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West Midlands
Sustainability and Transformation
Planning
April 2016 WebEx
1
2
2015-16
Contracts, RAPS,
Bi-lateral – not system
based
Performance
£ overspend
Long term prospects
Rising inequalities
Stabilise
Agree improvement
Improvement Trajectories
core standards –
£ control total
System based controls
Transparency of
QIPP/CIP
System Leadership and
Delivery – model the
future
February – April
stabilise
February – July
plan the future Hit the target
Triple aim gaps targeted
National strategies
prioritised
Value improved
Where are we now
Achieving the 5YFV Vision – the triple aim
1 Health &
Wellbeing Gap
Radical upgrade in
prevention
• National action required on major health risks such as smoking, drinking
and obesity
• Targeted prevention initiatives e.g. diabetes
• Much greater patient awareness
• Harnessing the ‘renewable energy’ of communities
• Address the greatest burdens of ill health by prevention, to close the gap
between life expectancy and healthy life expectancy and reduce health
inequalities
2 Care & Quality
Gap
New Care Models
+ new support
• Defining and measuring quality and tackling unwarranted variation
• A menu of New Care Models for local areas to consider, backed by
investment and flexibility in implementation
• New whole systems intervention regimes to transform local health
economies and raise standards
3 Funding and
Efficiency Gap
Efficiency &
investment
• Action required on three fronts: demand, efficiency and funding
• Action on prevention and care could deliver significant efficiency gains
• The Government has committed to an additional £8.4bn in funding by
2020/21 and, with this investment and implementation of new care models
we believe that we could close the known finance gap
• Build on local NHS and HWBB/partnership work on evidence based
prevention at scale" - this plays to the partnership between LA and NHS.
For the NHS to meet the needs of future patients in a sustainable way, we need to
close all three of these gaps:
3
The NHS Shared Planning Guidance outlined
key, national PH priorities that will need to be
considered in each section
Care and quality gap
• Out of hospital care
• Cancer prevention
• Mental health services
• Dementia services
• Learning disability
• AMR
• Maternity services
• Mental health (incl. CYP)
• Workforce
• Improving commissioning
Finance and efficiency gap
• What savings can be made from “moderating demand growth” e.g. through prevention?
E.g. reducing alcohol consumption can potentially save money via:
a) reduced A&E attendance
b) reduced alcohol related illnesses (liver cirrhosis)
c) reduced anti-social behaviour
d) reduced domestic violence incidences
Health and Wellbeing gap
• Preventable causes of ill health (incl. consumption of alcohol, tobacco)
• Diet and obesity
• Diabetes
• Workforce health
• Patient activation and self-care
Local areas will want to consider these and any other specific locality needs.
The Scale of the Financial Challenge and
Opportunity
5 Years
7 Years
0
0.5
1
1.5
2
2.5
Mar
-14
Jun
-14
Sep
-14
De
c-1
4
Mar
-15
Jun
-15
Sep
-15
De
c-1
5
Mar
-16
Jun
-16
Sep
-16
De
c-1
6
Mar
-17
Jun
-17
Sep
-17
De
c-1
7
Mar
-18
Jun
-18
Sep
-18
De
c-1
8
Mar
-19
Jun
-19
Sep
-19
De
c-1
9
Mar
-20
Jun
-20
Sep
-20
De
c-2
0
Mar
-21
West Midlands
strategic service change prevention pathway/serviceinnovation provider efficiency financial gap
Max deficit Max deficit Max deficit Max deficit ~
Illustration only
meeting the challenge - a potential scenario
Allocations across Commissioning streams
6
Commissioning 16/17 17/18 18/19 19/20 20/21
CCGs 3.4% 2.1% 2.0% 2.2% 3.8%
Primary Care (GP) 4.2% 4.0% 4.5% 4.8% 5.4%
Other DC -0.6% 0.0% -0.5% -1.2% -1.0%
Specialised Services 7.0% 4.8% 4.5% 4.5% 5.0%
Stability Fund £1.8bn
Transformation Fund £0.4bn £2.9bn £2.9bn £3.4bn £3.4bn
Sustainability funding is allocated to organisations-
but how will it move to systems?
7
• 2016-17
• Birmingham and Solihull £47.1m
• Black Country £40.8m
• Coventry and Warwickshire £27.3m
• Herefordshire and Worcestershire £17.9m
• West Midlands £133.1m
• Fair share by population would be very different £169m
8
(100.00)
(50.00)
-
50.00
100.00
150.00
200.00
250.00
300.00
£fairshare £base Diff 2017-18 2018-19 2019-20 2020-21
West Mids. STP funding
-20
0
20
40
60
80
100
£fairshare £base Diff 2017-18 2018-19 2019-20 2020-21
Birmingham and Solihull 2.62
Blackcountry 2.27
Coventry and Warwickshire 1.52
Hereford and Worcester 0.99
Sustainability
fund
Bridge to
Transformation
Scale of Challenge Requires a New
Leadership Approach
1. Herefordshire and Worcestershire
10
CCGs:
NHS Herefordshire: 188.7k
NHS Redditch and Bromsgrove: 181.3k
NHS South Worcestershire: 296.6k
NHS Wyre Forest: 98.6k
Total Population: 765.2k
Local Government:
Worcestershire County Council
Herefordshire Council
Providers:
Acute
Worcestershire Acute Hospitals NHS Trust
Wye Valley NHS Trust (Acute and Community)
Community
Worcestershire Health and Care NHS Trust
(Community and Mental Health)
Mental Health
2gether NHS FT
Ambulance
West Midlands Ambulance Service NHS FT
System Resilience Groups:
Worcestershire
Herefordshire
Urgent and Emergency Care Network:
West Midlands
Transformation and Vanguards:
Future of Acute Hospitals in Worcestershire
West Midlands NICU
Connecting care
One Herefordshire
Planning lead: Sarah Duggan(Worcestershire Health and
Social Care NHS Trust )
2. Birmingham and Solihull
11
CCGs:
NHS Birmingham South and Central: Pop 205.6k
NHS Solihull: 211.4k
NHS Birmingham Cross City: 743.3k
Total Population: 1,160.3k
Providers:
Acute
Birmingham Children's Hospital NHS FT
Birmingham Women's NHS FT
Heart of England NHS FT
The Royal Orthopaedic Hospital NHS FT
University Hospitals Birmingham NHS FT
Community
Birmingham Community Healthcare NHS Trust
Mental Health
Birmingham & Solihull Mental Health NHS FT
Ambulance
West Midlands Ambulance Service NHS FT
Urgent and Emergency Care Network:
West Midlands
System Resilience Group:
Birmingham and Solihull
Birmingham Children’s
Local Government:
Birmingham City Council
Solihull Metropolitan Council
Planning Lead: Mark Rogers
(CEO Birmingham City Council)
Transformation and Vanguards:
HEFT – Surgical reconfiguration (Paused)
West Midlands NICU review
BSBC Stroke Review
Solihull UEC Vanguard
MERIT –Mental Health Provider
Collaboration Vanguard
3. Coventry and Warwickshire
12
CCGs:
NHS Coventry and Rugby: 445.5k
NHS Warwickshire North: 191.2k
NHS South Warwickshire: 263.8k
Total Population: 900.5k
Providers:
Acute
George Eliot Hospital NHS Trust
South Warwickshire NHS FT (Acute &
Community)
University Hospitals Coventry and
Warwickshire NHS Trust
Mental Health
Coventry and Warwickshire Partnership NHS
Trust (Mental Health & Community)
Ambulance
West Midlands Ambulance Service NHS FT
Urgent and Emergency Care Network:
West Midlands
Transformation and Vanguards:
West Midlands NICU review
System Resilience Groups:
Coventry and Rugby
South Warwickshire
Warwickshire North
Local Government :
Warwickshire County Council
Coventry City Council
Planning Lead: Andy Hardy
(CEO - University Hospital Coventry Warwickshire)
4. Black Country
13
CCGs:
NHS Dudley: 316.4k
NHS Sandwell and West Birmingham: 492k
NHS Walsall: 276.2k
NHS Wolverhampton: 253.8k
Total Population: 1,338.4k
Local Authorities:
Birmingham City Council
Dudley Metropolitan Council
Sandwell Metropolitan Council
Walsall Council
Wolverhampton City Council
Providers:
Acute
Sandwell and West Birmingham Hospitals NHS Trust
The Dudley Group NHS FT (Acute & Community)
The Royal Wolverhampton NHS Trust (Acute & Community)
Walsall Healthcare NHS Trust (Acute & Community)
Community
Birmingham Community Healthcare NHS Trust
Black Country Partnership NHS FT
Mental Health
Birmingham and Solihull Mental Health NHS FT
Dudley and Walsall Mental Health Partnership NHS Trust
Ambulance
West Midlands Ambulance Service NHS FT
System Resilience Groups:
Dudley
Walsall
Wolverhampton
Sandwell and West Birmingham
Urgent and Emergency Care Network:
West Midlands
Transformation and Vanguards:
West Midlands NICU
Stroke Review
Dudley MCP
Modality MCP
MERIT – Mental Health Collaboration
Planning lead: Andy Williams (Sandwell and West Birmingham CCG)
Transformation Areas
• National commitment to have 20% of population into a fully reformed system
• Being ‘selected nationally’
• May cut across STP’s and natural flows – based on the PMAF, Vanguards – MCP, UEC,
etc.
15
3 6
5 9
10
7
1
4
11
12
13
14
1
1
2
2
8
2
5
4
3
5 9
6
West Midlands CCGs 1. Walsall CCG 2. Wolverhampton CCG 3. Sandwell & West
Birmingham CCG 4. Dudley CCG 5. Birmingham South &
Central CCG 6. Birmingham Cross City
CCG 7. Redditch & Bromsgrove
CCG 8. Wyre Forest CCG 9. Solihull CCG 10. Warwickshire North CCG 11. Coventry & Rugby CCG 12. South Worcestershire
CCG 13. South Warwickshire 14. Herefordshire CCG
Urgent & Emergency Care Vanguard 1. Solihull Together for Better Lives Acute Care Collaboration Vanguard 2. MERIT 3. National Orthopaedic Alliance
(Orthopaedics specialty franchise) Multispecialty Community Provider Vanguard 4. Vitality (Birmingham and Sandwell) 5. Dudley Multispecialty Community Provider Urgent & Emergency Care Networks 1. Mid Trent Urgent & Emergency Care
Network 2. West Midlands Urgent & Emergency Care
Network
3
Coventry and Warwickshire
Black Country
Birmingham and Solihull
Herefordshire and
Worcestershire
Public Service Reform
Outcomes Quality Value Social value Devolution ‘ask?’
West Midlands Planning Exec
Support across and between
STPs
STP leads, provider CEO, PHE, HEE, NHSI, NHSE, SS, LGA,
Combined Authority Health and Wider Public Services
Connected governance and communication
West Midlands Collective Leadership
• WM STP Executive
• Shared areas for work
– Clinical strategies including specialised (24 March)
– Modelling of Economics and sustainability of proposals
– Workforce strategy to underpin
– Right Care recommended interventions and scale of prevention
– Common growth areas – diagnostics as a work stream
– Exemplar areas and spread of innovation
• Consensus building sessions each month plus a steering group
• How can we use this leadership group more effectively?
• Promote a collective understanding of the HWB gap and the evidence base to
address it
The STP process is split in two: analysis of the
‘gaps’, and development of the action plan to
address these gaps
Stage 1 - By 11 April: scale of challenge, priorities, governance
Stage 2 – from April: Develop STPs and submit for assurance
National guidance and support, events, workshops
• Further guidance (e.g. gap analysis)
• Development days • Programme of
workshops with experts
• Use online tools so local areas can share information and examples of emerging best practice
• Identify the scale of the challenge for each of the three gaps (via ‘gap analysis’)
• Set priorities to address each gap
• Establish the governance arrangements and processes needed to produce and implement STP
• Local partners to develop plans that will address identified challenges and how to close the three gaps over the next five years
• This will include a local prevention plan and a monitoring and evaluation plan (tbc – NHS England)
Dev
elo
pin
g th
e p
lan
Sc
op
ing
the
chal
len
ge
‘Initial submission’ for 11 April
‘Final submission’ to RDs on 30 June
After Easter
Develop the plan
• Prevention
• Out of hospital care
• New models
• 7 day services, UEC
• Quality
• National priorities – cancer, MH, LD, Mat
• Achieve financial balance
• Describe enablers – digital roadmap,
workforce, premises
• Engage and enable communities
• Show the bridge from 2016-17
organisational plans to the system plans
National and regional support
• Regional meeting April
• Peer review
• Webinars
• Local support and transfer of knowledge
The Timetable
The most credible and compelling STPs will
secure the earliest funding
• High quality plan: integrated, ambitious, evidenced – does it hang together in words
and numbers
• Reach and quality of local process to develop the plan – how much is the plan ‘owned’
• Strength of partnerships to deliver – confidence in the team
• Clear implementation steps and progress already – credible execution capability
• Tested in July by dragons den?