirm continued support for the FT application process. 32. The board is asked to note and be assured on the progress assure itself that the actions identified are consistent with existing timeframes. Alison Hughes Trust Board Secretary 23 February 2015