NHSHERE024_Executive_Summary_2010_FINAL

Arthroscopy of the knee joint

East Surrey Hospital

Canada Avenue

Redhill

Surrey RH1 5RH

Tel: 01737 768511

Fax: 01737 231769

Arthroscopy 17/3/06 16:25 Page 1

A local solution for Herefordshire:The future provision of health and social care services

Executive Summary of the Transition Board Report to Sponsor Organisations

NHS HerefordshireHerefordshire CouncilHereford Hospitals NHS TrustPCT Provider ServicesandWest Midlands Strategic Health Authority

A brief introduction to arthroscopy

Arthroscopy is a “keyhole” operation that is used to look insideand treat joints, especially the knee joint.

It is performed through very small incisions in the skin, using anarrow telescope (arthroscope) attached to a video camera.Compared to open surgery, which involves a larger incision,keyhole surgery is less painful, carries less risk of infection, andenables people to recover more quickly.

Why do I need this operation?

The surgeon needs to look inside your knee to find out exactlywhat is causing your troubles. You may have a tear of one of yourcartilages. These are half moon shaped pieces of gristle cushioningthe bones in the knee. You may have torn one of the ligamentswithin your knee joint. These are strong bands of gristle holdingthe bone ends together inside the joint. You may have a loosepiece of bone in your knee joint. You may have arthritis in part ofyour knee.


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What are the benefits of surgery?

The first aim of arthroscopy is as an investigation to reach adiagnosis of the cause of your knee symptoms. It may bepossible to improve the symptoms if a loose body or torncartilage are found, which can be removed at the sameoperation. An arthroscopy does not guarantee to improve yoursymptoms. Arthroscopy is the only way to give a direct view ofthe inside of the joint.

Are there any alternatives to surgery?

Not everyone with a knee problem will need an arthroscopy. The problem can be diagnosed using non-surgical methods suchas MRI (Magnetic Resonance Imaging) and some problems canbe treated with physiotherapy.


1 Contents 2

2 Chair’s Foreword 3

3 Executive Summary 6

Introduction 6

Background 6

Transition Board 7

Pre-Consultation 7

Future State – Statement of Common Purpose 8

Future State – Service Principles 8

Risk Stratification 8

Shifting the Focus of Care 8

Locality Health & Social Care Teams 9

Integration of Health & Adult Social 9 Care Across Care Pathways

Financial Assessment 10

3.1 Organisational Implications 11

The Proposition 11

Recommendations 12

1 ContentsArthroscopy of theknee joint












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2 Chair’s Foreword

A huge step but only the beginning

Herefordshire is unique. It is not just its fine buildings, beautiful scenery, mainly rural population and strong sense of place but also in the existence of a difficult puzzle that has foxed previous efforts to solve it. It has been my privilege over the last eight months to work with clinical, social care and management colleagues from across the county to solve that puzzle. As the national economic position tightens with its impact on the NHS and local government in general and Herefordshire in particular, the need to agree how to sustain the future of Herefordshire’s health and social care becomes even more intense.

There have been several previous attempts to identify that future. Those studies have clarified that the catchment population of the county and surrounding areas of approximately 230,000 is half of what is now nationally considered necessary to support a fully functioning district general hospital with accident and emergency, maternity, intensive care, medical and surgical specialties. The uniqueness of Herefordshire and what makes it so challenging, is the delivery of a full range of services to a dispersed population.

Yet the geographical position of Herefordshire and distances to other cities mean that a local hospital with a broad range

of specialties is needed in the centre of the county. Combined with this position, the rural nature of the county determines that strong locality and community based services are also required.

Prior to this project, a clinically safe and financially viable solution had eluded sincere efforts to spot it. In August 2009 the four Sponsors backed by the SHA, established the Transition Board to develop a solution for Herefordshire that would take health and social care services into a good future. The Transition Board brought together social care, general practitioners, hospital and community consultants, nursing, non medical clinicians, patients’ representative, senior management, financial expertise, the joint PCT/Council commissioner, the SHA and specialist external advice with an independent chair to solve the puzzle.

The Transition Board began against a background of scepticism about whether this time the effort required to resolve the Herefordshire puzzle would lead to any action as recommendations from previous studies had not been implemented. I was very aware of this feeling both within the Transition Board itself and the wider community of health and social care practitioners. However, building on the previous work in the county, learning from other health and social care economies in the country and with the committed and

Arthroscopy of theknee joint


















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thoughtful contribution of 100 clinical and social care practitioners, the Transition Board has reached a unanimous conclusion about the overall way forward. Not surprisingly there remain caveats, concerns and some anxieties but these exist alongside a growing enthusiasm for the prospects that are opening up for a better future.

The Transition Board concluded that a model of care provided by a new integrated care organisation combining community services (currently provided by PCT Provider Services), acute health services (provided by Hereford Hospitals NHS Trust) and social services (provided by Herefordshire Council), could create not only a viable but a compelling option.

However, the Transition Board did not start with an organisational solution in mind. In fact the Transition Board actively sought to establish whether it would be possible to achieve virtual service integration and financial sustainability without the distraction of another organisational change.

Following the successful completion of four workstreams including the definition of five new clinical and social care pathways, and the financial requirements associated with them, the Transition Board has concluded that a new integrated care organisation would be the most effective mechanism to achieve better services for patients, service

users, carers and families while creating a sustainable and affordable health and social care system for the future.

The new organisation will need to inspire its existing and future staff with a shared purpose across community, hospital and social care. It will need to be a great partner to general practice and primary care, the children’s services Trust, mental health services and other statutory agencies, the West Midland Ambulance Service, the private health sector and the Third Sector of community, voluntary and charitable associations.

It is also essential that concerns are acknowledged. Practical measures of reassurance are needed to make sure that the hospital as the larger element of the new organisation does not take over and is seen not to have taken over community services and social care without any change in culture or approach. That required change is captured in the Statement of Common Purpose later in this report. All elements of the local health and social care system, including those within the new organisation if approved and those partners outside it, will need to do things differently if the many benefits identified in the work streams and pathways are to be achieved. A simple organisational merger will not achieve those outcomes.











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Rather, the social care, community and hospital services through combining in a way unique to Herefordshire could create a new and shared understanding of what it means to provide excellent services within the resources that it has and in a way that makes its staff pleased to be part of the endeavour. The new organisation, if approved, has the potential to be different and better than the sum of the existing parts.

It is important to acknowledge that even if the 4 Sponsors had not set up this project and were trying to make the current position work, they would still have to find a solution to the Herefordshire puzzle, to agree what the future would be for the PCT-provided community services and to cope with the national financial squeeze.

The current configuration is not sustainable and would not provide a viable future that is local to Herefordshire and capable of passing the rigours of becoming an NHS Foundation Trust.

I consider that the proposition about a new organisation with a new culture and the more detailed recommendations, offer to the four Sponsors and the SHA the potential to resolve the issue of achieving clinical and financial sustainability with a catchment population small by national standards. There is now clarity about a very positive future for community services. The concept of a

new organisation founded on the wisdom and experience of its clinical and social care practitioners and managers is an exciting one.

The proposition offers patients, service users, staff, primary care and other partners to do something great for Herefordshire. Others outside the county will wish to come and see how it can be done.

Peter GluckmanIndependent Chair

Transition Board

Provider Services Integration Project

Herefordshire Health and Social Care Community



















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3 Executive Summary

Introduction

The purpose of this document is to:

• set out the Transition Board’s recommendations to the four Sponsor organisations and the West Midlands Strategic Health Authority (SHA) regarding the organisation and delivery of health and social care in Herefordshire;

• recommend a preferred option for consideration and approval by the relevant statutory bodies (NHS Herefordshire, Herefordshire Council and Hereford Hospitals NHS Trust) and;

• indicate to the sponsor organisations and the SHA what is required to make the integrated service model better for patients and the public

This report is not a full business case. It does not cover the full range of material that would be part of such a document. The work to prepare a full business case would take place if the sponsors were to approve the proposed option in principle.

Background

Herefordshire’s population is relatively elderly and in the next five years is projected to grow by 2%. This growth is confined to the over 65 client group which will grow to represent 23% of the population. Services are provided over a broad geographic range; across Herefordshire and into mid-Wales.

Geographical context is a key consideration because, even though the population is smaller than the estimated 450-500,000 required to sustain an acute general hospital, without an acute hospital located in the County many residents would need to travel over an hour to a neighbouring hospital.

NHS Herefordshire spent £275 million in 2008/09 on care in the county and the local authority spent £39 million in 2008/09 on residential, nursing home and domiciliary care. The largest single client group, in terms of expenditure, is the elderly.

In 2008, the Herefordshire health and social care community commissioned the Health Services Management Centre (HSMC) to undertake a strategic ‘Provider Services Review’ that was designed to ensure that provider services are fit for purpose and organised in sustainable configurations in order to both drive service improvement and deliver real efficiency. There was significant consensus from clinical teams for the development of integrated care pathways delivered by an integrated hospital, community health and adult social care organisation, although the final review report did not make this explicit recommendation. Following the conclusion of the Provider Services Review in 2009, KPMG were commissioned to:











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• Assess the viability of HHT and the PCT Provider Arm as standalone organisations

• Determine the potential clinical and financial viability of a single integrated healthcare provider

KPMG reported back that HHT and PCT Provider Services, as currently configured, faced a significant cumulative financial deficit £23 million for the four year forecast period ending 31st March 2014. However, KPMG also pointed to the scope to achieve significant clinical and financial benefit through the redesign and integration of services, shifting work from bed-based settings to the community (potentially via a single organisation).

Government policy also signals a shift in health and social care towards a service model that focuses on care provided in the home and community as an alternative to hospital. The model is characterised by strong partnership arrangements and integration between health and social care providers, where partners agree shared outcomes in order to support people to live independently and stay healthy.

Transition Board

In August 2009 the Herefordshire health and social care community formed an independently-chaired Transition Board with multi-disciplinary membership to:

• Develop options for the organisation and delivery of health and social care services

• Recommend a preferred option for consideration and approval by the relevant statutory bodies

• Prepare public consultation documents and organise/lead public consultation on behalf of NHS Herefordshire

• Ensure that the subsequent proposals will contribute to maximising health and well being and reducing health and social inequalities in Herefordshire

• Create new integrated care pathways in adult services but recognise that these would be extended in due course to other areas such as children and young people and maternity services

• Recognise that mental health services, while essentially linked to any new arrangements will be provided by a different organisation

Pre-Consultation

The Transition Board undertook a pre-consultative process on behalf of NHS Herefordshire beginning in November 2009 and ending in February 2010. The exercise focussed on asking staff, stakeholders and the public how they think their local health and social services could be improved through closer integration. Feedback from consultees has been incorporated into this document.



















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Future State - Statement of Common Purpose

The Transition Board has developed a high-level statement of common purpose to reflect its ambition for health and social care in Herefordshire:

‘We will provide integrated, high quality and safe care to support personal health, well being and independence within a sustainable Herefordshire health and social care community.’

The full statement containing the under-pinning values and project benefits is included in the report.

Future State – Service Principles

The Transition Board has developed a new integrated model of care based on a number of key principles:

• Risk stratification – identifying our most ‘at risk’ clients and shifting from a diagnose and treat service to one that predicts and prevents

• Shifting the focus from institutional (primarily bed based) to non-institutional health and social care

• Services focussed heavily on locality health and social care teams with a GP acting in a crucial ‘gatekeeper’ role

• Clinical and operational integration of primary, community, acute and adult social care

These principles underpin the design of the proposed new model of care and are consistent with both the approach suggested by KPMG and the policy context.

Risk Stratification

Proactive risk management is central to the success of the new service model and care pathways. This is derived from a focus on ‘at risk’ populations as opposed to those that are currently known service users. Risk stratification focuses on minimising the likelihood of ill-health, disease progression, need for hospitalisation and costly interventions. Risk stratification will be used to:

• Identify the most at risk, frail elderly people within the community by ‘case finding’ from GP practice registers.

• Case find those at risk from chronic obstructive pulmonary disease (COPD), diabetes and cardiovascular disease

Shifting the Focus of Care

The tiered model of care is predicated on the needs of the population across five ‘tiers’ of care. The model places a greater emphasis on health promotion, self care and screening/case finding as a











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way of improving health outcomes. Active management and community intervention averts crisis management and unscheduled hospital admission. The overall effect of implementing risk stratification and a tiered approach to care means that non-acute care shifts back into a more appropriate setting. This translates into major changes in the way care is provided:

• The vast majority of chronic disease management care will be provided across the community in a variety of different settings

• Community Hospitals will be used as the locality focus for a range of activities from step up/step down beds to specialist clinics and unscheduled care

• Hospital care will only be provided where appropriate. In practice, less care will be provided from acute hospital beds and more care provided in community care settings

Locality Health & Social Care Teams

Locality teams will be the engine of the new model of health and social care delivery in Herefordshire with the GP acting as a crucial gatekeeper for access to other parts of the system. Effective locality teams will:

• Maximise independence and recovery for the service user

• Reduce A&E attendance and inpatient admissions

• Reduce inpatient length of stay • Support centralised services (acute/tertiary/

specialist)

Locality teams are key to the implementation of a new model of integrated working through their ability to:

• Provide care that is designed and delivered around the needs of their local population.

• Promote a culture that fosters accountability and consistency across all the care settings of Herefordshire.

• Enable a structure of integrated working across existing organisational and professional boundaries, that make it certain that service users receive treatment at the right time and in the right location

Integration of Health & Adult Social Care Across Care Pathways

The Transition Board has concluded that there are a number of key components which are essential to the delivery of an integrated service with the ability to provide consistent care across a pathway from beginning to end:

• Locality teams made up of GP’s, social care professionals, nurses, therapists and support workers, responsible for the overall care of service users



















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• An Urgent Care Centre fully integrated with the A&E Department, Clinical Decisions Unit and Minor Injuries Units

• Frail elderly Multi-Disciplinary Team consisting of nurses, therapists, social care professionals, support workers, GP and Geriatricians

• Step up/Step down COPD service working across primary and acute care on both admission avoidance and early supportive discharge

• A single Diabetes service incorporating diabetic nurse specialists, physicians, dieticians and podiatrists

• A multi-disciplinary approach, including early social care involvement, in the stroke rehabilitation service

Financial Assessment

KPMG’s Due Diligence Review (2009) indicated that the two main providers in Herefordshire faced a cumulative combined deficit of £23 million for the four year period to March 2014. Since this analysis there has been a further deterioration in prospects for public sector funding and further analysis suggests that the cumulative deficit could potentially reach some £46 million, of which £16million would be recurring.

Given the likely magnitude of the future cost improvements required at HHT and the PCT Provider Services, it is unlikely that either HHT or PCT Provider services could meet this challenge through internal efficiencies alone.

Initial modelling of the financial contribution from the care pathways workstream indicates that potential savings of up to £12.5 million per annum could be available across a range of scenarios. The financial modelling for NHS Herefordshire’s World Class Commissioning Strategy has assumed a mid-range scenario of £5 million annual savings derived from pathway redesign.

Further financial analysis will undoubtedly be required as implementation progresses but there is confidence at this stage that the new service model represents a financial positive.

The conclusion of the Transition Board is that an integrated service solution has the potential to close a proportion of the gap between income and spend in the local provider economy. However, cost improvement programmes will still be needed as will an open and evolving discussion on risk sharing between the commissioners and the new integrated care organisation as the national funding position clarifies over the summer of 2010.











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Eleven options for organisational restructure were drawn up by HSMC in their report as part of the Provider Services Review. Of the three preferred options, there was strong consensus for an integrated hospital, community health and social care organisation. The review concluded that it would be premature to recommend this configuration without more detailed work on integrated care pathways.

The KPMG due diligence report recommended that integration was an option that should be explored in order to overcome the difficult financial futures that both health providers face.

Supported by KPMG, the Transition Board has modelled a number of detailed, integrated care pathways which suggest that better, more appropriate care can be provided at lower cost through integrated delivery.

Transforming Community Services: the assurance and approvals process for PCT-provided community services (DH 02/10) mandates a number of options for preferred organisational forms, including integration between community services and an NHS acute trust.

The Proposition

The proposition to the four sponsors falls into two related parts:

1) The creation of a new integrated model of health and social care provision in Herefordshire, aimed at providing personalised high quality, safe and sustainable care for local people which promotes personal health, well being and independence; a model which is focused on providing care as close as possible to people’s homes, rather than in an institutional setting; a model which is also aimed at identifying our most vulnerable clients and shifting the emphasis from diagnosis and treatment to prediction and prevention.

2) The creation of an integrated care organisation under one management structure composed of an integrated NHS Trust combining community and acute health services that is also integrated with social care so far as is practicable under current legislation; an organisation that is characterised by a new culture, common purpose and shared objectives and has revised clinical, managerial and financial governance arrangements suitable for an organisation focused on patients, service users and the catchment population; that is an inspiring employer; is firmly rooted in the community and enjoys close

3.1 Organisational Implications



















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relationships with general practitioners and primary care, localities, other health service providers and its wider partners in the statutory, private and Third sectors.

Recommendations

The recommendations are grouped into five themes that support the proposition above:

Theme 1 – The proposed integrated model of health and social care:-

• The commissioners/sponsors agree as a fundamental principle that the service model should be founded on the early identification of ‘at risk’ or vulnerable clients in the primary or community setting in order to minimise the likelihood of ill health or disease progression, with a universal risk stratification tool being applied to support this approach.

• The commissioners/sponsors also support the adoption of a tiered model of care (tiers 0-4) as set out in the report to complement the focus on ‘at risk’ groups and to ensure appropriate integration of services and the shift from institutional provision.

• The commissioners/sponsors support the principle that care should, wherever possible, be based on clear pathways, focussed on improving patient outcomes and sanction the implementation of

the five initial care pathways outlined in the document, subject to sign off of implementation plans and business cases where necessary for:

• Frail elderly • Stroke care • COPD • Diabetes • Lower back pain

• The commissioners provide guidance to the Transition Board / Implementation team (if approved) on further pathways that they would wish to see designed and implemented (with clarity of timescales), taking account of feedback from the Clinical Task Group.

• The commissioners/sponsors agree in principle to the establishment of integrated locality health and social care teams as a crucial underpinning to the proposed tiered model of care, subject to further detailed assessment of workforce and financial implications and preparation of an appropriate business case/implementation plan.

• The commissioners/sponsors agree in principle the desired future state of the unscheduled care system as set out in the report and authorise the implementation team to:











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• Address those practical issues not requiring formal decisions or additional resources.

• Prepare business cases for crucial components of the new system e.g. rapid response teams, urgent care centre.

• The commissioners/sponsors consider the steps identified in the report to sustain and better integrate key acute hospital services (Accident & Emergency, Trauma, Emergency Surgery and Maternity), and provide feedback as to whether external validation of the proposals is required.

• The commissioners support the developing role of the GP, which is vital to the success of the proposition, in providing the right care in the right place.

• Sponsors and providers acknowledge that effective links will be essential with mental health services though they will be provided by a different organisation following the tendering process.

• The commissioners/sponsors and the new integrated care organisation will need to have an agreed joint risk sharing arrangement in place that is frequently reviewed on a collaborative basis as the new provider organisation is established and the national economic position clarifies over the summer 2010.

Theme 2 – The proposed integrated care organisation and its governance arrangements:-

• NHS Herefordshire should recommend to the West Midlands SHA, in the context of the eight tests set out in Transforming Community Services: the assurance and approvals process for PCT-provided community services (DH 02/10) integration of PCT Provider Services with an NHS acute provider (Hereford Hospitals NHS Trust) plus integration with the Local Authority’s social care services, so far as is practicably possible given the current legislative and funding framework.

• The four Sponsors and the SHA continue to strengthen their joint leadership of the integration process, providing guidance to the Transition Board, proposed implementation team, staff and partners on the path to the new organisational arrangements.

• In full consultation with the West Midlands SHA, the statutory organisations establish a Governance Group composed of Chairs and Chief Executives (or their very senior representatives) to take forward and to commission additional work as necessary so that a clear and detailed set of proposals is developed as to how the new organisation will be managed.



















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• The four Sponsors take account of discussions with the SHA, the statutory options and the valuable experience of the Transition Board’s visits to other health and social care economies, in agreeing the right legal framework for the new integrated care organisation, including its name, using the existing legal entity of Hereford Hospitals NHS Trust and changing the governance within it to reflect the requirements of a new organisation and culture.

Theme 3 – Managing the change – Transition Board and Implementation Team

• Subject to accepting the recommendations with any amendments required by the four Sponsors, that they establish an implementation team authorised to do the necessary work in order to make the proposition a reality and with the appropriate resources at its disposal (people and funding).

• The Implementation Team should be accountable to the four Sponsors with the reconstituted Transition Board acting as both a reference group to provide guidance and as a source of assurance to sponsors.

• The commissioners provide guidance on the future configuration of children’s services including the relationship to the Children’s Trust.

• The Implementation Team to be led by a senior executive backed up by suitable clinical, management, financial, administrative and other capacity as required

• The Implementation Team will meet regularly to monitor its progress and to hold contributing individuals and organisations to account for delivering their element of the project.

• The Implementation Team should develop a business case and an integrated project plan, with a clear timetable and milestones and that is subject to approval and scrutiny by the four Sponsors and the SHA.

• The project plan will include detailed planning for implementing each agreed element of the new service model, including care pathways and financial modelling, over the next two to three years, starting in 2010/11.

Theme 4 – Creating a new organisational culture

• The Statement of Common Purpose, and its supporting principles and objectives should form the basis for discussions with staff across the health and social care system as to how best to achieve the ambitions for the new organisation.











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• The proposed implementation team (if approved) consider as one of its first tasks how to develop a new organisational culture and objectives for the proposed integrated care organisation, building on the statement of Common Purpose developed by the Transition Board and set out in this report.

• The four Sponsors and the SHA to recognise that even with widespread support for the proposition of an integrated care organisation, there may well be a period of uncertainty for staff and that a joint Workforce Development Group is established to consult with staff and manage and to mitigate any difficulties and risks so far as is possible, learning from previous organisational change and visits to other economies.

• An organisational development programme is established to support the new integrated care organisation with a new culture, common purpose and objectives.

• The implementation team consider how best to build on the clinical and social care engagement achieved so far in order to strengthen and deepen such links across the integrated care organisation and primary care as a continuing legacy of the project to the Herefordshire health and social care community.

• The new integrated care organisation is characterised by a commitment to partnership with primary care, the provider of Mental Health Services in Herefordshire, West Midlands Ambulance Service, other health service providers, the Third Sector and relevant organisations beyond the county boundary.

• That if the four sponsors accept the proposition and recommendations, the Transition Board will have completed its work by 14th May 2010. It would then be replaced be a differently constituted Transition Board to help to maintain momentum and to provide scrutiny of and guidance to the Implementation Team along with assurance to the sponsors that their ambitions for the integrated care organisation were being achieved.

Theme 5 – Transitional Issues

• That Commissioners consider how they can support the care pathway work to achieve the best use of resources; this may be through investment in order to improve the standards of care and lower the eventual overall cost of delivery.

• Building on the experience, scope and feedback from the pre-consultation period (November 2009 to February 2010), the formal consultation on the proposition be led by the NHS Herefordshire in association

• General complications of any operation

The main possible complications of any surgery are excessivebleeding, infection or an unexpected reaction to the anaesthetic.

• Specific complications of this operation

Complications are rare and seldom serious. Bleeding into thejoint and infection of the joint may rarely happen after thearthroscopy.

Sometimes a repeat operation is needed to remove a damagedcartilage. If there is arthritis, the operation may do no morethan make this clear, without making the knee better.

How soon will I recover?

It may take up to three weeks to get back to usual activities.

Date of publication: April 2006Review Date: April 2008Ref: Arthroscopy of the knee joint

www.surreyandsussex.nhs.uk

Author: Terry Young, Senior Nurse Matron

Trauma & Orthopaedics Team

Further Information:

NHS Direct Health Advice Line (24 hr) - 0845 4647www.nhsdirect.nhs.uk

This information can be made available in other formats and languages.Please telephone 01737 768511 ext 6831.


• General complications of any operation

The main possible complications of any surgery are excessivebleeding, infection or an unexpected reaction to the anaesthetic.

• Specific complications of this operation

Complications are rare and seldom serious. Bleeding into thejoint and infection of the joint may rarely happen after thearthroscopy.

Sometimes a repeat operation is needed to remove a damagedcartilage. If there is arthritis, the operation may do no morethan make this clear, without making the knee better.

How soon will I recover?

It may take up to three weeks to get back to usual activities.

Date of publication: April 2006Review Date: April 2008Ref: Arthroscopy of the knee joint

www.surreyandsussex.nhs.uk

Further Information:

NHS Direct Health Advice Line (24 hr) - 0845 4647www.nhsdirect.nhs.uk

This information can be made available in other formats and languages.Please telephone 01737 768511 ext 6831.


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with the Council but be delegated to the Implementation Team working with others in the PCT and Council to manage and to prepare suitable documentation and implementation plans. The proposed restructured Transition Board would provide scrutiny, advice and reassurance that the proposed consultation was fully and properly planned and carried out.

• The Boards of the four Sponsors consider how they can best meet jointly in order to collaborate in the development of the new integrated care organisation and its new culture.

• The implementation team develops an interactive communications plan for NHS and social care staff directly affected by the proposition and for the wider partnerships across general practice, primary care, other health care providers, the community, voluntary and charitable sectors and public.

For further information about this document please contact:

Programme Team on: 01432 372928

Release/Status: Final Executive SummaryVersion: 1.0Date: 14th May 2010

Documents

NHSHERE024_Executive_Summary_2010_FINAL