Papers for the STP Programme Board meeting 23 January 2018 · Papers for the STP Programme Board...

Papers for the STP Programme Board meeting 23 January 2018 The papers from this meeting follow: Agenda

Page 2

Item 2 – Minutes of the meeting on 31 October 2017

Page 3

Item 3 – Sussex integrated urgent care transformation

Page 7

Item 4 – Digital workstream update

Page 17

Item 5 –Clinical board update

Page 35

Item 6 – Finance update

Page 38

Sussex&EastSurreySustainability&TransformationPartnership

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Sustainability&TransformationPartnershipProgrammeBoard

AGENDATuesday23January2018

CrawleyTownFootballClubStadium17:00–19:00

Time ItemDescriptionAttachments

Presenter

1. 17:00WelcomeandIntroductions• STPupdate

BobAlexander

2. 17:10Actionnotes• MattersArising

Enc2

BobAlexander

3. 17:15 SussexIntegratedUrgentCareTransformation Enc3 MaggieKeating

4. 17:30 Digitalworkstreamupdate Enc4 AdrianBull

5. 17:45 ClinicalBoardUpdateEnc5

MineshPatel

6. 18:05 FinanceUpdateEnc6

PaulSimpson

7. 18:25

PlaceBasedPlans• EastSussexBetterTogether(ESBT)• CoastalCare• CentralSussexandSurreyEastAlliance(CSESA)South• CentralSussexandSurreyEastAlliance(CSESA)North

VerbalKeithHinkleyRalphMcCormackWendyCarberry

8. 18:55AOB• NHSContinuingHealthcare

Sussex&EastSurreySustainability&TransformationPartnership

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Sustainability&TransformationProgrammeBoardACTIONNOTES

Thursday31stOctober201717:45-19.30

Jury’sInn,BrightonPresent:BobAlexander,CEOSTP AdrianBull,CEOESHTDenaMarshall,HWLHCCG AdamDoyle,BHCCGRickFraser,SPFT RichardBoyce,NHSImprovementKeithHinkley,ESCCandESBT PaulSimpson,SASHSamAllen,SPFT MarkWatson,HWLHCCGWendyCarberry,STPSRO&AO,HWLHCCG SallyDartnell,HealthwatchWSxCarolineHuff,STP,HWLHCCG RichardBrown,S&SLMC’sMaggieKeating,HWLHCCG MineshPatel,HMSCCGSamanthaStanbridge,ESCCG AmandaPhilpott,EHSCCGandH&RCCGTrudyMills,FCHC AlistairHill(onbehalfofRobPersey),BHCCPeteCarpenter,KSSAHSN SteveJenkin,CEOQVHGeraldineHoban,HMSCCG PennieFord,NHSEnglandDavidMcKenzie,HMSCCG AlisonNuttall,WSCCMarianneGriffiths,BSUH,WSHT DavidLiley,Healthwatch,BrightonandHoveKatieArmstrong,CWSCCG BenRichardson,CarnallFarrerSiobhanMelia,SCFT MayLi,CarnallFarrerDominicFord,SPFT YvonneTaylor,IC24SallyFlint,SPFT JaynePhoenix,SECambRichardBrown,S&SLMC’s Apologies:DanWood,HuseinOozeerally,OliverPhilips,RobPersey,SadieLeack,SarahBilliard,StephenIngram,ElangoVijaykumar,GeorgeFindlay,MichaelWilson,HelenAtkinson, Item Bywhom

Bywhen

1. Welcome&introductionsDenaMarshallwelcomedeveryonetothemeetingandintroducedBobAlexander.BobintroducedhimselftothegroupandpraisedtheBoardandtheSTPforamarkedimprovementinrecentmonths,offeringhissupport,commitmentanddeterminationtomakeimprovementsinthisSTP.Bobadvisedthegroupthatthereisaninductionprogrammeinplaceforeveryonetomeethimona1:1basisinthecomingmonths

2. ActionnotesTheactionnoteson19thSeptemberwereagreedasacorrectrecord.NoMattersArisingFluUpdate–MaggieKeating• Ithasbeenagreedacrosstheboardthatthefluvaccinationis

Sussex&EastSurreySustainability&TransformationPartnership

2

criticaltothesuccessofthewinterplansandmessagestopromotethishavebeenconsistentacrossallformsofmediaandpartners.

• KatieArmstrongrequestedeveryonetoactivelypushforthehighestleveloffluvaccinationsthiswinter.

• TargetshavebeenadheredsofarandtheperceptionisthatthisSTPisinamuchstrongerpositionthanlastyear.

3. InformationGovernance:AdrianBull/MarkWatson/CarnallFarrar

CarnallFarrerpresentedtheIGreport(Enc4),explainingthekeytargetistogetallproviders(GPpractices)tosigntheDataSharingagreement.Thiswillbealengthyprocessbutistheonlywaytogotobringaboutmajorimprovementsinplacebasedplansandidentifywhichgroupshavethemostpressingmedicalneeds.MineshcommentedthatisrighttobelookingforcontinuitynotdisruptionandalsolearnfromotherSTP’swhoalreadyhaveIGinplace.Healsonotedthatinhisexperience,thiswilltakealongtimetoembedandbringaboutchanges.PublicEngagement–willbebuiltintotheplanNextsteps–BobstressedthatthekeytosuccesswillbetomaximisesupportandendorsementfortheDataSharingagreementassoonaspossible.

4. MentalHealthupdate:WendyCarberry/SamAllen• WendyhighlightedhowthestatisticsuncoveredintheMental

HealthreviewhavehighlightedsomedisturbingfactsinthisSTPwhich,ifnotaddressedwillresultina£24millionMentalHealthdeficitby2020.

• Variationsacrossthepatchareakeyconcern.• Twoareashavebeenidentifiedwhichwouldhavethehighest

impactforquickimprovements:- Addressfragmentationacrosstheareas- Digitalenablement–integratedcareneeded(especiallywithinplacebasedDementiacare)

• Actiontakenintheareasidentifiedwillreleaseresourcesacrossthesystem,whichcouldleadtoa40%reductioninA&Erequests

• ChangesinMHlegislationon1stDecwillexacerbatetheissuessoit’scrucialtotakeaction,repurposesomeoftheresourceandimproveoutcomeswhichwillsavemoney

• Implementationhasalreadycommencedinsomeareas-namelySpecialistPlacementWorkstreams,StrategicCommissioningWorkstreamsandnewCaremodels.

• Nextsteps–developthedeliveryframeworkensuringpartnersareconsulted,ensurealignmentatSTPandplacebasedlevelwithoutdisengagingpartners

• QuestionswereaskedaroundwhetheralltheearlyinterventionpartnersarefullyinvolvedintheprocessincludinggroupssuchasSubstanceabuse.

• Therewasalsodiscussionaroundensuringtherightgovernanceisinplaceastheframeworkmovestodeliveryphase-SamAllen

3

assuredthegroupthatplansareinplacetoensuretheSteeringGroupincludestherightExeclevelpeoplewhocansignoffondecisions

ActionWendyandSamtopresentthedeliveryframeworkatthenextProgrammeBoardmeeting

WC/SA

12December

5. UpdatefromSTPClinicalBoard:MineshPatel• TheClinicalBoardhastwomainareasoffocus:

- UnwarrantedVariation- Service/OrganisationInterfacing

• Theintentionistoaddvalueintoworkingcollectively,bringprideintothewayprojectsarecarriedoutandfindwaystotapintoresourcesbetter

• ProjectsthattheClinicalBoardhasbecomeinvolvedininclude:GIRFT,RightCare,MedsOptimisation,EndofLifeCare(placebased),Repatriation,AHSN,thenewMentalHealthstrategy

• ThedraftClinicalCaseforChangedocument(v7)willbepresentedatthenextClinicalBoardmeeting

• Concernswereraisedabouttheprioritisationoftheworkandcareshouldbetakennotto‘over-commit’.Membersoftheboardcalledforaclearbudgetandplanforresourcingofalltheidentifiedpiecesofwork.

• Pointswerealsoraisedabouttheneedforimplementationnowthatmanyprojectshavebeenidentifiedasofkeyimportance

• ClarityneededtoagreeanSTPbudgetandwhetherthereisfundingavailablefromNHSE/NHSI

6. Financeupdate:PaulSimpsonPaulSimpsonexplainedthatheisnotyetinapositiontodeclaretheFinancialoutturnpositionashadoriginallybeenthepurposeofthisupdate,neitherisheabletoprovideafullpictureoftheRiskfiguresasitremainsachangingpictureacrosstheCCG’s,butthingsareworkingwellandmuchprogresshasbeenmade.PaulremindedthegroupthatlastyeartheSTPsystemhadclosedwithac.£150mdeficitandthatthestartingpositionfor2017/18hadbeenac£50mcontroltotaldeficitbut,duetosignificantdeteriorationastheyearhasprogressed(forprovidersandcommissioners),theworkingfigureisnow£88mdeficit.Paulalsoremindedthegroupthatthe‘DoNothing’scenario(ifnoplansareintroducedtomakesubstantialsavings)wouldresultina£1billiondeficit,soitisclearthatthe5yearFinancialModelmustberobustandimpactfultomakesignificantcostreductions.Paulexplainedthe4keyareasembeddedintothe5yearplanfortransformationarealignedtodiscussionsthatarealreadyunderway:- ClinicalCommissioningcoststhroughreductionofUnwarranted

Variation- TransformingCarethroughtheMentalHealthTransformation

Plan

4

- RightCare–Lookingatconsolidationofprogrammesthatwillchallengethecurrentproceduresandreducecosts

- DeliveringasimplemethodologyforallCCG’stoimplementthatwillgivemoredetailedanalysisaroundtheimpactofactivityreductionandprovidemoreinformativereportingoptions

8. AOB

Nofurtherbusiness.

Date&timeofnextmeeting:12thDecember2017,1745–1930,JurysInn,Brighton,EastSussexACTIONLOG31October2017 Action ByWhom ByWhen

1. MentalHealthStrategicFramework–re-presentto

ProgrammeBoardSamAllen 12December

20172. UpdateonClinicallyEffectiveCommissioning

GeraldineHoban/KatieArmstrong

19September2017

3. OversightworkshopnotestobesharedwiththeProgrammeBoard

DenaMarshall 31stOctober2017

4. Furtherinformationtobeprovidedtostakeholdersthroughcirculatinganadditionalpresentation

NicolaFriend 31stOctober2017

5. PStobringbacktotheSTPExecutiveGroupadetailedupdateofthelikelyoutturnposition

PaulSimpson 31stOctober2017

6. MaggieKeating,CarolineHuffandDanWoodtojointlyexplorehowtheClinicalBoardmightsupportaSTPwideCommsandEngagementcampaignrethefluvaccination

MaggieKeating/CarolineHuff/DanWood

31stOctober2017

7. ColinSimmonstoprovideanupdateontheSussexIntegratedUrgentCareTransformationatthenextProgrammeBoard

ColinSimmons January2018

8. ItwasagreedthatallProgrammeBoardmemberstoreadtheSTPupdateforHOSCChairspresentation

31stOctober2017

Sussex&EastSurrey Sustainability&TransformationPartnership

UrgentandEmergencyCare

STPProgrammeBoardUpdate

Tuesday23rdJanuary2018

Sussex&EastSurrey Sustainability&TransformationPartnership

TheSussexNetworkedModelofUrgentCare

Sussex&EastSurrey Sustainability&TransformationPartnership

•  NHS111IUCProcurement:–  NHS111CallHandling

–  SussexClinicalAssessmentService

–  GPOoH(Hear&Treat)

–  GPOoHHomeVisitingService(Excl.Coastal)

•  LocalProcurement:–  GPExtendedhours(18:30-20:00minimum)

–  UTCservicestostandard(12hours24/7minimum)

–  OoH‘basevisit’/urgentappointmentatastaticbasewilltypicallybeco-locatedwithUTCsites&/orGP

ExtendedHours‘bases’

–  Sharedresourceandofferingeconomiesofscale

–  Supportingappointmentsandwalk-inservicestothestandard12hours;and

–  OoHbasevisitservicesbyappointmentalignedtopatientdemographics

•  ProcurementProcess:–  AsimultaneousPreQualificationQuestionnaire(PQQ)andInvitationToTender(ITT)Procurementprocess

hasbeenadopted

•  ContractLength:–  Followingthefeedbackfromourfirstsoftmarkettestingeventweareproposingalongercontractoption

thanisnormallyconsideredi.e.5+2years

–  Ithasbeenagreedtoconsiderhowthecommitmentforthefull7yearscanbeconfirmedatanearlier

pointinthecontracttoaffordtheprovidergreaterflexibilitytoinnovate

•  Cost:ThefullserviceprovisionincludingF2FOoHisapprox.£17to£19millionperannumforthewholeofSussex.

–  OoHBasevisitsbeingprocuredlocallyreducingtheenvelopeby£5.4m

–  OoHhomevisitingserviceremainsinscope

–  PotentialCoastalvarianceinOoHhomevisiting(£1.4m)

SussexIUCProcurementModel

Sussex&EastSurrey Sustainability&TransformationPartnership

SussexIUCProcurementModel

Sussex&EastSurrey Sustainability&TransformationPartnership

NHS111IUCProcurementTimeline

•  NHSECheckpoint/assuranceprocessunderway

•  Procurementprocesslaunchw/c24thJanuary–runningthroughtothe

endofMarch

•  Evaluationtrainingw/b16thMarch

•  Intendopen3rdApriltoreviewsubmissions

•  Procurementcompletetheirinitialelements

•  Tocommissionersandfinanceon9thApril

•  Responseback16thApril–PQQcompleteby20

thApril

•  23rdAprilITTresponsesissued

–  NickyStemp=LeadCommissioner

–  VickieBeattie=LeadClinician•  4-11June–sitereferencevisittotop2bidders

•  July–GoverningBodiestoapproveawardoncontracts

Sussex&EastSurrey Sustainability&TransformationPartnership

NHSEAssuranceCheckpoint:KeyMessages

•  Comfortabletechnicalprocurementstepsareallinplace

•  Nervousaboutthevarianceinthemodelbeingproposed

–  Addedcomplexity

–  Varianceinpatientaccessandpathway–  Relianceonproviderbehavioursacrosscontractualboundaries

•  Needassurancearoundbasevisitvolumes/timeofday/

flow:

–  Howwillthenewmodel(s)supportdemandandensurethere

arenogapsintheservicesbeingprovided

–  Howdoesthisplaybackintermsoffinances,workforceand

contractualcomplexity

–  Assurancerequiredthatsystemisfullycoveredtosupport

patientpopulation

Sussex&EastSurrey Sustainability&TransformationPartnership

NHS111IUCSystemDependencies

Todeliverafullynetworkedmodelforurgentcare,systemwill:•  ProvideafacilitytosupportOoHfacetofaceGPled

consultationsatastaticbasethat111canbookdirect

appointmentsinto(orensurealternativeprotocolsarein

place).

•  Ensurethattheseprovisionsareavailable18:30-08:00andatweekends(hoursoutsideofGPinhoursservices):

–  Whatarethehoursandlocationofthese‘staticbase’services

–  Whataretheprotocols/patientpathwaysforfacetoface

outsideofthesetimes

•  Provideabase/facilitiesforOoHhomevisitingserviceproviderswhererequired

Sussex&EastSurrey Sustainability&TransformationPartnership

TheSESFacetoFaceUrgentCareModel

Sussex&EastSurrey Sustainability&TransformationPartnership

UTCSiteDesignations

Sussex&EastSurrey Sustainability&TransformationPartnership

UrgentCare-TheDigitalAskandEnablers

•  AccesstoappropriatePatientInformation

–  TransformationFundawarded-£518kacross3STPs

–  Focussedonincreasingcareplanvolumes,qualityandaccessibility

•  Callhandlingtoolsandinformation

–  DirectoryofServices&TransformationFund(MiDoS)

•  DirectBookingintoappropriatesettings

–  UTCsandGPOoHBases

•  Remoteaccessandvirtualworking

–  Supporting‘virtual’elementsoftheCAS

–  IncludedinNHS111IUCspecification

•  OnlineServices

–  NHS111Online(UEC5YFV)

•  SymptomsandServices

•  ClinicalReferrals(totheCAS)

–  OnlineConsultations(GP5YFV)

–  ConsultantConnect(Admissionsavoidance)

•  UrgentCareMDS

–  Managingdemandandmeasuringoutcomes

–  IncludedinNHS111IUCspecification(leadprovider)

Sussex&EastSurreyDigital

DrAdrianBullMarkWatson

WhatisDigital?

“Digitalmeansapplyingtheculture,practices,processesandtechnologiesoftheinterneteratorespondtopeople’sraisedexpectations.”

•  TomLoosemore

DigitalVision

DigitalVision

To work with citizens, communities, clinicians and professionals to re-design their health and care system, seizing the opportunities and practices of the digital era.

ThisisaDigitalProgramme

•  aDigitalProgrammethatis:

DesignLead–enablingredesignfromthecitizenandpatientperspective

DataLead–growingtheculture,communityandcommonservicesforevidencebaseddesign

DevelopmentLead–enablingcommondevelopmentservices&continuousimprovement

ProgrammeApproach

•  AgileDesignLeadProgramme–

•  Embednewdigitalcapabilitiesandroles

Oversight&

Prioritisation

Assurance&

Engagement

Escalation&

Direction

Delivery&

Change

DigitalProgramme

Board

STPExecutive/Programme

Board

STPFinanceGroup

PlaceBasedPlans

CoreDigitalTeam

DigitalDesign

Authority

STPClinicalBoard

GovernanceDiagram

ProblemAreas

•  Complextechnologylandscape

•  Mixedmaturitypicture–internalandsupplier

•  Capability&workforcegaps–Userresearch,Design,Analytics/DataScience,Digital

development,EnterpriseArchitecture,

•  Untappedassets–UniversitiesandSMEs

•  Systemconditions–PBR,Sharedbusiness

models,history,investmentplanning

KeyAims

•  Createhead-roominthesystemthroughchannelshifttodigital

•  Developdigitalrelationshipsandco-designbetweenpatientsandprofessionals

•  Increasecitizenandcommunityself-management

•  Developsustainabledatacapabilitiesandworkforce

•  Defineandagree“scale”ofcapabilities–local,place,STP,regional,national

•  Embedproduct&platformmanagement

KeyPriorities-Culture

•  Removethebarrierstodelivery

•  BuildcredibilityofSESDigitalasacommunity

throughdelivery,clarityandlistening

•  Developacultureofcollaboration(digital,clinicalandpartners)andagility

•  Definethescale(local,placebased,STPwide,Regional,National)whichcapabilitiesshould

bedeliveredat

DigitalMaturity-Provider

DigitalMaturity-Provider

2016Theme 2017Theme

Provider Readiness Capabilities

Enabling

Infrastructure Readiness Capabilities

Enabling

Infrastructure

BrightonAndSussexUniversityHospitalsNHSTrust 61 44 80 46 48 78

QueenVictoriaHospitalNHSFoundationTrust 51 23 43 74 39 61

SouthEastCoastAmbulanceServiceNHSFoundationTrust 85 40 80 90 35 88

Surrey&SussexHealthcareNHSTrust 89 49 84 86 43 81

SussexCommunityNHSFoundationTrust 61 20 39 81 32 59

SussexPartnershipNHSFoundationTrust 67 27 84 92 42 97

WesternSussexHospitalsNHSFoundationTrust 89 67 93 90 71 89

EastSussexHealthcareNHSTrust 69 33 66 75 36 56

DigitalMaturity–Commissioner2016

OverallCompliance

CoreGPIT&CentrallyMandated

Requirements

EnhancedPrimaryCareIT

TransformationinPrimaryCare

NHSBrighton&HoveCCG 74.26 81 37.5 33.33 NHSEastbourneHailshamand

SeafordCCG 94.1 94.1 0 0

NHSCoastalWestSussexCCG 73.47 76.75 62.5 33.33

NHSCrawleyCCG 73.48 76.74 62.5 33.33

NHSEastSurreyCCG 81.87 87.71 55.55 33.33

NHSHastings&RotherCCG 54.8 58.99 31.25 33.33 NHSHorshamandMidSussex

CCG 72.07 75.1 62.5 33.33 NHSHighWealdLewesHavens

CCG 64.48 68.99 33.33 66.66

InitialWorkstreams

•  InformationSharing&Analytics

– STP-wideInformationSharingFramework

– Directcareinformationsharing–ROCIapi

– SharedLinkedDataInformationAnalytics

– AnalyticsCommunityDevelopment

InitialWorkstreams

•  IntegratedUrgent&EmergencyCare

– Supporting111recommissioning

– 111Online– CarePlanSolutions

InitialWorkstreams

•  Citizen&PatientExperience– Patient/CitizenSharedRecord–learningfromexistingpositiveexamplesSASHIBD,BSUHVirtualFractureClinic

– Patientcommunications–testingPHRbusinessmodel

–  Integratingpatient/citizenrecords–ROCIapiinacutes

– DigitalRedesign–redesignofservicesfromcitizen/patientperspective

InitialWorkstreams

•  LocalMaternitySystem– Supportingdigitalvisionandprojects

•  ConnectingProfessionals– SEClinicalSenatereviewofPrimaryand

SecondaryCareCommunications

– SkypeforBusiness–Federatingacrossorganisationsandsectors

Questions?

Sussex & East Surrey Sustainability & Transformation Partnership

SussexandEastSurrey

Sustainabilityand

TransformationPartnership

STPCLINICALBOARDUPDATE

STPProgrammeBoardupdatebyCarolineHuff23-01-2018

Keyworkstreams•  Review,adviseandmakerecommendationstotheSTPonreducingun-

warrentedvariation(ClinicallyEffectiveCommissioning,RightcareandGIRFT).Pathwayredesignandpatientoptimisation

Ø  Circulation(Diabetes,Hypertension,AF,angina)Ø  MSK(Hips,knees)Ø  MedicinesØ  ReviewallGettingitRightFirstTime(GIRFT)reportstoagreenexttranchein

preparationforresources•  ImprovingaccesstoSpecialistadvice

•  Overseethedevelopmentoftheclinicalstrategy:Developthecaseforchangetoengagewidelyonwithpublic,stakeholders,professions

•  Provideclinicalandcareprofessionaloversight,andsupportto,allSTPworkstreams(LocalMaternitySystem,TraumaNetwork,UrgentandEmergencyCare,Cancer)

2

Sussex & East Surrey Sustainability & Transformation Partnership

STPExecutiveGroupsupporttoaddresssomeoftheemergingchallenges

•  Overseethedevelopmentoftheclinicalstrategy

Ø  InconsistentinformationacrossthePlaceBasedPlansandSTPreviewsmakingitdifficulttoestablishaSTP-widepicture

Ø  Gapsininformationinkeyareassuchaschildren,primarycare,acutecareØ  STPseenasanaddeddemandonhighlypressurisedstaffØ  Lackofdedicatedresourcetofillinthegaps,enableobjective

prioritisationandshiftthefocusfromplanningtodelivery•  Delayedprojectsupporttoimplementemergingopportunities

•  ConsistentClinicalBoardmembership

•  Inconsistentcommunicationflows

•  SROforkeyworkstreams

3

Sussex & East Surrey Sustainability & Transformation Partnership

Sustainability & Transformation PartnershipSussex & East Surrey

STP Programme Board –Finance Update

Tuesday, 23rd January 2018

Sustainability & Transformation PartnershipSussex & East Surrey

Contents

2

1. Update on 5 Year Model� Overview of modelling work� Scaling factors approach

2. Estates and Capital Strategy

Sustainability & Transformation PartnershipSussex & East Surrey

Component Status

SES STP 5 Year Financial Model

STP Workstreams –Financial Modelling

All STP workstreams has been reflected in the modelling with data validation outstanding for a minority of workstreams.

Mental Health Strategy

Some further information required to complete reflection of the Mental Health strategy in model.

Acute Provider Costs

Model built and scrutinised by working group. Requires fully developed activity plans as an input.

CommunityProvider Costs

Model built and final review by working group underway.

SECAmb Costs Illustrative model complete and being reviewed by trust.

1.1 Update on 5 Year Model – Overview of modelling work

The 5 Year STP Financial Model is being developed in several ways

3

� The SES STP 5 Year Model is being updated to reflect all STP workstreams and to more accurately forecast costs for the 4 different provider types.

� Next steps include developing activity plans, which will be used as inputs for provider cost modelling.

Common methodology based around scaling factors

Sustainability & Transformation PartnershipSussex & East Surrey

1.2 Update on 5 Year Model – Scaling factors approach

Provider cost modelling is based around theuse of scaling factors linking activity changes to cost changes

4

� A scaling factors approach is being used for modelling the costs of acute, community and ambulance trusts. Scaling factors show the marginal cost of doing extra activity on a site for a particular service.

� Our hypothesis is (% change in expenditure) = (scaling factor) x (% change in activity)

� The methodology has been scrutinised by a group of deputy directors of finance.

� Outputs are a good approximation that is useful and appropriate for strategic modelling.

� The approach was developed over several years for acute reconfiguration, and followed 8 stages.

# Summary Description

1. Activity group totals Scaling factors for activity group totals were calculated from Reference Costs activity and actual costs using regression analysis. These were used to calibrate scaling factors for expenditure lines.

2. Regression analysis Regression analysis of size of unit against medical WTEs from NHS Workforce Census data was performed for activity groups with significant on-call rotas.

3. Strict staffing ratios Strict midwife-to-mother ratios necessitate the use of nursing scaling factors of 100% in Obstetrics and Neonates.

4. Bottom-up estimates Interviews and assessment of cost line items within pathology and radiology were used to form estimates that were more bottom-up in nature than those used elsewhere.

5. Low economies of scale Only modest economies of scale were assumed in elective services for clinical staff.

6. No economies of scale

Cost lines where there is no rationale for assuming economies of scale were assigned a 100% scaling factor.

7. No link to activity Where activity is not a good predictor of expenditure, growth is excluded and will require separate modelling in the future. For example, premises costs and depreciation.

8. Case by case The remaining scaling factors were agreed on a case-by-case basis.

Sustainability & Transformation PartnershipSussex & East Surrey

1.2 Update on 5 Year Model – Scaling factors approach

8 stages were used to build up a complete set of scaling factors

5

A&E

Emergency

Medicine

Emergency

Surgery

Obstetrics & N

eonates

Emergency

Paediatrics

Elective Paediatrics

Elective Medicine

Elective Surgery

Adult critical careStaff- Medical 73% 80% 80% 80% 50% 90% 90% 90% 80%Staff- Nursing 70% 70% 70% 100% 75% 90% 90% 90% 70%Staff - other clinical 70% 70% 70% 70% 75% 90% 90% 90% 70%Staff- Non-clinical 10% 10% 10% 10% 10% 10% 10% 10% 10%Clinical service and supplies including drugs (but not PBR excluded drugs) 100% 100% 100% 100% 100% 100% 100% 100% 100%PBR Excluded Drugs 100% 100% 100% 100% 100% 100% 100% 100% 100%Non-clinical services 50% 50% 50% 50% 50% 50% 50% 50% 50%Corporate services 35% 35% 35% 35% 35% 35% 35% 35% 35%Premises costs 0% 0% 0% 0% 0% 0% 0% 0% 0%Depreciation and amortisation 0% 0% 0% 0% 0% 0% 0% 0% 0%Pathology 50% 50% 50% 50% 50% 50% 50% 50% 50%Radiology 80% 80% 80% 80% 80% 80% 80% 80% 80%Other shared clinical services 75% 75% 75% 75% 75% 75% 75% 75% 75%Other costs - operating 75% 75% 75% 75% 75% 75% 75% 75% 75%Other costs - financing and other 0% 0% 0% 0% 0% 0% 0% 0% 0%Outsourced clinical activity 100% 100% 100% 100% 100% 100% 100% 100% 100%Litigation 0% 0% 0% 0% 0% 0% 0% 0% 0%Total

Legend

1. Activity group totals

2. Regression analysis

3. Strict staffing ratios

4. Bottom-up estimates

5. Low economies of scale

6. No economies of scale

7. No link to activity

8. Case by case

Sustainability & Transformation PartnershipSussex & East Surrey

Estimated Duration

3 weeks 1 month 1 month

Key activities � T&F Group� Gather and upload SHAPE asset data

returns� Update disposal schedule� Confirm and complete capital template� Update STP strategy themes

�Analyse data returns�Generate summary slides�Review estates progress against

STP strategies�Review key STP and estates

projects�Agree implementation priorities and

critical decisions

�Summarise transformation by sectors�Summary slides and ppt QA�Review and signoff by Exec, place

bases, SEP function�Submit return

Key meetings

�Finance Group: 12 Jan�T&F Group: date tbc�Estates group: 18 Jan�Finance Group: 26 Jan

�T&F Group: dates tbc�Finance Group: 9 Feb�Capital Group: 19 Feb tbc�Finance Group: 23 Feb

�Exec: 6 Mar�Exec: 20 Mar�Place bases: tbc�SEP function: tbc

End products

�Uploaded SHAPE returns�Updated disposal schedule�Completed capital templates�Updated STP strategy themes and

enabling implications

�Data returns analysis�Updated estates and STP prioritised

projects

�Approved submission of Estates workbook

6

An updated STP Estates Strategy will be complete by the end of March

Data gatheringData analysis,

STP Investment,Project Priorities

Presentation and signoff

February MarchJanuary

2.1 Estates and Capital Strategy� Release of capital from NHSE is contingent on the submission of an up-to-date Estates Strategy, taking

the form of a workbook, by 31st March 2018.

� We have the following process in place to ensure delivery of the Strategy.