West Midlands

Sustainability and Transformation

Planning – PART 3

22 February2016

1

Emerging STPs (engagement, governance

and priorities)

• Birmingham and Solihull

• Black Country

• Coventry and Warwickshire

• Herefordshire and Worcestershire

2

Emerging STPs (engagement, governance

and priorities)

• Birmingham and Solihull

3

Birmingham and Solihull Sustainability & Transformation Plan

Partnership Current Full members: • Birmingham City Council • Solihull Metropolitan Borough Council • Birmingham Cross City CCG • Birmingham South Central CCG • Solihull CCG • Birmingham Children’s Hospital Foundation Trust • Birmingham Community Healthcare Trust • Birmingham & Solihull Mental Health Foundation Trust • Birmingham Women’s Hospital Foundation Trust • Heart of England Foundation Trust • Royal Orthopaedic Hospital Foundation Trust • University Hospitals Birmingham Foundation Trust • Primary Care – to be identified Associate Members: • Sandwell and West Birmingham CCG • Sandwell and West Birmingham Hospitals Trust

Birmingham and Solihull Proposed Placed Based Layers

National

Regional

West Midlands Combined Authority

STP – Birmingham and Solihull UHB + HEFT BSC CCG B’ham City Council

BCH + BWH BXC CCG Solihull MBC

BSMHT Solihull CCG

ROH

CCG

CCG Localities/Networks

Patient Awareness (One You Campaign) Prevention – Smoking/Alcohol/Obesity/Diabetes Military Offender Healthcare

Products from Clinical Senates/Networks CSE/PVVP/Troubled Families Programme/ Early Help Tier 4 CAMHS Specialised Services Public Health – Screening and Immunisations Major Reconfiguration (Trauma, Stroke, Cancer etc.) Mental Health Commission Emergency Care Network 111 / Ambulance

Strategy – LHE System Transformation • Urgent and Emergency Care • Mental Health (Dementia/ Adults 25+/ 0-25s) • Children, Maternity, Diagnostics, 7 day, Cancer, • Prioritisation • Capacity Reviews e.g. diagnostics BCF Schemes Carter Productivity Reviews/agency spend NDPP First Wave Implementer

Primary Care Local Mental Health Interface/Pathways Community Services / Integration Local Acute Interface/Pathways

Local Delivery

Birmingham & Solihull STP Logic Model

Rationale

The current health and social care model is

fragmented with misaligned resources.

We need to shift the emphasis from episodic

reactive care to sustainable person centered proactive

care with demonstrable outcomes

Triple Aim

Close the inequality gap

Improve wellbeing

Close the Quality gap

Improve Quality & reduce variation

Close the Financial gap

develop sustainable finances

Ambition

Strong Economy

Education

Community Cohesion

Population Health

Approach

Prevention

Quality

Efficiency

Innovation

Philanthropy

“Big Society”

Assets

Investment & Growth

Focus

Early intervention

Community Development

Primary care

Community Services

UEC

Scheduled Care

Women & Children

Mental Health

Specialized Commissioning

Outcomes

Improved engagement of citizens in their health and

wellness

More people supported to manage their own health

and prevent crisis

increased technology assisted healthcare delivery

Reduced Variation

More proactive care provided in the community

increased staff capacity and capability

More effective use of resources

Impacts

Better lives for the people of Birmingham and Solihull

with improved health outcomes and experience

of care with a focus on prevention and self care.

Sustainable , integrated and self improving system

of care that is cost effective.

Key determinants of health and wellbeing

Education

Economic prosperity

Cohesive communities

Population health

Ambition

Approach to Sustainability

Focus

• Early intervention • Community Development • Primary care • Community Services • Urgent & Emergency Care • Scheduled Care • Women & Children • Mental Health • Specialized Commissioning

Improved Outcomes

• Improved engagement of citizens in their health and wellness

• More people supported to manage their own health and prevent crisis

• Increased technology assisted healthcare delivery

• Reduced Variation

• More proactive care provided in the community

• increased staff capacity and capability

• More effective use of resources

Why Birmingham and Solihull Fulfil the requirements of strong STPs by identifying the broader platform of transformation including vision, priorities

• Prime Minister Challenge Fund - Primary Care Access

• Solihull Together UEC Vanguard

• Orthopaedic and Mental Health Chain of Care Vanguards

• Modality new model of care Vanguard (MCP)

• Prevention of Diabetes Vanguard

• Mental Health Test Bed

• Mental Health Innovation – young peoples mental health and emotional well being services, IAPT, Early Intervention, Crisis Care, Dementia

• 7 Day Services Early adopter

• Recognised as successful in digitalisation of health and social care, Your Care Connected

BSOL STP Challenges

• Align organisational visions • Develop a partnership which works collectively for our citizens,

where the entity is greater than the sum of its individual parts • Create and implement ‘place based’ strategies and plans including

key enablers – workforce, IT, estates, technology • Produce a compelling narrative in support of West Midlands

Combined Authority and devolution • Use available data and intelligence from all partners and central

support to inform the scale of our ‘gap’ • Establish effective metrics of success for our ambitions and

measure them consistently and collectively • Demonstrate value for money and bring transformation monies into

the system (business support, philanthropic, NHS)

Immediate Logistics (week 1)

• Accepted offer from BCC to assist funding of programme office • Dr Patrick Brooke interim system lead • Programme Director, and policy lead appointed • Offers of admin support, public health, quality and finance • Identified programme office space • Impower appointed to support planning, with special reference to

identifying the gaps in the local triple aim

Need to: • Identify programme manager • Establish IT solutions to promote joint working • Identify communications, engagement and PMO support

Task Date

Partners ratify interim exec and leadership team and outline governance 26th Feb

Confirm understanding of associate status 26th Feb

Receive NHSE Data w/c 29th Feb

Working Office Options Appraisal re PMO Communications and Engagement Solution

4th March

Working draft of vision and aspirations 4th March

Amalgamate local data with local intel 11th March

Partnership statement of intent 18th March

Agree prioritization and gaps Identify Partnership OD options (system leadership) Explore capital release to support transformation

5th April

Agree System Lead 11th April

Key Timeline

Operating principles:

• Independent chair

• Partners to be accountable for provision of appropriate expertise

• Empowered supportive programme office

• Committee light

• High engagement – weekly briefings

• Task and finish

• In Public by default

HWBB x 2

BSol STP Program Board

(independent chair)

Program Exec

Chairs & Senior Politicians

11+ Governing Bodies

Work stream Groups

CEO Group

Public Sector Reform Board

Combined Authority

Program Delivery Team Lead AO Dr P Brooke Program Director Judith Davis Policy Lead Cat Orchard Admin SMBC BCC Peter Hay Comms & Engagement Finance TBA Quality and Outcomes TBA Public Health TBA

Stakeholder Reference Groups • Citizen • Clinical • Public • Voluntary Sector • Education • LEP • Police & Fire

BSol STP Governance

Checklist part 1

STP Footprint name Birmingham and Solihull

Senior Officer identified with time and resource

Dr Patrick Brooke £2 million PM resources over next 2 years

Governance arrangements Proposal to partners for ratification 26/2/16

Clarity re problem to be addressed Impower commissioned + started

System ownership with HWBBs

CCG and Trust GBs have oversight and have signed off STP Plans

Oversight through governance

Agreement for HWBBs to come together Agreement for chairs to liaise

Key stakeholders engaged and identified In process

Checklist part 2

Appropriate project structures In development

Credible work program with impacts

Resources for implementation identified

Right Care gaps identified Impower will collate

Clarity on service strategy development for different population levels

Agreed System Communication Strategy

Impacts of STP Plan identified and processes in place to measure delivery

Emerging STPs (engagement, governance

and priorities)

• The Black Country

21

Progress so far

• Initial meeting held. Most potential partners able to attend other than: Walsall Council Dudley Council SWBHT (although they had signalled support)

• Important to note that none of the five* councils have formally confirmed their support for this process *BCC have discussed associate membership

Governance process

Three levels of governance agreed in principle:

Sponsoring group

(monthly) Operational group

(frequency tbc)

Finance group

(fortnightly) • CSU Strategy Unit

Resources

• Inclusive approach with resources drawn from partners (collective leadership)

• Chair for sponsorship group identified

• Public Health offer to support needs analysis

• CSU to provide additional support (financial and economic impact analysis packages agreed)

• Operational group yet to meet (will consider drafting/editorial process, PMO, risk register etc.)

• Subsidiarity – build on local planning arrangements and partnerships

• Mutuality – act together to maximise access to development funding

• Added value – don’t duplicate or compromise existing work/partnerships

• No boundaries – don’t allow the creation of the STP to create new boundaries that might compromise the delivery of care

Key principles

Initial programme

March

April

May

May/June

June

End of June

26

Agree

format of

plan and

develop

process

Consider

initial

draft

Agree

draft to be

submitted

(each

Board)

Sponsor

meeting

(final)

Approval

by all

partners

Submit

STP

Directors of finance meeting

Key discussion points:

• Scoping

• Standardised collection template

• CSU (Provex) to support financial management

• Data collection exercise

• High level income and expenditure analysis

Next steps:

• Final proposal and governance

arrangements

• Fortnightly meetings

• Analysis of 2016/17 plans

• Opportunities in parallel to

financial analysis

• Identify what’s already happening

• Set out finance and activity challenge

• Describe opportunity using Right Care

• Explore economic impact of health and care on wider determinants of health and wellbeing

Early priorities

Service areas (initial)

Cascade learning from MCP Vanguards

(Paul Maubach)

Maternity

(Salma Ali)

Mental Health/Learning Disabilities

(Helen Hibbs)

Urgent Care/Stroke

(Andy Williams)

Conclusion

• Areas of agreement but not all partners yet committed

• Focus on rigorous evaluation of innovation

• Further work to understand behavioural change

• Opportunity to understand the wider economic impact

• Shared data and information systems

• Build on existing provider alliances (Merit, BCA, BCPFT/DWMHT/BCHC)

Emerging STPs (engagement, governance

and priorities)

• Coventry and Warwickshire

31

32

Coventry & Warwickshire STP

What does our STP look like (who is in)

Warwickshire North CCG Coventry & Rugby CCG South Warwickshire CCG Coventry & Warwickshire Partnership NHS Trust University Hospitals Coventry & Warwickshire NHS Trust George Eliot Hospital NHS Trust South Warwickshire NHS FT Coventry City Council Warwickshire County Council

33

Coventry & Warwickshire STP

Map CCGs and LA boundaries Warwickshire North CCG: North Warwickshire and Nuneaton & Bedworth South Warwickshire CCG: Warwick and Stratford-Upon-Avon Coventry & Rugby: Coventry and Rugby

• South Warwickshire FT

• UHCW

• UHCW (Rugby Hospital)

• George Eliot Hospital

50 miles

34

Coventry & Warwickshire STP

Governance

x2 HWBs

Chair level

Warwickshire HWB

sub-structures

NHS CEO/LA Director

STP

Steering Group

Health Economy

CEO Group

STP

Finance and Activity

Director level

STP Strategy & Engagement

Director level

Coventry HWB

sub-structures

PMO

All groups are Provider & CCG membership Local Authority & NHS membership

C&W STP: Our Approach to Layers

5. National/Supra Regional

4. West Midlands Specialist Centre

Commissioning Network

3a Health Economy Service

Commissioning Footprint

3b Local Government Footprint

2. SRG Footprint

1. Individual CCG

and LA

• Military and offender

• Major Trauma

• 999 ambulance, NHS 111 Triage, Specialist Paediatrics, neonatal , MH and Cancer Treatment, Public Health Screening and Immunisation , Urgent & Emergency Care Network.

• Cancer, Stroke, Paediatrics, Maternity, Bed based Mental Health services, Hospital Emergency Department services, Emergency Medicine/Surgery.

• Children's Services, CAMHS, LD, Care Homes, Domiciliary Care and other Better Care Fund projects.

•Primary Care Transformation, Urgent Care, Out of Hospital, End of Life, Ambulatory Care , ‘ology’s & Chronic Disease Management, DTOC.

• Health Checks, Social Prescribing, community assets, lifestyle programmes.

Examples only based on current CCG programme of work

36

Coventry & Warwickshire STP:

Key Priorities and Challenges

1. Confirming/Establishing the Triple Aim Gap;

2. Areas in layers 1&2 to be accelerated to support transformation in acute setting;

3. Specialities and pathways most amenable to delivering the biggest system benefits on the triple aim front.

37

Coventry & Warwickshire STP:

Key Priorities and Challenges

1. Financial modelling: determine the drivers to high cost , sub-optimal outcomes.

2. Agree criteria for prioritisation.

3. Agree the layers - Have we drawn the layers in the right place and would re drawing them accelerate change?

4. What should be done on: • a locality basis/out-of-hospital basis; • at scale across the acute system?

5. Test ourselves - Are we agreed on what a good out-of-hospital system should do and what a good hospital system should do, what does a good interface look like?

Size of the Opportunities and Programmes of work to Realise the Benefit

Health & Wellbeing

Gap

Care & Quality

Gap

Funding & Efficiency

Gap

System in Balance

In 5 years if we do nothing

Estimate of health economy shortfall

Carter

Right Care

Prevention

New Models

NOT TO SCALE – ILLUSTRATIVE ONLY

-£100m

£0

Coventry & Warwickshire STP

Risks and Issues

Triple Aim Gap

Emerging STPs (engagement, governance

and priorities)

• Herefordshire and Worcestershire

39

40

Herefordshire and Worcestershire STP

Herefordshire Council Herefordshire CCG Wye Valley NHS Trust 2gether NHS Foundation Trust Taurus GP Federation

Wales Shropshire Dudley

Birmingham

Warwickshire

Worcestershire County Council Redditch and Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG Worcestershire Acute Hospitals NHS Trust Worcestershire Health and Care NHS Trust 4 Primary Care Collaborations

Gloucestershire

41

Governance

• Existing regional work to continue as now.

• Develop a Herefordshire and Worcestershire Joint Programme Board to oversee cross-county programmes where scale and volume is key to success.

• Where it makes sense to do so, continue working on the two existing county based transformation programmes.

• Develop joint work programme on key system enablers to support large scale transformational change where appropriate and beneficial to both programmes. Continue with local solutions where benefit is not clear.

• Continue with CCG level focus on New Models of Care and Primary Care Commissioning, where locality focus is key to success. Maintain focus on existing relationships beyond the new STP

footprint (Gloucestershire, Dudley, Birmingham, Warwickshire).

Common Objective: Collaboration and joint working on a scale not achieved before to deliver transformational change that closes the triple aim gap and supports a financially sustainable health and social care economy.

42

Risks, Issues and Opportunities

Risks and Issues: • Two providers in special measures. • Significant financial challenges across both health and social care economies. • Political history – Local Government Reorganisation in 1997. • Geography and demographics – 70+ miles from one side of the patch to the other. • Multiple “out of footprint” relationships.

Opportunities: • Existing Worcestershire Future of Acute Services programme and Integrated Pioneer

programme (Well Connected). • Existing One Herefordshire Transformation Programme. • Shared and common understanding of the challenge to be addressed and joint

commitment to tackle it. • Relatively simple footprint with many coterminous services.