NO ITEM LEAD FORMAT PURPOSE TIME 1. Welcome and apologies for absence RT Verbal To note 10.30 2. Declarations of Interest RT Verbal To note 3. Minutes of the last meeting held on 7th March 2019 RT Enc To approve 4. Matters Arising and action log update DS Enc To note OUR TEAMS 5. Presentation from our teams on delivering improvements in care: ‘Familiar Faces’ by Joanna Manley, Network Manager, Physical Health & Rehabilitation Psychology JM Presentation To note 10.35 6. Patient Safety Faculty/Stop the Line RO’D Presentation To note 10.50 SYSTEM DEVELOPMENT 7. National & Regional Updates SE Verbal To note 11.00 8. CPFT/NCUH Organisational Form Update SE Enc To note 11.10 9. Stakeholder Engagement Update JR Verbal To note 11.20 10. Third Sector Update CE Enc To note 11.30 STRATEGY 11. Updating our Strategy in line with the NHS Long Term Plan RD Enc To approve 11.40 12. Aligning System Strategies 1. Cumbria Health & Wellbeing Strategy 2. Population Health Update CC Enc Verbal 11.50 DELIVERY 13. Annual Plan Delivery 2019/20 RD Enc To note 12.00 14. People Plan JT Enc To note 12.10 15. Quality Metrics AS Verbal To note 12.20 16. MH/CAMHS/LD Update SE Verbal To note 12.30 OTHER ISSUES 17. Questions from members of the public relating to the agenda items GT Verbal For discussion 12.30 18. Any Other Urgent Business System Leadership Board – Meeting in Public – Agendav2 Thursday 2 May 2019 at 10.30 – 12.30 Venue: LEP Conference Centre, Redhills, Penrith, CA11 0DT
Transcript
NO ITEM LEAD FORMAT PURPOSE TIME
1. Welcome and apologies for absence RT Verbal To note 10.30
2. Declarations of Interest RT Verbal To note
3. Minutes of the last meeting held on 7th March 2019
RT Enc To approve
4. Matters Arising and action log update DS Enc To note
OUR TEAMS
5. Presentation from our teams on delivering improvements in care: ‘Familiar Faces’ by Joanna Manley, Network Manager, Physical Health & Rehabilitation Psychology
JM Presentation To note 10.35
6. Patient Safety Faculty/Stop the Line RO’D Presentation To note 10.50
SYSTEM DEVELOPMENT
7. National & Regional Updates SE Verbal To note 11.00
8. CPFT/NCUH Organisational Form Update SE Enc To note 11.10
9. Stakeholder Engagement Update JR Verbal To note 11.20
10. Third Sector Update CE Enc To note 11.30
STRATEGY
11. Updating our Strategy in line with the NHS Long Term Plan
RD Enc To approve 11.40
12. Aligning System Strategies 1. Cumbria Health & Wellbeing Strategy2. Population Health Update
CC Enc Verbal
11.50
DELIVERY
13. Annual Plan Delivery 2019/20 RD Enc To note 12.00
14. People Plan JT Enc To note 12.10
15. Quality Metrics AS Verbal To note 12.20
16. MH/CAMHS/LD Update SE Verbal To note 12.30
OTHER ISSUES
17. Questions from members of the public relating to the agenda items
GT Verbal For discussion
12.30
18. Any Other Urgent Business
System Leadership Board – Meeting in Public – Agendav2 Thursday 2 May 2019 at 10.30 – 12.30 Venue: LEP Conference Centre, Redhills, Penrith,
CA11 0DT
19. For Information a) NHS Strategic Framework for Safeguarding (Enc)b) Cumbria Health and Well Being Board Response to NHS Legislation Survey (Enc)
FUTURE MEETINGS 2019/20: 10.30 – 12.30 4 July 5 September 7 November (No meetings in January) 5 March
Niall McGreevy (NMG) ICC GP Lead, CCG Mark Alban (MA) ICC GP Lead, CCG
*Agenda and papers to be copied to 16, 17 and [email protected]@cumbria.gov.uk
Note: Other Directors and Officers may be required to attend for specific items
In attendance: Julian Auckland Lewis, Programme Director | Ramona Duguid, Executive Director of Strategy | Alison Smith, System Chief Nurse | Judith Toland, System Director of Workforce | Mandy Nagra, System Chief Operating Officer | Vince Connolly, System Medical Director | Daniel Scheffer, Joint Company Secretary CPFT & NCUHT | Julie Clayton, Head of Communications, NCCCG | Michael Smillie, Executive Director of Finance, Digital & Estates | Charles Welbourn, Chief Finance Officer, NCCCG | Clare Edwards, Health Partnerships Officer, Cumbria CVS | Helen Horne, Healthwatch Cumbria Chair | Francesca Bee, Corporate Governance Administrator, CPFT
UNCONFIRMED MINUTES OF SYSTEM LEADERSHIP BOARD PUBLIC MEETING HELD ON 7 MARCH 2019
Members Present:
NCUH CPFT NCCCG GP Representative
CCC
Ms Gina Tiller, Chair
Prof. Robin Talbot, Chair
Mr Jon Rush, Chair
Dr Mark Alban, ICC GP Lead (NC CCG)
Mr Colin Cox, Director of Public Health
Ms Heike Horsburgh, NED
Mr John Whitehouse, Governing Body Lay Member
Dr Niall McGreevy, ICC GP Lead (NC CCG)
Ms F Musgrave, Ass Director Integration & Partnerships (CCC)
Prof. Stephen Eames, CEO Mr Peter Rooney, COO
Mr Malcolm Cook, NED
Prof. J Howarth, Deputy CEO
Ms Alison Smith, System Chief Nurse
In Attendance:
Mrs Ramona Duguid, Director of Integration (ICS)
Ms Patricia Bell, Cabinet Member for Health & Care (CCC)
Dr Helen Horton GP Lead (NCCCG)
Ms Julie Clayton, Head of Communications (NC CCG)
Mrs Harriet Mouat, Governor Support Officer (CPFT)
Apologies:
Ms Judith Toland, System Director of Workforce & OD
Ms Catherine Whalley, Assistant Director of ASC (CCC)
Mr David Rogers, AO (NCCCG)
Mr Julian Auckland-Lewis, Programme Director (NCUHT)
Agenda No.
Minute Action by
1. Welcome and Apologies for Absence Ms Tiller, Chair welcomed everyone to the public meeting of the System Leadership Board (SLB) and apologies were noted.
Ms Tiller welcomed Ms Patricia Bell, Cabinet Member for Health and Care to SLB and Dr Helen Horton, GP Lead NCCCG/presenter.
There were five members of the public in attendance
2. Declarations of Interest There were no declarations of interest.
3. Minutes of the previous public meeting held on 10 January 2019
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Minutes of the Public System Leadership Board meeting held on 10 January 2019 were approved.
4. Matters Arising and action log update Action Log SLB4 was closed as update provided in the Third Sector Report on the agenda. No further matters were raised.
OUR TEAMS
5. Presentation from our teams on delivery improvements in care: ‘How is our system changing? – advice and guidance’ was presented by Dr Helen Horton, GP Lead at North Cumbria Clinical Commissioning Group.
Helen advised that an electronic system for Advice and Guidance requests between primary and secondary care clinicians was introduced in November 2017 as part of the CQUIN for North Cumbria University Hospitals NHS Trust. This was an important development as existing communications were not reliable and this was having a negative impact on patient care. Quantitative and qualitative data has been measured as part of the project and this has shown an improved patient journey; reduction in unnecessary testing; care closer to home, appropriate referrals and increased knowledge and education for GPs has had a positive impact on other patients care as well. The system is well liked by GPs. Now that there is over a year’s worth of data it can be interrogated further to help inform educational needs for the system and the individual.
The focus has been on secondary care specialities and this has been widened into mental health and we have ‘harder to reach’ specialities still to go on. Sexual Health services from CPFT wish to go on so there are other areas and other extensions can be done.
It has improved relationships but this is just part of developing relationships between clinicians in primary and secondary care.
Gina Tiller sounds like it is a win/win system and asked if there were any disadvantages. Helen advised that were no disadvantages and had been embraced by GPs and hospital consultants, it may be useful to write this into job plans. Stephen Eames commented that there is a cultural shift to work through but it was a valuable system. Dr Mark Alban and Dr Niall McGreevy thanked Helen for her energy in bringing in this system which was easy to use and popular with GPs and has improved as she has presented. Prof Robin Talbot commented that at a recent meeting with MPs in London patient delays in testing was raised and it was good to come here today and hear there are improvements being made in this way and suggested this good news story be publicised wider.
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Fiona Musgrave asked if this was a national system and should this shouted about nationally. Helen advised that it was developed by Morecambe Bay who gave it to us and helped us set it up. Stephen advised that this is a national directive but not about how you do it. Helen thanked Paul Counter at NCUHT as this was a collaborative approach. Gina thanked Helen for a great example of what we are doing across the patch.
NATIONAL/REGIONAL/LOCAL DEVELOPMENT UPDATES
6. National and Regional Updates Stephen Eames updated SLB on the following key points.
Nationally NHS England and NHS Improvement are merging with a single leadership team driving the key strategy and long terms plans of NHS and high value is being placed on relationships with third sector; primary care networks and local government.
A Joint Task Force has been established with CCC led by Stephen and Katherine Fairclough, CE, CCC to build on what is being done already with key priorities; building on ICCs; work closely on how we commission services together; developing relationships with the third sector. The task force is a co-ordinating group to gain traction and focus on the key areas of work which officers and executive directors are progressing in accordance with respective plans. One of the benefits of being one of the Integrated Health and Care Systems is we derive national support and resources so we have a couple of small investments this month to support some of the work we are doing in the third sector and also the ‘system engine’.,.
7. CPFT/NCUHT Merger Update Stephen Eames updated SLB on the progress with the merger and the timescales. An assessment from the national and regional teams of NHS Improvement had been undertaken with positive comment received. David Blacklock asked for clarity on what was meant by support services. Stephen advised that the provider Trusts have lots of individuals and small project teams and we have historically have an infrastructure to support the success regime development, some of which is still in place, and we get some support into the CCG from NECS, bringing these all together and derive any efficiencies from that.
8. Stakeholder Engagement Update Jon Rush advised that there have been 11 events, two of which were held with the West Cumbria Forum in January and March. Lots of information goes into those meetings. A wider conversation led by Healthwatch took place about replicating these type of conversations across North Cumbria. Other events include:
Consultation about the Health & Wellbeing Strategy
V1 Page 4 of 8 File Ref: SLB
Third sector connection – Action for Health network. Following that we visited the Currock Community Centre with Clare Edwards to see how connections work in local places.
Attended local authority briefings to start getting the GP ICC Leads embedded into the local district framework
Cumbria Leaders Board is a forum which we can link into at strategic level
Building Health Partnerships
Link with MPs It was agreed we should be developing wider partnerships and especially with educational providers. Over the next 12 months we need to change how our ICC Leads link in at the ICC level. Ramona Duguid commented that she has had discussions with Colin Cox and Fiona Musgrave about how the public health alliance work around local health and wellbeing forums link with the ICCs, which will be vitally important as we progress with the community placed based approach. Colin Cox commented that there are so many different strands coming together in one framework in a positive way which is significant. Prof Robin Talbot commented that he was keen to support improved engagement and wanted to ensure inclusion of the Governors Council role at CPFT and their role in engagement with members and the public. Jon agreed and responded that there was Governor representation at the last WCCF where this was highlighted. Patricia Bell commented that she had attending a recent clinical and political health leaders’ summit in London where the theme was partnership working and the key message from that was, it is key to bring together local partnerships to build confidence and have quick successes so that people can then have room in their minds for the wider strategic partnerships. Empowering people locally to do what they want to do in their local area and mapping it. Niall McGreevy, GP ICC Lead assured the Board that the Health & Wellbeing fora coincides with Local Authority groups have almost coalesced with the ICC leadership groups. The ICCs are planning events which includes Local Councillors. John Howarth commented that the reason for all of this is to improve the health of the local population and communities can help with this. Stephen Eames commented that this allows all of us at our different levels and engagement face to face where things are happening and endorsed the approach that Jon is taking.
Strategy
9. 9.3 Update on Cumbria Health and Wellbeing Strategy
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Colin Cox gave an update on this item first as would make more sense for the other 2 items. Given the stakeholder feedback received the four major themes will stay as they were in the consultation but the detail priorities are likely to change. The 4 major themes are: health protection; health and care service inspirations; improving health and wellbeing across the life course; and tackling the wider social, economic and environmental determinants of health and wellbeing. The Health & Wellbeing Board will be considering this along with the Joint Public Health Strategy and the Population Health Framework. John Howarth just wishes to emphasise that all four components are important. This for doctors is a new world away from their training focus into what keeps us healthy which includes all the different determinants. 9.1 Cumbria Joint Public Health Strategy Colin advised that this strategy is focused on the fourth strand of the health and wellbeing strategy (tackling the wider social, economic and environmental determinants). It was commissioned by the Cumbria Leadership Board and has been developed in a partnership approach across the County. We talk about ‘assets’ throughout the strategy and the ambition is to grow all the assets. The NHS has a significant role to play in this strategy, particularly its infrastructure, meaningful employment and trainer, working with the third sector is critical and the prosperity of the community. Colin suggested that the Board endorse this strategy at system level rather than take it to each individual organisational Board for endorsement. Stephen Eames commented that this is an essential building block and should be endorsed by this Board but it should also be formally endorsed by the individual Boards. Prof. Robin Talbot was keen to support this strategy and to progress the operationally and asked how we can support the timelines and activities to progress this. Colin agreed that operationalising this will be challenging and needs to be done at multiple levels. John Howarth commented that he strongly supported this strategy. 9.2 Population Health Framework progress update Colin advised that this framework describes the strategies can be taken forward. It focuses on the life course of the population in Cumbria. ACTION SLB5: Update to be provided at a future meeting John Howarth agreed it would be operationally challenging and that the five highest impacts should be brought into the ICC Steering Groups.
CC
V1 Page 6 of 8 File Ref: SLB
Stephen Eames commented that how do we make this meaningful to our local communities? Stephen suggested the Board set themselves a challenge that we have the specific big public campaigns and local developments targeting the gaps we need to close. Julie Clayton provided a practical example of what strategy means at a grassroots level; the stroke prevention coproduction projects in Copeland includes about twenty organisations and the challenge will be how we resource and support all these projects. Gina Tiller commented that these conversations are being had across the country.
Delivery
10. Transformation Delivery Update Ramona Duguid highlighted five update areas in the report. The maternity patient feedback is 98% is something to be proud of. This report will change and will have more of an outcome focus linking to the system work, and making the developments more visible.
11. Update on MH/CAMHS/LD Stephen Eames reported that there is NCUH & CPFT board agreement for the full business case that Northumberland Tyne and Wear NHS FT provide the mental health services in the north which is expected to go live in October 2019. In the south there were some issues about capacity and capability to stop that change happening. NHS England and MB CCG are reviewing that position and expect the outcome in next two weeks. In north Cumbria we will have a new provider and they need to part of the SLB. The Chair and CE will hopefully join us at our next meeting in May. David Blacklock commented that it will be reassuring for patients to hear what the new provider will bring. Prof. Robin Talbot met with the Chair yesterday and he is keen to come over to understand Cumbria and to meet staff. Jon Rush left the meeting
12. Third Sector Programme Update Clare Edwards provided a report with the papers and highlighted the following areas:
Capacity and resource to be reviewed and led by Ramona Duguid.
ICC third sector representatives – only 1 vacancy left and these additional resources will add value.
ICC referrals to and from third sector – there is a draft template and process and approval is being sought later today from the ICC Steering Group with a pilot in Carlisle and Copeland ICCs for 2 months.
ICC hub environment – we have secured £60k from NHS England for the proposed pilot for ICC Hub based third sector referral co-ordinators working on social prescribing, and with the support of CPFT, three pilots in Cockermouth, Maryport and Eden will start early in the new financial year.
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Stephen Eames commented that the pilots are to define the model and the intention is to roll them out across all the ICCs. Clare also highlighted the collaborative case study on the LeDeR programme in North Cumbria. Gina Tiller commented that this was a very sobering case study. Gina asked about if the Information Governance issues had been resolved. Clare advised that the funded posts of the ICC Hub referral coordinators will resolve this issue but this is a test bed.
Governance
13. Questions from the public relating to the agenda items Les Blacklock, CPFT Staff Governor Allerdale and Copeland asked Colin Cox if he agreed that the Health & Wellbeing Strategy applies to NHS staff, in the context of the uncertainty in mental health services, do you believe this could serious effect the staff. Colin advised that uncertainty is a challenge in any organisation and the question how well is change managed. Les also asked a question of Stephen Eames about the Mental Health Stakeholders group seems to have stopped. Stephen advised that there has been a break. Stephen commented on the issue of health and wellbeing of staff raised and reiterated that the halt in the transfer of services in the south is due to the Board listening to the concerns of staff and we hope we can be clear very soon. Prof. Robin Talbot confirmed that the last stakeholder group was cancelled and it will be timely to have a meeting once we know the decisions to be made in south. Neil Hughes arrived for this item and missed the earlier discussions. Neil asked about genuine affordable housing and what part this plays in the development of the system. Gina Tiller advised that Colin Cox mentioned this in his items and asked Colin to respond. Colin advised that there is a recognition that this is a critical part of the system and is referred to in the Public Health Strategy, improving access to quality affordable housing, tackling homelessness and a number of other strands. We have also referred to the need to build relationships with the district councils which is improving.
14. Any Other Business None Raised.
Closing comments: Ms Tiller highlighted the two items for information on the Better Care Fund and Brexit included in the pack.
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Gina thanked everyone for attending and how much she has enjoyed chairing this meeting. She hoped everyone would go on and turn this into a real health and care system. It has been a privilege to have the last 5 years in Cumbria. Prof. Robin Talbot thanked Gina for what she has achieved at NCUHT and in bringing people and organisations together to achieve what we have so far. Date, time and venue of next meeting (LEP Conference Centre, Redhills, Penrith) 2 May 2019, 10.30 – 12.00
What has changed?Familiar Faces is a new service for North Cumbria developed to address the needs of patients often termed ‘Frequent Attenders’. • These patients are complex , • Use a disproportionate amount of health and care resources, often with
little clinical benefit • Can be at the detriment of their health, and well-being, due to the
overuse of unnecessary investigations and procedures. • National data and our learning shows:
– Psychological needs, including trauma, presenting as somatic complaints
– Complex social needs and issues of deprivation– Isolation and relationship breakdown or loss– Poorly managed long term conditions– Fragmented relationships with health care
The traditional medical model of care is spectacularly inadequate when dealing with frequent attenders:
• needless referrals, investigations
• spurious labels and diagnoses.
• psychoactive drugs are often prescribed.
The only certainty is that investigation, referral, and labels make frequent attenders worse not better.
But we know they benefit from consistent management by a skilled team, through a clinical care plan shared across the health system
– psychological care from experienced staff, embedded in the primary care team
– appropriate social and community support
What have we measured?Activity April 2018 – March 2019
GP A&E
Emergency
Admissions
Hospital
stays Elective OP
Ambulance
to A&E
TOTAL
Contacts
Baseline 8784 1004 378 1576 74 711 680 15282
Target 5621 678 257 1063 45 489 460 10740
Achieved 5584 485 187 972 57 514 309 8971
Total
Reduction-3200 -519 -191 -604 -17 -197 -371 -6311
%
Reduction -36% -52% -51% -38% -23% -28% -55% -41%
Patient Complexity and Clinical Outcomes
Example: Familiar Faces patients
report a high level of psychological distress
GAD7
Mild Moderate
Mod
Severe Severe
Mild 9% 3% 0% 0%
PHQ9 Moderate 4% 4% 7% 2%
Mod Severe 1% 5% 10% 7%
Severe 0% 1% 13% 37%
System wide workingOne to one patient contact will not address the problem of frequent attenders. Instead, we need to address this as a system with:• Consistent management • Early identification• Staff with training to identify “vulnerable” patients, for
example those with ACEsFor example, in a 12 month period, adults with four or more ACEs are twice as likely to have visited their GP six or more times, twice as likely to have attended A&E and three times as likely to have experienced a hospital stay. For adults, this increased usage is evident from age 18 and continues until later life (age 70+).
• System co-ordination e.g. A & E
How has this impacted on
patients • Really good, really helpful. The clinician is really understanding
when I really have a bad day. She was so empathetic and understanding. Even my partner has noticed the massive difference in me and how better I am.
• Excellent. Hopefully benefiting long term with EMDR, feel exhausted after [sessions] and it's hard going.
• It's really good. The service has provided me some extra support and it’s a lift for me. I would recommend this service.
• Brilliant, cannot fault it. I feel very supported and have moved leaps and bounds. I have learnt so much about myself and my condition through PPSS groups and through 1:1 work.
How has this impacted on staff
Dr Chris Corrigan, GP Partner
This is a fantastic service. I have referred some of my most challenging patients whose lives have become stuck and totally dysfunctional, usually because of interplay between physical health issues and associated psychological difficulties.
The input from Familiar Faces has enabled the patients to unlock their situation and pick up their lives again to start moving forward.
This has also released GP time to meet my other demands as often the patients seen by Familiar Faces are at the extreme end of appointment demand upon our service.
• Dr Dan Berkeley, Maryport Surgery
The familiar faces project has been a good example of collaborative working across an ICC. We are able to offer a service within the practice that would normally not be available on the NHS without extremely long waits. Because the familiar faces team work alongside us we can build a good relationship with them and help our patients to do so as well. Patients have found the service very useful, and it has reduced the demand for appointments from some patients with significant psychological issues. It has also reduced admissions, with notably one patient reducing from attending A and E at least ten times a month, to no attendances following familiar faces support.
The Familiar Faces service is embedded in three integrated care communities across North Cumbria. Over the first 18 months of activity, the service has:
• Developed unique methods of reliably identifying the patient cohort from data across the health economy (including primary care, out of hours, emergency care, secondary care and emergency services)
• Worked closely (integrated) with primary care and engaged the system in providing a different model of care (i.e. offering suitable therapy)
• Supporting and educate the care team, across the system, to offer a consistent management model
• Initiated and led a system-wide initiative for Cumbria becoming a trauma-informed county (ACEs)
The priority for 2019/2020 is to extend the service to the remaining 5 ICCs offering equity of service and significant release of resource for the system
Where are we now? What next?
North Cumbria Patient
Safety Faculty.
Championing safe,
reliable, effective care
across our healthcare system
Dr Rod Harpin, Medical Director
Dr Ruth O’Dowd – Consultant Anaesthetist, CD Patient Safety, Surgical Care Group. Health Foundation GenerationQ Fellow
National Patient Safety Strategy (currently being consulted on by NHSI)
• Insight – how do we have a thorough clear understanding of safety issues
• Infrastructure – How does the organisation support safety
• Initiatives – Strategies to resolve issues and improve safety
Thoughts on underpinning elements
• Patient Safety Faculty to facilitate and support initiatives to address key safety issues across the system.
• Openness + transparency to promote a positive safety culture involving– Patients– Families– Public– Staff
• Overview of safety across the system to identify key themes• Facilitate directed continuous Quality Improvement initiatives and
learning to address identified safety priorities.• Utilise established infrastructure to deliver consistent messages for key
safety issues, including CLIC, simulation, Human Factors, example “Stop the Line”
• Initiatives that work across disciplines, professional groups and system-wide for example medication without harm.
• Patient Safety Faculty is not an assurance board.
Initial Vision of Patient Safety Faculty
Patient Safety Faculty.Facilitating
multidisciplinary group with Director
level chair
InsightIncident trends National safety
alertsIssues highlighted via Care Groups
Infrastructure CLIC, Simulation Faculty, Human
Factors, Quality Improvement teamAudit, Learning and
Development, Library services, Link staff
InitiativesEstablish/work with existing
groups to run key QI InitiativesEg medicine
safety, sepsis, care of dying.
Insight• Incident trends, Ulysses
development and training
• Excellence reporting• National safety alerts• Issues highlighted via
Care Groups• Patient/family Safety
feedback/suggestions
• CQC
Insight will be used to determine priority initiatives
Infrastructure
CLIC• Human Factors training• Cumbria Production system (training
QI)• Leadership for Safety and
Improvement• Engaging for Improvement
• RPIWs
Medical Education• Simulation FacultyQuality Improvement Team
Learning and Development
Library Services
Ward link nurses
AHSN
HEENE Patient Safety Faculty
Infrastructure will support teams to implement initiatives
Initiatives
Initial thoughts:
Management and Escalation of Deteriorating Patients
Learning from Deaths
NatSSIPS/LocSSIPs
Medication Without Harm
Care of patients with additional needs
Individualised care – "what do I value"
Stop the Line
Human Factors – for teams
Simulation – for clinical teams
Specific implementations driven by CAS/NPSA alerts
Faculty will facilitate and enable available infrastructure to support and prioritise learning and delivery of key initiatives.
Director led Patient Safety Faculty – senior team committed to influence to Facilitate Improvements in Patient Safety
“Patient safety starts with me –Stop the line”
Stop The Line background
• Developed by Virginia Mason Medical Institute, Seattle after a
visit to Japan’s Toyota factory
• “We were so impressed with the [Toyota] culture—the empowerment of assembly-line workers who felt completely comfortable stopping a multi-million-dollar line rather than sending a defective product to their teammate. That was so different from what we experienced in health care, which has historically been a very blaming, hierarchical culture.”
Key learning from VirginiaEmployees need to feel safe reporting a patient safety event, near miss or potential problem.
Every ‘stop the line’ moment is important no matter how big or small
No adverse consequences for staff who report the incident or who were potentially about to make a mistake
Leaders and board members need to support it – the concept means that managers must stop what they are doing to support staff to resolve the issue quickly. If this doesn’t happen, the distance between managers and staff will grow
Staff are part of the improvement process and are recognised and feedback continues to make it better
Re-launched in Cumbria
Previously launched at NCUH but focused on the Surgical division (theatres specifically) following series of Never Events, it has been relaunched across organisations
‘Stop the line’ is about addressing something urgent that needs to be immediately addressed. It is complimentary, yet different to ‘speak out safely’ or ‘Freedom to speak up’
Use of “Stop the Line” is being promoted and celebrated across our organisations.
It is part of our Quality Improvement Plan
ReferencesReferences:
NHSi – National Patient Safety Strategy Consultation December 2018
Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care.
White Paper, Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare 2017
NHSI – Just Culture Guide
Stop the line website with Video from Ruthhttps://staff.cumbria.nhs.uk/news/keeping-patients-safe-stop-line-1?reffererPageID=227
The purpose of this report is to update System Leadership Board (SLB) on the progress being
made of the organisational form transaction between North Cumbria University Hospitals NHS
Trust (NCUH) and Cumbria Partnership NHS FT (CPFT). The aim of the transaction is to form
a single NHS provider organisation in line with the North Cumbria Integrated Health & Care
System strategy.
KEY POINTS TO HIGHLIGHT
• The Strategic Case was submitted to NHS Improvement following approval by NCUH and
CPFT in December 2018;
• Strategic Case approved by NHSI by February 2019 with NCUH and CPFT receiving
confirmation to move forward into the next stage of the programme. Full Business Case
stage is now fully established;
• Check point meetings scheduled with NHSI during May,
• Full Business Case is timetabled to be considered and approved by NCUH and CPFT during
June with onward submission to NHSI;
• 6 week engagement period with staff, stakeholders and the public is ongoing
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
Development of Full Business Case including supporting statements from partners.
RECOMMENDATION
System Leadership Board is asked to note this paper for information including the request for
supporting statements from partners in June.
System Leadership Board
PUBLIC 2nd May 2019 Enc: 8
Title: Organisational Form Programme Update
Author: Daniel Scheffer, Joint Company Secretary for CPFT/NCUHT
1
Organisational Form Programme Update
2nd May 2019
1. Introduction
At the meeting held on 24th May 2018, both boards agreed that the arrangements between Cumbria Partnership NHS Foundation Trust (CPFT) and North Cumbria University Hospitals NHS Trust (NCUH) as set out within the Memorandum of Understanding (MoU) needed to progress to the next stage. As a result, it was agreed to formally explore opportunities to merge in order to form one NHS Foundation Trust. This paper is provided to the System Leadership Board to update on progress with this work. Since May 2018, a small internal programme team has been in place which has been considering and developing options, engaging with internal and external stakeholders together with providing formal updates to the Boards. The work of the programme team has been undertaken in line with Transaction guidance published by NHS Improvement (NHSI) who are the regulator with responsibility for such transactions. The Transaction guidance provides a clear framework and sets out three clear stages for approval by NHSI. The stages are: Stage 1: The development of a strategic case Stage 2: If the strategic case is approved, a Full Business Case (FBC) will be
developed by the Trusts which includes detailed plans on how the transaction will be delivered successfully;
Stage 3: Approvals – includes all the necessary regulatory and legal steps involved in completing the transaction.
The Strategic Case was considered and approved by the Board of Directors for CPFT and NCUH on the 20th December 2018 and formally submitted to NHSI on the 21st December 2018. After a full review and panel discussion, NHSI issued a letter of approval to proceed to Stage 2 of the process in February 2019. The letter of approval from NHSI did not flag any red flag issues. 2. Programme Update
The programme has continued to move forward at pace. Work streams are now all fully established and working towards content for the Full Business Case whilst delivering on implementation plans. A key part of this stage of the process is engaging with staff, stakeholders and the public about the merger, an update on this is provided in the next section.
2
The anticipated timeline for the programme is below:
In the development of the Strategic Case, partners provided statements in December 2018 supporting the proposals. CPFT and NCUH will be contacting partners during early June seeking updated supporting statements for submission of the Full Business Case to NHSI. The supporting statements seek to provide evidence of system level working and alignment of strategies. 3. Engagement Update
A six week engagement period with staff, stakeholders and the public commenced on 5th April. A survey (online & paper), animation, webpage, proactive press releases creating media coverage and staff engagement events have taken place. Opinions have also been canvassed at recruitment events together with support by Healthwatch for the survey in the community.
The main elements of the engagement period to seek views on the transaction and the potential names for the new trust. The four name options currently being considered are:
1. North Cumbria NHS Foundation Trust 2. Cumbria NHS Foundation Trust 3. Lake District NHS Foundation Trust 4. North Lake District NHS Foundation Trust
Date Milestone
Jan/Feb 2019 Feedback on Strategic Case from NHSI
Jan – May 2019
Development of Full Business Case
May 2019 Check in meetings with NHSI
June 2019 Full Business Case submitted to Boards for approval
June 2019 Submission of Full Business Case to NHSI
July 2019 NHSI transaction assurance process
Sept 2019 Approval provided by NHSI
Oct 2019 Merger Enacted
3
Examples of the graphics and messages are below:
The animation can be seen on the Trusts websites and social media platforms. To date the survey has had a good return rate, with over 1100 responses received. The internal ‘This is Us’ engagement events will continue to engage staff and hear views and encourage completion of the questionnaire. A summary of the engagement activity will be provided when the engagement period is closed.
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AGENDA ITEM: System Development 10:
THIRD SECTOR PROGRAMME REPORT - Health Partnerships Officer Report for SLB Board 02.05.2019
Additional issues identified
Subject Issue Recommendation Social Prescribing • At a national regional and local level Social Prescribing is
increasingly considered as a key part of a mature healthsystem delivering support to patients with long termconditions and supporting patient independence andactivation.
• Following recent funding for Primary Care Networks toemploy Social Prescribing Link Workers we will soon have asignificant number of Link Workers or similar working inNorth Cumbria (Living Well Coaches, Frailty Coordinators,HAWCs etc)
• Whilst this emphasis on Social Prescribing models willsupport effective referrals into third sector organisation andtheir services there is a real concern that it will putsignificant pressure on the sectors resources and capacity.
• As Social Prescribing models develop in North Cumbriaour system urgently needs to consider significantinvestment into the third sector to support the sectorto meet increased demand.
Progress in relation to paper presented at SLB 07.03.2019, 06.09.2018 , 01.11.2018 & 10.01.2019
Subject Recommendation Action to date & proposed action Capacity and resources • There is a need to map current investment by North
Cumbria Health and Care into the third sector including:o In kind resources e.g. hot desking, office space, co-
location, staff timeo Funding/grantso Contracts/SLA’so Access to national funding pots (particularly where
To be reviewed at a strategic system-wide level. Process to be led by Ramona Duguid.
Third Sector Paper SLB Board 02.05.2019
2
statutory sector partnership is key) • A review of this investment needs to take place. The review
should include: the development of a better understanding of this investment’s fit for purpose in light of ICC development and the expectations the system has on the sector to support and deliver key elements of the ICC programme
• A need to develop a strategic investment plan for the sector in relation to ICC development programme
• There is a need to develop a better understanding of how in kind support to the sector is offered and to develop more effective systems to enable the growth of this area of support
• There is a need for partners to consider additional support for the proposed CCC Public Health investment into third sector ‘Fundraising’ capacity. Current plans indicate that post holders would be expected to work across health, care and third sector partners (and funders) to coordinate and write bids for funding (specifically focusing on prevention funding that requires closer multi-sector collaboration)
• There is a need for key staff to invest time to understand the principles outlined in The Cumbria Compact* (a document supported by all partners that outlines the relationship between the public sector and the voluntary and community sector in Cumbria allowing them to work together more effectively to strengthen communities and improve people’s lives) and adhere to these in relation to issues relating to capacity and resource for the sector
*Copy of Compact available (Note: Compact refresh in progress): https://cumbriacvs.org.uk/compact/the-cumbria-compact/
• A solution needs to be found to issues relating to IG and the sharing of patient information with representatives of the third sector.
• 2 x ICC Hub based Third Sector Referral Co-ordinator posts have now been advertised. Posts will be based in Eden ICC and Cockermouth & Maryport ICC. A third post will be advertised in September.
Third sector involvement in ICC structures
• To develop a system wide model for the inclusion of third sector representation at Delivery Team meetings
• All representatives have now been recruited.
Co-Production • To develop a system wide model for Co-Production processes. The model will need to have clear directions as to how to engage the third sector. This plan should include best use of third sector infrastructure bodies (e.g. Cumbria CVS, ACT and Cumbria Youth Alliance) and existing third networks (Cumbria Action for Health Network, Learning Disability Provider Forum, Children & Young People’s Voluntary Sector Reference Group, Churches Together, County Volunteering Network etc.)
• To develop a system wide model that ensures best use of outcomes from Co-Production processes. The model should include a model for the continued engagement of third sector organisations in the development planning and review of services developed as a result of Co-Production processes.
• There is a need to consider how to effectively resource Co-Production. This is of particular reference to patients who have significant needs and may require support to attend and engage with Co-production activity and who may in addition be benefit dependent. In addition there is value in resourcing Co-production events to take place in community buildings. This will provide opportunities to support the community building’s sustainability and introduce patients, clinical staff and residents to a wealth of community based activity much of which could support health and wellbeing and ensure positive community engagement.
ICC referrals to & from third sector
• To develop a clear system wide pathway for referrals to and from the third sector using the Hub function
• Copeland ICC and Carlisle Network ICCs are currently piloting the new third sector referral pathway
ICC multi-disciplinary meetings
• To develop a system wide model for the inclusion of third sector representation at multi-disciplinary team meetings
• Third Sector Referral Co-ordinators will be attending MDT meetings in Eden ICC and Cockermouth & Maryport ICCs. There is still no opportunity for third sector organisations to be involved in the other 6 ICCs MDT meetings
Sector offer visibility in ICC Hub environment
• To develop a proposal that will enable system wide inclusion of third sector expertise in each ICC Hub.
See above Information Governance
Third Sector Paper SLB Board 02.05.2019
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Collaborative Case Study 3 An opportunity to show case examples of good practice where health professionals and staff from third sector organisations are working effectively to produce positive outcomes for patients and carers and where the health system or individual health professionals identify opportunities to work more effectively and efficiently. The Lighthouse Project The Lighthouse is a calm, safe and comfortable place for people in Carlisle and Eden to visit when they are experiencing a mental health crisis, feeling unsafe or finding it hard to cope. The project is open 6pm to 11pm 365 day per year, when most other services are closed. It is based in the centre of Carlisle.
The Lighthouse offer individuals an opportunity to meet with a crisis support workers providing time to be listened to or to explore ways to feel safe and strategies to help individuals cope with their crisis. Some people simply use The Lighthouse as a calm and safe place to have some time out, a sanctuary while the feelings pass. Others find support through talking to people in a similar situation as them. Many people visit The Lighthouse once, or a small number of times until their crisis has passed. Others use the service for a longer period of time, for out-of-hours support with serious mental health problems or because their lives are very difficult.
Visits to The Lighthouse are by appointment only. Individuals who feel they are in crisis and would like to visit the project can refer themselves. Over the last 12 months the Lighthouse project received over 2500 contacts.
The Lighthouse works in a very collaborative style with staff from Cumbria Police, CPFT, CMHRT and NWAS. Staff from all agencies work together to ensure that individuals experiencing a mental health crisis do not experience increased distress as a result of inappropriate admissions to health services and/or police cells.
The project receives a patchwork of funding on an annual basis from a variety of sources including North Cumbria CCG and CPFT. Funding for 2019/20 has yet to be confirmed.
The project has achieved savings both monetary and staff time for Cumbria Police, NWAS, and CPFT. They are also aware that individuals use the service rather than using Adult Social Care’s SPA and out of hours duty officer.
Third Sector Paper SLB Board 02.05.2019
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Other activity of note Q4 2018/19:
Other activity • Health Partnerships Officer has worked positively with CCG Communications and Engagement Team on the following issues: Building Health Partnerships Project Copeland – stroke prevention
• Health Partnerships Officer has met with Helen McGahon Associate Director of AHPs to discuss how our two sectors can work more effectively together Survey to be undertaken to map existing partnership working
• Health Partnerships Officer now engaged with Workforce Planning Group • Health Partnership Officer key member of team who organised our ICS first Social Prescribing Workshop • Providing ongoing learning opportunities for the third sector in relation to health and care initiatives and ICCs through
Cumbria Action for Health Network events including: mental health review information & updates, population health & ICC updates.
• Providing ongoing learning opportunities for the third sector in relation to health and care initiatives and ICCs through Cumbria Action for Health Network Bulletin
• Providing one to one support and information to over 21 third sector organisations in relation to ICCs and other health related matters (January to March)
Third Sector Paper SLB Board 02.05.2019
1
PURPOSE
In January 2019, the Long Term Plan for the NHS was published. The North Cumbria Integrated Health and Care System now needs to update and refresh its local strategy on the back of the NHS Long Term Plan. Over the last three months we have been developing our strategic aims and core narrative to support specific engagement with patients, communities and staff over the next three months. Attached at Appendix 1 is the proposed narrative for endorsement by the System Leadership Board with a short summary version attached at Appendix 2.
KEY POINTS TO HIGHLIGHT
The Pre Consultation Business case for West, North and East Cumbria (2016) and theSustainability and Transformation Plan, 2016 (STP) are the two current strategicdocuments which set out the strategic direction of travel for services across NorthCumbria. These documents also set out the broad drivers of change in relation to futuredemand for services, improving quality, addressing the workforce gaps and resolving thehistoric financial deficit across the health system. Irrespective of the national position withthe NHS Long Term Plan (LTP) it is timely for our strategy to be refreshed, including theposition on activity, workforce and financial assumptions across the system.
The system is engaged in the national work to develop the NHS Long Term Planimplementation framework, which will be published in the spring. As part of the work torefresh and update our strategy locally we have already started to map across the corecommitments as well as the engagement work we are required to undertake locally inorder to have an updated local plan published by the Autumn.
We have developed an engagement document/narrative which we will be using as thebasis for specific engagement over the next 3 months. An engagement timeline anddetailed plan has also been developed, some activities have already commenced.
Healthwatch have been commissioned nationally to undertake engagement which hascommenced locally and we are working together to deliver this locally.
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
Work to develop the specific content, including the activity and financial refresh will now bea key area of focus with the relevant director and clinical leads.
Work with partners, in particular the Health and Wellbeing Board to take a collective viewon the various strategies and plans which are now in place has been discussed. Thisincludes how they interrelate, and importantly show demonstrable progress on a numberof core outcomes that we need to improve on. This will be discussed further with Healthand Wellbeing Board members in June 2019.
RECOMMENDATION
SLB to endorse the engagement narrative attached at Appendix 1 and 2.
System Leadership Board
PUBLIC Date: 2 May 2019 Enc: 11
Title: Updating our Strategy in line with the NHS Long Term Plan
Author: Ramona Duguid, Executive Director of Strategy
CARE
NORTH CUMBRIA
Developing our strategy For the next five years 2019-2024
Engagement Document Building Integrated Care: Happier, healthier communities
Shaping our plans for the futureOur NHS is constantly changing to meet the growing needs of our community and the increasing demand for services.
In January 2019, the NHS published its ‘Long Term Plan’ setting out how the NHS will meet the challenges it faces. This plan recognises that we need to change and do things differently because:
More people are living longer with a number of long term conditions, such as diabetes, heart disease and dementia – so we need to join up how we co-ordinate and deliver health and care.
The demand for urgent and emergency care is increasing – so we need to be better at identifying the things that affect your health and wellbeing much earlier to prevent you becoming more unwell. There is variation in health outcomes and experiences for our patients – so we need to close the gaps across communities where there are health inequalities.
We need to make better use of new technologies – so we can change the way we access and deliver care, particularly given our rural geography.
We need to improve the experience of our staff and the culture in which they work so we can recruit more staff and develop fulfilling new roles.
We have limited resources and we need to spend this wisely – so we need to reduce duplication and provide care in the right place, in the right way at the right time.
Here in North Cumbria our health and care providers and commissioners are working in partnership with the third sector and our community to develop an integrated care system. This means that instead of working just within our individual organisations, we are working together and collaborating across all parts of the health and care system to improve outcomes for our local population.
We want to hear your views on some of the plans we have for working together to build happier, healthier communities.
Our Vision – where do we want to be?
We want to build a new integrated health and care system together, using our collective capabilities for a healthier and happier population.
Building Integrated Care: Happier, healthier communities
Happier, healthier communities2 |
What does this mean for patients and carers?
We’ll help you to stay well and when you need us we will ensure you get the right care, in the right place at the right time when you need us.
We will help you to be more involved in managing your own health conditions. We will get better at sharing information so you don’t have to tell your story many times. We know ‘There’s No Place Like Home’. So health and care will work together to ensure you only have to go into hospital if absolutely necessary. You will be able to access advice from specialists and their teams more easily – this will include better use of technology, where appropriate.
We will listen to you and value your time so we can ensure you are at the heart of all we do and have a good patient experience.
What does this mean for our staff?We want to be a great place to work and develop
You will feel valued and empowered – as an individual and as a team.
Our shared values of - Kindness, Respect, Ambition, and Collaboration – will guide the way we work from ward to board.
You will have more opportunities to develop your skills and shape new roles to meet the multiple needs of our patients. We will build and develop services which allow our staff to provide treatment and care in a way which is manageable and rewarding. We will develop new services supporting patients with more complex conditions. We will help you to keep the patient at the heart of your care by making it easier to share information with other teams and organisations. We will listen and respond to your ideas and concerns in order to build a culture which is safe, open and forward thinking.
Building Integrated Care: Happier, healthier communities
KINDNESS RESPECT AMBITION COLLABORATION
Happier, healthier communities | 3
What does this mean for our communities?We want our population to have the best start in life, live well and age well.
We will involve our community in shaping and improving services through co-production. By working together we will make the most of our shared commitment, expertise, energy and ideas. We want our communities to have confidence that we recognise the challenges we face – and that we will tackle them together. We will become a centre of excellence for planning and delivering services in rural, remote and dispersed communities, linking to the University of Central Lancashire’s (UCLAN) national centre for remote and rural medicine. We will tackle the significant challenges affecting the health and wellbeing of our urban and rural communities - focusing on those areas of greatest need. We will build trust and optimism in our approaches to meeting demand, reducing pressure and building a better and more sustainable future together. We will support our communities to feel confident they can live well independently and can access high quality care when it is needed.
Our Six Aims – what do we want to achieve?Working together with our communities, staff and third sector over the next five years:
1. We will improve the health and care outcomes of our local communities and support people of all ages to be in control of their own health.
2. We will build health and care services around local communities through our Integrated Care Communities (ICCs).
3. We will be a great place to work and develop.
4. We will provide safe and sustainable high quality services.
5. We will integrate how health and care and other organisations work together.
6. We will live within our means and spend resources wisely.
To achieve Our Vision
We want to build a new integrated health and care system together, using our collective capabilities for a healthier and happier population.
Building Integrated Care: Happier, healthier communities
Happier, healthier communities4 |
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Improve the health and care outcomes of our local communities and support people of all ages to be in control of their own health.
• Reduce the health inequalities that exist across our communities.• Work together to address the wider determinants of health - recognising the things that affect a person’s health such as housing and income as well as lifestyle.• Support people to actively manage their own health and wellbeing on a daily basis.• Understand the issues affecting the health and wellbeing of our communities.• Work to provide fair access across our communities to improve outcomes for all, especially for major health conditions.
Things we have already achieved together include:• Developed a ‘starting well’ programme - Giving every child the best start in life - offering improved support e.g. breastfeeding, emotional wellbeing and mental health.• Improved personalised care through dedicated coaching posts (Living Well and Health and Wellbeing Coaches).• Fire and Rescue Service detecting Atrial Fibrillation, an irregular or fast heartbeat, in people’s own homes. • Training Health Walk leaders.• Identified the specific health needs of our local communities in order that we can target the provision of help and support to prevent people becoming ill.
Our focus for the future:• Improve how we use data so we can better target action to prevent people becoming ill, save lives and improve the quality of life, throughout the life course.• A unified approach to Healthy Weight for all ages.• Working together with you to address the wider determinants of health and wellbeing. • Develop social prescribing – enabling people to access appropriate local sources of support.• Introduce targeted stop smoking support.• Improve the detection and management of major health, including cancer as well as cardiovascular and respiratory illnesses.
Case Study26% of children aged 4-5, 35% of children aged 10-11 and 62% of adults in Cumbria are overweight or obese. A range of programmes to support healthy weight are planned during 2019/20. These include local activities such as volunteer-led health walks and increasing the number of breastfeeding peer support groups. We will also be improving support for obese adults. By ‘making every contact count’ we will positively promote healthy weight through the 1000s of conversations that take place every day.
Case Study20% of strokes are caused by Atrial Fibrillation (AF) - an irregular or fast heartbeat. To identify people who might have AF the Cumbria Fire & Rescue Service now carry out AF screening during their fire and safety home visits to the over 65s. Using a mobile screening device people who have a positive result for AF are referred to their local Integrated Care Community (ICC) and invited to visit their GP to discuss appropriate treatment options, potentially reducing their chances of having a stroke in the future.
Our Aim:Building Integrated Care
Happier, healthier communities6 |
• Health and care teams working together organised into eight Integrated Care Communities (ICCs) providing more care closer to home – in the right place at the right time. • Developing and supporting primary and community care services within each Integrated Care Community. • Begin to actively identify people at risk of becoming ill and support them to stay well.• Develop mental health services within our Integrated Care Communities. • Supporting children and families to thrive in communities.
Build health and care services around our local communities.
Things we have already achieved together include:• Developed eight Integrated Care Communities to support the delivery of primary and community care closer to home, reducing the need for admission to hospital and supporting people to return home quicker. • GP records accessible online. • GP online services means people can order repeat prescriptions and book appointments more easily.• Developed new roles within the primary care team including clinical pharmacists and frailty co-ordinators.• Intravenous (IV) and blood transfusions are now available at some community hospitals.• Captured the learning from our work with the community, and developed a co-production toolkit to support more people to help shape service improvements.• Developed our working arrangements with the third sector.• Developed the ‘No Place Like Home’ initiatives – supporting out of hospital care.
Our focus for the future:• Further develop Integrated Care Communities to include mental health, muscular treatment service and children’s services. • Involve the community in developing future services, using their experience and local knowledge. • Develop pathways of care for patients that join together primary, community and secondary care, improve quality and experience. • Improve the opportunities for clinical staff across primary/community and secondary care to work and learn together.• Expand of treatments available locally.• Utilise technology to monitor people’s health at home and develop interventions and target disease areas across communities. • Utilise technology to improve access and communication with our services and help reduce our environmental footprint. • Develop information to help you take control of your own care planning through ‘No Place Like Home.’ www.northcumbriahealthandcare.nhs.uk/projects/no-place-like-home/
Case StudyOur 8 Integrated Care Communities are where health and social care professionals, GPs, the 3rd sector and the community are working together as one team to support the health and wellbeing of local people (more than 90 staff having been appointed). Each Integrated Care Community has a hub which co-ordinates care for local people. The impact has been very positive, with evidence of people avoiding unnecessary hospital admissions by being supported at home and those that do need hospital care being helped to return home more quickly. People with long term conditions are also being supported to stay well. Each Integrated Care Community provides the same core services in addition to services specific to the health and care needs of local people.
Our Aim:Building Integrated Care
Happier, healthier communities | 7
• Live our values and improve the experience of our staff. • Work in a healthy & safe culture.• Staff will feel valued and to know their contribution counts.• Empower staff to improve their job and develop new ways of working through workforce innovation and introducing digital capabilities.• Develop our staff and leaders to work and learn together in networks and across pathways of care.
Building Integrated Care
Be a great place to work and develop.
Things we have already achieved together include:• Created ‘this is us’ our staff identity and engaged on our values. • Reduced vacancies rate and reliance on locums through successful overseas recruitment and almost full recruitment of A&E consultants.• A new GP retention scheme.• Successful and innovative recruitment - ‘is this you.’ • Award winning innovative workforce models.• Training developed with University of Central Lancashire & University of Cumbria. • Cumbria Learning Improvement Collaborative (CLIC) : 16,000 attendees on courses over the last 4 years.• Undertaken Rapid Process Improvement Workshops (RPIW).
Our focus for the future:• Develop our culture and live our values. • Listen and care for our staff and provide opportunities for them to have a rewarding career.• Develop a workforce with targeted plans to ensure we have the right people and skills to meet future needs.• Develop new primary care roles such as first contact physiotherapists, physician’s associates, social prescribing link workers and community paramedics. • Develop attractive career pathways and programmes.• Focus on Talent Management & Succession Planning. • Develop more confidence in involving patients, the community and third sector in service improvement.• Create more significant opportunities for research.• Develop innovative roles which will be more attractive/rewarding.
Case StudyWe continue to run the Step into Work programme, the latest programme helped five individuals who were unemployed to get the training and experience they needed to get work as health care assistants. Further programmes are planned.
Case StudyOur Cumbria Learning and Improvement Collaborative (CLIC) works with teams across our health and care system focusing on how frontline staff can make their service more efficient and successful. Rapid Process Improvement Workshops (RPIW) involve frontline staff and patients looking at ways of improving the way teams work and patient experience. e.g. Accident & Emergency Team at the Cumberland Infirmary Carlisle identified duplications and other efficiencies saving them 600 hours a year which is now spent on patient care.
Our Aim:
Happier, healthier communities8 |
• Develop innovative ways to address workforce supply and demand in key specialities. • Develop and support primary care. • Develop strong networks and partnerships with specialist centres.• Develop our two District General Hospitals to deliver safe and sustainable acute services across our remote and rural footprint.• Improve the quality of mental health services for both adults and children.• Deliver safe personalised services joined up for children and their families.• Improve the models of care and experience for patients with Learning Disability & Autism.
Building Integrated Care
Provide safe and sustainable high quality services.
Things we have already achieved together include:• Progressing the next phases of the West Cumberland Hospital development in Whitehaven.• GP appointments are now available 7 days a week.• In Copeland patients can access appointments at the ‘Same Day Health Centre’ at West Cumberland Hospital.• Training developed with University of Central Lancashire & University of Cumbria.• Developed new workforce models (Composite Workforce).• Introduced a link between Consultants and GPs offering timely advice for patients.• Developed Short Stay Paediatric Assessment Units at both the Cumberland Infirmary and West Cumberland Hospital. • Developed midwifery led care at both Cumberland Infirmary and West Cumberland Hospital. • Developed a mental health crisis support service with Lighthouse.• Developed practical ways of involving people and the community in shaping service developments.• Joint working on emotional wellbeing and mental health of children and young people.
Our focus for the future:• Achieve a Care Quality Commission (CQC) ‘good’ rating for our hospital services.• Develop clinical networks for specialist services. • Integrate emergency care services at both district general hospitals. • Build a new Cancer Centre at Cumberland Infirmary and develop cancer services at the West Cumberland Hospital in partnership with Newcastle Hospitals NHS Foundation Trust.• Improve electronic patient records at Cumberland Infirmary and West Cumberland Hospital. • Develop an integrated stroke service and a Hyper Acute Stroke Unit.• Complete the redevelopment of West Cumberland Hospital.• Improve Mental Health Services in partnership with specialist providers. • Develop and support wider social and independent care services.
Case StudyThe composite workforce is an innovative approach to delivering care where roles and functions traditionally performed by junior and middle grade doctors are performed by a range of appropriately qualified and experienced clinicians. For example we have Advanced Clinical Practitioners (ACPs) & Physician Associates (PAs) delivering care traditionally provided by trainee doctors. The model has been commended by the Care Quality Commission (CQC) for its beneficial effect on the care we provide, and has received a national award for workforce innovation.
Our Aim:
Happier, healthier communities | 9
• Create a single integrated health care organisation for the development and delivery of quality health care services across North Cumbria.• Work closely with social care at a local and strategic level.• Work with third sector partners on the design and delivery of services.• Develop joint commissioning arrangements between health and local authority.• Develop strong networks and partnerships with other NHS organisations to deliver services.• Supporting the development of General Practice services across networks - practices working together.• Develop good relationships across North Cumbria and the North East.
Building Integrated Care
Integrate how health and care organisations work together.
Things we have already achieved together include:• Become one of the first 14 Integrated Care Systems in England.• Enabled primary care, social care & community services to work together in Integrated Care Communities.• Appointed a partnerships officer to support joined up working and build relationships between health, care and the 3rd sector.• Co-ordinated approach to improving outcomes for health and care with our partners.• Established a joint single executive team that has saved £500,000.
Our focus for the future:• Merge the Acute Hospital & Community Trusts and evolve the clinical commissioning group functions as part of a new integrated organisation.• Integrate IT services to improve patient care and staff working. • Increase joint commissioning with the County Council and develop opportunities for commissioning within the Integrated Care System. • Improve mental health services in partnership with specialist providers. • Continue to develop Integrated Care Communities as our core building blocks for primary and community services in our places across north Cumbria,• Develop closer clinical service delivery links with the North East for specialist services. • Support GP Practices to work together creating a primary care provider network. • Involving and working with our communities at every stage.• Continue to develop the input of our NHS Foundation Trust Governors across services.
Case StudyNorth Cumbria University Hospitals NHS Trust & Cumbria Partnership NHS Foundation Trust have been working closer together for the past 18 months. We are now planning to merge these two organisations. This will enable us to work as a single team to provide more joined up care. With a focus on learning and continual improvement we will raise standards, enhance efficiency and better utilise our limited resources.
Our Aim:
Happier, healthier communities10 |
• Create a single North Cumbria health economy budget.• Work together to reduce waste and become more efficient.• Commission more services collectively in order to get better value for money.• Rebalance investment to support out of hospital care and prevention.
Building Integrated Care
Live within our means and spend resources wisely.
Things we have already achieved together include:• Across the NHS in North Cumbria our overall annual deficit has reduced from approx. £80m in 2015/16 to approx. £30m in 2018/19.• At the same time invested in mental health services and Integrated Care Communities to provide community alternatives to hospital stays and worked as a system to reduce the amount of time patients stay in hospital.• Undertaken significant work to ensure cost effective use of medicines.• Reduced waste and duplication across our services.
Our focus for the future:• Reduce our corporate footprint – our bureaucracy, estate, energy and overheads by working collaboratively.• Supporting patients to access services at a local level earlier to avoid becoming acutely unwell.• Securing resources for our system by consistently meeting quality and performance targets and attracting investment funds in innovative projects.• Work with our community, third sector and other partners to make the best use of our collective capabilities• Maximising our productivity and reducing waste.
Case StudyWe have invested in new local services to support patients manage chronic pain and muscular skeletal problems. This has reduced the amount previously spent on sending patients outside of Cumbria by £2.4m.
We have supported our GPs through a Quality Incentive scheme to focus on optimising prescribed medicines to focus on better prescribing of medicines reducing costs by around £1M in 2018/19. We have also saved similar amounts by moving hospital patients on to lower cost medicines without impacting on clinical quality.
We have standardised our approach to using locums and agency staff and have reduced our medical staffing vacancy rate from 31% in 2015 to 11.2% in 2019. We now spend £6m less on locum and agency costs than we did in 2015.
Our Aim:
Happier, healthier communities | 11
Building Integrated Care: Happier, healthier communitiesThere are also surveys you may want to take part in covering:What is important to you, your health and how care is provided | Long term conditions
If you would like to become more involved, you can become a member of our Trust - have your say to help improve and shape our services as well as receiving regular updates from us including our latest news. www.cumbriapartnership.nhs.uk/the-trust/members
You can access our questionaire here:www.northcumbriahealthandcare.nhs.uk/have-your-say/
Alternatively return your completed questionnaire to: Engagement at Rosehill | 4 Wavell Drive | Carlisle | Cumbria | CA1 2SE
We want your views...On the aims we have set out and our focus for the future.
CARE
NORTH CUMBRIA
Developing our strategy For the next five years 2019-2024
Summary Engagement Document Building Integrated Care: Happier, healthier communities
Shaping our plans for the futureOur NHS is constantly changing to meet the needs of our community and the increasing demands for services. In January 2019, the NHS published its ‘Long Term Plan’, setting out how the NHS will meet the challenges it faces. We need to join up how we co-ordinate and deliver health and care to better support people who are now living longer with a number of long term conditions, such as diabetes, heart disease and dementia. We need to be better at identifying earlier the things that affect your health and wellbeing, support you to stay well, and ensure you get the right care, in the right place at the right time when you need us. We will embrace new technologies that will improve the way you access care, particularly given our rural geography and we need to make things more manageable and rewarding for our staff.
Here in North Cumbria our health and care providers and commissioners are working in partnership with the third sector and our community to develop an integrated care system. This means that instead of working just within our individual organisations, we are working together and collaborating across all parts of the health and care system to improve outcomes for our local population. We want to hear your views on some of the plans we have for working together to build happier, healthier communities.
What does this mean for patients and carers? We’ll help you to stay well and when you need to access help we will ensure you get the right care, in the right place at the right time when you need us. • We will help you to be more involved in managing your own health conditions.• We will get better at sharing information so you don’t have to tell your story many times.• We know ‘There’s No Place Like Home’. So health and care will work together to ensure you only have to go into hospital if absolutely necessary.• You will be able to access advice from specialists and their teams more easily – this might be through better use of technology.• We will listen to you and value your time so we can ensure you are at the heart of all we do.
What does this mean for our staff?We want to be a great place to work and develop.
• You will feel valued and empowered – as an individual and as a team.• Our shared values of - Kindness, Respect, Ambition, and Collaboration – will guide the way we work from board to ward.• You will have more opportunities to develop your skills and shape new roles to meet the multiple needs of our patients. We will build and develop services which allow our staff to provide treatment and care in a way which is manageable and rewarding.• We will develop new services supporting patients with more complex conditions.• We will help you to keep the patient at the heart of your care by making it easier to share information with other teams and organisations.• We will listen and respond to your ideas and concerns to build a culture which is safe, open and forward thinking.
KINDNESS RESPECT AMBITION COLLABORATION
What does this mean for our communities?• We want our population to have the best start in life, live well and age well.• We will involve our community in shaping and improving services through co-production. By working together we will make the most of our shared commitment, expertise, energy and ideas.• We want our communities to have confidence that we recognise the challenges we face – and that we will tackle them together.• We will become a centre of excellence for planning and delivering services in rural, remote and dispersed communities, linking to the University of Central Lancashire’s (UCLAN) national centre for remote and rural medicine.• We will tackle the significant challenges affecting the health and wellbeing of our urban and rural communities - focusing on those areas of greatest need. • We will build trust and optimism in our approaches to meeting demand, reducing pressure and building a better and more sustainable future together.• We will support our communities to feel confident they can live well independently and can access high quality care when it is needed.
Our Six Aims – what do we want to achieve?Working together with our communities, staff and third sector over the next five years:
Improve the health and care outcomes of our local communities and support people of all ages to be in control of their own health.
Support people to live well.Give our children the best start in life. We will make sure everyone can access information and support that will help them stay well at all points in their life.
We understand that not everyone has the same opportunities and some communities will need more support than others.
Access the right care closer to home.
Create health services around local communities and reduce duplication so we can spend money in the right places.
We will encourage members of our communities and health and care professionals to work together to help improve services.Build health and care
services around our local communities
Be a great place to work and develop.
Make Cumbria a great place to work by providing career opportunities for local people and attracting others to come and work here.
We will listen to our staff and provide opportunities for them to have a rewarding career.
Happier, healthier communities
Raise standards of care. Keep you safe and help you recover well.
When you need care and treatment we will do our best for you.
We are working in partnership with other organisations.
Merging our acute and community Trusts will help teams work together.
We will bring teams together so that they can do the best for you more easily regardless of who they work for?
Provide safe and sustainable high quality services.
Integrate how health and care and other organisations work together.
We are spending more money than we have.
We will reduce duplication so more resource is focused on caring for you.
Building Integrated Care: Happier, healthier communitiesThere are also surveys you may want to take part in covering:What is important to you, your health and how care is provided | Long term conditions
If you would like to become more involved, you can become a member of our Trust - have your say to help improve and shape our services as well as receiving regular updates from us including our latest news. www.cumbriapartnership.nhs.uk/the-trust/members
You can access our questionaire here:www.northcumbriahealthandcare.nhs.uk/have-your-say/ Alternatively return your completed questionnaire to: Engagement at Rosehill | 4 Wavell Drive | Carlisle | Cumbria | CA1 2SE
We want your views...On the aims we have set out and our focus for the future.
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PURPOSE
To present the Cumbria Joint Health and Wellbeing Strategy to the Board for endorsement.
KEY POINTS TO HIGHLIGHT
The development of a Joint Health and Wellbeing Strategy is a statutory requirement placed
on the County Council and NHS Commissioners. This document is intended to provide a high
level strategic direction of travel for the next 10 years, with initial priorities also highlighted;
these can be kept up to date more regularly as required. It is a requirement that local system
plans take account of the content of the Joint Health and Wellbeing Strategy.
The Strategy is formally a product of the Cumbria Health and Wellbeing Board, which
approved the document at its meeting on 18 April 2019.
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
Further work is being done to develop a clear monitoring framework for the strategy and this
will be presented back to the Board on completion.
The Joint Health and Wellbeing Strategy will now be used to help set the North Cumbria
Health and Care revised system strategy, currently in development.
RECOMMENDATION
The Board is asked to endorse the Cumbria Joint Health and Wellbeing Strategy.
System Leadership Board
PUBLIC 2 May 2019 Enc:
Title: Cumbria Joint Health and Wellbeing Strategy
Author: Colin Cox, Director of Public Health
12
Cumbria Joint Health
and Wellbeing Strategy
2019 - 2029
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Introduction
The Cumbria Joint Health and Wellbeing Strategy 2019-2029 sets out the vision and priorities that will shape how the Cumbria Health and Wellbeing Board will work together over the next ten years.
The strategy underpins the Board’s ultimate aim to improve the overall health and wellbeing of the people of Cumbria and reduce health inequalities.
It is an important document, all Clinical Commissioning Groups, Local Authority and NHS England plans should take the Joint Health and Wellbeing Strategy into account. The Integrated Care System Plans for North Cumbria and South Cumbria & Lancashire and the Cumbria Joint Public Health Strategy in particular are the delivery mechanisms for the Strategy and therefore will reflect its priorities.
Key to the implementation of this strategy will be the development of mechanisms for working together and for assessing how decisions that are being made influence the aims set out in this strategy. Some of these mechanisms, such as the Health and Well Being Board, Public Health Alliance and the Local Health and Wellbeing Fora, are in place already but some will be refreshed to enable them to develop local action in support of the strategy.
The Strategy is in two main sections:
The first outlines the framework for the Strategy, its vision, key themes, principles and outcomes.
The second expands on the four key themes and most importantly identifies potential priorities for immediate focus.
Feedback from the public and a wide range of partners has been taken into consideration.
The priorities for the strategy are evidenced based, building upon the data and intelligence provided through our Joint Strategic Needs Assessment (JSNA). More information on the JSNA can be accessed here:www.cumbriaobservatory.org.uk/jsna
How will we measure the overall success of the strategy?
The overall aim of the Cumbria Joint Health and Wellbeing Strategy is enable Cumbrian communities to be healthy and to tackle health inequalities. High level measures of success will be monitored through changes to life expectancy, healthy life expectancy and the life expectancy / healthy life expectancy gap between the most and least deprived communities.
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Vision - To enable Cumbrian communities to be healthy and to tackle health inequalitiesKey Themes
Protecting the health of the population as a
whole
Providing high quality, person- centred care
Tackling the wider determinants of health
and wellbeing
Improving health and wellbeing throughout
the life course
People in Cumbria are healthy and make positive choices about
their wellbeing
Clear governance supported by evidence based decision making
Proactive wide reaching partnerships especially
with our third sector
People remain independent and healthy
for longer
Prevention and Early Intervention at the Core
Independent, activated and resilient individuals
and communities
People access the right services in the right
place at the right time
Tackling inequalities in health and service
provision
A sustainable health and care workforce
Using technology to support population
health management, prevention and self-care
Service demand reduces and
satisfaction increases
Co-production at the heart of planning health
and care services
Outcomes
Delivered through North and South Systems’ bespoke delivery plans and the Joint Public Health Strategy
Principles
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Key Theme Protecting the health of the population as a wholeWhy is this important?
Health protection focuses particularly on how the public is protected from infectious diseases, cancer and environmental hazards such as chemicals, radiation and extreme weather.
Health protection has a significant multi-agency dimension. Screening and immunisations for children and adults are commissioned by NHS England and delivered by local health services. Communicable disease control involves significant joint efforts by the County Council public health team, District environmental health departments and Public Health England, among many others. Resilience work is coordinated through the multi-agency Local Resilience Forum.
Priorities for immediate focus
• Boosting uptake of MMR vaccine, flu vaccine and screening appointments in eligible groups;• Supporting people with Learning Disabilities to access immunisation and screening opportunities;• Tackling Antimicrobial Resistance.
How are we going to measure progress
• Flu/MMR Vaccination Coverage – At risk individuals;• Analysis of screening rates;• Rate of community acquired gram negative bloodstream infections?
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Key Theme Providing high quality, person-centred careWhy is this important?
Cumbria’s Health and Wellbeing Board agree that a focus on Health and Wellbeing needs to be more holistic than just looking at preventing ill health.
Like the rest of the country, there has been an unprecedented increase in the demand for health and social care services. Cumbria shares a common national aspiration to allow people right across the county to live in the best mental and physical health possible for as long as possible, not to primarily achieve sustainability and save money but because it’s the right thing to do.
It is recognised that to achieve change more services should be available closer to home and in the community. This will help to reduce the number of people entering acute provision and ensure people can access the right service in the right place at the right time. Integrated Care Communities are providing the building blocks for this to happen at a local level.
Providing person-centred care to people and families also requires services and teams to think differently, perhaps working more flexibly or in a joined up way to identify and deal with problems as far ‘downstream’ as possible. Carrying out this change in the context of wider integration work through Integrated Care Communities also provides the opportunity for service redesign to fully embrace community assets. This includes people and patients themselves. People who are empowered and activated, living in thriving communities are more likely to self-care and maintain independence for longer. Delivering successful health and care integration also means looking beyond healthcare to ensure the Cumbrian Pound goes as far as possible. There needs to be a focus on working across the public sector to maximise the impact of the workforce on the people served across the county. Instead of being a group of organisations, health and care needs to be seen as a collective of professionals, volunteers and residents who come together with the health and wellbeing of all Cumbrian People as a common concern and interest. The people who need to be involved aren’t necessarily health and care providers, they may be from the third sector, or other teams, such as the Fire and Rescue Service. They may be friends, family and neighbours.
This will support the principle of prevention and early intervention which is integral to delivering successful services right across Cumbria that reduces health inequalities, including rural inequalities.
Priorities for immediate focus
• Development of Integrated Health and Care Teams;• Integration of Reablement and Rehabilitation services; • Redesign of services aimed at families including the 0-19 Healthy Child Programme, Early Help and Family Hubs;• Ensuring mental health and learning disability services are fit for purpose.
How are we going to measure progress
• Number of avoided admissions per annum;• Number of reduced bed days per annum;• User and carer experience and quality of life;• Number of families accessing Early Help?• Breastfeeding rates at 6-8 weeks?• Access to mental health services?• Proportion of people with Learning Disabilities receiving their annual health check.
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Key Theme Tackling the wider determinants of health and wellbeingWhy is this important?
Cumbria is a large sparsely populated County made up of a number of towns and villages (many ex-industrial), a National Park, open expanses of countryside and the City of Carlisle. The geographical diversity exemplifies health inequalities across the county with life expectancy differing markedly depending on where you live.
The lower population density in more remote areas also masks small pockets of significant deprivation and poor health outcomes.
• Action is required at a broader social, environmental and economic level around the wider determinants of health and wellbeing. This is about creating the conditions in which individuals can reasonably be expected to be healthy and to take action in support of their own health and wellbeing. It recognises that
The factors that impact on people’s health and wellbeing go beyond their ability to access health and care services. A community is healthy and sustainable when it has:
• Natural assets: A high quality natural environment that provides opportunities for engagement with the natural world. This includes taking action on reducing climate emissions and promoting use of green spaces
• Human assets: People with the skills, knowledge and experience that give them the capacity to take part in society and have meaningful and fulfilling lives
• Social assets: A good social infrastructure, with networks and institutions that allow people to connect to each other
• Physical assets: a good physical infrastructure including housing, transport and a commercial environment that promotes healthy behaviors
• Financial assets: adequate financial resources that are fairly distributed, underpinned by well-paid and secure employment
A key feature of this framework is that it emphasises the importance of building all five types of community asset without degrading any of them. It sets a positive vision of building a better society in which everyone is able to maximise their potential for health and wellbeing.
Priorities for immediate focus
• Reduce levels of poverty and income inequalities;• Delivering improvement in air quality across Cumbria;• Improving educational attainment for all young people across Cumbria;• Availability of good quality housing that meets the needs of Cumbria’s people throughout their lives;• To develop the physical transport infrastructure in Cumbria to make it a great place to walk and cycle.
How are we going to measure progress
• % Low income households;• Improvement in air quality to 40µg/m3 for NO2 andPM10;• The number of Young People achieving level four qualifications;• Proportion of houses built which are deemed to be affordable;• Proportion of social and private housing in poor condition.
Cumbria Joint Health and Wellbeing Strategy - 2019-2029
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Key Theme Improving health and wellbeing throughout the life courseWhy is this important?
As we move through our lives, we are constantly adopting behaviours that can impact on the health and wellbeing of us as individuals, those we live and socialise with, as well as those we care for, including our children and people with disabilities.
Even before we are born, the behaviour s of our parents around factors such as diet and smoking can impact on our long-term health. The first 1000 days of life are a critical time when the foundations of optimum health, growth and neurodevelopment across the life course are established.
Throughout childhood, our working lives and as we age, maintaining a healthy weight, being active and smoke/drug free, drinking alcohol within recommended levels and experiencing good mental wellbeing (including good social connections) are all important to maintaining good health.
These factors used to be viewed as ‘lifestyle choices’, however we recognise that people’s life experiences and the environments in which they live significantly influence their behaviours and the choices they are able to make. .
Therefore, empowering people to take personal control and responsibility for their health and wellbeing requires a whole community approach.
We need to increase opportunities to achieve positive change by supporting people and communities to build on their own skills and knowledge and their communities’ assets - a move from preventing illness to promoting wellness; and from a ‘doing to’ culture to a ‘doing with’ culture.
Community-centred approaches are key to building resilient and flourishing individuals and communities. Resilience reduces the impact that the stresses of life have on our wellbeing, keeping us happy, healthy and independent for longer.
From the clinical perspective, there is increasing evidence and recognition that a ‘More than Medicine’ approach is required, which seeks to mainstream non-clinical interventions such as volunteering and community friendship groups. . This requires a culture change across health and social care to one in which alternative services accessed via social prescribing are seen as real alternatives to help people manage their own conditions better.
Priorities for immediate focus
• Improve mental wellbeing of children and adults;• Promoting breastfeeding;• Improving diet and tackling obesity; • Reducing the prevalence of smoking;
How are we going to measure progress
• Childhood obesity levels across the county;• Levels of smoking;• Self-report measures of social connection and mental wellbeing (e.g. via coaching services);• District levels of physical activity;• Initiation and continuation of breastfeeding at 6-8 weeks;• Reducing obesity and excess weight in children and young people.
• Drug use and unsafe alcohol consumption;• Reducing social isolation;• Promoting physical activity;• Reducing obesity and excess weight in children and young people.
1
PURPOSE
The purpose is to provide an update on the completed Joint Operating Plan (Annual Plan) for
2019-20, and an update on the process for monitoring the delivery of the plan, using quarterly
updates on the objectives, supported by the use of OGIMs.
KEY POINTS TO HIGHLIGHT
The Plan
The final plan was submitted on 4th April 2019 and is one system plan for North Cumbria
CCG, CPFT and NCUH. The national requirement was to produce a system plan and three
separate organisational documents. However, rather than produce four separate documents,
the three organisations successfully collaborated in producing one system plan for the year
2019-20. This document operationalises what we want to achieve in year one of the five year
strategy. It was submitted together with activity and financial submissions submitted by the
Trust and CCG. This submissions were also aligned.
The plan was constructed based on the NHSI and NHSE guidance but at the same time
ensuring we have a plan that works for North Cumbria. The plan describes how and what we
will achieve across the following areas:
IHCS
Performance and Activity
Quality
Finance
Workforce
17 system objectives (all with more detailed goals from page 39 in the attached).
These include the core elements of the NHS long term plan. Below is a list of some of
the objectives included (not exclusive): develop approaches to population health,
continue to develop the local care provided by our ICCs, primary care and community
services, integrated patient pathways, financial control, digital plan, improve prevention
and access to cancer services, deliver safe, personalised and joined up services for
children and young people, Improve quality of mental health services. See page 5 of
the attached for all 17 objectives
System Leadership Board Date: Enc:
Title: Joint Operational Plan (Annual Plan) 2019-20 - Update Author: Ramona Duguid, Executive Director of Strategy, North Cumbria IHCS
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2
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
Measuring success
There are 17 system objectives within the plan that have been broken down with specific
goals for delivery. For each of these 17 objectives there is an OGIM being produced which
will detail the goals, initiatives, timescales and measures for monitoring achievement against
each OGIM. Starting in quarter one, each of these OGIMs will highlight progress towards
achievement in that quarter and risks to delivery in future quarters. This will enable the
tracking of successful delivery of the plan.
RECOMMENDATION
Senior Leadership Board are asked to note the plan, and note and comment on; the process for monitoring progress towards achievement of the plan in 2019-20.
Cumbria Partnership NHS Foundation Trust
North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
FINAL Joint Operational Plan 2019/20
Cumbria Partnership NHS Foundation Trust Page 1 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
Table of Contents 1. INTRODUCTION ........................................................................................................... 3
2. LINK TO THE LOCAL SUSTAINABILITY AND TRANSFORMATION PLAN .................. 6
4S - System Working ................................................................................................... 6
Capital Planning .............................................................................................................. 34
9. MEMBERSHIP AND ELECTIONS ............................................................................... 36
10. KEY RISKS TO THE DELIVERY OF OUR PLAN ..................................................... 37
Appendix 1 System Objectives and Goals for 2019/20 ........................................................ 39
Appendix 2 Glossary of Acronyms ...................................................................................... 44
Cumbria Partnership NHS Foundation Trust Page 3 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
1. INTRODUCTION
In line with our approach to the 2018/19 business plan, this narrative plan document has been prepared collaboratively by Cumbria Partnership NHS Foundation Trust (CPFT), North Cumbria University Hospitals Trust (NCUHT) and NHS North Cumbria CCG (NCCCG) as key partners within the shadow North Cumbria Integrated Care System (ICS). As such, this represents the first fully joint system-based operational plan, and will set out the platform for the development of the integrated health and care system across the north of Cumbria through 2019/20 and beyond. Together, we continue to implement the service changes included in the system transformation programmes in the north and south of Cumbria, which have focussed on delivery of the public consultation outcomes as well as building our placed based approaches to health and care through our Integrated Care Communities. The transfer of mental health services in Cumbria is also a priority programme of work for 2019/20. Increased partnership working and collaboration across corporate services and functions has continued during 2018/19 across NHS organisations. To cement the collaborative working between CPFT and NCUHT, the trusts are working with NHS Improvement to become a single integrated organisation during 2019/20. This will involve the joining together of the provider trusts during 2019/20, as well as inclusion of how some of the CCG functions will evolve, further strengthening the cohesion of the system working for the commissioning and provision of services in north Cumbria. In preparing our plan for 2019/20, which is ‘year one’ of a five-year plan to be published during the autumn of 2019, a number of critical financial planning assumptions have been made. These are set out in the financial planning section of this plan. Importantly, the setting of contractual baselines for 2019/20 are deemed to represent a low risk as the key contracts are risk shared arrangements embodied within the ICS, and the external contracts are not considered to present undue risk. Through the system-wide risk share arrangement between NCCCG, NCUHT, and CPFT and associated collaborative working, we expect to deliver our system control total, and deliver on our collective efficiency programmes for 2019/20. We do, however, remain dependent upon whole system transformation programmes delivering to plan to achieve our service quality and financial intentions for 2019/20, whilst delivering services that are in the best interests of the populations that we serve. Our core priorities for 2019/20 have been developed collaboratively to reflect system-wide ambitions, which are aligned to our longer term service strategies and efficiency plans. In setting these priorities, we have engaged with clinical leaders and wider leaders within the Health and Care system to enable our finite resource to be directed toward the delivery of business priorities in line with risk appetite. The priorities set out in this plan align to the longer term strategic aims we have identified for 2019 – 2024 which we will continue to engage on and refine during quarter 1 of 2019/20 as part of the refresh of our five year strategic plan. Our objectives for 2019/20 are below and set out in more detail in Appendix 1.
Cumbria Partnership NHS Foundation Trust Page 4 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
Our longer term strategy has six core strategic aims identified for delivery over the next 5 years. These aims link to our balance scorecard 4Ss and Trust values as below.
Cumbria Partnership NHS Foundation Trust Page 5 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
Cumbria Partnership NHS Foundation Trust Page 6 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
The ‘This is Us’ campaign used throughout 2018/19 by CPFT and NCUHT to communicate with staff on business priorities and strategic developments, has been adopted by all health (NHS) organisations in north Cumbria for 2019/20, and will be our primary vehicle for communicating our collective priorities across the health and care system. Our plan is for all our staff and stakeholders and builds on the work we have already started across the system. It builds on the overarching strategic direction of travel as well as sets out the requirements from a regulatory perspective in relation to 2019/20 key deliverables. In setting this ambitious plan, the Boards of CPFT and NCUH, and Governing Body of NCCCG, are specifically aware of the high inherent risks, which include dependence on transitional support funding, workforce supply, capital investment and cost efficiencies. These risks are actively, and routinely, monitored at Board level, and are supported by comprehensive risk management processes which address and mitigate as much as possible of the risks. Communications, Engagement & Co-production There has been a focus on co-creating the joint operational plan for 2019/20 alongside our staff. The voice of our community is heard through our governors and other key stakeholders. Involving our staff is an important part of ensuring ownership of the priority objectives and care is taken to ensure we carefully communicate the objectives using our established ‘this is us’ staff engagement brand. These overarching objectives are supported by much more detailed objectives for each area and translated for staff into their own personal objectives set at appraisal. This enables our staff to clearly see how they are contributing to the joint organisational objectives. During 2019/20, work will be undertaken to embed our approach to co-production which was established in 2018/19 through the coproduction toolkit. In building this approach, we can ensure that we are more collaborative in developing future plans with other groups such as patients, the third sector and wider community.
2. LINK TO THE LOCAL SUSTAINABILITY AND TRANSFORMATION PLAN
4S - System Working The challenges for health and social care in North Cumbria have been deep-rooted, long-standing and spread across the whole system as opposed to individual organisations. The main health provider organisations CPFT and NCUH, along with the local commissioner (NCCCG) have faced multiple challenges in relation to quality, performance and financial sustainability. In addition to this the ability to
Cumbria Partnership NHS Foundation Trust Page 7 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
recruit to key positions whilst facing the rising demand for services has required partners to think about working together in different ways. In 2016 we held our ‘Healthcare for the Future’ public consultation about some of the services where there were concerns about the sustainability of services, and this has given us clear priorities, which we have continued to focus on and deliver across our local communities. Ensuring accessible, safe, high quality secondary care services will continue to form a key part of our strategic plans moving forwards, including how we develop district general hospital services and links to specialist centres for treatment. In May 2018 the North Cumbria Health & Care system was recognised as one of fourteen national exemplar areas as an ‘Integrated Care Systems’ (ICS). This has allowed the health organisations to work even closer together on the longer term needs and delivery of services, which will be a core feature in our refreshed strategy for health and care in North Cumbria. We have already realigned our staff to work in Integrated Care Communities (ICCs) where more care is being delivered closer to home and teams across primary, community, social care and third sector are working in much more joined up ways to meet the needs of our local communities. We are working more closely than ever before with our colleagues in Public Health and the Local Authority to focus on reducing health inequalities across our communities as well as recognising the crucial importance adult and children’s care services have in improving outcomes for the communities we serve. In 2019 a new Health and Wellbeing Strategy for Cumbria will be published which will sit at the heart of our plans to improve health outcomes across north Cumbria. A clear vision, ambition and purpose have been developed for the Integrated Health and Care system in north Cumbria:
Our Vision
We want to build a new integrated health and care system together, using our collective capabilities for a healthier and happier population.
Our Purpose
Using our collective will and capabilities we will work together in truly integrated ways with our people to reduce inequalities, raise standards of care, use our resources wisely and provide positive experiences for our local communities. We have set out what our integrated health and care system means for our patients, staff and communities which will form part of the engagement we undertake during quarter 1 2019/20 in developing our longer term strategy.
Cumbria Partnership NHS Foundation Trust Page 8 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
What does this mean for patients and carers? We want patients to be involved and empowered in managing their health
conditions and wellbeing. We want to create a modern service which allows information to be shared
between teams so patients don’t have to tell their stories repeatedly. We want to provide services as close to home as possible, reducing the demands
for inpatient hospital care and supporting our patients to live as independently as possible.
We want a system whereby patients and carers can easily navigate through and reduce non value adding activities.
We want to reduce unnecessary journeys by ensuring we make the most of technology to allow patients to interact with clinical specialists with as little disruption as possible, whilst recognising that patients requiring specialist treatment should be able to access experts at specialist centres.
We want the experience of our patients to be smooth and efficient so our patients receive the right care from the right team in the right place at the right time.
We want to create teams of health and care professional staff that can work seamlessly across traditional boundaries of care.
We want to listen to our patients and build confidence that their interests are at the heart of all we do.
What does this mean for our staff?
We want to create a workforce for tomorrow. This means creating teams and
roles that can respond to the multiple demands and conditions our patients have living in our communities.
By creating new roles we will improve the skill mix and create more opportunities for our people.
We want staff to work in a rewarding job and feel valued for both the individual and collective team contribution they make.
We must build and develop services locally which allow our staff to provide treatment and care in a way which is not only manageable, but enables staff to feel they have given their best for the local communities we serve. This includes pushing traditional models of care to serve our diverse communities well.
We want patients to be able to access care when they need it most, in the most appropriate setting, delivered by the most appropriate person/role. By developing services in the community we are helping to ensure hospital care is for those with acute needs, developing skills to deliver more complex services closer to home.
By integrating services and working across disciplines and organisations, we want to make it easier for our staff to ensure patients are being best served and supported, minimising the handovers of care between professionals and across organisations.
We want to listen to our staff and create a culture which is safe, open and forward thinking.
We want our staff to feel happy and fulfilled in their work.
What does this mean for our communities?
Cumbria Partnership NHS Foundation Trust Page 9 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
We want our community to have confidence that we recognise the unique challenges our services face and how we are tackling them.
We want to be a centre of excellence for planning and delivering services in rural, remote and dispersed communities, linking to UCLAN national centre for remote and rural medicine.
We want our communities to know that NHS and partner organisations are working together to reduce organisational ‘silo’ approaches to developing services.
We want our communities to have confidence and trust that we understand the significant challenges affecting their health and wellbeing and how we are focussing on those areas of greatest need.
We want our communities to understand the commitments we have made in order to ensure the local population has the best start in life, lives well and ages well.
We want to build trust and optimism that we are working hard to respond to pressures on our services, and are developing collaborative approaches that will sustain and improve our services - looking at the full range of health and care services and ensuring we are building a better future together.
We also want to reinforce the importance of our community in shaping and improving services by involving them in our service design and improvement through co-production. This involves sharing our challenges and problems, inviting patients to share their feedback and ideas and working with members of the community, third sector and independent providers. We want to make the most of our shared commitment and individual energy and ideas to ensure we are open minded and creative in our future planning.
We want our communities to feel confident that they are being supported to live well independently and can access quality care when they need it most.
3. APPROACH TO ACTIVITY AND CAPACITY PLANNING
4S - Service Quality
3.1. Activity Assumptions For 2019/20 activity plans and associated assumptions are based on system-wide assumptions agreed jointly across the North Cumbria Health and Care System. They are a continuation of the organisation and system recovery plans developed following the 2016 Success Regime Review. There is an agreement between all system partners to work together to ensure detailed activity and delivery plans based on a system-wide approaches to demand and capacity modelling, and operational management. This agreement has been reinforced through the contracts and associated risk-share agreement that is in place between NCCCG, CPFT and NCUHT. The risk share arrangement underpins aligned and cohesive effort by all organisations to deliver the systems key constitutional standards and resource limits, within the Single Control Total.
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NHS partners recognise the importance of the Better Care Fund (BCF) agreement between Cumbria County Council and NCCCG, and this is a key element to the system-wide approach. The health-economy has developed a range of transformation initiatives that will enable achievement of the desired ‘end-state’, as described in the Success Regime Pre-consultation Business Case (PCBC); a number of these are now approved and implemented, or in the course of implementation, and the impacts of these are reflected in the activity and financial plans of both commissioner and providers. 3.2. Activity Plan Construction Growth The original work of the Success Regime assumed a 2% year on year demographic growth. This was refined for the 2018/19 plans to a new baseline of 1.5%, and this has been carried through to the 2019/20 plans to ensure a consistency of approach. Monthly Profiling All baseline activity has been phased across each year using a combination of actual trends seen in 2018/19 modified by changes in the allocation of working days and by specific changes to policy. This includes a more sophisticated approach to the phasing of elective activity across the first nine months of the year to plan for, and address the risks associated with, the constraints on routine elective capacity and activity over winter. Reductions in activity levels following the introduction of Quality Innovation Productivity and Prevention (QIPP) schemes, other transformation schemes, and pathway variations, are phased in accordance with the agreed implementation plans for each scheme. The baseline activity reflects the changes seen during 2018/19, and the in-year 2019/20 variations take account of the agreed changes which still need to be delivered as per the relevant business cases. Transformational Change The Success Regime PCBC describes the modelling that was undertaken to identify the impact of the expected service changes through to the end of 2020/21, having identified opportunities for change through Rightcare and other benchmarking tools. The health system is still in the process of delivering the outcome of the Success Regime and the 2019/20 plans reflect the delivery timeline for transformational change through to March 2021. Whilst a number of pathway changes commenced in 2017/18, the major impacts were in 2018/19, continuing into 2019/20. A number of these are now embedded as part of ‘Business as Usual’. Schemes have been reflected as part of the Financial Plans, Contracts, and Activity Plans.
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3.3. Performance trajectories and their effect on activity planning The approach to the setting of local trajectories for the constitution targets is to set
out a stretched, but realistic forecast, aimed at delivering an improved position over
2018/19, whilst taking account of the operational workforce, capacity, and financial
risks to delivery.
A&E In addition to the 1.5% demographic growth, an additional 0.5% has been added to reflect non demographic demand growth before the impact of QIPP schemes. Recovery plans and local performance trajectories are in place via the Local A&E Delivery Board to further improve patient flow and the assumption therefore is that the system (combined NCUH and CPFT) will focus on improving performance. The local trajectory is based on delivering an improvement over 2018/19, whilst recognising the seasonal pressures from Easter and Christmas / New Year. It is targeted at an average of 91.2% over the year.
Time period Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total
NB: Mar 19 and total 18-19 Provisional figures only
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Non Elective In addition to the 1.5% demographic growth, an additional 2.5% has been added to reflect the non demographic demand growth before the impact of QIPP schemes. This reflects the experiences seen in 2018/19 and provides a realistic forecast of the baseline trend before reflecting demand management pathway changes. Acute capacity issues are being addressed by further support for zero day ambulatory activity and by addressing bed capacity through improved patient flow and discharge management. Revised pathways were put in place with the development of Integrated Care Communities (ICCs) during 2018/19 which will strengthen capacity, and the role of primary and community services in managing acute demand. These changes are reflected in the baseline activity assumptions for 2019/20. Further transformational investment in ICC focussed pathways during 2019/20 will continue the emphasis on reducing avoidable admissions, managing patient flow, and tailoring capacity to meet demand. Referrals Referrals make provision for 1.5% growth through 2019/20, before any QIPP savings. Adjustments have been built into the baseline for the impact of the major pathway changes in MSK and Pain Management. Outpatients, Elective, and Cancer New-outpatient growth is relatively stable currently. For 2019/20 a baseline 1.5% growth has been assumed, before QIPP savings. The same growth assumptions have been allowed for elective admissions. The baseline activity reflects the QIPP savings planned in 2018/19, but which have still to fully deliver. These are being achieved through major reviews of outpatient clinic protocols (especially follow ups), alternatives to hospital based face to face consultations, and the further use of advice and guidance and ‘attend anywhere’ initiatives. An adjustment has also been made to reflect the movement in the waiting list numbers to ensure that the activity assumptions take account of changes in the numbers on the waiting list, especially so on the admitted lists where there has been a slight increase through 2018/19. NCUH cancer standards to Q2 18/19 were on track for four quarters in a row but in Q3 18/19 were impacted by capacity issues, especially around medical staffing and diagnostic availability. These are, in many instances, national issues. Local performance has been eased with the opening of the second Linear Accelerator in Carlisle, and with strengthened tracking of patients and their progress. The 2019/20 plans reflect the moves to enhance capacity with greater cross-system working through investment in the Northern Cancer Centre, and rapid assessment and diagnostic pathways. However, the system performance reflects the ongoing challenges for out of county providers and assumes that the performance of 62 day tertiary patients will remain challenged through 2019/20. Although routine elective activity is being phased into the first nine months of the year to alleviate winter
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pressure, the intention is that cancer and other urgent elective activity will continue to be prioritised over the whole year.
Referral To Treatment (RTT) Performance 2018/19 has been a challenging year for the RTT % waiting over 18 weeks with a full recovery plan in place at NCUH to improve performance. The 2019/20 plans reflect the challenged position within NCUH regarding the ability to deliver significant improvement in 18 week standard. Capacity plans are being revised, with changes to theatre rostering, and how medical PAs are allocated to enhance the availability of elective capacity outside of the winter period. The theatre productivity work programme and outpatients transformation scheme will be fully operational in 2019/20. Both of these will free up capacity to meet both the increasing demand and reduce the backlog for RTT. The Trust is committed to ensuring that the position at the end of 2018/19 will improve through 2019/20 and will work towards delivering the 92% with a trajectory to improve by 6% percentage points on current performance and maintain the March 2018 waiting list numbers by March 2020. In addition the Trust intends to fully deliver the standard for zero patients waiting over 52 weeks. Although diagnostic performance was challenged in the later months of 2018/19, a recovery plan within NCUH was introduced to generate additional capacity. The intention is that the Trust will be compliant with the standard for all of 2019/20. Bed reductions and Clinic reductions
The investment in patient flow initiatives such as improved ambulatory and rapid access, together with the focus on admission avoidance through new pathways (eg. Delirium, MSK) and the Primary Care / ICC investment allowed 29 community beds to be closed, together with 16 acute beds. Further bed reconfiguration work is planned for 2019/20 in line with the PCBC and as a result of system transformation schemes. The bed number trajectory includes an increase in capacity in the winter based on previous year’s analysis and the knowledge that there will be a need to utilise a number of escalation beds to cope with system surge. The new MSK pathway has already allowed the reduction of 25 clinics per month. During 2019/20, the planned reforms of outpatient follow up protocols will remove 15,000 follow up appointments and the associated clinics. 3.4. Demand Management Winter capacity is being built into the plan by the re-profiling of elective activity across the non-winter period, to allow non elective demand to be expanded. The majority of elective activity will be planned to be delivered over 9 months. It is intended that this will provide a more stable service with less reliance on escalation beds, although these will remain available at times of peak demand. Activity levels and associated risks are monitored on a monthly basis between CCG and providers and managed on the shared risk principles agreed within the ICS.
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4. PERFORMANCE OVERVIEW 4S – Service Quality Both Trusts and North Cumbria CGG have a robust approach to performance management and a Performance Report aligning the performance of CCG, Mental Health, Community and Acute Services is currently presented to the Joint Trust Boards and CCG Governance meetings. There have been some significant achievements in operational performance in 2018/19 including:
Significantly improving the A&E performance compared to last year and meeting the Provider Sustainability Funding A&E targets. NCUH now regularly benchmarks in the top third out of 105 Trusts with Type 1 and Type 3 A&E;
The number of Delayed Transfers of Care has reduced by up to 40% compared to the same period last year. Targets are being regularly met in both the Acute and Community Services;
Significant improvement in ambulance response standards and handover times at both CIC and WCH;
Mortality rates sustained and have been in line with Hospital Standardised Mortality Ratios (HSMR) and Summary Hospital-level Mortality Indicator (SHMI) averages for over five years now;
All three secondary care dementia measures (case finding, assessment and referral) are on target and better than national average. They have been enhanced by the integrated working on the wards of the Delirium Outreach Service, one of the key transformational schemes.
All IAPT (Improving Access to Psychological Therapy) measures on target and better than national average.
The number of patients on the waiting list is projected to be lower in March 2019 than in March 2018 as per the trajectory.
Children’s wheelchair services are on target for the year.
All referrals are now received via e-referral with all GPs having access to a fully functioning Advice and Guidance service with consultants for 85% of referring specialities.
There have also been some significant challenges in operational performance in 2018/19 including:
Despite four straight quarters of NCUH achieving the 62, 31 and 14 day cancer targets the Trust was off track in Q3 of 2018-19. Continued capacity issues from our tertiary providers has presented significant challenges for the system-wide 62 day standard;
Diagnostics 6 week waits are off target following significant capacity issues late in 2018. A recovery plan is in place to return to compliance for 2019/20;
Mental Health out of area placements are off track despite being a national outlier;
Referral to Treatment percentages are poorer than the locally set trajectory;
The number of patients on the waiting list at NCUH has increased from the March 2018 baseline, impacted by reduced elective capacity in Q4 2018/19;
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Primary Care dementia standards have not been met, although there is a sustained improving position and expectation that the standard will be delivered from April 2019 onwards;
Primary Care Extended Access - A trajectory has been set which builds to the 75% standard by Quarter 4 2019/20 taking into account a realistic assessment of the access potential through the year.
Children and Young People Services and Eating Disorders have experienced significant challenges through most of 2018/19 to collate robust data and to fully meet the standard. Improvements made during the latter part of 2018/19 will enable the standard for urgent patients to be met; however, routine patients are not expected to meet the standard until later in Q4 2019/20.
There have been challenges through most of 2018/19 to collate robust data and to fully meet the standard. Following planned improvements during the latter part of the year, this standard will be met through 2019/20. Significant improvement work is ongoing to support the turnaround of these challenged performance measures to ensure improvement and delivery of these trajectories in 2019/20.
5. THE APPROACH TO DELIVERING EFFICIENCY
4S – Sustainable Finances The ICS is committed to delivering high levels of efficiency throughout its services, whilst also recognising that the current baseline position presents considerable scope for improvement. The governance for the programme of change within the ICS has been outlined in other parts of this plan and builds on the transformational change arrangements that are already well embedded within the ICS area and which are already managed on a joint basis. These developed out of the work of the Success Regime, culminating in the plans for change starting in 2016. The joint approach to managing risk shares across the system is reflected in a similar system-wide approach to efficiency which aims to ensure that improvements in one sector do not simply pass costs to other parts. There are three core components to delivering the efficiency programme across the system in 2019/20; maximising health outcomes, maximising productivity and minimising NHS cost.
Maximising Health Outcomes
Clinical pathway redesign to address unwarranted variation in quality and efficiency, including Getting it Right First Time (GIRFT) & NHS RightCare
Maximising Productivity
Best use of assets and resources to support patient flow and access
Theatre utilisation
Outpatients
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Minimising Cost
Medicines Optimisation
Workforce - reduction in temporary staffing
Workforce role innovation and clinical team redesign
Procurement & supplies
Estate rationalisation
Integration and merger benefits
Corporate services rationalisation
6. PLANNING 4S – Service Quality
6.1. Quality Goals
The fundamental priorities are to provide services that are safe, caring and responsive. In addition there is a commitment to transforming services, and ensuring financial sustainability across the system. NCUH and CPFT have jointly developed 2019/20 quality goals and improvement priorities through an engagement exercise to ensure continuous improvement in quality of services provided (in line with national and local commissioning priorities and standards). The quality goals for 2019/20 are as follows:
o Improved outcomes o Improved safe and reliable care o Improving the reporting and learning from incidents using human factors
methodology o Improved patient and staff experience o Development of quality improvement strategy and implementation plan o Strengthened clinical governance o Achievement of ‘Good’ CQC rating across all domains o Development and delivery of clinical leadership programmes o Alignment with system quality goals and priorities
6.2. National Guidance
The ICS and Trusts will continue to respond to evolving guidance, both from the Department of Health, the Royal Colleges and from other external bodies such as the National Institute for Health and Care Excellence (NICE). There is an increasing focus both nationally and locally to provide greater integration of services across acute, mental health community, primary and social care. The quality goals and improvement priorities for 2019/20 will be developed further in the Joint Trust’s Quality Improvement Strategy and delivery plan 2020-2023 that will set out a programme of work over the next three years to support continuous improvement in the quality of care we provide.
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Where appropriate, the Trust’s Quality Programme will be cross-worked with centrally and regionally driven programmes in collaboration with national bodies and regional/system wide local health and social care economy partners to develop our quality improvement programmes through collaborative learning and peer review. Collaborative work is already underway, currently focused on managing deteriorating patients with objectives to reduce cardiac arrest and reduce sepsis. In line with the national safety strategy which is slowly emerging, the Trust will improve the reporting and learning from incidents using human factors methodology. A number of staff have now completed the five day train the trainer human factors course with through Advancing Quality Alliance (AQuA). This means that we now have expert level members of staff who are able to roll out human factors training across the organisation(s). This one day training commenced in 2018 and dates are scheduled throughout 2019. We have also recently developed a new joint serious investigation template, which is based on the human factor complex system approach through a method know as (SEIPS – System Engineering Initiative for Patient Safety). The new joint template has been tested in a number of serious incident cases and is due to ‘go live’ in both organisations as of April 2019. In April 2019 the CPFT and NCUH weekly Patient Safety Panels (PSP) will come together as one meeting, with one set of Terms of Reference. This meeting will focus on the review of Serious Incidents (Sis) and importantly learning from lower graded trends to identify areas of improvement. Within the joint Terms of Reference for PSP it includes a clear statement in terms of learning from national investigations. When national investigations are published there will be initial consideration of the findings from these investigations through PSP. Where necessary and based on learning from national investigations, organisational improvement focused task and finish groups will be developed in order action points of learning. PSP reports to the Quality and Safety Committee, which is a sub group of The Board. One of the anticipated benefits of the development of a joint PSP is the organisational wide learning and improvement which can take place without organisational barriers. A benchmark was undertaken across the organisation following publication of the Kirkup Enquiry into Liverpool Community Hospitals this was shared with regulators and commissioners, in addition to formal presentation at Trust Board. The same approach will be taken for any future national enquiry publications.
6.3. CQC Registration
Both NCUH and CPFT are required to register with the Care Quality Commission (CQC). Achieving a CQC rating of ‘good’ is a goal for both Trusts during 2019/20. In November 2018 the CQC carried out a formal ‘Well Led’ inspection of NCUH services and the final report was published in December 2018 with the Trust’s overall rating of ‘Requires Improvement’ staying the same as the previous inspection.
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CQC have given notice they will be undertaking a formal ‘Well Led’ inspection CPFT during Q1 of 2019/20. At the time of writing it is uncertain whether NCUH will be inspected again prior to the Trusts coming together as a single organisation which is anticipated will take effect during Q3 of 2019/20. Any must or should do actions from previous inspections that are not closed at the time of when the Trusts formally join together will form the CQC action plan for the single entity.
6.4. Quality Impact Assessment Process and oversight of Implementation
All of the Trusts’ cost improvement programmes, captured as our efficiency programme, are subject to Quality Impact Assessments. The Trusts have a robust and comprehensive quality governance process, which ensures that no efficiency programmes that harm patient care are allowed to proceed, and the programmes are closely monitored once they are in place to ensure that the quality of care is not adversely affected. We have an agreed Quality Impact Assessment (QIA) process in place to support delivery of the plans. The process includes full consideration of each CIP scheme, whatever the value, against each of the CQC domains by the business, clinical and/or corporate lead as appropriate. The process includes QIA risk scoring; mitigation proposals; sign-off by the sponsoring Care Group business, nursing and medical team, Executive Director-level or Board level Committee (if the scheme is of high value or potentially high risk). This ensures that financial sustainability or efficiency decisions that may affect service delivery remain balanced and subject to careful process that retains quality, safety, and patient care as core values. The QIA work is underpinned by a formal governance structure, spanning both Trusts, that reports to a Financial Delivery Group which is overseen by the Quality & Safety Committee. Progress against efficiency programmes is overseen by the Finance Investment & Performance Committee. These arrangements provide the Board of Directors with a full awareness of the ongoing work and any subsequent risks attributed to the impacts of cost improvement programmes and major change schemes. During 2019/20 we will be strengthening our arrangements for understanding how changes have impacted upon patient and quality outcomes. Delivery of seven day services continues to be a priority for the organisation. Progress against all standards will be presented six monthly to Board. An internal audit plan, endorsed by NHSI, is being implemented. This comprises of a monthly audit based in care groups.
6.5. Approach to Quality Planning
A joint Quality Strategy is under development. The Quality Strategy will be underpinned by a joint Trust Quality Improvement Plan. During 2019/20 work will be undertaken to align systems, processes and leadership that underpin the delivery of the Trusts’ quality strategies and to build on the quality improvement successes achieved in both Trusts.
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Within the Joint Quality Plan for CPFT and NCUH there are four key aims: Aim 1: focus on culture: Just and Improvement Culture It has been recognised that as part of the organisational merger work that there need to be a focus on the organisational culture across all of our services. The evidence based tells us that organisational culture which focuses on Just Culture and improvement is key to embedding organisational change. Our new joint organisational values have been launched in March 2019 and underpinning the values are the expected behaviours in terms of what the organisations expect to see from all of our staff. In terms of Just Culture we are taking the opportunity to embed this thinking in a number of ways, including the roll out of a new joint e-learning package which focuses on Being Open and Duty of Candour for both organisations and also includes information on Just Culture and Human Factors thinking. We also have in place human factors investigation training, which included a real emphasis on Just Culture. Our improvement culture will continue to be built on within both organisations through increasing the capacity of improvement practitioners through the various quality improvement training packages provided through the Cumbria Learning and Improvement Collaborative (CLIC). CLIC has three key strategies: education, leadership and quality improvement. Within the quality improvement strategy sits a number of quality courses and support for front line services, including coaching for improvement. In terms of training provided through CLIC:
89 people attended face to face training in CPD QI methods in 2018-19;
65 attended human factors training
There were three waves of engaging for improvement training last financial year for 35 schemes across health in north Cumbria
Our agreed approach in terms of continuous improvement will continue to focus on the Cumbrian Production System (CPS) and the approaches established through CLIC, in terms of direct support for teams and the 20 week Engagement for Improvement projects.
North Cumbria Integrated Health Care Strategy
Overarching strategy covering
all elements driving to an IHCS
Quality Strategic Delivery Plan 2019-2023
Long term objectives and aims to delvier
against the IHCS strategy. System
wide development through 2019,
identiyfing shared opportunities &
actions
Annual Delivery Plan 2019-20
Focussed on the merged Trusts and associated organisations
Annual plan focusing on building sustainable workforce with clear
actions and outcomes. developed as part of the annual
business planning cycle
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This aim will be measured through:
National staff survey (particular questions Q16 -18)
Uptake of Human Factors Training
Update of improvement based training
Incident reporting – internal reporting and National Reporting and Learning System (NRLS) reports
Outcomes from Engagement for Improvement projects Aim 2: continuously seek out and reduce patient harm
Through the development of the Patient Safety Faculty and through of our
established quality improvement methodology within both Trusts we will focus on a
suite of improvement projects which aim to reduce harm in key areas such as
Aim 3: deliver what matters most to patients, families and carers through positive experiences when accessing our services Joint organisational work for a standardised approach for the methods to capture patient satisfaction through Meridian (patient experience survey system) has been in place in CPFT for some time and has now been rolled out to NCUHT.
A Baseline audit against the NHSI Patient Experience Framework has been
completed. Current state map in terms of patient experience within NCUH has also
been completed. Work is set to commence within Q1 in NCUH in terms of new
models and methodologies for patient experience and patient engagement.
There will also be consideration of learning from the Mental Health Triangle of Care work in terms of identification and support for carers and families of people who access our services. This aim will be measured through:
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Friends and family test (FFT)
Local questionnaires and surveys
National patient questionnaires
Complaints, compliments and comments
Patient and staff stories to the Board
Aim 4: achieve ‘Good’ rating in all CQC domains
A rating of ‘requires improvement’ from the CQC has been given to both
organisations at the latest CQC inspections. Since these inspections have taken
place there has been a significant amount of work and progress in terms of the
identified ‘Must Do’ and ‘Should Do’ actions, which are monitored through both
weekly and monthly meetings, with monthly reports being provided to the Quality and
Safety Committee.
Both organisations have been part of the most recent cohort of the NHSI Moving to
Good Programme. At the Summit Event which was held on 26th March, the following
areas of improvement were highlighted:
Development of initial draft of the joint Quality Plan;
A number of teams across clinical governance now working within joint team arrangements;
Specification for the joint risk management system which support key functions across both organisations now developed – moving into procurement and implementation phase;
Programme of improvement now in place in terms of joint policies – key joint policies in place e.g, Joint Being Open/ Duty of Candour Policy;
Joint Duty of Candour e learning package now mandatory and available for all staff across both Trusts. Includes sections on Just Culture and Human Factors;
Standardise approach for patient experience across both organisation now in the process of being agreed. Meridian (patient experience survey system) has been utilised with CPFT for some time – now rolled out to NCUH.
Baseline audit against the NHSI Patient Experience Framework completed. Current state map in terms of patient experience within NCUHT completed. Work to commence within NCUH in terms of new models and methodologies for patient experience and patient engagement.
As well as the above key deliverables there has also been a significant programme of work to develop in house quality and safety dashboards. This is a joint project between Digital Healthcare Team and Clinical Governance Team.
This aim will be measured through:
CQC inspections
Continuous actions against Must Do and Should action plans
Peer ‘mock’ Well Led Reviews
Weekly 15 Steps visiting programme
Annual care group governance assessments
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A health system quality improvement strategy and implementation plan will be developed and implemented during 2019/20. Executive leadership for quality improvement rests jointly between the system Executive Medical Director and the Executive Chief Nurse. The NCCCG Executive Director of Nursing and Quality has leadership responsibility for CCG accountable quality functions. A system quality dashboard is being developed in partnership with the county council, CCG and provider Trusts to reflect performance and outcomes across the north Cumbria health and care system. This will be presented in Quarter 1 2019 to the System Leadership Board. The report will initially cover care homes, safeguarding, primary and secondary Care, A&E, mortality, readmission, DTOC, and Population Health. Risks to the achievement of our strategic objectives are articulated in the Board Assurance Framework and monitored through our risk management processes. Our Boards of Directors have line of sight to the management of significant risks through corporate governance and Board Assurance Framework processes. Clinical governance arrangements and quality governance frameworks are structured to enable the effective identification, management, escalation and reporting of risks to quality. Work will continue during quarters 1 and 2 of 2019/20 on alignment of risk management and quality governance systems and processes across both trusts, and where appropriate, with NCCCG, to enable effective and strengthened quality governance across the system.
7. WORKFORCE PLANNING 4S - Staff
7.1. Challenges
We have difficulty in attracting people to work here and to pursue their careers in the region. This is historically due to rural and remote geography plus there is considerable competition from national centres of excellence in major metropolitan areas. This is replicated across the whole health economy in north Cumbria as staff move between health providers with fewer new people starting. Our young people leave the area for training, education and development and often do not return to take up careers in the region. The numbers of training places available make recruitment to posts challenging. The removal of the bursary has impacted upon us being able to attract new staff and has also affected retention and our ability to ‘grow our own’. Whilst our attraction campaigns have been successful in recruiting new starters into the system, our existing workforce is leaving in higher numbers leading to a gap in attrition rates, therefore, retention remains our top priority. We have a ‘super ageing’ population which is estimated to be at 32.4% of people over 65 by 2041, with all the health and wellbeing issues that brings. We also have an ageing workforce across both Trusts - 3.15% of our staff could retire immediately and a further 15.73% within the next five years. This is even more challenging within
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primary care with around 33% of practice nurses eligible to retire over the next five years and up to 50% in the next ten. Whilst nursing remains our primary workforce shortage across the health economy there are a number of other critical gaps such as doctors and consultants across a range of specialties. GP vacancy rates are higher than the national average and vary between 11-39%. We are a pilot site for the recruitment of international GPs, however, despite much effort being placed into this scheme, we have struggled to recruit GPs from oversees, much the same as the rest of the country. To date we have placed two GPs and have a number of others progressing through the system. Brexit has placed a significant challenge on this scheme as many European GPs, like other clinical and medical professions are now reconsidering whether they wish to work in the UK. With increasing workloads and a workforce seeking flexible working patterns, we need to consider different skill mixes and roles for our workforce of the future in order to meet changes in the complexity of conditions and patient outcomes. Gaps in our workforce lead to over reliance on agency and bank staff, which places further pressure on permanent teams to provide continuity, safety and assurance at increased cost. The EU Exit poses a significant threat in both retaining our EU workforce and our ability to attract from Europe, therefore, we will need to consider international recruitment from further afield with associated cost implications. A system-wide Brexit Planning Group is in place reporting weekly to assess risk to business continuity and delivery of safe quality patient care, with workforce one of the key elements. Our Approach We are currently implementing our People Plan for the developing IHCS for north Cumbria. Development of this strategic delivery plan over 2019-2025 will be undertaken through co-production by the whole system, with the first action plan for 2019-20 aligned with the current business planning cycle. This strongly links workforce with service and financial plans, focussed upon the merging Trusts and associated organisations. Following an extensive engagement process with key stakeholders, this plan was approved by the Board of Directors in March 2019. We have taken care in this strategy to ensure that we are not simply trying to solve the problems for 2019 or 2020. Instead, the strategy identifies the objectives which need to be achieved to ensure that we have the optimum number of workforce, with the best mix of skills, for the issues that will exist in 2025. The objectives therefore must allow for flexibility in how they will be implemented over the next five years. The development of a Workforce Plan for the system will follow and we are working closely with Cumbria County Council who are leading in this work. Engagement has taken place with Care Groups and System leaders to ensure that transformational Business Cases are balanced with operational pressures affecting service delivery and patient flow, to develop a programme of workforce activity over the short and medium terms. Retention is one of our top priorities across the IHCS, therefore, a multi-disciplinary group of key leaders have come together to understand the
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reasons why our staff are leaving and to develop interventions and initiatives to encourage people to stay. In addition to the recruitment of new GP trainees, we are also focusing upon retaining our existing GPs to stem the flow leaving the system. Using funding from NHSE we have a number of work streams focusing on ‘Recruit, Retain, Return’. This is aimed at offering bespoke and interesting salaried posts to our newly qualified trainees, offering new opportunities to our existing GPs to try and prevent them from reducing sessions and also in enticing our retiring GPs to stay for sessions when they would have otherwise left. These work streams have been designed after in-depth discussions across our GP population and will be in place by 31st March 2019. As part of this work we are also establishing an online academy which will be a single point of access for all educational events in north Cumbria and an online job matching hub. Our aim is to raise the profile of north Cumbria to one of being an excellent place to live and work with a wide and varied educational provision. As part of this, we are revamping our educational provision during Protected Learning Time (PLT) afternoons and will be facilitating Integrated Care Community level discussions and learning on system pathway topics, using the expertise of our system colleagues. Both the PLT learning sessions and our evening educational events will be video conferenced across the area to increase participation and will be hosted on the academy website for future viewing. Our approach to managing bank, agency and locum spend has been nationally recognised as an exemplar leading to a reduction in our temporary workforce and significant cost improvements. We have successfully recruited from overseas, including the appointment of paramedics from Poland into new roles within the Acute Sector. This work is now being considered wider into Community and Primary Care, to provide alternative workforce models to support traditional roles and fill workforce gaps. A recent recruitment campaign has also resulted in the successful appointment of over 20 International Clinical Fellows who will arrive in June 2019 to help fill our longstanding vacancies and support our existing medical workforce. Implementation of our Succession Planning and Talent Management programmes will enable us to further value, grow and retain our existing workforce. We are developing a range of shared initiatives including flexible retirement and return to practice to retain experience, knowledge and skills within the system. Our Apprentice Strategy has been implemented and we have strong links with higher education and schools to help grow our future local workforce. These include cadetships and a range of work experience and job shadowing programmes such as Dream Placement and our successful Blue Light Careers Fairs. We are further developing workforce planning and redesign capability across the system, using a common approach and tools such as the Population Centric Model and WRaPT workforce modelling. We have successfully received funding from Health Education Englane (HEE) for an integrated workforce planning project on Atrial Fibrillation, as part of the system-wide Cardiovascular Disease (CVD) Business Case. This project will develop both capability and capacity in workforce planning to
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support system transformation and will also be shared as a training tool for other Trusts and workforce planning leads across the North. We are rolling out the NHSE-funded Apex Insight Tool in our General Practices to better understand how our workforce is meeting the activity demands and how new and different roles can be considered to meet predicted future demand. As General Practice is made up of 39 independent businesses, plus our out of hours provider, Cumbria Health On Call (CHOC), maintaining workforce data and influencing workforce changes can be challenging in itself. The Apex Insight tool will help us in this as it will not only be used at individual practice level, but also to collate data at Integrated Care Community (ICC) and CCG level to help us meet workforce needs on a collective level within the financial constraints that Primary Care operates. Our nationally recognised Composite (Alternative) Workforce approach has been successfully implemented across the Trusts and is now being rolled out with wider partners. This will enable us to design innovative new roles across acute and community settings, including the pilot of rotational roles to further support community based healthcare and the NHS Long Term Plan. We presented this approach at a recent regional HEE Advanced Clinical Practitioner (ACP) event to demonstrate how we designed an alternative medical workforce for Emergency Medicine to ensure both a safe, sustainable service in areas of critical workforce shortage whilst also building in development and succession planning. Enhanced Training Practice has supported the expansion of student nurse placements and the recruitment of nursing leads within primary care. It has also facilitated the placements of six physicians associates and one radiographer. A number of practices are now employing paramedics, clinical pharmacists, physicians associates and advanced clinical practitioners to divert activity away from GPs and thereby fill the GP vacancy gap in an alternative way. In line with the NHS Long Term Plan, work is underway for the introduction and establishment of new roles including first contact physiotherapists, mental health workers as well as newer roles such as the development of medical assistants. Our Primary Care Workforce Group, with key stakeholders from different professions and organisations, provides operational and strategic leadership for all elements of workforce planning and implementation. A workforce mapping exercise has also commenced within Primary Care to understand the needs of the nursing workforce and how this will link with developing ICC’s.
Challenges
Description of Workforce Challenge
Impact on Workforce Initiatives in Place
High vacancy rates for clinical, medical and consultant roles
Skills gap, increase in stress & sickness, increase in temporary workforce, increase in cost of locum/agency
Targeted attraction programme Composite workforce models to redesign workforce on what we can recruit, retain and retrain.
Innovative, flexible and rotational roles
Recruitment of Nurses, Doctors and Consultants
Difficult to recruit in Cumbria, impact whole system
Targeted attraction Programme
International Recruitment options
Planned overhaul of Recruitment process
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Cumbria LEP Careers Hub workstream
Retention and Retirement of staff
High attrition rates with more staff leaving than starting. Aging workforce with large numbers due to retire.
Retention project for IHCS
Grow our own initiatives
Career pathways
Succession and talent management programmes
Flexible retirement
High GP vacancy rate Unmanageable workload on existing GPs; Reliance on Locums; unable to fill all clinical sessions with locums
GP training Scheme: currently fully subscribed
GP Retention programme: funded from NHSE. Creation of an online academy providing a single point of access to all educational provision. Creation of a job matching hub. Creation of attractive bespoke GP portfolio posts. Facilitation of research opportunities and academic qualifications through UCLAN to interest GPs due to retire
Composite workforce approach: training of ANPs, employment of Clinical Pharmacists, Physicians Associates, Paramedics
Oversees recruitment pilot: 2 GPs placed, additional GPs progressing through system
Changing the provision of GP services including ‘On the day’ access centres to treat urgent cases using Nurse Practitioners and recently retired GPs; collaborative working across Integrated Care Communities
Ageing nursing workforce
Nursing vacancy rates will increase within 5-10 years; impact on GP workload
Increasing the numbers of student nurse placements
Advanced Nurse Practitioner training opportunities to encourage nurses to work in General practice
Appointment of Practice Nurse leads to provide strategic leadership of Practice Nursing
Difficulty recruiting First Contact Physios
Unable to alleviate the workload of GPs as posts are difficult to fill
System wide planning of physiotherapy workforce to upskill physios to fill posts
7.2. Risks
As detailed in the narrative above, the workforce challenges we face as an IHCS have resulted in a number of risks which are intersectional across organisations. These have been formally recorded within Risk Registers and are regularly reviewed to ensure progress and risk reduction. These are captured in the table below:
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Risks
Description of Workforce Risk
Impact of risk (high, medium, low)
Risk response strategy Timescales and progress to date
Ageing Workforce
High Promotion of flexible retirement, succession planning, retirement planning association with appraisal.
Flexible retirement is promoted to staff as part of the retirement planning process within the appraisal. This has allowed us to utilise skills and knowledge to train other staff. (to be completed March 2020)
Temporary workforce
Medium Implementation of e-rostering and job planning, greater focus on health and wellbeing, developing firm retention programmes.
Ongoing project to implement e-rostering, job planning is ongoing to be centrally managed consistency alignment. (to be completed March 2020)
Recruitment High Creating attraction programmes, international recruitment and developing succession planning and talent management programmes.
Succession planning and talent management implementation is due to commence with Exec followed by a roll out multi organisation (to be completed March 2020)
Sickness and absence
Medium Focus on health and wellbeing, integrated policies, proactive management and occupational health.
In house occupation health has been implemented jointly across CPFT & NCUH, health and wellbeing programme is currently being delivered, integrated policies are now in place. (to be completed March 2019)
Retention High Retention Project across ICS
A retention project across the ICS, regular monitoring/reporting, exploration of interventions such as flexible working (to be completed Jun 2019)
Reliance on GP Locums – up to 34% in some areas
Medium Gaining information of regular locums through GP retention scheme in order to offer bespoke posts to encourage salaried employment
Job matching hub and bespoke portfolio post creation underway (to be completed March 2019)
Significant number of GPs due to retire within next 5 years
High Retention of ‘wise 5’ GPs as part of GP retention programme
Discussions with GPs due to retire to explore retention possibilities complete. Plans in place with UCLAN for research and academic opportunities. (offers to be publicised by 31
st march
2019)
Sustainability of clinical services where there have been long standing recruitment issues.
High Exploit clinical networking opportunities with specialist centres in the North East and continue to put in place alternative workforce models, particularly in relation to stroke, cancer and gastroenterology.
Reorganisation of care group structure and develop workforce plans (by 31
st march
2019)
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7.3. Long Term Vacancies
The table below, although not exhaustive, captures some of the main long term vacancies we have across the system. In response to national skills shortages and the local rural/geographical challenges we face, transformation and redesign of our services will be critical to ensure we continue to deliver sustainable, high quality services for our patients with the resources we have. This will be supported by targeted attraction campaigns, an overhaul of our recruitment processes and effective on-boarding, which are all currently being developed.
Long-term Vacancies
Description of long-term vacancy, including the time this has been a vacancy post
Whole-time equivalent (WTE) impact
Impact on service delivery
Initiatives in place, along with timescales
Gastroenterology consultant advertised 2+ years
6.0 WTE
Continuity of service and high cost
Outsourced provider
Referrals to other Trusts
Seeking long terms solution
Stroke HASU Consultant advertised 18 months
2.0 WTE for Stroke (5.0 WTE recommended by RCP for the HASU)
Delays on implementation of new HASU
Composite workforce approach to design sustainable model
Benchmarking
Commercial job fairs
BMJ advert & jobs fair
Engagement with permanent specialist agencies
International recruitment.
Consultant Old Age Psychiatry 4+ years
3.0 WTE Continuity service, safer staffing level and higher cost
Regular advertising for the last 4 years, included in medical staffing job fairs
Next BMJ advert
Engaged permanent specialist agencies.
B5 Mental Health Nurses
17.0 WTE Continuity service and high cost
Attended 25 uni career days, 6 commercial job fairs (incl Ireland & Scotland)
University job boards (est 130 nationally)
Social media and job of the week promotion
Dedicated Workforce Group monitoring
B5 Medicine Nurses 122.0 WTE Increase in establishment of 122 nurses led to large increase in vacancies on top of existing ones
Every university job board has our B5 vacancies posted (est 130 nationally),
Attended 25 uni career days, 6 commercial job fairs (incl Ireland & Scotland)
Launched onsite recruitment days in collaboration with NWAS, CPFT and UoC to promote nursing careers and the pathways available in the region.
Trailed B5 Nursing Times advert
Promotion of the national award winning Composite workforce model
GP vacancies in some practices since 2013
11-39% dependent upon recruitment
Impact on GP workload therefore affects GP retention
GP training Scheme
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8. Financial Planning 4S – Sustainable Finances
System financial forecasts and modelling
Introduction
The IHCS has been working to a five year financial plan commencing in 2016/17
profiled to 2020/21. The plan (PCBC plan) was aimed at addressing underlying
financial deficits in all organisations through the adoption of more efficient and higher
impact services and organisations. Specifically, against a likely worsening deficit of
up to £166m by 2021 the plan was to implement efficiencies and transformational
service changes along with using increased funding from CCG allocated growth and
national sustainability & transformation funds (STF) to an almost fully recovered
financial positon.
With two years of this PCBC plan remaining the following factors are worthy of note:
1) The actual financial performance of the Trusts and CCG has improved broadly in line with the planned profile. This is with significant non-recurrent cost savings and support in addition to levels of efficiency delivery above historic levels.
2) The transformational projects put in place have cost the IHCS around £10m per annum and whilst these have generated non-financial benefits the financial benefits have not been cash releasing (projected savings £16m) that has an impact on the underlying position. In addition, the system has received significantly less transformational support funding than identified in the PCBC.
3) The national financial framework has significantly changed in January 2019 with national STF moneys and pay settlements now included within CCG allocations when previously these were either in addition to forward allocations or at levels more in line with overall inflation.
4) The resulting financial performance in 2018/19 has been difficult to maintain against our original plan and significant use of non-recurrent savings and income has been required.
5) The original PCBC plan did not include a number of issues that have had an impact on the underlying financial assumptions used in the PCBC. For example, change to the level of resources available, such as the impact of NHSE business rules (CCG surpluses, ring-fenced funding allocations, etc) and PCBC assumption that STF funding would be made recurring. In addition, issues such as the as the CCG boundary change and the transfer of community services in South Cumbria has reduced the “residual” cost pool to derive future efficiencies.
With the new financial framework announced in early January draft organisational financial plans were submitted to NHSI and NHSE respectively in February. Since then we have been working to refine these taking into account further guidance, the developing 2018/19 position, feedback from regulators and more clarity on the 2019/20 CCG allocation and commitments. The NHS system has a proposed deficit control total of a £17.7 million for 2019/20 as represented by:
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NCUH £21.7 million deficit
CPFT: £Nil (breakeven)
NCCCG £4 million surplus (set by NHSE to recover historic overspend) The IHCS is committed to delivery of the control total. In doing so it is seeking to achieve plans that are ambitious and carry delivery risk that is mitigated through a programme of transformative change in line with being a national IHCS pilot. It is also noteworthy that 2019/20 effectively forms “Year 1” of the refreshed North Cumbria 5-year strategy to address the new “NHS Long Term Plan” that is currently under development for publication in the autumn of 2019. CCG Position North Cumbria CCG has received an uplift of £22.3m for 2019/20 based upon the new allocation formula. This is an uplift of 4.87% compared to an average of 5.14% for North East & North Cumbria and 5.65% nationally, and is among the 10 lowest uplifts in the country. This growth will be applied as follows: NC CCG Source & Application of Funds 2019/20 £M
CCG Programme Growth Funding 22.3
Application of Funds
Inflation Growth (exc. Mental Health) net of 1.1% efficiency 7.7
PSF/CNST/Procurement 3.1
Activity Growth (inc. CHC) 7.5
Mental Health Investment 3.6
FYE agreed contract changes 1.5
Agreed non-recurring commitments 0.9
Additional Clinical Standards 1.0
CCG Non- recurring QIPP 18/19 0.9
ICC Net QIPP target brought-forward 2.2
CCG Non-system QIPP 19/20 (6.1)
Total Application 22.3
Final financial plans are due for submission to regulators on 4 April following consideration by respective Boards and the CCG Governing Body. To enable this the Trusts and CCG have worked cohesively so that the CCG’s planned surplus of £4m has been secured (in line with ICS requirements). This means a continuation of the system’s provider financial plans holding a major element of the system’s financial risk. Combined Provider Position Baseline contracts with all commissioners have been agreed. Importantly, the CCG has identified and agreed a number of risk sharing areas effectively moving system risk from the provider to the commissioner within the shared arrangements in place in the IHCS. With the income agreements in place, the Trust budgets have been modelled to take account of the pay award for staff, a limited number of unavoidable cost pressures, expected levels of vacancies and non-recurrent support/cost savings being replaced. The resulting budgets specify a level of efficiency that will be delivered by the system efficiency plan.
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2018/19 provider position and 2019/20 challenge
The combined provider position is a deficit of £47m moving into 2019/20 before
inflationary pressures. (If costs of investing in transformational projects were
excluded then this figure would be around £37m so consistent with the PCBC
projection for 2018/19.) Adding the 2018/19 inflationary pressures presents a “do
nothing” deficit for 2019/20 of £63m thus requiring £41m of mitigations to reach the
control total. This position is subject to the following key risks:
Unfunded demand growth, which it is assumed can be managed with no additional cost.
Ability to meet key access targets, particularly improving RTT, with no additional cost.
Containment of cost pressures and current overspends against budgets including agency staffing, medical equipment and supplies, and service developments not funded by commissioners.
The potential impact of service transfers such as the proposed transfer of mental health services in October 2019 may have a significant adverse effect on the position.
The impact of recent guidance on property lives on depreciation which, in line with NHS I informal guidance nationally is not being adopted by the Trusts on the basis of immateriality and has not been reflected in CCG allocations or contract uplifts.
Planning to address this £41m savings challenge is centred on a number of themes including uncommitted CCG resources, commissioner opportunities, provider efficiencies and assumed national IHCS funding as shown in the table below: MITIGATING MEASURES 2019/20 £m
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The system efficiency plan target of £26.2m represents 7% of provider operating costs (excluding mental health services on the presumption that these will transfer to other providers during the year) and so needs to be considered as a whole system priority. Whilst this is extremely challenging the level of maturity in our relationships, previous delivery successes and strength of our capability gives us confidence in our ambition. As well as “business as usual” efficiencies the opportunities presented by further system integration, including the planned merger of NCUH and CPFT, and the progress made in tackling agency staff costs will enable significant improvement on the efficiency assumed in the tariff settlement. Commissioner savings are also being pursued within the “system” efficiency approach. At a system level initiatives already in place should deliver significant savings in 2019/20, including:
Integrated Care Communities providing community and social care alternatives to enable optimised patient flow and consolidation of acute service capacity back to optimum levels at high quality.
Acute service optimisation over two sites for key services in line with public consultation outcomes (surgery, stroke, paediatrics & maternity)
Population Health (including mental health) to secure prevention, wellbeing, independence and health equality across our communities.
Potential commissioner non-recurring opportunities include further funding for specific projects, achievement of the 2018/19 quality premium to support planned quality initiatives and reductions in out of area placements. All system partners are committed to continuing the risk share arrangements which have been successfully in place for the last 2 years. NCCCG, as previously noted, will assume a greater share of the overall system risk in 2019/20, and all parties are working cohesively on delivering a “system” efficiency plan. Risk sharing has been used to ensure all organisations take risks to implement the agreed programme and share benefits together. Importantly, the relationships and trust behind these arrangements are stable and reliable – enabling all parties to focus on delivery rather than positioning – this is evident in our progress as an IHCS. The remainder of this section addresses provider specific issues in support of the detailed planning templates. Key planning assumptions Key assumptions are as follows; applicable to both Trusts unless stated.
National settlement fully reflected in contract income, including tariff inflation, increase in urgent and emergency care prices (NCUH), MRET (NCUH), PSF and FRF.
Pay inflation in line with AfC changes and changes in employer’s pensions contributions fully funded in line with guidance.
Vacancies continue at 2018/19 levels.
No incremental drift beyond impact of AfC settlement.
No significant non-pay pressures.
Demand growth met and access targets achieved at no additional cost.
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In addition, there are two potential significant transactions anticipated in 2019/20 that are not reflected in the current plan submission. Provider efficiency plan
The impact on providers of the system efficiency plan outlined above, together with
progress to date, is set out below.
2019/20 PROVIDER EFFICIENCY PLAN
TOTAL
GAP Identified Achieved Notes
£m £m £m
Pathways and clinical services
Bed changes - 50 beds 2.0 0.1 0.1 A
Outpatient changes 0.5 0.1
Transformational schemes - achieve savings or cease 2.5
Carter - estates and procurement
Buildings consolidation (net of costs) 2.0
Better buying procurement 3.0 1.0 0.5 B
Medicines
Avastin & biosimilars 1.0 2.0 1.8 C
Other Trust 1.0
Outpatient dispensing 0.2
Other CCG 1.8 1.8 E
One organisation
1/2 year merger benefits 1.5 0.2 0.2
Workforce
Reduced agency 2.1
Revised staffing models & skill mix 1.0 G
CCG QIPP 1.2 1.2 F
Other CCG opportunities & Trust departmental efficiencies 6.4 1.9 1.1 D, G
26.2 8.3 3.7
Notes
A £0.1m part year effect for Maple BCD configuration
B £0.5m part year effect of 18/19 schemes.
£0.5m identified for 19/20 includes £175K for pharmacy outsourcing.
C Humira - £1.8M of part year effect into 19/20
Infliximab - £0.1m planned saving for 19/20
D £1.1m achieved is part year effect of 18/19 schemes.
£1.9m identified on tracker
E Pregabalin rebate: being pursued by NHS CCC (non-rec), £1.0m
2% of drugs budget through system-wide meds optimisation, £0.8m
F Additional elements of national ICS funding cfwd, £0.4m
Opportunities for non-rec slippage of CCG spend owing to new GP contract, £0.4m
Reduction in PTS owing to o/p reform (FU red'n, virtual consultation & ICCs), £0.2m
New VBC policies: impact on out of Cumbria activity, £0.2m
G Includes opportunities highlighted by Model Hospital and corporate service benchmarking data.
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Significant Transactions Expected in 2019/20
Transfer of Mental Health and Learning Disability Services On 1st October 2019 approx. £66m income will be transferred from CPFT to two other Trusts representing the contract to provide mental health and learning disability services across Cumbria. The transfer of these services is being undertaken following commissioning intentions and by agreement between the respective parties. The transfer of staff, premises and support services is being enacted. The parties have reached agreement on the direct service costs and premises transferring and are working through the support service and infrastructure costs with a view to these either transferring, being shared or being reduced through a cohesive programme of joint work. It is expected that this programme will successfully ensure that all parties are not exposed to financial risk from the transfer. The annual plan submission assumes this outcome from the transfer programme. Merger of CPFT and NCUH On 1st October 2019 the CPFT and NCUH Trusts are planning to merge to form a unified Foundation Trust. The outline case for the merger has been agreed with NHS I and a programme to finalise the final case is underway. This is expected to receive support from NHS I to proceed in June/July following detailed review processes being completed. The annual plan submission does not model the impact of the merger as this is still subject to full business case submission including the formulation of the unified long term financial plan. Significant unification work has taken place already and continues in advance of merger so that benefits realisation is achieved with maximum possible momentum. The system efficiency plan includes a number of financial efficiency savings being achieved in 2019/20 linked to the benefits of the planned merger. Agency Rules Recruitment and retention is a major challenge in north Cumbria. Heavy reliance on agency staff remains one of the key drivers of the deficit. We have made progress in reducing agency costs in recent years, assisted by the agency rules, and expect to continue to do so to contribute to the 2019/20 efficiency target. The financial plan includes a further £2.1m reduction in agency premium. Management will continue to focus on agency costs and compliance with agency rules but, for reasons of patient safety, it is not possible to guarantee that we will be able to do so at all times. Capital Planning Major capital programmes are planned and being delivered across five portfolios of delivery with funding streams indicated below;
1) Major capital schemes; Cancer Centre – Wave 1 STP capital
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West Cumberland Hospital – Wave 1 STP capital Community Hospitals – Wave 1 STP capital CIC configuration – PFI re-funded
2) Minor capital enhancements; Internal financing
3) Equipment refresh; Internal financing Capital loan to be sought to enhance radiology capacity
4) Digital Transformation; EPR, EPMA, Infrastructure from HSLI & GDE programme finance
5) Digital equipment refresh; Internal finance
All opportunities to access national capital or other financing routes are being explored as internal financing is insufficient for long term investment needs. The draft capital plan for 2019/20 and sources of funding is as follows:
TOTAL Internal
£m £m
Major capital schemes
WCH redevelopment 3.6 1
Northern Cancer Centre 10.3
CT & MRI enabling works 0.7
Community hospitals/ICCs 2
16.6 1
Minor capital enhancements
CIC PFI life cycle 5.2 5.2
Minor works and backlog 3 3
8.2 8.2
Equipment refresh
CT & MRI scanners 3.1
General equipment replacement 1.9 0.5
5 0.5
Digital equipment refresh 1.5 1.5
Total 31.3 11.2 17.4 2.7
FUNDING SOURCE
2.5 2
1.1 2
1.4
0 0
0.7
2
14.9 0.7
2.6
10.3
PDCCapital
loan£m £m
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9. MEMBERSHIP AND ELECTIONS Elections to the CPFT Governors Council are held annually, usually in September although in 2018/19 they were held in December 2018. Governors hold a three-year term of office, which are staggered so that one third of the Council is due for election each year. Online voting is used as well as paper for Governor elections with which the Trust is supported by an Election Returning Officer and the Membership Database Service Provider. Whilst we continue to have vacancies across most constituencies, which has been the case for a number of years, we have a very active Governors Council. In addition to Governors Council General meetings, governor development sessions are scheduled throughout the year to raise awareness of governance issues in order that they are better able to hold the Trust to account on behalf of their membership. The Governors Council have an agreed training and development plan and self-assessment process to evaluate their effectiveness. We continue to support governors with their training programme. In November 2018 the Governors Council endorsed the strategic direction for CPFT and NCUH to join together as a single organisation. We will be engaging with governors on the due diligence activity and will be working collaboratively with governors during Quarter 4 of 2018/19 and Quarter 1 of 2019/20 to review the constitution and future arrangements for the Governors Council. It is anticipated the next round of Governors Council elections will be held during Quarter 3 of 2019/20. The Governors Council present the outcome of their bi-annual self-assessment together with a quarterly update on their activities to the Board of Directors. Examples of actions taken forward from the outcome of the self-assessment process:
Amending the structure of the Governors Council to include constituencies in Lancashire and North East England
Reducing the number of locality groups to two and renamed as North/South Engagement Partnership groups
Reduced number of special interest groups to focus on Mental Health, Specialist services and Governance
The Membership and Communications Committee disbanded and incorporated into the Advisory Committee
The Advisory Committee to include a focus on strategic direction with the CEO and Chair attending to update on this area
The Annual Members meeting was held in September 2018 jointly with NCUH where members of staff and public attended. Governors attend local groups to listen to the views of the public and encourage the public and staff to understand the role of the governor. We encourage governors to attend public meetings on the major transformational programmes in order that they can engage with the Trust in representing their membership’s views on those programmes and provide feedback to the Board of Directors. The Chief Executive provided updates throughout 2018/19 on
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developments for the north Cumbria integrated health and care system and will continue to do so during 2019/20. Implementation of the Membership Engagement Strategy is overseen by the Governors’ Advisory Committee which provides updates to the Governors Council on progress towards achievements of the strategy’s targets. The strategy is due for review which will be actioned as part of the review of the constitution. We will also be engaging with members throughout the year on coproduction opportunities.
10. KEY RISKS TO THE DELIVERY OF OUR PLAN In setting this ambitious plan, which builds on previous plans approved with regulators, the Boards of CPFT and NCUH, and Governing Body of NCCCG, are specifically aware of the high inherent risks. These include;
Significant transformational change and dependence upon transitional support funding as discussed with regulators;
Significant cost reduction programmes in a climate of demand growth and wider health and care system funding restraint;
Significant imperatives to improve quality (outcomes, safety and experience) as set out within national standards and regulators;
Significant workforce supply risks to be mitigated as new workforce models are developed over time;
Significant restrictions in access to capital investment for routine replacement/maintenance programmes available through both local and national capital processes;
Significant investment in digital infrastructure to ensure that it reflects the integrated way of service delivery across all system partners;
Assumption that the RTT trajectories and target maximum numbers waiting can be achieved with no additional investment.
In preparing this plan we are aware that our aspirations are quite high, and we are optimistic that it is realistically achievable, albeit with some stretched challenges. We have reflected on where we have made huge progress but not delivered the full extent of what was planned in previous years. This is a potential risk for 2019/20 which we will be actively monitoring through governance arrangements at organisational and system level, taking appropriate steps to notify our Regulators if plan delivery is likely to be substantially impacted. It is important to emphasise that in addition to the joint development of this plan, work has already commenced on the joint delivery framework which will take the form of the ‘OGIM’ methodology of:
Objectives
Goals
Initiatives
Measures
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The OGIM methodology is important due to some of the objectives running for more than the 2019/20 year therefore clarity on the specific in year deliverables and metrics is crucial to demonstrate and track progress. In quarter 4 2018/19 work to develop the programme management office approach into a ‘system engine’ to support delivery has commenced. During Quarter 1 of 2018/19, the Boards of Directors of NCUHT and CPFT jointly agreed a common set of top strategic risks which impact upon the jointly agreed strategic objectives. These jointly agreed strategic risks, which are reviewed on a quarterly basis by the Board of Directors via the Board Assurance Framework are stated below. Ref Strategic Risk
1. Leadership and workforce is not sufficient to deliver the scale and pace of transformative change
2. Cultural change to improve quality and empower people is not sustained
3. Engagement with the public and partners is not effective in achieving positive change that improves or transforms services
4. Quality of services (experience, safety, outcomes) are not improved because programmes to transform, integrate and save have adverse quality impacts
5. Financial sustainability is not achieved as the effectiveness of cost reduction plans and implementation of new service models does not deliver the anticipated financial benefits set out in our long term plans
6. Health and Health Service improvement plans are impeded by dependency on key partners who are not sufficiently ready / able to support our plans
7. Vulnerable services become too unstable to continue during the implementation of wider transformation programmes across Cumbria and North East
8. Infrastructure developments are not sufficiently enabling of transformation
9. Fragility within primary care impacts our ability to effectively manage patient flow
10. Transfer of Mental Health, LD and CAMHS Services significantly disrupts the service continuity and resilience of estates, IMT and all support services
Cumbria Partnership NHS Foundation Trust Page 39 FINAL Joint Operational Plan 2019/20 North Cumbria University Hospitals NHS Trust
North Cumbria Clinical Commissioning Group
Appendix 1 System Objectives and Goals for 2019/20 The national operational planning requirements for the NHS, together with the Long Term Plan highlight a range of service enhancements which we are committed to implementing locally across the ICS. Many of the initiatives are already either in place, or are in the process if implementation, and will form the core route by which the service objectives are delivered. This section highlights the key objectives that will drive delivery of the local and national aspirations and embrace the requirements of the NHS Operational Plan, the local ICS Memorandum of Understanding, and the local plans for service transformation following the Success Regime consultation
Objectives Goals
NHSE NHSI
National
Plan
ICS MOU
Objective
Local
Objective
Strong leadership for population health in place across the system
Five population health high impact changes to be appropriately resourced and embedded across relevant long term condition pathways
ICCs to have developed and be implementing placed based population health plans
Develop and implement a population health management plan
Utilise business intelligence tools (such as RAIDR) to inform pathway development
ICCs to have utilised Business Intelligence tools (such as RAIDR) to risk stratify/segment their populations to better manage population health
Establish a method and process for pathway redesign and implementation
Reduce unwarranted variation in treatment and prevention in Diabetes
Improve the prevention, diagnosis and treatment of Cardiovascular disease
Deliver pathway change to reflect best practice with a focus on prevention, self-management and community services
Develop and design the Frailty and Falls pathway
Design pathway for Stroke to enable the ESSD service
2. Develop integrated patient
pathways, which deliver care in
the most appropriate setting, and
improve outcomes
1. Develop and implement
approaches for population
health and population health
management at:
ICC network/pathway and
system level.
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North Cumbria Clinical Commissioning Group
Objectives Goals
NHSE NHSI
National
Plan
ICS MOU
Objective
Local
Objective
Establish the system engine delivery model including (CLIC & OD / PMOs / BI) to support delivery of strategic agenda
To support the production of the OBC and FBC for the future provision of Pathology Services in the NE and Cumbria.
Consider the delivery of 7 day services across of all areas and in particular; meets the core 7 Day standards for acute and primary care
services.
To ensure stability and sustainability of services by procurement and/or development of a network model with Newcastle and the NE, for
certain specialities; Neurology, Vascular, Haematology, Max Fax, Head and Neck, Gastroenterology, Acquired Brain Injury, Weight
Management Services.
Medicines Optimisation to help patients to: improve their outcomes; take their medicines correctly; avoid taking unnecessary medicines;
reduce wastage of medicines; and improve medicines safety.
Continue to develop ICC based primary and community care services to prevent people being admitted to hospital and facilitate discharge at
the right place and time.
Support ICCs to develop patient and wider community involvement approaches, linking into existing forums and local district council plans
where appropriate.
Establish Primary Care Networks through the evolvement of ICCs and implement requirements set out in revised GP contract framework &
Service Specifications.
Establish NCPC alliance and implement the clinical model.
Develop Primary Care Mental Health Services;
Review and develop the social prescribing model for ICCs.
Embed third sector working across ICCs.
Develop MSK and Orthopaedics services in Primary Care based on First Contact Practitioner
Continued implementation of Community Hospital Redevelopment
Identify the priority areas of improvement in relation to the Enhanced Health in Care Home Framework.
A focus on continuing timely hospital discharge with emphasis on stranded and (40% reduction in) super stranded patients and a decrease in
Delayed Transfers of Care working with Adult Social Care, continuing to improve Continuing Healthcare processes/pathways, and working
with the Trust and ICCs
Provide patients with the right care at the right time in the right place, reviewing and consolidating the use of beds in the Acute setting.
Frailty service covering 70 hours a week to be in place by December 2019
Deliver frailty and falls pathway change to reflect best practice with a focus on falls prevention, self-management and community services;
5. Develop preventative services,
and improved care pathways, for
frail & elderly patients
4. Continue to develop our local
care provided by ICCs, Primary
Care and Community Services.
3. Deliver safe and sustainable
services for all our patients,
supported by Continuous Service
Improvement
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Objectives Goals
NHSE NHSI
National
Plan
ICS MOU
Objective
Local
Objective
Deliver a comprehensive CHC end to end process to aligned with the new National Framework October 2018.
Formal merger of NCUHT / CPFT and delivery of a single corporate governance structure for the new Integrated Health and Care System
(merged provider and CCG) recognising all statutory and other required duties and leanest possible overheads.
Develop Primary Care Networks and a 'collaborative' representing general practice allowing practices to be effective partners within the
wider system.
Ensure quality and safety of Mental Health services improve by the successful transfer of services to new providers
Alignment of health and care services with the County Council through the ICCs and delivery of the Population Health Framework.
Develop Joint Commissioning arrangements with Cumbria County Council for example; children with SEND
Further work to streamline local service provision, including working to integrate local GPwSI and AQP providers;
Enhance staff engagement
Reduce medical, dental and nursing / AHP vacancies
Ensure staff have core skills to do their job
Develop the Urgent Care Village and work across the health and care system to ensure ambulatory same day services are in place by
September 2019 (covering 12 hours per day 7 days a week, with 30% of non elective admissions to be same day emergency care by March
2020), A&E discharge, and patient flow arrangements and progress towards delivering the 95% 4 hour target.
Develop 'same day' primary care services
Work with the ambulance service to improve ambulance response times
Deliver the operating plan objectives for 111 and ambulance services
Develop HASU, and Early Support Stroke Discharge (ESSD) services at WCH, as per Consultation
Develop hospitals all age MH liaison service in A&E and inpatient wards
Implement GP Streaming in the Acute Hospitals
Ongoing development of the Northern Cancer Centre at CIC jointly with NUTH
Manage capacity to ensure delivery of 14 day, 31 day and 62 day constitutional standards and compliance with timescales for tertiary
transfers
Support the identification of the most locally appropriate rapid diagnostic pathway, and work closely with the Northern Cancer Alliance and
3rd sector partners to support local rollout
Building on the implementation of the risk stratified follow up model within the breast service, roll out the new follow up models to prostate
and colorectal services by April 2020;
Support earlier diagnosis of cancers through raising awareness of symptoms, in conjunction with targeted support to reduce health
inequalities, whilst also ensuring robust and accurate data collection regarding stage of cancer at diagnosis;
Launch an Acute Oncology Service, aligned with national guidelines
Support the development of the new Radiotherapy service and specification
Prepare stretch targets for 28 day diagnosis
Roll out fully operational screening service for HPV primary screening for cervical cancer service and Bowel Scope Screening
6. Develop our system to support
the integration of
commissioning and service
provision with our partners
7. Deliver the priorities of the
people plan including; enhancing
staff engagement, reducing
9. Improve the prevention,
access and treatment for
patients requiring our cancer
services
8. Reduce the demand for, and
improve the provision of services
for patients accessing urgent and
emergency care services
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Objectives Goals
NHSE NHSI
National
Plan
ICS MOU
Objective
Local
Objective
Managing the RTT open pathways waiting list to ensure that overall numbers are maintained at no higher than 31 March 2018 levels,
recovery towards the 92% 18 week RTT and 99% 6 week diagnostic standard by March 2020.
Transformation of outpatient services improving the efficiency and managing the capacity and demand effectively
Improve theatre efficiency to increase throughput and utilisation
To deliver on the consultation regarding centralisation of elective care onto WCH site
Deliver investment standards that will deliver improved outcomes and ensure sustainability services in Mental Health.
Develop appropriate local services to reduce reliance on out of county placements and services
Develop pathways to deliver a Mental Health Service within ICCs, including primary care mental health services
Develop perinatal Mental health - target 4.5% of population birth rate - and with access to psychological therapies
Improve the current delivery and future sustainability of CAMHS services
Pilot a whole system approach to commissioning CYP EWMH services, with the support of NHS England and a focus on the delivery of the
new constitution standards for CAMHS and Eating Disorders
Develop new models of care for children and young people with learning disability and/or Autism Spectrum Disorder as part of the TCP
accelerator site
75% of patients with learning disability and/or Autism Spectrum Disorder over 14 years will receive an annual health check
Further Development of an Enhanced Community model into a sustainable model for people with a learning disability and/or Autism
preventing unnecessary admissions to hospital
Provision of inpatient services for adults with a learning disability experiencing a mental health crisis (target 4 beds for North Cumbria in a 6
bed unit covering the whole Cumbrian population) and community teams
Working in partnership with Cumbria County Council and NHSE to transition from the Transforming Care Programme to a Citizenship model
for all ways of working
Addressing health and mortality inequalities across the Cumbrian population of people with a learning disability and/or autism
Conclude work on Maternity Consultation Outcome ( Option 1) - Respond to the outcome of the 12 month sustainability period and develop
an appropriate workforce and operational response to support delivery
Implement the 'Better Births' objectives within the WNEC Local Maternity System
Implement the preferred delivery model for paediatrics (as described in the Paediatric Business Case) , including Short Stay Paediatric
Assessment Units on both acute sites, and the development of Integrated teams across Acute and Community Specialist teams
Develop the concept of integrated and place based services with ICCs and CCC - Work with all relevant stakeholders to look at local centres
where maternity and children’s services are provided alongside other family-orientated health and social care services
10. Deliver improvements and
innovations for elective care
13. Deliver safe, personalised
services that are joined up for
children and families
11. Improve quality of mental
health services for both adults
and children
12. Improve the models of care
and experience for patients with
Learning Disability and Autism
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Objectives Goals
NHSE NHSI
National
Plan
ICS MOU
Objective
Local
Objective
Improved outcomes
Improved safe and reliable care
Improving the reporting & learning from incidents using QI methodology
Improved patient and staff experience
Development of quality improvement strategy and implementation plan
Strengthened clinical governance
Get to 'GOOD' CQC rating for all services across the system including; General Practice, Mental Health, Community and Acute Care and
regulated residential homes.
Development and delivery of clinical leadership programmes
Alignment with system quality goals and priorities
Develop System quality metrics to drive quality improvement
Support quality improvement within general practice in line with new GP contract framework.
Ensure compliance with new Nursing Standard;
Strategic Investment to enable system transformation - a. Cancer Centre Development
Strategic Investment to enable system transformation - b. WCH Redevelopment Project
Strategic Investment to enable system transformation - c. Community Hospital Inpatient Consolidation
CIC Strategic Development - a. GP Streaming and A&E improvements
CIC Strategic Development -b. HASU
CIC Strategic Development - c. Radiology expansion
Consolidation of the current estates in line with service strategy
Meet statutory and mandatory digital targets
Support both Trusts in the digital elements of the merger
Deliver the digital elements for MH & LD Transfer
Support and deliver digital requirements for Regional Programmes (Cancer)
Support and deliver digital requirements for Regional Programmes (Pathology)
Support and deliver digital requirements for Regional Programmes (Radiology)
Design, develop and start rollout of Agile working for ICCs, incl. rollout of Instant Messaging, Audio, Video & Collaboration tools
Continue design, development and rollout of Digital Care Records Programme incl: maximise existing systems and convergence
Deliver Phase 1 of 3 for Infrastructure modernisation - Reduce the risk
17. Deliver financial control total
for 19-20 and reset our 5 yr
financial plan
Ensure services consider the best practices and pathways recommended by GIRFT, Model Hospital and Carter, Right Care, and that QIPP and
CIP programmes take account of appropriate local opportunities.
16. Deliver the Digital Plan
including: supporting the merger
and transition of MH&LD,
supporting regional and ICC
Initiatives, delivery of 'Digital
Ready' and design of 'Digital Set'
themes
14. Improve Safety & Quality
across the system and achieve a
CQC rating of "GOOD"
15. Deliver strategic investment
in estates: Strategic investment
including; a.) Cancer Centre, WCH
redevelopment and Community
Hospitals development, b.) CIC
Strategic Development and c.)
consolidation of current estates
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Appendix 2 Glossary of Acronyms
Acronym Detail Acronym Detail
A&E Accident & Emergency ICS Integrated Care System
ACP Advanced Clinical Practitioner IHCS Integrated Health Care System
AfC Agenda for Change IHCS Integrated Health Care System
AHP Allied Health Professional IMT Information Management Technology
ANP Advanced Nurse Practitioner MH&LD Mental Health & Learning Development
AQP Any Qualified Provider MRET Marginal Rate Emergency Rule
AQuA Advancing Quality Alliance MRI Magnetic resonance imaging
BCF Better Care Fund MSK Musculoskeletal
BI Business Intelligence NCCCG North Cumbria Clinical Commissioning Group
BMJ British Medical Journal NCPC North Cumbria Primary Care
CAMHS Children and Adolescent Mental Health Service NCUHT North Cumbria University Hospitals NHS Trust
CCG Clinical Commissioning Group NE North East
CEO Chief Operating Officer NHSE NHS England
CHC Continuing Healthcare NHSI NHS Improvement
CHOC Cumbria Health On Call NICE National Institute for Health and Care Excellence
CIC Cumberland Infirmary Carlisle NRLS National Reporting and Learning System
CIP Cost Improvement Plan NUTH Newcastle Hospitals NHS Foundation Trust
CLIC Cumbria Learning and Improvement Collaborative NWAS North West Ambulance Service
CNST Clinical Negligence Scheme for Trusts OBC Outline Business Case
CPD Continuing Professional Development OD Organisational Development
CPFT Cumbria Partnership NHS Foundation Trust PAs Programmed activity (for consultants)
CPS Cumbrian Production System PCBC Pre-consultation Business Case
CQC Care Quality Commission PFI Private Finance Initiative
CT Computed Tomography PLT Protected Learning Time
CYP Children and Young People PMO Project Management Office
LEP Local Enterprise Partnership PSF Provider Sustainability Fund
DTOC Delayed Transfer of Care PTS Patient Transport Service
EPMA E-Prescribing and Medicines Administration QI Quality Improvement
EPR Electronic Patient Record QIA Quality Impact Assessment
ESSD Early Support Stroke Discharge QIPP Quality Innovation Productivity and Prevention
EWMH Emotional Wellbeing and Mental Health RAIDR Reporting Analysis and Intelligence Delivering Results
EU European Union RCP Royal College of Physicians
FBC Full Business Case RTT Referral to Treatment
FFT Friends and Family Test SEIPS System Engineering Initiative for Patient Safety
FRF Financial Recovery Fund SEND Special Educational Needs and Disability
FYE Financial Year End SHMI Summary Hospital-level Mortality Indicator
GDE Global Digital Exemplars SI Serious Incident
GIRFT Getting in Right First Time STF Sustainability and Transformation Fund
GPwSI GP with Special Interest STP Sustainability and Transformation Partnership
HASU Hyper Acute Stroke Unit TCP Transforming Care Partnership
HEE Health Education England UCLAN University of Central Lancashire
HPV Human papillomavirus UoC University of Cumbria
HSLI High Speed Line Interface VBC Value Based Commissioning
HSMR Hospital Standardised Mortality Ratios WCH West Cumberland Hospital Whitehaven
IAPT Improving Access to Psychological Therapy WNEC West North and East Cumbria
ICC Integrated Care Community WRaPT A strategic workforce planning tool for health and social care
1
PURPOSE
The plan outlines the strategy, framework and priorities for 2019/20 and highlights the move
to a System strategic delivery plan for 2019-2025. It is intended to provide the high level
framework to guide our work and detailed delivery plans. The framework we are using is that
of the Employee Lifecycle (details in plan). This is a well-recognised HR/OD framework and
enables organisations to ensure they capture, design and develop processes and initiatives
based on employee experience i.e. user centred design.
It is important to note that the underpinning detail and action plans for this will take
considerable work and engagement both within the current organisation(s) and across the
system. As such it is important to note that this document focusses on building a shared
framework, priorities, understanding and guidelines for action.
KEY POINTS TO HIGHLIGHT
The plan is in two parts
System Strategic Delivery Plan 2019-2025
a. An overarching strategic framework for the system 2019-2025. This part of the plan
will be developed in partnership with wider stakeholders including the County
Council, third sector, primary care, universities and community. As such the
attached plan highlights the approach but recognises that to develop this will take
some time and require focus. That is not to say that we will wait for the Strategic
Delivery Plan to be finalised. Work can begin now and has begun in working with
partners to identify our data gaps, our potential scenarios for the delivery of
healthcare in the future to help identify what questions we should be asking to get
insight and intelligence and the implications of wider population health and care
trends.
b. The detail of underpinning plans such as workforce, talent management etc will be
an ongoing process and the intent is to start the work and recognise that this is an
agile, iterative approach. There is no purpose to a plan that is static and
unresponsive to changing circumstances.
System Leadership Board
PUBLIC
Date 2nd May
2019 Enc: 14
Title: People Plan
Author:
2
Annual Plan 2019-2020
c. A more focussed short term plan for the combined Trusts and other partners such
as the CCG for 2019/20. This plan is about ensuring we build a solid foundation
based on a clear framework to guide actions. There are a number of issues
impacting on the capacity of the overall team, but particularly the HR team to deliver
this plan including the merger and the mental health transfer however we have
identified priorities for action. The intention is to develop these plans in as agile a
fashion as possible i.e. recognise we will not have perfection but we will have clear
milestones and improvement in key areas.
d. In line with the priorities and in accordance with the overarching framework of the
Employee Lifecycle the following are the delivery plan priorities and when the Board
can expect to see further detail
a. Workforce planning (including redesigning roles to reflect multi-professional
teams (composite workforce) and rolling out as appropriate – April - June
2019
b. Values and value based appraisal – April 2019
c. Talent management and succession planning – June 2019
d. Recruitment overhaul and detailed plan– September 2019
e. Induction – June 2019
f. Review and redesign of our volunteer approach – September 2019
e. In addition we will be supporting ongoing organisation change and development
including:-
a. Supporting the establishment of Care Groups including the ICCs
b. Developing integrated teams
c. Support to the merger programme – the workforce element
d. Leading the HR workstream for the Mental Health transfer
e. Supporting the design and roll out of clinical pathways
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
The plan is deliberately based on a framework approach and acknowledges that there will be
considerable development across all areas of the Employee Lifecycle required. The wider
System Plan will be an ongoing iterative process as a co-production exercise and work is
underway to share the individual organisation plans and consider opportunities for shared
development. We will be agile and keep the detail and actions under review, monitored and
reported upon in the light of a constantly changing environment.
RECOMMENDATION
3
1 The People Plan | January 2019
The People Plan 2019 – 2025
Our Annual Delivery Plan 2019 – 2020
North Cumbria Integrated Health & Care System
2 The People Plan | January 2019
Transform
There is no option but to transform how we deliver health and social care in North
Cumbria. Demand for services has never been so high, and will only increase.
Thanks to healthier lifestyles, and advances in medical science and technology,
people are living longer and with increasing numbers of people with more than one
health condition.
As the system is currently structured, funding levels cannot keep pace. If we accept
a conservative estimate of inflation at 1%, new medical developments at 1% and
demand rising at 4%, then the health and social care system as currently configured
would require at least a 6% budget increase each year simply to stand still.
This workforce strategic delivery plan is just one of the components required for
successful transformation; central to it will be how services are reconfigured. Other
workstreams within the transformation process will play their role in moving towards
a sustainable integrated health and social care system for the future.
Ultimately, our aim, by 2025, is to meet our patient needs and the needs of our
workforce.
The World Health Organisation highlights the importance of developing workforce
strategies:
“Health systems can only function with health workers; improving health service
coverage and realising the right to the enjoyment of the highest attainable standard
of health is dependent on their availability, accessibility, acceptability and quality.
Mere availability of health workers is not sufficient: only when they are equitably
distributed and accessible by the population, when they possess the required
competency, and are motivated and empowered to deliver quality care that is
appropriate and acceptable to the sociocultural expectations of the population, and
when they are adequately supported by the health system, can theoretical coverage
translate into effective service coverage.”
The workforce is also the most valuable asset in health and social care, and can be
at the forefront of empowering people’s independence, choice and improving their
social inclusion and social wellbeing. Delivering this vision for North Cumbria
requires a confident, capable, well-trained, motivated and engaged workforce.
3 The People Plan | January 2019
Overview
In this document we set out:
• the aims and objectives of the strategic delivery plan and how it fits with the
overall Integrated Health and Care System (IHCS) strategy for North Cumbria.
• development of the strategic delivery plan 2019 -2025 over the next year
which will be undertaken through co-production by the whole system.
• the first action plan 2019-20 in line with the current business planning cycle,
focussing on the merging Trusts and associated organisations.
We have taken care in this strategy to ensure that we are not simply trying to solve
the problems of 2019 or 2020. Instead, the strategy identifies the objectives which
need to be achieved to ensure that we have the optimum number of the workforce,
with the best mix of skills, for the issues that will exist in 2025. The objectives
therefore must allow for flexibility in how they will be implemented over the next five
years.
To begin, however, it is worth setting out the workforce strengths, challenges,
frustrations and expectations in context. These are also national challenges,
however, given the geography, rural economy and associated issues in North
Cumbria, they are particularly stark in their implications for us.
Strengths
Our workforce is our greatest strength, working across a wide range of professions with skill and dedication.
We have a good understanding of workforce risks and issues with a firm commitment to reduce/overcome.
We are developing workforce planning and redesign capability, using a common approach and tools.
Alternative (Composite) workforce models have been successfully implemented and being shared with wider Health system.
Good working relationships have been developed with external stakeholders such as HEE, AQuA, NELA, UCLAN, UoC.
Our Apprentice Strategy has been implemented and strong links with higher education and schools developed.
We are growing experience and expertise in co-production and working together with community groups.
Expertise in supporting flexible medical careers, aiding retention and attraction in critical workforce shortages.
Challenges
Recruitment, in terms of the numbers of training places available, planning for
retirements, and the processes by which vacancies are managed.
Young people leave the area for training, education and development and
often do not return to take up careers in the region.
We have a ’super-aging’ population which is estimated to be at 32.4% of
people over 65 by 2041, with all the health and wellbeing issues that brings.
4 The People Plan | January 2019
Difficulty in attracting people to work here and pursue their careers in the
region, historically due to rural and remote geography.
Considerable competition from national centres of excellence in major
metropolitan areas.
Increasing workloads.
We have an aging workforce, of which 3.15% could retire now and a further
15.73% within the next five years, therefore need to consider flexible job plans
and roles to enable and encourage individuals to work longer should they
wish.
The need to consider different skill mixes and different roles for the workforce
of the future, taking changes in the complexity of conditions and patient
outcomes into account.
A workforce increasingly seeking flexible working patterns, for a variety of
generational and practical reasons.
Gaps in our workforce which leads to over reliance on agency and bank staff
which places further pressure on permanent. teams to provide continuity,
safety and assurance.
The increasing attractiveness of agency work de-stabilises teams, and can
have a demoralising impact upon the directly employed permanent workforce.
Frustrations - clearly identified from staff surveys and managers in North Cumbria
• The need to actively encourage innovation and to share the learning from
positive changes across organisations.
• Frustration at a perceived lack of communication about ongoing reform and
system change.
• A desire for more upskilling opportunities, and the ability to use newly
acquired skills after training.
• There is a perceived lack of information gathered from those leaving, and a
need for exit interviews that encourage open and honest discussions.
• There are potential opportunities to publicise health and social care services
more effectively, and raise awareness amongst young people in particular, for
example by offering more volunteering and work experience placements to
those at GCSE level and above.
• A frustration at perceived lack of opportunities for people living in rural
locations to gain employment in local Health and Social Care (HSC)
organisations, and also with the perception that rural services were struggling
to continue to provide the depth of training and work required to sustain
services.
• Frustration about technology and lack of inter-operability, particularly as the
Trusts merge.
• A desire for a more long-term, consistent view of North Cumbria
transformation taken by decision-makers, with a balance struck between
political/public expectation and what was realistically deliverable in the context
of resourcing pressures.
5 The People Plan | January 2019
• A concern the health and well-being of the workforce is not properly
addressed and supported by existing occupational health policies, which
could be more person-centred and less focussed on managing attendance.
Constant Change and Expectations
• We are managing a significant period of change as we move to an integrated
health care system. This will bring together partners across North Cumbria to
work in a person centred way, focussing on the needs of our population and
delivering better outcomes.
• All of this requires our staff to change how we deliver services and support,
develop careers and competencies and continuously improve. Health care,
technology, knowledge are changing faster than ever and we need to provide
our staff with the right resources, development, skills and tools to work in this
environment.
• Over the period of this delivery plan we will deliver a merged Trust, change
delivery of mental health services, new clinical pathways, changing primary
care and GP services, and move to a continuous improvement focus, building
on work already underway.
Our Strategy 2019 - 2025 - Building the Integrated System
As stated above we are in a period of considerable change and flux as we build an
integrated health care system. We are still in early days and have a complex
landscape to support, manage and develop. To this end this plan does not seek to
deliver the full workforce strategic delivery plan – this will take further development
and engagement with the wider system. Instead the People Plan describes high level
aims and objectives to provide direction and lead to longer term joint delivery.
We do, however, need to produce a clear Annual Delivery Plan for the merging trusts
for the next year, together with identifying opportunities to develop joint objectives
and actions with partners such as the CCG and primary care. Hence this plan needs
to be read in context of an emerging system wide approach, together with an
immediate organisation delivery need.
Integrated Health Care Strategy
Overarching strategy
covering all elements
driving to an IHCS
People Plan 2019-2025
Long term objectives and aims to deliver against the IHCS
strategy. System wide development through
2019, identiyfing shared opportunities
and actions
Annual Delivery Plan 2019-20
Focussed on the merged Trusts and
associated organisations
Annual plan focusing on building sustainable workforce with clear
actions and outcomes. developed as part of the annual business
planning cycle
6 The People Plan | January 2019
The North Cumbria Integrated Health Care Strategy
Our five Strategic Priorities are outlined below. Behind each of these priorities sit a
range of plans and actions, with the common theme being that they are all reliant
upon our people. The NHS is its workforce and the overall North Cumbria IHC
strategy will not be delivered without our investing time and money in our teams and
local community.
Strategic priorities How
1. Integrate how health and care organisations work together
2. Improve our health and care outcomes for our local communities
3. Deliver placed based care through our care communities
4. Accessible sustainable high quality secondary care services
5. Be a great place to work
Use our collective capabilities
Build teams ‘without walls’ Focus on pathways within
and across services and providers
Maximise our digital and information capabilities
Reduce variation and raise standards of care
Be consistent in how we lead and manage change
Our Vision and Aim For Our People Plan 2019-2025
The right people in the right place with the right skills and
development to deliver excellence in health and social care
7 The People Plan | January 2019
Our Strategic Delivery Approach for Workforce
Our overall approach is based upon the employee lifecycle as below,
which outlines the key stages and themes in people’s engagement with
any organisation. For each of the themes we have an overarching
objective and subsequent key actions for the first year of 2019 -20. The
plan will be reviewed on an annual basis to identify opportunities for
innovation, new approaches, demands and continuous improvement.
Flexibility is key; we cannot know all the demands and opportunities for
the next five years and hence need to be able to adapt and amend in
response to circumstances whilst maintaining our overall strategic intent.
Design
Recruitment
Welcome &
Induct
Perform &
Develop
Retention
Transition
Employee Life
Cycle
Shape
Attract Develop
8 The People Plan | January 2019
Objectives for each theme by 2025:
Design Attract & Recruit
An optimum workforce model developed, agreed and in place.
Design of multi-disciplinary and inter-professional teams based on competencies required not traditional job roles (composite workforce)
Coherent, clear, well designed jobs with flexibility built in
Utilising technology to free up staff for caring and skilled activities
Eradicating unnecessary bureaucracy and duplication
Continually looking to see how we can improve service delivery & Improve ‘user centred’ HR processes for staff and managers
Multiple routes to entry – apprenticeships, sponsorship, cadetships, supporting local community engagement
Specific bespoke recruitment for hard to fill roles including International recruitment
Flexible working: support work life balance & portfolio careers
Provide opportunities to return to work for experienced colleagues
Improve working conditions and environment
Engaging Volunteers
Welcome & Induct Perform & Develop
On boarding – pre-arrival information and support
Effective induction and ongoing support
Ensuring people have the tools to do the job
Providing training ‘in time’
Engage with the community to develop wider support networks
Development opportunities are properly planned & sustainably provided.
Training needs are recognised as dynamic and constantly need to be reviewed
Effective appraisal & supervision process
Equitable talent management plan
Retention Transition
Valuing the contribution that all make to delivering excellent, compassionate care and to improving the health, quality of life and wellbeing of the people of Cumbria
Leadership development & succession planning
Providing Career opportunities and pathways
Clear wellbeing and health support for all
Reshaping teams in response to needs
Reskilling staff for new exciting roles & ways of working
Supporting people through retirement including developing flexible options to retain skills and experience
Effective succession planning
9 The People Plan | January 2019
It is recognised that we need to build our approach over a period of time and learn as
we go. Plans developed now may not be fit for purpose in 2 or 3 years time and must
be kept under review. Many elements of the People Plan for 2025 will take time,
however we can make a start through building on what works, continuously
improving and seeking opportunities to engage and consult with others. The last
thing we want to do is write a plan that people do not feel part of or gathers dust on
the shelf.
The action plans at a system level that underpin this, will be developed in
collaboration with our partners. The document as it stands is intended to support a
direction of travel for the system.
In this context the remainder of this document outlines the priorities for the first year
of the plan 2019-20 and identifies the key priorities and action required. This is
initially focussed on the merging Trusts and associated organisations. During the
year 2019-20 as the system develops we will work ever closer with our partners and
identify opportunities for mutual and co-produced action plans.
10 Annual Delivery Plan | January 2019
Annual Delivery Plan
2019-2020
North Cumbria University Hospitals NHS Trust
Cumbria Partnership NHS Foundation Trust
11 Annual Delivery Plan | January 2019
This Annual Delivery Plan focusses in the main on the merging
Trusts and seeks to engage our partners throughout the year to
develop a wider system Strategic Delivery Plan. This approach
aims to align system-wide objectives with individual organisational
need in the short term, to develop effective partnerships and
maximise opportunities for collaboration, fast tracking system
working wherever possible.
Our Priorities for 2019/20
We have considerable vulnerability across the majority of our services in relation to
delivering against our needs. We therefore need to target our activity to focus
resources in line with our strategic priorities. This means we will have clear
programmes of action which will include the resources of CLIC, Organisational
Development, Education &Learning, Workforce and HR working in a more integrated
fashion and with clear outcomes articulated.
• Develop an attraction plan and improve recruitment processes to secure the right staff and make them feel welcome.
• Develop attractive career pathways and programmes which will allow new people to access NHS careers and existing staff to progress.
• Design an effective, inclusive and engaged workforce through local plans that meet the needs of the population and are built on multi professional working and new roles.
• Integrate and improve HR and OD service delivery to standardise practice, enhance performance and embed the Trust values.
• Review education and learning to meet quality outcomes and regulatory requirements and ensure clinical and professional development is co-designed, to meet the needs of our transition plans plus current and future drivers.
• Review our leadership and management development offer and strengthen our approach to talent management and succession planning.
• Support our people through transition and change ensuring that they receive the best experience and are skilled to continuously improve in their roles.
12 Annual Delivery Plan | January 2019
Service Support Focus
We will also provide support for specific major organisational change programmes
including:
o the establishment of Care Groups including the ICCs
o the re-development of clinical/professional and corporate services
o development of integrated teams
o the workforce element of the merger programme
o the HR workstream for the Mental Health transfer
o the design and roll out of clinical pathways
o re-design of roles to reflect multi-professional teams (composite
workforce)
Employee Lifecycle Theme Objectives
In addition we will begin the process of a comprehensive review and reshape of our
HR and OD Service and Processes in order to deliver our employee lifecycle
objectives as at page 8. This will be undertaken as we integrate our services across
the two Trusts through 2019-20 and will also enable us to offer support to North
Clinical Commissioning Group (NCCG) and primary care as required.
For 2019/20 the high level plan is as follows. This will be further developed through
the current business planning round and detailed work to complete our OGIM’s
(Objectives, Goals, Initiatives & Measures).
13 Annual Delivery Plan | January 2019
•Deliver a coherent, dynamic workforce model that clearly outlines the people and skills required to meet service and population needs across North Cumbria by 2025.
•Undertake effective workforce demand modelling and integrated workforce redesign to support a system wide approach.
Dynamic Workforce
Models
•Develop short term workforce action plans to target gaps in nursing, medical and specialist services.
•Develop and implement multi-disciplinary and inter-professional team roles (Composite workforce) building upon existing pilots to target vulnerable and priority services.
Innovative Roles
•Realign CLIC, OD and associated functions into how we improve and support services.
•Target vulnerable services in line with overall strategy and priority areas for support.
Continous Improvement
•Develop new processes and KPI's for recruitment and retention.
•Clear convergence path for ESR and self service manager roll out to all areas.
•Ensure all HR processes streamlined and integrated and joint policies embedded.
•Develop and improve data and dashboards to support decision making and plans.
Improve HR & OD Service
Delivery
Design Some our awards for innovation:
BMJ Careers Award
& HSJ Capsticks Award for Innovation
14 Annual Delivery Plan | January 2019
Hermann is one of our much
valued volunteers and a
Biomedical Science student
Claire is our
Volunteer &
Charity
Development
Officer
Attract & Recruit
• Develop attraction plan based on workforce plans and local intelligence.
• Explore and establish non-salary incentive programmes as a means of recruiting and/or retaining people and/or dealing with pressures in less popular specialties and locations.
Attraction
• Review and update our recruitment process to improve both quality and time to recruit.
• Agree overall plan for year and ensure delivery in line with numbers.
• Introduce values based recruitment processes.
Recruitment Plan 2019/20
•Set up and roll out a regional health and social care careers service targeted at the existing workforce, young people from the age of 14, and possible returners to service.
•Actively support Cumbria Careers Hub through Cumbria LEP & Partners.
•Develop and review a range of pre-employment programmes and new routes to work including Step into Health.
Routes to Entry
• Review the Volunteer Service to support staff and patients.
• Integrate the volunteer workforce within workforce plans.
• Promote volunteering through recruitment campaign, providing support and development.
Volunteers
One of the many Nursing and Medical
Recruitment Fairs we attend each year
15 Annual Delivery Plan | January 2019
Sam and Kylie recently joined
us as Newly Qualified Nurses
Working together to
support Cumbria
Pride 2018
Deploy: Welcome & Induct
•Review and refresh our induction and onboarding approach including alternative methods of delivery based upon a single policy.Induction
•Working with the community to develop 'welcome packs' for national and international recruits.
•Develop digital solutions e.g. micro sites, apps to provide guidance and support for new recruits.
On Boarding
•Develop a singe approach to a managed bank service and efficient use of temporary staffing.
•Embed and further develop Staff Networks
•Deliver Cultural Awareness Project and Action Plans
Inclusive Workforce
We have over 200
Diversity and Inclusion
Representatives
16 Annual Delivery Plan | January 2019
Dr Amit Paik is one
of our GP Registrars
& CLIC Leadership &
Improvement
Leo is one of our Registered Nurses and
successfully gained a place on the national
Windrush Leadership Programme Perform / Develop
•Review our clinical and professional training and development needs and co-design development plan which takes account of reconfiguration plans, current and future drivers and pressures.
•Commissioning of time-protected, appropriately located, sustainable post registration training programmes, and development opportunities for more experienced people.
•Develop and make visible career pathway offer and support for staff.
Clinical & Professional Development
• Roll out and review of redesigned values based appraisal scheme.
• Develop and deliver first phase of our approach to Talent Management and Succession Planning.
Appraisal & Supervision
•Leadership & management development reviewed and refreshed.
•Review and improve training & development provision.
•Review mandatory training to align Trusts requriements and ensure capacity issues addressed.
•Deliver the HEE quality & outcomes improvement plan.
•Standardise approach to apprenticeships in line with strategy.
Development
17 Annual Delivery Plan | January 2019
Professor Sam Dearman is our
Director of Medical Education,
Consultant Psychiatrist &
Fellow of the Academy of
Medical Educators
Dr Laura Hipple is one of our
SAS Doctors & the National
RCOG SAS Lead
Nicola is Senior
Programme Manager with
the CCG and leads NHS
Park Run
Retention
•Review options for flexible working and target pilot areas in line with redesign of services and roles.
•Consider opportunities for staff to explore portfolio careers and development into specialites.
•Deliver Retention Project for Health System,.
Flexible Working
•Develop leadership plan and deliver improved leadership and management training
•Phase 1 of Succession Plan in place
Succession Planning
•Deliver a refreshed & reinvigorated Health and Well Being plan that achieves a silver Health and Wellbeing award. Well Being
•Develop workforce engagement plans at Care Group/ICC level aligned to staff survey.
•Develop and maximise communication channels for staff engagement.
•Refresh recognition schemes in line with values.
•Engage with community groups and partners.
Engagement
18 Annual Delivery Plan | January 2019
Dr Helen Horton is one of
our GP’s & the Primary Care
Lead for Pathway
Development
Transition & Change
• Exit interviews process overhauled and refreshed.
• Support organisational merger for clincal services in transition.
• Support the workforce within the change process and to develop the skils to undertake new roles and ways of working.
Transitions
Some of our Senior Nursing and AHP Leaders
19 Workforce Data | January 2019
How we will measure
We are developing KPI’s against all the priorities and services identified and will aim
to report against these on a quarterly basis to Boards together with to the current HR
dashboards.
In addition and in line with other changes across the merging Trusts and
organisations we will develop service level agreements with Care Groups, ICC’s and
other partners to agree expectations and target times for service, quality and with
reference to national benchmarks.
Conclusion
This is a deliberately challenging plan for challenging times and we do not
underestimate the task at hand. In the first half of this document we set out the
significant challenges facing health and social care in North Cumbria. These
combine to create a complex environment in which to transform.
The strategic plan for 2019-2025 will seek to contribute to the transformation of
health and social care in North Cumbria by establishing a long-term, sustainable and
sensible approach to meeting our workforce needs, and the needs of our workforce.
Success will rely on cooperation between employers, staff, their representatives,
professions and disciplines, and across all parts of the system as it develops. There
are already very positive examples of the fantastic work carried out by the health and
social care workforce on a daily basis to transform and improve services, which
showcase the dedication, innovation and caring approach we can deliver.
To make sure the strategic delivery and the action plan achieve their objectives, we
will provide annual progress updates along with regular highlight reports showing the
progress of each action. These will be reported to the Strategic Leadership Board,
the Non-Executive Board, the Executive Team and on the intranet.
This plan cannot be seen in isolation. Many of the actions contained in the plan are
dependent on a number of other enablers and actions on the health and social care
transformation agenda. We will work in partnership with our colleagues across the
system to develop the health and social care environment the people of North
Cumbria deserve.
20 Workforce Data | January 2019
Appendix 1
Annual Delivery Plan
Workforce Data
North Cumbria University Hospitals NHS Trust
Cumbria Partnership NHS Foundation Trust
Page 21 of 23
North Cumbria University Hospitals NHS Trust
Cumbria Partnership NHS Foundation Trust
3.15%
15.73%
31.47%
Retire now Retire in 5 yrs Retire in 10 yrs
% Predicted Retirements
Staff retirements could have a big impact on our
services in the next 5 years (Age 60)
8404 Headcount
21%
Starters
6280.43
WTE
Allied Health Profes
18%
Medical and
Dental
18%
Nursing and
Midwifery Reg
65%
% Clinical StaffingSplit
Male16%
Female85%
Gender % Split
This information is a snapshot of
our workforce from Jan 18 – Jan
19
The Trusts employ 8404 staff
(January 2019)
Nursing and Midwifery is the
largest staff group in the clinical
workforce.
29% Attrition
Page 22 of 23
North Cumbria University Hospitals NHS Trust
Cumbria Partnership NHS Foundation Trust
0.64%
5.93%
10.30%
10.76%
11.18%
11.18%
13.69%
15.84%
12.71%
6.30%
1.09%
0.41%
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65
66 - 70
71 & Above
Age by Headcount
2.27%
14.22%
15.43%
8.01%
19.10%
16.89%
10.78%
2.53%
1.23%
0.55%
0.30%
0.19%
8.46%
Band 1
Band 2
Band 3
Band 4
Band 5
Band 6
Band 7
Band 8 -…
Band 8 -…
Band 8 -…
Band 8 -…
Band 9
Non AfC
Pay grade by WTE
Pay accounts for 75% of the Trust budget, Non AfC includes Medical,
Dental and Board posts.
23 Our People | January 2019
PURPOSE
To present the final draft of the NHS Strategic Safeguarding Framework for North Cumbria:the framework aims to ensure that the NHS has a central focus on safeguarding, has anapproach to how it will be organised, ensures staff within it will be supported to deliver thesearrangements and that assurance mechanisms will be in place to monitor and ensureeffective delivery.
KEY POINTS TO HIGHLIGHT
In support of the developing arrangements for North Cumbria Health and Care during2018/2019 the Designated Safeguarding Healthcare Leads in North Cumbria CCG agreed todevelop a framework to ensure effective safeguarding arrangements would be in place acrossthe health system.
The framework outlines the key safeguarding enablers that will support system complianceand assurance and build on the opportunities afforded in the growing culture of collaboration.Whilst its focus is on NHS arrangements it will ensure that our engagement with all partners’agencies can be more easily described and thus afford even greater opportunity to contributeand enhance multi agency safeguarding practice, and drive forward practice improvementsand learning.
This is a timely opportunity to ensure that health services will be working together tosafeguard the most vulnerable with our partners agencies in preparation for the newintegrated landscape.
This document outlines the local context for safeguarding in Cumbria, the case for changeand how three key safeguarding enablers – Learning and Practice, Performance, andWorkforce - should support that change. It requires all the parts of the system to acknowledgetheir role in the delivery of these enablers and in holding the system to account for thedelivery and assurance of these arrangements.
NHS organisations who have contributed and/or been consulted on the framework includeCumbria Partnership NHS Foundation Trust, North Cumbria University Hospitals Trust,Cumbria Health on Call, Unity, Primary Care, Northumberland Tyne and Wear FoundationTrust, Morecambe Bay Clinical Commissioning Group, NHS England, Cumbria CountyCouncil and North West Ambulance Service.
NEXT STEPS / AREAS OF WORK TO BE PROGRESSED
The Designated Leads for Safeguarding will work with health organisations to implement theactions required to deliver the system arrangements.
RECOMMENDATION
That the System Leadership Board receives the Report, noting that it was approved by theJoint System Executive Committee on 26 February 2019.
System Leadership Board
PUBLIC2nd May 2019 Enc: 19a
Title: NHS Strategic Safeguarding FrameworkAuthor: Louise Mason-Lodge, Deputy Director of Nursing & Qualityand Designated Nurse for Safeguarding, North Cumbria CCG
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Run by everyone, for everyone
NHS Strategic Safeguarding Framework for North Cumbria (final draft) Date: 14th February 2019
Louise Mason-Lodge, Deputy Director of Nursing & Quality and Designated Nurse for Safeguarding North Cumbria CCG
NHS Strategic Safeguarding Framework for North Cumbria Executive Summary In support of the developing arrangements for North Cumbria Health and Care during 2018/2019 the Designated Safeguarding Healthcare Leads in North Cumbria CCG agreed to develop a framework to ensure effective safeguarding arrangements would be in place across the health system. This strategic framework aims to ensure that the NHS has a central focus on safeguarding, has an approach to how it will be organised, ensures staff within it will be supported to deliver these arrangements and that assurance mechanisms will be in place to monitor and ensure effective delivery. The framework outlines the key safeguarding enablers that will support system compliance and assurance and build on the opportunities afforded in the growing culture of collaboration. Whilst its focus is on NHS arrangements it will ensure that our engagement with all partners’ agencies can be more easily described and thus afford even greater opportunity to contribute and enhance multi agency safeguarding practice, and drive forward practice improvements and learning. This is a timely opportunity to ensure that health services will be working together to safeguard the most vulnerable with our partners agencies in preparation for the new integrated landscape. This document outlines the local context for safeguarding in Cumbria, the case for change and how three key safeguarding enablers – Learning and Practice, Performance and Workforce - should support that change. It requires all the parts of the system to acknowledge their role in the delivery of these enablers and in holding the system to account for the delivery and assurance of these arrangements. NHS organisations who have contributed and/or been consulted on the framework include Cumbria Partnership NHS Foundation Trust, North Cumbria University Hospitals Trust, Cumbria Health on Call, Unity, Primary Care, Northumberland Tyne and Wear Foundation Trust, Morecambe Bay Clinical Commissioning Group, NHS England, Cumbria County Council and North West Ambulance Service.
1
Introduction Overall Purpose
It was confirmed on 24th May 2018 that North Cumbria was announced as one of fourteen Integrated Care Systems. This local system partnership is known as North Cumbria Health and Care. Its vision is - “To build a new integrated health and care system together, using our collective capabilities for a healthier and happier population. We are our communities; the health and care of our people run with our people for our people.” Its purpose is- Working together we will use our collective capabilities to reduce inequalities, raise standards of care, use our resources wisely and provide positive experiences for our local communities. http://www.northcumbriahealthandcare.nhs.uk/ In support of the developing arrangements for North Cumbria Health and Care during 2018/19 the Designated Safeguarding Healthcare Leads in North Cumbria CCG agreed to develop a framework for the health system to ensure effective safeguarding arrangements would be in place. This strategic framework aims to ensure that the NHS has a central focus on safeguarding, has an approach to how it will be organised, ensures staff within it will be supported to deliver these arrangements and that assurance mechanisms are in place to monitor and ensure effective delivery. This framework requires the high level commitment of strategic leads in ensuring the delivery of safe high quality care and requiring the system to work together collectively and collaboratively to achieve this. This document is not designed to replace or negate current statutory and regulatory requirements for all NHS organisations, including Primary Care – it is designed to support NHS organisations to enable our maximum collaborative effort in support of our partner agencies in safeguarding the population of North Cumbria. The approach is focused on how the NHS should organise itself to deliver high quality safeguarding practice and how this will enable/connect directly to our work with our safeguarding partners. It will continually build on best practice and research evidence and be informed by the engagement of families, users and carers. This health framework supports the development of consistent standards and mechanisms that will provide assurance from local Integrated Care Communities (ICCs) to Board level. This health framework sets out the key enablers that will support health organisations to work together to effectively support staff and enable safeguarding specialists to support the system to drive forward practice improvements and learning. This is a timely opportunity to
ensure that health services will be working together to safeguard the most vulnerable with our partner agencies in preparation for the new integrated landscape. The approach is ably described in the NHS England Safeguarding Accountability & Assurance Framework (June 2015). All NHS organisations need to ensure that there is sufficient capacity in place to fulfil their statutory duties and should regularly review their arrangements to assure themselves that they are working effectively. Organisations need to come together to mitigate risks and develop workable local solutions based on local need. Some of the issues that must be considered include:
• The size and geography of the ‘patch’ • The deprivation of the population served and the numbers of children and adults in
need, including Children Looked After • The evidence and advice from recent inspections, reviews, audits and case reviews
of safeguarding • The number of providers and the complexity of the provider landscape.
This document comprises five sections:-
1. SAFEGUARDING IN CUMBRIA: the local picture 2. CASE FOR CHANGE: changing national and local arrangements 3. NHS SAFEGUARDING SYSTEM ENABLERS: what will support effective safeguarding
arrangements 4. DELIVERY AND ASSURANCE: what must be in place to ensure effective delivery,
oversight and assurance of our NHS safeguarding arrangements 5. POLICY AND LEGISLATION: The range of requirements that the NHS needs to take
account of in ensuring the delivery of effective safeguarding arrangements
3
SECTION ONE: Safeguarding in Cumbria: The Local Picture Children and Young People Cumbria County Council’s services for children have been subject to continuous scrutiny and challenge since 2012 when the local authority was judged (by Ofsted) to be “Inadequate” in the delivery of services to children and young people in Cumbria. The last inspection in November 2017 identified that significant progress has been made since the previous inspections (2012, 2013 and 2015) and services are now judged as “Requires Improvement” overall. Approximately 92,600 children and young people under the age of 18 years live in Cumbria. This is 19% of the total population in the area. (Source: Mid-2016 Population Estimates, ONS). 11,800 children age 0-19 years in Cumbria are living in low income families (12.7%)
Child Protection in Cumbria At 31 March 2018, 613 children and young people were the subject of a Child Protection Plan. This is an increase from 523 children and young people at 31 March 2015. This has been an area of focus for the Local Safeguarding Children’s Board over the past year, and will remain so for 2018/19. This is mirrored by the national picture.
At 31 March 2018, 3,311 children had been identified through assessment as being formally “In Need” of a specialist Children’s Service in the year. This means that they need specialist help from the Local Authority (LA) to achieve or maintain a reasonable standard of health or development: this is an increase from 3,081 at 31 March 2017. The three key factors identified in Safeguarding assessments are (% of cases where factors were identified): - Mental Health – Parent (31%) Domestic Violence – Parent (27%) Abuse or Neglect – Emotional Abuse (19%) Table of Child Protection Plans by District as at 31 December 2018 Allerdale Barrow Carlisle Copeland Eden South
Children Looked After in this area. At 31 March 2018, 665 children were being “Looked After” by the LA, a rate of 71.9 per 10,000 children. This is an increase from 31st March 2018 when 627 children were Looked After, a rate of 67.6 per 10,000. This is significantly higher than the national average (although those numbers are also increasing) and has been an area of focus for some time. Cumbria LSCB has agreed to prioritise this cohort in a whole system approach.
There are 208 (March 2018) Cumbrian children and young people who are in placements outside Cumbria. Table of Children Looked After numbers as at 31 December 2018 Allerdale Barrow Carlisle Copeland Eden South
Lakeland Cumbria
Number 163 147 135 133 22 66 679 Rate 90 110 64 102 24 38 73 Adults The over 18 population of the North Cumbria CCG area is approximately 260,000. Cumbria data for 2017/18 showed that there were 2,745 safeguarding referrals logged by Health and Care Services, Cumbria County Council In 2018/19 on average the number of received referrals per quarter is 835. The highest proportions of the main abuse types were: - Physical Neglect and Acts of Omission Financial This section broadly outlines the whole range of requirements that the NHS needs to take account of in ensuring the delivery of effective safeguarding arrangements and a brief descriptor of the landscape for safeguarding locally.
5
SECTION TWO: Case for Change: Changing National and Local Arrangements In 2016, NHS organisations and local councils came together to form Integrated Partnerships covering the whole of England, and started to set out their proposals to improve health and care for patients. Breaking down barriers to better health and care (June 2018) explained that to make this happen, all parts of local systems – such as GPs, care homes and home care, hospitals, community and mental health services – should be working together more closely than ever before to join fragmented services into local partnerships. Integrated Care Systems (ICSs) as they became known aim to ensure that every person who needs support from health and care professionals see them acting as one team and work for organisations that behave as one system. The 2019 Long Term Plan reaffirms that ICSs are central to the delivery of the Plan bringing together local organisations to redesign care and improve population health, creating shared leadership and action (pg.29). In North Cumbria our ambition http://www.northcumbriahealthandcare.nhs.uk/ is to develop an integrated health and care system which improves the health and wellbeing of our community by:
• building real teams around place and pathways • involving our community as part of the local leadership and delivery team • redesigning our health system to make it more effective
How we’re organised - Integrated Care Communities, our Primary Care Networks An Integrated Care Community (ICC) is the arrangement in place to improve the overall health and wellbeing of the community where primary care, community care and adult social care are working together. 1. Joining up health and care services to work better together 2. Providing more care out of hospital where possible 3. Supporting people to have information about their health conditions In an ICC Health and social care professionals, GPs, the voluntary sector and the community are working together as one team to support the health and wellbeing of local people. North Cumbria has been divided into eight ICCs based on groups of GP practices and their patients. By understanding the challenges that each area faces it is hoped that the community can work together with health and care organisations to improve the health and wellbeing of local people by identifying the specific needs of that community.
The NHS Long Term Plan is encouraging all GP practices to become part of a local Primary Care Network (PCN). PCNs are based around a GP registered list of approximately 30,000 – 50,000 patients, encompassing general practice and other partners in community and social care. These networks offer care on a scale which is small enough for patients to get the continuous and personalised care they value, but large enough – in their partnership with others in the local health and care system – to be resilient. Our Primary Care Network are our ICCs in North Cumbria It was on this basis that these local and national changes that the CCG as system leader worked collaboratively with lead managers and safeguarding leads across the system to develop a health framework outlining the key next steps to support effective delivery and improvements in our the NHS safeguarding arrangements and underpin the role of the NHS with partner agencies in safeguarding the most vulnerable within such an integrated system (See Appendix One: Approach and Methodology and workshop feedback).
7
SECTION THREE NHS Safeguarding System Enablers: what will support effective safeguarding arrangements? The outcome of the system wide work led by the Designated Safeguarding Healthcare Leads outlined three key enablers: the following section describes those threes enablers and, for each, what we propose are the aims, what needs to be done for them to succeed and how we will know that the aim has been achieved
1. ENABLER ONE: Learning and Practice What is the aim? NHS organisations in North Cumbria including Primary Care to work collaboratively to lead and promote a strong culture of learning that directly supports lessons learnt and drives safeguarding practice improvements, reduces risk and promotes prevention and early intervention. This will be dependent on the NHS organisations working together to deliver and disseminate learning, to incorporate learning in workforce plans, and to review regularly through agreed assurance mechanisms. What needs to be done to succeed? The recommendations from a plethora of national reports including Francis (2013), Berwick (2013), National Quality Board (2017), DfE (2016) and Working Together all highlight the importance of a culture that encourages staff to process and share information, nurture innovation and learn from mistakes. Summed up by Berwick (2013) “The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end” (pp 5) This is reiterated in the purpose of reviews in relation to safeguarding for children: -
“reviews of serious child safeguarding cases, at both local and national level, are to identify improvements to be made to safeguard and promote the welfare of children”(WT pp82) And further for Adult Safeguarding: “there should be a culture of continuous learning and improvement across the organisations that work together to safeguard and promote the wellbeing and empowerment of adults, identifying opportunities to draw on what works and promote good practice”(Care and Support Act Statutory Guidance 2018 para 14.167) To support this approach, NHS organisations in North Cumbria, including Primary Care, should design and adopt a shared approach to safeguarding learning, align policies
8
procedures and guidance, and focus current resources on aligning key learning opportunities at an ICC as well as organisational level to support responsive local learning in relation to current practice. This should include systems of cascading information, a competency based learning approach, varied learning model and critical learning events to focus on the most significant changes required to improve practice. This will create a more systemic approach to supporting practitioners to take account of and contribute to service and practice improvements and feel supported to take accountability for their own learning needs, be encouraged to take routine opportunities for peer review and engage in audit and assurance work. This approach should be focused at ICC level to enable the learning to be more directly linked to day to day practice. How will we know when this aim has been achieved? (See also Workforce)
• Staff will have access to a portfolio of training and learning opportunities/learning models designed to fulfil their competency requirements – a passport for learning approach.
• 2 or 3 key system wide areas for improvement will be agreed to improve practice at the frontline following reviews and linked learning opportunities will be focussed at team and ICC level.
• Patient stories, users’ and carers’ experience will be a central part of the learning • Experts by experience will feel able to lead peer review and disseminate good
practice • Staff would have access to a central learning portal which will include safeguarding
procedures, good practice, the NHSE repository and research evidence • Clear communication systems would routinely cascade briefings with expectations of
review e.g. in team meetings, supervision, appraisal, significant debriefs etc. • An audit and assurance programme with outcomes which would drive improvements
and be reported from Board to ICC level. • All staff would have access to a programme of learning events which routinely
engage multi agency partners. • Staff would have constant and creative opportunities for practice and
growth/continual improvement. NB Alignment with CCG Quality Strategy: -
• The integrated system is able to demonstrate that learning from errors is embedded within organisations with systems and practice to prevent reoccurrence (QS)
• A culture exists of open and honest cooperation to identify potential incidents or serious quality failures and take corrective action (QS)
• A high trust environment exists where members feel able to share worries (QS)
9
2. ENABLER TWO: Performance and Outcomes
What is the aim?
NHS organisations in North Cumbria including primary care should adopt a set of qualitative and quantitative indicators – safeguarding performance framework - that describes and monitors compliance, practice improvements and key deliverables for safeguarding. This would include current regulatory and self-assessment requirements and a range of broader indicators including effectiveness of pathways and patient/client experience. It would connect national, regional and local intelligence to routinely describe the safeguarding “landscape” and enable more responsive planning and inform service developments at ICC and organisational levels. Extracts would be used to provide robust evidence and assurance to the North Cumbria Health and Care System and regulators as required. What needs to be done to succeed? An outcomes framework is a resource to help link what you do (activities) with what you want to achieve (outcomes). The NHS Outcomes Framework is an example of indicators at a national level that provide accountability for the outcomes the NHS delivers; they are intended to drive transparency, quality improvement and outcome measurement through the NHS. NICE Quality Standards are a further example of an approach that can be used in order to improve the quality of care commissioned including identifying gaps and areas for improvement and understanding how to improve care. The production of good local indicators must be supported by systems in place to make use of the information collated and describe how they demonstrate improved outcomes. Staff should always be involved in the development of performance measures and be empowered to use data and understand where and how to improve their own performance i.e. be meaningful. Clinicians express concerns that good performance on a given set of indicators is not necessarily good care at the individual patient level. (Kings Fund 2010) A system based solely on process-based targets and performance indicators results in a focus on specific aspects of process rather than practice quality and learning. To this end an understanding of how the workforce views the role they play in safeguarding and the difficulties they face is imperative in informing professional development and service improvement. Delivering good outcomes is also more than identifying indicators as Don Berwick highlights in his report “A Promise to Learn – a commitment to act”, that the key to implementing the Francis recommendations is a shift in culture and the need for a collaborative programme that would work to develop the NHS into a learning system supporting, engaging, and inspiring staff to continually improve what they do.
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Performance and outcomes therefore need to incorporate good indicators, have good feedback and communication systems: they should also be informed by users and carers as key to understanding the impact of services. How will we know when this aim has been achieved?
• Each ICC knows if it is doing a good job and understands why, based on local need • There is a visible collective and consistent descriptor in the NHS of the safeguarding
“offer” supporting the system • Key risks and challenges and plans to improve are in place e.g. for transition • Reporting requirements are streamlined and provide an accurate picture that is
meaningful at ICC level and Board level • Incident reporting processes are aligned and coordinated • The voice and feedback from users, carers and families will be consistently reported
in our improvements • Pathways are in place to identify risk and support the most vulnerable and we are
able to report on how we have contributed to improving outcomes and reducing risk • Performance improvements include a focus on prevention and early intervention • Outcomes of audit and assurance work are routinely shared • There is clarity about should and must do’s • The system will move from reactive to a more proactive continual improvement
approach to safeguarding
3. ENABLER THREE: Workforce
What is the aim?
NHS organisations in North Cumbria, including Primary Care, will have a training and workforce plan that describes how safeguarding supervision, appraisal and support will enable staff at all levels to be confident and competent in delivering person centred safeguarding practice. NHS organisations in North Cumbria will have arrangements for specialist safeguarding professionals to provide the advice, support and guidance required at Board and ICC level, to NHS staff, regulators and partner agencies What needs to be done to succeed? For the first time in almost 25 years the health service in England has set about producing a Workforce Strategy. This was in response to the 5YFV (Five Year Forward View) which described a growing NHS workforce under real pressure and a landscape of both the numbers and complexity of patients cared for continuing to increase. Next Steps on the Five Year Forward View described the intention “to make the biggest move to integrated care of any major western country”. Integrating services means staff working in new environments. Workforce development overlaps with all aspects of organisational redesign and should be concerned with the development of new skills and capabilities within the workforce in response to national
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policy and local demographics. This function applies equally to safeguarding leaders and safeguarding specialists’ roles in the context of integration. Within the context of productivity and changing structures in health and social care, workforce development will be critical to maintaining a good service and achieving positive safeguarding outcomes for people. How will we know when this aim has been achieved?
• Safeguarding professionals with a clear line of sight, support and held to account to lead and mobilise safeguarding improvements
• Succession plans are in place for specialised safeguarding professionals including doctors, nurses and midwives
• Specialist safeguarding leads to provide support, problem solving and enable practitioners within ICCs to promote all areas of safeguarding practice including Prevent, neglect, exploitation, domestic and sexual abuse
• Staff are able to understand the purpose and routinely access safeguarding supervision, enable peer supervision and reflection
• Staff feel confident in the health system’s arrangements to support them through supervision, appraisal, access to advice and learning opportunities
• A person centred approach will focus on individuals rather than service provision and multiple hand offs
SECTION FOUR DELIVERY AND ASSURANCE: What must be in place to ensure effective delivery, oversight and assurance of our NHS safeguarding arrangements? This section outlines the requirements that must be in place to ensure effective delivery, oversight and assurance of our safeguarding arrangements across NHS Organisations in North Cumbria including Primary Care. Requirements to deliver: North Cumbria Health and Care
• Strategic commitment is required from NHS executive leads to ensure the delivery of safe high quality care and to ensure the health system works together collectively and collaboratively to achieve this. Safeguarding arrangements should be at the heart of the developing NHS arrangements and in support of the wider integrated system in North Cumbria.
• At System Leadership Board level there need to be requirements to receive highlight assurance reports and to review safeguarding issues by exception from Executive Leads, NHS England and Improvement, Safeguarding Boards, County Council and the CCG/Designated Healthcare Leads.
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• NHS executives and non-executive leaders must provide a single consistent voice across the health system, coordinate both the “ask” and provide assurance in terms of local, regional and national priorities and hold all departments, senior managers and staff to account for the effective delivery and assurance on the required outcomes/outputs.
• Whilst it is not the function of this health framework to outline staff arrangements, it is important to note that effective implementation will be dependent on a well-supported network of NHS specialist safeguarding professionals coordinated in a system wide team supporting the multidisciplinary teams in ICCs or service areas. It should have: -
NHS directors and senior managers across NHS and partner agencies, commissioners will work closely with the Designated Safeguarding Healthcare Leads to ensure consistent effective safeguarding arrangements are in place. With NHS executive and non-executives, the system will produce clear plans and manage the “golden thread” of safeguarding assurance and improvements across the system from Board to ICCs
Required statutory roles i.e. named professional/s (nurse, doctors, GPs and midwife) to work as a team to support all NHS staff and multi-disciplinary teams: these staff will be able to demonstrate expertise in Adults and Protection, Maternity and Children in a “Think Family” approach. As a senior team they will provide required leadership to support and deliver the NHS arrangements to meet its statutory requirements and the wider safeguarding partnerships for safeguarding. . This team will work closely with safeguarding specialist staff and the Designated Healthcare Professionals to drive forward improvements in safeguarding practice including training and supervision. All the resources allocated should take account of the Intercollegiate Document ICD guidance for both children and adults. All safeguarding leads will work to improve multi agency practice and ensure effective working arrangements
Specialist safeguarding staff should provide more operational support in and across ICCs to facilitate more effective safeguarding arrangements through leading and/or facilitating learning events, peer review and sharing of best practice
Consideration should be given to the effective use of resources to lead both the development and the delivery of a learning programme for safeguarding e.g. safeguarding practice educator role
Consideration should be given to the delivery of the health IDSVAs (Independent Domestic and Sexual Violence Advisor) functions
NHS staff based in the children’s multi agency hub will also form part of this network of safeguarding support to within and across the NHS.
Requirements to deliver: NHS England and Improvement The Accountability & Assurance Framework (June 2015) outlines the central assurance role of NHSE. It sets out a number of objectives which NHS England is legally obliged to pursue. The objectives relevant to safeguarding are:
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Objective 13 - NHS England’s objective is to ensure that Clinical Commissioning Groups (CCGs) work with local authorities to ensure that adults at risk of abuse or neglect, particularly those with learning disabilities and autism, receive safe, appropriate, high quality care. Objective 23 - NHS England’s objective is to make partnership a success. This includes, in particular, demonstrating progress against the Government’s priorities of: Continuing to improve safeguarding practice in the NHS Contributing to multi-agency family support services for adults at risk of abuse or neglect and troubled families Contributing to reducing violence, in particular by improving the way the NHS shares information about violent assaults with partners, and supports victims of crime.
There is further narrative within the mandate that provides detail on the expectations of the Government:
“We expect to see the NHS, working together with schools and children’s social services, supporting and safeguarding vulnerable, looked-after and adopted children, through a more joined-up approach to addressing their needs.”
NHS England’s overall roles in terms of safeguarding are direct commissioning and assurance and system leadership. It is noted that NHSE and NHSI are currently committed to working together and supporting improvements across their organisations. Requirements to deliver: System Leadership Board The System Leadership Board will have a key role in monitoring and receiving assurance of the effectiveness of safeguarding across the NHS and in the wider integrated system.
Requirements to deliver: Clinical Commissioning Group
• The NHS England Safeguarding Accountability & Assurance Framework (June 2015) describes the role and function of CCGs in gaining assurance from all commissioned services, both NHS and independent healthcare providers, to ensure continuous improvement. In North Cumbria Health and Care the role of CCGs will continue to be fundamentally about working with all NHS organisations and partners to ensure that critical services are in place to respond to children and adults who are at risk or who have been harmed, and working to improve the outcomes and life chances for the most vulnerable. This includes the authority for the Designated Healthcare Leads to work within local health system to influence local thinking and practice.
• The Designated Healthcare Leads will take a key leadership role in the coordination, support, and development of the systems safeguarding arrangements. With the Executive Chief Nurses they will ensure that the required governance is in place to provide the required system assurance
• CCG assurance and exceptions should be reported to Executive Leads, NHSE/I, Safeguarding Boards and System Leadership Board.
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• Working Together (2018) emphasises the key function of the CCG’s Accountable Officer and Designated Healthcare Leads in the new statutory safeguarding partners arrangements for children as referenced.
• CCGs will have to continue to demonstrate that they have appropriate systems in place for discharging their statutory duties in terms of safeguarding.
• North Cumbria CCG and Morecambe Bay CCG are required to work closely together to ensure that the Cumbria county wide footprint for NHS Safeguarding is consistent and that both CCGs can equally provide assurance to the Safeguarding Boards.
Requirements to deliver: Engagement
• As previously described the principal approach to safeguarding should be personalisation. NHS current safeguarding systems show limited engagement and/or communication with service users, families and the wider public/communities in our safeguarding arrangements. Whilst some of this responsibility lies with the Safeguarding Boards, expectations around patients, carers and users being involved in service developments needs to be a foundation for the delivery of this framework. This approach needs to include use of case studies, patient stories, feedback and direct engagement and co-production work.
• NHS staff should be also be directly engaged and encouraged to support innovation and drive forward improvements.
Requirements to deliver: Partners
• The very essence of safeguarding practice is built on partnership working. This health framework has an initial focus on how NHS organisations in North Cumbria need to work collaboratively and support staff in order that we can be clear with our partners our “offer”, roles and responsibilities and how the NHS will be organised to then work together to engage more effectively with the children and adult safeguarding systems. Examples of engagement would include multi agency learning, peer review and supervision, management of complex individuals and responding to vulnerable communities.
SECTION FIVE: POLICY AND LEGISLATION: The range of requirements that the NHS needs to take account of in ensuring the delivery of effective safeguarding arrangements This section broadly outlines the range of requirements that the NHS needs to take account of in ensuring the delivery of effective safeguarding arrangements; it briefly outlines the landscape for safeguarding locally and the headlines from CCG and regulatory reviews of safeguarding.
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1. National Context There are a range of statutory safeguarding responsibilities, guidance and regulatory requirements that all NHS organisations must or should take account of: -
2. Accountability and Assurance Framework The duties and functions in relation to safeguarding for the NHS are currently outlined within Accountability & Assurance Framework (June 2015) http://www.england.nhs.uk/wp-content/uploads/2015/07/safeguarding-accountability-assurance-framework.pdf The framework states that the fundamental responsibility of every NHS funded organisation and each individual healthcare professional working in the NHS is to ensure that the principles and duties of safeguarding adults and children are holistically, consistently and conscientiously applied, with the well-being of those adults and children at the heart of what they do. For adult safeguarding this also needs to respect the autonomy of adults and the need for empowerment of individual decision making, in keeping with the Mental Capacity Act and its Code of Practice. It is expected that this document will be updated in Spring 2019 in response to changes in the national legislation
3. Adult Legislation The legislation and guidance relevant to safeguarding adults at risk of abuse or neglect includes the following: Care Act 2014 Care and Support Statutory Guidance (Chapter 14 – Safeguarding) There are some broad and fundamental safeguarding duties covering adult services, namely:
• Local Authorities must promote the adult’s “well-being”. Within this broad concept, the authority must “have regard to the need to protect people from abuse and neglect”.
• If a Local Authority has reasonable cause to suspect an adult in its area is suffering or
is at risk of abuse and neglect, and has needs which leave him or her unable to protect himself or herself, then it must ensure enquiries are made in order to decide what action (if any) should be taken, and by whom (the “duty to enquire”). Enquiries should be made by the most appropriate professional, and in some circumstances that will be a health professional.
In discharging these duties, there are express reciprocal duties to co-operate on local authorities and their “relevant partners”, and that category includes NHS England, and all CCGs and health trusts in the local authority’s area.
4. Children’s Legislation 4.1 Children and Social Work Act In 2015, in response to a number of disappointing outcomes of Local Safeguarding Children’s Boards (LSCBs) inspections, the Government commissioned Alan Wood, a former President of the Association of Directors of Children’s Services and ex-Director of Children’s Services in Hackney, to lead a review of LSCBs. This review took place between January and March 2016. In its May 2016 response, the Government said that it agreed with Alan Wood’s analysis, and that “current arrangements are inflexible and too often ineffective. Meetings take place involving large numbers of people, but decision making leading to effective action on the ground can be all too often lacking” (‘Review of the role and functions of local safeguarding children boards: the government response to Alan Wood CBE’, Department for Education, May 2016, page 5). Instead, it proposed a stronger but more flexible statutory framework to support local partners to work together more effectively to protect and safeguard children and young people, embedding improved multiagency behaviours and practices. The Children and Social Work Act 2017 received Royal Assent in April 2017. Section 30 of the Act removes the requirement for local areas to have LSCBs. Sections 16 – 23 introduce a duty on 3 key partners (Local Authorities, Police and CCGs) to make arrangements with other partners as locally determined to work together in a local area to protect and safeguard children. These arrangements must identify and respond to the needs of children in the area and also identify and review serious child safeguarding cases which raise issues of importance in relation to the area 4.2 Working Together 2018 Working Together was revised and updated following the amendments made to the Children Act 2004 by the Children and Social Work Act 2017. This updated guidance focuses on the core legal requirements that individuals, organisations and agencies must and should do to keep children safe. In doing so, it seeks to emphasise that effective safeguarding is achieved by putting children at the centre of the system and by every individual and agency playing their full part. This statutory guidance sets out key roles for individual organisations and agencies to deliver effective arrangements for safeguarding.
5. Competency Frameworks – Children and Adults 5.1 Children
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The competency framework states that to protect children and young people from harm, all healthcare staff must have the competences to recognise child maltreatment and to take effective action as appropriate to their role. It is the duty of employers to ensure that those working for them clearly understand their contractual obligations within the employing organisation, and it is the responsibility of employers to facilitate access to training and education which enable the organisation to fulfil its aims, objectives and statutory duties effectively and safely. It remains the responsibility of organisations to develop and maintain quality standards and quality assurance, to ensure appropriate systems and processes are in place and to embed a safeguarding culture within the organisation through mechanisms such as safe recruitment processes including use of vetting and barring, staff induction, effective training and education, patient experience and feedback, critical incident analysis, risk assessments and risk registers, cyclical and other reviews and audits, annual staff appraisal (and revalidation of medical staff). It is also important to be aware of the role of external regulators such as CQC in monitoring safeguarding systems within organisations. The Safeguarding Children and Young People - Roles and Competences for Healthcare Staff (updated January 2019) outlines minimum training and learning requirements to ensure staff working in health care settings have competencies relevant to their roles. 5.2 Adults Health care staff frequently work with people in their moments of greatest need and can witness health and social inequalities which have a direct impact on the lives of people they care for. In August 2018 the first intercollegiate document was published designed to guide professionals and the teams they work with to identify the competencies they need in order to support individuals to receive personalised and culturally sensitive safeguarding. The guidance highlights that increasing health and social care integration necessitates new roles and ways of working. The document provides a point of reference to help identify and develop the knowledge, skills and competence in safeguarding of the healthcare workforce. It sets out minimum training requirements along with education and training principles.
6. Regulatory Requirements Requirements are outlined in the NHS England Safeguarding Accountability & Assurance Framework (June 2015) and for the CQC in Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 13. There is a range of information currently available to inform the effectiveness of safeguarding arrangements including: • Providers’ key performance indicators identified in the markers of good practice,
Section 11 audits and safeguarding adults assurance framework • Inspection findings • Statutory reviews that have taken place – their findings and action plans • Regulation 28 reports • Intelligence from CCG and direct commissioning assurance processes
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• Designated Healthcare Leads Audit and Assurance Programme • Feedback from LSCB/SAB chairs. • Contract monitoring processes. • Complaints.
7. Inspection frameworks The safeguarding regulatory inspection framework for Joint Targeted Area Inspections (JTAI) of arrangements and services for Children in Need of Help and Protection in Local Authority Areas in England has been updated to enable the three safeguarding partners together with other agencies to understand how inspections are conducted. These inspections are undertaken by Ofsted, the Care Quality Commission (CQC), Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Service (HMICFRS) and Her Majesty’s Inspectorate of Probation (HMI Probation). CONCLUSION In preparation for the new arrangements the Designated Safeguarding Healthcare Leads in North Cumbria CCG agreed to develop a plan of action for the health system to ensure effective safeguarding arrangements would be in place in support of the new North Cumbria Health and Care system. This strategic framework is intended to ensure that the NHS has a central focus on safeguarding, has an approach to how the NHS could be organised, has staff within it which will be supported to deliver these arrangements, and has assurance mechanisms in place to monitor and ensure effective delivery. This health framework focuses on three key enablers that will support effective safeguarding arrangements across NHS organisations in North Cumbria including Primary Care and identifies the key requirements to deliver these including how the system will provide assurance. It reinforces a more person centred, proactive approach to safeguarding which aims to maximise current expertise and resources; the aim in doing so is to start to describe a more clearly defined ‘offer’ for the system and for our safeguarding partners. It provides an opportunity to more effectively support staff and the system, based on multidisciplinary teams working in ICCs and across service areas. RECOMMENDATIONS
1. To acknowledge the central tenet of the framework in supporting effective NHS safeguarding arrangements in an integrated system
2. To accept the approach and principles outlined in the framework and endorse the three key enablers in developing:-
• Learning and Practice • Performance and outcomes • Workforce
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3. Acknowledge the requirements to deliver and the assurance arrangements that need to be in place
Once approved, the next step is to develop an implementation plan with safeguarding experts and portfolio holders across the NHS to ensure delivery of the Framework outlined above (by March 2019) and to provide regular updates as required through the relevant governance processes within the integrated system.
Louise Mason-Lodge Deputy Director of Nursing and Quality Designated Nurse for Safeguarding Dr Nicola Cleghorn Designated Doctor for Safeguarding Children Dr Amanda Boardman Named GP for Safeguarding Simon Parker Deputy Designated Nurse for Safeguarding
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Appendix One: Approach and Methodology In order to inform and develop this health framework the Designated Healthcare Leads in North Cumbria CCG arranged a series of three workshops with safeguarding specialists and safeguarding portfolio leads from the NHS Providers working in North Cumbria, including NCUHT, CPFT, CHOC, Unity and NWAS. Colleagues also attended from MBCCG and the Local Authority. Using continuous improvement methodologies the three sessions focussed on:
• Current Position, Threats and Opportunities
• Leadership, Learning and Integrated Pathways
• Agreeing the Priorities
The workshop events allowed safeguarding leaders from across the health system to identify areas that were working well, not working well and where the key gaps and opportunities were. This work not only informed the development of the health framework but served the function of a self-assessment of our current arrangements across the NHS in Cumbria. There has been subsequent engagement with ICC leads recognising their central role in implementation and early engagement with prospective partners NTW with regard to sharing of good practice and to future possible working arrangements.
1. ENABLER ONE: Learning and Practice Workshop Feedback Summary points from the safeguarding leaders for Learning and Practice concluded that: What’s working well?
• Engagement in practitioner learning events
• Well represented in governance arrangements
• Learning is sometimes included in policy changes What’s not working well?
• Communication systems complex
• Still reactive not proactive
• No robust system to evidence learning/or gaps in practice
• Opportunities for Improvement?
• Audit and assurance programme of lessons learned
• 2 or 3 key system wide actions to improve practice with metrics for “so what”
• Annual Learning events
• Shared learning portal
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2. ENABLER TWO: Performance and Outcomes
Workshop Feedback Summary points from the safeguarding leaders for Performance and Outcomes concluded that: What’s working well?
• More focussed on making safeguarding personal, capturing the child’s voice
• Some good pockets of soft outcome monitoring
• Health infrastructure that is passionate about safeguarding and wants to make a difference to keep our communities safe
What’s not working well?
• Data collected is not the same across organisations
• Don’t recognise when things are working well and learn from it
• Very tick box focused as opposed to measuring how meaningful and effective our safeguarding practice is
• Opportunities for Improvement?
• Using patient feedback and experience to inform training
• Meaningful quality/outcome measures based on communities we serve in terms of safeguarding shared across all agencies
• Looking at the context of noncompliance to overcome barriers Waste Wheel Points
• Over processing: of information to inform compliance, duplicate systems, multiple unconnected assurance processes
• Waiting: for information to be shared
• Resources : lots of intelligence available not being brought together and used effectively
• Overproduction: need to produce compliance reports/data for multiple regulators
3 ENABLER THREE: Workforce Workshop Feedback Summary points from the safeguarding leaders for Workforce concluded that: What’s working well?
• Pockets of good practice
• Named professionals understand their roles and responsibilities
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• Able to articulate safeguarding knowledge within organisations What’s not working well?
• Capacity – supervision and training and development
• Length of time to complete work due to complexity
• Teams knowledge of each other’s functions
• Opportunities for Improvement?
• Safeguarding in ICCs
• Clear succession planning
• Shared working across health pathways
• Waste Wheel Points
• Defects: due to poor quality reports, referrals and perceived barriers to information sharing
• Over processing: engagement of line managers, safeguarding leads and wider partners due to lack of understanding of systems/expectations creating delays and duplication
• Resource: staff and managers not utilising supervision or specialist advice to navigate/improve
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Business Plan | 2014 -
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1
Cumbria Health and Well Being Board Response to NHS Legislation Survey
Comments
Should the law be changed to prioritise integration and collaboration in the NHS through the changes we recommend?
Strongly agree
Changes to current legislation are required to aid integration
1. Promotingcollaboration
• Do you agree with our proposals to remove theCompetition and Markets Authority’s functions to review mergers involving NHS foundation trusts?
Strongly agree
The Board supports the drive within the NHS Long term Plan to foster collaboration over competition. These proposals seem reasonable in reducing unnecessary reporting and review requirements. The Board supports the direction of travel in terms of increasing transparency and accountability to partners and the public, and advocate further strengthening the role of HWBs within these arrangements.
• Do you agree with our proposals to remove NHSImprovement’s powers to enforce competition?
Strongly agree
• Do you agree with our proposals to remove the needfor contested National Tariff provisions or licence conditions to be referred to the CMA?
Strongly agree
2. Gettingbetter value for the NHS
• Do you agree with our proposals to free upprocurement rules including revoking section 75 of the Health and Social Care Act 2012 and giving NHS commissioners more freedom to determine when a procurement process is needed, subject to a new best value test?
Strongly agree
The Board understands the relaxing of rules to support closer working with existing providers, whilst retaining the power to go to procurement if need be, would be helpful for CCGs. It will be important for guidance to outline how local communities can be assured that the NHS has secured best value, and of the role of HWBs and health overview and scrutiny in providing assurance. The best value test will be especially important to areas of health care and support that could be provided by non-NHS providers.
3. Increasingthe flexibility of national payment systems
• Do you agree with our proposals to increase theflexibility of the national NHS payments system?
Strongly agree
Flexibility on funding mechanisms will allow the development and testing of new funding approaches that align funding based on need with clear expectations on required outcomes. We would also welcome guidance on the involvement of non-NHS bodies in local price setting – in particular local government
4. Integratingcare provision
• Do you agree that it should be possible to establishnew NHS trusts to deliver integrated care?
Strongly agree
The Board stresses the importance of the views of local communities and councils being sought on whether the creation of a new trust will lead to better health and wellbeing outcomes, better care and support services
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5. Managing the NHS’s resources better
• Do you agree that there should be targeted powers to direct mergers or acquisitions involving NHS foundation trusts in specific circumstances where there is clear patient benefit?
Strongly agree
Whilst the Board recognises the need in some instances to direct mergers it would like to see the existing powers of HWBs and council overview and scrutiny of health used to help local health commissioners and providers come to a consensus in the best interests of local health and wellbeing outcomes, better care and support services and better use of public resources.
• Do you agree that it should be possible to set annual capital spending limits for NHS foundation trusts?
Strongly agree
6. Every part of the NHS working together
• Do you agree that CCGs and NHS providers be able to create joint decision-making committees to support integrated care systems (ICSs)?
Strongly agree
Allowing joint decision making with providers would seem to be an essential step towards future integration. Flexibility on joint appointments and governing body membership would certainly facilitate system working and understanding. However joint committees created under new legal powers need to be locally accountable, with clear lines of accountability to and from HWBs.
• Do you agree that the nurse and secondary care doctor on CCG governing bodies be able to come from local providers?
Strongly agree
• Do you agree that there should be greater flexibility for CCGs and NHS providers to make joint appointments?
Strongly agree
7. Shared responsibility for the NHS
• Do you agree that NHS commissioners and providers should have a shared duty to promote the ‘triple aim’ of better health for everyone, better care for all patients and to use NHS resources efficiently?
Strongly agree
The formal statutory confirmation of this requirement would be really helpful. In particular, the Board supports the duty requiring sustainability and transformation partnerships and ICSs to engage with HWBs to develop local plans to reshape and integrate health and care services that are genuinely locally agreed.
8. Planning our services together
• Do you agree that it should be easier for NHS England and CCGs to work together to commission care?
Strongly agree
The Board supports measures to enable CCGs to collaborate with each other and with NHS England, and to use joint and lead commissioning arrangements to make decisions and pool resources.
9. Joined-up national leadership
• Which of these options to join up national leadership do you prefer?
The Board’s view would be that there should be a total integration of NHSE and I into a new operating model, not just a combination and alignment of the two regulators. a) combine NHS England and NHS Improvement
b) provide flexibility for NHS England and NHS Improvement to work more closely together
c) neither of the above
• Do you agree that the Secretary of State should have power to transfer, or require delegation of, ALB functions to other ALBs, and create new functions of ALBs, with appropriate safeguards
