commissioninggroups ... packs... · roshan patel 14:50 12 quality report 12 quality exception...

Combined Meeting in public of the Governing Bodies ofFareham and Gosport and South Eastern Hampshire Clinical

Commissioning GroupsFerneham Hall, Osborn Road, Fareham, Hampshire PO16 7DB

24 October 2018 13:00 - 24 October 2018 16:00

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AGENDA

# Description Owner Time

Public Seminar - Engaging with our Local Communities

FINAL Big Health Conversation GB presentation Oc... 5

13:00

Introductory Items

1 Welcome and apologies Chair 13:30

2 Register and declarations of interests

2 register of interests cover sheet.docx 23

2 register of interests.pdf 25

Chair 13:32

3 Minutes of the last meeting

3 previous minutes cover sheet.docx 29

3 previous draft minutes public.docx 31

Chair 13:34

4 Action Log

3 Action log.xlsx 39

Chair 13:36

5 Chairs' Report including Partnership Update - JOINT

Chairs report October.docx 47

Clinical Chairs

13:40

Items for Decision

6 STP System Reform

6 STP system reform cover sheet.docx 51

6 STP system reform proposal.pdf 53

Sara Tiller 13:50

7 Whitehill and Bordon UpdateWhitehill and Bordon Health Campus and re-provision of Hampshire Hospitals NHS Foundation Trust Services update

7 Whitehill and Bordon update cover sheet.docx 99

7 Whitehill and Bordon update paper.docx 101

Elizabeth Kerwood

14:00

Items to Note

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# Description Owner Time

8 EPRR Annual Plan

8 EPRR Annual Plan.docx 109

Tracy Davies 14:15

9 Winter Plan

9 Winter Plan cover sheet.docx 115

9 Winter Plan 2018 vs 7.pdf 117

9 Winter Preparedness 2018-19 National letter and... 157

Sarah Malcolm

14:30

10 PSEH Operating Plan 2018/19

10 PSEH LCP Operating Plan 1819 cover sheet.do... 159

10 PSEH LCP Operating Plan 1819.pptx 161

Sara Tiller 14:40

Key Reports to Note

11 Finance Report

11 Finance Report cover sheet.docx 203

11 Finance Report.pptx 205

Roshan Patel 14:50

12 Quality Report

12 Quality Exception report.docx 217

Julia Barton 15:00

13 Integrated Performance Report

13 Performance Report 201810.docx 237

13 performance FG.pdf 245

13 performance SEH.pdf 247

Stuart Harris 15:10

Discussion

14 Questions received from the public in advance of the meeting

Clinical Chairs

15:20

Information to note

15 Minutes of previous meetings Chair 15:30

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INDEX

FINAL Big Health Conversation GB presentation Oct 2018 (v4).pptx............................................5

2 register of interests cover sheet.docx..........................................................................................23

2 register of interests.pdf................................................................................................................25

3 previous minutes cover sheet.docx.............................................................................................29

3 previous draft minutes public.docx..............................................................................................31

3 Action log.xlsx..............................................................................................................................39

Chairs report October.docx.............................................................................................................47

6 STP system reform cover sheet.docx..........................................................................................51

6 STP system reform proposal.pdf.................................................................................................53

7 Whitehill and Bordon update cover sheet.docx.............................................................................99

7 Whitehill and Bordon update paper.docx......................................................................................101

8 EPRR Annual Plan.docx..............................................................................................................109

9 Winter Plan cover sheet.docx.......................................................................................................115

9 Winter Plan 2018 vs 7.pdf.............................................................................................................117

9 Winter Preparedness 2018-19 National letter and request for plans (2).pdf.................................157

10 PSEH LCP Operating Plan 1819 cover sheet.docx...................................................................159

10 PSEH LCP Operating Plan 1819.pptx.......................................................................................161

11 Finance Report cover sheet.docx..............................................................................................203

11 Finance Report.pptx..................................................................................................................205

12 Quality Exception report.docx....................................................................................................217

13 Performance Report 201810.docx.............................................................................................237

13 performance FG.pdf...................................................................................................................245

13 performance SEH.pdf................................................................................................................247

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Engaging with our local communities

Page 1 of 18FINAL Big Health Conversation GB presentation Oct 2018 (v4).pptxOverall of 247

The CCGs are committed to taking the views of local people into account when making decisions about local healthcare and to hearing ongoing feedback make sure local services provide the highest quality.

To do this we have clear routes in place:

• Each GP practice has a Patient Participation Group (PPG) in some form

• Each PPG has a representative on its Locality Patient Group• Each Locality Patient Group has a representative on the CCGs’

Community Engagement Committees

Taking the views of local people into account


We seek the views of local people on the work we are doing in a variety of ways including:

• Surveys – both online and face-to-face• Focus groups• Conversations with individual people• Attending local events• Attending local groups

We promote our engagement opportunities in a variety of ways including:

• Our websites and social media• Locality Patient Groups, Patient Participation Groups, GP practices,

local councils and the voluntary sector• Local media

Seeking the views of local people


Your Big Health Conversation:Phase 2


Your Big Health Conversation: Phase 1 - recap

Starting point:

“The NHS needs to change….” But what does that mean…?

Asked about “big picture” issues

• What should a ‘seven day NHS’ mean?

• Would you travel further for care from a specialist department?

• Are you happy to see surgery staff other than GPs?

• Could more services be delivered away from hospital?


Your Big Health Conversation: Phase 1 - recap

Largely survey-based, and online – almost 2,000 respondents

Feedback included:• Most people (64%) agreed that the NHS must change, and wanted a

focus on community-based services

• Most people (57%) supported a focus on community-based care even if that meant fewer hospital beds

• About half felt that pressure on GPs could be eased if patients saw other staff instead

• Almost 3 in 4 prepared to travel further for specialist care

• 1 in 3 said all NHS services should be available, all day every day


Your Big Health Conversation: Phase 2 - scope

Phase 2 intended to build upon findings from Phase 1, and move conversation forward.

Focus on face-to-face discussions. Asking people with first-hand experience of services for their views on possible changes.

Focus on four key areas:

• Community-based mental health care

• Living with long-term illnesses

• Living with frailty

• Using same-day services


Your Big Health Conversation: Phase 2 - approach

Group discussions held from Petersfield to Gosport and Portsmouth.

Talked patients and carers. 20+ groups discussions, ranging from 5/6 people to 15 upwards.

Structured conversations – setting out how services struggle to give patients the best experience now, and sketching an outline picture of how services could change.

The outlines of future care had some common overall themes – need a future with a greater emphasis on community services, prevention, early intervention, self-care.

Some online engagement as well – 110+ respondents.


Your Big Health Conversation: Phase 2 - findings

Mental health: feedback themes

“Walk a mile in my shoes” – the need to understand, to empathise.Care – compassion matters, a lack of it is quickly damaging.“Computer says no 1” – services do not flex to meet patient needs.“Computer says no 2” – systems don’t talk to each other.Cliff-edge – sense that support is time-limited, and then stops.“Pills or counselling…?” Limited options, by the numbers.Capacity – long waiting times, with nothing in the meantimeMind the gap – little support between therapy and crisisRound the clock – ‘out of hours’ is a long, long time



Mental health: selected comments

Counselling stops very abruptly – you’re left high and dry

It’s a lottery how long you wait after being referred – what do you do in the meantime?

You want to speak to someone who knows how you feel – clinical experience isn’t enough

“Out of hours” is a long time when you can’t sleep – who can you call?

…a ‘patchwork quilt’ of different services but nothing joining them up

There is a big gap – nothing for people approaching a crisis



Long-term illnesses: feedback themes

“Communication breakdown” – systems still don’t talk.Burden of care – patient expected to check, to chase.Right hand, meet left hand – teams work without reference to others.Capacity – waiting times.“Your call is important to us” – the struggle to access help, quickly.Specialists – the importance of access to specialist nurses / doctors.Support the support groups – for advice, and wellbeing.Continuity of care – good for patients, and clinicians



Long-term illnesses: selected comments

GPs need specialist support, or they can’t give you the right care

Each patient needs a case manager – too often your conditions are dealt with separately

People with long-term illnesses often suffer from depression as well

Not having to explain your health problems to different people each time you see someone

I don’t want to have to explain myself to receptionists – they’re not qualified to help

A lead professional overseeing others would be a real step forward



Same day care: feedback themes

“Working 9 to 5…” – opening hours still don’t reflect modern life.Distance matters – concerns that care will be too far away.“Doesn’t have to be a GP…” – people just want appropriate support.“I need to see my GP…” – but for some, continuity matters.Decisions, decisions – lots of choice, not so much awareness.Help people to help themselves – people need the tools to self-care.Communication breakdown – impossible to contact, and book.Capacity – are there the people and funding for the job?



Same day care: selected comments

Nurse practitioners are amazing – worth their weight in gold

You don’t know how ill you are, so you don’t know which path to choose

We’re still a generation away from understanding that a GP isn’t always the best person to see

We need a wider range of ways to talk to medical staff – calling or Skype

At night, someone could be very vulnerable but not know where to turn

Everybody hates travelling too far, especially when they’re ill



Frailty: feedback themes

Care for the carer – support those around the patientShare the knowledge – make sure everyone is informed and involvedPlan, don’t just react – not enough to just respond to emergenciesTake time to care – people are not just ill, they are often lonely too“Keep it simple” – not always clear who is in charge, and responsibleCapacity – need to have enough staff in the community to helpStronger together – need teams working together, not in silos



Frailty: selected comments

Get things done quickly – end the endless referring onwards to another team

The biggest enemy is loneliness – bring people together so they can socialise

It is confusing – trying to weave your way through the system can be awful

If there is family or a carer, support the carers!

Listen to what people say they need, don’t make decisions on their behalf

Care is fragmented, it only responds to emergencies


Phase 2 – next steps

Full analysis of findings – to be shared with participants and publicised

Findings from both Phase 1 and Phase 2 will inform the work to develop new models of care in local communities. Projects such as developing a long-term conditions hub in Gosport, or testing new ways of giving people in care homes better support.

Early discussions about a third – possibly final – phase. Still scope to become more specific about engaging over new models of care, as they emerge. Questions such as:

• How can services develop to better meet your needs?• Which staff best meet your needs?• Where should services be delivered?


Questions


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FOR THE ATTENTION OF THE GOVERNING BODY

Title of Paper Register of InterestsAgenda Item 2 Date of meeting 24 October 2018Exec Lead Clinical Sponsor Dr B Rushton/Dr D ChilversAuthor Lesley Winter

For DecisionTo RatifyTo Discuss

Purpose

To Note x

Link to Strategic Objective Statutory requirement

Executive Summary

This paper sets out the relevant and material interests of the members of the CCG Joint Governing Body. This paper supports the CCG Joint Governing Body in fulfilling its duties in accordance with the NHS Code of Accountability. The register of interests is presented for consideration by the Governing Body

Recommendations The Joint Governing Body is asked to note the information set out in the paper

Publication Public Website

Please provide details on the impact of following aspectsEquality and Quality Impact Assessment

Patient and Stakeholder EngagementFinancial Impact, Legal implications and Risk

Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed Outcome

Page 1 of 12 register of interests cover sheet.docxOverall of 247

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Fareham and Gosport and South Eastern Hampshire Combined Governing Body

###############

First Name Surname Declared Interest - Name and Nature of Business

Sarah Anderson Trustee, No Limits

Sarah Anderson Director and owner of Hollybrook Associates Limited

Sarah Anderson Trustee and Company Secretary, Moving on Project

David Bailey No interests to be declared

Julia Barton Friends with the family of contractor, Marcus Pullen, director of Blue Donut Studios

Julia Barton Patient at the Bosmere Medical Practice

Alastair Bateman GP principal at Vine medical group Waterlooville

Alastair Bateman Member of NICE prescribing Associates group

Alastair Bateman Vine Medical Group is a member of the South Eastern Hants GP Alliance

Alastair Bateman GP Trainer Wessex

Alastair Bateman Practice involved in Waterlooville MCP discussions

Ian Bell Clinical/IT Advisor to the RES Consortium

Ian Bell GP Principal Dr Bell & Partners

Ian Bell Work for GPEA service part of service provided by Southern Hampshire Primary Care Alliance

Ian Bell Practice is member of Southern Hampshire Primary Care Alliance

David Chilvers Undertakes section 12(2) Mental Health Act assessments for Social Services

David Chilvers SCAS Governing Body Member

David Chilvers Fareham & Gosport Alliance

David Chilvers GP with Willow Group

Tracy Davies No interests to be declared

Lucy Docherty Chair of Fareham Good Neighbours

Lucy Docherty Member of the Lighthouse Learning Trust

Lucy Docherty Patron of Fareham Community Hospital

Lucy Docherty Spouse works for HCC Childrens services in a senior position

Lucy Docherty Close relative is an employee of Portsmouth Hospitals NHS Trust

Lucy Docherty Chair of Portsmouth Diocese Council for Social Responsibility

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Alison Edgington AE Executive Interim LTD

Timothy Goulder Working at QAH UCC paid via Alliance to Eckhoff Medical and Media Ltd

Timothy Goulder Catholic Medical Association

Timothy Goulder Membership of BMA

Susanne Hasselmann Chair of Wessex PDLP (Performers List Decision Panel)

Susanne Hasselmann Husband is trustee of Valley Leisure

Susanne Hasselmann Husband is Director System Delivery, Southampton City CCG

Susanne Hasselmann Board Member, NHS Clinical Commissioners (Chair of CCG Lay Member Network)

Susanne Hasselmann Director & Owner of Scirum Ltd

Zaid Hirmiz Extended hours GP for Southampton Primary Care Hub

Zaid Hirmiz Director of MyOne Clinic

Zaid Hirmiz GP advisor- Spire Portsmouth Hospital- speaker on the education programme

Zaid Hirmiz Various educational events speaker and chair Fourteen Fish Ltd

Zaid Hirmiz Partner at Horndean Surgery

Zaid Hirmiz ZNH HIRMIZ Medical Ltd Private company

Zaid Hirmiz GPSI in training for SMS (Solent Medical Services)

Zaid Hirmiz South East Hants CCG governing body board member, integrated care clinical lead, MSK clinical lead, Quality clinical lead.

Zaid Hirmiz Private work for Spire Hospital

Zaid Hirmiz Clinical Lead for Southampton City CCG

Andrew Holden Swan Medical Group provides medical cover for Petersfield Hospital wards with L&L and Grange surgeries - subcontract from SHFT

Andrew Holden Dr Laly - partner at Swan Medical Group involved in Laly Pharmacies

Andrew Holden Liss and Liphook Surgery have contract for community ENT and audiology vial Alliance

Andrew Holden Swan Medical Group holds a sub-contract for community dermatology contract

Andrew Holden NICE GP reference panel - non-funded GP casual role to comment on draft NICE guidance

Andrew Holden Wenham Holt (Chase Hospital) Beds - medical cover provided by Swan Medical Group



Andrew Holden Swan Medical Group is a member practice of South Eastern Hampshire Alliance

Andrew Holden Supporter - Friends of Petersfield Hospital

Andrew Holden Local Medical Committee - Representative for Hampshire & IOW LMC

Andrew Holden Partner at Swan Medical Group

Andrew Holden Wife is Partner at Liss and Liphook Surgery

Andrew Holden Both my wife (GP) and I work GPEA sessions

Paul Howden Diabetes UK - National Clinical Champion 2017-2019

Paul Howden The Whiteley Surgery is a member practice of the F&G/South Eastern Hampshire Primary Care Alliance

Paul Howden Financial partnership interest in Yew Tree Clinic - Suite of consulting rooms attached to The Whiteley Surgery available for private hire for medical purposes

Paul Howden GP Partner, The Whiteley Surgery

Paul Howden Wife works privately as a qualified Foot Health Practitioner (does not work within areas covered by F&G or SHE CCGs)

Elizabeth Kerwood Involved with discussions with provider organisations about the MCP and supporting them on projects

Simon Larmer Practice is a member of South Hampshire Primary Care Alliance

Simon Larmer Two Fareham Area Clinical Enterprise Ltd Shares - no Directorships

Simon Larmer Employed GP Southern Health NHS Foundation Trust, and working at the Willow Group and same day access service

Maggie MacIsaac Sister in law’s father sits on the Patient and Public Engagement Group in Whitchurch, which is in the West Hampshire CCG patch. In this role he is also undertaking some work with North Hampshire CCG.

Emma Nash Married to Jonathan Nash, consultant radiologist at QAH

Emma Nash GP partner at Westlands medical centre, Portchester

Emma Nash RCGP e-Learning Development Fellow

Adel Resouly No interests to be declared

Sally Robins Works for PHL, and Out of Hours Service on sessional basis, once a month

Sally Robins Has shares in FACE

Sally Robins GP Partner Stubbington Medical Practice member of Alliance since its creation

Barbara Rushton CCG Clinical Chair South East Hants CCG

Barbara Rushton Co-Chair of NHS Clinical Commissioners



Barbara Rushton NHSCC Board Member for the South East of England

Barbara Rushton Partner in a GP practice where partners provide medical cover to Rowan and Cedarwood ward SHFT

Barbara Rushton Member of Alliance

Barbara Rushton GP Principal at Liphook and Liss Surgery which holds contract for microsuction for the CCG

Margaret Scott Governor of University of Portsmouth

Anna Shaw No interests to be declared

Pat Shirley Family member works for Solent Healthcare

Pat Shirley Partner works in a senior management position for Virgin Healthcare

Pat Shirley Chair of the Portsmouth and South Eastern/Fareham & Gosport Crisis Care Strategic planning group

Pat Shirley Member of the Hampshire-wide Crisis Concordat Steering group

June Thomson Employed by Lockswood Surgery

Sara Tiller Working closely with South Hampshire GP Allicance, Southern Health NHS Foundation Trust and GP practices on the development of new care models

Campbell Todd No interests to be declared

Fiona White Partner is Dominic Hardy, National Director for Primary Care at NHS England

Nick Wilson Indirect personal interest in Bromley Healthcare CIC (as friend of the Chairman)

Nick Wilson Member of Southern Health Foundation Trust

Nick Wilson Member of Portsmouth Hospitals NHS Trust

Nick Wilson Governor, Treloar School and College

Nick Wilson Member of South East England Forum on Ageing (SEEFA) Executive Group

Nick Wilson Parish Councillor, Liss

Nick Wilson Champion for voluntary organisations including Community First, MIND HEH and Age Concern Hampshire

Andrew Wood No interests to be declared


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Title of Paper Minutes of the previous Governing Body meeting in publicAgenda Item 3 Date of meeting 24 October 2018Exec Lead Clinical Sponsor Dr B Rushton/Dr D ChilversAuthor Lesley Winter

For Decision xTo RatifyTo Discuss

Purpose

To Note


Executive Summary

The minutes of the Fareham and Gosport and South Eastern Hampshire CCGs Governing Body meeting held on 25 July 2018 are presented for consideration by the Governing Body, along with the Action Log.

Recommendations

The Joint Governing Body is asked to: Approve the minutes of the Fareham and Gosport and South Eastern

Hampshire CCGs Governing Body meeting held on 25 July 2018 subject to any amendments which will be recorded in the minutes of this meeting

Note any updates to the Action Log





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Minutes of the meeting held in public of the combined Governing Bodies of Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Group

1pm Wednesday 25 July 2018Hollybank Room, Havant Borough Council, Public Service Plaza, Havant - PO9 2AX

Members present:Fareham & Gosport CCGDr David Chilvers Clinical Chair Sarah Anderson Lay Member Governance and AuditJulia Barton Director of Quality and Nursing/ Registered NurseLucy Docherty Lay member for commissioning and procurementDr Paul Howden Clinical Lead, Elective, EoL, Cancer and LTCDr Simon Larmer Clinical Lead, QualityMaggie MacIsaac Chief Executive, Accountable OfficerDr Sally Robins Clinical Lead, Children and MaternityPat Shirley Lay Member for Patient and Public InvolvementAndrew Wood Chief Finance Officer

South Eastern Hampshire CCGDr Barbara Rushton Clinical Chair (Chair)Julia Barton Director of Quality and Nursing/ Registered NurseDr Alastair Bateman Clinical Lead, Medicine Management Susanne Hasselmann Lay Member Governance and AuditDr Zaid Hirmiz Clinical Lead, Integrated Care and QualityMaggie MacIsaac Chief Executive, Accountable OfficerAdel Resouly Secondary Care Consultant RepresentativeMargaret Scott Lay Member for Commissioning and ProcurementNick Wilson Lay Member for Patient and Public InvolvementAndrew Wood Chief Finance Officer

Joint ExecutiveAlex Berry Director of TransformationAlison Edgington Director of DeliverySara Tiller Director of Primary Care Development

In AttendanceCllr Keith Budden East Hampshire District CouncilMichael Drake Director of Planning and PerformanceSarah Malcolm Senior Commissioning Programme OfficerLisa Medway Estates Project Manager

ApologiesDr Ian Bell Clinical Lead, IT (Fareham and Gosport)Dr Tim Goulder Clinical Lead, Urgent Care, CHC and MCP OutcomesCllr Trevor Cartwright Fareham Borough CouncilDr Andrew Holden Clinical Lead, Primary CareDr Emma Nash Clinical Lead, Mental Health (Fareham and Gosport)Cllr Philip Raffaelli Gosport Borough CouncilJune Thomson Practice Managers Representative (Fareham and Gosport)

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The meeting was preceded by a public seminar on Care Homes. The seminar was presented by the Associate Director of Nursing and Quality (South).

1 Chair’s Welcome and Apologies

The Chair welcomed members, attendees and members of the public. Apologies had been received from:

Dr Ian Bell Clinical Lead, IT (Fareham and Gosport)Dr Tim Goulder Clinical Lead, Urgent Care, CHC and MCP OutcomesCllr Trevor Cartwright Fareham Borough CouncilDr Andrew Holden Clinical Lead, Primary CareDr Emma Nash Clinical Lead, Mental Health (Fareham and Gosport)Cllr Philip Raffaelli Gosport Borough CouncilJune Thomson Practice Managers Representative (Fareham and Gosport)

The Governing Bodies noted and accepted the apologies

2 Register of Interests and Declarations of Interest

Members were asked by the Chair if they had any interests to declare relating to agenda items being considered at the meeting or if they had anything more to add to the register. They were also reminded to raise any interests or potential conflicts should they arise during the course of discussions.

The Governing Bodies noted the register of interests.

3 Minutes of the previous Meeting

The minutes of the last combined public meeting of the Governing Bodies of Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Group which took place on 25 April 2018 were presented.

The Governing Bodies approved the minutes of the combined public meeting of the Governing Bodies of Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Group which took place on 25 April 2018.

4 Action Log

The Action Log was presented to the Governing Body.

The Governing Bodies noted the updates to the Action Log.

Risk and Strategy5 Governing Body Assurance Framework

The Chief Finance Officer advised that the GBAF was being looked at by Planning and Performance, with a view to recording the information by Business Unit. He confirmed that currently there were no risks recommended for


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escalation to or removal from the GBAF.

It was noted that there were no Financial risks on the report, only Quality; this was thought to be due to the work being undertaken on the database.

Cllr Budden commented that the risk around delays in Radiology had gone from 15 to 16; he stated that actions should be driving the risk rating down. The Director of Quality and Nursing advised that the increase was partly to do with the way the Trust scores risks and she confirmed that the CCGs had aligned with the Trust on this score.

The Governing Bodies noted the Governing Body Assurance Framework, including any very high risks. They further noted that there were no risks recommended for escalation to the Board Assurance Framework and no risks to be removed from the Board Assurance Framework. The Governing Bodies also considered whether the risks were articulated correctly and that the score reflects the severity and likelihood

Items for Decision6 PSEH System Reform – Statement of Intent

The Chief Finance Officer presented the PSEH System Reform Statement of Intent to the Governing Bodies. He outlined the reasoning for the statement of intent and explained that it was to formalise the intent to work together.

The Governing Bodies reaffirmed their commitment to working within the Portsmouth and South Eastern Hampshire System.

7 Whitehill and Bordon Update PaperThe Director of Primary Care Development and the Estates Project Manager presented this item.

It was noted that in January 2016 the Governing Bodies restated their commitment and agreed that the CCG should focus on working with local GPs and partner organisations to develop plans for a new health and well-being facility as part of the NHS England Healthy New Town programme in Whitehill and Bordon. The preferred option was to build a new Primary and Community hub in place of Chase Hospital which would incorporate the 2 town practices. Pinehill Surgery and Southern Health Foundation Trust have both signalled their intent to move into the new development. Forrest Surgery is currently in negotiations with Apollo, the appointed 3rd party developer, regarding moving in. The 3rd party developer is asking for a 25 year lease and it is thought unlikely that any of the prospective tenants would sign up for that length of time.

Initially the CCG was seeking ETTF funding to support the GMS elements of the scheme by way of a capital injection. This route is now closed. However, the CCG has been able to apply for STP capital which could be used either to finance a capital build or to provide a “bullet” payment to offset rental payments. The outcome of this funding bid will be known in November.


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The Governing Bodies noted the progress made to date and also noted that a full Outline Business Case would be presented to a Governing Bodies meeting in public in December. The lack of progress was also noted.

8 New Care Models Steering Group – Terms of ReferenceUpdated Terms of Reference for the New Care Models Steering Group were presented to the Governing Bodies; it was noted that the terms set out the accountability for the FGSEH New Care Models Steering Group which works alongside the Portsmouth MCP Programme Board to develop and deliver the LCP New Care Models Programme. The arrangements have been set out in detail to ensure that all representatives of organisations involved in the Fareham and Gosport and South Eastern Hampshire (FGSEH) New Care Models Steering Group are clear about the responsibilities to aid the delivery of the programme.

The Terms of Reference are due to be reviewed in April 2019 as part of an assessment of how the programme is being delivered, however it was noted that they would need to be reviewed in line with the Governance structure.

The Governing Bodies approved the updated Terms of Reference for the New Care Models Steering Group and noted that they would need to be reviewed in line with the new Governance Structure.

Items to Note9 Spinal Pathway

The Director of Transformation provided an update on the current position with the transfer of spinal services from Portsmouth Hospitals NHS Trust (PHT) to University Hospitals Southampton (UHS) and sought agreement to the ratification of the proposed transfer of the service from November 2018.

The Governing Bodies were notified that the Spinal working group had agreed the following principles: PHT to transfer their elective Spinal activity to integrate it into a new Regional

Spine Service model at UHS subject to the necessary engagement and Board agreements, TUPE will apply,

All referrals would continue to go through the community MSK service first (NHS Solent) to ensure that patients care continued closer to home and that all non-surgical options had been explored prior to referral,

Consultants on call for the Spinal Service will be based on 10 PA contracts to ensure sustainability,

UHS will recruit a new Spinal consultant for the service and support staff, Capacity will be secured to facilitate the transfer at UHS Income will be with

the Trust providing the activity (UHS) and risks will be shared as per the Acute Alliance agreement.

The business case for the final clinical model has been considered and


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supported by the Clinical Executive and the Finance and Performance Committee of Portsmouth, South East Hampshire and Fareham and Gosport CCGs and is now in the process of being ratified by respective Governing Bodies and Boards of PHT and UHS.

It was advised that further engagement is taking place with patients. The Governing Bodies ratified the transfer of the spinal service to University Hospital Southampton, from Portsmouth Hospital Trust from November 2018.

Key Reports to Note10 Chairs’ Report

The Clinical Chair for SEH updated the Governing Bodies on some key highlights since the last meeting.

Recently the national CCG assessments were announced by NHS England. Both of our CCGs have been assessed as ‘requires improvement’. The assessment looks at our performance in 51 indicators including diabetes, dementia, cancer, mental health and urgent care. Both of the CCGs have challenging financial situations which has impacted on our overall ratings but I know that if we focus on achieving our objectives for local people this will be reflected in future assessment scores;

Holding our first joint AGM last month in Fareham where we talked about our achievements during 2017/19 and future plans;

Training around 140 GP reception staff to become care navigators who talk to patients to understand their needs and identify the most appropriate support;

Winning the Improving Care Through Collaborative category at the national Health Transformation Awards with our partners for our integrated working and the aligned incentive contract with Portsmouth Hospitals NHS Trust;

Rolling the red bag scheme out to a number of care homes across both CCGs and fully rolling out the continence prescription service;

Supporting GP practices to develop and launch a new home visiting service; Commissioning a new community phlebotomy service from general practice

which is due to start in October; Successfully running GP extended access with over 16,000 appointments

being provided outside core hours in the first six months; Changing the pathways for GI (liver function tests) and faecal calprotectin

with more patients being seen in primary care; Working with our partners across the system to develop our commissioning

framework to ensure it enables organisations to make to make the changes that are needed for local people.

The Chairs’ report was noted by the Governing Bodies.

11 Finance Report - JOINTThe Chief Finance Officer presented the report which set out the financial performance of the CCGs at month 3. He explained that the CCGs were on


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target to achieve their control totals; however there was still a significant risk to this position. The risk was around spend on acute contracts, Continuing Healthcare, achievement of identified QIPP plus identification of unidentified QIPP; currently £18m QIPP savings have been identified out of £28m needed and mitigated risks are being reported monthly to NHSE.

The report showed that pressures were arising around over performance at Spire and 2 other private providers. It was noted that currently there was an underspend on CHC in F&G and a £1.4m CHC overspend in SEH. It was further noted that the 3 key financial risks were QIPP Schemes, Financial Recovery Plan and Social Care and Public Health Funding Cuts.

The information in the Finance Report was noted by the Governing Bodies.

12 Quality Report - JOINTThe Director of Quality and Nursing highlighted the following key points in the report:

CQC Inspections resulting in 3 x section 31 enforcement notices. 1 x section 29a warning notice remains in place. The report of the whole trust CQC inspection undertaken in May 2018 is with the Trust for factual accuracy checks.

Urgent care risk: the Joint Quality Assurance Committee (JQAC) of June 2018 reviewed and decreased the risk from 20 to 16. It noted the improvement in performance against the four hour target, and reduction in patient moves, outliers, MFFD numbers and ambulance holds over 60 minutes. Two x 12 hour decision to admit breaches (May 2018) were reported. Unfilled registered nursing shifts in AMU are showing deterioration, with a peak gaps reported in the week of 17th June. The Trust’s quality improvement advisory group oversees the delivery of the improvement plan and external monitoring is in place via the quality improvement oversight group.

Delays in implementation of the spinal network model: the proposed transfer model is progressing, with a target date for completion of October 2018. A report is to be provided to governing body in July 2018.

Safeguarding adults, children and looked after children: The annual safeguarding report was discussed at the trust board. The leadership and processes for safeguarding have been enhanced. Further work is required on PREVENT training, children’s safeguarding level 3 training, reporting mechanisms for Deprivation of Liberty Safeguards and detained patients under the Mental Health Act 1983.

Delays in assessment and treatment of patients for planned care: There are a number of unrecorded patients on waiting lists and there is not yet full assurance around the consistency of management of waiting lists. The trust has a risk on inconsistent application of policy on non-18 week waiting lists. There is focussed work on demand/capacity, improving quality and safety fed through the elective care board. Quality and capacity meetings have been held with ophthalmology, audiology and trauma & orthopaedics. Patient safety incidents (associated with delays) have been reported in hepatology,


of 7

ophthalmology and audiology. This remains a high risk with insufficient commissioner assurance.

The information in the Quality Report was noted by the Governing Bodies.

13 Integrated Performance Report - JOINTThe following points were highlighted in the Performance Report, by the Director of Planning and Performance:

Audiology: The CCG are aware of a number of issues relating to the delivery of the Audiology service at our main acute provider, Portsmouth NHS Trust. The following paper summaries the issues identified and actions being taken as a result.

Diagnostics: Due to capacity issues at our main acute provider, patients are currently experiencing long waiting times for MSK Ultrasound diagnostic tests. This is negatively impacting on both Trust and CCG performance against the 6 week wait diagnostic target. A plan is in place to reduce the waiting times however it is not anticipated that performance will recover until August 2018.

RTT: Finally, this paper also provides a summary of the CCGs current Referral To Treatment Performance (RTT), the risks to delivery against 18/19 operating plan trajectories and actions being taken as a result.

The information in the Integrated Performance Report was noted by the Governing Bodies.

14 No questions received from members of the public prior to the meeting.

15 Audit and Risk Committee in Common – Terms of ReferenceThe Governing Bodies noted the final version of the Terms of Reference for the HIOW CCG Partnership Audit and Risk Committee in Common which were approved by the Audit and Risk Committee in Common on 22 May 2018 and then ratified by a Chairs’ Action.

The meeting closed at 5.30pm


Overall of 247

Ref.number

Type ofmeeting

Date ofMeeting Agenda item no Action Lead Officer Date for

completion RAG rating

104 Public 25/07/2018 7Whitehill and Bordon full Outline BusinessCase to be taken to GB meeting in public inDecember

Director ofPrimary CareDevelopment

Dec-18 ongoing

Page 1 of 83 Action log.xlsxOverall of 247

Narrative


Ref.number

Type ofmeeting

Date ofMeeting

Minutereferenc

eAction Lead Officer

87 Public 31/01/2018 FGSEH locality performance figures forambulances to be reported back to GB

Director of Quality andNursing

88 Public 31/01/2018 FGSEH waiting times for cardi angiography to bereported back to GB


89 Public 31/01/2018 FGSEH IAPT deep dive to be added to the F&Pagenda in February Governance Team

92 Private 31/01/2018 FGSEHUpdate on 111 to be brought to GB inFebruary - setting out clinical model,rationale and the way forward

Director for Delivery

93 Private 31/01/2018 FGSEHComments on the Strategic Prioritesto be sent to Management Team

All GB Members

94 Private 31/01/2018 FGSEHDiscussion around key priorities totake place at February GB meeting

Director for Delivery/governance Team

98 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheDirector of Delivery to bring back tothe next Governing Body meeting, anassessed Planned Care trajectoryregarding what can be achievedrelating to performance in line withfinancial constraints.

Director of Delivery

101 Private 28/02/2018 FGSEH

Priorities and Plans 2018/19 -Timescales on the Programme 4. NHSFunded Continuing Healthcare slideare currently labelled as Q1, Q3, Q3and Q3. The Clinical Chair for F&G toamend to Q1, Q2, Q3 and Q4.

Clinical Chair for F&G

103 Private 28/02/2018 5

Priorities and Plans 2018/19 - The LayMember for Commissioning andProcurement, SEH, to email theDirector of Delivery with the list ofLay Member names for each deliveryteam unit

Lay Member forCommissioning andProcurement, SEH


104 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheDirector of Quality and Nursing willsend document to the Lay Memberfor Commissioning and Procurement,SEH, detailing the expectations of laymembers relating to the delivery units


105 Private 28/02/2018 8

111 – Decision on procurement modelor co-design - The Director ofPrimary Care to bring paper back toPCCC meeting on 7 March 2018 todetail the proposal on theopportunities to strengthen anddevelop the Alliance

Director of Primary Care

106 Private 28/02/2018 10

Portsmouth CCG giving notice of theirintention to separate out the compactarrangement around commissioning -The Director of Quality and Nursing togive a formal presentation at the nextgoverning body meeting to ensuregoverning body members areproperly informaed


95 Private 31/01/2018 FGSEHFinal Operating Plan/StrategicPriorities paper to come back to GB inMarch

Director for Delivery

97 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheClinical Chair for F&G to reflectconversation (Programme 1. Urgentand Emergency Care) at OperatingGroup


99 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheDirector of Delivery to ensure thatrisk assessment for planned carepathways takes in to account reducedresource



100 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheDirector of Delivery to assess the keyareas of work to be focused on inrelation to planned care taking intoaccount quality and finances. To alsoestablish how we could achieve thedelivery of the programme if wesacrificed something else and hone inwhere we can have the best effect onthe population


102 Private 28/02/2018 5

Priorities and Plans 2018/19 - TheClinical Chair for F&G to provideinformation at the next GoverningBody meeting regarding what factorsaffect speed of discharge and detailsof any factors that differentiatebetween LA funded patients and self-funded patients


100 Public 24/04/2018 FGSEH 10Partnership Board Terms of Referenceto be looked at regarding number ofnon-exec members

M Scott

101 Private 24/04/2018 FGSEH 5Clinical Chair FG to reflect commentsback to the Partnership Boardregarding CAMHs

D Chilvers

103 Private 23/05/2018 11Whitehill and Bordon update to betaken to next GB meeting in public fordecision

Director of Primary CareDevelopment

105 Public 25/07/2018 8New Care Models ToRs to bereviewed in line with futureGovernance arrangements

Governance Team

96 Private 31/01/2018 FGSEHNew Care Models update to be givenat a future GB along with 'a patient'sjourney' in NCM narrative

Director ofTransformation


Date forcompletion

RAGrating Narrative

28/02/2018 CompleteEmail sent to all GBmembers

28/02/2018 Complete

22/03/2018 complete

28/02/2018 CompleteDiscussed underagenda item 7

23/02/2018 Complete On this agenda

28/02/2018 CompleteDiscussed underagenda item 5

28/03/2018 completethe question has beenanswered and is in theoperating plan

28/03/2018 Complete

Complete

28/03/2018 Complete


28/03/2018 Complete

07/03/2018 Complete

28/03/2018 Complete

25/04/2018 complete

Final OperatingPlan/StrategicPriorities paper will bebrought to the nextmeeting onWednesday 28 March2018. Update- Thiswould be added to theApril agenda.

28/03/2018 complete

Final OperatingPlan/StrategicPriorities paper will bebrought to the nextmeeting on 25 April

28/03/2018 complete



28/03/2018 complete


28/03/2018 complete


23/05/2018 complete

23/05/2018 complete

25/07/2018 complete

paper taken to meetingin private on 25/07/18and a futher papertaken to meeting inpublic on 25/07/18.

- Complete

will be looked at, alongwith other ToRs whenthe new structurecomes into being

23/05/2018 In progress


Joint Chairs’ ReportOctober 2018

1. Governing Body future arrangementsReducing duplication and strengthening local decision makingFareham & Gosport CCG and South Eastern Hampshire CCG are members of the Hampshire & Isle of Wight CCG Partnership. Working with the other CCGs in the Partnership we are able to share expertise and experience, and learn from each other so that good ideas to improve patient services in one part of Hampshire can more easily spread to other areas. Being part of the Partnership also means that we can reduce duplication, carrying out some of our work together, whilst also retaining local decision making. The Governing Bodies of the CCGs in the Partnership plan to begin to meet together, through a Committee-in-Common, rather than separately. Meetings of the Committee-in-Common will be held in public. This means that our local team of clinicians and managers are able to focus on improving services, making local decisions about health services for our local area.

Clinical leadership is a core strength of CCGs and the new arrangements are designed to preserve and reinforce clinical leadership at the heart of all of the work of the Partnership. Clinical Commissioning Groups provide a strong local focus with local clinical leadership and the opportunity to engage local patients, member practices, local partners and communities. An important principle as we have come together as a Partnership is that any changes we make should protect and maximise these strengths locally.

We continue to look for opportunities to increase the opportunities to involve local people in the work of the CCG, and to listen to their views, building on our existing arrangements which include: Our community engagement committees Patient Groups in each locality Patient participation groups in each practice The Fareham and Gosport Voluntary Sector Forum

We welcome views and ideas about how we can further improve the way we work with our local communities.

2. GP extended accessThousands of patients are benefiting from a pilot scheme which is providing extended GP access across the two CCG areas. Patients registered at our 38 practices are making use of six ‘hubs’ which offer opening times over and above their usual GP surgery for both routine and same-day appointments.

All GP practices already offer opening times over their core hours of 8am to 6.30pm for patients registered at their surgery. The GP Extended Access (GPEA) Service, an 18-month pilot due to run until March 2019, means patients can go to any of the hubs to see a doctor – providing they have given consent for their medical records to be shared.

Page 1 of 4Chairs report October.docxOverall of 247

GPEA clinics are currently available at the following locations:

Fareham, at Fareham Community Hospital, on Monday to Saturdays

Gosport, Gosport War Memorial Hospital, Mondays to Sundays

Havant, Havant Health Centre, Monday to Fridays and Sundays

Petersfield, Petersfield Community Hospital, Monday to Saturdays

Waterlooville, Waterlooville Health Centre, Monday to Saturdays

Bordon, Badgerswood Surgery, Saturdays.

These clinics are available Monday to Fridays from 6.30pm-8pm; Saturday clinics run from 8am-4.30pm and Sunday sessions are 8am-1pm.

The CCG has paid for the service with the staffing resourced by the Southern Hampshire Primary Care Alliance, drawn from GPs, nurses and healthcare assistants from all the practices and locums.

3. Your Big Health ConversationThe Communications and Engagement Team has been conducting extensive engagement with patients, patient groups, and voluntary/third sector organisations over the summer.

The engagement represents Phase 2 of Your Big Health Conversation, an ongoing programme designed to both communicate to local communities how local health services might change in the future, and also to gather feedback about how possible changes could be made. This current activity was largely qualitative (face to face) engagement, seeking views of people with direct experience of care relating to mental health problems, long-term illnesses, frailty and those needing same-day care.

Phase 1 of this engagement was largely quantitative (online surveys), and sought views on some broad-brush issues such as seven day services, concentration of care into specialist departments, and the preferred balance between hospital-based services and community-based care.

Feedback from Phase 2 is being collated and analysed, but various key themes have been evident throughout. For example, people who have experienced mental health care frequently highlighted a sense that they had little choice of treatment, little input into the care they received, and a sense that they needed to fit into the services which were available, rather than the services being able to adapt to meet their needs. People living with long-term illnesses often spoke of their frustration that services continue to feel disjointed, and communication between teams is still patchy – in turn this leads to individual patients often bearing the burden of the need to manage complex arrangements and coping with inefficiency and duplication.

Many thanks to all of those who took part in this phase of our engagement, giving up their time to help us hear about their experiences and their views. The feedback will be published shortly.


4. Winter preparednessThe Portsmouth and South East Hampshire Care System’s Winter Plan 2018/19, published in September, sets out the collective actions that will be taken to mitigate key risks and manage surges in demand through winter.

It draws on the evaluation of last year’s approach and reflects NHS England operating guidance - we are therefore committed to achieving 90% 4 hour A&E waits and ensuring that the number of patients on an incomplete elective care pathway in March 2019, will not exceed levels in March 2018.

To make this happen, the system has predicted capacity requirements and all partners have contributed towards the funding requirements of the £4m Winter Capacity Plan.

Planning for winter commenced early with the result that the system has already achieved the 25% reduction in long stay patients and we have a collective ambition to reduce this number further.

A communications and engagement plan has also been put in place to support the winter plan and urgent care services in the system. It has five themes – flu; Stay Well This Winter; demand management; building confidence in local services and the system’s ability to cope and how our staff can help. 5. Phlebotomy servicesChanges have begun to take place for GP-initiated blood tests across the two CCG areas as we look to streamline arrangements for all our patients.

Before October 1, patients at our 38 practices, depending on which practice they were registered at, received blood tests from either:

Surgery staff at their own practice Portsmouth Hospitals NHS Trust at their own practice – or from another location Southern Health NHS Foundation Trust staff at their own practice – or another

location.

Since October 1, those practices which previously used PHT staff have been using their own staff – which is widely recognised as the best outcome for patients for a number of reasons including accessibility, full patient record access and holistic patient treatment – on site.

We hope that those practices using Southern Health staff will follow suit by early 2019.

Patients who already receive blood tests at home (domiciliary services), perhaps because they are housebound, will not be affected. Their home service has continued unchanged.

Consultant-initiated blood tests will continue to be in hospital, although, under the changes, PHT patients can now chose instead to have their tests at Gosport War Memorial Hospital, Fareham Community Hospital or Petersfield Community Hospital.


6. Quasar team poster successOur CCGs’ Quasar team has won a Wessex regional poster competition to showcase and celebrate patient safety and quality improvement excellence.

The team beat 32 other entries to triumph in the event run by the Wessex Academic Health Sciences Network, which was open to every health organisation in Hampshire, Dorset and the Isle of Wight.

The entry, ‘Improving the Safety Culture in Primary Care,’ shows how a tool developed by clinicians for use in primary care is improving the patient safety culture in primary care and how feedback from healthcare professionals leads to changes in local healthcare systems.

7. Electronic (or E) referralsImportant changes introduced to the e-Referral Service (eRS) should already be greatly benefiting patients.

Since October 1, the 38 GP practices in our two CCG areas have been contractually required to ensure that all referrals for the first outpatient consultant led services are submitted electronically via the eRS - and therefore paperless.

E-referrals are a more secure and confidential way of transferring information; it is more efficient (it reduces wait times for patients and reduces costs associated with paper referrals); and it’s more transparent – as it’s a fully auditable system that helps to manage demand and capacity.

Patients using e-RS are waiting less for appointments and therefore their care has improved; confident they are accessing the right services and getting appointments swiftly; and less likely of being booked on to an inappropriate appointment.

The CCGs’ Primary Care Team monitors e-referrals on a weekly basis and has praised practices for their positive approach to the changes.


of 1

FOR THE ATTENTION OF THE GOVERNING BODIES

Title of Paper Partnership System Reform ProposalAgenda Item 6 Date of meeting 24 October 2018Exec Lead Sara Tiller Clinical SponsorAuthor Richard Samuel (STP)

For Decision xTo RatifyTo Discuss

Purpose

To Note

Link to Strategic Objective

Executive Summary

This paper summarises the system reform proposal which has been developed through the Hampshire and Isle of Wight Sustainability and Transformation Partnership’s (STP) Executive Delivery Group.

The proposal is being considered by NHS Provider Boards, CCG Governing Bodies and local government cabinets throughout the autumn.

Recommendations The Governing Body is asked to endorse the recommendations





Page 1 of 16 STP system reform cover sheet.docxOverall of 247

Overall of 247

Hampshire and Isle of Wight

System reform proposal Statutory body pack

August 2018 Page 1 of 466 STP system reform proposal.pdf

Overall of 247

1. Introduction and context 3

2. Our case for change 4

3. The proposed Hampshire and Isle of Wight integrated care system 9

4. Components of the HIOW Integrated Care system 16

o Clusters - integrated primary and community care teams 17

o Integrated planning for a place: Health and Wellbeing Board footprints 26

o Integrated care partnerships 28

o Functions at the scale of HIOW including strategic commissioning 34

5. Summary of recommendations 40

6. Next steps 43

7. Glossary 45

Contents

Page 2 of 466 STP system reform proposal.pdfOverall of 247

Purpose of this document

This document summarises the system reform proposal as developed to date

through the work of the Hampshire and Isle of Wight Sustainability and

Transformation Partnership’s (STP) Executive Delivery Group (EDG) and

informed by the broader health and care system leadership.

It forms the basis for NHS provider board, CCG governing body and local

government cabinet consideration at their respective meetings in autumn 2018.

Context

The health and care system across Hampshire and the Isle of Wight has been

working together to develop a response to the national ambition to improve the

integration of health and care for the benefit of local people.

As the Care Quality Commission put it in its 2016/17 State of Care report:

“People should be able to expect good, safe care when they need it, regardless of how this care is delivered... It’s clear that where care providers, professionals and local stakeholders have been able to do this – where they have stopped thinking in terms of ‘health care’ and ‘social care’ (or specialties within these) and instead focused their combined efforts around the needs of people – there is improvement in the quality of care that people receive. To deliver good, safe care that is sustainable into the future, providers will have to think beyond their traditional boundaries to reflect the experience of the people they support.”

Introduction and context

National context

The most recent mandate given by the Government to NHS England includes

increasing integration with social care so that care is more joined up to meet

physical health, mental health and social care needs. More recently, the House of

Commons Health and Social Care Committee has expressed its support for

improving integration of care, highlighting its potential to improve patient

experience.

NHS England’s policy goals in relation to this area have been clear for some time.

NHS England’s ambition to transform the delivery of care in this spirit was first

described in 2014’s Five Year Forward View (FYFV):

“The traditional divide between primary care, community services, and

hospitals – largely unaltered since the birth of the NHS – is increasingly a

barrier to the personalised and coordinated health services patients need.

And just as GPs and hospitals tend to be rigidly demarcated, so too are

social care and mental health services even though people increasingly

need all three”

3


Case for change


Our citizens have been consistent in telling us that…

• they want better and more convenient access to support to help them to live

well for longer. We have diverse communities across Hampshire and the Isle of

Wight and people want support better suited to their needs;

• they value and have confidence in General Practice and the wider primary

and community team, but there is a bewildering array of teams who do not

appear to communicate with each other. People often have to repeat their

story multiple times, making accessing care a frustrating experience. So they

want all of the clinicians and care workers involved in their care to know their

care plan, to work together and to communicate with one another. Many people

also want greater control of their care, from better access to their records

through to personalised budgets;

• when they have an urgent care need, rapid access to the right clinical advice

and support is the most important factor to them. They want the health and care

system to make sure they know how to rapidly access a complicated and

sometimes confusing system;

• when they are managing a long term physical and/or mental health condition

they typically want continuity of relationship with a trusted clinician to support

them; they want better support to understand and manage their condition; and

they want to ensure that when they travel for specialist advice and support, then

the journey is worthwhile. Currently 40% of people whom have a long term

condition tell us they don’t feel supported to manage their condition.

• they are more willing to travel a little further for specialist care if the services

they access will give them better outcomes. People also add however, that there

is nowhere like home and that they would rather be there, than a hospital bed.

Unfortunately a quarter of people in hospital still do not feel involved in decisions

about getting them home.

What do our citizens and our staff tell us? 5

Our workforce are telling us that:

• they are under more pressure than ever before. They often feel that there is not enough time in the day, with too many targets to reach and administrative tasks to perform, both of which take time away from patients;

• services are running on such low staff numbers that any unplanned sick leave or annual leave has a significant effect. Despite significant efforts of some providers, we continue to exceed our planned expenditure on agency and locum spend;

• care professionals want a means by which to share information with other professionals within the system. There is often a poor interface between primary, secondary and community care with time wasted trying to contact other care services;

• whilst it doesn’t feel this way in general practice, and in the community and hospital services, our workforce has actually increased over the last few years. However so too has the number of people leaving within two years;

• many frontline staff have spent large parts of their professional careers trying to integrate care for patients, often working around policies that construct rather than remove barriers to integrated care at local level;

• they want better career options along with opportunities to improve their skills and expertise.


What does the data tell us?

We need to strengthen our approach to prevention, early

intervention and supported self-management…

• We have a national reputation for developing innovative models of prevention,

case finding and early intervention and supported self-management. However, we

have not systematically implemented these innovative models. For example,

within three years, 330 heart attacks and 490 strokes could be averted with

improved detection and treatment of hypertension and atrial fibrillation. This

represents a cost saving of up to £2.5m for heart attacks and £6.7m for strokes

through optimal anti-hypertensive treatment of diagnosed hypertensives.

• For cancer services, for example, we have made real progress in improving the

early diagnosis of cancers over the past 4 years, and are now are one of the best

performing systems in the country. But we still only diagnose just over half of

cancers at stage 1 and 2.

• The life expectancy of people with serious mental illness is 15-20 years less

than the average life expectancy in Hampshire and the Isle of Wight, with two

thirds of these deaths due to avoidable causes. And yet the number of health

checks for people with severe mental illness in HIOW is below the national

average.

• We are making improvements, but we are not yet closing the inequalities gap -

the life expectancy gap (and disability-free years gap) across HIOW is not closing.

We have a significant opportunity to improve discharge and flow across Hampshire and the Isle of Wight…

• Our citizens continue to stay in hospital for a long time even though many are medically fit to leave. As we know the longer people stay in hospital, the more likely they are to develop complications and reduced independence; and it is also expensive to keep someone in hospital unnecessarily.

• Our flow and discharge is noted as being in the lowest performance quartile in the country

• We continue to be the second poorest performing system in the country with regards to delayed transfers of care.

• We are the second poorest performer nationally with regards to CHC assessments in the community.

• Recent data positions us as having one of the greatest opportunities nationally to reduce excess bed days and super-stranded patients.

• There has been a relentless focus on improving discharge and flow across all of our systems and yet despite this the number of delayed transfers of care per 100,000 population remains at the same rate it did two years ago*

This data would indicate that continuing to operate as we have done in the past will not yield a different outcome. We need to reform the system in a way that best allows us to tackle the challenges we face.

* with the exception of the Isle of Wight which now operates with three times fewer delays as other HIOW systems.

6

The complexity and fragmentation of our current system (including

siloed budgets and payment systems) is currently holding back a

system focus on this agenda.


What do we know about new models of care? 7

The past four years have seen significant progress in developing ‘new care models’ which are founded on integration between partners and a

systematic focus on the whole population’s needs. Nationally we have seen both Multispecialty Community Provider and the Integrated Primary

and Acute Care Systems develop. More recently the Next Steps on the Five Year Forward View further articulated the ambition ‘to make the

biggest national move to integrated care of any major western country’.

Within our patch we are reporting very tangible benefits for our citizens as a result of health and care partners working together / integrating

more effectively than we have seen before. In the most developed systems we are seeing:

• 1% reduced emergency admissions compared to an average of 3.5% growth nationally;

• New models of care are successfully managing and treating people more effectively in the community reducing potentially “avoidable”

emergency admissions by 10% on last year;

• 4% reduction in GP referrals on last year;

• Reduction in the number of people experiencing mental health crisis / emergency admission to acute mental health beds as a result of

enhanced support in the community

• A&E attendances are holding at the same level as last year compared to demographically similar systems which have increased activity

on last year;

• Citizens engaging with integrated care teams are reporting significant improvements in health status, personal wellbeing, experience

and health confidence;

• Staff satisfaction rates significantly improving where they are operating in integrated care teams.

These achievements are both important for citizens, staff and for the financial health of the system. We know that new models of care work,

however, our integrated primary and community teams are at different stages of development and so too are their interfaces with local health

and wellbeing footprints and the acute physical and mental health system.


Increasing value for money

The current funding and budget systems make it hard to reallocate resources to where they are needed most. This can also be prohibitive to collaborative working between partner organisations. Frustratingly for all, the current payment systems can be unhelpful – rewarding activity rather than outcomes.

Our financial position is unsustainable. Hampshire and Isle of Wight NHS has forecast a ‘do nothing’ gap of £577million gap by 2020/21 (23% of our £2.5bn allocation) and in addition to this, the pressures in social care and local government more broadly are unprecedented. Whilst the required level of efficiency has been delivered to date we require a step change in productivity and cost reduction to ensure we meet our financial targets.

In many organisations too much resource and energy is focused on seeking to suppress expenditure in providers or generate additional income from commissioners, rather than work in partnership to focus on cost reduction, quality improvement and living within the system’s finite resources. We will require different approaches, including collaboration, e.g. pathology, pharmacy distribution centres; scale, eg: collective procurement; back-office optimisation, eg: HR, finance; greater partnerships, eg: increasing retention of our workforce, reducing bank and agency costs; and reduced unwarranted variation in practice.

If we are to make the transformational changes required to improve outcomes, experience, satisfaction, quality, performance, financial sustainability and address our workforce challenges we must radically enhance our functionality, removing obstacles to enable far greater collaboration and integration. These radical changes will become a reality only if there is a collective commitment from all partners to transform and implement a new way of working.

Reducing complexity

• We have 21 NHS and local authority statutory partners as signatories to our transformation partnership and three non-statutory partners (with leadership responsibilities around workforce, innovation and research).

• We have grown our workforce by 4.5% over the past three years. Too much of this growth has, however, been in non-clinical roles. One of the key drivers for this is the continuing burden of reporting, assurance and inter-organisational contract management.

• We are a complex system. Whilst there has been collaboration between provider, commissioner and regulatory partners, our system reform work over the past six months has demonstrated significantly greater opportunity to reduce system complexity; reduce the burden of assurance and reporting and ensure all partners collaborate towards clearer strategic goals;

• NHS England and NHS Improvement are currently undergoing a national and regional integration programme. The expectation is that locally the Hampshire and Isle of Wight system will develop simpler but more effective self-regulation and assurance models that will allow NHSE/I to work more strategically with the system.

The system reform programme is a means by which we can reduce this complexity and develop strong self-regulation and assurance models.

Finance and efficiency 8


The proposed system


“Our vision is to support citizens to lead healthier lives, by promoting wellbeing in addition to treating illness, and supporting people to take responsibility for their own health and care. We will ensure that our citizens have access to high quality consistent care 24/7, as close to home as possible.

Our vision 10


Our vision – tomorrow’s system

Supporting people to stay well

Joining up care locally

Specialised care when

needed

• Harnessing technology more

effectively to support wellbeing

• Developing integrated health and

social care teams designed to

support the needs of the local

communities they serve

• Ensuring a strong and appropriately

resourced primary care workforce

• Providing care in the right place at the

right time by reducing over-reliance on

hospitals and care homes

• Using technology to revolutionise

people’s experiences and outcomes;

• Identifying, understanding and

reducing unwarranted variation in

outcomes, clinical quality,

efficiency;

We will make

intelligent

use of data

and

information

to empower

citizens,

patients,

service users

and support

our

workforce to

be more

efficient and

effective in

delivering

high-quality

care

We are taking action to prevent ill-health and promote self care...

• Empowering citizens, patients,

service users and communities

We are strengthening local primary and community care...

We are improving services for people who need specialist care...

• Through consolidating more

specialised care on fewer sites;

11


Integrated care systems

The HIOW Executive Delivery Group (EDG) – representing the HIOW health and care system – recommend that to deliver our vision

for health and care, we need to reform our system to ensure ‘form follows function’, signalling a shift from the separation of

provision and commissioning to integrated planning and delivery. Nationally there is a similar realisation, which has led to the

national guidance on Integrated Care Systems.

What is an integrated care system (ICS)?

NHS England defines ICS as those systems in which:

“Commissioners and NHS providers, working closely with GP networks,

local authorities and other partners, agree to take shared responsibility (in

ways that are consistent with their individual legal obligations) for how they

operate their collective resources for the benefit of local populations”.

What will an integrated care system do?

National guidance sets a number of expectations for ICS:

• ICS are expected to produce together a credible plan that delivers a

single system control total, resolving any disputes themselves.

• ICS will assure and track progress against organisation-level plans

within their system, ensuring that they underpin delivery of agreed

system objectives.

• [ICS] will be given the flexibility, on a net neutral basis, and in agreement

with NHS regulators, to vary individual control totals during the planning

process and agree in-year offsets in one organisation against financial

under-performance in another.

• NHS England (NHSE) and NHS Improvement (NHSI) will focus on the

assurance of system plans for ICS rather than organisation-level plans.

There is an expectation that, over time, ICSs will replace STPs.

Benefits of ICS – the national view

• Creating more robust cross-organisational arrangements to tackle the

systemic challenges facing the health and care;

• Supporting population health management approaches that facilitate the

integration of services focused on populations that are at risk of

developing acute illness and hospitalisation;

• Delivering more care through re-designed community-based and home-

based services, including in partnership with social care, the voluntary

and community sector; and

• Allowing systems to take collective responsibility for financial and

operational performance and health outcomes.

Local alignment

The EDG tasked a sub-set of its members, supported by others, to form a

series of task and finish groups to develop the key elements of a proposal

for moving the HIOW system towards ICS (“the system reform

programme”).

12


How could HIOW look in the future?

Isle of Wight

Portsmouth and South

Eastern Hampshire

North & Mid

Hampshire

Southampton and South West

Hampshire

Strategic planning/commissioning at HIOW tier. Health and Wellbeing Alliance for HIOW

Southampton Portsmouth Isle of Wight Hampshire

South West

Hampshire Southampton

South East

Hampshire Portsmouth Isle of Wight

North & mid

Hampshire

Joint planning of services and activities best undertaken at population of 2m

13


The proposed HIOW integrated care system: A whole system planning, delivering and transforming in collaboration The proposed reformed system envisages providers, commissioners and local

authorities working in ever closer collaboration with each other and with citizens

and voluntary sector organisations to address the case for change, empowering

and supporting citizens to best manage their own health and wellbeing and

frontline teams to provide and sustain the best possible services and care.

Component Purpose and description

• The foundations of the reformed system

• Strengthening primary care

• Delivering integrated mental and physical health, care and

wider services to cluster population

• 36 clusters, aligned to ‘natural communities’.

• Proactively managing the population health needs

Natural communities

of 20-100,000 people

HIOW integrated

care system • System strategy and planning

• Implementing strategic change across multiple integrated

care partnership footprints/places

• Alignment of strategic health and LA commissioning

• Provider alliances (acute physical & mental health)

• Oversight of performance and single system interface with

regulators

• Integrated local authority & NHS planning

• Aligned to HWB (local authority) footprints

• Health & LA aligned commissioning resource & agreed

leadership/management models

• Basis of the JSNA, means through which HWB exert tangible

influence on the direction of health and care services for the

population through health and care commissioning and wider

determinants of health

Ongoing

development of

place based

planning

Simplified structure

of 4 integrated care

partnerships

• Support the vertical alignment of care enabling the

optimisation of acute physical & mental health services

• Design and implement optimal care pathways

• Support improved operational, quality and financial

delivery

Notes:

1. The term ‘cluster’ is used for consistency to describe the foundation of the system where

general practices with statutory and voluntary community health and care services work

together in 20-100k populations to meet the needs of local residents. A variety of terms are

currently used to describe this including localities, extended primary care teams, natural

communities of care, neighbourhood teams.

2. Where HWB and integrated care partnerships are coterminous, activities are undertaken

together. In areas where integrated care partnerships span more than one HWB footprint,

the partners will work together to determine the most appropriate allocation of

responsibilities between HWB area and the integrated care partnership to achieve the

shared objectives.

3. The Hampshire HWB area also includes North East Hampshire, which is also part of the

Frimley Integrated Care System and therefore omitted from the figure above

Accelerated

implementation

of 36 clusters

Existing Health &

Wellbeing Board

footprints

populations of c600k served

by acute partners

Drawing together the

above component

parts, delivering some

functions at a scale of

2 million population

14


Conditions for integration

The development of an ICS for Hampshire and Isle of Wight has been based upon a variety of national guidance and

evidence from around the country about best practice approaches. We have studied the work ongoing in Surrey Heartlands

Dorset, Manchester and South Yorkshire and Bassetlaw and learnt from their experiences.

The work of the Kings Fund on integration is also helpful in setting out conditions which support greater integration. Their

assessment is that current and future ICS must address the following development needs if they are to succeed in

transforming health and care, building on new care models and related initiatives:

• Developing trust and relationships among and between leadership teams

• Establishing governance arrangement to support system working

• Committing to a shared vision and plans for implementing the vision

• Identifying people with the right skills and experience to do the work

• Communicating and engaging with partner organisations, staff and the public

• Aligning commissioning behind the plans of the system

• Working towards single regulatory oversight

• Planning for a system control total and financial risk sharing.

The work involved in addressing these needs is time consuming and cannot be rushed: ‘progress occurs at the speed of

trust’, collaborative rather than heroic leadership holds the key to progress.

15


Components of the system


Isle of Wight


Eastern Hampshire

North & Mid

Hampshire


Hampshire

Strategic Commissioning at HIOW tier. Health and Wellbeing Alliance for HIOW


South West


South East


North & mid

Hampshire


Clusters - integrated primary and community care teams 17


Clusters will be the bedrock of the reformed delivery system. The key purpose of our wider system reform arrangements is to support empowered clusters.

Role and benefits of clusters:

• Clusters will see health and care professionals, GPs, the voluntary sector and the community working as one team to support the health and care needs of their local community. They will focus on helping people to manage long term conditions and improve access to information about healthier lifestyles and improving/maintaining wellbeing.

• Evidence shows that the most successful work of this type will reduce the overall number of people who need to be cared for in hospital and improve the health and wellbeing of communities. Clusters will shift the pattern of care and services to be more preventative, proactive and local for people of all ages

Clusters - integrated primary and community care teams

18

Impact of clusters for people

People are supported to stay well and take greater responsibility

for their own health and wellbeing

People can easily access support and advice that is timely,

delivered close to home and with the right professional to meet

their needs

People with chronic or complex illness receive care that is

consistent, joined up and centred around their needs and wishes,

with fewer hand-offs and reduced duplication

People are only in hospital for the acute phase of their illness and

injury and are supported to regain/retain independence in their

usual place of residence

People have greater choice and control over decisions that affect

their own health and wellbeing

Impact of clusters for HIOW system

Increased capacity in primary and community care to manage local

health and care needs

Reduction in rate of acute mental and physical acute non-elective

activity growth and demand for urgent care services

Optimised resource utilisation as a result of better managed

chronic conditions and reduction in preventable conditions

Reduction in variation in access and outcomes

Fewer permanent admissions to residential and nursing care

Primary care is sustainable and supported leading to improving GP

recruitment and retention rates

Attract and retain right workforce in all sectors with particular

emphasis on those sectors in greater need such as mental health

More efficient bed use and fewer delayed transfers of care


Characteristics of clusters Clusters will vary based on the needs of the communities they serve, but

will be built on a common foundation and share common characteristics:

• Clusters will be empowered to innovate in order to best serve their

populations. In order to facilitate this, they will work to a specification which is

outcome-based, but which is common across HIOW. Developing this

specification will be an early priority.

• Cluster footprints align to ‘natural communities of care.’ Areas must be

meaningful to those they serve, as they provide the basis for community-

focussed services. Clusters’ population range provides flexibility in cluster

boundaries to ensure they align with both natural communities and GP

registered lists.

• Clusters will include a range of mental and physical health, care and wider

services in one place. Multi-professional working will be supported by multi-

agency information sharing and, wherever possible, physical co-location.

• Co-ordinate services and teams from across organisations through

alignment arrangements (MOU, alliance contract or joint venture) – allowing

professionals to maintain their current employment status.

• Multi-professional (including clinical) leadership. Each cluster will have a

named lead, and will be supported by a professional managerial team, who

will be responsible and accountable for the performance of cluster services

and the management of an indicative cluster budget. Clusters will manage

their performance based on agreed datasets.

• GP federations will be vital in facilitating clinical leadership in clusters, as well

as in leading the transformation of primary care, which will be vital to

clusters’ capability.

• Clusters will identify, understand and reduce unwarranted variation between

their practices. Colleagues and systems across the footprint of HWB and

integrated care partnerships will support clusters in this, as well as identifying

unwarranted variation between clusters (see below).

• Clusters and acute physical and mental health providers will work together in

integrated care partnerships, to ensure alignment of pathways and integrate

services to optimise the health and care support they provide, responsive to

the populations they serve.

The 5 core functions of a cluster:

1. Supporting people to stay well

2. Improving on the day access to primary care

3. Proactively joining up care for

those with complex or

ongoing needs

4. Improving access to step-up

and step-down care

5. Improving access to

specialist care

19


Portsmouth and South East

Hampshire

1. East Hampshire

2. Waterlooville

3. Havant

4. Fareham

5. Gosport

North and Mid Hampshire

1. Mosaic

2. Whitewater Loddon

3. Acorn

4. A31

5. Rural West

6. Andover

7. Winchester City

8. Winchester Rural North

9. Winchester Rural East

10. Winchester Rural South

Isle of Wight

1. North and East

2. West and Central

3. South Wight

36 clusters across HIOW (as at August 2018)

1. Portsmouth North

2. Portsmouth Central

3. Portsmouth South

South West

Hampshire

1. Eastleigh

2. Eastleigh

Southern Parishes

3. Chandler’s Ford

4. North Baddesley

5. Avon Valley

6. New Milton

7. Lymington

8. Totton

9. Waterside

Southampton

1. Cluster 1

2. Cluster 2

3. Cluster 3

4. Cluster 4

5. Cluster 5

6. Cluster 6

20


Operationalising clusters is a key priority. This will include developing an outcomes-based cluster specification and providing management and development resources to clusters from CCGs

A key test of this proposal overall is that cluster governance must accelerate and facilitate, rather than impede, local change and improvement. Therefore clusters will be encouraged to innovate and improve services for their citizens.

This innovation will be facilitated by both their contract /incentive structure and support from HWB and integrated care partnerships (see next slides).

HWB and partnerships will support clusters in identifying and reducing unwarranted variation, including striking the right balance between standardisation / consistency and local flexibility (ie. standardising only where this adds value).

Standardisation may apply across a HWB or partnership footprint, or more widely, as appropriate. We would expect some pathways, services, systems and processes to be standardised across HWB or partnership footprints, some to be standardised across the whole of HIOW. Elements not standardised will allow each cluster to take the approach which works best for them, but with encouragement and support to consider what other clusters are doing and the potential to spread best practice where it adds value (or reduces duplication of effort) to do so.

As part of this freedom to innovate, we recognise that clusters will continue to evolve. The current structure of clusters across HIOW (see next slide) may therefore change as clusters become established and take on an increasing role in service delivery.

Balancing autonomy and standardisation in clusters 21


Every part of the HIOW system has confirmed the development of integrated cluster teams as a key priority for 2018/19, and every area has a change programme in place to deliver this.

• The 36 cluster teams across HIOW are at variable stages of development and maturity.

• The most established teams, formed under Better Care and Vanguard programmes, offer a wealth of evidence and learning about what works; however we are yet to effectively capitalise on this across HIOW.

• There are currently different names for cluster teams in each care system, reflective of evolutionary local plans.

• However, there are high levels of congruence in the overall description of the function and form of these teams across the system.

Therefore, the ambition for cluster development for 2018/19 is to:

• Accelerate and embed the infrastructure for all 36 cluster teams by March 2019

• Evidence impact on patient outcomes, primary care capacity, hospital admissions and system flow

Current thinking about the development of the clusters by March 2019 and March 2020 is described on the following page.

Accelerating the implementation of clusters 22


23

By April 2020 October 2018 – March 2019

• Practices working together to improve access and resilience

• Core cluster team membership defined

• Integrated primary and community care teams in place with joint

assessment and planning processes

• Prototypes in place for highest risk groups

• Gap analysis undertaken, end state defined for key functions

• Components of delivery model in place for each of key functions

(minimum 50% completion)

• Active signposting to community assets in place

• Shift of specialist resources into cluster teams

• Integrated teams fully functioning and include social care

Care

Redesign

• Information sharing agreements in place between all partners

• Plan for shared care record confirmed

• Cluster responsibilities documented via MOU/alliance agreement

• Data used to drive improvement and reduction in variation within and

between clusters

• Shared care record (health) in place

• Cluster monitoring impact on key outcomes

Accountability &

performance

management

• Shift of specialist resources into cluster teams

• Clusters have sight of resource use and can pilot new incentive

schemes

• Cluster level plan to optimise use of assets and early components in

place

Managing

collective

resources

• Cluster priorities identified and delivery plan in place

• Cluster level population data available and used to support priority

setting and planning

Strategy and

Planning

• Longer-term cluster objectives being shaped, informed by data

• Mechanism in place for co-production of plans and services with local

people

• Cluster assets mapped to inform future planning (estate, back office,

people, funding)

• Resources identified to enable/support cluster plan delivery (eg

change management)

• Cluster level dashboard including outcomes in place

• Dedicated professional and operational leadership in place in each

cluster

• Governance arrangements in place in each cluster, eg cluster board

• Cluster partners identified and engaged in the development and

delivery of the cluster plan

• Cluster engaged in integrated care partnership decision making

• Cluster leadership embedded with defined responsibilities for co-

ordination of cluster responsibilities

• Mechanism in place to share learning between clusters

• Practices have defined how they wish to work together going forward

• Cluster is full decision making member of integrated care partnership

Leadership &

governance

Workforce

development

• Cluster workforce plan defined with targeted action to support

recruitment/retention of key roles

• Cluster level OD/team development plan in place

• Development of new/extended roles in cluster teams to meet local need

• Beginning to share workforce and skills within clusters

The developing role of clusters

23


Endorse:

1. The developing role of clusters as outlined on the previous slide

2. The recommendation that partners across HWB footprints and integrated care

partnerships work together to define the resources required for cluster operation – a

critical first step is establishing professional and operational leadership to drive cluster

development

3. the proposed next steps for the cluster task and finish group which are summarised as

follows:

a. Quantify the impact/expected outcomes of cluster teams (already in progress in most

areas): defining outcome metrics for individual clusters and a small set of common metrics

across whole HIOW

b. Describe the support requirements and responsibilities to accelerate full cluster

implementation

c. Describe the proposed interplay between clusters and other components of the ICS,

including governance and participation arrangements for clusters as part of HWB footprints

and integrated care partnership structures

d. Strengthen primary and social care involvement in this work at a Hampshire and Isle of

Wight level (membership of the task and finish has already been extended to reflect this)

Statutory bodies are asked to: 24


Isle of Wight


Eastern Hampshire

North & Mid

Hampshire


Hampshire



South West


South East


North & mid

Hampshire


Integrated planning for a place: Health and Wellbeing Board footprints 25


Local government partners have convened to start work on restating the critical function of integrated health and care planning and delivery on

a Health & Wellbeing Board (HWB) footprint.

An early draft definition of the function is summarised below:

HWB footprints will continue to be the focus for place-based planning (undertaking population needs assessment) and for aligning health, care and other

sector resources to focus on delivering the improved outcomes for local people, building on the long-established integrated working arrangements, e.g.

Better Care Fund, Section 75 arrangements, etc. Working in collaboration, partners will maximise the potential to further improve wellbeing, independence

and social connectivity through the wider determinants of health including public health, housing, employment, leisure and environment.

The statutory role of the HWB with their political and clinical leadership, means that they should be central to the governance of health and care planning for

a ‘place’. The sustainability of the health and care system depends on public and political acceptability and support – as well as the right systems of design

and delivery. So the active and effective democratic engagement at all levels (cluster through to whole HIOW) is vital. Strong and equitable relationships

between NHS and local government will provide the necessary collective energy and focus required for system change. Furthermore, cross sectoral

partnerships of public, private and voluntary and community organisations have important roles in all components of the system.

Much of our prevention and health improvement activities will continue to be designed and delivered in HWB footprints. We will use our ability to align / pool

monies between NHS and local government partners to ensure that a clear focus for each HWB footprint is the resourcing of our 36 clusters (integrated

primary and community care teams).

Our HWBs are based on local authority footprints. We will continue to integrate our CCG and LA teams focused on place-based health and care planning on

these HWB footprints, reducing complexity and duplication. We will also be deploying some of our health (CCG) and care staff directly to support the

operationalisation of our 36 clusters.

All four LAs have committed to meet with health provider and commissioner colleagues during August/September as a task and finish group to

further develop the above definition and proposed next steps (see more detailed recommendation on the next page).

Restating the function of Health and Wellbeing Board footprints within an integrated care system

26


Endorse the following recommendations from the EDG, informed by the task and finish

group work to date:

1. The emerging ‘restatement’ of the function of partnership working on a HWB

footprint as described on the previous slide

2. The proposed next steps for a task and finish group by the end of September, which

are to:

a. define the common functions of the role of HWB footprints in an integrated care system

b. clarify the relationship between this and the other component parts of the proposed

Hampshire and Isle of Wight Integrated care system

c. set out a mechanism for achieving ‘active and effective democratic engagement at all

levels’ across the Hampshire and Isle of Wight integrated care system (including the role of

HWB)

Leads from the other Hampshire and Isle of Wight task and finish groups on integrated

care partnerships, strategic commissioning and clusters will be involved in developing

this thinking.



Isle of Wight


Eastern Hampshire

North & Mid

Hampshire


Hampshire



South West


South East


North & mid

Hampshire


Integrated care partnerships 28


Integrated care partnerships

Providers of mental and physical health and care

services including general practice, NHS commissioners,

local authorities and voluntary sector organisations come

together in geographies based on the local catchments of

acute hospitals to benefit their local population.

The term ‘integrated care partnership’ [ICP] is being used

to describe the collaboration of partners on these

geographies.

The ICPs across HIOW will reflect local needs and will

differ in the extent of their focus and work programme.

For some, the focus may be predominately on improving

operational ED performance. In others there is already an

intent to work together on a more comprehensive basis

with established governance structures to deliver agreed

improvement programmes.

The balance and focus of the planning and delivery

that takes place in HWB footprints and integrated

care partnerships will vary in each part of HIOW.

Integrated care partnerships are where we align the work of the local clusters, community services, acute and

specialised physical and mental health services, for the benefit of the local population.

29


The nature of Integrated Care Partnerships [ICPs] will vary according to local circumstances, challenges and opportunities. For some the arrangements will mirror current

state. For others their development is such that by April 2020, integrated care partnerships could be working together to:

• implement a integrated care partnership delivery plan which sets out the collective priorities of the integrated care partnership, over the medium term (3-5 years) and

in the short term (1-2 years) [noting that as previously alluded to, the balance and focus of planning and delivery that takes place in integrated care partnerships is

likely to vary in each part of HIOW]

• design and implement optimal care pathways, and to identify, understand and reduce unwarranted clinical, operational and service variation

• make the best use of the collective resources of the integrated care partnership, including workforce, financial resources and estate, maximising system wide

efficiencies and encouraging resources to flow to address the key risks facing the partnership

• support the ongoing development of the integrated care partnership:

o progressively building the capabilities to manage the health of the population, to keep people well and to reduce avoidable demand

o supporting the ongoing development of clusters, as the bedrock of the local health and care system

o in some areas, potentially managing the transition to evolved organisational form arrangements that enable members of the integrated care partnership to

sustainably meet the population needs

An integrated care partnership board could lead the partnership, providing strong system leadership, actively breaking down barriers that hinder progress in the delivery

of integrated care, building trust and acting together to deliver improvements for citizens, for the system as a whole and through which partners hold each other to

account for delivery of the shared priorities.

In integrated care partnerships, NHS providers including primary care, commissioners and local authorities work to overcome the barriers to collaboration associated with

the separation of provision and commissioning. Whilst recognising the important individual statutory responsibilities of each partner, it is envisaged that:

• CCGs will deploy their people and resources to work collaboratively with other CCGs in the integrated care partnership, focussed on implementation of the integrated

care partnership delivery plan – improving services, improving operational performance and delivering cost reduction.

• NHS providers will work together to make strategic and operational decisions that are in the best interest of the integrated care partnership.

• Where possible, in order to reduce duplication and bureaucracy, CCGs, NHS providers and if relevant local authorities, will seek opportunities to optimise corporate

support services and infrastructure such as finance, quality, communications and governance teams.

Current thinking about the development of integrated care partnerships by March 2019 and March 2020 is described on a subsequent slide.

What could integrated care partnerships look like? 30


ICPs: an example of a different approach

• CCGs deploying their people and resources to work

collaboratively with other CCGs in the local care system

and with providers

• Providers making decisions and delivering care

together – provider alliances

• CCGs, NHS providers and potentially local authorities

sharing corporate support services and infrastructure?

• Over the next 18 months, working through together the

impact on financial flows, contractual models and

organisational forms (drawing national models such as

the ICP contract consultation)

• Better grip on improving the money, performance and

quality

• Integrated care partnerships supporting clusters to

develop and thrive

• Whole system implementation of improved care

pathways, and reduction in unwarranted clinical,

operational and service variation

• Collective support for all services in the integrated care

partnership to meet operational performance and quality

standards

• Reduced transaction costs

We anticipate seeing: Enabling us to have:

The ICP Task and Finish Group has been developing a vision of how the future might look. Each ICP will develop proposals that

reflect their local context, challenges and opportunities

31


A potential timeline for the development of ICPs


• Implementing Urgent & Emergency Care priorities for the integrated care

partnership

• Developing optimal care pathways across the integrated care partnership

• Agreed plan to support the development of clusters

• Engaging staff and local communities in redesign

• 100% of clusters thriving, with lower mental and physical acute care demand as

integrated teams support people to stay well at home

• Managing a comprehensive programme of service improvement to address the

integrated care partnership priorities

• Population groups with high service utilisation or unmet need identified and

action agreed

Care

Redesign

• Working together to monitor and improve delivery of constitutional standards • Instigating clinically led quality improvement

• Extensive use of data to drive improvement

• Oversight of delivery in clusters

• Leading recovery of standards without outside intervention

Accountability

& performance

management

• Managing the collective resources of the integrated care partnership

• Capable of taking on a delegated budget

• Directing resources to address the key integrated care partnership risks

• Shared corporate support services

• Shared medium term financial plan including efficiencies

Managing

collective

resources

• Develop and agree plan to make optimal use of acute and specialised physical

and mental health services

• Aligning the work of clusters at HWB footprint with community and acute physical

and mental health services

Strategy and

Planning

• Agreed single strategy and operational plan for the integrated care partnership

describing collective priorities and how those priorities will be delivered

• Planning undertaken jointly by CCGs, providers and LAs

• Understand current resource use in the integrated care partnership

• Working together to make the best use of the collective resources (workforce,

estate, financial) in the integrated care partnership

• Test new approaches to manage funding flows (e.g. DTOC)

• Maximising system wide efficiencies

• Understanding the context, ambitions and challenges of each member of the

integrated care partnership, building trust, acting together

• Governance structure in place to enable collaboration

• Cluster leaders engaged in integrated care partnership planning and decision

making

• Members of the integrated care partnership working together to agree any

changes required to organisational structures

• Joint provider, CCG and LA leadership to enable planning and delivery in the

integrated care partnership

• Care professionals leading service integration

• Governance mechanisms in place to enable decisions to be made in the best

interests of the system and residents

• Implementing agreed changes to organisational structures to better enable

delivery in the integrated care partnership

Leadership &

governance

Workforce

development

• Understanding the workforce issues for the integrated care partnership • Securing the right workforce, in the right place with the right skills in the

integrated care partnership, and ensuring the wellbeing of staff

32


Work with geographically aligned partners within the identified four ICP footprints to:

1. Discuss and agree the remit and focus of the ICP;

2. By October 2018 prepare a Memorandum of Understanding [MoU] that sets out the remit, focus and the leadership / governance / decision making arrangements of the ICP and how the local Health and Wellbeing Boards (Care systems) and the ICP interface with one another - the balance and focus of each;

3. Set out the key milestones for the ICP for April 2019 and April 2020.

33 Statutory bodies are asked to:


Isle of Wight


Eastern Hampshire

North & Mid

Hampshire


Hampshire

Strategic planning/commissioning at HIOW tier. Health and Wellbeing Alliance for HIOW


South West


South East


North & mid

Hampshire


Strategic planning, transformation, resource allocation and assurance at the scale of Hampshire & Isle of Wight

34


In order to support and add value to the work of clusters, HWB footprints and integrated care partnerships, it is envisaged that providers, commissioners and local authorities will work together to undertake strategic planning, transformation, resource allocation and oversight activities at HIOW level.

This could be achieved, by April 2020, through a single entity for HIOW which, in its mature form, would develop strategy, set priorities and provide strategic leadership and direction to the HIOW integrated care system.

The strategic planning and transformation function in the HIOW integrated care system would:

• include the input and expertise of providers, CCGs and local authorities

• programme manage the implementation of HIOW level transformational change (change that spans more than one integrated care partnership or which is most appropriately managed at HIOW system level)

• proactively support the development of integrated care partnerships

• manage the specialised commissioning budget for HIOW

• align the resources coming into HIOW from a wide variety of sources around the delivery of the agreed strategic priorities, in order to increase the impact for populations

• act as the assurance body for HIOW, providing oversight of operational, quality and financial performance, and enabling the HIOW integrated care system to take action to improve performance without the need for outside intervention.

Whilst recognising the important role of external regulation, it is anticipated that the integrated care system will increasingly develop the capacity and capability to role-model ‘self-regulation’ – where robust processes are in place to ensure that action is taken to identify issues and improve performance without the need for outside intervention.

Creating this strategic planning and transformation function for the HIOW, which involves providers, CCGs and local authorities, is an opportunity to bring together in one place a number of functions including: those CCG functions best undertaken at HIOW level, STP functions, functions currently undertaken by the Director of Commissioning Operations, NHS England/NHS Improvement regulatory functions, specialised services commissioning and potentially other NHS England direct commissioning activities; HIOW clinical networks.

Current thinking about the transition towards this new way of working, by March 2019 and March 2020, is described on a subsequent page.

Strategic planning, transformation, resource allocation and assurance at the scale of Hampshire & Isle of Wight

35


It is proposed that, based upon national ICS, national guidance and evidence of best practice, an entity operating at the scale of HIOW could display the following characteristics:

Subsidiarity: only undertaking functions that for reasons of cost or complexity need to be undertaken at the scale of 2m+ population. Unnecessary complexity and bureaucracy are stripped out with 80% of the transformation process led by local place-based teams;

Inclusive: national models / guidance show that prospective ICS are founded on partnership; for HIOW this would draw together:

• A newly established strategic commissioning function

• the four HWB footprints

• the four integrated care partnerships

• provider alliance

Founded on self-regulation: all components of reformed systems have effective self-regulation and enable a model of collective assurance at the scale of the ICS. This allows NHS England and NHS Improvement to deploy resource into the ICS and have a single touch point on delivery to the newly reformed regional and national infrastructure;

Politically-led: prospective ICS all demonstrate strong political leadership and close connection with Health and Wellbeing Strategies and Boards.

The characteristics of the HIOW integrated care system 36


As an immediate next step in the transition to this future system model, it is proposed that HIOW CCGs and local authorities establish a

strategic planning/commissioning function during Q3 2018/19.

By working together at HIOW level, CCGs and local authorities expect to be able to reduce fragmentation and bring the following immediate benefits:

• stronger alignment of health and local authority commissioning

• the development & agreement of consistent whole system strategic priorities for HIOW

• improved and simplified commissioning decision-making for HIOW wide issues.

The functions of the strategic planning/commissioning function in its initial form would include:

• Setting consistent commissioning strategy and strategic priorities for HIOW

• Managing whole system resilience at HIOW level

• Management and deployment of supra-allocation resources (including capital)

• Demand and capacity planning and commissioning decisions about the future configuration of acute physical and mental health services for the 2 million population of HIOW

• Oversight of NHS constitutional standards, financial performance and quality improvement – with work to be done to ensure this activity isn’t duplicated elsewhere

• Work with specialised commissioners, understanding current activity flows and costs, inputting to and aligning decision making

• It is also proposed that the strategic planning/commissioning function incorporates the transformation programme function of the HIOW Sustainability and Transformation Partnership.

Strategic planning/commissioning at the scale of HIOW

Proposed governance:

• Established through a joint committee, in the first

instance, during Q3 2018/19

• Members include CCGs, NHS England (specialist

commissioning and Regional Director of

Commissioning) and local authorities

• Joint committee will have delegated authority to

make binding decisions in relation to the in-scope

functions and responsibilities

• Expect by April 2019 the governance and

organisational arrangements evolve further

The strategic planning/commissioning function is a

mechanism through which commissioners can pool

skills, expertise, resources and accountability to

deliver transformation at HIOW level. There is a

strong desire to create a new way of working, rather

than add layers to existing ways of working.

37


The developing functions at a scale of HIOW


Care

Redesign

Accountability

&

performance

management

Managing

collective

resources

Strategy and

Planning

Leadership &

governance

Workforce

development

• Understanding the workforce issues for the system

• Influencing the addressing of key workforce issues

• Strategic workforce plan in place and being implemented

• Influencing future workforce supply and training requirements

• Decisions being made about future configuration of acute physical

health and mental health crisis and acute care

• Leadership of plans to improve urgent care for HIOW, including

oversight of delivery of the Integrated Urgent Care Plan

• Decisions about community services provision for Hampshire

• Well developed plans being enacted to support the development of

integrated care partnerships

• Programme managing the implementation of HIOW level strategic change

programme

• Leading on implementation of acute service and estate reconfiguration

• Clear commissioning priorities agreed for HIOW

• HIOW system strategy and priorities being refreshed/updated

• Demand and capacity planning for HIOW acute services

• Agree aligned planning process for 2019/20-2020/21

• CCGs, providers & LAs setting shared strategy & priorities for HIOW with

aligned health & LA planning processes

• Fully own a single HIOW system operating plan that brings together plans

of constituent parts of the system

• Oversight of HIOW winter resilience and preparedness

• Oversight of delivery of integrated urgent care plan

• Acting as interface with assurance bodies for HIOW

• Collective oversight of quality, operational performance and money

• Acting as the assurance body for HIOW – supporting the system to take

action to improve performance and address challenges without the ned

for outside intervention

• Take accountability for a HIOW system control total

• Managing collective finances & risk openly and as a system

• Aligning resources flowing into HIOW to achieve priorities

• Support integrated care partnerships to take delegated budget

• Managing the specialised commissioning budget

• Agree system wide capital and estate priorities and sign off wave 4

capital allocations

• Develop understanding of whole system financial plans and financial

risks

• Plan for aligned management of specialised commissioning

• CCGs operating with a single decision making committee for HIOW

level commissioning business

• All STP partners involved in the design of the future HIOW level system

strategic planning, implementation and assurance function

• STP partners providing leadership to strategic change programmes

• A single coherent entity in place that brings together HIOW level CCG

functions, STP and NHSE/I functions

• Strategic alignment of providers, commissioners and local authorities

around the system strategy and priorities

• Clear clinical leadership for the system and input from HWB footprints and

integrated care partnerships in decision making

38


Endorse the recommendations of the EDG, informed by the work of the strategic

commissioning task and finish group, that:

1. The strategic commissioning task and finish group further develop the proposal with an

aim to establish a strategic commissioning function by October 2018, initially through a

joint committee which will have delegated authority to make binding decisions in relation

to its in-scope functions and responsibilities.

2. That a new task and finish group is convened including providers, commissioners, local

authorities, and NHS England and NHS Improvement, to work together and take

responsibility for the development of the next phase of the work to build the strategic

planning, transformation, resource allocation and assurance function for HIOW,

constructing ICS governance that supports our approach.



Summary of recommendations


1. The emerging ‘restatement’ of the function of partnership

working on a HWB footprint as described earlier in the

document

2. The proposed next steps for the task and finish group by the

end of September, which are to:

a. define the common functions of the role of HWB footprints in an

integrated care system

b. clarify the relationship between this and the other component

parts of the proposed Hampshire and Isle of Wight Integrated care

system

c. set out a mechanism for achieving ‘active and effective democratic

engagement at all levels’ across the Hampshire and Isle of Wight

integrated care system (including the role of HWB)

1. The developing role of clusters as outlined earlier

2. The recommendation that partners across HWB footprints and

integrated care partnerships work together to define the resources

required for cluster operation – a critical first step is establishing

professional and operational leadership to drive cluster

development

3. The proposed next steps for the cluster task and finish group

which are summarised as follows:

a. Quantify the impact/expected outcomes of cluster teams (already in

progress in most areas): defining outcome metrics for individual

clusters and a small set of common metrics across whole HIOW

b. Describe the support requirements and responsibilities to accelerate

full cluster implementation

c. Describe the proposed interplay between clusters and other

components of the ICS, including governance and participation

arrangements for clusters as part of HWB footprints and integrated

care partnership structures

d. Strengthen primary and social care involvement in this work at a

Hampshire and Isle of Wight level (membership of the task and finish

has already been extended to reflect this)

In summary, the governing bodies and boards of statutory organisations are asked to endorse the following

recommendations from the EDG, informed by task and finish group work to date:

Health and Wellbeing Board Footprints Clusters

41


1. The strategic commissioning task and finish group further

develop the proposal with an aim to establish a strategic

commissioning function by October 2018, initially through a joint

committee which will have delegated authority to make binding

decisions in relation to its in-scope functions and responsibilities.

2. That a new task and finish group is convened including

providers, commissioners, local authorities, and NHS England

and NHS Improvement, to work together and take responsibility

for the development of the next phase of the work to build the

strategic planning, transformation, resource allocation and

assurance function for HIOW, constructing ICS governance that

supports our approach.

Work with geographically aligned partners within the identified four ICP footprints to:

1. Discuss and agree the remit and focus of the ICP;

2. By October 2018 prepare a Memorandum of Understanding [MoU] that sets out the remit, focus and the leadership / governance / decision making arrangements of the ICP and how the local Health and Wellbeing Boards (Care systems) and the ICP interface with one another - the balance and focus of each;

3. Set out the key milestones for the ICP for April 2019 and April 2020.

Integrated care partnerships Strategic commissioning

42


Next steps


A number of recommendations have been set out linked to each component of the proposed ICS. In addition to those associated with

the specific components of the proposal, there are a number of overarching ‘implementation programme deliverables’, some of which

will result as a coming together of the outputs from the various task and finish groups. These include:

• System reform implementation programme plan

• Structure and leadership plan – transitionary and end state

• Development and implementation of a communications and engagement plan

• Request for support (endorsement , agreement in principle, technical and financial) from NHS England , NHS Improvement and other arms

length bodies such as the Local Government Association, NHS Leadership Academy, Health Education England

• Proposals to replace STP infrastructure (inc. Chair & SRO) to align with future form

• Organisational change plan and talent management plan

• HIOW ICS Chair and relevant leadership appointments

• Indicative budgets and financial framework for all components of the ICS

• Three year financial plans

It is recommended that a working group is formed, reporting to the EDG, to support the development of the above. Members of EDG

are asked to nominate a representative to represent the interests of their part of the system.

System reform programme next steps 44


Glossary


Clusters - also referred to locally and nationally as neighbourhoods, localities, primary care networks. Multi-disciplinary teams delivering

integrated health, care and wider services to cluster populations based on natural communities of 20-100,000 people.

Health and Wellbeing Board (HWB) footprints – also known as care systems and are based on local authority footprints. The basis of

the joint strategic needs assessment (JSNA), means through which HWB exert tangible influence on the direction of health and care

services for the population through health and care commissioning and wider determinants of health. Locally the HWB footprints come

under the guise of Better Care Southampton, Health and Care Portsmouth, Hampshire Care and the Isle of Wight Care Board.

Integrated care partnerships – also know as local care partnerships and are based on acute (physical) hospital footprints. Integrating

care delivered in clusters with broader community and acute physical and mental health services; optimising the utilisation of acute

services; designing and implementing optimal care pathways.

Integrated care system - the Hampshire and Isle of Wight health and care system, serving a population of 2 million citizens.

NHS England defines ICS as those systems in which:

“Commissioners and NHS providers, working closely with GP networks, local authorities and other partners, agree to take shared

responsibility (in ways that are consistent with their individual legal obligations) for how they operate their collective resources for the

benefit of local populations”.

Glossary of terms 46


of 2Version 1 February 2018


Title of Paper Whitehill & Bordon Health Campus and re-provision of Hampshire Hospitals NHS Foundation Trust services update

Agenda Item 7 Date of meeting

Exec Lead Sara Tiller, Managing Director Clinical Sponsor

Author Elizabeth Kerwood, Head of Communications and Engagement

For Decision XTo RatifyTo Discuss

Purpose

To Note


Executive SummaryThis report provides an update on the development of a health hub in Whitehill & Bordon and sets out proposals from Hampshire Hospitals NHS Foundation Trust (HHFT) to re-provide outpatient services currently delivered in the local area. It also provides an update on the CCG’s progress on sourcing alternative provision.

The CCG is working with East Hampshire District Council and other partners to progress the development of a new town centre health facility to be delivered in 2020. There are a number of key next steps for the programme. These are:

Continuing to work with potential tenantso Review and agree space requirements with tenantso Supporting potential tenants to understand the financial requirements

Development of the Outline Business Caseo Fully develop the outline business case for the CCG Governing Body to agree

Applying for planning permissiono Preparing planning permission applicationo Planning to submit this in December

Development of full business caseo Agree/appoint developmento Finalise service provisiono Tenants agreement to lease.

Hampshire Hospitals NHS Foundation Trust currently provides a small number of services from Chase Community Hospital in Whitehill & Bordon. These are five outpatient services, community midwifery and x-ray. The Trust no longer feels able to sustain these efficiently and economically due to a declining share of outpatient activity; the small number of attendances; the cost of renting space at the hospital relative to the activity delivered; and the relative distance of the town from the Trust’s main sites. The Trust intends to withdraw its services by March 31, 2019.

The Trust, with support from the CCG, has sought the views of local people which highlighted five clear themes:

1. Strength of positive feeling about Chase Community Hospital and local services2. Availability of public transport

Page 1 of 27 Whitehill and Bordon update cover sheet.docxOverall of 247


3. The town’s growing population4. Lack of choice5. Local provision is more important than who provides it.

The CCG has been having discussions with alternative providers including Care UK, Royal Surrey and County Hospital (RSCH) and Portsmouth Hospitals NHS Trust (PHT). Midwifery and ophthalmology services are now provided by Royal Surrey County Hospital (RSCH). Alternative providers have confirmed that the activity is too low to deliver a sustainable service for ENT, audiology, maxillo facial, x-ray and some elements of the paediatrics service. However, discussions are underway between HHFT, RSCH and the CCG regarding RSCH potentially providing general paediatrics.

Recommendations The Governing Body is asked to note the progress on the health hub and agree the re-provision of the HHFT services



Patient and Stakeholder Engagement

The Trust has undertaken an engagement programme with support from the CCG.

Financial Impact, Legal implications and Risk


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Whitehill & Bordon Health Campus and re-provision of Hampshire Hospitals NHS Foundation Trust services update

1. Purpose

1.1. This report provides an update on the development of a health hub in Whitehill & Bordon and sets out proposals from Hampshire Hospitals NHS Foundation Trust (HHFT) to re-provide outpatient services currently delivered in the local area. It also provides an update on the CCG’s progress on sourcing alternative provision.

2. Development of a health hub

2.1. Background South Eastern Hampshire CCG’s publicly stated commitment since 2013 has been to ensure that residents in Whitehill and Bordon have access to a comprehensive range of health and well-being services. The CCG worked with community representatives to develop the ‘Chase Charter’ which set out the services that would be provided from the Chase Community Hospital based on the health needs of local people.

At its meeting in January 2016 the Governing Body restated this commitment and agreed that the progression of a capital investment bid for the Chase Community Hospital was no longer a viable option and that the CCG should focus on working with local GPs and partner organisations to develop plans for a new health and well-being facility as part of the NHS England Healthy New Town programme in Whitehill & Bordon.

A Steering Group made up of community representatives (elected members from HCC, EHDC and the Town Council, PPG representatives, voluntary sector colleagues, Southern Health NHS Foundation Trust, NHS Property Services, local GPs and the CCG’s Lay Member for PPI) has been involved in the project and continues to meet regularly to discuss issues and make recommendations.

A range of engagement exercises have been carried out in the local area over the last five years and these has had three consistent themes – local people want to be able to access a range of high quality and accessible services in the local area; local people supportive of the commitment to provide a range of services; and transport, including public transport, is a concern for the local community.

2.2. Population changes Whitehill & Bordon has a current population of approximately 16,100. The table below details the current population for the area and the forecasted growth.

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YEAR 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 20290-4 Years 895 939 986 1,013 1,029 1,011 982 931 920 918 913 913 8895 - 10 Years 1,416 1,422 1,408 1,425 1,449 1,443 1,466 1,467 1,475 1,472 1,445 1,412 1,36111 - 15 Years 1,034 1,114 1,218 1,302 1,372 1,434 1,428 1,364 1,352 1,346 1,323 1,345 1,35316-17 417 429 443 466 486 526 558 602 618 599 621 604 554Adults 18- 64 9,747 10,155 10,729 11,227 11,766 12,088 12,282 12,238 12,465 12,728 12,897 13,079 13,02665 -74 1,873 1,989 2,100 2,212 2,338 2,419 2,505 2,595 2,720 2,870 2,995 3,123 3,24875-84 645 698 774 835 896 983 1,059 1,096 1,147 1,206 1,258 1,320 1,35285+ 87 79 75 77 82 86 93 95 104 116 126 142 157TOTAL 16,114 16,825 17,732 18,557 19,418 19,992 20,372 20,388 20,803 21,255 21,578 21,939 21,940Population impact of constraintNumber of persons 616 612 806 720 756 466 277 -83 317 358 233 269 -88HouseholdsNumber of Households 6,541 6,822 7,181 7,523 7,883 8,153 8,371 8,464 8,691 8,937 9,131 9,337 9,412Change in Households over previous year 275 281 359 342 361 269 218 93 227 247 194 206 75Number of supply units 6,871 7,166 7,543 7,902 8,281 8,564 8,793 8,891 9,129 9,388 9,592 9,808 9,887Change in over previous year 289 295 377 359 379 283 229 98 238 259 204 216 79

The population in this area is generally older than that of Hampshire and England. The predicted forecast for 2029 highlights that over 80% of the population for this area will be of adult age, the highest proportion of this group is in the age range 18-64. There are no significant increases in population predicted for the under 18 age ranges, however, in the 65 plus age category there is a significant increase which sees the age category of 65-84 double in population by 2026.

A recent housing strategic review estimates the population growth will be staggered over a number of years with:

31% of the population growth occurring between 2017 and 2020 21% between 2021 and 2022 48% between 2023 and 2027 53% of the new households are forecast to be three, four or five bed houses.

This is likely to mean new families moving into the town.

2.3. Developing plans for a new health hubThe CCG has been working with East Hampshire District Council (EHDC) and other partners to progress one of the core ambitions within the Healthy New Town Programme in Whitehill and Bordon – the development of a new town centre health facility to be delivered in 2020.

In 2017, the CCG commissioned Hampshire LIFT to produce a Strategic Outline Business Case (Post PID Option Appraisal) for Whitehill and Bordon, building on the findings and recommendations of an earlier study.

The Strategic Outline Case (SOC) considered a range of options to deliver the stated investment of objective of:

“Co-locating general practice with existing and planned community health services and providing the capacity to deliver primary and community health services to the increased population.”


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The SOC concluded that the Preferred Option was for a new building in the town centre as part of the Healthy New Towns programme. The building would house both GP practices from the town; all services currently provided at Chase Community Hospital and have flexible space for other services. Under this option the CCG and partnering NHS bodies (GP practices, SHFT and other Trusts) would lease space within the new building.

This was agreed by the Governing Body in December 2017 and the SOC was subsequently submitted to NHS England. The CCG is now working with partners to develop an Outline Business Case.

2.4. Next steps There are a number of key next steps for the programme. These are:

Continuing to work with potential tenantso Review and agree space requirements with tenantso Supporting potential tenants to understand the financial requirements

Development of the Outline Business Caseo Fully develop the outline business case for the CCG Governing Body to

agree Applying for planning permission

o Preparing planning permission applicationo Planning to submit this in December

Development of full business caseo Agree/appoint developmento Finalise service provisiono Tenants agreement to lease.

3. Re-provision of Hampshire Hospitals NHS Foundation Trust services

3.1. BackgroundHampshire Hospitals NHS Foundation Trust (HHFT) runs the hospitals in Andover, Basingstoke and Winchester. It also runs outpatient, x-ray and community midwifery in other locations including Alton and Whitehill & Bordon. Outpatient and x-ray services run from Chase Community Hospital. This is also the base for community midwifery team who provide services from the hospital as well as home visits.

The community midwifery service is in the process of transferring to Royal Surrey County Hospital NHS Foundation Trust who is already delivering this service locally.

In 2017/18 the number of outpatient attendances HHFT delivered (regardless of delivery location) for patients registered to one of the Whitehill and Bordon practices was 9,090 or about 1.5% of the Trust total.

In total HHFT delivered 602,457 outpatient attendances across all of its sites during the same period. The activity delivered at the Chase Community Hospital (2,382) therefore represents about 0.39% of the Trust total.

In 2017/18 HHFT received 3,918 referrals from the GP practices in Whitehill & Bordon. For the 9,090 outpatient attendances from these referrals (both new and follow-up),


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around 74% were seen at the Trust’s main hospitals or locations other than Whitehill & Bordon. 26% were seen locally in Chase Community Hospital.

The outpatient services currently provided in Whitehill & Bordon are run by medical and nursing staff and clinics are across five main specialties at differing frequencies between Mondays and Fridays. X-ray (plain film only) is provided across two sessions held on Mondays and Thursdays.

The x-ray service at Chase Community Hospital performed 1,816 examinations 2017/18 for around 1,280 individual patients (some individual patients have multiple x-ray examinations).

In total over the course of 12 months HHFT typically provide around 167,000 x-ray examinations across all of its sites. The activity delivered at Chase Community Hospital therefore represents about 1% of the Trust total.

HHFT’s ‘market share’ (the percentage of new outpatient appointments for Whitehill & Bordon patients that are provided by HHFT) has fallen. It has fallen to just 22.8% at the end of 2017/18 from 29.2% in 2015/16. Therefore 77% of first outpatient attendances are provided by other Trusts.

3.2. Views of local peopleThe Trust, with support from the CCG, sought the views of local people on the plans to re-provide these services.

The feedback received highlighted five clear themes:

1. Strength of feeling about Chase Community Hospital: The people of Whitehill & Bordon care passionately about the retention of local services and any proposal to relocate services away from Chase Community Hospital is seen as a further erosion of local health provision. The hospital is very much viewed as an under-used public asset whose future is of great concern to the population of Whitehill & Bordon.

2. Transport issues: Whitehill & Bordon is poorly served and public transport to any hospital site is extremely difficult involving lengthy journeys and bus changes. Any additional requirement to travel to alternative sites would put pressure on existing travel options. Volunteer car services already feel under pressure where volunteers are already in short supply. A trip to the hospital in Basingstoke lasts at least four hours and often longer and removes a driver from local journeys.

3. The growing population: It is felt that the issue that HHFT faces of reduced referrals and small numbers attending local clinics could be a short term problem given the expanding population of Whitehill & Bordon.

4. Lack of Choice: Patients feel they are not given the choice to attend Chase Community Hospital where provision exists. This issue was common to all the services at the hospital, not just those provided by HHFT.

5. Local provision is more important than who provides it: Attendees felt strongly that local provision was more important than who actually provides it.


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There were 452 respondents to the survey and the key findings were:

The majority of respondents (54%) consider Royal Surrey County Hospital to be their main District General Hospital (DGH) with around 30% of respondents considering Basingstoke and North Hampshire Hospital (HHFT) to be their local DGH

Around 45% of respondents found their journeys to their chosen DGH difficult or very difficult. And around 18% consider the journey to Alton difficult or very difficult

Being seen in a location that was local to them was an extremely important factor in accessing health care. This is confirmed by the result that around 80% of respondents would not choose to travel more than 20 miles to access their healthcare

76% of respondents drive their own car when accessing healthcare 88% of respondents would approve or strongly approve of the same service being

provided by another provider.

3.3. Potential alternative providersSouth Eastern Hampshire CCG has been considering alternative arrangements for the services provided by HHFT at Chase Community Hospital. This has included meetings and discussions with potential alternative providers including Care UK, Royal Surrey County Hospital (RSCH) and Portsmouth Hospitals NHS Trust. HHFT has fully supported these discussions providing detailed information on clinic activity, the types of cases seen and facilities available at the community hospital.

The following tables detail each of the services, the outcome of discussions to date and proposed new arrangements. A table is also included outlining additional or changes to current services for Chase Community Hospital (not provided by HHFT).

Service / clinic

What does HHFT currently

provide in Whitehill & Bordon?

How will this be re-provided by HHFT?

Could a different provider provide this in Whitehill &

Bordon?

Will this service move to the new

health hub?ENT HHFT have

provided one clinic a month providing around 230 appointments a year

Patients can choose to be seen by HHFT in Alton, Basingstoke or Winchester or choose to be seen by RSCH in Haslemere

Alternative providers have confirmed that the activity is too low to deliver a sustainable service.

HHFT will not relocate their service until March 31, 2019

This service will not move to the new health hub

Audiology Around one audiology clinic a week providing around 260 appointments a year

Patients can choose to be seen by HHFT in Alton, Basingstoke or Winchester or choose to be seen by RSCH in Haslemere

The number of patients using this service is very low so the CCG is seeking clarification about the service provision, for example does it primarily provide battery replacement and repairs which could potentially be provided at another location or by post.


This will be determined when the service provision is clarified


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Service / clinic

What does HHFT currently

provide in Whitehill & Bordon?

How will this be re-provided by HHFT?

Could a different provider provide this in Whitehill &

Bordon?


health hub?Maxillo Facial Just less than

one clinic a month seeing around 48 patients a year

Patients choosing HHFT as their provider will be offered an appointment at Alton Community Hospital or Basingstoke / Winchester



This service will not move to the new health hub

Paediatrics services (general paediatrics, hearing clinics, child develop-ment and physio-therapy)

These clinics provide around 20 new and 39 follow-up appointments each month

Patients choosing HHFT as their provider will be offered an appointment in Alton, either in the Community Hospital or a GP practice, or Basingstoke / Winchester

Discussions are underway between HHFT, RSCH and the CCG regarding RSCH potentially providing general paediatrics.


This will be determined when the service provision is clarified

X-ray Some x-ray services twice a week seeing about 1,300 patients every year

HHFT x-ray services in Alton are walk-in accessed by GP referral. Patients from Whitehill and Bordon are able to choose this service


HHFT has proposed it gradually withdraws the service by June 30, 2019 pending certain conditions being met.

The CCG will keep diagnostic provision under review as the town develops and will explore opportunities for a service that works across a wider area

This will be included in future discussions

Midwifery Pre and post-natal care for all local women, although over 80% chose to give birth at Frimley and Surrey hospitals

Where women choose to be referred to HHFT, they will continue to provide care in line with patient choice from their Alton base

Following the May HASC arrangements have been put in place for RSCH to take over the case load in Whitehill and Bordon including providing pre and post-natal care to the women who chose to give birth with them. This is being provided in the local community.

There is a commitment from them to keep the pre and post-natal care local (either at Chase Community Hospital or in GP surgeries)

Yes as it will transfer either from Chase or with the GP services

Ophthal-mology

These clinics provide one clinic a week seeing an average of 75 appointments per month

Patients choosing HHFT as their provider will be offered an appointment at Alton, either in the Community Hospital or a GP practice, or Basingstoke / Winchester

RSCH has confirmed with the CCG that it will provide a service from Badgerswood GP practice.

HHFT will not relocate its clinics until the new provider service is in place or March 31, 2019 (whichever is soonest)

This will be discussed with RSCH as part of the health hub plans


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Additional or changes to current services for Chase Community Hospital (not provided by HHFT)Service How is/has this

service been provided?

How has/is this service changed/

changing?

Is the service provided in Whitehill and Bordon?


health hub?Physiotherapy Patients used to

travel to Haselemere

Southern Health NHS Foundation Trust now provides this service locally

Yes, with the service being provided at Chase Community Hospital

This will relocate to the health hub

Podiatry Patients used to travel to Haselmere

Solent NHS Trust now provides this service locally

Yes, with the service being provided at Chase Community Hospital

This will relocate to the health hub

Phlebotomy Currently provided at Chase Community Hospital as a bookable service

The CCG has procured a GP led, bookable service. This new service will replace the existing service in January 2019

Yes, with the service being provided in GP practices

Discussions are underway

4. Recommendation

4.1. The Governing Body is asked to note the progress on the health hub and agree the re-provision of the HHFT services as set out at point 3.3.


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of 6FINAL Version Oct 2018


Title of Paper EPRR Core Standards Assurance ReportAgenda Item 8 Date of meeting 24 October 2018Exec Lead Sara Tiller Clinical Sponsor N/aAuthor Tracy Davies, Associate Director of EPRR


Purpose

To Note X

Link to Strategic Objective This is a statutory requirement.

Executive Summary

This is the Emergency Planning Resilience and Response Annual report to Governing Body for noting.

It contains the Core Standards Assurance process which was completed and as part of this process the Accountable Emergency Officer must ensure that the Governing Body receive as appropriate, reports, no less frequently than annually, regarding EPRR, including reports on exercises undertaken by the organisation, significant incidents, and that adequate resources are made available to enable the organisation to meet the requirements of these core standards.

Key areas for note in the report are:• 8 - Exercises• 10 - Incidents• 12 – CCG self-assessment

Recommendations The Governing Body is asked to note the information set out in the paper.




Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed OutcomePortsmouth CCG Governing Body October 2018 TBC

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Emergency Preparedness Resilience and Response (EPRR)Report to Governing Body 2018

1. Introduction

The three CCGs continue to have an agreement to work together to deliver their responsibilities as category 2 responders under the Civil Contingencies Act 2004 using a service level agreement. They have a joint on call rota and a joint incident response plan which has been formally agreed by each organisation.

In addition in April 2017 NHS England agreed to joint leadership under one Accountable Officer for the North Eastern Hampshire, North, and South Eastern Hampshire & Fareham & Gosport CCG’s and in April 2018 this also included Isle of Wight CCG. For 2018 this has not affected the requirement to have a single AEO for each of the CCG’s. However a new Associate Director of Emergency Preparedness Resilience and Response has been appointed which covers the Hampshire Partnership CCG’s and Portsmouth CCG.

2. Accountable Emergency Officers/Non-Executive Directors

Each CCG is required to appoint a board level officer/director as accountable emergency officer (AEO):

Sara Tiller, Managing Director is AEO for Fareham and Gosport and South Eastern Hampshire CCGs and under the current arrangements also AEO for Portsmouth CCG.

Additionally they require a Non-Executive Director (NED). This can be a Lay Member who is an independent member of the Board who can support the AEO but also hold them to account. The independence/impartiality of this person is essential. We have the following appointed:

Andrew Silvester, Portsmouth CCG Sarah Anderson, Fareham & Gosport CCG Suzanne Hasselmann, South Eastern Hampshire CCG

3. Core EPRR

This year CCGs are required to self-assess against the NHS core standards for EPRR including a ‘deep dive’ into ‘Incident Coordination Centres’ and this report forms part of the formal reporting process.

The CCGs have three key documents which detail their organisational response to emergency preparedness and resilience and response:

Joint CCG Incident Response plan



Manual of Operations, detailing the running of an incident Business continuity plan

4. Governance

EPRR documents and reports will now be approved by the following committees: Clinical Operational Group (COG - Formal) – Fareham & Gosport and

South Eastern Hampshire CCGs CCG Clinical Executive Committee (CEC – Formal) – Portsmouth

CCG

In Fareham & Gosport and South Eastern Hampshire CCG EPRR is discussed on a quarterly basis at the Senior Managers meeting with task and finish groups taking on specific relevant EPRR projects.

In Portsmouth CCG EPRR is discussed on a regular basis at the Clinical Executive Committee informal meetings.

5. On call

The joint on-call has been running since April 2012 and is now comprised of 17 senior managers (with 8C’s now supporting from South East Hampshire CCG) from across the 3 CCGs. The number of calls received is on average 7 a month with the main reason for calls being:

Pressure in the local health system Influenza Outbreak information from Public Health England

The CCGs on call pack is issued to all on call managers and details the Portsmouth and South Eastern Hampshire system escalation process, contacts list, major incident action cards, site risk action cards and the health protection process. There is a training package in place for on-call managers to ensure they are supported to undertake their role.

6. Local Health Resilience Partnership (LHRP)

The LHRP is a strategic emergency planning meeting of all the NHS organisations from across Hampshire and Isle of Wight. It is co-chaired by the Director of Assurance and Delivery NHS England (South East) and the Hampshire director of Public Health.

The CCGs have attended meetings during the year. The LHRP has produced a new Three Year Strategy and has carried out an annual review of progress.

The CCGs Associate Director of EPRR has been an active member of the sub group which supports the LHRP and attended all formal meetings.

The LHRP Three Year Strategy bases its strategic approach on a risk based process.



These risks will be identified at local, regional and national level. The LHRP will plan its preparedness, resilience and response to those identified risks culminating in a robust and collaborative annual training and exercising work programme, complete with milestones deadlines and identified work stream leads to ultimately improve and enhance EPRR interoperability across the local health community.

7. Training

On call training for local system resilience and escalation took place throughout 2018. Regular training sessions will be scheduled throughout 2019.

There is currently 12 staff trained as loggists across the 3 CCGs. All will be receiving refresher training over the coming year and further loggists will be identified teams and provided with training.

8. Exercises

The CCG took part in a multi-agency a Mass Casualty exercise at Winchester in May 2018 as well as a Mass Fatalities Workshop in Sept 2018.

The CCG supported a winter table top exercise (Exercise Soughdough) September 2018 which involved multiple HIOW system pressures.

The three yearly statutory exercises for testing the local arrangements for nuclear submarines visiting the dockyard took place in October 2016. The next one will take place on 10th October 2019.

9. Communications exercise

The following communications exercises have taken place: Feb 18 – PHT Major Incident communications test Jul 18 – Text Anywhere staff communications test (SEH CCG)

Portsmouth CCG has agreed to adopt the Text Anywhere service and a communications test will take place in October 2018.

10. Incidents

The CCGs have responded to the local health system pressures and played an active part in the gold command arrangements as well as working with the wider system. In June 2018 the CCG’s opened the Incident Control Centre at Portsmouth CCG due to the Gosport Panel incident and operated a command and control structure for three days.



The CCGs have attended planning meetings for Victorious and were also involved in the incident at Mutiny Festival in May 2018.

11.EPRR Core Standards

In September 2018 NHS organisations carried out a self-assessment of their state of readiness against the NHS England published EPRR core standards.

12.CCG self-assessment

The AEO and Associate Director of EPRR have completed the self-assessment of 43 core standards and identified that the organisation are compliant with 38 of them.

The following 5 core standards were rated as amber and form part of the action plan for the coming year:

Core standard number:2 EPRR Policy Statement - EPRR Policy needs updating and combining with

On Call and BCP. A review will be completed to consider if this should become a Hampshire Partnership and Portsmouth CCG policy.

6 Business Continuity, Continuous improvement – This is described in Business Continuity Policy but is not explicit enough. EPRR policy will be revised.

8 Risk Management – Whilst there is a Risk Policy it is not explicit about EPRR. The policy will be amended accordingly.

25 Trained On Call Staff – This needs to be explicit in the EPRR policy.30 Incident Coordination Centre – Fort Southwick ICC is being reviewed for

space.

Additionally the following standard on Deep Dive – Incident Control Centre was also rated amber:

DD3 Equipment Testing – Testing once a year will now organise quarterly audits.13.NHS Providers self-assessment



NHSE has overseen the process and agreed with CCGs which providers will be reviewed by which commissioners:

Portsmouth Hospitals NHS Trust is being reviewed by SE Hampshire CCG Solent NHS Trust is being reviewed by the SE Hampshire CCG Southern Health NHS FT by West Hampshire CCG 999 South Central Ambulance Service by West Berkshire CCG 111 South Central Ambulance Service by SE Hampshire CCG PTS South Central Ambulance Service by SE Hampshire CCG

The Associate Director of EPRR and Accountable Emergency Officers reviewed with Portsmouth Hospitals NHS Trust, Solent NHS Trust, 111 South Central Ambulance Service, PTS South Central Ambulance Service their self-assessment submission and resulting action plans.

Trusts have signed a statement of compliance and provided a report to their respective Boards as part of this process.

14.Summary

The Accountable Emergency Officer and Associate Director of EPRR met with Director of Assurance and Delivery NHS England (South East) as part of the assurance process on 2nd October. They agreed a position of Substantially Compliant for the three CCG’s.

The level of compliance of all Trusts in Hampshire and Isle of Wight will be confirmed at the next Local Health Resilience Partnership.

Tracy DaviesAssociate Director of EPRR

8th October 2018




Title of Paper Portsmouth & South East Hampshire Care System Winter Plan 2018/19 Agenda Item Date of meeting 24 October 2018Exec Lead Mark Cubbon Clinical Sponsor Elizabeth FellowsAuthor Chloe Weaver


Purpose

To Note X


Executive SummaryThe Portsmouth & South East Hampshire Care System’s Winter Plan 2018/19 has been produced and approved by the A&E Delivery Board. All sovereign organisations have committed to the delivery of this plan. The plan was submitted to NHS England in September 2018.

The Winter Countdown Actions are continuously being monitored through the fortnightly A&E Operational Group.

Recommendations Governing Body note the information





Page 1 of 19 Winter Plan cover sheet.docxOverall of 247

Overall of 247

Portsmouth & South East Hampshire Care System

Winter Plan 2018/19

Portsmouth A&E Delivery Board

September 2018

Version 7 1

Page 1 of 399 Winter Plan 2018 vs 7.pdfOverall of 247

2

Contents

3. Portsmouth & South East Hampshire Care System Introduction

4. Map of Urgent & Emergency Care Pathway

5. Key System Resilience Roles

6. Key System Resilience Roles – Executive Escalation

7. A&E Planning based on Winter 2017/18 Evaluation Report

8. Demand & Capacity Modelling

9. Closing the Capacity Gap to achieve 92% Bed Occupancy & 90% Performance

10. Improving Complex Discharges

11. Integrated Urgent Care

12. Integrated Urgent Care Forecasted Demand

13. Integrated Primary Care

14.Winter Countdown Plan

15.Gateway Review 1 – September

16.Gateway Review 2 – October

17.Gateway Review 3 – November (1)

18.Gateway Review 4 – November (2)

19.Managing Surge & Escalation throughout Winter 2018/19

20.Ambulance Handover Implementation Plan

21.PSEH System Flu Plan

22.PSEH System Infection Control Plan

23.PSEH Communications Plan

36.Our 5 Wishes

37.Local Delivery System – Key Initiatives for Winter 2018/19

38. Monitoring Delivery of the Winter Plan 2018/19

39. Appendices


Introduction

3

The Portsmouth & South East Hampshire Care System’s Winter Plan 2018/19 sets out the collective actions that will be taken to mitigate key risks and manage

surges in demand through winter. The plan draws on the evaluation of last year’s approach and reflects NHS England operating guidance: hence we are

committed to achieving >90% 4 hour A&E waits and ensuring that the number of patients on an incomplete elective care pathway in March 2019, will not exceed

levels in March 2018. In order to make this happen, the system has predicted capacity requirements and all partners have contributed towards the funding

requirements of the £4.052m Winter Capacity Plan. Planning for winter commenced early with the result that the system has already achieved the 25%

reduction in long stay patients and we have a collective ambition to reduce this number further. Our plan is comprehensive , collaborative, and based on the

following key components:

• Fostering effective leadership, clear roles and responsibilities, and strong relationships across organisations and at every level,

• Built upon analysis of predicted demand, and the additional capacity required across the entire urgent and emergency care pathway,

• Effective mobilisation of our Winter Capacity Plan to ensure additional ‘home first’ capacity in fully in place ahead of December 2018,

• Updating our Surge and Escalation Plan to ensure system ‘OPEL triggers’ appropriately reflect levels of escalation and the mitigating actions to be taken,

and

• A robust plan for communicating with the public and our staff, linking both local and national approaches to social marketing.

There are five key risks facing our system which we hope to mitigate through our plans described above. These are:

• Securing through agencies the required level of ‘home first’ capacity as set out in the PSEH Winter Capacity Plan,

• Managing ambulance handovers during times of high demand, given the impact of current emergency department environmental constraints and home

first capacity limitations on hospital flow.

• Recognising the financial challenge to all partners who have contributed resources to fund the winter capacity plan at risk.

• Lack of primary care resourcing for winter to support ‘acute care avoidance’.

• NHS Continuing Health Care Pathway response is not sufficient to prevent unnecessary acute delays.

The first is being mitigated through early mobilisation, so that the additional capacity is agreed and secured now. In the event of any shortfall in capacity the

system has agreed a plan B which will be deployed in October if necessary. The local delivery system partners are:

• 650,000 population (approximately)

• 3 CCGs: Portsmouth CCG; South East Hampshire CCG; Fareham & Gosport CCG

• 1 acute district general hospital: Portsmouth Hospitals Trust

• 2 Community and mental health providers: Solent NHS Trust; Southern Health NHS Foundation Trust

• 1 Ambulance Trust: South Central Ambulance Service

• 2 local authorities: Portsmouth City Council; Hampshire County Council

• 1 out of hours provider: Partnering Health Limited

• 59 General Practices


4

This map of the urgent & emergency care pathway illustrates our approach to better understanding the drivers of performance - while symptoms are most visible at QAH, root causes could lie in any part of the pathway

GP

Population

Primary Care

Wider determinants of health

Joint Services

Discharge to

assess (D2A)

Long term

condition hubs

Enhanced care

home team

Reablement Neighbourhood

teams

Third Sector Housing

Education

Unemployment

Other…

Out of Hours / 111

Ambulance

See and treat Convey

GP

GP

Acute Care at QAH

ED

-Adults

-Paeds

Ambulatory

Frailty

Acute MH AU

Psych liaison

GP streaming Dis

charg

e a

ctio

ns

Inpatients

Admission avoidance

Community Services

Mental Health

Social Services & Self-funded

Community

nursing Therapies Rapid response

Community

hospitals

Specialist rehab

facilities

Inpatient MH Community MH

teams Crisis response

EUPD

Nursing homes Residential

homes Domiciliary care

Social workers Equipment Other…

Symptoms (performance) become most visible at QAH,

e.g., Ambulance handover delays, ED 4 hour performance,

MFFD & delayed transfers of care (DTOC).

Root causes (capacity, efficiency) could lie in any part of

the U&EC pathway. The project aims to link root causes in

any part of the system to symptoms, to identify where

capacity or efficiency should be addressed.


Key System Resilience Roles

Key System Resilience Roles

Central system resilience

operational Lead

[email protected]

Sarah

Malcolm

Associate Director Unscheduled & Out of Hospital Care

(Fareham & Gosport and South East Hampshire CCGs)

System Resilience Officer

[email protected]

02392 212402

Chloe

Weaver

Programme Support Officer Urgent and Emergency Care

(Portsmouth and South East Hampshire CCGs)

A&E Delivery Board Chair Mark

Cubbon

CEO (Portsmouth Hospital NHS Trust)

Urgent and Emergency Care

Senior Responsible Officer

Sarah

Austin

Chief Operating Officer and Commercial Director, (Solent

NHS Trust)

System Resilience Senior

Responsible Officer

[email protected]

Sara Tiller Managing Director, Fareham & Gosport and South East

Hampshire CCGs

5 Page 5 of 399 Winter Plan 2018 vs 7.pdf

Overall of 247

mailto:[email protected]



Key System Resilience Roles: Executive Escalation Team

Accountable for the management of Urgent & Emergency Care and having a direct relationship with the CEO of

the Acute Trust

Designated Doctor Mark Roland Associate Medical Director Portsmouth Hospitals NHS Trust

Designated Nurse Theresa Murphy Chief Nurse Portsmouth Hospitals NHS Trust

Designated Operational Manager Paul Bytheway Chief Operating Officer Portsmouth Hospitals NHS Trust

A local cross-system winter operations team, at a level of seniority sufficient to commit organisational resources

Designated Senior Manager responsible for

Urgent & Emergency Care

CCGs

Sara Tiller Managing Director Portsmouth, Fareham & Gosport and South East Hampshire CCGs

Designated Local Authority Lead

Hampshire

Karen Ashton Integrated Services Director Hampshire County Council

Designated Local Authority Lead

Portsmouth

Andy Biddle Interim Director of Adult Social Care Portsmouth City Council

Designated Senior Operational Lead

South Central Ambulance Service

Tracy Redman Head of Operations South Central Ambulance Service

Designated Community Provider Senior

Operational Lead

Solent NHS Trust

Sarah Austin Chief Operating Officer Solent NHS Trust

Designated Community Provider Senior

Operational Lead

Southern Health

Barry Day Chief Operating Officer Southern Health Foundation Trust


Overall of 247

The Portsmouth & South East Hampshire Care System experienced significant pressures over the Christmas and

New Year period of 2017/18. The system remained at Opel 4 from 27th December 2017 – 8th January 2018 with

the requirement of critical incident to be declared on Sunday 31st December 2017.

A&E Planning based on Winter 2017/18 Evaluation Report

7

The following issues that contributed

to the system position

The following were

perceived to work well

Recommendations for 2018/19

• Lack of ‘Home First’ capacity which led

to delayed transfers in care.

• Lack of demand analysis and capacity

planning.

• Inadequate patient flow through the

acute system:

• Ambulances queuing

• Insufficient daily discharges

• Patient Transport Service not

booked in advance, crews

waiting around

• Lack of community capacity:

• Domiciliary Care availability

from Christmas and through

January,

• Flexible access to Victory

House & Rowans

• Staffing sickness and impact of flu.

• Ambulance soft diverts

• Relationships and

working together as a

system

• Flexing criteria for

admission to

community wards

• Ability to increase

capacity in acute and

community

• Robust review of EDDs

within community beds

• Out of Hours

supporting handover in

morning

• Acute Visiting Service

• GP Triage

• Robust demand and capacity planning.

• Investment in ‘home first’ capacity.

• Proactive approach to12 noon daily silver command

teleconference calls

• Executive Gold Command

• Adjust 999 and 111 workforce rotas accordingly and

flex staffing to meet the demand

• Ensure that all identified community and social care

beds are available for patient discharge throughout the

whole of the winter period, and criteria flexed to meet

agreed demand

• GP Out of Hours to work closely with SCAS 111

colleagues and share demand/staffing profiles in order

to deal with surges in demand

• Increase capacity in; Bridging Services, Domiciliary

Care & Community Capacity

• Increased staffing to support the off-loading of

ambulance patients

• Develop dedicated ambulance handover area

• Detailed planning for the reduction in occupancy prior

to the festive period


Demand & Capacity Modelling

8

Setting the scene

The system faced severe challenges in Winter 2017/18

Winter 2017/18 saw the Portsmouth & South East Hampshire (P&SEH) health and care system come under extreme pressure, which manifested in a number of ways. For example, in December the number of ED patients seen within four hours was 70% on average – at one point performance was as low as 49% at Queen Alexandra Hospital (QAH).

The national target is that at least 95% of patients attending ED should be admitted, transferred or discharged within four hours. The national average during this period was 85% (for all ED types), and only two hospitals were able to hit the national target – Luton and Dunstable University Hospital and Yeovil District Hospital.

Additionally, bed occupancy at QAH averaged 97% across the winter period, well above the NHSE occupancy target of 92%. On many occasions, bed occupancy was close to, or at, 100%. Further to this there were times where half of ambulance handovers were delayed for over an hour.

Since then, the system has made significant improvements

Improvements have been made since winter 2017/18 on a number of key metrics related to demand and capacity across the pathway. For example, there has been a 27% fall in the number of patients that are medically fit for discharge (MFFD) at any one point. However, ED 4-hour performance was 82% in May (for all ED types), well below the England average of 90% and the target of 95%. Bed occupancy at QAH at the start of June 2018 was also high at 96%.

Short-term assessment

However, demand is still expected to outstrip capacity next winter

Despite the improvements that have been made in the system, winter 2018/19 will again be challenging for P&SEH and demand will continue to outstrip capacity. We forecast that there will be a peak acute bed capacity gap of 114 beds QAH in the first week of January 2019 to meet 92% bed occupancy. Demand will also outstrip capacity for community, social care, and mental health services.

Our modelling has shown that at no point will acute capacity be sufficient to meet 95% bed occupancy. From the start of January until March, demand for beds is expected to be in excess of 100% occupancy.

Note that this is under a ‘do nothing’ scenario, which assumes that current measures put in place will continue to be delivered, but no further improvements will be made.

Root causes of urgent and emergency care pathway performance

Our analysis has identified a number of root causes of performance in the system. However, the main underlying cause is that the P&SEH health and care system has significantly more patients who are stranded or super-stranded than its peers. Therefore there is room for improvement with complex discharges through increasing out-of-hospital (OOH) capacity and improving processes throughout the pathway.

There is also a small opportunity associated with patient flow and effective discharge of ‘simple’ patients.

Both our analysis and regional analysis conducted by NHS Improvement (NHSI) shows that there is a clear link between bed occupancy and Emergency Department (ED) performance. Through increasing OOH capacity and through improving processes, acute beds will be freed up and consequently ED performance will be enhanced.

114

85

36

-40

10

60

110

160

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

Dec

-18

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Be

d g

ap

QAH: Forecast weekly average bed gap

92% occupancy 95% occupancy 100% occupancy


Short-term assessment (continued)

We have worked with stakeholders from across the system to develop a plan for winter 2018/19 that can close the capacity gap, achieve 92% bed occupancy, and achieve 90% ED 4-hour performance. This has been agreed across the system as an achievable goal, within the timeframe, and success will require full collaboration across the system and delivery at pace. The peak acute bed gap as predicted is 114 beds, however there is also a desire to convert a single ward into flexible capacity. Allowing it to be closed during summer and gradually reopened through winter. Therefore the total peak winter bed gap is 144 beds per week.

Our analysis has identified and quantified four key opportunities to focus interventions around, in order to deliver the improvements across the system:

90 beds to be released through improving complex discharges

This is the greatest area of opportunity in the system to help close the acute bed gap. Our analysis of long-stay patients in comparison to peers, as well as audits conducted by Newton Europe, conclude that there is a significant opportunity to improve complex discharges (an opportunity ranging rom 135 to 237 beds).

Therefore a complex discharge improvement target of 90 beds is seen as achievable. The aim is to reduce the number of long-stayers at QAH by improving discharge processes and right-sizing out-of-hospital capacity. Delivering this requires maintenance of existing Agincare and bridging support, whilst commissioning further packages of domiciliary care and community capacity (see across).

20 beds to be released through improving daily flow

A further 20 beds could be also released by improving daily flow in the hospital to reduce the length of stay for ‘simple’ discharges, e.g., through continuing the implementation of Red2Green and SAFER.

10 beds to be released through avoiding admissions

10 beds could be avoided through fewer patients being admitted as an emergency through targeted interventions such as care home admission avoidance schemes.

30 beds to be reopened as escalation capacity through winter

During peak winter periods it has been proposed that escalation capacity will be opened so that 92% bed occupancy can still be achieved.

Out-of-hospital capacity requirements

We have determined the services that patients no longer requiring acute care at QAH would have required, if they had been discharged earlier – this was done through the use of audits conducted by Newton Europe across the P&SEH system. These estimates are summarised in the table below, and have been refined further by each local system (Portsmouth and Hampshire) – see Part D. Note that these estimates also assume a level of efficiency improvement in the community sector, as determined by bed audits.

Through implementing a number of changes, the health and care system can close the capacity gap this winter, achieve 92% bed occupancy and 90% in ED 4-hour performance

9

144

90

20 10

30

114

30

0

20

40

60

80

100

120

140

160

Peak winterbed gap

Reducecapacity

Total winterbed gap

Improvecomplex

discharges

Improvedaily flow

Avoidadmissions

Increasecapacity

Nu

mb

er

of

be

ds

Closing the acute bed gap in winter

30 OOH capacity requirements Portsmouth SEH/F&G Total

Reablement/dom. care hours (per week) 200 600 800

Community beds 4 13 17

Care home beds 4 13 17

Therapy/rehab visits (per week) 43 130 173


10

Improving Complex Discharges Responsible Forum – Rapid Improvement Group

SRO – Sarah Austin, Chief Operating Officer, Solent NHS Trust

90 beds to be released through improving complex discharges

This is the greatest area of opportunity in the system to help close the acute bed gap. The analysis completed by the system and

PricewaterhouseCoopers concludes that there is a significant opportunity to improve complex discharges. Therefore a complex discharge

improvement target of 90 beds is seen as achievable. The aim is to reduce the long-stayers at QAH by improving discharge processes and

right-sizing out-of-hospital capacity. Delivering this requires maintenance of existing Agincare and bridging support, whilst commissioning

further packages of care and community capacity.

In response to the above, both Portsmouth and Hampshire Systems have turned the requirements for improving complex discharges at QAH

into local delivery plans;

Portsmouth City Council & Solent NHS Trust

Requirement Impact Proposal £1.252 m investment required

Pathway 1: Sustain current provision [Agincare]

N/A • 350 care hours p.w. through AginCare • MFFD/blue team • Social care assessment capacity in QA

Pathway 1: Additional provision

19 beds • 606 care hours p.w. (TDS x 2, 45 min sessions)

Pathway 2 0 beds • 0 beds

Pathway 3 4 beds • 4 care home beds delivered through transformation at Jubilee House (opportunity associated with EoL patients)

Enablers • PRRT to support Agincare • CHC nurse (band 7) • Agincare (24 hour live in)

Total 23 beds

Hampshire County Council & Southern Health

Requirement Impact Proposal £2.799m investment required

Pathway 1 56 beds • 330 care hours p.w. through reablement efficiencies (HCC)

• 250 care hours p.w. (HCC reablement) • 200 care hours p.w. (HCC reablement) • 11 WTE community rehabilitation

Pathway 2 0 beds • No additional community beds

Pathway 3: Sustain

current provision [FAB Beds]

N/A • 1,000 care hours, 2 care home beds p.m. (CCG) • 135 additional DSTs (CCG)

Pathway 3: Additional provision

13 beds • Potential re-commissioning of current FAB beds (CCG

Enablers • Enhanced in-reach support (SHFT) • Support util. 3rd sector/council services • Increasing ‘health connector’ avail. (SHFT) • Increase in resilience in comm. nursing • Enhanced Independent Mental Capacity Advocate

(IMCA) support • Increased temporary assessment capacity • Mobilisation and service manager (SHFT) • Joint Hosp. Prev. Service [JHPS] (HCC) • SCAS social work support

Total 69 beds


Integrated Urgent Care

11

There is national focus on Admission Avoidance for Winter 2018/19 as NHS England/Improvement audits

repeatedly demonstrate that patients with long stays in hospital may not have required admission in the

first instance. The ‘Reducing Long Stays in Hospital’ letter sent to all local delivery systems reaffirms the

10 days leads to 10 years’ muscle ageing for people most at risk.

In response to this the PSEH System have translated the letter into an action plan to ensure robust

mitigations are in place to avoid and reduce long stays in hospital. A fundamental part for the delivery of

this plan sits with Admission Avoidance.

The key areas for maximising Admission Avoidance are bulleted below and the next four slides provide

the actions each area are taking in light of the letter.

• Primary Care

• 111

• Out of Hours

• Pharmacy

• Walk in Centres

• Minor Injuries Unit


12

Integrated Urgent Care Forecasted Demand The attachment below shows the budget demand forecast for 111 for the duration of the Winter 2018/19 period.

This has been modelled on last years activity with a 3% uplift. Adjustments will be made to a short term forecast

at the 6 week planning stage which will reflect more recent trends in demand.

The below table shows the forecasted demand for Type 1 and 3 attendances at the front door on a low level of +4%. Currently for September

2018, Type 1 attendances have increased to +7.9% and Type 3’s to 8.0%. For the year to date the position is approximately 4.6%. It is important

to note that these figures do not take into consideration the winter schemes that aim to reduce attendances/admissions.

Month

Partnering Health Limited

Fareham & Gosport/South East Hampshire

PPCA

Portsmouth

Total Calls PCC HV Total Calls PCC HV

Oct 11,392 2,049 2,184 To be populated – October 2018

Nov 11,887 2,128 2,214

Dec 18,941 3,549 3,236

Jan 13,346 2,466 2,458

Feb 11,504 2,073 2,135

Mar 12,929 2,370 2,409

South Central Ambulance Service 999 forecasted demand to be received – October 2018


13

Integrated Primary Care

Fareham & Gosport CCG South East Hampshire CCG Portsmouth CCG

Extended Access Hubs

99 Hours per week across 2 hubs

Fareham Hub – Minimum of 6

appointments per hour dedicated to

same day access

Gosport Hub – Minimum of 5

appointments per hour dedicated to

same day access

* The provider will have flexibility to increase

access during times of pressure within the

system E.G. bank holidays, Christmas, New

Year and this would be following discussion

with the commissioner *


109 Hours per week across 3 hubs

Petersfield – Minimum of 3 appointments

per hour dedicated to same day access

Bordon Spoke – Minimum of 2

appointments per hour dedicated to same

day access

Waterlooville – Minimum of 6


day access


access during times of pressure within the

system E.G. bank holidays, Christmas, New

Year and this would be following discussion with

the commissioner *


45.5 Hours per week within 1 hub

Lake Road Health Centre – Minimum 4


day access


access during times of pressure within the system

E.G. bank holidays, Christmas, New Year and this

would be following discussion with the

commissioner*

Enhanced Primary Care

386 Hours per 4 week rota across 15

practices

Enhanced Primary Care

500 Hours per 4 week rota across 19

practices

Extended Hours Directly Enhanced

Services (DES)

Hours per 494 week rota across 16

practices Page 13 of 399 Winter Plan 2018 vs 7.pdfOverall of 247

Winter Countdown Plan

14

The Winter Countdown Plan consists of focussed actions that need to be taken prior to, and during the winter period. All partner organisations

that form the Portsmouth & South East Hampshire Care System are committed to delivering the plan and have all contributed to the actions

and associated timescales. The A&E Operational Group will monitor and oversee the actions in place through the use of Gateway Review

Sessions, commencing in September 2018.

Gateway Review 1 - Thursday 13th September 2018

Management & Prevention of Infection Control

Demand & Capacity Management

Gateway Review 2 – Thursday 11th October 2018

Exercising Plans

Community Capacity Management Checkpoint

System Resilience

Gateway Review 3 – Thursday 8th November 2018

Primary Care Capacity Management Checkpoint

Pharmacies Capacity Management Checkpoint

Actions to be taken to address non-conveyance, front door and flow, and discharge

Gateway Review 4 – Thursday 22nd November 2018

South Central Ambulance Service Capacity Management Checkpoint

Portsmouth Hospitals Trust Capacity Management Checkpoint

Finalising the Operational Plan with provider organisations’ actions

Gateway Review 5 - Thursday 10th January 2018

Recovery actions post Christmas/New Year

Plan for de-escalating and closing additional capacity by March 2019 Page 14 of 399 Winter Plan 2018 vs 7.pdfOverall of 247

15

Winter Countdown Plan Actions to be progressed in advance of

Gateway 1 Review

Action Lead Deadline Status Comments

Infection Prevention/Management

All individual organisations to submit their Flu Plans All 13.09.18

All individual organisations to submit their Outbreak Plans All 13.09.18

Refine the PSEH Flu Standard Operating Procedure Chloe Weaver 13.09.18 Reviewed 02.08.18

Develop a collaborative system-wide promotion of Flu

Prevention (Flu Campaign, Staff Flu Vaccination Promotion)

David Barker 13.09.18

Produce an advice and guidance plan for the Care Home

Forum around the management and prevention of Flu

Anne-Marie

Appleton

Emma Aldred

13.09.18

Review robustness of infection prevention plans and identify

risks and associated mitigations

A&E Ops Group 27.09.18

Demand & Capacity Management

Review the Winter Capacity Plan in conjunction with the

forecasted demand, and identify interventions for dates that are

predicted to be more challenged i.e. Black Monday


Identify and escalate any risks associated to the following;

Admission Avoidance

Front Door & Flow

Discharge

Community/Social Care



16


Gateway 2 Review


Testing the robustness of the Plans

Test the robustness of the Winter Assurance Plan 2018/19 at a

system-wide Table Top Exercise with EPRR and Operational

Leads.

Chloe Weaver 04.10.18

Test the robustness of the PSEH Surge & Escalation Plan at a

system-wide Table Top Exercise with EPRR and Operational

Leads.


Scrutinising the robustness of provider plans

Community Capacity Management Checkpoint:

Solent NHS Trust

Southern Health Foundation Trust


Social Care Capacity Management Checkpoint:

Portsmouth City Council

Hampshire County Council


System Resilience

Develop a system-wide Communications Plan and submit to

A&E Operational Group for review. A&E Delivery Board to sign

off plan.

David Barker 11.10.18

Set up training sessions on SHREWD for newly appointed on

call managers/directors.



17


Gateway 3 Review



Primary Care Capacity Management Checkpoint:

Fareham & Gosport/South East Hampshire Primary Care

Portsmouth Primary Care

Partnering Health Limited

Keeley Ellis

Mark Compton

Andrew Kandiah

08.11.18

Pharmacies Capacity Management Checkpoint:

Medicines Management – Portsmouth

Medicines Management – Fareham & Gosport

Medicines Management – South East Hampshire

Simon Cooper

Jason Peett

08.11.18

Coordinate Operational Plan for December/January 2018/19

Agree actions to be taken forward for non-conveyance Tracy Redman 08.11.18

Agree actions to be taken forward for managing front door flow Paul Bostock 08.11.18

Agree actions to be taken forward for expediting discharges –

To include an Integrated Discharge Service Plan

Sarah Eggleton 08.11.18


18


Gateway 4 Review



South Central Ambulance Service Capacity Management

Checkpoint:

111

999

Patient Transport Service

Mark Rowell

Tracy Redman

Andy Courtney

22.11.18

Portsmouth Hospitals Trust Capacity Management

Checkpoint:

Red2Green/SAFER

Workforce

Immediate Handover Policy

FIT Team

Command & Control

Paul Bostock

22.11.18

Coordinate Operational Plan for December/January 2018/19

Final collation of on call rotas for the System for December &

January to be submitted to the System Delivery Team.


Identify any risks and articulate the impact for A&E Delivery

Board oversight.


Finalise and sign off the Home for Christmas Initiative. A&E Ops Group 22.11.18

Finalise and sign off the January Recovery Initiative. A&E Ops Group 22.11.18 Page 18 of 399 Winter Plan 2018 vs 7.pdf

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Managing Surge & Escalation throughout Winter 2018/19

The key mechanisms used to ensure resilience is maintained throughout Winter 2018/19 have been outlined below;

SHREWD (Single Health Resilience Early Warning Indicator)

The tool provides real-time oversight of PSEH System pressures as well as visibility of surrounding local delivery system

pressures. This allows operational and executive leads to take proactive management of surges in demand and/or

reduced capacity.

Local Escalation Framework (PSEH Surge & Escalation Plan) (Appendix A)

In conjunction with the resilience tool, the PSEH Surge & Escalation Plan is the framework used for addressing the real-

time pressures highlighted on SHREWD and includes the actions to be taken by each organisation for a quicker

recovery and de-escalation. The plan combines national and local actions and guidance for each Opel Status.

Severe Weather Plan (Appendix B)

4 Day Discharge Plan / 5 Day Discharge Plan

A continued emphasis on ensuring sufficient complex and simple discharges are leaving the Acute Trust.

Whole System Teleconferences

Twice weekly whole system teleconferences are scheduled in the diary (Monday & Thursday) for operational leads to

escalate any exceptions indicated by SHREWD and outline plans for the week/weekend. These calls are chaired by the

Programme Officer for System Resilience. Further calls may be introduced if there is a need to bring partners together in

times of heightened escalation


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20

Ambulance Handover Implementation Plan

4 Key Principles

• The patient in the urgent care pathway who are at the highest risk of preventable harm are those for

whom a high priority 999 emergency call has been received, but no ambulance resource is available for

dispatch.

• Acute Trusts must always accept handover of patients within 15 minutes of an ambulance arriving at the

ED or other urgent admission facility (e.g. AMU/SAU)

• Leaving patients waiting in ambulances or in a corridor unsupervised by ambulance personnel is

inappropriate.

• The patient is the responsibility of the ED from the moment that the ambulance arrives outside the ED,

regardless of the exact location of the patient.


PSEH System Flu Plan

During Winter 2017/18 the Portsmouth & South East Hampshire Care System were burdened by Flu

which had a significant impact on the elderly and student population. Historically it is nationally

recognised that the UK will see the same impact and follow the pattern that Australia see a few months

earlier. The high risk groups which are mitigated in the overarching PSEH System Flu Plan are as

follows;

• Children between six months and five years old

• People living with long term conditions which increase the risk of complications from the flu

• Pregnant women

• People over the age of 65 (elderly)

A number of Flu Prevention mitigations have been put in place and ALL of the PSEH Workforce are

encouraged to have the Flu Vaccination with a number of clinics set up at various locations within the

locality. The below embedded document is the PSEH standard operating procedure for managing

Pandemic Flu.


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PSEH System Infection Control Plans

22

Organisation Plan Reviewed Date

Portsmouth Hospitals Trust To follow

Southern Health Foundation Trust

August 2018

Solent NHS Trust August 2018

South Central Ambulance Service

August 2018


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Portsmouth & South East Hampshire Health and Care

Winter communications plan: SUMMARY

• All organisations working together – coordinated approach to enhance impact, avoid

duplication, offer clear and consistent advice.

• Built around winter planning principles of PREVENTION (focus on flu), PREPARED (supporting

smoother, smarter system working around urgent care) and PERFORMANCE (ensuring we

respond to reputational issues in a coordinated, responsible way)

• Mix of nationally led and local initiatives – our plan has five main areas of focus (see overleaf)

• Builds on what worked well with some new elements, too – eg promoting new schemes

• Social media will be a big focus; local media support sought too

• Funding discussions needed – plan can be more effective if resourced appropriately

• Reputation management will be key – NHS E/I focus on system rather than solely acute care

• Big focus this year on staff – what role they can play, how we can equip them with the

information they need, how we can encourage flu jab uptake and how we can all work

effectively together as one system.


Portsmouth & South East Hampshire Health and Care Five main elements of the plan

GET YOUR FLU JAB

HELP US HELP YOU

LOCAL OPTIONS AND

CHOICES

BUILDING CONFIDENCE

HOW STAFF CAN HELP

• National campaign – launches September; Public Health England resources available • Public facing – support national messages and share approach across whole HIOW area

where possible; • Big push across system on encouraging staff to get flu jab

• This is the rebranded NHS national winter campaign – launches in October • ‘Stay Well This Winter’ becomes a sub-brand • Expectation is that this is supported and promoted locally – resources available • Focus on respiratory illness, LTCs and will continue to push flu jab • Includes focus on NHS111 and pharmacy with some reference to GP access early Dec

• This is our local demand management campaign, publicising urgent care options and choices • Revamped urgent care guide to promote this winter – social media campaign (can do more if

funding available) • If funding available for print costs can make available in surgeries /to anyone who has a jab • Considering possibility of winter health event in Portsmouth area to support

• Weekly coordinated message campaign as last year (media release and social media) • Regular programme of promotional stories re schemes which have been introduced to help

system cope better with winter and which are making a difference (synced with overall plan) • Need for a robust reactive handling approach if crisis hits this winter which ensures focus is

on system not just acute hospital

• New element this year is a concerted internal/staff campaign focusing on the steps staff can take to support the winter effort…tackling winter together

• Campaign built around 5 actions each individual can take to provide support – successful approach used elsewhere

• Consistent approach preferred but may need different actions for different staff groups Page 35 of 399 Winter Plan 2018 vs 7.pdf

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What you do personally can make a big difference!

5 wishes to maintain patient flow!

Have a flu jab: Having a flu jab protects you, your family, your colleagues and your patients!

Be prepared and be aware: Local Health & Care Services are planning ahead for Winter together. You can play your part by preparing now: Find out how any new initiatives may affect your role, and what alternatives to A&E are available locally in case anyone asks you.

Speak up if it’s not working: If you become aware that something has not been managed as it should, speak up. We have time to put it right if we do something now, and you will be thanked for bringing attention to the issue no matter how difficult.

Be collaborative and be flexible: All agencies are working in partnership and have equal responsibility for making the System work. We can build trust between partners if we communicate our concerns as early as possible, work to find the solution in partnership and avoid unhelpful defensive behaviour.

Make improving patient flow your priority: During ‘Home for Christmas’ all managers and staff should ensure that their priority is to have a personal impact on improving patient flow and safety during the most busy time of the year. This means reducing activity not related to improving patient flow such as email traffic and postponing meetings. For some staff and managers this will mean transferring your skills into new patient flow-related responsibilities for a short period of time.


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Local Delivery System – Key Initiatives for Winter 2018/19

The evaluation report completed following on from Winter 2017/18 indicated that the pre-emptive actions taken by the System

prior to Christmas exhausted all capacity and resource, which led to a very challenging January & February 2018.

The local initiatives planned for Winter 2018/19 aim to maintain flow prior and during to peak dates without exhausting all of the

pre-existing and additional resource. PricewaterhouseCoopers Consultants have worked with System Leads to map the peak

dates where bed occupancy levels and demand will be at its most challenged and the key initiatives for Winter 2018/19 have been

aligned to this.

Initiative Start Date End Date Status

October Half Term A plan to support the System through the first school half

term break of Winter 2018/19.

Friday 20th

October 2018

Monday 30th

October 2018

In Progress

Home For Christmas – December A recalibration plan to achieve a 92% bed

occupancy by Christmas Eve with involvement from all key system stakeholders. The

predominant focus of this campaign is to release as much bedded capacity in the

Acute and Community Beds ahead of Christmas.

Monday 17th

December 2018

Monday 24th

December 2018

In Progress

Christmas & New Year Operating Plan To support the System through the

most pressured time of the year for the NHS Urgent & Emergency Care Services.

Tuesday 25th

December 2018

Sunday 6th

January 2019

In Progress

Recovery – January Recovery plan to reduce the bed occupancy levels within the Acute Trust and

Community Wards through maximising ‘Home First’ services and reinvigorating

Red2Green. MADE Events will be established to support this.

Monday 7th

January 2019

Monday 14th

January 2019

In Progress

February Sprint – February Following on from the festive period there is an expectation that Delayed Transfers of

Care will be at its peak and therefore this initiative will aim to reduce the DTOCs

through Newton Europe methodology. All partners will be engaged in this initiative.

Monday 4th

February 2019

Monday 11th

February 2019

Not Started

Yet

System Spring Clean – March The System will collectively engage in a System Spring Clean exercise in order to

man-mark complex patients that can be worked up and progressed for Discharge or

transferred to an alternative service. The key measurement of success will be

indicated through the flow through the acute and community trusts.

Monday 4th

March 2019

Monday 11th

March 2019

Not Started

Yet


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Monitoring Delivery of the Winter Plan 2018/19

The Winter Plan will be reviewed and monitored to ensure actions are having the required impact and where changes are needed,

that they are implemented at pace. Performance review and recovery action will be undertaken at the following forums;

A&E Delivery Board – will provide the strategic steer for the management of winter in the local delivery system

• Overall review of the Winter 2018/19 Plan

• Escalation and sign off of additional winter schemes and investment where required

A&E Operational Group – will become a dedicated Gateway Meeting to review the following;

• Fortnightly analytical trends and anomalies in forecasting

• Review of schemes and the impact they are having

• Identification of additional actions that need to be undertaken

• Escalations to A&E Delivery Board where System Leads intervention is required

Seasonal Resilience & Business Continuity Group – will continue to lead on the management of system resilience

• Reviewing the accuracy of data fed into SHREWD

• Identify actions to maintain and monitor System Resilience throughout the whole of the Winter Period

• Testing the robustness of the Winter 2018/19 Plan in September 2018


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39

Appendices

Appendix Document

A – Surge & Escalation Plan

B – Severe Weather Plan


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Portsmouth and South East Hampshire Health System

24 September 2018 Pauline Philip National Urgent & Emergency Care Director NHS England Dear Pauline Thank you for your letter dated 7th September 2018, in which you request sight of our plans for Winter 2018/19. I have now had chance to receive feedback from the Accountable Officers within the Portsmouth and South East Hampshire System regarding our plans for winter and your request for information to support this response. I am pleased to advise that the development of Portsmouth and South East Hampshire plans for winter commenced in March, with the result that our local system now has a well-developed approach based on sound analysis of our capacity requirements. In addition our surge and escalation plan has been refreshed to ensure we have clear protocols, operational roles and responsibilities at senior managerial and clinical level embedded across our system. On the 20th September 2018 all system partners attended the A&E Delivery Board workshop dedicated to winter preparedness, to formally approve all our plans. In March we secured the services of PricewaterhouseCoopers to conduct a comprehensive analysis of our health and social care capacity requirements along the urgent and emergency care pathway for this year and beyond. This work was aligned with a broader investigation into delayed transfers of care involving all health and social care partners across the Hampshire and Isle of Wight STP conducted by Newton Europe. The result has been a winter Capacity Plan and agreement reached in August, from all constituent partners to contribute towards the £4.052 million resource requirement to fund the plan. This agreement has been reached despite the considerable financial challenges facing our system and the risks this may pose to the year-end position of some of our partners. In terms of the areas highlighted in your letter, we are committed to achieving the A&E and elective care targets and have developed our plans with those issues in mind. As an indication of our improving performance, it is worth noting that our system is now consistently achieving the local standard for long stay patients, despite which we have an ambition and plan to improve upon this target ahead of winter. We have been reviewing our primary care streaming activity in A&E over the last year and do not believe this pathway is as effective as it could be, hence we are aligning this work with the GP enhanced access agenda and plans across Hampshire to co-design the urgent emergency care pathway and procurement for 111. In addition a primary “redirection” pilot is being trialled at the front door of A&E, which returns appropriate patients back to primary care service as an alternative to being seen in A&E. In addition our local system influenza campaigns are in process, we are achieving the current primary care enhanced access requirements and we have secured capital funding to commence the development of a mental health assessment unit adjacent to A&E (not before winter). These developments will progress at pace.

Page 1 of 29 Winter Preparedness 2018-19 National letter and request for plans (2).pdfOverall of 247

There are five key risks facing our system which we hope to mitigate through our plans described above. These are:

1. Securing through agencies, temporary staff to mitigate the required level of “home first capacity as set out in the PSEH winter capacity plan.

2. Managing ambulance handovers during times of high demand, given the impact of current emergency department environmental constraints and home first capacity limitations on hospital.

3. Recognising the financial challenge to all partners who have contributed resources to fund the winter capacity plan at risk.

4. Lack of primary care resourcing for winter to support “acute care avoidance”.

5. NHS Continuing Health Care Pathway response. The first is being mitigated through early mobilisation, so that the additional capacity is agreed and secured now. In the event of any shortfall in capacity the system has agreed a plan B which will be deployed later this month if necessary. The second is being mitigated through our ambulance immediate handover plan and process improvements which have been implemented within the A&E department. In addition Portsmouth Hospital NHS Trust is creating additional capacity to support improvements to ambulance handover delays. In respect of the third, fourth and fifth risks, partners continue to operate diligently to balance the delivery of services with cost containment, but this is a considerable challenge I hope our plans provide assurance that our system is striving to ensure patient safety and deliver quality services as we approach winter 2018/19. All system leaders have collaborated on this plan and my response is on behalf of us all. We welcome feedback from you, and any learning or advice from other systems that could improve our plans further. Yours sincerely,

Mark Cubbon Chief Executive of Portsmouth Hospitals NHS Trust Chair of the Portsmouth South East Hampshire A&E Delivery Board CC: Sue Harriman Maggie MacIsaac Nick Broughton Graham Allen Will Hancock Linda Collie

Page 2 of 29 Winter Preparedness 2018-19 National letter and request for plans (2).pdfOverall of 247

of 1


Title of Paper Portsmouth and South East Hampshire Operating Plan 2018/19Agenda Item 10 Date of meeting 24 October 2018Exec Lead Sara Tiller Clinical Sponsor Dr B RushtonAuthor Sarah Austin


Purpose

To Note x


Executive Summary

The Local Care Partnership (LCP) has requested that the LCP Operating Plan 2018/19 is taken to and noted by the respective Boards of the Organisations within the Portsmouth and South East Hampshire Local Care Partnership. The LCP Operating Plan 2018/19 sets out:

The financial challenge across the LCP for 2018/19 and a 3 year financial plan The 5 Transformation Programmes that are in place for 2018/19 which will support the

system in delivering the financial and operational pressures Governance and Risk

The process has already started for developing the LCP Operating Plan for 2019/20.

Recommendations The Joint Governing Body is asked to note the information set out in the paper and formally receive the LCP Operating Plan





Page 1 of 110 PSEH LCP Operating Plan 1819 cover sheet.docxOverall of 247

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Portsmouth and South Eastern Hampshire Local Care Partnership (LCP)

Operating Plan 2018/19

10th July 2018Needs all organisations Logos and front cover pic.

Item 11.2

Page 1 of 4110 PSEH LCP Operating Plan 1819.pptxOverall of 247

• Executive Summary 3• Operating Plan Alignment 4• System Finances 5• Key LCP Programmes 8

– Community Health and Care 9– Urgent & Emergency Care 14– Mental Health 18– Elective Care 23– Maternity and Child Health 28

• Delivery of Operating Plan Standards 32• Governance 33• Key Risks and Issues 35• Annex A – Individual Organisation Operating Plans 36• Annex B – LCP Programme Triangles 37

Slide No

2

PSEH LCP Operating Plan Contents


The Portsmouth and South Eastern Hampshire (PSEH) Local Delivery System (LCP) Operating Plan sets out ‘what’ the PSEH LCP will deliver in 2018/19 and ‘how’ this will be done in order to meet the objectives that have been set out in the LCP Improvement Plan.

‘The What’

The high level objectives from the Improvement Plan state that as the organisations with responsibility for health and care in Portsmouth and South East Hampshire we have come together to deliver the following objectives:

❶ To deliver long-term improvements in health and care outcomes, supporting residents to stay well, reducing inequalities and reducing avoidable illness. ❷ To improve the quality and safety of health and care services, with all services assessed by the CQC and Ofsted to be ‘good’ or better, and increasing proportions of people reporting a positive experience of, and greater involvement in their care. ❸ To deliver the agreed waiting time standards2 for health and care services, by making fast and tangible progress in urgent and emergency care reform, strengthening general practice, community and social care services, improving mental health and planned care services. ❹ To manage services within the money available, delivering substantial system efficiencies and moderating the growth in demand for health and care services.

In order to deliver these objectives we committed to:

❶ Agree and deliver a single system improvement plan to restore and improve service quality, performance and financial health, with clear and agreed priorities. The immediate priority is to deliver significant improvements in urgent and emergency care performance. ❷ Establish a new way of working together, where our organisations and teams are aligned around a common purpose, with clarity about roles and responsibilities, with stronger operational ‘grip’ and a culture that enables leaders and frontline staff to work together to drive and deliver the improvement plan. As providers and commissioners we are increasingly taking collective responsibility for population health and resources in Portsmouth & South East Hampshire.

PSEH LCP Operating Plan Executive Summary

3Page 3 of 4110 PSEH LCP Operating Plan 1819.pptx

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With all organisations committed to working as part of the Portsmouth and South Eastern Hampshire Local Delivery System (PSEH LCP) it is fundamental that we have demonstrated alignment and delivery of system priorities through our individual organisational operating plans

Through our respective individual plans we have:q Demonstrated alignment of key assumptions on income, expenditure,

activity and workforce between commissioners and providers within the PSEH LCP

q Ensured that organisational plans underpin and together express the PSEH system’s priorities

q Produce together a credible plan that delivers the system control total

“The task for commissioners and providers is to update the 2018/19 year of existing two-year plans…to ensure that operating plans…are the product of partnership working across STPs, with clear triangulation between commissioner and provider plans and related contracts”

Refreshing NHS Plans for 2018/19

PSEH LCP Operating Plan Operating Plan AlignmentThe Portsmouth and South Eastern Hampshire (PSEH) Local Delivery System (LCP) Operating Plan sets out the areas where the LCP will bring added value through closer system working. This operating plan is underpinned by each of the constituent organisations individual operating plans.


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PSEH LCP Operating Plan System Finances – Control Totals

Notified Planned

18/19 FOT (£000)

CSF/PSF (£000)

In Year FOT (£000) (Control

Total)18/19 FOT (£000)

CSF/PSF (£000)

In Year FOT (£000)

Savings Requirement (£000)

Savings Requirement

%

F&G (4,000) 4,000 0 (4,000) 4,000 0 14,407 5.2%

Portsmouth 0 0 0 0 0 0 10,768 3.4%

SE Hampshire (2,500) 2,500 0 (2,500) 2,500 0 13,271 4.4%

Commissioner Total (6,500) 6,500 0 (6,500) 6,500 0 38,446 4.3%

Portsmouth Hospitals NHS Trust 6,844 18,887 25,731 (29,900) 0 (29,900) 35,280 5.8%

Solent NHS Trust: 55% share (1,425) 891 (534) (1,425) 891 (534) 3,901 3.7%

Southern Health NHS Foundation Trust: 20.5% share (145) 838 693 (145) 838 693

2,624 4.0%

Provider Total 5,274 20,616 25,890 (31,470) 1,729 (29,741) 41,805 5.4%

Total (1,226) 27,116 25,890 (37,970) 8,229 (29,741) 80,251


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2018/19 System Savings Plan

19/10/2018 6

Planned Savings

£mWorkforce Transformation 14.6Procurement 6.1Pharmacy and Prescribing 7.6Productivity and capacity 2.5Elective & Outpatients 5.9Unscheduled Care Pathway 2.5New Care Models 3.1Non-pay & Commercial 3.4Other PHT 5.9Continuing Healthcare 4.0Primary Care 2.0Income Generation 1.5Other CCG 3.3Unidentified 17.9

TOTAL 80.3

PSEH LCP Operating Plan System Finances – Savings Plans


3 Year System Financial Plan

19/10/2018 7

2018/19 2019/20 2020/21

Income/ allocation Expenditure

(Deficit)/ surplus


(Deficit)/ surplus


(Deficit)/ surplus

£'m £'m £'m £'m £'m £'m £'m £'m £'m

Portsmouth Hospitals NHS TrustGross Spend 539 604 561 609 593 617CIP -35 -30 -28 -20 -25 1

Solent (55%)Gross Spend 102 105 103 106 105 108CIP -3 0 -3 0 -3 0

Southern (20.5%)Gross Spend 64 65 66 66 67 67CIP -3 2 -2 2 -1 1

PROVIDER TOTAL 705 733 -28 730 748 -18 765 763 2

CCGsGross Spend 895 941 915 950 950 968QIPP -39 -7 -35 0 -18 0

CCG TOTAL 895 902 -7 915 915 0 950 950 0

TOTAL SYSTEM SAVINGS REQUIREMENT -80 -68 -47 SYSTEM SURPLUS/ (DEFICIT) -35 -18 2

PSEH LCP Operating Plan System Finances – Spend


All PSEH organisations are committed key partners of the PSEH LCP and the Operating Plan demonstrates the systems contribution to delivery of the PSEH LCP objectives. Through this, the Plan aligns and contributes to delivery of the priorities set out within:• The 2018/19 planning guidance• The Hampshire and Isle of Wight (HIOW) Sustainability and Transformation Partnership plan• The Improvement and Assessment FrameworkIn 2018/19 these will be delivered across 5 PSEH LCP priority Programmes. These are:

The PSEH Operating Plan:

• Summarises the key LCP programmes of work as above• Describes ‘how’ these will be achieved through delivery of the underpinning projects - outlining the milestones;

KPIs; timelines; associated impact (activity and finance); risks; outcomes etc. for each• Lays out the appropriate level of Governance that is in place to manage and monitor delivery • Provides assurance that the appropriate level of reporting is provided to the LCP Board, individual organisations

Boards, STP, NHSE/NHSI to provide the level of assurance required

PSEH LCP Operating Plan Key LCP Programmes

‘The How’

Urgent Care Elective Care Mental Health Maternity and Child Health

Community Health and Care


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To prevent ill health, increase early intervention and build the strong, sustainable primary and community care services required to proactively manage the needs of the population at home and in the community

•Enhanced Care Home Team roll out

•Front Door Admission Avoidance

•LTC Hub Development

•Neighbourhood Teams (Integrated Care Teams)

Deliverables:

Reduce avoidable acute care episodes by delivering LCP care home and end of life programmes

Redesign community services to deliver sustainable models to maintain health and independence of frail elderly

Integrated health and care model to enable people to stay independent and better manage their LTCs.

IAF Measures impacted:Patient experience of GP servicesPrimary care workforce - GPs and practice nurses per 1,000 populationPrimary care accessEffectiveness of working relationships in the local systemDelayed transfers of care attributable to the NHS and Social Care per 100,000 population% patients admitted, transferred or discharged from A&E within 4 hoursEmergency admissions for urgent care sensitive conditions per 100,000 populationInjuries from falls in people aged 65 and over per 100,000 populationPersonal Health Budgets per 100,000 population

Programme Quality and Performance Outcomes and Benefits§ Extended access to GP services for 100% of population Reduction in avoidable acute care episodes

§ Reduction in ambulance call outs/conveyances and subsequent admissions

§ Increased effectiveness of ED and MAU to avoid ED attendances unnecessarily converting into admissions

1819 Project Focus:

9

Community Health and CareProgramme

Detailed in individual Organisational Operating Plans (See Annex A)

PSEH LCP Operating Plan Community Health and Care


Programme: Community Health and CareEnhanced Care Home Team Roll Out

10

10

Aims & Objectives•Expand the existing care home team models in each of the localities in a way that is best likely to have maximum impact. Work with the care homes in each area to develop a trusted assessor approach to supporting 7 day per week discharge.

•Reduce avoidable acute care episodes by delivering LCP care home and end of life programmes. Key enabler is delivery of a shared care record across all localities.

Deliverables

•Reducing ambulance call outs, conveyances and subsequent admissions of care home residents where these could be better managed in the community.

•Reduction in conveyances, A&E attendance, reduced admissions, reduced LoS, better patient experience

•More patients being cared for in their usual place of residence, fewer unnecessary hospital admissions, and free up rehabilitation beds for complex patients who cannot be cared for at home.

Key actions & timelines Q1 1819

Q2 1819

Q3 1819

Q4 1819

Completion of the business case to support roll-out of the team; to include data and financial analysis. This will include review of the effectiveness of the Red Bag scheme

Red bag scheme to be established as business as usual, based on evaluation, across all relevant homes, ambulance trust and acute and community hospitals

Roll-out of the enhanced care home team, as agreed

Pilot a trusted assessor model to support 7 day a week discharge for care homes in one or more localities.


Programme: Community Health and CareEnhanced front door admission avoidance team

11

11

Aims & Objectives:

• Increasing the effectiveness of ED and MAU to avoid ED attendances unnecessarily converting into admissions, where there is not a clinical lead.

•Reduce the conversion rate to 30% through enhanced FIT and appropriate ambulance conveyance and handover

•Reduction in inappropriate admissions where this might be due to a social care need, ensuring existing care packages can be kept open for 5 days and increasing the number of people able to return home with the same package

• Increase the use of the voluntary sector to support people to return home safely following an ED attendance•Strengthen and increase the ability of the FIT team to manage short stay admissions, of less than 24 hours.

Deliverables:

•A Frailty Intervention Team is based within A&E to identify and screen those at risk of frailty at the front door of hospital. To ensure frail patients are supported to return to home, or their place of residence sooner.

Key actions & timelines: Q1 1819

Q2 1819

Q3 1819

Q4 1819

Increase social work support into ED, with additional admin support to also identify those people who have an existing package which has been kept open for the first few days of admission and pro-actively work with teams to identify possible PDDs within this timeframe

Pilot use of home from hospital VCS services from ED.

Work with FIT team to identify blocks in achieving 72 hour discharges and identify opportunities to increase the numbers discharged within 72 hours.


Programme: Community Health and CareReduction in SCAS non-conveyance to QA

12

12

Aims & Objectives:• Improve the ability of paramedic teams to see, treat and refer rather than convey to QAH ED, thereby reducing conveyance of patients who could be better managed in community settings

•Reduce end of life conveyances • Increase use of effective anticipatory care planning for key cohorts of patients• Improved information sharing between primary care and SCAS teams through use of the summary care record

Deliverables:•Reduction in conveyances, A&E attendance, reduced admissions, reduced LoS, better patient experience •More patients being cared for in their usual place of residence, fewer unnecessary hospital admissions, and free up rehabilitation beds for complex patients who cannot be cared for at home.


Q2 1819

Q3 1819

Q4 1819

To be determined by first meeting of project group


Programme: Community Health and CareLong term conditions hub development

13

13

Aims & Objectives:•To improve long term condition management, (including self care) within primary and community care. Ensuring more proactive care model for respiratory care, diabetes and heart failure, based on agreed inclusion criteria to improve patient outcomes and avoid hospital admissions in future.

•Establish locality based , primary care led models of LTC care•Agree secondary care input across PSEH•Agree single model for community based specialist services

Deliverables:• Patients receive enhanced support and care planning, improving outcomes and enabling patients to

manage their conditions, maintaining independence•Positive impact on frailty pathway through increased GP capacity to support this cohort •Reduced clinical risk through all staff accessing full medical records


Q2 1819

Q3 1819

Q4 1819

To be determined by first meeting of project group


To improve urgent care access and performance, reduce demand, reduce harm, and manage clinical variation, enabling the system to meet A&E and Delayed Transfers of Care targets

High impact change discharge actions

GP streaming in the Emergency Department (Urgent Care Centre)

Deliver new 111 integrated urgent care model

Deliverables:Early discharge planning; Systems to monitor flow; Integrated discharge teams; Home first D2A; 7 day services; Trusted assessorsFocus on choice; (Enhancing health in care homes)

Urgent care centre development to make it more effective, improve the efficiency of GP streaming in the Emergency Department, improve A&E Waiting times.

Co-design and procure an effective 111 integrated urgent care service in collaboration with Hampshire partners

Programme Quality and Performance Outcomes and Benefits

§Achieve 85% A&E access target by September 2018§ Improved patient experience with care being given in the right place at the right time – Home first wherever possible

§Delayed transfers of care – Reduced to 3.5% national target§Reduction in excess beds days § Inpatient admissions growth reduced by 2% §Stranded and super-stranded reduced to 40% of inpatient population

1819 Project Focus:

IAF Measures impacted:% patients admitted, transferred or discharged from A&E within 4 hoursDelayed transfers of care attributable to the NHS and Social Care per 100,000 pop’nEmergency bed days per 1,000 population

Emergency admissions for urgent care sensitive conditions per 100,000 pop’nEmergency admissions for chronic ambulatory care sensitive conditions per 100,000 populationAmbulance waits 14

Urgent & Emergency CareProgramme


PSEH LCP Operating Plan Urgent and Emergency Care


Programme: Urgent & Emergency CareDischarge to assess (D2A) – 8 High Impact Changes

15

15

Aims & Outcomes• The eight High Impact Changes identify and provide a transformational change model which is nationally recognised as best practice. The High Impact Changes provide a framework which evidences best practice for creating and maintaining discharge flow, such as early discharge planning, multi-disciplinary teams, trusted assessors and care home teams

Deliverables:


Q2 1819

Q3 1819

Q4 1819

Embed ‘Why not home, why not today?’ culture across all teams and at ward level

Increase use of proportional assessments

Introduction of 5Qs and implementation of new CHC guidance

Introduce Trusted Assessors

High Impact Change (HIC) Outcome

HIC 1: - Early discharge planning Outcome - early assessment of discharge needs and more people discharged in line with EDD

HIC 2 - Systems to monitor patient flow Outcome - Improved ability to manage patient flow

HIC 3 - Multi-disciplinary/multi-agency discharge teams, including the voluntary and community sector

Outcome - single team approach within IDS and streamlined process

HIC 4 - Home first/discharge to assess Outcome - increase in numbers of people discharge home through D2A pathways and reduced assessments in hospital

HIC 5 Seven-day service Outcome - increase numbers of weekend discharges

HIC 6 - Trusted assessors Outcome - implementation of a trusted assessor approach to support D2A.

HIC 7 - Focus on choice Outcome – improved clarity for patients and their families and consistency in expectations

HIC 8 Enhancing health in care homes Outcome – reduced admissions from care homes and improved discharge processes


Programme: Urgent & Emergency CareGP streaming in the Emergency Department (Urgent Care Centre)

16

16

Aims & Outcomes• Urgent Care Centre development to make it more effective• Improve the efficiency of GP streaming• Continue the delivery of co-located out of hours services

Deliverables:• Reduction in A&E attendances• Improved A&E triage, treat and discharge, achieve the 85%/4hour target. • Achieve flow of 60 patients per day.


Q2 1819

Q3 1819

Q4 1819

Relocation of Urgent Care Centre

Review of redirection model


Programme: Urgent & Emergency CareDeliver new 111 integrated urgent care model

17

17

Aims & Outcomes• Co-design and procure an effective 111 integrated urgent care service in collaboration with

Hampshire partners.

Deliverables• Reduced A&E/UTC attendances• Reduced conveyances• Improved patient experience• The right capacity and skill sets to support an increase in hear and treat; calls referred to a clinical

advisor


Q2 1819

Q3 1819

Q4 1819

Co-design process to test, adapt and refine models of care

Robust evaluation of models

Direct award of interim, fixed-term contracts to cover the time between current contract expiry dates and 31 May 2021

Competitive procurement process to resume in Quarter 3 of 2019/20 to enable the new IUC service to mobilise by 01 June 2021


Acute MH Assessment Unit

Crisis Pathway

Emotionally Unstable Personality Disorder (EUPD)

MH Acute Beds

Deliverables:

Deliver a mental health assessment unit in the Emergency Department.

Improve access to 24/7 mental health crisis care for both community and acute provisions.

Improve EUPD pathways

Implement STP acute mental health locality bed model and repatriation

IAF Measures impacted:Out of area placements for acute mental health inpatient care - transformationPeople with 1st episode of psychosis starting treatment with a NICE-recommended package of care treated within 2 weeks of referralPercentage compliance with a self-assessed list of minimum service expectations for Out of Area Placements, weighted to reflect preparedness for transformationPercentage compliance with a self-assessed list of minimum service expectations for Crisis Care, weighted to reflect preparedness for transformation.Crisis care and liaison mental health services transformation

To improve the quality of and access to mental health care for adults and children

1819 Project Focus:

Programme Quality and Performance Outcomes and Benefits• Improve access to 24/7 mental health crisis care • Delivery of daily mental health clinic within Same Day Access Service

- reduce A&E by 5%• Increase early intervention in psychosis in line with national markers

to an ageless model. • Continued reduction in Out of Area Treatment Placements (OATs).

18

Mental HealthProgramme


PSEH LCP Operating Plan Mental Health


Programme: Mental HealthAcute Bed Transformation

19

19

Aims & Outcomes• Portsmouth and South East Hampshire locally managed acute in-patient and PICU bed stock for

flexible use across the LCP with aligned, common systems and processes to improve in-patient flow.

Deliverables• Local bed stock will be used flexibly and seamlessly across providers with aligned admission,

management and discharge processes, systems and operating procedures. This will improve patient flow and help to free up beds to decrease the number of Out of Area Placements.


Q2 1819

Q3 1819

Q4 1819

Review pathways for patient flow across providers

Clinical Engagement

Service model review and design


Programme: Mental HealthEmotionally Unstable Personality Disorder

20

20

Aims & Outcomes• Reduce pathway variation between providers and expand pathway parameters to include emotional dysregulation and Personality Disorder traits. Explore improved models of service delivery.

• Improving and increasing modalities for treatment in the community

Deliverables:• Reduced Length of Stay• Reduced Delayed Transfers of Care• Reduction in Inappropriate admissions and re-admissions


Q2 1819

Q3 1819

Q4 1819

Obtain validated data

Review the current pathway, and review wastage and efficiencies to map an agreed pathway across providers

EUPD Standard operating procedures drafted and agreed across PSEH

Review data to evidence any issues around LoS, DToC, Inappropriate admissions and re-admissions


Programme: Mental HealthMental Health Assessment Unit (MHAU)

21

21

Aims & Outcomes• Develop and commission a service model to provide the right care, in the right place and at the

right time for patients attending ED in a mental health crisis.

Deliverables• Crisis Care plans, alongside the review of acute and community pathways will ensure delivery of

the mental health access and quality standards including 24/7 access to community crisis resolution teams and home treatment teams and mental health liaison services in acute hospitals.

• Improve patient experience; right treatment, right place, right time • Delivery of the mental health access and quality standards including 24/7 access to community

crisis resolution teams and home treatment teams and mental health liaison services in acute hospitals


Q2 1819

Q3 1819

Q4 1819

Outcome of Capital Bid

Consultations and design work

Service spec and SOP finalised

38 week capital work programme

Go Live Page 21 of 4110 PSEH LCP Operating Plan 1819.pptxOverall of 247

Programme: Mental HealthCrisis Response Project

22

22

Aims & Outcomes•Everyone should be able to access an appropriate and acceptable level of support when they need it. Scope to include:•A 24/7 offer•Self referral to Crisis service•All age service offer including older people•Potential to include teenagers (as there is no crisis support for CAMHS)•Professionals i.e. advice line for GPs and other health professionals•Carers•Crisis housing

Deliverables•People in crisis are able to access Mental Health Services to meet their needs • Improved patient experience of crisis care services•No further inappropriate detentions for mental health assessment in police cells •Fewer people reach crisis •Reduction in the number of suicides


Q2 1819

Q3 1819

Q4 1819

Alignment of AMH and OPMH Crisis Teams

Alignment of Crisis, Psych Liaison and MHAU teams and pathways

Enabling workstream for crisis projects Page 22 of 4110 PSEH LCP Operating Plan 1819.pptx

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• Reduction in out-patient attendances and follow-ups

• End to end pathway redesign

• Implementation of ERS• Improvement in cancer

pathways• End to end system Long

term conditions pathways

• Review of diagnostics• Procedures of low

Clinical Priority and threshoLCP

Deliverables:

• End to end pathway design and Plans agreed & implemented at speciality level

• Improved clinical triage service and increased scope within the community, with an emphasis on self management

• Reduction of Acute referrals and activity

• Increase use of e-referrals to proactively manage demand and capacity within the system

To improve how we manage demand for elective care, and to redesign how we provide elective care, ensuring demand and capacity are in balance to enable constitutional targets to be met.

1819 Project Focus:

Programme Quality and Performance Outcomes and Benefits§ Sustain reduction in GP referrals §Reducing length of stay – improving the experience for patients and ensuring best use of resources

§ 52 week RTT and 104 day cancer breaches to be reduced– improvement to patient journey and efficiency

§RTT incomplete waiting list to be no higher in March 2019 than it is in March 2018 – maintaining patient pathways

IAF Measures impacted:

Diabetes patients that have achieved all NICE recommended treatment targets

People with diabetes diagnosed less than a year who attend a structured education courseEmergency admissions for chronic ambulatory care sensitive conditions per 100,000 population

23

Planned Care Programme


PSEH LCP Operating Plan Planned Care


Programme: Planned CareEnd to end pathway redesign

24

24

Aims & Objectives:•Achieving constitutional targets for referral to treatment, diagnostics and cancer waiting time standards •End to end system Pathway redesign: Cardiology, MSK, Dermatology, ENT, Urology, Digestive Disorders initially with other specialties to follow as the year progresses

•Improved clinical triage service and increased treatments within community services with an emphasis in self managementReduction of Acute referrals and activity

•Use of innovation and supportive technologies to improve patient experience and flow•Ensure robust and timely clinical triage occurs so that patients are seen in the most appropriate service at the right time.•Focus services around early diagnosis of chronic conditions and self-management in primary care.

Deliverables:

• Reduction in referrals/ acute activity through newly designed pathways to improve patient experience and reduce unwarranted clinical demand

• Reduction in clinical variation • Development of community clinics where required• Reduction in waiting times for secondary care services.• Reduction in demand and capacity gap which has been identified.• Assist with achievement of RTT trajectory• Improved access and quality for patients through streamlined pathways, including straight to test where possible.


Q2 1819

Q3 1819

Q4 1819

New ways of working such as referral via consultant triage, advice and guidance, straight to test pathways

Trialling 'virtual clinics' to reduce face to face follow up attendances where clinically appropriate

Reviewing management of patients on long term follow-ups to ensure all contacts add value to the patient pathway


Programme: Planned CareERS

25

25

Aims & Objectives:

• Full implementation of E-Referrals (eRS), incorporating greater use of Advice and Guidance as an alternative to traditional face to face consultation

Deliverables:• Achievement of 80% of referrals into Consultant led service via ERS• Improved patient experience and flexibility• Improved referrer experience• Fewer unwarranted outpatient attendances• Reduction in DNAs• Reduction in acute activity• Improved demand management


Q2 1819

Q3 1819

Q4 1819

All clinics available on eRS across all providers

Primary care teams work to support the increase in GP utilisation

Achievement of 80% of referrals into Consultant led service via ERSPage 25 of 4110 PSEH LCP Operating Plan 1819.pptx

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Programme: Planned CareLong Term conditions

26

26

Aims & Objectives:•End to end pathway design•Upskilling in primary care•Focus on increased self-management and citizen activation•Reduction in follow ups and a move to increase the use of technology in all patient pathways exploring the use of virtual clinics.

•Use of RightCare Analysis of circulation, cancer and respiratory and other long term condition ‘where to look packs’ to target improvement areas

Deliverables:

•Reduced waiting times in secondary care for both new and follow up activity.•Development of a generic model with the aim of reducing unwarranted referrals and clinical variation•Reported improvement in self-management•Reduction in clinical variation•Reduction in face to face consultations for both new and follow ups•Reduction in workload for primary care


Q2 1819

Q3 1819

Q4 1819

Patients feel enabled to better manage their own condition and maintain independenceReduction in acute activity

Creation of community hubs working in conjunction with the Community Health and Care programme


24 hour paediatric ED department at PHT

Paediatric psychiatric liaison service in ED

COAST in ED

Integrated Children’s Community Model

Community Epilepsy Nurse

Deliverables:A single point of access for children with urgent presentations via a 24hour ED to improve outcomes and maximise efficiencies.

Creation of a children’s Mental Health lead in ED linking with CAMHs

Children arriving at ED will be triaged by COAST to prevent them from being admitted to ED or CAU unnecessarily.

Children and young people can access appropriate community support to prevent unnecessary hospital admissions.

Improved Epilepsy pathways and services to improve patient outcomes.

Continue to improve the quality of and access to Children and Young Persons Services

1819 Project Focus:Maternity and Child Health Programme

Programme Quality and Performance Outcomes and Benefits

• Deliver improvements to children’s ED pathways • Improved patient experience• Reduced admissions• Reduced referrals for epilepsy patients and improved patient outcomes

IAF Measures impacted:Women’s experience of maternity servicesChoices in maternity servicesChild ObesityNeonatal mortality and stillbirths per 1,000 birthsMH - CYP Mental Health Maternal Smoking at delivery

27


PSEH LCP Operating Plan Maternity and Child Health


Programme: Maternity and Child HealthCommunity Epilepsy Nurse

Aims and Objectives:

• To improve the Community Epilepsy Service for Children and Young People.• To prevent the referral to PHT for those children under the CPMS Service with Epilepsy related to a

neurodevelopmental condition.

Deliverables:

• Improved outcomes for the individual, fewer seizures may lead to reduced long term complications. • High quality care through a clear robust epilepsy pathway• Reduction in outpatient referrals between community paediatric medical service and PHT• Hospital admissions are prevented wherever possible • Children are discharged from hospital in a timely manner• Improved training for care givers and educators to ensure medication and treatment compliance.


Q2 1819

Q3 1819

Q4 1819

Community Epilepsy Nurse starts in her post

Community Epilepsy Nurse to provide CCG with timetable for school visits

Review first 6 months data and agree baselines and targets


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Programme: Maternity and Child HealthIntegrated Children’s Community Model


Deliverables:

• Develop an integrated community children's service model which combines Children's Community Nursing (CCN) / COAST and Community Paediatric Medical Services (CPMS)

• To increase the number of children cared for outside of the hospital by a system wide team• Removing boundaries and the internal silos within the Provider to enable more efficient use of

resources.• Improved system wide Community Children’s Model

29


Q2 1819

Q3 1819

Q4 1819

Agree final CCN Service Specification across 3 CCGs

Agree final CCN Service Specification - Year 1 System wide CPMS

Scope options for Integrated Model


Programme: Maternity and Child HealthCOAST in ED


Deliverables:

• Solent COAST (Children's Community Nursing Acute Pathway Team) to be based in the emergency department in the evenings and weekends. To triage patients and see if they could be managed in the community, avoiding an admission.

• Develop and implement new pathways to reduce avoidable admissions and attendances

• Reduction in number of children admitted to CAU via Paediatric ED• Improved patient care by providing community based services and preventing unnecessary

inpatient stays• Implementation of the recommendations from “Facing the future”

30


Q2 1819

Q3 1819

Q4 1819

COAST Team to start working within Paediatric ED for evenings and weekends

Monitoring of admissions avoided and activity deflected

Solent and PHT to agree monitoring of the scheme

Solent and PHT to sign SLA

3 month reviewPage 30 of 4110 PSEH LCP Operating Plan 1819.pptx

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Programme: Maternity and Child HealthPaediatric Psychiatric Liaison in ED


Deliverables:

• Introduction of a Children and young persons Mental Health Lead in ED, with a specific remit to link in with CAMHs

• Support joint working between ED and CAMHs teams by maximising use of Care Plans• Develop and implement new pathways to reduce avoidable admissions and attendances

• Reduction in unnecessary admissions• Timely and accessible consultation from specialist trained staff• Improved experience of assessment, reducing the need for young people and families to repeat

their story• Improved relationships and joint working between PHT, MHLT, Hampshire CAMHS and

Portsmouth CAMHS

31


Q2 1819

Q3 1819

Q4 1819

3 month pilot of service

Interim review of service provision

Full review of pilot and recommendations

Initiate phase 2/roll out (assuming successful review of pilot)Page 31 of 4110 PSEH LCP Operating Plan 1819.pptx

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PSEH LCP Operating Plan Delivery of Operating Plan Standards

32

RTT, Cancer Standards, Diagnostics and A&EKey deliverables, and where applicable, improvement trajectories have been set out in the Operating Plans as follows:• RTT – 86% for 2018/19, based on holding the March RTT waiting list

– This is based on PHT expecting to finish the year on circa 86%. – This additionally assumes zero 52 week waits using this scenario.

• Diagnostics – 99% to be sustained through 2018/19 from June onwards• Cancer 62 days – 85% to be sustained through 2018/19• Delivery of all other cancer standards• A&E 4 hrs – Trajectory across 2018/19

Delivery of IAPT access standards • Portsmouth CCG - 19% standard not met. The CCG has made a decision to partially fund

the LTC expansion at a 17% access rate for 2018/19, not 19%, to fully prove the business case.

• F&G and SEH CCGs - Plan does not meet IAPT standard in 18/19 which is reflective of historic under performance although currently on improvement trajectory. Page 32 of 4110 PSEH LCP Operating Plan 1819.pptx

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PSEH LCP Operating Plan Governance (1/2)

Collaborative and cross boundary clinical leadership is a critical enabler of accountable care, supported by a clear structure that delivers appropriate accountability and authority


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PSEH LCP Operating Plan Governance (2/2)

The programme arrangements must be streamlined, transparent and flexible to enable effective and efficient decision making and action


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PSEH LCP Operating Plan Key Risks and Issues

Risks Mitigating Actions RAG Rating

Challenging Savings Plans with a high level of unidentified savings

• Establish contracts set at affordable levels for commissioners.• PWC and Turnaround Director providing support to development of PHT

CIP Programme.• Aligned Incentives Contract in place to ensure focus remains on system

improvement and cost reduction• System workstreams being developed; need to assess and deliver

financial impact.• Robust in year monitoring at organisational and system level to ensure

schemes deliver expected savings.• Seek NHS England and Improvement support for a longer term

transformation programme

Risk to delivery of key Constitution Standards and potential patient safety issues due to lack of elective capacity in the system

• Robust modelling of demand and capacity on a specialty by specialty basis

• Quality teams oversight of quality and safety risks

Urgent Care system continues to operate suboptimally with associated impact on ED waits and quality

• A&E Delivery Board in place and meeting regularly with exec leadership; system urgent care workstream aimed at improving out of hospital model

• Newton review of HCC/ community capacity and PWC system capacity review


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PSEH LCP Operating Plan Annex A – Individual Organisation 2018/19 Operating Plans

36

Solent NHS Trust Plan

Southern Health NHS Trust Plan

NHS FGSEH CCGs Plan

NHS Portsmouth CCG Plan

Portsmouth Hospitals Trust Plan


LCPPRIORITY:- Care Homes (extension across PSEH)

PRIORITY:- Front Door Admission Avoidance (incl. FIT and frailty)SCAS Conveyance - End of Life – (SCAS – Ticket to Ride)

LTC hubs Alignment of community model across PSEH

Modelling on impact of changes in workforce, finance and estates based on NCM

PORTS CCGs• Integrated 24/7 primary care service – bringing AVS, GP OOHs

and extended access into one City wide service – up and running by June 2018 and will also include UTC integration over time

• Practice based MSK Triage • Enhanced Care home team in Portsmouth (currently operating

across 7 homes)• Local Neighbourhood Teams – MDT Teams in 3 Portsmouth

localities, piloting reablement and locality rapid response in South locality from June 2018.

• Shared Care Record SystmOne used by Solent and all practices, ASC to start using SystmOne from Oct 2018.

• Revised social prescribing and care navigator service development• Delivery of 111 and OOH procurement options

LCP - Community Health and Care

ENABLERSNeed to further understand links and work being undertaken across different tiers for:

1. Population health – testing and roll-out of Integrated Population Analytics. Learning from FG Integrator to develop locality plans

2. Estates

FGSEH CCGs• Integrated 24/7 primary care service – bringing AVS, GP OOHs

and extended access into one service – up and running by June 2019 and will also include GP-led UTC integration over time

• Same Day Access GP hub development in localities• Practice based MSK Triage • Plans for local Neighbourhood Teams in place in every locality

by May 2018, implementation June 2018 – June 2019.• Well-being programmes including care navigator s and Patient

Activation Measure embedded across localities• All neighbourhood teams to have access to EMIS Community

Shared Care Record by March 2019• Review of community contracts to align with neighbourhood

model including ERS • Delivery of 111 and OOH procurement options

37

PSEH LCP Operating Plan Annex B – LCP Programme Triangles


•High Impact Changes discharge actions•UCC•111

• See next slide (D2A actions)

LCP

Local System

Organisational level

Urgent and Emergency Care Programme Alignment

Flow and Effective discharge

Urgent Care Delivery Programme - Triangle


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Priority ActionsPRIORITY:- Embed SAFER and Red to Green across all wards

PRIORITY:- Embed single leadership and single team approach for IDSPRIORITY – Embed Why not home? Why not today? - start by piloting new approach in

one ward from May 2018PRIORITY – Implement 5Qs to ensure delivery of new CHC guidance from October 2018

Hampshire Specific ActionsReview role of ERS/CRT in line with Hampshire wide intermediate care strategyAddress any home and care home capacity issues to better support D2AReview community bed pathways to better support D2A

SystemComplete Newton and PWC demand and capacity diagnostics

Streamline IDS processes Implement proportionate assessment to support trusted assessor model

Embed choice and expectation policy as BAU by June 2018.

Portsmouth specific actions• Establish in-house re-ablement team• Pilot new way of neighbourhood team way

of working • Ensure sustainability of intermediate care

model and investment to deliver D2A, alongside new way of working

High Impact Change Discharge Actions


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19/10/2018

Mental Health Delivery Programme


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19/10/2018

Elective Care Delivery Programme - Triangle


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of 1


Title of Paper Finance ReportAgenda Item 11 Date of meeting 24.10.18Exec Lead Roshan Patel Clinical SponsorAuthor David Bailey


Purpose

To Note To note


Executive Summary

The report sets out the financial performance of the CCGs at month 6. The CCGs are on target to achieve their control totals, however there is still a significant risk to this position. The risk is around spend on acute contracts, Continuing Healthcare spend, achievement of identified QIPP plus identification of unidentified QIPP

Recommendations The Governing Body is asked to note this paper





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Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups

Finance Report Month 6 (September) 2018/19

Page 1 of 1211 Finance Report.pptxOverall of 247

Finance Summary – Key IssuesNHS Fareham and Gosport CCG forecast outturn at M6 is an in-year deficit position of £4.0m. This is the agreed control total. The current YTD position is a £2.0m deficit, which is as planned. Note, many QIPP schemes deliver later in the year, and there is still significant unidentified QIPP. Also there are known pressures on acute contracts.

NHS South Eastern Hampshire CCG forecast outturn at M6 is an in-year deficit position of £2.5m. This is the agreed control total. The current YTD position is a £1.25m deficit, which is as planned. Note, many QIPP schemes deliver later in the year, and there is still significant unidentified QIPP. Pressure continues within Continuing Healthcare and there are also pressures emerging on acute contracts.

The CCGs are in line to access Commissioner Sustainability Funding (CSF) for both quarters 1 and 2, as a result of current performance we have met the control total at Q2. The CSF for the 2 CCGs totals £6.5m and is earned on a quarterly basis, with the shares being as follows: Q1 10%; Q2 25%; Q3 30%; Q4 35%.Currently there are combined unmitigated risks totaling £18m, the same level as last month. NHS Fareham and Gosport CCG has unmitigated risks totaling £9.2m with NHS South Eastern Hampshire CCG having unmitigated risks of £8.8m.

The risks are mainly due to concerns about acute expenditure, Continuing Healthcare expenditure, and QIPP delivery. Urgent action is being taken to try to reduce the size of the unidentified QIPP and a Financial Recovery Plan has been prepared. QIPP overviewThe QIPP plan for 2018/19 is £27.7m. There are 3 ‘buckets’ for QIPP which make up the £27.7m as follows. 1 Portsmouth Hospitals Trust (PHT) Aligned Incentive Contract (AIC). Scheme value £6m. These are schemes which have been worked up with PHT to help reduce demand and agree the AIC contract. 2 Other. There is £12.7m in the ‘bucket’, which is a slight increase from last month. The £12.7m needs to be delivered to improve the financial position. 3 Unidentified – There is £9m in this ‘bucket’ which is the major financial problem.

• The year to date position has got worse by £121k due to slippage on the Solent review.• The Forecast outturn has been increased by £42k due to a benefit in the re-provision of services following the cessation of the Virgin Contract from

30 September 2018.


Spend vs In-year Plan

Year To Date Annual Forecast Forecast UnmitigatedPlan Vs Actual Position Plan Actual Variance Plan Actual Variance Risks

£'m £'m £'m £'m £'m £'m £'mNHS Fareham and Gosport CCG 2.00 2.00 0.0 4.0 4.0 0.0 9.2

NHS South Eastern Hampshire CCG 1.25 1.25 0.0 2.5 2.5 0.0 8.8

Total FG SEH CCG 3.25 3.25 0.0 6.5 6.5 0.0 18.0


Financial Performance 2018/19NHS Fareham and Gosport CCG – September 2018 Summary:The forecast outturn in M6 is the planned in year deficit of £4.0m. The current YTD in year position is showing a £2.0m deficit, which is on plan.

NHS South Eastern Hampshire CCG – September 2018 Summary:The forecast outturn in M6 is the planned in year deficit of £2.5m. The current YTD in year position is showing a £1.25m deficit, which is on plan.

See annexes for further detail

Annual MONTH 6 - SEPTEMBER 2018 Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'mAcute Commissioning 151.5 76.0 76.7 0.7 153.1 1.6Mental Health Commissioning 25.1 12.6 12.3 (0.3) 24.7 (0.4)Community Services Commissioning 32.2 16.4 16.5 0.1 32.8 0.6Primary Care Commissioning 69.9 34.9 34.7 (0.3) 69.5 (0.4)Continuing Care 21.7 10.9 11.6 0.7 23.1 1.4Other Commissioning 7.0 4.8 4.6 (0.2) 7.0 0.0Running Costs 4.6 2.3 1.9 (0.4) 4.0 (0.5)Reserves & Contingencies (4.0) 0.3 0.0 (0.3) (6.2) (2.2)Control Total (2.5) (1.3) 0.0 1.3 0.0 2.5Total NHS South Eastern Hants CCG IN YEAR 305.5 157.0 158.2 1.2 308.0 2.5

Memorandum - Commissioner Sustainablity Fund (2.5)

Historic CCG deficit bought forward (1.8) (0.9) 0.0 0.9 0.0 1.8

NHS South Eastern Hants CCG Cumulative 303.7 156.1 158.2 2.1 308.0 1.8

Annual MONTH 06 - SEPTEMBER 2018 Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'mAcute Commissioning 139.6 69.6 70.3 0.7 141.0 1.5 Mental Health Commissioning 22.5 11.3 11.5 0.2 23.1 0.6 Community Services Commissioning 26.8 13.6 13.8 0.1 27.0 0.2 Primary Care Commissioning 64.3 32.1 31.9 (0.2) 64.0 (0.3)Continuing Care 24.5 12.2 12.1 (0.1) 24.3 (0.2)Other Commissioning 5.6 3.2 3.1 (0.0) 5.5 (0.1)Running Costs 4.4 2.2 1.9 (0.4) 3.9 (0.6)Reserves & Contingencies (5.0) 0.3 0.0 (0.3) (6.1) (1.1)Control Total (4.0) (2.0) 0.0 2.0 0.0 4.0 NHS Fareham & Gosport CCG In Year Position 278.7 142.5 144.5 2.0 282.7 4.0

Memorandum - Commissioner Sustainability Fund (4.0)

Historic CCG Deficit (12.6) (6.3) 0.0 6.3 0.0 12.6

NHS Fareham & Gosport CCG Cumulative Position 266.1 136.2 144.5 8.3 282.7 12.6


Creditors note:The 40% of creditors over 30 days has a financial value of £1.4m. This is a reduction of 100k when compared to last month. Ongoing issues around Estates currently make up £0.9m of the balance. £0.3m relates to disputed activity invoices from acute providers. The remaining balance is primarily for non-contract activity that is either disputed or awaiting backing information.

Creditors note:The 41% of creditors over 30 days has a financial value of £1.4m, of which £0.7m relates to Estates issues, £0.4m Acute and £0.1m a disputed Warrington drug issue, total £1.2m, leaving £0.3m of other invoices, primarily for non-contract activity that is either disputed or awaiting backing information.

Finance Dashboard

Cash balance note: £1m relates to cash drawn down for hosted services, but invoices were not received.

Cash balance note: Cash held in respect of Better Care Fund Invoices , which were received later than anticipated and staff recharges, with both due to be paid in October

NHS FAREHAM & GOSPORT CCG TARGET ACTUAL VARIANCE RAG

(Surplus) / Deficit - Year to date in year (£ m) 2.00 2.00 0.0 G

(Surplus) / Deficit - Full year forecast in year (£ m) 4.00 4.00 0.0 G

Quality, Innovation, Productivity and Prevention savings- Year to date (£ m) 4.18 3.98 (0.2) G

Quality, Innovation, Productivity and Prevention savings- Full Year Forecast (£ m) 14.40 9.75 (4.7) R

Plan Running costs plan v forecast (£ per head) 21.61 18.90 2.71 G

Invoices paid within Better Payment Practice Code - Value 95% 100% 5% G

Invoices paid within Better Payment Practice Code - Volume 95% 99% 4% G

Cash balance at month end (£ m) 0.23 3.60

Creditors - percentage over 30 days < 10% 40% 30% A

NHS SOUTH EASTERN HAMPSHIRE CCG TARGET ACTUAL VARIANCE RAG

(Surplus) / Deficit - Year to date in year (£ m) 1.25 1.25 0.0 G

(Surplus) / Deficit - Full year forecast in year (£ m) 2.50 2.50 0.0 G

Quality, Innovation, Productivity and Prevention savings- Year to date (£ m) 3.86 3.67 (0.2) G

Quality, Innovation, Productivity and Prevention savings- Full Year Forecast (£ m) 13.30 9.00 (4.3) R

Plan Running costs plan v forecast (£ per head) 21.21 18.82 2.39 G

Invoices paid within Better Payment Practice Code - Value 95% 100% 5% G

Invoices paid within Better Payment Practice Code - Volume 95% 99% 4% G

Cash balance at month end (£ m) 0.43 1.08

Creditors - percentage over 30 days < 10% 41% 31% APage 5 of 1211 Finance Report.pptx

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QIPP: Fareham & Gosport CCG and South Eastern Hampshire CCG Financial Recovery Programme Board Summary


Key Financial RisksRisks – The CCGs have a combined £18m of unmitigated risks.

Risk Ref Risk Title Description Actions Current Impact Current Likelihood Current Risk Score Action Owner Date of Last Review

Fin.FG&SEH.04 QIPP Schemes There is a risk that 18/19 QIPP schemes do not deliver the required activity changes, resulting in inability to reduce system capacity and causing organisational financial pressures. There is still Unidentified QIPP.

Actions- Iterative pipeline process for producing QIPP plans.-Regular meetings between PMO and those responsible for delivery-Seek NHS England support for a longer term transformation programme

4 4 16 Andy Wood 19-Jun-2018

Fin.FG&SEH.15 Financial Recovery Plan

There is a risk that the financial recovery plan is not able to generate the level of savings needed to achieve the 2 CCGs' control totals in 2018/19

Actions - Align CCG Delivery Units with system workstreams to maximize impact. - Programme Management Office strengthened and processes of holding to account improved.- Additional finance support being secured .

4 4 16 Andy Wood 19-Jun-2018

Fin.FG&SEH.19 Social Care and Public Health funding cuts

There is a risk that significant cuts in funding for social care and public health will have an impact on the delivery and sustainability of services , particularly over the winter period.

Actions- Risk assess likely impact of cuts. Via A&E Delivery Board, discuss ways to mitigate impact of cuts.- Discussions under way with HCC and Southern Health on system action to reduce delayed discharges- ensure iBCF funding across Hampshire is used to maximum effect

4 4 16 Andy Wood 19-Jun-2018


Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups

Annexes Month 6 (September) 2018/19


F&G Detailed Financial Performance 2018/19

Please Note : Due to roundings, the values in the table above may not cast completely

Annual MONTH 06 - SEPTEMBER 2018 Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'m

Acute Commissioning

Portsmouth Hospitals NHS Trust 111.4 55.7 55.7 0.0 111.4 0.0University Hospital Southampton NHS FT 9.6 4.8 4.6 (0.2) 9.3 (0.3)Western Sussex Hospitals NHS FT 0.4 0.2 0.2 0.0 0.3 (0.1)Hampshire Hospitals NHS FT 0.7 0.3 0.3 0.0 0.7 0.0London Providers 0.9 0.5 0.5 0.1 1.1 0.2Frimley Park Hospital NHS FT 0.0 0.0 0.0 0.0 0.1 0.1Royal Surrey County Hospital 0.1 0.0 0.0 0.0 0.0 0.0Spire HealthCare 1.8 0.9 1.0 0.1 2.0 0.2South Central Ambulance 7.4 3.7 3.8 0.1 7.7 0.3Clinical Assessment and Treatment Centres 2.7 1.4 1.7 0.3 3.4 0.6NCAs / OATs 2.2 1.1 1.0 (0.1) 2.0 (0.1)Other Acute Commissioning 2.4 1.0 1.4 0.4 3.1 0.7

Mental Health Commissioning

Solent NHS Trust (MH) 0.7 0.4 0.4 0.0 0.7 0.0Southern Healthcare FT (MH) 12.0 6.0 6.0 0.0 12.0 0.0Child Trust Pooled Budget (CAMHS) 2.1 1.0 1.0 0.0 2.3 0.2IAPT 1.2 0.6 0.6 0.0 1.2 0.0Non CHC Special Placements - LD and MH 6.4 3.2 3.3 0.1 6.7 0.3Other Mental Health Commissioning 0.1 0.0 0.1 0.1 0.2 0.1

Community Health Commissioning

Solent NHS Trust (Community) 4.8 2.4 2.4 0.0 4.8 0.0Southern Healthcare FT (Community) 16.4 8.2 8.2 0.0 16.4 0.0Better Care Fund 4.5 2.5 2.5 0.0 4.5 0.0Hampshire County Council 0.3 0.1 0.1 0.0 0.3 0.0Tier 2 0.6 0.3 0.1 (0.2) 0.2 (0.4)Other Community Services Commissioning 0.2 0.1 0.4 0.3 0.9 0.6

Primary Care Commissioning

Practice Primary Care Prescribing 34.0 17.0 16.8 (0.2) 33.6 (0.3)Primary Care GP IT 0.6 0.3 0.3 0.0 0.6 0.0Local Enhanced Services 1.3 0.6 0.6 0.0 1.3 0.0Primary Care Co-Commissioning 24.9 12.5 12.4 (0.1) 24.9 0.0GPFV £3 and £6 per head 2.2 1.1 1.1 0.0 2.2 0.0OOH (Care UK) 1.3 0.7 0.7 0.0 1.3 0.0

Continuing Care Continuing Care Adults / Children 20.3 10.1 10.2 0.0 20.2 0.0Funded Nursing Care 4.2 2.1 2.0 (0.1) 4.0 (0.2)

Other Commissioning

Recharges NHS Property Services Ltd 1.5 0.7 0.7 0.0 1.5 0.0IVF / IFRs 0.2 0.1 0.1 0.0 0.2 (0.1)111 Service 0.8 0.4 0.4 0.0 0.7 0.0Other Commissioning 3.1 1.9 1.9 0.0 3.1 0.0

CorporateHeadquarters Costs 2.7 1.4 1.3 0.0 2.7 (0.1)CSU Charges 1.1 0.5 0.5 0.0 1.1 0.0General Reserve 0.6 0.3 0.0 (0.3) 0.2 (0.5)

Centrally Managed Programmes

Commissioning Reserve (5.0) 0.3 0.0 (0.3) (6.1) (1.1)Control Total (4.0) (2.0) 0.0 2.0 0.0 4.0

NHS Fareham & Gosport CCG In Year Position 278.7 142.5 144.5 2.0 282.7 4.0


Historic CCG Deficit (12.6) (6.3) 0.0 6.3 0.0 12.6

NHS Fareham & Gosport CCG Cumulative Position 266.1 136.2 144.5 8.3 282.7 12.6Page 9 of 1211 Finance Report.pptx

Overall of 247

SEH CCG - Detailed Financial Performance 2018/19

Please Note : Due to roundings, the values in the table above may not cast completely

Annual MONTH 6 - SEPTEMBER 2018 Forecast Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance Variance £'m £'m £'m £'m £'m £'m %

Acute Commissioning

Portsmouth Hospitals NHS Trust 101.8 50.9 50.9 0.0 101.8 0.0 0%University Hospital Southampton NHS FT 3.0 1.5 1.3 (0.2) 2.5 (0.5) (17%)Western Sussex Hospitals NHS FT 6.0 3.0 3.0 0.0 6.0 (0.1) (1%)Hampshire Hospitals NHS FT 4.7 2.4 2.5 0.1 4.9 0.2 4%London Providers 2.1 1.1 1.1 0.0 2.2 0.1 3%Frimley Park Hospital NHS FT 2.4 1.2 1.1 (0.1) 2.3 (0.1) (5%)Royal Surrey County Hospital 12.4 6.2 6.8 0.6 13.6 1.2 9%Spire HealthCare 2.7 1.4 1.3 0.0 2.7 (0.1) (2%)South Central Ambulance 7.8 3.9 4.0 0.1 8.1 0.3 4%Clinical Assessment and Treatment Centres 3.1 1.5 1.7 0.2 3.4 0.3 11%NCAs / OATs 2.7 1.3 1.3 (0.1) 2.5 (0.2) (6%)Other Acute Commissioning 2.7 1.6 1.8 0.2 3.2 0.5 (17%)

Mental Health Commissioning

Solent NHS Trust (MH) 0.7 0.4 0.4 0.0 0.7 0.0 0%Southern Healthcare FT (MH) 14.9 7.5 7.5 0.0 14.9 0.0 0%Child Trust Pooled Budget (CAMHS) 2.3 1.1 1.1 0.0 2.4 0.2 8%IAPT 1.2 0.6 0.6 0.0 1.2 0.0 0%Non-CHC specialist placements 5.7 2.9 2.5 (0.4) 4.9 (0.8) (14%)Other Mental Health Commissioning 0.3 0.2 0.3 0.1 0.6 0.2 67%

Community Health Commissioning

Solent NHS Trust (Community) 5.1 2.5 2.6 0.0 5.1 0.0 1%Southern Healthcare FT (Community) 20.2 10.1 10.1 0.0 20.2 0.0 0%Better Care Fund 4.8 2.7 2.7 0.0 4.8 0.0 0%S256 (HCC and PCC) 0.4 0.2 0.2 0.0 0.4 0.0 0%Any Qualified Provider 0.0 0.0 0.0 0.0 0.0 0.0 0%Tier 2 0.3 0.1 0.1 0.0 0.2 (0.1) (27%)Other Community Services Commissioning 1.4 0.8 0.9 0.1 2.0 0.6 41%

Primary Care Commissioning

Practice Primary Care Prescribing 36.8 18.4 18.3 (0.2) 36.5 (0.3) (1%)Primary Care GP IT 0.6 0.3 0.3 0.0 0.6 0.0 1%Local Enhanced Services 1.4 0.7 0.7 0.0 1.4 0.0 0%Primary Care Co-Commissioning 27.2 13.6 13.5 (0.1) 27.1 0.0 0%GPFV £3 and £6 per head 2.4 1.2 1.2 0.0 2.4 0.0 0%OOH (Care UK) 1.4 0.7 0.7 0.0 1.4 0.0 (2%)

Continuing Care Continuing Care Adults / Children 18.2 9.1 10.0 0.9 19.9 1.7 9%Funded Nursing Care 3.5 1.8 1.6 (0.1) 3.2 (0.3) (9%)

Other Commissioning

Recharges NHS Property Services Ltd 1.1 0.6 0.6 0.0 1.2 0.1 9%IVF / IFRs 0.1 0.1 0.0 0.0 0.1 (0.1) (46%)111 Service 0.7 0.3 0.3 0.0 0.7 0.0 1%Other Commissioning 5.0 3.9 3.6 (0.2) 5.0 0.0 (1%)

CorporateHeadquarters Costs 3.0 1.5 1.4 (0.1) 2.9 (0.1) (3%)CSU Charges 1.0 0.5 0.5 0.0 1.0 0.0 0%General Reserve 0.6 0.3 0.0 (0.3) 0.2 (0.4) (74%)

Centrally Managed Programmes

Commissioning Reserve (4.0) 0.3 0.0 (0.3) (6.2) (2.2) 56%Control Total (2.5) (1.3) 0.0 1.3 0.0 2.5 (100%)

NHS South Eastern Hampshire CCG IN YEAR Position 305.5 157.0 158.2 1.2 308.0 2.5 1%


Historic CCG deficit bought forward (1.8) (0.9) 0.0 0.9 0.0 1.8 (100%)

NHS South Eastern Hampshire CCG Cumulative Position 303.7 156.1 158.2 2.1 308.0 1.8 1%Page 10 of 1211 Finance Report.pptx

Overall of 247

NHS FAREHAM AND GOSPORT CCG - CONTINUING HEALTHCARE PERFORMANCE AS AT M6• Note these values will not fully align with the CCG summary because NHSE accounting rules require CHC to be shown across

different ledger codes, including mental health


NHS SOUTH EASTERN HAMPSHIRE CCG - CONTINUING HEALTHCARE PERFORMANCE AS AT M6• Note these values will not fully align with the CCG summary because NHSE accounting rules require CHC to be shown across

different ledger codes, including mental health.


CCGs quality exception report I October GB I 1


Title of Paper Quality Exception Report

Agenda Item 13 Date of meeting 24th October 2018

Exec Lead Julia Barton, Executive Director of Quality & Nursing Clinical Sponsors Dr Zaid Hirmiz

Dr Simon LarmerAuthor Louise Spencer, Associate Director of Quality & Nursing

To AgreeTo RatifyTo Discuss

Purpose

To Note X


Strategic Objective 5: Patients using local health services will experience reduced variation in treatment and care standards; they will notice increasing consistency in the quality of services across all care providers

Executive SummaryPortsmouth Hospital NHS Trust CQC Inspections and notices Overall; the CQC published its report on the findings of the comprehensive and well led

inspections carried out at the trust in April and May in August. The trust has been rated as ‘Requires Improvement’ in all domains and overall. The report outlined 54 ‘must do’s’ and 71 ‘should do’s’. In support of the list of must/should dos, the trust were served with a notice under section 29a of the Health & Social Care Act 2012 which requires action to be taken to address all breaches 13 2018.

Urgent Care Risk (16): compliance with the 4-hour standard has improved since April however the prolonged period of warm weather resulted in an increase in demand for emergency services, which increased the number of ambulance holds, escalation beds open, patient moves at night and outliers. There were no breaches of the 12 hour decision to admit standard.

Governance Risk: (16): the revised organisational structure went live on 2 July. Quality and performance measurements are aligned with the four divisions and the revised performance and accountability framework will capture the positon for each division. This risk remains whilst the new structure is being embedded.

Radiology Risk (16): the trust’s own risk for radiology is rated at 20, due to ongoing workforce challenges. The error rate for radiology is reported within the expected error rate range; workforce issues continue, discussions are taking place with the Solent Acute Alliance; a clinical advisory group remains in place; the backlog identified in CQC notice has now been cleared.

Delays in full implementation of the spinal network model (15): progression is being made to transfer spinal services to UHS in November. Recruitment has taken place and the TUPE process is underway for a small number of staff. A quality impact assessment was completed by the CCG quality team and has been shared with PHT and UHS.

Safeguarding adults, children and looked after children (16): the section 29a, issued 13 July 2018, indicates that further work is required to support improvements around mental capacity act (MCA) and the deprivation of liberty safeguards (DOLS)

Delays in assessment and treatment of patients for planned care (15): There is focussed work on demand/capacity, and on improving quality and safety which links through the Local Care Partnership Elective Care Board. Key specialties of concern are gastro and ophthalmology, followed by audiology and trauma & orthopedics. All have plans in place to reduce the outpatient waiting list.

Page 1 of 2012 Quality Exception report.docxOverall of 247


Southern Health NHS Foundation Trust (SHFT) Quality & safety of services provided by SHFT (16): a task and finish group met on 1st

August 2018 to discuss the areas of outstanding assurance the CCGs had for quality in SHFT and the Quality Oversight Committee reviewed/discussed this at their October meeting. A decision has been made to stand the QOC down and return the trust to “business as usual” in terms of quality oversight.

Millbrook Healthcare Ltd (MHWS) wheelchair services

Waiting list delays (12): August 2018 data demonstrates Millbrook are continuing to see a growing demand for wheelchair services, therefore the work completed to clear the backlog is not having a significant impact on the total waiting list size.. Work continues in PSEH on demand and capacity modelling.

Sussex Partnership Trust Waiting times (20): there continues to be a significant impact of long waiting lists on children

and their families and workforce welfare as the trust is working consistently over plan. NEHF CCG continue to work with the trust to progress the actions identified and agreed as part of the ‘call to action’ meeting. Negotiations with a new autism spectrum disorder provider (Psicon) have taken place to support the service delivery and a reduction of the waiting list; the service commenced in September 2018 and will remain to 30th June 2019.

Recommendations

Governing Body is asked to: Note the removal of the PHT mortality risk, and the reduction of the

SCAS long waits risk and SHFT governance risk ratings.

Publication Public Website No

Please provide details on the impact of following aspectsEquality and Quality Impact Assessment No direct impact on protected groups to note

Patient and Stakeholder Engagement No engagement has taken place to support the content of this paper.

Financial Impact, Legal implications and Risk

Risks are included in this report that are included to the quality team risk register and that are linked to the BAF


Joint Quality Operational Group

July and August 2018

Two changes to the provider risk register and one change to rating of a risk on the quality duty risk register made.

Joint Quality Assurance Committee September 2018 Endorsed the changes to the provider risk

register.



Group Quality Indicator Threshold Frequency Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18YTD RAG

RatingCurrent CQC Rating Good as required RI RI RI RI RI RI RI RI RI RI RI RI RICQC or NHSI Regulatory requirements in place

NA as required

MRSA Bacteraemia 0 monthly 0 0 0 1 1 0 0 0 0 1 0 1 1C.Difficile (trajectory) 40 monthly 3 3 3 4 4 3 3 4 3 3 3 3 NAC.Difficile (actual) n/a monthly 4 6 5 5 5 3 4 2 1 5 1 4 9

Hospital Standardised Mortality Ratio (HSMR)

similar to or below national average

monthly 112.4 111.5 111.7 110.1 109.1 111.3 108.2 107.9 107.1 107.1 107.1 106.6

Summary Hospital Level Mortality indicator (SHMI)

similar to or below national average

quarterly 108.89 108.89 108.89 108.89 109.13 109.13 109.13 107.19 107.19 107.19 105.71 105.71

Grade 3 + 4 avoidable pressure ulcers monitor monthly 4 0 2 4 3 1 1 0 0 0 3 3 3

Falls per 1,000 occupied bed days monitor monthly 0.1 0 0.2 0.1 0.1 0.1 0.2 0.1 0.1 0.1 0.1 ** 0.1

Serious Incidents (including Never Events)

monitor monthly 46 17 20 38 20 9 16 11 11 12 10 10 N/A

Total patient safety incidents reported monitor monthly 1573 1770 1739 1863 1851 1577 1646 1500 1719 1544 1848 1674 N/A

Complaints (actual numbers received) monitor monthly 45 69 62 31 54 56 52 57 55 52 64 52 N/A

Complaints (per 1,000 contacts) monitor monthly 0.56 0.77 0.69 0.43 0.64 0.74 0.64 0.69 0.61 0.64 0.74 N/A

FFT Inpatient & Day Cases % recommend (+ve)

similar or above

national monthly 96% 97% ** 97% 97% 97% 97% 98% 97% 98% 98% 97%

FFT Outpatient % recommend (+ve) monitor monthly 94% 95% ** 94% 93% 93% 91% 94% 93% 92% 94% 96%

FFT ED % recommend (+ve)similar or

above national

monthly 95% 96% ** 96% 94% 93% 95% 96% 90% 89% 89% 91%

FFT Maternity % recommend (+ve)similar or

above national

monthly 100% 99% ** 99% 98% 99% 97% 97% 99% 99% 98% 99%

Mixed Sex Accommodation Breaches (non clinically justified)

0 monthly 0 0 ** 0 10 0 1 0 0 4 0 0

12 hour trolley breaches (DTA) 0 monthly 32 6 2 52 73 21 11 0 2 0 0 0 2Number of patient moves on average per month of non clinical moves after 2100hrs

<3 monthly 7.2 8.8 ** 8.9 8.5 5.8 8.5 3.7 3.9 4.7 5.1 4.9

Patient Safety

Patient Experience

Urgent and Emergency Care

Regulatory

HCAI

Clinical Outcomes

1.0Portsmouth Hospitals NHS Trust (PHT)



PORTSMOUTH HOSPITAL TRUST1.1 Portsmouth Hospitals Trust quality dashboard exceptionsCQC The trust received an overall rating of ‘requires improvement’ – see below for further information. Never event: There was 1 low harm never event reported. The event related to a patient having the wrong joint injected whilst

undergoing a therapeutic arthrogram. The year-to-date position is 2 reported never events.

1.2 Portsmouth Hospital Trust risk assurance statementsCQC Regulatory Requirements

Urgent Care risk rating 16

Overall The CQC published its report on the findings of the comprehensive and well led inspections carried out in April and

May in August. The trust has been rated as ‘Requires Improvement’ in all domains and overall. A summary of the ratings can be found in Appendix 1. The CQC inspection report outlined 54 ‘must do’s’ and 71 ‘should do’s’. In support of the list of must/should do’s, the trust was formally served with a notice under section 29a of the Health & Social Care Act 2012 in July 2018. This sets out the observed circumstances which led to the conclusion that the trust has breached relevant regulations, and requires action to be taken to address these breaches by 31 October 2018.

The trust has established a Quality Recovery Group (QRG) to oversee the delivery of the quality recovery plan. The QRG will replace the Quality Improvement Oversight Group established by NHS Improvement to scrutinise the trust’s delivery of required improvements.

The trust currently has three Section 31 Enforcement Notices and one Warning Notice under Section 29a of the Health and Social Care Act 2018 in place. The CQC has notified the trust they these are in the process of being removed.

Urgent Care The CQC inspection report rated urgent and emergency care services as ‘requires improvement’ overall. The safe,

effective, caring and well-led domains were rated as ‘requires improvement’ but ‘inadequate’ for the responsive domain.

The CQC Section 29a notice (July 2018) included concerns specific to urgent care and these were lack of awareness from emergency department (ED) medical and nursing staff about Mental Capacity Act (MCA) and consent, ambulance handover delays, inefficient streaming and delayed 15 minutes triage assessments as well as patients spending too long in pit stop and the ED corridor.

The compliance with the 4 hour standard steadily improved since April, reported at 83% in August, however the prolonged period of warm weather over the summer provided challenges to the trust and the system to support the



1.2 Portsmouth Hospital Trust risk assurance statements

Mental health care risk rating 12

increase in presentations to ED. The increase in demand also impacted on the number of ambulance holds, escalation beds open and patient moves at night. The performance and therefore the impact on quality has however since recovered. There have been zero breaches of the 12hr decision to admit standard.

Urgent care plan continues to focus on 4 areas; emergency care, patient flow, admission avoidance and workforce.

Mental Health: Section 31 Enforcement Notice issued in May 2017 CQC report (August) continues to identify areas for improvement in relation to care for patients with mental health

concerns including compliance with the Mental Health Act 2005, Deprivation of Liberty Safeguards (DoLS) and care for patients with dementia.

Response times within the emergency department for the Mental Health Liaison Team declined to 28% from 38% in July. Response times are discussed with SHFT at bi-weekly Mental Health meetings.

Risk assessments for patients attending ED with mental health needs continue to exceed 95%. Health WRAP training compliance remains below trajectory however improved to 74% in August. Work continues, in partnership with mental health providers to improve pathways and care plans to reduce

attendances at the emergency department for high intensity users. Risks remain with ligature free requirements and embedding DoLS management and MCA management and slow

movement to psychiatric beds. Weekly compliance information continuous to be provided to the CQC as part of the Section 31 Notice.

Section 29a (issued July 2018). Failing to comply with regulation 11 (consent), regulation 12 (safety) and regulation 17 (governance) The trust received a Section 29a notice from the CQC on 13 July 2018 (Section 29a of the Health and Social Care

Act 2008) highlighting concerns under regulation 11 (consent), regulation 12 (safety) and regulation 17 (governance); The trust has been given until 30 October 2018 to complete the required improvements; a plan has been submitted.

Radiology: Section 31 CQC enforcement notice for backlog of radiology reporting –

Section 31 Enforcement Notice (Diagnostic and Screening Procedures) issued 28 July 2017 regarding the backlog of radiology reporting remains in place. All ED plain films continue to be reported (since September 2017). The backlog relating to the Section 31 notice has been cleared. Weekly CQC reporting as per requirement of the Section 31 remains in place. The trust risk rating for radiology is 20; primarily due to workforce challenges and recruitment remains concern.



1.2 Portsmouth Hospital Trust risk assurance statementsrisk rating 16 Error rate for radiology is reported within the expected error rate range.

Diagnostic imaging received a rating of ‘good’ following the CQC inspection (August 2018).Safeguarding Independent Review and CQC system inspection risk rating 16

Safeguarding improvement plan in place and monitored through the safeguarding improvement board. An internal safeguarding committee is in place.

Safeguarding training compliance for safeguarding children level 3 training remains below target as is enhanced mental capacity act training compliance. Safeguarding children level 3 compliance remains below the required compliance trajectory at 79% in August

An adult safeguarding lead has been appointed and is due to commence their post late October 2018.Delays in assessment and treatment of patients for planned care - risk rating 16

The trust has identified a risk for inconsistent application of their policy on non 18-week waiting lists. There is focussed work on demand/capacity, and improving quality/safety via the Elective Care Board. Key specialties of concern remain gastro, ophthalmology, audiology and trauma & orthopaedics; all have plans in

place to reduce the outpatient waiting list. Additional clinical appointments have been made and these will begin to impact on activity delivery and reduction in backlog in the autumn.

Patient safety incidents (associated with delays) have been reported in ophthalmology and audiology. There were 4 breaches of the 52 week standard in August, 2 due to delays in first appointment in gastroenterology. Ophthalmology: the harm review process has commenced; terms of reference have been agreed and the process is

supported by an external consultant. Improvement plan in place; a dedicated manager and matron are supporting the service, peripheral units are fully optimised however concern of patients whom are waiting over 7 months – key focus to ensure they are seen.

Audiology: case by case approach in place to ensure no 52 week breaches, additional locum cover sourced to support long waiters domiciliary visits continue to be under pressure due to challenged capacity, short and long term plan being explored. CCG intelligence continuous to be received through Quasar, complaints and concerns.

Cancer services: trust is predicting not achieving the 62-day first definitive treatment standard for the fourth month in a row as demand remains high.

Cancelled Operations: 2 urgent operations were cancelled in July for non-clinical reasons and 3 in August (equipment failure, overrunning list, bed availability) and 50 patients in July and 37 patients in August were cancelled on the day for non-clinical reasons (list overrunning).

Diagnostic Capacity is impacting on RTT and achievement of cancer targets. The standard has not been achieved; modelling indicated that there would be a capacity gap in August due to low up take of additional sessions and locum leave and steps to mitigate this were not successful. This has been compounded by high demand, machine breakdown and sewage leaks which have further impacted on capacity. Focus on addressing capacity for cancer patients has reduced capacity for routine patients; this increases the risk of potential harm.



1.2 Portsmouth Hospital Trust risk assurance statementsGovernance risk rating 16

The revised organisational structure was implemented on 2 July and consists of four divisions supported by a corporate level operations team and led by a delivery director. Quality and performance measurements are aligned with the four divisions. This will be reflected in the integrated performance report in September trust board. This risk remains whilst being embedded.

Spinal Network risk rating 15

Transfer of services to be undertaken in November 2018; Quality Impact Assessment conducted by the CCG and shared with providers.

Mortality The CCG quality team has removed this risk from the risk register but it remains on the issues register for monitoring. This decision was made due to the continued assurance received, through CCG attendance, at trust mortality group and observation of the mortality review panel. A robust process is in place to ensure any potential learning from a patient’s death is considered, discussed at the right forums, investigated and actions taken.

1.3 Concerns to noteWorkforce Nursing staffing: significant shortfall in the nursing establishment, with nursing vacancies across the trust, significant

reliance on temporary staffing resource, decreasing compliance of appraisal compliance and essential skills compliance. Nurse fill rate fell to 86% in July.

Medical staffing: vacancies in ED (overnight), shortfall in junior doctors for gynaecology and stroke consultants. Constraints remain in hepatology and gastroenterology however new ways of working are allowing improvements in delivery of the services. Also, radiology workforce, tumour site specific radiologists and overall challenges with recruitment should be noted. The stroke staffing challenges are not due to be resolved until April 2019.

Maternity Services

(Enhanced Monitoring opened February 2018)

Quality intelligence for maternity services has indicated there are concerns in respect of compliance with safeguarding principles, records management, domestic violence requirement’s, supervision, leadership, capacity and governance (CQC August and September), serious case reviews, some performance elements within audits (higher rates of category 2 emergency caesarean section rates and post-partum haemorrhage), reduction of the number of births at Fareham & Petersfield maternity units and the Regulation 28 Coroner Report recommendations. An increase in the number of complaints received, a reduction in ‘would recommend’ in the family and friends test and number of serious incidents open post 60 day deadline also have been noted.

Maternity had been rated ‘good’ overall (CQC 2015) however the recent inspection rated all 5 of the CQC domains as ‘requires improvement’. The safe, effective, responsive and well-led were rated ‘requires improvement’ and the caring domain as ‘good’.

Under the new governance arrangements, a divisional accountability and performance review with the service was held in August and actions have been identified to support improvements. The maternity board, chaired by the director of nursing, has a key focus on improving the areas of concern.

There is a deep dive and clinical visit scheduled for November 2018.



2.0 South Central Ambulance NHS Foundation Trust (SCAS)

Group Quality IndicatorThreshold Frequency Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18

YTD RAG

Rating

Current CQC Rating (999 specific) Requires Improvement

Last available

CQC or NHSI regulatory requirements in place

0 Current Green Green Green Green Green Green Green Green Green Green Green Green Green

Never Events 0 Monthly 0 0 0 0 0 0 0 0 0 0 0 0 Green Serious Incidents monitor Monthly 0 0 0 2 3 2 2 2 0 0 1 1 N/A

Number of DATIX incidents - non-staff (this is the internal form to report incidents in SCAS - this covers all types of incident - accidents, injuries, missing equipment etc.)

monitor Monthly 385 321 346 337 314 317 385 293 307 354 411 382 N/A

Long Waits - the number of incidents identified (clinical/non-clinical) as a result of delayed treatment/ transport

N/A Monthly ** ** ** ** ** ** ** ** ** ** ** ** N/A

Complaints - total number received N/A Monthly 6 7 7 9 6 7 8 6 9 9 4 ** N/AComplaints - % by activity N/A Monthly 0.04% 0.04% 0.04% 0.04% 0.03% 0.04% 0.05% 0.03% 0.05% 0.03% 0.02% 0.06% Green Concerns - total number received N/A Monthly 11 11 18 21 23 12 13 9 20 ** N/AHCP Feedback - total number received N/A 1 9 8 20 9 14 13 15 8 14 10 16 ** N/AFriends and Family Test - % positive - **No SCAS data has been published since April 2016 because of an extremely low volume of responses for the trust.

N/A Monthly 11 8 8 20 ** ** ** ** ** ** ** ** Red

Stroke Care bundle compliance

Similar or above

national average

Monthly 99% 100% 99% 99% 99% 98% 97% 97% 97% 95% 97% 98% Amber

STEMI Care bundle compliance

Similar or above

national average

Monthly 77% 78% 82% 82% 79% 76% 68% 70% 0% 0% 0% 0% Red

ROSC (Return of Spontaneous Circulation post cardiac arrest)

Similar or above

national average

Monthly 36% 51% 41% 55% 48% 49% 31% 31% 27% 32% 67% 29% Red

Clinical Outcomes**4 month data lag

Patient Experience# data not yet available

Regulatory

Patient Safety

36



2.1South Central Ambulance Service (SCAS) quality dashboard exceptionsCQC Rating

STEMI Care

ROSC

CQC: CQC visits took place in August 2018 with the 111 report being recently published and the service rated as ‘good’ across all 5 CQC domains. It is anticipated that the 999 report will be published in November. No immediate concerns and improvements where identified by the CQC..

STEMI Care Bundle: Compliance has seen a slight improvement but performance is still below plan and last year. A quality improvement exercise is being planned to increase performance for this metric.

Return of spontaneous circulation (ROSC): SCAS benchmark performance against other ambulance trusts and internally this is monitored. Numbers remain low which affects the reported percentage. SCAS are undertaking a further review of their records to identify any trends or issues with data quality.

2.2South Central Ambulance Service risks 999: delays in response time risk rating 9

Hospital handover delays increased over the summer and were impacted by the trust’s meal break and end of shift policies Audits identified that no moderate harm or above has occurred however ‘poor’ patient experience is noted.

No intelligence is being received by the CCG quality team that identifies harm to patients through long waits. NHS Improvement are supporting a local plan to reduce delays.

2.3 South Central Ambulance Service issues to noteWorkforce The SCAS risk for their ability to recruit and retain staff has been increased from 12 to 16 on their risk register.

Specialist paramedic rotational posts are being explored. Vacancy concern for clinical advisors within both the 111 & 999 call centres across the north and south locality remain. A separate workforce meeting with SCAS and commissioners was held in October which provided assurance on

various work streams in place to recruit and retain staff. 111 Warm transfer delays

The ‘call answer and warm transfer’ remedial action plan (RAP) revised in May 2018. f. Compliance with the warm transfer rates and 10 minute call backs remain below the improvement trajectory, having

declined more recently due to increased activity and the nationally mandated process change (all Cat 3 and Cat 4 dispositions to be reviewed by a clinician). The latter has led the CCG agreeing to remove sanctions while continuing to monitor warm transfer rates. 111 warm transfer and call back rates compare poorly with other NHS 111 providers.

SCAS have increased the call audit rate (1% of calls + an extra 50 audits) to review that no harm is being caused, validation of category 3 and 4 calls and implemented a clinical navigator role to review the high acuity of patients.

In June 2018 SCAS submitted to commissioners a proposal to review the clinical key performance indicators relating to warm transfer and call backs so that safety is maintained. These were discussed at a meeting in August between SCAS and the Portsmouth City CCG clinical lead. Actions have been identified, together with a proposal to try and align Hampshire footprint and Thames Valley KPIs.

Safeguarding An overarching action plan is in place following concerns raised in regards to the provision of safeguarding across all 3 SCAS services provides for adults, children and looked after children. Progress is being made.



3.0 Southern Health NHS Foundation Trust (SHFT) : SHFT Integrated Care Services SHFT Integrated Services Division Scorecard for Quality Contract with WHCCG 2017/18/19

Month 14 July 2018 data. Date submitted: Aug 2018

Targ

et /

thre

shol

d

Aug-17 Sep-17 Oct-17 ###### Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18

Number of reportable deaths (meeting SIRI criteria) 0 0 0 1 1 0 0 0 0 0 0 0

Total number of complaints received in month 2* 2 2 1 1 4 7 8 3 5 5 11Number of Patient FFT responses 289 171 78 271 174 163 155 263 ** ** ** **% positive response to: How likely are you to recommend our services to friends and family if they needed similar care or treatment?

98% 97% 97% 97% 98% 99% 96% 99% 100% 100% 100% 100%

Number of SIRIs reported on STEIS (including Never Events) 2 2 0 2 2 2 0 0 2 3 0 0Percentage of compliance in respect of Duty of Candour response whereby the provider has notified the Relevant Person of a suspected or actual Reportable Patient Safety Incident, (moderate and above) (as per Service Condition 35)

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Grade 2 pressure ulcers - where there has been provider lapses in care 0 0 1 1 0 1 1 4 2 1 1 0



Number of pressure ulcers reported as SIRIs on STEIS 1 0 0 1 1 2 0 0 0 2 0 0Number of falls reported as incidents (all falls) 17 18 17 18 12 21 12 20 22 23 5 12Number of moderate and above harm falls 0 1 0 0 0 0 0 0 ** ** ** **Number of falls meeting the SIRI criteria 95% 0 1 0 0 0 0 0% 0% 2 1 0 0In-patient falls rate per 1,000 occupied bed days 7 8 7 8 5 8 5 8 8 9 2 4Medicines reconciled by a pharmacist within 48 hours for Gosport 80% 94% 100% 89% 92% 93% 80% 85% 91% 85% 100% 100% 100%Medicines reconciled by a pharmacist within 48 hours for Petersfield 80% ** ** ** ** ** ** ** ** 93% 80% 100% 100%Number of Whistleblowing Events 0 0 2 1 5 0 0 1 ** ** ** **

Preventing people from dying prematurely

Treating and caring for people in a safe environment and protecting them from harm

Ensuring people have a positive experience of care

To note: An SHFT process change has resulted in the organisation sending one dashboard for all ICS CCGs changing a number of data views, of which the CCG has requested clarity.



SHFT Mental Health (MH) dashboard

Ensuring people have a positive experience of care Data LevelTarget/thr

esholdFriends and Family Test

AMH %

total responses

LD %

total responses

OPMH %

total responsesComplaints

AMH 17LD 1

OPMH 2

% of complaints acknowledged by provider within 3 days Trust-wide 100%

% of complaints responded to by provider within agreed timescales Trust-wide 95%

Treating and caring for people in a safe environment and protecting them from harm Data Level Threshold

Duty of Candour breaches Trust 0

AMH 8

LD 1

OPMH 2

AMH

LD

OPMH

AMH

LDOPMH

Appropriate decision recorded for conversion of death to SI Trust 95%

AMH 30

LD 60

OPMH 15

AMH 0

LD 0

OPMH 0

% patients having VTE risk assessment OPMH

1 0

0

0 0

0

JulMay

3

0

12 8

5 5 3

0

12

102

44 45

5

59

0

2

0 2

0

2

8

0

0

5 01

10

26% 62% 64%

PATIENT EXPERIENCE Are services caring? Are services responsive to people's needs?

Number of Serious Incidents (SIs) reported

SeptAugJul

Quarter 1 2018/19

Jun

Quarter 2 2018/19

Aug

0

SeptApr

0 1

0

93% 93%

Apr May

3

6

0

4

95%

95%

14 13Total number of complaints received by provider

91% 90%

Jun

48

Friends and Family: inpatient % who would be likely or extremely likely to recommend the service

95% 91% 93% 96% 93%

100% 100% 93% 100%

PATIENT SAFETY Are services safe? Are services responsive to people's needs?

0

1

0n/a

23 14 21

95%98%

Total numbers of inpatient deaths

100% 100% 100%

Number of deaths meeting the SI criteria (including suspected suicide)

03

n/a

0 0

0

0 0

0 1

100%

4

0

Quarter 2 2018/19

0

0

0

0

1

0

0

0

0

2 4

Quarter 1 2018/19

42

00 0

65%

0

0

0

0

4336

Numbers of incidents of hands-on restraint

Numbers of restraint resulting in moderate to severe harm 00

0

64 53

0 0

26

8

54 40

100%

207 252 193 207 167

18 15 15 13 7

56% 48%

21

45% 76%69%

0

6088 99

0

73%

88% 96% 100%

100%

100% 96%



3.1 Southern Health NHS Foundation Trust (SHFT) quality dashboard exceptionsCare Quality Commission (CQC) outcomes and regulatory breaches

(Table extract from SHFT CQC 2018 Summary presented at SHFT Board on 02/10/18)

The CQC report published in October 2018 rated the trust as above. The CQC noted the progress being made. SHFT breached seven regulations of the Health and Social Care Act and is working towards improvements to

ensure services are in line with requirements; Areas of concern had been raised around Bluebird House and Leigh House, however the CQC has been in to re-

inspect. The Section 29a enforcement notice was lifted after a detailed response and evidence of assurance had been provided by the trust, which demonstrates a significant improvement in trust processes / culture.

3.2Southern Health NHS Foundation Trust risks Quality of services at SHFT risk rating 16

The Quality Oversight Committee meets monthly to review the level of assurance the CCGs and regulators have of quality in SHFT. At the October meeting, a decision was made to stand the committee down and return the trust to business as usual assurance and oversight arrangements e.g. through contract quality review meetings.

3.3 Southern Health NHS Foundation Trust issues to noteWorkforce for ICT, mental health and learning disability

The CCG continues to seek assurance that current significant challenges with staffing levels (including nurse staffing skill mix, medical staffing and support staffing), recruitment challenges, and leadership changes do not have a negative impact on the quality of services.

Workforce concerns are affecting all SHFT services including inpatient and community teams, both nurses, medical and allied health professional staff.

Locally in the East division, SHFT have raised concerns that the integrated care teams may be working beyond capacity which may affect the patient care delivered to the population and both the trust and the CCGs are monitoring mitigation plans and impact.



SHFT.ICS.13 specialist palliative care

There is a combination of increased demand and reduced capacity in clinical nurse specialists and medical workforce in this service. A workforce plan is in place and mitigating actions were received by the CCG. These are being monitored by

commissioning and quality. Process mapping across all providers is planned for mid-October Enhanced monitoring.

4.0 Nursing HomesNursing Homes- risk register 16

There is a risk that people living in nursing homes, across the CCGs’ areas are not receiving optimal nursing care due to significant shortages in the registered nursing workforce, along with nursing leadership capacity gaps, resulting in skill mix challenges and impacting on quality of care. This challenge affects the safe delivery of care and the nursing home’s ability to adhere to CQC registration requirements potentially resulting in CQC actions and decisions to close.

All homes are monitored through the Local Authority (LA) governance processes, CQC, CHC reviews and any safeguarding alerts the CCG receives. The CCG is working together with the SHFT Care Homes Team and the Local Authority to understand the risks for residents associated with these staff shortages.

Quality improvement strategies are ongoing with the CCG planning a programme of work with the LA to support health elements of training where there are gaps and the implementation of the NEWS 2 and RESTORE project through the new models of care work stream

Through analysis of qualitative and quantitative data, it has been identified that there are three pillars of concern in relation to the quality of care delivered to residents within nursing homes: recruitment and retention, leadership and core nursing assessment skills. A joint approach is to be implemented with Hampshire County Council who has secured two years of investment through the Better Care Fund to address these themes. A partnership engagement day is to take place on 18 October 2018 to co-produce an initial development plan.

In addition to the above, ongoing strategic plans include the identification of one nursing home who would be appropriate for intensive clinical and leadership development from the CCG. Currently, scoping exercises are being undertaken jointly with the Care Homes Team.

5.0 Associate Provider Contracts Millbrook Healthcare Wheelchair Services

Future Priorities – Continuous Improvement (CI) Plan: MHWS and commissioners have agreed improvements to build on the work undertaken as part of the service review. The Continuous Improvement plan has been developed to include actions to address the key challenges faced by MHWS (excess demand and staff retention) and includes the remaining actions identified in the Service Review action plan. From a quality perspective, areas



5.0 Associate Provider Contracts (MHWS): patients are experiencing long waits for wheelchairs - risk rating 12

include workforce, record keeping and complaint management. Workforce – clinical and operational leadership positions have now been recruited to. Although some vacancies

remain there is a much improved position. Workforce attrition and retention forms part of the CI Plan. Children’s Referral To Treatment (RTT) - There is the potential for the 18 week RTT children’s targets to impact on

adults. The CCGs are working in partnership with Millbrook to undertake a review of school clinics. Performance impacting quality: August 2018 data shows that MHWS has a waiting list of 1692 adults

(deterioration from July) and 295 children (static from July). Millbrook have shared their revised triage tool and the CCG has partial assurance that service users are being protected from harm whilst they are experiencing longer than anticipated waits. However, clarity is being sought on how patients are being actively monitored whilst on the waiting list if they do not have regular input from community teams. WHCCG continues to promote provider collaboration to prevent patient harm and to ensure that in cases where it is thought harm may have occurred that they are effectively investigated and appropriate changes to practice are made by the relevant provider. However, the quality intervention cannot address the underlying issue that activity is above the commissioned threshold. Delivering evening and Saturday clinics are being considered.

Complaint response time: The CCG is not assured by MHWS’ current complaint response performance and that the controls that were put in place to support improvement in this area will be adequate given the current operational challenges. WHCCG is working with MHWS to review the controls in place and to agree realistic improvement trajectories. There are robust processes in place to monitor MHWS’ complaint management performance.

Partnering Health Limited (PHL) - risk rating 10

There is improving performance in Home Visiting (HV) following a systems review and the initiative of a HV improvement plan which has been rolled out to dispatch teams. This initiative remains in the early phases but PHL continue to have good engagement and feedback from teams.

Retention of staff across PHL and particularly Out of Hours remains good University Hospitals Southampton NHS Foundation Trust (UHS)

Ophthalmology: despite the ongoing work to manage the backlog for follow up appointments the position is not improving which is impacted by increasing demand for ophthalmology services.

Delayed discharges continue to be an area of focus; the timeliness safety and effective discharge of patients. Continued challenges with meeting the cancer waiting time standards and in specific the achievement of the two

week wait standard for breast where cancer is not initially suspected. Staffing was been rated amber in June 2018; as UHS were not achieving several KPIs, including those relating to

nursing vacancies, staff turnover, appraisal completion and sickness. Sickness absence however is reducing and UHS was close to achieving the target in the last three reported months so although nursing vacancies are increasing, care hours per patient day is also increasing and remain well above the national average.

Quality impact for all areas is monitored through the CQRM process.



5.0 Associate Provider Contracts Sussex Partnership NHS Foundation Trust (SPT) – Specialised Children and Adolescent Mental Health Services Risk rating 20

There continues to be a significant impact of long waiting lists on children and their families and workforce welfare as the trust is working consistently over plan. NEHCCG continue to work with SPT to progress the actions identified and agreed as part of the ‘call to action’ meeting. Negotiations with a new provider (Psicon) have taken place to support the service delivery and a reduction of the waiting list; the service will commence from 10th September 2018 to 30th June 2019 supporting clinics in venues Hampshire.

The recruitment issues seen over the past 18 months have reduced considerably, with current vacancy rate remaining at 4%. Fixed term contracts can account for some increase with retention but the service understands this is an area to concentrate on over the coming months. Now recruitment difficulties have lessened mandatory training service compliance overall is above the Trust target of 85%.

Western Sussex Hospital NHS Foundation Trust

Challenges reported to achieve referral to treatment targets with 12 specialties reporting to be non-compliant including ophthalmology and orthopaedics.

Challenges with achieving stroke care key performance indicators The trust was non-compliant for cancer 62-day performance and RTT 18-week compliance was below the national

constitutional target. Royal Surrey County Hospital

The trust no longer has an NHSI breach of its operating licence. The trust continues to struggle with cancer performance, which includes 2 week waits, breast symptomatic and the

62-day standards. Significant capacity issues are impacting on the ability to offer patients an appointment <7days for their first outpatient appointment and work is ongoing in order to improve this.

The retention of overseas nurses remains an issue Staffing challenges continue: progress in filling vacancies is affected by the number of leavers each month, plus

internal moves/promotions; an average of 40WTE staff are choosing to leave the trust every month, and since April 2018, 40% of advertised posts have been filled internally.

Solent NHS Trust

Prescribed Home oxygen therapy in the community: risk rating 10. Solent has identified a number of patient safety incidents related to falls/equipment, patients who smoke whilst in receipt of oxygen therapy are the highest risk to the service. Portsmouth City CCG (PCCCG) is monitoring this risk.

Impact of missed community nursing visits: this continues to be monitored by PCCG and a thematic review is being undertaken.

Safeguarding: in July 2017 the trust participated to the CQC Portsmouth CLAS inspection. The report identified a number of actions for the Trust which are in progress and being monitored through the Hampshire and Portsmouth Local Safeguarding Boards Improvement Committee.

Staffing remains challenging across all service lines and there is high use of bank and agency staff.



5.0 Associate Provider Contracts Hampshire Hospitals NHS Foundation Trust (HHFT)

The CQC undertook unannounced visits to all three sites at HHFT during June 2018 and for the ‘well-led’ element of their review in July 2018. The overall findings indicated that not all areas inspected had made improvements since the last CQC inspection; the trust was rated overall as requires improvement. The safe, effective, responsive and well led domains were rated as requires improvement, and caring as good.

Infection prevention training requires improvement: 72% compliance for all staff, except doctors, reported for July; improvement plans in place.

Safety Culture: following identification of repeated themes when reviewing Serious Incidents involving pressure ulcers and falls (risk assessment, care planning, documentation, one to one care), the WHCCG are supporting HHFT to review their patient safety culture.

Tier 2 Providers There is an established process for quality monitoring in place utilising an annual quality self-assessment toolkit. Contracts and quality requirements including an updated self-assessment tool are being shared with providers. The 2018 assessment has been requested as part of the contract review.

6.0 Independent providers Priory Group - Nelson House Knightsbridge House

Nelson house had a CQC inspection on 17th and 18th July 2018. The outcome of this inspection was ‘overall good’. Safe was rated as ‘requires improvement’. The report advises that the staff team were using blanket restrictions rather than undertaking individual risk assessments. It was noted that not all bedroom doors had observation panels that staff could lock to ensure individual’s privacy could be maintained. The staff could also deliver improvements should care plans be provided to service users in an easy to understand format. It was reported that there were regular environmental checks to find and address any risks. The environment was clean and in a good state of repair. Staff knew what to report as an incident and took action following incidents to keep patients safe. Staff followed good hygiene. Strong leadership was recognised within Nelson House by the CQC. The process of improvement continues to be supported through the CQRM.

Knightsbridge House (Contract led by West Hampshire CCG). An interim pathway has been developed to ensure that patients have appropriate access to primary care. A private practice arrangement is being considered as an option. Six alerts were raised during August 2018 however there are no open Section 42 enquiries at present. Occupancy rate is currently 56%. A substantive ward manager is now in post. Staff training compliance is at 94%.


CCGs quality exception report I October GB I 17Page 17 of 2012 Quality Exception report.docxOverall of 247


Group Sub group Quality Indicator Threshold Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Total18/19Complaints F&GCCG N/A 3 1 1 4 0 5 0 0 1 4 7 0 12Complaints SEHCCG N/A 1 0 0 2 2 1 4 3 0 2 1 1 103 day acknowledgement compliance 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 50% 0% 100% 50%PHSO Referrals N/A 0 0 0 0 0 0 0 0 0 1 1 0 2Complaints re-opened 3 1 1 0 2 2 2 0 0 2 1 0 0 3Complaints - closure in agreed timeframe 95% 4 1 1 5 2 2 4 0 0 0 0 1 5Complaints - not closed in agreed timeframe N/A 1 0 2 0 0 0 6 0 0 6Complaints - ongoing N/A 0 1 1 3 14 5 24Complaint - number upheld N/A 0 0 0 0 0 0 0 0 0 0 0 0 0Complaint - number partially upheld N/A 0 0 0 1 0 3 1 1 0 0 0 1 3Complaint - number not upheld N/A 4 0 1 5 2 3 3 1 0 0 0 0 4Concerns and Enquiries F&GCCG N/A 14 23 22 83 25 21 24 18 24 12 16 34 128Concerns and Enquiries SEHCCG N/A 18 26 17 33 40 19 13 11 18 11 10 17 80Concerns and Enquiries (for associate CCGs) N/A 4 3 4 0 5 3 3 3 1 0 0 2 9Compliments N/A 1 1 1 2 0 1 1 1 1 1 2 3

Serious incidents CCG reported N/A 0 0 0 0 0 0 0 0 0 0 0 0 0Serious incidents CCG reported closed in time N/A NA 1 NA NA 1 NA NA NA NA NA NA NA 0Serious incidents reported by PHT N/A 11 11 12 10 9 11 64Never events reported by PHT 0 1 1 2 0 2 0 1 0 0 0 0 0 1Serious incidents reported by SCAS N/A 2 0 0 1 0 0 3Serious incidents reported by SHFT ICT BU1 N/A 2 3 0 0 2 2 9Cdiff cases F&GCCG 29 7 4 0 2 2 4 3 4 12 3 6 tbc 28MRSA BSI cases F&GCCG 0 0 0 0 1 1 0 0 0 0 0 1 tbc 1CDiff cases SEHCCG 49 2 5 2 4 4 2 3 3 4 6 4 tbc 20MRSA BSI cases SEHCCG 0 0 0 0 0 0 0 0 0 0 0 1 tbc 1Cdiff cases PHT 39 6 5 5 5 3 4 2 1 5 1 4 tbc 13MRSA cases reported PHT 0 0 0 1 0 0 tbc 1E-Coli F&GCCG 113 16 14 11 12 11 11 7 13 16 15 17 tbc 68E-Coli SEHCCG 127 12 16 9 7 24 20 10 11 16 17 14 tbc 68HCP Feedback received F&GCCG N/A 28 23 28 24 32 37 35 55 56 96 48 95 385HCP Feedback received SEHCCG N/A 33 43 27 38 63 87 79 110 84 56 123 46 489

CAS

CAS Alerts raised N/A 7 9 15 11 12 6 12 14 10 12 5 8 61Number of adult safeguarding cases F&G/SEHCCG (new) NA 28 23 25 17 36 20 149

Number of open safeguarding CHC cases (sect42 enquiries) NA

2 3 7 1 4 3 20

CHC open alerts pending investigation/feedback from CGC NA

8 21 9 69

Non CHC FG/SEHCCG - CCG contribution to investigations NA

8 11 8 49

Multi-Agency Risk Management Framework implementation (New cases) NA

1 0 0 1 0 4 3 0 8

Case Closures NA 5 18 23

Number of NEW LEDER cases assigned to CCGs NA 3 2 2 1 3 4 15

Number of cases on hold (CDOP) NA 2 2 2 2 2 2 12

Number of LEDER cases open/under review NA 16 18 21 21 21 25 25

Number of completed & submitted cases NA 0 0 0 0 2 0 2

SGA Training Compliance Level 1 - CCG tbc not due 62%Number of children safeguarding cases F&G/SEHCCG (new) NA

tbc tbc tbc tbc tbc tbc tbc

SGC Training Compliance Level 1 - CCG 75% not due 63%

IG Caldicott Breaches 0 0 1 0 1 2 0 0 1 0 0 0 0 1

Patie

nt S

afet

y

68%

31

22

62%

63%

new indicator for 2018/19




New indicator new indicator for 2018/19

new indicator



Quality Duty Indicator DashboardPa

tient

Exp

erie

nce

Safe

guar

ding

safe

guar

ding

ch

ildre

nSa

fegu

ardin

g ad

ults


Com

plaint

sCo

ncer

ns

64%

72%

68%

new indicator for 2018/19new indicator for 2018/19



Serio

us in

ciden

tsIn

fect

ion p

reve

ntion

&

cont

rol

HCP




Section 7 CCG Quality Duty Dashboard exception reporting



Clostridium difficile infection (CDI)

F&GCCG have reported 28 cases of CDI April – August against an annual trajectory of no more than 29 cases; compared to 26 cases in the same period in 2017/18. Risk rating discussed at JQAC and to remain on the risk register rated at 15. Continued review of community cases occurs and any learning identified is shared with the relevant people. No themes have been identified as such during the reviews of quarter 1 and the quarter 1 report is included in the papers for the meeting.

Enquiries, concerns and complaints

Contingency plans are in place to support the complaints function whilst the complaints manager is on phased return. One local resolution meeting was been held in September.

Serious Incidents (SIs)

26 serious incidents were reported by the three main providers during September 2018, please note that not all these serious incidents affected FGSEH CCG patients. Of the 26 reported, 12 are being managed by F&G and SEH CCG. 3 incidents affected FGSEH patients, but are not being managed by FGSEH

Top 3 themes for SIs reported (managed by F&G/SEHCCG) in July were:o Apparent/actual/suspected self-inflicted harm meeting SI criteria (6)o Slips, trips and fall meeting SI criteria (4)o Pressure ulcer meeting SI criteria (3)

Quality Surveillance and Reporting (Quasar)

151 items of HCP feedback received during September 2018 The types of concerns raised in September 2018 were information governance breaches (IG), reporting and

medicines management treatment From April to September 2018 it is noted that every GP practice is submitting feedback.



Appendix 1: CQC ratings by service for PHT

The full report can be found: https://www.cqc.org.uk/sites/default/files/new_reports/AAAH3372.pdf




Title of Paper Integrated Performance ReportAgenda Item 13 Date of meeting 24/10/2018Exec Lead Andy Wood Clinical SponsorAuthor Michael Drake

For DecisionTo RatifyTo Discuss X

Purpose

To Note X


2 - Integrate primary care, community care, social care and voluntary services to deliver a range of care, close to home that allows people with complex needs and the most vulnerable to stay healthy and feel in control of their health.

3 - Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis.

4 - Commission consistently high quality planned care services that work with patients to deliver the best outcomes possible.

Executive SummaryAccident and Emergency (A&E) PerformanceA&E Performance at our main Acute Provider Portsmouth Hospitals NHS Trust is currently off trajectory. Performance is being impacted by a number of issues including a lack of adequate patient flow, high levels of bed occupancy and demand. This paper outlines the actions being taken by the system to address these issues.

Cancer StandardsCCG performance against the 62 Day Wait for First Treatment following a GP referral is being impacted by an under performance at our main Acute provider; Portsmouth Hospitals NHS Trust. The Trust has failed to consistently achieve the standard in 2018/19 with increasing demands for Cancer Services and a capacity shortfall in diagnostics and diagnostic reporting impacting on the Trust’s delivery of this standard. This paper outlines the key actions being taken to address this and recover performance to a sustainable position.

Referral To Treatment Performance (RTT) PerformanceFinally, this paper also provides a summary of the CCGs current Referral To Treatment Performance (RTT), the risks to delivery against 18/19 operating plan trajectories and actions being taken as a result.

Recommendations Governing Body to note information in the paper.


Page 1 of 713 Performance Report 201810.docxOverall of 247


CONTENT – MEETING PAPERS

1. Summary

1.1 This paper provides an overview of the CCG’s current performance against key constitutional targets and priorities of the NHS. The paper outlines a summary of the current challenges impacting on delivery of the A&E 4 Hour Wait Standard, sustainable delivery of the Cancer 62 Day Wait from Referral to Treatment following a GP referral and delivery of the 18/19 RTT Waiting List Size targets as per the CCG’s 18/19 operating plan.

The paper will provide a summary of the corrective actions being taken to address the key challenges identified.

The Joint Governing Body is asked to note the information set out in the paper.

1.2 Identify and summarise a description of the key risks associated with the issue to be developed in the paper.

Risk one: IF the issues relating to A&E demand and hospital flow are not addressed THEN there is a risk to further deterioration in performance and patient outcomes.

Risk two: IF the issues impacting on Cancer Performance are not addressed THEN there is a risk of increased waiting times for patients and patient outcomes.

Risk three: IF the demand and capacity issues impacting on RTT performance are not addressed THEN there is a risk of increased waiting times for patients and patient outcomes.

1.3 This paper will:

Provide a summary of the latest nationally published performance.

Please provide details on the impact of following aspectsEquality and Quality Impact Assessment Not applicable

Patient and Stakeholder Engagement

Demonstrates the actions being taken by the CCG and wider system in response to the current performance related challenges

Financial Impact, Legal implications and Risk Not applicable




Where performance is below standard, a summary of the underlying issues. Details of key actions being take to address areas of underperformance. Progress against recovery trajectories where applicable. Summary of provider level and national performance for context.

2. Context

2.1 The paper provides a summary of the latest nationally published data, any local intelligence relating to ‘in month performance’ or ‘latest positions’.

3. Addressing issues and risks

3.1 The paper outlines the key actions being taken across the system to address the highlighted performance issues.

3.2 Sub-Headings (for each risk or issue)

Risk one: IF the issues relating to A&E demand and hospital flow are not addressed THEN there is a risk to further deterioration in performance and patient outcomes.

Latest nationally published data places the Trust’s September ‘18 A&E performance at 80.44% compared to 83.04% in August ‘18. There were no reported breaches of the 12 hour trolley wait standard in September ‘18.

Demand for A&E remains above forecast levels and is current 3.8% up year on year (April – September 2017/18 v 2018/19). This equates to an additional 16 (15.5) attendances per day.

As we approach winter, system wide plans are now well underway to address the increases seen in demand and improve patient flow within the Hospital.

Plans have been produced with the objective of sustaining A&E performance and maintaining a safe level of bed occupancy at the Trust over winter. System plans are focused on closing the identified ‘peak’ winter bed gap through a combination of;

Increasing the number of complex patient discharges. Improving daily flow. Avoiding admissions. Use of escalation capacity through winter.

A Rapid Capacity Implementation team has been established across CCGs, Local providers and City / County Councils to lead on this.



The team meet on a weekly basis to monitor and track progress against key deliverables required to achieve the objective of maintaining A&E performance and a safe level of bed occupancy over winter.

Longer term sustainability plans to address the forecast increases in demand expected over the next 5 years are being progressed with a focus on Admission Avoidance.

The latest performance data is starting to show a reduction in the average length of delay seen in discharging patients identified by the Hospital as medically fit and no longer requiring an acute bed.

Looking at the nationally published Delayed Transfers of Care (DTOC) for the Trust; For August 18, there were on average 41.1 beds occupied each day by a patient medically fit for discharge at the Trust. The daily average for August ‘17 was 78.6 beds.

A delayed transfer of care occurs when a patient is medically fit for discharge from acute or non-acute care and is still occupying a bed. This is a key indicator of flow at the hospital.

Risk two: IF the issues impacting on Cancer Performance are not addressed THEN there is a risk of increased waiting times for patients and patient outcomes.

CCG performance against the Cancer 62 Day Wait for First Treatment following a GP referral is under pinned by that of our main Acute provider, Portsmouth Hospitals NHS Trust.

Latest nationally published data (August ’18) shows that Fareham and Gosport CCG achieved the Cancer 62 Day Wait for First Treatment following a GP referral standard. The standard was however missed by South Eastern Hampshire CCG reporting 83.6% against a target of 85%.

Portsmouth Hospitals NHS Trust continues to highlight that increases in demand and a capacity shortfall in diagnostics and diagnostic reporting present a risk to sustainable delivery of this standard.

For the period April – September 2017/18 v 2018/19, the Trust have seen an increase of 9% (8.59%) in suspected cancer 2 Week Wait referrals. There has been no reduction in the conversion rate to confirmed cancer.

The Trust has developed a recovery plan targeting sustainable achievement of the Cancer 62 Day Wait for First Treatment following a GP referral standard from November 18 onwards.

To support the increase in Cancer demand and to address the gaps in diagnostic capacity, the Trust has reviewed applicable diagnostic clinic templates to match the increases seen in Cancer demand. In doing so the Trust recognises this represent a risk to delivery of the



Diagnostic 6 Week Wait standard for routine patients. In response, the Trust and CCGs are undertaking demand and capacity modelling to identify any gaps at test level and ways to jointly address these.

Risk three: IF the demand and capacity issues impacting on RTT performance are not addressed THEN there is a risk of increased waiting times for patients and patient outcomes.

As at the end of August ’18, the Referral to Treatment (RTT) waiting list size for both Fareham and Gosport CCG and South Eastern Hampshire CCG is off trajectory;

CCG August ‘18 Plan August ‘18 ActualFareham & Gosport 11,595 12,666South Eastern Hampshire 13,273 13,920

As with Cancer, the CCG’s RTT performance is primarily underpinned by Portsmouth Hospitals NHS Trust.

At the end of August 18, the number of patients on the Trust’s RTT waiting list was 34,817 against an operating plan trajectory of 33,500. Overall, the total Trust waiting list size increased by 216 patients compared to the previous month. The number of patients waiting over target (18 weeks+) increased to 5,309 pathways up from 5,047 in July.

The Trust reported 4 patients waiting in excess of 52 weeks at the end of August; 3 x Gastroenterology (2 x Fareham & Gosport CCG and 1 x South Eastern Hampshire

CCG). 1 x Urology (1 x Fareham & Gosport CCG).

All patients reported waiting over 52 weeks at the end of August have now received treatment.

The growth seen in PHT’s waiting list size is driven by a demand and capacity mismatch across a number of specialties including Audiological Medicine, Dermatology, ENT, Eye Unit, Oral Surgery (NHSE commissioning), Cardiology, Diabetes, Gastroenterology, Hepatology, Respiratory Medicine, Stroke, Orthopaedics, Breast Surgery, Colorectal Surgery, General Surgery, Plastic Surgery, Urology, Gynaecology.

The CCG’s are working with those specialties where demand and capacity gaps have been identified to develop plans to achieve a reduction in new referrals, follow-up and procedure attendances to help close the gap. As a result the following actions have been taken to-date:



The roll out of Cardiology Advice and Guidance (A&G) completed for Portsmouth CCG. Commissioners are meeting with Community providers to discuss alternative options for Fareham and Gosport and South Eastern Hampshire CCGs.

The Teledermatology project is now up and running and is subject to ongoing monitoring to ensure the conversion rates and reduction in activity in Dermatology outpatients are as expected.

Roll out of Dermatology Advice and Guidance pathway progressing targeting a reduction in referrals into the Trust.

Working to implement a Single Point of Access for Colorectal, Gastroenterology and Upper Gastro Intestinal services. It is anticipated that this will assist the Trust in reducing duplication, result in more efficient pathways and allow for increased triaging of referrals.

Current MSK pathways to be redesigned to include an enhanced clinical triage element which will support a reduction in referrals to our main acute provider.

4. Options (if applicable)

Not applicable.

5. Recommendations

The Governing Body are recommended to support the actions outlined under next steps.

6. Governance

Latest performance data, including local indicators is available via the CCGs Planning and Performance tool. In addition to the performance data this provides a summary of all actions being taken to address areas of underperformance by the CCG and wider system together with timescales and associated risks.

7. Next steps

Accident and Emergency Performance Gateway to review of progress made against key actions to support 18/19 winter

planning to be held on the 18th of October. All teams (CCG, Providers and Councils) are required to present their delivery of inputs.

Cancer Standards Trust to undertake demand and capacity modelling to reflect the increased demand in

cancer referrals and capacity required to support this and maintain the 6 week diagnostic standard.

RTT



Overcome barriers in Cardiology and Dermatology to allow the implementation of Advice and Guidance as the principle route for both services.

Conclude the final Digestive disorders pathways and prepare to launch within Primary Care.

Develop the Common Condition pathways for Dermatology. Launch the final Cardiology pathway in Primary Care. Continue to increase the focus on outpatient follow ups.

8. Decision Required

The Finance and Performance Committee are asked to: Note and approve the paper.

Annex

F&G_Performance_Tables.pdf

SEH_Performance_Tables.pdf


Overall of 247

Organisation Frequency Target Jun-18 Jul-18 Aug-18 Perf Dir Q1 2018/19 Q2 2018/19 2018/19 Trend

111 Calls answered within 60 seconds SCAS M 95.0% 86.6% 79.7% 82.8% 84.5% 81.2% 83.2%

Category 1 - 7 minutes mean response time SCAS M 00:07:00 00:06:53 00:07:12 00:07:08

Category 1 - 15 minutes 90th percentile response time SCAS M 00:15:00 00:12:39 00:12:52 00:13:07





A&E 4hr Wait Performance PHT M 95.0% 82.1% 80.0% 83.0% 82.9% 81.5% 82.3%

A&E 4hr Wait Performance Acute Trust Footprint PHT+SMTC M 95.0% 86.8% 85.3% 87.8% 87.6% 86.5% 87.1%

Trolley Waits in A&E - Total (>12 Hours) PHT M 0 0 0 0 2 0 2

Cancer: 2 Week Wait CCG M 93.0% 96.6% 94.9% 96.5% 95.9% 95.6% 95.8%

Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 93.0% 98.7% 96.6% 89.3% 98.1% 92.9%

Cancer: 31 Day Wait for First Treatment CCG M 96.0% 100.0% 100.0% 97.5% 99.4% 98.8% 99.1%

Cancer: 31 Day Subsequent Surgery CCG M 94.0% 92.9% 100.0% 93.9% 95.2% 97.1% 96.1%

Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 97.7% 93.5% 98.0% 96.5% 95.9% 96.2%


Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 90.0% 88.5% 100.0% 91.4% 93.2% 92.4%

RTT: Incomplete Waiting List Size CCG M 11747 12300 12464 12666

RTT: Incomplete CCG M 92.0% 87.6% 86.6% 85.4% 87.6% 86.0% 86.93%

RTT: Patients waiting more than 52 Weeks CCG M 0 1 0 3 2 3 5

Diagnostic Test Waiting Times CCG M 99.0% 98.3% 99.5% 97.4% 97.9% 98.4% 98.1%

Incidents of C.Diff CCG M 30 12 3 6 19 9 28

Incidents of MRSA CCG M 0 0 0 1 0 1 1

Mixed Sex Accommodation Breaches CCG M 0 3 1 6 3 7 10

Dementia Diagnosis Rate CCG M 66.7% 63.5% 63.7% 63.7% 62.8% 63.7% 63.2%

IAPT: People entering treatment CCG M 3.75% 3.9% 3.9% #N/A 3.6% 3.9% 3.7%

IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 48.6% 52.0% #N/A 48.4% 52.0% 49.3%

IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 97.5% 96.5% #N/A 96.6% 96.5% 96.6%


Early Intervention in Psychosis - Started Treatment CCG M 50.0% 100.0% 100.0% 100.0% 83.3% 100.0% 86.4%

Out of Area Placements for Mental Health Active at Period End CCG M 0 5 5 #N/A 10 5 15

Children & Young People Eating Disorders Seen <4 Weeks (Routine) CCG Q 95% #N/A #N/A

Children & Young People Eating Disorders Seen <1 Week (Urgent) CCG Q 95% #N/A #N/A

NHS Fareham & Gosport CCG Constitutional Target Performance

Page 1 of 113 performance FG.pdfOverall of 247

Overall of 247

Organisation Frequency Target Jun-18 Jul-18 Aug-18 Perf Dir Q1 2018/19 Q2 2018/19 2018/19 Trend

111 Calls answered within 60 seconds SCAS M 95.0% 86.6% 79.7% 82.8% 84.5% 81.2% 83.2%







A&E 4hr Wait Performance PHT M 95.0% 82.1% 80.0% 83.0% 82.9% 81.5% 82.3%

A&E 4hr Wait Performance Acute Trust Footprint PHT+SMTC M 95.0% 86.8% 85.3% 87.8% 87.6% 86.5% 87.1%

Trolley Waits in A&E - Total (>12 Hours) PHT M 0 0 0 0 2 0 2

Cancer: 2 Week Wait CCG M 93.0% 94.4% 94.6% 96.9% 95.0% 95.8% 95.3%

Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 91.4% 91.3% 92.5% 90.9% 91.7% 91.2%


Cancer: 31 Day Subsequent Surgery CCG M 94.0% 100.0% 95.7% 100.0% 97.5% 98.0% 97.7%

Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 100.0% 94.0% 90.9% 96.0% 92.6% 94.5%


Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 80.0% 100.0% 100.0% 78.6% 100.0% 85.0%

RTT: Incomplete Waiting List Size CCG M 13127 13655 13811 13920

RTT: Incomplete CCG M 92.0% 87.7% 87.1% 86.4% 87.9% 86.7% 87.43%

RTT: Patients waiting more than 52 Weeks CCG M 0 0 0 1 0 1 1

Diagnostic Test Waiting Times CCG M 99.0% 98.7% 99.2% 97.4% 98.5% 98.3% 98.4%

Incidents of C.Diff CCG M 30 4 6 4 10 10 20

Incidents of MRSA CCG M 0 0 0 1 0 1 1

Mixed Sex Accommodation Breaches CCG M 0 2 2 4 5 6 11

Dementia Diagnosis Rate CCG M 66.7% 68.8% 69.2% 69.7% 68.9% 69.4% 69.1%

IAPT: People entering treatment CCG M 3.75% 3.3% 3.7% #N/A 3.1% 3.7% 3.2%

IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 46.6% 45.8% #N/A 46.3% 45.8% 46.2%



Early Intervention in Psychosis - Started Treatment CCG M 50.0% 100.0% 80.0% 100.0% 100.0% 85.7% 93.8%

Out of Area Placements for Mental Health Active at Period End CCG M 0 5 5 #N/A 15 5 20

Children & Young People Eating Disorders Seen <4 Weeks (Routine) CCG Q 95% 65.0% #N/A

Children & Young People Eating Disorders Seen <1 Week (Urgent) CCG Q 95% 44.4% #N/A

NHS South Eastern Hampshire CCG Constitutional Target Performance

Page 1 of 113 performance SEH.pdfOverall of 247

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