Workstream Highlight Report Item 20(b)(ii) US/CCG... · Workstream Highlight Report . ... Summary...

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Workstream Highlight Report

SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM COLLABORATIVE PARTNERSHIP BOARD

19 October 2018

Author(s) SYB ICS Workstream Leads

Sponsor Lisa Kell, SYB ICS

Is your report for Approval / Consideration / Noting

For approval

Links to the ICS (please tick)

Reduce

inequalitiesJoin up health

and care

Invest and grow

primary and

community care

Treat the whole

person, mental

and physical

Standardise

acute hospital

care

Simplify urgent

and emergency

care

Develop our

workforce

Use the best

technology

Create financial

sustainability

Work with

patients and the

public to do this

Are there any resource implications (including Financial, Staffing etc)?

N/A

Summary of key issues

A summary of progress for the SYB ICS workstreams is included within this report, accompanied by a high level overview of progress to date for each area. The progress report is also intended to support updates to SYB Boards and Governing Bodies on developments and delivery progress.

Recommendations

The Collaborative Partnership Board is asked to note and approve the contents of this report.

Paper C

Item 20(b)(ii)

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Workstream Highlight Report

SOUTH YORKSHIRE AND BASSETLAW INTEGRATED CARE SYSTEM COLLABORATIVE PARTNERSHIP BOARD

19th October 2018

1. Purpose The purpose of this report is to provide an overview of the progress being made in each of the ICS transformation workstreams through the highlight reports and an overall summary dashboard setting out points for escalation and risks to the ICS. The information has been compiled in conjunction with SROs and programme leads and signed off by SROs for each priority area. 2. Progress to date The summary dashboard is shown on page 2. SRO leads for each workstream may wish to raise particular issues captured within the report

3. Recommendations The Collaborative Partnership Board is asked to consider the report for the ICS workstreams and to use this to inform local discussions. Lisa Kell October 2018

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SYB ICS transformational workstreams progress – Summary Dashboard

ICS workstream and RAG status

Progress this month – October 18 Key Risks

Cancer Alliance ICS Cancer Waiting Times recovery plan being monitored through Cancer Operational Group. 62 day

continues to be below target. Urology and head & neck backlog and capacity issues to impact on Q3 & Q4.

Business case and pathology model for integrated pathway for lower GI symptoms approved.

3243 cancer champions created to support raising awareness of signs & symptoms of cancer.

Alliance Board supported piloting nurse led chemotherapy

Place based plans being developed for rapid assessment & diagnostic pathways (lung, prostate, lower GI)

Guidance to support risk stratification for breast, lung and colorectal pathways agreed and included in

19/20 commissioning intentions

62 day CWT below target Prostate - Demand increasing due to media impact on 2ww plus mobilisation of RAPID pathway creating peak in treatment demand with insufficient robot and surgical capacity to manage.

Children's and Maternity

CSA - Agreement of clinical pathways nearing completion. Designation visits and feedback complete, most action plans back in, specific work in place to manage actions re Mid Yorkshire Hospitals (MYH) issues. AUC Clinical Working Groups (CWGs – including Paeds) being re-convened under HSP, alongside HSP consideration of modelling approach to support potential reconfiguration Maternity – Proposal implemented in each Place receiving a capitated allocation (of overall £762k) to enable delivery of their local LMS Place Plan, based upon trajectory delivery. Some funding ring fenced for SYB-wide web information.

Limited PMO capacity re Programme Director, plus CSA workstream lead (currently provided from within the ICS)

Corporate Services HR Provider Efficiency Group disbanded in order to support development of new ICS Finance Groups.

Six-month pilot of collaborative medical bank commenced in May across BHNFT, CRHFT, DBTHFT, SCHFT

plus NLAG. The plot has broken even on costs, with opportunities extend across other SYB Trusts. a

recommendation has been made to extend for 12 months

Building on collective procurement for non-medical bank management completed across four Trusts in April

delivered savings of £389k across CRHFT, DBTHFT, SCHFT, STHFT.

Digital and IT The NHSE Health System Led Investment fund will result in a range of deliveries against the theme of

maturing the Electronic Patient Record capability across the region, with £2.838m investment spread across

Limited capacity to support the digital workstream is impacting on progress

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all providers in 2018/19, followed by £2.5 and £5.9m in 2019/20 and 2020/21.

Progress is being made with delivery of wifi in GP Practice, with Rotherham now achieving over 90% of

practices with wifi services

Elective and Diagnostics

Allocation of NHSE Elective transformation monies made circa £160k, resource requirements identified and

submitted for E&D work stream

Commissioning for Outcomes Policy has been implemented across SYB with some variations. Assessment of

variation has begun and will be shared with Accountable Officers end of October.

Ophthalmology out of hours model (MCN) – Proposed changes to the current model have been agreed with

leads, if all Trust Medical Directors agree, the change will take place from 3rd December.

Capacity issues E&D resource requirements submitted to ICS DoF. includes the extension of the 2 x Clinical Lead posts for the Radiology programme.

Mental Health and Learning Disabilities

The SYB ICS Suicide Prevention Steering Group met in September to check progress on: (1) Reducing suicide

and self-harm in mental health services, (2) Reducing self-harm in community and acute services, (3) Suicide

prevention in men and/or work with primary care. The SYB ICS Suicide Prevention Steering Group held a

real time surveillance of suicide workshop, facilitated by the Innovation Unit, on 19 September 2018.

The Suicide Prevention Steering Group has received confirmation of Year 2 monies of £555,622 for

2019/20. Suicide prevention SYB ICS priority with LAs being considered by ICS exec team

Resource issues – Program support has been previously covered by NHSE and this has now ceased, no replacement / alternative arrangements in place yet

Medicines Optimisation

Primary & Secondary Care prescribing- joint efficiency work being scoped. Prescribing cost reductions underway:

Common basket of cost effective product switches; Rebates –tacit agreement to move towards a consistent

position; Polypharmacy and de-prescribing –opportunities explored to reduce morbidity and risk caused by

inappropriate polypharmacy, standout Media campaign; Gluten Free, Resources uploaded to the NHS

Futures platform for wider sharing across SYB.

Medicines Optimisation in Care Homes:

Operating model agreed. Hubs agreed (Barnsley, Bassetlaw, and Sheffield). Recruitment process

commenced.

Service Redesign:

Head of MM appointed 1 day/ wk to lead prescribing projects to drive efficiency savings across SYB,

including: nutritional products, continence and stoma appliances to be managed by other health care

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professionals not a GP.

Pathology Completed risk assessment of procurement options of pathology hub model .

Pathology Transformation Programme Board has recommended that “all Trusts in SYB work together to

complete the procurement of a single fully managed service contract with a single provider for Pathology

Services across SYB” including the issue of a Prior Information Notice (PIN) to notify the market of the SYB

procurement plan.

BHNFT and TRFT Trust Boards have supported BRILS recommendation to issue a direct award to their

current MSC suppliers for 3-4 years to address operational issues due to ageing equipment and support the

SYB procurement plan.

None

Prevention Tobacco: Steering Group planning for QUIT SYB ICS Event (7th November). Meetings with Executive

Sponsors at Acute Trusts and identification of place based Clinical Champions taking place.

Social Prescribing: SYB SP strategy and common outcome framework to be developed supported by ICS

primary care steering board. CCG/LA reps asked to take proposal through local committees to support .

Lack of Public Health capacity in ICS to meet competing demands that would benefit from Public Health support and progress priorities at pace.

Primary Care Places continuing to undertake their own engagement and consultation on primary care at scale. the ICS

level comms plan will assist in creating the standardized message for this.

LCN development and future forecasting is to be revisited by NHSE for realistic expected status of networks

for March 2019.

Apex/Insight workforce/workload tool being rolled out

Capital bids have been submitted, review and further information requests are expected in relation to the

bids in September 2018 with decisions in November 2018.

Personalised care and population Health workshop held on 25th September, positive feedback recieved.

Radiology Development of first draft of workforce strategy, which has been shared more widely across the Radiology

Network Management Group to progress draft and get comments from across the system

Capacity and Demand Modelling: MRI/CT first outputs reviewed including quick wins around coding and

PMO resource limited

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processes to be followed across the network

engagement with Cancer Alliance Board on how to develop solutions to support achieving changes to

cancer waiting times,

Research and Innovation

AHSN -Strengthening the R&I workstream paper discussed at ESG July with agreement that a final proposal to come back in October/November to confirm support of the approach and the use of the SYB partners AHSN membership fees. The AHSN is supporting the definition, resource and delivery of a small number of exemplar projects to support the priority areas of the ICS, in workforce innovation, innovation to support an identified unmet need in urgent and emergency care delivery and support to define and develop the population health management opportunities for SYB. Project briefs are currently in development. The areas have been selected due to national AHSN expertise, combined with areas which require innovative solutions to solve their problems. Workstream leads are working with their Exec Leads to define a specific problem (unmet need) to commission the AHSN to propose and implement potential solutions. This paper is is expected to go to November ESG, subject to further discussions between the AHSN CEO and the SYB Exec team.

AHSN support and membership fees R&I prog lead capacity – current lead leaves in Dec 18

Stroke JCCCG agreed the contractual approach in September. The HASU model will be contracted through, in the first instance, integrated aligned contracts with Sheffield CCG acting as the contract coordinator. This enables the system to use existing contracting resources and mechanisms, whilst exploring longer term options eg potential prime provider or alliance agreement for the whole stroke pathway. The HASU Tariff technical group provided some data on income and cost (baseline and post reconfiguration). Further work is still required as not all providers were able to share the requested information. This has created a delay in the development of the HASU tariff. The plan is to now share a proposal in October, with the technical group due to meet again in mid October

it may not be possible to agree new tariff arrangements for HASU (split HASU from ASU) and transitional funding has been requested from providers

Urgent and Emergency care

NHS 111 Online implemented 24/7 from 12/3/18 with no issues reported. South Yorkshire and Bassetlaw accounted for 5% of the overall 111 activity undertaken online in August 2018. (Humber Coast and Vale 8%, West Yorkshire and Harrogate 7%). There has not been a corresponding decrease in 111 call volumes. Top 3 most frequented pathways in the North of England (since December 2017) comprised; dental, abdominal pain and breathing difficulties. National publicity is anticipated from January 2019. Local campaigns are being considered in the meantime.

Delivery of the A&E 4 hour target continues to be a challenge, only Sheffield Children’s Hospital has a cumulative position (August 2018) of >95%. ICS YTD cumulative (July 2018) position is 91.14%. PMO capacity limited impacting on progress

Workforce Five fixed-term Place based Workforce Lead roles have been advertised, supported by LWAB via HEE funding. Doncaster and Rotherham roles have been appointed to, with active recruitment in Bassetlaw

None

Estates – not received

South Yorkshire & Bassetlaw ICS – Programme Highlight Report

Programme: Cancer Alliance Provider CEO / CCG AO sponsors: Lesley Smith

Date of report: October 2018 Report completed by: Julia Jessop, Programme Director

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Amber

Plan for 2017-2019 Summary of plan and key ambitions Deliver Cancer Taskforce Recommendations. Prepare for ICS. Deliver 8 CWTs. Single integrated assurance framework with NHSE/I. Test integrated commissioning & provision for chemotherapy/FIT/LWABC/Vague Symptoms. Redesign clinical models to deliver rapid assessment and diagnosis timed pathway with associated Cancer Workforce Plan to ensure sustainability. Deliver against key milestones for Early Diagnosis Transformation Programme to increase diagnosis at stage 1 and 2/improve 1 year survival. Integrate Macmillan LWABC programme to ensure delivery of risk stratified follow up, recovery package and self-management.

MOU commitments List of MOU commitments and deadline Deliver 62 day CWT – 85% Alliance level sustained through 18-19 Deliver Cancer Taskforce Recommendations. 62% cancers diagnosed stage 1 or 2 by 2020. Improve 1 year survival. Reduce emergency admissions. Support introduction of new screening models (FIT/HPV). Roll out recovery package and risk stratified pathways (Breast by 2019).

Engagement Summary of PPE activities undertaken in most recent period (month / quarter)

Cancer Be Safe work with community volunteers. LW&BC learning and development sessions.

Progress Summary of achievements from most recent period (month / quarter)

System level composite CWT recovery plan being monitored through Cancer Operational Group. 62 day performance continues to be below target. Urology and head and neck backlog and capacity issues likely to continue to impact on Q3 & Q4.

Business case and pathology model for Integrated pathway for lower GI symptoms approved. 3243 cancer champions created to support raising awareness of signs & symptoms of cancer. Baseline review of CT & MRI report completed. SACT: Alliance Board supported piloting nurse led chemotherapy Place based implementation plans being developed for rapid assessment and diagnostic pathways (lung, prostate, lower GI) Guidance to support risk stratification for breast, lung and colorectal pathways agreed and included in 19/20 commissioning

intentions. 500 eHNAs completed with 6/8 localities now live. Learning and development support commended with 450 EOIs

Next steps – over next month Summary of planned actions for next period (month / quarter)

Undertake a review of inequalities and develop strategy to reduce Develop plans to mobilise new models of working with CDGs SACT: ensure ICS engagement with case for change and future developments Development of PH2 workforce strategy in association with HEE and elective & diagnostic workstreams Initiate planning for 19/20 onwards in response to Long term plan priorities.

Benefits Summary of benefits

1 year survival and stage at presentation remains statistically worse than the England average. Inequalities review commissioned to review the programme and develop a strategy based on known and innovative interventions.

Performance: Continues to fluctuate as recovery plans impact and transformation is embedded. Quality - LWABC: 830+ people referred for support in three localities between 2016 and 2017. Average increase from approx


Risks Pre-mitigation

RAG

Post-mitigation

RAG Mitigating Action Due date

Prostate - Demand increasing due to media impact on 2ww plus mobilisation of RAPID pathway creating peak in treatment demand with insufficient robot and surgical capacity to manage.

Red Red

Recovery plan including outsourcing treatment to Stockport Backlog of breaches forecast to impact on Q3&4.

Ongoing

Interdependency with other work streams leading to delay in key milestones and transformation - require networked radiology, pathology and Inter Trust Messaging to support new models

Red Amber

Collaborative working with associated work streams to ensure consistency of information for decision making.

Ongoing

Short term nature of funding could lead to experienced staff leaving for a more secure role Red Amber

Ensure clarity regarding transformation allocation within ICS to inform structures for 19/20

September

2ww referrals increase across the footprint creating additional capacity issues and risk 62 day recovery Red Amber

Exploring possibility of ERS download to assist in understanding demand to build capacity

Ongoing

Issues Pre-mitigation

Urgency

Post-mitigation Urgency

Mitigating Action Due date

SACT – Further work is required to understand impact across the whole pathway and interdependent services. Need to ensure resource commitment

High Medium Ongoing discussions to determine process for next steps and identify required ICS resource

October

Demand & Capacity modelling: Endoscopy report delayed until June 2018 due to lack of engagement

High High Elective and Diagnostic workstream establishing required for a dependent on next steps on recommendations of HSR

September

South Yorkshire & Bassetlaw (SYB) Integrated Care System (ICS) – Programme Highlight Report

Programme: Maternity & Children’s (M&C) Workstream Provider Chief Executive / CCG Accountable Officer sponsors:

Chris Edwards – Rotherham CCG John Somers – Sheffield Children’s Hospital FT

Date of report: 1 October 2018 Report completed by: Marianna Hargreaves / James Scott

Progress Assessment Current Period (Red-Amber-Green; RAG) Red

Progress Assessment Previous Period (RAG) Amber

Plan for 2017-2019 Children’s Non-Specialised Surgery and Anaesthesia (CSA)

To continue to develop a Managed Clinical Network (MCN) to facilitate a coordinated regional approach to implement the agreed changes to CSA to reduce variation and secure delivery in line with Standards. To make best use of the workforce to secure equitable, resilient and sustainable CSA services, ensuring management of interdependencies with paediatrics (acutely unwell children) and the outputs of the Hospital Review processes .

Acutely Unwell Child To continue to develop a Network to facilitate a coordinated regional approach, including the development of standardised clinical pathways and joint work on areas such as management of locum availability, recruitment/retention and communication. Taking into consideration outputs of the Hospital Services Programme (HSP) and managing the key interdependencies (maternity, CSA, neonates and wider urgent care).

Maternity To continue to develop the SYB Local Maternity System (LMS). To translate the SYB LMS Plan into delivery with mothers, babies and families to realise the vision set out in ‘Better Births’. The SYB plan is to improve the quality and safety of provision through a Managed Maternity Clinical Network. To facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care.

MOU commitments

All commissioner and provider organisations are signed up to the ICS Memorandum of Understanding (MOU); within which there is a commitment to collaborative work on Children’s and Maternity as set out above.The Maternity and Children’s Delivery Board and the LMS Board are part of the ICS governance structure.

Engagement CSA – Significant engagement throughout CSA review followed by a public consultation. Throughout implementation

further consideration of engagement is necessary.

Acutely Unwell Child – Engagement through the HSP, following publication the expectation is that further engagement will take place as part of developing site-specific future service models.

Maternity – Engagement via the Maternity Voices Partnership (MVP) strand. A user friendly version of the plan under development. The plan going forward is to where possible facilitate co production, particularly re Local Maternity Place


Plans. Additionally, engagement through the HSP as per acute paediatrics above.

Progress CSA – Issue Oct 2018: Network Manager, employed via agency, has left to take up a substantive NHS post elsewhere.

Interim arrangements are being clarified. Funding arrangements, initially agreed via JCCCG July 2017, are being reviewed. There is a requirement to resolve both of these matters urgently to avoid delays to implementation.

Development and agreement of clinical pathways almost complete; abdomen pathway discussed July. Designation visits and feedback complete, most action plans received and dialog underway, specific work to manage actions re Mid Yorkshire Hospitals (MYH), no action plan yet received. Sub-regional transport policy in development, with colleagues from Yorkshire Ambulance Service (YAS) and Embrace. In addition, there is an ongoing refresh of transfer numbers data, to complete Oct 2018. MCN specification finalised, now with commissioners for technical consideration.

Acutely Unwell Child – Issue Oct 2018: Network Manager, employed via agency, has left to take up a substantive NHS post elsewhere. Interim arrangements are being clarified.

Clinical Working Groups (CWGs – including Paeds) are being re-convened under HSP, alongside HSP consideration of modelling approach to support possible reconfiguration. Further discussions have been taking place as HN process develops. In parallel, further discussions between Sheffield Children’s Hospital (SCH) and District General Hospital (DGH) partners re possible collaboration. MCN funding for rest of year confirmed but not yet formally in writing. MCN guidelines group is underway, to link with work of HSR-CWG. MCN have sent a delegation to North America (Sep 18) to consider PA roles in paeds, awaiting formal reporting of outputs.

Maternity – Proposal implemented re each Place receiving a capitated allocation (of overall £762k) to enable delivery of their local LMS Place Plan, based upon trajectory delivery. Some funding ring fenced for SYB-wide web information. Plan template has been circulated and first drafts received, still a few outstanding. For further review at November 2018 LMS Board. HS Review report recommends consideration of choice re Better Births, with possible downstream reconfiguration issues for some services, plus evolution into ‘Hosted Network’. Instability in local Maternity Voices Partnerships; being addressed in each Place. Clinical leadership proposals in development, further detailed proposal re core team to be tabled at LMS Board (future years’ funding arrangements being clarified with NHS E to assist).

Membership nominations for LMS Board and for M&C Board are being finalised.

Next steps – over next month CSA – Issues re handover / interim management and re funding arrangements to be clarified as a matter of urgency. Handover arrangements will include a programme of work in progress, for completion. Assuming sufficient capacity in place, MCN to ensure clinical pathway sign off and support delivery of action plans from each Trust, with specific attention required re MYH. Continue to work with commissioners to enable contractual agreement of CSA Specification with action plans. Continue work on transfer policy and data. MCN specification with commissioners for scrutiny.

Acutely Unwell Child – Issues re network management capacity / handover require urgent resolution Continuing HN development (workshop 5 October), furthering of work with SCH and DGHes. Further work required to understand the impact on neonatal services and to continue to strengthen neonatal voice in relation to HSR. MCN developing shared draft guidelines, quality measures, assessment standards. First set Oct 2018, assuming effective management handover. Thereafter MCN process mapping exercise October 2018 re febrile child pathway. Forthcoming discussions via MCN re role of the Advanced Nurse Practitioners, and the Medical Training Initiative scheme. Write up of visit to USA re Physicians’ Associates Sep 2018 expected in October. Development of MCN specification as per CS&A MCN spec. Delivery timelines aligned to HSP, output to enable next stage of planning. Further engagement of local commissioners


Maternity – Project Manager progressing options for clinical leadership and core team via detailed proposals to LMS Board. Support further development of MVPs, with core re-basing meetings being held in each Place to assess options and agree SYB approach to enable engagement and co-production. Place Plan responses to be assessed, for feedback and support at November Board. Continue to monitor progress on milestones within the LMS Plan. Further engagement in regional and national processes. Refinement of overall LMS Plan in light of Place Plans, to be accompanied by Comms Plan.

Continue to implement new workstream infrastructure and governance arrangements. Undertake work to manage interdependencies building on ICS workstream. Strengthen workstream risk log.

Benefits

CSA and Acutely Unwell Child – Reduced variation in current delivery of children’s surgery and anaesthesia, and care for the acutely unwell child. Improved safety, effectiveness and continuity of care and experience for children, with increased delivery in line with Standards to improve outcomes. Most effective use of current workforce and delivery of equitable, resilient and sustainable children’s services.

Maternity – The delivery of the SYB LMS plan through the SYB LMS will improve the quality and safety of maternity care through a Managed Maternity Clinical Network. It will facilitate continuity of care, offer choice where possible and ensure delivery of high quality personalised maternity care that improves outcomes for mothers, babies and families.


RAG Post-mitigation


Capacity & Engagement There is a risk across the workstream that capacity challenges will hinder delivery of plans, in particular the implementation of CSA, progression of the network for acutely unwell child and the translation of the SYB LMS plan into delivery. Capacity challenges within the team are also starting to result in wider engagement issues.

R R

Cover for Programme Director, plus CSA workstream lead (original incumbents both now have left the ICS) continues to be provided from within the ICS. Cover for Maternity has improved with PM appointment. Maternity Project Manager recruited (started 8th May). Options re maternity clinical leadership considered by LMS Board and LMS infrastructure to be reviewed thereafter. MVP development required. Significant risk in children’s MCNs re management capacity, as above: To determine options re ongoing management support for paediatric MCNs. This could impact upon CSA implementation.

Managed Clinical Networks

There is a risk that without confirmation of funding for 18/19 or actions to address capacity challenges

A R

Funding for the CSA network previously confirmed within the CSA Decision Making Business Case, to be reviewed. MCN specification to be finalised and agreed to enable this to be


that MCNs will not be able to further develop and therefore not be in position to further develop and deliver their work plans or respond to HSR.

contractually agreed. Concern re: funding for Unwell Child MCN – funding approved in principle for 18/19; require written confirmation Significant risk in children’s MCNs re management capacity, as above: To determine options re ongoing management support for paediatric MCNs. This could impact upon CSA implementation.

Alignment to Hospital Services Programme

(HSP)

HSR outputs likely to impact on all areas of the children’s and maternity workstream; alignment is essential to ensure this is effectively managed. E.g. potential impact on CSA implementation (local ability to meet designation standards); potential impact on development and delivery of the SYB LMS plan, and use of transformation funding.

R A

Continue ongoing dialog with the HSO team to ensure alignment. Agree use Maternity and Children’s Board as conduit to facilitate alignment.


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Programme: Corporate Services (Exc Procurement /

Informatics)

Provider CEO / CCG AO sponsors: Richard Parker

Date of report: Oct / Q3 / 2018-19 Report completed by: Ben Chico

Progress Assessment Current Period (RAG) Green Progress Assessment Previous Period (RAG) Green

Plan for 2018-2019 This workstream has formed part of the Working Together Provider Programme, and is overseen by the Provider Efficiency Group. It relates to collaborative activities across corporate service functions, excluding Procurement and Informatics which are managed as separate projects. A separate highlight report has been submitted for Procurement. Excluding Informatics there are six corporate service functions as defined by NHSI; HR, Finance, Procurement, Payroll, Legal, Governance and Risk. Corporate service workstreams aim to support Trusts in meeting efficiency and productivity requirements as well as enabling wider ICS service transformation. The Provider Efficiency Group is overseeing the analysis of NHSI Benchmarking information in order to identify further efficiency opportunities across corporate services. Whilst being managed independently by Trusts, the development of Special Purpose Vehicles forms a key initiative across Trusts and the Provider Efficiency Group has included a standing item to share updates and knowledge. The current focus of planned activities for 2018/19 are: HR:

o To ensure compliance with emerging national streamlining objectives (MAST, recruitment, OH and Doctors in Training). o To target reduction in unwarranted variation across systems, policies and processes. o To deliver a collaborative temporary staffing strategy on behalf of SYB. o To provide an advisory role to the ICS and Local Workforce Action Board on HR matters, and to support in delivery of

associated workforce transformation objectives as required (including alignment of Place vs System level workstreams). o To deliver integrated services where this can be shown to support sustainability and efficiency.

Finance: Standardisation of ledgers across four of the Trusts to enable increased collaboration with a view to future sharing of ledger support function and wider transactional services.

Payroll: Exploitation of Salary Sacrifice schemes across Trusts, and further review of opportunities to consolidate services. Legal: Reassessment of current arrangements and opportunities following initial review in 2015.

MOU commitments “To become system leaders in implementing operational productivity improvements and increasing focus on reducing unwarranted provider expenditure, including but not limited to the consolidation of corporate services,……….. and concerted action to drive better value from NHS procurement.”

Engagement PPE is not relevant to this workstream. Relevant service stakeholders are engaged during initiatives.

Progress The Provider Efficiency Group agreed on 5 October to disband in order to support development of new ICS Finance Groups


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including Efficiency Board. The Group received a presentation on Robotics Automation across Corporate Services, which aims to increase efficiency in

back office transactional functions, and this will be followed up to confirm if collaborative approach to proof of concept will be undertaken.

HR:

It has been agreed that HR will be aligned under the workforce Programme led by Kevan Taylor, and so future updates will be included under the Workforce Highlight Report.

A six-month pilot of collaborative medical bank commenced in May across four SYB Trusts (BHNFT, CRHFT, DBTHFT, SCHFT) plus NLAG. The plot has broken even on costs, with opportunities to increase further including extension across other SYB Trusts. On this basis a recommendation has been made to extend for 12 months supported by the Clinical Reference Group. Group reviewing variation in rates paid with a view to agreement of common bank rates.

Building on collective procurement for non-medical bank management completed across four Trusts in April which delivered savings of £389k (across CRHFT, DBTHFT, SCHFT, STHFT), BHNFT has confirmed it will be implementing NHSP within the Trust in October 2018, which has increased the savings to the Partnership by a further £32k. Proposals for common nursing bank rates, development of collaborative bank and preferred supplier list are all under way to be reported to HRD Group on 18 October.

Mandatory and Statutory Training: Trusts have aligned to national core skills framework and are delivering local workplans to enable transfer / passporting of relevant competences via the ESR system between organisation. Building upon a project to review and reduce variation across six core subjects in 2017, workshops were held in September to identify variation across the following subjects: Equality and diversity, conflict resolution, resuscitation and dementia (Tier 1).

eRostering: Trust leads are meeting on a monthly basis on a rolling “masterclass” programme where best practice is reviewed across organisations to reduce unwarranted variation. To date the areas covered by masterclasses are; confirm and challenge meetings, net hours balance management and absence management. A mid programme report setting out opportunities to work together will be submitted to HRD Group on 18 October.

Sheffield Shared Service Outline Case: Case developed to final draft stage and shared with CEOs of three Sheffield Trusts agreement of next steps. Kevan Taylor will be providing leadership on Workforce for ICS and confirmed he will support process to move forward.

Payroll:

Opportunities for exploitation of salary sacrifice scoped and presented to Trusts via HRDs and DoFs. Based upon delivery of deployment targets in 2017/18 a £30k bonus payment has been secured and will be distributed across Trusts that provide core schemes by end September 2018, plus financial support to provision of Employee Assistance Programme. A meeting is planned 17 October to agree TRFT plans and wider opportunities.

Finance:

System testing currently being undertaken of document management system, where fixes have been required. Implementation delivered September 2018.

Next steps – over next month General:


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To reconfirm corporate services collaborative strategy aligned to implementation of Efficiency Board. To agree approach to Robotics Automation proof of concept.

HR:

To confirm approvals to extend medical bank pilot for 12 months, including engagement of other SYB Trusts. To submit recommendations for non-medical bank and agency. To deliver eRostering mid project review To respond to national requirements on HR streamlining workstreams (Mandatory and Statutory Training, Recruitment, OH,

Doctors in Training). Finance+ Payroll:

Streamlining of oversea visitors systems and processes, teams sharing best practice and identifying what good would look like with proposals to Provider Efficiency Group (Directors of Finance) in October.

To work TRFT to and other support implementation of salary sacrifice.

Benefits Reduction of unwarranted variation and associated efficiencies. Streamlining of systems across Trusts and enablement of mobile workforce agenda. Collaborative procurement savings (eg non-medical bank provider). Assessment of benefits from implementation of shared service.


RAG Post-mitigation


Trusts select not to engage in initiatives based upon local risk profile (eg medical bank). A G Trust engagement monitored and reported through to Provider

Efficiency Group / Acute Federation. Ongoing

ICS and Place Level streamlining and standardisation strategies are not co-ordinated. A G

Engagement of Executive stakeholders to align workstreams. Ongoing

Trusts do not implement successfully at local level owing to lack of capacity. R A

PMO support offered with implementation as well as identification of standardisation opportunities.

Ongoing

Shared services do not move forward owing to savings being considered too low to proceed, or other Trust level rationale. A G

Trust positions monitored and reported through to Provider Efficiency Group / Acute Federation. Where Trusts select not to move forward and supply rationale this is only a programme issue if it adversely affects other Trusts.

Ongoing


Programme: Digital Provider CEO / CCG AO sponsors: Richard Cullen

Date of report: September 2018 Report completed by: Ben Gildersleve


Plan for 2017-2019 a. ICS Digital Delivery Framework: Implementation of team, Digital Capabilities and Health Care and Reform Benefits Catalogue, Progressing 1st phase of the agreed programme, ICS Digital Innovation Partnership Procurement Framework

b. Population Health Data and Information: Integrated Intelligence Team; Intelligence requirements and data mapping; Technical solution and tools e.g. for collating data, supporting analysis, creating information and presenting intelligence to the system; Data definitions; Coding standards e.g. SNOMED; Information modelling standards e.g. OpenEHR

c. Interoperability: System integration architecture; Integration platforms; Care flow applications for GPs, Standard for integration, sharing records and data, Regional Infrastructure Strategy (networks, storage, desktop, security); Integrated MH Care System

d. IG: Regional IG/GDPR Toolkit; Consolidated Information and Data Governance Policies; Privacy Agreements e. National programmes; federated approaches to procuring and implementing solutions to meet target completion dates for national

programmes: HSCN; WiFi; On-line Consultation; On-line 111

MoU Commitments Enabling People and Patient Empowerment Supporting Clinical and Strategic Decisions Delivering System Integration and contributing to Operational Efficiency Developing Local Health Tech Skills & facilitating Innovation

Engagement For D2: Primary Care Self-Health Connect, D3: Technical Infrastructure Interoperability, D4: Patient Records & Sharing Clinical Information: NHS England – Digital Primary Care Team, CCIO Office, Health Systems Support Framework West Yorkshire and Harrogate ICS, West Yorkshire Acute Trust Group and Leeds Teaching Hospital trust. Yorkshire and Humber LHCR and Synanetics (Tech Consultancy) NHS Digital Implementation & Business Change team region reps, e-Referral Service Team, NHS.UK Maternity Team, Primary &

Social Care Team, GP IT Futures Team. SYB CIO leads Edenbridge (supplier of Apex Insight – GP Workload tool) Local Authority CIOs for Sheffield City Region Leeds Teaching Hospital Trust for Scan for Safety

Progress General Updates: Positive progress has been made in this period to respond to the NHS England Health System Led Investment fund. This has

required input from all provider trusts in the region including South West Yorkshire Partnership and Yorkshire Ambulance Service. Work throughout the period has resulted in a position that is endorsed by the ICS Exec Team, has been socialized with DOFs and is with NHS England for their region review. This fund will result in a range of deliveries against the theme of maturing the Electronic Patient Record capability across the region, with £2.838m investment spread across all providers in 2018/19, followed by £2.5 and £5.9m in 2019/20 and 2020/21.

The SYB ICS Digital Steering Board met on 14 September. The meeting covered a range of areas and involved representation from across the region. Work remains ongoing to formally initiate the other Digital Strand level governance.

Work ongoing to refine dependencies and alignment across ICS strand teams such as UEC, Cancer, Hospital Services review, etc and the Digital portfolio. Outputs will be shared with organisations in SYB ICS region and governance fora.


D2: Primary Care Self-Health Connect Progress is being made with delivery of wifi in GP Practice, with Rotherham now achieving over 90% of practices with wifi services. Progress is being made with delivery of the Apex Insight (GP Workload tool) from Edenbridge, with positive engagement across all

CCGs, agreement reached on how to share data for EMIS practices and work ongoing to agree the approach for TPP Practices. Many practices are keen on taking on this solution, with the deployment approach being based on the appetite from the GP Practices.

An approach for eConsults services across SYB has been agreed at the SYB ICS Primary Care Steering Board, which will allow for further information to be gathered from the supplier market (on the prequalified NHS England Framework for eConsults) prior to deciding whether different solutions for each CCG or a single solution for the ICS region as a whole is the best approach.

Updates provided to the SYB ICS Primary Care Steering Board. Preparation ongoing for the D2 workshop on 16 October. GPIT – Capital investments: BAU capital for core & mandated hardware and software. ETTF for transformation.

D3: Technical Infrastructure Interoperability, D4: Patient Records & Sharing Clinical Information A Sheffield Care Record workshop was completed in the period, with attendance from Sheffield Teaching, Sheffield Childrens,

Sheffield Health and Social Care and Sheffield CCG. Sheffield City Council have positively engaged in the work but could not attend the session. The session shared a significant amount of background and context, identified a range of user needs and the priority actions to progress greater sharing of data across Sheffield for the benefit of patients and professionals.

Further activity has been completed to confirm the approach regarding Barnsley place and the deployment of a shared record solution . An outline approach has been identified that has been verbally agreed by the Trust and CCG leads, which requires formalizing via CCN that the Trust will sign subject to formal approval.

Further input has been provided from the region into the Yorkshire and Humber LHCR programme, including supporting development and refinement of the technical architecture cookbook (design, approach and standards), a benefits approach has been developed for the funding agreement, SYB representation has been provided into the LHCR delivery team.

Attended a Scan for Safety demonstration and drafted an approach for SYB to progress this clinical priority. Discovery activity ongoing regarding how e-Referral Service can better support management of Cancer referrals. Webinars for SYB CIOs completed on Technology Strategy that was drafted by C3 Consulting to support the Infrastructrue

Programme No progress with progress below due to capacity constraints D1: Digital Inclusion D5: Integrated Healthcare Intelligence & Systems Reform D6: Integrated Health & Care Co-Ordination D7: Integrated Well-being & Recovery Relationship Management D8: Use & Governance of Citizen Information and Data D9: Digital Health Tech Innovation


Next steps – over next month

General Updates: Gain approval to the SYB ICS plan for the NHS England HSLI Funding scheme. Complete business cases for each priority and

establish the portfolio management and governance for this ongoing. Initiate the Digital Strand level governance. Draft proposal to refine SYB ICS Digital portfolio to better highlight areas that are priorities and are progressing

D2: Primary Care Self-Health Connect Progress the GP Wifi, Apex Insight (GP Workload) and eConsults project deliveries, and complete the D2 workshop.

D3: Technical Infrastructure Interoperability, D4: Patient Records & Sharing Clinical Information Progress CareCentric deployment, confirm Barnsley approach, sign CCNs. Follow up on Sheffield Care Record workshop outputs, formally commence deployment activity. Wider engagement with users,

initiate work with organisation’s on areas that can progress such as public engagement and comms, data sharing and privacy impact assessments.

Understand and document alignment to LHCR, and agree activity within the SYB region that will support the LHCR Follow up on priorities that emerged from the Technology Strategy webinars

Benefits B2.1 Increased patient control of own care; B2.2 Increased patient choice; B2.3 More effective use of GP appointments B3 1 Reduce in infrastructure costs; B3.2 Reduction in cost lost to lack of access to records, data and information B4.1 Reduction in A&E attendances; B4.2 Reduction in non-elective admissions; B4.3 Reduction in UEC activity B5.1 Quicker clinical intervention across all regional service user pathways; B5.2 Better commissioning decisions B6.1 Better healthcare co-ordination; B6.2 Reduce treatment waiting times; B6.3Reduction in the intensity of care packages and associated costs; B6.4 Reduction in admissions to residential/care homes B7.1 Improved wellbeing of citizens; B7.2 Increased likelihood of, and accelerated recovery rates; B7.3 Reduce rates of relapse, and admissions to crisis care; B7.4 Reduce Premature Mortality in people with PSMI) and/or Learning Difficulties B.8 Maintain/Increase Public Trust


RAG Post-mitigation


Dedicated resource and budget is required to drive the programme

R A

The Digital Director has engaged ICS exec regarding the level of resource in the digital team, and the consequent impact on capacity, the priorities that can be supported. An ICS Exec team lead that is dedicated onto Digital has been agreed but not appointed.

June 2018

Challenge in articulating benefits of digital interventions in isolation. They are key enablers to system level changes A G

The Strategic Outline Case will include a benefits section. The benefits will have been developed with clinical stakeholder, Workstream leads and the Population Health Integrated Intelligence Team. Further work is required in each workstream to understand benefits, and with the ICS Strand teams to understand potential opportunities.

June 2018


It is proving very difficult for the wider team of CIOs who are contributing to the leadership of the intervention across the programme to find any time to work together on their respective projects.

A G

It is being proposed that quarterly planning days or monthly half days are held where CIOs leading on current priorities, their technical deputies the programme director and her team work together to refine individual project forward plans and interdependencies across the overall programme and to determine and review time critical milestones, dedicated resource requirements and budgets.

April 2018

South Yorkshire & Bassetlaw Shadow ICS – Programme Highlight Report

Programme: Elective and Diagnostic Provider CEO / CCG AO sponsors: Richard Jenkins & Idris Griffiths

Date of report: October 2018 Report completed by: Jade Rose


Plan for 2017-2019 1. Managing demand 2. Transforming Outpatients 3. Delivery of RTT and diagnostic targets 4. Specialty reviews

MOU commitments Delivery of the constitutional standards for diagnostic waits and referral to treatment.

Engagement Engagement plans in progress for; - Integrated Lower GI - Orthopaedic follow up pathway

Progress * Allocation of NHSE Elective transformation monies made circa £160k * Resource requirements identified and submitted for Elective and Diagnostic work stream * Echocardiography Recovery – The overall SYB position against the diagnostic target is significantly improving. The development of a regional online training tool to compress echo training has commenced – contract to be awarded. A regional cardiology workshop was held 26/09 to agree a standardised set of referral criteria for discussion across the region. * Radiology – See separate highlight report * Endoscopy (FCP / FIT) – Implementation group underway. STH has commenced mobilisation of FIT Pathology service. * GIRFT – Data sharing agreement in development to enable wider sharing of provider GIRFT data than has previously been approved. * Outpatient Transformation – Multi year work programme in development for Digital Enablers. Provider workshop to be held on 11th October. * Barnsley CCG and Doncaster CCG have agreed to pilot the First Contact Practitioner NHSE pack * Diagnostic Capacity and Demand – Report for MRI & CT has been shared. Endoscopy project plan has been revised with new dates agreed. Phase 2 of MR & CT project has begun. * Commissioning for Outcomes - The Commissioning for Outcomes Policy as agreed by the CCGs has been implemented across SYB with some variations. Assessment of variation has begun and will be shared with Accountable Officers end of October. * Ophthalmology out of hours model (MCN) – Proposed changes to the current model have been agreed with leads, if all Trust Medical Directors agree, the change will take place from 3rd December. * OMFS Trauma Model (MCN) – Delays from some Trusts in submitting the financial and operational plans, which has been escalated. * Orthopaedics Hip & Knee follow up pathway – Clinical consultation on newly designed pathway been carried out throughout August. Collating feedback from the Trusts to identify approval of proposed pathway. * Oral Surgery (MCN) – Managed Clinical Network meeting held in September 2018 with good representation and engagement across SYB. NHS England has confirmed they have funding for a Chair and funding for a Referral Management System for SYB.


Next steps – over next month * Echocardiography – Identify website developer for training portal, agree course content and project plan. Develop first draft of regional echo referral guidelines for clinical review * Hospital Services Review - Understand outputs of Hospital Services Review and implications for E&D work stream for Hosted Clinical Networks and Elective reconfiguration * Commissioning for Outcomes – Right Care will lead an evaluation supported by the CCGs on the compliance of the Commissioning for Outcomes Policy and the impact. The next phase will include the Y&H Infertility Treatment Commissioning Policy and the Criteria for Cryopreservation for patients due to commence medical or surgical treatment likely to permanently affect their fertility policy. * Outpatient Transformation - The Trust leads will meet in October to consider tools and techniques and to discuss their outpatient transformation plans in terms of any overlap or any shared learning to be gained. * Further review of different meeting groups, priorities and resource within the work stream * Implement NHSE Elective transformation funding plans * Ophthalmology out of hours model – Agree implementation date of proposed changes and work with Trusts on implementation plans. * OMFS Trauma Model – Financial impact to be submitted to the Clinical Reference Group for discussion. * Endoscopy (FIT / FCP)- Implementation group arranged for 09/10 to commence roll out. * Orthopaedics Hip & Knee follow up pathway – Identify any risks from the Trusts feedback, research technology and costs for virtual clinics, identify with CGGs impact of proposed model on their contracts. * Oral Surgery – NHS England to advertise for a Chair of the Managed Clinical Network. A provisional date in December has been agreed for the next meeting pending the appointment of a Chair.

Benefits Improved access to treatment for patients. Improved health outcomes through access to evidence based care. Improved patient experience by improving the effectiveness of health care contacts. Improved financial sustainability by optimising care delivery and removing unwarranted activity.


RAG Post-mitigation


Increasing Financial Challenge 25 20

Continual investigation and development of new initiatives to close the gap. Close monitoring of savings performance and forecast delivery against targets.

March 2019

Pace of delivery is limited by work stream resource

2016 20

Resource requirements identified and submitted to sICS for review. This includes the extension of the 2 x Clinical Lead posts for the Radiology programme. Consider suitability of secondments, interim appointments or consultants. Priorities and associated scale of ambition reduced accordingly

June 2018


Programme: Mental Health & Learning Disabilities Provider CEO / CCG AO sponsors: Kathryn Singh & Jackie Pederson

Date of report: October 2018 Report completed by: Rachel Gillott


Plan for 2017-2019 1. Perinatal mental health: developing a specialist community service across Doncaster, Rotherham and Sheffield

2. Children and young people’s mental health crisis care: covering all crisis pathways including section 136 assessments, intensive home treatment and specialist placements

3. Out of area placements (OAPs): eliminating non-specialist acute inappropriate OAPs; and scoping the opportunities within secure care and complex dementia care

4. ASD and ADHD: developing an ICS-wide service, with further consideration of whether this is an adult or all age service, building on existing provision

5. Employment: improving support for people with mental health problems, with a focus on securing NHS England transformation funding for individual placement and support (IPS) for people with severe mental illness (SMI)

6. Suicide prevention: SYB has received £555,622 targeted funding from NHS England for 2018/19, with a possibility that this will recur for one or two years; to focus on men, support to primary care, self-harm including pathways for people in acute and mental health services, and bereavement support

A data and finance group will support delivery of the priority projects and the wider data and finance work programme. The workstream will also work proactively to support development of the mental health workforce plan. In addition, the steering group will hold workshops every two months to look in depth at particular issues with a wider audience. It has been further agreed that the Transforming Care Partnerships (TCP) programme will also transition to MH&LD workstream this year.

MOU commitments Increasing access to psychological therapies, so that at least 16.8% of people with common mental health conditions access psychological therapies in 2017/18, increasing to 19% in 2018/19

Increasing access to NHS commissioned community mental health services for children and young people, so that 30% of children and young people with a diagnosable mental health condition receive treatment from NHS-funded community mental health services in 2017/18, increasing to 32% in 2018/19, and meeting standards for access to eating disorder services

Implementing physical health checks for people with severe mental illness (SMI): demonstrating delivery against local plans and trajectories, in line with national ambition of 140,000 people with SMI receiving complete list of physical checks in 2017/18 and 280,000 in 2018/19

Meeting standards for access to early intervention in psychosis services

Developing specialist perinatal mental health provision including mother and baby units (where present in the ICS) and community teams

Ensuring ICS wide coverage of 24/7 community crisis response and intensive home treatment teams as a genuine alternative to admission by 2021. From April 2018, delivering a one third reduction year-on-year in adults sent out-of-area for non-specialist acute mental health care, towards eliminating this practice by 2021


Making demonstrable progress on delivering a workforce plan that meets national ambitions for increased mental health staffing including,

therapists in primary care and staff to support expanded services, as set out in Next Steps

Engagement A co-production approach is being developed as part of the suicide prevention work programme.

Consultation with children and young people with mental health (CYPMH) problems and their parents and carers is being planned as part of the work to scope the CYPMH crisis pathways across SYB.

The employment task and finish group held focus groups with service users as part of developing the funding bid, and has agreed to continue to consult regularly as the work programme develops.

Progress The SYB ICS Suicide Prevention Steering Group formally met in September to check progress on locality based driver diagrams to support the following areas of work: (1) Reducing suicide and self-harm in mental health services, (2) Reducing self-harm in community and acute services, (3) Suicide prevention in men and/or work with primary care. The SYB ICS Suicide Prevention Steering Group held a real time surveillance of suicide workshop, facilitated by the Innovation Unit, on 19 September 2018. The Suicide Prevention Steering Group have received confirmation of Year 2 monies of £555,622 for 2019/20.

The employment task and finish group has reconvened meetings following the unsuccessful Wave 1 IPS Transformation Funding bid based on national encouragement to bid for Wave 2. Members of the employment task and finish group have been supporting the successful commissioning and procurement of the Health Led Trial “Working Win”. A launch with Mayor Dan Jarvis and a Government Minister took place on 16 August 2018. 1,000 referrals to Working Win already achieved across Sheffield City Region since May.

The ASC/ADHD task and finish group met in August to progress a multiagency workshop around the development of an SYB ICS wide Adult ASC/ADHD service. The programme of work is now benefitting from dedicated project resource provided by Barnsley CCG.

The OAP Providers Group met in August to review local OAPs data and to consider areas of opportunity in the short and medium term.

HEE colleagues and ICS colleagues met in August to confirm the membership of a workforce task and finish group and identified the supply chain of mental health staff as the key area of initial focus for 2018/19.

An ICS response to ‘Mental Health in the Long Term Plan’ has been compiled.

A workshop was held in September, facilitated by Deloittes, to identify opportunities for efficiency. Three priority areas were identified from discussions, with a full report and recommendations expected imminently;

1. Enablers e.g. workforce, interoperability, contractual arrangements 2. Pathways e.g. ADHD/ASD, CAMHs, Trauma 3. Issues e.g. primary care investment


Following the SYB ICS Suicide Prevention Steering Group real time surveillance (RTS) of suicide workshop, facilitated by the Innovation Unit, the group will now be taking forward proposals to implement an RTS system across all of SYB to provide appropriate support to those affected by suicide/suicide attempts.

The employment task and finish group will meet in October 2018 in response to the anticipated IPS Wave 2 funding release in the same month.

The OAP Providers Group will present report findings of the group in terms of improvement opportunity to the ICS MH Steering Group, to include


Common continuity of care principles, PICU utilisation, Organic acute – demand / capacity mismatch – potential sharing agreement and adoption of PIPA principles – purposeful inpatient admission.

The CYP Mental Health Steering Group will meet on 19 October to progress the work programme for CYP focussing on: Acute inpatient mental health services, Children and young people in crisis and Children and young people who are in and / or on the edge of care with emotional wellbeing and / or mental health issues.

Discussions with NHS England Yorkshire and the Humber and North Region mental health leads on how to align mental health support to ICSs / STPs are ongoing.

Benefits Increase in access to mental health services

Improvement in the experiences of people with mental health problems

Care closer to home, with associated reductions in costs

Reduction in UEC activity for people with mental health problems

Risks Pre-

mitigation RAG

Post-mitigation


Programme support for 2018/19 not secured R A Work with NHS England to align resources September 2018

Programme support reduced by 0.4 Band 8A for three months due to the individual undertaking a career break

R A Work with NHS England to align resources

September 2018

Failure to secure transformation funding for IPS for SMI R A Advance preparation of bid against wave 2 IPS for SMI funding January 2019


Programme: Meds Optimisation Workstream Provider CEO / CCG AO sponsors: Idris Griffiths

Date of report: 8 Oct 2018 Report completed by: Michael Rodgers

Progress Assessment Current Period (RAG) GREEN Progress Assessment Previous Period (RAG) GREEN

Plan for 2017-2019 The overall planned savings for CCGs QIPP plans by Meds Opt interventions for 2018/19 is projected at £15.3m. The workstream’s priority interventions:

1. Prescribing Cost Reductions - to generate direct savings linked specifically to medicine costs. 2. Pathway Redesign - to improve medicines management related to health efficiencies & patient care. 3. Applying Guidance – to identify medicines related areas suitable for guidance across SYB. 4. Effective use of medicines related NHS resources - to review medicines related resources and ensures resources are

optimised 5. Optimise the management of the interface between primary and secondary care initiatives and innovations - to maximise the

use of medicines related systems across the interface 6. Meds Opt in Care Homes – to support the delivery of Meds Opt by clinical pharmacists and pharmacy technicians in care

homes and the work already underway via NHS E to implement the Enhanced health in Care Homes framework. MOU commitments • Manage improvements within a shared financial control total and maximise the system-wide efficiencies necessary to manage

within this share of the NHS budget. • Integrate services and funding, operating as an integrated health system, and progressively to build the capabilities to manage the

health of the ICS’ defined population, keeping people healthier for longer and reducing avoidable demand for healthcare services. • Act as a leadership cohort, demonstrating what can be achieved with strong local leadership and increased freedoms and

flexibilities, and to develop learning together with the national bodies that other systems can subsequently follow.

Engagement Work is progressing to schedule and budget for the Media Campaign to build local awareness for a Do Not Prescribe campaign at targeted patient groups and their carers. This work is a joint effect between the Meds Opt workstream and the sICS Comms and Engagement team.

Progress Primary & Secondary Care interface: Scoping exercise out for responses – 2/4 responses received Prescribing cost reductions:

o Common basket of cost effective product switches - The 5 CCG medicines optimisation teams are continuing to implement the agreed amendments to prescribing recommendations. At the point of writing, July ePACT data is still unavailable so will bring update to the October meeting

o Rebates – Variation in attitudes to rebates across the ICS has been discussed and there is tacit agreement to move towards a harmonised position on rebates.

o Polypharmacy and de-prescribing – Early examination of polypharmacy metrics indicates there is work to be done in all 5 CCGs to reduce the morbidity and risk associated with inappropriate polypharmacy.

Medicines Optimisation in Care Homes: o Operating model agreed. Hubs agreed (Barnsley, Bassetlaw, and Sheffield). Recruitment process commenced.

Service Redesign: o It has been agreed that the HOMM will work one day a week for the next 12 months to;

Identify the opportunities for the prescribing of nutritional products, continence and stoma appliances to be managed by other health care professionals than the patients GP.

Identify the size of the CCGs nutrition, continence and stoma prescribing business. Identify potential hosts of for a nutrition, continence and stoma prescribing service. Identify the investment required by each CCG to provide the redesigned service.


Applying Guidance: o Standout Media

Finalisation of campaign material for launch of campaign & surveys AOs briefed by Idris

o Gluten Free Paper to propose gluten free consultation written (for 4 CCGs) AOs briefed by Idris

Effective use of medicines related resources o Resources uploaded to the NHS Futures platform.

Other: o Prescribing changes, encourage adoption of a common approach to rebate schemes and begin to highlight opportunities

for improvements in polypharmacy and de-prescribing. o NHS Futures platform is up and running and in use.


Primary & Secondary Care interface: Response to scoping exercise and identification of shared areas required, consideration of shared communications, adalimumab policy to be created.

Prescribing cost reductions: Update monitoring documents and continue discussions via SYB HOMMs Medicines Optimisation in Care Homes: Advertise vacancies, short-list and arrange interviews for early to mid-October in order

to appoint in time for the training cohort that commences 7th Jan 2019 Service Redesign:

o Secure locum pharmacist to backfill HOMM at Rotherham CCG. o Produce patient search templates o Identify potential service hosts.

Applying Guidance: o Standout Media

Final approval of campaign material Launch of campaign & surveys. Standout to provide information to comms leads to enable CCG implementation

with practices & others. Standout to undertake raising public awareness – via social media & information to community organisations, e.g. parish councils, libraries, community centres & community pharmacies.

o Gluten Free Finalisation of paper to go to November Governing bodies for Barnsley, Bassetlaw, Doncaster & Rotherham

Effective use of medicines related resources o Agreement on the scope of this workstream.

Other: o Work with Michael Rodgers to develop programme management approach with improved reporting arrangements to the

Meds Opt Steering Board meetings Benefits • Reduce Waste

• Reduce Financial Pressures • Reduce unwarranted variations across SYB


Pathology

Provider CEO / CCG AO sponsors: Richard Parker

Date of report: 30 Sept. / Q2 / 2018-19 Report completed by: Sarah Bayliss

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Green

Plan for 2018-2019 In 2017, NHSI published twenty-nine pathology networks across the NHS in England. The four South Yorkshire and Bassetlaw services (Barnsley and Rotherham Integrated Laboratory Service, DBTHFT, SCHFT and STHFT) formed one of the proposed networks. NHSI listed STHFT as hub/Central Service Laboratory (CSL) and the other sites as spokes/Essential Service Laboratories (ESL) as a recommended future operating model. NHSI estimates, based upon latest reported figures, that £5.2m per year could be saved through consolidation of services across the network. In response to this, relevant Trusts have agreed a Memorandum of Understanding which sets out a commitment to work together collaboratively including delivery of business case process to assess the potential benefits in details. NHSI has made the strategic case for change. Collection of data and appointment of members to workgroups is underway. These groups will inform and make recommendations to the Pathology Transformation Programme Board by undertaking tasks and analysis essential to develop an outline business case (OBC) and evaluate options (expected end January 2019) with a full business case (FBC) on the Transformation of SYB Pathology Services by end March 2019. The process is led by a Pathology Programme Board Co-Chaired by Richard Parker (CEO Sponsor) and Dr David Throssell (MD Sponsor). The Board reports to the Provider Efficiency Board and Acute Federation, with updates to the ICS Elective and Diagnostics Board.

MOU commitments To implement a common strategy to network pathology services across SYB with the aim of improving sustainability, ensuring services are as cost-effective as possible whilst maintaining high quality patient care. Delivery of the constitutional standards for diagnostic waits and referral to treatment.

Engagement A communications and engagement plan is in development which incorporates engagement activities across stakeholders over the coming months including internal staff and commissioners.

Progress Completed risk assessment of procurement options. Pathology Transformation Programme Board has recommended that “all Trusts in SYB work together to complete the

procurement of a single fully managed service contract with a single provider for Pathology Services across SYB” including the issue of a Prior Information Notice (PIN) to notify the market of the SYB procurement plan.

BHNFT and TRFT Trust Boards have supported BRILS recommendation to issue a direct award to their current MSC suppliers for 3-4 years to address operational issues due to ageing equipment and support the SYB procurement plan.

Terms of Reference have been agreed for key workgroups and the application/appointment process for members has commenced.

Group of Histopathology staff met with Leads from GeNEQ (Genomics North East Quadrant) to improve understanding of the likely impact of genomics on cellular pathology services


1

Project Delivery Team members continue to attend clinical reference groups e.g. Breast, Lower GI, Head & Neck to engage with stakeholders

Next steps – over next month Confirm membership for each workgroup and schedule November meetings Add more detail to comms and engagement plan and continue engagement with stakeholders Continue collection of detailed data to inform option evaluation for operational model and outline business case Describe existing logistics

Benefits To exploit network opportunities to:

Sustain and build quality Develop workforce Exploit innovation, technology and research Deliver value for money


RAG Post-mitigation


Trusts do not agree business case recommendations R A

Structured business case process underway to examine implications of NHSI model at SYB level. Routine updates to Trusts through Acute Federation with MoU in place.

Ongoing

Investment requirements are not met / supported R A

Capital bid developed awaiting confirmation of shortlisting for national submission in July.

Ongoing

Staff retention issues impact services A A Communications and engagement plan in place with Programme Board including service clinical and management leads.

Ongoing


Programme: Healthy Lives, Living Well and Prevention workstream Provider CEO / CCG AO sponsors: John Mothersole

Date of report: October 2018 Report completed by: Lisa Wilkins/ Caroline Burrows

Progress Assessment Current Period (RAG) Amber AMBER

Plan for 2017-2019 Three key priorities identified and signed off at CPB on 12/01/18. 1) Embedding the treatment of tobacco dependence in secondary care 2) Systematic quality improvement in the identification and management of clinical risk factors for cardiovascular disease

to address unwarranted variation and drive quality improvement in detection and management of high risk conditions relating to CVD at scale through primary care (including wider primary care team eg pharmacists), self-care and community interventions.

3) Expansion of social prescribing; many patients attending health and social care services have non-clinical issues that are affecting their health and wellbeing (eg social isolation, debt or housing problems) and can lead to high usage of health/social care services. Social prescribing is a way of connecting patients to non-medical forms of support (eg community and voluntary sector services) and of empowering patients to enhance their own wellbeing. Developing the social prescribing offer in SY&B is also a priority in 3 other ICS transformational workstreams charters: Primary Care; Mental Health; and Urgent and Emergency Care.

Other areas of work in this workstream are continuing through Place-based plans led by the Local Authorities, and work and health through the Sheffield City Region.

MOU commitments MOU with NHSE re social prescribing

Engagement N/A

Progress 1. Tobacco: Steering Group meeting every 6-8 weeks (next meeting end November). Planning for QUIT SYB ICS Event (7th November) taking place. Meetings with Executive Sponsors at Acute Trusts and identification of place based Clinical Champions taking place. Caroline Burrows is now working 3 days/week to support QUIT Implementation across SY&B.

2. CVD: CVD Prevention Task Group met 19th Sept; it was agreed that the next steps were to agree Work Programme and Programme Governance. The group agreed that a literature review of available data sources and evidence would be beneficial as there were concerns over the reliability of “Size of the Prize” and other recently published data. Date of next meeting tba (Nov 2018). PHE producing some CVD Prevention data packs for STPs/ICSs to support PHE’s national CVD Prevention Programme, ICS & PHE programmes align very closely; 3 main areas of focus are: hypertension, atrial fibrillation and dyslipidaemia. Common themes for work - Communications; Further embedding of MECC; and the use of medical/digital technologies to assist with diagnosis and management. Ginny Fielding attended wider CVD Prevention Stakeholder Event for the North Region (17th Sept). Links being made with AHSN re AF.

3. Social Prescribing: Proposal for SYB SP strategy and common outcome framework supported by ICS primary care board. CCG/LA reps asked to take proposal through local committees over summer to get local buy in. First steering group held 19 Sept. Draft SY&B ICS case study of good practice for NHSE SP guide completed and with design company. SP prevention programme manager and Strategy Advisor commenced 1 October. Social prescribing highlighted in ICS Primary Care Workshop on Population Health Management on 25th Sept. SHU submitted stage one research proposal for national funding for comparative study across SYB SP schemes.

Next steps – over next month 1) Tobacco: Support QUIT steering group to support QUIT Implementation across Hospitals in SY&B. CCG’s agreed to sign up to Smoke Free Pledge (needs progressing via Comms). Meet with Trust Exec Sponsors. Trust boards to sign off NHS Smokefree pledge commitment. Detailed planning for QUIT Event and ensure stakeholder attendance including local Clinical Champions.

2) CVD: First task group meeting 19 Sept. Attendance at Regional Group meeting 17 sept. Review and dissemination of PHE data pack.


3) Social Prescribing: SP prevention programme manager and strategy advisor commence work and undertake induction meetings. Second steering group meeting 31 Oct. Finalise TOR and draft action plan for strategy development; Finalizse SP case study for NHSE.

Benefits 1) Tobacco: Impact: Reduction in preventable mortality and huge burden of avoidable illness associated with smoking. Target: Reducing smoking prevalence from current baseline to 10% and smoking in pregnancy to 0%.

2) CVD: Impact: Contribute to avoidance of 19,000 CVD-related hospital events by increasing the identification and management of hypertension, AF and lipids in line with NICE guidelines. Target: By reducing average population blood pressure by 5%, reducing average population total cholesterol by 6% and increasing the proportion of people with diagnosed high blood pressure, cholesterol and atrial fibrillation who achieve NICE-recommended reductions in blood pressure and cholesterol, and high rates of anticoagulation in atrial fibrillation.

3) Social Prescribing: Impact: A reduction in health inequalities and an improvement in health and wellbeing by supporting residents to address wider determinants of health and take control of their own health. Decrease social isolation and low level mental health issues such as depression and anxiety. Decrease the use of health and social care services by residents who attend frequently with non-clinically related issues. Support the discharge of patients from mental health services. Free up health care professional time in primary care and widen the skill mix of the primary care team. Target: To increase access for a wider range of residents of SY&B to social prescribing as a gate way to accessing non-medical forms of support and to empower clients to enhance their own wellbeing.

Planned Savings 2017/18 TBC Savings Forecast 2017/18 TBC RAG

Planned Savings 2018/19 TBC Savings Forecast 2018/19 TBC RAG


RAG Post-mitigation


Lack of Public Health capacity in ICS to meet competing demands that would benefit from Public Health support and progress priorities at pace.

R A

NHSE have provided temporary post (AfC 8b) to support the programme at 2d/wk from 09/04/18 for unspecified length of time, to be reviewed at 6m.

Tobacco dependence work requires significant resource and trusts may be unable to fully fund alone.

R A ICS funding of £18.4K will be used to initially support the programme eg for training of clinical leads. Business case to be drawn up in collaboration with trusts.

CVD requires dedicated project management and widespread clinical engagement. R A

One day a week support from PHE. PHE support currently determining what CVD prevention work is taking place in each area. .


Programme: Radiology Provider CEO / CCG AO sponsors: Richard Jenkins

Date of report: September 2018 Report completed by: Sophia Malik

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG)

Plan for 2017-2019 1. Workforce Strategy 2. Capacity and Demand 3. Upper GI 4. Imaging Academy 5. Insourcing 6. PACs Manager IT Solution 7. Cancer Waiting Times

MOU commitments To deliver diagnostics within 6 weeks of referral

To support delivery of cancer targets in collaboration with the Cancer Alliance

Engagement Engagement plans in progress for; - Workforce Strategy

Progress - Development of first draft of workforce strategy, which has been shared more widely across the Radiology Network Management Group to progress draft and get comments from across the system

- Engagement on strategy planned for; HR Directors Forum, LWAB, Departments and Trusts Boards including any consultation requirements

- Working towards second cohort for Imaging Academy to include chest/abdo modules for Feb cohort - Capacity and Demand Modelling: MRI/CT first outputs reviewed including quick wins around coding and processes to be

followed across the network - Currently scoping the upper GI and insourcing projects - Engagement with Cancer Alliance Board on how to develop solutions to support achieving changes to cancer waiting times,

Next steps – over next month - identify scale of programme risk and resource required for delivery’ - align radiology work programme with cancer alliance board priorities - Develop regional risk register to include organisational risks from a networked perspective - identify funding opportunities and start recruitment process for programme management capacity - networked radiology workshop scheduled for 12th October to discuss potential IT solutions - present capacity and demand work (phase 1) to cancer alliance board - Hold next PMO meeting to further develop workforce strategy for presentation at HR Directors on 18th October - Work up the detail behind the Upper GI and Insourcing projects including development of sub groups - Plan visit to National Imaging Academy in Wales to take learning away to progress local academy - Develop the newsletter for sharing across departments to increase engagement

Benefits Improved access to treatment for patients. Improved patient experience by improving the effectiveness of health care contacts.



RAG Post-mitigation


Increasing demand on the system 25 20 Developing solutions through workplan to work collaboratively across the system

March 2019

Pace of delivery is limited by work stream resource 2016 20 Developing resource requirements breakdown Oct 2018


Programme: Research & Innovation Workstream Provider CEO / CCG AO sponsors: Andrew Cash

Date of report: 5th October 2018 Report completed by: Clare Morgan

Progress Assessment Current Period (RAG)

AMBER Progress Assessment Previous Period (RAG)

n/a

Plan for 2017-2019 The research and innovation workstream will: (i) Develop a high level Research and Innovation strategy for SYB (ii) Design and implement cross-cutting system architecture to bring together partners to co-create innovative

solutions to our SYB priorities and unmet clinical needs through a SYB Innovation Hub (iii) Support ICS workstreams to ensure that research and innovation opportunities are leveraged to enhance the

delivery of their work programmes. (iv) Closely align with the Digital and IT workstream to maximise opportunities for co-designing solutions with

commercial organisations to develop, evaluate and embed innovative solutions to support rapid adoption into the SYB system.

(v) Continue to build links with our SYB partners to exploit regional research and innovation strengths and connectivity (being developed in part through Sheffield City Region) in advanced manufacturing and engineering, particularly in areas such as artificial intelligence, digital-led manufacturing, healthcare, well-being and medical technologies.

MOU commitments Research and Innovation has been introduced as an enabler workstream in 2018, supporting the ICS Clinical workstreams in delivery of MOU priorities which may be supported by Research & Innovation.

Engagement Summary of Stakeholder activities undertaken in most recent period (month / quarter)

Academic Health Sciences Network- support at EXPO 18; interactions detailed below

National Institute for Health Research- joint meeting planned with the Local Clinical Research Network with all Yorkshire and Humber ICS/STPs to discuss opportunities for closer working with systems. Ongoing SYB meetings to define an approach to better understand and share ongoing research activity across SYB partners in order to maximize opportunities for participating in more research across SYB ICS in light of the STP priorities; workstream linkage with the NIHR CLAHRC around specific funding calls for workforce and UEC.

Life Sciences Industry – ongoing conversations with Novartis and AstraZeneca about potential strategic opportunities around system added value. Specifically conversations now linked into the ICS efficiency board and workforce opportunities. Kick off meeting with WY&H ICS with ABPI and AHSN to initiate creation of an MOU defining ways of working between systems and the pharma industry. Draft MOU timeline is end December 2018

Progress Summary of achievements from most recent period (month / quarter)

Increasing research & Innovation opportunities arising for SYB ICS, with ambition shared with workstream leads Shadow Health and Care Partnership Steering Board- ICS committed as a core organization in the

development of a Sheffield city region wide strategic approach to Research & Innovation, workforce and service delivery (formally Care 2050). The Institute of Health and an SYB footprint will be incorporated into discussions by the shadow Board. Two Board places allocated to the ICS with AC chairing the Board. First meeting now


planned for late October/November due to members availability Develop a standardised approach for capturing, validating and prioritising unmet need (clinical &

service delivery) o Existing models for capturing, validating and prioritising unmet need evaluated and an approach (process

& documentation) will be piloted in an exemplar project, developed through an initial sandpit session in July run and funded by University of Sheffield and Sheffield Hallam University. Review of applications planned for 19th October with over 50 applications from innovators submitted.

o Commitment for the ICS to lead a workstream to define and embed a regional standardized approach for capturing, validating and prioritising unmet need (clinical & service delivery) will be led by the ICS, on behalf of the Sheffield Health and Care Partners. Workshop planned for November which will form the basis of SYB innovation hub process. ICS will also be part of working groups to define partnership working, including: a Framework for Partnership Working, Industry Fora, sandpit development and arising opportunities for Advanced Manufacturing and Health. The third workstream will focus on adoption of innovation, providing a lit runway to ensure that new evidence-based products and services would be adopted by the system and made available to support the health and care of the local community.

o Buy in from Sheffield ACP to adopt a SYB approach to maximize opportunities arising from the five ‘places’, with further conversations planned for the other ACPs. Outputs from sandpit will demonstrate impact of approach.

Hospital Services Review- Ongoing working with HSR lead to define how the proposed Innovation hub will interface with the Hosted Networks and fit within the larger regional R&I infrastructure. Discussed proposals with HSR reference group and Hosted Network workshop In September.

AHSN o Innovation and Improvement: Strengthening the R&I workstream paper submitted to Exec Steering

Board in July with a commitment that a final proposal will come back to the steering group in October/November to confirm support for the approach and use of the SYB partners AHSN membership fees.

o Progress-The AHSN is supporting the definition, resource and delivery of a small number of exemplar projects to support the priority areas of the ICS. These will be in workforce innovation, innovation to support an identified unmet need in urgent and emergency care delivery and support to define and develop the population health management opportunities for SYB. Project briefs are currently in development and will come to the exec steering group to detail the use and sign off of SYB partner membership fees. The areas have been selected due to national AHSN expertise, combined with areas which require innovative solutions to solve their problems. Workstream leads are working with their Exec Leads to define a specific problem (unmet need) to commission the AHSN to propose and implement potential solutions. This paper is now likely to come to Exec Steering Group in November, subject to further discussions between the AHSN CEO and the SYB Exec Leadership group.

o AHSN has identified resource to work with the ICS R&I lead to define and establish an innovation hub within the SYB ICS to implement and manage capture, validate and prioritise unmet clinical and system need. A proposal will come to the exec steering group to detail the use and sign off of SYB partner membership fees to create two posts to develop and manage the SYB Innovation Hub, which will be a


SYB resource. o Ongoing work with workstream leads and Directors to determine the SYB commitment to the NHSE

funded basket of evaluated innovations. Roll out is being managed by the AHSN team. A summary paper is being developed for sign off by the Clinical Reference Group which will come to the exec steering group for information. This is being overseen by Des Breen.

Applied Research Opportunities o ICS thanked for its support in the bid for the NIHR Applied Research Collaboration, which will replace the

existing CLAHRC. Closer working with the current CLAHRC as funding opportunities have arisen. Opportunities being signposted as they arise.

Next steps – over next month Develop a high level strategy for Research & Innovation across SYB ICS, which aligns with planned Sheffield Health & Care Partners and the proposed Institute of Health after the initial steering group meeting (late October tbc) NB. This is a significant interdependency

Evaluate (through the sandpit exemplar project) the proposed approach for capturing, validating and prioritising unmet need (clinical & service delivery) across SYB following the review session on 19th October

Finalise 12 month workplan with the AHSN to submit to the exec steering board in November to support use of the pooled AHSN membership fee to resource and create the SYB Innovation Hub to support unmet need capture and interfaces with the innovation exchange and the priority exemplar projects around system need for the AHSN to propose and deliver solutions. This will be a defined framework to jointly manage delivery against plan.

Define a regional standardized approach/process for capturing, validating and prioritising unmet need (clinical & service delivery). Inclusive workshop planned for November which will form the basis of SYB innovation hub process.

Progress the two potential strategic partnerships with the life sciences industry, subject to SYB appetite Progress and work with ABPI to support development of a MOU for STP footprints to engage with the life

sciences industry. Create visibility of SYB research & innovation projects and associated opportunities supporting translation into

evaluated and adopted solutions.

Benefits It is our ambition to be national and international leaders in the development, implementation and adoption of innovative approaches to improve the quality of care people receive; our health and well-being; service efficiency and our workforce capacity and capability. The Research & Innovation workstream will: 1. Create system wide oversight of our existing R&I strengths; 2. Identify emerging research and innovation opportunities to support clinical workstreams in delivery of their aims; 3. Create opportunities for system wide partnership working to improve patient experience and outcomes for our population.

Risks Pre- Post- Mitigating Action Due date


mitigation RAG

mitigation RAG

Dedicated resource is required to project manage the establishment of R&I workstream projects

RED AMBER

A proposal will due to be made to the ICS steering group to use a proportion of the AHSN membership fee to create resource to support the management of a standardised approach for capturing, validating and prioritising unmet need (clinical & service delivery) across SYB, with alignment to the 5 ‘places. The AHSN have also provided resource to support SYB ICS to define and develop the framework of the Innovation Hub for capturing, validating, prioritising and solving the unmet innovation need of the system. This has been put on hold until November as the SYB exec leadership team wish to discuss use of AHSN membership fee with AHSN CEO

November 2018

Progress becomes dependent upon ongoing work to consolidate Sheffield City Region and the Shadow Health and Care Partnership Board/ Institute of Health approaches to Research & Innovation

RED RED

ICS lead finishes at Christmas and delays in this meeting risk delaying creation of a SYB innovation strategy,as impossible to create without clarity from this group around interdependencies. ICS lead is a member of all steering and advisory groups and has negotiated a SYB footprint for establishing and managing a standardised approach for capturing, validating and prioritising unmet need (clinical & service delivery). Sheffield ACP Director committed to evaluating and supporting the SYB established approach to R&I. ICS exec lead is chair of Shadow Health and Care Partnership Board.

September 2018


Programme: Hyper Acute Stroke Care - Reconfiguration Provider CEO / CCG AO sponsors: Lesley Smith

Date of report: 1st October 2018 Report completed by: Marianna Hargreaves

Progress Assessment Current Period (RAG) AMBER Progress Assessment Previous Period (RAG) AMBER

Plan for 2017-2019 The plan for the reconfiguration of hyper acute stroke across the SYB ICS includes the development of the following: A Stroke Managed Network (MCN) to support the development of networked provision of stroke care across the SYB ICS. Consolidation of hyper acute stroke care at Doncaster Royal Infirmary, Royal Hallamshire Hospital, Pinderfields Hospital Wakefield. Plus the continuation of existing hyper acute stroke care at Royal Chesterfield Hospital. It is being supported by NHSE commissioning and the gradual implementation of mechanical thrombectomy. It is being supported by a review of the wider stroke care pathway as part of the Hospital Services Review – including Acute Stroke Units, Early Supported Discharge, Stroke Rehabilitation and TIA Services. There is also a need to continue improvements in primary and secondary prevention of stroke risk factors via the SYB ACS prevention and primary care workstreams to decrease the incidence of first and subsequent strokes.

MOU commitments The reconfiguration of hyper acute stroke care is identified in the MOU and it is noted that a Joint Committee of CCGs has delegated authority from CCG Governing bodies in relation to HASU.

Engagement Significant engagement has been undertaken throughout the review process for HASU. Views were initially gathered from patients and the public during a pre-consultation phase. Following this and the options appraisal a preferred option was formally consulted upon. Work is now underway to develop a service specification for the new model and to seek input from stakeholders, including patients and carers to inform this. The specification includes a section on expectations for the Stroke Managed Clinical Network, and this sets out the expectation that the MCN will develop mechanisms to enable further engagement. The Equality Impact Assessment has been updated using the Equality Analysis and Engagement Plan template and discussed at the Citizens Panel in early March.

Progress The renewed application for a Judicial Review was dismissed on both grounds on the 25th June and we now have confirmation that there will be no appeal. Work can now progress to implement the new HASU model from 1 April 2019.

Providers continue to progress development of contingency plans. JCCCG is seeking assurance plans are agreed. A meeting took place on 18/7 with the Lead Commissioner and Operational Managers to identify the actions to progress

implementation for commissioners/contractors, providers independently and those to progress collaboratively. ICS funding continues to fund a manager to work cross provider organisations for 2 days a week. This was secured until

October and agreement has now been reached to extend this for 6 months. This will focus on clinical aspects. Consideration is still required to ensure sufficient project management resource is in place to enable providers to progress implementation, collaboratively where necessary.

The hosted network was identified as a way to enable this but the timeline for the development of hosted networks too long to support HASU implementation. A new stroke group structure to support HASU implementation has been developed, with a proposed implementation group and a number of sub groups. This still requires sign off by providers and chairs to be identified. A meeting is scheduled with Richard Jenkins in his Provider Development role, to agree how best to enable this.

A comms plan and key messages are under development by the ICS comms team.


The Clinical Reference Group is considering the output of the workforce development workshop in particular the options for securing the medical workforce. Des Breen will follow this up medical workforce issues with individual discussions with MDs and the wider workforce development (upskilling/new roles) will be led by the stroke workforce group.

Doncaster successfully recruited a substantive Consultant (pending HR process) to the DBTH team. The HASU specification has been finalised with outstanding work now progressed. It has been agreed that further work on

the Stroke Managed Network Section will progress once the next steps on hosted networks are in place. SCCG is working with the HASU Commissioning and Contracting Group to develop the lead commissioning role. JCCCG agreed the contractual approach in September. The HASU model will be contracted through, in the first instance,

integrated aligned contracts with Sheffield CCG acting as the contract coordinator. This enables the system to use existing contracting resources and mechanisms, whilst exploring longer term options eg potential prime provider or alliance agreement for the whole stroke pathway.

Work is ongoing to develop financial arrangements. o 2017/18 out turn positions for stroke spend is being validated by CCGs. o The HASU Tariff technical group provided some data on income and cost (baseline and post reconfiguration).

Further work is still required as not all providers were able to share the requested information. This has created a delay in the development of the HASU tariff. The plan is to now share a proposal in October, with the technical group due to meet again in mid October.

o A session was held for members of the CCG Stroke Commissioning and Contracting Group and CCG Finance Colleagues re HASU tariff proposals and CCGs agreed to meet collectively to discuss how they each plan to take forward the commissioning / contracting of the acute / inpt rehab element. This took place 31/8 and a follow up meeting was held on 24/09.

o A letter from SYB ICS and SCCG was sent to YAS to request their updated QIA by the end of August and to move into a process in the autumn to enable us to agree the finance for the additional transport requirements.

o The YAS QIA was received in September and a teleconference took place on 27/9. YAS outlined that they are working to deliver against the Ambulance Response Programme and agreed to review their resource/cost implications to support the SYB HASU reconfiguration in this new environment. A follow up finance discussion is planned with the SYB ICS DOF and linkages are being made to ensure operational input from YAS in implementation planning.

Both the equality impact assessment and quality impact assessment continue to be updated. NHSE commissioned Mechanical Thrombectomy commenced April 2018. The STHFT protocols have been finalised and

SYB provider organisations requested to take through their internal governance arrangements. Mid Yorkshire Hospital confirmed at the end of June they would be securing the expertise of the National Clinical Director

for Stroke, and that they would develop an implementation plan for the provision of HASU that reflected their risks and mitigations. Further correspondence from MY has been received and a response provided in August, with information to support MY to revisit their planning assumptions and a request to share the output of their visit with the National Clinical Director. The National Clinical Director visited MY on 20/9 and it is understood that this went well. A follow up discussion is planned on 8/10 to discuss the output with the central SYB ICS team with MY COO and WCCG COO.

Next steps – over next month Confirm and progress new programme infrastructure to enable work to move into the implementation and delivery phase – linking with Richard Jenkins in his new Provider Development role.

Support lead commissioner and providers to progress key actions and secure the skills and expertise for implementation Providers to prioritise and progress developing and agreeing contingency plans. Commissioners to finalise specification further where now able to do so

Progress work on financial arrangement to enable HASU tariff proposal value in October. Aligned to the HASU tariff development the ASU component is for local CCGs to determine how they will commission and


contract for the ASU/inpt element. Facilitate as requested by CCGs any follow up discussions. Providers to progress their risk assessments and business cases (mindful the above is necessary to finalise) CRG to further consider options to secure the medical workforce. Planned individual discussions to take place. Providers to progress planning, independently and collaboratively, including progressing the patient flow policy

Continue to work with Sheffield CCG as the lead commissioner. Progress planning for the agreed contractual approach (aligned integrated contracts) working with Sheffield as the contract coordinator.

Provide YAS with feedback on their QIA and set up more detailed financial discussions. Ensure identification of operational leads from YAS to contribute to implementation planning.

Benefits Delivery of an improved, more resilient and sustainable service. An established MCN facilitating more resilient networked provision and an enhanced ability to attract and retain a specialist workforce, and to facilitate 7 day provision. A service that delivers improved clinical quality (clinical effectiveness, patient safety and patient experience). All SYB units will have the patient numbers to fall within the nationally recommended 600-1500 confirmed strokes shown to result in the most clinically effective service. There will be an enhanced ability to meet evidence based national stroke standards (NICE, RCP and STP guidelines) for HASU care, and the NHSE Urgent and Emergency Standards for seven day care. Reduced inequalities in access, patient experience, quality of care and outcomes. All patients across SYB ICS will have access to high quality hyper acute stroke care that meets national best practice standards. Contribution to improved health outcomes – Contribution to wider health outcomes including a reduction in in hospital mortality from stroke, a reduction in disability from stroke and improved quality of life. A higher proportion of people who have had a stroke are able to return home to live independently and return to work. A reduction in the number of patients newly discharged to care homes/continuing health care.

Planned Savings 2017/18 N/A Savings Forecast 2017/18 N/A RAG

Planned Savings 2018/19 N/A Savings Forecast 2018/19 N/A RAG

Risks Pre-

mitigation RAG

Post-mitigation


Fragility of existing provision – There is a risk that fragile services in Barnsley and Rotherham will find it increasingly difficult to operate as timescales are extended and that could mean unplanned change.

20

15

To mitigate the risk Trusts are developing contingency plan, to be enacted if necessary. JCCCG are seeking assurance that robust plans are developed and agreed.

Financial - There is a risk that it may not be possible to agree new tariff arrangements for HASU (split HASU from ASU). Providers may be unable to agree their internal business cases. Although commissioners have agreed the risk limits (HASU tariff x activity) and investment funding for HASU they may find this difficult to secure. There are therefore financial risks for both providers and commissioners.

16 12

To mitigate the risk around the agreement of new tariff arrangements for HASU (split HASU from ASU) detailed work is underway and a task and finish group is taking this forward with all key parties are involved. A technical group has now been established to support the Task and Finish Group.


Operational – There are a number of risks associated with operationalising the model that have been identified by providers if enabled to progress, including securing the skilled workforce (medical cover and specialist nurses), ensuring sufficient capacity for CT scanning and implications for other service delivery (if displaced). There is a risk to enabling delivery of the new model once able to do so if providers are unable to lead and collaborate the mobilisation. There is also a risk if the additional transport requirements are not sufficiently secured or mobilised. Mid York have identified a number of risks and are reviewing the quality and efficiency of their service.

16 12

To mitigate the risk around securing the medical workforce discussions are taking place now and it has been agreed that the Clinical Reference Group will consider further. The ICS are supporting a capital bid for a CT Scanner for Doncaster. To mitigate the risk around collaborative mobilisation it was recommended that a COO would be well placed to lead across providers. Joint lead Medical Directors are in place. MY confirmed that they are seeking the support of the National Clinical Director for Stroke.

Hospital Services Review – There is a risk that the pace of the Hospital Services Review and work thereafter means that it is not possible to effectively plan for the whole pathway in the way that is necessary to ensure successful HASU implementation. The output of the HSR may also have implications for the delivery of the new HASU model that will need to be managed.

12 9

This risk is mitigated now the HSR has been published and set out no further reconfiguration recommendations. They do recommend the consideration of a consistent approach to specify the post HASU pathway. The need for rapid consideration of the recommendations and the interdependencies with implementation of the HASU model have been flagged to JCCCG. The likely slower timeline to progress hosted networks and need to progress implementation of the new HASU model in parallel is now being flagged.


Programme: Urgent and Emergency Care Network Provider CEO / CCG AO sponsors: Maddy Ruff, Louise Barnett

Date of report: October 2018 Report completed by: Rachel Gillott

Progress Assessment Current Period (RAG) Amber Progress Assessment Previous Period (RAG) Green

Plan for 2017-2019 Plan for 2017-19:

1. NHS 111 Online: By March 2019 30% of the population should have access to NHS online 2. NHS 111 Calls: Clinical advice to be offered to 50% of callers to 111 by March 2018. All patients who call NHS 111 OOHs

to be directly booked into further appointments by March 2019. 20% in hours. Fully integrated 24/7 urgent care services by March 2019.

3. GP Access: Coverage of enhanced access to reach 50% by March 2018 and 100% by March 2019 4. Urgent Treatment Centres: All services designated as UTCs to meet the guidelines and be in place by December 2019 5. Ambulance: Roll out of the Ambulance Response Programme by Autumn 2017, Implementation of enhanced Hear and

Treat and See and Treat by March 2018 6. Hospitals: 95% achievement of the 4hr A&E standard by March 2019. 100% of patients arriving to ED by ambulance

handed over within 15 minutes. Co-located GP streaming in place by October 2017. 100% provision of ambulatory urgent care, frailty pathways and wards with SAFER bundles by September 2017.13%+ of acute hospitals to meet CORE 24 by March 2018.

7. Hospitals to Home: High impact interventions to be in place by September 2017 – continue to embed in 2018/19. Delayed Transfers of Care to be reduced to 3.5% by September 2017. CHC full assessments in acute settings to be less than 15% by March 2018.

8-12 are local deliverables, metrics as yet unspecified. Additional South Yorkshire and Bassetlaw priorities; Improving System Intelligence – Implementation of EMS – to have all relevant services included on the system by May 2018. All services reporting on the system by July 2018. All ‘places’ to have reviewed current resilience and demand management processed by end of June 2018. Embed throughout July – September 2018. Review options for mutual support and joint working across shadow ICS by September 2018. Implement new mutual support process as part of the winter October – Dec 2018/19.

MOU commitments Good progress is being made against the MOU commitments albeit there are some risks on specific requirements. Delivery of the A&E 4 hour target continues to be a challenge, as only Sheffield Children’s Hospital has a cumulative position (as at 29 August 2018) of >95%. ICS YTD cumulative (July 2018) position is 91.14%.

Engagement Ongoing engagement for HSR. South Yorkshire and Bassetlaw are leading on Communications and engagement for the IUC procurement process with input from other STPs.

Progress Bi-weekly UEC Delivery Group meetings/calls are in place with UEC Commissioning Leads to track performance and delivery against key workstreams. Bi-weekly EMSPlus Project Implementation calls are also in place, supported by the CSU. Significant progress has been made to increase the number of services now ‘on-board’ and using the system. Meetings have been held with all health economies to refresh their UEC Delivery Plans. Further revisions are being made in line with revised KPIs. A position statement will be presented to the October UEC Steering Board.


1. NHS 111 Online Implemented 24/7 from 12/3/18 with no issues reported. South Yorkshire and Bassetlaw accounted for 5% of the overall 111 activity undertaken online in August 2018. (Humber Coast and Vale 8%, West Yorkshire and Harrogate 7%). There has not been a corresponding decrease in 111 call volumes. Top 3 most frequented pathways in the North of England (since December 2017) comprised; dental, abdominal pain and breathing difficulties. National publicity is anticipated from January 2019. Local campaigns are being considered in the meantime. 2. Integrated Urgent Care A SYB model has been designed and continues to evolve with input from UEC Commissioning Leads from each place. Direct Booking: Performance currently under standard. National focus has been re-invigorated with some stated priority areas to support the implementation of direct booking into primary and urgent care facilities. SDIP exists (see below) with YAS for in-year development and a project group has been established. Out of hours: Enabled in all health economies; Latest data from YAS (September 2018) –

1.8% (=) Barnsley 0.5% (↓) Bassetlaw 8.2% (=) Doncaster 16.4% (↑) Rotherham 33.4% (↑) Sheffield.

In hours: Latest data from YAS – 0% Extended hours: Enabled in some health economies Latest data from YAS (September 2018)

75.0% (↑) Barnsley 0% (=) Bassetlaw 23.7% (↓) Doncaster 40.0% (↓) Rotherham 95.35 (↓) Sheffield

UTC: Enabled in Doncaster UTC Meeting scheduled with NHS England colleagues 16 October. Service Development Improvement Plan 18/19 – Following the workshop held with YAS to discuss opportunities and service developments on 21 May 2018, an SDIP has been produced for Y&H Commissioners. The SYB priorities within this are;

All DX5 dispositions (most urgent to be seen by primary care) to be directly booked as clinical advice was unlikely to add value to this cohort of patients (e.g. complex frail, acutely unwell child, acute mental health). Consideration is now being given to demand and capacity to ensure sufficient numbers of appointments are made available.

A pilot minor ailment scheme should be established in Sheffield using the learning from the service established in West Yorkshire.

Consideration should be given to the screening prescription requests out of hours from the DoS, as per West Yorkshire.


Clinical Advice: Exceeding the national standard at SYB sub-regional level. Procurement 19/20:

Sheffield CCG and UEC Programme Director continue to input into the Y&H commissioning collaborative and procurement process. Invitation to continue dialogue issued on the 7 September with the preferred bidder and approvals due to be concluded by November 2018. 3. GP Access - Work ongoing at place. Primary Care Workstream are leading on this work (See Primary Care highlight report) 4. Urgent Treatment Centres Doncaster (tranche 1) has an approved exception in place for Direct Booking. Work is continuing around x-ray and EPS. Sheffield (tranche 5) subject to the outcome of the consultation (see Reshaping Hospital Services) 5. Ambulance

Non-Conveyance/Diversionary Pathways Task and Finish Group established with three key priorities identified, namely; 1. Respiratory 2. Care Homes 3. Mental Health

A baseline of place based programmes is currently in development. Areas of opportunities will be agreed thereafter when the group next meets in October 2018. 6. Hospitals

Patient flow identified as a top priority for 2018/19. Workshop on ‘front door emergency services’ scheduled for the 11 October 2018. 7. Hospitals to Home Care Home (Capacity Tracker)

All health economies are using NHS England Capacity Tracker (previously referred to as the Care Home Live Bed State Portal). Coverage and frequency of update variable. UEC Workstream supporting the use of the Capacity Tracker into operational practice. WebEx currently being scheduled for UEC Steering Board members and colleagues to raise awareness of the tool. SYB Care Home Group leading and overseeing this work and provide quarterly updates to the UEC Steering Board. (See links to 5. Ambulance) Priorities 8 to 11 - Work ongoing at Place. 12. Reshaping Hospital Services Sheffield’s consultation ‘Making Urgent Care Work Better in Sheffield’

SYB Hospital Service Review – UEC Workstream ensuring this is linked in where appropriate (e.g. 5. Ambulance and 6. Hospitals) HASU stroke reconfiguration progressing (See separate Highlight Report) Additional Priority: 13. Improving System Intelligence

Work ongoing with NHS England to develop supporting system intelligence. First draft presented to the September UEC Steering Board.


a) EMSPlus

Progress and challenges presented to September UEC Steering Board. UEC Steering Board agreed it would be beneficial to extend the pilot if additional funding could be sought, in order to enable the technology to become embedded and evaluated over the entire winter period. Remedial action plan in place to address the lack of place based engagement in specific health economies. This lack of engagement was leading to uncertainty in adopting EMSPlus beyond the pilot at a system level. Winter pressures reporting form in development (CSU and NHS England) to support winter/escalation reporting. 14. Respiratory

Scoping exercise in progress. Workshop facilitated by Deloittes held in September to explore areas of opportunity. (See links also to 5. Ambulance)

Next steps – over next month Continued implementation and roll out of EMSPlus including the progression of the live data feed. Face to face meeting with the CSU scheduled for 9 October 2018. Funding/contract duration to be revisited at future meeting of UEC Steering Board. Development of plans and baseline scoping work for ‘Hospital to Home’ with increased emphasis on discharge. Active engagement in the IUC Procurement. Continued exploration of opportunities to improve direct booking performance. Scoping exercise and baseline work for Respiratory. ‘Focus on Emergency Front Door Services’ Workshop Continued discussions on the opportunities for non-conveyance.

Benefits Expansion of capacity and services to provide better support and experiences for patients. Increased consistency in accessing urgent and emergency care services.

Risks Pre-

mitigation RAG

Post-mitigation


Insufficient programme capacity to progress priorities Red Amber

Programme capacity requirements identified and shared with ICS SMT colleagues. Small amount of non-recurrent additional resource from NHSE North PMO has been received.

September 18

Not all providers & partners engage fully with the implementation of EMSPlus and unable to develop/test out collaborative working and potential for mutual support.

Red Amber

Provision of engagement, support and training from CSU. Local health economy and system wide workshops held. SROs reconfirming senior leadership commitment.

Ongoing

Non-achievement of the A&E standard Red Amber

Local A&E Delivery Improvement plans in ‘place’. Sharing of

Action on A&E Priority areas across South Yorkshire and Bassetlaw to promote shared and expedited improvement.

Ongoing

Lack of commitment to the protocol of mutual support Red Amber

UEC Steering Board endorsement and Local A&E Delivery Board support

Ongoing


Lead CCG unable to produce and provide level of BI support required to fully cost finance and activity implications of 111 service procurement

Red Amber BI requirements submitted and awaiting production from Embed. September 18

Unable to obtain information on local performance of NHS 111 service and national targets

Red Amber Lead CCG requested to provide level of information required. September 18

CCGs unable to commit sufficient resource to contribute to the procurement process arrangements. Amber Green

Additional resource for procurement support in place across Y&H. SCCG and other subject matter experts identified to participate in the procurement process. SYB procurement group with reps from across CCGs established.

Ongoing - November 2018


Programme: Workforce Provider CEO / CCG AO sponsors: Kevan Taylor / Mike Curtis

Date of report: Oct / Q1 / 2018-19 Report completed by: Ben Chico

Progress Assessment Current Period (RAG) Green Progress Assessment Previous Period (RAG) Green Plan for 2018-2019 In October 2017, LWAB published a Workforce Framework which set out a number of recommendations, from which the following

priorities have been identified: PRIORITY KEY WORKSTREAMS

1. Developing the Current SYB Workforce

Develop integrated workforce governance across ICS, overseen by LWAB. Implement SYB workforce hub working closely with programme leads and wider stakeholders. Create SYB workforce intelligence function (within hub) to support improved visibility and streamlining of

processes. Support ICS programme leads and other stakeholders by increasing workforce planning knowledge and

skills. Establish best practice process for workforce investment-decision making. Delivery of SYB Leadership Strategy.

2. Increasing Future Supply

Deliver best practice core and essential skills development across key staff groups (Primary Care, SYREC and FACP).

Reduce unwarranted variation across competences, supervision and validation standards (Primary Care, SYREC and FACP).

Collaborate to optimise recruitment and retention across organisations. Support best practice health and wellbeing / engagement across organisation. Support development of flexible / mobile employment models between organisations. Deliver / support collaborative initiatives to increase workforce efficiency and productivity.

3. Enabling and Aligning Effective Workforce Planning across Organisations, ACPs and ACS

Increase primary and community care workforce (Primary Care). Increase registered workforce training places. Maximise Advanced Clinical Practice roles across SYB (FACP). Maximise Apprenticeship scheme (SYREC). Maximise Employability opportunities (SYREC).

Under each of the workstreams, a number of deliverables have been recommended for 2018/19, extending beyond the initial developments above. To support this, an ICS workforce “hub” is in implementation which will function as a delivery unit as well as providing an advisory function to the clinical ICS workstreams. Key developments include:

South Yorkshire Excellence Centre Faculty of Advanced Clinical Practice Primary Care Workforce Strategy HR Streamlining and Standardisation (Aligned with Corporate Services)


MOU commitments This workstream acts as an enabler to the wider ICS Clinical workstreams in delivery of relevant workforce developments. A process will be undertaken to ensure alignment in reporting over the coming months.

Engagement There are no identified PPE requirements at this stage. LWAB has taken steps to engage Staff Side who are now represented in new membership from 2018/19. Increased engagement with ICS workstream leads has taken place and there is now a focus on one workstreams at each LWAB meeting, attended by relevant lead.

Progress Kevan Taylor has commenced his Executive role for ICS workforce, and has met with Linda Crofts and Ben Chico to discuss workstreams and agree ways of working. Mike Curtis has commenced leave until end December. It has been identified that workforce governance should be reviewed including staff side engagement forums to ensure streamlined ways of working.

Lisa Kell has joined LWAB to support effective linkage between Workforce Programme and ICS Programmes. LWAB reviewed national guidance around Physician Associate Preceptorships in Primary Care and agreed to work to

maximize across South Yorkshire and Bassetlaw. A proposal has been developed for a general practice nurse VTS scheme.

Suzanne Bolam updated at LWAB regarding the development of the AHP Council, which will support ICS Programmes to maximize the role of AHPs in service development.

Five fixed-term Place based Workforce Lead roles have been advertised, supported by LWAB via HEE funding. Doncaster and Rotherham roles have been appointed to, with active recruitment in Bassetlaw. Linda Crofts working with Place based Directors for Sheffield and Barnsley to agree plans.

Workforce Hub support being provided to ICS and Place based workstreams, inc Future Workforce events being held across Bassetlaw and Sheffield.

Retention initiative: Development of collaborative streams for staff health and wellbeing, and values based recruitment. Following engagement of NHSI to scope support package, a proposal for a SYB programme is being developed which will require approval from all Trusts.

Workforce / HR requirements across the ICS to March 19 have been collated to inform planning, including HRD support. Next HR Director meeting (HR Services Management Group) being held 18 October.

Next steps – over next month Complete recruitment of Place Based Workforce Lead roles. Agree HR support to ICS Programmes including response to HSR Hosted Network Session 5 October. Confirm approvals for a NHSI / SYB Retention Programme. Deliver event for Chief Nurses on 26 October to confirm opportunities to collaborate.

Benefits Establishment of infrastructure, workforce governance (including review of LWAB Terms of Reference) and reporting processes.

Alignment of workforce governance across organisation, place and system. Delivery of workforce framework priorities / deliverables including:

o Implementation of Faculty of Advanced Clinical Practice o Implementation of South Yorkshire Regional Excellence Centre

Provision of advisory Service to ACS Clinical Workstreams / Hospital Services Review


RAG Post-mitigation



The workforce hub is unable to effectively demonstrate added value above national and local (place based) initiatives. R G

Deliverables / success criteria agreed and overseen by LWAB reporting to Collaborative Partnership Board. Proactive engagement of HSR team and ICS Workstream leads to identify how strategies can be enabled.

Ongoing

Partners are unable to agree on upon collaborative strategies owing to competitive or other agendas. R A

LWAB Terms of Reference developed but ongoing risk to be managed through engagement across stakeholders.

Ongoing

There is not enough management capacity at organisational or place level to support transformation. R A

Each ACP is developing local governance to manage workforce activities. HEE considering support to primary care infrastructure at place. Ongoing risk to be managed through engagement across stakeholders.

Ongoing

The hub disengages stakeholders by focusing on strategic projects and does not support “business

as usual” pressures R G

Deliverables to be structured on short, medium and longer term in agreement with key stakeholders. Comms and Engagement key part of Workforce Hub function.

Ongoing

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