Purpose This paper provides a summary of the key areas of business led by the Chief Officer in the CWHHE Clinical Commissioning Groups. CWHHE comprises NHS Central London, NHS West London, NHS Hammersmith & Fulham, NHS Hounslow, and NHS Ealing CCGs. The report is a standard report across the five CCGs. The report covers the following areas: Sustainability and Transformation Plan; Quality and Patient Safety; General Data Protection Regulation (GDPR) across NWL CCGs; and Leadership changes across NWL CCGs Sustainability and Transformation Plan The content below highlights some key developments made in delivery areas since the last reporting round. Outside of the delivery area boards there have been some important areas of activity. The Joint Health and Care Transformation Group met in March and reviewed the outputs of the workshop held to reset the group and ensure more effective group working. As a result of this the terms of reference are being updated to stress the areas that the partnership is wishing to make progress in, and the information coming to the group is going to be refined to ensure the group gets a concise account against progress with key work programmes. The arrangements for North West London QIPP delivery are being reviewed by a small working group to improve the visibility and accountability of those schemes that are undertaken across NW London, and to get greater assurance on the risks to delivery. A report will be going to the Joint Senior Management team early in May. Delivery Area 1 Improving health and wellbeing Wellbeing & Prevention: CCGs have committed to match funding with Local Authorities and the Social Impact Bond ( 1.2 million) for the Work on Individual Placement Support (IPS). The programme is progressing well, and West London Alliance likely to be only national pilot to achieve its caseload. Making Every Contact Count: Additional training sessions are being rolled out in April / May with specialist training sessions available for maternity staff. Delivery Area 2 Better care for people with long term conditions Primary Care Provider Development: NHS England has agreed resources for all CCGs for funding to support practice resilience, online consultations and practice website development and cervical screening uptake. Further work is underway with CCGs and GP Federations (and Networks) to prepare an STP funding plan for NHS England, to develop General Practice at-scale. Following a Member practice vote, both Brent and Hounslow CCGs took on delegated commissioning for general medical services from NHS England, from April 2018. Right Care: Diabetes - specialist diabetes nurse consultants have now been appointed to work with each CCG and along with local GP leads will work with practices to increase access to structured education and reduce variation in care 1
Atrial Fibrillation/Hypertension - using the whole systems integrated care database an AF dashboard has been developed this gives patient and practice level information on key AF indicators, enabling practices to more easily proactively manage care for their AF patients. Self-Care: Diabetes apps project has been evaluated, highlighting significant impact on patients Hba1c (a blood marker for glucose levels), blood pressure and weight, with positive feedback from patients and clinicians. Phase two commenced with 2,500 apps procured for 2018/19, meaning that more patients can benefit this year Over 20,000 patient activation measurement (PAM) assessments have now taken place across NW London. PAM assesses a patient s knowledge, skills and confidence to self-care, enabling tailored approaches to support. 54,000 licences have been secured through NHS England for 2018/19 mycopd digital tool commenced roll out to embed across NW London for 20% of the COPD population in 2018/19. Improving Access to Psychological Therapy (IAPT) - Long Term Conditions (LTC): A communication strategy has been completed and agreed by the steering group Engagement work between mental and physical health practitioners has begun to yield good results Between January - March 2018, 335 people entered treatment against a target of 280. Delivery Area 3 - Improving Care for Older People Integrated commissioning: The team received positive feedback from local areas on the progress of work highlighted in integrated commissioning plans received from local areas and from Continuing Healthcare (CHC) placement data for subsequent price/trend analysis. Enhanced care in care homes: Over 40% of care home managers across NW London have signed up to the care home leadership programme aimed at driving positive culture change in care homes. With the support of the NW London Older Peoples team, Brent local area have mobilised plans to scale up the red bag scheme from five care homes to all 21 older people s care homes in the CCG area. Training and engagement activities continue at pace across the sector including the Recognising Signs of Deterioration training. Intermediate care & rapid response: The re-launch of the pan-nw London prevention of admission pathway resulted in a 38% increase in London Ambulance Service (LAS) referrals to rapid response teams (Q4 2017/18 compared to Q4 2016/17). This involved extensive engagement and training of LAS crew through joint working with intermediate care providers and ensuring that appropriate care pathways were accessible through the roll-out of ipads. This has so far resulted in the avoidance of 345 conveyances to A&E departments. On-going evaluation of the pathway, alongside an audit from LAS on calls for "catheter problems", showed a high prevalence of transports to A&E. To mitigate this, all NW London CCGs and intermediate care providers drafted a district nursing pathway for LAS crews to be signposted to alternative responses. Response in time of crisis: In Northwick Park Hospital, the frailty team continue to identify their incoming patient cohort upon arrival at A&E. An average of 20 patients are seen by the team per week resulting in fewer admissions and more appropriate care pathways being delivered. London North West Healthcare Trust and Brent and Harrow CCGs have begun to work together with the 2
support of the Strategy and Transformation team to transition the proof of concept into a business as usual model. Home First: A total of almost 2000 patients have been discharged through the Home First pathway as at April 2018. Brent, Harrow and Imperial schemes are currently at, or close to achieving their planned trajectories for patients being discharged and assessed in their home environment. The number of patients discharged using the discharge to assess processes has increased by 50% over the past 4 months. Delivery Area 4 - Improving Mental Health Services Transforming Care Programme: The NW London CCG 'inpatients with length of stay 5+ years' cohort, remains on its discharge trajectory target for the end of Q2 & going into Q3. Monthly dial-in meetings with NHSE, Commissioners & Transforming Care Partnership Leads ensure that potential barriers to discharge are addressed at the earliest opportunity. Crisis Care: The crisis care concordat meeting provided input into the key areas of work. The meeting was very beneficial and highlighted identifying top priorities and an approach to addressing these. Children and Young People (CYP): New 24/7 Crisis service for CYP was launched in shadow form in December across NW London. To support the new workforce an additional 197,000 was awarded by NHS England to develop a comprehensive training programme. Serious and Long Term Mental Health Needs (SLTMHN): There is an on-going discussion regarding the detailed flow modelling of the New Model of Care. The specification has now been finalised. A refreshed Out of Hospital specification has been endorsed to support the review and treatment of physical health needs of people with serious and long term mental health needs. A London-wide evaluation of primary care mental health models has started, supported by Catalyze. Hounslow CCG is the NW London participating CCG. Individual Placement Support (IPS): NW London was successful in bidding for NHS England funding to expand IPS services in Central and North West London (CNWL) facing CCGs. Negotiations are underway to try to secure two years guaranteed funding instead of the current one year offer. Delivery Area 5 - Safe, High Quality Sustainable Acute Services Capital Business Cases: SOC1 is in the latter stages of approval and a response to the latest assurance request was submitted to the NHSI Board in the first part of 2018 for their consideration. Maternity: Implementation of new models of care underway across all 8 NWL CCGs Local Models of Care: The Ealing Steering Group have agreed to set up a focus group on developing a proposed model of care for the Ealing Local Hospital. Radiology: The programme board agreed to resume the procurement process and supported the reallocation of programme resources. Outpatients: CCGs and NHS Providers have met to redesign clinical outpatient pathways in three areas; with very good feedback from cardiology and dermatology. The radical redesign has been enabled by the system decision not to automatically use the current activity based payment method for new outpatient pathways. This is a system where the payment acts as a disincentive to improving care for patients and reducing costs (DA5a&d) 3
Enablers Workforce: Primary Care Workforce Strategy has been approved by all 8 CCG Governing Bodies. Implementation planning is underway and will include change management support in the form of Change Agents Diabetes Workforce Transformation Directors of Nursing have agreed a way forward to enable Diabetes Nurse Consultants to work across primary, community and secondary care (including honorary contracts and Memorandums of Understanding). This will enable greater sharing of advice and best practice models of care, learning and working across boundaries Geriatric Workforce - the clinical leads from the frailty standards group agreed to complete an analysis of the older people s consultant and geriatric workforce. Findings which indicate NWL has sufficient number of geriatricians in NWL were reported back to the London Geriatricians group in April Care Home leaders training for the final 2 cohorts of My Home Life has started. A preparatory discussion on input on Telemedicine and RASD has taken place. Recognising and Acting on Signs of Deterioration (RASD) delivery trainers are being commissioned for a train the trainer programme in May The NW London response to the Mental Health Workforce Plan was developed with CNWL, WLMHT and the Mental Health programme; it was also endorsed by the Mental Health Transformation Board and submitted in mid-march. A task and finish group will be established to drive delivery against the plans and support the assurance process Staffing Project as at month 10, agency spend is 27% lower and the overall spend on bank and agency staff is 1% lower compared to last year. All 10 trusts have signed up to continuing the programme and will contribute 200k of funding for 2018/19; which will continue this year s priorities of occupational health process review, reducing agency medical costs and developing collaborative banks. The programme will also: o examine the case for changes to the way OH services are structured across NW London, looking at the case for more collaboration o explore opportunities to deliver apprenticeships collectively to make best use of the apprenticeship levy and avoid losing this money o reduce the rates for medical bank staff to bring them in line with agency pay rates. Change Academy programmes (High Performing Care and Leading Transformation) are approaching their conclusion and evaluation phase. The Change Coach Development and Delivering Outcome-based Care and Integration (cohort 3) programmes are at half way point with cohort 4 launching in May. Digital: There is continued good progress with the Primary Care Digital Programme, which is already funded through Estates & Technology Transformation Fund (ETTF) Provider Digital Projects new governance is in place, led by NHS NWL Digital CQUINs work on e-referrals and Advice & Guidance CQUINs under way in all Trusts. 4
Business intelligence: Good progress has been made to identify and quantify QIPP opportunity for each scheme There has been significant analysis work to describe the full outpatient flow picture for dermatology, cardiology and MSK pathways Access to WSIC de-identified data is now in place and being used to support work around GP hubs modelling and Care Home usage analysis Options for delivering SOC2 / OBC activity and demand modelling have been included in a paper for SOC2 board. Estates: Project Initiation Document (PIDs) for Brentford and Chiswick Hubs have been approved by Hounslow GB Works on the new Park Royal Medical Practice at Central Middlesex Hospital with snagging and contract variation work was currently being undertaken, practice services commenced on site in March. Communications: North West London health and care partnership update a booklet was developed and shared with staff and stakeholders which showcases progress and key achievements made towards the five priority areas set out to transform health and care in North West London. Maternity programme - postnatal booklet - A guide for new mothers was rolled out across NW London in February/March. Care home pocket guide - a new guide to spot signs and symptoms of a resident deteriorating or becoming unwell has been developed for care home staff. The 24 page pocket guide will be used as part of a new training programme which will be rolled out in May for health care assistants Outpatient engagement - patients have taken part in specialist workshops for five clinical areas to support the outpatient transformation programme. An engagement report from the focus groups/workshops will be circulated, when the final workshops are complete HSJ awards the diabetes team and the team that developed the Radiology Career Framework were shortlisted in this year s HSJ awards, which were judged in April. Quality and Patient Safety Safeguarding Good news stories: Triborough Nursing Homes- Older People and People with End of life care needs. We have received some really good news in the past two weeks that St Vincent s (Hammersmith & Fulham), Forrester Court (Central London CCG) and Princess Louise (West London CCG) Nursing Homes have now been inspected by CQC as 'Good' after many years of requiring improvement grading. This is positive news for the homes and the residents which reflects the effective partnership working across the health and social care strategic partners. The Nursing Homes have consistently engaged in a range of Service Improvement initiatives during financially challenging times, increased dependency of need and demand for nursing beds. 5
The homes have all shared their thanks for the support from the CCG and Local Authority in helping to achieve this success. The Joint Commissioning Team and the Safeguarding Team have been working closely with the Nursing Homes by offering support and leadership. The current position: Hammersmith & Fulham: all four of the Nursing Homes now have CQC rating of 'Good' overall Central London: two of the three CCG contracted Nursing Homes have CQC rating of 'Good' overall West London: all the CCG Contracted Nursing Homes have CQC rating of 'Good' overall This is the strongest position for a number of years. Embedding the Department of Health Pressure Ulcer Safeguarding Protocol: The Patient Safety and Safeguarding Teams have been working collaboratively with Brent, Harrow and Hillingdon CCGs, as well as our providers across NW London to raise awareness, embed the new Department of Health Pressure Ulcer Safeguarding Protocol. This piece of work required a system wide approach to identify current gaps in training (professionals and carers) and refining safeguarding triggers across the healthcare, care home and Local Authority landscape. A joint work shop to promote the protocol took place on the 20th April; attendees were engaged and will take the learning back to their organisations as we work towards a consistent NWL approach to the reporting of safeguarding concerns in patients who have pressure ulcers. Ealing CCG Good News: Ealing CCG has been listed as best in class in the UK with regard to Delayed Transfers of Care. This demonstrates the huge coordinated efforts led by the Ealing CCG Teams and partner Local Authority and Provider organisations. West London CCG Good News: Our main Acute Provider Chelsea and Westminster Hospital, NHS Foundation Trust, has been rated GOOD by CQC across all domains and Outstanding by NHSI for use of Resources. Equalities and Patient Experience Good News: Business case templates have been reviewed, aligned and amended to be more explicit around the requirements around the Public Sector Equality Duty and Patient Experience. Work is underway to align Equality Impact Analysis template across the 8 CCG s. The team has worked with the BME staff network to support drafting of their Terms of Reference. Update on North West London CCGs General Data Protection Regulation (GDPR) across NWL CCGs Following Governing Body approvals in March/early April, NWL CCGs have now formally appointed a 'Data Protection Officer' (DPO) and work is progressing well on the seven identified work streams towards achieving GDPR compliance by the 25th May. In particular, areas within CCGs which handle patient data, such as Medicines Management and HR, are having targeted training with data use, purpose and flow all being mapped. At a GP level, advice has been circulated to all practices and a 'GDPR pack' is being constructed inclusive of 'Fair Processing Notices' to help GPs with their compliance. The NWL CCGs DPO will provide DPO services to GPs subject only to capacity. At a NWL level, the digital 'Information Sharing Agreement' (ISA) which underpins the use of NWL's WSIC and CIE solutions has been re-written to be GDPR compliant. GPs will shortly be contacted to re-sign the new agreement using the online 'Data Controller Console'. 6
Leadership changes Since the previous Governing Body meeting we have said goodbye to departing Chief Officer Clare Parker. We thank Clare for her resolute leadership over the past 2 ½ years as Chief Officer and, prior to that, as Chief Finance Officer. Rob Larkman will take on the Chief Officer role from 1 May 2018 pending a permanent appointment to the role. Rob Larkman, Chief Officer NWL CCGs 25 April 2018 7