NHSE Meeting 28 th Feb - NHS Ealing CCG submission QIPP SUMMARY - - PowerPoint PPT Presentation

NHSE Meeting 28th Feb

• NHS Ealing CCG submission

QIPP SUMMARY

The next section of the pack describes the QIPP schemes and operating plan trajectories that have been developed by each of the CCGs. Both respond to and reflect Everyone Counts and our Commissioning Intentions. We will be undertaking a mapping exercise to ensure that we have taken account of all of the relevant benchmarking data available. For example, based on a preliminary assessment, many of our schemes

• verlap with areas presented as high impact interventions and early adopter interventions in Anytown.

We will be formalising this assessment in the coming weeks so that we can ensure that we are exploiting the maximum opportunity, and ensuring alignment with our key strategies and collaborating across CWHHE where this offers additional benefit and synergies. We will use the outcomes of this exercise to refine our submission for the 4th of April.

Ealing CCG QIPP 2014-15 and 2015-16

Ealing CCG QIPP Summary 2014-15 and 2015-16

Scheme Type Scheme Code Scheme Name Gross Saving (£000) Investment (£000k) Net Savings (£000) Risk Rating (% Deliverable) Net Rated Savings (£000) Gross Saving (£000) Investment (£000k) Net Savings (£000) Risk Rating (% Deliverable) Net Rated Savings (£000) 07W-1415-001 Intermediate Care Service (ICE) £2,952 £2,253 £699 107% £750 £2,010 £525 £1,485 67% £990 07W-1415-002 U&USC Pathway: Ambulatory Care £0 £0 £0 0% £0 £0 £0 £0 0% £0 07W-1415-003 U&USC Pathway: Frail Elderly £0 £0 £0 0% £0 £0 £0 £0 0% £0 07W-1415-004 GP Service for Nursing Homes £1,354 £642 £712 81% £576 £301 £165 £136 100% £136 07W-1415-005 Pulmonary rehabilitation £195 £0 £195 50% £97 £200 £100 £100 100% £100 07W-1415-006 Falls Pathway TBD TBD TBD TBD TBD £0 £0 £0 0% £0 07W-1415-007 Referral Facilitation Service (RFS) £1,000 £500 £500 57% £285 £1,499 £0 £1,499 67% £1,000 07W-1415-008 CVD Anticoagulation Schemes £663 £72 £591 40% £236 £200 £70 £130 100% £130 07W-1415-009 MSK Pathway £1,281 £387 £894 100% £894 £1,333 £400 £933 75% £700 07W-1415-010 Diabetes £371 £324 £47 100% £47 £400 £133 £267 75% £200 07W-1415-011 Cardiology £720 £552 £168 30% £51 £4,380 £3,207 £1,173 100% £1,173 07W-1415-012 Gynaecology £672 £0 £672 39% £261 £0 £0 £0 0% £0 07W-1415-013 Dermatology £1,412 £326 £1,087 88% £960 £466 £149 £317 100% £317 07W-1415-014 Ophthalmology TBD TBD TBD TBD TBD £400 £200 £200 100% £200 07W-1415-015 Paediatric Pathways £100 £0 £100 100% £100 TBD TBD TBD 0% TBD 07W-1415-016 Connecting Care for Children £107 £81 £26 0% £0 TBD TBD TBD 0% TBD 07W-1415-017 Mental Health CC £650 £0 £650 100% £650 £0 £0 £0 0% £0 07W-1415-018 Shifting Settings of Care (Mental Health) £750 £0 £750 67% £500 £0 £0 £0 0% £0 07W-1415-019 Mental Health: Productivity; Recovery Houses; Ward closure & bed reconfiguration £1,280 £0 £1,280 47% £600 £1,250 £0 £1,250 80% £1,000 07W-1415-020 Prescribing £1,612 £36 £1,576 79% £1,251 £1,250 £250 £1,000 80% £800 07W-1415-021 Acute High Cost Drugs Risk Share £100 £0 £100 100% £100 £100 £0 £100 100% £100

Financial Management

07W-1415-022 NCA Validations £100 £0 £100 75% £75 £75 £0 £75 100% £75 07W-1415-023 Emergency Admissions Reduction £2,250 £0 £2,250 50% £1,125 £1,125 £0 £1,125 100% £1,125 07W-1415-024 Productive Community Services Efficiency 2014-15 £735 £0 £735 50% £368 £368 £0 £368 100% £368 07W-1415-025 Old Productivity and Efficiency Metrics TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 07W-1415-026 Diagnostics: Pathlology £100 £0 £100 100% £100 £0 £0 £0 0% £0 07W-1415-027 Diagnostics Cloud £0 £0 £0 0% £0 £275 £0 £275 100% £275 07W-1415-028 Pathology Services Re-procurement £443 Net £443 78% £344 £1,095 Net £1,095 100% £1,095

Totals (roll forward of 2014-15 QIPP schemes)

£18,845 £5,172 £13,674 £9,369 £16,727 £5,199 £11,528 £9,784 Net QIPP Target £13,674 £11,528 High cost appliances £100 £0 £100 100% £100 Adoption of Non-Pbr tariffs for all non consultant lead £200 £0 £200 100% £200 Procurement: 111 services £0 £0 £0 0% £0 MCAP benefit £0 £0 £0 0% £0 BCF 3.2.1 Dementia Care Pathway £900 £469 £431 80% £345 BCF 3.2.7 Supportd Discharge and Rehab (non-bedded) Totals (New 2015-16 QIPP schemes) £1,900 £469 £1,431 £645 Net QIPP Target £1,431 Grand Totals £18,845 £5,172 £13,674 £9,369 £18,627 £5,668 £12,959 £10,429 NET QIPP Target £13,674 £12,959 2014-15 QIPP Summary Plan 2015-16 QIPP Summary Plan Included in ICE

Unplanned Care Planned Care Paediatrics Mental Health Medicines Management Efficiency and Productivity Diagnostics Planned Care Unplanned Care Better Care Fund Schemes

New Commissioning Intentions

Ealing CCG 2014-15 QIPP Programmes Summary (1/4)

44% 44% 12%

Schemes supporting Unplanned Care ( Total £1.6m net saving)

Intermediate Care Service (ICE): £750k GP Service for Nursing Homes: £712k Pulmonary rehabilitation: £195k 11% 13% 19% 1% 4% 15% 23% 2% 2% 10%

Schemes supporting Planned Care ( Total £4.6m net saving)

Referral Facilitation Service (RFS): £500k CVD Anticoagulation Schemes: £591k MSK Pathway: £894k Diabetes: £47k Cardiology: £168k Gynaecology: £672k Dermatology: £1087k Paediatric Pathways: £100k Diagnostics: Pathlology: £100k Pathology Services Re-procurement: £443k 75% 25%

Schemes supporting Effieciency and Productivity savings ( Total £2.9m net saving)

Emergency Admissions Reduction: £2250k Productive Community Services Efficiency 2014-15: £735k 24% 28% 48%

Schemes supporting Mental Health savings ( Total £2.7m net saving)

Mental Health CC: £650k Shifting Settings of Care (Mental Health): £750k Mental Health: Productivity; Recovery Houses; Ward closure & bed reconfiguration: £1280k 6% 94%

Schemes supporting Medicine Management savings ( Total £1.6m net saving)

Acute High Cost Drugs Risk Share: £100k Prescribing: £1576k

Ealing CCG 2014-15 QIPP Programmes Summary (2/4)

Scheme Name QIPP Scheme Description Intermediate Care Service (ICE) An emergency admissions avoidance scheme that provides step up services in the community including step up beds. The scheme takes referrals from GPs, and from A&E departments at both EHT and IHT. GP Service for Nursing Homes An emergency admissions avoidance scheme, that provides for an enhanced primary care service for the 1,100 nursing home residents in

• Ealing. The contract with the provider stipulated a high frequency of appointments for the patients, and includes high responses times from

urgent calls from the nursing homes. Pulmonary rehabilitation An emergency admissions and re-admissions avoidance scheme. GPs refer qualified patients on the COPD long term conditions register for pulmonary rehab services. The provider contract allowed for 900 patients. Scheme Name QIPP Scheme Description Prescribing A primary care prescribing cost reduction scheme based upon analysis and expert advise to Practices. the Medicine Management team has undertaken a detailed review of the areas of prescribing that do not confirm to best practice and/or guidelines. An evaluation of the

• pportunity to influence and reduce prescribing in these specific drug categories has identified a total opportunity equivalent to the budget

figure. Acute High Cost Drugs Risk Share A secondary care prescribing cost reduction scheme focussed on the" High Cost Drugs" (i.e. excluded drugs under PbR). The scheme is based

• n combined work of the Trust Pharmacists and the CCG, with both parties incentivised to seek savings via a gain share agreement.

44% 44% 12%

Schemes supporting Unplanned Care ( Total £1.6m net saving)

Intermediate Care Service (ICE): £750k GP Service for Nursing Homes: £712k Pulmonary rehabilitation: £195k 6% 94%

Schemes supporting Medicine Management savings ( Total £1.6m net saving)

Acute High Cost Drugs Risk Share: £100k Prescribing: £1576k

Ealing CCG 2014-15 QIPP Programmes Summary (3/4)

Scheme Name QIPP Scheme Description Emergency Admissions Reduction A metric based incentive scheme to be built into the 2014-15 acute contracts. Productive Community Services Efficiency 2014-15 A reduction in the costs of commissioning Community services, based upon an efficiency saving, informed by comparative benchmarking. Scheme Name QIPP Scheme Description Mental Health CC A scheme that will re-assess of the use of Commissioner funds, based upon a forthcoming Joint Review with Ealing Social Services Health funded Section 117 patients Shifting Settings of Care (Mental Health) A reduction in the number of patients in the care of the Mental Health Trust, based on a through clinical review of the needs of various categories of patients. The scheme is focussed on transferring these patients back in the care of primary care, combined with additional support services to help these patient groups avoid the need for re-admission to the Mental Heath Trust. Mental Health: Productivity; Recovery Houses; Ward closure & bed reconfiguration A reduction in the costs of commissioning Mental Health services based on two distinct strategies. A) Efficiency savings informed by benchmarking of the costs of comparable services; b) implementation of recovery house services.

75% 25%

Schemes supporting Effieciency and Productivity savings ( Total £2.9m net saving)

Emergency Admissions Reduction: £2250k Productive Community Services Efficiency 2014-15: £735k 24% 28% 48%

Schemes supporting Mental Health savings ( Total £2.7m net saving)

Mental Health CC: £650k Shifting Settings of Care (Mental Health): £750k Mental Health: Productivity; Recovery Houses; Ward closure & bed reconfiguration: £1280k

Ealing CCG 2014-15 QIPP Programmes Summary (4/4)

Scheme Name QIPP Scheme Description Referral Facilitation Service (RFS) An outpatients new and follow-up avoidance and diversion scheme. The RFS triages GP referrals for 8 conditions including 1.Cardiology, 2. Dermatology, 3. Gastroenterology, 4. Gynaecology ,5. Uro-renal (Nephrology & Urology) ,6. Paediatrics, 7.Orthopaedics, 8. ENT. The RFS is being expanded in 2014-15 to also triage consultant: consultant referrals and internal referrals. CVD Anticoagulation Schemes An Outpatient follow-up reduction scheme that seeks to transfer stable anti-coagulation patients for on-going Warfarin dosage and treatment closer to home and with a range of primary care providers. MSK Pathway An outpatient new , outpatient follow-up and radiology test reduction (MRIs) scheme that provides expanded "interface" and physiotherapy services in the Community. Patients are triaged by the RFS and then either seen at the Interface clinics or sent direct to Physiotherapy. The Interface clinics provided community based treatment, and only refer those in most need of surgery or specialist care to consultant lead clinics in the acute sector. Diabetes An outpatient new and Outpatient follow reduction scheme that provides community based clinics in multiple locations for stable Type 2 diabetes

• patients. The CCG's overall diabetes services provide expanded capacity given the high prevalence of the condition amongst the Ealing population. In

2014-15, all new GP referrals are to be triaged subject to a "super six" set of clinical criteria and then navigated to acute or community services as the condition dictates. Cardiology Both an elective inpatient and outpatient reduction scheme that provided for a wide range of new services in the community. The details of the scheme are under development, and are not scheduled to start until 2015. Gynaecology An outpatient new and follow-up reduction scheme. GP referrals re triaged by the RFS, and only qualified referrals are sent to the acute sector. The scheme is also focussed on changing the pathway for a number of conditions which historically have been treated in acute in follow-up clinics, but which should normally be performed in primary care. Dermatology An outpatient new, outpatient follow-up and procedures reductions scheme which provides for consultant lead teledermoscopy and teledermatology diagnostic services based in the community. Following the completion of a competitive tender, the service is scheduled to start in 2Q 2014-15. Paediatric Pathways Both an inpatient and outpatient reduction scheme focussed on the development of multiple new pathways for the under 16s. Diagnostics: Pathology Savings associated with credits from the Direct Access Pathology services contract. Pathology Services Re- procurement Saving associated by the re-commissioning of Direct Access Pathology services on behalf of all GP Practices. The CCG is running a competitive tender to select a pathology provider.

11% 13% 19% 1% 4% 15% 23% 2% 2% 10%

Schemes supporting Planned Care ( Total £4.6m net saving)

Referral Facilitation Service (RFS): £500k CVD Anticoagulation Schemes: £591k MSK Pathway: £894k Diabetes: £47k Cardiology: £168k Gynaecology: £672k Dermatology: £1087k Paediatric Pathways: £100k Diagnostics: Pathlology: £100k Pathology Services Re-procurement: £443k

Risks assessment and mitigation for 2014-15 QIPP Delivery

Risk types Risk description Mitigation

Procurement outcome Managing the Procurement timetable slippage; Bidder proposed prices being equal to or less than market based assumptions. Ensuring procurement projects had sufficient skilled resources; Effective Steering Groups. Strong project management Delivery by provider Managing acute providers to reduce acute inpatient or outpatient activity, according to commissioned Activity Plan Contracting intentions preparation. Provider performance management and joint Clinical Steering Groups. Sufficent CDM resources Delivery integration Dependency on EHT reducing acute activity, whilst delivery community service Integrated approach to contracting intentiones with EHT across communuity and acute GP referrals Encouraging GP to refer patients into QIPP community service: Managing provider (EHT) to market the service to attract referrals Performance management. Use of specialists to supplement GP resources GP behaviour Encouraging GPs to reduce referrals, sign up to Local Enhanced Service agreements, or reduce spend with primary care arena Use of Network Relationship managers; Sufficient resources to engage Contract negotiation: Dependency on achieving contracting intention Contracting intention preparation and CWHHE consistency Scheme design in progress Proposed QIPP schemes, where activity and cost reduction estimates may not be accurate. Business case is not completed, and implementation decision not yet made. Sufficient resources to design the schemes in detail, and in timely way Scheme effectiveness assumption Uncertainty that the scheme will have the outcome predicted. Reviews to investigate outcome gaps Measurement: Double counting: Some patient care activities are the focus of more than one QIPP scheme. QIPP OOH dashboard report has been designed to only count a patient record once.

Monthly QIPP Report is prepared to track progress against plan and escalate issues, using: 1. OOH Dashboard for GP Practices and Networks

• Tracking of output measures using SUS data
• Variance against target

2. Tracking of input measures 3. PMO Project Highlight report 4. Ealing Procurement Projects Progress Report (provided by CSU) Procurements are monitored via Steering Committee that operate under mandate granted by Finance and Performance Committee. In addition, North West London CSU provides Procurement advisory service on a monthly basis for some of the procurements, which is monitored by the CCG. New schemes are subject to development through defined stages and approvals through Executive Management and Innovation Committee and Finance and Performance Committees.

Ealing CCG has ensured that robust governance is in place for its QIPP portfolio

Ealing CCG Finance and Performance Committee (Monthly) QIPP Program Director Managing Director Deputy CFO

QIPP Program Director/ Deputy COO Commissioning Development Managers Procurement Project managers Clinical Leads

QIPP Workstream A QIPP Workstream B QIPP Workstream C QIPP Workstream D QIPP Workstream E

Monthly PMO Meeting Monthly QIPP Review Meeting QIPP Delivery workstreams

Ealing CCG Governing Board (Monthly) CWHHE Collaborative Review (Monthly)

F e e d b a c k

OUTCOME MEASURES & LOCAL PRIORITY

2014-19 Outcome measures and proposed trajectories (1/2)

Indicator Proposed target Rationale

Potential years of life lost (PYLL) from causes considered amenable to healthcare (adults and children) 3.2% improvement year on year between 2014/15 and 2018/19. The CCG is currently between third and fourth quintile for performance. 3.2% is a nationally mandated minimum annual improvement target. The CCG understands from public health colleagues that this will be a stretch target and as such the CCG does not propose to set a more ambitious target. Health-related quality of life for people with long-term conditions Measure derived by asking patients with a long- term condition a series of 5 questions, which include how they rate their mobility, ability to self- care, ability to carry out usual activities, pain and anxiety/depression. Movement from a score of 75.8 to 76.1 (out of possible 100) between 2014/15 and 2018/19. The CCG is currently in the second quintile for this

• indicator. As such, the CCG proposes to set a target

which would move the CCG to the lower end of top quintile (also the top of the range for similar CCGs) over 5 years. Composite measure on emergency admissions, including:

• Rates for unplanned hospitalisation for

chronic ambulatory care sensitive conditions;

• Unplanned hospitalisation for asthma,

diabetes and epilepsy in under 19s;

• Emergency admissions for acute conditions

that should not usually require hospital admission;

• Emergency admissions for children with

lower respiratory tract infections. 13% improvement between 2014/15 and 2018/19. The CCGs in the CWHHE Collaborative are all applying a 13% reduction in emergency admissions. The target is derived from Shaping a Healthier Future plans for hospital reconfiguration. The CCG also has strong plans in place for the development of Whole Systems Integrated Care to support this objective.

Indicator Proposed target Rationale

Positive patient experience of hospital care Measure derived by counting the number of ‘poor’ responses to experience of hospital care per 100 patients. 6.9% improvement in CCG’s score between 2014/15 and 2018/19. The CCG is currently in the fourth quintile. This constitutes movement to the current average of the five CCGs in North West London. Positive patient experience of out of hospital care, in general practice and the community Measure derived by counting the number of ‘poor’ responses to experience of GP practice and GP out of hours services. 23% improvement in CCG’s score between 2014/15 and 2018/19. . The CCG is currently in the fifth quintile. This constitutes movement to the current average of the five CCGs in North West London. The CCG has plans in place to improve patient experience of GP care through the Primary Care Strategy, which focuses on access and quality. Improving Access to Psychological Therapies roll out Nationally mandated target of 15%, which the CCG proposes to achieve in 2014/15 and maintain in 2015/16. The CCG plans to achieve 15% in the next two financial years in line with the national mandate. This is a significant improvement from 2013/14 performance of 11.3% Improving Access to Psychological Therapies recovery rate Nationally mandated target of 50%, which the CCG proposes to achieve in 2014/15 and maintain in 2015/16. The CCG plans to achieve 50% in the next two financial years in line with the national mandate. The CCG is already performing more that national average on this indicator (at 46%) Dementia diagnosis rate Nationally mandated target of 67% diagnosis rate by March 2015, which the CCG proposes to achieve in 2014/15 and maintain in 2015/16. The CCG plans to achieve 67% in the next two financial years in line with the national mandate. This will be a stretch target against March 2013 performance which was approximately 51.9%. The CCG is going to jointly work with Public Health and LBE and providers to develop plans to reach this target.

2014-19 Outcome measures and proposed trajectories (2/2)

Local Priority for 2014-15

Local priority Indicator Definition Numerator Denominator Measure Target Increase the percentage of elderly patients (over 75s) having completed comprehensive care plans ( target 20%) 2450 elderly patients in Ealing will have a completed care plan by March

• 2014. The target is to ensure a review
• f the already completed care plans

and increase the total number of comprehensive care plans for 3776 patients by March 2015. No of elderly patients with care plans completed = 3776 Number of elderly patients in Ealing = 18879 Comprehensive elderly care plans Increase to 20% by March 2015 i.e. 7% increase per year

In 2014/15, the CCG is required to select one local priority that is tied to the Quality Premium and is achievable and

• measurable. Ealing CCG has chosen the following local priority for 2014-15, which has been jointly agreed with LBE.

“Increase the percentage of elderly patients (over 75s) having completed comprehensive care plans ( target 20%)”

BETTER CARE FUND SUBMISSION

Governance: Delivery & Implementation

• Approach

– Health & Wellbeing Board oversees all Integration plans – Governance and terms of reference for the HWBB will be reviewed in 14/15 – We will develop the S75 agreement during 2014/15 – Governance: “Commissioner led” and “Provider & Patient Engagement” arrangements – Maintain strategic alignment to wider plans – Culture Change - embedded in BCF programme -supported by Home Truths evaluation – Communications and engagement will be a cross-cutting theme for all workstreams.

• Transitional Structures

– Integration Steering Group established - oversees delivery of integration plans – Supported by Programme Management Structure – Workstreams - Programme Mgt, Commissioning Development & H&SC Integration – Integration Working Group will continue co-design of care co-ordination and move into “delivery” phase during 2014/15

16

Health and Wellbeing Board JSNA, H&WB Strategy, Integration, ITF Health Watch Work-stream 1 Establish Programme Management Office (PMO) Integration Work- streams Work-stream 2 Commissioning Development Work-stream 3 H&SC Integration

NHS Ealing CCG Governing Body

Statutory Accountabilities Ealing Borough Council EHT ICO NHS Trust Board WLMH NHS Trust Board Ealing Executive - Integration Steering Group Governance and Oversight of Integration Integration Working Group (NHS Ealing CCG, LBE, WLMHT, Health Watch, Voluntary Sector) Making Integration Happen Health & Social Care BCF Joint Management Team

Governance arrangements for 2014-15

• Section 75 will be in Place - The BCF financial model is balanced to offer a sustainable vehicle

to support us in shifting the pattern of activity and spend across the whole system over time.

• Our financial model reflects our ambitions and approach to risk:

– a balance of up-front investment (invest to save) supported by a re-investment of benefits realised from cost avoidance projects. – Rigorous Financial Risk Management – As a response to the growing demand for services and difficult economic conditions. – Developing contingency plans to manage Financial and Performance related risks

• BCF plans are “front loaded” to maximise delivery potential and reduce risks.
• During 14/15 measures will be subject to regular review. We will focus on:

– Management of the impact in the acute sector – The protection of social care – Embedding care coordination – Sustaining our improved performance on DTOC, and reducing avoidable admissions – Expanding 7 day working – Accelerating data sharing

How will the pooled fund be managed?

BCF Spending in 14/15 £18,683,000 BCF Spending in 15/16 £24,844,000

• Some funding is being released to invest in new BCF

schemes and the vast majority is currently already encumbered

• Further budgets identified to align between Health and

Social Care as potential budgets to pool in 15/16 or 16/17

BCF Funding

BCF Strategic Themes BCF Transformational Change - What we will do to make a difference

Care Coordination

• Alignment of health and social care teams around Geographical Networks (facilitate a more proactive rather than

reactive model of care)

• Health & Social Care Co-ordinators working in Networks
• Working with the Voluntary Sector – Care and System Navigation
• Single Point of Access – for Professionals and for Users and Carers
• Self-care – users and carers empowered & supported

Clinical Leadership & Governance

• Named GP for top 2% most complex and everyone over 75 years
• Named Lead Professional for Care Co-ordination of the most complex people and their carers and family
• Robust governance structures in place to support a strengthened HWBB, joint finance and integrated

commissioning and service delivery models Commissioning & Procurement & Co- design of Community Based Services

• Joint governance arrangements between CCG & LBE to oversee commissioning, performance and risk mitigation
• Exploring opportunities to joint commission services and pool budgets
• Work with providers and all key stakeholders in co-designing services
• Managing the procurement “roadmap” and its links to Shaping a Healthier Future (SaHF), Out of Hospital Strategy,

Commissioning Intentions Conditions of BCF

• Ensuring the conditions of the Better Care Fund are met for example
• 7-day working; better data sharing; joint assessments; joint agreement on plans; impact on acute services

Contingency & Risk management

• The new governance arrangements will be underpinned by robust contingency and risk management framework.
• This will ensure financial risks relating to the model of investment in the pooled fund are managed and that

performance related funding risks are mitigated. Customer and Patient Experience

• Patient and customer quality assurance programmes e.g. ‘Home Truths’ initiative on culture, relationship building

and enabling Care Setting appropriate for Patients’ Needs

• A greater focus on shifting the settings of care and support to the community
• Appropriate admissions to residential care homes
• Investment in supported discharge and rehabilitation to reduce Delayed Discharges
• Widening Enablement & Reablement approaches
• More focus on admission avoidance

Strategic themes – High level summary The 7C’s of BCF Transformation

Workstream Project Objectives/ Scope 14-15 BCF Spend 15-16 BCF Spend H&SC Integration Health and Social Care Integration:

• BCF 1.1: Health and Social Care Integration of

Preventative and Front Line Services  Care coordination principles, risk stratification, commission CLICCSs, provider network alignment  Estates - hub development  Points of contact - scope specification for new single points of contact £385,000 £888,000 H&SC Integration NHS numbers, IT & IG Governance

• BCF 1.2: Improve Data Sharing through NHS Number

 Transfer NHS numbers into FWI and develop

• n going data capture mechanisms

 Information Governance Protocols for Data Sharing  Support Hub Development  On Line referral tools £50,000

Summary of key schemes (BCF1) Care Coordination

Workstream Project Objectives/ Scope 14-15 BCF Spend 15-16 BCF Spend

Programme Management BCF Programme Management, Transitional Structures & Communications Plan

• BCF 2.1: Joint management team established to support delivery
• f jointly agreed plans

 Co-location 14/15  PMO established, Workstream and Project Leads established  Reporting/meeting forward plan established  Manage BCF Contingencies £2m £2,080,000 Programme Management Governance for HWBB and S75

• Governance review of HWBB and Develop S75 agreements

 Scope options for HWBB governance - implement recommendations via Full Council /CCG equivalent  Draft Section 75 Agreement for pooled fund in 15/16 £50,000 Commissioning Development Early Adopter - Capitation Project

• BCF 2.2: Feb - March - Business Case Development.

 April 14 onwards Deliver Accelerated Learning Project for Capitation approaches for over 75s with 1 or more long term conditions and top 2% TBD H&SC Integration Culture Change

• BCF 2.3: Culture Change work via Home Truths

£135,000

Summary of key schemes (BCF2) Clinical Leadership and Governance

Workstream Project Objectives/ Scope 14-15 BCF Spend 15-16 BCF Spend

Commissioning Development Monitor QIP projects and benefits realisation.

• BCF 3.1 : Review of unplanned service provision

 GP Nursing Home  PR  Intermediate Care £5,710,000 £5,795,000 Commissioning Development Review of Aligned Budgets

• Joint Commissioning Task and Finish Group - Scoping aligned budgets for

future pooling £0 £0 Commissioning Development Develop BCF proposals aligned JSNA for Drug and Alcohol

• Proposals to be developed to support JSNA plans for Drug and Alcohol - to

support reduction in unplanned emergency care for this population group £0 £0 Commissioning Development Develop BCF proposals aligned JSNA for Mental Health

• May need to develop a specific project for MH over an above Care

coordination - e.g. Psychiatric Liaison.  Link to WLMHT Early Adopter Work £0 £0 Commissioning Development Dementia Pathway Development • BCF 3.2.1 Dementia Care Pathway  Support improvements integrated working, admission avoidance, diagnosis, care and support, dementia care bed categories £125,000 £250,000 Commissioning Development Housing Related Support Development

• BCF 3.2.2 Housing related support services and improving access to

appropriate housing options to facilitate discharge  Procurement of additional Housing Related Support services for either Older People or people with complex needs  Housing Liaison Officer to support discharge £0 £250,000 Commissioning Development NHS personal Budgets

• BCF 3.2.3 Develop and roll out NHS Personal Budgets

 Develop the offer, MOU and business process for support planning, funding and review £50,000 TBC Commissioning Development Reablement and Homecare Capacity

• BCF 3.2.4 Invest in additional Reablement and home care services to support

demographic growth, reduce DTOCs, and deliver BCF performance indicators £0 £3,500,000 Commissioning Development Rehab Beds& Supported Discharge

• BCF 3.2.5 Retender of rehab beds
• BCF 3.2.7 Supported Discharge and Rehab (non-bedded)

£1,675,000 £2,350,000 Commissioning Development Third Sector Co-Design and Procurement

• BCF 3.2.6: Third Sector Commissioning

 Co-design during 14/14 to develop appropriate business model/specification for voluntary sector grants.  Procurement plan for new services to go live in April 15 £1,929,000 £2,279,000 Commissioning Development Carers Services (TBD))

• Specific services for carers under consideration

£0 Commissioning Development Self Care ( TBD))

• BCF 3.2.8 Support systems to enable self-management/care

£113,000 £225,000 Commissioning Development WLA review of accommodation based support

• Strategic review of residential, nursing and supported living provision across

West London Sub Region - market management for future needs £0 £0 Commissioning Development Extend WLA Approved List for 55+ Residential and Nursing Homes

• Re-open existing approved list to expand capacity at agreed ceiling rates

£0 £0 Commissioning Development Joint Operational Commissioning Protocols

• Scope opportunities to create single buying team for Health and Social Care.

£0 £0

Summary of key schemes (BCF3) Commissioning , Procurement and Co-design

Workstream Project Objectives/ Scope 14-15 BCF Spend 15-16 BCF Spend

Programme Management Admissions to Residential Care

• Monitor and report on BCF performance

target £0 £0 Programme Management Reablement

• Monitor and report on BCF performance

target £0 £0 Programme Management Delayed Transfers of Care (DTOCs)

• Monitor and report on BCF performance

target £0 £0 Programme Management Emergency Admissions

• Monitor and report on BCF performance

target £0 £0 Programme Management Care Planning

• Monitor and report on BCF performance

target £0 £0 Programme Management Customer, User and Patient Experience (New)

• Monitor and report on BCF performance

target £0 £0 Programme Management Customer /User Experience (ASCOF)

• Monitor and report on BCF performance

target £0 £0 H&SC Integration 7 day working in Social Care

• BCF 4.1. Increase 7-day services in health

and social care £0 £743,000 H&SC Integration NHS Out of Hours Services

• NHS out of hours care under consideration

Programme Management Jointly agreed financial plan for NHS Transfer and DFG for 15/16

• BCF 4.2: Additional NHS transfer agreed as

minimum requirement to protect social care services

• BCF 3.2.9 Deliver Social Care Capital Projects

£6,431,000 £7,414,000 Programme Management Social Care Bill Implementation

• BCF 4.3 Statutory Requirements protected -

Organisations have capacity to respond to changing statutory requirements £0 £1,000,000

Summary of key schemes (BCF 4) Conditions of BCF

Workstream Project Objectives/ Scope 14-15 BCF Spend 15-16 BCF Spend

Commissioning Development Joint Quality Assurance Framework (BCF funded in 15/16)

• BCF 6.1: Develop joint contract and quality

assurance framework for patients and service users  Local Account Group Established,  Framework for QA agreed for community based and accommodation based support,  Regular mapping back to CQC inspection and safeguarding issues  Commission Customer care questionnaires/surveys/provider reviews. £0 £100,000

Summary of key schemes (BCF 6) Customer & Patient Experience

Local Indicator – Care Plans National Indicators

1 Comprehensive Care Planning for

the elderly population, building on the success of the ICP Residential Care Admissions – Maintain performance in top quartile with 14/15 target of 307 ( 120 admissions)

2 Care Planning baseline: 2450 elderly

patients in Ealing will have a completed care plan by March 2014. Reablement – maintain effectiveness measure of 93%, but increase numbers of people receiving reablement following discharge to 300 (from 240)

3 The target for care plans is 20%

increase in the total number of comprehensive care plans to 3776 patients by March 2015. DTOCs – target 2.5% reduction in days delayed from 12/13 baseline (to achieve average of 721 average days delayed per month)

4 This measure will be reported

quarterly , and more regularly as reporting systems mature. Avoidable Admissions – in line with CCG operating plan, achieve 1% reduction in admissions in 14/15 (based on LA population)

Key Performance Measures

Progress to date: Key messages heard:

• Health & Wellbeing Board includes patient

representatives, voluntary sector and Healthwatch.

• Steering Group includes Healthwatch & Voluntary

Sector

• Working Group includes Healthwatch and Voluntary

Sector

• Event held with the Voluntary Sector on 10th December
• Older People’s Partnership Board – 28th January
• Event for Patients & Voluntary Sector on 29th January
• Event with Providers on 30th January
• Health & Wellbeing Board – Approved 1st Draft BCF 11th

February

• Healthwatch Public Event – 14th March
• Other Events are being Planned
• Strong desire by all stakeholders to be involved in

the co-design and co-production of services

• Use patient experience in co-designing services
• Voluntary sector keen to have more delegated

functions to undertake preventative Case Management & to work in localities with MDTs

• Acknowledged a need to improve joined up working

across voluntary sector & to reduce barriers

• Keen for service specifications to focus on people not
• n silo organisational models
• Spending should be on service delivery that will have

the greatest impact

• Share information about what is happening
• Need to ensure that we are realistic about

expectations

• Work out priorities together
• Develop new skills and invest in Networks
• “Approach Problems as a Challenge”
• Care Coordination and Clinical Leadership seen by all

stakeholders as the 2 strategic themes with the largest potential impact.

PPI & Stakeholder involvement ( H&WB) Consultation and engagement to date

• Our H&WBB Governance arrangements will be underpinned by robust contingency and risk management framework.
• BCF Programme Risk Register - will capture key risks and ensure appropriate mitigation plans in place.
• During 2014/15 we will focus in particular on managing the following risks:
• Financial Risks

– We will undertake detailed appraisal and joint risk assessment of the joint financing arrangements proposed, including

• pportunities to pool budgets over and above the BCF minimum requirements.

– Financial Modelling - will take account of the Councils medium term financial strategies and NHS QIPP targets, the whole system impact of transformation, the costs of delivering change & the increasing demand on services – Financial contingencies will be identified and managed in line with BCF’s performance related funding regime

• Performance Risks

– Proactive management action to achieve the national outcomes and deliver the KPIs associated with the BCF – Ensuring there is capacity within respective organisations to manage and oversee the transformation programme in a sustainable way, while continuing to deliver core services and meet our statutory duties.

• Statutory Risks

– Health and Social Care Integration – we recognise that the statutory frameworks within which the CCG and the Council are required to determine the extent of their obligations and powers towards individuals are not the same. – These differences need to be reflected in the governance arrangements for any joint undertakings between the Council and NHS bodies whether or not pooled budgets form part of those arrangements.

Contingency and Risk Management (BCF5)

FINANCE SUMMARY

£390.0 £410.0 £430.0 £450.0 £470.0 £490.0 £510.0 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 £m

'Do nothing' financial scenario

Resource income Net expenditure

• £20,000.0
• £10,000.0

£0.0 £10,000.0 £20,000.0 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 £m

Investment / QIPP programmes

Investment QIPP £390.0 £410.0 £430.0 £450.0 £470.0 £490.0 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 £m

5 yr plan with QIPP and investments

Resource income Net expenditure

'Do nothing' scenario - £m

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Resource income £414.0 £433.9 £425.1 £424.0 £420.5 £411.6 Net expenditure £407.3 £434.3 £440.0 £457.5 £478.7 £500.8

Investment / QIPP programme - £k

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Investment £4,384.0 £7,467.0 £7,050.0 £9,788.0 £9,296.0 QIPP

• £11,698.2
• £11,647.7
• £12,049.6
• £12,465.3
• £12,895.3

MTFS Plan - £m

2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Resource income £414.0 £433.9 £432.4 £443.1 £458.4 £474.2 Net expenditure £407.3 £427.0 £428.2 £438.8 £453.9 £469.6

Ealing CCG Medium Term Financial Plan