agend and papers ics board 12 march 2020 final v2...2020/03/12 · 1 | p a g e item 3. enc a1. ics...

1 | P a g e A g e n d a I C S B o a r d 1 2 M a r c h 2 0 2 0 F I N A L v 2 . d o c x

Integrated Care System Board Meeting held in public

Thursday 12 March 2020, 09:00 – 10:30 Civic Suite, County Hall, Nottingham

AGENDA

Time Agenda Items

Paper Lead Action

1. 09:00 Welcome and Introductions

Verbal Chair To note

2. 09:05 Conflicts of Interest

Verbal Chair To note

3. 09:10 Minutes of 13 February ICS Board meeting and action log

Papers A1 A2

Chair To agree

4. 09:15 Patient Story - One Person’s Story of Pro-active Integrated Care

Paper B Melanie Brookes

To discuss

Outcomes Framework, Prevention and Inequalities 5. 09:30 Outcomes Framework Papers

C1 C2

Tom Diamond

and Helen Pledger

To discuss

Oversight of System Resources and Performance Issue s (including MoU) 6. 10:00 Integrated Performance and

Finance Report Papers

E1 E2 E3

Andy Haynes

and Paul Robinson

To discuss

Strategy and System Planning 7. 10:15 Update from ICPs:

• Mid – to discuss • City – to note • South – to note

Papers F1 F2 F3 F4 F5

Richard Mitchell

To discuss

Governance No items on the workplan

10:30 Close Next meeting date: 14 May 2020, 09:00-12:00

1 | P a g e Item 3. Enc A1. ICS Board draft minutes 13.02.2020 v1.docx

Item 3. Enc A1. Integrated Care System Board

Meeting held in public

Thursday 13 February 2020, 09:00 – 10:45 Civic Suite, County Hall, Nottingham

Present: NAME ORGANISATION Adele Williams Councillor, Nottingham City Council Alex Ball Director of Communications and Engagement,

Nottinghamshire CCGs and ICS Amanda Sullivan Accountable Officer, Nottinghamshire CCGs Andy Haynes ICS Executive Lead, Nottinghamshire ICS Colin Monckton Director of Strategy and Policy, Nottingham City Council David Pearson ICS Independent Chair Elaine Moss Chief Nurse, Nottinghamshire ICS Eric Morton Chair, Nottingham University Hospitals NHS Trust Gavin Lunn GP (representing PCNs in Mid Nottinghamshire ICP) Hugh Porter Clinical Lead, Nottingham City CCG (representing

Nottingham City ICP) John Brewin Chief Executive, Nottinghamshire Healthcare NHS FT John MacDonald Chair, Sherwood Forest Hospitals NHS FT Lyn Bacon Chief Executive, Nottingham CityCare Melanie Brooks Corporate Director Adult Social Care and Health,

Nottinghamshire County Council Michael Williams Chair, Nottingham CityCare Nicole Atkinson ICS Clinical Lead and Chair Nottingham West Clinical

Commissioning Group (representing South Nottinghamshire ICP)

Paul Devlin Chair, Nottinghamshire Healthcare NHS Foundation Trust Paul Robinson ICS Finance Director and Chief Financial Officer, Sherwood

Forest Hospitals Foundation Trust Richard Mitchell Chief Executive, Sherwood Forest Hospitals NHS FT Richard Stratton GP Lead Partners Health (representing PCNs in South

Nottinghamshire ICP) Tracy Taylor Chief Executive, Nottingham University Hospitals Trust In Attendance: Emma Wilson (item 4) Specialist Safeguarding Nurse, Sherwood Forest Hospitals

NHS FT Helen Pledger (item 5) ICS Lead for System Value Improvement Joanna Cooper Assistant Director, Nottinghamshire ICS Kate Wright (item 4) Associate Chief AHP, Sherwood Forest Hospitals NHS FT Lynn Smart (item 4) Divisional Head of Nursing and AHP, Sherwood Forest

Hospitals NHS FT Rebecca Larder Programme Director, Nottinghamshire ICS Tom Diamond (item 5) ICS Lead for System Value Improvement


Apologies: Eunice Campbell-Clark Chair, Nottingham City Health and Wellbeing Board Ian Curryer Chief Executive, Nottingham City Council Jonathan Harte GP Partner and PCN Clinical Director (representing PCNs

in Nottingham City ICP) Jon Towler Lay Chair, Nottinghamshire CCGs Richard Henderson Chief Executive, East Midlands Ambulance Service Steve Vickers Chair, Nottinghamshire County Health and Wellbeing Board Thilan Bartholomeuz Chair Newark and Sherwood Clinical Commissioning Group

(representing Mid Nottinghamshire ICP) Tony Harper Councillor, Nottinghamshire County Council

1. Welcome and introductions Apologies received as noted above.

2. Conflicts of Interest No conflicts were noted in relation to items on the agenda.

3. Minutes of 16 January ICS Board meeting and acti on log The minutes of the meeting held on 16 January 2020 were agreed as an accurate record of the meeting by those present. The action log and updates were noted.

4. Patient Story –Street Health Lynn Smart, Kate Wright and Emma Wilson attended the meeting to present on the Street Health initiative led by Sherwood Forest Hospitals Foundation Trust. The presentation raised awareness of the project and needs of homeless and socially excluded people. Board expressed thanks for the presentation and remarked on how the initiative embodies system working. Board made the following comments:

• RM emphasised the role of organisation leaders to create the context within their organisation for similar initiatives to flourish.

• JB highlighted the role of the ICS Board in creating the right environment and the need to create commissioning mechanism to embed. AS advised that establishing the right team should be the focus as commissioning mechanisms will become apparent as the initiative develops.

• RS reflected the learning from this initiative that leaders should inspire rather than plan, remarked on the person centred nature of the initiative, and suggested that seed funding be created to support the development of future innovations.

• AW highlighted the similar experiences of the homeless population in Nottingham City and the prevalence of childhood trauma in this cohort. AW emphasised the need for organisations to think about how the impact of trauma can be reduced for citizens.

DP invited the team to support an upcoming visit from Department of Health and Social Care colleagues.


ACTIONS: JC to liaise with Lynn Smart and Kate Wright regarding the Department of Health and Social Care visit.

5. Operational Planning for 2020/21 PR presented the circulated report on NHS Operational Planning for 2020/21 which provided Board with a summary of the work underway and the national planning guidance issued on 30 January. Board to note the requirements in the planning guidance for ICSs:

System by default with two core roles: 1. System transformation 2. Collective management of system performance

ICS Board has a role to support system working and to ensure that the system requirements of this guidance are met. Finance Directors Group and Performance Oversight Group meet jointly on Friday to discuss how the levers can be delivered. Board discussed the paper and noted the following:

• TT asked how much of the operational plan relates to levers, and how much remains aspirational. PR advised that there is further work to do on this. AH asked that 2020/21 be addressed urgently and that Board be assured on the realism of the plan and capability to deliver the levers.

• PD highlighted the significance of system working in the planning guidance. PD asked for clarity on the assurance mechanism for Mental Health Investment Standard. AH advised that work is in place for year end aligned to levers for system response to the NHS Long Term Plan. Organisations will need to engage fully to support this work. Further guidance anticipated over the coming weeks.

• LB stressed the importance of staff and asked that the leaders of statutory organisations enable their people leads to support this work.

• TT highlighted the new ways of working already in place to reduce outpatients appointments. System to continue to build on this momentum to achieve ambitions set out in the planning guidance.

• EMor emphasised the fixed points stated within the planning guidance which need to be taken into consideration, e.g. no reduction in bed numbers whilst reducing bed occupancy to 92%.

• RM and TT raised concerns about the deteriorated financial position and asked for further conversations on what activity needs to stop to enable funding to be utilised to transform services. MW supported this point and asked that Board shift focus from roles and functions across the system to transformation to demonstrate leadership.

Further conversations to take place at the 28 February Financial Sustainability Group. ACTIONS: PR to provide ICS Board with an update on finance at the 12 March meeting. PR to provide an overview of the Mental Health Investment Standard at the 16 April meeting.


6. Update from ICPs JB and NA provided an overview of progress to date in the South Nottinghamshire ICP. Board members discussed the presentation and made the following comments:

• TT praised the work undertaken and focus on the practical examples of transformation. • RS advised of the additional roles being created in General Practice to build capacity

and enable system transformation. • JM asked for further work on the return on investment of schemes to ascertain value

for money for the system, and highlighted that further discussion on the form of ICPs and operating frameworks is needed at ICS Board to better understand the implications for statutory organisations. AH advised that the ICS Executive Group are developing a paper on ICP development for a future ICS Board meeting.

Board noted the updates from the ICPs. ACTIONS: AH to lead a discussion with the ICS Executive Group on ICP development and arranging a development workshop with ICS Board.

7. Integrated Performance and Finance Report AH and PR presented the circulated Integrated Performance and Finance Report. There is continued progress against Mental Health standards. Challenges remain on urgent care, planned care, cancer and finance. A system oversight framework has been published and an overview of performance is included in the covering paper circulated. AH reflected to Board that there are early indications of progress for demand management, e.g. the Street Health initiative and impact of Population Health Management on diabetes, and that the three ICPs are beginning to make progress echoing TT’s earlier comments on ICPs being the vehicle for transformation. AH highlighted the additional funding received for pregnant mums, and early scanning for lung cancer. PR advised that City Council finances have now been received. There is a timing issue which has been resolved for future reporting. PR highlighted the challenging financial position for the system and loss of Provider Sustainability Funding (PSF). Board discussed the report and noted the following:

• TT asked that work to further define the role of the ICS and ICS Board continue through the review and strengthening of governance arrangements. TT highlighted that further consideration needs to be given to the Board agenda to focus on transformation and performance, and that Board be sighted on System Review Meeting (SRM) outputs.

• RS asked that consideration be given to understanding organisational contributions to performance.

Board agreed the recommendation to progress SRM actions through the ICS Performance Oversight Group.


ACTIONS: AH to work with the ICS Executive Group to further develop the ICS Board agenda and forward workplan to meet the national direction of travel for ICSs.

8. Finance Director Group Terms of Reference PR presented the circulated paper outlining an update to the Terms of Reference for the Finance Directors Group. The Board noted the amendments and agreed the Terms of Reference with the caveat that the Group make recommendations on solutions and actions rather than agree them. ACTIONS: PR to make the necessary amendments to the Finance Director Group Terms of Reference in line with the conversation at the ICS Board. Time and place of next meeting: 12 March 2020 09:00 – 12:00 Civic Suite, County Hall, Nottingham NG2 7QP

1 | P a g e I t e m 3 . E n c . A 2 . I C S B o a r d A c t i o n l o g M a r c h 2 0 2 0 v 1 . 0 . d o c x

Item 3. Enc. A2 ICS Board Action Log March 2020 ID Action Action

owner Date Added

Deadline Action update

B203 To provide an estimation of the timeline to develop and embed the outcomes framework based on the current levels of resourcing and what impact additional capacity and capability could have on this.

Tom Diamond

12 September

2019

31 March 2020

The key risks to developing and embedding the system outcome framework reported to the ICS Board are:

• The requirements on the system in relation to responding to the Long Term Plan (LTP) pulling resource away from the System Outcomes Framework

• Data availability and reporting frequency and boundaries

• Analytical capacity to build a fully operational System Outcomes Framework report

Agenda item 5 updates the ICS Board on the first two risks. Following the discussion at the meeting a further update on next steps and capacity will be developed.

B205 *Actions B179, B205, B250 and B259 consolidated* Conversations on the alignment of resources reporting back to the ICS Board for a wider discussion.

ICS Team 12 September

2019

31 March 2020

Initial discussion held. The ICS Executive Group progressing the development of the governance structure and ICP working principles through the review and strengthening of ICS governance in the first instance and will report recommendations to the ICS Board

B247 To work with Local Authority colleagues in City Council and County Council to bring items to ICS Board on wider determinants of health.

Adele Williams

16 January 2020

31 March 2020

Updated requested

B244 To incorporate the views of the ICS Board into planning for winter through A&E Delivery Boards and provide

Amanda Sullivan, Tracy Taylor and

16 January 2020

14 May 2020

Item deferred to the May meeting to enable A&E Delivery Board to complete relevant work.

2 | P a g e I t e m 3 . E n c . A 2 . I C S B o a r d A c t i o n l o g M a r c h 2 0 2 0 v 1 . 0 . d o c x

ID Action Action owner

Date Added

Deadline Action update

an update at the 12 March meeting.

Richard Mitchell

B236 To incorporate a discussion on system finance into the workplan for a future Chairs, NEDs and Elected Member event.

David Pearson and Andy Haynes

06 November

2019

1 June 2020

It is proposed to strengthen financial governance and oversight of ICS finances to include; 1. Formal processes to assure the ICS Board of individual organisation consistency with ICS planning 2. Formal processes of escalation for individual organisation risk to be considered for ICS solutions/mitigation

B253 To provide ICS Board with report on the development of joint arrangements for intellectual and developmental disorders.

John Brewin and Amanda Sullivan

16 January 2020

1 June 2020

Update requested

B257 To lead a discussion with the ICS Executive Group on ICP Development and arranging a development workshop with ICS Board

Andy Haynes

13 February

2020

30 June 2020

B258 To further develop the ICS Board agenda and forward workplan to meet the national direction of travel for ICSs

Andy Haynes

13 February

2020

30 June 2020

1 | P a g e I t e m 4 . E n c . B . P a t i e n t S t o r y . d o c x

Item Number: 4 Enclosure

Number : B

Meeting : ICS Board Date of meeting: 12 March 2020 Report Title: One Person’s Story of Pro-active Integrated Care Sponsor: ICP Lead: Clinical Sponsor: Report Author: Sue Batty, Service Director Social Care, Ageing Well

Community Services Enclosure / Appendices:

To follow

Summary: This presentation shares Mr C’s story.

• Mr C is a 72-year-old man with Alzheimer's, insulin-controlled diabetes and severe falls risk

• His mental capacity to make decisions about where he lives and his care and treatment fluctuate

• He lives in an isolated rural property which is in extremely poor repair, no reliable heating, or accessible toilet. He has a history of self-neglect and has been targeted by fraudulent traders.

• He has lived in this property from birth and his most important wish is to remain there.

• Following a fall Mr C was admitted to hospital following a collapse and whilst on the ward was advised that he would need to move into a residential care home

Moving into a care home could have been the next stage of Mr C’s story. The presentation shows how a different, strength- based and therapy-led approach helped him to return home and how integrated, co-ordinated care from his local co-located health and social care team has supported him to remain living there, maximising his health and wellbeing. The social care teams in Ashfield and Mansfield have been co-located with community health teams which has helped to change the culture and ways of working to achieve this. This was following an LGA funded evaluation of the impact on social care of the development of integrated care teams across Nottinghamshire. Not all teams across the county, however, are yet co-located/aligned county. This is leading to inconsistent practice, missed opportunities and outcomes. PCNs and pro-active care provide opportunities. How can these be maximised? Actions requested of the ICS Board


To receive the report Recommendations:

1. To receive the report and discuss the issues raised and next steps to increase integrated pro-active working as part of the development of PCNs.

Presented to:

Board Partnership Forum

Finance Directors

Group

Planning Group

Workstream Network

☐ ☐ ☐ ☐ ☐ Performance

Oversight Group

Clinical Reference

Group

Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-

shire ICP ☐ ☐ ☐ ☐ ☐

Contribution to delivering the ICS MOU priorities: Urgent and Emergency Care

☐

Proactive and Personalised Care

☒

Cancer

☐

Mental health ☐

Alcohol ☐ Clinical services strategy

☐

System architecture ☐

Contribution to delivering System Level Outcomes Fr amework ambitions Our people and families are resilient and have good health and wellbeing

☒ Our people will have equitable access to the right care at the right time in the right place

☒ Our teams work in a positive, supportive environment and have the skills, confidence and resources to deliver high quality care and support to our population

☒

Conflicts of Interest ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion and decision ☐ Conflict noted, conflicted party can participate in discussion, but not decision ☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision ☐ Conflict noted, conflicted party to be excluded from meeting Risks identified in the paper


Risk Ref

Risk Category Risk Description

Residual Risk

Risk owner

Like

lihoo

d

Con

sequ

ence

Sco

re

Cla

ssifi

catio

n

Is the paper confidential? ☐ Yes ☒ No ☐ Document is in draft form

Note: Upon request for the release of a paper deemed confidential, under Section 36 of the Freedom of Information Act 2000, parts or all of the paper will be considered for release.

1 | P a g e I t e m 5 . E n c . C 1 . M o n i t o r i n g a n d E v a l u a t i o n S y s t e m T r a n s f o r m a t i o n v 0 . 4 . d o c x

Item Number: 5 Enclosure Number :

C1

Meeting : ICS Board Date of meeting: 12 March 2020 Report Title : Monitoring and Evaluating System Transformation Sponsor : Andy Haynes ICP Lead: Clinical Sponsor: Report Author: Helen Pledger and Tom Diamond Enclosure / Appendices :

Enc. C2. Monitoring and Evaluating System Transformation in 2020/21

Summary: The purpose of this paper is to set out the proposed approach for the ICS to monitor and evaluate system transformation in 2020/21 (Enc. C2 – specifically slides 17-25). The proposed approach is considered, systematic and proportionate and aligns back to the ICS System Outcomes Framework agreed by the ICS Board 15 March 2019. The approach:

• Reflects the system’s five-year strategic plan developed in response to the NHS Long Term plan and local challenges, agreed November 2019;

• Supports the system to meet the expectations on it for delivering the strategic plan - ‘2020/21 is the time to deliver’;

• Aligns to the recent national guidance that has defined a core role of the ‘system tier’ of an ICS as facilitating transformational change to improve patient outcomes and secure the long-term sustainability of the system;

• Reflects the discussion and agreement at the ICS Board in February 2020, that the ICS Board needs a greater focus on system transformation; and

• Is expected to be iterative in nature and will need to continue to evolve and adapt, including the scope of transformation programmes included.

By having a systematic approach to monitoring and evaluating the delivery of its strategic plan staff and leaders within the health and care system can make strategic and tactical decisions, informed by data-driven assessments, in relation to initiatives/interventions and associated investments. This approach is very much in line with the national direction of travel in terms of the core roles of the ‘system tier’ of an ICS. However, what constitutes good performance or system value can only be determined in relation to a set of goals that the integrated care system has agreed. Hence the approach for monitoring and evaluating transformation being aligned back to the ICS’s System Outcomes Framework. The ICS System Outcomes Framework defines the vision, ambitions and goals for the ICS thereby, provides a ‘compass’ for the required impact of system transformation and change initiatives/interventions. This approach to embedding the ICS System Outcomes Framework is a development and evolution of that originally discussed with the ICS Board to reflect


the fact the ICS now has a five-year strategic plan and the expectations on ICSs is being clarified regionally and nationally. The paper outlines the role of all system partners in the development and embedding of this approach. In addition, commissioners (CCG and LA) have a key role in the commissioning of transformation initiatives/interventions and the associated allocation of resources to support the delivery of the 2020/21 operational planning requirements, ICS five-year plan and ultimately ICS System Outcomes Framework. Actions requested of the ICS Board The Board are asked to AGREE the recommendations of the report and NOTE the next steps

Recommendations: 1. The Board are asked to AGREE the proposed approach to monitoring

and evaluating system transformation in 2020/21 2. The Board are asked to AGREE the proposed system transformation

priorities that form the basis of developing the approach to monitoring and evaluating system transformation at ‘Level 1 – System Performance Measurement’

3. The Board are asked to AGREE the proposed system transformation priorities that form the basis of developing the approach to monitoring and evaluating system transformation at ‘Level 2 – System Evaluation’

4. The Board are asked to NOTE the next steps Presented to:

Board Partnership

Forum

Finance Directors

Group

Planning Group

Workstream Network

☒ ☐ ☐ ☐ ☐ Performance

Oversight Group

Clinical Reference

Group

Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-



☒


☒

Cancer

☒

Mental health ☒

Alcohol ☒ Clinical services strategy

☒

System architecture ☒



☒ Our teams work in a positive, supportive environment and have the skills, confidence and resources to deliver

☒


high quality care and support to our population

Conflicts of Interest ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion and decision ☐ Conflict noted, conflicted party can participate in discussion, but not decision ☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision ☐ Conflict noted, conflicted party to be excluded from meeting

Risks identified in the paper

Risk Ref


Residual Risk

Risk owner

Like

lihoo

d

Con

sequ

ence

S

core

Cla

ssifi

cati

on

Ref e.g. quality, financial, performance

Cause, event and effect There is a risk that… L1

-5

L1-5

L x

I

Gra

ding

Person responsible for managing the risk



Nottingham and Nottinghamshire Integrated Care System

Monitoring and EvaluatingSystem Transformation in 2020/21

WORKING DRAFT TO INFORM DISCUSSIONS

ICS Board Meeting 12 March 2020Item 5. Enc. C2

Contents


• Introduction

• Overview of ICS five-year strategic plan

• ICS System Outcomes Framework

• ICS transformational change - focus for 2020/21

• ICS approach to monitoring and evaluating system

transformation

1

2

3

4

5

2

Introduction

WORKING DRAFT TO INFORM DISCUSSIONS 3

National context


In January 2019 the NHS in England published the NHS Long Term Plan, which set out a 10-year programme of phased improvements to NHS services and outcomes, including a number of specific commitments to invest the agreed NHS five-year revenue settlement.

All local health and care systems in England were required to create a five-year strategic plan covering the period 2019/20 to 2023/24 setting out how they will deliver all the commitments within the Long Term Plan to address the challenges the NHS faces.

The development of Integrated Care Systems (ICSs) is seen as being fundamental to delivering the Long Term Plan ambitions and to:

• Move from competition to collaboration as a driver of better service change;

• Shape decisions and use of resources more closely to communities; and

• Organisation (NHS, Local Government and other sectors) working together to address the root causes if ill-health

Building on this approach, recent national guidance has defined two core roles for the ‘system’ tier of an ICS:

• System partners work together to agree and deliver a co-ordinated programme of transformational change, to improve patient outcomes and secure the long-term sustainability of the system

• ICS partners come together to collectively manage overall system performance – ICS NHS partners together are collectively responsible for the overall NHS financial and operational performance of the system

2020/21 is seen as a critical year in the development of system working as the NHS starts to work through ICS and STPs on a ‘system by default’ basis.

4

Local context


The Nottingham and Nottinghamshire Integrated Care System (ICS) has developed an ambitious strategic plan to transform the local health and care system over the next five years to improve the health and wellbeing of our local people through high quality care delivered in a sustainable way. This has been developed in line with the ambitions set out in the NHS Long Term Plan (LTP) and the challenges faced by the local health and care system.

Expectations on the ICS for delivering the strategic plan, starting in 2020/21, are high – the system has received significant investment to transform over recent years and it’s ‘now time to deliver’.

In light of this challenge and in recognition that many transformation programs lack an embedded approach to monitoring and evaluating delivery, the Nottingham and Nottinghamshire ICS has developed a considered, systematic and proportionate approach to monitoring and evaluating the delivery of the system’s strategic plan.

Evaluation is an essential part of quality improvement and when done well it can help solve problems, inform decision making and build knowledge.

While evaluation comes in many shapes and sizes, its key purpose is to help us to develop a deeper understanding of how best to improve health

care.

The intention is such an approach will:

• Focus efforts of staff and stakeholders across the system to work together and deliver impact;

• Build ownership, buy-in and support for greater integration and person-centred care; and

• Provide higher quality services more effectively

This approach is very much in line with the national direction of travel in terms of the core roles of the ‘system tier’ of an ICS.

5

Local context (continued)


By having a systematic approach to monitoring and evaluating the delivery of its strategic plan staff and leaders within the health and care system can make strategic and tactical decisions, informed by data-driven assessments, in relation to initiatives/interventions and associated investments.

However, what constitutes good performance or system value can only be determined in relation to a set of goals that the integrated care system has agreed. The ICS’s approach to monitoring and evaluation therefore flows from the system’s strategic plan that articulates a long-term vision and aims for the health and care system.

At the core of the Nottingham and Nottinghamshire ICS strategic plan is the ICS System Outcomes Framework that’s purpose is two-fold:

• Defines the goals, aligned to the system’s vision and aims, for the ICS thereby, providing a ‘compass’ for the required impact of system transformation and change initiatives/interventions; and

• Acts as a foundation for population health management, by providing an ‘anchor point’ for the outcomes for each population segment that in turn drive the identification of population segment specific system transformation initiatives/interventions.

The system’s monitoring and evaluation approach will therefore support all system partners (commissioners and providers) to evaluate system change and transformation initiatives/interventions against an agreed set of measures that align to the ICS System Outcomes Framework and therefore delivery of the system’s strategic plan overall.

When done well, measuring success:

• Shows that outcomes for citizens are being achieved across the system;

• Focuses plans and informs priorities through clearly articulated key performance indicators; and

• Supports organisations to work as one health and social care system to deliver impact and continually improve

Dr Nick Goodwin, CEO, International Foundation for Integrated Care

6

Overview of ICSfive-year strategic plan


The Nottingham and Nottinghamshire ICS Vision, Aims and approach to Population Health Management


In light of the challenges we face as a health and care system, the Nottingham and Nottinghamshire ICS has set an ambitious vision, adopted the

triple aim framework and embraced a Population Health Management (PHM) approach

Health and

Wellbeing

Service

provision

Resource

Utilisation

• Healthy life expectancy

• Inequalities

• Wider determinants of health

• Workforce

• Estates

• Funding

• Integrated Care

• Service delivery (key areas incl. UEC,

MH & Primary Care)

ICS

Challenges

Our Triple Aim

To help us address the challenges we face and optimise the performance of our health and

care system, we have adopted the triple aim - the guiding principles for a truly integrated

health and care system:

• Improving the health and wellbeing of our population

• Improving the overall quality of care and life our service users and carers are able to

have and receive

• Improving the effective utilisation of our resources

Our Vision

Across Nottinghamshire, we seek to both increase the duration of people’s lives and to

improve those additional years, allowing people to live longer, happier, healthier and more

independently into their old age

Our Approach to PHM

8

Overview of our ICS Sustainability Model

Outcomes

Framework

Service

Provision KPIs

Resource

Model

ICS

Sustainability

Model

Focusses the plans for system transformation initiatives/interventions by ensuring clearly articulated measures

are established that align to the outcomes

Measures that reflect the

performance of services

Measures that reflect

changes needed to deliver

sustainable services for the

population served

Our Approach to PHM

Our Triple Aim

To help us address the challenges we face and

optimise the performance of our health and care

system, we have adopted the triple aim framework -

the guiding principles for a truly integrated health and

care system:

• Improving the health and wellbeing of our

population

• Improving the overall quality of care and life our

service users and carers are able to have and

receive

• Improving the effective utilisation of our resources

Our Vision

Across Nottinghamshire, we seek to both increase the

duration of people’s lives and to improve those

additional years, allowing people to live longer,

happier, healthier and more independently into their

old age

To translate achievement of our vision, monitor performance against our triple aim and assess the success of our PHM approach, we have developed an ICS Sustainability Model

Our ICS Sustainability Model

9WORKING DRAFT TO INFORM DISCUSSIONS

Overview of our Strategic Priorities

To address the challenges we face and deliver our vision, aims and ICS Sustainability Model we have identified five priorities and five priority enablers for our ICS. These form the core of our five-year strategic plan


ICS SystemOutcomes Framework


The Nottingham and Nottinghamshire ICS System Outcomes Framework


Overview

The purpose of the ICS System Outcomes Framework is two-fold:

1. To define the goals (aligned to the system’s vision and aims) for the ICS, thereby providing a ‘compass’ for the required impact of system transformation and change initiatives/interventions

2. To act as a foundation for population health management, by providing an ‘anchor point’ for the outcomes for each population segment that drive the identification of population segment specific transformation initiatives/interventions

1. Providing a compass for the required impact of system transformation and change initiatives/interventions

To provide a clear view of progress and success as an ICS in delivering our five-year strategic plan a System Outcomes Framework has been developed that:

• Defines the outcomes (goals) the whole ICS will work together to achieve, aligned to the vision;

• Shapes strategic and tactical planning by ensuring system priority transformation initiatives/interventions support achievement of the outcomes; and

• Focusses the plans for system transformation initiatives/interventions by ensuring clearly articulated measures are established that align to the outcomes.

2. Providing an anchor point for the outcomes for each population segment to support the identification of segment specific transformation initiatives/interventions

As our ICS continues to move away from a system based on an individual’s service utilisation at a point in time to one based on delivering outcomes for segments of the population with similar needs (as being progressed through our the Population Health Management Programme), the ICS System Outcomes Framework will also act as an ‘anchor point’ for shaping what the outcomes for each of the population segments should be.

With population segment outcomes agreed the specific transformation initiatives/interventions can be identified that drive improvements in the agreed outcomes.

The ICS System Level Outcomes Framework does not replace existing statutory

frameworks such as the CCG Improvement and Assessment Framework (IAF) and

provider System Oversight Framework (SOF). Longer term the aim is to reduce the

number of outcome frameworks used within the system, where possible, to

increase focus and streamline monitoring and reporting.

1.

Healthy

2.

Maternal

and Child

Health

3.

Disability

5.

End of

Life

4.

LTCs

Segment Specific Outcomes

System Outcomes Framework

The ICS Board agreed the ambitions and outcomes set out in the ICS System Outcomes Framework - recognising the framework will continue to

refine and develop over time (March 2019)

12

Design principles


To help guide the identification of which outcomes should be included in the ICS System Outcomes Framework a set of principles have been developed.

PrincipleWhat does this mean for the Framework?

The ICS System Level Outcomes Framework....

Can and will be routinely measured, and used to hold the system to account • The quality of our measures will be assessed

• Available metrics will be drawn upon where possible, without constraining transformation

• The system level outcomes selected are those that the system can influence

• Holding to account is within the context of demonstrating progress towards achievement (or not) of our outcomes and associated measures

Will focus on improving the health and wellbeing for the population overall as well

as reducing inequalities across the population

• Outcomes are whole system (physical, mental, emotional and social) and are therefore purposefully generic – specificity will come through the definition of the measures for transformation initiatives/interventions that align to the system outcomes

• Outcomes are not designed to be population or condition / service user specific, however the ICS System Outcomes Framework will act as an ‘anchor point’ for shaping what the outcomes for each of the population segments should be

Will provide a clear foundation for programmes of change to assess their impact

against

• Demonstrating progress (or not) will highlight the impact of transformation activity for areas of improvement and their impact – by proxy against the selected outcomes

• Recognition that there are number of outcomes frameworks system partners are working to and reporting against.

Should be based on best practice, local need and co-produced with local citizens • The framework draws on national frameworks and best available evidence and good practice

• Engagement and review with local people and partners is integral to the framework development.

Will take into account the statutory duties of the ICS’s constituent organisations • The framework is not designed to capture statutory outcomes

• The framework is designed to support the achievement of statutory duties through shared working across the system.

Is not static, and may change and evolve over time • Engagement with partners across the system is integral to the frameworks design and in

turns it evolution.

Will focus on unmet need and the prevention of poor health and wellbeing as well

as health and care outcomes

• The framework is all age and its design focuses on the maintenance and achievement of good health and wellbeing and keeping our population healthy from the onset for longer.

Recognises that prevention is critical to delivering a fair and affordable ICS, and is

central to the achievement of the outcomes framework

• A shift towards prevention activity and interventions is essential.

13

Design and structure


Design

Our ICS System Outcomes Framework has been developed within a governance model that enables different perspectives, expertise and experience from key partners from across the ICS to come together to design and develop the framework structure.

The framework is built on good practice following a review of outcomes frameworks in existence across Nottingham and Nottinghamshire, nationally and internationally, and engagement with colleagues across the system. A small task and finish group has been established to lead the development.

Structure

The Nottingham and Nottinghamshire ICS System Outcomes Framework is based on the triple aim (improved health and wellbeing, transformed quality of care, and sustainable resources) and reflects the priorities within the Health and Wellbeing Board Strategies.

The Health and Wellbeing Board strategies are informed by the needs of our population and have undergone consultation and engagement with local health and social care stakeholders and the public.

The System Outcomes Framework is based on four components: Domain, Ambition, Outcome, Measure

.

14

ICS System Outcomes Framework


ICS System Outcomes


Ambition System Level Outcome

Our people live

longer, healthier

lives

• Increase in life expectancy

• Increase in healthy life

expectancy

• Increase in life expectancy at

birth in lower deprivation

quintiles

Our children have a

good start in life

• Reduction in infant mortality

• Increase in school readiness

• Reduction in smoking

prevalence at time of delivery

Our people and

families are

resilient and have

good health and

wellbeing

• Reduction in illness and disease

prevalence

• Narrow the gap in the onset of

multiple morbidities between

the poorest and wealthiest

sections of the population

• Increase the number of people

who have the support to self-

care and self-manage and

improve their health and

wellbeing

Our people will

enjoy healthy and

independent

ageing at home or

in their

communities for

longer

• Reduction in premature

mortality

• Reduction in potential years of

life lost

• Increase in early identification

and early diagnosis


Our people will

have equitable

access to the right

care at the right

time in the right

place

• Reduction in avoidable and

unplanned admissions to

hospital and care homes

• Increase in appropriate access to

primary and community based

health and care services

• Increase in the number of

people being cared for in

appropriate care settings

Our services meet

the needs of our

people in a positive

way

• Increase in the proportion of

people reporting high

satisfaction with the service they

receive

• Increase in the proportion of

people reporting their needs are

met


people that report having

choice, control and dignity over

their care and support

Our people with

care and support

needs and their

carers have a good

quality of life

• Increase in quality of life for

people with care needs

• Increase in appropriate and

effective care for people who

are coming to the end of their

lives


Our system is in

financial balance

• Financial control total achieved

• Transformation target delivered

Our system has a

sustainable

infrastructure

• Increase in the total use and

appropriate utilisation of our

estate

• Alignment of capital spending

for new and pre-existing estate

proposals with clinical and

service improvement objectives

• Increase in collaborative data

and information systems

Our teams work in

a positive,

supportive

environment and

have the skills,

confidence and

resources to deliver

high quality care

and support to our

population

• Sustainable teams with skill mix

designed around our population

and mechanisms to deploy them

flexibly to respond to care &

support needs

• Increase in skills, knowledge and

confidence to take every

opportunity to support people

to self-care and take a flexible,

holistic approach to people’s

needs with a strong focus on

prevention and personalised

care


people reporting a positive and

rewarding experience working

and training in the Nottingham

and Nottinghamshire health and

care system

Health and Wellbeing Independence, Care and Quality Effective Resource Utilisation

16

ICS transformational change - focus for 2020/21


ICS 5yr Strategic Plan

Process for identifying priorities for system transformation 2020/21

• Strategy alignment

(LTP/CCSS/PHM)

• Impact on activity levers

• Additional funding available

Prioritisation Hurdle 1

LTP Ambitions

CCSSPHM

Inputs

• Requires system partnership

working

• Improved consistency of

commissioning /provision

• Low investment / funding

available

• Brings primary care to the table

• Supports programme budgeting

Prioritisation Hurdle 2

ICS

2020/21 System

Transformation

Priorities

Principles for prioritisation criteria

1. Ensure alignment to ICS strategies (LTP/CCSS/PHM)

2. Supports the implementation of the ICS Sustainability Model (aligned to five

government tests)

3. Builds on system working and development of ICS infrastructure

Sense check the system transformation priorities against regulatory expectations:

Where Is the system making a difference to address the current pressures and

deliver transformational change?

• Financial balance

• Activity/performance

• System partnership working

• Evidence of transformational change

• 2020/21 operational planning

guidance


CCG Commissioning

Intentions

18

Proposed system transformation priorities for 2020/21 The process identified the following initiatives and sub initiatives as key system transformation priorities for

2020/21 to be developed and delivered by the ICS constituent organisations and ICPs:

+ DAIT (Data, Analytics and Information Technology):

Enablers were not subject to the same process but considered as part of the final sense check. This identified that DAIT should be added to the list of

system transformational priorities for 2020/21. It is a key enable to a number of the identified system transformational priorities and digital is a key

focus of the operational planning guidance.

1 2 3 4 5 6 7 8 9 10

Tobacco and Related Harm Smoking Cessation � �

Alcohol Related Harm Reduce alcohol related harm � �

Diet & Physical Inactivity Diabetes Prevention Programme � �

Children & Young People Obesity / Healthy Weight � �

Segmentation and Risk Stratification Segmentation and Risk Stratification � � �

Care coordination through integrated health and social care teams

(MDTs)

MDT Operating Model� � �

Frailty management (incl. carers) � � �

Respiratory disease management � � �

Cardiovascular disease management � � �

Diabetes management � � �

End of life management � � �

Enhanced Health to Care Homes Enhanced Health to Care Homes � � �

Single Point of Access for Community Crisis Response � �

Community Crisis Response � �

Pre Hospital Urgent Care Integrated Urgent Care Service � �

Integrated Discharge Function �

Discharge to Assess and Manage �

Stroke Services Stroke Services � � �

Perinatal mental health � �

Children and young people mental health � � �

Mental Health Crisis Care and Liaison � � � �

Planned Care Fundamental redesign of outpatients Redesign of Pathways �

Learning Disability and

Autism

Timely diagnosis and support Key worker support – initial focus on most complex needs � � �

Children and Young

People

Improving the health of the whole child Transitions� � �

Levers

Proactive care, self

management and

personalisation

Disease and Condition Management Programmes

Prevention

Priority Initiative Sub Initiative

Mental Health Improving access to services

Urgent Care Out of Hospital Urgent Care

Effective Integrated Discharge


Proposed system transformation priorities for 2020/21

Once the priority areas have been agreed, the next step is for system partners to identify and agree the key interventions to be delivered in

2020/21 and how they will be implemented, including any funding and contractual arrangements between commissioners and providers. Below

is an example based on initial discussions with leads for the Prevention workstream.

Intervention Targeted Funding into

System in 20/21

Fair Shares Funding

into System in 20/21

Other Funding

Considerations for 20/21

Support to those with mental illness - increase awareness and training

amongst mental health practitioners of very brief advice (VBA) and

prescribing medications for smoking cessation

£70,000 Share of £810k

(Under ‘other’ with

CVD, Stroke &

Respiratory, CYP &

Maternity and LD &

Autism)

Potential to repurpose

current spend

Maternity focused tobacco dependency - dedicated support to pregnant

women who smoke, need for support identified at antenatal booking and

support provided in the antenatal period

£358,579 – whole system

(+£50k non-recurrent for

PM support)

Priority: Prevention

Initiative: Tobacco and Related Harm

Sub-initiative: Smoking Cessation

EXAMPLE

Intervention Targeted Funding into

System in 20/21

Fair Shares Funding into

System in 20/21

Other Funding

Considerations for 20/21

Alcohol Identification and Brief Advice (IBA) - increase awareness and

training amongst staff in LA / NHS organisations and their partners on IBA

through the implementation of a single standard approach (City Council

have already developed an on line training package for their staff that could

be used across the health and care system)

Potential to repurpose

current spend

Alcohol Care Teams (ACT) - Provision of ACT in A&E of NUH £256,000 – NUH

focussed

(£450,000 from 21/22)

Priority: Prevention

Initiative: Alcohol Related Harm

Sub-initiative: Reduce Alcohol Related Harm


ICS approach to monitoring and evaluating system transformation


Overview of approach


By having a systematic approach to monitoring and evaluating the delivery of its strategic plan staff and leaders within the health and care system can make strategic and tactical decisions, informed by data-driven assessments, in relation to initiatives/interventions and associated investments. However, what constitutes good performance or system value can only be determined in relation to a set of goals that the integrated care system has agreed. The ICS’s approach to monitoring and evaluation therefore flows from the system’s strategic plan that articulates a long-term vision and aims for the health and care system.

At the core of the Nottingham and Nottinghamshire ICS strategic plan is the ICS System Outcomes Framework that:

• Defines the goals, aligned to the system’s vision and aims, for the ICS thereby, providing a ‘compass’ for the required impact of system transformation and change initiatives/interventions; and

• Acts as a foundation for population health management, by providing an ‘anchor point’ for the outcomes for each population segment that in turn drive the identification of population segment specific system transformation initiatives/interventions.

The system’s monitoring and evaluation approach will therefore support all system partners (commissioners and providers) to evaluate system change and transformation initiatives/interventions through an agreed set of measures that align to the ICS System Outcomes Framework and therefore delivery of the system’s strategic plan overall.

Single framework that sets out the goals

for the entire Nottingham and

Nottinghamshire health and care system

System Outcomes Framework Priority Transformation Initiatives/Interventions

Initiative / Intervention 1



Measure A

Measure B

Measure C

Measure D

Measure E

Measure F

Measures aligned

to system

outcomes

Outcomes for agreed population

segments aligned to system outcomes

framework

Measures aligned

to population

segment outcomes

It is important for the system to be able to assess the impact of system transformation in a transparent and objective way i.e. “hold the mirror up”. This

will support quality improvement and decision making on system transformation i.e. rapid roll out of successful initiatives. To support this it is proposed

the monitoring and evaluation of system transformation priorities will operate at two levels: i)System Performance Measurement ii)System Evaluation

22

Level 1: System Performance Measurement

Level 1: System Performance Measurement

Use of data to determine the progress of a particular intervention

against a set of targets or objectives.

• Agreed performance measures for each sub initiative i.e. more

traditional measures – aligned to outcomes framework

• Work with programme leads and relevant system leads to

agree measures - aligned to ICS System Outcomes Framework

• Measured at regular intervals (outlined at start of year)

• Reported to system partners in an independent and impartial

manner

• Identify progress, areas for concern and potential for

improvement Proposal: All 25 sub initiatives are monitored at level 1 and

reported regularly to ICS Board


Level 2: System Evaluation

Level 2: System Evaluation• For a small number of sub initiatives detailed independent

evaluation will be undertaken. The expected system impact will be

assessed at a granular level and a range of measures will be

identified.

Work with programme leads to understand the sub initiative in

detail i.e. what is it trying to achieve , what does success look

like and what actions are required

This will include support to develop logic models aligned to

System Outcomes Framework which will identify:

• Measured at regular intervals (outlined at start of year)

• Reported to system partners in an independent and impartial

manner

• Identify progress, areas for concern and potential for improvement

Inputs Activities OutputsOutcomes

Short-term (2020/21)

Intermediate (2021-24)

Process Outcome evaluation

Proposal: The following areas are monitored at level 2:

1. Prevention (Smoking Cessation and Alcohol)

2. Population Health Management (Diabetes and Frailty)

3. Integrated Discharge

4. Children & Young People

5. DAIT


How we develop and embed this across the system

The system needs to work differently to continue to develop and embed an approach to delivering system transformation and demonstrating an

evidence based assessment of impact across the system. During 2020/21 we will be testing our approach to this and it will need to continue to

evolve and adapt.

It is important that system evaluation is objective and an evidence based assessment of system impact, this will allow the ICS Board to “hold the

mirror up” and support continuous system quality improvement and system decision making.

In recognition of the recent national guidance identifying the facilitation of system transformation and improved outcomes as a core role of the

‘system tier’ of an ICS, members of the ICS team have been working on this approach and will continue to take it forward in 2020. This paper

outlines the work to date including the key building blocks that have been put in place, which will be tested throughout 2020/21:

• Systems Outcome Framework

• System Evaluation - approach to monitoring system impact of transformation

It is critical that this is embedded and owned across the system and by all organisations. To implement this successfully all system partners will

need to be involved in this work programme at each stage :

• Agreeing measures (for level 1 and 2)

• Agreeing logic models (for level 2)

• Reviewing monitoring and evaluation outputs

• Using outputs to support system decision making and system quality improvement

In addition, commissioners (CCG and LA) have a key role in the commissioning of transformation initiatives/interventions and the associated

allocation of resources to support the delivery of the 2020/21 operational planning requirements, ICS five-year plan and ultimately ICS System

Outcomes Framework.

Next Steps:

• Consider pace of implementation for 2020/21 and available resource

Are there any opportunities to maximise/consolidate resource to deliver greater benefits?

• Consider how ICS partners are fully embedded in this process:

How do we align System Outcome Framework, PHM and System Evaluation?

Is current meeting structure fit for purpose?

How are system partners engaged in this work – do we need to consider this as part of the ICS governance review


1 | P a g e I t e m 7 E n c E 1 . I n t e g r a t e d P e r f o r m a n c e R e v i e w M a r c h 2 0 2 0 - n e w v e r s i o n


E1

Meeting : ICS Board Date of meeting: 12 March 2020 Report Title : March 2020 Integrated Performance Report Sponsor : Andy Haynes – ICS Executive Lead ICP Lead: Clinical Sponsor: Report Author: Sarah Bray – Associate Director of System Assurance Enclosure / Appendices:

Enc. E2. Appendix 1. Integrated Performance Summary March 2020 Enc. E3. Appendix 2. ICS Board Mental Health March 2020

Summary: This report supports the ICS Board in discharging collective responsibility for financial and operational performance as well as quality of care (including patient/user experience). The Board are asked to note the report and key risk areas. An assurance report into mental health areas has been provided:

a. Key risk areas: • Urgent Care System delivery - high demand continues, with 114 x12

hour breaches in January due to capacity & flow constraints • Mental Health - Children & Young People Access & Physical Health

Checks • Financial Sustainability • Planned Care – rising waiting lists, referral to treatment increases and

management of all 52 week breaches, population and provider b. Areas of Emerging Risks:

• Local Maternity & Neonatal Services Transformation • Transforming Care Programme (inpatient numbers) • Cancer Services Delivery

c. Areas of Improvement: • Diagnostics • Out of Area Placements – Mental Health

Actions requested of the ICS Board To receive the report. Recommendations:

1. To receive the report Presented to:


Finance Directors

Group

Planning Group

Workstream Network


Oversight Group

Clinical Reference

Group

Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-

shire ICP


☒ ☐ ☐ ☐ ☐ Contribution to delivering the ICS MOU priorities: Urgent and Emergency Care

☒


☐

Cancer

☒

Mental health ☒


☐




☒ Our teams work in a positive, supportive environment and have the skills, confidence and resources to deliver high quality care and support to our population

☒


Risk Ref


Residual Risk

Risk owner

Like

lihoo

d

Con

sequ

ence

Sco

re

Cla

ssifi

catio

n



-5

L1-5

L x

I

Gra

ding





Integrated Performance Overview 3rd March 2020

KPIs

Achieving Performance - Executive Overview

8/12 Mental Health • Workforce factors impact upon IAPT, CYP and EIP, relating to vacancies, sickness and training. • CYP Access continues to make slow improvements and is forecasting 29.6% at year-end against 34% target.

IST support in Q4 2020/21 is underway and a Regional NHSEI Deep-Dive review is scheduled for 24th March 2020. ICS is the first area nationally to operationalise the Mental Health Support Teams (Wave 1) for schools.

• IAPT Access reductions have partially related to data reporting issues at Nottinghamshire Healthcare Trust which, although have now been addressed, will affect Q3 performance. Local data reports 5.26% December 2019. Clinical Network support has been engaged to undertake local deep dive into data, service and commissioning approaches

• OAPs continue to improve Q3 618 OBDs v 1748 plan (64.6% better than plan). Remaining beds relate to PICU for which additional beds have been secured for Q4 2019/20.

• Physical Health Checks are currently not progressing in line with requirements, the system is reviewing alternative service models, and targeting specific cohorts of patients and specific GP areas.

• ICS Executive Mental Health meeting continues to oversee service improvements across all mental health areas. 4/11 Urgent Care

• System has had increased 12 hour breaches during Q4 2019/20 as a result on sustained system and service pressures. (114 January 2020). System has had 6% increase in A&E Attendances with increasing complexity of patients. System focus is on maximising utilisation of system bed capacity, improving flow and complex discharges, and improving signposting for urgent care options outside the ED setting.

5/12 Planned Care • 52 week breaches reported are population (CCG) based and not within the local trusts. These have mainly

related to data issues with Independent sector providers, for which Data Quality Notices have been issued, as well as the CCG reviewing Standard Operating Procedures for monitoring out of area waiting lists.

• RTT increased waits are mainly across Ophthalmology, Cardiology and ENT for which specialty recovery plans are in place. Performance during the year has been impacted by reduction in capacity as well as prioritisation of cancer and urgent patients.

• Waiting lists have increased over the year, currently 16.3% over planned trajectory. NUH have received winter monies to transfer some appropriate activity to the independent sector.

• Diagnostics – under-performance is population (CCG) based and not the local trusts for December 2019. Commissioner performance related to non-obstetric ultrasounds at an independent sector provider, and some SFHT activity, however this is expected to improve. Provider performance is expected to reduce in Q4 in relation to MRI and CT scanners, and is not expected to recover until Q1 2020/21. 5/8 Cancer

• 62 weeks and subsequent surgery - Performance levels remain a concern, impacted by capacity reductions and referral increases experienced in the year. System recovery plan indicates recovery during Q3 2020/21, however this is not without risk, due to the level of staff vacancies and new posts required, as well as equipment and clinical capacity requirements. Additional capacity continues to be sourced from the independent sector where appropriate.

• Backlogs have started to reduce in February. 1/5 Nursing & Quality

• Transforming Care targeted reductions have not been achieved for December 2019 for Specialised Commissioning patients. TCP entered regional escalation during December 2019 due to the NHSE SpecCom inpatient numbers. Deep Dive conducted into all NHSE cases with additional case management support being sought. Non-achievement was expected due to the number of planned discharges scheduled for the year. TCP not expected to achieve end of year target.

• CHC: ICS did not achieve 28 day standard for January 2019, due to Mid Notts CCGs performance. CCGs and Local Authorities are identifying any additional actions required, to be supported by virtual MDTs for CHC.

• LeDeR – There has been an increase in the number of completed reviews to 81% (128) December. 23 reviews are in progress. There are currently no unallocated reviews in line with national expectations.


• Maternity not on track to deliver the national target of 35% for CoC, achieving cumulative YTD position of 11.1% December 2019. The ICS is assessed by NHSE as ‘Requiring Some Support’ because of delayed implementation of Savings Babies Lives Care Bundle, CoC and higher than average rates of Smoking at the Time of Delivery. Maternity CoC Implementation plan in place to progress towards a locally agreed target of 20% for March 2020 (as per LTP submission). Further pilot to be launched during March therefore on track to deliver 20%. However, 2020/21 locally agreed target of 35% remains a challenge. Work underway to agree a plan to upscale the current pilots. ICS will be an early implementer site for the National Tobacco Dependence Programme for 2020/2021. LMNS continue to work with both providers in the roll out the SBLCBv2. 2/8 Finance

• The NHS and Local Authority system has not delivered against the system financial plan for January 2020 due to continuing pressures (activity/demand, staffing pressures and non-delivery of savings & efficiency programmes).

• The NHS has not delivered on the system control total for January 2020 and therefore reporting a shortfall against the System Provider Sustainability Funding at month 10.

• The report is based upon Month 9 figures for Nottingham City Council (due to the timing of available information) • The system is forecasting a shortfall against the financial plan and system control total by year-end. Further risks

to delivery of this position remain, notably the delivery of savings/efficiency programmes and activity pressures. • The ICS Financial Sustainability Group are monitoring the year-to-date and forecast position and identifying

where further actions are necessary. • The system continues to have monthly joint assurance reviews by ICS FD and NHSEI.

Governance & Leadership

ICS Governance arrangements are continuing to be strengthened, with on-going work programmes related to management of risk, organisational and system arrangements, and workstream oversight. This includes development of the ICS Outcomes Framework. A governance review is being undertaken during Q4 2019/20, to ensure progress towards oversight as ‘System by Default’. CCG joint management arrangements are progressing, and the CCG proposal for merger April 2020 has been approved. All key statutory posts for the new organisation, have been appointed to as required by the conditions. The performance report will continue to be developed during 2019/20 to reflect the emerging governance of the ICS and ICPs, the establishment of the ICS Outcomes Framework, and the development of the System Operating Framework, to support provider SOF and CCG IAF processes. Q3 ICS Integrated Assurance Framework (based on CCG )

Best ICS Ranking

Worst ICS Ranking

• Dementia Diagnosis Rate 76.6% (2019 11) • IAPT Access 5.45% (19-20 Q1) • Personal Health Budgets 183 (19-20 Q2) • 6 weeks Diagnostics 0.95% (2019 11)

3/42 4/42 5/42 5/42

• Maternal Smoking at delivery 15.18% (19-20 Q2)

• Cancers Diagnosed at an early stage 48.12% (2017)

• Diabetes patients who achieved NICE targets 36.3% (2018-19)

• Mental Health Out of Area Placements 220 (2019 09)

40/42

38/42

35/42

32/42

*to note A&E and RTT no longer reported on STP/ICS IAF due to new metric trials Oversight & Assurance

Escalation Areas: As a system there are several areas where additional assurance and support processes are in place with NHSE-I Regulators, to support and monitor improvements. • Urgent Care - Greater Nottingham • Mental Health – Out of Area Placements / IST support & NHSEI Review for CYP in progress / IAPT Clinical

Network support • Maternity – additional support offer being developed • Transforming Care – additional support for NHSE specialised commissioning being sought • Finance – additional review meetings jointly chaired by NHSEI and ICS FD • There is increasing focus upon Cancer across the region, due to the deterioration of the positions and the impact

on patients. ICS and Trust recovery plans have been provided to the regulator.

Latest Period

National

Month RAG

Month

Delivery

Trend

Forecast

Delivery Risk

CYP Access Rate CCG 34% Nov-19 25.1% CYP Eating Disorders Urgent 1st <1 weeks CCG 95% Q3 19/20 100.0% CYP Eating Disorders Routine 1st <4 weeks CCG 95% Q3 19/20 85.00% IAPT Access - 22% (4.94% Q1%, 5.13% Q2, to 5.5% Q4)

2/3 of increase in IAPT-LTCCCG 5.31% Nov-19 4.80% 5.11%

IAPT Waiting Times - 6 weeks (Rolling Quarter) CCG 75% Nov-19 87.4% 82.9% IAPT Waiting Times - 18 weeks (Rolling Quarter) CCG 95% Nov-19 98.5% 98.7% IAPT Recovery Standards (Rolling Quarter) CCG 50% Nov-19 51.3% 52.0% Perinatal Acces - Proportion of births (Rolling 12 months) CCG 4.5% Nov-19 7.4% SMI - Physical Health Checks (Rolling 12 months) CCG 60% Q3 19/20 35.7% EIP NICE Concordant Care within 2 Weeks CCG 56% Sep-19 76.5% Inappropriate Out of Area Placements (bed days)Q1 3432, Q2 2024, Q3 1748, Q4 1440

CCG 2024 Nov-19 675 Maintain Dementia diagnosis rate at 2/3 of prevalence CCG 66.7% Dec-19 67.83% 75.8%

Aggregate performance of 4 Hour A&E Standard(SFHT performance only as NUH trialing new metrics) Provider 95% Jan-20 83.51% 89.6% 12 Hour Breaches Provider 0 Jan-20 114 NHS 111 50% population receiving clinical input Provider 50% Jan-20 47.43% 58.3% Ambulance (mean) response time Category 1 Incidents (Notts Only) Provider 00:07:00 Jan-20 00:06:34

Ambulance (mean) response time Category 2 Incidents (Notts Only) Provider 00:18:00 Jan-20 00:23:52 Manage Optimal Length of Stay - reduction in >21 days Provider 279 Dec-19 307 Reduce DTOCs across health and social care- NUH Provider 3.5% Dec-19 4.3% 3.01% Reduce DTOCs across health and social care- SHFT Provider 3.5% Dec-19 4.3% 3.79% A&E Attendances - Variance to Plan CCG ±2% of plan Dec-19 0.21% NEL - Variance to Plan CCG ±2% of plan Dec-19 -6.24% Zero Day NEL - Variance to Plan CCG ±2% of plan Dec-19 -14.11%

C. Planned Care RTT Incomplete 92% Standard Provider 92% Dec-19 89.1% RTT Waiting List - March 2020 incomplete pathway < March 2019 CCG 56,751 Dec-19 67,397 +52 Week Waits - to be halved by March 2019, and eliminated where possible Provider 0 Dec-19 4 Diagnostics +6 weeks CCG 1.0% Dec-19 1.08% Children's Wheelchair Waits < 18 Weeks CCG 92% Q3 19/20 99.30% E-Referrals increased coverage 100% CCG 100% Nov-19 94% GP Referrals - Variance to Plan CCG ±2% of plan Dec-19 0.10% Other Referrals - Variance to Plan CCG ±2% of plan Dec-19 1.02% Total Referrals - Variance to Plan CCG ±2% of plan Dec-19 0.41% Outpatient 1st - Variance to Plan CCG ±2% of plan Dec-19 -7.74% Outpatient F/U - Variance to Plan CCG ±2% of plan Dec-19 7.65% Total Elective - Variance to Plan CCG ±2% of plan Dec-19 -0.28%

A. Mental Health

Deliver the MHFV, with a focus on Children and Young Peoples services (CYP), reductions in Out of Area Placements, improved access to mental health services (EIP / IAPT / Crisis and Liaison services)

RTT Waiting Times – NUH: 12 specialties failed standard due to capacity challenges across these specialties. SFH: Rising number of patients waiting over 18wks in Ophthalmology, Cardiology, and ENT is main driver in below standard performance. Elective capacity facing increasing pressure due to reduction in staff undertaking additional sessions caused by the national tax and pensions issue.Waiting list – Following combination of NUH and the treatment centre, the ICS waiting list is +16.3% over trajectory.

52 Week Waits - 4x breaches for December '19 relating to CCG patients not local NHS trusts. 3 breaches related to potential incorrect data submissions from independent sector providers. 1 CCG patient at Hampshire Foundation Trust, has been treated in January 2020. Diagnostics - Trusts achieved the 1% standard for Diagnostics waiting times. however CCG did not, due to non-obstetric ultrasound service within the independent sector.

Nottinghamshire ICS

System Integrated Performance Summary

March 2020

Key Performance Indicator19/20 ICS

Basis

19/20

Reporting

Period

2019/20 ICS Performance

Exception NarrativeNational 19/20

Required

Performance

National

Average

B. Urgent & Emergency Care

Improved A&E performance in 2018/19, reduce DTOCs and stranded patients, underpinned by realistic activity plans. Implementation of NHS 111 Online & Urgent Treatment Centres.

A&E - NUH Continue to trial the new urgent and emergency care clinical standards and so not providing data against 4hr standard in line with the nationally agreed MOU. ED average daily attendances dipped slightly in Dec19, but saw a sustained increase in paediatric daily average attendances. SFH: Performance in January was 89.65%, Improvement when comparing against December (87.01%). Performance declined to 77.61% on 6/1/20, driven by high attendances over weekend and high admissions. Limited admitting capacity at beginning of month impacted on performance, however improved throughout the month. Front door demand decreased by -4.7% when comparing January to December activity. At the co-located front door Primary Care service, performance against the 4 hour standard at PC24 improved in January at 96.45%, compared to 93.26% in December.12 Hour Wait - NUH x 93 and SFH x 22. Capacity issues DTOCs - Greater Notts achieved target with 3.01% in December. Mid Notts achieved 3.79%, an improvement against November (4.68%). Improvement mainly due to the use of 26 beds at Ashmere Care Homes where patients most likely to be in delay are cared for.

Children and Young People (CYP) Access – despite performance increases the ICS in not forecasting to achieve the year end target. NHSEI IST support review is in place. CYP specialist eating disorder service - 4 weeks: Performance remains below national target, however there has been improvement and performance is expected at 88.9% in Q3. The urgent target was achieved with 100% of cases seen within the timeframe.IAPT – ICS under target however is now improving, Mid-Notts under-achieving. EIP – ICS achieved 2 week access target. The ICS is currently rated as a Level 2- Requires Improvement for delivery of NICE standards, and continues to progress improvement plans to achieve level 3.Physical Health Checks - slow progress across the ICS. An improvement plan has been developed across secondary and primary care provision

OAPs – Continued reduction in inappropriate OBDs. Q3 19/20 target was 1748, actual OBDs expected 618 which is 64.6% (1130 OBDs) lower than target. Zero acute OAP OBDs for Dec19. PICU beds remain, targeted improvements progressing.Dementia – ICS achieved, however Newark & Sherwood remains below target

ICS Board

12 March 2020

Item 7. Enc. E2.

Latest Period

National

Month RAG

Month

Delivery

Trend

Forecast

Delivery Risk

Nottinghamshire ICS


March 2020


Basis

19/20

Reporting

Period



Required

Performance

National

Average

Cancer 2 weeks - Suspected Cancer referrals Provider 93.0% Dec-19 91.8% 94.5%

Cancer 2 weeks - Breast Symptomatic Referrals Provider 93.0% Dec-19 84.3% 98.5%

Cancer 31 Days - First Definitive Treatment Provider 96.0% Dec-19 96.0% 94.4%

Cancer 31 Days - Subsequent Treatment - Surgery Provider 94.0% Dec-19 91.6% 82.2% Cancer 31 Days - Subsequent Treatment - Anti Can Provider 98.0% Dec-19 99.3% 98.7% Cancer 31 Days - Subsequent Treatment - Radiothy Provider 94.0% Dec-19 96.6% 100.0% Cancer 62 Days - First Definitive Treatment - GP Referral Provider 85.0% Dec-19 78.0% 78.9% Cancer 62 Days - Treatment from Screening Referral Provider 90.0% Dec-19 85.2% 96.4% Cancer 62 Days - Treatment from Consultant Upgrade Provider Dec-19 82.9% 80.9%

E. Nursing & Quality

Reductions in patients against Local planning trajectories - Total for Nottinghamshire

CCG 35 Jan-20 43 Learning Disability Mortality Reviews (LeDeR) 85% Mar 2020 CCG 85% Dec-19 81% Fewer than 15% of Continuing Health Care Full Assessments undertaken in acute setting

CCG <15% Jan-20 5% More than 80% eligibility decisions undertaken within 28 days from receipt of checklist

CCG 80% Jan-20 73% Maternity

Deliver improvements in safety for maternity services, and improve personal and mental health service provision

Continuity of Carer Provider 20% Nov-19 11.10%

Quality Measures Mixed Sex Breaches 0 Nov-19 TBC MSSA Breaches Provider No Target Nov-19 0 MRSA Provider 0 Dec-19 1 C-Difficile Provider 40 Dec-19 26 E Coli Provider 92 Dec-19 86

ED Demand: Ongoing challenges in ED regarding demand management, with a significant increase in 12 hour trolley breaches reported by Nottingham University Hospitals NHS Trust (NUH) during January 2020LeDeR: There are currently no backlog cases for LeDeR and the CCG are now able to allocate reviews from the point of notification which is in line with NHSE/I trajectories.Maternity: NUH and SFHFT continue to book women onto continuity of care (CoC) models. Across the system there are now 1150 women on a CoC pathway. However upscaling CoC continues to be challenging requiring significant workforce change and resource investment.

Continuing Health Care

31 Day DTT - NUH performance continued impact from urology backlog due to referral increases over the past year. Also impact from difficulties in recruiting to additional consultant and lack of additional theatre capacity. Sourcing additional capacity via locums and independent sector. SFHT reviewing booking processes.62 Day RTT- 78.85%. NUH – 74.18%, SFHT - 85.71%. NUH total number of breaches increased to 47 in December 2019 from 43.5 in November 2019. Tumour sites with the most breaches were - Urological – 10.5, Lung – 7, UGI – 6.5, LGI – 5.5, H&N – 4.5, Skin – 3. Treatment numbers were lower than planned at 182. Performance impacted by lower treatment numbers in Breast and Skin – mainly through patient choice with patients choosing to wait until after Christmas. ICS and trust recovery plans are in place which focus on capacity and transformational programmes, with actions expected to return performance to standard by October 2020. Significant risks remain related to successful recruitment to significant number of additional posts (consultants, nurses, theatre staff).

MRSA: (7 CCG cases, 2 NUH cases YTD). Zero reported during December 2019C Diff: Both Nottingham City CCG and NUH are over plan.E. Coli: Both Mansfield & Ashfield CCG (21 cases against 15) and SFH (5 cases against 4) are not on plan for a 10% reductionNever Events: 2 new Never Events reported during January 2020 with a total of 6 reported YtD across Nottingham and Nottinghamshire providers. RCA’s underway in accordance with National Serious Incident Framework

D. Cancer

Delivery of all eight waiting time standards, implementation of nationally agreed radiotherapy specifications and diagnostic pathways, progress risk stratified scanning and follow-up pathway

Transforming Care

Continued reduction of inappropriate hospitalisation of people with Learning Disabilities focusing on long stay (5 year +) placements

Latest Period

National

Month RAG

Month

Delivery

Trend

Forecast

Delivery Risk

Nottinghamshire ICS


March 2020


Basis

19/20

Reporting

Period



Required

Performance

National

Average

Overall Revenue Financial Position

(excluding Provider Sustainability Funding, Marginal Rate Emergency Threshold and Financial Recovery Fund)

ICS -

Health & Social Care

Nil variance to the system financial

plan of £65.7m in year deficit

-£12.7

Year-to-date deficit higher than planned due to Local Authority pressures as a result of social worker staffing pressures and growth pressures on external residential placements. NHS Commissioner pressures arising for acute activity & non-delivery of QIPP and provider pressures arising from non-delivery of CIP.

FORECAST - NHS forecast to deliver £9m shortfall against £65.7m in-year planned deficit (control total £67.7m deficit) with the Local Authority forecasting a £8.8m over-spend. Further risks to delivery of this position remain, notably the delivery of savings/efficiency programmes and activity pressures.

Overall Revenue Financial Position

(including Provider Sustainability Funding, Marginal Rate Emergency Threshold and Financial Recovery Fund)

ICS -


Nil variance to the system financial plan of £8.3m in

year deficit

-£18.4

Year-to-date deficit higher than planned due to the pressures above & shortfall at M10 on PSF system monies due to the YTD financial position.

FORECAST - NHS forecast to deliver £27.6m in-year deficit with Local Authority forecasting a £8.8m over-spend. This is a very challenging position with key risks being the delivery of savings/efficiency programmes and activity pressures across the system. This could impact further on the receipt on provider sustainability funding in year.

NHS Revenue System Control Total

(excluding Provider Sustainability Funding, Marginal Rate Emergency Threshold and Financial Recovery Fund)

NHS

Deficit does not exceed System Control Total of £67.7m in year

deficit

-£6.3

Year-to-date the NHS system was off plan due to acute activity pressures and non-delivery of savings.

FORECAST - NHS forecast to deliver £9m shortfall against £65.7m in-year planned deficit (control total £67.7m deficit). £7m shortfall against in-year deficit control total and £9m shortfall against plan.

System Capital Control Limit NHS

Spend does not

exceed system capital control limit

of £70.5m

£0.0 All provider organisations are within the System Capital Control Limit year-to-date plan. YTD spend is £49.4m.

FORECAST - to deliver with CDEL.

Savings & Efficiency Programme ICS -


Nil variance to plan -

£159.7m (4.9%)-£11.2

Delivered £148.9m of savings year-to-date, under delivery across both the NHS and Local Authority savings plans.

FORECAST - NHS organisations are forecasting £125.8m (£145m plan) & Local Authority £23m (£24.1m plan)

Provider Sustainability Funding (PSF) NHSNil variance to

available PSF of £27.5m

-£5.7

The system is reporting to be off plan at Month 10 & therefore a shortfall on PSF Organisation & System monies.

FORECAST - All provider organisations are forecasting a shortfall due to the forecast position against control total.

Mental Health Investment Standard (MHIS) NHSMH spend (exc LD & Dementia) is at

least £165.1m-£0.1 The system if forecasting to be off target at the end of January 2020 with 2 out of the 6

CCGs projecting to fail the target (last month 4 were forecast to fail).

Agency Ceiling NHSAgency Spend is

within the ceiling limit of £45.4m

£0.5 Two provider organisations are within the agency spend ceiling year-to-date.

FORECAST - NUH forecasting to spend above their agency ceiling at Month 10 partially due to a service change but also staffing pressures in escalation areas.

Jan-20

G. Finance & Efficiency

1 | P a g e I t e m 7 . E n c . E 3 . I C S B o a r d M e n t a l H e a l t h - r e p o r t M a r c h 2 0 2 0

ICS Board 12 March 2020 Item 7. Enc. E3.

NOTTINGHAM & NOTTINGHAMSHIRE ICS – MENTAL HEALTH / LD &

AUTISM EXECUTIVE SUMMARY REPORT

March 2020

Prepared By: Appendices :

Sarah Bray – Associate Director of System Assurance Appendix 01. ICS Mental Health Dashboard

Performance Summary: ICS / NHSEI Joint Oversight Arrangements There are two main groups which provide joint oversight of the ICS mental health service areas and specific recovery plans relating to IAPT, CYP, OAPs, Physical Health Checks, EIP;

• ICS Mental Health / LD & Autism Executive Oversight Group – (ICS, NHSEI, CCG and Trust) • ICS Mental Health Assurance Group – Operational (ICS, NHSEI, Network, CCG and Trust) • Transforming Care Partnership Board – Operational (ICS, NHSEI, Spec Comm)

MH Area Performance Exceptions Actions RAG

Status Oversight / Assurance

CYP - Access Slow progress on access, will not achieve year end target (29% v 34%). One of lowest 5 ICS/STPs in Midlands.

Providers engaging in IST Data Improvement Project, new service to start from June 2020, reviewing early support pathway Q2 2020/21. Service improvements: Dec 2020 – Wave 1 MHST Jan 2020 – Waiting Time initiative

Red Regional CYP Review scheduled March 2020 IST Data Review Q4 CYP Optimisation -Provider Maturity Tool March 2020

Latest

Period

National

Month RAG

Month

Delivery

Trend

Forecast

Delivery Risk

CYP Access Rate CCG 34% Nov-19 25.1% ● ●

CYP Eating Disorders Urgent 1st <1 weeks CCG 95% Q3 19/20 100.0% ● ●

CYP Eating Disorders Routine 1st <4 weeks CCG 95% Q3 19/20 85.00% ● ●

IAPT Access - 22% (4.94% Q1%, 5.13% Q2, to 5.5% Q4)

2/3 of increase in IAPT-LTCCCG 5.31% Nov-19 4.80% 5.11% ● ●

IAPT Waiting Times - 6 weeks (Rolling Quarter) CCG 75% Nov-19 87.4% 82.9% ● ●

IAPT Waiting Times - 18 weeks (Rolling Quarter) CCG 95% Nov-19 98.5% 98.7% ● ●

IAPT Recovery Standards (Rolling Quarter) CCG 50% Nov-19 51.3% 52.0% ● ●

Perinatal Acces - Proportion of births (Rolling 12 months) CCG 4.5% Nov-19 7.4% ● ●

SMI - Physical Health Checks (Rolling 12 months) CCG 60% Q3 19/20 35.7% ● ●

EIP NICE Concordant Care within 2 Weeks CCG 56% Sep-19 76.5% ● ●

Inappropriate Out of Area Placements (bed days)

Q1 3432, Q2 2024, Q3 1748, Q4 1440CCG 2024 Nov-19 675 ● � ●

CPA Follow Up < 7 days CCG

Maintain Dementia diagnosis rate at 2/3 of prevalence CCG 66.7% Dec-19 67.83% 75.8% ● ●

Transforming Care

Reductions in patients against Local planning trajectories - Total

for NottinghamshireCCG 35 Jan-20 43 ● � ●

Learning Disability Mortality Reviews (LeDeR) 85% Mar 2020 CCG 85% Dec-19 81% ● ●


Basis

19/20

Reporting

Period

2019/20 ICS PerformanceNational 19/20

Required

Performance

National

Average


However are first ICS nationally to operationalise MHSTs.

June 2020 – Small steps service goes live Sept 2020 – Wave 2 MHST

CYP – ED - Routine

Sustained non-achievement of standard

Investment made in 2018/19, staff recruited and trained. System examine on case by case basis reasons for delays – large proportion relates to patient choice, large impact due to small patient volumes

Amber

IAPT - Access ICS Reduction in performance Q2-Q3. Mid-Notts sustained lower performance.

Reduction related to technical data submission issues now resolved, however will impact performance until Dec due to rolling quarter metric. Capacity increasing as trainees undertake assessments and pick up caseloads. Communications and awareness activities, including working across other services (sexual violence / probation) and on-line platforms. Increasing social media presence and undertaking promotional activities.

Amber Clinical Network support deep dive into performance and workforce March 2020. Review workforce, capacity and demand, commissioning model.

SMI Physical Health Checks

Plateaued performance – not expected to achieve year end target

Continued engagement with PCN leads Establish connections with Community Pharmacists to identify opportunities for engaging with SMI patients Effective use of data and intelligence to target support at practice level Evaluate GPEDS incentivisation scheme and Health Improvement Worker Pilot for replicability across ICS

Red

EIP NICE Compliant Care – Level 2 (target 25% level 3)

CBTp Trained staff remains issue for progressing to level 3. 4 staff commenced 2 year training programme, clinical lead engaged who is CBTp trained, service continues to try to recruit CBTp trained staff.

Amber NCAP 2019 audit undertaken in January 2020, will report in Q1 2020/21.

OAP Sustainability of position and PICU provision

Recovery plan is ahead of trajectory, (Q3 target 1748, expected OBDs 618, 64.6% lower than target). Zero acute OAPs Dec 2019, however PICU beds remain. 3 additional female PICU beds March 2020.

Green ICS remains under Monthly National OAP calls with NHS England Mental Health Director

Dementia ICS is achieving however Newark & Sherwood are not achieving the standard

Additional investment agreed to increase access to Memory Assessment Service to address long waits.

Green


Specific review being undertaken by the CCG on the whole dementia pathway.

Mental Health Investment Standard

Movement in forecast position – month 9 £1.8m under target improved to £0.2m under target at month 10 (however this is £0.6m under across 2 CCGs)

Forecast to be reviewed as at month 11, expect it to be more in line with year end requirement. NHSEI lead to verify whether the position expected is aggregated ICS position, and not individual CCG given that the CCGs will merge in April 2020.

Amber Joint MHIS ICS review undertaken 28th Feb 2020, including NHSEI, ICS, CCG and Trust.

Transforming Care Partnership

Reductions are not in line with trajectory – Spec Comm are 9 over plan. ICS is not expected to achieve year end target

Deep dive into all NHSE patients with additional case management being sought. Spec Comm trajectories have been refreshed to be reflective of the clinical appropriateness of each patient for discharge

Red Regional escalation – Dec 2019

Red: Current and Forecast non-delivery Amber: Current non-delivery, forecast

delivery – some risk Green : ICS on target, however place

based risks

1 | P a g e I t e m 8 . E n c . F 1 . M i d N o t t s I C P U p d a t e t o I C S B o a r d ( 1 ) . d o c x


F1

Meeting : ICS Board Date of meeting: 12 March 2020 Report Title : Mid-Nottinghamshire ICP Board Update – February 2020 Sponsor : Richard Mitchell, Chief Executive Sherwood Forest Hospitals ICP Lead: Richard Mitchell Clinical Sponsor: - Report Author: Kerry Beadling-Barron, Director of Communications and

Engagement at Mid-Nottinghamshire ICP Enclosure / Appendices :

Enc. F2. Appendix 1: Q3 Performance Report Enc. F3. Appendix 2: Mid-Notts ICP Extended Update

Summary: The Board met on 27 February at The Summit Centre, Pavilion Road, Kirkby in Ashfield and welcomed two members of the public. The main item discussed was setting of the ICP priorities with a particular emphasis on prevention, population health management and proactive care.

Actions requested of the ICS Board The Board is asked to NOTE the Mid-Nottinghamshire ICP work to date.

Recommendations: 1. To note the report

Presented to:


Finance Directors

Group

Planning Group

Workstream Network

☐ ☐ ☐ ☐ ☐ Performance

Oversight Group

Clinical Reference

Group

Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-

shire ICP ☐ ☐ ☒ ☐ ☐


☒


☒

Cancer

☒

Mental health ☒

Alcohol ☒ Clinical services strategy

☐




☒ Our teams work in a positive, supportive environment and have the skills, confidence and resources to deliver

☒


high quality care and support to our population


Risk Ref


Residual Risk

Risk owner

Like

lihoo

d

Con

sequ

ence

Sco

re

Cla

ssifi

catio

n




MID-NOTTINGHAMSHIRE ICP BOARD UPDATE - February 202 0

Discussion on ICP Priorities for 2020/21

1. A facilitated discussion took place to set the priorities for the ICP in 2020/21 which was contextualised with an update on the 2019/20 ICS priorities for the ICP and then followed by a presentation on the ICP plan and alignment with ICP objectives.

2. This was followed by table discussions focusing on three key areas: prevention, population health management and proactive care. The attending members of the public sat around the tables with ICP colleagues and were actively involved in these discussions.

3. These discussions allowed ICP colleagues to focus on how the longer term ICS plans (for public health etc) are balanced with the immediate need for financial improvement and improvement to access. There were also similar conversations around how partners can work together to balance the needs of the NHS and local authorities.

4. The results from the table discussions are being gathered together by Locality Director David Ainsworth with the resultant ICP priorities for 2020/21 due to be agreed at the March Board.

Quarter 3 system progress report (see full report i n Appendix 1)

5. The Board acknowledged that urgent care demand continues at high and growing levels, outstripping national averages by a considerable margin. This is putting the system under pressure and is driving an increasingly difficult underlying financial position. In spite of the pressure, the system continues to perform strongly by comparison with peers and national averages.

6. For planned care, performance is also comparatively strong, although not consistently compliant with national standards. The underlying position is improving, and significant inroads are being made into re-designing outpatient care and reducing activity in this area.

Invitation to participate in a Musculoskeletal valu e improvement programme

7. Following the discussion at the previous Board meeting it was agreed that the ICP would take part in in a 12-month value improvement programme in partnership with the Oxford Centre for Triple Value Healthcare.


8. Next month’s meeting will take place on 26 March at 1pm at the Towers,

Botany Avenue, Mansfield. Papers will be available a week in advance on the ICP website.

Mid Nottinghamshire Transformation Programme

Summary report from Transformation Board, Operational Delivery Group and

A&E Delivery Board to ICP BoardQuarter 3 ending December 2019

ICS Board Meeting 12 March 2020Item 8. Enc. F2

Report Content

The report enclosed is intended to provide ICP Board members with an overview of

the key areas of performance

1. Current Performance across key Urgent and Planned Care Metrics

2. Mitigation of urgent and emergency care demand

3. Planned Care Overview

4. Summary of Q3 ICP Financial Performance

1. Q3 Performance Summary

4

SFH view

CCG view (all providers)

Activity and Performance Summary – Emergency Care –ED Attendances

5.5% Above

Plan

6.7% Above

Plan

4.3 % Above

Plan

5.6% Above

Plan

Comparison 18/19

Nationally ED

attendances are up

by 4.4%

At the end of Q3 - 19/20

5

At the end of Q3;

SFH view

CCG view (all providers)

Activity and Performance Summary – Emergency Care –Non Elective Admissions

10.3% Above

Plan

13.3 % Above

Plan

9.2% Above

Plan

12.9% Above

Plan

Comparison 18/19

Nationally Non

Elective Admissions

are up by 3.8%

At the end of Q3 - 19/20

6

The graphs below provide a longer term view of activity to provide context on performance and have been

included in the Drivers of Demand work.

Activity and Performance Summary – Emergency Care -

7

• Performance against the four hour standard was 88.9%

• KMH ED 85.4%

• Newark UCC 97.1%

• PC24 95.1%

Compared to the following:

• Peer Group Average 79.3%

• National Average 81.6%

Activity and Performance Summary – Emergency Care -Four Hour Standard Performance

8

Activity and Performance Summary –Elective CareTotal Mid- Nottinghamshire Data

Outpatients First

Appointments –

Q3

Day Case– Q3Outpatient

Follow Ups– Q3

Outpatients First

Appointments –

18/19

Day Case - 18/19

0.5%

Below

Plan

Inpatient

Elective

Admissions– Q3

5.8%

Below

Plan

Outpatient

Follow Ups–

18/19

Inpatient Elective

Admissions– 18/19

3.2%

Above

Plan

3%

Above

Plan

2.2%

Below

Plan

6.3%

Below

Plan

4.3%

Above

Plan

7.6%

Above

Plan

9

• Referral to Treatment - 86.04% of people were treated within 18 weeks as at

Dec 2019 against a standard of 92%.

This compares to

• Peer Group performance of 84.16% and

• National average of 83.80%, both as at Nov 2019.

• Main specialties driving the position are Ophthalmology, Cardiology and ENT.

• Recovery plans are in place for all specialties achieving below the standard.

• There were no month end 52 week waits.

• The overall size of the waiting list is reducing.

Activity and Performance Summary – Elective CarePerformance Indicators

10

• Cancer waits - 85.71% received their first definitive treatment within 62 days

following an urgent referral for suspected cancer as at Dec 19, against a standard

of 85%.

This compares to

• Peer Group performance of 78.33% and

• National average of 77.37% , both as at Nov 19.

• 2 week wait referrals up 5% and treatments up 11% when compared to 18/19

• January forecast 70% as patients choose to wait for diagnostic tests and/or

treatment until after Christmas and New year

• A revised Trust and CCG recovery action plan will be in place by the end of

February 2020. It will be based around 3 key themes:

• Wait for first outpatient appointment

• Wait for diagnostic tests

• Efficiency in the management of pathways

Activity and Performance Summary – Elective CarePerformance Indicators

2. Mitigation of urgent and

emergency care demand

12

• End of Life Together, MSK Together and High Intensity Service User services continue to

successfully enhance and improve the patient experience as well as delivering significant

financial benefit to the ICP

• EOL Together £1.7 million savings delivered in 19/20 at month 9

• Home First Integrated Discharge Model (HFID - Discharge to Assess) has facilitated Non

Weight Bearing Patients not requiring an acute bed to return home with packages of care.

• The HFID model commenced its roll-out on Monday 10th February, to support the early

discharge of patients to their place of residence for assessment.

• Benefits will include, improve flow through SFH, a reduction in length of stay, reduced

risk for patients remaining in a bed from hospital acquired infection

• 6 patients were safely discharged through the new model in week 1 of the roll-out

Activity and demand summary – Urgent Care Demand – Mitigation of Demand

13

• The Operational Delivery Group has been focusing on the high and increasing number of people

being conveyed to ED by ambulance, and steps that can be taken to reduce these volumes.

• There has also been a focus on community service capacity, and how this can be optimised to

reduce ED attendances and non-elective admissions – the mobilisation of an Integrated Rapid

Response Service has been the main element of this work.

• In support of the demand mitigation work, a number of audits are being undertaken during

February and March, led by the ICP team and in conjunction with key clinical and operational

colleagues from across the system, including:

• An audit of 300 patients conveyed by ambulance to ED, to determine whether their

attendance/admission could have been avoided;

• An audit of 300 people who attended ED and were known to be approaching the end of

their life, to determine whether the EOL Together service could have avoided the

attendance/admission.

• The Urgent and Emergency Care Drivers of Demand work is being refreshed in order to give

more insight into specific factors that may be amenable to interventions to reduce demand.

Activity and demand summary – Urgent Care Demand – Mitigation of Demand

3. Planned Care Overview

Elective / Day case activity:

• Focus on day case activity over winter period as planned.

• Reduced in-patient operating for orthopaedics Jan /Feb. Back to full IP

operating from 6th March.

Outpatient Innovation Programme:

• Successful implementation during 2019/20 is being forecast to result in

21,000 fewer appointments than in 2018/19.

• Plans for 2020/21 well developed with a firm SFH plan to reduce

appointments by a further 12,000 , against a target of 18,000, and further

work to identify other opportunities.

4. Q3 ICP Financial Summary

Year-to-date (pre-PSF, MRET & FRF) – health and social care position of £39.7 million deficit (£7.4m

worse than plan).

• Local Authority pressures £2.2m due to overspends on staffing & growth pressures on external

residential placements.

• Commissioner pressures £4.8m arising for acute activity & non-delivery of QIPP.

• Provider pressures £0.4m arising from non-delivery of CIP.

Forecast (pre-PSF, MRET & FRF) – health and social care position of £43.4 million deficit (£3.2 million

worse than plan).

• £0.4 million better than plan associated with the required additional surplus requirement.

• £2.9 million worse than plan on Local Authorities in line with above pressures.

• £0.7 million worse than plan on NUH arising from non-delivery of CIP and staffing pressures.

Provider Sustainability Funding (PSF), Marginal Rate Emergency Tariff (MRET) & Financial Recovery

Fund (FRF): year-to-date have received £18.2 million (£0.8m worse than plan), year-end forecast to

receive £26.9million (£1.5m worse than plan).

Underlying recurrent position – £71.9 million deficit (£27.1 worse than plan), this movement reflects

the deteriorating in-year position and non-recurrent mitigations.

Q3 ICP Financial Summary at Month 9

Richard Mitchell

Executive Lead

ICS Board Meeting 12 March 2020Item 8. Enc. F3

Our neighbourhood

approach

We are focusing on key neighbourhoods that

have been identified due to the number of

residents in those areas with poor mental and

physical health, low income and low education

achievement.

• Build up relationships

with community

voluntary sector

• Agreed set of

engagement principles

worked up by a cross-

sector group

• Agreed Community

Insight Model worked up

by a cross-sector group

Our engagementapproach

• Meeting in public

since September

• Meetings held in

locations across

Mid Notts

• Members of the

public take part in

the discussions

Our engagementapproach – in practice

Crystallisingaround threekey areas.

Will befinalised andagreed atMarch Boardandimplementedfrom April2020.

Our priorities

Prevention

Proactive

Care

Population

Health

Management

Includes clinical, local authority and NHS

colleagues alongside our independent chair.

Our executive team

Headline achievements

• MSK team being extended toinclude six new First ContactMSK Physiotherapists inPrimary Care.

• End of Life programme hasworked with NottinghamshireHospice to introduce aHospice at Night serviceacross Mid Notts.

• The Outpatientsimprovement programme hassafely reduced 12,000appointments this year.

Summary

• We focus on how collaborative working can

add the most value and improve the lives of

our residents.

• The voice of our residents is central to this.

• We are already seeing some benefits to this

way of working.

1 | P a g e I t e m 8 . E n c . F 4 . I C S B o a r d C i t y I C P u p d a t e M a r c h 2 0 2 0 ( 1 ) . d o c x

Item Number: 8 Enclosure

Number : F4

Meeting : ICS Board Date of meeting: 12 March 2020 Report Title : Update from the Nottingham City Integrated Care Partnership Sponsor : Ian Curryer ICP Lead: Ian Curryer Clinical Sponsor: - Report Author: Rich Brady, Programme Director, Nottingham City ICP Enclosure / Appendices :

None

Summary: To update on Integrated Care Partnership progress over the last month. Actions requested of the ICS Board The Board is asked to note the Nottingham City ICP work to date. Recommendations:

1. The Board is asked to note the Nottingham City ICP work to date. Presented to:

Board Partnership

Forum

Finance Directors

Group

Planning Group

Workstream Network


Oversight Group

Clinical Reference

Group

Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-

shire ICP ☐ ☐ ☐ ☒ ☐


☐


☐

Cancer

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NOTTINGHAM CITY INTEGRATED CARE PARTNERSHIP UPDATE

27 February 2020 Establishing priorities for 2020/21

1. The Nottingham City Integrated Care Partnership (ICP) is soon to establish its priorities and work programme for 2020/21, following engagement with a range of partners and wider stakeholders across the City.

2. Following an initial workshop on 28 January with the community and voluntary sector, hosted by Healthwatch Nottingham and Nottinghamshire and Nottingham Community Voluntary Service, a second workshop was held on 5 February with strategic and operational leads from across the partnership.

3. Over 70 strategic and operational leads, representing NHS, local authority and voluntary, community and social enterprise sector organisations in the City attended the full-day workshop. Partners worked together to identify the key priority areas of focus for the City ICP in 2020/21, as well as setting the values and principles for the partnership going forward.

4. The City ICP Executive Management Team has taken the feedback from the two workshops, utilised population health data and information, the ICS Strategy and accompanying outcomes framework, to develop a draft set of priorities for the ICP to deliver in 2020/21.

5. Before establishing the ICP programme for 2020/21, the draft set of priorities

will be shared and tested with Nottingham City citizens at an upcoming Primary Care Network (PCN) event on 19 March. The event seeks to understand the challenges and opportunities in the City’s neighbourhoods in relation to delivering the priorities and understand how the ICP programme can have the greatest impact on citizens’ health and wellbeing.

Primary Care Network development

6. The City’s PCNs are continuing to establish links with wider public sector services and have had positive meetings with the Police and Fire Services to establish how they can better work together to support the City’s neighbourhoods.

7. Learning events being led by PCNs have expanded to include partners from wider organisations to share common understanding of service delivery and opportunities to support joint working.

8. The PCNs have also been working with the Department for Work and

Pensions to develop an approach of ‘work as a health outcome’. Several areas being are explored including improving connections between the City’s GP practices (including linking social prescribing) with Employment Advisors and providing training to practices on ‘Fit Notes’.


9. Engagement and alignment between Community and Primary Care Services

continues to strengthen. The move of core community clinical services from Care Delivery Groups to PCNs has been completed in Top Valley, Bulwell, Bestwood and Sherwood as part of a rolling programme of adult services. It is projected that all adult services will be fully aligned by the end of April 2020. A collaborative approach to enhancing Multi-Disciplinary Team working is underway.

Alcohol Care Teams

10. Nottingham University Hospitals has been approved as an Alcohol Care Team (ACT) early implementer site and will receive recurrent funding from April 2020. The ACT will work across partners taking on an important role in increasing the number of people with alcohol issues receiving support, ensuring appropriate treatment in the secondary care settings and facilitating on-going support from community based services

The team will:

• be led by a senior clinician with dedicated time for the team • facilitate widespread case identification and brief advice (IBA) • provide comprehensive alcohol assessment • contribute to nursing and medical care planning • provide psychosocial interventions • manage medically-assisted alcohol withdrawal • plan safe discharge, including referral to community services

Leadership

11. The Nottingham City ICP is seeking a new Lead to replace Ian Curryer who

will be leaving the role at the end of April 2020. Ian Curryer has announced that he will be stepping down as the Chief Executive Officer of Nottingham City Council and as a consequence the Lead of the Nottingham City ICP. The City ICP Executive Management Team will work with the ICS to support the process of appointing a replacement.

12. Following the appointment of Dr Hugh Porter as the ICP Clinical Director, the City ICP is now also seeking a Deputy Clinical Director to work alongside Dr Porter to continue to build and establish a strong clinical team across a range of disciplines. Interviews will be held on 11 March 2020. The City ICP is also exploring the possibility of appointing a Health Inequalities Clinical Lead to work with the ICP Leadership Team.

Ian Curryer Nottingham City ICP Lead [email protected]

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Meeting : ICS Board Date of meeting: 12 March 2020 Report Title : South Nottinghamshire Integrated Care Provider Update Sponsor : John Brewin ICP Lead: John Brewin Clinical Sponsor: Nicole Atkinson Report Author: John Brewin Enclosure / Appendices :

Summary: To update on South Nottinghamshire Integrated Care Provider progress over the last month since the last update report. Actions requested of the ICS Board The Board is asked to NOTE the South Nottinghamshire ICP work to date.

Recommendations: 1. The Board is asked to NOTE the South Nottinghamshire ICP work to

date. Presented to:

Board Partnership

Forum

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Mid Nottingham-

shire ICP

Nottingham City ICP

South Nottingham-



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Cancer

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Mental health ☐


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☒ Our teams work in a positive, supportive environment and have the skills, confidence and resources to deliver high quality care and

☒


support to our population

Conflicts of Interest ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion and decision ☐ Conflict noted, conflicted party can participate in discussion, but not decision ☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision ☐ Conflict noted, conflicted party to be excluded from meeting Risks identified in the paper None Is the paper confidential? ☐ Yes ☒ No ☐ Document is in draft form



Update from South Nottinghamshire Integrated Care P rovider 12 March 2020

Background 1. This paper provides an update on the key areas of development that have taken

place in the South Nottinghamshire ICP (SN ICP) since the last update report.

ICP Planning and Implementation 2. Joint City and South Nottinghamshire ICP planning meetings continue to identify

key areas of delivery in the NHS Long Term Plan that would benefit from a City and South Nottinghamshire approach.

3. A SN ICP development plan is in progress outlining the key actions and milestones in the areas of governance, strategy and planning, workforce, Primary Care Networks (PCNs), finance and performance, communications and engagement and organisational development.

4. Working with system partners on ICP priorities around frailty

a. Identification of frailty b. Advanced Care Planning c. Falls and loneliness

South Nottinghamshire ICP Transformational Funding Progress Report 5. Social Prescribing

• Delivery on schedule with full implementation achieved in January 2020 • 300 referrals received to date • 7 additional link workers coming on board from April 2020 • Data management systems now implemented aiming to robustly capture

outcomes based on learning from the Rushcliffe Vanguard • 4 co-production forums delivered with over 120 stakeholders taking part

supporting the community engagement and activation across the South Locality.

6. Primary Care Psychological Medicine

• Referral rates for the South all on target • Advertised and shortlisted for all remaining vacancies • Agreement for the team to be co-located with Primary Care • A proposal is going to the Strategic Commissioning Committee to secure

recurrent funding for the service in South Notts with a view to extend the service to City and Mid Notts.


7. High Intensity Service Users • Service specification and key performance indicators now finalised • Data has been received for the South locality (April to September 2019)

identifying savings delivered • Dashboard now set up and will be backdating to provide monthly data from

September 2019 onwards. Reporting will be available on the 20th of each month.

• Data Protection Impact Assessment is finalised • Delays to recruitment have caused some slippage in the service being rolled

out as the second clinical post is not in place. This is a key risk and other options are being explored to ensure the delivery of the service.

News from the South 8. Rushcliffe PCN launch took place on 6 February with over 90 stakeholders

attending. Key priority areas identified as part of the local planning include a focus on; integrated working, mental health, ageing population, workforce and prevention

9. PCN Plans on a Page have now been completed for each PCN. They include membership of the PCN, map of the local area, public health priorities as well as the local priorities. These can be found at https://healthandcarenotts.co.uk/care-in-my-area/south-nottinghamshire-icp/

10. The South Notts Locality Director presented the South Notts ICP work at the start of the Patient Citizen Leadership Programme in February, to an audience of developing patient leaders across the ICS

11. A South Notts PCN Clinical Directors Group was established in November chaired by the ICP Clinical Lead, Dr Nicole Atkinson. The membership is made up of 15 PCN Clinical Directors supported by Locality Directors / Deputy Locality Directors and Business Managers from the respective GP Federations (Partners Health and PICS). At its meeting in February the group discussed working together as a network of PCNs in the South and identified areas to contribute to clinical transformation

12. A South Notts ICP channel is up and running with good engagement. We will create some engaging content about the exciting and innovative work taking place across South Notts (@SouthNottsICP )

13. A South Nottinghamshire Community Engagement Strategy has been drafted and a SN ICP community engagement event is scheduled to take place on 19 May. Community Engagement work is progressing with community and voluntary sector partners in Eastwood coming together to establish ‘Healthy Eastwood’


Resource requirements 14. Interviews for the post of Programme Director for South Notts ICP take place on

Tuesday 3 March. This is for a 2 year role.

15. Recruitment has started for additional clinical support to work alongside Dr Nicole Atkinson. The SN ICP will look to identify clinical capacity from NUH and NHCT.

John Brewin South Nottinghamshire ICP Lead [email protected] 12 March 2020

agend and papers ics board 12 march 2020 final v2...2020/03/12 · 1 | p a g e item 3. enc a1. ics...

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