Hertfordshire and West Essex Sustainability and Transformation Partnership ICS/ ICA design process The Chairs and CEO Boards have commissioned the Independent Chair and STP Lead to develop and test proposals for the future system architecture for an HWE Integrated Care System and Alliances (ICS and ICAs) to realise its ambition to deliver improved wellbeing, health and care outcomes for its population. The work will devise and test proposals for: • the role, purpose, culture, functions, structure, business intelligence and performance of an ICS, ICAs and neighbourhoods in the HWE system. • the key enablers to delivering and ICS and ICAs, including financial models, commissioning arrangements, risk appetite and sharing, organising principles, organisational form and governance. • further design work to be undertaken to operationalise the proposed model. • options for transitioning from the current governance arrangements to the proposed arrangements and the organisation and leadership development required to support new ways of working. In undertaking this work the Independent Chair and STP Lead will engage with existing work on the establishment of ICAs and ensure that progress is not delayed or disrupted but that the relationships between the ICAs and ICS are explicit and rules of engagement clearly articulated. This is a rapid action process with an expectation that the proposals will be developed over the next two months with the goal of bringing proposals to a joint meeting of the CEOs and Chairs.
Hertfordshire and West Essex Sustainability and Transformation Partnership 19/20 planning update As per national guidance, the STP has worked with system partners in January & February to co-ordinate a STP system operating plan. A work shop was held on the 1 st February 2019 with nominated planning leads to agree the approach and timescales and the initial draft operating plan and contract / plan alignment draft was successfully submitted on the 19 th February. The nationally set key priorities for this submission were to articulate: • System Priorities and deliverables • Activity assumptions • Contact financial alignment • Capacity planning • Workforce • Financial risk management • Efficiencies The next deadline for an interim submission is the 5 th March before a final submission on the 11 th April 2019.
Hertfordshire and West Essex Sustainability and Transformation Partnership Work Stream Update Overview Following an initial review of the programme at the end of Jan ‘19 it was agreed that, starting with the clinical work streams, we would prioritise one project per work stream to work up a detailed PID/ BC and plan. This was completed for the first six projects on 19 th Feb ’19. Led by the FD lead for the work stream, an impact assessment is now to be completed (following the methodology trialled by frailty) over the subsequent 4 weeks and presented to the CEO board on the 19 th March. The next six projects are due to be presented to the CEO board on the 19 th March. Individual work stream updates: Cancer - FiT testing The aim of this project is to implement FiT testing as a diagnostic tool for patients seen in primary care, who have symptoms and require investigations associated with a low risk (<3%) of lower GI cancer. The implementation of FIT in Primary Care Pathway, is expected to provide savings based on the reduction in the number of colonoscopies, as only patients from within the higher risk group will be referred immediately for a colonoscopy. Capital funding has been received for the analysers. WHHT have taken delivery of their analyser and have received their training. Testing of samples has commenced. ENHT and PAH will receive delivery of their analysers in March and the project is on track for its planned Go-Live date of the 1 st May 2019.
Hertfordshire and West Essex Sustainability and Transformation Partnership Work Stream Update Planned Care Urogynaecolgy The Urogynaecolgy group is on track to sign off and implement an STP streamlined referral pathway from primary care through to community care and to secondary care in order to ensure that patients are seen in the right place at the right time by the right services, reduce inappropriate or mistimed UroGynaecological secondary care referrals by 30% and minimise variation in the quality and standard of care across the STP as well reduce variation in the patient experience in their referral journey across the STP. Cardiovascular disease The aim of this project is to increase the number of newly diagnosed hypertension patients by training a number of health care providers to conduct hyper tension tests outside of the GP surgery before referral on as required. This is supported by a successful bid to the British Heart Foundation to fund the piloting of this service for a year. Progress with the project has been good. The clinical pathways for this project have been agreed and service specification approved. Training and comms plans are in progress and the project is on track to deliver as planned. Outpatients The STP outpatient review process begins with a workshop on 12.03.19 involving commissioners, service managers and clinicians from primary, secondary and community care providers. This initial workshop will confine itself to addressing the challenge of streamlining the First Out-patient appointment segment of the outpatient pathway with a focus on 4 key themes: • Ensuring appropriate outpatient referrals pre-appointment • Removal of technical (diagnostic) limitations • Removal of waiting time (capacity) limitations • Improving service integration. . .
Hertfordshire and West Essex Sustainability and Transformation Partnership Work Stream Update Mental Health Primary care MH (Embed Clinical psychiatric nurses into GP surgeries and offer access to MH primary care based interventions) Herts Valleys CCG has supported the expansion of primary care mental health pilots with £650k, progressing to a proof of concept phase across the whole CCG. Localities have developed approved delivery plans alongside HPFT, Community Navigation services, and local MIND organisations, to deliver an integrated service, with those organisations working as a single team in function within Primary Care and on Primary Care IT systems. This will bring the right care and support closer to thousands of patients across the CCG, accessed in a familiar setting, far quicker than at present. Individual placement support (IPS) Herts Valleys CCG and East and North Herts CCG have made it through the first part of a two part bidding process for NHSE transformation funding for IPS. If the bid is successful it will provide employment support for around 380 service users with severe and enduring mental illness. The funding application is for £543k in total over two years. This will help bridge the inequality between people with severe mental illness in work and the rest of the population and bring the Hertfordshire services in line with West Essex. Other The work stream has co-ordinated an STP Mental Health Investment standard meeting to correlate intended funding and delivery plans for 19/20 to ensure delivery against the Mental Health Five Year Forward view requirements and begin the process toward building a five year plan related to the NHS 10 year plan
Hertfordshire and West Essex Sustainability and Transformation Partnership Work Stream Update UEC A programme manager has been appointed to establish an STP wide discharge to assess programme. The draft aims of this programme will be to agree a standardised approach and outcomes to discharge assess pathways (using best practice in system & national evidence base) Frailty The work stream remains focussed on progressing the ‘ask’ agreed by STP CEOs at the recent deep dive. This included: • ‘My plan’ organisational sign off • Continued frailty pathway commitment to implementation and commitment to explore mandatory. Essential frailty education and training across the STP work force • Pre and post falls prevention pathways organisational sign off • Frailty pathway minimum data set organisational self-assessment to be undertaken • Dementia pathway implementation organisational sign off, once the design has been approved by the work stream later this month • EOL pathways organisational sign off, once the design has been approved by the work stream later this month • Revised frailty financial and activity modelling timescales to be committed to • Organisational feedback on the ‘as-is’ of existing hubs and those under development
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