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Workstream Highlight eport SOUTH YOKSHIE ND BSSETLW SHDOW INTEGTED CE SYSTEM COLLBOTIVE PTNESHIP BOD Item 23c(c) 13 pril 2018 uthor(s) Sponsor SYB Shadow ICS Workstream Leads Will Cleary-Gray, Sustainability and Transformation Director, SYB sics Is your report for pproval / Consideration / Noting For approval Links to the STP (please tick) educe inequalities Join up health and care Invest and grow primary and community care Treat the whole person, mental and physical Standardise acute hospital care Simplify urgent and emergency care Develop our workforce Use the best technology Create financial sustainability Work with patients and the public to do this re there any resource implications (including Financial, Staffing etc)? N Summary of key issues summary of progress for the Shadow ISC workstreams is included within this report, accompanied by a high level overview of progress to date for each area. It is in addition to the detailed work with each of the work areas and should therefore be read in conjunction with these. It is also intended to support updates to local Boards and Governing Bodies on developments and delivery progress. ecommendations The Collaborative Partnership Board are asked to note and approve the contents of this report. 1

Workstream Highlight eport SOUTH YOKSHIE ND BSSETLW SHDOW INTEGTED CE SYSTEM COLLBOTIVE BOD 13 pril 2018 1. Purpose The purpose of this report is to provide a summary overview of the main focus of activities at a South Yorkshire and Bassetlaw level within the Shadow Integrated Care System (sics) in one document. It is in addition to the detailed work with each of the work areas and should therefore be read in conjunction with these. It is also intended to support updates to local Boards and Governing Bodies on developments and delivery progress. The information has been compiled in conjunction with SOs and programme leads and signed off by SOs for each priority area. Separate reports on finance and the hospital services review will be presented and available. 2. Key issues summary of the progress assessment for the current period is set out as below Shadow ICS Workstream Cancer lliance Children's and Maternity Corporate services Digital and IT Elective and Diagnostics Estates Medicines Optimisation Mental Health and Learning Disabilities Prevention Primary Care Stroke Urgent and Emergency Care Workforce Progress assessment for the current period (G) mber mber Green Green Green Green Green Green mber mber mber mber Green 3. ecommendations The Collaborative Partnership board are asked to consider the report for the sics workstreams and to use this to inform local discussions. Paper prepared by workstream leads On behalf of Sir ndrew Cash Date pril 2018 2

Programme: Cancer lliance Date of report: pril 2018 Provider CEO / CCG O sponsors: Lesley Smith eport completed by: Julia Jessop, Programme Director Progress ssessment Current Period (G) mber Progress ssessment Previous Period (G) mber Plan for 2017-2019 MOU commitments Engagement Progress Next steps over next month Summary of plan and key ambitions Deliver Cancer Taskforce ecommendations. Prepare for ICS. Deliver 8 CWTs. Single integrated assurance framework with NHSE/I. Test integrated commissioning & provision for chemotherapy/fit/lwbc/vague Symptoms. edesign clinical models to deliver rapid assessment and diagnosis timed pathway with associated Cancer Workforce Plan to ensure sustainability. Deliver against key milestones for Early Diagnosis Transformation Programme to increase diagnosis at stage 1 and 2/improve 1 year survival. Integrate Macmillan LWBC programme to ensure delivery of risk stratified follow up, recovery package and selfmanagement. List of MOU commitments and deadline Deliver 62 day CWT 85% lliance level by March 2018 Deliver Cancer Taskforce ecommendations. 62% cancers diagnosed stage 1 or 2 by 2020. Improve 1 year survival. educe emergency admissions. Support introduction of new screening models (FIT/HPV). oll out recovery package and risk stratified pathways (Breast by 2019). Summary of PPE activities undertaken in most recent period (month / quarter) Be Cancer SFE Campaign Summary of achievements from most recent period (month / quarter) Proposal for place based representation a lead commissioner governance arrangements under consideration by the system. Preparations underway for new CWTs and monitoring of 38 IPT and 28 Day FDS. Tripartite 62 day deep dive meetings completed. 18/19 priorities submitted to reflect 25% reduction in transformation funding linked to 62 day performance. Early Diagnosis Transformation Programme: Key milestones delivered Business case for Integrated pathway for lower GI symptoms developed Gap analysis completed with CDGs re rapid assessment and diagnostic pathways for Lung & prostate. System redesign of Upper GI model - Single Operating Procedure agreed and discussions ongoing re regional service model. Initiated pathway improvement work on head and neck pathway. Produced PH1 Cancer Workforce Plan in partnership with HEE Integrated system review of Chemotherapy: Strategic and operational groups established. Scope for chemotherapy review established and resource being secured to support development of case for change. LWBC programme progressing: implementation of ehn & care planning. Summary of planned actions for next period (month / quarter) Confirm ICS functions being adopted by lliance, governance arrangements & identify resource to facilitate Develop composite 62 day recovery report for system and place. Define future performance & assurance arrangements within a mutual accountability framework Finalise funding agreement with national team and review establishment accordingly. Continue to deliver key milestones for early diagnosis workstream Design new models of working with CDGs to implement timed pathways & pathway improvements 3 Further refinement of workforce strategy in association with HEE and elective & diagnostic workstreams

Benefits Initiate integrated commissioner and provider case for change for chemotherapy. ecruit to patient experience posts to develop strategy Design Benefits realisation approach adiotherapy Service Specification anticipated. Development of risk stratified models for follow up of prostate and colorectal cancers. Summary of benefits Tripartite approach to performance, place based conversation and mutual accountability leading to better grip on CWTs and shift to system level focus LWBC: Nearly 700 additional people referred for support in three localities between 2016 and 2017 Planned Savings 2017/18 None Savings Forecast 2017/18 None G Planned Savings 2018/19 None Savings Forecast 2018/19 None G isks National funding for timed pathways not secured limiting the resource available to deliver Pre-mitigation G mber Postmitigation G mber Performance conversations not aligned and continue to focus on organisation not system. mber mber Mitigating ction eprioritisation exercise which will impact on ability to affect stage shift Clarity regarding roles and responsibilities to facilitate implementation of a Single assurance framework Due date pril 2018 pril 2018 esource & expertise to deliver the expanding work programme and ICS expectations; ability to recruit to short term FTC mber mber Organisational buy in to deliver new system models of care mber mber Interdependency with other work streams - require networked radiology, pathology and Inter Trust Messaging to support new models Patient engagement; ability to recruit to Macmillan funded posts. Continue to explore possibilities for alignments of posts within system Governance strategy to support achievement at system not organisational /place level. Identification of Lead CCG Commissioner for Cancer ed mber Collaborative working with associated work streams mber Green Explore alternative hosting arrangements to facilitate longer contract pril 2018 pril 2018 Ongoing pril 2018 Benefits realisation ability to demonstrate/evaluate impact of short term interventions. ed mber Dedicated session planned to devise 17/18 and 18/19 benefits realisation plan. May 2018 4

Programme: Children and Maternity Workstream Date of report: pril 2018 Provider CEO / CCG O sponsors: Chris Edwards otherham CCG John Somers Sheffield Children s Hospital FT eport completed by: Marianna Hargreaves Progress ssessment Current Period (G) mber Progress ssessment Previous Period (G) Plan for 2017-2019 Children s Non Specialised Surgery and naesthesia (CS) To continue to develop a Managed Clinical Network to facilitate a coordinated regional approach to implement the agreed changes to CS to reduce variation and secure delivery in line with Standards. To make best use of the workforce to secure equitable, resilient and sustainable CS services, ensuring management of interdependencies with paediatrics (acutely unwell children). cutely Unwell Child To continue to develop a Managed Clinical Network to facilitate a coordinated regional approach, including the development of standardised clinical pathways and joint work on areas such as management of locum availability, recruitment/retention and communication. Taking into consideration outputs of the Hospital Services eview (HS) and managing the key interdependencies (maternity, CS, neonates and wider urgent care). Maternity To continue to develop the SYB Local Maternity System. To translate the SYB LMS Plan into delivery with mothers, babies and families to realise the vision set out in Better Births. The SYB plan is to improve the quality and safety of provision through a Managed Maternity Clinical Network. To facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care. MOU commitments ll commissioner and provider organisations are signed up to the ICS MOU; within which there is a commitment to collaborative work on Children s and Maternity as set out above. Engagement CS Significant engagement throughout CS review followed by a public consultation. Throughout implementation further consideration of engagement is necessary. cutely Unwell Child Engagement through the HS, following publication the expectation is that further engagement will take place as part of developing site-specific future service models. Maternity Engagement via the Maternity Voices Partnership T&F Group. Two events taken place and an LMS hashtag created. user friendly version of the plan under development. The plan going forward is to where possible facilitate co production. Progress CS Development and agreement of clinical pathways almost complete. Designation visits complete, feedback in progress. CS specification finalised. Designation output shared with JCCCG and they endorsed a 6 month pause on implementation to enable action planning with providers to support hub development, to 5

plan for management of torsions and secure the transport. MCN specification circulated to network members. cutely unwell child HS on track, outline models in development, substantial clinical input via CWGs. MCN fully set up and developing a work plan. MCN funding confirmed for Qtr 1 2018/19. Maternity Final SYB LMS Plan submitted. T&F groups preparing to translate the plan into action, identifying resources for delivery, progressing actions. Project Manager interviews complete, post offered to applicant. Next steps over next month CS MCN to progress clinical pathway sign off and provide all Trusts designation visit feedback. Work with commissioners to enable contractual agreement of CS Specification with action plans. Dialog with ambulance service(s) to secure additional transport. MCN specification to be agreed. efreshed delivery timeline to be confirmed to the Workstream Board, slippage due to capacity challenges in the team. cutely unwell child HS CWG and public engagement event early March. Final report end of pril. Consolidation of MCN workplan. Development of MCN specification and clarification of funding. Progress further commissioner engagement. Delivery timelines aligned to HS, output to enable next stage of planning. Maternity Continue to progress actions in SYB LMS plan through T&F Groups. Secure Project Manager, review options for clinical leadership and LMS infrastructure. Plan stakeholder event and ensure ongoing alignment to HS timelines. Initiate development of a finan ce plan to enable effective use of transformation resources (as outlined in the MOU) to enable delivery of the SYB LMS plan. wait central feedback on LMS plan/trajectories and act upon it. LMS Board to monitor progress on milestones within the LMS Plan. eview the workstream meetings, including Boards to ensure clear roles, responsibilities and accountability. Benefits CS and cutely unwell child - educed variation in current delivery of children s surgery and anaesthesia, and care for the acutely unwell child. Improved safety, effectiveness and continuity of care and experience for children, with increased delivery in line with Standards to improve outcomes. Most effective use of current workforce and delivery of equitable, resilient and sustainable children s services. Maternity The delivery of the SYB LMS plan through the SYB LMS will improve the quality and safety of maternity care through a Managed Maternity Clinical Network. It will facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care that improves outcomes for mothers, babies and families. Planned Savings 2017/18 N/ Savings Forecast 2017/18 N/ G 6

Planned Savings 2018/19 N/ Savings Forecast 2018/19 N/ G isks Capacity & Engagement There is a risk across the workstream that capacity challenges will hinder delivery of plans, in particular the implementation of CS, progression of the network for acutely unwell child and the translation of the SYB LMS plan into delivery. Capacity challenges within the team are also starting to result in wider engagement issues. Managed Clinical Networks There is a risk that without confirmation of funding for 18/19 or actions to address capacity challenges that MCNs will not be able to further develop and therefore not be in position to further develop and deliver their work plans or respond to HS. Pre-mitigation G Post-mitigation G Mitigating ction Due date G The capacity challenges due to the workstream lead and CS programme lead not being in work and limited capacity within the MCN have been flagged to both the SO and ICS Senior Leadership team. plan to look at capacity for CS delivery is under discussion. ecruitment to the Maternity Project Manager is underway (interviews now complete and post offered). Options re clinical leadership and LMS infrastructure to be reviewed thereafter. Funding for the CS network is confirmed within the CS DMBC, the CS MCN specification needs to be finalised and agreed to enable this to be contractually agreed. The importance of the MCN for cutely Unwell Child is to be flagged to the ICS leadership, especially to ensure the system is well placed to respond to the HS recommendations lignment to Hospital Services eview (HS) There is risk that the outputs from the HS will impact on all areas of the children s and maternity workstream and alignment is essential to ensure this is effectively managed. Eg Potential impact on CS implementation (local ability to meet designation standards), Continue ongoing dialog with the HS team to ensure alignment. gree use of Children s and Maternity Workstream Board as conduit to facilitate alignment. Potential impact on development and delivery of the SYB LMS plan, and use of transformation funding. 7

Programme: Corporate Services (Exc Procurement / Informatics) Date of report: pril 2018 Provider CEO / CCG O sponsors: ichard Parker eport completed by: Ben Chico Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) Green Plan for 2017-2019 This workstream has formed part of the Working Together Provider Programme, and is overseen by the Provider Efficiency Group. It relates to collaborative activities across corporate service functions, excluding Procurement and Informatics which have separate project management arrangements in place. Excluding Procurement and Informatics there are six corporate service functions as defined by NHSI; H, Payroll, Finance, Legal, Governance and isk, and Service Improvement / PMO. It was agreed that H, Finance and Payroll should form the priority areas for review. The focus of current and planned activities is: H: Streamlining and Standardisation Project covering; workforce systems (inc e ostering), Mandatory and Statutory Training, ecruitment, Bank and gency Management, Occupational Health, and Pay Band Management. ctive shared service review underway across three Sheffield Trusts covering all sub functions. Finance: Standardisation of ledgers across four of the Trusts to enable increased collaboration with a view to sharing of ledger support function and wider transactional services. Payroll: Exploitation of Salary Sacrifice Schemes across Trusts. Legal: Whilst not one of the agreed priorities in 2017/18, the status of current arrangements and opportunities will be assessed following initial review in 2015. MOU commitments Engagement To become system leaders in implementing operational productivity improvements and increasing focus on reducing unwarranted provider expenditure, including but not limited to the consolidation of corporate services,.. and concerted action to drive better value from NHS procurement. PPE is not relevant to this workstream. Progress In relation to streamlining and standardisation; there have been a number of successes over the last months, including: Completion of collective procurement for provider of non-medical bank across four Trusts, with other to potentially join over coming months. Support to implementation of collaborative medical bank pilot planned to go live in March 2018, delayed to pril. eduction of unwarranted variation across Mandatory and Statutory Training, supporting increased efficiency and enabling passporting. Implementation of factual referencing as a means of reducing time to hire to vacant posts. Development of shared services has proven more challenging. n extensive process to develop shared payroll services (covering 8 BHNFT, DSH and TFT) was closed in January owing to a lack of demonstrable savings. STHFT currently provide payroll to

SCHFT and SHSC, and it has been agreed that Trusts may re-engage directly with STHFT over coming months should a local decision be taken to proceed. n outline case for delivery of H shared services is underway which is currently focused upon the three Sheffield Trusts, with outline business case drafted. DBTHFT are working with DSH to identify functions to collaborate upon as part of Doncaster place based plan. In Finance there has been a move to align Trusts on the same ledger which will act as an enabler to shared services, with formal review to take place in the coming months. Whilst being managed independently, the development of Special Purpose Vehicles forms a key initiative across Trusts and the Provider Efficiency Group has included a standing item to share updates. Next steps over next month To confirm work plans for 2018/19 To agree Benefits eduction of unwarranted variation and associated efficiencies Collaborative procurement savings (eg non-medical bank provider) ssessment of benefits from implementation of shared service Planned Savings 2017/18 N/ Savings Forecast 2017/18 BEING CONFIMED G Planned Savings 2018/19 TBC Savings Forecast 2018/19 TBC G isks Trusts select not to engage in initiatives based upon local risk profile (eg medical bank). Pre-mitigation G Trusts do not implement successfully at local level owing to lack of capacity. G Post-mitigation G Mitigating ction Due date G Trust engagement monitored and reported through to cute Federation. PMO support offered with implementation as well as identification of standardisation opportunities. Ongoing Ongoing Shared services do not move forward owing to savings being considered too low to proceed, or other Trust level rationale. G Trust positions monitored and reported through to cute Federation. Ongoing 9

Programme: Digital Date of report: pril 2018 Provider CEO / CCG O sponsors: ichard Cullen eport completed by: Michael odgers Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) mber Plan for 2017-2019 a. ICS Digital Delivery Framework: Implementation of team, Digital Capabilities and Health Care and eform Benefits Catalogue, Progressing 1 st phase of the agreed programme, ICS Digital Innovation Partnership Procurement Framework b. Population Health Data and Information: Integrated Intelligence Team; Intelligence requirements and data mapping; Technical solution and tools e.g. for collating data, supporting analysis, creating information and presenting intelligence to the system; Data definitions; Coding standards e.g. SNOMED; Information modelling standards e.g. OpenEH c. Interoperability: System integration architecture; Integration platforms; Care flow applications for GPs, Standard for integration, sharing records and data, egional Infrastructure Strategy (networks, storage, desktop, security); Integrated MH Care System d. IG: egional IG/GDP Toolkit; Consolidated Information and Data Governance Policies; Privacy greements e. National programmes; federated approaches to procuring and implementing solutions to meet target completion dates for national programmes: HSCN; WiFi; On-line Consultation; On-line 111 MoU Commitments Enabling People and Patient Empowerment Supporting Clinical and Strategic Decisions Delivering System Integration and contributing to Operational Efficiency Developing Local Health Tech Skills & facilitating Innovation Engagement NHSE Digital aims, funding streams, programmes and plans; North egion Digital Portfolio; NHS England North egion Digital Stakeholder Forum; NHSD national digital programmes priorities and funding options; SYB Partner CIOs and Exec Leads for Digital on SOC LHCE. LHCE kick-off meeting with the core team and the rchitect meeting to start the design process. Bid questions have been allocated for coordination. Fast Follower Bid SHSC have completed their FF bid. The Channel 3 Group engagement for the SOC. D1 - Digital Inclusion meeting with Tom Davison CIO lead scheduled for 10th pril. D2 - Self Health Connect Victoria McGregor iley and ndy Clayton D3 - Technical Interoperability Kevin Connolly, Nigel Hall, Shaun ddy, Simon Marsh D4 - Patient ecords and Sharing Clinical Information Simon March, Stephen Stewart D5 - Predictive nalytics Des Breen, David obinson D6 - Healthcare Co-ordination James awlinson, Philip Easthope, Jon Greatorex D7 Wellbeing and ecovery elationship Management Nicola Haywood-lexander D8 Use and Governance of Information and Data ichard Banks and Sue Meakin D9 Digital Health Innovation Wendy Tindale, Mark Gannon Progress Stakeholder meetings with all workstreams except D1 have been held; Workstream documentation reviewed where this is available; Meetings are scheduled to conclude on 10th pril 2018; Work to establish current digital provision in each place has commenced; Current Digital strategies and summary of current/planned programmes requested some have been provided; 10

Next steps over next month Potential dates for workshops in next stage gathered. Develop strategic case section of SOC; Develop patient scenarios to demonstrate information flows; Develop strategic options; Hold options review workshops; Confirm preferred strategic option(s). Benefits LHCE bid drafted, tested and submitted. D4 governance setup based of the ETTF success. B2.1 Increased patient control of own care; B2.2 Increased patient choice; B2.3 More effective use of GP appointments B3 1 educe in infrastructure costs; B3.2 eduction in cost lost to lack of access to records, data and information B4.1 eduction in &E attendances; B4.2 eduction in non-elective admissions; B4.3 eduction in UEC activity B5.1 Quicker clinical intervention across all regional service user pathways; B5.2 Better commissioning decisions B6.1 Better healthcare co-ordination; B6.2 educe treatment waiting times; B6.3eduction in the intensity of care packages and associated costs; B6.4 eduction in admissions to residential/care homes B7.1 Improved wellbeing of citizens; B7.2 Increased likelihood of, and accelerated recovery rates; B7.3 educe rates of relapse, and admissions to crisis care; B7.4 educe Premature Mortality in people with PSMI) and/or Learning Difficulties B.8 Maintain/Increase Public Trust Planned Savings 2017/18 2.5M for GP interoperability and care flow capabilities for Barnsley, Sheffield and Bassetlaw 195k for GP public Wifi for all 5 CCGs These have arisen from taking a federated rather than individual approach to procurement. Savings Forecast 2017/18 2.5M to be confirmed following EETF funding decision by NHSE on 15 th March 195k achieved G Planned Savings 2018/19 TBC following development of SOC Savings Forecast 2018/19 TBC following development of SOC G isks Dedicated resource and budget is required to drive the programme Challenge in articulating benefits of digital interventions in isolation. They are key enablers to system level changes Pre-mitigation G Post-mitigation G Mitigating ction Due date G The Digital Steering Board have review and endorse the Programme Director s proposal for as lean as possible core team. The Chair and Programme Director will present proposed organisation and costs to ICS SMT in March 2018, with options for financing The Strategic Outline Case will include a benefits section. The benefits will have been developed with clinical stakeholder, Workstream leads and the Population Health Integrated Intelligence Team June 2018 June 2018 11

It is proving very difficult for the wider team of CIOs who are contributing to the leadership of the intervention across the programme to find any time to work together on their respective projects. G It is being proposed that quarterly planning days or monthly half days are held where CIOs leading on current priorities, their technical deputies the programme director and her team work together to refine individual project forward plans and interdependencies across the overall programme and to determine and review time critical milestones, dedicated resource requirements and budgets. pril 2018 12

Programme: Elective and Diagnostics Date of report: pril 2018 Provider CEO / CCG O sponsors: Idris Griffiths, ichard Jenkins eport completed by: Jade ose Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) Green Plan for 2017-2019 1. Efficiencies through Optimising Demand 2. Outpatient Efficiencies 3. Delivering key diagnostic wait and TT standards. MOU commitments Engagement Delivery of the constitutional standards for diagnostic waits and referral to treatment. (blank) Progress Commissioning for Outcomes - revised final version of the SYB commissioning for outcomes policy (including clinical threshold procedures) has now been agreed by all of the 5 Governing Bodies and is in implementation phase across SYB. The working group continue to meet to revise any issues that arise through implementation. Echocardiography ecovery - Working Group has been established. SOP to allow DGHs to relieve waiting list pressure for STH has been developed and some additional activity has been arranged to repatriate patients to local providers in Barnsley and Doncaster. capacity and demand analysis has commenced to identify the level of backlog and on-going capacity gap. STH have developed an internal recovery plan to support achievement of the SYB target. funding bid has been successful to pilot an SYB training programme. It has been agreed that the key areas of focus going forward are; SYB training plan; SYB clinical guidelines (clinical workshop to be arranged); adiology - high level action plan has been agreed following the Strategy way Day held on the 25th February. ight Care and GIFT - CVD project team has been created and is scoping out the programme of work to improve outcomes for patients with CVD Endoscopy (FCP) - clinical workshop was held on 28th February to agree a single integrated model for Lower GI symptoms. This is now being discussed with individual CCGs for clinical support and the full business case is in development. Transforming Outpatients - Data pack shared with CCGs to identify areas of opportunity. Orthopaedic follow up - workshop was held on 28th March. Excellent representation from across SYB. number of actions were agreed with a general consensus that there is unwarranted variation taking place across SYB. Next steps over next month Confirm 18/19 priorities and resource allocation Echocardiography - Finalise capacity analysis. Develop SYB training programme plan. rrange workshop to agree clinical guidelines Outpatient Transformation - agree specific areas within programme of work and consider how to resource programme for 18/19. Integrated Lower GI pathway - Develop SYB business case for integrated Lower GI pathway for agreement. Implement pathway (aligned to Cancer lliance Board). Ongoing engagement across SYB Orthopaedics - Develop data pack and agree action plan. Hospital Services eview - Understand outputs of Hospital Services eview and implications for E&D workstream 13 adiology - develop detailed work programme. ttend and present at national radiology workforce conference. Develop

PCs manager network across SYB. Commissioning for Outcomes - Meet with Commissioning Managers to review implementation of policy ight care / CVD - develop clear narrative for this work based on health inequalities and outcomes across SYB and develop an action plan to respond to this. Benefits Improved access to treatment for patients. Improved health outcomes through access to evidence based care. Improved patient experience by improving the effectiveness of health care contacts. Improved financial sustainability by optimising care delivery and removing unwarranted activity. Planned Savings 2017/18 17.29 Savings Forecast 2017/18 10.87 ed Planned Savings 2018/19 In Dev Savings Forecast 2018/19 In Dev G isks Increasing Financial Challenge Premitigation G B Postmitigation G B Mitigating ction Continual investigation and development of new initiatives to close the gap. Close monitoring of savings performance and forecast delivery against targets. Due date Pace of delivery is limited by supporting workstream resource. Consider suitability of secondments, interim appointments or consultants. 14

Programme: Estates Date of report: pril 2018 Provider CEO / CCG O sponsors: Chris Edwards eport completed by: ichard Taylor Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) Green Plan for 2017-2019 Development and agreement of the SY & B Estates Strategy to support transformational change across the area, including focusing on Implementation of estates priorities emerging from clinical workstreams and delivery of new models of care Developing a coordinated approach to identification of needs and Capital Investment including strategic prioritisation Optimisation/Utilisation of NHS/LIFT/PFI estate and local plans to divest of poor quality assets Development of and execution of ICS Disposals Strategy and approach to re-investment of proceeds Development of appropriate structures to enable estates activities to support sics priorities. Development of sics approach to Maintenance backlog MOU commitments Unknown Engagement PPE is associated with specific clinical activities and not directly undertaken by this workstream Progress Next steps over next month Benefits Q review of the SY&B Estates workbook completed Estates workbook aligned with capital bidding process Capital prioritisation matrix agreed Support for appropriate capital business cases Support workstreams in their understanding and articulation of the estates impact Develop a sics wide Primary Care estates strategic view Continue to promote strategies and approaches to enhance utilisation/optimisation of the core NHS estate Continue the development of the Estates workbook into an Estates Strategy, meeting the new DH content/format Work across the sics to ensure a pipeline of disposals across the plan period Further develop the links with SC Estates Transformation Strategy. consensus view around estate priorities and their role in wider transformation Enhanced clarity on the SY&B capital ask Business case support and a context for decision making Development of a pipeline for disposals inc the release of land for housing Supporting change to help increase the utilisation of NHS fixed assets/costs (e.g. reducing the annual costs (approx. 3.5M) of voids in NHS PS and LIFT Planned Savings 2017/18 tbc Savings Forecast 2017/18 tbc G 15

Planned Savings 2018/19 tbc Savings Forecast 2018/19 tbc G isks Lack of alignment with clinical workstreams due to lack of engagement Under developed Primary Care service vision Pre-mitigation G Post-mitigation G Mitigating ction Due date Continue to engage and build relationships with workstreams Support the PC Estates strategy development process recently launched Ongoing May 2018 Data sources are fragmented and under developed Continue to build plans for data validation and consolidation Ongoing Lack of resources to deliver key estates projects/outcomes G Optimise external and partner resources Ongoing Critical maintenance backlog Develop pan-sics thinking on options for resolution July 2018 16

Programme: Meds Optimisation Workstream Date of report: pril 2018 Provider CEO / CCG O sponsors: Idris Griffiths eport completed by: Francis Maietta Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) Green Plan for 2017-2019 This workstream set out 5 key interventions: 1. Prescribing Cost eductions - to generate direct savings linked specifically to medicine costs. 2. Pathway edesign - to improve medicines management related to health efficiencies & patient care. 3. pplying Guidance to identify medicines related areas suitable for guidance across SYB. 4. Effective use of medicines related NHS resources - to review medicines related resources and ensures resources are optimised 5. Optimise the management of the interface between primary and secondary care initiatives and innovations - to maximise the use of medicines related systems across the interface MOU commitments Manage improvements within a shared financial control total and maximise the system-wide efficiencies necessary to manage within this share of the NHS budget. Integrate services and funding, operating as an integrated health system, and progressively to build the capabilities to manage the health of the ICS defined population, keeping people healthier for longer and reducing avoidable demand for healthcare services. ct as a leadership cohort, demonstrating what can be achieved with strong local leadership and increased freedoms and flexibilities, and to develop learning together with the national bodies that other systems can subsequently follow. Engagement Engage with provider pharmacists and ophthalmologists across SYB Develop and target media messages focused on primary care prescribing for patient groups and their significant others within SYB to enable them to better take up self-care. Progress Steering Committee sat for its monthly meeting on the 21 March 2018 Steering Committee reviewed 3 proposition papers on a gap analysis of the consultation across all 5 CCGs. o Commissioning Position on 3 Consultations. Members noted the item which absorbs most costs systematically for all CCGs is fentanyl and a greater management of its prescribing would have the greatest impact in the regional prescribing costs. discussion was undertaken regarding the prescribing by Provider s and how this could be raised at an ICS level to take this forward and promote a change in prescribing culture. The cost savings opportunities from reducing gluten free items are up to c. 613k across SYB. CCGs across SYB have started to align their guidelines with the NHS consultations and the gap analysis suggests that CCGs have started making a start in changing their OTC prescribing. o Biosimilar: Medicine spects Currently, a range of gain share agreements have been mapped across the five SYB CCGs. These range from zero savings shared to between 20% and 80% of savings shared, which are dependent on the period. o vastin Three scenarios for the prescribing of vastin were discussed by the group. Steering Committee reviewed its financial position of 2017/18 from each CCG and the planned savings for 2018/19. The HoMM leads updated the Steering Committee on the progress and next steps specific to their invention area. 17

Next steps over next month Interact with the sics Comms team and agree the plan and resource required to develop a targeted media strategy and public engagement activities aligned to two of the workstream s interventions (1) pplying NHS Consultation guidance and (2) Optimise primary/secondary care interface. Work will be delivered in Q1 2018/19 (pril to June) within a controlled environment project management structure ensuring value for money is created and captured. Programme Lead to design and circulate a template of a delivery plan for 2018/19. ll HoMMS to send before the end of March 2018 all expected outcomes and milestones specific to their intervention area for the 6-motnh period (pril to Sept 2018). Quality Impact ssessments will be carried out with each CCG for each of their QIPP plans. QI will be added to the Steering Committee s pril agenda. Programme Lead to write the Job Brief for a fixed term Programme Lead with the responsibility to support the delivery of the workstream s oadmap and Implementation Plan Set up admin support at Sheffield CCG offices to enable close working relationships with other workstreams and sics support Steering Committee to review and update at its monthly meetings: isk Log, Monthly Highlight eport, Quality Impact ssessments, ecommendations for Governing Body and Delivery Plan 2018/19 Workstream to support and engage with enabling sics workstreams, namely: Comms (National consultation on NHS spending on low priority prescriptions) Benefits educe Waste educe Financial Pressures educe unwarranted variations across SYB Planned Savings 2017/18 15.34m Savings Forecast 2017/18 17.22m Planned Savings 2018/19 15.29m Savings Forecast 2018/19 TBC G isks esource support to work with the Steering Committee to deliver the Programme Plan Q1 2018/19 Premitigation G Postmitigation G G Mitigating ction Due date Engage interim Programme Lead until end pril 2018 03/04/18 18

Programme: Mental Health & Learning Disabilities Date of report: pril 2018 Provider CEO / CCG O sponsors: Kathryn Singh & Jackie Pederson eport completed by: Sarah Boul Progress ssessment Current Period (G) Green Progress ssessment Previous Period (G) Green Plan for 2017-2019 The workstream reviewed its workplan in January this year, and agreed the priorities for 2018/19 as follows: 1. Perinatal mental health: we are currently finalising a bid for a specialist community perinatal service across Doncaster, otherham and Sheffield, for submission by 09 March 2. Children and young people s mental health crisis care: covering all crisis pathways including section 136 assessments, intensive home treatment and specialist placements 3. Out of area placements (OPs): starting with setting trajectories for the elimination of non-specialist acute placements as required by NHS England; and scoping the opportunities as regards complex dementia care, secure placements and Tier 4 CMHS beds (linked to the work on improving alternatives to admission included in point 2 above) 4. Developing an ICS-wide SD and DHD service: with further consideration of whether this is an adult or all age service, building on existing provision 5. Improving employment support for people with mental health problems: with a focus on securing NHS England transformation funding for individual placement and support (IPS) for people with severe mental illness (SMI) either in wave 1, for which a bid was submitted at the end of February, or wave 2 whenever this is announced The workstream has also submitted a bid for targeted suicide prevention funding, to reduce our suicide rate by 10%, and we are awaiting the outcome of this. The indicative allocation for SYB for this was 555,622, and we have been told verbally that this would be recurrent for three years. If successful, this will be added to the workplan. Whilst these are the priority delivery areas, it is recognised that there is a wider mental health and learning disabilities agenda which will be supported through a networking and sharing best practice approach. The workstream will also maintain an oversight function through development of the mental health dashboard, which will support the identification of emerging problems and the impact of service developments. Two further strands of work will support the workforce and data and finance elements of the SYB mental health and learning disabilities programme. Lastly, the SYB mental health and learning disabilities programme will aim to increase collaborative working across the wider sics throughout 2018/19. This work is already underway with joint working between the MHLD and U&EC work streams on the integrated care hub within NHS 111. MOU commitments Increasing access to psychological therapies, so that at least 16.8% of people with common mental health conditions access psychological therapies in 2017/18, increasing to 19% in 2018/19 Increasing access to NHS commissioned community mental health services for children and young people, so that 30% of children and young people with a diagnosable mental health condition receive treatment from NHS-funded community mental health services in 2017/18, increasing to 32% in 2018/19, and meeting standards for access to eating disorder services 19

Implementing physical health checks for people with severe mental illness (SMI): demonstrating delivery against local plans and trajectories, in line with national ambition of 140,000 people with SMI receiving complete list of physical checks in 2017/18 and 280,000 in 2018/19 Meeting standards for access to early intervention in psychosis services Developing specialist perinatal mental health provision including mother and baby units (where present in the ICS) and community teams Ensuring ICS wide coverage of 24/7 community crisis response and intensive home treatment teams as a genuine alternative to admission by 2021. From pril 2018, delivering a one third reduction year-on-year in adults sent out-of-area for nonspecialist acute mental health care, towards eliminating this practice by 2021 Making demonstrable progress on delivering a workforce plan that meets national ambitions for increased mental health staffing including, therapists in primary care and staff to support expanded services, as set out in Next Steps Engagement PPE focus groups were held as part of the development of the IPS for SMI bid. PPE involvement will be a crucial part of the further development of the suicide prevention bid. Progress eview and further development of the workplan as described above Submission of bids for IPS for SMI, suicide prevention funding and perinatal mental health funding Improved engagement with local authority partners and voluntary and community sector through the IPS and suicide prevention bid development processes Further engagement with Health Education England to support development of the mental health workforce plan Next steps over next month Finalisation of end of year summary of the MHLD workstream s work to date and delivery of the proposed project plans for the priority delivery areas Outcomes from IPS for SMI, suicide prevention and perinatal mental health bids expected and implementation groups will begin to be set up as appropriate greed trajectory for improvement to ensure the elimination of out of area placements within acute mental health inpatient services by 2020/21 will be signed off by end of pril 2018 Work with Health Education England to scope training place allocations for IPT staff across the sics will be undertaken The first workforce and data and finance group meetings will be held The development of a comms strategy for the MHLD workstream for 2018/19 will be initiated Benefits Increase in access to mental health services Improvement in the experiences of people with mental health problems Care closer to home, with associated reductions in costs eduction in UEC activity for people with mental health problems Planned Savings 2017/18 2.1m Savings Forecast 2017/18 TBC G 20

Planned Savings 2018/19 5.5m Savings Forecast 2018/19 TBC G isks Pre-mitigation G Post-mitigation G Mitigating ction Due date Programme support for 2018/19 not secured Work with NHS England to align resources 30/04/2018 Failure to secure transformation funding for identified work areas Identify funding going into CCG baseline 30/06/2018 21

Programme: Healthy Lives, Living Well and Prevention workstream Date of report: pril 2018 Provider CEO / CCG O sponsors: John Mothersole eport completed by: Gilly Brenner Progress ssessment Current Period (G) mber Plan for 2017-2019 Three key priorities identified and signed off at CPB on 12/01/18. 1) Embedding the treatment of tobacco dependence in secondary care 2) Systematic quality improvement in the identification and management of clinical risk factors for cardiovascular disease To address unwarranted variation and drive quality improvement in detection and management of high risk conditions relating to CVD at scale through primary care (including wider primary care team eg pharmacists), self-care and community interventions. 3) Expansion of social prescribing Many patients attending health and social care service have non-clinical issues that are affecting their health and wellbeing (eg social isolation, debt or housing problems) and can lead to high usage of health/social care services. Social prescribing is a way of connecting patients to non-medical forms of support (eg community and voluntary sector services) and of empowering patients to enhance their own wellbeing. Developing the social prescribing offer in SY&B is also a priority in 3 other sics transformational workstreams charters: Primary Care; Mental Health; and Urgent and Emergency Care. Other areas of work in this workstream are continuing through Place-based plans led by the Local uthorities, and work and health through the Sheffield City egion. MOU commitments Engagement Progress Next steps over next month Benefits MOU with NHSE re social prescribing N/ 1) Tobacco: Paper prepared to describe plan for treatment of tobacco dependence in secondary care. Supported by UEC board (26/2/19) and cute Federation Chief Executives meeting (5/3/18). 2) CVD: Mel Earlam from PHE supporting CVD project by looking at size of the prize implications locally and reviewing best practice. lso linked to work with E&D workstream around CVD right care supported by NHSE. Specification with Embed awaiting decision with regards to whether they will carry out further analysis at practice level. 3) Social Prescribing: waiting the outcomes of nationally submitted bids from December 2018. MOU with NHSE being progressed. Held 2 workshops (with primary care workstream) and identified 2 priorities: a) Developing a SY&B social prescribing strategy and linked strategy for investment b) Developing a framework for measurement and monitoring of outcomes 4) Programme management support secured on temporary basis from NHSE for band 8b 2d/wk, to be reviewed in 3m and 6m from pril 2019. 1) Tobacco: SY&B QUIT steering group to be convened inc. trust CQUIN leads, clinical champions, L PH tobacco leads. Group to support CQUIN implementation and develop business case for investment to systematically deliver QUIT. Trust boards to sign off NHS Smokefree pledge commitment. 2) CVD: Continued input from PHE and NHSE to determine best approaches for CVD prevention in primary care. 3) Social Prescribing: waiting the outcomes of nationally submitted bids from December 2018. Working groups to be initiated to work on the priorities agreed. NHSE resource available to recruit support for this, but further work required to determine the nature of the support required. 1) Tobacco: Impact: eduction in preventable mortality and huge burden of avoidable illness associated with smoking. 22

Target: educing smoking prevalence from current baseline to 10% and smoking in pregnancy to 0%. 2) CVD: Impact: Contribute to avoidance of 19,000 CVD-related hospital events by increasing the identification and management of hypertension, F and lipids in line with NICE guidelines. Target: By reducing average population blood pressure by 5%, reducing average population total cholesterol by 6% and increasing the proportion of people with diagnosed high blood pressure, cholesterol and atrial fibrillation who achieve NICErecommended reductions in blood pressure and cholesterol, and high rates of anticoagulation in atrial fibrillation. 3) Social Prescribing: Impact: reduction in health inequalities and an improvement in health and wellbeing by supporting residents to address wider determinants of health and take control of their own health. Decrease social isolation and low level mental health issues such as depression and anxiety. Decrease the use of health and social care services by residents who attend frequently with nonclinically related issues. Support the discharge of patients from mental health services. Free up health care professional time in primary care and widen the skill mix of the primary care team. Target: To increase access for a wider range of residents of SY&B to social prescribing as a gate way to accessing non-medical forms of support and to empower clients to enhance their own wellbeing. Planned Savings 2017/18 TBC Savings Forecast 2017/18 TBC G Planned Savings 2018/19 TBC Savings Forecast 2018/19 TBC G isks Pre-mitigation G Lack of dedicated programme management support: Unable to allocate capacity to attend workstream leads meetings, or complete PMO documentation. Programme work not at place-level is being driven by public health registrar on placement until pril (was only 1d/wk) and capacity from Public Health Consultant which is impacting on her ability to support ICS health care commissioning. Tobacco dependence work requires significant resource and trusts may be unable to fully fund alone. CVD requires dedicated project management and widespread clinical engagement. Post-mitigation G Mitigating ction Due date NHSE have provided temporary post (fc 8b) to support the programme at 2d/wk from 01/04/18 for unspecified length of time, to be reviewed at 3m and 6m. ICS funding of 18.4K will be used to initially support the programme eg for training of clinical leads. Business case to be drawn up in collaboration with trusts. PHE support currently determining what CVD prevention work is taking place in each area. No further project management resource identified. 23