Briefing on developing the five year plan for Cornwall and the Isles of ScillyTransformation Board 15 August 2019Karl Simkins, System CFO and SRO for LTP

IntroductionLTP Implementation Framework issued 28/6/19, adding to the January initial planning guidance. We now have:

• Initial planning guidance 7/1/19;• Interim people plan 3/6/19;• Implementation Framework 28/6/19;• NHS LTP: System support offer 1/7/19 ( signposts the national and regional

support available to systems to draw upon);• Letter from Regional Director to STP Leads & CEOs 3rd July 19, confirming

requirements and submission dates (Draft 27/9/19 / Final 15/11/19);• Early sight of a non-functional ‘Strategic Planning Tool’ and guidance;• Additional LTP funding ‘allocations’;• Dates for NHSE/I webinars on wide range subjects;• Various presentations from briefings w/c 1/7/19 from NHSE/I STP/Finance

leads on the planning requirements;• BCF planning guidance 2019-20 released 18/7/19;• There are further updates and more complete tools expected in the coming

weeks including technical guidance ‘due’ w/c 29/7/19. 2

NHS Long Term Plan (LTP)Implementation Framework

WHAT we have to produce• A five year plan (April 2019 to March 2024) of which the 2019/20 system

operating plan is the first year with this submission covering April 2020 to March 2024;

• It must deliver all the commitments in the national NHS Long Term Plan;

• The guidance has identified ‘critical foundations to wider change’ which must be included in line with – Nationally defined timetables or trajectories– Proposed metrics– The Government’s five financial tests

• For those commitments in the NHS Long Term Plan that are not part of the ‘critical foundations’ there is freedom to respond to local need, prioritise, and define their pace of delivery within the end points the Plan has set.

• Our local plan must comprise– A system narrative setting out how we will deliver the commitments in

the national NHS Long Term Plan – Integrated finance, activity and workforce plans 3

Phase Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar

Assess and prepare1 May – 30 June

Engage and define23 July – 9 September

Writing the plan1 September –31 October

Operational planning for 2020/21

4

ON

ETW

OTH

REE

FOU

R

NHS Long Term Plan implementation frameworkWHEN we have to submit

Initial submission 27th Sept

Plan agreed with regional team 15 November

4

First submission draft operational

plan

NHS LTP Implementation FrameworkHOW we will be expected to produce our plan i.e. apply the following principles• Clinically led i.e. systems identify and support senior clinicians to lead on development of

implementation proposals for all Long Term Plan commitments that have clinical implications and the totality of the plan.

• Locally owned – local communities, local government, voluntary and community sector involved in development of the plan;

• Realistic workforce planning – assumptions matched to activity and finance, local steps to improve retention and recruitment;

• Financially balanced – show how commitments will be delivered within resources available and meet five tests;

• Delivery of all commitments in the Long Term Plan and national access standards –including performance for cancer, mental health and A&E and how elective care activity will be increased to reduce waiting lists and eliminate 52 week waits;

• Phased based on local need – apart from foundational requirements, scale and pace of local implementation should be based on local needs and priorities;

• Reducing local health inequalities and unwarranted variation – set out key areas of inequality that we will tackle and how additional funding is targeted;

• Focussed on prevention;• Engaged with Local Authorities – plans developed in conjunction with Local Authorities

and consideration of the need to integrate with relevant Local Authority services;• Driving innovation – all plans must consider how to harness innovation locally.

5

NHS LTP Implementation Framework‘Foundational’ requirements

The Framework states that delivering the fundamental service changes set out in the chapter on delivering a new service model for the 21st century, along with productivity ambitions in the NHS Long Term Plan, are a prerequisite for being able to develop and improve other services based on local population health needs. Plans should set out how these foundational commitments within the Long Term Plan will be delivered and their five year trajectories for doing so:1. Transforming ‘out of hospital’ care and fully integrated community-based care including

primary care networks and multi-disciplinary teams;2. Reducing pressure on emergency hospital services – showing how local urgent and

emergency care services will continue to develop to provide an integrated network of community and hospital-based care;

3. Giving people more control over their own health and more personalised care (includes the comprehensive model of personalised care and social prescribing);

4. Digitally-enablingprimary care and outpatient care – we need to set out how we will increase use of digital tools in outpatient services and deliver digital primary care commitments (including online consultation and video consultation);

5. Better care for major health conditions– Improving cancer outcomes - working with the Cancer Alliance;– Improving mental health services – how systems will deliver the commitments in the Long

Term Plan and the Five Year Forward View for Mental Health;– Shorter waits for planned care – how systems will expand the volume, cut long waits and

reduce the size of waiting lists, including expanding digital and online services.

6

Developing our five year plan

Cornwall and Isles of Scilly five year plan

Including:• Service / clinical

strategies (eg, mental health and primary care)

• Enabling strategies (workforce, digital and estates)

NHS Long Term Plan commitments

Local Integrated Care Area

plans

Ten year Health & Wellbeing Strategy

• Informed by the JSNA with a comprehensive assessment of population need

• Shaped by a new ten year Health and Well-Being Strategy

• Informing, and informed by, local Integrated Care Area plans

• Aligning plans between the NHS and councils

• A longer-term understanding of demand and capacity

• Confirming our future operating model and the workforce, IT, estates and finance needed to deliver it

Improving the physical and mental health outcomes and wellbeing of people, whilst reducing health inequalities

Building on our extensive co-production

7

Adult Social Care Transformation

Plan

One Vision

What have we done to date• Building on the work done for the 2019/20 operating plans, refocused the bi-weekly

Planning Steering Group to lead the development of the five year plan (7th meeting 1/8/19);

• Maintained finance & information working group to oversee financial elements of LTP;• Analysed the deliverables in the NHS Long Term Plan by programme area i.e. urgent

care, planned care, integrated care in the community, children and young people, enablers;

• The Planned Care Board held a workshop with a range of colleagues from across the system to start to consider changes beyond the 2019/20 plan;

• Reviewed current ambitions and how well they align with the NHS Long Term Plan –shared with chief officers in presentational format (and in appendix);

• Received back initial feedback from 4 system SROs on ambition/gaps in achieving LTP deliverables (see background information);

• Analysed the requirements of the Implementation Framework which both add to and duplicate the initial LTP deliverables;

• Produced detailed timeline and requirements plan updated;• Initial assessment through early testing of the financial framework and template

requirements (pending full publication expected end July);• Produced and progressed draft programme resource requirement for CEO review;• Produced draft engagement & communications plan.• Produced draft sign off governance process. 8

Immediate Next Steps

• Complete assessment of key deliverables against all deliverables in initial guidance and implementation framework , determine what the gaps are and what it will take to close the gap (LTP team and system SROs / wider teams);

• Evaluate programme of development of core ‘target operating models’ and 5 year priorities for each workstream including enabling strategies (e.g. digital);

• Plan wider programme of determining prioritisation process of system ambition against deliver targets by workstream;

• Launch engagement programme and capacity to deliver;• Finalise additional resources and team needed to develop the plan guidance;• Set workshops to inform/feedback stakeholders (LTP team):

– PHM presentation and information session (complete - 23/7/19)– Initial stakeholder session (21/8/19)– Formal stakeholder session wide management and clinical reps(10/9/19)

• Programme summer schedule of briefings for System Groups / Organisational Boards;

• Initiate financial activity & workforce modelling work linked to Strategic Planning Tool templates once released (expected w/c 29/7).

9

BACKGROUND INFORMATION

10

DEVELOPING OUR AMBITIONS FOR THE FIVE YEAR PLAN –INITIAL THOUGHTS

11

What is our ambition for population health and prevention?

Population health is:An approach that aims to improve physical and mental health outcomes, promote well-being and reduce health inequalities across an entire population

From the King’s Fund: A vision for population health:

The wider determinants of health

An integrated health and care system

Behaviours and lifestyles

The placesand communitieswe live in,and with

A framework for action: the four pillars of population health

• Will Integrated Care Areas take action to influence behaviours in their communities?

• Will primary care networks develop local relationships with schools, neighbourhood police, local housing associations, local voluntary organisations and community groups who can help tackle wider determinants of health?

Is this the scope of our five year plan?

Will the Integrated Care System take action to influence wider determinants e.g. as an employer?

12

How much influence can the Health and Wellbeing Strategy have on these?

What is our ambition for population health management?

Population health management is:Segment and stratify a population identifying people at risk of poor health or wellbeing and interventions to prevent it or help them to manage it using data to guide planning and delivery of care to achieve maximum impact on population health.

Endof

life

Support to self-manage

Co-ordinated care

Managed care

End of life care, 24 hour support available

Targeted prevention

85,000 people living well

280,000 at risk

20,000 needing some help

4,000 with complex conditions needing more help

135-145,000 managing long term conditions well

4,000 approaching end of life

Ad hoc care

Starting to segment our population for population health managementType of care and support

Proactive care

13

This needs refining, can we develop our intelligence functions to segment and stratify our population further?

What are our ambitions for our support for children and young people to give them a strong start in life?

Maternity services to be safer, more joined up, more personal and more family friendly:• All women will be able to make choices about their maternity care,

during pregnancy, birth and postnatally;• More women will be able to give birth in midwifery settings;• All pregnant women will have a personalised care plan;• Most women will receive continuity of the person caring for them during

pregnancy, labour and postnatally.Physical, intellectual and emotional development of children and young people is fully supported:• Population health is improved by focusing on early years: fewer parents

smoke, more mothers breast feed, and fewer children are overweight;• Care and support for children and young people’s mental health is

transformed by in-reach to schools, an improved multi-agency response to a crisis, and Cornwall’s first Tier 4 unit .

Care and support for children and young people with lifelong and life-limiting conditions is well coordinated, provides choice and promotes independence.

14

What is our ambition for ‘out of hospital’ care? Will it be a place-based operating model by March 2024?

Eight integrated care communities and their population

Hayle

Helston

BodminLiskeard

TorpointSaltash

64,545

63,494

101,910 129,746

64,579

102,291

Isles of Scilly

1. Penwith2. North Kerrier3. Carrick4. Restormel and

The Roseland5. North Cornwall6. East Cornwall7. South Kerrier8. Isles of Scilly

32,280

2,500

Within these are primary care networks with populations of c. 30,000 – 60,000

15

‘Out of hospital’ care

What we have done so far• Started to develop Integrated Care Area

leadership teams;• Improved access to general practice

services;• Work is ongoing to improve the resilience

of general practice;• Started to grow the primary care

workforce – improving recruitment of existing roles and developing new ones;

• Supported the development of primary care networks;

• Developed multi-disciplinary team meetings;

• Started to review the role of community hospitals within their integrated care communities;

• Commissioned a system diagnostic to determine how productivity can be improved in intermediate are and wider frail elderly services.

What will it be like in March 2024• Our ambition is to bring together

primary, community, mental health, social care and voluntary sector practitioners into integrated care teams to better coordinate care and support;

• Improved place-based coordination and collaboration with voluntary sector organisations and community groups and volunteers;

• Support is in place for more people to successfully manage long-term conditions themselves;

• More people will receive personal health budgets

• Health and social care rehabilitation and re-enablement services will have been redesigned to provide a rapid community response when people need urgent care at home.

16

What is our ambition for integrating teams before March 2024?

How integrated will teams be?• Will they be co-located?• Will they share a computer

system?

When will they be in place?

Will integrated multidisciplinary teams from health and the councils also look to embrace practitioners from other local providers e.g. housing associations or voluntary sector partners?

Could community hospitals act as a multipurpose hub for these teams?

17

What is our ambition for Planned Care?

System priorities:• Improve standards across all elements,

for whole population 2019/20• Eliminate 52 week waits• Protect capacity in winter• New pathways to drive more prevention

and less intervention

Transformation Elements

OutpatientsImprove quality of

referralsTransform Delivery; Promote self care

Pathways / care Models

MSK, CVD, Respiratory Falls and Frailty

Cancer, PathologyPeninsula Clinical Services Strategy

Elective Long Term Plan

Enhanced care in communityHot/cold, area based

acute sitesWorkforce / Skills

Provider Collaboration

RTT DeliveryReducing delay

e.g. theatres, bookingscheduling, flow,

cancellations, productivity

Critical to Success Development of our joint workforceLocality / Area leadership for new service modelsRealising digital opportunities GP/Consultant engagementProvider co operation

iInterdependencies with Urgent Care, Integrated Communities, Mental Health18

Our ambition for a future model of care

• Person centric pathways, time is our currency;• Placed based, out of hospital care and support;• ‘Choice’ meaning informed decision making;

secondary care referrals only where necessary• Combined workforce strategy, developing our

collective skills and capacity;• Digitally enabled transformation ;• All providers invited to be part of Cornwall and

IOS Clinically led Practice Groups – (Primary, Community, Secondary) ;

• Facilities used inline with pathways and whole system plan, based on ICA footprints;

• New business model, new contract mechanisms, potential for devolved budgets;

• Research active, levering investment.

CIOS ‘Health and

Care’

CIOS ‘Dermatology’

CIOS ‘Orthopaedics’

Examples

19

What are our ambitions for urgent care?

What we have done so far• NHS 111 online has been available

since July 2018;• Clinical validation of category 3/4 NHS

111 calls to 999;• Trialling clinical validation of category 2

NHS 111 calls;• The Truro Urgent Treatment Centre is

operational with full designation planned for December 2019;

• West Cornwall Urgent Treatment Centre is fully operational;

• For the Urgent Treatment Centre at Bodmin an improvement plan will be defined and agreed during 2019/20.

• We have started to expand our High Intensity User Service with the ambition to extend it.

What will it be like in March 2024• People stay safe, well and

independent at home;• Ambulatory care is our default, with

bed based care only when clinically indicated;

• There is a rapid assessment and advice or treatment of urgent care needs;

• People admitted to hospital get back home quickly ;

• Planned levels of access to elective care are maintained;

• Safety and standards are maintained and people have and a good experience of care 24/7;

• Demand is contained freeing up resources for investment into prevention, self-care and early intervention.

20

What is our ambition for the target operating model in March 2024 for urgent care?

Shifting more people from right to left, delivering as much care close to home as possible

Out

com

es b

y M

arch

20

24

HHospital admissions avoided

Fewer peoplegoing to

A&E

Fewer 999 calls

More calls resolved over the telephone or more people helped by out

of hospital services

More peopleknowledgeable and confident

to care for themselves

More people identified at

risk and supported to prevent them having major

illnesses

• Structured education

• Support groups• Online

consultations

Integrated urgent care in the community

• UTCs• MIUs

• GP same day appointments

• Community pharmacies

• Crisis response team (multi-disciplinary)

• Increased detection of risk factors using AI

• Medicines optimisation

Key

com

pone

nts o

f the

targ

et

oper

atin

g m

odel

21

LTP ‘DELIVERABLES’ –EXTRACTS AS EXAMPLES

22

LTP Deliverables - overview

• How we move to an increased focus on population health, putting in place population health management and steps to reduce inequalities;

• More action on prevention - for people in hospital , pregnant women and users of high-risk outpatient services who smoke, for diabetes, alcohol dependency;

• More personalised care – rolling out the NHS Personalised Care Model including accelerating the roll out of personal health budgets and social prescribing;

• Transforming ‘out of hospital’ care and fully integrated community care – developing primary care networks, expanded community multidisciplinary teams aligned with networks, increasing volunteering and enhanced health in care homes;

• Better care for major health conditions (cancer, cardiovascular disease, stroke, respiratory disease, diabetes) – earlier diagnosis and treatment, increasing access to rehabilitation, improving education and self-management support, and shorter waits for planned care including 30% fewer face to face outpatient appointments.

• Improving mental health services – integrated community care, access to IAPT, reducing out of area placements, liaison services in the Emergency Departments, improving services for people with a learning disability and/or autism;

• Reducing pressure on emergency hospital services – improving community crisis response, multidisciplinary clinical assessment service, urgent treatment centres and same day emergency care in acute hospitals;

• A strong start in life for children and young people – improving maternity and mental health services and services for children with developmental disorders or long-term conditions.

23

LTP Deliverables – Summary

(NB 2023/24 is the endpoint and we are expected to determine our own phasing for many of the deliverables up to that endpoint).

24

19/20 20/21 21/22 22/23 23/24Population health and prevention 3 3 1 1 4Personalised care 1 8‘Out of hospital’ care 4 5 2 5Better care for major health conditions 3 5 1 1 22Reducing pressure on emergency hospital services

6 4 1 5

A strong start for children and youngpeople

4 3 1 17

Improving services for people with learning disabilities and/or autism

17

Total 20 21 4 4 77

This does not include enabling work streams.

2. Increasing focus on population health

NHS Long Term Plan deliverables

NHS LTP deliverables deadline

NHS LTP expectations of how systems will operate

Implementation framework

2.1

2.1a

Population health management

Systems that support population health management in every Integrated Care System with a Chief Clinical Information Officer or Chief Information Officer on the board of every local NHS organisation.

2021-22 • Using a proactive population health approach focused on moderate frailty will also enable earlier detection and intervention to treat undiagnosed disorders, such as heart failure.

• Extending independence as we age requires a targeted and personalised approach, enabled by digital health records and shared health management tools – using a proactive population health approach focused on moderate frailty will enable earlier detection and intervention …. people identified as having the greatest risks and needs will be offered targeted support for both their physical and mental health needs, which will include musculoskeletal conditions, cardiovascular disease, dementia and frailty….. Integrated primary and community teams will work with people to maintain their independence. (1.17).

• Systems show how they will reach the ‘mature’ level of the ICS maturity matrix, which includes population health management capabilities that support the design of new integrated care models for different groups of people.

2.2

2.2a

Health inequalitiesSet out during 2019 how we will reduce health inequalities by 2023-24

2019-20

• Ensure inequalities reduction is at the centre of our plans

• System plans should demonstrate the key areas of inequality they will tackle and how additional funding is targeted, for example actions that will address the health inequalities experienced by disadvantaged or vulnerable groups.25

3. More action on prevention

NHS Long Term Plan deliverables NHS LTP deliverables deadline

NHS LTP expectations of how systems will operate

NHS LTP Implementationframework

1. Smoking cessationAll people admitted to hospital who smoke offered NHS-funded tobacco treatment services (2.9)

2023-24• Targeted investment to develop

NHS-funded smoking cessation services in selected sites in 2020-21.

• Additional indicative allocations for all STPs /ICSs from 2021-22 for the phased implementation for all inpatients who smoke, pregnant women and uses of high-risk outpatient services (to complement LA funding)

2. Diabetes preventionThe NHS will ensure that, in line with clinical guidelines, people with type 1 diabetes benefit from life changing flash glucose monitors from April (3.80)

2019 • The NHS Diabetes Prevention Programme will be significantly expanded (doubled) over the next five years, and there will be a new digital option.

• Diabetes prevention programme –systems should set out local referral trajectories that will contribute to the national DPP uptake.

3. Weight managementA targeted support offer and access to weight management services in primary care for people with a diagnosis of type 2 diabetes with a BMI of 30+ (2.14)

- • Not a requirement of all systems at this stage.

• Targeted funding for 2020-21 and 2021-22 for a small number of sites to test and refine an enhanced weight management support offer.

4. Alcohol dependencyHospitals with the highest rate of alcohol dependence-related admissions will establish ACTs using funding from CCGs health inequalities funding supplement (2.20)

- • Not a requirement of all systems• Targeted funding available from

2020-21 to support the development and improvement of optimal Alcohol Care Teams in hospitals with the highest rates of alcohol dependence-related admissions.26

5. Delivering a new service model for the 21st century

NHS Long Term Plan deliverables

NHS LTP deliverablesdeadline

NHS LTP expectations of how systems will operate

Implementation framework

5.1

5.1a

Giving people more control over their own health and more personalised care

Role out NHS Personalised Care Model1. Patient choice2. Shared decision making3. Patient activation and

supported self-management

4. Social prescribing and community based support

5. Personalised care and support planning

6. Personal health budgets

2023-24

• Accelerating the roll out of personal health budgets will include provision of bespoke wheelchairs and community-based packages of personal and domestic support. The offer will be expanded in mental health services for people with learning disabilities, people receiving social care support and those receiving specialist end of life care (1.41).

• Proactive and personalised care planning for everyone identified as being in the last year of life

• Set out how we will implement the six components of the NHS Comprehensive Model of Personalised Care.

• Funding to support delivery of ‘Universal Personalised Care’ will be Through the Network Contract

Direct Enhanced Services from 2019/20 for employment of social prescribing link workers.

Targeted funding to deliver the comprehensive model from 2019/20 to 2021/22.

5.1b Trained social prescribing link workers in place ( two phases)

2020-212023-24

Social prescribing link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. (1.40)

• The GP contract guarantees funding to develop multi-disciplinary teams and will meet 100% of the costs of additional social prescribing link workers.

• Regional teams will support systems to develop local trajectories in line with national ambition in the NHS Long Term Plan, including their shares of social prescribing activity and personal health budget take up.

5.1c Accelerate the roll out of personal health budgets (1.41) 2023-24

27

6. Delivering further progress on care quality outcomes

NHS Long Term Plan deliverables NHS LTP final deadline

LTP expectationsof how systems will operate

Implementation framework

6.1aiii Accelerate action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury

2025 Targeted funding for neonatal critical care service from 2021-22

6,1aiv Expanded saving babies lives care bundle to include pre-term births 2020-21

6.1av Every trust is part of the National Maternal and Neonatal Health Safety Collaborative and has a named Maternity Safety Champion.

2019-20

6.1avi Most women receive continuity of the person caring for them during pregnancy, birth and postnatally by March 2021

2020-21 Continuity of carer targeted funding (from 2021-22 to 2023-24)to support

6.1avii All women able to access their maternity notes and informationthrough their smart phones

2023-24

6.1aviii Increased access to evidence based care for women with moderate to severe perinatal mental health difficulties and a personality disorder

2023-24

6.1aix If not already in place, maternityservices begin accreditation for evidence based infant feeding programme

2019-20 Targeted funding (2019-20 to 2023-24) for the UNICEF Baby Friendly Initiative

28

6. Delivering further progress on care quality outcomes

6.5 Research and innovationSystem plans should set out how they will:• Contribute to the national ambitions to

increase public and patient participation in research;

• Work with innovators to test innovations that meet the NHS’s needs in real world settings;

• Ensure local adoption and spread of proven innovations, working with Academic Health Science Networks where appropriate.

Following production of system plans, a small number of exemplar systems will be selected to undertake more detailed co-design of how the research and innovation commitments in the Long Term Plan can be delivered locally.

6.6 GenomicsSystems will work with relevant Genomic Laboratory Hub and NHS Genomic Medicine Centres to ensure clinical pathways are in place, operating to national standards and protocols to ensure all eligible patients receive access to appropriate genomic testing and requests are consistent with the national genomic test directory and delivered by the designated providers.

29

7. Giving NHS staff the backing they need• Workforce planning central to overall planning processes covering workforce growth and

transformation for all areas of NHS-funded care including primary care, community, mental health and acute services – designing workforce models to delivery Long Term Plan service priorities.

• Set out actions to make the NHS the best place to work – delivering the themes set out in the interim NHS People Plan;

• Actions to improve leadership culture, implementing system wide processes for managing and supporting talent, and developing strategies to support all staff to work in compassionate and inclusive leadership cultures

• Deliver a holistic approach to workforce transformation and workforce growth– Setting out workforce growth planned for different groups– Show action that will be taken locally to improve retention, international recruitment and maximise

use of the Apprenticeship levy– Improve workforce efficiency and release greater time for care, including changes in skill mix, new

ways of working, better use of scientific and technological innovation, and reductions in sickness absence

• Change the workforce operating model i.e. describing as part of ICT development plans to develop capacity (including prioritising urgent action on nursing shortages), capability, governance and ways of working – will enable ICSs to take on growing responsibility for workforce and people activities, informed by the capacity building diagnostic tool developed with local systems.

• STPs/ICSs will need to work with trusts, primary care networks and other partners to develop optimal workforce models for their local health system.

30

8. Delivering digitally enabled care across the NHS

Systems need to develop a comprehensive digital strategy and investment plan that describes how digital technology will underpin their local system’s wider transformation plans over the next five years, including describing:• How and when each organisation will achieve a defined minimum level of digital maturity;• How they will adopt Global Digital Exemplar (GDE) Blueprints and an approach based on IT

system convergence to reduce unnecessary duplication and costs;• How they will adhere to controls and use approved commercial vehicles such as the Health

System Support Framework to ensure technology vendors and platforms comply with national standards for the capture, storage and sharing of data.

Systems are expected to set out plans for how they will significantly improve the provision of services and information through digital routes aligned to national standards and requirements:• Drive forward digitisation focussed on the user need and engage staff and patients in its

development;• Draw on national platforms such as NHS App and NHS Login and nationally led programmes such

as the Provider Digitisation Programme.• Include support for NHS staff to make adjustments to how they work• By 2021/22 all staff working the community will have access to mobile digital services to help

them perform their role, with ambulance services having access to digital services that reduce avoidable conveyance;

• By 2022 an integrated child protection system will replace dozens of legacy systems;• Nationally 96% of GP practices expected to be connected to the NHS App by July 2019.

31