SUMMARY REPORT Meeting Date: 31 May 2018 Agenda Item: 9.1 Enclosure Number: 9 Meeting: Trust Board (Part 1) Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Service Transformation Report Tricia Finch, Head of Development and Transformation Ros Preen, Director of Finance Steve Gregory, Director of Nursing and Operations Committee Resource and Performance Committee Date Reviewed 29 May 2018 Key Points/Recommendation from that Committee Purpose of the report Provide details and an update on System-led Transformation and the Trust s internal Transformation Programme. Strategic goals this report relates to: To deliver high quality care To support people to live independently at home To deliver integrated care Consider for Action Approval Assurance Information To develop sustainable community services Summary of key points in report : Executive Summary SERVICE TRANSFORMATION The Trust is taking the lead on the Intravenous (IV) Antibiotics pathway which is one of the priority pathways that are being redesigned under the Urgent Emergency Care system transformation scheme. The final documentation and process for the public consultation regarding the Acute Reconfiguration has been agreed by both CCGs. It has been extended to 14 weeks beginning on 30th May 2018 The Care Closer to Home programme (previously known as the Out of Hospital Programme) for Shropshire will continue to be progressed in 3 phases 1. Frailty, 2. Case Management and 3.Hospital at Home. Telford CCG held a workshop to evaluate the impact of Neighbourhood working. The output will formulate the long term outcomes and impacts The Telford Care Home MDT and Wound Healing Service projects are now operational in 1 Accountable Directors: Ros Preen and Steve Gregory Trust Board: 31 May 2018
a number of locations and feedback and outcomes are already positive. Roll out to the remaining Wound Healing Service locations is planned from July onwards. Whereas a phased implementation will be discussed with the CCG to increase the number of homes that the Care Home MDT team can work with. NHS Providers have issued a report providing insight to how Community Services providers are performing, challenges that they face and solutions that will enable success as we head towards a longer term funding settlement Key Recommendations The Board is asked to: Receive an update on the development of our internal Transformation Programme and supporting projects. Agree any further actions required. Is this report relevant to compliance with any key standards? YES OR NO CQC No IG Governance Toolkit Board Assurance Framework No Impacts and Implications? Yes Patient safety & experience Financial (revenue & capital) OD/Workforce Legal YES or NO Yes Yes Yes Yes State specific standard or BAF risk If yes, what impact or implication Future transformation programmes are intended to have a favourable impact. Variable according to value of individual development schemes. New service models will result in new ways of working and new roles for the workforce. Efficiency programmes are likely to impact on the existing workforce. Contractual arrangements with external suppliers are subject to legal review. 2 Accountable Directors: Ros Preen and Steve Gregory Trust Board: 31 May 2018
Service Transformation Report Trust Board (Part 1) 31 st May 2018 Accountable Directors: Ros Preen, Director of Finance and Steve Gregory, Director of Nursing and Operations Improving Lives in Our Communities
Improving Lives in Our Communities Introduction This report provides an update to the Board on transformation programmes and strategic initiatives that are being progressed within the local health system: All information contained within the report is correct at time of writing, 16 th May, updates and developments since that time will be provided verbally to the Board Contents Service Transformation Overview Timeline System Transformation Programme Sustainability and Transformation Plan Urgent Emergency Care Acute Reconfiguration Developing Future Community Services Shropshire Care Closer to Home Telford Neighbourhoods Shropshire Community Trust Transformation Programme Project Status Dashboard Risks Recommendations
Improving Lives in Our Communities Overview Community Services Transformation Sustainability and Transformation Plan Resilient Communities & Health Prevention Community Offer Telford CCG Development of Integrated Teams Shropshire CCG Care Closer to Home Future Fit Acute Reconfiguration PARTNERS Patients, Carers, Families, Communities, CCGs, Local Authorities, NHS Providers, Mental Health, Private Sector, Voluntary Sector, Charities DRIVERS Maintaining Independence & Staying Well Needs Based Local Services Value for Money Managing 2 Sites & Repatriation SERVICES Children s 0-19 Services Children Community Nursing and Therapy Community Nursing and Therapy MIUs / DAART Community Hospitals (incl. beds) Community Specialist Services Hospital Beds Ambulatory Services Admission Avoidance Supported Discharge Emergency Care Planned Care (inpatient and outpatients) Acute Specialist Services FUTURE STATE Neighbourhood Teams and Community Hubs Telford Wound Care Telford Care Home MDT Diabetes SE Telford Pilot Telford Neighbourhood Teams IV Antibiotics Pathway Preferred Option RSH: Emergency Centre / W&C PRH: Urgent Care / Daycase New Clinical Models CCG Case for Change SaTH Business Case PROCESS Service Transformation and Redesign Patient and Public Engagement CCG Consultation V3: 06.04.2018
Timeline Local Health Economy Strategic Programmes Timeline Shropshire Community Trust: Wound Healing Telford Central 5 April Newport 10 April Teldoc 30 April Service commences across 6 care homes in Telford. Wellington July Date TBC Telford South East Start date TBC Care Homes MDT Confirmation of funding Implementation Pilot Go live Diabetes Pilot Shropshire CCG: Shropshire Care Closer to Home Telford and Wrekin CCG: Neighbourhood Work Phase 1: Frailty Work Development of neighbourhood integrated teams Phase 2: Case Management There are no timescales published for Phase 3 yet. Phase 3 Hospital at Home/Crisis Intervention/Rapid Response/DAART and Step Up Community Beds Shropshire & Telford CCG: Acute Reconfiguration TIMELINE Public Consultation (Date TBC) V6: 15.05.2018 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sep 18 Oct 18 Nov 18 Dec 18 Jan 19 Jan 19 Feb 19 Mar 19 The above present the latest published deadlines. As these are formally changed the timeline will be updated. Improving Lives in Our Communities
System Transformation Sustainability and Transformation Plan (STP) The STP Director s Report is now being published bi-monthly and now provides a detailed update on the whole STP Programme. The latest report was published at the end of April. A copy of this report will be included in this month s Board report to support discussions. The report (attached) provides information and context in relation to the wider system developments that require consideration when developing our own services. Urgent Emergency Care County wide solutions are being developed by the A&E Delivery Board, our Director of Nursing and Operations / Deputy COO are members of this Board. Intravenous (IV) Antibiotics has been identified as one of the priority pathways for redesign. The Trust is taking the lead on this piece of work. The first workshop was held on 30 th April and updates will be provided as this programme develops. Acute Reconfiguration The final documentation and process for public consultation period has been agreed by both CCGs. The consultation period has been extended to 14 weeks and will commence on 30 th May. The CCGs will consult on the preferred option which is the location of the emergency centre at the Royal Shrewsbury Hospital site and also the second option which is PRH to house Shropshire s emergency department and for RSH to become a planned care site. The consultation process will include staff engagement sessions, public exhibition events, and pop-up style roadshows at community and public venues across the county. CCG members will attend a range of meetings to provide updated and take questions. Consultation documentation will be available on the Futurefit website throughout the process. Improving Lives in Our Communities
Improving Lives in Our Communities Developing Future Community Services Shropshire Care Closer to Home (previously know as the Out of Hospital Programme) The CCG have refreshed their Care Closer to Home programme. The programme will continue to be progressed in 3 phases: 1. Frailty Work, 2. Case Management and 3. Hospital at Home. The Frailty MDT in RSH pilot commenced in September and remains operational and GP Practices are using the Frailty Index to identify/risk stratify patients. Work has started with clinical teams to develop models of care to support Case Management. Telford Neighbourhoods Telford Integrated Neighbourhood Teams The CCG are now focusing on how to evaluate the impact of Neighbourhood Working. A Workshop in May started looking at how to assess long term outcomes and impacts. Shropshire Community Trust Transformation Programme The Care Home MDT service is now operational in 6 Care Homes in Telford and feedback received from stakeholders has been positive. Phased implementation will be discussed with Telford CCG. The new Wound Healing Service commenced 1st April 2018. This is initially a pilot for 12 months and will be reviewed in 6 months. A phased implementation across the Telford neighbourhoods will see the transfer all of GP's complex wound care from practices into the new wound healing service provided by our teams. Feedback and outcomes are already positive. NHS Providers Report (recommended reading) This recent report sets out to provide a valuable commentary on how Community Services providers are performing, the challenges that those providers are facing, and the solutions that will enable success as we head towards a longer term funding settlement. The report can be accessed via the NHS providers website and was also shared by separate email from our Chief Executive.
Improving Lives in Our Communities Project Status Dashboard Programme Overview KEY PROJECT STATUS On Track Off Track Complete Programme SERVICE TRANSFORMATION PID Completed QEIA Completed Plan for Implement ation Diabetes S/E Telford Pilot Telford Clinical Input into Care Homes Telford Primary Care Complex Wound Healing Service Out of Hospital Diabetes 3 Tier Model Project Status Project Lead Project Start Date Project Finish Date Project Value k Diabetes Team Lead Oct-18 Sep-19 65k Clinical Services Manager Jan-18 Jun-18 323k Clinical Services Manager Apr-18 Oct-18 476k Diabetes Team Lead TBC 1.3m
Improving Lives in Our Communities Risks The risks associated with our Transformation Programme and business developments are shown below. There have been no new risks identified this month. Risk Commissioner do not support for our proposals or agree additional investment where required. Different commissioning strategies by the CCGs result in different models of care across the county. Lack of capacity and capability to respond to new transformation developments and to maintain our own transformation agenda. Loss of key members of the individual project teams impact on completion of the projects. Impact on workforce morale as further changes evolve. Mitigation Regular dialogue with commissioners and representation at local health economy groups to present our case for change rationale and try to influence decision makers. Monitoring of progress to ensure projects are on track. Ongoing assessment of project requirements is undertaken to quantify requirements to support either investment or prioritisation. Detailed Implementation Plans are developed by whole teams / services. Engagement with staff involved in service areas that are subject to change. General communications through operational teams and staff communications. Recommendations The Board is asked to: Receive an update on the development of our Transformation Programme and the system transformation activities. Consider potential risks and opportunities to the organisation presented by this work. Agree any further actions required.