Lunch & Learn – Session 5

Plan and Contracts Overview

19th March 2014

Aim

To provide attendees with an overview of key messages contained in the NHS planning guidance, the Strategic Plan, Operational Plan and Financial Plan submission and contracts, thus assisting with the ongoing development of programme/project plans.

Previously….on Lunch & Learn #1• Keep it Simple• Keep it Proportionate• Remove the Bureaucracy

Feedback from previous Lunch & Learn events:

“great to have opportunity to input”

“good to have engaged input from leads to enable them to feel they are part of the process. Everyone will have the same understanding”

“I really value the introduction of the PMO, I think it will help Programme Leads manage and prioritise their work and help us to know what is expected and when”

Agenda

Part 1:

Overview of NHS Planning Guidance

Part 2:

• 5 Year Strategic Plan: Highlights and key messages

• 2 Year Operational/Activity Plan: Highlights and key messages

• Finance Plan: Highlights and key messages

Part 3:

• Contracts Overview

Part 1: Overview of NHS Planning Guidance

A little test!!!................

Part 1: Overview of NHS Planning Guidance

1. Complete NHS England’s vision statement:

High quality care for - - - , now and for - - - - - - generations

2. There are four fundamental outcomes detailed in the NHS planning guidance:

• Delivery across the five domains and seven outcome measures• Improving health• Reducing health inequalities• Parity of esteem

Can you identify which of the following improving outcomes ambitions are the real SEVEN?

Part 1: Overview of NHS Planning Guidance

Securing additional years of life for the people of England with treatable mental and physical health conditions.

Improving the health related quality of life of the 15 million+ people with one or more long-term condition, including mental health conditions.

Securing ‘more for less’: ensuring that the NHS continues to provide high quality services using less resources and a greater use of technology.

Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital.

Increasing the proportion of older people living independently at home following discharge from hospital.

Increasing the number of people having a positive experience of hospital care.

Improving clinical leadership and reducing the number of managers wasting NHS money.

Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community.

Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in care.

Part 1: Overview of NHS Planning Guidance

3. NHS England has introduced six transformational service models that they believe will determine any high quality, sustainable health and care system in England in the next five years.

Can you fill in the gaps?

• A completely new approach to ensuring that citizens are fully included in all aspects of _______ _______ and ______ and that patients are fully _________ in their own care.

• Wider _______ care, provided at scale. • A modern model of __________ care. • Access to the highest quality ______ and _________ care. • A step-change in the productivity of ________ care. • ___________ services concentrated in centres of excellence.

Part 1: Overview of NHS Planning Guidance

4. When do NHS England expect CCGs to have:a) determined the footprint of their urgent and emergency care network?

b) begin the process of designating facilities within the network?

5. One of the six transformational models of care requires a ‘step change in the productivity of elective care’.

What is the level of improvement required within the next 5 years?

Part 1: Overview of NHS Planning Guidance

6. According to the NHS England Allocation process ND CCG has a greater share of CCG resources than is equitable in 2014/2015, but by how much?

7. What are the total Programme Resources available to the CCG in 2014/2015?

8. What are the following percentages in 2014/2015:a) Minimum risk reserveb) Minimum Control totalc) Minimum Transformation monies

9. When we have to have the BCF in place in 2015/2016 how much will it be?

Part 1: Overview of NHS Planning Guidance

And the answers…………

Part 1: Answers

Part 1: Answers

1. Complete NHS England’s vision statement:

High quality care for ALL, now and for FUTURE generations

2. There are four fundamental outcomes detailed in the NHS planning guidance:

• Delivery across the five domains and seven outcome measures• Improving health• Reducing health inequalities• Parity of esteem

Can you identify which of the following improving outcomes ambitions are the real SEVEN?

Part 1: Answers

Securing additional years of life for the people of England with treatable mental and physical health conditions.

Improving the health related quality of life of the 15 million+ people with one or more long-term condition, including mental health conditions.

Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital.

Increasing the proportion of older people living independently at home following discharge from hospital.

Increasing the number of people having a positive experience of hospital care.

Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community.

Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in care.

Part 1: Answers

3. NHS England has introduced six transformational service models that they believe will determine any high quality, sustainable health and care system in England in the next five years.

Can you fill in the gaps?

• A completely new approach to ensuring that citizens are fully included in all aspects of SERVICE REDESIGN and CHANGE and that patients are fully EMPOWERED in their own care.

• Wider PRIMARY care, provided at scale.

• A modern model of INTEGRATED care.

• Access to the highest quality URGENT and EMERGENCY care.

• A step-change in the productivity of ELECTIVE care.

• SPECIALISED services concentrated in centres of excellence.

Part 1: Answers

4. When do NHS England expect CCGs to have:a) determined the footprint of their urgent and emergency care network?

‘During 2014/15’

b) begin the process of designating facilities within the network?

‘In 2015/16’

5. One of the six transformational models of care requires a ‘step change in the productivity of elective care’.

What is the level of improvement required within the next 5 years?

‘20% productivity improvement within 5 years, so that existing activity levels can be delivered with better outcomes and 20% less resource’

Part 1: Answers

6. According to the NHS England Allocation process ND CCG has a greater share of CCG resources than is equitable in 2014/2015, but by how much?

8.8%

7. What are the total Programme Resources available to the CCG in 2014/2015?

£369.807m

8. What are the following percentages in 2014/2015:a) Minimum risk reserve 0.5%b) Minimum Control total 1.0%c) Minimum Transformation monies 2.5%

9. When we have to have the BCF in place in 2015/2016 how much will it be?

£19.439m

Part 2: Overview of Strategic Plan

NDCCG Strategic Vision:

Work together across health, social care, housing, voluntary sector and with the

public itself to enable people to retain independence supported by their local

community. When publicly funded services are required they will be

responsive, safe, caring and provide a good experience of care still within the

local community in the majority of cases. Where exceptionally people need to

access more specialised services outside of their community this will happen

easily and they will be supported to return to their local community as quickly

as possible.

5 Year Strategic Plan – NDCCG Plan on a Page

Measured using the following success criteria:

The health and wellbeing of the North Derbyshire population will be maximised

Inequalities and unwarranted clinical variation will be reduced People will increasingly be enabled to retain their independence

with the support of their local community and through integrated care teams provided in the community

Services, when required, will be responsive, safe, caring and provide a good experience of care

All organisations within the health economy will meet their financial targets year on year.

No provider will be under enhanced regulatory scrutiny due to performance concerns

Achievement of the improving outcomes ambitions will be used as the key set of measures to determine whether the above criteria have been met.

Strategic Aim One Transform Primary Care

Strategic Aim Two Develop integrated models of care (with a focus on frail and elderly, children’s and young

people and mental health pathways)

Strategic Aim Three

Redesign urgent and emergency care

Strategic Aim Four Improve the management of

long term conditions

Strategic Aim Five Focus on prevention/

self management

Strategic Aim Six Review the productivity of

elective care

1. Develop a GP Federation 2. Address clinical variation through RMMT visits and the wider medicines management programme 3. Ensure seamless 24/7 access to primary care 4. Introduce a shared clinical record across all primary care medical care providers 5. Implement Flo telehealth system

Overseen through the following governance arrangements:

Existing system wide structures: o Adult Care Board o Health and Well Being Board o Joint Commissioning Co-ordinating Group o 21st Century Transformation Programme Board

Internal governance structure support by Programme Management Office

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3

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System values and principles

All services will be commissioned in accordance with the publically consulted on system wide guiding principles for service change and the CCG’s values: Patient Focus Integrity Courage Responsiveness

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Delivered through the following improvement interventions:

Description of the improvement intervention required to deliver the desired state outlined in the vision section above

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1. Develop integrated community services for the frail elderly 2. Develop an integrated behaviour pathway for children and young people 3. Introduce new commissioning arrangements for children’s continuing care 4. Review of children’s services mapping, cost and value to enable outcomes based commissioning 5. Develop primary care based dementia services 6. Implement RAID psychiatric liaison service 7. Transform the care pathway for patients with learning disabilities moving to a more integrated,

community based service

1. Offer assessment, treatment and care in the community as an alternative to travel to hospital 2. Optimise emergency patient pathway flow through CRH – ED, CDU, EMU and wards 3. Improve discharge planning and post acute pathway

1. Review and recommission new integrated diabetes pathways for type 1 and 2 patients 2. Review the current model provision/services for patients with COPD 3. Develop the Hospice at Home model supporting patients to die at home.

1. Continue to work with Public Health on a range of measures related to prevention and early diagnosis 2. Review and adopt the recommendations (as appropriate) of the prevention review commissioned

from Public Health

1. Commission a deep dive analysis on a number of elective care pathways commencing with Neurological conditions and MSK

2. Analyse and benchmark CCG performance on a range of elective care metrics such as conversion rates, day surgery rates and new to follow up ratios

3. Work with the Clinical Strategic Networks to identify specialised services which necessitate concentration in centres of excellence

DERBYSHIRE SYSTEM VISION

Derbyshire health and social care economy is a system comprised of partners from Erewash, Hardwick, North and Southern CCGs, Derbyshire County Council and all Provider Trusts within the Derbyshire borders. Our common vision focuses on achieving a seamless health and social care service; at an individual level we have adopted the vision from National Voices: ‘I can plan my care with people who work together to understand

me and my carer (s), allowing me control and bringing together services to achieve the outcomes important to me’.

North Derbyshire CCG supports this with their vision:

‘Work together across health, social care, housing, voluntary sector and with the public itself to enable people to retain independence supported by their local community. When publicly funded services are required they will be responsive, safe, caring and provide a good experience of care still within the local community in the majority of cases. Where exceptionally people need to access more specialised services outside of their

community this will happen easily and they will be supported to return to their local community as quickly as possible’.

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Part 2: Overview of Operational Plan

Targets:

• As per NHS Constitution/CCG Assurance Framework

• IAPT:• % of need in population served by IAPT: 15%• % of people completing treatment and moving to recovery: 50%

• Local priority: 80% of clinical navigation referrals into the SPA will avoid acute admission or be maintained in the community

• Dementia diagnosis rate:• 2014/15: 67%• 2015/16: 68%

• C-Diff: Trajectory now received from NHS England: ceiling of 138 cases (vs 85 cases)

Part 2: Overview of Operational Plan

Improving Outcomes Ambitions

Ambition Area Metric Proposed Attainment in 18/19Unit of planning Average % change between baseline

and 18/19

1. Securing additional years of life for the people of England with treatable mental and physical health

conditionsPYLL for causes considered amenable to healthcare - ALL

2061-8%-8%

2. Improving the health related quality of life of the 15 million+ people with one or more long term condition,

including mental health conditions

Health related quality of life for people with Long term conditions (12/13) 73.4 2%

2.1%

3. Reducing the amount of time people spend avoidably in hospital through better and more

integrated care in the community outside of hospital.Composite of all avoidable emergency admissions (12/13)

1648-30%-30%

5. Increasing the number of people having a positive experience of hospital care.

Patient experience of hospital care - av. number of negative responses per 100 patients (2012)

138.3 -5.5%-6%

6. Increasing the number of people with mental and physical health conditions having a position

experience of care outside hospital, in general practice and in the community.

Patient experience of hospital care - av. number of negative responses per 100 patients (2012)

4.1 -11.0%-7%

Part 2: Overview of Activity Plan

• Operational, activity and finance plans must triangulate

• Growth set at:• NEL: 5.7% (offset by 3.2% QIPP)• OP & EL: 1%• A & E: 2%

• QIPP:• NEL: 3.2% = reduction of c. 700 NEL admissions (per year)• OP: 0.3% = reduction of c. 300 attendances

• More work to do before final submission on 4th April

Part 2: Overview of Finance Plan

Resources in 2014/2015:

• Programme £369,807,000• Admin £7,077,000

The first priority is to:

• Recurrently fund all budget shortfalls• Fund all recurrent expenditure funded in 2013/2014 from non-recurrent

sources of funding• Fund 2013/2014 outturn

Whilst maintaining realistic and achievable levels of:

• QIPP and efficiencies• Growth in secondary care activity• Contingencies to mitigate risk

Part 3: Contracts Overview

DCHS• Continuation of the contract rebasing• Reapportion the contract over CCG’s

Chesterfield Royal FT• Work toward the closure of a Non elective ward by 1st September• Work on the frailty unit

Contract penalties• Standard contract penalties national and local.

Any Questions?

Next Steps

APRIL MAY JUNE PLAN Submit final versions of:

Operational plan Activity plan Finance plan

Submit final version of 5 year strategic plan (North Derbyshire Unit of Planning)

Public facing plan

document developed and published

PMO Go live – 1st April

ePMO system developed ePMO system implemented and programme/project data uploaded

Plan Delivery Group terms of

reference/process agreed with SMT

First Plan Delivery Group/reporting cycle

Lunch & Learn – Session 5

Next Lunch & LearnsThursday 20th March PMO A Basic Introduction to PMO

Wednesday 26th March Last Chance Saloon:Open space for questions, specific project support and development

Thank you for coming and please provide us with your feedback!

Is there anything you felt was missing from this presentation?

How could we do this better next time?