November 2015 1 Co-led strategy with SEL CCGs and NHS England - - PowerPoint PPT Presentation

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November 2015

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• Co-led strategy with SEL CCGs and NHS England

(London)

• Working in partnership with local authorities, local

providers of care and other partners

• Six priorities for improvement. These are referred to

as Clinical Leadership Groups (CLGs) and focus on:

• Community based care
• Planned care
• Urgent and emergency care
• Maternity
• Children and young people
• Cancer

Clinical Leadership Groups Majority of strategy has been designed through clinical leadership groups:

• Formed from clinicians, commissioners,

social care leads and other experts

• Include Healthwatch representatives and
• ther patient and public voices
• Each CLG has developed a number of

interventions and assessed the impacts of these

• Impacts include improved quality, better

and less variable outcomes. value for money and sustainability

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• Clinical Commissioning Board, a senior joint

forum for strategic direction and decision making

• South East London Partnership Group, a

collaborative forum for partnership working

• Clinical Executive Group, a clinical forum to

guide design work –

• Implementation Executive Group is the

Delivery focused forum to manage design and implementation activities

• Public and Patient Advisory Group is a

collective forum for the patients to contribute to shaping the strategy’s content These groups are accountable to the clinical Strategy Committee and the CCG Governing Bodies. The Governance of the programme consists of 6 core groups:

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We have a shared understanding of the challenges facing south east London. These are outlined in

• ur Case for Change.

Our health outcomes in south east London are not as good as they should be:

• Too many people live with preventable ill health or die too early
• The outcomes from care in our health services vary significantly and high quality care is not

available all the time

• We don’t treat people early enough to have the best results
• People’s experience of care is very variable and can be much better
• Patients tell us that their care is not joined up between different services
• The money to pay for the NHS is limited and need is continually increasing
• Every one of us pays for the NHS and we have a responsibility to spend this money well

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Our collective vision for the south east London: In south east London we spend £2.3billion in the NHS. Over the next five years we aim to achieve much better outcomes than we do now by:

• Supporting people to be more in control of their health and have a greater say in their own care
• Helping people to live independently and know what to do when things go wrong
• Helping communities to support one another
• Making sure primary care services are consistently excellent and with an increased focus on

prevention

• Reducing variation in healthcare outcomes and addressing inequalities by raising the standards in our

health services to match the best

• Developing joined up care so that people receive the support they need when they need it
• Delivering services that meet the same high quality standards whenever and wherever care is

provided

• Spending our money wisely, to deliver better outcomes and avoid waste

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• The strategy has been focused around communicating and working in partnership with our

stakeholders

• The strategy is clinically-led and developed, with over 300 clinicians, nurses, allied health

professionals, social care staff, commissioners and others developing ideas through the six Clinical Leadership Groups

• These Clinical Leadership Groups also include Patient and Public Voices and Healthwatch

representatives

• Additional work on the strategy has been built on, and compliments, existing local borough-level

work

• A series of deliberative events were held in June 2014, December 2014 and February 2015
• Engagement and communication is led by Clinical Commissioning Groups via the Communications

and Engagement Steering Group which has met at least monthly since May 2014

• Engagement at local level and through local channels is on-going

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Community Based Care delivered though Local Care Networks

• Transformation foundation of the strategy

by supporting people to live healthier lives in their communities

• Place people at the centre of care
• Local Care Networks will deliver Community

Based Care to local populations Maternity:

• Assessment of pregnancy risk at or before

10 weeks to assign the most appropriate midwife team from the outset

• Culture of birthing units to encourage

straightforward birth and improve the experience for low risk women

• Achieving the London Quality Standards

and supporting improvement in the quality of service, safety, outcomes and satisfaction Children and Young People:

• Primary prevention and wellness
• Children’s integrated community teams
• Short stay paediatric units
• Support transition to adult services

Urgent and emergency

• Meeting the London Quality Standards
• Meeting the National standards Facilities

specification and designation including Urgent Care Centres

• Improving access in primary care

Enhanced ED front door

• ED interface with MH: Quicker interface

with specialist MH services Cancer

• Education and Training package
• High quality acute oncology services (AOS)

across south east London through integrated IT solutions and improved emergency pathways

• Coordination of Care: during diagnosis and

treatment Planned Care:

• High Level Standards across the Planned

Care Pathway

• Enabled Network Solutions for diagnostics
• Provider collaboration to create

Orthopaedic centres of excellence for high volume specialities that drive up quality of and improve outcomes for patients

• Clinical pathway review of specific

specialities to identify opportunities and benefits for standardisation, consolidation

• r to test new models of patient care

These models are interlinked and have a number of independencies

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• Primary and community care (defined in its broadest sense) will be provided at scale by 24 local care networks
• A local care network will involve primary, community and social care colleagues working together and drawing on others from

across the health, social care and the voluntary sector to provide proactive patient centered care

• Services will be delivered in ways that respond to the varied needs and characteristics of our communities

Primary care working within LCN’s

GP Units & Community services GP Networks

Enablers supporting the transformation The Local Care Networks are the super enabler for integration of services IM&T, Commissioning Framework, Workforce, Estates

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Community Based Care delivered by Local Care Networks is the foundation of the integrated whole system model that has been developed for south east London. This diagram provides an overview of the whole system model, incorporating initiatives from all 6 Clinical Leadership Groups.

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• A framework has been developed

to help us monitor the successful delivery of the strategy

• A range of outcomes have been

identified

• These have been developed by

working with out partners

• Further work is taking place to

define the best-fit indicators and develop a baseline position Eight outcomes have been identified

• Preventing people from dying prematurely and can live longer

and healthier lives

• Reducing differences in life expectancy and healthy life

expectancy between communities

• People are independent, in control of their health, and able to

access personalised care to suit their needs

• Health and care services enable people to live a good quality of

life with their long term condition

• Treatment is effective and delivers the best results for patients

and service users

• Delivering the right care, at right place, at the right time along the

whole cycle of care

• Commitment to people having a positive experience of care
• Caring for people in a safe environment and protecting them

from avoidable harm

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• The costs of providing care are rising much faster

than inflation because the NHS is now treating more people with more complex conditions than ever before and the costs of care often grow faster than consumer inflation

• The NHS Five Year Forward View outlines a £30

billion financial challenge nationally by 2020/21

• In the absence of action, the scale of the

affordability challenge in SEL is forecast to grow to

• ver £1 billion by 2019/20
• The affordability challenge can be broken down

into component parts, including: – The elements that would traditionally sit as QIPPs and CIPs and the overlap between these. – Differences between planning assumptions that lead to a further challenge.

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The benefits from the programme can be combined with savings within individual organisations to close a substantial amount of the £1.1 billion The benefits shown are as follows:

• Programme central case (gross benefit)
• Provider efficiencies at 2.5%
• Savings are presented gross of investment

requirements (which total £90 million in the programme central case). Expected that these investment requirements will, at least in part, be satisfied through additional funding requested through the Five Year Forward View

• The resultant position is a £279 million affordability

challenge for the South East London health care economy

NB: Profiling of benefits shown above may significantly change as implementation plans are developed.

1,091 218 594 279 200 400 600 800 1,000 1,200 Affordability challenge (2019/20) Programme central case (gross benefits) Provider efficiences at 2.5% Residual challenge (2019/20) Affordability challenge (£m)

5,903 5,685 5,091 4,812 3,900 4,400 4,900 5,400 5,900 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 System wide income/expenditure (£ millions) Expenditure (Do Nothing) Expenditure (Strategy) Expenditure (Residual)

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Four areas have been identified which potentially require an option appraisal process:

• Urgent and Emergency Care (requirement to

meet the London Quality Standards and 7 Day Standards)

• Maternity services (requirement to meet the

London Quality Standards)

• Children and Young People’s services (impact
• f implementing a Short Stay Paediatric

Assessment Unit and the requirement to meet the London Quality Standards)

• Planned Care (implementing elective care

centre(s)

Achievement against the LQS

• Overall for south east London, a large number
• f standards are being met or are expected to

be met within trusts existing plans

• No single site is meeting all the LQS or 7 Day

Standards

• A number of key standards such as increased

consultant presence are not currently met by any trust in SEL

• Workforce is the main area where additional

investment is required to meet the London Quality Standards in SEL with additional consultant cover and MDT the key cost drivers

Draft in progress | 14

Aug

Define scope and potential reconfiguration requirements

Finalise inputs

Confirm Shortlist for Consultation (if required)

Develop pre-consultation business case for elective orthopaedic centres Working groups

London Quality Standards Appraisal Business case development and assurance

Four tests review (1) Four tests review (2) Clinical Senate Review Submit for NHSE assurance (Mar) Decision to proceed to consultation if required (early Jun) Governing body and trust review

CLG Implementation Implementation plan and programme reporting established

Ongoing local implementation of CLG plans Supporting activities Ongoing Communications and engagement Supporting strategies outlined Draft and finalise CLG implementation plans

Launch consultation (if required)

Final draft PCBC if required Implemtnation of plans and timelines to meet London Quality Standard – overseen by Network Groups as required London Quality Standards working groups defining plan for South East London standards alignment for Children and Young People (SSPAUs); Urgent and Emergency Care; Maternity; and Planned Care (elective orthopaedic centres) Local Care Network Delivery Community Based Care Delivery Group set-up

CBC Delivery Group planning Local Care Network models

CBC Federation / Alliances established (April) Local delivery of Big-Hitters in progress

Sept Oct Nov Dec Jan Feb March April May June