NW London Sustainability
& Transformation Plan
STP Highlight Report
November 2017
Contents 2
• Executive Summary (pages 3 - 6)
• STP NW London STP Programme Lifecycle (page 7)
• Risk Framework (page 8)
• Issue Framework (page 9)
• Delivery Area 1 report: Improving health and wellbeing (pages 13 & 12)
• Delivery Area 2 report: Better care for people with long term conditions (pages 13 - 17)
• Delivery Area 3 report: Better care for older people (pages 18 - 20)
• Delivery Area 4 report: Improving mental health services (pages 21 - 24)
• Delivery Area 5 report: Safe, high quality and sustainable hospital services (pages 25 - 28)
• Workforce workstream update (pages 30 - 32)
• Digital workstream update (pages 33 & 34)
• Business Intelligence (pages 35 & 36)
• Estates workstream update (pages 37 - 42)
• Glossary (page 43)
• Contents and key messages for NWL project work book updates (page 44)
• NW London project work book – Risk framework (page 45)
• NWL project updates ( DA1ai, DA1di, DA5b, DA5ci & DA5ciii)
Executive Summary:
DA Overall what went well this month in your area? (one sentence)
(Good news that JHCTG /communications can share)
Overall what is the main action needed across your area? (one
sentence)
How can JHCTG help? (Share/act as lever/ note)
DA1 • Making Every Contact Count programme continues to be rolled out across NW London- with particularly strong
engagement across probation services, the voluntary sector and primary care.
• Discussions are progressing well at an STP level regarding the approval fro the alcohol business case –
Reducing Harmful Drinking will report via the NWL workbook (DA1ai)
• MECC training has commenced in Hounslow- Making Every Contact Count will report via the NWL workbook
(DA1di)
• Reprioritise and refocus the DA1 Prevention workstream.
• Support in obtaining commitment from key stakeholders across
health and care to the programme.
• Ealing, Brent and Harrow CCGs to agree to fund the alcohol
business cases and the JHCTG to act as a lever to prioritise alcohol
prevention work and support this decision making progress (DA1ai)
• Further recruitment drive needed to fill spaces as there has been
reduced appetite in some of the boroughs (DA1di)
DA2 Primary Care
• Access – Harrow CCG are now offering full extended Access in to their hubs
• Provider Maturity – First provider maturity evaluation held Ealing and dates for other CCG launch events and
evaluation also arranged for H&F and Brent.
• 30 Expressions of interests made by NW L for international GP recruitment programme
NW L Diabetes Programme : Winner of 3 awards at the Quality in Care Diabetes 2017.
Self Care
• PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over
12,000
• Received approval to proceed with myCOPD digital project from DA2 Programme Board.
Cancer Recovery: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds
IAPT-LTC
• 200 practitioners (50 from NWL) have registered for the PWP/ counsellors online training on LTCs. Online
training to be reviewed by the IAPT Education Expert Reference Group (Skills for Health) with a view to
recommending the resource nationally. Long Term Conditions/IAPT service staff recruited and the service
launched across 7 Boroughs (DA2c)
• DA2 is the most diverse delivery area and therefore it is not possible
to pull out one main action common to all areas.
• Work across the system to promote patient behaviour change away
from UCCs to available capacity that can meet their requirements
within the primary care centres where utilisation averages 57%.
• Support in engaging with CareUK in relation to direct booking roll-out
and alignment with NW London timelines.
• Joint working to promote work and ensure enduring clinical pathway
change on diabetes and other right care areas of focus.
DA3 • Integrated commissioning-The project team has focussed on providing clarity to local areas about which
deliverables can occur across all local areas.
• Enhanced care in care homes- Consultation on the leadership care home manager programme was
completed. Local delivery groups were established for the roll out of the red bag scheme in Brent, Ealing,
Hillingdon with implementation initiated.
• Intermediate care & rapid response- An London Ambulance Service (LAS) training session on accountable
care partnerships (ACPs) was delivered at the Brent Ambulance Station, attended by 50+ paramedics on
04/10 to increase referrals and reduce Accident & Emergency (A&E) conveyances.
• Response at time of crisis- At Northwick Park Hospital a fully staffed and operating Multidisciplinary Team
(MDT) model was agreed for w/c 30/10.
• Home first- 501 patients have been discharged on the Home first pathway across North West London (NW
London) (as of 23/10).
• Last phase of life-Telemedicine- Three business cases were developed on time and localised to each individual
CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10 - 24/10, Brent CCGs business case
was approved.
• Integrated commissioning- The project team aim to work with each
local area, however, may need some direction on whether to
prioritise support to local areas that are fully engaged or those areas
needing further persuasion.
• Enhanced care in care homes- Local CCGs need to identify named
support and the capacity to implement the schemes.
• Home First- The project team will need to engage with local
authorities to validate the financial model.
• Last phase of life-Telemedicine- Harrow and Hillingdon CCGs
business cases will go to executive committee for approval.
3
Executive Summary: continued
Enabler Overall what went well this month in your area? (one sentence)
(Good news that JHCTG /communications can share)
Overall what is the main action needed across your area? (one
sentence)
How can JHCTG help? (Share/act as lever/ note)
DA4 • PCMHT Evaluation, jointly run with HLP, is on track to go to procurement on
13/11 (DA4a). Out of Hospital Contract for GPs, to provide enhanced physical
health care for people with Serious Mental Illness (SMI) is on track to be
implemented across NWL in 18/19 (DA4a)
• Early Discharge Planning tool is gaining traction and having desired effect across
CNWL; similar DTOC-reducing initiatives are bringing results in WLMHT. Service
spec and Service Operating Procedure for WLMHT Rehab presented with minor
queries to be endorsed over email. Agreed investment in detailed flow modelling,
bed modelling, and implementation decision-making analysis to take place across
NWL (DA4a).
• NWL is on course to achieve 5 years plus inpatient discharges for people with
learning disability/autism and challenging behaviour (DA4b).
• Children and Young People Transformation Plan has been refreshed and new
priorities for 2018/19 have been set. The new crisis pathway and community
outreach service has been launched to provide support in the community (DA4c)
• Can we agree the principle across the system that services likely to
yield return on investment and reduction in need for beds, may be
funded for 6-12 months using transformation funding as a “bridging”
fund; until such time as the service is self-sustaining. (DA4a)
• Urgent and crisis care pathway integration discussions to begin
requiring input from all agencies. Partners are encouraged and asked
to participate and prioritise. (DA4c)
• The funding flow model for specialised commissioning patients will be
shared by NHSE through ADASS forum which require system level
response from health, social care and housing stakeholders. DASS’s
and Director of Corporate Resources/Finance to engage in the
debate.
DA5 • Official opening of the North West London Ultrasound Academy is due on
01/11/2017; this will take in a cohort of five sonographers. A paper was produced
to show how seven successful pilots have demonstrated clear evidence of length
of stay reduction, and have been implemented in various hospitals. Radiology
and diagnostics/ inpatient model of care will report via combined the NWL
workbook (DA5bi & DA5bii)
• Assurance of SOC 1 continues - SOC 1 will report via the NWL workbook
(DA5ci)
• New pilot models implemented at Hillingdon. Launch of personalised postnatal
care plan at all sites - Early Adopters will report via the NWL workbook (DA5ciii)
• Paediatric review was taken to Ealing Health and Adult Social Services Scrutiny
Panel (HASC) meeting on 24/10. Project is now officially closed (DA5c)
• Successful proof of concept of added value of new renal pathway supported by
STP Clinical Board. Project team is in place to deliver outpatient transformation.
There is good progress and clinical engagement for cardiology and MSK
(DA5a&d)
• Support in implementing the development of outline business cases
for both hubs and Trusts as far as possible without confirmed funding
(DA5ci).
• DA5a & d – A formal agreement of Business Principles has been
agreed by CFOs and is being discussed by Provider Board and CCG
Collaboration Board. This is a key enabler to transformation by
removing the current payment system which acts as a disincentive to
improving care and reducing costs.
4
Executive Summary: continued
Enabler Overall what went well this month in your area? (one sentence)
(Good news that JHCTG /communications can share)
Overall what is the main action needed across your area? (one sentence)
How can JHCTG help? (Share/act as lever/ note)
Workforce • HEE Workforce Observatory now in operation; the Observatory will
provide workforce intelligence and planning support to the 5
London STPs, making more effective and efficient use of existing
data sets, participate in new collections and will have the capacity
to assist in appropriate workforce modelling approaches.
• NW London response to the national Mental Health Workforce
Plan will be shared for agreement at the Mental Health
Transformation Board on 24th November. The first draft report of
analysis of pay rates for substantive and bank clinical staff
at WLMHT and CNWL has been produced, to enable greater
transparency around pay and incentives and understand where
there could be opportunities to create a coherent pay strategy.
• Revised savings target for NW London staffing project have been
agreed at £1.9m for 17/18 and £6.7m for 18/19.
• There is a need for a NWL-wide Organisational Development plan to support the
delivery of the STP. This will require a significant amount of engagement from
the outset to identify needs, establish ownership and gain buy in from the sector.
Digital • Continued good progress with Primary Care Digital Programme
(already funded through Estates & Technology Transformation
Fund – ETTF).
• CCGs and Trusts working well together on existing project
initiatives (e.g. e-Referrals)
• Improved progress with interoperability in some areas, but full
realisation of the digital vision for shared records to support
integrated care will require capital funding.
• NHSE have confirmed that no STP/LDR funding will be received during 2017/18;
details of funding 2018/19 to 2020/21 will be confirmed after the Budget.
• The transformational step change required to fully automate clinical operations
and build shared care records, as set out in the STP and LDR vision, will not occur
without the required capital funding, especially in LNWHT and THH. NHSE have
recognised that the Five Year Forward View target of “Paperless by 2020” is no
longer achievable.
• Prioritisation of investment will occur at Technical Design Authority and Digital
Portfolio Board once funding amount and guidance are confirmed.
• JHCTG should consider alternative sources of funding for STP digital enablers.
Business
Intelligence (BI) • Recruitment to 2 substantive transformational informatics roles in
BI team progressing well.
• To try to get reliable feeds for project related data, either from social care, or other
parts of the health sector.
Estates • OPE expression of interest submitted across the WLA supported
with follow up information provided by 3 November deadline.
• The NHSE London Capital Committee confirmed partial funding for
Parson’s Green (the relocation of Lilyville practice) and for the
reconfiguration of the first floor at Belmont Health Centre, Harrow.
• Heston OBC submitted to NHSE for approval.
• Positive meeting held with NHSE London Region Finance team and
PAU to discuss progression of pipeline of scheme. Joint review of
Heston OBC to take place in Nov.
• Brent joint public sector asset review completed and due to report
imminently.
• Reaffirming partner support and engagement with delivering the NWL Hub
strategy
5
Executive Summary: continued
Delivery
Area
Key issue/risk across the whole programme (one sentence)
What do they needed to be sighted on - How can JHCTG help?
DA1 Key stakeholders have not committed to the prevention agenda as previously stated in the STP, due to lack of strong financial modelling and ROI evidence.
There is still a resistance to commitment in the presence of strong and robust evidence. IMPACT: focus gets shifted/momentum drops meaning we cannot
complete planned projects, we are unable to make detailed plans/fund projects, and/or we are unable to realise any predicted savings. Note: Alcohol Prevention
(DA1ai) - key issue is the on-going uncertainty of funding for the alcohol work and the consequential delays in implementation.
Risk of causing damage to relationships between the STP and funding providers due to being overly ambitious in project development and setting unachievable
targets (DA1di)
DA2 No risk to escalated this period
DA3 There is a risk that the pace of implementation for the DA3 Programme is compromised due to significant dependencies on other delivery areas, such as DA5,
e.g. re-investment into community services is dependent on shifting resources from other areas in the system.
Staffing – Staffing constraints are delaying the implementation of an emergency frailty model at Ealing hospital. Similar constraints are likely to be encountered at
other sites.
DA4 There is a risk across the programme that significant transformation required across multiple workstreams does not have sustainable funding streams, and that
we are unable to generate re-investable savings from benefits realised elsewhere in the health and care system. JHCTG is asked to support developing views
on where our priorities should lie and what has most impact.
There is a risk that there is an unknown financial exposure as individuals with learning disability/autism and challenging behaviour are discharged from NHSE
funded care to locally funded care and no confirmation has been received of funding flows. JHCTG is asked to continue to support efforts to understand the
financial impact – with particular support needed from CFOs.
DA5 Clinical Decision Support (CDS): there is an issue with the integration of CDS with ICE. The delay is because of Sunquest, who have integrated the wrong
version of ICE into CDS (DA5b).
Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not considered for autumn capital announcement.
Trusts OBCs are also on hold until the approval of SOC Part 1 and funding being available to commence the necessary work. (DA5ci).
Some delays to programme due to accessibility of data sets. Delays in advertising / recruitment to CW and Imperial teams has resulted in a risk to launch in Jan
'18 (DA5ciii).
Need financial models to support programmes with system benefits but where there are interim provider stranded costs. CFOs have developed business
principles and this work should be supported by JHCTG (DA5a&d).
Workforce
There is a risk that the GP targets (set out in the GPFV) may hamper innovative workforce planning for new models of care. Primary care transformation
initiatives and programmes are more focused on retaining and developing existing staff and ways of working to build resilience in the primary care workforce,
than recruitment alone.
Digital
Further delay and reduction in NHSE STP/Local Digital Road map (LDR) funding will impact on many of the digital enabling projects for the STP. Funding will be
at a much lower level than required to enable the STP and national clinical objectives. Digitisation of provider records, and automated transfers to support
integrated care, will be delayed.
BI Access to Whole Systems Integrated Care (WSIC) data is key to progressing many Business Intelligence Unit (BIU) development projects.
Estates
Risk to delivery of Hub programme if external consultancy support cannot be secured. Lack of resource internally to deliver the programme of work within the
timescales required and subsequent risk to delivery of SoC 1. Following delays to reconfirming funding for support and the associated governance processes
that need to be followed there is an expected two – three month delay to the programme.
6
NW London STP Programme Lifecycle 7
Implementation of all solutions;
troubleshooting, monitoring and
reporting
Our portfolio management approach creates an
environment in which teams, resources and
activities are optimised to best achieve our
clinical, operational and financial goals and
identify and manage our key risks. It is
supported by the Strategy & Transformation
Project Management Framework. It is designed
to be a scalable framework suitable for all
audiences.
The Framework has been designed to ensure
that projects and programmes:
• remain aligned in their approach to
delivering transformation activity
• can easily access and learn from best
practice and experience from across the
sector
• follow a structured and proven methodology
for delivering projects and programmes.
To ensure consistency in our approach to
delivery and assurance, each of our
transformation initiatives is based upon an
agreed project lifecycle which takes a gated
approach. Gateway reviews will be undertaken
by an independent panel composed of:
• Clinicians
• Lay partners
• Technical experts from within the
sector
Note: There will be a minimum of two
gateway reviews for each programme,
however depending on the scale of change,
additional gateway reviews may be added.
NWL STP programme lifecycle
Risk framework 8
Risks are score as a multiplication of the risk likelihood and risk severity (1-25)
Issues framework 9
Severity Rating
5
4
3
2
1
Issues are scored only on severity (1-5)
ExtremeIncapable to deliver service
MajorSignificantly impairs ability to deliver service
ModerateImpairs ability to deliver service
MinorNo effect on critical path (within float)Some effect on ability to
MinimalNo effect on critical path (within float)Minimal effect on ability
STP Highlight Report
Delivery Area
10
10
Delivery Area 1 report 11
PROJECT AREA LIFECYCLE
STAGE
DATE
DUE TO
ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Supporting
local people to
live healthier
lives
(DA1a)
Reducing
harmful
drinking
(DA1ai)
Report via NWL
workbook – see
section below
Promoting
mental
wellbeing and
reducing
loneliness
(DA1b)
Health
benefits of
employment
(DA1bi)
Project
identification
Jan
2018
AMBER
(Due to
slippage)
• IPS for Substance Misuse Project to receive 46%
match funding from Life Chances fund assuming we
can agree remaining 54% funding from CCGs and
LAs. Continuing to work with Social Finance to
develop a payment by health outcomes model that
reduces risk for CCGs.
• NHSE target to double IPS for SLTMH by 2020-
future funding to be released in Jan 2018
• Continue to work with Social
Finance to agree payment by
health outcomes model.
• Continue to liaise with NHSE
for updates and information
on funding application
process for SLTMH IPS
models.
Helping
children get
the best start
(DA1c)
Parenting
Programme/
Conduct
Disorder
(DA1ci)
Implementation Mar
2018
GREEN
(on
track)
• 7 Recruited schools in Ealing have been matched
to health supervisors.
• Training for multidisciplinary teams began in
September.
• Initial data collection with schools taking place.
• Continue implementation and
evaluation.
Roll out of the
National MECC
Programme
(DA1d)
Making
Every
Contact
Count
(DA1di)
Report via NWL
workbook – see
section below
AMBER
HEADLINES
• NHSE target to double IPS for SLTMH by 2020- funding to be released in Jan 2018 to enable the expansion of our existing Individual Placement
Support schemes, with funding to develop new models released in 2019. (DA1b)
• Delivery in schools of parenting programme training started in November (DA1c)
RAG key: On track Risk of delay – management in hand Delayed or unmitigated risk of delay –
immediate action required IMPROVING HEALTH AND WELLBEING
12
Delivery Area 1 report (continued)
IMPROVING HEALTH AND WELLBEING RAG key: On track Risk of delay – management in hand Delayed or unmitigated risk of delay –
immediate action required
KEY AREAS FOR DISCUSSION
none
12
KEY OUTSTANDING ISSUES THIS PERIOD
DA Issue Score Mitigation (latest progress) Score
DA1
There is an issue that there is insufficient resource within the
DA1 STP team available to progress work within DA1
IMPACT: unable to complete/continue planned projects/
existing work
4
Interim measures have been put in place however there is currently no
longer term plan. 4
DA1
Programme wide - we are unable to obtain sufficient support
and buy in from the system to take forward prevention at a
NWL wide level 4
The DA1 Programme Board is revising its function, and has been exploring
alternative ways of working for the Programme. The programme is currently
looking to review the level of commitment to prevention across NWL, asking
for revised commitment to prevention from the NW London system.
4
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
DA1
Key stakeholders have not committed to the prevention
agenda as previously stated in the STP, due to lack of strong
financial modelling and ROI evidence. There is still a
resistance to commitment in the presence of strong and
robust evidence. IMPACT: focus gets shifted/momentum
drops meaning we cannot complete planned projects, we are
unable to make detailed plans/fund projects, and/or we are
unable to realise any predicted savings. Note: Alcohol
Prevention work and the significant delay to progress.
20
Looking to source match funding from Social Investment Bond to reduce
cost and risk to CCGs. Reviewing the DA1 programme and
representation, challenging system commitment to the prevention agenda.
Concerns that national published guidance is misleading in terms of RoI-
will be cautious to fully review and explore figures in relation to all project
work.
16
Delivery Area 2 report 13
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Primary Care
Investment
and support
for GPs and
their teams -
delivering
the national
GP Forward
View (DA2a)
DA2ai
Primary Care
Access -
Hubs
Implementation Evaluation
(Jan 2019)
GREEN
(Running
to Plan)
• Harrow CCG is now offering full extended access in
to primary care hubs.
• Ealing have been successful with direct booking in
to hubs and all 5 inner CCGs expected to be
offering this in the next fortnight.
• Current efforts are now on IT and Integration to
install direct booking in to UCCs in time for winter
pressures.
• Implement direct booking IT solution in place
across all Access Hubs and UCCs to enable
direct booking and progress patient
redirection.
• Create outcomes and metrics dashboard for
all 8 CCGs.
DA2aii
Provider
Development
Solution Design
Implementation
Planning
(TBC)
GREEN
(Running
to Plan)
• Progress made across all project outcomes –
individual practices now receiving practice resilience
support.
• Groups of practices working at scale are beginning
to participate in the Provider Maturity Evaluation.
• Ealing and H&F have both had provider maturity
launch events with a very good response.
• Roll out of additional Provider Maturity
evaluations in at least two more CCGs, likely
to be Hammersmith and Fulham and Brent.
• Pull together the tools and guidance that
support transformation in the commissioning
of primary care at scale.
• Hold workshops/sessions with primary care
leads and NHS E.
• Start to look at how we will measure impact of
£3ph investment.
DA2aiii
Workforce Solution Design
Implementation
planning
(Jan 2018)
GREEN
(Running
to Plan)
• Primary care workforce strategy is close to
completion and the process for reviewing and taking
the strategy through CCGs governance is
underway.
• International GP recruitment programme is
underway and guidance has been shared by NHS
E. 30 Expressions of interest have been received
from NW London across all 8 CCGs.
• Develop project plans aligned to the primary
care workforce strategy.
• Progress review of workforce and strategy with
CCGs.
• Undertake thorough gap analysis of current
CCG PC workforce work.
• Confirm final number for expressions of
interest post 10th Nov deadline.
BETTER CARE FOR PEOPLE WITH LONG
TERM CONDITIONS RAG key: On track
Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
AMBER
HEADLINES
• GPFV: Full extended access in to hubs available in Harrow; National guidance on Online Consultations has been released and shared with primary care leads (DA2ai)
• Progress made across all project outcomes – individual practices now receiving practice resilience support. (DA2aii)
• Expressions of interest have been received from NW L across all 8 CCGs for the International GP recruitment drive (DA2aiii)
• Cancer: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds (DA2b)
• Mental Health: 200 practitioners (50 from NW L) have registered for the Psychological Wellbeing Practitioner/ counsellors online training on LTCs (DA2c)
• Diabetes: Diabetes programmes won 3 Quality in Care awards (DA2d)
• Self Care: PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over 12,000 (DA2e)
Delivery Area 2 report (continued) 14
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Investment &
support for
GPs & their
teams -
delivering the
national GP
Forward View
(DA2a)
DA2aiv
Practice
Infrastructure
Implementation
Planning
Implementation
(TBC)
AMBER
(Way forward
to be
determined
following
decision to
halt pilot with
Babylon)
Online Consultations
• National guidance for online
consultations released and discussed
with primary care leads.
• Online consultation planning meeting
held with leads, from across NW London
to agree recommended approach.
• Two small GP engagement workshops
held by ICHP to gain GP views.
Practice Infrastructure - Digital
• IT exhibited several stalls at the
Transforming Primary Care conference
in Brent on 19th October. Feedback
from GPs was very positive and due to
the high level of interest this “roadshow”
may be rolled out to other CCGs.
• Identify project team and set up
online consultations project
delivery group.
• Develop plans for and begin GP
and patient engagement.
• Commence development of plans
for pan-NW London approach to
be submitted to HLP on 1st
December.
• Complete mapping of digital
programme to DA2a delivery
areas.
Saving lives
by Improved
cancer
outcomes
(DA2b)
Improving
cancer
outcomes
Diagnostic Solution Design
(TBC)
AMBER
(Concentrated
efforts on 62
day standard
& less
assurance on
STP priorities
in primary
care.
However, now
transformation
funding has
been
released,
planning is
developing at
greater pace)
• Hillingdon went live with Prostrate
pathway.
• Safety netting tool to enable
identification of at risk patients and
earlier diagnosis and prevention of
emergency presentations in A&E will be
rolled out across practices in Q4.
• Transformation funds released to
Hillingdon; ChelWest; Imperial and
London NW Trust to implement optimal
lung, prostate and colorectal
performance to enable sustainable
approach.
• Governance still to be agreed regarding
reporting lines and accountability to STP
for acute standards.
• Confirm achievement of 62 day
standard.
• Agree governance and reporting
lines to STP for acute standards.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required BETTER CARE FOR PEOPLE WITH LONG
TERM CONDITIONS
Delivery Area 2 report (continued)
BETTER CARE FOR PEOPLE WITH LONG
TERM CONDITIONS RAG key: On track
Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Long term
conditions and
mental health
(DA2c)
Implementation Monitoring
(Mar 2018) GREEN
• IAPT LTC service promotion amongst
physical health clinicians continue.
• Clinical models have been developed. The
intention is to standardise the model across
NWL.
• Evaluation framework methodology and
proposed KPIs are being developed.
• NWL clinical model to be agreed between the
two Trusts.
• Co-location discussions to begin.
• Evaluation framework to be shared with
physical health commissioners and Acute
Trust to gain consensus on KPIs.
Providing the
right care every
time to prevent
serious illness
(DA2d)
Implementation
Evaluation
(Jan 2022)
GREEN
(Running to
plan)
• The NW London STP Diabetes
Transformation programme won 3 awards at
the Quality in Care Diabetes 2017.
• Successful engagement event took place on
October 19 for the Diabetes Footcare
delivery group.
• Commenced developing baselines and
dashboards for effective measurement of
the AF/Hypertension programme.
• Launch of the Know Diabetes website.
• Hold digital interoperability workshop for call
centre launch in April 2018.
• Meet with British Heart Foundation Strategic
Engagement Lead to discuss partnership
working re: AF and Hypertension.
Supporting
people to take
control of their
own health
(DA2e)
Implementation Evaluation
(Jan 2019)
GREEN
(Running to
plan)
• PAM 17/18 activity for quarter two totals
5,502 across NW London bringing totals
assessments to over 12,000.
• PAM activity presented at Virtual Primary
Care meeting to promote best practice and
encourage CCGs with low activity (H&F,
Ealing, Central London and Hillingdon).
• Received approval to progress with
myCOPD digital project from DA2
Programme Board.
• Successful kick off workshop held with leads
from across NW London to establish
myCOPD workstream.
• Four CCGs developing business cases for
DoH fund on Social Prescribing supported
by HLP.
• Establish plan to determine trial for myCOPD.
• Identify and support CCG expressions of
interest in DoH Social Prescribing fund.
• Hold Carer PAM workshop to establish Harrow
project.
• Increased PAM activity following targeted
support.
15
Delivery Area 2 report (continued) 16
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
BETTER CARE FOR PEOPLE WITH LONG TERM
CONDITIONS
KEY AREAS FOR DISCUSSION
DA2c: How can we promote an integrated shared agenda of mental & physical health commissioners?
DA2d: How we can encourage and gain traction with CCGs to pursue Hypertension?
KEY OUTSTANDING ISSUES THIS PERIOD
DA Issue Score Mitigation (latest progress) Score
DA2ai
Primary Care
Hubs
Regional team have asked that CCGs use part of their
allocation to fund London-wide communications.
CCGs access fund has been fully committed & they
are unlikely to be able to meet this ask.
4 This has been escalated to the NHSE regional team for solution.
N.b. other STP areas have also raised a similar issue. 3
DA2aii
Provider
Development
Primary care providers across NW London have
different levels of readiness & capacity to work at
scale or deliver new models of care. The change
programme underway is resource & time intensive.
4
Substantial work underway on the development of at scale providers.
A number of CCGs have clear & well developed primary care strategies which
outline their journey to delivering primary care at scale.
Many CCGs have used some of their £3ph investment in 17/18 & 18/19
specifically to support at-scale provider development.
Specific Local Services resource is available to support CCGs directly.
3
DA2aiii
Workforce
CCGs do not have a consensus/agreement on what the
workforce priorities are for NW London. 3
Strategy in development and close to being finalised. Mapping activity to
showcase gaps in workforce activity is also underway and once completed will
inform some of the priorities. 2
DA2d Right
Care
AF - There is a lack of resource to ensure programme
rollout at pace and scale, and to take advantage of
potential opportunities.
Business case shows cost pressure due to
anticoagulation medicines cost, and savings will
mainly be made in social care therefore CCGs are
keen to identify opportunity for programme wide
resource.
3
Request made for extension of funding.
Learn lessons from diabetes programme and develop case for resource based
on potential savings across the whole health economy.
3
DA2d Right
Care
CCGs all engaged on AF activity but not yet pursuing
hypertension. 3
Use ‘Size of the Prize’ to reinforce need for addressing hypertension. Work with
Cardiac & Stroke Transformation Board on pan London Stroke Prevention plans
which align with AF/Hypertension/Cholesterol.
3
Delivery Area 2 report (continued)
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required BETTER CARE FOR PEOPLE WITH LONG
TERM CONDITIONS
17
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
DA2ai
Primary Care
hubs
There is a risk that Brent, Hillingdon and Harrow will not have
direct booking from 111 in place by 1-Nov as CareUK 111
are only agreeing to go live with Ealing hubs and 1 Hounslow
Hub by 1 Nov 2017.
16
This has been escalated to NHS England National as this is a
national issue and conversations with Care UK are on-going. 16
DA2b
Cancer
There is no administration or project management resource
for the programme from within NW London; without managed
timelines & plans, there will be slippage in delivery or the
desired outcomes may not be achieved.
15
Resource from NW London still to be secured; Vanguard are
providing project management for most of the primary care
programmes but requires support for NW London governance &
to support delivery within each CCG.
12
DA2b
Cancer
There is a risk that the increased national scrutiny on
delivery of 62-day target, by end Q1, in addition to delivery of
cancer transformation commitments may result in significant
system overload.
15
Revision of secondary care cancer board membership to ensure
executive engagement across NW London. Regular
communication underway between Vanguard, NW London & NHS
E regarding scope & deliverability of key programmes. Increased
input & oversight for any Trusts at high risk of non-delivery.
12
DA2c Long
Term
Conditions
and
Mental Health
The fragmented way of working between physical health and
mental health commissioning and delivery minimises
opportunities for better utilisation of resources and improved
outcomes for vulnerable people.
20
Creating opportunities for commissioners and clinicians to come
together to change practice and encourage joint working and co-
location.
Identifying referral points in pathways to develop joint practices.
16
DA2c Long
Term
Conditions
and
Mental Health
The cultural shift in physical health environment required is
significant and is being slowly addressed which may impact
on longer term benefit realisation.
12
Discussions between physical health and mental health
commissioners to encourage joint/integrated commissioning as
well as integrated delivery.
8
DA2d
Self Care
Lack of investment in social prescribing prevent sustained
roll out across NW London. 12
Scoping of social prescribing across NW London to identify gaps
has commenced and the Roll out of i5Health tool will support
economic case.
Also Identifying additional funding opportunities beyond CCG and
LA.
12
DA2d
Self Care
H&F, Hillingdon, Hounslow, Central London and Ealing PAM
activity within 2nd quarter highlights risk to CCG 17-18 PAM
targets.
12
CCGs engaged via NW London PAM Working Group to identify
support requirements. Monthly reporting provided. Number of
CCGs embedding PAM within local primary care contracts.
Engagement with community, acute and local authority to expand
use beyond primary care.
9
Delivery Area 3 report 18
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Commissioning
high quality and
effective care for
older people
Integrated
commissioning
(DA3ai)
Implementation
planning
Implementation
(April 2018)
GREEN (Due to
deliverables
running to time
and to scope)
• A project plan and implementation brief have been prepared.
• Senior stakeholder engagement has been completed.
• Senior responsible officers (SROs) need
to agree the project plan and
implementation brief.
• Local implementation project teams are
to meet on a regular basis.
• Local areas are to all agree on work
that can be delivered once across the
eight areas e.g. pricing.
Enhanced care
in care homes
(DA3aii)
Implementation
planning
Implementation
(Dec 2017)
AMBER (Due to delays in
agreeing CCG
specific
approach)
• There was positive feedback on the draft care home managers
leadership programme specification from care home managers,
NW London CCG/Local authority (LA) commissioners, Care
Quality Commission(CQC) and Health watch.
• A test comprehensive NW London care home dashboard has
gone live with CCG and LA commissioners.
• Local delivery groups were established to progress the red
bag scheme in Brent, Ealing and Hillingdon. Implementation
has commenced.
• Discussions were initiated with London North West Healthcare
NHS Trust (LNWHT) and Hillingdon Hospital Trust to develop
internal processes regarding the transfer pathway.
• Roll out of the joint intelligence working
guidance and a NW London care home
dashboard.
• Undertake procurement of the training
provider (Nov – Dec 2017).
• Engage stakeholders on the
development of the standardised
hospital transfer pathway.
• Audit compliance against joint
intelligence working guidance.
Getting the whole
health and care
system working
together for older
people
Improved
Intermediate
Care Services
(IC) and Rapid
Response (RR)
(DA3ci)
Solution Design/
Implementation
Planning (various
workstreams are
at various stages).
Implementation
Planning/
Implementation
(various
workstreams are
at various
stages).
AMBER (Due to review of
IC&RR working
group priorities
underway)
• An LAS training session on ACPs was delivered at the Brent
Ambulance Station, attended by 50+ paramedics on 04/10 to
increase referrals and reduce A&E conveyances.
• Urgent & emergency care (UEC) conditions data has been
refined to focus on rapid response (RR) top referral reasons.
• A decision was made by RR providers and commissioners to
focus on falls and urinary tract infections (UTIs) as an
opportunity identified to reduce <2days admissions (65yrs+).
• The intermediate care and rapid response (IC&RR) working
group decided to review medical accountability variation
across the eight NW London boroughs to mitigate risk.
• Providers and commissioners agreed to consider accepting RR
referrals directly from the LAS control centre.
• The LAS protocol communications strategy was developed to
ensure wider communication engagement by the LAS crew.
• Sign off the RR dashboard prototype
with the IC&RR working group.
• Agree triggers and mitigating actions for
rapid response services pan NW London
to continue to meet demand at times of
low capacity.
• Deliver the LAS protocol
communications strategy.
AMBER
HEADLINES
• The project team has focussed on providing clarity to local areas about which deliverables can occur across all local areas (DA3a).
• Consultation on the leadership care home manager programme has been completed, local delivery groups have been established for roll out of the red bag scheme in Brent, Ealing
and Hillingdon (DA3a).
• A London Ambulance Service (LAS) training session on accountable care partnerships (ACPs) was delivered at the Brent Ambulance Station and was attended by 50+ paramedics
on 04/10 to increase referrals and reduce A&E conveyances (DA3c).
• At Northwick Park Hospital a fully staffed and operating multi disciplinary team (MDT) model was agreed for w/c 30/10 (DA3c).
• 501 patients have been discharged on the Home first pathway across North West London (NW L) (as of 23/10) (DA3d).
• Three business cases were developed on time and localised to each individual CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10 - 24/10, Brent CCGs business
case was approved (DA3e).
BETTER CARE FOR OLDER PEOPLE RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Delivery Area 3 report (continued) 19
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Getting
the whole
health
and care
system
working
together
for older
people
(DA3c)
Response in
time of crisis
(DA3cii)
Implementation
Planning
Implementation
(March 2018)
AMBER
(Due to
variation in
uptake of
the model
across the
different
sites)
• There was a soft launch of the Northwick Park
hospital project with an extension of locum
geriatrician post whilst substantive recruitment
continues.
• An extension till the end of November was agreed
for occupational therapist input to the project at the
Ealing site.
• Agree metrics and evaluation
processes, staff resources and
governance structures at Northwick
Park hospital.
• Determine a plan of action and
implementation in the Hounslow frailty
conversation on the 25/10.
• Agree to increase hours of operation
for the Ealing pilot.
Home
from
Hospital
(DA3d)
Home first
(DA3di) Implementation
BAU
(March 2018)
AMBER
(Due to
variation in
uptake of
the model
across the
different
sites)
• 501 patients have been discharged on the Home
first pathway across NW London (as of 23/10).
• A Memorandum of Understanding (MoU) was
agreed in principle between health and social care
partners in Hillingdon to enable the full roll out of
Home first.
• Validation of financial model.
• A communication plan to include all
pathways out of hospital (including
front door discharges) aligned to
Home first’s ethos.
• Continued delivery and spread of
Home first pathways.
Last
phase of
life
(DA3e)
Telemedicine
(DA3ei)
Implementation
Planning
Implementation
(Dec 2017)
AMBER
(Due to
the
delays in
awarding
the
contract)
• Brent, Harrow and Hillingdon (BHH) chairs and
managing directors (MDs) have agreed in principle
to participate in the programme with Executive
Committees to review and approve the business
case in October.
• Three business cases were developed on time and
localised to each individual CCG area (Brent
Harrow and Hillingdon).
• The Brent business case was presented and
approved at executive committee.
• Sign funding agreement between
Central London, West London,
Hammersmith & Fulham, Hounslow
and Ealing (CWHHE) CCGs and
Social Finance.
• Pre-mobilisation to commence with
Provider Alliance and Social Finance.
• Harrow and Hillingdon CCGs business
cases will go to executive committee
for approval.
BETTER CARE FOR OLDER PEOPLE
Delivery Area 3 report (continued) 20
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required BETTER CARE FOR OLDER PEOPLE
KEY AREAS FOR DISCUSSION
None
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
DA3b
There is a risk that constraints from CCGs/LAs to prioritise
capacity and funding to support initiatives will restrict the Strategy
& Transformation’s team ability to transform care delivered in care
homes.
15 Work with local CCGs/LAs to influence prioritisation of efforts for 2017/18
and alignment with business planning for 2018/19. 12
DA3b
There is a risk that there will be resistance to implement
standardised approaches across a diverse spectrum of care home
providers (140 providers) across the sector.
15 Work with a spectrum of diverse care home representatives to agree
standardised approaches. 12
DA3b
There is a risk that the pace of implementation for the overall
project is compromised due to significant dependencies on other
sector and local projects e.g. setting up of ACP, transforming
primary care, market management and telemedicine.
15
Maintain close links with linked projects via regular meetings – DA3 team
level, DA3 board level, NW London S&T local services team, long term
needs clinical reference group (CRG), Older Peoples CRG, workforce
transformation group and any other key meetings.
6
DA3c There is a risk that the proposed model of care will be resourced
using existing staff groups with known supply shortages. 16
Seek support from providers and CCGs to identify resources which could
be reallocated and look at alternative staffing options . 9
DA3c
The counting, coding and financial impact that this change will
have on all organisations, will present a barrier to the model going
live or moving from pilot stage to business as usual.
12
Up front conversations to ensure that all providers are operating with the
same expectations and that there is a plan to address these issues prior to
moving to a sustainable model.
9
DA3c There is a risk that RR teams do not have sufficient capacity to
expand to the numbers of patients required. 20
Early evaluation to understand the baseline capacity within services. Early
sector wide modelling to understand requirements and investment
decisions. Sector-wide conversations throughout. 15
DA3d
There is a risk that the rapid assessment function required to
support the Home first model does not have sufficient capacity to
expand to the numbers of patients required.
16
Initial phase of pathway testing is designed specifically with
comprehensive evaluation to understand the baseline capacity within
services early. Sector wide modelling then allows scaled up values to be
understood and investment decisions to be made early. Local A&E Boards
and CCGs are involved throughout the process to increase likelihood of
investment.
12
DA3d
There is a risk that the required care provision to support
discharge to assess pathways can not be provided, particularly
due to reductions in social care funding, which will delay progress
and increase scale in implementation.
12
Evaluation process of the initial phase gives evidence for on-going care
needs and the new NW London Home. The first activity model will enable
translation of the evidence to "at scale" values. Work is also on-going with
LA colleagues to improve data quality in order to test.
9
Delivery Area 4 report 21
AMBER
HEADLINES
• Investment in detailed flow modelling and implementation decision-making analysis has been agreed, which will take place across NW London (DA4a)
• Review of selected inpatients cohort has been completed to inform future model development (DA4b)
• Urgent care evaluation recommendations are being taken forward by Trusts (DA4c)
• Refresh of the NWL Children and Young People’s Transformation plan submitted to NHSE 31 October, will be used to agree work plan and priorities (DA4d)
IMPROVING MENTAL HEALTH SERVICES RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA LIFECYCLE
STAGE
DATE DUE
TO ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Supporting
adults with
serious and
long term
mental health
needs
(DA4a)
New Model of
Care for
SLTMHN
(DA4ai )
Implementation
Planning
Implementation
Jan 2018
AMBER
(due to
slippage)
• Needs mapping at a local level has been
completed with information gleaned from
GP Clinical Leads, MH Commissioners,
Trust management and Trust clinical staff;
and presented to Programme Exec. An
investment plan was not endorsed as
funding specific services is not in the remit
of transformation.
• Agreed investment in detailed flow
modelling and implementation decision-
making analysis to take place across NW
London.
• Out of Hospital services on track to be
implemented across NWL in 18/19.
• Progressing with bed modelling; PCMHT
Evaluation and Out of Hospital across-NWL
roll-out.
• Commencing a review and optimisation of
Community Mental Health Teams, together
with HLP Embedded Resource.
Targeted
support for
specific
groups of
people
(DA4bi)
Supporting
people with
learning
disabilities
and/or autism
with
challenging
behaviour
(DA4bi)
Diagnostics
Mar 2018
AMBER
(delays in
receiving
funding
model and in
completion of
forensic
patient
reviews)
• NWL is on track to achieve its discharge
trajectory for CCG patients.
• Review of selected inpatients cohort has
been completed to inform future model
development.
• Development of options for community
forensic services has began.
• Meetings have taken place with specialist
assessment and treatment inpatient unit in
to discuss NWL bed usage and future
need.
• Meeting with NHSE, SRO, CFOs and TCP
took place on 20/11 to review and test the
assumptions made in finance submissions
including transition costs, future costs of
care packages and assumptions
surrounding block contracts.
• Development of the future operating model to
inform commissioning intentions.
• Recommendations for future Community
Forensic Service for NWL to be discussed.
• Local engagement and possible workshop to be
set up to discuss Autism Spectrum Disorder
pathways and services for diagnostic and
diagnostic support.
• Further roll out of behaviour support to begin in
December. Additional training sessions to be
confirmed.
• Social Supervision Training to begin in Jan, Feb
2018.
PROJECT AREA LIFECYCLE
STAGE
DATE
DUE TO
ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Targeted
support
for
specific
groups of
people
(DA4bi)
Mental health
support for
new mothers
during and
after
pregnancy
(perinatal)
(DA4bii)
Now closed -
reported within
Trusts and in
BAU
N/A
GREEN
(on track)
(BAU)
• BAU • BAU
Crisis
Care
(DA4c)
Section 136
Pathway
(DA4ci)
Planning December
2017
GREEN
(on track)
• Availability of capital funding for S136 related
initiatives/ innovations has been launched.
Conversations underway to determine local interest for
developing a bid.
• In order to continue local discussions and develop a
business case for reconfiguration of health based
places of safety, further data and analysis of demand
and patient flows are required. Healthy London
Partnership to progress with the data analysis.
• Develop costed capital bid application.
Liaison
Psychiatry
Service
(DA4cii )
Now closed -
reported within
Trusts and in
BAU
N/A
GREEN
(on track)
(BAU)
• LPS is now managed by the Trusts and the S&T team
no longer manages this workstream.
• BAU
Urgent Care
Pathway
(DA4ciii)
Phase1-
Evaluation
Phase 2-
Feasibility
November
2017
GREEN
(on track)
Phase 1
• Trusts and CCGs have developed plans to address
areas of concern as part of the crisis care concordat
• Evaluation recommendations are being taken forward
by Trusts.
Phase 2
• Scoping work started to define an integrated approach
to urgent and crisis care across NWL. This will feed
into the development of the new programme of work
that manage demand in ED.
• Meeting is taking place in early December to agree
and implement Crisis Care Concordat plan.
• An approach to redesign of the urgent and crisis
care to be developed and discussed with MH and
Acute stakeholders.
• Governance to be established to oversee this new
work programme.
Delivery Area 4 report continued
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required IMPROVING MENTAL HEALTH SERVICES
22
Delivery Area 4 report (continued)
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
23
IMPROVING MENTAL HEALTH SERVICES
PROJECT AREA LIFECYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
Children
and
young
people
(DA4d)
Vulnerable
groups
(DA4di)
Project
identification March 2018
AMBER
(Due to
slippage)
• Mapping of Autism and LD completed across NW
London. The recommendations have been
discussed between commissioners and clinicians,
both mental health and paediatrician.
• Further discussions to determine local
level work vs the work that can be
completed across NWL as Autism and LD
landscape is complicated due to different
social care and education infrastructure.
• Short listed ideas to be discussed and
prioritised for delivery in 2018/19.
Specialist
community
eating
disorder
(DA4dii)
Evaluation/ BAU BAU
Jan 2018
AMBER
(Due to
slippage)
• Service evaluation is underway. Collation of data
has been problematic due to Trusts’ reporting
systems and resulting in the delay of completion of
the evaluation.
• Provider/commissioning event planned
for Dec to identify quality of service, action
plan to address issues and adapt to
ensure service meets local needs.
Crisis and
urgent care
(DA4diii)
Phase 1-
Implementation
Planning
Phase 2-
Scoping
Dec 2017 GREEN
(on-track)
Phase 1
• New NWL CAMHS Crisis and Liaison Team
across both MH Trusts have now been launched
to provide intensive support for young people in
mental health crisis.
Phase 2
• Work began to develop and agree a long term
crisis pathway with representatives from young
champions, the Metropolitan police, clinicians and
commissioners.
Phase 1
• Governance for service monitoring and
evaluation framework to be developed.
Phase 2
• Following the workshop work to begin to
define the new pathway.
Redesigning
the system
(DA4div)
Diagnostics March 2018 GREEN
(on-track)
• The refresh of the Local Transformation Plan
gave an opportunity to review local and NWL
priorities to develop a new work programme.
• Priorities and work plan to be agreed
specifying which elements will be carried
out at local level and which will be carried
out at system level.
Delivery Area 4 report (continued) 24
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required IMPROVING MENTAL HEALTH SERVICES
KEY AREAS FOR DISCUSSION
None
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
DA4a Fidelity to the ambition of the model is compromised given the
non-availability of the significant funding required. 20
Ongoing commitment to optimising existing elements of the model;
and in addition focussing our limited resource on the most
significant blockage, CMHT, should enable flow and better delivery
of the model’s aims.
15
DA4b Specialised commissioning funding following the patient upon
discharges will be subject to bed de-commissioning. NHSE has not
yet confirmed how this is to be achieved.
IMPACT; CCGs not receiving the funding required for community
packages therefore LAs and CCGs having increase in their
operating costs.
25
Conversations have been held with NHSE regarding funding,
following the de-commissioning of beds in London. NHSE to provide
clarification on funding specific to London. This will help determine
impact on cost of services and investment requirements to manage
demand for inpatient beds.
20
DA4b Lack of housing availability for the TCP cohort may result in our
inability to reduce overall need for inpatient beds.
25
Review the needs of this cohort and the range and scope of existing
services, specifically for people with complex and challenging
behaviour across residential care. Engage with social care and
housing departments of LAs and provider sector to identify
opportunities.
20
DA4c Fragmented approach to pathway redesign will result in missed
opportunities to better utilise resources to reduce demand in ED
and specialist services. 20
An integrated urgent and crisis pathway has been proposed to key
stakeholder group.
A proposal is being developed to be shared with Acute
stakeholders.
Joint governance will be in place to minimise fragmentation and
promote integration.
8
DA4d Insufficient workforce to meet the new service delivery CYP roles
(volume and skills/ capability) within the new service delivery
framework may result in delays in implementing new services 16
A workforce strategy is in development which sets out the plans to
ensure the wider CYP workforce have the right skills to deliver the
right intervention at the right time. We are aligning to National HEE
education and training directives and implementing designated
initiatives across NW London.
9
DA4d Fragmented crisis service commissioning with numerous
interdependent services being developed by different agencies
(Crisis pathway, Forensic London CAMHS Service, New Models of
Care).
12
Linking up the various system components and agencies will ensure
there is seamless pathway in place enabling children to access the
right help at the right time. 9
Delivery Area 5 report 25
PROJECT AREA LIFE CYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Improving
commissioning
of specialist
services
(DA5a)
Improving
commissioning
of specialist
services
(DA5a)
Solution
design TBC
RED
( no strategic
mitigating plans
for £188m gap)
• Renal: successful proof of concept of added
value of new renal pathway supported by STP
Clinical Board.
• HIV: ICHP supporting multi-trust discussions
around consolidation opportunities.
• Cardiac: Good progress bringing together
CCGs and NHSE and providers to develop a
cardiology transformation programme.
Successful launch workshop on 2nd
November. Clinical leads identified and
priorities identified. Dates set for redesign
workshops January-March.
• Renal: model and agree new funding flows to
accelerate adoption for all renal patients.
• HIV: Multi-stakeholder event to be held and
proposal developed.
• Cardiac: agree tertiary redesign priorities with
NHSE mid November.
• Overall:. Only 0.5 post dedicated to support
specialised commissioning despite £188m
forecast gap.
Getting hospital
patients better,
quicker
(DA5b)
Radiology and
Diagnostics
(DA5bi)
Report via
NWL
workbook –
see section
below
Inpatient model
of care
(DA5bii)
AMBER
HEADLINES
• Ongoing work around Renal, HIV and early exploratory work around Cardiac (resource constrained) No strategic plan to close forecast £188m gap (DA5a)
• Outpatients – secured mandate in STP Clinical Board for the work, with a view of starting clinical working groups in November (subject to funding/resourcing agreements and
mandate at Collaboration Board) (DA5d)
SAFE, HIGH QUALITY SUSTAINABLE
HOSPITAL SERVICES RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Delivery Area 5 report (continued) 26
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA LIFE CYCLE
STAGE
DATE DUE TO
ENTER NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Organising
Hospital
services
(DA5c)
Capital
business cases
to support
clinical
improvements
(DA5ci)
Planning
Report via NWL
workbook – see
section below
Organising
Hospital
services
(DA5c)
Improvements
to children
services
(DA5cii)
Transition to
BAU N/A CLOSED
• Paediatric review was taken to Ealing Health and
Adult Social Services Scrutiny Panel (HASC)
meeting on 24/10
• Project is now officially closed.
• N/A
Improvements
to women’s
services
(DA5ciii )
Planning
Report via NWL
workbook – see
section below
Development
of local hospital
models of care
(DA5civ)
Planning
TBC – depends
on ImBC
approval
?Q1 2018/19
AMBER
(due to
dependency with
SOC approval)
• Engagement around developing older people’s care
services in Ealing started on 1 August 2017 and is
expected to run until November 2017.
• Ealing Transformation Steering Group on 10/11/17
• On-going work to develop frail elderly model
of care.
• The following areas have been agreed as
priority work packages :
1. ambulatory care sensitivity map for
LNWHT;
2. outpatient activity analysis by age group;
3.diabetes as well as respiratory activity
analysis by age group.
• The next step with the estate feasibility study
is to consider whether this is a viable option
worthy of further investigation to OBC level.
SAFE, HIGH QUALITY SUSTAINABLE
HOSPITAL SERVICES
KEY AREAS FOR DISCUSSION
27
PROJECT AREA LIFE CYCLE
STAGE
DATE DUE
TO ENTER
NEXT
STAGE
RAG RATING PROGRESS NEXT STEPS
Hospital
productivity
programme
(DA5d)
Muscular
Skeletal
(MSK)
(DA5di)
Rolling
programme
N/A
because of
rolling programme
AMBER
(due to funding
flows causing
blocks to
progress)
• Programme has been reprioritised to deliver most
savings in 18/19 and to fit within 0.5 support post.
• MSK is a priority for the outpatient programme,
clinical leads have been identified.
• Identified that model of care for fracture clinics
needs to offer higher value.
• Agree new model for fracture clinic .
• Set up redesign groups for outpatients.
• Identify overlap between Harrow CCG MSK work and
sector work .
• Identify facilitator for community MSK pathway.
Procurement
(DA5dii ) N/A N/A
AMBER
(due to
Resource
demands)
• NWL Procurement Director started this month:
market activity around Continence and Advanced
Woundcare, evaluating the opportunities to
aggregate demand, standardise products and swap
to clinically equivalent products.
• Invitation to tender (ITT) to be finalised to identify
expertise to support procurement opportunities in
specialist technical areas.
Staffing
(DA5diii) N/A N/A
AMBER
(Based on the
fact that the
agreed £3.1m
benefits will
not be realised
in 17/18 and
we do not yet
know how
much will be
saved in 17/18)
Pan London Medical Locums:
• Break glass ceiling rates for medical locums have
gone live and monitoring process put in place.
Occupational Health
• Baseline of current OH services at each of the
trusts carried out to identify opportunities.
• Deep dive into Imperial OH service with action plan
to address £390k 2016/17 overspend.
• A lead HR director is to lead the Shared Bank -
Options Appraisal/ Business Case on behalf of the
sector
Medical Locums:
Plan to extend break-glass ceiling rates to medical bank 1st
April 2018 . Team working with NWL Trusts to calculate
savings for each Trust.
Occupational Health:
Cost savings for Imperial in 2017/18 and for all Trusts in
18/19 (savings targets are being calculated). Plan process
mapping workshops to develop standardised processes for
sickness absence an pre-employment checks.
Shared bank:
• Develop Business Case to evaluate options for
temporary staffing – in-house vs. outsourcing vs. shared
service vs. virtual bank – and identify financial savings.
• Develop break-glass ceiling rates for nursing bank staff
in NW London (building on pan-London medical locum
methodology).
• Develop work to consider priorities for 18/19.
DA5div
Outpatients
(DA5div)
Project
Identification
N/A
AMBER
(due to start
delay in
securing
Resource)
• Developed business case with specific work plan.
• Programme mandate from Outpatient Board, STP
Clinical Board.
• Agreed five priority specialties.
• Identified clinical lead s on all five specialties .
• Should have permanent band 5 administrator in
post March 2018.
• Chief Transformation Officer (CTO) drafted
business rules for discussion with CFOs on
financial models which incentivise providers and
deal with stranded costs.
• Identification of resources and funding to carry out the
work from November.
• Brief clinical leads on their role.
• Set up all clinically led meetings.
• Agree change process to facilitate radical solutions.
• Work with FRG to explore how this transformation
programme fits with CCG CIPs for 18/19.
• Identify two further facilitators.
• Take business rules to Nov/Dec Provider Board for
discussion and agreement.
Delivery Area 5 report (continued)
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL
SERVICES
27
Delivery Area 5 report (continued) 28
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
SAFE, HIGH QUALITY SUSTAINABLE
HOSPITAL SERVICES
KEY OUTSTANDING ISSUES THIS PERIOD
DA Issue Score Mitigation (latest progress) Score
DA5d
Financial systems to support system transformation, to incentivise
providers during transition of interim stranded costs and to identify
investment where there is a strong ROI. 4
Chief Transformation Officer (CTO) drafted business rules for
discussion and agreement with Provider Board and with CCG
Collaboration Board. 3
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
DA5a
This programme has limited NWL and NHSE resources, over and above
BAU within providers. Successful delivery requires engagement and
prioritisation across a range of stakeholders. 20
The risk of the forecast £188m gap has been accepted for now.
CTO working with CFOs to develop options for November provider
Board to agree. 20
DA5d Outpatients: 2/5 pathways delayed as we have not yet identified
facilitator of clinical redesign groups. 8
Outpatient: Discussions with CLARC and other stakeholders 6
DA5d
Procurement: Resources within procurement departments are limited,
driven by the demands of BAU, local CIP and Collaboration. There is
limited capacity to undertake work in non-traditional opportunity areas. 8
Procurement: ITT being developed for approval by CFOs which
would support additional specialist resource to focus on non-
traditional opportunity areas.
Appointment of NWL Procurement Director will also support this
activity.
6
Enabler workstream
29
29
AMBER
HEADLINES
• As of October the new HEE Workforce Observatory is in operation and is starting to organise its operating model with the aim of providing workforce intelligence
and planning support for the 5 London STP's. This team will work closely with the HEE central team and Information Development to make more effective and
efficient use of existing data sets, participate in new collections and will have the capacity to assist in appropriate workforce modelling approaches.
• Mental Health: Initial meeting held to agree approach to agreeing the NW London response to the national Mental Health Workforce Plan. First draft report of
analysis of pay rates for substantive and bank clinical staff at WLMHT and CNWL produced, to enable greater transparency and understand where there could be
opportunities to create a coherent pay strategy. There can be seen significant differences in the overall approaches to both the way that staff banks operate and
approaches to bonus schemes and other initiatives across both trusts.
• Change Academy: Provider has been appointed for the Change Coach Development programme, 36 strong applications were received, the programme is due to
launch in December.
• Organisational Development: Scoping meeting held on 7/11 to agree approach to develop a NW London-wide Organisational Development Strategy across
health, social care and voluntary sector to support delivery of the STP.
• Staffing project: Revised savings target for NW London staffing project has been agreed: £1.9m for 17/18 and £6.7m for 18/19.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler workstream report: Workforce 30
PROJECT AREA/
WORKSTREAM
LIFECYCLE
STAGE
DATE DUE
TO ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
1
STP Delivery
Area 1: Health
coaching – Self
care
Implementation Evaluation
Q3
GREEN
(on track)
• Evaluation report for the carers
programme in development.
• Held first leaders and champions event
in October inviting past participants of
our training who are currently integrating Coaching for Health into systems.
• Completion and review of evaluation report of Health Coaching for
Carers
• Agree the on-going provision of embedding activities for around 300
people already trained as well as other approaches for shared
learning.
2
STP Delivery
Area 2: Primary
Care
Transformation
projects
Project initiation
& start-up
Diagnostics
Q3
GREEN
(on track)
• Medical Assistant training
(Correspondence Management and
Signposting) delivered via 8 local pilots
to over 600 existing members of practice
staff. 70 GP Practices are participating in
the pilot across NW London.
• NWL currently has 13 Partnership
Innovative Education (PIES) projects, to
increase sustainability and address
current issues in the workforce. PIEs
bring together health & social care
service providers, community groups and
education providers to create innovative
educational models to support local
workforce transformation. The funding
for 7 of these has just been awarded.
• Joint workshop with CLAHRC planned
for early November to discuss
challenges of PAs in primary care.
• Activity and capacity benchmarking – launch of initiative to provide
support to practices to understand their future capacity issues and
subsequent workforce requirements.
• Locum booking platforms – exploring potential NW London roll-out of
locum booking platforms, this is designed to release similar benefits to
staffing banks with considerably reduced costs.
• Action on indemnity – dependent on progression of national work, this
aims to reduce the financial burden of indemnity on GPs through e.g.
helping GPs to “shop around” and target training to address specific
factors driving up indemnity costs.
• Sharing best practice - We are identifying areas of best practice locally
that will benefit from dissemination across North West London and
action scaling of these interventions. These will potentially include such
examples as e.g. the Brent and Ealing digital training platforms, and
the H&F practice support teams.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler workstream report: Workforce 31
PROJECT AREA/
WORKSTREAM
LIFECYCLE
STAGE
DATE DUE
TO ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
3
STP
Delivery
Area 3:
Achieving
better
outcomes
and
experiences
for older
people
Initiation Diagnostics
Q3
AMBER
(funding
secured,
identifying
sites)
• Agreed the workforce support for Acute Frailty teams. • Analysis of consultant geriatrician workforce across
NW London and identify opportunities to use the
workforce more effectively to support strategic
priorities.
4
STP
Delivery
Area 4:
Improving
outcomes
for children
& adults with
mental
health needs
Diagnostics
for SLTMHN
Identification
for
collaborative
programmes
Initiation Q3
AMBER
(Due to
being in
scoping
phase)
• Held initial meeting 6/11 to discuss and agree the NW London
approach and response to the HEE the Mental Health Workforce
Plan, and alignment with Workforce delivery plans to support
DA4.
• First draft report of analysis of pay rates for substantive and bank
clinical staff produced. This will help WLMHT and CNWL to have
greater transparency and understand where there could be
opportunities to create a coherent pay strategy.
• Findings and recommendations report from pay
rate review to be presented at CNWL and WLMHT
board meetings in November.
• Begin developing STP level response to inform
regional plan and approach. This will be presented
at the Mental Health Transformation Board meeting
on 24/11.
• Continue development of workforce delivery plans.
5
STP
Delivery
Area 5: NW
London
Staffing
Project
Project
initiation &
start-up
Diagnostics
Q3
AMBER
(not all 8
priorities
have
traction)
• The project board have agreed the savings targets for agreed
areas of focus and identified additional opportunities for further
savings to be quantified.
• Local London rates have been live since 2 October, intelligence
to date across London suggests these rates are reducing very
high cost medical locum shifts.
• Provider appointed to support collaborative process improvement
for occupational health services.
• Develop work plan and resource requirements for
18/19 to deliver programme
• Commence planning to introduce local London
rates for medical bank staff from 1 April 2018
• Set up process improvement workshop to be ready
to implement new processes by 1 April 2018
• Agreement from trust on collaborative bank
working scope for agreement at next project board,
4 December.
6
Recruitment
and
Retention
Project
initiation &
start-up
Diagnostics
Q3
AMBER
(strategy
to meet
GPFV
targets required)
• GPFV targets to increase GP numbers for NW London by 218
currently confirmed (targets are not yet fully fixed and could
potentially be modified).
• GP international recruitment programme established –
participation is mandatory, a single London-wide application is
due for 30th November, it will include a NW London
chapter. Formal guidance has still not been released.
• PC retention workshops/focus groups completed alongside draft
retention strategy – initial meeting of retention T&F group met to
set the agenda and prioritisation for delivery moving forwards.
• PC workforce strategy initiatives including activity
and capacity benchmarking & locum booking
platforms scoping is underway.
• S&T coordinating NW London approach to GP
International Recruitment – CCGs have sent EOI
forms and outline communications to practices,
follow-up engagement planned.
• Retention T&F group currently being formed, with
ToR, membership and key work streams currently
under review.
32 32 Enabler workstream report: Workforce (continued) 32
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
KEY AREAS FOR DISCUSSION
None
PROJECT AREA/
WORKSTREAM
LIFECYCLE
STAGE
DATE DUE
TO ENTER
NEXT
STAGE
RAG
RATING PROGRESS NEXT STEPS
7
HEE NW London -
supporting future
workforce growth
Implementation Evaluation
(various)
GREEN
(on track)
• Capital Nurse Programme - recruitment to rotation
programmes for September has been concluded with a lower
uptake than anticipated.
• CEPNs have taken up an extended role to develop
relationships with education providers and work
collaboratively to increase placement capacity in primary
care.
• Discussion needs to happen around the
impacts of lower numbers recruited to the
Capital Nurse Programme in NW London.
• Participation in London-wide bid for
international GP recruitment. Currently
engaging with practices to obtain
expressions of interest.
8
Change Academy
High Performing
Care (HPC) &
Leading
Transformation
programmes (LTP)
Commissioning for
Outcomes
programme (C4O)
Implementation Evaluation
Q4
AMBER
(tailoring
coproduction
to
readiness)
• Cohort 2 (6 teams) of Commissioning for Outcomes and
Integration programme completed their third workshop on
31/10. HPC Change Coaches are being flexible in their
approach and support offers to meet needs of the 9 project
teams.
• Final preparation for the Change Coach Development
programme to launch in December with a cohort of
approximately 40 Change Coaches, who will use their
training to support local transformation projects.
• Change Coach programme launch in
December.
• C4O programme; final workshops to be
held and follow on support to be agreed.
• HPC nd LTP programmes to continue.
• evaluation report will be completed this
month to show progress.
KEY OUTSTANDING ISSUES THIS PERIOD
DA Issue Score Mitigation (latest progress) Score
All Relationships with local government colleagues needs be maintained and strengthened
to address social care workforce challenges and improve integration. 3
Workforce strategy encompasses workforce challenges and implications. Health
and Social Care Workforce Lead role to be re-advertised for permanent
recruitment. 2
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
2
There is a risk that the GP targets (set out in the GPFV) may hamper innovative
workforce planning for new models of care. Primary care transformation initiatives and
programmes are more focused on retaining and developing existing staff and ways of
working to build resilience in the primary care workforce, than recruitment alone.
9
Work with Local Services Team and forums including the Workforce & Provider
Development Delivery Group, Workforce Transformation Delivery Board and
Advisory Council to develop a Primary Care Workforce Strategy and Delivery Plan
to address the challenges. Dedicated resource in place to lead on the strategy.
6
AMBER
HEADLINES
• STP/ Local Digital Roadmap – no funding will be received during 2017/18; funding 2018/19 to 2020/21 likely to be announced after the Budget in
November; NHSE guidance will follow. This will delay paperless records in providers, and shared digital records to support better integrated
care. NHSE has accepted that the FYFV target of “Paperless by 2020” will not now be achieved.
• Digital Portfolio/ Primary Care/BI – good progress against agreed plan
• Provider Digital Projects – continued progress with Care Information Exchange, but slow
• Digital CQUINs – work on e-Referrals and Advice & Guidance CQUINs under way in all Trusts
Enabler workstream report: Digital 33
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA/
WORKSTREAM
RAG
RATING PROGRESS NEXT STEPS
1
STP/ Local
Digital
Roadmap
RED
(due to delay
and
reduction in
STP/LDR
funding)
• NHSE have confirmed that no STP/LDR digital funding will be received during the current FY. NHSE will ask the Treasury in
November 2017 for £800m of funding over 2018/19 to 2020/21. This is expected to be distributed to STP footprints on a capitation
basis, suggesting an allocation to NWL of £32m (4% of £800m) over three years, which compares with the original LDR request for
£146m over five years (based on the Secretary of State’s announcement in February 2016 of a £4.2bn technology fund) and the
previous planning assumption of £32m in the first two years, with more in the subsequent two years. However, NHSE have stated
that the allocation will be reduced to reflect the Global Digital Exemplar funding already awarded to Imperial (£10m) and Chelwest
(£5m) – so the final number will be less than £32m.
• Existing projects are proceeding, but the step change required to fully automate clinical operations and build shared care
records, as set out in the STP and LDR vision, will not occur without the required capital funding. This will impact LNWHT
and THH especially, since their clinical processes remain paper-based and the funding will be insufficient to implement systems
such as Electronic Prescribing and Electronic Document Management. The Five Year Forward View target of “Paperless by 2020”
is no longer achievable and this has now been explicitly recognised by NHSE (Will Smart, CIO, speech at EHI, 31 Oct).
• Projects will need to be re-prioritised once final guidance has been received from NHSE.
• Final funding
guidance to be
received from
NHSE
• LDR Digital
Programme
Plan to be
developed for
high priority
projects – likely
deadline is Feb
2018.
2
Digital
Portfolio/
Primary
Care/BI
GREEN
(proceeding
as planned)
• Planning for 17/18 GP Practice Hardware Refresh is under way, with the bids submitted to NHS England. Approval from the
London Capital Committee is expected early November. Video Conferencing project is under way, reviewing As-Is and To-Be.
• Health Help Now patient application has been assured as being SCCI0129 compliant and is now included in the NHS app library.
Working with the Cabinet Office, NHSD, LCIE on patient verification authentication by Feb 2018.
• Patient Online making good process with the patient facing campaign. Target is 85% of practices to have 20% of patients with an
on-line account by end October.
• GP practice Wi-Fi: pilot practices have been established, testing the capacity to manage network traffic and additional
infrastructure resilience. Phase 1 of the deployment is now under way.
• Whole Systems Integrated Care continues to make good progress with GP sign up, deployment, training and establishing GP data
flows and release 11. Diabetes population health RADAR pilot completed. Population health views development work started.
• Personalised Integrated Care Planning Standards carried out its expert group review, draft 3 of the design standards is now the
focus.
• Data Quality Framework is progressing defining local standards and local tools. SNOMED planning work continues on governance,
stakeholder engagement and resource review.
• The E-Learning Hub - the system is on track to be procured in October, with deployment plans now being developed.
• BI Re-procurement – NWL CCGs working with London LPF team to procure a BI system for 32 CCGs to include population health
functionality. Sep 17 ITT date has been delayed, but the London programme reports that mobilisation for Sep 18 is still on target
• NHSMail2 work is well underway with communications being released, deployment and support being made available for the
migration.
• Work is progressing well for Infrastructure & IT Operations, disaster recovery testing, moving databases to the NWL environment,
developing the business case for the Data Centre.
• Continue with
planning and
deployment
phases
• Development
of the
Corporate
Infrastructure
Strategy
Enabler workstream report: Digital continued 34
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
PROJECT AREA/
WORKSTREAM
RAG
RATING PROGRESS NEXT STEPS
3
Provider
Digital
Projects
and
Digital
CQUINs:
GREEN
(proceeding
as planned)
• Continued progress with NW London Care Information Exchange – development of further interfaces (see above), but
deployment to clinicians has been slow (e.g. care planning pilot in Hillingdon – delayed again pending EMIS interface) and
there is no agreement on funding for the CIE beyond March 2018 – though Imperial’s Charity, which has funded the CIE to
date, may be prepared to fund it for a further year if the care community as a whole is supportive.
• NWL Digital Programme is providing support for the digital elements of national clinical CQUINs for 2017/18 (e-Referrals,
Advice & Guidance): planning is under way in all acute Trusts, being managed by lead CCGs as a commissioning and
contracts issue since digital enablement via e-RS is in place.
• Providers are participating strongly in Digital governance, with partners working together on core system-wide plans and
capabilities, though delivery is dependent on STP/LDR funding (see above)
• Current resourcing for PMO is not sufficient to collate Provider project progress for STP reporting purposes.
• Care Information
exchange (CIE)
options analysis
• Ongoing support of
e-RS and Advice &
Guidance CQUINs
• Continued work
between CCGs and
providers through
joint governance
KEY OUTSTANDING ISSUES THIS PERIOD
No Issue
Score Mitigation (latest progress) Score
1 STP/LDR funding has been delayed and will be insufficient to fully automate clinical
operations and build shared care records, as set out in the STP and LDR vision. It is
unlikely that there will be funding for an overall Digital PMO for NWL – so it will be
difficult to report consolidated progress.
5
• JHCTG to consider alternative sources of funding for STP enablers
• Prioritisation of investment at Technical Design Authority and Digital
Portfolio Board re priorities, once funding amount and guidance are
confirmed.
4
2
Integrated care requires shared patient records – but currently our GP and community
systems (SystmOne and EMIS) do not have open interfaces and progress towards
interoperability is slow. NHS Digital’s GP Connect interfaces will fill this gap, but are still
in pilot stage. 3
• Extracts from EMIS and SystmOne to WSIC implemented using third party
product (Apollo).
• EMIS interfaces are improving (primary/community sharing pilot in
Hillingdon, links to Care Information Exchange being tested, CMC interface
now in place).
• Positive news – Technology partnerships TPP has announced it plans open
interfaces for SystmOne (details of scope and timescales are awaited).
3
DELIVERY RISKS FOR NEXT PERIOD
No Risk Score Mitigation (latest progress) Score
1
The further delay in NHSE STP/LDR funding will impact many of the digital enabling
projects for the STP. Funding will be at a much lower level than required to enable the
STP and national clinical objectives.
20
• JHCTG to consider alternative sources of funding for STP digital enablers
• Prioritisation of investment at Technical Design Authority and Digital
Portfolio Board, once funding amount and guidance are confirmed.
16
KEY AREAS FOR DISCUSSION
JHCTG to consider alternative sources of funding for STP digital enablers
In meantime, be aware that existing projects will continue, accepting that there will be delays in digital enablement of STP Delivery Areas, especially automation of clinical operations and shared
care records
PROJECT AREA/ WORKSTREAM RAG RATING PROGRESS NEXT STEPS
DA2
DA2e - Supporting people
to take control of their own
health
GREEN
On track • Handover of BAU reporting on PAM measures routine report
now complete.
• Automate labour intensive process and provide second line
cover to produce each month.
• Request for new Atrial Fibrillation and Hypertension
dashboard. Work in progress to understand requirements.
DA3
DA3 – Better care for older
people
GREEN
On track
• Further developed opportunity analysis for Rapid Response
services using Ambulatory Care Directory and activity in low
acuity ED attendances
• Work up routine Low Acuity ED analysis and Ambulatory
analysis for Falls and UTI pathways to help group better
understand cohort.
• Taken a version of the programme dashboard to the DA3
programme board. Featured context data for older peoples
urgent care usage in NWL, and SPC charts to show
progress against outcome metrics.
• A live data feed has been requested for Care Home activity
and is currently being developed by Kavitha S in BIU.
• Combine ASCOF data and data available from WSIC to
include in programme dashboard.
• New request for a frailty dashboard to cover Northwick Park
and Ealing Hospitals
DA4
DA4a - Supporting adults
with serious and long
term mental health needs
AMBER
(Previous
identification
of BI resource
has delayed
development)
• Resource now in place to develop dashboard. Some
revision to original data requirements but good engagement
with WLMHT
• Review options for additional datafeeds for workforce and
quality data. Will need similar conversations with CNWL.
DA4 – Improving mental
health services • Routinely producing Grenfell attempted suicide and self-
harm reporting. • Looking into how we could identify where patients may
now be in other localities.
DA5 DA5 - Acute
Transformation
GREEN
On track
• GP Hubs and 111 dashboard development continues with
some additional requirements identified • Incorporate UCC capacity and staffing grades into current
report.
• Developed further areas of potential QIPP and produced
materials to facilitate and engage providers. Working closely
with WLCCG colleagues and provider transformation team.
• On-going work with stakeholders to determine true QIPP
potential
QIPP Opportunity assessment
templates GREEN
• Some initial work on MSK, admissions from care homes /
end of life, emergency ED attendances,
• BI support as necessary to support production of OATs for
dermatology, ENT/audiology, gastroenterology,
ophthalmology, cardiology, mental health prescribing and
diabetes.
GREEN
HEADLINES
• S&T team now taken on reporting from previous interim staff (DA2)
• Development of prototype programme, rapid response and frailty dashboards (DA3)
• Continued working on MH dashboard previously identified as risk by DA4 programme (DA4)
• Produced datasets and doing continued work to support GE Healthcare in their assurance of SOC1/SaHF (DA5)
• Supporting Delivery Areas to produce OATs for QIPP schemes across NWL (QIPP)
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler workstream report: Business Intelligence 35
36 36 Enabler workstream report: Business Intelligence (continued) 36
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
KEY AREAS FOR DISCUSSION
None
DELIVERY RISKS FOR NEXT PERIOD
DA Risk Score Mitigation (latest progress) Score
Unexpected complexity in backend SQL server tables causing
delay in being able to use WSIC data to support S&T 6
Discussions with WSIC team about data structures and run through of tables 6
KEY OUTSTANDING ISSUES THIS PERIOD
DA Issue Score Mitigation (latest progress) Score
Delay to development of MH dashboard 6
Dedicated analyst capacity identified, risk with providers ability to provide
necessary data fields. Meeting arranged with WLMHT. 3
Enabler report: Estates 37
CCG PROJECT PROJECT
TYPE
FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAME
FOR
DELIVERY
PROGRESS
Brent
Wembley
Centre for
Health and
Care
Hub increase
utilisation and
reduce voids
NHS Capital 2.45
Year 1 – 7
(Aligned to
CMH)
Work continues to commission out of hospital services from the site and work is starting
on looking at the possibility of reducing HQ costs at Wembley by consolidating the CCG
space to reduce the cost of the accommodation. The opportunity to co-locate the CCG
HQ with Brent Council is also being explored. NHS Property Services (PS) is leading
a review of the current occupation of the site to establish the future clinical space
required to support Hub delivery. This information will feed into a proposed OPE
project to establish the potential mixed use development opportunity of the site with
Brent Council and other adjacent land owners. This will also identify potential capital to
be generated from land release.
Willesden
Centre for
Health and
Care
Hub increase
utilisation and
reduce voids
NHS Capital 4.46
Year 1 – 7
(Aligned to
CMH)
Work continues to introduce new providers to deliver out of hospital services from the
site. An improvement grant bid to relocate Burnley Practice to larger vacant
accommodation was successful and the project has been initiated and work is
underway to complete NHSE due diligence. The CCG is working with providers and
the Council to develop a long term strategy for the use of the site linked to the
emerging plans for Central Middlesex Hospital.
Central
Middlesex
Hospital PC
Hub increase
utilisation and
reduce voids
ETTF 1.90 Year 1
The ETTF bid to create a primary care facility at Central Middlesex Hospital was
successfully funded and due diligence has been completed. The London Capital
Committee approved the enhanced PID in July and the CCG received national sign off
in August and work has commenced on site. NHSE has completed the procurement of
a new APMS practice with a new contract awarded. Some internal LNWHT delays has
pushed back completion of the works to 1 Feb 2018.
Central
Central
Westminster
Hub
New build NHS Capital 4.92 Year 3-4
Hubs and Spoke Workshops have been undertaken to test the original assumptions
and re-focus models of care that are deliverable. The CCG is now exploring alternative
options for a Central Hub .
Church
Street
Hub
New build
NHS
Capital/
Westminster
City Council
14.73 Year 5+
Dialogue continues with Westminster City Council to develop a community hub on a
site at Lilestone Street as part of the Church Street regeneration. Phase 1 works to
create new housing units at Lisson Arches has been delayed and this is having a knock
on effect to vacating the Lilestone Street site. Alternative options are being considered
AMBER
HEADLINES
• BRENT – NHS Property Services review of occupation being undertaken to feed in to proposed One Public Estates project.
• CENTRAL LONDON – Refresh of current space /demand is being undertaken
• EALING – Mattock Lane PID drafted for submission to F&P in November
• HAMMERSMITH & FULHAM – PID for Phase 1 redevelopment at Parsons Green was approved by NHSE London Capital Committee in October
• HARROW – NHSE London Capital Committee has approved funding for improvement works to first floor of Belmont Health Centre
• HILLINGDON – PIDs for both the North Hillingdon Hub and Uxbridge and West Drayton Hub approved by F&P and GB
• HOUNSLOW – Community Health Partnerships (CHP) approved capital funding PID for £400k for improvements/reconfiguration at Heart of Hounslow. Heston OBC approved by
F&P and GB in September
• WEST LONDON – ETTF funding secured to the value of £4.4m relating to the South Hub
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler report: Estates (continued) 38
CCG PROJECT PROJECT
TYPE
FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAM
E FOR
DELIVERY
PROGRESS
Ealing
Ealing East Hub
New build LIFT 21.15 (£23m) Year 2
The PID and Options Appraisal (OA) have been approved by the CCG
and following NHSE approval of the PID the OA has been submitted to
NHSE for approval. The preferred option is to rebuild Acton Health Centre
which is a LNWHT owned site. Work now to commence on OBC.
Ealing North Hub
New build 3PD 14.613m Year 2
The PID and Options Appraisal (OA) have been approved by the CCG
and following NHSE approval of the PID the OA has been submitted to
NHSE for approval. The preferred option is a new health centre on the
former Glaxo (GSK) site. The GSK developer has successfully obtained
planning consent for the scheme which includes a 2,000 m2 of health
facility (subject to commercial terms and necessary approvals being in
place). Work now to commence on OBC.
Mattock
Lane
Non-Hub
New build TBC TBC Year 3-5
Proposal to develop Mattock Lane as a large primary care centre for
central Ealing to serve a registered patient list of circa 50,000, plus
community services. A feasibility report was commissioned to
demonstrate how the site could potentially be redeveloped to provide a
health facility of between 2,000 and 2,500 m2. Several local GP practices
have expressed an interest in collaborating to consolidate primary care
services on this site. The recommendation from the feasibility report is
now informing the development of the PID which is due to be submitted to
the Finance Committee in December 2017
Hammersmith
and Fulham
Parsons
Green
Health
Centre
Hub
Reconfiguration
of existing site
NHS
Capital/
ETTF
4.81 Year 2-3
Partial funding of £794k via ETTF was expected to be confirmed at
London Capital Committee in July 2017 to support the relocation of
Lilyville Surgery, however this decision was not confirmed until the LCC in
October 2017. Work will now progress on completing the due diligence
required for the project.
Bridge
House
Non-hub
Reconfiguration
NHS
Capital 0.25 Year 1
ICHT are now delivering Cardiology and Respiratory services from the
newly reconfigured accommodation and ICHT has also agreed to facilitate
a new IAPT pilot service from this space. Minor works to convert two void
rooms on the ground floor as accommodation for the IAPT Service
displaced from Charing Cross has completed. IAPT due to move in during
November.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler report: Estates (continued) 39
CCG PROJECT PROJECT
TYPE
FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAME
FOR
DELIVERY
PROGRESS
Harrow
The Pinn
Medical
Centre
Hub
increase
utilisation and
reduce voids
NHS
Capital 0.68 Year 1-2
A utilisation review of the site has been undertaken and further
opportunity to accommodate services was identified. The site houses a
practice with a patient list of 23,000 and a walk-in centre (WiC). This is
an operational Hub offering a range of OOH, community and primary
care services. X-ray and ultrasound services are also offered from the
site. The opportunity to reorganise some space at the site to create
additional clinical capacity will now be explored..
East
Harrow
Hub
New build
NHS
Capital
15.19 (£2.9m-
£7.8m) Year 3-4
The PID for this scheme has been approved by the CCG and NHSE.
The Options Appraisal (OA) has been completed for the scheme and
has identified the preferred option as the redevelopment of the existing
Belmont Health Centre. CCG F&P and GB approval was obtained in
August 2017. The project has also been Identified as a possible One
Public Estate scheme to maximise development potential with Harrow
Council and release surplus public sector land for residential
development.
Belmont
Health
Centre
Non-hub
Reconfiguration
NHS
Capital 0.7 Year 1
NHSE operational capital had been approved to convert the void first
floor office accommodation into clinical space to address overcrowding a
lack of capacity at the site. NHS PS has undertaken the tendering for the
detailed design for the work and engagement with the existing tenants
and PPG continues. Concept design ready is being reviewed with the
tenants week of the 13 November.
Alexandra
Avenue
Hub
increase
utilisation and
reduce voids
LIFT 2.70 Year 1-2
Following a space utilisation review and a piece of targeted work all
admin and clinical space on the lower ground floor is now occupied and
void space at this site has been reduced to less than 3%. Utilisation has
increased from 44% in 2016 to a current rate of 75%. Minor works to
meet current Infection Control requirement is currently underway and
once completed Tissue Viability will commence from this site. Alexandra
Avenue currently provides most of the core services identified in the
OOH hub strategy.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler report: Estates (continued) 40
CCG PROJECT PROJECT
TYPE
FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAM
E FOR
DELIVERY
PROGRESS
Hillingdon
Hesa
Health
Centre
Hub
increase
utilisation and
reduce voids
NHS
Capital TBC Year 1 - 3
The re-procurement of primary care services at the site has triggered a
requirement to look at the primary care space at the site. This may also
create an opportunity to release further space for the delivery of out of
hospital services at the site.
Yiewsley
Health
Centre
Non-hub
Reconfiguration
of existing site
ETTF 0.5 Year 1
The ETTF scheme to convert void space into clinical space is progressing
with the design agreed. Practices have agreed the allocation of space
and will now enter into lease negotiations with NHS PS in order to satisfy
NHSE due diligence. The ETTF investment will negate any revenue
increase. There remains a significant risk with respect to the delivery of
this scheme, and all ETTF schemes in NHS PS properties as currently
there is no mechanism for NHSE to transfer capital to NHS PS. This
matter has been escalated and is being dealt with by DH. Tender for
works has commenced with tenders due 21 November. Additional s106
funding sought to improve entrance, lobby and reception areas.
North
Hillingdon
Hub
New build
NHS
Capital 5.67 Year 2-3
Discussions continue with THH to include the provision of the Hub space
requirement in its new build skin clinic on the Mount Vernon site. An
alternative scheme has been worked up with NHSPS for the combined
Northwood & Pinner Community Hospital and Northwood Health Centre
sites. These two site options will be analysed at Options Appraisal. The
PID was approved by F&P in August and GB in September 2017 and has
been submitted to NHSE for approval. The PID was approved by F&P in
August and GB in September 2017 and has been submitted to NHSE for
approval.
Uxbridge
and West
Drayton
Hub
New build
3rd party
developer
/ NHS
Capital
11.05 Year 3-4
Having been unable to secure a site on the St Andrews site with St
Modwen, the redevelopment of the Uxbridge Health Centre is being
assessed with CNWL. A feasibility study has been undertaken for input to
the Options Appraisal. The PID was approved by F&P in August and GB
in September 2017 and has been submitted to NHSE for approval.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Enabler report: Estates (continued)
41
CCG PROJECT PROJECT TYPE FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAME
FOR
DELIVERY
PROGRESS
Hounslow
Heart of
Hounslow
Hub
increase
utilisation and
reduce voids
LIFT 1.72 Year 1-2
CHP has secured £400k capital funding for 17/18 to reconfigure space
that will lead to further improvement in utilisation, including bringing
void space back into use. A PID for the additional work has been
approved and the project is due to commence shortly with works
expected to complete by end of the financial year.
Heston Hub
New build LIFT 15.89 (£1.9m) Year 2-3
Stage 1 (OBC) document approved by Hounslow GB on 14 March
2017 subject to further cost reduction measures being explored as part
of design development. Stage 1 (OBC) document was approved by
Hounslow F&P and GB in September. Due to the six month delay, due
to affordability concerns and logic model requirements, the FBC is now
expected to be completed in May 2018.
Chiswick
Health
Centre
Hub
Reconfiguration
of existing site
ETTF 1.00 Year 1-2
ETTF PID for Chiswick Health Centre has been submitted to London
Capital Committee and approved. The proposed scheme has been re-
presented to GP practices, HRCH and NHS PS to ensure that key
stakeholders are engaged. All parties are positive about the proposed
scheme that will deliver additional clinical space through an internal re-
configuration/refurbishment. NHS PS has completed a competitive
procurement process and has appointed a design consultant to
progress the scheme. The CCG and NHS PS is considering the short-
term opportunity versus the medium-term redevelopment option and in
parallel with the Brentford approach NHS PS has appointed a design
team who have recently completed a feasibility and viability study. This
approach was discussed with NHSE at the recent ETTF Surgery held
on 3 October 2017. A draft paper is being prepared collaboratively with
NHS PS that will re-state the consistent objectives and benefits
Brentford/
West
Middlesex
Hub
New build
NHS
Capital 10.21 Year 3-4
Early discussions with West London Mental Health Trust have
identified an opportunity for a collaborative redevelopment of the site,
which could include both Brentford Lodge and the Brentford Health
Centre. This is being explored further with WLMHT and NHS PS who
have appointed a design team who have recently completed a
feasibility and viability study. Draft PIDs have been prepared for both
sites and are expected to be presented to F&P in November. OA list
from NHS PS still awaited.
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
42
CCG PROJECT PROJECT TYPE FUNDING
TYPE
ESTIMATED
INVESTMENT
(£m)
TIMEFRAME
FOR
DELIVERY
PROGRESS
West
South
locality
Hub
Refurbishment
and extension
3rd party
developer/
NHS
Capital/
ETTF
12.71
(£10.4m) Year 2-3
Dialogue continues with The Cadogan Estate with respect to the
refurbishment and extension of the Violet Melchett Clinic to determine
how the scheme can be taken forward and the associated
costs/delivery route. Cadogan has commenced pre-application
discussions with the Local Authority and Cadogan have recently
advised that a planning application is unlikely to be submitted before
January 2018. The Options Appraisal (OA) was approved by CCG GB
in March 2017, subject to financial alignment with SOC1, which was
completed in June 2017. The OA has now been submitted to NHSE for
approval. Partial funding of £4.4m via ETTF was confirmed at London
Capital Committee (LCC) in July 2017.
St Charles
reduced
Hub
Reconfiguration
of existing site
and reduce voids
NHS
Capital 3.95 Year 2-3
Initial discussions have commenced with NHS PS relating to options to
utilise space at St Charles Centre for Health and Care. CNWL has
withdrawn its interest in leasing space in Courtfield House due to the
poor general condition of the building and thus overall scheme viability.
A workshop is being planned for Nov 2017 to allow the CCG to define
its commissioning intentions for the site.
Enabler report: Estates (continued)
42
KEY AREAS FOR DISCUSSION
Reaffirming partner support and engagement with delivering the NWL Hub strategy
RAG key: On track Risk of delay – management in
hand
Delayed or unmitigated risk of
delay – immediate action required
Glossary
Acronym Term in Full Acronym Term in Full
A&E Accident & Emergency iBCF Improved better care fund
ACP Accountable care partnership IC Intermediate care
ADASS Association of Directors of Adult Social Services ICHP Imperial college health partners
APMS Alternative provider medical services ITT Invitation to tender
ASD Autism spectrum disorder JHCTG Joint Health Care Transformation Group
BAU Business as usual LAS London Ambulance Service
BHH Brent Hillingdon and Harrow LA CYP Local authority children and young people
BI Business Intelligence LDR Local digital road map
BIU Business Intelligence Unit LNWHT London North West Healthcare NHS Trust
CAMHS Child and adolescent mental health services MSK Muscular Skeletal
CEPNS Community Education Provider Networks (CEPNs) NHSE National Health Service England
CIPs Continuous improvement process NHSI NHS Institute for Innovation and Improvement
CFO Chief Finance Officer OPE One Public Estate
CLARCH CLAHRC - Collaboration for Leadership in Applied Health
Research and Care
PAM Patient Activation Measures
CNWL Central and North West London NHS Foundation Trust PBS Positive behavioural support
COOs Chief Operating Officers PID Project Initiation Document
COPD Chronic obstructive pulmonary disease QIPP Quality innovation productivity prevention
CQUINs Commissioning for Quality and Innovation ROI Return on investment
CRG Clinical reference group RR Rapid response
CTO Chief Transformation Officer SLTMHN Supporting adults with serious & long term mental health needs
CTPLD Community team for people with learning disabilities SNOMED Systematised nomenclature of medicine
EMIS (Egton medical information system) a supplier of electronic patient
record software systems for primary care
SOC Strategic outline case
EOI Expression of interest SQL Structured query language
F&Ps Finance & Procurement STARRS Short-term assessment, rehabilitation & reablement service
GPFV General Practice Forward View THH The Hillingdon Hospitals NHS Foundation Trust
HASC Health & Adult social care select committee TPP The Phoenix Partnership a Government accredited clinical
computer system used in Primary Care
HEE Health Education England UCC Urgent Care Centre
HEENWL Health Education England North West London WLA West London Alliance
HLP Healthy London Partnerships WSIC Whole Systems Integrated Care
IAPT-LTC Improving Access to Psychological Therapies (programme) - long
term conditions
WTAC Workforce Transformation Advisory Council
IAPTUS Improving Access to Psychological Therapies a Clinician online
patient management system
WTDB Workforce Transformation Delivery Board
43
Contents for NWL work book updates 44
• NWL project workbook- Risk Framework
• Supporting local people to live healthier lives (DA1a) - Reducing harmful drinking (DA1ai)
• Roll out of the National MECC Programme (DA1d) - Making Every Contact Count (DA1di)
• Getting hospital patients better, quicker (DA5b) - Radiology and Diagnostics (DA5bi) & Inpatient model of
care (DA5bii)
• Organising Hospital services (DA5c) Capital business cases to support clinical improvements (DA5ci)
• Organising Hospital services (DA5c) - Improvements to women’s services (DA5ciii)
• Transition to using the NWL project workbook is underway across S&T
• The workbooks presented in this section are the first projects to transfer and are being developed
• We are awaiting the development of programme level work books
• This is the GANTT chart key used in the workbooks
GANTT Chart Key Completed
milestones: 0
Completed
tasks: 0
Incomplete
milestones: 3
Incomplete
tasks: 6
Key messages for NWL work book updates
NWL project workbook - Risk framework 45
Taken from CWHHE policy (CWHEE/GOV/003-(Source: National Patient Safety Agency)
Highlight_report Report generated on 17/11/2017 at 14:08 hours
All CCGs | Highlight report (DA1ai | Reducing Harmful Drinking)
Roles
Year to date | Year: 2017/18 | Month: 6 | Financial performance Full year forecast | Year: 2017/18 | Month: 6 | Financial performance
Narrative updates | Updated on:
Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP 0 0 0 0 0 -
0 0 0 0 -
0 0 0 0 0 -
Net saving 0 0 0 0 0 - Net saving 0
Ops plan All plans Actual Reported Variance to all plans
QIPP
Gross saving 0 0 0 0 0 -
QIPP
Gross saving 0 0 0 0 0 -
0 - Investment
SRO
07/11/17
R RPlanning and Delivery Outcomes and Benefits
1. Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications
can share)
Discussions are progressing at an STP level regarding the approval for the alcohol business case
2. Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act
as lever/ note)
Ealing, Brent and Harrow CCGs to agree to fund the alcohol business cases and the JHCTG to act as a lever
to prioritise alcohol prevention work and support this decision making progress.
3. Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How
can JHCTG help?
Key issue is the on-going uncertainty of funding for the alcohol work and the consequential delays in
implementation.
PROGRESS:
- We have submitted an EOI for a social impact bond to part fund the business case
- The business cases have been esclated to the STP leads
NEXT STEPS
- As the JHCTG was cancelled last month, we are awaiting Novembers meeting
- Awaiting the outcomes of the social impact bond.
Rebecca Hall
Melanie Smith
Supporting Local People to live Healthier LivesProgrammeProject manager
Clinical leadClare Parker
£000's Ops plan All plans Actual Reported Variance to all plans £000's
0 0Investment 0 0
Source file: DA1ai Alcohol PW 301017 PW Page 1 of 3
Highlight_report Report generated on 17/11/2017 at 14:08 hours
Planning
92% 8%
22/1
2
29/1
2
05/0
1Revised
start
00/01/00
End
(date)
01/11/16
01/1
2
03/1
1
10/1
1
17/1
1
24/1
1
Done?
06/1
0
13/1
0
20/1
0
27/1
0
12/0
1Revised
end
00/01/00
1.03 0
1.02 M 00/01/0000/01/00 30/01/17
01/07/17 02/10/17
1.08
Preliminary business case developed for the STP 0 01/12/16
01/09/17
1.09 0
Review of best practice and literature relating to alcohol care teams 0
1.01
Mile
-
sto
ne
M
Ref.
0The increasing consequences of probelmatic drinking and its cost to hospital identifed as a key
priority by the NW London STP and RCP, PHE and NICE supported intervention with ACT
recommended
01/09/16
80% 20%■ Milestone progress ■ On time | ■ delayed
08/1
2
15/1
2
OwnerTask / milestone descriptionStart
(date)
1.05 M Establishment of the NW London Alcohol Steering Group with key stakeholders across NW London
to develop the ACT model and evaluation
0 01/04/17
1.04 M Mapping of current community and hospital alcohol care services 0 15/01/17 00/01/00 01/04/17 00/01/00
01/04/17 00/01/0001/01/17 00/01/00
.
1.07 0 ACT model developed and approved 0 01/04/17 00/01/00 01/07/17 00/01/00
0 Finanical modelling and estimated ROI completed 0 01/04/17 00/01/00
Data analysis of impact on alcohol related A&E attendances and admissions 0 01/03/17 00/01/00
01/08/17 00/01/00
01/06/17 00/01/00
00/01/00 01/09/17 01/12/17
1.10 0 Businsess case developed for Ealing, Harrow and Brent CCG 0 01/05/17 00/01/00 01/08/17 00/01/00
||| . .1.11 0 Business case awaiting approval by CCGs
■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
. . . . . .0 10/07/17
È
Source file: DA1ai Alcohol PW 301017 PW Page 2 of 3
Highlight_report Report generated on 17/11/2017 at 14:08 hours
Risks and issues
Rating
Severe
RH
RH
Severe
Severe
Risk distribution (active) Issue distribution (active)
Description of risk / issue and potential consequence(s)
It is an issue that the delay in the alcohol business case
signoff by Ealing and Brent CCGs have impacted and
delayed the anticipated start of the teams in October has
been missed and therefore missing the beginning of the
winter pressure. Brent CCG is awaiting approval from
Ealing CCG before signing off and the approval of Harrow
CCG is under jeopardy.
IMPACT with an estimated four to six months needed to
recruit and implement teams, it is unlikely that without a
funding decision shortly, that the teams are unlikely to be
implemented this year and the increasing rates of alochol
related harm and costs to the NHS is likely to continue to
rise.
Date
added
30/10/17
Type
I
30/10/17 I
30/10/17 I Engagement has commenced to understand any
amendments required for full agreement. Additional external
funding sources also being explored.
Discussion at the JHCTG Board
There is an significant issue that the Harrow alcohol
business case has been approved by Harrow CCG on the
provision of a Harrow LA funded worker however with the
significant changes to Harrow LA and cuts (£0.5 million),
Harrow LA are no longer able to contribute to this service
therefore making the current approved business case
unviable.
IMPACT without the additional funding, the Harrow business
case is not viable and therefore nor is the wider business
case
There is an issue that Ealing and Brent CCG are only
proposing to fund the alcohol service for one year rather
than the 18 months requested
IMPACT as the ROI relies on the preventing re-attendances
and re-admissions, this is unlikely to demonstrate a
significant benefits with the shorter pilot time frame. This
will detrimentally effect outcomes and consequent further
funding into alcohol services importantly sustaining the
service and scale up across NW London.
Clear communication with CCGs and development of the
business case to provide as strong a case for investment as
possible.
Esclated to STP leads.
Looking to source match funding from Social Investment
Bond to reduce cost to CCGs
Action still to be taken (planned) to mitigate impact further
0
Action taken to date to mitigate impact of risk / issue
Escalated within Harrow CCG and to DA1 Programme
Board and to STP leads.
Owner
RH
Source file: DA1ai Alcohol PW 301017 PW Page 3 of 3
Highlight_report Report generated on 17/11/2017 at 14:09 hours
All CCGs | Highlight report (DA31di | Making Every Contact Count )
Roles
Year to date | Year: 2017/18 | Month: 6 | Financial performance Full year forecast | Year: 2017/18 | Month: 6 | Financial performance
Narrative updates | Updated on:
0Planning and Delivery Outcomes and Benefits
JHCTG November 2017
Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can
share) - MECC training has commenced in Hounslow.
Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act
as lever/ note) - Further recruitment drive needed to fill spaces as there has been reduced appetite in some of
the boroughs.
Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can
JHCTG help? - Risk of causing damage to relationships between the STP and funding providers due to being
overly ambitious in project development and setting unachievable targets.
PROGRESS THIS MONTH (planning and delivery) - Training has taken place in Central London, West
London, H&F, Brent and Harrow and has now commenced in Hounslow.
NEXT STEPS (Planning and delivery) - Second recruitment drive taking place to fill spaces where there has
been reduced apetite. Further trainings to take place and to be booked for January, February and March 2018.
Alexandra Blowers
Fiona Butler
Improving Health and WellbeingProgrammeProject manager
Clinical leadClare Parker
£000's Ops plan All plans Actual Reported Variance to all plans £000's
0 0Investment 0 0
SRO
08/11/17
A
Ops plan All plans Actual Reported Variance to all plans
QIPP
Gross saving 0 0 0 0 0 -
QIPP
Gross saving 0 0 0 0 0 -
0 - Investment 0 0 0 0 0 -
Net saving 0 0 0 0 0 - Net saving 0
0 0 0 0 0 -
0 0 0 0 -
Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP
Source file: DA1di MECC PW Page 1 of 2
Highlight_report Report generated on 17/11/2017 at 14:09 hours
Planning
Risks and issues
È
■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
Action still to be taken (planned) to mitigate impact further
Develop plan with HLP, HEE and borough's Public Health
leads to ensure programmes of work are sustainable and
deliverable.
Action taken to date to mitigate impact of risk / issue
Engage with HEENWL to highlight an awareness of
unrealistic targets and continue to work with boroughs to
ensure that programmes of work are sustainable.
Owner
SS
Date
added
08/11/17
Type
R
08/11/17 R Paper has been developed and taken to DA1 Programme
Board to establish next steps- this will go to the JHCTG for a
system wide decision.
The Making Every Contact Count project has facilitated the
development of strong relationships with each of the 8
Borough's Public Health teams. There is a risk that these
relationships will be lost should the work discontinue.
IMPACT prevention as a system becomes much more
challenging.
Unmitigated L: 3
Unmitigated C: 3
Unmitigated risk: 9
Reviewing the DA1 programme and representation,
challenging system commitment to the prevention agenda
and working with boroughs to ensure that they continue with
projects in train.
31/08/18 00/01/0016/06/18 00/01/00
08/1
2
15/1
2
OwnerTask / milestone descriptionStart
(date)
. . . 6.01
Mile
-
sto
ne
M
Ref.
0Roll out of MECC training 01/06/17
90% 10%■ Milestone progress ■ On time | ■ delayed
Revised
end
00/01/00
7.01 M
Risk distribution (active) Issue distribution (active)
Description of risk / issue and potential consequence(s)
We have been ambitious in our project development and
have set ourselves targets that are unachievable. IMPACT:
This may cause damage to relationships between the STP
and funding providers
Unmitigated L: 3
Unmitigated C: 3
Unmitigated risk: 9
6.02 0 00/01/0000/01/00 14/11/17Recruitment push for Q3 and Q4 2017/18 0 01/11/17
Evaluation completed with reports from trainer 0
Done?
|||. .
06/1
0
13/1
0
20/1
0
27/1
0
. .
12/0
1Revised
start
00/01/00
End
(date)
16/06/18 .
01/1
2
. . . . .
03/1
1
10/1
1
17/1
1
24/1
1
. ||| .
100% 0%
22/1
2
29/1
2
05/0
1
.
Rating
6
SS 6
Source file: DA1di MECC PW Page 2 of 2
Highlight_report Report generated on 16/11/2017 at 12:56 hours
All CCGs | Highlight report (DA5bi & DA5bii | Radiology and Diagnostics (DA5bi) & Inpatient Model of Care (DA5bii))
Roles
Year to date | Year: | Month: 6 | Financial performance Full year forecast | Year: | Month: 6 | Financial performance
Narrative updates | Updated on:
Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP 0 0 0 0 0 -
0 0 0 0 -
0 0 0 0 0 -
Net saving 0 0 0 0 0 - Net saving 0
Ops plan All plans Actual Reported Variance to all plans
QIPP
Gross saving 0 0 0 0 0 -
QIPP
Gross saving 0 0 0 0 0 -
0 - Investment
SRO
10/11/17
A APlanning and Delivery Outcomes and Benefits
November 2017 JHCTG
Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can
share)
Official opening of the North West London Ultrasound Academy is due on 01/11/2017; this will take in a cohort
of five sonographers.
A paper was produced to show how seven successful pilots have demonstrated clear evidence of length of
stay reduction, and have been implemented in various hospitals.
Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can
JHCTG help?
Clinical Decision Support (CDS): there is an issue with the integration of CDS with ICE. The delay is because
of Sunquest, who have integrated the wrong version of ICE into CDS.
PROGRESS THIS MONTH
- A paper was taken to Provider Board which outlines the impact of work of 7DS and trust flow initiatives. The
paper showed the evidence generated through the 7 Day Services programme, the implementation in trusts,
and subsequence impact on length of stay and patient flow.
- Official opening of the North West London Ultrasound Academy on 01/11/2017; this will take in a cohort of
five sonographers.
NEXT STEPS
- Some actions were required from Provider Board before the trust flow project can be moved to BAU.
- Radiology MRI project originally due to begin in Summer 2017 is still delayed due to issues with IT systems
and Information Governance (IG) implications. Awaiting new start date - this has been escalated to senior staff
at Chelsea and Westminster hospital
- Radiology Clinical Decision Support pilot will begin in early 2018.
Xiao Cai
Susan La Brooy
DA5: Safe, high quality and sustainable hospital servicesProgrammeProject manager
Clinical leadClare Parker
£000's Ops plan All plans Actual Reported Variance to all plans £000's
0 0Investment 0 0
Source file: DA5b_Inpatient MoC_(NWLPWv 3 1) FV Page 1 of 2
Highlight_report Report generated on 16/11/2017 at 12:56 hours
Planning
Risks and issues
Rating
High
75% 25%
22/1
2
29/1
2
05/0
1
. .
. . .
Revised
start
00/01/00
End
(date)
09/11/17
01/1
2
03/1
1
10/1
1
17/1
1
24/1
1
.
Done?
P
. P
06/1
0
13/1
0
20/1
0
27/1
0
12/0
1Revised
end
00/01/00
3.20 M
Risk distribution (active) Issue distribution (active)
Description of risk / issue and potential consequence(s)
SDS03a - Clinical Decision Support (CDS) there is a delay in
the start of pilot due to Sunquest integrating CDS into wrong
version of ICE
3.10 M 00/01/0000/01/00 01/11/17
01/11/17 00/01/00
Official opening of the NWL Ultrasound Academy GS 01/11/17
00/01/00
Clinical Decision Support (CDS) pilot (for Radiology & Diagnostics) GS
10.10
Mile
-
sto
ne
M
Ref.
XCProject closure report to Provider Board 09/11/17
83% 17%■ Milestone progress ■ On time | ■ delayed
08/1
2
15/1
2
OwnerTask / milestone descriptionStart
(date)
7.40 0 Seven day therapy proposal review by ICHT XC 01/11/17
3.30 M MRI pilot (for Radiology & Diagnostics) at CWFT **delayed** GS 01/07/17 01/01/18 31/12/17 30/06/18
30/09/18 00/01/0031/03/18 00/01/00
P .
7.30 0 Seven day therapy proposal review by CWFT XC 01/11/17 00/01/00 01/11/17 31/12/17 .. .. ||| ..
Date
added
01/08/17
Type
I
Action still to be taken (planned) to mitigate impact further
0
Action taken to date to mitigate impact of risk / issue
Conversations and engagement with Sunquest to develop a
patch for the current version within the Trusts. Pilot should
be able to begin in early 2018
Owner
RK
■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
È
Source file: DA5b_Inpatient MoC_(NWLPWv 3 1) FV Page 2 of 2
Highlight_report Report generated on 16/11/2017 at 12:55 hours
Highlight report (DA5ci | Strategic Outline Case 1 )
All CCGs | Highlight report (DA5ci | Strategic Outline Case 1 )
Roles
Year to date | Year: 2017/18 | Month: 6 | Financial performance Full year forecast | Year: 2017/18 | Month: 6 | Financial performance
Narrative updates | Updated on:
RPlanning and Delivery Outcomes and Benefits
JHCTG November 2017
Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can
share)
Assurance of SOC 1 continues
Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act
as lever/ note)
Support in implementing the development of outline business cases for both hubs and Trusts as far as
possible without confirmed funding.
Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can
JHCTG help?
Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not
considered for autumn capital announcement.
PROGRESS THIS MONTH (planning and delivery)
SOC Part 1 was considered at the NHSI Board meeting on September 28 - the Board have asked for
additional assurance information.
Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not
considered for autumn capital announcement.
Programme team working with Trusts to plan OBC production and mitigate slippage.
Strategic Estates leading on developing Hub OBCs.
NEXT STEPS (Planning and delivery)
Developing responses to all NHSE and NHSI additional assurance requests as appropriate.
Conversation with the National team will continue while SaHF programme team continues to actively work with
NHSI colleagues to clarify and produce the additional information needed by the NHSI Board, to progress DH
and treasury approval.
Cerith Lewis
Mark Spencer
Organising Hospital ServicesProgrammeProject manager
Clinical leadClare Parker
£000's Ops plan All plans Actual Reported Variance to all plans £000's
0 0Investment 0 0
SRO
10/11/17
R
Ops plan All plans Actual Reported Variance to all plans
QIPP
Gross saving 0 0 0 0 0 -
QIPP
Gross saving 0 0 0 0 0 -
0 - Investment 0 0 0 0 0 -
Net saving 0 0 0 0 0 - Net saving 0
0 0 0 0 0 -
0 0 0 0 -
Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP
Source file: Copy of DA5ci SOC1 PW Page 1 of 2
Highlight_report Report generated on 16/11/2017 at 12:55 hours
Planning
Risks and issues
È
■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
Action still to be taken (planned) to mitigate impact further
Continue monthly Trust OBC progress calls
Action taken to date to mitigate impact of risk / issue
Actively engaging with Trusts, NHSE, NHSI and DH to
address issues being raised.
Owner
KN
Date
added
00/01/00
Type
I
30/11/17 00/01/0030/11/17 00/01/00
08/1
2
15/1
2
OwnerTask / milestone descriptionStart
(date)
.
4.14
Mile
-
sto
ne
M
Ref.
0SOC1 approved by NHSE Investment Committee 18/07/17
92% 8%■ Milestone progress ■ On time | ■ delayed
Revised
end
00/01/00
4.15 m
Risk distribution (active) Issue distribution (active)
Description of risk / issue and potential consequence(s)
Due to the delay to SOC Part 1 assurance process by NHSI,
Trusts OBCs are delayed and/or on hold until the approval of
SOC Part 1 and funding made available to commence the
necessary work.
4.12 M 00/01/0000/01/00 18/09/17SOC 1 to NHSI Resources Committee 0 18/09/17
SOC 1 draft timeline response to NHSI 0
Done?
P
P
06/1
0
13/1
0
20/1
0
27/1
0
12/0
1Revised
start
00/01/00
End
(date)
18/07/17
01/1
2
03/1
1
10/1
1
17/1
1
24/1
1
22/1
2
29/1
2
05/0
1
Rating
Severe
Source file: Copy of DA5ci SOC1 PW Page 2 of 2
Highlight_report Report generated on 16/11/2017 at 14:37 hours
All CCGs | Highlight report (DA5ciii | Maternity Early Adopters)
Roles
Year to date | Year: 2017/18 | Month: 6 | Financial performance Full year forecast | Year: 2017/18 | Month: 6 | Financial performance
Narrative updates | Updated on:
0Planning and Delivery Outcomes and Benefits
Victoria Lyon
Pippa Nightingale
Improving Women's ServicesProgrammeProject manager
Clinical leadPippa Nightingale
£000's Ops plan All plans Actual Reported Variance to all plans £000's
0 0Investment 0 0
SRO
16/11/17
A
Ops plan All plans Actual Reported Variance to all plans
QIPP
Gross saving 0 0 0 0 0 -
QIPP
Gross saving 0 0 0 0 0 -
0 - Investment 0 0 0 0 0 -
Net saving 0 0 0 0 0 - Net saving 0
0 0 0 0 0 -
0 0 0 0 -
Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP
Source file: DA5Ciii Early Adopters PW Page 1 of 3
Highlight_report Report generated on 16/11/2017 at 14:37 hours
Planning È
■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
.. . .
00/01/00 00/01/00 P
31/01/18 00/01/00 . . .
6.01 M Hillingdon launch of Model 2: Birth Centre Continuity 0 00/01/00 00/01/00 00/01/00 00/01/00 P
M Hillingdon launch of Model 3a: Group Practice (Amber Team) 0 00/01/00 00/01/00
Evaluation of personalised postnatal care plan across all sites 0 01/12/17 00/01/00
5.03 0 West Mid recruitment to Model 1: caseloading teams 0 00/01/00
5.01 0 Chelsea and Westminster recruitment to Model 1: caseloading teams 0 00/01/00 00/01/00 00/01/00 00/01/00
01/08/17 00/01/00 P01/05/17 00/01/00
JHCTG November 2017
Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can
share)
New pilot models implemented at Hillingdon. Launch of personalised postnatal care plan at all sites.
Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act
as lever/ note)
N/A
Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can
JHCTG help?
Some delays to programme due to accessibilty of data sets. Delays in advertising / recruitment to CW and
Imperial teams has resulted in a risk to launch in Jan '18.
PROGRESS THIS MONTH (planning and delivery)
Launch of personalised postnatal care plan at all sites
Launch of midwifery led care in birth centres at Hillingdon
Launch of Group practice - team continuity in amber team at Hillingdon
Launch of photobooklet at Hillingdon
Continuity of Care baseline audit complete
Evaluation approach signed off with academic panel
NEXT STEPS (Planning and delivery)
Recruitment to caseloading teams Chelsea and Imperial
Re launch of reconfigured group practice model at LNWHT
Baseline established (quantitative and qualitative elements)
08/1
2
15/1
2
OwnerTask / milestone descriptionStart
(date)
. . . 3.02
Mile
-
sto
ne
M
Ref.
0Establish quantative baseline (ICHP) 18/07/17
95% 5%■ Milestone progress ■ On time | ■ delayed
Revised
end
31/12/17
4.02 M
3.03 M 30/11/1700/01/00 29/09/17
00/01/00 00/01/00
6.02
Establish qualitative baseline (OneplusOne) 0 18/07/17
00/01/00
7.01 0
Codesign models of care 0
Done?
||| . . . .
06/1
0
13/1
0
20/1
0
27/1
0
. .
12/0
1Revised
start
00/01/00
End
(date)
29/09/17 .
.
01/1
2
. . . . .
. .
03/1
1
10/1
1
17/1
1
24/1
1
.
. ||| .
100% 0%
22/1
2
29/1
2
05/0
1
Source file: DA5Ciii Early Adopters PW Page 2 of 3
Highlight_report Report generated on 16/11/2017 at 14:37 hours
Risks and issues
Action still to be taken (planned) to mitigate impact further
Use Better Births as recruitment tool into sector.
Attending midwifery events (e.g. RCM conference) to
promote NWL sector and use as recruitment opportunities
Work with NWL university partners to promote Trusts and
recruitment cycles
Hold recruitment day at CWFHT (where majority of new
teams are being developed)
Action taken to date to mitigate impact of risk / issue
Co-design all models with workforce and early engagement
to ensure buy in.
Offer mix of models to ensure satisfaction for all maternity
workforce (different types of role)
Owner
VL
Date
added
00/01/00
Type
R
Risk distribution (active) Issue distribution (active)
Description of risk / issue and potential consequence(s)
There is a risk that recruitment of maternity workforce
(internal and external) at each Trust is insufficient to pilot /
test the new models of care and there are insufficient
midwives to run the new models
Rating
16
Source file: DA5Ciii Early Adopters PW Page 3 of 3