south yorkshire and bassetlaw shadow integrated … us... · mcn specification to be agreed....

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Workstream Highlight Report

SOUTH YORKSHIRE AND BASSETLAW SHADOW INTEGRATED CARE SYSTEM

COLLABORATIVE PARTNERSHIP BOARD

13 April 2018

Author(s) SYB Shadow ICS Workstream Leads

Sponsor Will Cleary-Gray, Sustainability and Transformation Director, SYB sICS

Is your report for Approval / Consideration / Noting

For approval

Links to the STP (please tick)

Reduce

inequalitiesJoin up health

and care

Invest and grow

primary and

community care

Treat the whole

person, mental

and physical

Standardise

acute hospital

care

Simplify urgent

and emergency

care

Develop our

workforce

Use the best

technology

Create financial

sustainability

Work with

patients and the

public to do this

Are there any resource implications (including Financial, Staffing etc)?

NA

Summary of key issues

A summary of progress for the Shadow ISC workstreams is included within this report, accompanied by a high level overview of progress to date for each area. It is in addition to the detailed work with each of the work areas and should therefore be read in conjunction with these. It is also intended to support updates to local Boards and Governing Bodies on developments and delivery progress.

Recommendations

The Collaborative Partnership Board are asked to note and approve the contents of this report.

Item 23c(c)

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Workstream Highlight Report

SOUTH YORKSHIRE AND BASSETLAW SHADOW INTEGRATED CARE SYSTEM COLLABORATIVE BOARD

13 April 2018

1. Purpose The purpose of this report is to provide a summary overview of the main focus of activities at a South Yorkshire and Bassetlaw level within the Shadow Integrated Care System (sICS) in one document. It is in addition to the detailed work with each of the work areas and should therefore be read in conjunction with these. It is also intended to support updates to local Boards and Governing Bodies on developments and delivery progress. The information has been compiled in conjunction with SROs and programme leads and signed off by SROs for each priority area. Separate reports on finance and the hospital services review will be presented and available. 2. Key issues A summary of the progress assessment for the current period is set out as below

Shadow ICS Workstream

Progress assessment

for the current period (RAG)

Cancer Alliance Amber Children's and Maternity Amber Corporate services Green Digital and IT Green Elective and Diagnostics Green Estates Green Medicines Optimisation Green Mental Health and Learning Disabilities Green Prevention Amber Primary Care Amber Stroke Amber Urgent and Emergency Care Amber Workforce Green

3. Recommendations The Collaborative Partnership board are asked to consider the report for the sICS workstreams and to use this to inform local discussions. Paper prepared by workstream leads On behalf of Sir Andrew Cash Date April 2018

South Yorkshire & Bassetlaw Shadow ICS – Programme Highlight Report

Programme: Cancer Alliance Provider CEO / CCG AO sponsors: Lesley Smith

Date of report: April 2018 Report completed by: Julia Jessop, Programme Director

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Amber

Plan for 2017-2019 Summary of plan and key ambitions Deliver Cancer Taskforce Recommendations. Prepare for ICS. Deliver 8 CWTs. Single integrated assurance framework with NHSE/I. Test integrated commissioning & provision for chemotherapy/FIT/LWABC/Vague Symptoms. Redesign clinical models to deliver rapid assessment and diagnosis timed pathway with associated Cancer Workforce Plan to ensure sustainability. Deliver against key milestones for Early Diagnosis Transformation Programme to increase diagnosis at stage 1 and 2/improve 1 year survival. Integrate Macmillan LWABC programme to ensure delivery of risk stratified follow up, recovery package and self-management.

MOU commitments List of MOU commitments and deadline Deliver 62 day CWT – 85% Alliance level by March 2018 Deliver Cancer Taskforce Recommendations. 62% cancers diagnosed stage 1 or 2 by 2020. Improve 1 year survival. Reduce emergency admissions. Support introduction of new screening models (FIT/HPV). Roll out recovery package and risk stratified pathways (Breast by 2019).

Engagement Summary of PPE activities undertaken in most recent period (month / quarter)

Be Cancer SAFE Campaign

Progress Summary of achievements from most recent period (month / quarter)

Proposal for place based representation a lead commissioner governance arrangements under consideration by the system. Preparations underway for new CWTs and monitoring of 38 IPT and 28 Day FDS. Tripartite 62 day deep dive meetings completed. 18/19 priorities submitted to reflect 25% reduction in transformation funding linked to 62 day performance. Early Diagnosis Transformation Programme: Key milestones delivered Business case for Integrated pathway for lower GI symptoms developed Gap analysis completed with CDGs re rapid assessment and diagnostic pathways for Lung & prostate. System redesign of Upper GI model - Single Operating Procedure agreed and discussions ongoing re regional service model. Initiated pathway improvement work on head and neck pathway. Produced PH1 Cancer Workforce Plan in partnership with HEE

Integrated system review of Chemotherapy: Strategic and operational groups established. Scope for chemotherapy review established and resource being secured to support development of case for change.

LWABC programme progressing: implementation of eHNA & care planning.

Next steps – over next month Summary of planned actions for next period (month / quarter)

Confirm ICS functions being adopted by Alliance , governance arrangements & identify resource to facilitate Develop composite 62 day recovery report for system and place. Define future performance & assurance arrangements within a

mutual accountability framework Finalise funding agreement with national team and review establishment accordingly. Continue to deliver key milestones for early diagnosis workstream Design new models of working with CDGs to implement timed pathways & pathway improvements Further refinement of workforce strategy in association with HEE and elective & diagnostic workstreams 3


Initiate integrated commissioner and provider case for change for chemotherapy. Recruit to patient experience posts to develop strategy Design Benefits realisation approach Radiotherapy Service Specification anticipated. Development of risk stratified models for follow up of prostate and colorectal cancers.

Benefits Summary of benefits

Tripartite approach to performance, place based conversation and mutual accountability leading to better grip on CWTs and shift to system level focus

LWABC: Nearly 700 additional people referred for support in three localities between 2016 and 2017

Planned Savings 2017/18 None Savings Forecast 2017/18 None RAG

Planned Savings 2018/19 None Savings Forecast 2018/19 None RAG

Risks Pre-mitigation

RAG

Post-mitigation

RAG Mitigating Action Due date

National funding for timed pathways not secured limiting the resource available to deliver Amber Amber Reprioritisation exercise which will impact on ability to affect

stage shift April 2018

Performance conversations not aligned and continue to focus on organisation not system. Amber Amber

Clarity regarding roles and responsibilities to facilitate implementation of a Single assurance framework

April 2018

Resource & expertise to deliver the expanding work programme and ICS expectations; ability to recruit to short term FTC

Amber Amber Continue to explore possibilities for alignments of posts within system

April 2018

Organisational buy in to deliver new system models of care Amber Amber

Governance strategy to support achievement at system not organisational /place level. Identification of Lead CCG Commissioner for Cancer

April 2018

Interdependency with other work streams - require networked radiology, pathology and Inter Trust Messaging to support new models

Red Amber Collaborative working with associated work streams

Ongoing

Patient engagement; ability to recruit to Macmillan funded posts. Amber Green

Explore alternative hosting arrangements to facilitate longer contract

April 2018

Benefits realisation –ability to demonstrate/evaluate impact of short term interventions. Red Amber Dedicated session planned to devise 17/18 and 18/19 benefits

realisation plan. May 2018

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Programme: Children and Maternity Workstream Provider CEO / CCG AO sponsors:

Chris Edwards – Rotherham CCG John Somers – Sheffield Children’s Hospital FT

Date of report: April 2018 Report completed by: Marianna Hargreaves

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG)

Plan for 2017-2019 Children’s Non Specialised Surgery and Anaesthesia (CSA) To continue to develop a Managed Clinical Network to facilitate a coordinated regional approach to implement the agreed changes to CSA to reduce variation and secure delivery in line with Standards. To make best use of the workforce to secure equitable, resilient and sustainable CSA services, ensuring management of interdependencies with paediatrics (acutely unwell children).

Acutely Unwell Child – To continue to develop a Managed Clinical Network to facilitate a coordinated regional approach, including the development of standardised clinical pathways and joint work on areas such as management of locum availability, recruitment/retention and communication. Taking into consideration outputs of the Hospital Services Review (HSR) and managing the key interdependencies (maternity, CSA, neonates and wider urgent care).

Maternity – To continue to develop the SYB Local Maternity System. To translate the SYB LMS Plan into delivery with mothers, babies and families to realise the vision set out in ‘Better Births’. The SYB plan is to improve the quality and safety of provision through a Managed Maternity Clinical Network. To facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care.

MOU commitments All commissioner and provider organisations are signed up to the ICS MOU; within which there is a

commitment to collaborative work on Children’s and Maternity as set out above.

Engagement CSA – Significant engagement throughout CSA review followed by a public consultation. Throughout implementation further consideration of engagement is necessary.

Acutely Unwell Child – Engagement through the HSR, following publication the expectation is that further engagement will take place as part of developing site-specific future service models. Maternity – Engagement via the Maternity Voices Partnership T&F Group. Two events taken place and an LMS hashtag created. A user friendly version of the plan under development. The plan going forward is to where possible facilitate co production.

Progress CSA – Development and agreement of clinical pathways almost complete. Designation visits complete, feedback in progress. CSA specification finalised. Designation output shared with JCCCG and they endorsed a 6 month pause on implementation to enable action planning with providers to support hub development, to 5


plan for management of torsions and secure the transport. MCN specification circulated to network members.

Acutely unwell child – HSR on track, outline models in development, substantial clinical input via CWGs. MCN fully set up and developing a work plan. MCN funding confirmed for Qtr 1 2018/19.

Maternity – Final SYB LMS Plan submitted. T&F groups preparing to translate the plan into action, identifying resources for delivery, progressing actions. Project Manager interviews complete, post offered to applicant.

Next steps – over next month CSA – MCN to progress clinical pathway sign off and provide all Trusts designation visit feedback. Work with commissioners to enable contractual agreement of CSA Specification with action plans. Dialog with ambulance service(s) to secure additional transport. MCN specification to be agreed. Refreshed delivery timeline to be confirmed to the Workstream Board, slippage due to capacity challenges in the team.

Acutely unwell child – HSR CWG and public engagement event early March. Final report end of April. Consolidation of MCN workplan. Development of MCN specification and clarification of funding. Progress further commissioner engagement. Delivery timelines aligned to HSR, output to enable next stage of planning.

Maternity – Continue to progress actions in SYB LMS plan through T&F Groups. Secure Project Manager, review options for clinical leadership and LMS infrastructure. Plan stakeholder event and ensure ongoing alignment to HSR timelines. Initiate development of a finan

ce plan to enable effective use of transformation resources (as outlined in the MOU) to enable delivery of the SYB LMS plan. Await central feedback on LMS plan/trajectories and act upon it. LMS Board to monitor progress on milestones within the LMS Plan.

Review the workstream meetings, including Boards to ensure clear roles, responsibilities and accountability.

Benefits CSA and Acutely unwell child - Reduced variation in current delivery of children’s surgery and anaesthesia, and care for the acutely unwell child. Improved safety, effectiveness and continuity of care and experience for children, with increased delivery in line with Standards to improve outcomes. Most effective use of current workforce and delivery of equitable, resilient and sustainable children’s services.

Maternity – The delivery of the SYB LMS plan through the SYB LMS will improve the quality and safety of maternity care through a Managed Maternity Clinical Network. It will facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care that improves outcomes for mothers, babies and families.

Planned Savings 2017/18 N/A Savings Forecast 2017/18 N/A RAG

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RAG Post-mitigation


Capacity & Engagement There is a risk across the workstream that capacity challenges will hinder delivery of plans, in particular the implementation of CSA, progression of the network for acutely unwell child and the translation of the SYB LMS plan into delivery. Capacity challenges within the team are also starting to result in wider engagement issues.

R A

The capacity challenges due to the workstream lead and CSA programme lead not being in work and limited capacity within the MCN have been flagged to both the SRO and ICS Senior Leadership team. A plan to look at capacity for CSA delivery is under discussion. Recruitment to the Maternity Project Manager is underway (interviews now complete and post offered). Options re clinical leadership and LMS infrastructure to be reviewed thereafter.

Managed Clinical Networks

There is a risk that without confirmation of funding for 18/19 or actions to address capacity challenges that MCNs will not be able to further develop and therefore not be in position to further develop and deliver their work plans or respond to HSR.

A G

Funding for the CSA network is confirmed within the CSA DMBC, the CSA MCN specification needs to be finalised and agreed to enable this to be contractually agreed. The importance of the MCN for Acutely Unwell Child is to be flagged to the ICS leadership, especially to ensure the system is well placed to respond to the HSR recommendations

Alignment to Hospital Services Review (HSR)

There is risk that the outputs from the HSR will impact on all areas of the children’s and maternity

workstream and alignment is essential to ensure this is effectively managed. Eg Potential impact on CSA implementation (local ability to meet designation standards), Potential impact on development and delivery of the SYB LMS plan, and use of transformation funding.

R A

Continue ongoing dialog with the HSR team to ensure alignment. Agree use of Children’s and Maternity Workstream Board as conduit to facilitate alignment.

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Programme: Corporate Services (Exc Procurement / Informatics) Provider CEO / CCG AO sponsors: Richard Parker

Date of report: April 2018 Report completed by: Ben Chico

Progress Assessment Current Period (RAG) Green Progress Assessment Previous Period (RAG) Green

Plan for 2017-2019 This workstream has formed part of the Working Together Provider Programme, and is overseen by the Provider Efficiency Group. It relates to collaborative activities across corporate service functions, excluding Procurement and Informatics which have separate project management arrangements in place. Excluding Procurement and Informatics there are six corporate service functions as defined by NHSI; HR, Payroll, Finance, Legal, Governance and Risk, and Service Improvement / PMO. It was agreed that HR, Finance and Payroll should form the priority areas for review. The focus of current and planned activities is: HR: Streamlining and Standardisation Project covering; workforce systems (inc e Rostering), Mandatory and Statutory Training,

Recruitment, Bank and Agency Management, Occupational Health, and Pay Band Management. Active shared service review underway across three Sheffield Trusts covering all sub functions.

Finance: Standardisation of ledgers across four of the Trusts to enable increased collaboration with a view to sharing of ledger support function and wider transactional services.

Payroll: Exploitation of Salary Sacrifice Schemes across Trusts. Legal: Whilst not one of the agreed priorities in 2017/18, the status of current arrangements and opportunities will be assessed following initial review in 2015.

MOU commitments “To become system leaders in implementing operational productivity improvements and increasing focus on reducing unwarranted provider expenditure, including but not limited to the consolidation of corporate services,……….. and concerted action to drive better value from NHS procurement.”

Engagement PPE is not relevant to this workstream.

Progress In relation to streamlining and standardisation; there have been a number of successes over the last months, including: Completion of collective procurement for provider of non-medical bank across four Trusts, with other to potentially join over

coming months. Support to implementation of collaborative medical bank pilot planned to go live in March 2018, delayed to April. Reduction of unwarranted variation across Mandatory and Statutory Training, supporting increased efficiency and enabling

passporting. Implementation of “factual referencing” as a means of reducing time to hire to vacant posts. Development of shared services has proven more challenging. An extensive process to develop shared payroll services (covering BHNFT, RDASH and TRFT) was closed in January owing to a lack of demonstrable savings. STHFT currently provide payroll to

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SCHFT and SHSC, and it has been agreed that Trusts may re-engage directly with STHFT over coming months should a local decision be taken to proceed. An outline case for delivery of HR shared services is underway which is currently focused upon the three Sheffield Trusts, with outline business case drafted. DBTHFT are working with RDASH to identify functions to collaborate upon as part of Doncaster place based plan. In Finance there has been a move to align Trusts on the same ledger which will act as an enabler to shared services, with formal review to take place in the coming months. Whilst being managed independently, the development of Special Purpose Vehicles forms a key initiative across Trusts and the Provider Efficiency Group has included a standing item to share updates.

Next steps – over next month To confirm work plans for 2018/19 To agree

Benefits Reduction of unwarranted variation and associated efficiencies Collaborative procurement savings (eg non-medical bank provider) Assessment of benefits from implementation of shared service

Planned Savings 2017/18 N/A Savings Forecast 2017/18 BEING CONFIRMED RAG

Planned Savings 2018/19 TBC Savings Forecast 2018/19 TBC RAG


RAG Post-mitigation


Trusts select not to engage in initiatives based upon local risk profile (eg medical bank). R G Trust engagement monitored and reported through to Acute

Federation. Ongoing

Trusts do not implement successfully at local level owing to lack of capacity. R G

PMO support offered with implementation as well as identification of standardisation opportunities.

Ongoing

Shared services do not move forward owing to savings being considered too low to proceed, or other Trust level rationale.

R G Trust positions monitored and reported through to Acute Federation.

Ongoing

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Programme: Digital Provider CEO / CCG AO sponsors: Richard Cullen

Date of report: April 2018 Report completed by: Michael Rodgers

Progress Assessment Current Period (RAG) Green Progress Assessment Previous Period (RAG) Amber

Plan for 2017-2019 a. ICS Digital Delivery Framework: Implementation of team, Digital Capabilities and Health Care and Reform Benefits Catalogue, Progressing 1st phase of the agreed programme, ICS Digital Innovation Partnership Procurement Framework

b. Population Health Data and Information: Integrated Intelligence Team; Intelligence requirements and data mapping; Technical solution and tools e.g. for collating data, supporting analysis, creating information and presenting intelligence to the system; Data definitions; Coding standards e.g. SNOMED; Information modelling standards e.g. OpenEHR

c. Interoperability: System integration architecture; Integration platforms; Care flow applications for GPs, Standard for integration, sharing records and data, Regional Infrastructure Strategy (networks, storage, desktop, security); Integrated MH Care System

d. IG: Regional IG/GDPR Toolkit; Consolidated Information and Data Governance Policies; Privacy Agreements e. National programmes; federated approaches to procuring and implementing solutions to meet target completion dates for national

programmes: HSCN; WiFi; On-line Consultation; On-line 111

MoU Commitments Enabling People and Patient Empowerment Supporting Clinical and Strategic Decisions Delivering System Integration and contributing to Operational Efficiency Developing Local Health Tech Skills & facilitating Innovation

Engagement NHSE – Digital aims, funding streams, programmes and plans; North Region Digital Portfolio; NHS England North Region Digital Stakeholder Forum; NHSD – national digital programmes’ priorities and funding options; SYB Partner CIOs and Exec Leads for Digital on SOC LHCRE . LHRCE kick-off meeting with the core team and the Architect meeting to start the design process. Bid questions have been allocated for coordination. Fast Follower Bid SHSC have completed their FF bid. The Channel 3 Group engagement for the SOC. • D1 - Digital Inclusion– meeting with Tom Davison CIO lead scheduled for 10th April. • D2 - Self Health Connect– Victoria McGregor Riley and Andy Clayton • D3 - Technical Interoperability – Kevin Connolly, Nigel Hall, Shaun Addy, Simon Marsh • D4 - Patient Records and Sharing Clinical Information– Simon March, Stephen Stewart • D5 - Predictive Analytics– Des Breen, David Robinson • D6 - Healthcare Co-ordination – James Rawlinson, Philip Easthope, Jon Greatorex • D7 – Wellbeing and Recovery Relationship Management – Nicola Haywood-Alexander • D8 – Use and Governance of Information and Data – Richard Banks and Sue Meakin • D9 – Digital Health Innovation – Wendy Tindale, Mark Gannon

Progress Stakeholder meetings with all workstreams except D1 have been held; Workstream documentation reviewed where this is available; Meetings are scheduled to conclude on 10th April 2018; Work to establish current digital provision in each place has commenced; Current Digital strategies and summary of current/planned programmes requested – some have been provided; 10


Potential dates for workshops in next stage gathered.

Next steps – over next month

Develop strategic case section of SOC; Develop patient scenarios to demonstrate information flows; Develop strategic options; Hold options review workshops;

Confirm preferred strategic option(s).

LHCRE bid drafted, tested and submitted. D4 governance setup based of the ETTF success.

Benefits B2.1 Increased patient control of own care; B2.2 Increased patient choice; B2.3 More effective use of GP appointments B3 1 Reduce in infrastructure costs; B3.2 Reduction in cost lost to lack of access to records, data and information B4.1 Reduction in A&E attendances; B4.2 Reduction in non-elective admissions; B4.3 Reduction in UEC activity B5.1 Quicker clinical intervention across all regional service user pathways; B5.2 Better commissioning decisions B6.1 Better healthcare co-ordination; B6.2 Reduce treatment waiting times; B6.3Reduction in the intensity of care packages and associated costs; B6.4 Reduction in admissions to residential/care homes B7.1 Improved wellbeing of citizens; B7.2 Increased likelihood of, and accelerated recovery rates; B7.3 Reduce rates of relapse, and admissions to crisis care; B7.4 Reduce Premature Mortality in people with PSMI) and/or Learning Difficulties B.8 Maintain/Increase Public Trust

Planned Savings 2017/18

£2.5M for GP interoperability and care flow capabilities for Barnsley, Sheffield and Bassetlaw £195k for GP public Wifi for all 5 CCGs These have arisen from taking a federated rather than individual approach to procurement.

Savings Forecast 2017/18

£2.5M to be confirmed following EETF funding decision by NHSE on 15th March £195k achieved

G

Planned Savings 2018/19 TBC following development of SOC Savings Forecast 2018/19 TBC following development of SOC RAG


RAG Post-mitigation


Dedicated resource and budget is required to drive the programme R A

The Digital Steering Board have review and endorse the Programme Director’s proposal for “as lean as possible” core team. The Chair and Programme Director will present proposed organisation and costs to ICS SMT in March 2018, with options for financing

June 2018

Challenge in articulating benefits of digital interventions in isolation. They are key enablers to system level changes

A G The Strategic Outline Case will include a benefits section. The benefits will have been developed with clinical stakeholder, Workstream leads and the Population Health Integrated Intelligence Team

June 2018

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It is proving very difficult for the wider team of CIOs who are contributing to the leadership of the intervention across the programme to find any time to work together on their respective projects.

A G

It is being proposed that quarterly planning days or monthly half days are held where CIOs leading on current priorities, their technical deputies the programme director and her team work together to refine individual project forward plans and interdependencies across the overall programme and to determine and review time critical milestones, dedicated resource requirements and budgets.

April 2018

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Programme: Elective and Diagnostics Provider CEO / CCG AO sponsors: Idris Griffiths, Richard Jenkins

Date of report: April 2018 Report completed by: Jade Rose


Plan for 2017-2019 1. Efficiencies through Optimising Demand 2. Outpatient Efficiencies 3. Delivering key diagnostic wait and RTT standards.

MOU commitments Delivery of the constitutional standards for diagnostic waits and referral to treatment.

Engagement (blank)

Progress Commissioning for Outcomes - A revised final version of the SYB commissioning for outcomes policy (including clinical threshold procedures) has now been agreed by all of the 5 Governing Bodies and is in implementation phase across SYB. The working group continue to meet to revise any issues that arise through implementation.

Echocardiography Recovery - Working Group has been established. A SOP to allow DGHs to relieve waiting list pressure for STH has been developed and some additional activity has been arranged to repatriate patients to local providers in Barnsley and Doncaster. A capacity and demand analysis has commenced to identify the level of backlog and on-going capacity gap. STH have developed an internal recovery plan to support achievement of the SYB target. A funding bid has been successful to pilot an SYB training programme. It has been agreed that the key areas of focus going forward are; SYB training plan; SYB clinical guidelines (clinical workshop to be arranged);

Radiology - A high level action plan has been agreed following the Strategy Away Day held on the 25th February. Right Care and GIRFT - A CVD project team has been created and is scoping out the programme of work to improve

outcomes for patients with CVD Endoscopy (FCP) - A clinical workshop was held on 28th February to agree a single integrated model for Lower GI

symptoms. This is now being discussed with individual CCGs for clinical support and the full business case is in development.

Transforming Outpatients - Data pack shared with CCGs to identify areas of opportunity. Orthopaedic follow up - A workshop was held on 28th March. Excellent representation from across SYB. A number of

actions were agreed with a general consensus that there is unwarranted variation taking place across SYB.

Next steps – over next month Confirm 18/19 priorities and resource allocation Echocardiography - Finalise capacity analysis. Develop SYB training programme plan. Arrange workshop to agree clinical

guidelines Outpatient Transformation - agree specific areas within programme of work and consider how to resource programme for

18/19. Integrated Lower GI pathway - Develop SYB business case for integrated Lower GI pathway for agreement. Implement

pathway (aligned to Cancer Alliance Board). Ongoing engagement across SYB Orthopaedics - Develop data pack and agree action plan. Hospital Services Review - Understand outputs of Hospital Services Review and implications for E&D workstream Radiology - develop detailed work programme. Attend and present at national radiology workforce conference. Develop 13


PACs manager network across SYB. Commissioning for Outcomes - Meet with Commissioning Managers to review implementation of policy Right care / CVD - develop clear narrative for this work based on health inequalities and outcomes across SYB and develop

an action plan to respond to this.

Benefits Improved access to treatment for patients. Improved health outcomes through access to evidence based care. Improved patient experience by improving the effectiveness of health care contacts. Improved financial sustainability by optimising care delivery and removing unwarranted activity.

Planned Savings 2017/18 £17.29

Savings Forecast 2017/18 £10.87

Red

Planned Savings 2018/19 In Dev

Savings Forecast 2018/19

In Dev

RAG

Risks Pre-

mitigation RAG

Post-mitigation


Increasing Financial Challenge

B B

Continual investigation and development of new initiatives to close the gap. Close monitoring of savings performance and forecast delivery against targets.

Pace of delivery is limited by supporting workstream resource.

R R

Consider suitability of secondments, interim appointments or consultants.

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Programme: Estates Provider CEO / CCG AO sponsors: Chris Edwards

Date of report: April 2018 Report completed by: Richard Taylor


Plan for 2017-2019 Development and agreement of the SY & B Estates Strategy to support transformational change across the area, including focusing on

Implementation of estates priorities emerging from clinical workstreams and delivery of new models of care Developing a coordinated approach to identification of needs and Capital Investment including strategic prioritisation Optimisation/Utilisation of NHS/LIFT/PFI estate and local plans to divest of poor quality assets Development of and execution of ICS Disposals Strategy and approach to re-investment of proceeds Development of appropriate structures to enable estates activities to support sICS priorities. Development of sICS approach to Maintenance backlog

MOU commitments Unknown

Engagement PPE is associated with specific clinical activities and not directly undertaken by this workstream

Progress QA review of the SY&B Estates workbook completed Estates workbook aligned with capital bidding process Capital prioritisation matrix agreed Support for appropriate capital business cases

Next steps – over next month Support workstreams in their understanding and articulation of the estates impact Develop a sICS wide Primary Care estates strategic view Continue to promote strategies and approaches to enhance utilisation/optimisation of the core NHS estate Continue the development of the Estates workbook into an Estates Strategy, meeting the new DH content/format Work across the sICS to ensure a pipeline of disposals across the plan period Further develop the links with SCR Estates Transformation Strategy.

Benefits A consensus view around estate priorities and their role in wider transformation Enhanced clarity on the SY&B capital ask Business case support and a context for decision making Development of a pipeline for disposals inc the release of land for housing Supporting change to help increase the utilisation of NHS fixed assets/costs (e.g. reducing the annual costs (approx. £3.5M) of voids in NHS PS and LIFT

Planned Savings 2017/18 tbc Savings Forecast 2017/18 tbc RAG 15


Planned Savings 2018/19 tbc Savings Forecast 2018/19 tbc RAG


RAG Post-mitigation


Lack of alignment with clinical workstreams due to lack of engagement R A Continue to engage and build relationships with workstreams Ongoing

Under developed Primary Care service vision R A

Support the PC Estates strategy development process recently launched

May 2018

Data sources are fragmented and under developed A A Continue to build plans for data validation and consolidation Ongoing

Lack of resources to deliver key estates projects/outcomes A G

Optimise external and partner resources Ongoing

Critical maintenance backlog R R Develop pan-sICS thinking on options for resolution July 2018

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Programme: Meds Optimisation Workstream Provider CEO / CCG AO sponsors: Idris Griffiths

Date of report: April 2018 Report completed by: Francis Maietta


Plan for 2017-2019 This workstream set out 5 key interventions:

1. Prescribing Cost Reductions - to generate “direct” savings linked specifically to medicine costs. 2. Pathway Redesign - to improve medicines management related to health efficiencies & patient care. 3. Applying Guidance – to identify medicines related areas suitable for guidance across SYB. 4. Effective use of medicines related NHS resources - to review medicines related resources and ensures resources are

optimised 5. Optimise the management of the interface between primary and secondary care initiatives and innovations - to maximise

the use of medicines related systems across the interface

MOU commitments Manage improvements within a shared financial control total and maximise the system-wide efficiencies necessary to manage within this share of the NHS budget.

Integrate services and funding, operating as an integrated health system, and progressively to build the capabilities to manage the health of the ICS’ defined population, keeping people healthier for longer and reducing avoidable demand for healthcare services.

Act as a leadership cohort, demonstrating what can be achieved with strong local leadership and increased freedoms and flexibilities, and to develop learning together with the national bodies that other systems can subsequently follow.

Engagement Engage with provider pharmacists and ophthalmologists across SYB Develop and target media messages focused on primary care prescribing for patient groups and their significant others within

SYB to enable them to better take up self-care.

Progress Steering Committee sat for its monthly meeting on the 21 March 2018 Steering Committee reviewed 3 proposition papers on a gap analysis of the consultation across all 5 CCGs.

o Commissioning Position on 3 Consultations. Members noted the item which absorbs most costs systematically for all CCGs is fentanyl and a greater management of its prescribing would have the greatest impact in the regional prescribing costs. A discussion was undertaken regarding the prescribing by Provider’s and how this could be raised at an ICS level to take this forward and promote a change in prescribing culture. The cost savings opportunities from reducing gluten free items are up to c. £613k across SYB. CCGs across SYB have started to align their guidelines with the NHS consultations and the gap analysis suggests that CCGs have started making a start in changing their OTC prescribing.

o Biosimilar: Medicine Aspects Currently, a range of gain share agreements have been mapped across the five SYB CCGs. These range from zero savings shared to between 20% and 80% of savings shared, which are dependent on the period.

o Avastin Three scenarios for the prescribing of Avastin were discussed by the group. Steering Committee reviewed its financial position of 2017/18 from each CCG and the planned savings for 2018/19. The HoMM leads updated the Steering Committee on the progress and next steps specific to their invention area.

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Next steps – over next month Interact with the sICS Comms team and agree the plan and resource required to develop a targeted media strategy and public engagement activities aligned to two of the workstream’s interventions (1) Applying NHS Consultation guidance and (2) Optimise primary/secondary care interface. Work will be delivered in Q1 2018/19 (April to June) within a controlled environment project management structure ensuring value for money is created and captured.

Programme Lead to design and circulate a template of a delivery plan for 2018/19. All HoMMS to send before the end of March 2018 all expected outcomes and milestones specific to their intervention area for the 6-motnh period (April to Sept 2018).

Quality Impact Assessments will be carried out with each CCG for each of their QIPP plans. QIA will be added to the Steering Committee’s April agenda.

Programme Lead to write the Job Brief for a fixed term Programme Lead with the responsibility to support the delivery of the workstream’s Roadmap and Implementation Plan

Set up admin support at Sheffield CCG offices to enable close working relationships with other workstreams and sICS support Steering Committee to review and update at its monthly meetings: Risk Log, Monthly Highlight Report, Quality Impact

Assessments, Recommendations for Governing Body and Delivery Plan 2018/19 Workstream to support and engage with enabling sICS workstreams, namely: Comms (National consultation on NHS spending

on “low priority” prescriptions) Benefits Reduce Waste

Reduce Financial Pressures Reduce unwarranted variations across SYB

Planned Savings 2017/18 £15.34m Savings Forecast 2017/18 £17.22m

Planned Savings 2018/19 £15.29m Savings Forecast 2018/19 TBC RAG

Risks Pre-

mitigation RAG

Post-mitigation


Resource support to work with the Steering Committee to deliver the Programme Plan Q1 2018/19

A G Engage interim Programme Lead until end April 2018 03/04/18

18


Programme: Mental Health & Learning Disabilities Provider CEO / CCG AO sponsors: Kathryn Singh & Jackie Pederson

Date of report: April 2018 Report completed by: Sarah Boul


Plan for 2017-2019 The workstream reviewed its workplan in January this year, and agreed the priorities for 2018/19 as follows:

1. Perinatal mental health: we are currently finalising a bid for a specialist community perinatal service across Doncaster, Rotherham and Sheffield, for submission by 09 March

2. Children and young people’s mental health crisis care: covering all crisis pathways including section 136 assessments, intensive home treatment and specialist placements

3. Out of area placements (OAPs): starting with setting trajectories for the elimination of non-specialist acute placements as required by NHS England; and scoping the opportunities as regards complex dementia care, secure placements and Tier 4 CAMHS beds (linked to the work on improving alternatives to admission included in point 2 above)

4. Developing an ICS-wide ASD and ADHD service: with further consideration of whether this is an adult or all age service, building on existing provision

5. Improving employment support for people with mental health problems: with a focus on securing NHS England transformation funding for individual placement and support (IPS) for people with severe mental illness (SMI) either in wave 1, for which a bid was submitted at the end of February, or wave 2 whenever this is announced

The workstream has also submitted a bid for targeted suicide prevention funding, to reduce our suicide rate by 10%, and we are awaiting the outcome of this. The indicative allocation for SYB for this was £555,622, and we have been told verbally that this would be recurrent for three years. If successful, this will be added to the workplan.

Whilst these are the priority delivery areas, it is recognised that there is a wider mental health and learning disabilities agenda which will be supported through a networking and sharing best practice approach. The workstream will also maintain an oversight function through development of the mental health dashboard, which will support the identification of emerging problems and the impact of service developments.

Two further strands of work will support the workforce and data and finance elements of the SYB mental health and learning disabilities programme. Lastly, the SYB mental health and learning disabilities programme will aim to increase collaborative working across the wider sICS throughout 2018/19. This work is already underway with joint working between the MHLD and U&EC work streams on the integrated care hub within NHS 111.

MOU commitments Increasing access to psychological therapies, so that at least 16.8% of people with common mental health conditions access

psychological therapies in 2017/18, increasing to 19% in 2018/19 Increasing access to NHS commissioned community mental health services for children and young people, so that 30% of

children and young people with a diagnosable mental health condition receive treatment from NHS-funded community mental health services in 2017/18, increasing to 32% in 2018/19, and meeting standards for access to eating disorder services 19


Implementing physical health checks for people with severe mental illness (SMI): demonstrating delivery against local plans and trajectories, in line with national ambition of 140,000 people with SMI receiving complete list of physical checks in 2017/18 and 280,000 in 2018/19

Meeting standards for access to early intervention in psychosis services Developing specialist perinatal mental health provision including mother and baby units (where present in the ICS) and

community teams Ensuring ICS wide coverage of 24/7 community crisis response and intensive home treatment teams as a genuine alternative

to admission by 2021. From April 2018, delivering a one third reduction year-on-year in adults sent out-of-area for non-specialist acute mental health care, towards eliminating this practice by 2021

Making demonstrable progress on delivering a workforce plan that meets national ambitions for increased mental health staffing including, therapists in primary care and staff to support expanded services, as set out in Next Steps

Engagement PPE focus groups were held as part of the development of the IPS for SMI bid.

PPE involvement will be a crucial part of the further development of the suicide prevention bid.

Progress Review and further development of the workplan as described above Submission of bids for IPS for SMI, suicide prevention funding and perinatal mental health funding Improved engagement with local authority partners and voluntary and community sector through the IPS and suicide

prevention bid development processes Further engagement with Health Education England to support development of the mental health workforce plan

Next steps – over next month Finalisation of end of year summary of the MHLD workstream’s work to date and delivery of the proposed project plans for the

priority delivery areas Outcomes from IPS for SMI, suicide prevention and perinatal mental health bids expected and implementation groups will

begin to be set up as appropriate Agreed trajectory for improvement to ensure the elimination of out of area placements within acute mental health inpatient

services by 2020/21 will be signed off by end of April 2018 Work with Health Education England to scope training place allocations for IAPT staff across the sICS will be undertaken The first workforce and data and finance group meetings will be held The development of a comms strategy for the MHLD workstream for 2018/19 will be initiated

Benefits Increase in access to mental health services Improvement in the experiences of people with mental health problems Care closer to home, with associated reductions in costs Reduction in UEC activity for people with mental health problems

Planned Savings 2017/18 £2.1m Savings Forecast 2017/18 TBC RAG 20


Planned Savings 2018/19 £5.5m Savings Forecast 2018/19 TBC RAG


RAG Post-mitigation


Programme support for 2018/19 not secured R A Work with NHS England to align resources 30/04/2018

Failure to secure transformation funding for identified work areas R A

Identify funding going into CCG baseline 30/06/2018

21


Programme: Healthy Lives, Living Well and Prevention workstream Provider CEO / CCG AO sponsors: John Mothersole

Date of report: April 2018 Report completed by: Gilly Brenner

Progress Assessment Current Period (RAG) Amber

Plan for 2017-2019 Three key priorities identified and signed off at CPB on 12/01/18. 1) Embedding the treatment of tobacco dependence in secondary care 2) Systematic quality improvement in the identification and management of clinical risk factors for cardiovascular disease

To address unwarranted variation and drive quality improvement in detection and management of high risk conditions relating to CVD at scale through primary care (including wider primary care team eg pharmacists), self-care and community interventions.

3) Expansion of social prescribing Many patients attending health and social care service have non-clinical issues that are affecting their health and wellbeing (eg social isolation, debt or housing problems) and can lead to high usage of health/social care services. Social prescribing is a way of connecting patients to non-medical forms of support (eg community and voluntary sector services) and of empowering patients to enhance their own wellbeing.

Developing the social prescribing offer in SY&B is also a priority in 3 other sICS transformational workstreams charters: Primary Care; Mental Health; and Urgent and Emergency Care. Other areas of work in this workstream are continuing through Place-based plans led by the Local Authorities, and work and health through the Sheffield City Region.

MOU commitments MOU with NHSE re social prescribing

Engagement N/A

Progress 1) Tobacco: Paper prepared to describe plan for treatment of tobacco dependence in secondary care. Supported by UEC board (26/2/19) and Acute Federation Chief Executives’ meeting (5/3/18).

2) CVD: Mel Earlam from PHE supporting CVD project by looking at ‘size of the prize’ implications locally and reviewing best practice. Also linked to work with E&D workstream around CVD right care supported by NHSE. Specification with Embed awaiting decision with regards to whether they will carry out further analysis at practice level.

3) Social Prescribing: Awaiting the outcomes of nationally submitted bids from December 2018. MOU with NHSE being progressed. Held 2 workshops (with primary care workstream) and identified 2 priorities: a) Developing a SY&B social prescribing strategy and linked strategy for investment b) Developing a framework for measurement and monitoring of outcomes

4) Programme management support secured on temporary basis from NHSE for band 8b 2d/wk, to be reviewed in 3m and 6m from April 2019.

Next steps – over next month 1) Tobacco: SY&B QUIT steering group to be convened inc. trust CQUIN leads, clinical champions, LA PH tobacco leads. Group to support CQUIN implementation and develop business case for investment to systematically deliver QUIT. Trust boards to sign off NHS Smokefree pledge commitment.

2) CVD: Continued input from PHE and NHSE to determine best approaches for CVD prevention in primary care. 3) Social Prescribing: Awaiting the outcomes of nationally submitted bids from December 2018. Working groups to be initiated to

work on the priorities agreed. NHSE resource available to recruit support for this, but further work required to determine the nature of the support required.

Benefits 1) Tobacco: Impact: Reduction in preventable mortality and huge burden of avoidable illness associated with smoking.

22


Target: Reducing smoking prevalence from current baseline to 10% and smoking in pregnancy to 0%. 2) CVD:

Impact: Contribute to avoidance of 19,000 CVD-related hospital events by increasing the identification and management of hypertension, AF and lipids in line with NICE guidelines. Target: By reducing average population blood pressure by 5%, reducing average population total cholesterol by 6% and increasing the proportion of people with diagnosed high blood pressure, cholesterol and atrial fibrillation who achieve NICE-recommended reductions in blood pressure and cholesterol, and high rates of anticoagulation in atrial fibrillation.

3) Social Prescribing: Impact: A reduction in health inequalities and an improvement in health and wellbeing by supporting residents to address wider determinants of health and take control of their own health. Decrease social isolation and low level mental health issues such as depression and anxiety. Decrease the use of health and social care services by residents who attend frequently with non-clinically related issues. Support the discharge of patients from mental health services. Free up health care professional time in primary care and widen the skill mix of the primary care team. Target: To increase access for a wider range of residents of SY&B to social prescribing as a gate way to accessing non-medical forms of support and to empower clients to enhance their own wellbeing.




RAG Post-mitigation


Lack of dedicated programme management support: Unable to allocate capacity to attend workstream leads meetings, or complete PMO documentation. Programme work not at place-level is being driven by public health registrar on placement until April (was only 1d/wk) and capacity from Public Health Consultant which is impacting on her ability to support ICS health care commissioning.

R A

NHSE have provided temporary post (AfC 8b) to support the programme at 2d/wk from 01/04/18 for unspecified length of time, to be reviewed at 3m and 6m.

Tobacco dependence work requires significant resource and trusts may be unable to fully fund alone.

R A ICS funding of £18.4K will be used to initially support the programme eg for training of clinical leads. Business case to be drawn up in collaboration with trusts.

CVD requires dedicated project management and widespread clinical engagement. R A

PHE support currently determining what CVD prevention work is taking place in each area. No further project management resource identified.

23


Programme: Primary Care Workstream Provider CEO / CCG AO sponsors: Maddy Ruff/Tim Moorhead

Date of report: April 2018 Report completed by: Karen Curran

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Red

Plan for 2017-2019 To transform Primary Care through the establishment of ‘at scale’ primary care organisations capable of taking on population health responsibilities, which are accessible 7 days per week, are increasingly resilient and able to plan for and deliver outcomes described within the 5YFV/GPFV. To expand the clinical workforce which will be increasingly multidisciplinary and which facilitates improvements in recruitment and retention. A complete primary care offer aligned to the delivery of the GP Five Year Forward View, which includes a collective approach to managing urgent access to primary care, repositioning of the GP role as the senior decision maker in driving prevention, integration with social and voluntary sector partners and managing complex patients with long term conditions in the most appropriate setting through the registered list. Expansion and diversification of the clinical workforce will require development of Clinical Governance to support workforce development linked to the GP Forward View and the local ‘Place’ in association with New Models of Care and the ‘left–shift’. Key Ambitions -Eight 8 Key themes run through each of the 5 place based plans, ensuring that they are able to contribute to the delivery of our vision as a system (* Top 3 work stream priorities) Theme 1 Development of primary care ‘at scale’* Theme 2 Increasing the primary care and clinical workforce,* Theme 3 Building sustainable and resilient general practice Theme 4 Extending access Theme 5 Increasing investment in primary care* Theme 6 Addressing the wider determinants of health (including social prescribing) Theme 7 Integrated out of hospital services Theme 8 Development of wider primary care

MOU commitments • Deliver extended access to general practice for 100% of the population by October 2018.

- Barnsley and Sheffield are delivering extended access to 100% of the population. - Doncaster, Bassetlaw and Rotherham have plans to deliver to 100% of the population by October 2018.

• Delivery of the GPFV including boosting local GP Numbers and improving retention – National target 20/21, expecting local target ‘share’ for SY&B. • Catalyse the formation of Local Care Networks that establish integrated primary care teams, by March 2019,that:

- share workforce, infrastructure and responsibilities for urgent care and extended access, - cover geographically defined populations of between 30,000 and 50,000. - work with local community, mental health and social providers. - Offer a flexible working environment for new GPs and promote retention of current workforce. - Focus on prevention and admission avoidance, sharing risks and rewards with hospitals.

- Invest in premises to support team based working and additional facilities to support out of hospital work i.e. 24


diagnostics. • Delegated commissioning arrangements for Primary Care Medical Services by April 2018. (100% of SY&B are fully Delegated)

Engagement None taken via PC workstream. Individual CCGs/Place undertaking consultation on primary care at scale.

Progress - Agreement for SYB CCGs to engage in NHS England International Recruitment programme - Proposal submitted to North Region (NHS England) February 2018.

- Additional funding secured from National System Transformation Group to enable ‘at scale’ primary care plans to be progressed faster. In addition, funding secures SYB Workforce Development Hub for a further year.

- Funding secured from NHS England/North to purchase licenses and training for SYB practices utilising the Apex/Insight workforce/workload tool which will establish consistent baseline for workforce across SYB.

Next steps – over next month Key Stakeholder event in March 18 on workforce development plans for SY&B, outcomes to include; - plan for Workforce Development Hubs to deliver programme that meets system needs. - commitment to adopt North Region workforce/workload tool

Maturity matrix to be completed for all Primary Care Networks ( 36 across SYB) Priority is now to understand baselines for development of Primary Care Networks (using maturity matrix) and place plans

for establishment and progression of each network, identifying where collective approach can add most value - currently focused on OD and leadership development.

Benefits Closer alignment of workforce and primary care work streams, greater streamlining of work associated with common objectives. Consistency in workforce data Opportunities to include Local Care Networks in workforce plans which support and enable ‘at scale’ working




RAG Post-mitigation


There is a risk of inconsistent workforce baseline data if all GP practices/CCGs do not engage in utilisation of Apex/Insight tool funded by NHS England/North. R A

ICS Primary Care workforce workshop planned for March 2018. Agenda includes demonstrator site for utilisation of workforce tool. SYB ‘share’ of national workforce target figures anticipated

March 18, with CCGs required to report on plans to deliver including trajectories – accurate baseline required which Apex/Insight tool will deliver consistently across SYB.

April 2018

25


Programme: Hyper Acute Stroke Care - Reconfiguration Provider CEO / CCG AO sponsors: Lesley Smith

Date of report: April 2018 Report completed by: Marianna Hargreaves

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG)

Plan for 2017-2019 The plan for the reconfiguration of hyper acute stroke across the SYB ICS includes the development of the following: A Stroke Managed Network (MCN) to support the development of networked provision of stroke care across the SYB ICS. Consolidation of hyper acute stroke care at Doncaster Royal Infirmary, Royal Hallamshire Hospital, Pinderfields Hospital Wakefield. Plus the continuation of existing hyper acute stroke care at Royal Chesterfield Hospital. It is being supported by NHSE commissioning and the gradual implementation of mechanical thrombectomy. It is being supported by a review of the wider stroke care pathway as part of the Hospital Services Review – including Acute Stroke Units, Early Supported Discharge, Stroke Rehabilitation and TIA Services. There is also a need to continue improvements in primary and secondary prevention of stroke risk factors via the SYB ACS prevention and primary care workstreams to decrease the incidence of first and subsequent strokes.

MOU commitments The reconfiguration of hyper acute stroke care is identified in the MOU and it is noted that a Joint Committee of CCGs has delegated authority from CCG Governing bodies in relation to HASU.

Engagement Significant engagement has been undertaken throughout the review process for HASU. Views were initially gathered from patients and the public during a pre-consultation phase. Following this and the options appraisal a preferred option was formally consulted upon. Work is now underway to develop a service specification for the new model and to seek input from stakeholders, including patients and carers to inform this. The specification includes a section on expectations for the Stroke Managed Clinical Network, and this sets out the expectation that the MCN will develop mechanisms to enable further engagement. The Equality Impact Assessment has been updated using the Equality Analysis and Engagement Plan template and discussed at the Citizens Panel in early March.

Progress The JCCCG approved the decision making business case for changes to Hyper Acute Stroke Services in November 2017. The Joint Health Overview and Scrutiny Committee was taken through the detail of the decision making business case in

January 2018, the ratified notes indicate they have no questions or queries and would like updates on implementation. In early February a letter before action was received from a Barnsley resident setting out a challenge to the decision and

proceedings have been initiated for a Judicial Review. With legal advice and support, we have responded to the letter and continue to work with our lawyer through the process.

We are advised to continue to plan, but not take any irreversible steps. This will impact on timescales for delivery - the extent will depend on the route through the Judicial Review (JR) Process (the latter could be up to the end of the year).

Prior to the letter before action, in January the JCCCG agreed to extend the delivery timescales to enable sufficient planning time. They requested that plans aimed for Rotherham patients to change HASU provider in September 2018, with Barnsley following soon after before the 18/19 winter period. Revisiting this in light of the JR and feedback from providers it was proposed to JCCCG in March that it would therefore be reasonable to plan for April 2019 and this was endorsed. It was acknowledged that this would mean a continuation of existing provision in Barnsley and Rotherham that is increasingly fragile, and the Trusts would therefore need robust contingency plans. It was agreed that the JCCCG would seek assurance that robust contingency plans were developed and agreed.

The JCCCG in January had agreed that Sheffield CCG would be the lead commissioner for the new model (SYB HASUs) 26


and to initiate dialog with Providers to enable them to consider their preferred contractual model, representation at a task and finish group to discuss local tariffs, how best to work collaboratively to enable delivery (including workforce planning – options for consultant recruitment) and preparation for the Stroke MCN (host, financial arrangements).

A discussion took place at the Committee in Common in early February, where providers were asked to consider the above. The Clinical Reference Group (Medical Directors) considered a paper about the challenges of consultant recruitment and

the MD for Doncaster, Barnsley and Rotherham agreed to support the Clinical Lead to look at this. It was agreed at the March JCCCG that the workstream would benefit from a Provider SRO and that this would be

requested via the CEs during in April. Work has progressed with commissioners and providers (via the Operational Group) to develop the service specification. It has also been agreed at the Operational Group agreed to use the £25K ICS funding to fund an operational manager to

work across organisations to take forward work that would benefit from collaboration. Work is ongoing to enable us to develop the financial arrangements – options for local tariffs for discussion and dates are

now set for an informal task and finish group with representation from all relevant providers in April and May. Further dialog with YAS has taken place so the JCCCG now has a more detailed understanding of the refined costings. Both the equality impact assessment and quality impact assessment have been updated and reviewed. Dialog is established with NHSE to ensure that we planning collaboratively for Mechanical Thrombectomy. NHSE are planning to commission MT from April. An SYB discussion is planned to look at local implementation issues. Through a teleconference with Mid Yorkshire we have confirmed the model & are starting to understand their concerns in

more detail. They are undertaking a risk assessment and we have agreed how to engage with them going forward. Next steps – over next month Continue to work with our lawyer through the JR process and keep all stakeholders informed.

Request via CEs that they consider establishing a Provider SRO for the workstream (as per other workstreams). Plan for the April HASU Operational Group, Commissioning and Contracting Group and JCCCG Further develop the service specification and review the proposed KPIs with commissioners Agree the sign off route and timeline for finalising the specification

Plan for the informal task and finish group to discuss local tariff options with representation from all key parties

Providers to progress their risk assessments and business cases (mindful the above is necessary to finalise) Medical Directors to support the Clinical Lead to progress options re Medical Cover Providers to develop contingency plans (JCCCG to seek assurance this takes place). Continue to work with NHSE to ensure collaborative planning for Mechanical Thrombectomy is aligned to the new model

Benefits Delivery of an improved, more resilient and sustainable service. An established MCN facilitating more resilient networked provision and an enhanced ability to attract and retain a specialist workforce, and to facilitate 7 day provision. A service that delivers improved clinical quality (clinical effectiveness, patient safety and patient experience). All SYB units will have the patient numbers to fall within the nationally recommended 600-1500 confirmed strokes shown to result in the most clinically effective service. There will be an enhanced ability to meet evidence based national stroke standards (NICE, RCP and STP guidelines) for HASU care, and the NHSE Urgent and Emergency Standards for seven day care. Reduced inequalities in access, patient experience, quality of care and outcomes. All patients across SYB ICS will have access to high quality hyper acute stroke care that meets national best practice standards. Contribution to improved health outcomes – Contribution to wider health outcomes including a reduction in in hospital mortality from stroke, a reduction in disability from stroke and improved quality of life. A higher proportion of people who have had a stroke are able to return home to live independently and return to work. A reduction in the number of patients newly discharged to care homes/continuing health care. 27




Risks Pre-

mitigation RAG

Post-mitigation RAG Mitigating Action Due date

Judicial Review – There are a number of significant risks associated with the JR. The process could take a long time and therefore significantly impact on timescales and/or it could be upheld and the JCCCG decision no longer stand.

R A

To mitigate the risks we will continue to work with our lawyer through the process to ensure all the grounds are appropriately responded to. We will as advised continue to plan, but not take any irreversible steps.

Fragility of existing provision – There is a risk that fragile services in Barnsley and Rotherham will find it increasingly difficult to operate as timescales are extended and they may need to enact unplanned service change.

B

R

To mitigate the risk Trusts will agree contingency plans and commissioners will seek assurance that these are in place. If arrangements are required at short notice the plans will be enacted through Medical Directors.

Financial - There is a risk that it may not be possible to agree local tariff arrangements, providers may be unable to agree their internal business cases and commissioners will also find it difficult securing funds for the required investment through tariff. There are financial risks for both providers and commissioners

R A

To mitigate the risk around the agreement of local tariff arrangements detailed work is underway and a task and finish group is to be established to ensure all key parties are involved. Dates are now set for the task and finish group in April and May.

Operational – There are a number of risks associated with operationalising the model that have been identified by providers if enabled to progress, including securing the skilled workforce (medical cover and specialist nurses), ensuring sufficient capacity for CT scanning and implications for other service delivery (if displaced).

R A

To mitigate the risk around securing the medical workforce discussions are taking place now and it has been agreed that the Clinical Reference Group will support the Clinical Lead to look at this. The ICS are supporting a capital bid for a CT Scanner for Doncaster. More dialog is necessary with MY once their risk assessment is complete.

Hospital Services Review – There is a risk that the pace of the Hospital Services Review and work thereafter means that it is not possible to effectively plan for the whole pathway in the way that is necessary to ensure successful HASU implementation. The output of the HSR may also have implications for the delivery of the new HASU model that will need to be managed.

A G

This risk is mitigated as it is now likely that the timescale for the delivery of the HASU reconfiguration will be extended due to the JR and complexity of the work and therefore the two timescales are more likely to align.

28


Programme: Urgent and Emergency Care Provider CEO / CCG AO sponsors: Maddy Ruff, Louise Barnett

Date of report: April 2018 Report completed by: Rachel Gillott

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Green

Plan for 2017-2019 Plan for 2017-19:

1. NHS 111 Online: By March 2019 30% of the population should have access to NHS online 2. NHS 111 Calls: Clinical advice to be offered to 50% of callers to 111 by March 2018. All patients who call NHS 111

OOHs to be directly booked into further appointments by March 2019, 20% in hours. Fully integrated 24/7 urgent care services by March 2019.

3. GP Access: Coverage of enhanced access to reach 50% by March 2018 and 100% by March 2019 4. Urgent Treatment Centres: All services designated as UTCs to meet the guidelines and be in place by December 2019 5. Ambulance: Roll out of the Ambulance Response Programme by Autumn 2017, implementation of enhanced Hear and

Treat and See and Treat by March 2018 6. Hospitals: 95% achievement of the 4hr A&E standard by March 2018. 100% of patients arriving to ED by ambulance

handed over within 15 minutes. Co-located GP streaming in place by October 2017. 100% provision of ambulatory urgent care, frailty pathways and wards with SAFER bundles by September 2017.13%+ of acute hospitals to meet CORE 24 by March 2018.

7. Hospitals to Home: High impact interventions to be in place by September 2017. Delayed Transfers of Care to be reduced to 3.5% by September 2017. CHC full assessments in acute settings to be less than 15% by March 2018.

8. 8-12 are deliverables for local health economies. Additional South Yorkshire and Bassetlaw priorities; Improving System Intelligence – Implementation of EMS – to implement as part of the 17/18 winter plans.

MOU commitments Good progress is being made against the MOU commitments albeit there exist some risks on specific requirements.

Engagement None specific to the workstream priorities, ongoing engagement for HSR

Progress NHS 111 Online – now live 24 hours per day across South Yorkshire and Bassetlaw (and Yorkshire and Humber). Utilisation data being issued weekly. Formal monitoring will be undertaken via the Yorkshire and Humber lead commissioning arrangements via Greater Huddersfield CCG with local monitoring taking place through South Yorkshire and Bassetlaw delivery group.

NHS 111 Calls - Additional capacity to support Integrated Urgent Care development across Yorkshire and Humber region has now ceased.

2017 – 19 targets – Clinical Advice: South Yorkshire and Bassetlaw Position is 57.7% better than the national standard including clinical advice given from the virtual CAS i.e OOH service and local Dental hubs

Direct Booking: variable practice across South Yorkshire and Bassetlaw with some areas doing better than others against the national standard.

19/20 service requirements – The procurement process will commence in April 2018, a supplier engagement event took place on 28th March 2018 with an South Yorkshire and Bassetlaw model presentation included in the event. ‘Place’ based models have been refined and latest position will be included in the overall service specification. Additional resource has been secured to support and lead the procurement process.

GP Access – see Primary Care Highlight report Urgent Treatment Centres - Doncaster UCC working towards Tranche 1 to become a UTC, with the aim to have all

29


standards met by end of March 2018. Sheffield working towards Tranche 2 (subject to the outcome of their local Urgent care consultation).

Ambulance – Patient Transport Summit held on 6 March 2018. YAS presented an overview of strategic issues. EMAS invited but did not attend. The implications of service reconfigurations (i.e. Hospital Services Review), ARP and national changes to 999 considered along with opportunities of working differently across South Yorkshire and Bassetlaw. Proposal to establish an ongoing Strategic (Transformation) Transport Group for the ICS and to identify the areas to work collectively on as an ICS.

Hospitals - Primary Care Streaming in place across South Yorkshire and Bassetlaw, variable performance/throughput. ED performance across South Yorkshire and Bassetlaw YTD 91.46% @ 28.3.18 with 4 out of 5 NHS Foundation Trusts YTD position (28.3.18) over 90%.

Hospitals to Home – Care Home Bed availability tool – decision to roll out the NHS England tool in Summer 2017, variable implementation and usage across South Yorkshire and Bassetlaw with 100% of Sheffield based care homes inputting bed availability/capacity. To review use of tool and assess best method of collecting and using this information to be undertaken in Q1 2018/19.

Reshaping Hospital Services - Sheffield’s consultation ‘Making Urgent Care Work Better in Sheffield’ concluded. Hospital Service Review ongoing. HASU stroke reconfiguration progressing – see separate Highlight Report

Additional Priorities:

Improving System Intelligence Implementation of EMSplus – EMSplus system has been purchased with a roll out plan agreed for South Yorkshire and

Bassetlaw. All acute providers and YAS input information onto the system and usage remains variable across South Yorkshire and Bassetlaw at present. Roll out plan to include all local UEC services developed in conjunction with each CCGs and local A&E Delivery boards. Live data feeds are available with the latest version and it was agreed at Steering Board to implement these across our acute sights and ambulance providers. This will provide live data on ED activity & performance, along with live data feeds from the ambulance providers.

Mutual Support – links to usage of EMSplus. A workshop held on 22nd February. Some ‘trial’ system calls implemented to establish how best to use the intelligence from the EMSPlus system and develop a prototype for System management and mutual support.

Channel Shift modelling tool – work programme developed with ICS finance colleagues, promote use of tool with CCGs, 3 consultancy days secured from system developer to aide implementation/raising awareness of modelling tool.

Next steps – over next month Continued implementation of EMS Plus to UEC services Development of Mutual Support approach using EMS Plus Confirm local CCG plans for IUC for inclusion in specification Establishment of South Yorkshire and Bassetlaw Project Group to support Procurement of IUC Development of plans for ‘Hospital to Home’ with increased emphasis on discharge Review UEC priorities for 18/19 and beyond

Benefits Expansion of capacity and services to provide better support and experiences for patients Increased consistency in accessing urgent and emergency care services



30


Risks Pre-

mitigation RAG

Post-mitigation


Insufficient capacity in providers to implement EMS A G Provision of engagement, support and training through CSU May 2018

Unable to fully review use of EMSplus over full winter period due to contract end date and secure funds to extend contract

R A Requested funding through non-recurrent transformation May 2018

Non-achievement of the A&E standard by March 2018 R A

Winter plans and OPEL escalation in place. Local delivery plans exist.

Ongoing

Lack of commitment to the protocol and mutual support R A UECN Steering Board endorsement and Local A&E Delivery

Board support Ongoing

Unable to obtain information on local performance of NHS 111 service and national targets R G Request submitted to YAS for adhoc information requirements

and raise through contract negotiations Ongoing

CCG’s unable to confirm IUC model locally for

inclusion in service specification R G CCG commissioning leads engaged in process and developing local requirements

December Jan - March

Insufficient capacity in ICS team to deliver ongoing requirements and workstream priorities R A Request submitted for interim arrangements April 18

Unable to contribute adequately to the procurement process due to lack of resources R A

Request additional resource through ICS transformation fund Establish South Yorkshire and Bassetlaw procurement oversight group with reps from across CCGs

February 2018 February 2018

31


Programme: Workforce Provider CEO / CCG AO sponsors: Mike Curtis / Kevan Taylor

Date of report: April 2018 Report completed by: Ben Chico


Plan for 2017-2019 The SYB LWAB initially focused upon three key developments: South Yorkshire Excellence Centre Faculty of Advanced Clinical Practice Primary Care Workforce Strategy

In October 2017, LWAB published a Workforce Framework which set out a number of recommendations, from which the following priorities have been identified:

PRIORITY WORKSTREAMS

1. Developing the Current SYB Workforce

Support development of flexible / mobile employment models Collaborate to achieve best practice skills development Collaborate to optimise recruitment and retention

2. Increasing Future Supply Increase primary and community care workforce (sustainability and “left shift”) Increase registered workforce training places Develop Emerging / New Roles (Faculty of Advanced Practice and SY Regional

Excellence Centre)

3. Enabling and Aligning Effective Workforce Planning across Organisations, ACPs and ACS

Support ICS and ACP programmes by enabling increased workforce planning knowledge and skills

Develop SYB workforce intelligence function working closely with programme leads and wider stakeholders

Create best practice process for workforce investment-decision making

Under each of the workstreams, a number of deliverables have been recommended for 2018/19, extending beyond the initial developments above. To support this, an ICS workforce “hub” is in implementation which will function as a delivery unit as well as providing an advisory function to the clinical ICS workstreams.

MOU commitments This workstream acts as an enabler to the wider ICS Clinical workstreams in delivery of relevant workforce developments. A process will be undertaken to ensure alignment in reporting over the coming months.

Engagement There are no identified PPE requirements at this stage, but LWAB has taken steps to improve Staff Side relations and will be including a staff side representative in new membership from 2018/19. Increased engagement with ACS workstream leads has taken place and there is now a focus on one workstreams at each LWAB meeting, attended by relevant lead. 32


Progress Recommended Investments for HEE Workforce Transformation submitted to LWAB 27 April. Refreshed LWAB Terms of Reference approved in principle by LWAB on 27 April.

Next steps – over next month Implementation of Workforce Hub led by new SYB Workforce Transformation Lead Linda Crofts (Based at 722) Development of project plans against recommended investment areas. Identify relevant recommendations from Hospital Services Review and align into planning for 2018/19.

Benefits Establishment of infrastructure, workforce governance (including review of LWAB Terms of Reference) and reporting processes.

Alignment of workforce governance across organisation, place and system. Delivery of workforce framework priorities / deliverables including:

o Implementation of Faculty of Advanced Clinical Practice o Implementation of South Yorkshire Regional Excellence Centre

Provision of advisory Service to ACS Clinical Workstreams / Hospital Services Review




RAG Post-mitigation


The workforce hub is unable to effectively demonstrate added value above national and local (place based) initiatives.

R G

Deliverables / success criteria agreed and overseen by LWAB reporting to Collaborative Partnership Board.

April to May 18

Partners are unable to agree on upon collaborative strategies owing to competitive or other agendas. R G

LWAB Terms of Reference to be developed to oversee alignment of system versus place / organisational level activities.

April 18

There is not enough management capacity at organisational or place level to support transformation.

R G

Each ACP is developing local governance to manage workforce activities. HEE considering support to primary care infrastructure at place.

April 18

The hub disengages stakeholders by focusing on strategic projects and does not support “business

as usual” pressures R G

Deliverables to be structured on short, medium and longer term in agreement with key stakeholders.

April to May 18

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south yorkshire and bassetlaw shadow integrated … us... · mcn specification to be agreed....

Documents