operational plan 2019/20

Operational Plan 2019/20 Final

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Operational Plan 2019/20

NHS Coventry & Rugby Clinical Commissioning Group

NHS Warwickshire North Clinical Commissioning Group


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Contents Section Page

1 About this document 4

2 Our system 7

3 Our place 9

4 Our plan 18

• Assurance & performance 18

• Quality 120

• Finance 21

• Engagement 23

• Risks 24

5 Our response to the NHS Planning guidance for 2019/20 27

• Cancer 27

• Maternity Care 43

• Mental health 47

• Out of Hospital care (OOH) 59

• Personalisation 70

• Planned Care 77

• Urgent & Emergency Care 79

6 Appendix 82

1. Coventry JSNA profile 82

2. Warwickshire JSNA profile 82


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SECTION 1: About this document This document sets out the Warwickshire North and Coventry and Rugby CCGs Operational Plan for 2019/20. Developed in response to the publication of the NHS Long Term Plan (NHS LTP) and associated NHS Operational Planning and Contracting Guidance (the NHS OP&CG), this plan recognises that 2019/20 will be a pivotal year for the two CCGs and the wider Coventry and Warwickshire health and care system. Just as the NHS LTP describes 2019/20 as a ‘transitional year’ for the NHS, this Operational Plan gives a clear signal that 2019/20 will be a year of transition in Coventry and Warwickshire – one in which the architecture of our system will change and both CCGs and Providers will redefine their ‘business as usual’ ways of working. All of this with the aim of creating conditions in which, over the coming five years, real progress is able to be made in transforming the way that health and care services are commissioned and delivered, resulting in improving outcomes for individuals and populations, so that over time the people of Coventry and Warwickshire are healthier and more able to live fulfilled lives.

As this Plan will demonstrate, we have strong foundations to build from moving into 2019/20. The NHS LTP describes a new world of system working, in which, by April 2021, Integrated Care Systems (ICS) cover the whole country. Section 2 outlines what has already been achieved in 2018/19 in relation to the development of an ICS for Coventry and Warwickshire and how we will build on this during 2019/20. The formation of the Coventry and Warwickshire Better Health, Better Care, Better Value (BHBCBV) Partnership in 2016 is recognised as a critical milestone in the local ICS journey. As a consequence of the experience gained over the last two years through the development and delivery of the BHBCBV programme, Commissioner and Provider organisations from across the Coventry and Warwickshire system are firmly of the belief that if we are going to deliver the best possible outcomes for our population within the resources available to us:

• We cannot keep doing things the way that we have always done them; and • Greater collaboration between organisations (be that between Commissioners, between Providers or between

Commissioners and Providers) is needed to transform services and manage resources.

The work (both completed and planned) described in Section 2 demonstrates every BHBCBV partner organisation’s full commitment to accelerating the development of the ICS in 2019/20, driving the transition of our system from its current form to a new one which both enables and prioritises collaboration.

Section 2 provides an overview of the work streams established within the BHBCBV programme. These are five transformational work streams (Planned Care, Urgent and Emergency Care, Mental Health and Emotional Wellbeing, Maternity and Paediatrics and Proactive and Preventative Care) and three enabling work streams (Productivity and Efficiency, Digital Transformation and Estates). Each work stream has established its priorities for 2019/20 and the work stream plans will drive the achievement of deliverables identified in the NHS OP&CG. Section 2 also highlights the work undertaken by the BHBCBV Clinical Design Authority (made up of senior clinicians from across Coventry and Warwickshire) during 2018/19 to develop a system-wide clinical strategy. The clinical strategy identifies three priority areas for the local system which are frailty, mental health and musculoskeletal (MSK) services. These are areas where there is a clear opportunity to deliver improved outcomes for patients and a recognised need to test whether the combined financial investment being made by the system represents value in relation to the outcomes being delivered. We are rolling out Place Based profiles as part of our JSNA process. These allow us to dig deeper into the needs, health inequalities, assets and priorities for our local communities than our city and borough wide profiles allow. As Place Based profiles are developed these will inform our place based approaches to improving health and wellbeing and reducing inequalities. We want to ensure that the first chapter of all our work streams is prevention and reduction in inequalities and this will be overseen by our Proactive and Preventative Care work stream.

As we have already signalled in our commissioning intentions for 2019/20, the future Coventry and Warwickshire ICS will be a place-based system, made up of four places including South Warwickshire. Section 3 sets out what we expect to be happening at Place level in 2019/20. Our own experience through the on-going local Out of Hospital transformation programme and that of other areas nationally, tells us that place will be the level where most service change will take place in the future ICS, where decisions about how money is spent will be made and where opportunities to get better value will be identified. As such, place development will continue to be an area of focus in 2019/20. We will again be able to build on the foundation of work completed in 2018/19. Design principles agreed in January 2019 will provide a framework for the three CCGs to work with providers in each place in a way that will


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ensure that there is consistency of purpose across the places whilst allowing local variation on the delivery of the purpose, recognising the need to reflect different populations and provider landscapes in each place.

In line with the NHS LTP and as part of place development, supporting the development of GP networks will also continue to be a priority in 2019/20. Networks will be the building blocks of the future ICS and much progress has already been made. We have seven networks in Coventry and three in development in WNCCG and one PCN in Rugby – however some of these networks are larger than the 50,000 and may be subdivided to reflect the new PCN contract requirements. Section 3 recaps what has been achieved locally in relation to Network development to date and what we will be focusing on in 2019/20. We acknowledge that considerable effort and resource will need to be directed into expanding engagement with our GP and broader general practice workforce during 2019/20 to ensure that they understand and are confident in the purpose of their participation in both Networks and place. We expect that the publication of the new national network contract during 2019 will provide additional impetus for this engagement.

As set out in Sections 2 and 3, both CCGs and Providers will need to devote significant time, resource and energy to reshaping the architecture of the local system in 2019/20. For CCGs the focus will be on the roadmap to developing a single commissioning function for Coventry and Warwickshire. This “Strategic Commissioner” will move away from commissioning volume and activity to commissioning improved outcomes for defined groups of people or populations, as well as focusing on health inequalities within the population. This commissioning approach will be fundamentally driven by engagement with patients and the public to understand what outcomes matter most and are meaningful to them. Whilst the development of the single commissioning function will accelerate the CCG’s ability to act as a Strategic Commissioner, it is not contingent on it; indeed our commissioning intentions clearly articulate our intent to act as a Strategic Commissioner as our standard approach in 2019/20. Already we have done this within the local Out of Hospital and CAMHS (Child and Adolescent Mental Health Services) transformation programmes, which have delivered two new outcome based contracts.

Section 3 sets out how, acting as a Strategic Commissioner and as the system architecture gradually evolves to that of a fully functioning ICS, we will focus on a number of ‘developmental’ contracts during 2019/20. Not only will this enable the CCG and Providers to further develop and embed the competencies and capabilities that will be required within the future ICS, it will also allow us to drive improvements in quality, outcomes and financial sustainability in the short to medium term. A number of national and local priorities (including frailty, mental health and MSK services) will ultimately sit in one the developmental contracts. The developmental contracts should not, however, in themselves be seen as a solution; what they will enable us to do is put in place the financial and contractual incentives for transformation to happen at place level.

In Sections 4 and 5 we confirm that we will not be distracted from the need to remain focused on the delivery of our statutory functions as a CCG (as these relate to performance, quality, finance and engagement) and the continued delivery of priorities set out in our 2016-2020 strategy ‘Translating our 2020 Vision into Reality’ in the coming year of transition. Although 2019/20 is the final year of the strategy, the key drivers for it remain relevant and the priorities that it identifies are aligned to national priorities set out in the NHS LTP and reflected in the NHS OP&CG. The strategy’s focus on the transformation of out of hospital care is particularly noteworthy. Through the local Out of Hospital transformation programme, which was a major area of focus within the CCG’s previous two year Operational Plan, the out of hospital system in Warwickshire North, Coventry and Rugby is already being fundamentally reshaped in line with the new model described in the NHS LTP. The Transformation Programme also gives us local proof of the effectiveness of contracts delivered through an outcome based approach in driving integrated, person-centred care. Our strategy and associated plans will continue to be a focal point for our work in 2019/20 and we remain committed to finishing what we have started, even as we work on the development of the ICS and begin to pave the way for a seamless transition to a new system wide strategy.

In order to ensure that our population and stakeholders have maximum clarity regarding our response to the NHS LTP and NHS OP&CG, in Section 5 we confirm our priorities and deliverables for 2019/20 against the key areas identified in the NHS OP&CG. We have ensured that there is a clear read across between the priorities identified in Section 5 and the deliverables outlined in sections 4.1 to 4.9 of the NHS OP&CG.

This Operational Plan should be read in conjunction with other published documents including our commissioning intentions 2019/20, Primary Care strategy and GP workforce strategy. These can be downloaded from:


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Warwickshire North CCG: https://www.warwickshirenorthccg.nhs.uk/

Coventry and Rugby CCG: https://www.coventryrugbyccg.nhs.uk/Home

https://www.warwickshirenorthccg.nhs.uk/

https://www.coventryrugbyccg.nhs.uk/Home


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SECTION 2: Our System

The NHS Long Term Plan (LTP) describes 2019/20 as a transition year for the NHS as we move from our traditional, competitive ways of working towards a more collaborative and integrated approach. During this period, the Coventry and Warwickshire health and care system, will focus on three key priorities; continue to deliver great care for our patients; to develop, test and embed the building blocks which allow us to transform the way we commission and provide services in the future; and to refresh our system Health and Well Being Strategy and develop an associated five year Transformational Plan that ensures we deliver the best quality and outcomes for our population, within the resources available.

Priority 1

Throughout 2019/20, the BHBCBV programme will maintain over-arching responsibility for driving system-wide achievement of all national deliverables including the NHS Constitutional Standards and the targets/milestones identified in the LTP. Each programme work-stream has already identified the national deliverables for 2019/20 underpinned by a project plan. Where appropriate, these plans are mirrored at organisation and place level to ensure system alignment. Monthly progress will be monitored and reported through existing governance arrangements up to the BHBCBV Board.

Alongside the national priorities, senior clinical leaders across the system have worked together as the BHBCBV Clinical Design Authority (CDA) to produce a Clinical Strategy. This identifies three local priorities that will be our focus for 2019/20; frailty, musculoskeletal (MSK) and mental health services. These were prioritised following a full review of all services and were thought to offer the biggest opportunity to demonstrate improved value-based outcomes. Throughout 2019/20, the CDA will oversee work to develop best practice pathways for these areas and at place, work will be undertaken to redesign pathways to maximise quality and outcome for minimal cost. To support this we have invested in a Value Improvement Programme for our clinical leaders, which will be rolled out in 2019/20.

Priority 2

As highlighted in the LTC, significant transformational change is expected over the next five years. As such, in 2019/20 we will have all the necessary foundations in place to commence this transformational change at three levels; system, place and network. At system level, the BHBCBV programme will be redesigned to better support system-wide transformational projects and performance such as our ‘single shared-care’ record project, system-wide estates and digital strategies and a system-wide performance framework.

The Coventry and Warwickshire place forum have identified that our system will be made up of four places; North Warwickshire, Rugby, Coventry and South Warwickshire. Through our Out of Hospital (OOH) programme we have already successfully tested our assumption that significant amounts of the service transformation can be delivered in place and that these defined communities are the most appropriate for our system. To accelerate place development, we have also produced a set of design principles that support the Strategic Commissioner and the Provider Alliance to interact with each other across the four places in a consistent manner whilst allowing for local variation of need and delivery.

In 2019/20 we intend to build on these strong foundations at place and further engage our local populations with regards to defining the services they want. We will align this with Place JSNA/population health management data to identify true population need and then utilise this information to define the outcomes required for that defined Place population.

As part of place development, we will focus significant energy on supporting 100% system-wide coverage of well-developed GP Networks. These are critical building blocks within our ICS and they will be key partners in identifying possible place- based opportunities for more out-of-hospital models of care, for the co-location of integrated community and mental health teams, for supporting the redesign of care pathways and for implementing horizontal efficiencies such as shared clinical workforce and back office functions.

As well as embedding a process to allow transformational change to accelerate at system, place and network level, we recognise the need to redesign the way we commission and provide services. For our three CCGs, the focus for 2019/20 will be working together and with the Local Authority to develop of a single Strategic Commissioner function


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as identified within their 2019/20 commissioning intentions. Their commissioning approach will move away from the traditional commissioning of volume and activity style contracts to commissioning improved outcomes for defined groups, underpinned by robust engagement with patients and the public and population health management data. This approach has already been successfully demonstrated through the commissioning of the current OOH and CAMHs contracts. Throughout 2019/20, our Strategic Commissioners will develop and award more outcome-based contracts initially Maternity and Paediatrics and Planned Care as well as explore the transition to our preferred end-state of a single ICP contract per Place.

Throughout 2019/20, we will also focus on how we redesign our services to respond to the identified commissioning outcomes. Both horizontal and vertical Provider Alliance discussions have commenced with 2019/20 priorities already agreed at system (maternity and paediatrics and cancer) and at Place (frailty, MSK and mental health). System providers have developed a Provider Alliance/Network (within our STP footprint and across into Hereford and Worcestershire) with 2019/20 agreements being made as to how they more effectively utilise resource, capacity and expertise across the systems in selected specialties. Providers are also well embedded in discussions at Place with regards to ensuring best practice pathways are delivered and clinicians are engaged in redesigning care pathways.

Priority 3

In response to the NHS LTP we will take the opportunity throughout the spring and summer of 2019/20 to work with our Health and Well Being Boards, our Local Authority colleagues, other partners, our staff and the patients and populations of Coventry and Warwickshire to refresh our system-wide Health and Well Being Strategy. This will be underpinned by a revised system Transformation Delivery Plan that outlines the programmes of work we will undertake over the next five years to deliver the best quality and outcomes for our patients and population within the resources available.


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SECTION 3: Our Place Setting the CCG Operating Plan within the ICS System Plan: The NHS Long term plan sets out an intention to continue to develop Integrated Care Systems, building on the progress the NHS has already made. By April 2021 ICSs will cover the whole country. NHS England described an integrated care system as an arrangement in which NHS organisations, in partnership with local councils and others take collective responsibility for planning and commissioning care, managing resources, delivering NHS standards, and improving the health of the population they serve. (NHS England 2017b in March 2017,).

Coventry and Warwickshire ICS will operate at 3 interdependent levels: Primary Care Networks (PCN) Places (Coventry, Rugby, Warwickshire North and South Warwickshire) and System (Coventry and Warwickshire).

As a CCG we have developed our operating plan within the context of this emerging ICS architecture, setting out our CCG ambitions for each of our places within the local ICS system; alongside our CCG strategic work programme priorities which we anticipate will be delivered across place’s or across the wider STP foot print by undertaking commissioning activities at the most appropriate foot print, be this at place (or across places) or as a single commissioner across our Coventry and Warwickshire system.

Consequently our plan represents a transition plan which recognises the statutory accountability of the CCGs and the population they serve, with clear reference to our commitment to drive forward delivery to achieve the requirements of the NHS operating plan / performance requirements; and contributing as a system partner in delivering the Coventry and Warwickshire system plan to deliver improving health outcomes for our populations.

Place:

Coventry and Rugby CCG has two distinct places. Coventry which serves a population of 490,000 with 69 GP practices and a unitary authority, and Rugby which has a population of 190,000 with 12 GP practices which sits within the County of Warwickshire.

Warwickshire North CCG is classed as one distinct place which serves a population of 125,000 with 26 GP practices which sits within the County of Warwickshire. The geography and population profile of each place is reflected in JSNA’s produced by Public Health (see appendix).

As health commissioners the 3 CCGs have worked together to develop a suit of consistent design principals for Place:

Place design principles

1

Robust systems and processes in place to in order to understand the needs of the local population and develop an agreed population health improvement plan that fits with the Health & Wellbeing Board Strategy; E.g. Integrated IT systems that support a population health management system and then the process and governance structures which allow clinicians to analyse the data and make decisions about people’s mental and physical health needs.

2

Mechanisms to effectively deploy the resources of all public sector organisation in a coordinated way to meet needs and promote Place based integration; E.g. We are able to mobilise the education sector to respond to young people’s mental health needs either through partnership working, or more formally risk and gain share agreements across all public sector organisations at Place, that allow the system to effectively use public money to address need, regardless of which organisation financially or operationally benefits.

3

Have in place arrangements that enable ability to respond to system wide outcomes in a way that is sensitive to place; E.g. Across the system we are all working to reduce obesity, but we can all tackle it in a different way to that of the other three places as long as we achieve a reduction.

4

Mechanisms to facilitate joint ownership of demand and cost; E.g. instead of the CCG commissioning GPs considering how to reduce demand for hip replacements on their own, they do it collectively with the orthopaedic surgeons and both groups take ownership for reducing system cost for hip replacements.


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5 Sets the environment for effective community engagement in improving outcomes and planning; E.g. Engagement with the community is frequent to ensure that services are meeting their needs and that they are encouraged to take action to improve their own health.

6

Encourages a collaborative provider market that is supported to innovate, in which there will be a collective GP and primary care voice; E.g. General practice has the mechanisms in place to be able to speak to the rest of the system in a way that that transforms service at practice, network and Place level. Other people in Place know who to talk to in primary care.

7

Clear and visible leadership; E.g. Identified planning lead to take lead on Place planning and assurance of population health improvement as agreed in the Place plan (in 1 above), E.g. Identified lead organisation/s that will be accountable for identifying and managing risk for the Place and its capitated budget set by the strategic commissioner, to deliver population health improvements.

8 Clear and effective governance arrangements that allow effective decision making at network, place and system levels.

For our CCG ‘place’ is about a move away from operating as individual organisations, towards collective action, with blended commissioner and provider functions, to achieve efficient, cost effect care, that delivers improved patient outcomes for our defined place population. The specific activities that will be undertaken at place are currently being scoped, (and as a membership organisation, we are currently engaging with our member practices), in recognition that some of the CCG commissioning activities are likely to transition to place within a future ICS arrangement.

Over the 2019/2020 operating plan period, each of our places will establish governance arrangements and embed clear reporting arrangements that connect our PCNs, Place Partnership Board, wider Integrated Care Partnership forum, and Provider Alliance, and Strategic Commissioner to achieve a fully functioning and mature ICS. At a place our focus will be on driving the local delivery system, engage meaningfully with local partners, coordinating and segmenting care delivery (uninhibited by organisational boundaries) through multi-disciplinary / integrated workforce, to deliver our operating plan and system plan priorities, contribute towards long term health plan reforms, and in so doing achieve improved population health outcomes.

Primary Care Networks and Out of Hospital Care:

General Practice is considered to be the foundation of the health service now and in the future; with care continuing to be based around general practice holding primary responsibility for a registered patient list. However, it is widely accepted that, demographic growth, aging population, more people living with chronic conditions, comorbidities and complex care needs are resulting in increased demand on general practice. This is further exacerbated by increased patient expectations characterised by demand for flexible convenient access to care, the impact of wider social determinants of health particularly for our most deprived population groups, provide a compelling case that our existing fragmented care system is unsustainable. It is in this context that we are seeking to build the resilience and sustainability of general practice, whilst transforming out of hospital care within each of our Places.

Our ambition is to provide each of our citizens within each place, with a primary care and out of hospital offer, that includes support and tolls to facilitate and promote proactive preventative and self-care, access to anticipatory and same day urgent care, rapid response and new standardised models of care for key cohort groups to address variation and inequality.

A fundamental building block for delivering and co-ordinating this care ambition within each of our places will be the development of our Primary Care Networks around which out of hospital care will be organised. NHSE describes the function of a PCN as ‘Enabling the provision of proactive, accessible, coordinated and more integrated primary and community care improving outcomes for patients; formed around natural communities based on GP registered lists, often serving populations of around 30,000 to 50,000.

Within each of our places we have already made significant headway with regard to developing PCNs. Our operating plan appendix now sets out our intention to mobilise a support offer that will enable each of our PCNs to develop and mature, so that they provide the personal care valued by both patients and GPs, achieve increased resilience through deeper collaboration between practices and others in the local health (community and primary care) and social care system, and provide the foundation for delivering sustainable care within each of our Places now and in the future.


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We will continue to build on the progress we have made in Out Of Hospital care; we already have an outcome based contract for OOH service in place across our CCG, with Place Based Teams already mobilised in each of our Places. Over the coming year we will utilise PCN’s as a vehicle to provide re-designed community-based and home-based services, in partnership with social care, the voluntary and community sector. Over the coming year we will further strengthen risk stratification and MDT case management, with Place Based Teams and general practice working alongside other local partners to provide proactive care to people at risk of becoming acutely unwell, as well as urgent rapid response capacity for individuals with escalating needs, to avoid hospital admission where is safe to do so. Our PCNs will provide a local focal point for partnership collaboration and will be the delivery vehicle for holistic integrated care delivered by a range of providers including voluntary sector and primary care. As a CCG we are committed to continued investment in primary care as set out in the spending review and underpinning the commitments in the General Practice Forward View. This investment will focus on resilience and sustainability at a practice level and transform the care and services provided through PCNs for their local population. We have already made considerable progress in achieving 100% coverage of GP practices in PCN’s well ahead of the national 30 June 2019 target. We will now work with our PCN’s to support their journey through the NHSE maturity matrix and to work with PCN’s to identify and deliver on population health priorities, including focused action to manage demand, reduce variation, and extend the range of services available in out of hospital settings. The CCG is already in the process of refreshing its primary care strategy, which will be set within an overarching system strategy by autumn 2019. We will build on existing engagement with general practice, through our relationships with the LMC, GP federations and PCN to co-produce our refreshed strategy and to develop credible plans to mobilise and implement our plans. We already have a PCN development plan for each of our places, which will now be further developed in response to the NHS Long Term Plan. By June 2019 we will confirm our PCN local support and investment offer, and work with PCN leads to agree transformation priorities, local workforce plans and support requirements to enable our PCNs to mature. As a CCG with delegated primary medical care commissioning responsibilities we have set out plans for internal audits to provide assurance that our statutory functions are being discharged effectively. The scope of the planed audit will be:

• primary care commissioning and procurement activities; • primary care contract and performance management; • primary care financial management; and • governance of all primary medical care delivery.

We will work with Public Health and CCG intelligence teams to further enhance existing data packs and neighbourhood JSNA profiles that are currently available to PCNs, so that they have the data analytics for population segmentation and risk stratification, according to a national data set, complemented with local data indicator requirements, so that PCNs understand in depth their populations’ needs for symptomatic and prevention programmes including screening and immunisation services. General Practice Workforce: In order to achieve sustainable general practice and an extended Out of Hospital offer for our patients, we have developed a credible work force strategy, premised on the principal that: “A growing and ageing population, with complex, multiple conditions, means that personal and population-orientated primary care is central to our local health system, and the belief that, “if general practice fails, the whole NHS fails”. As a CCG we are clear that some work force challenges will require system wide action whilst others will be specific to place. It is in this context that we have led on the development of The Coventry and Warwickshire Primary Care Workforce Framework – Our Journey to Sustainable Primary Care Workforce. This document sets out the workforce implications, challenges, and opportunities we face as a local system, if we are to achieve sustainable transformed general practice, which is at the centre of new models of out of hospital care.

As a system (STP) we currently anticipate a GP workforce gap of 180 WTE. Our Primary Care Workforce Framework outlines the strategic objectives to address this gap and details the actions that we will take collectively across our


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health system to deliver and support a resilient primary care workforce, working as part of a multi-disciplinary team working together to deliver out of hospital care, organised around general practice lists.

In summary our latest work force trajectory plans to deliver:

• 5.4% increase in GPs • 7.1% increase in nurses • 8.3% increase in direct patient care roles • 324.1% increase in Clinical Pharmacists

As a CCG we are committed to working at a system level through the LWAB, STP work stream and our Primary Care GPFV workforce sub group; to ensure we have credible plans to meet the projected work force and skill mix gaps. As a CCG we will focus on:

I. Stabilising current primary care workforce – with recruitment and retention activities II. Putting in place the foundations for a more robust approach to workforce planning, so we have

workforce succession plans in place, encourage carer development and on-going professional development and training.

III. Investing in the development of the wider primary care workforce – encouraging new roles to expand the general practice team skill Mix, development of portfolio roles and extended GP roles, ensuring staff are empowered to work to their clinical competence.

IV. Supporting the continuing development of primary care networks – to encourage sharing of resources, skill mix, peer support, mentoring, vital for a resilient workforce.

The key workforce initiatives that we will take forward during this operating plan period reflect the planning guidance requirements for providers in respect to action focused on, work force supply and retention challenges, move towards establishing bank first temporary staffing model, workforce transformation encouraging new roles, attracting and retaining trainees. The specific initiatives we will implement during this operating planning period include:

Local GP Retention scheme and promotion of HEE scheme Recruitment campaign across all areas of PC Encouraging practices to become training practices and offer training placements and ‘Taster’ clinical

sessions in local practices. GP Mentor Development programme Workforce survey and succession planning General Practice staff bank/network development Development of Portfolio GPs with community and acute providers Clinical Pharmacists deployed in general practice Leadership development programme for primary care HCA Training Nurse prescribing training Nurse Associate training Nurse Mentorship

We will continue to work closely with NHSE and our local capacity planners to ensure that all our member practices are aware of the workforce implications associated with EU Exit and through our localities teams, Practice Managers Forums, members meetings and PCN’s work to minimise any potential resilience risk in general practice.

General Practice Digital Transformation:

As a CCG we have identified 6 strategic priorities that will drive our GPIT work programme during this operational plan period:

IT infrastructure and digital solutions that reduce general practice work load and optimise efficiency Increase timely and convenient access to general practice IT enabled care co-ordination and care planning to support multidisciplinary working across locations and

settings.


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Respond to GP estate utilisation pressures releasing space for clinical capacity, and optimising extended access

Promoting and supporting self-care Enhance quality and safety – shared access to full patient records, remote access to records

We have an established GPIT work programme with a refreshed governance and reporting structure that connects our local GPIT working group with the STP Digital Transformation Board at a system level, so that at each place our local GPIT working group (which includes GP clinical representation and practice manager representation), as the end user shape our IT programme and drive achievement of our strategic digital transformation priorities; with a detailed delivery plan setting out the specific range of initiatives that will be implemented during this operational planning period through four focused delivery work streams summarised below:

1. Net-work infrastructure improvements - such as increased band width HSCN procurement to support 2. Hardware refresh – Updating GPTI infrastructure such as PC’s and sever cabinets and WIFI speed 3. Software refresh – Updating windows 10, Cyber security, improvements to Doc Man. 4. GPIT enabled productive general practice – such as digital dictation, single sign on, two way text

messaging, on line consultations, self-check-in and digitisation and summarisation of patient records, on line services such as prescription re ordering, on line consultations, telephone triage, on line booking, access to shared records, and access to self-care apps.

Our Digital work program reflects the GPIT Operating Model ‘Securing Excellence in GPIT Service and the 2019/18 addendum. We will assess the impact of our GPIT work programme using the national Primary Care Digital Maturity Assessment. Our Plan – Commissioning Intention Priorities – summary Warwickshire North and Coventry and Rugby CCGs: Primary Care

• Enhance the resilience and sustainability of general practice by working with member practices to maximise opportunities available through the General Practice Forward View to, embed high impact actions, adopt new ways of working eg IT solutions, and actively encouraging general practice to be part of a local primary care network (Clusters).

• Encourage GPs to proactively engage with the development of the Out of Hospital model ( MDT’s and Risk Stratification )

• Work towards having a full coverage of GP extended hours • To continue working with GP practices in developing flexible, timely access to general practice, as the

foundation for our local integrated care system.

Out of Hospital • Improve the quality of life for people with long term conditions • Identify people at risk of ill health or hospital admission who are ‘frail’ • Better coordinate the care of people with complex problems via joined up hospital and community services

Maternity and Paediatrics

• To reduce the numbers of stillbirths and neonatal deaths by 20% in 2021 and 50% in 2025 • Achieve 35% of women receiving continuity of carer during pregnancy (by March 2020) • Increase access to specialist perinatal mental health services • Continue working in a multi-disciplinary way across the Local Maternity System (LMS)

Urgent Care

• To provide better, clearer and easier-to-access alternatives to A&E, • Provide holistic support service for frequent A&E attenders to help address their non-clinical needs • To develop and implement plans to ensure urgent treatment centres meet the national specification standards

for integrated urgent care Planned Care

• Deliver reduction in avoidable demand for elective care by tackling variations in referrals and providing referral advice to GPs

• Creation of redesigned and efficient hospital pathways, avoiding duplication and unnecessary hospital visits • To support patients to live well with cancer through the implementation of the Macmillan recovery package


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• To increase knowledge of the benefits of cancer screening across all population groups • Patients with diabetes receive the right support in accessing the right education and self-care resources to

self-manage their condition and live well • Review phlebotomy provision in Rugby

Mental Health

• Increase dementia diagnosis rate • Increase number of people accessing talking therapies • Improves services for people experiencing first episode of psychosis. • Reduction in out of area mental health and learning disability placements • Improve the system’s response for children and young people in crisis. • Continue to reduce hospitalisation of people with a learning disability and/or autism.

Self-Care An overarching theme for the 2019/20 localised commissioning intentions will be Self-care. Patients need to be provided with the necessary skills and education to help them better manage their own condition. Improved partnerships and collaborative working will contribute to:

• Strengthening self-care and education provision for our patients • Continue to strengthen our partnership working with Public Health to promote healthy lifestyles • Improve our population access to information to support them to self-care, and access life style services, local

community assets through effective sign posting and navigation support. • Develop in partnership with the Local Authority a sustainable social prescribing offer that addresses the social

determinant of health and diverts non clinical demand appropriately. • Multi-disciplinary working with community pharmacists, secondary, primary care diabetes services • Improved investment into local diabetes services


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Key Focus Areas for 2019/20 Commissioning Intentions (in reference to JSNA priority areas and key deliverables from the NHS operating Plan)

JSNA Priority WN Cov Rugby Operating Plan Priority Mental Health Improvement in diagnosis for people with

dementia.

Dementia diagnosis rate to be delivered at / maintained at 67% of prevalence

Improvement in quality of life for people with a mental illness

Maintain delivery of access target for IAPT ( 19% of prevalence in 2019/20)

Maintain 2 week standard for being seen in early intervention for Psychosis

Reduction in Out of Area placements Reducing Self Harm in young people in particular including building resilience

Further develop crises response for Children and young people and fully implement a ‘CAMHs 3.5 service’ model

Cancer Reduction in under 75’s mortality rates from Cancer by supporting the following:

• Halt rise of obesity in children and reduction in adults who are obese

• Reduction in smoking in adults • Increase in physical activity • Increase screening uptake • Reduce inequality of screening

uptake

Ensure all eight waiting time standards are met, including the 62 day referral –to-treatment cancer standard.

Cardiovascular Disease

Reduction in under 75’s mortality rates from Cardiovascular Disease (CVD) Increase in Health Check uptake

Children & Young People and Maternity

Reducing Teenage Pregnancy rates Vulnerable Children (including LAC) Improving levels of educational attainment and employment Reducing higher rates of child mortality Reducing higher rates of 0-4 years A&E attendances Reducing higher rates of self-harm related hospital admissions for 10-24 yr olds Reducing higher rates of admissions due to substance misuse amongst those aged 15-24 years Reducing higher rates of under 18 conceptions Lower rates of breastfeeding at 6-8 weeks

Deliver improvements in safety towards the 2020 ambition to reduce stillbirths, neonatal deaths, maternal death and brain injuries by 20 and by 50% in 2025 Increase the number of women receiving continuity of the person caring for them during pregnancy Continue to increase access to specialist perinatal mental health services

Physical wellbeing

Reducing obesity, improving diet and physical activity Reducing higher rates of smoking in those aged 35 years + Reducing levels of substance misuse – alcohol and smoking Reducing levels of infectious diseases including HIV, TB and increasing immunisation rates

Planned Care Reducing higher rates of hip fractures in those aged 60 years +

Meet and maintain planned care referral to treatment waiting time standards Deliver reduction in avoidable demand for elective care by tackling variations in in referrals and providing advice first options for primary care Creation of redesigned and efficient hospital pathways, avoiding duplication and unnecessary hospital visits


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JSNA Priority WN Cov Rugby Operating Plan Priority Expanding cancer screening uptake – focus on bowel, breast and cervical cancer

Primary Care Providing extended access to GP services, including at evenings and weekends, for 100% of the population Delivering their contribution to the workforce commitment to have an extra 5,000 Doctors and 5,000 other staff working in primary care Ensuring every practice implements at least two of the high impact ‘time to care’ actions Actively encourage every practice to be part of a local primary care network

Urgent and Emergency Care

Higher excess winter mortality

Deliver national performance targets for A&E and other urgent care targets Deliver integrated urgent care services with simple access for patients Standardise Urgent Treatment Centres in line with national standards

Transforming Care for people with Learning Disabilities

Continue to reduce inappropriate hospitalisation of people with a learning disability, autism or both

Prevention and Health Inequalities Coventry and Warwickshire face complex health and wellbeing challenges and inequalities across our geography. Healthy life expectancy and many of our health outcomes mirror patterns of deprivation across the region, generally with worse outcomes affecting the north east of Coventry and the Nuneaton and Bedworth areas of North Warwickshire. These patterns mean that certain areas may need greater resource to improve health outcomes than others. Coventry has an ethnically diverse population and our approaches and interventions need to be tailored to reflect this. The two Health and Wellbeing Boards (HWB) for Coventry and Warwickshire are meeting on a regular basis as the Place Forum to work on collective system challenges. As a key organisational member of the HWBs and Place Forum we have signed up to the Coventry and Warwickshire Health & Wellbeing Concordat and system design. These outline our principles and ways of working to prioritise prevention, strengthen our communities, coordinate our services and share responsibility across organisations and partnerships. We have agreed system level priorities for a Coventry and Warwickshire wide Year of Wellbeing 2019; celebrating and sharing good practice, improving physical activity, tackling social isolation and promoting workplace wellbeing. Both Coventry and Warwickshire local authorities are leading on Place Based Joint Strategic Needs Assessments, helping us to better understand the needs and assets of our local communities engage with local communities and provide evidence to inform our commissioning intentions. The coming years offer great opportunities for improving health and wellbeing through physical activity, sports and the arts. Coventry is European City of Sport 2019, City of Culture 2021 and Birmingham and the wider region will host the Commonwealth Games in 2022. The Marmot programme approach emphasises the need for a broader view of health inequalities, recognising our need to influence wider determinants of health such as housing and employment, take a life course approach promoting the best start in life through our maternity and paediatrics work programme and the need for a proportionate universalism approach to our resources with greater emphasis on those with greater needs. We work to ensure these principles are at the heart of our commissioning and partnership approach. We know that alcohol, smoking, obesity, inactivity and many more issues impact on the health and wellbeing of our population, increasing the risk of long term conditions and early preventable death. Our local Public Health teams


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commission a range of services and programmes that can support people to live well, including healthy lifestyles, sexual health, drug and alcohol services and affordable warmth programmes. We will work to ensure that our pathways and services link in to these, giving brief advice, signposting and referring as appropriate. Health checks are a great opportunity to identify and respond to lifestyles risks, cardiovascular disease risk and pre-diabetes. The National Diabetes Prevention Programme (NDPP) started in Coventry and Warwickshire in April 2018 and we will continue to roll this out across the region as the programme expands. Where our primary care networks and wider NHS partner organisations deliver or contribute to these services we will support improvements in uptake and delivery through our partnerships and contractual processes. Long term conditions often represent the onset of regular contact with health services for people and impact on quality of life and healthy life expectancy. In addition to the NDPP we are actively working to improve our offer for people with diabetes, strengthening our self-care and education offer and improving delivery of care and outcomes across primary, community and secondary care pathways. We recognise the importance of supporting prevention and better outcomes for people with cancer through improving uptake of screening programmes, improving early diagnosis rates and streamlining site specific pathways. We are actively working to improve in these areas and have created a network of cancer champions and strengthened our approach to the promotion of bowel and cervical screening. We are working to improve our identification and treatment of atrial fibrillation and wider cardiovascular disease risks. Our out of hospital transformation programme for 2019 onwards includes work to strengthen our community pathways for heart failure and respiratory disease. We know that people with severe and enduring mental illness and learning disabilities are disproportionately affected by lifestyles risks and poor health outcomes and are actively working to ensure that they have good access to physical health checks and appropriate risk reduction and management. We are working with our communities and partners to promote strong resilient communities and networks influencing how and when people access our services. We are strengthening our links to community pharmacies recognising the role they can play in self-care and prevention. We are working through our primary care networks, out of hospital transformation programme and voluntary and community sector partners to strengthen our approach to healthy ageing and frailty including approaches such as social prescribing, navigation and buddying to recognise the wider contributors to health and wellbeing and help people engage with support beyond formal services.


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SECTION 4: Our Plan Assurance & Performance The NHS Long Term Plan 2019 highlights the key priorities that are fundamental to Coventry & Rugby CCG and Warwickshire North CCG to achieving further progress in the provision of high quality care for its residents, and there are several important performance measures that are used to demonstrate progress through the year, covering each individual area of care. Emergency Care The two CCGs will work to ensure that both Coventry and Warwickshire University Hospitals NHS Trust (UHCW) and the George Eliot NHS Trust (GEH), will move to a comprehensive model of Same Day Emergency Care (SDEC) operating at least 12 hours a day, seven days a week by September 2019. This will ensure that the proportion of acute admissions discharged on the day of attendance increases from around a fifth to a third of all patients. In addition both hospitals will ensure that by December 2019 their current frailty services are in operation for at least 70 hours per week, so that such patients can be assessed, treated and supported by skilled multidisciplinary teams delivering comprehensive geriatric assessments in A&E or care of the elderly receiving wards. Both CCGs are working with providers on the redesign of urgent care services outside main A&Es, to designate community based services as Urgent Treatment Centres by December 2019, this simplifies the offer for patients and adds additional services into previous minor injury centres, WICs so that less severe conditions can be dealt with more quickly away from the main A&E, with access to a range of diagnostics and operated by a multi-disciplinary team and being open at least 12 hours a day. One key performance measure will be the ability to book appointments to this service directly from the patient contacting NHS 111, doing so helps remove uncertainty by the patient as they know they are expected and have a time for their appointment. Across Coventry and Warwickshire we have seen the numbers of delayed transfers of care in acute hospitals reduce by over 40% during 2018-19, which has had the effect of freeing up the equivalent of 67 acute medical beds, the CCGs have agreed through the Health and Well Being Boards (HWBs) how to sustain these reductions in (DToC) rates through 2019-20. Care Uk who provide NHS 111 services for the West Midlands and therefore for our residents, have in year increased the proportion of calls with a clinical assessment to over 50%, this improvement will be sustained in 2019-20, and we will work to enable patients to be directly book patients triaged by the service into a face-to-face appointment where needed. During 2019-20 there will be a national clinical standards review that will develop new ways to focus on patients with the most serious illness and injury, and indicate new clinical standards to be measured, likely to be in place by October 2019. Until the review is completed the existing NHS Constitution standards remain in force, namely that 95% of patients attending A&E need to be seen, treated and discharged within 4 hours. This is a measure where, as Coventry and Warwickshire we have seen real improvements in 2018-19 over the previous year, and expect to see further improvements in the first half of 2019-20. Elective Care Referral to treatment times RTT have shown significant improvement during 2018-19, and both CCGs are committed to sustaining this improvement into 2019-20, and we will continue to provide patients with a wide choice of options for quick access to elective care, including promoting the choice of patients via e-Referral service to include referral to providers with the shortest waiting times. This will include agreeing options for patients who have been waiting six months or longer being contacted by the provider on whose waiting list they appear, to be given the option of faster treatment at an alternative provider.


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We have worked hard during 2018-19 to reduce very long waits for treatment to ensure that no-one waits more than 52 weeks for treatment going into 2019-20 and this position will be sustained, through the whole of 2019-20. The CCGs and providers (UHCW & GEH) have been working jointly through 2018-19 on transformation programmes that help to reduce cancellations and non-attendances, as well as looking for opportunities to deliver care differently through the use of new technologies, such as increasing virtual appointments by phone and/or Skype like services, or removing the need for follow up appointments altogether, or through the development of direct access services such as MSK First Contact Practitioners; these will all be developed further in 2019-20. Part of improving the patients experience and reducing unnecessary waits is the delivery of shorter waiting times for access to diagnostic tests, the standard is that no more than 1% of patients should wait more than six weeks for a diagnostic test, this was met in 2018-19, for example that last monthly information showed that for Coventry & Rugby CCG only 0.1% (7 patients) were waiting more than 6 weeks, and that Warwickshire North CCG had no one waiting over 6 weeks, this was against a national position of 2.4% waiting over 6 weeks. Cancer treatment Both CCGs see that the delivery of all eight clinically set cancer waiting times standards remain an absolute priority, with most of these targets being met regularly on a monthly basis through 2018-19 these targets are:

• 93% of patients have first outpatient attendance within 2 weeks of being referred with suspected cancer. • 93% of patients with breast symptoms have their first hospital assessment within a maximum of two weeks. • 96% of patients wait no more than one month (31 days) for their first definitive treatment, from the date a

decision to treat is made, for all cancers. • 94% of patients wait no more than one month (31 days) for subsequent treatment, where the treatment is

surgery. • 98% of patients wait no more than one month (31 days) for subsequent treatment, where the treatment is drug

treatment. • 94% of patients wait no more than one month (31 days) for subsequent treatment, where the treatment is

radiotherapy. • 85% of patients receiving an urgent referral for suspected cancer should wait no more than two month (62

days) for their first definitive treatment, for all cancers. • 90% of patients receiving an urgent referral from NHS cancer screening programmes should wait no more

than two months (62 days) for their first definitive treatment. Mental Health The CCGs already spend more than their indicative spending target for Mental Health, but intend to use the extra resources outlined in the NHS Plan to deliver improved services such as community mental health teams, enhanced crisis services for adults, children and young people, and perinatal mental health services. Key deliverables are:

• By March 2020 Improving Access to Psychological Services (IAPTs) should be provided for at least 22% of people with anxiety disorders and depression.

• At least 50% of people who complete IAPT treatment should recover. • At least 75% of people referred to IAPT programme should begin treatment within 6 weeks of referral. • At least 95% of people referred to IAPT programme should begin treatment within 18 weeks of referral. • At least two thirds of people with dementia, aged over 65 should receive a formal diagnosis. • At least 56% of people aged 14-65 experiencing their first episode of psychosis should start treatment within

two weeks. • At least 34% of children and young people with a diagnosable mental health condition receive treatment from

an NHS-funded community mental health service. • At least 60% of people with a severe mental illness should receive a full annual physical check-up.


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Learning Disabilities and Autism In 2019-20 more will be done to ensure that the ambitions set out in ‘Building the Right Support’ are met and sustained, ensuring more people are supported to live in the community.

• 75% of people on the learning disability register should have had an annual health check. • All Learning from Deaths report (LeDeR) reviews are undertaken within 6 months of the notification of death in

the local areas. • An annual report is submitted through statutory bodies, demonstrating action taken and outcomes from

LeDeR reviews. • Ensure more children and young people with a learning disability, autism or both get a community Care,

Education and Treatment Review (CETR), such that 90% of under-18s admitted to hospital have either had a community CETR or a CETR post-admission.

• By March 2020, no more than 26 adults and 6 children with a learning disability should be in a mental health or specialist learning disability inpatient setting

Additional Performance Measures There are many more performance indicators that both CCGs report on and are held to account for delivery, many of these are operational standards and some of them fall into the Integrated Assessment Framework (IAF) for CCGs which has 58 individual standards broken across four key areas:

• Better Health (9 measures) • Better Care (40 measures) • Sustainability (3 measures) • Leadership (6 measures)

There is a certain overlap between these measures and some of the operational standards or constitutional standards, of the 58 standards those which the CCGs will focus on during 2019-20 include:

• Personal health budgets demonstrate the increasing number of patients in receipt of a (PHB) • Increasing the proportion of carers with long term physical or mental health conditions, disabilities, or illnesses

who feel supported to manage any issues arising from their condition(s). • Improving the score from 0 – 100 for the hospital sector-based indicators based on CQC inspection ratings on

five key questions for each service asking “Is it safe?”, “Is it effective?”, “Is it well-led?”, “is it caring?”, “is it responsive?”

• Further improvement to one-year survival from all cancers • Reducing reliance on specialist inpatient care for people with a learning disability and/or autism • Reducing the population use of hospital beds following emergency admission • Increasing patient reported experience of GP services • Increasing sepsis awareness raising amongst healthcare professionals • Demonstrating greater effectiveness of working relationships within the local system

These 58 measures are used by NHS England as way of marking the CCGs as to how well they are undertaking their responsibilities as a CCG, and used as part of their accountability framework by which CCGs can be ordered to make improvements. As such they are nationally produced each year and are made available by NHS England via their website https://www.england.nhs.uk/commissioning/regulation/ccg-assess/ Quality Our Clinical Commissioning Groups (CCGs) are committed to working together and in partnership with other stakeholders to commission local services, responding to the health needs and inequalities of our diverse populations. Our vision is to work with the people of Coventry, Rugby, Nuneaton, Bedworth and Warwickshire North to improve the quality and experience of services so that our population live happier, healthier lives, transforming lives together. Our

https://www.england.nhs.uk/commissioning/regulation/ccg-assess/


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CCGs support the Better Health, Better Care, Better Value vision to work together to deliver high quality care which supports our communities to live well, stay independent and enjoy life. Our CCGs are committed to working towards a ‘system’ Quality Assurance Framework (QAF) which can provide a mechanism to assure the CCGs’ Governing Bodies regarding the quality of service delivery in commissioned services; identifying early warnings so that potential failings in provider health services are avoided. The QAF would be applied at a system level and there are elements which will allow place based quality surveillance. The QAF includes an action escalation matrix that is used to inform of additional actions and quality visits to be considered for implementation by the CCG quality team, and partner agencies, in addition to routine surveillance. Building on the existing QAF and escalation matrix the combined system overview and system quality data aggregation will contribute to securing the best clinical quality outcomes for patients and the public. The three pillars of Quality, Clinical Effectiveness, Patient Safety, and Patient Experience provide the foundation of the QAF. The following definition of controls have been adopted to mitigate risk as part of business as usual; •Preventative - Stops the problem occurring •Detective - Can detect a problem once it has occurred •Directive – Written or verbal instructions such as manuals, policies and procedures The use of a system wide QAF will demonstrate to external stakeholders including NHS England, NHS Improvement, NHS providers, patients, patient advocate groups, charitable organisations and the public the approach being taken to fulfil our CCGs statutory duties with regard to quality. Quality and Equality Impact Assessments would be implemented across the system wide commissioning portfolio. Place based quality impact assessments will be used to inform if any service redesign, commissioning or decommissioning would have a detrimental on patient Quality. Finance Coventry & Rugby CCG

• The CCG has a commissioning budget of £727.8m to spend on healthcare for the population of Coventry and Rugby. In 2019/20, the CCG is expected to deliver a small surplus of £0.4m in order to maintain the 1.0% cumulative under-spend required under NHS England business rules.

Warwickshire North CCG

• The CCG has a commissioning budget of £282.8m to spend on healthcare for the population of Nuneaton, Bedworth and North Warwickshire. In 2019/20, the CCG is expected to deliver a break-even position; this will maintain but not start to repay the CCG’s historic cumulative over-spend which is expected to be £18.9m at the end of March 2019.

At the time writing, the two CCGs are completing contract agreements with their main providers that move towards Aligned incentive contracts, prior to the 19/20 budget being approved by the two CCG Governing Bodies in March. The planning guidance requires the CCG to increase spend on Mental Health at a higher rate than the allocation growth that we have received. We plan to deliver this commitment and to direct more growth into the expansion of local services rather than into high cost placements, reversing the pattern seen in recent years. Priorities for investment are likely to include CAMHS, Psychological Therapies, Perinatal MH and Early Intervention in Psychosis. We will also set aside the requisite £1.50 per patient to support the development of Primary Care Networks which will be a key to building the capacity and resilience of primary and community care, enabling these services to support people to stay as well as possible for as long as possible, thereby reducing the pressure on our secondary care services.


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Whilst the five year financial settlement for the NHS is very welcome, it will not be adequate to address the current budgetary pressures being experience across the health and care system and fund the improvements in services that we all want to see. A continued focus on reducing cost and demand therefore is needed. This will require a collaborative approach across the partner organisations, both at Place and at system-level. We wish to focus our energies on a joint work programme that focusses on early intervention, supporting people to better manage their own health and reducing unwarranted variation in the way that service are delivered and the outcomes achieved. This Transformation programme is planned to yield the following savings: Table – WNCCG QIPP Savings Table – CRCCG QIPP savings

These assumptions lead to expenditure plans for the two CCGs which show the following split by service area:

£m (net)Provider-facing 1.9CHC/S117 Packages 2.3Prescribing 2.1Running Costs 0.2Other cost avoidance 4.0

10.53.7% of RRL

£m (net)Provider-facing 5.5CHC/S117 Packages 2.6Prescribing 3.2Running Costs 1.0Other cost avoidance 9.5

21.83% of RRL

371.5

93.1

69.6

71.2

49.7

39.5

24.7 9.8

How CR CCG plans to spend its money in 2019/20 (£m)

Acute services

Mental HealthservicesGP Prescribing &Primary CareGP Services(Delegated)Community Services


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CCG Running Costs CRCCG has been set a running cost allowance of £10.3m for 2019/20 and WNCCG has been set an allowance of £4.0m. We will set our budget to ensure that we do not exceed this allowance and have some headroom to accommodate any restructuring costs required in year to prepare for the 20% reduction that we need to make in 20/21 as our contribution to the overall £700m administrative savings requirement for commissioners and providers by 2023/24. Engagement The health challenges we face both nationally and locally require collective action not only from organisations but a meaning partnership with our citizens. The way patients use and access health and care services over the coming years needs to change, if we are to deliver a high quality health system that promotes wellbeing, prevention self-care early intervention and supports people to have an active quality of life longer. Consequently our operational plans must be informed by patient insight and lived experience and a shared sense of ownership and responsibility for health and wellbeing; to achieve a local health system in each of our Places which is sustainable and valued by the local community; with access to more specialist care within the wider Coventry and Warwickshire Integrated Health System. We will continue to build our commissioning programme on a basis of inclusive coproduction. We will listen to our patients, the public and wider stakeholders, ensuring that we pay due regard to those with protected characteristics to give them opportunities for their voices to be heard. We will use the feedback we gather to help inform and shape our Place priorities as well as our strategic work programmes; so that care is shaped around population health needs with an understanding of the critical characteristics that need to shape the way service are commissioned and delivered to meet patients’ needs and deliver improved outcomes. We will adhere to the statutory guidance set out by NHS England for “Patient and public participation in commissioning health and care” and this will be embedded into the methodology we use to deliver engagement. To successful deliver this commitment , we will utilise local partnerships developed in each of our places to secure on going engagement with a range of all stakeholders that have access to our diverse communities and ensure this engagement shapes our decision making whether they are clinical staff, community leaders, providers, patients or the public at large. The diversity of our stakeholders means that we must adapt and offer multiple routes to allow people to engage with us on their terms, in the way they tell us is most convenient to them. As a commissioner of NHS services, our patients’ care and interests will remain at the heart of everything we do. We believe passionately that we can best

154.3

28.3

29.8

26.4

18.2

14.9 7.0

3.8

How WN CCG plans to spend its money in 2019/20 (£m)

Acute services

Mental HealthservicesGP Prescribing &Primary CareGP Services(Delegated)Community Services


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achieve our objectives by working in collaboration with our patients as well as the clinicians and other professionals who provide services to them. Understanding what our patients want and expect from the NHS will allow us to design services that are efficient, effective, sustainable and responsive to patient needs. Our engagement plans reflect the five principles for public engagement identified by Healthwatch and highlighted in the Next Steps on the Five Year Forward View and will be embedded within our engagement priorities for the coming year(s) which include engagement aligned to:

• our commissioning intentions – as set out above • delivering the NHS long-term plan; • system-wide priorities including maternity and paediatrics, planned care and out of hospital care; • securing patient and citizen partnership to achieve Better Health, Better Care, Better Value • ensuring patients and local citizens are at the very heart of our journey towards an integrated care system. • ensuring that we support patients to utilise new forms of digital technology to access their care.

The chart below shows how some of the core communications and engagement activities will be split across system, place, neighbourhood and individual as we take our operating plan and system plan forward over the coming year and beyond.

Risks The following section sets out the key risks to delivery of the Operation Plan, together with the mitigating actions that are in place. The CCG’s approach to risk management is set out below. This provides a framework for the effective identification and focused management of risk across the organisation and wider ‘system’. The Governing Body Assurance Framework (AF) provides the CCG with a simple but comprehensive method for the effective identification and focused management of risk across the ‘system’. Through the AF, the Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The AF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of


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risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified. The AF also brings together all of the evidence required to support the Annual Governance Statement. The AF is a working document and updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body quarterly. The AF is linked to the CCG Corporate Risk Register, the content of which is also provided for review by the Chief Officers Team. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above migrate to the AF and thereby inform the Governing Body agenda. Summary of Key risks Risk Causes Mitigations Failure to deliver the overall plan • Lack of, or under-developed, delivery plans to

achieve stated outcomes; • Lack of, or under-developed, delivery

structure in place; • Contractual arrangements not in place to

support delivery of plans objectives.

• PMO approach and oversight to ensuring all plans have sufficient detail and robust assumptions.

• Robust governance and accountability arrangements embedded across organisation and ‘system’

• Ensure contracts reflect Operational Plan (and STP) objectives and key deliverables

Failure to achieve financial balance in 2018/19 and secure financial sustainability from 2019/20 to deliver optimum services from the financial resources available

Savings opportunities may under-deliver against plan; Increasing demand in acute Trusts activity. Increase in prescribing costs. Cost pressures from Continuing Healthcare activity

• Project management approach to delivery of joint cost and demand reduction plans with providers. PMO in place;

• Benchmark and horizon scan to identify further cost and demand reduction opportunities;

• Focus on activity levels at acute provider with clear actions to mitigate against over performance;

• Close monitoring of joint cost and demand reduction plans with providers;

• Encourage innovative changes to improve efficiency;

• Clinical Executive , Finance and Performance and Governing Body review of expenditure and significant investments;

• Review progress on the system implementation on a regular basis through existing mechanisms.

• Implementation of Financial recovery plans to mitigate overspends

Failure to meet constitutional standards around A&E 4 hour standard and RTT standards presenting a potential risk to patient safety and experience.

• Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments;

• Risk of patient experience deterioration due to long waits;

• Risk of breaching constitutional obligations

• Where required, daily system wide teleconferences designed to ensure all actions to improve patient flow are taken as part of Urgent Care Escalation Plan;

• Quality reviews completed on site; • A&E Delivery Board embedded • Local resilience plans

Workforce • general practice vacancies identified; • Ageing workforce; • Level of NHS vacancies; • Recruitment of staff into local NHS; • Retention of staff during time of change; • Maintaining the support and engagement of

staff of all partners during the process; • Cultural and behavioural change.

• Agree general practice strategy • Develop and agree primary care workforce

strategy • Continuing to Work with HEE on the Local

Workforce Action Board • All benefits are clearly articulated in case for

change supported by a comprehensive engagement and communication plan

• Development and agreement of workforce plan to address recruitment and retention issues

Transforming Care • Failure of community provision to prevent

fewer admissions than the number of discharges

• Across LD and MH services, operationalise joint admission prevention standards for multi-agency working, including ensuring care education and treatment reviews completed


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Risk Causes Mitigations prior to hospital admission

• Continue regular health, social care and education joint oversight and review of individuals with LD or ASD in hospital

• With CWPT, jointly review all community specifications for LD services and ensure admission prevention offer is clear across specifications

• Agree roles and responsibilities for all community teams (health, education and social care) in relation to admission prevention and discharge.

• Continue accelerated discharge programme, including developing proactive plans with housing leads

• Deliver pilot DBT community pathway • Support regional Respond pilot

Digital Transformation • Lack of or under developed digital strategy • Contractual arrangements to support IT/

digital ambitions • Project management capacity • Compliance with digital maturity matrix

• Digital Transformation Board established with key work streams

• Chief Clinical Information Officer Role appointed

• Programme structure and governance in place for IT schemes

Development of a Single Coventry and Warwickshire Commissioner during 2019/20

• Lack of , or under developed preparation to deliver the transitional requirements

• Increased demand on CCG staff time

• Appointment of a Single AO and CFO • Joint Commissioning Committee established • STP Independent chair appointed • BCBCBV Board Oversight


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SECTION 5: Our Response to the NHS Planning Guidance for 2019/20

CANCER PLACE SRO: JANE FOWLES (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) ALISON CARTWRIGHT (NHS SOUTH WARWICKSHIRE CCG) Priorities Workstream Key deliverables Baseline Position 2019/20 Actions/Milestones

(steps to delivery) Success Measure (include reference to plan trajectories)

Relationship to System Programmes (Out of Hospital, Planned Care, etc.)

Timing Action Owner (CCG or Provider)

Strategy and Governance Maintain active participation in the Cancer Alliance.

STP wide Cancer Exec leads

• Agree Cancer STP

membership at Board level • Ensure STP structures and

roles in place (including clinical representation across all EAGS)

• Ensure governance structure and communication routes established

• Arrange a STP wider cancer workshop

STP membership to be finalised at March meeting STP Structure discussed and accepted at C&W Cancer Board.. Dialogue to commence with assigned clinical leads Under development

• Develop a local strategy

and system wide plan with key stakeholders aligned to national priorities and WMCA plan

• Formal sign off by C&W Cancer Board, STP and CCGs/providers

• Staff in post in line with

agreed structure • High level plan with

agreed STP trajectories • Continued monitoring

of plan & escalation process

Planned Care

March 2019 April 2019 April 2019 May 2019

System wide

As part of the Coventry and Warwickshire Cancer Board, continue to drive delivery of the National Cancer Strategy and recommendations from the cancer task force

C&W Cancer Board with support of STP wide Cancer Exec leads

Implementation of the local STP wide system plan reflecting national and local priorities and requirements

Strategy and Governance structure under development Detailed work programme developed and first review undertaken by STP Cancer Group (Feb 2019)

• Governance Structured finalized and agreed

• Ensure STP wide Task and Finish Groups established to address national / WMCA requirements and to support delivery of local trajectories

Workstreams achieve planned objectives and milestones as evidenced via reporting to the Cancer Board.

Planned Care March 2019 System wide

Prevention

Improve uptake of bowel cancer screening

Primary Care & Prevention

Secure local roll-out of the national plan to replace FoB with FIT in the screening Programme

Awaiting formal notification from national team confirming FIT roll out plan

Revised colonoscopy and pathology impact to be re-modelled in light of latest guidance. Capacity plan to meet demand to be developed and contingencies to avoid

Local roll out of FIT in line with national plan Increased uptake of primary screening offer. Increased detection of pre-cancerous lesions,

• Proactive and

Prevention • Planned Care

National teams to confirm date

Providers CCG and NHSE (commissioner of bowel screening)


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waiting time breaches to be developed. Service and workforce implications to be addressed.

(preventing cancer) earlier detection of cancer, reduced emergency diagnoses, increasing survival rates. Contributes to 75% early diagnosis target and reduced emergency diagnosis target.



All C&W GP practices endorsing primary invitations for bowel screening

100% of practices currently endorsing invitations Screening uptake: (2017/18) CRCCG 54.5% WNCCG 59.8% SWCCG 60.1%

Establish trajectory to improve the bowel cancer screening uptake

All practices providing endorsement, giving increased uptake of screening. Increased detection of pre-cancerous lesions, (preventing cancer) earlier detection of cancer, reduced emergency diagnoses, increasing survival rates Contributes to 75% early diagnosis target and reduced emergency diagnosis target.

• Proactive and Prevention

• Planned Care

Trajectories and targets to be agreed via work stream

System/Place



Promoting bowel screening among those patients who initially DNA (do not return their specimen) through delivery of interventions as part of a local research study with Warwick Medical School

Study protocol agreed, funding secured and data sharing agreement approved.

Estimate impact of interventions on endoscopy services and secure approval to proceed. Support GP Alliance in mobilizing plans to deliver interventions.

Estimated 70% of practices participating in the study providing giving increased uptake of screening. Increased detection of pre-cancerous lesions, (preventing cancer) earlier detection of cancer, reduced emergency diagnoses, increasing survival rates. Contributes to 75% early diagnosis target and


• Planned Care

Trajectories and targets to be agreed via work stream

System/place


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reduced emergency diagnosis target.

Support roll-out of bowel-scope screening


Roll-out of bowel scope as per plan

TBC Awaiting confirmation of current plan

Roll-out of bowel scope to 55 year olds, as per plan


• Planned care

Trajectories and targets determined by commissioner via contracts

System/place

Improve uptake of cervical cancer screening


Roll-out of campaign to promote uptake among community groups and GP practices

Screening uptake: (2017/18) CRCCG 70% WNCCG 59.8% SWCCG 74.8%

Continue promotion of cervical screening awareness messages among target population groups, using a range of media and through arrangement of further community events Support CRUK facilitator in working with GP practices to improve cervical screening uptake. Revise local campaign in light of national campaign anticipated March 2019 Evaluate the impact of the campaign on screening uptake and exception rates.

A greater proportion of patients will receive screening opportunities, resulting in cancer prevention and earlier detection of cancer, reduced emergency diagnoses, increasing survival rates Contributes to 75% early diagnosis target and reduced emergency diagnosis target.


• Planned care


Providers CCG and NHSE (commissioner of cervical screening)

Improve detection of cervical cancer through screening


Support implementation of HPV primary screening Programme for cervical cancer.

Partial roll-out of HPV primary screening (South Warwickshire)

Finalise local implementation plan to include: Adoption of revised call recall system Confirmation of laboratory readiness Staff training Implement revised patient communication Model/monitor colposcopy

Increased sensitivity of screening test, resulting in improved detection of abnormalities, earlier detection of cancer, reduced emergency diagnosis and increasing survival rates. Contributes to 75% early diagnosis target and


• Planned care

Trajectories and targets determined by commissioner via contracts. Implementation by 2020

Providers CCG and NHSE (commissioner of cervical screening)


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demand and capacity

reduced emergency diagnosis target.

Improved uptake of cancer screening in general

Primary Care & Prevention (with Comms support)

Engage with local communities to explore how to improve cancer screening uptake

• Link in with wider projects (currently led by WCC) to determine how the role of the cancer champion (clinical and no clinical can be taken forward)

A greater proportion of patients will take up screening opportunities, resulting in earlier detection of cancer and increasing survival rates


• Planned care

Ongoing in line with cervical screening comms plan

System

Early Diagnosis and Pathway Redesign

Early diagnosis of breast cancer - through Improved uptake of breast cancer screening

Rapid Access/Diagnostic pathways

Agree local action to improve breast screening uptake in light of recommendations of national review (anticipated summer 2019)

Screening uptake: 2017/18) CRCCG 69.1% WNCCG 74.6% SWCCG 73% (Insert % ED – stage 1 or 2)

TBC

TBC

Planned Care


Providers CCG and NHSE (commissioner of breast screening)

Early diagnosis of lung cancer


Develop plans in preparation for future participation in national ‘lung health check Programme’ (lung cancer screening)

Currently no local lung cancer screening (Insert % ED Lung Cancer – stage 1 or 2)

• Review learning from other national pilots

• Improve local lung cancer pathway, reducing bottlenecks so lung screening can be introduced

• Gather baseline data to support development of future business case

Future delivery of lung cancer screening resulting in earlier detection of cancer, reduced emergency diagnoses, increased curative treatment rates and increased survival rates.


• Planned care

By 2022 the lung health check will be extended (this may be earlier across STP)

System/Place


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Improved lung cancer pathway


Delivery of National Optimal Lung pathway

Non-compliance with NOLCP (insert detail)

• Appoint project manger • Support cross STP clinical

lung group in developing and delivering local plan in line with national and WMCA EAG guidance , including direct to CT, thoracic surgery test bundle

Compliance with NOLCP with equitable provision across STP Increased early diagnosis, curative treatment rates and survival

• Planned Care New diagnosis standard from 2020

System/Place

Early diagnosis of bowel cancer

Primary Care & Prevention (linking in with Rapid Access/Diagnostic Pathways)

Continue to support the roll out of FIT in symptomatic patients (outside of 2ww) across the STP

Continue to raise awareness with GP practices (in line with 18/19 actions) (Insert % ED Bowel Cancer – stage 1 or 2)

• Agree formal audit process with Pathology Network to understand activity and implications on 2ww referral capacity

• Establish feedback mechanism across primary care e.g. case study approach at future training and education events

Earlier diagnosis (Stage 1 & 2) Contributes to 75% early diagnosis target and reduced emergency diagnosis target.


• Planned care

New diagnosis standard from 2020

System/Place

Improved bowel cancer pathway


Delivery of bowel cancer timed pathway

Non-compliance with bowel cancer pathway (insert) detail

Appoint project manger Support cross STP clinical bowel group in developing and delivering local plan in line with national and WMCA EAG guidance

Compliance with bowel timed pathway with equitable provision across STP Increased early diagnosis, curative treatment rates and survival

• Planned Care New diagnosis standard from 2020

System/Place

Early diagnosis of upper GI cancers


Agree Programme of work to secure early diagnosis of upper GI cancers

(Insert % ED Upper GI Cancer – stage 1 or 2)

• Agree Programme for PLT education event in collaboration with secondary care clinicians

• Agree future workplan in line with national guidance and WMCA EAG recommendations

Earlier detection of cancer, reduced emergency diagnoses, increasing survival rates Contributes to 75% early diagnosis target and reduced emergency diagnosis target.

• Planned Care

New diagnosis standard from 2020

System/Place


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Improved upper GI cancer pathway


Delivery of recommended upper GI cancer pathways (including implement ion of national timed pathway for oesophago-gastric cancer)

TBC in light of EAG guidance


upper GI group in developing and delivering local plans in line with national and WMCA EAG guidance

Compliance with recommended pathways with equitable provision across STP Increased early diagnosis, curative treatment rates and survival

Planned Care New diagnosis standard from 2020

System/Place

Improved prostate cancer pathway


Delivery of prostate timed cancer pathway

TBC in light of EAG guidance


prostate cancer group in developing and delivering local plans in line with national and WMCA EAG guidance

Compliance with recommended pathways with equitable provision across STP Increased early diagnosis, curative treatment rates and survival


System/Place

Deliver improvement in the proportion of other cancers diagnosed at stages 1 and 2, and reduce proportion of cancers diagnosed following emergency presentation


Improved early diagnosis/reduced emergency diagnoses through improved early detection

Reduce mean by 3% to 18.8% by 2020/21 and reduce variation

• Baseline assessment to be provided across STP at specialty level

• Review national benchmarking data to understand how STP data compares i.e. GIRFT, RightCare

• Local action plan to be developed including a focus on quality of recording information

• Develop a sustainable communication plan to raise awareness across the local population

Stage at diagnosis – proportion diagnosed at stages 1 and 2 to rise. Improved 1- and 5-year survival rates


System/Place

Supporting HCPS through Training and Education

Primary Care and Prevention

Develop a workforce Training and Education Programme focusing on earlier diagnosis and supporting management of those patients LWBC

• Colorectal Cancer PLT March 2017

• STP Lung Cancer PLT

March 2018 • STP Upper GI Cancer

• Targeted Education events across the STP (supported/delivered by primary and secondary care specialists), key messages/case study approach

Stage at diagnosis – proportion diagnosed at stages 1 and 2 to rise.

Planned Care In line with T&E plan

System/Place


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PLT scheduled for November 2019

Rapid Diagnostic Centre’s


Support roll out of Rapid Diagnostic Centres

No C&W RDC TBC Guidance awaited

1 RDC established in Alliance area.

Planned Care

Roll out commences from 2019

System/Place

Review of STP wide diagnostic demand and capacity


Designated project manager to undertake a review of diagnostic capacity across the STP (To include CT, MRI, Pathology, Endoscopy)

Formal approval of STP plan via WMCA funding Commence recruitment process

• Ensure STP lead in post • Comprehensive activity

plan based on current and future demand requirements

• Action plan to support local delivery and reflecting NHS Long Term plan requirements & WMCA recommendations i.e. extending the use of molecular diagnostics, investment and upgrade of equipment,

Completion of STP wider capacity and demand review (including recommendations) complete

Planned Care

TBC System/Place

Deliver eight NHS Constitution Standards for cancer waiting times.

Primary Care and System Delivery/Performance

Deliver 2 week wait from GP urgent referral to first consultant appointment standard.

Year to date achievement based on April to Dec 2018: • UHCW 93.5% • GEH 97.2% • SWFT 95.1% • STP 94.4%

• Identify & recruit STP Performance lead

• Ensure robust consistent performance management mechanisms in place across STP including reporting on targets and common themes affecting delivery of waiting times

• Identify common themes and work with providers to improve patients waits via improved performance management

• Providers to move towards first OP appointment within 7 days

• Improving access to

• Delivery of 93% target for whole year at aggregate level.

• Earlier diagnosis (Stage

1 and 2 cancers in line with WMCA trajectory and national target; by 2028 the proportion of stages 1 and 2 will rise to 75%)

• Long term improvement

of one and five year survival rates

• Reduce emergency

presentations/late stage diagnosis

Planned Care Formal Commissioner/CCG contractual groups

System/Place


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specialist advice and guidance , starting with ovarian cancer as stated in the NHSLTP

• Understand demand and capacity across specialties and identify gaps, bottlenecks across pathways

• Develop contingency plan for workforce shortages/diagnostic capacity

• All providers to undertake Root Cause Analysis for patients waiting in excess of 100 days

• Embed consistent performance management targets within commissioner/provider contracts

• Commissioners and providers to develop a plan to tackle high pressure specialty areas reviewing appropriates of 2week wait and routine referrals. Determine how potential changes impact on 2ww capacity

• Broader understanding and local knowledge on reasons for performance under achievement

• Strengthening inter provider contractual agreements ie Acute and pathology network with a


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focus on waiting times specifically for cancer patients

• Further develop a sustainable Primary Care Training and Education Plan

• Improved communication with GPs; specialty specific information in Primary Care Cancer Newsletter

• CCGs to ensure revised 2ww referral forms embedded within the system.

• Improving awareness of 2ww pathways with patients

• Where appropriate embed diagnostic information into referral forms to reduce patient waits i.e. lung CT

• Ensure compliance/adherence to national and local referral guidance

• Develop formal action plan based on STP performance once baseline position and emerging themes identified


System Delivery/Performance

Deliver 2 week wait breast symptomatic (where cancer not initially suspected) from GP urgent referral to first consultant appointment.

Year to date achievement based on April to Dec 2018: • UHCW 89.8% • GEH 94.7 % • SWFT 96.9%

As above Delivery of 93% target for whole year at aggregate level. As above

Planned Care System/Place


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• STP 95.3%



Deliver 1 month wait from a decision to treat to a first treatment for cancer.






Deliver 1 month wait from a decision to treat to a subsequent treatment for cancer (anti-cancer drug regimen).

Year to date achievement based on April to Dec 2018: • UHCW 99.8% • GEH 100% • SWFT 100% • STP 99.8%





Deliver 1 month wait from a decision to treat to a subsequent treatment for cancer (radiotherapy).

Year to date achievement based on April to Dec 2018: • UHCW 97.7% • GEH - • SWFT 100% • STP 97.7%





Deliver 1 month wait from a decision to treat to a subsequent treatment for cancer (surgery).

Year to date achievement based on April to Dec 2018: • UHCW 96.7% • GEH 100% • SWFT 90.3% • STP 96%




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Deliver 2 month wait from GP urgent referral to a first treatment for cancer.






Deliver 2 month wait from a national screening service to a first treatment for cancer.




Ensure collection of 28-day Faster Diagnosis Standard data items ahead of the introduction of the standard in 2020.


Understand baseline position by provider across STP for each of the specialties

To be confirmed with providers

• Baseline information to be collated by providers

• Develop and agree trajectories at specialty level

• Embed within commissioner/provider contractual agreements

Improve waiting time to diagnosis, in particular for lung, prostate colorectal and Upper GI cancers.

Planned Care Implementation of faster diagnosis standard will be introduced from 2020

System/Place

Living with and Beyond Cancer

Implement person centered follow up for breast cancer and prepare for subsequent stratification of follow up approaches for prostate and colorectal cancer.

Living with and Beyond

Deliver person centred follow up for breast cancer patients including systems for remote monitoring

Currently this does not take place. Remote monitoring surveillance system not in place across all Trusts.

• Identify STP leads

across each Trust • Trusts to develop

implementation plans • Each Trust recruit posts

to deliver Person centered follow up using Transformation funding

• Robust remote monitoring system needs to be in place,

All Trusts should have a clinically-agreed protocol and remote monitoring system in place for stratified follow-up for breast cancer March 2019 Increase in the proportion of people with breast cancer who have been stratified to (A) ‘self-managed’ follow up and

Planned Care Breast pathway to be agreed across the Cancer Alliance by 31st March 2019. STPs to ensure Trust develop plans to fully 1st April 2019 Proportion of patients on a supported self-

System/place


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with clear process for re-entry in each Trust

• Ensure consistent recruitment process across the STP; supporting implementation of breast pathway and development of recovery package initiatives.

(B) professional-led follow up

management follow up pathway by 2020/21: Breast 70% Prostate 40% Colorectal: 30%

Implement person centered follow up for breast cancer and prepare for subsequent stratification of follow up approaches for prostate and colorectal cancer.

Living with and Beyond Develop person centered follow up protocols for prostate and colorectal cancer patients including systems for remote monitoring.

Currently this does not take place. Remote monitoring surveillance system not in place across all Trusts.

• Work in collaboration with WMCA to develop protocols

• Development of STP/Place Implementation plan to include agreed trajectories

Clinically agreed protocols and remote monitoring systems in place the end of 2019/20.

• Planned Care Breast pathway to be agreed across the Cancer Alliance by 31st March 2019. STPs to ensure Trust develop plans to fully 1st April 2019 Proportion of patients on a supported self-management follow up pathway by 2020/21: Breast 70% Prostate 40% Colorectal: 30%

Providers

Ensure all elements of the recovery package are commissioned (holistic needs assessment, care plan, pain management, GP/PN reviews)

Living with and Beyond Ensure all elements of the recovery package are commissioned namely: • Timely Holistic Needs

Assessments and Care Plans at Trust level

• Electronic Treatment

Baseline undertaken. Considerable variation across the STP and many elements are not currently in place.

• Each Trust to produce implementation plan for the RP by March 2019

• CCR implementation plan by March 2019, deliver primary care nurse training and embed using

Every person with cancer has access to the elements of the Recovery Package by 2020 Increase in the proportion of people receiving each

• Planned Care • Digitalisation

Transformation Board

STP action plan to be defined including 2018/19 delivery and beyond

System/place including third sector


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Summaries required across Trusts and Primary Care

• Health and Wellbeing Support required across STP footprint

• Cancer Care Reviews (holistic) in primary care

cancer transformation funding.

• Collaborate with Digital Transformation Board to scope the IT requirements for the LWBC Programme

• Plan and implement patient engagement event to understand cancer patient experiences whilst LWBC

• Scope Information, Advice and support for each locality to enable self-management

element of the Recovery Package

By 2020/21 a proportion of patients receiving HNA; 65% Care Plan ; 65% Treatment summary; 40% Accessing holistic information & support ; 24% By 2021 every person where appropriate diagnosed with cancer will have access to personalized care, including needs assessment , a care plan and health and wellbeing information and support By 2023 stratified follow up pathways for patients who are worried their cancer may have recurred (all clinically appropriate cancers)


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Service Specific (including specialised commissioning requirements)

Radiotherapy Oncology Children’s & Young People Cancers Diagnostics Urology Options Appraisal Urology Robotic Review HPB

Specialised Commissioning Specialised Commissioning Specialised Commissioning System Delivery System Delivery System Delivery

Establish links with relevant commissioner lead and agree mechanisms to ensure regular communication and updates provided to the C&W Cancer board Ensure the local STP Cancer group is consulted and sited on services commissioned via NHSE Ensure requirements of the NHS LT plan , commissioned directly by specialized form part of the regular communication with the C&W Cancer Board Engagement with Radiotherapy networks Develop service models across the network that are compliant with service specifications and standards e.g. GIRFT, NICE Improving outcomes guidance Investment in new equipment,

• No formal plan/communication with specialised commissioner

• Formal plan to be developed

TBC Planned Care TBC • Implement

a new generation of CAR-T cancer therapies

• From 2019 begin to offer al children cancer whole genome sequencing

• Support C&YP to take part in clinical trials

• Increase funding for children’s palliative and EOL care

System/Place


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Upper GI Head and Neck Pathology (rapid diagnostics – enabling strategy with elective programme)

System Delivery System Delivery System Delivery Rapid Access/Diagnostic pathways

including CT and MRI scanners Upgrade of Radiotherapy Machines

Enabling strategies (Workforce, IT, Communications)

Support delivery of regional plans for implementation of Phase 1 of the Cancer Workforce Plan taking into account key enablers IT/Performance/Comms

C&W Cancer Board/ STP leads (TBC)

• Review the requirements of the Cancer Workforce plan and understand a baseline assessment against the key recommendations

• Ensure key leads focusing

on IT/Performance /Comms engaged and aware of Cancer STP structures

STP to ensure that where project funding is allocated to workforce staffing resources, arrangements are in place to ensure sustainable an transformation change beyond the life of the project Identify relevant STP leads (workforce, IT etc) Identify potential risks associated with increased demand and potential long term impact on the workforce Develop a robust comms and engagement, workforce and IT strategy to support

TBC TBC TBC System


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the STP Cancer structures Develop local dashboards and evaluation tools to support development of further roll out


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MATERNITY PLACE SRO: JO DILLON (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) ANNA HARGRAVE (NHS SOUTH WARWICKSHIRE CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones


Relationship to System Programmes (Out Of Hospital, Planned Care, etc.)

Action Owner (CCG or Provider)

Continue to work with Commissioner and Provider partners from across the system to deliver the recommendations in the National Maternity Review 'Better Births' and the West Midlands Neonatal Review through the implementation of the Coventry and Warwickshire Local Maternity System Transformation Plan.

Implement an enhanced and targeted continuity of carer model to help improve outcomes for the most vulnerable mothers and babies. Ensure that continuity of carer is provided to groups that experience the poorest outcomes, such as women from ethnic minorities and the most deprived socio-economic groups.

Pilot projects for Continuity of Carer (CoC) are underway at each provider trust within the LMS. Pilot project estimate achieving 20% of women booked onto a CoC pathway by March 2019. Current trajectory Baseline 2015 = 0 March 2019 = 2,219 – 20% of births March 2020 = 3,884 - 35% of births (Long Term Plan) The long term plan requires 75% of the most vulnerable women to experience CoC by March 2024 . In order to meet this we will focus the work of the emerging Maternity Voices Partnership to engage with these communities to inform the Quality and Safety workstream enabling the workstream to develop clear plans to roll out CoC .

The LMS Quality & Safety workstream with support from the PMO confirm a plan to deliver continuity at scale to meet the confirmed trajectory of 35% by March 2020 Trajectories will be developed during 2019/20

By March 2020, 35%+ of women experience a continuity of carer pathway.

Provider

Make progress against trajectory to deliver improvements in safety towards the 2020 ambition to reduce stillbirths, neonatal deaths, maternal death and brain injuries by 20% and by 50% in 2025.

StillBirths Baseline 2015 = 5.2 per 1,000 Trajectory: March 2019 = 5/1,000 March 2020 = 4.1/1,000 March 2021 = 3.9/1,000 Intrapartum Brain Injury 2015 = 5/1,000 March 2019 = 5/1,000 March 2020 = 4/1,000 March 2021 = 4/1,000

The Quality & Safety and Health & Wellbeing workstreams across the LMS both contain plans that support the reduction in deaths. These include: - Agreeing & adopting

uniformed care pathways across the LMS

- Developing a parent education programme

- Increasing the support offered to women to stop smoking

- Implement v2 of the Saving Babies Lives Care Bundle.

- Increasing the rate of CoC - Improving access to

perinatal mental health services

- Uniform Care Pathways adopted across the LMS

- Implementation of V2 of the Saving Babies Lives Care Bundle.

- Increase the number of pregnant women who stop smoking during pregnancy.

Provider

Deliver full implementation of the

All recommendations within V1 of the Saving Babies’ Lives Care Bundle are met. Performance

The Quality & Safety workstream have a task and finished group

Full implementation of the Saving Babies’ Lives Care Bundle

Provider


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Saving Babies’ Lives Care Bundle (v2) by 31 March 2020.

is measured across the LMS and reported to the LMS Board.

focussed on Safety. This group will develop and implement plans to meet the additional recommendations found in V2 of the Saving Babies Lives Care Bundle across the LMS.

(v2) at each provider unit.

Continue against trajectory to deliver improvements in choice and personalisation so that by March 2021 all women have a personalised care plan.

Current trajectory* Baseline 2015 = 0 March 2019 = 2,433 March 2020 = 4,485 March 2021 = 11,213

During review in 2018/19 the Choice & Personalisation workstream have identified that the current use of the Perinatal Institute Antenatal Record at UHCW and GEH and the electronic Badgernet system at SWFT both contain a personalised care plan. Therefore performance is already at 100%. However in the spirit of continuous improvement and in line with meeting the digital aim for maternity care, the LMS will be focussing on delivering a uniformed electronic care record that offers an online portal for women to access and personalise their own care record, this is currently available at SWFT through the Badgernet system. GEH are finalising a business case to implement a maternity EPR within 2019/20. UHCW is in the process of confirming their trusts approach to a trustwide EPR, and the LMS will revisit the pace needed to deliver a an electronic Maternity Record, and ensure that all three records interface and meet the same capability standards.

Roll out of a uniformed or at least an interfaced Maternity Electronic Patient Record.

Provider / CCG

Continue against trajectory to deliver improvements in choice and personalisation

Current trajectory* Baseline 2015 = 590 March 2019 = 800

In July 2018 SWFT opened their Co-Located Midwifery Led Birth Unit (MLU) Bluebell. This is the

Increase birth rate in low risk settings to achieve agreed trajectory.


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so that by March 2021 more women can give birth in midwifery settings.

March 2020 = 1000 March 20221 = 2450

second MLU in the LMS with UHCW already supporting women in the Lucina MLU. There are currently no further plans to develop additional birth settings. Focus is now on agreeing uniform care pathways and safely increasing the number of women supported to birth in the MLU or at home.

Offer all women who smoke during their pregnancy, specialist smoking cessation support.

Baseline 2018 =

* No electronic referral system currently available in Coventry.

KPI's UHCW SWFT GEH

CO at Booking >95% 100% >75%

CO at 36/40 >70% 100% >75%

Smokers referred to SSiPS * 100% >75%

The Health & Well-being workstream have a dedicated Smoking Cessation task and finish group delving improvements in the care pathway. Currently the ambition is to secure E-referrals for Coventry so that all trusts can electronically refer to Specialist Smoking cessation services. The health and Well-being workstream has a task and finish group focused on smoking cessation that will work up action plans to increase each trusts performance in the indicator CO testing at 36 weeks gestation.

Achievement of the following targets: * CO at booking recorded, greater that 95% at all Trusts * Smokers referred to SSIPS 90% for all Trusts. Implementation of a uniformed Smoking cessation care pathway and guideline.

Provider/CCG

Continue to work with Commissioner partners from across the system through the Maternity and Children's Strategic Commissioning

To develop an Outcomes Framework for Maternity and Paediatric Services

There are no agreed set of outcomes for the maternity and paediatrics across the system. There is significant variation in health outcomes and therefore an opportunity to reduce health inequalities by focusing on a common set of outcomes.

During Qtr 4 of 2018/19 and Qtr 1 staff engagement will be undertaken Final Outcomes Framework finalised at the end of Q1

Approved Outcomes Framework Maternity Transformation Group

Commissioners


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Programme Board to progress the Coventry and Warwickshire Maternity, Children and Young People Transformation Programme.

To design a delivery model for maternity and paediatrics across Coventry and Warwickshire that delivers a clinical and financially sustainable service that improves the outcomes for women, babies and children.

The current services are not effectively meeting the needs of the population as evidenced by lower than expected outcomes on key measures and variability across the system. Providers have workforce challenges that cannot be resolved without a significant redesign of the delivery model. Phase One has been completed by Commissioners who have undertaken public and patient engagement to determine desirable criteria and the first draft of the outcomes Framework.

Qtr 4 2018/19 Provider Alliance will undertake a Current Service Analysis to provide a baseline position. Qtr 1-3 Following the launch of Phase Two the Provider Alliance will undertake a process to develop a delivery model that delivers the commissioners outcomes within a financial envelope. Providers will undertake public and patient engagement as part of the design process. Qtr 3 Commissioners will assess the delivery model and subject to satisfactory response will commission the model.

New delivery model ready to implement in Qtr 2 2020/21

Maternity Transformation Group

Providers


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MENTAL HEALTH PLACE SRO: MATT GILKS (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Deliver in full the local plan which responds to the Five Year Forward View for Mental Health and Implementing the Mental Health Forward View.

Additional baseline funding deployed in support of delivery of identified priorities.

In 2018/19, the following BBG baseline funding was agreed to support MHFYFV priorities; the funding is recurrent so will support delivery into 2019/20

• EIP • IAPT • Perinatal • CAMHS 3.5

Discussions and action plans agreed with local MH provider in order to deliver expectations within FYFV. Periodic monitoring

Implementation of plans/trajectories achieved.

N/A CCG

Continue to focus on expanding access to Improving Access to Psychological Therapies (IAPT) services for adults and older adults with common mental health problems, with a focus on those with long-term conditions (LTC).

Across C&W an IAPT service is in place for individuals aged 16+years, delivering evidence based treatment pathways, which meets current KPIs. The service is exploring how access can be increased for a wide range of patient cohorts such as BME; older adults; new parents and patients with LTCs. Transformational funding was secured in2017/18 to develop IAPT-LTC pathways, with agreement from CCGs to fund on a recurrent basis. As a result, an additional £1.2million of investment has been secured into the IAPT-LTC pathways. An evaluation plan is being developed between the CCGs and CWPT to demonstrate the impact of the LTC expansion in relation to health outcomes, financial savings and impact on healthcare utilisation

Develop a system wide plan with trajectories to track and monitor increases in:

• Meeting the access rate and maintaining the recovery rate

• Expansion in LTC pathways and treatment

• Co-location of therapists

• Uptake of trainee courses for PWPs, HITs and LTC trainees

To increase system grip and assurance on IAPT delivery and mitigate any risks to delivery with system held actions.

IAPT services providing timely access to treatment for at least 22% of those who could benefit (people with anxiety disorders and depression) by March 2020, (increasing to 25%by 2020/21) with two thirds of the increase in access anticipated to be delivered within the IAPT for LTC service. At least 75% of people referred to the IAPT programme begin treatment within six weeks of referral. At least 95% of people referred to the IAPT programme begin treatment within 18 weeks of referral. At least 50% of people who complete IAPT treatment recover.

Establish an IAPT steering group, with core members meeting monthly and a larger group of stakeholders meeting quarterly to include Primary care leads, comms, SRO for MH and GP MH Clinical lead/s Reporting by exception to the MH STP Primary care workstream and/or MH STP Board.

STP

Expand capacity for people experiencing a first episode of psychosis.

Across C&W an EIP service is in place for individuals aged 14 – 65years, delivering evidence based treatment pathways. The service has pathways in place for ARMS (At Risk MH State) and over 35years. Additional investment has been approved in 2018/19 to recurrently fund an additional 8 wte Care Coordinators.

Develop a system wide plan with trajectories to explore how to:

• Increase referrals from individuals experiencing first episode of Psychosis

• Reduce duration of untreated psychosis

Increase length of treatment to

At least 56% of people aged 14-65 experiencing their first episode of psychosis start treatment within two weeks. Ensure the 2018/19 commitment for NICE concordance for EIP is met; then deliver against the further ambition for 50% of services to be graded at level

Development of an EIP steering group with representation from system wide partners. Reporting by exception to the MH STP Specialists care work stream and/or MH STP Board.

STP


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align with national average of 36 months

3 by the end of 2019/20.

Increase access to high-quality mental health services for children and young people (CYP).

Projected year end position: SWCCG: 32.3% WNCCG: 27.2% CRCCG: 26.2% STP: 28.5%

The LTP outlined a number of key actions areas in relation to improving the timeliness and breadth of access to emotional wellbeing and mental health support available to children and young people. Each of the following areas will be monitored through the collaborative, C&W-wide CAMHS operational group. • Refresh the referral to

treatment pathway • Undertake further system

capacity and demand and generate proposals to best manage the system pressures;

• Continue with collaborative waiting list management arrangements to optimize the management of all key waits, particularly CAMHS follow-up waits

• Continue to increase the scale of available multi-agency early help opportunities in schools and in the community to help to reduce some of the requirement for specialist help

• Ongoing development of the digital offer, including further development of the website, availability of an electronic referrals portal, e-consultation, further development of

At least 32% of children and young people with a diagnosable mental health condition receive treatment from an NHS-funded community mental health service.

N/A STP


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the Dimensions Tool and the use of social media

• Remodelled multi-agency “targeted” support with strengthened partnership working with PMHT and which is closely aligned to Coventry Family Hubs and Warwickshire Health & Wellbeing Hubs

• Continued development of the Warwickshire Rise Community Partnerships to increase access to a range of information, training, advice and support, from a range of agencies

• Implement a refreshed framework for Mental Health Interventions for School-aged Children (MHISC)

Community eating disorder teams for children and young people meet access and waiting time standards.

Latest 2018/19 position as follows: Table 1: Access rate performance for routine referrals

Routine

Q1 Routine

Q2 Routine

Q3 CRCCG 100% 100% 87.50%

WNCCG 50% 100% 100.00%

SWCCG 100% 100% 78.75%

STP 90% 100% 88.75%

Table 2: Access rate performance for urgent referrals

Urgent

Q1 Urgent

Q2 Urgent

Q3

CRCCG 100% 100% N/A

WNCCG 100% 100% N/A

SWCCG 100% 100% N/A

This is a contract KPI so is monitored monthly.

By March 2021, at least 95% of children and young people with an eating disorder are seen within one week of an urgent referral. By March 2021, at least 95% of children and young people with an eating disorder are seen within four weeks of a routine referral.

N/A STP


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STP 100% 100% N/A

Continue to focus on working with Warwickshire County Council and other system partners to progress the implementation of the 2016-2020 Warwickshire Suicide Prevention Strategy.

2015-17 Local Authority figures show that there were 245 deaths by suicide across Coventry and Warwickshire

Work with providers to ensure that plans are in place for a zero-suicide ambition for mental health inpatients. Ten initiatives are currently in progress across the system with further ideas currently being developed for 19/20.

At least 10% reduction in suicides by 2020/21.

Emergency and crisis care/acute work streams

STP

Continued reduction in out of area placements for acute mental health care for adults, in line with agreed trajectories.

The trajectory for Coventry and Warwickshire STP is as follows:

Month

Projected number of OAP occupied bed days

Year 1 (18/19)

Jun-18 1,108

Sep-18 1,805

Dec-18 1,444

Apr-19 1,011

Year 2 (19/20)

Jun-19 708

Sep-19 495

Dec-19 347

Apr-20 243

Year 3 (20/21)

Jun-20 170

Sep-20 119

Dec-20 83

Apr-21 0

CCG actions for 2019/20: • Continuation of CQUIN for

out of area co-ordinator • CR/WNCCG increase

investment in CWPT CRT to focus on MH cases

• Director-level oversight Key areas of focus for 2019/20 (supporting action plan with more detail available): • Improve patient flow • Ensure timely discharge • Improve patient

experience • Digital technology to

support management and oversight in real time (Cambio)

Joint actions: • Joint reviews of all OAPs • Joint task and finish group

to obtain system grip on reasons for OAPs and

To eliminate all inappropriate Out of Area Placements (OAPs) by December 2021 through a series of service improvements.

Acute/crisis care work streams

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There has been a sustained increase in the number of OAPs from October 2018 – March 2019.

current position: understand the reason for the sustained increase in pressure on inpatient beds, particularly as this does not reflect a seasonal variation; review the current capacity for overseeing and actively supporting the AOOA placements repatriation

• Engagement with NHSI collaborative on OAPs

• Fortnightly face to face meeting to review inpatient capacity, flow and in turn the out of area placements.

Continued reduction in out of area placements for acute mental health care for CYP, in line with agreed trajectories.

Coventry and Warwickshire identified as having high numbers of tier 4 bed usage. Extension made to Acute Liaison Team as precursor to Home Treatment Team Agreement of Business case for tier 3.5 Camhs service

Establishing operational Crisis Home Treatment Team.

Reduction in T4 occupied bed days in Coventry and Warwickshire

New service to link with NHSE New Care Models for regional T4 commissioning approach

CCG

Continue to focus on support for adults and older adults with severe mental illnesses (SMI).

People with a SMI receive a full annual physical health check.

The number of patients receiving a full annual physical health check (all 6 indicators) are as below: CRCCG: 13.7% WNCCG: 13.5% SWCCG: 27.4% STP: 17.5%

Physical Health Checks for people with SMI could be carried out exclusively by GP Practices, a combination of GP Practices and practice based (or locality based) HCAs, by a combination of Cluster based GP Practices and HCAs - or by HCAs alone. Plan in development to support primary care to increase number of checks.

At least 60% people with SMI receive a full annual physical health check.

Primary Care CCG

Undertake preparatory work for the mobilisation of a

This activity currently forms part of the block contract with the local provider (CWPT).

Strengthen local relationships between primary care, secondary care, local authorities and VCS services.

Having new services for people who have the most complex needs in place whilst proactively working to

Primary Care STP


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new integrated primary and community model (as per the Long Term Plan).

Develop understanding of local need through information and data. Clear KPIs to be developed for this cohort in order for a baseline to be established.

address racial disparities. Effective redesign and reorganisation of core community mental health teams that enable us to move towards a new place-based, multidisciplinary service across health and social care, aligned with primary care networks in order to support people to live well in their communities.

Increase access to Individual Placement and Support (IPS) services in line with STP trajectory.

IPS service in place delivered by Rethink Funded by WCC/CCC with additional funding from the European Social Fund Service working to targets (both numbers of clients it should work with and outcomes) as agreed with DWP for ESF allocation. The service is integrated within CWPT and receives many referrals from IPUs and Crisis Team alongside the Job shop.

Current provision in place until March 2020. Continued monitoring and development of the service to ensure is delivering to targets.

Targets for Warwickshire as follows: Deliver MH5YFV target to double the number of people accessing IPS, with the majority of this cohort supported into employment and a further proportion supported into training and education.

Community capacity/resilience STP work stream

STP

Develop plan to establish baselines and track access to psychological therapies for people with SMI.

Liaise with the C&W IAPT service to explore how access to psychological therapies can be increased for people with SMI

• Baseline current access to psychological therapies for patients with SMI

• Plan joint actions to increase access for SMI patients

• Review any training implications

• An increase in the uptake of psychological therapies for patients with SMI

• Improvement in clinical outcome measures

• Recovery rates

Establish an IAPT steering group, with core members meeting monthly and a larger group of stakeholders meeting quarterly to include Primary care leads, comms, SRO for MH and GP MH Clinical lead/s Reporting by exception to the MH STP Primary care work stream and/or MH STP Board.

Develop plan to establish baselines and track access to psychological therapies for people with SMI.

Dementia diagnosis, care and support.

Diagnosis rates across STP at December 2018: CRCCG 61.1% WNCCG 58.8% SWCCG 59.4%

Continue to implement detailed Dementia Diagnosis Action Plan across STP area. Headline actions: • Memory Assessment Service (MAS) (STP wide) • Review of Dementia Pathway & Stakeholder Engagement (STP

Wide) - Enabler • Incentivised Primary Care Diagnosis Model (STP, delivered at CCG

At least two thirds (66.7%) of people with dementia, aged 65 and over, receive a formal diagnosis.

Target is delivered CCG CCG


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Level) • Care Home Dementia Approach (STP, delivered at CCG level) • Practice Intensive Support (SWCCG Pilot) • Dementia Pop-up Clinic (CRCCG Pilot)

Review and recommission post-diagnostic support offer to ensure those diagnosed and their families and carers receive the necessary support to live well with dementia

Range of post diagnostic support services including: - MAS Community Team - Dementia Navigators - Admiral Nurses (CRCCG) - Dementia Cafes - Dementia Portal Dementia Action Alliances in place across the STP with work to build on and increase to number of Dementia Friends Contracts aligned in 2018 to enable comprehensive review and recommissioning activity in 2019/20

Review of current provision March 2019 Agree public and stakeholder engagement plan with WCC and CCC April 2019 Recommissioning plan June 2019 Develop and implement improved training for carers, including supporting carers to share their knowledge with new carers, August 2019

Improve post diagnostic care in line with published guidance and quality standards (NICE NG97 and QS30 and QS1) Monitor using service level data from commissioned services, including waiting times, service outcomes for clients and carer wellbeing; NHS Rightcare figures of deaths of people with dementia by usual place of residence, rate of emergency admissions aged 65+ with dementia, etc.

(see above) Aligned recommissioning across CCG and Local Authorities (WCC and CCC) Dementia also forms part of the End of Life Work Programme

CCG

Increase access to high-quality perinatal mental health services.

The Perinatal MH service supports women who are pregnant, or in the postnatal year, who are experiencing serious perinatal mental health difficulties, such as; needing support with medically complicated pregnancies such as placenta praevia or a multiple pregnancy.

Consider opportunities to use additional baseline investment through roles such as: • Team administration – increase administration time to support efficiency of the service • Paid peer support workers • Clinical Pharmacists • Parent-infant or Family Therapists – ensure that the therapists in the team can deliver the wide range of therapies recommended in NICE guidance

• Access increased for at least 4.5% of population birth rate. • Increasing access to evidence-based care for women with moderate to severe perinatal mental health difficulties and a personality disorder diagnosis • Extending services to preconception to 24 months after birth, in line with the cross-government ambition for women and children focusing on the first 1,001 critical days of child’s life • Expanding access to evidence-based psychological therapies to also include parent-infant, couple, co-parenting and family interventions • Implementing maternity

A Perinatal MH steering group is in place which meets regularly with representation from system wide partners. Reporting by exception to the MH STP Specialists care work stream and/or MH STP Board.

N/A STP


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Through Wave 2 funding the team are expanding capacity and capability to reach more women.

outreach clinics, that will integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience • Ensuring partners of women accessing specialist perinatal mental health services receive evidence-based assessment of their mental health and are signposted to support as required.

Expansion to include timely access to psychological therapies.

As above Consider opportunities to use additional baseline investment through roles such as: • Clinical Psychologists – increase clinical psychology provision in line with Perinatal Service Provision: The role of Perinatal Clinical Psychology (BP8).

As above As above

Continue to focus on the expansion of services for people experiencing a mental health crisis.

Progress plans for acute hospitals to have mental health liaison services that can meet the specific needs of people of all ages, including CYP and older adults by 2020/21.

Across the STP Acute MH liaison services are in place across all three Acute sites, but currently provision is below CORE 24 standards.

A business case to explore additional investment is being developed with options to increase the capacity and capability in provision. A range of services have been commissioned to support acute mental health pathways over the winter period.

• Expansion of provision (both in hours and evidence based pathways) • Alignment to national KPIs An urgent and emergency liaison mental health service responds to a person within 60 minutes of receiving a referral. Within four hours of arriving in an ED or being referred from a ward it is recommended that the person should: • Have received a full biopsychosocial assessment

Reporting by exception to the: • MH STP Specialists care work stream and/or MH STP Board • A&E Delivery Board

STP


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• Have an urgent and emergency mental health care plan in place; and • At a minimum, be on route to their next location if geographically different, or • Have been accepted and scheduled for follow-up care by a responding service; or • Have been discharged because the crisis has resolved; or • Have started a Mental Health Act assessment.

Ensure there is a crisis response that meets the needs of under 18 year olds.

Coventry & Warwickshire CCGs have agreed to a further expansion of the CAMHS Tier 3.5 Service that will create much needed home treatment capacity, as per Phase 2 of the business case prepared in August 2018 (Phase 1 – extension of the Acute Liaison Service – having already been approved in November 2018).

Implementation of full Tier 3.5 service across Coventry and Warwickshire: 24/7 crisis provision for CYP which combines crisis, liaison and intensive community support functions.

KPIs to be developed to encourage and demonstrate improvement in:

• Alternative to tier 4 admission through intensive intervention in the community

• Swift crisis response times, in line with the adult CRHTT

• Alternative to presentation at hospital through rapid community assessment

• Less hand offs and more seamless discharge due to one organisation providing case management in tier 4 and delivery of local community services

• Subsequent reductions in admissions and

NHS Specialised Commissioning

STP

Work towards delivering age-appropriate 24/7 crisis provision for CYP which combines crisis, liaison and intensive community support functions.


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length of stay Focus on the expansion of the mental health workforce, including through the implementation of training and retention schemes.

Understand current workforce position.

Coventry and Warwickshire Mental Health STP workforce plan sets out the local baseline and details improvement targets, as follows: Table 1: Staff in post - growth trajectory

Total expansion 2016/17 2017/18 2018/19 2019/20 2020/21

312 14 74 78 85 61

Previous submissions of the C&W MH STP workforce plan have been based on targets within MHFYFV and the Stepping Forward to 2020/21 Mental Health Workforce Plan for England. Updated intentions from commissioners relating to MH investment to deliver the targets.

The local aspiration is to deliver an additional 312 staff to the mental health workforce by 2020/21. This includes an increase in the number of mental health therapists co-located in primary care by 2020/21 to support increase in access to be delivered through IAPT-Long Term Conditions services. Capacity and capability of CYP workforce expanded.

STP

Understand required expansion numbers.

Provider level expansion plan/s in place.

Understand key local pressure points for service areas or staff groups, and identify mitigation.

Commissioner intentions reflect investment and continued scrutiny in key areas such as perinatal, IAPT, CYP, etc.

Expansion and enabling of training schemes.

Supply is likely to be an issue, given the numbers involved. Some courses are available to meet this demand, however a combination of factors including the removal of the secondment and bursary, delay in commencing alternative study routes (e.g. degree apprenticeship) and training time required to deliver the staff.

Expansion and enabling of retention schemes.

Retention is a national issue, there is an action plan in place which aims to reduce turnover within CWPT, particularly within key roles.

Ensure Providers submit

Routine monitoring of data

CWPT submits the MHSDS and the IAPT dataset national dataset on a monthly basis in line with their statutory requirements to do so.

Continue to monitor submissions in line with current contract systems and processes.

N/A STP/CSU


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comprehensive data to the Mental Health Services Dataset (MHSDS)/Improving Access to Psychological Therapies (IAPT) dataset.

sets, with outputs used to inform Commissioner to Provider discussions.

The Commissioner utilises outputs from these flows, particularly in respect of monitoring a number of Mental Health Performance areas in relation to IAPT access, recovery and waiting times, Early Intervention and Children and Young People Access. Currently, routine monitoring within these areas adopts reporting outputs derived by NHS Digital and/ or SDCS (Strategic Data Collection Service) as appropriate. Current utilisation of the patient level national flows is subject to assurance in the use of the data and development of criteria to extract data as appropriate to monitoring/ reporting requirements.

Ensure operational plans reflect understanding of local health inequalities.

MHSDS/ IAPT is not currently being utilised to provide relevant intelligence. In the past the IAPT dataset has been utilised to identify referrals/ access by age/ gender and ethnicity and more recently data extracted from the MHSDS to quantify referrals to mental health services also by age/gender/ ethnicity.

Contracting teams will work with BI to understand how MHSDS can be used to understand health inequalities and how the data can be utilised in informing commissioning decisions.

N/A STP/CSU

Mid-year review undertaken with Providers.

There is no mid- year review undertaken currently with CWPT to review the MHSDS/ IAPT.

Contracting teams will await and implement any guidance from NHSE in relation to a requirement to undertake a mid-year review with providers. IAPT and MHSHS submissions are monitored monthly as a matter of routine and this will continue.

N/A STP/CSU

Contract penalties applied as appropriate i.e. where data reporting or quality standards are not being met.

Financial sanctions for 2018/19 linked to reporting via MHSDS. Development of new sanctions for 2019/20 in line with new NHS contract requirements for IAPT and Data Quality Maturity Index.

Continued monitoring and implementation of penalties where appropriate, issuing of quarterly financial sanctions. Continuation of DQIP for EIP data. Implementation of a DQIP for the Data Quality Maturity Index, as per the 2019/20 NHS standard contract.

N/A STP/CSU

Deliver Mental Health Digital Strategy, which addresses digital record sharing and the integration of digital tools and digitally-enabled therapies.

Board level sign off achieved.

No joint digital strategy for MH currently in existence. Develop a joint digital strategy covering the integration of digital tools and digitally-enabled therapies. Implement new NHS contract guidance around e-referrals into MH services.

Board level sign off achieved. CWPT digital delivery group

STP

Increase baseline spend on mental health.

Meet Mental Health Investment Standard (MHIS).

Indicative M9 plan position (based on in-year outturn at point in time): CRCCG: target 7.5%/plan 7.7% WNCCG: target 6.0%/plan 7.0% SWCCG: target 5.9%/plan 5.9%

Monthly monitoring to assess achievement of MHIS

NHSE mandated requirement to meet MHIS. CCGs must achieve.

Any MH/LD related expenditure through OOH (IPU 18-21) will be included as part of calculation.

CCG

Undertake joint review of MHIS

No current joint review planned. To be discussed with CWPT. Plans on how to undertake review to be determined.

Joint review made. Review of all MH expenditure

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investment plan (review to engage identified lead mental health provider).

Progress planning and preparation with Provider collaboratives to manage patients needing specialised services.

NHS Specialised Commissioning

STP


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OUT OF HOSPITAL (MODEL OF CARE) PLACE SRO: JENNI NORTHCOTE (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




To have fully completed and embedded the redesign, implementation and transition to a new Out of Hospital model of care.

An Integrated Single Point of Access (iSPA) for professionals, patients and carers which will achieve a streamlined referral process, ensure patient flow through the system is seamless and improve the management of the highest acuity patients.

To evaluate and continue to evolve the iSPA introduced in 2018/19 and to maximise opportunities for the iSPA to be integrated with other system partners, ie. social care.

To continue to develop the relationships and integration between primary care, community services and other key stakeholders to ensure the Out of Hospital model delivers improved case management and outcomes for its patient population, and supports the wider system objectives.

The Out of Hospital model to demonstrate improvement against agreed range of system wide metrics.

Clear interdependency with Urgent Care Programme, to ensure patients only need to access Urgent Care services when really necessary.

Chief Strategy and Primary Care Officer Chief Finance Officer Director of Commissioning Senior Contracts Manager

Implementation of a Locality Hub(s) to ensure access is available on a City wide/Locality basis to specialist care teams, eg tissue viability.

To ensure an effective referral process and interface between the centrally based services within the Locality Hub and PBTs and iSPA.

Ensure robust governance arrangements are in place to monitor and ensure delivery of the key deliverables/milestones by the Out of Hospital provider.

The Provider demonstrates positive outcomes against the requirements of the Outcomes Framework.

Out of Hospital has close inter-dependencies with avoiding hospital admissions and supporting improved DTOC.

Implementation of Placed Based Teams which are fully integrated with Primary Care Clusters each supporting a population of 30,000 to 50,000, with multi-disciplinary team working at the heart of the PBTs.

To continue and complete the roll out and implementation of PBTs and MDT working that commenced in 2018/19

Develop and agree with providers full Outcomes Based Reporting requirements that will evidence full delivery against the Outcomes Framework from 2020.

Improved satisfaction from a range of stakeholders (including patients/carers and staff).

Out of Hospital will only truly be successful through integration with primary care and the evolvement of cluster working.

A fully functional Integrated Patient Care Record/Information Management System.

To continue to progress and complete the implementation of a new clinical system that will deliver an integrated patient care record.

Work with the provider in reviewing feedback from a range of stakeholders to ensure this feedback is listened to, acted upon and that the Out of Hospital model is evolved as appropriate in response.

To evidence a culture change within community services and the relationships with primary care and wider stakeholders.

Working closely with Public Health, together with adoption of a risk stratification tool to support the pro-active case management of the PBTs practice populations and develop jointly agreed plans for improving health outcomes.

To start testing the use of agreed risk stratification tool to support identification of patients and more pro-active case management.

-


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OUT OF HOSPITAL (PREVENTION, GENERAL PRACTICE SERVICES & COMMUNITY SERVICES) PLACE SRO: Jenni Northcote (NHS North WARWICKSHIRE CCG and CRCCG ) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Continue working with our Member Practices to focus on the sustainability of general practice here and now, and how general practice will transform over time to remain sustainable for the future.

Primary Care Strategy incorporated as part of wider System Strategy.

CCG strategy’s in CRCCG and WNCCG in place till 2019

Stocktake review of against strategy action plan – to form the basis for next steps strategy refresh – February 2019

Refreshed strategy at system level in place Autumn 2019 Strategy recognised as an integral part of ICS strategic plans General practice and other providers acknowledge the strategy as credible and contributing to transformation / ICS.

ICS plan Health and Wellbeing Plan Provider work force plans Digital Road Map

Jenni Northcote – GPFV LEAD FOR THE stp AND Chief Strategy and Primary Care Officer WNCCG and CRCCG.

Establish C&W PC Programme board

April 2019 - identify a single team to support delivery of the primary care work programme across all three CCG’s linking in to STP /ICS, and reporting to the CCG governance through PCC’s

Transformation projects identified and approved by the CCG for funding - Effective use of £1.50 per head of population recurrent investment.

Mixed take up of funding across practices

Review impact of existing Transformation projects Share best practice from transformation funded projects Role out successful transformation projects across PCN’s All PCN’s have identified transformation initiatives planed All PCNs implemented at least two high impact transformation initiatives across their PCN

Recurrent investment until 31 March 2024. Evaluation of projects identifies positive impact against GPFV objectives and local priorities.

ICS plan Place Plans


Continue to focus on the development of the GP Networks (groupings of CCG Member Practices) established in 2018/19 as the foundation for future Out of Hospital service delivery models.

Effective use of £1.50 per head of population recurrent investment to support development of PCN maturity PCN Directors role scoped and PCN lead role reviewed in light of this new role. PCN Directors in post

Coventry 7 PCNs in place all with clinical leads, co-ordinators and meeting Rugby working as one PCN delivery group – Clinical lead in place and co-ordinator capacity in place WN one PCN operational with clinical lead and co-

PCN development and mobilisation • PCNs work towards meeting

registration requirements (Jan to April 2019)

• Network agreement and contract disseminated to PCNs for consideration and completion following release from NHSE (29th March 2019)

• CCG confirms network coverage and approves variation to GP

100% population coverage of GP Networks by 30 June 2019 at the latest

Place Plans Primary Care Strategy GPFV NHS Long Term Plan



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GP One Voice arrangements in place so that PCNs are appropriately represented within the ICS, Provider alliance and Place Arrangements in place to support member practices to engage in MDT working with OOH provider / PBTs

ordinator – meetings taking place Plans for two more PCNs to come on stream MOU agreed with GP federation to support WN PCN co-ordination Gemima training already delivered across WNCCG member practices to support risk stratification

contracts (31st May 2019) • PCN contract goes live across all

PCNs (1st July 2019) • Preparation for delivery of

national network services ready to commence under 2020/21 (December 2019)

MDT’s mobilised with PBTs Training on Gemima to support risk stratification PCN configuration confirmed across WNCCG - 3 PCNs covering Nuneaton Bedworth and Rural North Warwickshire) by January 31st 2019 Across CRCCG and WNCCG 100% PCN coverage achieved across member practices – with all practices aware of which PCN they are assigned to - by 31st March 2019 An agreed schedule of PCN meetings in place across WNCCG ( already achieved CRCCG) to enable practices to engage in PCN’s) with an initial meeting held by all PCNs by 31st March 31stl 2019 Clinical lead for each WNCCG PCN identified by 1st May 2019 WNCCG MDT arrangements in place with out of hospital place based team aligned to each PCN by 1st May 2019. PCN priorities identified (in line with the requirements set out in the NHS long term plan and aligned to JSNA priorities and population health needs); in collaboration with the CCG by June 2019


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All PCNs across WNCCG and CRCCG completed maturity self-assessment by June 2019.

Maintain active support to local GP Network development, including by supporting the agreement of any nationally agreed contract arrangements.

PCN’s and member practices made aware of leadership programmes – and currently three WN representatives engaged Several CRCCG member practice representatives have attended leadership programmes CRCCG and WNCCG members engaged re ICS developments – listening exercise Dec – Feb

Support GP Networks to access the PCN Development Programme. Identify named CCG liaison / relationship manager for each PCN’s to provide proactive support and access to commissioner skills / capacity. Member practices support direction of travel towards for ICS and endorse GB proposals and time scales – as identified PCN contract in place which secure sustainability of general practice and address variation of enhanced service delivery across PCN registered patient lists.

100% population coverage of GP Networks by 30 June 2019 at the latest.

As above As above

Respond to guidance on future direction of GP Networks.

CCG Representatives proactively engaging in webinars and learning events made available by the national team

Complete PCN maturity matrix Ensure PCNs are aware of latest guidance and requirements through PLT and member meetings

GP Network Development Plan incorporated within Primary Care Strategy. Milestones being met.

As above PCN Directors CCG PCT

Provide GP Networks with data analytics for population segmentation and risk stratification to allow them to understand their populations’ needs for symptomatic and prevention programmes.

Practice level data packs currently provided PLT sessions organised to discuss data packs and encourage peer review and shared best practices Gemima training made available and being rolled out across CRCCG – Completed in WNCCG

PCN data packs available Gemima training rolled out across all PCNs Population health tools and population segmentation tools available to PCNs with appropriate training to support their use

PCN population risk stratification and population health management ensures effective use of resources and improved patient outcomes; as well as system savings due to cost and demand avoidance achieved through OOH / proactive preventative care

As above Business Intelligence and Public Health

Primary care network workforce plan implemented

PCN work force and skill mix requirements identified July 2019, to inform submission for Workforce reimbursement for eligible roles.


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Work force reimbursement fully committed against identified skill mix requirements at PCN level and practice level Sept 2019 Recruitment to Roles identified by PCN against workforce reimbursement scheme in progress from September 2019 Roles identified against 2019/20 workforce reimbursement scheme fully recruited to by March 2020

Continue to focus on connectivity across PCNs

Various regular communication and engagement channels – newsletter, etc.

MOU with GP alliance to support engagement and synergies across PCNs Identified CCG staff aligned to PCN’s

Effective relationship management and positive 360 feedback

As above Comms Team PCN Directors

Prioritise public health service needs as part of GP Network development.

JSNA base line profiles Work with GP Networks to sustain and improve uptake and coverage of national screening and immunisation programmes. Work with PCNs to ensure PCN plans reflect population health needs / priorities

Improved patient outcomes and demand management OOH Increase in self care

As above Public Health Plans

PH team PCN directors PCT

Continue to proactively identify Member GP Practices (individual and groups) likely to meet the criteria for securing support from the General Practice Resilience Programme and work with the practices to formulate requests for support for submission to NHS England.

Implementation of resilience plan submitted to NHSE

The CCG will not need to submit a resilience plan as such this year. We will receive an allocation for the STP and we will then be able to prioritise locally

Agree principals for allocation of resilience funds under two themes : 1. Planned resilience intervention

based on risk assessment and identification of known resilience risks.

2. Unplanned crisis mitigation as a pot of funding we retain for any unforeseen resilience issues, and the remained we agree set of principles for allocating the funds allocate and monitor delivery and impact of investment ie principles

q1, agreed plan and allocation q2, interim implementation & assurance,

As above


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q4 impact review and lessons learnt. Bi monthly Resilience reviews with GP federation to identify practices in need of support

In place / on going Continued support for identified practices as a result of contract closures, recruitment and retention issues, as required via the GP federation MoU for those that seek support

Avoid practices giving up contracts Maintain high CQC scores

As above PCN directors GP Federations Chief strategy and primary care officer

General Practice Resilience assessment undertaken by each PCN supported by the GP federation under an MOU

Vulnerable practices identified adhoc through LMC and Federation meetings or as a result of referral by the practices

MOU with GP federation to provide resilience support from January 2019

Work in partnership with our Member Practices, the other Coventry and Warwickshire CCGs, South Warwickshire NHS Foundation Trust and the wider training and education system (including the Local Workforce Action Board, Health Education England and the local Training Hub) to deliver the Coventry and Warwickshire Primary Care Workforce Strategy.

Continue to focus on implementation of the Primary Care Workforce Strategy.

Strategy in place and assured by NHS England. Trajectories identified by role type in work force plan

Deliver work force planned activities

Achieve reduction in work force gap and improve skill mix and expansion of general practice team roles.

STP work force strategy Primary Care Strategy HEE plans

Chief Strategy and Primary care officer STP Work force lead

Continue to focus on retention – specifically retention of GP trainees. Support eligible GPs to access the national GP Retention Scheme.

Evaluate impact of work force plan

Continue to focus on delivery of the GP nursing plan.

Refresh work force plan

Pharmacy Integration Fund/Clinical Pharmacist Programme

Ensure all staff working in general practice has access to the support of a training hub.

Expand the range of professionals working within general practice teams.

In line with the GPICT Strategy, make progress to deliver a robust, resilient, accessible, secure and high performing GP ICT infrastructure that provides the platform to enable and deliver the transformation of

Online consultations. 25% of appointments available for on line booking by July 2019

Pipeline of schemes in place funded via the national Estates and Technology Transformation Fund.

GPIT work plan in place Review GPIT SLA Identify project capacity and skill gap to deliver / implement GPIT plans

Revised Contract and SLA in place to support delivery of our GPIT work plans Capacity and skills in place to secure delivery of our work programme within specified time scales

Schemes delivered within planned timescales as evidenced via reporting to NHS England regional team.

Digital Road Map CCG IT strategy

CCG GPIT lead Chief Strategy and Primary Care Officer. GPIT GROUP and GP clinical IT lead and PM lead

Ensure all Member GP Practices are able to provide

100% of population able to access NHS App by 31 July 2019.


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general practice locally; to deliver integrated person centred care; to support new ways of working and to put Member Practices in the best position to seize on future opportunities.

all of the functionality offered through the NHS App.

Continue to implement our Primary Care Estates Strategy.

Under take options appraisal against identified housing and population demand needs to identify required estates capacity

Design Buro practice profiles Initial options appraisals FBC and OBC in development

Complete OBC and FBC for key estates priorities Refresh design buro work Secure 106 funding Produce refreshed estates strategy

Refreshed estates strategy in place with key priorities Estates work plan implemented New estates capacity realised and existing estates capacity optimised

Estates strategy Chief strategy and primary care officer STP estates programme lead.

Continue to provide extended access to general practice services for 100% of the population.

Optimise extended access capacity to deliver quality accessible service to our population

Compliant with NHSE extended access requirements

Review current capacity and put in place plans to optimise utilisation and take up across practices. Improve awareness of extended access across our patient population Roel out additional extended access hubs in locations which improve utilisation and access to services provided

Compliance with NHSE specification High satisfaction of service users Take up across member practices

Primary Care strategy Chief strategy and primary care officer

Working closely with Out of Hospital Transformation, driving service redesign in line with the NHS Long Term Plan and the improvement of patient outcomes.

Ensure consistent models of care and pathways for specific groups.

Some pathway work currently under development eg frailty

Clear pathways in place for key cohort groups Reduction in variation and inequitable access to consistent high quality care

GP Networks working at full engaged with the Transformation Programme at place level.

OOH outcome framework OOH contract

Chief strategy and primary care officer OOH provider PCN Directors

Continue to manage the Out of Hospital contract through the governance approach established in 2018/19.

Contract review meetings KPIs delivered and outcomes framework shows improvement in outcomes for patients Satisfaction of PCN with OOH provider

Delivery of Service Development and Improvement Plan (SDIP) milestones. Achievement of Out Comes Framework Demonstrable improvement in population health outcomes

OOH outcome framework OOH contract

Chief strategy and primary care officer OOH provider PCN Directors

Continue to work with Member GP Practices to trial different ways of

Active Monitoring and other social prescribing initiatives.

Social prescribing offer available but not universal model across CCGs / Places

Agree social prescribing model that delivers standardised offer but reflects the needs of each place

Reduction in clinical time spent on non clinical consultations Improved outcomes for patients as a

Public Health


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connecting their patients with sources of support within their communities.

result of being signposted to more appropriate services / support

Support the commitments within the Cancer Strategy and the Section 7a public health functions agreement in relation to population screening and national immunisation programmes.

Plan in place articulating how the CCG will work with Public Heallth commissioning teams to improve the quality of and access to screening and immunisation programmes.

Mc Millan champion in place

Continue to support the implementation of the annual flu programme.

Continue to focus on diabetes.

Reduce variation in achievement of diabetes treatment targets.

Diabetes work program in place

Achieve Diabetes transformation and prevention targets Improve patient self-care support for LTC s Improve utilisation of self-care apps and digital monitoring equipment by patients

Improve self-care

Ensure mechanisms are in place for appropriate patients to be referred to the NHS Diabetes Prevention Programme, in line with agreed targets and local population need.

Continue to discharge relevant functions in line with the Delegation Agreement for full Delegation of Primary Medical Services.

Undertake series of internal audits.

Local investment, including deployment of funding associated with development offers within the General Practice

Effective use of £1.50 per head of population recurrent investment.

Detailed local plan published by 1 July 2019.

Effective use of other funding flows (practice manager training, training for

Every Member Practice has delivered at least 2 high impact actions by 31 March 2020.


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Forward View. receptionists and clerical staff, etc.)

Support practices to deliver quality improvement

Fully implement the new QOF indicators across all practices to optimise quality improvement for our population

Variation in QOF achievement across GP practices

Practices encouraged to undertake QOF training modules for end of life and care and prescribing safety from April 2019 Ensure practices are ready for and actively respond to the introduction of the 15 new QOF indicators From April 2019 Encourage PCNs to get involved in relevant testbed programmes relevant to population health priorities from July 2019 Ensure PCN’s and individual practice respond proactively to Improvements to QOF introduced from April 2019 linked to priorities within the NHSE Long Term Plan

OUT OF HOSPITAL (GP IT) PLACE SRO: JENNI NORTHCOTE (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTH CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




IT infrastructure and digital solutions that reduce general practice work load and optimise efficiency

HSCN procurement, including increased bandwidth

Practices currently using historically provided N3 connections with limited bandwidth.

HSCN connections to be procured for practices in each area, to include appropriate facility for increased bandwidth

Practices provided with faster higher bandwidth network and internet connections to support future working

IT refresh, Including Windows 10 licenses, refresh of PCs and practice IT infrastructure

Feedback from practices indicates age of current equipment risks becoming a barrier to future ways of working

Full IT refresh to be carried out for all areas, to ensure equipment is fit for the future

IT equipment to be secured for all practices that supports future working and current standards such as Windows 10 minimum requirements. Digital maturity assessment to be utilised

Digital Dictation

Limited number of practices have secured digital dictation services

Digital dictation services to be secured and rolled out to all practices who request the facility

All practices that wish to do so able to access digital dictation services


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Single Sign on Practices reporting significant time is spent signing in/out to different IT systems.

Single sign on facility to be procured Roll out completed for all practices who wish to have single sign on

Single sign on facility secured and rolled out to all interested practices

Electronic ordering and repeat prescriptions

Implementation by April 2019

Increase timely and convenient access to general practice.

GP On Line Consultation

Limited availability of online consultations

Procurement of online consultation Roll out completed for all practices who wish to have online consultation facility 25% of appointments available for on line booking by July 2019

Recurrent investment until 31 March 2024.

Wi-Fi

Patient facing Wi-Fi rolled out to practices as per national requirements

Provision and speed of patient facing Wi-Fi to be reviewed and improved as appropriate

Patient feedback that patient facing Wi-Fi is of sufficient speed and coverage

IT enabled care co-ordination and care planning

Shared records systems Limited shared records systems in place for specific areas only, such as end of life and extended access services.

Further development of appropriate data sharing agreements and systems to support a shared clinical record

Progress made towards a shared clinical record

Two way text messaging Some utilisation of two text messaging within primary care

Two way text messaging facility to be promoted to WN practices and secured for CR CCGs

Two way text messaging facility to be available to all practices

All practices to have an on-line presence – including directory of services

Implementation by April 2020

Respond to GP estate utilisation pressures

Digitalisation of Patient Records

Strategy in place and assured by NHS England. Trajectories identified by role type.

Secure notes digitisation service, allowing the scanning and electronic storage of patient records On line to full patient record by April 2020 and for new registrations by April 2019

Notes digitisation and storage facility to be implemented in all areas

Promoting and supporting self-care

Use of MyGP app secured as part of two way text messaging

MyGP app available for patients using two way text messaging

Secure two way messaging service and attached MyGP app for all practices

MyGP all to be available to patients of all practices

Ensure all Member GP Practices are able to provide all of the functionality offered through the NHS App.

NHS App still in development nationally

NHS App to be promoted to patients and practices when available

100% of population able to access NHS App by 31 July 2019.

Enhance quality and safety

(As above) Shared clinical records system

Limited shared records systems in place for specific areas only, such as end of life and extended

Further development of appropriate data sharing agreements and systems to support a shared clinical record

Progress made towards a shared clinical record


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access services.


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PERSONALISATION (LEARNING DISABILITIES AND AUTISM, PERSONAL HEALTH BUDGETS, CONTINUING HEALTHCARE) PLACE SRO: JAMIE SODEN (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTH CCG) ALISON WALSHE (NHS SOUTH WARWICKSHIRE CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Continue transforming care for people with a learning disability, autistic spectrum condition or both by implementing ‘Transforming Care for People with Learning Disabilities’, the joint plan developed through the Arden Transforming Care Partnership.

Continue to reduce reliance on inpatient care (both CCG and NHS England funded).

Dynamic risk stratification process in place with clear function of identifying those at risk of admission Intensive support for adults with LD and ASD in place and recurrently funded Forensic support for adults in place and funded to 2020 Intensive support for children and young people with ASD in place and funded to 2020 CCG Inpatients as at 31/12/18 - 21 NHSE adult inpatients as at 31/12/18 - 20 CAMHS inpatients as at 31/12/18 - 12 CRCCG – 4 WNCCG – 2 SWCCG - 6

Evaluate intensive support service for children and young people and secure recurrent funding from April 2021 Evaluate forensic support service for adults and secure recurrent funding from April 2021 Implement new service specifications and review capacity of community learning disability services to ensure people are supported to live in the community Improve admission avoidance offer including exploring potential to develop bed based and in-reach emergency respite services Clarify key worker arrangements for children and young people with a learning disability, autism or both Undertake review of readmissions for children and young people and implement recommendations Deliver Accelerator Programme, including evaluation of impact of ASD outreach service for children and young people and co-production of single planning framework for children and young people at risk of admission to hospital. Work with education to conduct a needs assessment for young people with ASD who are out of school or on limited timetable. Develop and deliver multi-agency response to needs assessment in order to prevent hospital admission.

Achieve planned trajectory of 18.5 inpatients per million population for CCG commissioned inpatient services by March 2020 (13 adults). By March 2021, reduce adults in CCG commissioning inpatient services to 9 individuals across the TCP – each CCG will also have their own target to meet. Achieve planned trajectory of 18.5 inpatients per million population for NHSE commissioned inpatient services by March 2020 (13 adults). By March 2021, reduce adults in NHSE commissioned inpatient services to 12 individuals across the TCP – each CCG will also have their own target to meet. Achieve planned trajectory for children and young people in Tier 4 inpatient services by March 2020. By March 2021, reduce children and young people in Tier 4 services, in line with the national target, to 2 All Age Autism strategy is signed off and in place Functions of support outlined in Building the Right Support are recurrently funded.

Mental Health and Emotional Well-being

CCG


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Develop pathway for children and young people with ASD who present with self-harming and self-injurious behaviour

Reduce length of stay for those who do require inpatient care.

12 point discharge plans in place for all inpatients Additional case management resource in place in all CCGs to progress discharge Average length of stay for children and young people in tier 4 is 8 months, 1 month longer than the regional average Average length of stay for adults in assessment and treatment is 6 months 17 adults have been in hospital for more than 5 years

Continue to promote use of 12 point discharge plans to progress discharges Improve care coordination for children and young people in hospital Review capacity of intensive support services to support young people stepping down from hospital Progress planned discharges for long stay adults Work collaboratively with West Midlands commissioners to develop pathways for people with autism, commission in patient services in least restrictive setting with reduced length of stay, and implement the respond pilot.

Reduce length of stay for young people in CAMHS Tier 4 to be in line with regional average Reduce number of people in hospital with length of stay for over 5 years (for adults) and for over 1 year (for children)


CCG

Improve the quality of inpatient care across the NHS and independent sector.

Pre-admission CETR compliance is below 90%. Advocacy organisation commissioned to deliver experts by experience hub to support delivery of CTR and CETR.

CCG to be represented at Care, Education and Treatment Reviews (CETRs) for children and young people who are inpatients Alongside Birmingham and Solihull CCG, implement new specification for assessment and treatment services. Strengthen process to proactively identify children and young people and adults who are subject to regular and or prolonged restrictive practices including the use of seclusion/long term segregation and ensure that appropriate safeguarding and review

Care and Treatment Reviews (CTRs) carried out in line with policy both pre- and post-admission. Uptake of CETRs increased – 90% of under-18s admitted to hospital to have either a community CETR or a CETR post-admission. Demonstrable increase in compliance and quality of CETRs. Reduction in use of prolonged or regular restrictive practices


CCG


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measures are followed. Ensure inpatient service specifications include requirement to reduce the use of restrictive practices. Ensure commissioned services are aware of and working towards national improvement standards for learning disability services.

Continue to focus on tackling the causes of morbidity and preventable deaths in people with a learning disability, autistic spectrum condition or both.

Improve uptake of annual health checks in general practice for people aged over 14 years with a learning disability

2017/18 figures: CRCCG = 40.6% WNCCG = 52.8% SWCCG = 52.3%

Specify requirements for Health Facilitation Resource to support delivery. Promote AHCs with client group, formal and informal carers. Support primary care in delivery of DES.

At least 75% of people on the learning disability register have had an annual health check.


CCG

Increase identification of people who should be on the GP LD register and consequently benefitting from enhanced services.

2017/18 figures: CRCCG – 0.42% of GP registered population is on register WNCCG – 0.48% of GP registered population is on register SWCCG - 0.37% of GP registered population is on register National average (0.49%)

Awareness raising with the LD cohort, their formal and informal carers. Support the workforce to identify those individuals eligible for the register. Specify contractual requirements for Health Facilitation Resource to support delivery.

Registered population on the GP LD register increases in line with the national ambition for the LD register to grow year on year.


CCG

Continued learning and action from Learning Disabilities Mortality Reviews (LeDeRs).

Steering group established, chaired by the SWCCG Chief Nurse. Local area contact for each CCG attends. NHSE LeDeR trajectory developed and reported against. As at end 2018 40% of reviews complete. Administration support in

Bi-monthly steering groups scheduled. Reviewer allocation system to continue with internal monthly monitoring by CCG. Scheduled updates provided to provider CQRMs and CCG governing body committees. Communication strategy to be developed to ensure that all learning

Annual report submitted to appropriate local Boards and Committees to demonstrate action taken and outcomes from LeDeR reviews. Learning shared with stakeholders, recommended actions implemented.


CCG


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place to assist in obtaining documentation for analysis. Themes, recommendations and best practice examples identified and reported to Steering Group.

outcomes, required actions and quality improvement requirements are shared with stakeholders.

Implement the National Disability Improvement Standards and apply to all NHS funded services over the next 5 years

CCG aware of requirements. Standards being built into service specifications as developed

Begin work to ensure that all commissioned service providers are aware of the standards. Require local providers to review current practice in line with the four improvement standards and to produce plans that outline how sustained quality improvement will be developed in line with the standards. Agree mechanisms for reporting progress towards delivering improvement standards for all providers Ensure that all contracts with NHS providers include reference to the National Disability Improvement Standards and that progress monitoring is built in to quality assurance processes.

Plans are established demonstrating baseline position against standards guidance. Improvement measures are outlined. Patient experience of NHS funded services is improved. Progress to be picked up within TCP assurance and monitoring processes


CCG

The whole NHS to improve its understanding of the needs of people with LD/ASD

Working group in place with CCG and CWPT representation to address reasonable adjustment requirements for children and adults with mental health and learning disabilities.

With CWPT, co-produce and deliver plan to improve reasonable adjustments in mental health services for children and adults with LD/ASD or both. Scope the potential to roll out reasonable adjustments programme to other NHS providers including primary care.

Plan in place and implemented


CCG


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Deliver Transforming Care workforce plan, including ASD training for providers and development of self-assessment tool for Autism Friendly Services With social care, education and health providers, clarify keyworker arrangements for people with LD, ASD or both who are in hospital or at risk of admission to hospital. Identify any gaps and develop plan to address gaps. Review and share appropriate training resources including e-learning packages. Co-produce Coventry and Warwickshire All Age Autism Strategy and ensure associated workplan is owned by all partners.

Coventry and Warwickshire wide strategy developed encompassing range of activity for delivery

Expand the STOMP-STAMP programmes to stop the overmedication of people with a learning disability, autism or both.

STOMP established within secondary care - active steering group and action plan for delivery established.

Develop all-age STOMP-STAMP plan for the STP to expand beyond secondary care. Increase local intelligence with regard to levels of use of psychotropic medicine amongst LD cohort, particularly those not supported by secondary care services. Work with primary care and medicines optimisation colleagues to develop and establish a programme for medication reviews and appropriate specialist pharmacy support. Consider inclusion in the primary care incentives scheme (quality component) for 2020/21

Use of psychotropic medication is reduced. Use of appropriate non-medical intervention increases, subsequently avoiding need for/use of medication. STOMP-STAMP embedded in quality assurance processes across health and social care.

Proactive and Preventative CCG


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Ensure that STOMP-STAMP is embedded in provider quality assurance processes. Develop materials and resources to raise awareness of STOMP-STAMP amongst the LD population, their carers and supporters as well as NHS staff.

Continue to evolve our approach to person centred assessment and review, including by expanding our Personal Health Budget (PHB) offer beyond the nationally defined priority groups.

Ensure the delivery of all new Continuing Healthcare home-based packages (excluding fast track), use the personal health budgets model as the default delivery process from April 2019 onwards.

PHB offer available to those who express interest or transfer from LA with existing budget. Preparatory work in progress to ensure default offer for this cohort as of April 2019. CRCCG PHB count as at Dec 19 = 53 ( exceeded CRCCG trajectory of 42 for 18/19) WNCCG PHB count as at Dec 19 = 24 (will not meet WNCCG trajectory of 157 for 18/19)

Revised process for homecare based packages to be rolled out in readiness for April 2019 mandate. Stakeholder engagement required to ensure understanding of PHB concept and principles.

All new and reviewed NHS Continuing Healthcare home-based packages (excluding fast track) use the PHB model as the default delivery process.


Enable people with LD/ASD to have a PHB

Expansion activity into transforming care, S117 and joint funded packages of care will extend the offer amongst the LD/ASD cohort

Increase in the number of PHBs (notional, third party and direct payments) and integrated budgets.

Proactive and Preventative Mental Health and Well-being

CCG

Deliver the CCGs contribution (via trajectory set) to the national ambition for 50,000 to 100,000 people to have a PHB by March 2021.

Expansion plan exercise in progress to determine areas for PHB development beyond CHC homecare mandate. Personal Wheelchair Budget (PWB) pilot to be initiated in Coventry. Review joint funding approach for potential to deliver joint funded packages as integrated PHBs.

PHB uptake increases in areas beyond CHC homecare in line with trajectory requirements.


NHS Continuing Healthcare (CHC) delivery.

Develop plan to incorporate CHC strategic improvement programme opportunities into QIPP for 2019/20 through continued standardisation of process and adoption of best practice including the implementation of digital solutions, use of CHC SIP tools

QIPP CHC related programme for 19/20 agreed to include - EOL (fast track

assessment timescale review)

- Single handed care

QIPP schemes delivered in line with project plans, monitored monthly via assurance processes.

QIPP schemes delivered successfully, meeting savings targets and achieving intended quality benefits.

Productivity and Efficiency Mental health and well-being

CCG


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and guidance, and use of the CHAT assurance tools.

SIP tools (Finance, workforce, Digitalization, etc) - Webex sessions

completed - CHAT assurance –

implementation of the CHAT tool is in progress

System wide group to align processes with WCC established

Detailed delivery plan produced and submitted to NHS England regional team by the end of quarter 1 2019/20. Achievement against plan reviewed at least quarterly. System Wide Group to align process with CCC to be confirmed for 19/20 Liaison with other CCGs to review use of CHAT tool/resource requirements to inform implementation planning Deliver implementation plan for CHAT tool Ensure stakeholder engagement via provider forums and feedback from customers regards process and flow.

SIP tools successfully implemented and embedded within CHC processes. Improved patient experience and reduction in complaints 80%+ of cases with a positive NHS CHC Checklist receive an eligibility decision within 28 days from receipt of the Checklist (or other notification of potential eligibility). Improved relations with LAs result in less disputes.

Continue to focus on delivery of standards within the National Framework.

Plan established to implement Train the Trainer approach Project initiated to improve DToC process

Train the trainers to be appointed to lead the understanding and implementation of the framework for all staff involved with the assessment and decision making processes. FNC assessment tool to be improved for robust assessment and decision making

80%+ of cases with a positive NHS CHC Checklist, receive an eligibility decision within 28 days from receipt of the Checklist (or other notification of potential eligibility). Zero referrals breaching 28 days by more than 12 weeks in each reporting quarter, or by Q4 2019/20. Less than 15% of full CHC assessments take place in an acute hospital setting.

Productivity and Efficiency Mental health and well-being

CCG


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PLANNED CARE (INCLUDING REFERRAL TO TREATMENT TIMES) PLACE SRO: STEVEN JARMAN DAVIES (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) ALISON CARTWRIGHT (NHS SOUTH WARWICKSHIRE CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Continue to focus on delivery of relevant

NHS Constitution Standards.

Deliver 18 week Referral to Treatment (RTT) standard.

Expect to be at 90% by end of March 2019 for the

STP as a whole, with UHCW expected to be at

87%, GEH at 87%, SWFT at 92%

Work to move further towards delivery of 92%, though incorporation of

additional activity in contracts and confirmation of capacity within

providers.

Delivery of 92% RTT target for whole year at aggregate level. Contracting CCG /

Trusts

Already seen significant movements of patients hosing to be referred to providers with shorter waiting times through adoption of E-Referral.

Working across the system to review where capacity is available to look to

promote movement of patients towards that capacity within the constraints of patient choice. Use capacity alerts within the NHS e-

Referral Service (e-RS) to support shifts in flows of activity.

Potential Agreement of capacity alerts within E-Referral to promote

movement.

Improved waiting list position.

Planned Care SRO COOs

Expect to end the year with around 2,300

patients waiting over 26 weeks, this will be a

reduction of 700 from the start of 2018-19.

Most of these patients will have dates for treatment will look to focus on those

without date for treatment.

Contact every patient waiting 6 months or longer and offer the option of care at

an alternative provider. – Need to agree how providers do this on behalf

of commissioners due to IG rules.

Reduction in patients waiting over 6 months for treatment.

Planned Care SRO

COOs Contracting Teams

Expect to end the year with zero patients waiting more than 52 weeks for

treatment.

Sustain zero over 52 week waiters through the year.

Zero patients waiting more than 52 weeks for treatment. Planned Care SRO

COOs

Continue to focus on providing our

population with choice and control over their elective

care.

Expand the use of non-face-to-face alternatives e.g. virtual

clinics and telehealth.

Have undertaken a number of specialty

reviews and have actions plans for development of alternatives in 2019-20

Specialty and provider based action plans for mobilisation

Increased % of patients having no follow-up appointment for agreed

pathways Reduced new to Follow-up ratio

Primary Care Place based provision & OOHs

Planned Care SRO COOs

Promote the use of Advice and guidance to avoid need for

referral

Have advice and guidance in place at all Trusts, both

as part of Consultant Connect & email-advice

Increase coverage of Consultant Connect – telephone advice and

guidance to GPs from Consultants

Have 8 specialties in place across UHCW by Sept 2019

Look to opportunities to provide cross cover across providers and specialties, where appropriate

Primary Care Planned Care SRO

COOs Scott Maddox


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PLANNED CARE (INCLUDING REFERRAL TO TREATMENT TIMES) PLACE SRO: STEVEN JARMAN DAVIES (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) ALISON CARTWRIGHT (NHS SOUTH WARWICKSHIRE CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Continue to embed First Contact Practitioner services.

FCP equivalent service in Warwickshire – lessons to

be used to develop strategy for STP

Pilot FCP in other ICS place

Patients have direct access to MSK First Contact Practitioners.

Increased numbers of patients accessing physiotherapy directly

without having to contact

Primary Care

Planned Care SRO Gerard Dillon

Primary Care SRO

Continue to focus on streamlining elective

care pathways, including through

outpatient redesign and avoiding

unnecessary follow-up.

Ensure redesign/transformation plans

reflect recommendations in the elective care speciality

based handbooks.

Ophthalmology / Dermatology work books

reviewed and incorporated into service

specifications

Attend webinars on specialty workbooks as they are developed Review local services against these

handbooks to update specification and service provision as necessary

Increased standardisation of service specifications across the STP, used as part of development of shadow ICP

place based provision

Primary Care Place based provision & OOHs

Planned Care SRO Primary Care SRO

Place Based Boards

Ophthalmology

Maintain failsafe prioritisation processes and policies in all areas to manage the risk of

harm to ophthalmology patients.

In place

Act on the outcomes from the eye health capacity reviews. In place


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URGENT AND EMERGENCY CARE PLACE SRO:STEVEN JARMAN DAVIES (NHS COVENTRY AND RUGBY CCG/NHS WARWICKSHIRE NORTYH CCG) ALISON CARTWRIGHT (NHS SOUTH WARWICKSHIRE CCG) Priorities Key deliverables Baseline Position 2019/20 Actions/Milestones




Continue to focus on the redesign of

urgent care services outside of A&E, providing more

opportunities for patients to be seen

without going to A&E.

Patients are supported to navigate to the optimal urgent

care service.

Services in place, awaiting designation of UTC and

mobilisation to allow for improved pathways for accessing urgent care services – Pharmacy,

Primary Care including extended hours, NHS 111,

the new NHS App, UTC, A&E.

New communications strategy for urgent care access to support the

deployment of UTCs, development of place based care and how patients should seek to access urgent care.

Increase in access to UTC over baseline activity before designation Associated reduction in type 1A&E

attendances

ICS Development UTC designation

Out of Hospital (OOH) & Placed based provision

Urgent Care SRO

Implementation of HIU service to reduce unnecessary attendance at A&E

through focused support to repeat attenders.

Reduction in A&E attendances for patients supported through

programme over baseline levels prior to involvement in scheme

Mental Health Place based provision & OOH

Jenni Mclaren / Jade Rayfield

Improve GP and community practitioner use of advice and

deflection phone-lines eg GP Liaison, iSPAs

Increase numbers of calls. % direct referral to SDEC/hot clinics % deflections to other alternatives

Primary Care Place based provision & OOH

Primary Care SRO Jenni Mclaren / Jade

Rayfield

Support consent uptake and use of eSCR, Castle Register (EoL) and other

shared records

Increase number of service able to access shared records

Number of patients consenting to eSCR

Digital Transformation IM&T SRO WMAS

Increased use of risk stratification to identify and support proactive care

planning for frequent admitters / those at highest risk of hospitalisation

Increased number of referrals/patients seen Hospital avoidance %

Placed based provision & OOH Primary Care SRO

Jenni Mclaren / Jade Rayfield

Implementation of NHS 111 Online In place Launch of national NHS app National

50% of NHS 111 calls receiving clinical assessment Being achieved Maintain a 50%+ proportion of NHS

111 calls receiving clinical assessment Care Uk (NHS 111 provider)

30% of patients triaged through NHS 111 able to be

booked into face to face appointments where

appropriate.

Technical solution requires specific software at UTC for NHS 111 to access.

Work with NHS Digital to address existing interoperability issues, and

practical workarounds in the interim.

% of people booked into a face-to-face appointment, to be greater than

40% by 31 March 2020.

Digital Transformation UTC designation

Placed based provision & OOH

IM&T SRO Local A&E Delivery

Boards Provider COOs

Appropriately resource the Directory of Services (DOS) used by NHS 111 /

WMAS.

Reduction in ‘A&E by default’ selections on DOS to less than 1% by

March 2020. Placed based provision & OOH Care Uk / Jeeni Mclaren / Jade

Rayfield

Support Sandwell IUC Team and 111 efforts to promote the use of *6 by

Care Homes and *5 by Paramedics for direct access to CAS/clinical advice

Regular DOS reviews inc A&E by default cohort data.

UTC implementation. Support Sandwell IUC Team and 111

efforts to improve decision-making for mental health cases

111 A&E vs other disposition %s. Reducing A&E attendances relating

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Fully implement the Urgent Treatment Centre model.

GEH and UHCW UTC task and finish project groups

to oversee implementation of UTC

designation.

Rugby Urgent Care Centre ( June 19, tranche 4 ) Coventry Walk In Centre ( December 19, tranche 5) and GEH UCC

(June 19, tranche 4) . The Stratford MIU has been identified as becoming a UTC by December 19, tranche 5. Work

with NHS Digital will need to be resumed to address existing

interoperability issues.

Urgent Treatment Centres designated by December 2019

(exceptions subject to agreement by Regional Director).

Digital Transformation Placed based provision & OOH

Local A&E Delivery Boards

Provider COOs

Deliver NHS Constitution

Standards for urgent and emergency care, and other relevant

standards (Ambulance Quality

Indicators).

Deliver 4 hour A&E standard. Maintenance of 91% in last quarter of 2018/19

(STP)

SWFT (95%) UHCW (91%)

GEH (91%) Delivery of 4 hour A&E standard.


Provider COOs Deliver Category 1, 2, 3 and 4

ambulance response time standards.

Delivery of ambulance response time standards. WMAS

Zero tolerance approach to ambulance handover delays of

more than 30 minutes from arrival to hospital handover.

Confirmation of operational HALO capacity at site

100% of ambulance handovers occur within 30 minutes (working towards

no patient waiting more than 15 minutes).

WMAS Local A&E Delivery


Implement new urgent and emergency care standards (arising from the Clinical Standards Review) from

October 2019.

Success Measures TBC depending on output of National Clinical Standards

Review

Urgent Care SRO Local A&E Delivery


Implement the recommendations in the Carter review on

operational productivity and performance in

ambulance trusts.

Agree trajectory for safe reduction in avoidable

conveyances to emergency departments.

Trajectory to be agreed by April 2019 Trajectory to deliver reduction in avoidable conveyances agreed by

Lead Commissioner.

WMAS Sandwell CCG as lead

Commissioner

Ambulance services meet a baseline level of digital

maturity. WMAS access to Castle Register

Ambulance services are able to access and use patient and service

information at scene including access to EoL/Care Plans

Digital Transformation WMAS

IM&T SRO

Electronic prescribing deployed.

Implement comprehensive

model of Same Day Emergency Care (SDEC) in both

medical and surgical specialties.

Providers to record SDEC activity via standard core

dataset.

Undertake an independent review of acute SCED functions and implement

recommendations.

SDEC delivered 12 hours per day, seven days a week by September

2019.



Establish current baseline of % of non-elective admissions delivered via SDEC

30% of non-elective admissions delivered via SDEC by March 2020.

Urgent Care SRO


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Reduce avoidable admissions through the establishment of acute frailty services.

Comprehensive geriatric

assessments via MDTs in A&E and acute receiving units.

Implementation of actions plan from system wide peer review audit

Acute frailty service being provided for at least 70 hours a week by

December 2019. Place based provision & OOHs

Primary Care



WMAS Primary Care SRO

Coordination of system wide Frailty Programme with local place based

programmes such as UHCW IFN working with NHS Elect

Work in progress towards achieving clinical frailty assessment within 30

minutes of arrival.

Reduce potentially frail patients suffering avoidable

attendances / incidents relating to use of medicines

Commission independent care sector PMO medicines optimisation for care

home residents. March 2020.

Reduce levels of avoidable incidents relating to medicine use from Care

Homes Primary Care Primary Care SRO

Review care pathways for those patients with the

most serious illness and injury (heart

attack, major trauma, severe asthma attack

or with sepsis).

Review current pathways. Agree and Sign-off revised pathways. Agree and deliver additional operational actions

when identified.

Revised pathways in place. Place based provision & OOHs



Continue to improve performance at

getting people home without

unnecessary delay

Continue to reduce ALOS figures for admitted patients

following unscheduled admission

Reductions in ALOS seen in first part of 2018/19

(excluding 0 LOS) SWFT fell from 7.5 to 6.9 UHCW fell from 7.5 to 7.2

GEH fell from 7.8 to 7.2

Providers to agree local targets for reduction in 7-day or more lengths of stay.

Bed occupancy by long stay patients reduced by 25% versus 2017/18

baseline.

Place based provision & OOHs Continuing Health Care / Discharge

to Assess Urgent Care SRO


Provider COOs LA DoASC

Providers to agree local targets for reduction in 14-day or more lengths of

stay.

Once above achieved, reduce by 40% versus 2017/18 baseline by March

2020.


to Assess Continue to work with system partners to address Delayed

Transfers of Care (DToC) performance.

DTOCs currently 3.7% as a system

DTOCs below 3.5% Patients in hospital over 21 days within nationally set targets for each provider

DToC targets delivered in line with Better Care Fund Plan.


to Assess Health & Wellbeing


of 82

Appendix

Joint Strategic Needs Assessment documentation

Coventry City Council

JSNA profiles:

Link: http://www.coventry.gov.uk/info/190/health_and_wellbeing/1878/joint_strategic_needs_assessment_jsna

Presentation on JSNA including:

• an explanation of what the Joint Strategic Needs Assessment (JSNA) is and how it relates to the Joint Health and Wellbeing Strategy (JHWBS)

• the forthcoming refresh of the JSNA and JHWBS • key facts and figures from the latest JSNA (updated for 2018)

Link: http://democraticservices.coventry.gov.uk/documents/s37667/Coventry%20Joint%20Strategic%20Needs%20Assessment%20-%20presentation.pdf

Warwickshire County Council

JSNA profiles:

Link: http://hwb.warwickshire.gov.uk/jsna-place-based-approach/

http://www.coventry.gov.uk/info/190/health_and_wellbeing/1878/joint_strategic_needs_assessment_jsna

http://democraticservices.coventry.gov.uk/documents/s37667/Coventry%20Joint%20Strategic%20Needs%20Assessment%20-%20presentation.pdf

http://democraticservices.coventry.gov.uk/documents/s37667/Coventry%20Joint%20Strategic%20Needs%20Assessment%20-%20presentation.pdf

http://hwb.warwickshire.gov.uk/jsna-place-based-approach/

operational plan 2019/20

Documents