Invest and grow primary and community care. Develop our workforce

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Item 21b(c) Workstream Highlight Report SOUTH YORKSHIRE ND BSSETLW SHDOW INTEGRTED CRE SYSTEM COLLBORTIVE BORD 8 June 2018 uthor(s) Sponsor SYB Shadow ICS Workstream Leads Will Cleary-Gray, Director of Sustainability and Transformation, SYB sics Is your report for pproval / Consideration / Noting For approval Links to the STP (please tick) Reduce 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. Recommendations The Collaborative Partnership Board are asked to note and approve the contents of this report. 1

Workstream Highlight Report SOUTH YORKSHIRE ND BSSETLW SHDOW INTEGRTED CRE SYSTEM COLLBORTIVE BORD 8 June 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 SROs and programme leads and signed off by SROs 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 Pathology Prevention Primary Care Research and innovation Stroke Urgent and Emergency Care Workforce Progress assessment for the current period (RG) mber mber Green Green Green Green Green Green Green mber Green Green mber mber Green 3. Recommendations The Collaborative Partnership board are asked to consider the report for the sics workstreams and to use this to inform local discussions. 2

Paper prepared by workstream leads On behalf of Sir ndrew Cash Date June 2018 3

Programme: Cancer lliance Date of report: May 2018 Provider CEO / CCG O sponsors: Lesley Smith Report completed by: Julia Jessop, Programme Director Progress ssessment Current Period (RG) mber Progress ssessment Previous Period (RG) mber Plan for 2017-2019 MOU commitments Engagement Progress Next steps over next month Summary of plan and key ambitions Deliver Cancer Taskforce Recommendations. Prepare for ICS. Deliver 8 CWTs. Single integrated assurance framework with NHSE/I. Test integrated commissioning & provision for chemotherapy/fit/lwbc/vague Symptoms. Redesign 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 sustained through 18-19 Deliver Cancer Taskforce Recommendations. 62% cancers diagnosed stage 1 or 2 by 2020. Improve 1 year survival. Reduce emergency admissions. Support introduction of new screening models (FIT/HPV). Roll out recovery package and risk stratified pathways (Breast by 2019). Summary of PPE activities undertaken in most recent period (month / quarter) Initiating patient focus group for chemotherapy and prostate pathways. GP education events to prepare for implementation of FIT/lower GI pathway. Patient engagement co-ordinator and officer appointed. Summary of achievements from most recent period (month / quarter) Composite 62 day recovery plan developed to support securing delivery of Q1 62 day performance including impact of national breast cancer screening recall. 62 Day Deep Dive follow on meetings established. 18-19 funding agreement released from National and Regional team (25% reduction in Q1&2 linked to performance). dditional 371 National Support Funding secured to implement timed pathways and remote monitoring. Place representation at board and scope of service for system wide commissioning under consideration by the system. SCT Integrated commissioner and provider case for change workshop planned 24 th July 2018. New CWT system activated. Shadow monitoring of 38 IPT (breach allocation policy) and 28 Day FDS. Early Diagnosis Transformation Programme: Key milestones delivered. Benefits realisation workshop scheduled to ensure the impact of transformation work streams can be evaluated e.g. vague symptoms Business case for Integrated pathway for lower GI symptoms agreed at Early Diagnosis Steering Board Place based implementation plans being developed for rapid assessment and diagnostic pathways (lung, prostate, lower GI) Urology services Review scoping underway to re-design pathway to ensure equitable and consistent access to joint clinics. Initial meeting to identify improvements for head and neck pathway. Patient engagement co-ordinator and project officer successfully recruited. 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 Tripartite oversight of 62 day recovery plan to secure May/June/July 62 day performance and associated transformation funds. Continue to deliver key milestones for early diagnosis workstream. Place based checkpoint meetings established for July 2018. Design new models of working with CDGs to implement timed pathways & pathway improvements

Benefits Develop Ph2 workforce strategy in association with HEE and elective & diagnostic workstreams Radiotherapy Service Specification anticipated. Formal ratification of risk stratified models for follow up of prostate and colorectal cancers. Review of governance structures to ensure alignment with sics ambitions. 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 Risks Potential for transformation funding to be reduced further (linked to 62 day performance) limiting the programme capability Pre-mitigation RG R Postmitigation RG Mitigating ction System response enacted to try and secure system achievement in May, June and July 2018. Reprioritisation exercise undertaken to reflect reduced funding. National Support funding agreed but utilisation restricted to implementing RPID pathways and remote monitoring Due date July 2018 Ongoing May 2018 Performance conversations not aligned with regulators leading to fragmentation and a focus on organisation not system. Focus on operational recovery issues detracts from implementing transformation programmes G G Conversations ongoing to agree future tripartite arrangements with NHS E and NHS I Ensure PMO maintains a focus on transformation and that resources are deployed to provide headspace for organisations May 2018 Ongoing Organisational buy in to deliver new system models of care. The CDGs have highlighted concerns that they do not feel empowered to enact change in their organisation G Ensure governance arrangements aligned at system and place to enable one conversation across all levels Ongoing Interdependency with other work streams - require networked radiology, pathology and Inter Trust Messaging to support new models R Collaborative working with associated work streams. Transformational funding not available unless 62 performance recovered. Ongoing Benefits realisation ability to demonstrate/evaluate impact of short term interventions. R Dedicated session planned to devise 17/18 and 18/19 benefits realisation plan. Ongoing

Programme: Children and Maternity Workstream Date of report: May 2018 Progress ssessment Current Period (RG) mber Provider CEO / CCG O sponsors: Chris Edwards Rotherham CCG John Somers Sheffield Children s Hospital FT Report completed by: Marianna Hargreaves / James Scott Progress ssessment Previous Period (RG) 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 Review (HSR) 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 HSR, 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. dditionally, engagement through the HSR as per acute paediatrics above. Progress CS Development and agreement of clinical pathways almost complete. Designation visits and feedback complete, awaiting action plans. CS specification finalised. Designation output shared with JCCCG March 2018 and they endorsed a 6 month pause on implementation to enable action planning with providers to support hub development, to plan for management of torsions and secure the transport. MCN specification finalised. Initial transport meeting complete, numbers still to be revisited and operational protocols to be developed. cutely Unwell Child HSR reported on schedule May 2018, substantial clinical input via CWGs. Report recommends consideration of reconfiguration in some paediatric services, plus evolution of MCN into Hosted Network therefore network will play a key role in taking all HSR responses forwards. MCN finalising work plan. MCN funding confirmed for Quarter 1 2018/19. Maternity Final SYB LMS Plan submitted, positive regional feedback. T&F groups translating the plan into action, identifying resources for delivery, progressing actions. Project Manager in place and induction underway. Clinical leadership to be progressed by PM. Trajectories under development to submit end of May. HSR report recommends consideration of choice re Better Births, with possible downstream reconfiguration issues for some services, plus evolution into Hosted Network. greed streamlined workstream governance including co located wider workstream and LMS Boards. Next steps over next month CS MCN to progress clinical pathway sign off and secure action plans from each Trust. Continue to 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. Refresh timeline, include slippage due to capacity challenges and agreed pause to undertake work identified during designation process. cutely Unwell Child HSR follow up work Network development, beginning to consider (with HSR team) reconfiguration aspects. Consolidation of MCN work plan. Development of MCN specification and clarification of funding funding beyond Q1 18-19 remains uncertain and a key risk. Delivery timelines aligned to HSR, output to enable next stage of planning. Commissioner workshop to be rescheduled.

Maternity Continue to progress actions in SYB LMS plan through T&F Groups. Project Manager to progress options for clinical leadership and LMS infrastructure. Support MVP group to consider engagement approaches. Develop a plan to enable effective use of transformation resources (as outlined in the MOU) to enable delivery of the SYB LMS plan. ct upon positive regional feedback on LMS plan. Continue to monitor progress on milestones within the LMS Plan. Delivery timelines aligned to HSR, output to enable next stage of planning. sics Exec SG June 2018 to consider proposed new workstream governance thereafter, implement including co located Children s & Maternity and LMS Boards. Benefits CS and cutely Unwell Child Reduced 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. Risks Pre-mitigation RG Post-mitigation RG Mitigating ction Due date 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. R Cover for Programme Director, plus CS workstream lead (original incumbents both absent) continues to be provided from within the ICS. Cover for Maternity has improved with PM appointment. Maternity Project Manager recruited (started 8 th May). Options re maternity clinical leadership considered by LMS Board and LMS infrastructure to be reviewed thereafter. 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 G Funding for the CS network is confirmed within the CS DMBC. MCN specification to be finalised and agreed to enable this to be

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 HSR. contractually agreed. Concern re: funding for Unwell Child MCN interim funding for lead and manager agreed for Q1, nothing thereafter.this has been flagged to the ICS leadership, especially to ensure the system is well placed to respond to the HSR recommendations lignment to Hospital Services Review (HSR) HSR outputs likely to impact on all areas of the children s and maternity workstream; alignment is essential to ensure this is effectively managed. E.g. potential impact on CS implementation (local ability to meet designation standards); potential impact on development and delivery of the SYB LMS plan, and use of transformation funding. R Continue ongoing dialog with the HSR team to ensure alignment. gree use Maternity and Children s Board Board as conduit to facilitate alignment.

Programme: Corporate Services (Exc Informatics) Date of report: May 2018 Provider CEO / CCG O sponsors: Richard Parker / Sir ndrew Cash Report completed by: Ben Chico (Non Procurement) /Paul Ralston (Procurement) Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) Green Plan for 2018-2019 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 are managed as separate projects. separate highlight report has been submitted for Procurement. Excluding Informatics there are six corporate service functions as defined by NHSI; HR, Finance, Procurement, Payroll, Legal, Governance and Risk. Corporate service workstreams aim to support Trusts in meeting efficiency and productivity requirements as well as enabling wider ICS service transformation. The Provider Efficiency Group is overseeing the analysis of NHSI Benchmarking information in order to identify further efficiency opportunities across corporate services. Whilst being managed independently by Trusts, 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 and knowledge. The current focus of planned activities for 2018/19 are: HR: o To ensure compliance with emerging national streamlining objectives (MST, recruitment, OH and Doctors in Training). o To target reduction in unwarranted variation across systems, policies and processes. o To deliver a collaborative temporary staffing strategy on behalf of SYB. o To provide an advisory role to the ICS and Local Workforce ction Board on HR matters, and to support in delivery of associated workforce transformation objectives as required (including alignment of Place vs System level workstreams). o To deliver integrated services where this can be shown to support sustainability and efficiency. Finance: Standardisation of ledgers across four of the Trusts to enable increased collaboration with a view to future sharing of ledger support function and wider transactional services. Payroll: Exploitation of Salary Sacrifice schemes across Trusts, and further review of opportunities to consolidate services. Legal: Reassessment of current arrangements and opportunities following initial review in 2015. Procurement: To continue to drive increased standardisation and decreased variation across the procurement portfolio in line with Carters recommendations. This will be achieved through increased collaborative procurements and better use of data [PPIB]. The collaborative procurement will not only increase the opportunity to attract lower pricing through greater commitment but will also reduce the resource required to achieve it. Focus for the 18/19 plan is split equally between traditional medical/surgical opportunities and wider non clinical projects which will be of benefit to both the acute providers and the Mental Health and Community Trusts. Because of the length of time some of the projects take to scope, market test, quantify and embed the 18/19 pan Trust work-plan will have fewer projects. The Future Operating Model which replaces the existing arrangements with NHS Supply Chain will commence in full in October 2018 and as yet it is not fully understood what impact this will have on individual procurement teams but collaborative purchasing will continue as it is proven to provide realistic cash releasing 1

focus for the Trusts. MOU commitments Engagement Progress 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. Relevant service stakeholders are engaged during initiatives. In 2017/18, efficiencies valued at up to 1.9m were delivered by Trusts enabled by Working Together Corporate Service Workstreams (exc procurement). Recent progress over the last period is set out below; HR: collective procurement for non-medical bank management was completed across four Trusts in pril (CRHFT, DBTHFT, SCHFT, STHFT). This was awarded to NHS Professionals with a combined saving of 389k.Other Trusts which currently operate in-house models are now reviewing the opportunity to join agreement and associated activities. six-month pilot of collaborative medical bank commenced in May across four SYB Trusts (BHNFT, CRHFT, SCHFT, STHFT) plus NLG. This is an innovative concept testing the scope to convert agency to bank spend. 135 medics have registered to date and bookings have commenced. Mandatory and Statutory Training: Trusts have aligned to national core skills framework and with a view to accepting passporting of training between organisations. Recruitment: Trusts have implemented factual referencing as a means of reducing time to hire and report this to PMO. Retention: review has commenced to identify and recommend standardisation of best practice across Trusts. n outline case for delivery of HR shared services is underway which is currently focused upon the three Sheffield Trusts, with outline business case drafted. Payroll: Standardisation of salary sacrifice schemes during 2017/18 with further developments planned in 2018/19. Finance: Current project plan is for all Trusts to be live on the new system by the end of June 2018. System testing currently being undertaken, with issue of system resilience highlighted as a problem under stress testing conditions. Streamlining of oversea visitors systems and processes, teams sharing best practice and identifying what good would look like. Legal: Refresh of spend data 2017/18 to inform review. Procurement: The IOL trial undertaken by Sheffield Teaching Hospital has completed and Bausch & Lomb selected as the supplier. Both 2

Next steps over next month HR: Chesterfield and Rotherham have also commenced trials are expected to select the same partner. Further discussions are ongoing to determine what capital equipment the supplier will provide other than the replacement of the Phaco machines. Two meetings have taken place with NHS Supply Chain to discuss maintenance contracts. The outcome of which is that early analysis has been completed and options examined to align contracts in terms of date with reviews of cover and discount structure. The current spend through Supply Chain is in the region of 17m annually so the potential for savings is high with added value coming from aligned contracts, the possibility of no indexation and the right cover for the usage profiles. The Minimally Invasive Surgery wet lab workshop took place on the 23 rd of May at the Medical Education Centre on the Northern General site. It was well attended and clinical consultants were represented from every Trust. The workshop was well received by all who attended. To support medical collaborative bank pilot. To agree workplan for management of non-medical bank and agency. To complete review of job planning processes across Trusts. To respond to requirements following development of Sheffield HR Shared Service outline case. Finance+ Payroll: To confirm work plans for 2018/19 with Provider Efficiency Group. Procurement: The feedback gathered from the MIS wet lab workshop will be reviewed to determine the next steps, but the expectation will be to take the findings back to the Clinical Reference Group for them to determine in what fashion the project will progress. Further data is being gathered to better understand the products currently used by each surgeon in each speciality in each Trust. Further meetings are planned with NHS Supply Chain to review the maintenance contract opportunity. Decisions will be due from Rotherham and Chesterfield to select their partner for the IOL initiative. Further refinement of the work-plan for 18/19. Benefits Reduction of unwarranted variation and associated efficiencies. Streamlining of systems across Trusts and enablement of mobile workforce agenda. Collaborative procurement savings (eg non-medical bank provider). ssessment of benefits from implementation of shared service. Risks Trusts select not to engage in initiatives based upon local risk profile (eg medical bank). Pre-mitigation RG Post-mitigation RG Mitigating ction Due date G Trust engagement monitored and reported through to Provider Efficiency Group / cute Federation. Ongoing 3

ICS and Place Level streamlining and standardisation strategies are not co-ordinated. Trusts do not implement successfully at local level owing to lack of capacity. R G Engagement of Executive stakeholders to align workstreams. 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 Provider Efficiency Group / cute Federation. Where Trusts select not to move forward and supply rationale this is only a programme issue if it adversely affects other Trusts. Ongoing Minimally Invasive Surgery initiative is rejected by the Clinical reference Group G Wet lab workshop day planned for the 23 rd May hosted by the preferred supplier, clinical engagement piece is in train to attract all specialities from all the Trusts to try the instruments in a realistic setting. Decision to move forward will only be made after satisfactory returns from the day. 23/05/2018 The Future Operating Model fails to have the impact and potential cost savings that the Business Services gency have forecast R Continued pursuance of projects outside of the Future Operating Model to have solid contingency in the event of the FOM under delivering October 2018 Stagnation period as staff and roles move from NHS Supply Chain to the new Category Tower providers which impacts on project delivery R Concerted effort to maintain relationships with the new category tower providers and those of the staff that have transferred N/ 4

Programme: Digital Date of report: June 2018 Provider CEO / CCG O sponsors: Richard Cullen Report completed by: Michael Rodgers Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) Green Plan for 2017-2019 a. ICS Digital Delivery Framework: Implementation of team, Digital Capabilities and Health Care and Reform 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. OpenEHR c. Interoperability: System integration architecture; Integration platforms; Care flow applications for GPs, Standard for integration, sharing records and data, Regional Infrastructure Strategy (networks, storage, desktop, security); Integrated MH Care System d. IG: Regional IG/GDPR 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 RISE System C Chanel 3 South Yorkshire Region Excellence Centre Local Pharmaceutical Committee meeting Population Health TEV Synanetics Sheffield Council.

Progress Next steps over next month Benefits RISE graduate scheme information. System C Sheffield CCG & Barnsley CCG planning meeting. Chanel 3 - Options appraisal and final Strategic Outline Case drafting. ppointment of the Interoperability Programme Manager Ben Gilderselve. D4 scoping meeting SYB ICS Priorities South Yorkshire Region Excellence Centre Digital and Communications Support Local Pharmaceutical Committee meeting Shared Care requirements meeting. Population Health Scoping meeting TEV introduction to the innovations from the Test Bed. Online Consultation PID and MoU design. Synanetics Document Exchange, Synanetics are experiencing engagement issues with Sheffield Teaching Hospitals IT Department. D5 & D6 Scoping meeting. Sheffield Council Interoperability scoping meeting. LHCRE Yorkshire and Humber were not successful in the first round, but are replying to the lines of enquiry from NHSE for the second round for the last two places. LHCRE - bid outcome and platform work. Strategic Outline Case presentation to the Digital Programme Board. ICS PMO development work. ICS Information Governance Planning. YHHSN Collaboration. Sheffield City Council follow up work on integration. B2.1 Increased patient control of own care; B2.2 Increased patient choice; B2.3 More effective use of GP appointments B3 1 Reduce in infrastructure costs; B3.2 Reduction in cost lost to lack of access to records, data and information B4.1 Reduction in &E attendances; B4.2 Reduction in non-elective admissions; B4.3 Reduction 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 Reduce treatment waiting times; B6.3Reduction in the intensity of care packages and associated costs; B6.4 Reduction in admissions to residential/care homes B7.1 Improved wellbeing of citizens; B7.2 Increased likelihood of, and accelerated recovery rates; B7.3 Reduce rates of relapse, and admissions to crisis care; B7.4 Reduce Premature Mortality in people with PSMI) and/or Learning Difficulties B.8 Maintain/Increase Public Trust Risks Pre-mitigation RG Post-mitigation RG Mitigating ction Due date Dedicated resource and budget is required to drive the programme R The Digital Steering Board have review and endorse the Programme Director s proposal for as lean as possible core team. The Chair and June 2018

Programme Director will present proposed organisation and costs to ICS SMT in March 2018, with options for financing Challenge in articulating benefits of digital interventions in isolation. They are key enablers to system level changes G 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 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

Programme: Elective and Diagnostic Date of report: May 2018 Provider CEO / CCG O sponsors: Richard Jenkins & Idris Griffiths Report completed by: Jade Rose Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) Green Plan for 2017-2019 1. Efficiencies through Optimising Demand 2. Outpatient Efficiencies 3. Delivering key diagnostic wait and RTT standards. MOU commitments Engagement Progress Delivery of the constitutional standards for diagnostic waits and referral to treatment. Engagement plans in progress for; - Integrated Lower GI - Orthopaedic follow up pathway * Resource requirements identified and submitted for Elective and Diagnostic work stream * Echocardiography Recovery The overall SYB position against the diagnostic target is improving although still underperforming HEE has awarded the Project Team 77k to develop an SYB online training tool regional event has been planned to develop a set of regional clinical referral criteria for echo Potential activity that would be suitable for repatriation as part of a standard pathway with diagnostic echo performed locally has been identified. Consideration needs to be given as to whether and how this can be taken forward across the region. * Radiology - PMO have met and agreed proposed work plan RNMG reconvened, have approved work plan approach overall, now commenting on finer detail of plan. lso approved governance proposal to link formally to EDSB. 1:1 visits between radiologist clinical lead and local CDs, useful scoping of local pressures cademy first trainees have graduated Established links with E&D Capacity & Demand work * Right Care and GIRFT - CVD project team has been created and is scoping out the programme of work to improve outcomes for patients with CVD * Endoscopy (FCP) The full business case for an integrated lower GI pathway is in development. The options regarding pathology are under review. * Bassetlaw CCG agreed to pilot the First Contact Practitioner NHSE pack * Diagnostic Capacity and Demand regional events have taken place for all 3 modalities; CT, MR and endoscopy. CT and MR data collection exercises have commenced. Recognition of overlap with radiology and Cancer Workforce Strategy and HEE. Links made between different groupings with a review to look at where data can be shared. *Ophthalmology out of hours model The proposed changes by the Ophthalmology MCN have not been accepted by the consultants of one of the hubs and there is resistance to continue with the model. *OMFS Trauma Model Consultant jobs plans from all Trusts have been submitted to calculate the impact of the proposed hot week on each Trust

Next steps over next month Benefits * Confirm 18/19 priorities and resource allocation * Echocardiography - Finalise capacity analysis. Develop SYB training programme plan. rrange workshop to agree clinical guidelines * Outpatient Transformation First regional session 8 th June to develop a multi year work programme * Integrated Lower GI pathway - Finalise SYB business case for integrated Lower GI pathway for agreement at E&D Steering Board 7 th June. Implement pathway (aligned to Cancer lliance Board). Ongoing engagement across SYB. Current ttain contract funding expires end June need to secure funding to take SYB through implementation (due to start September 2018) * Orthopaedics - Develop data pack and agree action plan. * Hospital Services Review - Understand outputs of Hospital Services Review and implications for E&D work stream * Radiology -Following RNMG, presentations of work plan, current status / C4C and proposed governance to EDSB on June 7 th. Need to secure funding beyond Q1 for both Clinical Leads (radiographer and radiologist) Begin to enact work plan developing workforce strategy for July 2018 Regional PCS managers meeting 11 June re local technical capabilities feed into work around shared cancer reporting (e.g. Upper GI MDT) develop detailed work programme * Commissioning for Outcomes - Meet with Commissioning Managers to review implementation of policy * Right 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. * GIRFT develop data sharing agreement to enable wider sharing of provider GGIRFT data than has previously been approved * Further review of different meeting groups, priorities and resource within the work stream * Bid for NHSE Elective Transformation funding *Ophthalmology out of hours model Develop a plan to support the non-hubs *OMFS Trauma Model Work through impact assessments with the Trusts and the Managed Clinical Network 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. Risks Increasing Financial Challenge Pre-mitigation RG B Post-mitigation RG Mitigating ction Due date B Continual investigation and development of new initiatives to close the gap. Close monitoring of savings performance and forecast delivery against targets. March 2019 Pace of delivery is limited by work stream resource B B Resource requirements identified and submitted to sics for review. This includes the extension of the 2 x Clinical Lead posts for the Radiology programme. Consider suitability of secondments, interim appointments or consultants. Priorities and associated scale of ambition reduced accordingly June 2018

Programme: Estates Date of report: May 2018 Provider CEO / CCG O sponsors: Chris Edwards Report completed by: Richard Taylor Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) 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 SCR Estates Transformation Strategy. Review of relevant submitted business cases as part of the capital bidding process 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 Risk reduction through planning remediation of Backlog maintenance components

Risks Lack of alignment with clinical workstreams due to lack of engagement Under developed Primary Care service vision Pre-mitigation RG R R Post-mitigation RG Mitigating ction Due date Continue to engage and build relationships with workstreams Support the PC Estates strategy development process recently launched Ongoing Ongoing 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 R Develop pan-sics thinking on options for resolution July 2018

Programme: Meds Optimisation Workstream Date of report: May 2018 Provider CEO / CCG O sponsors: Idris Griffiths Report completed by: Stuart Lakin Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) Green Plan for 2017-2019 This workstream set out 5 priorities: 1. Prescribing Cost Reductions - to generate direct savings linked specifically to medicine costs. 2. Pathway Redesign - 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 Progress Joint meeting held between the sics Comms team and the Comms leads from each CCG to agree the plan and resource required to develop a targeted media strategy and public and general practice engagement activities aligned to over the counter/self-care. Work will commence June 2018 within a controlled environment project management structure ensuring value for money is created and captured. Meds Opt in Care Homes Sheffield CCG to take the authority role, including brokering the funding. draft plan based on NHS England requirements enabling NHS E to issue a Memo of Understanding to Sheffield CCG and release the funds has been informally accepted by NHS England and reviewed by this Steering Group. The Steering Group agreed to further clarify the service model, develop the service spec and monitor & evaluate delivery of the service model. The proposed service spec needs to enhance and not duplicate current services and be flexible to adapt to the different services currently in place in each CCG. Pathway Redesign The Lead for this initiative suggested that it may be beneficial to refresh the data as 2017/18 data is now available. number of opportunities have been considered including looking at different models and the potential of nutritionists joining the medicine management team. The SG noted that the Nottinghamshire model is being considered NHS Consultations: Reducing prescribing of OTC medicines The SG noted that this initiative is the most developed: 1. dopt national guidance on a SYB footprint with local flexibility. 2. Support CCGs for consultation light where needed 3. Support campaign for awareness raising 4. Provide information to GP s and work with public

The Lead for this initiative briefed the SG on current actions including setting up and facilitating a media campaign workgroup meeting with communications leads and HoMMS across SYB to discuss the alignment of the message across SYB. The SG confirmed that the National consultation is only to provide guidance to CCGs and the workstream needs to undertake local consultation, where needed, on the back of this guidance. The media campaign work group entered into a competitive dialogue having invited four media providers to submit proposals for a piece of work valued at 14k. The SG accepted the recommendation of the media campaign group to contract the successful bidder, a company who had previously worked with Rotherham CCG. It was noted that the campaign needs to be more of a nudge campaign. NHS Consultations: Gluten Free prescribing in primary care The Lead for this initiative will bring figures up to date for 2017/18 ensuring continuity in data quality. The Lead to carry out further trend analysis using latest data for relative prescribing costs, complete dataset for 17/18 and use as a benchmark. The Lead to complete and ensure consistent approach on EPCT 2. MM Heads to provide the guidance they issue to practices to ensure best practice across SY&B SG to review data to determine if current recommendation to restrict further should be retained or status quo with improved guidance for prescribers and the public. Meds Related Resources The lead for this initiative has identified 2 areas in progress: waste and care homes. Mapping nearly completed, written report to be provided at the next SG NHS Consultations Biosimilars Taken to O s meeting. Business as usual; keep the status quo was the preferred option. ctivity patterns would remain unchanged. CCGs continue with different gain share agreements with their respective providers in 2018/19. Over the next few years several originator patents are expiring, and a new wave of biosimilars is expected to enter the market in Sept/Oct 2018. The Steering Group will reconsider its options at that time with a view to convergence of the gain share approach over time. NHS Consultations vastin Taken to O s meeting. Business as usual; keep the status quo was the preferred option. ctivity patterns would remain unchanged. Difficult to make any recommendations in this area until the conclusions from the court case in North of England ruling has been received. The ruling is expected in July 2018. The Steering Group will reconsider its options at that time. Next steps over next month Meds Opt in Care Homes The service model will be designed around a core offer with local flexibility which would require sign off by all HoMMs. The SG will explore a link to the frailty pathway. Each HoMM to discuss with their respective CCGs and get an agreement in principle for the funding of 50% of costs for year 2 and 100% of costs from year 3. The procurement process will follow Sheffield CCG procurement rules. Initial discussions to find a host/provider are scheduled to take place with the market to ensure feasibility. n exercise will be carried out to map out what is taking place in each CCG around care homes. Barnsley CCG have already developed a mapping questionnaire which would support some of the work required around mapping services and ensure a clear picture of the services in the system.

Pathway Redesign Circulate the data by the end of July and complete gaps. discussion paper will be developed and circulated to CCGs. Future hosts will be identified. Business Cases are being developed. The data will show trends to identify the opportunities to take work forward. There is an opportunity for service redesign rather than a pricing exercise. NHS Consultations Reducing prescribing of OTC medicines Media campaign to kick start. Support is required from CCGs at different levels. The media company will engage with communications leads. The framework and lessons learned from this work will be used to support communications of other areas going forward if it proves effective. Local engagement must start and each CCG must have Governing Body sign up for the SY&B approach to OTC medication. The SG to consider the best value for the further spend of 10k after requirements from other areas, e.g. Gluten Free, are identified Benefits Reduce Waste Reduce Financial Pressures Reduce unwarranted variations across SYB Risks Resource support to work with the Steering Committee to deliver the Programme Plan Q1/Q2 2018/19 Premitigation RG Postmitigation RG G Mitigating ction Due date Engage Business dvisor/consultant until end July 2018 31/07/18

Programme: Mental Health & Learning Disabilities Date of report: May 2018 Provider CEO / CCG O sponsors: Kathryn Singh & Jackie Pederson Report completed by: Marie Watkins Progress ssessment Current Period (RG) Green Progress ssessment Previous Period (RG) Green Plan for 2017-2019 1. Perinatal mental health: developing a specialist community service across Doncaster, Rotherham and Sheffield 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): eliminating non-specialist acute inappropriate OPs; and scoping the opportunities within secure care and complex dementia care 4. SD and DHD: developing an ICS-wide service, with further consideration of whether this is an adult or all age service, building on existing provision 5. Employment: improving 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) 6. Suicide prevention: SYB has received 555,622 targeted funding from NHS England for 2018/19, with a possibility that this will recur for one or two years; to focus on men, support to primary care, self-harm including pathways for people in acute and mental health services, and bereavement support data and finance group will support delivery of the priority projects and the wider data and finance work programme. The workstream will also work proactively to support development of the mental health workforce plan. In addition, the steering group will hold workshops every two months to look in depth at particular issues with a wider audience. 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 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 non-specialist 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