clinical commissioning group, adult social care …...kingston’s ccg, adult social care and public...

Kingston’s

Clinical Commissioning Group,

Adult Social Care and

Public Health Services

Integrated Operating Plan

2014/15 – 2015/16

Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014

CONTENTS

Page

1. Introduction 3

2. Quality and Patient Safety 4

3. Patient and Citizen Voices 5

4. Children and Young People 6

5. Integrated Health and Care Services for Adults 7

6. Mental Health 8

7. Primary Care 9

8. Urgent and Emergency Care 10

9. Cancer and End of Life Care 11

10. Socially Excluded and Disadvantaged Groups 12

11. Health promotion and disease prevention 13

12. Integrated Commissioning of Health and Adult Social Care 14

Appendix 1 How this plan addresses the fundamental elements of commissioning as identified in NHSE’s Operating Framework

15

Appendix 2 Outcomes we will use to measure our success 17

Appendix 3 2014/2015 Kingston CCG and Adult Social Care Budgets and saving plans 19

Appendix 4 Related Documents 22

Appendix 5 Kingston Draft Better Care Fund Plan

Appendix 6 Draft Kingston CCG 5 Year Plan-on-a-Page

23

24

Appendix 7 Draft SW London 5 Year Plan-on-a-Page 25


1. Introduction

Kingston Clinical Commissioning Group (the CCG) and the Royal Borough of Kingston (RBK) have been exploring ways in which

to collaborate on commissioning for the benefit of the population of Kingston.

This plan brings together priorities that Kingston’s CCG, Adult Social Care and Public Health have identified for the next 2 years

into a single document for the first time. These priorities have been derived from previously published documents such as the Joint

Strategic Needs Assessment (JSNA), Health and Well Being Strategy and the CCG Commissioning Intentions. This Plan should

be read alongside these and the other documents listed in Appendix 4.

Following the transfer of public health responsibilities from the health service to the local authority, the Royal Borough of Kingston

upon Thames recognises that to fully deliver its new responsibilities as a Public Health organisation all aspects of council business

need to be influenced by Public Health. The Public Health Team will continue to ensure that mechanisms are in place to enable

Public Health specialists to work with all council services to ensure that this occurs. The delivery of the third domain of Public

Health, which is that of commissioning support, will be a priority for RBK which will assist in maintaining the excellent working

relationship with the Kingston Clinical Commissioning Group.

The priorities identified in this plan are deliberately described at a high level so that the document acts as an easy reference guide

for our population, partners and staff. The delivery of the priorities is supported by detailed implementation service plans.

This document will be reviewed regularly to ensure that it reflects the priorities identified by our population and partners. We

welcome any feedback on the document – please email to [email protected]

David Smith

Director of Health and Adult Services, Royal Borough of Kingston upon Thames and

Chief Officer, Kingston Clinical Commissioning Group

mailto:[email protected]


2. Quality and Patient Safety

Aim: To achieve visible leadership in quality improvement across health and care commissioning and provision,

embedding the learning from Francis, Berwick and Winterbourne into local services.

What we will do

Establish a regular health & social care quality information sharing meeting using SBAR (Situation, Background, Assessment and Recommendation) tool

Mature relationships with providers include ‘15 steps’ (quality from a patient’s perspective) and walk rounds

Focus attention on smaller less developed contracts and providers to establish quality reporting

Be an active member of the London Quality Surveillance Group and work collaboratively with other CCGs and Local Authorities on issues of quality and patient safety

Ensure requirements and good practice in Adult and Children’s Safeguarding are rigorously applied

Extend the use of focused user outcome measures to all Adult Safeguarding investigations

Reduce the number of Health Care Acquired Infections being reported by our providers

Ensure the 6 action areas and ‘6 Cs behaviours’ of Compassion in Practice are rolled out across providers

Continue and expand the current projects to improve medicines safety optimisation in care homes

Improve access and sharing of data across health and social care

Implement a local quality framework for residential and nursing homes in Kingston

Deliver the London Quality Standards and equivalent in cooperation with other commissioners and providers

Outcomes we will realise

Establish a culture where health and care providers raise their own concerns with commissioners which triangulate with other information to enable intelligent decision-making and appropriate action

Kingston CCG’s Integrated Governance Committee receives quality reports from all health and care commissioned providers

Commissioners gain assurance from providers against a set of agreed standards and early warning systems are in place


3. Patient and Citizen Voices

Aim: To ensure that the voices of patients, carers and the wider population are central to the development and delivery

of both their own health and care and the health and care services provided in Kingston

What we will do

Establish a Patient Experience Group across health and care services to monitor and drive improvements in service quality based on service user feedback data

Ensure providers involve patients in the Root Cause Analysis arising from any Serious Incident

Integrate learning from complaints and feedback into practice

Continue to commission Kingston Voluntary Action (KVA) to disseminate health and social care information and support and contribute to the development of local strategies

Roll out personal health budgets for NHS Continuing Health Care and plan for widening the opportunity to people with long term conditions, using processes in place in Adult Social Care for direct payments

Build on current strategies and plans to develop and implement a Joint Engagement Strategy

Establish a formal link between the PLD Parliament and Kingston Healthwatch, to ensure independence of the Parliament

Ensure that the JSNA incorporates the views of patients and the public


A measured improvement in service users’ experience of health and care services

Real involvement of patients and carers in the development of individual care plans and wider service planning and development

Feedback is used to inform commissioning processes


4. Children and Young People

Aim: Children and Young People are able to access the right service in the right place and the right time and have a

positive experience of care.

What we will do

Support the implementation of MASH (Multi-agency Safeguarding Hub)

Implement the new statutory duties of the Children and Families Bill and review and update existing transition protocols focusing on vulnerable groups

Implement the recommendations of the CAMHS (Children’s Mental Health Service) Tier 2 review including the introduction of a Single Point of Access with streamlined onward referral arrangements, and support the implementation to IAPT (Improving Access to Psychological Services)

Offer children, young people and families Personal Health Budgets and continue to improve the quality of the continuing care service

Identify approaches to ensuring that children and young people are involved in the design and delivery of local services e.g. ensuring that there is a health section included in the Local Authorities annual Young People’s School Survey

Extend health assessments on school entry from September 2014

Deliver targeted prevention and education at secondary school age via 5 Young People’s Health Link Workers

Continue with the established collaborative commissioning arrangements with the Children’s Joint Commissioner working across the CCG and Local Authority and continue to develop the multi-agency Children’s Health Commissioning Board

Work with the newly established ‘Achieving for Children’ social enterprise, supporting it to achieve its aims and objectives


Children and young people have a positive experience of care, feel empowered in decisions about their care or treatment and have improving levels of health and wellbeing

Support children and young people to achieve their full potential

Improve the experience of transition for those service users moving between children and adult services

Collaborative working across professions and integrated commissioning


5. Integrated Health and Care Services for Adults

Aim: To improve choice, outcomes and experience of care for vulnerable adults, people with long term conditions and

the frail elderly within our population

What we will do

Under the leadership of the Health and Wellbeing Board, develop and deliver Kingston’s Better Care Fund Plan

Consolidate the Kingston at Home service model to further integrate health and care services

Develop and adopt Multi-disciplinary Team (MDT) and Multi-provider Team (MPT) approaches to managing those most in need of health and care services in our population

Review and redesign of community (district) nursing and community matrons service model and care pathways in light of the caseload profiling project

Review, specify and implement an Older People’s Mental Health service model by April 2015, particularly a comprehensive Dementia Service with associated Carer Support and Community Development

Implement the changes brought in by the new Care Bill from April 2015

Review and re-commission the meals service and accompanying transport services

Explore the requirement for step-up and step-down community beds (including Cedars Unit)

Emphasise the need for an holistic approach to the care of older people using the comprehensive geriatric assessment tool and a recovery and rehabilitation philosophy

Pursue opportunities for increased 7 day working and delivery of the 10 x 7 day service clinical standards

Continued support for the provision and expansion of dedicated support to care homes (IMPACT team)


Provide more care closer to and in the home

Establish a single point of access to community based services

Reduce the number of avoidable admissions into hospital

Reduce the length of stay in hospital and delayed transfers of care by supporting early discharge

Reduce the number of nursing home and residential placements made in Kingston

Improve support available to carers


6. Mental Health

Aim: Improve mental health and wellbeing, extend local mental health services and support for carers, and provide

effective mental health commissioning leadership for a wider area

What we will do

Be fully engaged and committed to the ‘No health without mental health programme’ – cross sector work to aid recovery, reduce stigma and enhance positive outcomes

Value mental health equally with physical health (‘parity of esteem’) so that all those for whom we have responsibility can say ‘I have access to services which enable me to maintain both my mental and physical wellbeing’

Continue to support the development of the Kingston Community Wellbeing Service, particularly refocusing services towards prevention and early intervention; improving access to treatment for service users with a dual diagnosis; supporting the expansion of the substance misuse element of the service to meet the increase in people accessing the service

Develop in-Borough adult rehabilitation services with the 3rd Sector, ensuring effective links and reducing bed days

Contain out of area placements including review, repatriation and demand management arrangements

Finalise future arrangements for personality disorder services

Support the delivery of a range of mental wellbeing initiatives across the population of Kingston from children and young people and their families, through the adult years, to older people

Continue with the collaborative commissioning approach both locally through a joint commissioning approach between the CCG and the Local Authority as well as providing the leadership for South West London and St George’s Mental Health Trust for 5 of the CCGs in South West London


Increased numbers or people accessing IAPT (improving access to psychological therapies) services

Progress a single point of entry to both primary and secondary care mental health services

Better support for Carers including carer network established and carer engagement in mental health programmes

Seek to achieve continually improving levels of mental health and wellbeing


7. Primary Care

Aim: Support primary care in core provision and in tackling new requirements, seek to assure quality and consistency

in patients’ experience and help establish a longer term plan for primary care in Kingston

What we will do

Support GPs to provide continuity of care to the over 75s and meet the new obligations under the contract to provide an ‘accountable GP’ for those individuals; support GPs in a similar role for people with complex needs

Enable GPs to play a central role in delivery of the Better Care Fund Plan, including implementation of risk stratification, extension of multidisciplinary team (MDT) working, specific arrangements around mental health and end of life care in primary care

Work with primary care to assure appropriate access and consistent quality provision; work with primary care to tackle unexplained variability in aspects of primary care provision, including referral management

Further improve prescribing efficiency and the uptake of medicines optimisation initiatives in primary care through the investment in a Medicines Management Incentive Scheme and support the reduction of unexplained variations in GP prescribing practice

Assist primary care in exploring the options around the future models and ways of working for primary care, focusing on areas of change highlighted in ‘Improving General Practice – A Call to Action’ and recommendations that emerge from the Strategy for Primary Care for London being developed by NHS England

Review the portfolio of Locally Commissioned Services exploring the potential for change in order to meet health and care priorities in Kingston


Positive patient experience of primary care (including via extension of Friends and Family Test)

Changing requirements of primary care effectively and consistently implemented

A clear direction of travel for primary care development and provision across Kingston


8. Urgent and Emergency Care (U&EC)

Aim: To build on the achievement of the Kingston Urgent Care Working Group in actively engaging all key partners in

the development and implementation of a whole system Urgent Care Plan

What we will do

Evaluate the Acute Care Physician and Older People / Psychiatric liaison pilots with a review to mainstream services if demonstrably effective

Procure an integrated GP Out of Hours and NHS 111 service

Develop and implement local alternatives to A&E attendance; options include improving access to other timely advice and support, potential for urgent care front end at KHT A&E, GP-led health centre provision at Chessington, potential for Urgent Care service at Surbiton Health Centre

Enhance the NHS 111 Directory of Services to signpost service users to right services not just A&E

Ensure cross-system plans are in place early to manage winter pressures and adapt them to manage pressures throughout the year

As part of the BCF develop plans for seven day working for Adult Social Care


Reviewed and refreshed membership of the Urgent Care Working Group and Kingston Urgent Care Plan; assurance of delivery of the 5 key elements of the national Urgent and Emergency Care Review; assurance of quality of U&EC services outside hospital across 7 day working

Improved patient satisfaction with Kingston’s U&EC services

Reduce patients’ reliance on A&E to gain access to urgent treatment

Achievement of outcome measures associated with urgent and emergency care including the 4 hour A&E waiting time target

Increase choice and access in urgent care services


9. Cancer and End of Life Care

Aims: Ensure a comprehensive range of cancer prevention and treatment services are in place, and ensure they are fit

for the future.

Continue to improve provision and coordination of end of life care services, enabling an increasing number of

people to die in their place of choice

What we will do

Continue to commission and provide prevention services and work with the South London Commissioning Support Unit and NHS England to ensure a full range of Cancer treatment services are in place and accessible for Kingston residents

Provide local leadership to review Cancer prevention and treatment services in light of the London Cancer Strategy launched in January 2014; revise local plans accordingly

Review and update Kingston’s End of Life Care Strategy

Continue to promote partnership working, ensure comprehensive service information shared across health and social services, champion joint education programmes

Make progress in extending 7 day and 7 night provision for end of life care patients, particularly working with NHS111


Maintain high levels of public awareness of issues around cancer and increase early detection rates

Implement ‘living with and beyond cancer’ best practice

Improve patient experience of cancer services, especially at the primary / secondary care interface

Increased use of coordinate my care, particularly for patients near or at end of life

Implement an out of hours pharmacy dispensing service

Increase the number and proportion of people who die in the place of their choice

Reduce the number of palliative care patients dying in hospital


10. Socially Excluded and Disadvantaged Groups

Aim: For people who are disadvantaged or socially excluded to have similar opportunities for good health and

wellbeing as the wider population in Kingston

What we will do

Via the Equalities and Community Engagement Team (ECET):

Provide targeted initiatives in disadvantaged areas and to disadvantaged population groups in Kingston

Continue to undertake participatory needs assessments so that a detailed understanding of local needs and assets can be developed

Continue to implement the Joint Refugee and Migrant Strategy including commissioning Refugee Action Crisis Support to provide 1:1 advice, information, and support sessions for Refugees and Asylum seekers

Focus on homeless people and ensure they can access all relevant services

Implement (if finally agreed) the planned PLD transfer of specific elements of provision (supported living, residential, work activities) to a social enterprise, to increase user involvement and enable more flexibility, innovation and development

Deliver the CCG’s obligations in relation to the Armed Forces and Veteran Health. These include

responsibility for commissioning all secondary and community services required by Armed Forces’ families where registered with NHS GP Practices and services for veterans and reservists when not mobilised

commissioning bespoke services for veterans, such as veterans’ mental health services


Increased engagement with and improved health and wellbeing of people who are disadvantaged or socially excluded

Ensure that universal services are more sensitive and responsive to the specific requirements of these groups within our population

Seek, receive and act on feedback from these groups, and increase the range of intelligence available to commissioners to inform future planning and commissioning


11. Health and Prevention

Aim: Make sure that there is an accessible range of information and opportunities which promote health and wellbeing

and prevent illness, which are suited to the varying needs of Kingston residents

What we will do

Specify and tender a range of early intervention and support services with the independent / voluntary sector, to include services such as case finding and combating isolation for older people, support to manage personalisation / personal health budgets, support to carers

Continue to upscale obesity prevention and physical activity promotion services and focus on increasing utilisation of these services by men

Support London wide health improvement initiatives including Healthy Schools and the Healthy Workplace Charter

Promote our tobacco control and smoking cessation services by both discouraging people (including young people) to take up the habit as well as providing a range of service to support people who want to quit smoking

Ensure there is a high level of awareness of the issues regarding shisha use

Promote safe and sensible drinking and provide education around illegal substances and substance misuse

Deliver the Health Check programme, ensuring that it targets disadvantaged populations within Kingston

Undertake a review of local sexual and reproductive health services

Prepare for the transfer of commissioning responsibilities for children’s public health services for 0 to 5 year olds from NHSE to RBK

Ensure that the adolescent health link workers programme is fully embedded in local schools

Review the range of self-care and self-management provided and develop a plan fit for future ambitions

Establish demonstrator projects for clinical coaching


Tender for early intervention and support services let, achieving better use of available resources, simplification of commissioning arrangements and clearer and increased provision

Increase uptake across the full range of health promotion and disease prevention services available

Increase the coverage of the Health Checks programme


12. Integrated Commissioning of Health and Adult Social Care

Aim: To improve alignment and efficiency of health and social care commissioning, with the aim of ensuring seamless

provision and best use of resources

What we will do

Bring together under a single leadership team commissioners from health, and adult social care

Increase the level of funding that is pooled between health and adult social care

Establish an organisational development (OD) programme to foster a culture of collaborative and cross boundary working to support the integration of the respective teams

Consolidate and better align staff development arrangements

Seek opportunities to improve information sharing to address both local and national requirements

Foster an innovation culture, to enable and enhance integrated working and optimise commissioning

Apply best practice in procurement

Align the Adult Social Care and CCG saving plans to ensure that a decision in one area does not adversely impact on another part of the system


Improve patient and service user experience particularly where they require both health and social care services

Optimise the commissioning capacity in Kingston, with an efficient, motivated integrated commissioning team streamlined where appropriate to help offset the reduction in running costs that the CCG and RBK face

Ensure the resources spent on services by the CCG and RBK are used in the most effective way possible, optimising value for money


Appendix 1 How our Plan addresses the Fundamental Areas identified in NHSE’s Operating Framework

Fundamental Elements of Commissioning How these are addressed in this Plan

Ou

tco

mes

Delivery of outcomes set out in the NHS, Adult Social Care and Public Health Outcomes Frameworks

Throughout

Improving Health

Aims and actions throughout are generally aimed at improving health and wellbeing through promotion, prevention and intervention

Promotion and prevention actions particularly emphasised in section 4, via the BCF in section 5, sections 6, 9, 10, and particularly section 11

Reducing Health Inequalities Section 10

Parity of esteem Sections 5, 6, 7, Appendix 5

Pati

en

t S

erv

ices

Citizen involvement, patient empowerment Sections 3, 4, 5, 6

Wider primary care provided at scale Section 7

A modern model of integrated care Section 5

Access to highest quality urgent and emergency care Section 8

Step-change in productivity of elective care Appendix 3 – commitment to duties to deliver balanced budgets incorporating national requirements including PbR changes

Specialised services concentrated in centres of excellence Section 2 ref London Quality Standards

Acces

s

Convenient for everyone Sections 4, 5, 6, 7, 8, 9, 10, 11

NHS Constitution pledges Addressed through contracts, covered by performance

management arrangements including Appendix 2


Qu

ality

Francis, Berwick, Winterbourne View Section 2

Patient safety Section 2

Patient experience Sections 3, 4, 5, 6, 7,12

Compassion in practice Section 2

Staff satisfaction Addressed through NHS standard contracts

Section 12

7 day services Sections 5, 8

Safeguarding Sections 2, 4,

Research and innovation Section 12

De

liv

eri

ng

valv

e

Value for money Throughout, Appendix 3

Effectiveness Throughout, esp. Section 12

Efficiency Throughout, esp Section 12

Procurement Section 12


Appendix 2 Outcomes we will use to measure our success

For joint, high level reporting we will use the following indicators which are broadly shared across the Health, Adult Social Care

and Public Health Outcomes Frameworks:

Outcomes Frameworks: Core Domains 2014/15 – 2015/16

Adult Social Care (A) NHS (N) Public Health (P) Performance Measures A N P

Preventing people from

dying prematurely

Measures in blue required for the Better Care Fund Plan

Enhancing quality of life for people with care and support needs

Enhancing quality of life for people with long term conditions

Health Improvement

Improving the

wider

determinants of

health

1 Proportion of adults with LD in paid employment (NHSOF – employment of people with long term conditions)

1E 2.2 1.8

2 Proportion of adults with MH in paid employment 1F 1.8

3 Estimated diagnosis rate for people with dementia** 2.6 4.16

4 Local social care dementia measure? (* = Placeholder in ASCOF) *

5 Proportion of people who use services and their carers who reported they had much social contact as they would like / social isolation (survey measure)

1L 1.18

6 Self Directed Support and Direct Payments 1C

7 Personal Health Budgets – local measure? ?

Delaying and reducing the need for care and support

Helping people to recover from episodes of ill health or following injury

Healthcare public health and preventing premature mortality

8 Delayed Transfers of Care (We can disaggregate this measure to show health as well as social care delays)

2C

9 Permanent admissions to residential/nursing care 2A

10 Proportion of older people (>65) still at home 91 days after discharge from hospital into reablement / rehabilitation (part 2 of this measure also captures proportion of people offered reablement at discharge from acute or community hospital – NHSOF 3.6ii)

2B 3.6

11 Local measure – outcome of reablement

12 Avoidable emergency admissions 3B 4.11

13 Successful completion of drug treatment 2.15

Ensuring that people have a positive experience of care and support

Ensuring that people have a positive experience of care

14 Improving people’s experience of integrated care (Survey measure) 3E 4.9

15 Overall satisfaction of people who use services with their care and support / Patient experience of primary and hospital care

3A 4A

4B

Safeguarding adults … and protecting from avoidable harm

Treating and caring for people in a safe environment and protecting them from avoidable harm

Health protection

16 Local measure – percentage of adult discharges from hospital

over the weekend


In RBK these high level measures will be reported as part of the Council-wide performance reporting arrangements.

In the CCG, performance against the full range of NHS (CCG) Outcome Framework indicators and a range of other local

measures is regularly reported to the CCG’s Integrated Governance Committee (IGC) - monthly in summary and quarterly in detail

- with significant exceptions identified supported with relevant commentary. The IGC in turn reports monthly to the Governing

Body.

The CCG, Adult Social Care and Public Health have in place more detailed plans which underpin this high level plan, and which

have their own performance measures and milestones which are the focus of regular internal / departmental performance

management. We regularly review the contractual and quality performance of providers.

The Kingston Commissioning Collaborative has in place an overarching governance structure, and certain programmes have their

own governance arrangements. For example the Better Care Fund programme will be reporting on a number of inter-

organisational programmes, using a variety of indicators and outcome measures, to the Health and Wellbeing Board.


Appendix 3 2014/2015 CCG and Adult Social Care Budgets and Saving Plans

CCG Expenditure Plan 2013/14 Total

Budget

Run Rate Adj

Conting Release

ITF Transfer

Non Rec Adjust

2014/15 Baseline

Budget

Tariff & Growth

%

Tariff & Growth

Non Rec Adjust

Other Costs

Sub Total

QIPP Net Save

2014/15 Total

Budget

APPLICATION OF FUNDS £,000 £,000 £,000 £,000 £,000 £,000

£,000 £,000 £,000 £,000 £,000 £,000 Acute Commissioning

General Acute (FTs & Non FTs) 103,262 2,041 105,303 2.60% 2,738 108,041 (2,700) 105,341 Non Contract Activity 1,509 84

1,593 2.60% 41

1,634

1,634

Non SLAs/Acute Other 1,648 (18) 1,630 2.60% 42 1,672 1,672

Total Acute (before reserves) 106,419 2,107 0

0 108,526 0 2,822 0 0 111,348 (2,700) 108,648

Non Acute Commissioning

Mental Health 19,601 362 (140) 19,823 1.80% 357 20,180 (400) 19,780 Continuing Care 11,261 1,702

12,963 8.00% 1,037

14,000 (400) 13,600

Children with disabilities 2,000 598

2,598 1.80% 47

2,645

2,645 Learning Difficulties 1,062 (53)

1,009 1.80% 18

1,027

1,027

Community Health Services 16,196 (31)

16,165 1.80% 291

16,456 (500) 15,956 Reablement

0 1.80% 0

0

0

Vol Sector Grants

0 1.80% 0

0

0 Other Non Acute 4,699 (477) (932) 3,290 1.80% 59 3,349 (222) 3,127

Total Non Acute 54,819 2,101 0 (1,072) 0 55,848 1,809 0

57,657 (1,522) 56,135

Primary Care

0

Prescribing 19,611 (146) 19,465 6.00% 1,168 20,633 (400) 20,233 Enhanced Services 1,478 (1)

1,477 1.50% 22

1,499

1,499

Out of Hours 1,475 (66)

1,409 1.50% 21

1,430

1,430 Other Primary Care 306 74 380 1.50% 6 386 386

Total Primary Care 22,870 (139) 0

0 22,731 1,217 0 0 23,948 (400) 23,548

Sub Total 184,108 4,069 0 (1,072) 0 187,105

5,848 0 0 192,953 (4,622) 188,331

Running Costs 4,610 0

4,610

85 4,695

4,695 Non Running Costs 577 (192)

385

385

385

Reserves

Non-Recurrent Reserve (2% in 2013/14) 3,937 (1,268) 1,118 3,787 1,094 4,880 4,880 0.5% Additional Contingency 962 (962) 962

962

962

962

Acute Commissioning reserves 1,647 (1,647) 1,647

1,647

1,647

1,647 Cost Pressure Reserve 0 0 0

Total Reserves 6,546 (3,877) 3,727

0 6,396 0 1,094 0 7,489 0 7,489 0

Total Applications 195,841 0 3,727 (1,072) 0 198,496 0.00% 5,848 1,094 85 205,522 (4,622) 200,900 0 In Year (Deficit)/ Surplus 2,013 2,041 1.0% 1.0%


Kingston CCG Quality, Innovation, Productivity and Prevention (QIPP) Plan 2014/15

Preliminary v3

Better Care Fund pump-priming year including e.g.

risk stratification, MDT & MPT working, proactive intervention with high risk patients

End of life care programme

IMPACT team - expansion in care homes, extension to sheltered housing

Respiratory services development – expand community services, clinical coaching, oxygen services

Reduce cost of A&E attendances e.g.

reducing attendances (range of initiatives)

reducing cost of attendances (e.g. urgent care f/e?, local tariff?)

GP referral management scheme

Musculoskeletal pathway redesign

Patient centred angina management service - FY effect of 13/14

Continuing care incl. implement Newton review recommendations

Medicines management programme e.g.

Care Homes: Commissioning support for reviews

Commissioning discharge scheme for community pharmacists

Specialist clinics to assist to manage high cost medicines and patients requiring pharmacist, that provide educational

information and outreach services to reduce prescribing and monitoring errors among high-risk patients

Mental health - service reviews and efficiencies

Contained provision growth – acute, community, mental health, NHS continuing care


RBK Health & Adult Social Care planned net expenditure 2014/15

Health & Adults Social Care (Net Expenditure)

Base Budget 2013/14

Adjustments to Base Budget

Base Budget 2014/15

Inflation Growth Budget Reductions

Budget 2014/15

By service £'000 £'000 £'000 £'000 £'000 £'000 £'000

Concessionary Travel, Safeguard & ASC Other 4,685 662 5,347 612 178 -640 5,497

Commissioning Long-Term 7,000 6,582 13,582 211 0 -34 13,759

Mental Health 4,120 84 4,204 18 0 -300 3,922

Commissioning Short-Term 18,330 -6,383 11,947 26 1,000 -60 12,913

Public Health 303 635 937 0 0 -400 537

Supporting People 3,428 -607 2,822 75 0 -170 2,726

Provider Services Long-Term 12,115 -7 12,109 56 0 -265 11,899

ADULT SOCIAL CARE 49,982 965 50,947 998 1,178 -1,869 51,254

Subjective Analysis Adult Social Care 2014/15- Summary

Base Budget 2013/14

Adjustments to Base

Budgets

Base Budget 2014/15

Inflation Growth Budget Reductions

Budget 2014/15

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Depreciation & Impairment losses 793 -12 781 0 0 0 781

Direct Employee Costs 14,809 -459 14,350 148 0 -340 14,158

Indirect Employee Costs 118 -2 117 0 0 0 117

Premises related expenditure 1,034 7 1,041 0 0 0 1,041

Supplies & Services 1,565 13 1,579 400 0 -605 1,374

Support Services 6,938 524 7,462 0 0 0 7,462

Third Party Payments 39,504 425 39,929 495 1,329 -942 40,811

Transport related expenditure 451 -10 442 0 0 -8 434

Transfer Payments 9,226 -335 8,891 0 0 0 8,891

Expense Reporting Classes 74,439 152 74,591 1,043 1,329 -1,895 75,069

Fees & Charges for Services -7,061 749 -6,312 -46 -60 22 -6,396

Grants & Contributions Income -15,110 -256 -15,366 0 -91 4 -15,453

Other Income 0 0 0 0 0 0 0

Recharge credits -2,310 321 -1,989 0 0 0 -1,989

Income Reporting Classes -24,481 813 -23,668 -46 -151 26 -23,839

Reserve Movements 24 0 24 0 0 0 24

Total Reserves 24 0 24 0 0 0 24

HEALTH & ADULT SOCIAL CARE TOTAL 49,982 965 50,947 998 1,178 -1,869 51,254


Appendix 4 Related Documents

NHS Planning Guidance – Everyone Counts: Planning for Patients 2014/15 to 2018/19

The Care Bill 2013

The Children and Families Bill 2013

The NHS Belongs to the People: A Call To Action

A Call To Action – Commissioning for Prevention

Improving General Practice – A Call to Action

Securing excellence for Armed Forces – NHS England

London – A Call To Action

SW London Better Services Better Value Case For Change

5 Year Cancer Commissioning Strategy for London

Kingston Joint Strategic Needs Assessment

Kingston Joint Health and Wellbeing Strategy

Annual Public Health Report for Kingston 2013

Kingston CCG Commissioning Intentions 2014/15

Kingston Adult Social Care Plan 2013/14

Kingston Health and Wellbeing Board Commissioning Mandate for Mental Health

SW London Dementia Conference Report Dec13

Kingston Carers Strategy

Kingston Carers Action Plan

Kingston Voluntary and Community Sector Strategy

Kingston Better Care Fund Plan April 2014


Appendix 5 Kingston’s Better Care Fund Plan (April 2014)

Expected BCF allocations National Kingston

£m

14/15

£m

15/16

£000 14/15 (Established

funding routes)

£000 15/16 (BCF pooled

budget)

Existing transfer from health to

adult social care 1100 1100 2627 2627

Carers’ breaks funding 130 140 140

CCG reablement funding 300 932 932

Capital funding (including

Disabled Facilities Grant)+

354 859 859

Additional transfer from health

to pooled Better Care Fund 1900 6183

^

Totals 1100 3800* 4558 10741

CCG non-recurrent pump-

priming funding TBC

= contribution from adult social care budgets

= aggregate allowing for rounding etc

^ = expected to be made up 50 / 50 : rebadged / released from current spend

Kingston Draft BCF Plan – Key Elements

1. Multi-disciplinary working

1.1. MDT working

1.2. Kingston at Home extension (phase 1)

1.3. 7 day and 7 night working

1.4. Enhanced community support and development

1.5. Self-care and self-management

1.6. Housing (options and adaptations)

1.7. Information sharing

2. Out of Hospital Dementia Service (=Kingston at Home

extension phase 2)

3. Care and Support Reform (The care Bill)

4. Modified RAID Model (psychiatric liaison – rapid

assessment, interface, discharge)

5. Carers Support


Appendix 6 Draft Kingston CCG 5 Year Plan-on-a-Page

1: Im

pro

ve Q

ual

ity

esp

. Del

iver

Lo

nd

on

Qu

alit

y St

an

da

rds

(LQ

S); 7

day

/nig

ht

wo

rkin

g; o

pti

mis

e ac

cess

to c

on

sult

ant-

led

an

d s

up

po

rt s

ervi

ces;

imp

rove

d in

tegr

ated

wo

rkin

g o

ut

of

ho

spit

al

2: F

inan

cial

Su

stai

nab

ility

esp

ref

SWL

CC

Gs

‘do

no

thin

g’ t

arge

t sa

vin

g o

f 12

%; C

CG

tra

nsf

er o

f

£9.9

m t

o B

ette

r C

are

Fun

d in

15/

16 w

ith

aim

of

incr

easi

ng

sub

seq

uen

tly;

fin

anci

al p

ress

ure

s o

n T

rust

s es

pac

ute

se.

g. fr

om

ou

t o

f h

osp

ital

pre

ven

tio

n a

nd

ear

ly in

terv

enti

on

, an

d s

hif

ts o

f p

rovi

sio

n o

ut

of h

osp

ital

Kingston CCG – 5 Year Plan on a Page – March 2014 - DRAFT

Children - LQS esp specialists undertaking sufficient work to maintain specialist

skills, sufficient paediatric trained staff in all settings; improved CAMHS , single point of access and IAPT; improved Transition; assured Safeguarding; targeted prevention and education widespread and mainstreamed

Integrated Care - widespread, mainstreamed integrated working across

primary, community health and social, independent, voluntary and acute sectors facilitated by expanded, enhanced Better Care Fund and Kingston at Home programmes; mental health provision, esp. dementia care embedded; 7 day/night working as routine

Maternity – LQS: all consistently met for Kingston residents; extended midwife-

led provision; enhanced family-focussed, ante & postnatal community maternity service fully established; outcome-based commissioning implemented where beneficial; improved patient experience

Mental Health – extended, enhanced IAPT , ‘Community Wellbeing’ and adult

rehabilitation services; a range of mental wellbeing initiatives, all ages, mainstreamed; measurable delivery of the ‘Closing the Gap’ priorities

Planned Care – separation of planned and unplanned surgery; Kingston part of

SW London ‘Centre of Excellence’ model for planned care, using ‘multi-specialty elective centre’ (MSEC) for elective inpatients; clinical networks effective in support of MSEC incl. emergency cover

Transforming Primary Care – primary care established roles at core of BCF

implementation esp. risk stratification, MDT and multi-prof. team working; other new roles embedded e.g. for >75s; enhanced and extended self-care options; enhanced ‘federated working’ between GP practices extended and demonstrably beneficial

Urgent and Emergency Care – Kingston part of 2-level acute emergency

arrangements - major emergency centres, emergency centres; re-commissioned NHS111 and out of hours provision established; enhanced out of hospital capacity and capability in place; continued public information and education re. options C

: IT

–im

pro

ved

info

rmat

ion

sh

arin

g an

d g

ove

rnan

ce in

pla

ce t

o s

up

po

rt in

div

idu

al p

atie

nt

care

an

d w

ider

pla

nn

igan

d p

erfo

rman

ce m

anag

em

ent,

esp

acro

ss h

ealt

h a

nd

so

cial

car

e se

cto

rs

A:

Wo

rkfo

rce

–p

lan

nin

g an

d d

evel

op

men

t o

f w

ork

forc

e to

su

pp

ort

tra

nsi

tio

n o

f ex

isti

ng

staf

f fro

m a

cute

to p

rim

ary

and

co

mm

un

ity

sett

ings

; dev

elo

pm

ent

of

hyb

rid

hea

lth

/ s

oci

al c

are

role

s; in

tegr

ate

volu

nta

ry /

in

dep

end

ent

sect

or

wo

rkfo

rce

and

su

pp

ort

th

eir

dev

elo

pm

ent

to a

dd

ress

cle

ar r

equ

irem

ents

D:

Org

anis

atio

nal

Dev

elo

pm

ent

–fu

rth

er p

rogr

ess

on

bo

th f

orm

al a

nd

info

rmal

inte

grat

ed

wo

rkin

g –

bo

th c

om

mis

sio

ner

s an

d p

rovi

der

s

B:

Res

ou

rcin

g –

mo

re c

om

mis

sio

nin

g o

n o

utc

om

es b

asis

; no

vel f

un

din

g ar

ran

gem

ents

like

ly o

tb

e in

pla

ce

to r

ewar

d m

ult

i-p

rovi

der

arr

ange

men

ts fo

r jo

int

del

iver

y, in

itia

l fo

cus

aro

un

d B

CF

Drivers Enablers

PC, 28/3/14


Appendix 7 Draft NHS SW London 5 Year Plan-on-a-Page

For information: SWL SPG System plan on a page v.07 submitted to NHSE on 20th December 2013

People in south west London can access the right service, when and where they need it. Many services are delivered close to or in people’s homes, and innovation in service delivery is encouraged. Our hospitals are centres of excellence.

All care is safe, consistently of a high quality, and delivered by a suitably trained and experienced workforce. Patients are involved in their care, value their NHS and feel valued by it.

Improve safety, clinical quality and patient experience• We will address the issues in our Case for Change and will

agree the scale and pace of change in spring ‘14• As a minimum, we will commission:• full London Quality Standards (LQS) from [date TBA] &• Full implementation of the 10 Keogh key standards re: 7

day working by 2018/19

Overseen through the following governance arrangements• CCG Governing Bodies• Strategic Commissioning Group (SCG) composed of CCGs

and NHSE with LA representation• SWL Partnership Group: commissioners, providers and LAsWe will set up a number of subgroups eg:

• Patient and Public Advisory Group• OOH Programme Board• Clinical Advisory Group• Finance and Activity Group

Financially sustainable providers of NHS care• By 2018/19 all our providers of NHS care will be delivering

quality services in a financially sustainable way

Financially sustainable commissioners of services in SWL • By 2018/19 all commissioners of services in SWL will be

delivering a financial surplus

Delivery of the Out of Hospital Programme• Our CCGs will support each other in delivering individual

OOH strategies, focused on improving patient outcomes, integration and access.

• We will track our progress against our OOH metrics

Measured using the following success criteria• All providers of NHS care delivering high quality and safe

services in a financially sustainable way• All our commissioners delivering a financial surplus• Delivery of the agreed priorities• Health and wellbeing boards to have signed off all BCF

plans by March 2014• Demonstrable improvements in patient outcomes and

experience

Improve Out of Hospital (OOH) care, as a minimum, the following changes (from 10/11 baseline):

NHSE levers and enablers for primary care

Priorities for primary care• NHSE’s objective(s) for primary care in SWL to be agreed with

local commissioners and incorporated in the plan.

NHSE levers and enablers for specialised commissioning

Closer working between health and social care• We expect providers of NHS services to work closely

together, to share information and to work across the boundary between health and social care

Delivery of the Better Care Fund (BCF)• A significant shift of resources from institutionally based

services into services that support patients in their own homes and communities & agreed with acute providers

• CCGs will agree with LAs a set of common principles to be applied across SWL

• CCGs to develop BCF plans by March 2014

• 10% fewer A&E attendances

• 50% of remaining A&E attendances seen in an Urgent Care Centre

• 15%* fewer NEL admissions

• 5% reduction in overall outpatient appointments

• 12%* of outpatient appointments to be undertaken not on an acute hospital site

Priorities for specialised commissioning• NHSE’s objective(s) for specialised commissioning in south

west London to be agreed with local commissioners and incorporated in the plan.

Risk Mitigation(s)

CCGs and trusts run into deficit

•Demand management•Providers to reduce fixed costs

Acute providers differentially meet LQS with worsening unacceptable variation in safety and quality

•Providers to develop joint plans to be agreed with SCG•Contractual penalties/rewards egCQUINs•FT applications will be reviewed to ensure consistency with this plan.

Acute, MH and community providers do not work together

•A binding agreement between providers and commissioners to deliver the agreed changes •Contractual levers across different sites – eg CQUIN incentives

Recruitment and retention of appropriately skilled workforce

•Workforce engaged in co-designing new models of care and developing the necessary changes to education and training to meet the needs of the new system.

VIS

ION

Priorities Levers and enablers Governance

Priorities for Mental Health• High quality standards, care focused in the community,

reduced reliance on in patients beds and fewer sites for theseWorkforce transformation• Support local initiatives which engage the workforce in

meeting the dual challenge of delivering the necessary shifts in activity out of hospital whilst meeting the Keogh and LQS standards.

Key risks

Success criteria

Transparency re comparative performance• Increased provision of publically available information

*Targets vary by CCG

Development of a Joint Commissioning framework which will specify the pace of change to implement our priorities and be delivered through:• The commissioning process, specifically a shared approach

to contractual T&Cs and:1. Development of clinical networks to reduce variation in standards of care•Continued support for the Maternity Network•Development of a Children’s Network•Expectation that acute providers will work in networks eg: cancer, pathology, urgent care etc2. Provider development of clinical pathways•Providers to work together to redesign clinical pathways to deliver 7 day working and LQS – this may require proposals for changes in service configuration to be agreed at SCG