DRAFT BUSINESS PLAN AND CORPORATE OBJECTIVES 2017/8

DRAFT BUSINESS PLAN AND CORPORATE OBJECTIVES 2017/8 West London Clinical Commissioning Group This document sets out a clear set of plans and priorities for 2017/18 reflecting West London CCGs ambition to improve health and wellbeing for local people.

1 Section A Local and National Strategies 1. The Five Year Forward View from NHS England Over the past fifteen years, the NHS has dramatically improved. Cancer survival is its highest ever. Early deaths from heart disease are down by over 40%. Avoidable deaths overall are down by 20%. About 160,000 more nurses, doctors and other clinicians are treating millions more patients so that most long waits for operations have been slashed down from 18 months to 18 weeks. Mixed sex wards and shabby hospital buildings have been tackled. Public satisfaction with the NHS has nearly doubled. The Forward View sets out a clear direction for continued improvement within NHS and sets out the changes that need to happen to manage the long term predicted 30b shortfall in health services. Some of what is needed can be brought about by the NHS itself. Other actions require new partnerships with local communities, local authorities and employers. Key elements of the FYFV are: A radical upgrade in prevention and public health, with hard-hitting national action on obesity, smoking, alcohol and other major health risks. When people do need health services, patients will gain far greater control of their own care, including the option of shared budgets combining health and social care. The NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases. Urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services Provision of services should be reviewed, although it is acknowledged that one size does not fit all, potential models could include: Multispecialty Community Provider. Integrated hospital and primary care provider Primary and acute care systems These new providers mentioned in the FYFV have started to emerge as collaborations between GP Federations and other provider to from Accountable Care Partnerships (ACPs) or Accountable Care Organisations (ACOs).

2 2. North West London Strategy and Transformation Plan The NHS and councils of NW London developed the Sustainability and Transformation Plan (STP). The STP takes its starting point from the ambitions and knowledge in the national NHS Five Year Forward View strategy and translates it for our local situation. The STP describes shared ambition across health and local government to create an integrated health and care system that enables people to live well and be well and involved over 30 organisations. STP aims and priorities We aim to improve: 1. Health and wellbeing 2. Care and quality 3. Efficiency, to balance the budget Our priorities are to: 1. Support people who are mainly healthy to stay mentally and physically well 2. Improve children s mental and physical health and well- being 3. Reduce health inequalities for the top three killers: cancer, heart diseases and respiratory illness 4. Reduce social isolation 5. Reduce unfair variation in the management of long-term conditions 6. Ensure people access the right care in the right place at the right time 7. Improve the quality of care for people in their last phase of life, enabling them to die in their place of choice 8. Reduce the gap in life expectancy between adults with serious and long-term mental health needs and the rest of the population 9. Ensure services and experiences are of a high quality every day of the week Delivery areas To support implementation of our NWL priorities we have identified five key delivery areas and an enabler. NWL, Strategy & Transformation and local West London CCG schemes are aligned to these key delivery areas. Delivery area 1: Improving your health and wellbeing - Reducing loneliness by encouraging everyone to be part of their local community - Supporting campaigns to increase self-care; to prevent cancer; and to reduce the stigma of mental health problems - Encouraging exercise, healthier eating, and the reduction of smoking and alcohol consumption - Encouraging employment for people with a learning disability or mental health problem - Supporting children to get the best start in life by increasing immunisation rates, tackling childhood obesity and providing more mental health care and support

3 Delivery area 2: Better care for people with long-term conditions - Catching cancers earlier and starting treatment more quickly - Developing new ways of preventing and managing long-term conditions, like diabetes - Improving access to mental health services - Helping the voluntary sector to support self-care Delivery area 3: Better care for older people - Tackling the lack of nursing and care homes - Providing specialist teams which can react quickly when there is a problem - commissioning all services for older people with local government and coordinating care between the NHS, social care and other organisations - Improving end of life care, supporting people to die in the place of their choice Delivery area 4: Improving mental health services - Providing a more proactive service focused on recovery - Supporting more GPs to become experts in mental health care - Improving early intervention services and crisis support services; and introduce 24/7 mental health A&E teams - Improving child and adolescent services - particularly in the evenings and weekends Delivery area 5: Safe, high-quality and sustainable services - More services at night and weekends - particularly assessments by a consultant and access to vital tests - Introduce specialist children s assessment units and improve children s services, for example by recruiting more children s nurses - Make the most of new technology to save everyone time and worry, and improve services - Concentrate our skills and experience where they make the biggest difference for patients What will primary, intermediate and hospital care look like? Primary care: - Greater focus on keeping people healthy, including more health screening and better management of long-term conditions - Appointments earlier in the day, later at night, and at weekends, wider access to online advice - GP practices working together and in partnership with other services for patient convenience Intermediate care: - Intermediate health and social care will respond more quickly when people become ill - More services available in, or close to people s homes, in GP practices, in local services hubs or in hospitals Hospital care: - Concentrating specialist doctors, teams and equipment in 24/7 units

4 - Major hospitals at Chelsea and Westminster, Hammersmith, Hillingdon, Northwick Park, St Mary's and West Middlesex, will be supported by local hospitals at Charing Cross, Central Middlesex and Ealing - All three local hospitals will have a local A&E and a range of services to meet population needs Supporting the transformation To transform services and make them sustainable, we need to invest in our workforce and digital technology, improve our buildings and make services more efficient. Workforce: - We need to recruit and retaining a permanent workforce that works in multi-disciplinary teams with new roles and careers - Invest 15million in developing, educating and training staff, to support changing population needs - Establish leadership development forums to drive transformation and share good practice and learning Digital: - Increase the use of technology to reduce unnecessary trips to and from hospital - reduce paper and share electronic care records across the NHS to make sure patients are properly cared for at all times - Patient records, online information and support should be readily available and understood by patients and carers so they can become more involved in their own care - Use population care data to make better decisions about future services and to support integrated health and social care. Buildings and facilities: - Share facilities between health, social care and local government and develop local services hubs to maximise the use of space, be more efficient and make services more integrated - Use an investment fund of up to 100million to improve the condition of primary care buildings and facilities - Improve hospital buildings and facilities and introduce new ways of working which will reduce the 625million we need to maintain outdated buildings

5 3. West London CCG objectives 5.1 Corporate Objectives Delivery Areas The refresh of Corporate Objectives by the CCG in 2017/18 the CCG has aligned service transformation into the following key delivery areas:- Primary Care Leading the development of high quality primary care services in West London, and supporting member practices to meet relevant challenges, as both providers and commissioners of services. In 2017/8, the CCG will continue to deliver the GP5YFV and utilise the established Commissioning Learning Set programme to support practices and deliver efficiencies. The three major priorities for 2017/18 are: Ensure delegation transfers successfully from NHS England and supports the development of primary care Produce an agreed PMS plan and implement from 1 October 2017 Support the GP Federation to develop primary care alternatives aligned with the ambition within the STP Integrating Care Out of Hospital (MyCare MyWay and Transformation) Developing MyCare MyWay Integrated Care, centred on the holistic needs of the service users and their carers. Focusing on the development of the Out of Hospital patient services, was agreed as the main priority for West London CCG, and strongly supports delivery of DAs 2, 3 and 5 within the STP. The major priorities for 2017/18 are: Evaluate and refine the MyCare, MyWay model to ensure cost effective best practice and apply this learning to the roll out wave 3 during 2017/18. Maintain a focus on MyCare, MyWay operations, establishing a multi provider operations group to ensure consistent delivery of the model and to support implementation of any additional service developments/ transformation areas Develop the future options for MyCare MyWay, focusing on services from 18/19, including the options for new capitated budgets, and alignment of mental health and other out of hospital services Progress the Urgent Care Review, produce an option appraisal for Governing Body review, and produce a plan for the implementation, including the standardisation of Walk-In-Centres, Minor Injury Units and Urgent Care Centres Produce an Intermediate Care Beds Strategy that reviews current effectiveness, and plans for future provision of step up and step down requirements, strengthen support for care homes and links with other OOH plans. Develop the hub model within WL CCG, including the IMBC ambition

6 Mental Health Transforming Mental Health services to meet the needs of our diverse population, through commissioning integrated, personalised and responsive mental health & well-being services. The development if MH services in West London will support all the STP delivery areas. The major priorities for 2017/18 are: Develop the Community Living Well strategy to prevent people getting unwell, improve pro-active care and plan for increased capacity for OOH MH & IAPT services Develop Crisis Services to ensure patients are cared by the rapid response team at home not hospital and reduce unnecessary emergency admissions and facilitate early discharge. Ensure that no preventable MH patients are assessed in Emergency Departments. Develop a strategy and action plan covering the Tier 4 Pathway (In-patient, Rehabilitation, Out of Area and supporting Panel Processes) with the aim of ensuring effective pathway flow, reduced DTOCs, increased alternatives to in-patient admission and elimination of unwarranted OOA placements/ecrs in line with NHSE requirements. Enabling Strategies Supporting our objectives through developing a strong culture of enabling patients, members and staff to deliver and realise the benefits of transformation, together with new ways of commissioning and providing. The major priorities for 2017/18 are: Deliver the Financial plan for 2017/18, including QIPP delivery and focus on reduction of interim costs Develop and implement OD strategy for WL CCG senior management team Implement the Primary Care IT Strategy to support practices Review decision-making meetings, refresh the ToR and review meeting frequency to support delivery of the CCGs key objectives. Alignment to the Delivery Areas within the STP (appendix A) Appendix A sets out the local CCG Corporate Objectives using a CHHWE wide standard template. The local objectives are set in the context of the STP delivery areas. Many of the Corporate Objectives support delivery of more than one delivery area, but the objectives have been mapped to the strongest link. In addition, S&T and public health initiatives have been added to provide an overview of objectives to support delivery of the STP in 2017/18. Alignment to the Delivery Areas within System wide priorities and initiatives are being developed by the S&T team covering the delivery areas and enablers in the STP and will be incorporated into the West London CCG objectives and presented to the Governing Body meeting in May 2017.

7 Section B PMO and CCG Delivery Oversight 1. Project Initiation Document (PID) for Corporate Objectives and delivery of CCG Efficiency Plans To support delivery of the CCGs Corporate Objectives, Project Initiation Documents PIDs) have been drafted for each priority. Title of delivery programme Managerial and clinical accountability Brief scheme description Links to FVFW, STP and operating plan must dos Patient benefits Consistency with commissioning plans Cost and efficiency savings summary within objective Organisational review process Project overview, including method of implementation Provider impact Benefits realisation Investment and efficiency, including sign off spend and savings profiles GANTT implantation timescale and key milestones Committee sign off schedule In addition, if the Corporate Objectives have a financial investment requirement and/or deliver efficiency savings, a monthly profiled activity and finance plan will supplement the PID. 2. Monitoring and reporting of Corporate Objective Delivery Building on the PMO process introduced in 2015/16, detailed templates of monthly progress, or risks, with corporate objective delivery will be reported to the CCG Senior Management Team and formally reviewed by the CCG Transformation Board on a monthly basis. A summary of progress will be reported quarterly to the CCG Governing Body, similarly to the report in 2015/16. For the first time in 2016/7 all efficiency plans will be linked directly to a Corporate Objective Key Actions, therefore Transformation Board and Governing Body reports can be extended to link objective delivery with NHS target delivery performance and savings delivery.

8 Section C Risk Management 1. Local Project Risks The governing body met and considered the projects that would be delivered in 2017/18 in West London CCG that fall under the four key areas of: primary care; mental health; My Care, My Way; and Transformation. These projects represent the West London CCG contribution to the NWL STP for the coming year. Risks to achieving the projects and general risks to successful delivery of our objectives were considered as were mitigating actions. These risks will be developed further as part of the PID development and updated via the PMO reporting process to the Transformation Board. 2. Corporate Risks As part of plan development for 2017/8, the CCG will identify the top strategic risks facing us as an organisation. The CCG is part of a collaborative arrangement with other CCGs in inner North West London comprising Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs. The CCGs have worked together to identify a common set of risks and to develop common approaches to their management, as appropriate. This Board Assurance Framework (BAF) identifies key risks to the delivery of the CCG s strategic objectives and sets out the controls that have been put in place to manage those risks and the assurances that have been received that demonstrate whether the controls are having the desired impact. It includes an action plan to reduce the risks and an assessment of current performance. Risks ratings are reviewed throughout the year by the allocated leads.