project initiation document [pid] transforming

Transforming Commissioning in Learning Disabilities

Project Initiation Document [PID]

Transforming Commissioning in Learning Disabilities

Version: 0.6

Date: 04/04/2013

Project Owner: David Trousdale/ Caroline Fryer

PID: Transforming Commissioning in Learning Disabilities

Transforming Commissioning in Learning Disabilities v0.6

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Document Purpose:

The purpose of the Project Initiation Documentation is to define the project, in order to

form the basis for its management and an assessment of its overall success. The Project

Initiation Documentation gives the direction and scope of the project and (along with

the Project Plan) forms the "contract" between the Project Management team and the

Governance Boards.

Version history:

Date Version No. Author Summary of changes

04/04/20

13

V0.1

David

Trousdale

First Draft

26/04/20

13

V0.2 Phil Brown Amendments

1/05/201

3

V0.3 Phil Brown &

Francis Ma

Amendments

16/05/20

13

V0.4 David

Trousdale

Amendments following the first North Essex Transforming

Commissioning in Learning Disabilities Executive Board

23/05/20

13

V0.5 David

Trousdale

Tweak to language across document and amendments

30/05/20

13

V0.6 Phil Brown Amendments following Executive Board Meeting

Document Approval:

Name of Approver Role Version No. Date approved

People:

Role Amend as appropriate Name

Project Sponsors (and Joint Chairs) Clare Morris (North CCG Cluster) and Nick Presmeg (ECC)

Project Manager/s David Trousdale/Caroline Fryer

Programme Manager – Integrated

Commissioning

Phil Stephens

Workstream Lead (Integrated

Commissioning in Practice)

Steve Allen/Steve Thumpston

Workstream Lead (Finance) Francis Ma/ Helen Chittock



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Workstream Lead (Strategies) Steve Allen / Steve Thumpston & Francis Ma

Workstream Lead (Contracting) Steve Allen /Steve Thumpston

Workstream Lead (User Engagement

and Communication)

Chris Gee

Workstream Lead (Information and Data

Sharing)

Phil Brown / Francis Ma

Workstream Lead (Winterbourne) Steve Thumpston / Phil Brown

Workstream Lead (LD Self Assessments) Chris Gee

Subject Matter Experts (SMEs)

LD Clinical Lead (West Essex CCG) Miranda Roberts

LD Clinical Lead (Mid Essex CCG) Iain Tweedlie

LD Clinical Lead (North East Essex CCG) Mark Roberts

Commissioning Support Unit Lead Steve Thumpston

Commissioning Support Unit Lead Francis Ma

CCG Regional Lead for Managed

Clinical Network

Caroline Dollery

Quality Lead for LDMH Alexina Weston

Programme Director – Adults, Health

and Community Wellbeing

Peter Tempest

All Age Adults Lead Barbara Herts

Finance Lead Helen Chittock

Strategy Lead Helen Terry

Communications and Engagement

Lead

Rob field

Commercial Lead James Wilson

Governance Lead TBC

HR Lead TBC

HRA Advice TBC

Legal Lead TBC

See also Roles & Responsibilities

1. Background:

‘Valuing People’ describes the importance of effective partnerships in promoting holistic services and

social inclusion for people with learning disabilities. The aim of this project is to strengthen the partnership

between health and social care commissioners in Essex to deliver improved outcomes for our citizens

with learning disabilities. The financial situation of the public sector is well understood and integrated

commissioning should yield efficiencies that will help both the County Council and the Clinical

Commissioning Group’s manage the demand for services within the budget constraints that are faced.

However the financial situation should not dampen our aspirations to improve services through working

together. Instead the economic challenges should be viewed as a catalyst to take the bold steps

required to reconfigure and improve our existing model of services.

There is a strong history of integrated commissioning of learning disability services in Essex. Prior to the

recent NHS and Local Authority restructures, joint commissioning arrangements included joint

appointments; a Health & Social Care Commissioning Board; and a shared strategy articulated through

the Joint Investment Plan. This enabled the successful closure of the long stay hospitals and NHS campus

provision with many people who lived as in-patients moving to their own homes in the community.

However some areas remained fragmented. The commissioning of specialist health in-patient and

community services were never fully integrated with social care and a succession of restructures within

both the NHS and the County Council led to deterioration in integrated commissioning arrangements.

The architecture to provide health and social care system leadership and coordination across public

services is being established through the statutory Health and Wellbeing Boards. Alongside this the

Integrated Planning process for the new Clinical Commissioning Groups has resulted in stronger working



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relationships between health and social care services. Mid, North and West Clinical Commissioning

Groups (3CCG’S) have stated their intention within their integrated plans to align commissioning

arrangements for learning disability services. West Essex CCG will act as the coordinating commissioner

on behalf of the three CCG’s, and the County Council has provisionally offered to take on lead

commissioning responsibilities for the partnership. Initial conversations have also been held with the

South Essex CCG’s about the potential for integrated commissioning arrangements in South Essex.

These conversations are still at an early stage and there are complexities around their relationships with

the unitary authorities and CCG’s of Southend and Thurrock that will need to be considered.

The Council is developing an All Age approach to disability to improve the experience of people with

disabilities, particularly at the time of transition into adulthood. The overall aspiration of this project will

be to encompass the All Age approach so that the integrated commissioning arrangements for

learning disability services will cover adult and children’s services, including health services across North

and South Essex. As part of this there may also be opportunities to incorporate the commissioning

undertaking by local authorities and CCG’s of Southend and Thurrock within these arrangements. To

ensure progress is made it is proposed that the work is progressed in phases. The first phase will involve

implementing the agreement between the North Essex CCG’s and the County Council to integrate

commissioning for adult learning disability services. Subsequent phases will look to involve the South

Essex CCG’s and to include children’s services, with an open invitation to Southend and Thurrock to

participate in these arrangements.

The combined health and social care expenditure by the County Council and North Essex CCG’s on

adult learning disability services is in the region of £185 million (the council’s expenditure covers all of

Essex). This consists of:

Social Care Expenditure (Essex Wide) - £171 million gross – includes £44m that has transferred from

health, of which:

• £75 million registered care

• £50 million community support and supported living

• £16 million direct payments

• £10 million employment and inclusion services

• £9 million assessment and care management

Specialist Health LD Services in North Essex - £14 million

• In Patient and Specialist Community Services - HPFT £10.1 million

• Learning Disability Allied Health Professionals - ACE £2.4 million

• Individual Placements - £700K

• West Essex AHPs, S256, QIPP and miscellaneous historical expenditure - £800K

Increasing demographics is placing significant demands on both health and social care services for

people with learning disabilities. More people with learning disabilities are surviving into adulthood, and

people are living longer. There has been an annual growth of 2.5% per year in people with learning

disabilities aged 18-64, and 6.5% for those aged 65+. Furthermore people’s needs are increasingly

complex. The overall impact of these demographic changes is estimated to be an £8.5million annual

demographic pressure on council funding. If we also take into consideration the pressures on CCGs

across Essex, this figure increases even further. The Council cannot continue to increase funding to meet

this level of demand and future savings plans are being developed, but are still to be agreed, to meet

any new demand within the current level of spending. In addition the CCG’s have efficiency targets

within their QIPP programmes that need to be delivered.

There are also several national drivers that require an integrated response from health and social care

services. The abuse that took place at Winterbourne View highlighted the potential consequences of

fragmented commissioning. The resulting action plan tasks CCG’s and Local Authorities with

commissioning local integrated services for people with challenging behaviours, with an expectation

that this will be supported by financial arrangements. The recent publication of the “Confidential Inquiry

into premature deaths of people with learning disabilities” by the University of Bristol reported that

people with learning disabilities continue to experience poorer health than the general population.



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Over a quarter of the deaths they examined were amenable to better quality health care (i.e. they

could have been delayed or avoided).

To manage the increasing demographics and respond effectively to these national drivers, partners will

have to think radically about how to manage demand and commission services together. Services will

need to be prioritised, commissioned, designed and delivered in an integrated way to support people

with learning disabilities to enjoy good health and lead independent fulfilling lives. The journey towards

integrated commissioning will require the development of a shared plan; agreement on how resources

including staff and finances are best utilised; and on how risks and benefits are shared.

2. Objectives, Desired Outcomes and Priorities: The overarching objective of this project is to firstly explore what Integrated Commissioning in Learning

Disabilities could look like through a number of options appraisals. Once this is completed the next step

will focus on the establishment of a single integrated commissioning approach to learning disability

services across North Essex, with the eventual aim to roll this out across the whole of Essex. This will take

the form of a partnership with the three North Essex CCGs and ECC.

To achieve the above objective this project will deliver the following outputs. These are the creation of:

A Transforming Commissioning in Learning Disabilities Executive Board with representation

from CCGs and ECC; A set of the governance arrangements and delegated decision-making mandates; A set of priorities for service transformation that reflect current local and national

imperatives; An agreed and published joint health and social care strategy; An exploration of the financial options available to support integrated commissioning and

the adoption of one of those financial options; Joint arrangements for commissioning and contracting with health & social care providers.

The objectives and outputs will feed into the ‘deliverables’ section of this document. These objectives

are underpinned by a number of project activities which will need to be completed:

The development of a unified All Age Learning Disability Register. An analysis of need including current & future demand. The development of a Market Position Statement for learning disability services. The development of the model for engaging with citizens with learning disabilities and their

families. The development of an integrated health and social care approach to people who challenge

services. The development of an integrated approach to supporting family carers.

All of these activities will require full and active engagement with people with learning disabilities and

family carers. There is a strong infrastructure in Essex for user engagement which includes the Partnership

Board, Local Action Groups, The Essex People’s Parliament and the Essex Carer’s Network. The project

will use these existing networks rather than create new ones to ensure the voices of service users and

carers are represented.

The overarching outcomes of what we aim to achieve as a result of the establishment of a single

integrated commissioning approach to learning disability services across North Essex is that people with

learning disabilities will have improved health and wellbeing through:

• Having access to good quality information, advice, and guidance.

• Having choice and control over the support they receive.

• Being supported to maximise their work capacity and skills and to enter employment.

• Being supported to access positive activities within their communities.

• Being able to maintain and strengthen friendships and relationships.



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• Being supported in accommodation that gives them maximum independence.

• Making healthy choices and adopting healthy lifestyles.

• Having equitable access to health services.

• Learning to manage their own health and social care needs.

• Feeling safe in their local communities.

• Being supported with dignity and respect.

• Supporting families and informal carers.

There are a number of priorities that have already been agreed through the Integrated Plans. These

are:

• Improving access to primary and secondary health services:

Annual health checks, health action plans, access to screening programmes, and ensuring

reasonable adjustment by mainstream health services

• Developing an approach for people whose behaviour challenges services:

Aligned to the Winterbourne response, develop integrated health and social care pathways

and integrated commissioning of specialist services for people whose behaviour challenges

services. A focus of this project will be to consider the needs of all people currently living in

closed communities, and to develop appropriate community based solutions so people are

supported in the least restrictive environment possible.

• Responding to Winterbourne:

Ensuring those people currently living in in-patient services are reviewed, that person centred

plans are in place, and that people are discharged to their local communities if they no longer

require in-patient services.

• Development of an All Age Approach to Commissioning

3. Critical Success Criteria:

Description of CSC How will success be

measured

Associated Deliverable (and

date) Who signs off?

A new joint health

and social care

strategy for people

with learning

disabilities

Publishing of strategy

and demonstration of

delivery of strategy

Joint Health and Social Care

Strategy

TBC

Clare Morris, Nick

Presmeg

A cross

organisational

approach to

commissioning

services for people

with learning

disabilities

Publishing the joint

health and social care

strategy

Regular commissioning

reports delivered to the

Integrated

Commissioning Board

Regular board

meetings which

produce regular

actions

A combined data set of

information about

people with learning

disabilities.

Learning disability

services no longer

duplicated across

Health and Social Care

Transition to Integrated

Commissioning

Completion 11/09/2013

Sign off 25/09/14

Clare Morris, Nick

Presmeg

A consistent service The publication of the Joint Health and Social Care Clare Morris, Nick



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Description of CSC How will success be

measured

Associated Deliverable (and

date) Who signs off?

offer to people with

Learning Disabilities

strategy will describe

the “service offer” that

people with learning

disabilities can expect

from health and social

care services.

User engagement

forums will be used to

monitor user and carer

satisfaction with

learning disability

services against this

offer.

Strategy

TBC

Engagement and

communication plans

Draft

TBC

Presmeg, James

Wilson

Efficiencies as a

result of integrated

commissioning

The efficiencies can be

seen as mitigating the

impact of increased

demand.

Options Appraisal

TBC

Clare Morris, Nick

Presmeg, Helen

Chittock

Successful merging

of benefits of both

QIPP (Quality,

Innovation,

Productivity and

Prevention) and Best

Value in Social Care

Increase in quality of

services

Increase in value of

services

Current contracts &

commercial arrangements

TBC Steve Allen, Francis

Ma

The financial options

available to support

integrated

commissioning are

explored and

assessed on merits

Completion of an

options appraisal

Design of what financial

arrangement will look like

Plan for how financial

arrangement will operate

when in place

TBC

Francis Ma, Helen

Chittock

Delivery of

Recommendations

from Winterbourne

View

Report demonstrating

evidence of delivery

against each

recommendation

The required actions in the

Winterbourne View action

plan are completed on

time.

Completed 1/06/2014

Steve Allen, Steve

Thumpston

Development of

robust integrated

service specification

which can be taken

to market

TBC TBC TBC

4. Benefits:

Integrated commissioning arrangements will help ensure that services provide best quality and value

through:



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• Taking a whole-system approach to the health and social care needs of people with learning

disabilities.

• Reducing dependency by encouraging and supporting people to develop skills and capabilities

to do as much as possible for themselves.

• Maximising use of low level interventions, equipment, technology and adaptations that increase

independence and reduce the need for more intensive support.

• Maximising use of community and mainstream facilities and services that allow people to lead

as ordinary a life as possible.

• Closer collaboration of specialist health and social care services and integrated care and

support pathways.

• Improving access to primary and secondary health services.

• Improving support to those people whose behaviours challenge services, and through doing so

respond to the requirements of the Winterbourne View action plan.

• Improving the experience of people during the transition from children’s services to adult

services through developing an All Age Approach to commissioning learning disability services.

• Supporting family carers to care for their family members, and ensuring that they enjoy a good

quality life whilst maintaining their caring role.

5. Costs:

As this project focuses on establishing an integrated approach to commissioning learning disability

services through the establishment of an integrated commissioning board with new governance

arrangements a vast majority of the costs centre around officers providing their time to get the new

structures in place. There may also be legal costs relating:

Establishing the board;

Working through the governance arrangements;

Drafting and agreeing Partnership Agreements;

Working through the financial arrangements

The table below summarises the costs expected as part of this project.

A breakdown of the FTE for the project is demonstrated below along with associated costs.

Resource Opportunity /

New FTE Cost

Programme Manager Opportunity 0.1 None

Project Manager Opportunity 0.5 None

Workstream Leads Opportunity 5 None

CCG Clinical Leads Opportunity 1 None

SCF Lead Opportunity 0.1 None

Financial Specialist Opportunity 0.4 None

Policy and Strategy

Resource Opportunity 0.2 None

Communication and Opportunity 0.2 None



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Resource Opportunity /

New FTE Cost

Engagement Resource

Commercial Lead Opportunity 0.1 None

Governance Lead Opportunity 0.1 None

HR Lead Opportunity 0.4 None

HRA Advice Lead Opportunity 0.2 None

Clinical Leads Opportunity 1.5 None

Legal Lead (In two

stages. The first relates to

legal advice in

developing integrated

commissioning

approach. The second

relates to legal advice

around procurement)

New 0.1 TBC

Financial specialist Opportunity 0.2 None

Total 10.1 TBC

6. Approach:

In establishing a single integrated commissioning approach to learning disability services in Essex, the

project will be divided into phases. This PID outlines the details relating to phase one, which will focus on

integrating the commissioning of adult learning disability services in the North CCG cluster and ECC. To

achieve this each workstream will explore what integrated commissioning means with regards to their

specific workstreams and then outline what will need to be done to develop an integrated

commissioning approach to Learning Disabilities. Later phases will explore the integration of learning

disability services in South Essex, and integrating children’s learning disability services within the

commissioning approach established in phase one.

Phase one will involve the establishment of a Learning Disabilities Executive Board to oversee the

running of the project. A project team will be established below this, comprised of a project manager

and a number of project leads. Each workstream lead will be tasked with setting up a project action

plan for each of the workstreams, detailing how they will deliver their deliverables over the period April

2013-14. They will then be expected to manage this plan. Workstream leads will be drawn from the

Working Age Adults Team (in ECC) and the NHS Essex Commissioning Support Unit.

The Executive Board will meet monthly to be kept up to date on the developments of the project. The

project team will meet twice a month to update the project manager on the progress made to date.

The workstreams for the programme are shown below along with a detailed description of the

approach for each.



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Governance

(including

establishing

new board)

Structure

(including

human

resources)

Integrated

Commissioning

in practice

Contracting &

Commercial

LD Pathway

Strategies

Current

Contracts &

Commercial

arrangements

Information and

Data Sharing

Processes,

challenges,

governance and

approach

Integrated

Commissioning

Processes

Transition to

integrated

commissioning

Future

contracts &

commercial

arrangements

Joint Health and

Social Care

Strategy

User

Engagement

and

Communication

Communication

plan

Engagement

plan

Transforming Commissioning in

Learning Disabilities Project

Executive Board

Project Team

Financial

Arrangements

Design of what

the financial

arrangements

might look like

Current LD

budgets across

CCG Cluster

and ECC

Governance

Workstream

Deliverable

Needs Analysis

& Priorities for

Service

Transformation

Winterbourne Recommendations

Options

appraisal

Sign off of

whole approach

to integrated

commissioning

Sign off

(ECC/CCG

Governance)

including s151

Sign off by

ECC/CCG

Governing

bodies

Memorandum of

Understanding

signed

LD Self

Assessments

Strategies

This workstream will focus specifically on the production of ‘The Joint Health and Social Care Strategy for

people with Learning Disabilities’. It will also develop the Learning Disabilities Pathway for Integrated

Commissioning.

User engagement and communications

This workstream will aim to produce a user engagement and communication plan. This will

communicate the key changes as part of transition towards integrated commissioning and will ensure

that key stakeholders are engaged with.

The Winterbourne View Recommendations

This workstream will oversee the implementation of the recommendations from the Winterbourne View

action plan.

Integrated Commissioning in practice

The approach of this workstream is firstly to explore what integrated commissioning might look like

through an options appraisal. Once this is completed the next step is to adopt one of the approaches

and then to establish the structures, governance and working practices to support integrated

commissioning across North Essex. The workstream will establish a joint commissioning Executive Board

with governance arrangements and processes enabling it to commission joint services across the North

Essex Cluster. This will involve setting out the governance arrangements for this new approach to

commissioning, the priorities it will focus on as well as other areas including membership of the board,

how regular it will meet, and setting the legal basis for the partnership arrangements. This workstream

will explore whether there will be any human resource implications as part of the new structure. It will

also cover the sign off of the approach through ECC and CCG governance processes. A Memorandum

of understanding will also need to be signed before integrated commissioning can be delivered

Financial Arrangements

Through an option appraisal this workstream will explore what financial arrangements need to be put in

place to support Integrated Commissioning. Once a suitable option has been determined this

workstream will then set out the work that needs to be completed to put in place the financial

arrangements to support integrated commissioning. It will also cover the sign off of the financial

arrangements (including the s151 officer) through ECC and CCG governance processes.

Contracting and Commercial

This workstream focuses specifically on the commercial aspects of joint commissioning. It will look at the

current contracts and commercial agreements, map the timelines for each contract, and explore the

potential for efficiencies through joint commercial arrangements going forward. This will include the

development of an integrated Essex Market Position Statement for learning disability services.



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Information and Data Sharing

This workstream will explore the information and data sharing challenges of integrated commissioning

including an establishment of a unified all age register, and will seek to put in place measures to ensure

that the new integrated commissioning approach adheres to all information and data sharing protocols

across Essex County Council and the North CCG Cluster. It will also establish the processes and

governance for the sharing of data across ECC and the North CCG Cluster. The deliverables in this

workstream will need to be signed of ECC and CCG governance bodies.

LD Self Assessments

This workstream will focus on aligning LD Self Assessments across CCGs and ECC

Project Plan:

The below project plan shows the key milestones and workstreams as well as the associated

deliverables.

The following deliverables and indicative timescales were agreed as part of the project: A Transforming Commissioning in Learning Disabilities Executive Board with representation

from CCGs and ECC (to be set up in shadow form from 1st May to oversee the project); Agreed governance arrangements and delegated decision-making mandates (to be

agreed by September 2013); A set of priorities for service transformation that reflect current local and national imperatives

(to be agreed by September 2013); An agreed and published joint health and social care learning disability strategy (to be

completed by September 2013); Completion of an options appraisal outlining the financial arrangements required to support

integrated commissioning where possible. The preferred option will need to be signed off by

both ECC and CCG governance processes(agreement in principle by September 2013 for

implementation by 1st April 2014) Joint arrangements for commissioning and contracting with health & social care providers

(by 1st April 2014)

A detailed project plan will be built following the completion of workstream action plans by each

workstream lead however a high level timeline has been included below outlining key milestones:



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Workstream2013 2014

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

Integrated Commissioning in

practice

Financial

Arrangements

Contracting and

Commercial

Strategies

Communication and Engagement

Plan

Information and

Data Sharing

Winterbourne Recommendations

LD Self Assessments

Other

Deliverables signed off

25/09/2013

25/09/2013

Deliverables

signed off

25/09/2013

Deliverable signed

off

25/09/2013

Deliverables

signed off

Key Milestone Key Milestone

31/03/2014

Implementation of

approach

31/03/2014

Implementation of

approach

31/03/2014

Future contractual

arrangements outlined

17/04/2013

PID Draft

completed

15/05/2013

First Exec

Board Meeting

25/05/2013

Key Exec

Board Meeting

01/04/2014

Go-live

01/06/2013

Review and person centred plan

31/03/2014

Strategy Developed

Key Milestone

29/11/2013

Governance sign off

29/11/2013

29/11/2013

29/11/2013

29/11/2013

Governance sign off

(including s151)

Governance sign off

Governance sign off

Governance sign off of entire

project by CCG/ECC governance

7.1 Scope – Inclusions:

The following areas are in scope of phase one of this project:

Adult learning disability services commissioned on behalf of the North Essex CCGs

Adult learning disability services commissioned and provided by ECC.

Learning disability services for younger people (14+) commissioned and provided by ECC.

Governance arrangements for Learning Disability services in both North CCGs and ECC

Processes relating to the commissioning/de-commissioning of Learning Disability services in both

North CCGs and ECC

Learning Disabilities information and data held by both North CCGs and ECC

The current Learning Disabilities priorities in both North CCGs and EEC

Financial arrangements for commissioning LD services in both North CCGs and ECC

Current North CCG/ECC partnership arrangements across North Essex

Learning disability strategies either published or in the process of being written in both North

CCGs and ECC.

The current Essex Market Position Statement.

Current User engagement and communications arrangements in both North CCGs and ECC.

Office accommodation and human resources involved in learning disability commissioning

across North CCGs and ECC.

The following areas will be in scope as part of the next phases for the project:

Adult learning disability services commissioned on behalf of the South Essex CCGs

Children’s learning disability services commissioned on behalf of the CCGs

7.2 Scope – Exclusions:

The following areas are not in scope of phase one of this project:



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Learning Disability services commissioned on behalf of the South CCG Cluster (including services

commissioned by Thurrock and Southend CCGs). This includes contracts, grant agreements,

governance arrangements, processes, information and data, financial resources, partnership

arrangements, strategies, user engagement and communications.

Other services provided to adults by North CCG and ECC.

Learning disability services provided by Thurrock and Southend Councils.

8. Constraints:

Constraint Description of Constraint Owner

Time This project must be delivered by 1 April

2014

David Trousdale/Caroline Fryer

Resources

Neither ECC nor the North CCGs have

unlimited resources to deliver this project.

Resources must be managed carefully.

Resources refer both to the finances and

time of staff to run the project.

David Trousdale/ Caroline Fryer

Contractual

Arrangements

The North CCGs and ECC may be locked

into a number of contractual

arrangements with regards to the provision

of services. This may limit the ability to

integrate approaches to LD commissioning

Clare Morris/ Nick Presmeg

9. Assumptions:

Assumptions How will it be validated? By When By Who

The political will of both ECC and North

CCGs to integrate their commissioning

approaches.

Through formal

agreement of this PID by

the Executive Board

End of April

2013

Nick

Presmeg/Clare

Morris

There is potential for Efficiencies

Tracking of financial

expenditure once

integrated

commissioning approach

is in place. This will then

be compared to

financial expenditure

prior to integrated

commissioning approach

End of 2014

and on

going

Francis Ma/

Helen Chittock

Initial arrangements will be between

ECC and the North Essex CCG Cluster.

Discussions with the South Essex CCGs

will continue as the project progresses.

Through formal

agreement by the

Executive Board

End of May

2013

Nick

Presmeg/Clare

Morris

Commissioned CCG LD services for

children are outside the scope of this

project (ECC Children’s LD services from

14+ are, however, in scope)

Through formal

agreement of this PID by

the Executive Board

End of May

2013

David

Trousdale/

Caroline Fryer

Project resources are available to

support the project The Executive Board will

identify resources for the

End of May

2013 Nick

Presmeg/Clare



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Assumptions How will it be validated? By When By Who

project Morris/ Phil

Stephens

10. Deliverables:

Workstream Deliverable Deliverable Description Owner Date

Integrated

Commissioning in

practice

Governance

arrangements

for the new

board

This deliverable outlines the

governance arrangements

for the new integrated

commissioning executive

board.

Steve Allen/

Steve

Thumpston

Sign off

25/09/13

Implementation

31/03/2014

Needs Analysis

& Priorities for

service

transformation

This deliverable will establish

the priorities for the

integrated commissioning

board. This will build on

current priorities and data

gathered through a needs

analysis.

Steve Allen/

Steve

Thumpston

Sign off

25/09/14

Transition to

Integrated

Commissioning

This deliverable sets out the

steps involved in combining

LD commissioning functions

in North Cluster CCGs and

ECC.

Steve Allen/

Steve

Thumpston

Sign off

25/09/13

Implementation

31/03/2014

Integrated

Commissioning

Structure

This deliverable sets out the

new structure of the

Integrated Commissioning

Executive Board including

who will sit on the board and

responsibilities of board

members.

Steve Allen/

Steve

Thumpston

Sign off

25/09/2013 then

implementation

31/03/2014

Integrated

Commissioning

Processes

This deliverable will focus on

the processes involved in

commissioning integrated

services for people with

learning disability.

Steve Allen/

Steve

Thumpston

Sign off

25/09/2013

Implementation

31/03/2014

Sign off of

overall

approach

Sign off of approach by ECC

and CCG governance

processes (including s151

officer where appropriate)

Steve Allen/

Steve

Thumpston

By 29/11/2013

Memorandum

of

Understanding

signed

Document signed ensuring

all partners buy into the

approach

Steve Allen/

Steve

Thumpston

By 29/11/2013

Financial

Arrangements

Options

appraisal

exploring

financial options

to support

integrated

commissioning

This deliverable will look at

what options exist to support

integrated commissioning,

including exploring risks and

benefits

Francis Ma/

Helen

Chittock

Sign off

25/09/2013



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Identification of

current LD

budgets

across North

CCG Cluster

and ECC

This deliverable focuses on

current budgetary

arrangements.

Francis Ma/

Helen

Chittock

Sign off

25/09/2013

Design of what

financial

arrangements

will look like

This deliverable will focus on

how pooled budgets will

look like.

Francis Ma/

Helen

Chittock

Sign off

25/09/2013

Plan for how

Financial

arrangements

will operate

when in place

This deliverable outlines how

pooled budgets will operate

and the transition to get

there.

Francis Ma/

Helen

Chittock

Sign off

25/09/2013

Sign off of

approach

Sign off by ECC/CCG

governing bodies (including

s151 officer)

Francis Ma/

Helen

Chittock

Sign off

25/09/2013

Memorandum

of

Understanding

signed

Document signed ensuring

all partners buy into the

approach

Francis Ma/

Helen

Chittock

Sign off

25/09/2013

Contracting and

Commercial

Current

contracts &

commercial

arrangements

This workstream will draw

together the current LD

contracts and commercial

arrangements in ECC and

the North CCG Cluster. It will

also look at opportunities to

commission services jointly in

the future.

Steve Allen

/Steve

Thumpston

Sign off

25/09/2013

Future contracts

& commercials

arrangements

This workstream focuses on

the future contractual and

commercial arrangements

for integrated

commissioning.

Steve Allen

/Steve

Thumpston

Implementation

31/03/2014

Strategies

Joint Health and

Social Care

Strategy

This workstream focuses on

writing the Joint Health and

Social Strategy.

Steve Allen

/ Steve

Thumpston

& Francis

Ma

Sign off

25/09/2013

LD Pathway

This deliverable will set out

the new LD Pathway for

integrated commissioning of

LD services for Service Users

in the North Essex Cluster

and ECC.

Steve Allen

/ Steve

Thumpston

& Francis

Ma

Sign off

25/09/2013

User engagement

and

communication

Communication

plan

This workstream sets out how


will be communicated to

Service Users and key

partners.

Chris Gee

Sign off

25/09/2013



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Engagement

plan

This workstream sets out who

will be engaged with as the

North Cluster and ECC move

towards integrated

commissioning.

Chris Gee

Sign off

25/09/2013

Information and

Data Sharing

Information and

Data Sharing

processes,

challenges,

governance

and approach

This workstream will set out

the processes, governance

mechanisms and challenges

for sharing information and

data between the North

CCG Cluster and ECC.

Phil Brown /

Francis Ma

Sign off

25/09/2013

Sign off of

Information and

data sharing

approach

Sign off by ECC/CCG

governing bodies

Phil Brown /

Francis Ma

Sign off

25/09/2013

Winterbourne

View Actions

The required

actions in the

Winterbourne

View action

plan are

completed on

time.

These actions include:

All people with learning

disabilities in in-patient

services have a review and

person centred plan by

June 1st 2013.

All people who no longer

need in-patient services are

supported to move to local

community based services

by 1st June 2014.

Local authorities and CCG’s

have developed a strategy

for people with behaviours

that challenge services by

March 31st 2014. This strategy

should include a market

development strategy to

develop appropriate local

solutions.

Steve

Thumpston /

Phil Brown

June 1st 2013

June 1st 2014

March 31st 2014

11. Key Milestones:

Milestone Description of Milestone Owner Date

Initial Project Meeting This milestone marks the initiation

of the project

David

Trousdale/

Caroline Fryer

09/04/2013

Project Initiation Document first

draft

This milestone will mark the

completion of the first draft of

the PID

David

Trousdale/

Caroline Fryer

17/04/2013

Initial Transforming

Commissioning in Learning

Disabilities Executive Board

Meeting*

This milestone will involve the

sign off of the approach to

integrated commissioning and

give the ‘green light’ for the

project to progress

Clare Morris/

Nick Presmeg 15/05/2013



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All people with learning

disabilities in in-patient services

have a review and person

centred plan

N/A

Steve Allen,

Steve

Thumpston

1/06/2013

Options appraisal exploring

financial arrangements to

support integrated

commissioning

N/A Francis Ma/

Helen Chittock

Sign off

25/09/2013

Engagement Plan signed off N/A Chris Gee

Sign off

25/09/2013

Communication Plan signed off N/A Chris Gee

Sign off

25/09/2013

First draft of an agreed joint

health and social care learning

disability strategy


completion of the agreed joint

health and social care learning

disability strategy

Steve Allen/

Steve

Thumpston &

Francis Ma

TBC

Needs Analysis completed N/A

Steve Allen/

Steve

Thumpston &

Francis Ma

TBC

Integrated Commissioning LD

Pathway

This milestone will mark the sign

off of the Integrated

Commissioning LD Pathway

Steve Allen/

Steve

Thumpston &

Francis Ma

TBC

Information and Data Sharing

processes, approach and

governance paper signed off

N/A Phil Brown /

Francis Ma

Sign off

25/09/2013

Document outlining Priorities for

Service Transformation signed off N/A

Steve Allen /

Steve

Thumpston &

Francis Ma

Sign off

25/09/2013

Document outlining new

governance arrangements and

delegated decision-making

mandates for April 2014 onwards


completion of the first draft of

the documentation outlining

new governance arrangements

and delegated decision-making

mandates for April 2014 onwards

Steve

Allen/Steve

Thumpston

Sign off

25/09/2013

Design of integrated

commissioning structure

completed

N/A

Steve

Allen/Steve

Thumpston

Sign off

25/09/2013

Integrated Commissioning

business processes outlined in

document

N/A

Steve

Allen/Steve

Thumpston

Sign off

25/09/2013

Identification of current

contractual and commercial

arrangements completed

N/A

Steve Allen

/Steve

Thumpston

Sign off

25/09/2013



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Learning Disabilities Executive

Board Meeting*

This milestone will involve sign off

of above documents including:

governance arrangements

and delegated decision-

making mandates

set of priorities for service

transformation that reflect

current local and national

imperatives

approach to financial

arrangements where

possible with appropriate

governance

an agreed and published

joint health and social care

learning disability strategy.

This milestone will mark a critical

point in the project as it will act

as a ‘green light’ to start rolling

out integrated commissioning. It

will involve the actioning of the

various documents signed off at

this meeting

Clare Morris /


Overall sign off of Integrated

commissioning approach by

ECC and CCG governing bodies

(including CLT, Cabinet and

s151)*

This includes sign off of key

deliverables as part of all

workstreams

Clare Morris /

Nick Presmeg

By

29/11/2013

Signing of Memorandum of

Understanding* N/A

Clare Morris /

Nick Presmeg

By

29/11/2013

Joint arrangements for

commissioning and contracting

with health & social care

providers in place


finalisation of joint

arrangements for commissioning

and contracting with health

and social providers

Clare Morris /


Local authorities and CCG’s

have developed a strategy for

people with behaviours that

challenge services

N/A

Steve Allen/

Steve

Thumpston &

Francis Ma

31/03/2014

Completion of transition to

integrated commissioning and

Go- live*

This milestone marks the

beginning of integrated

commissioning

Clare Morris /


All people who no longer need

in-patient services are supported

to move to local community

based services

N/A Clare Morris /


*Bold text mark critical milestones which must be reached for the project to be a success.

12. Stakeholders:



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Stakeholders (Named)

Clare Morris – Chief Officer for West Essex NHS CCG and Joint Chair of Executive Steering Group

Nick Presmeg – Commissioning & Delivery Director - North East Essex and Joint Chair of Executive Steering Group

Phil Stephens – Programme Manager – Integrated Commissioning

Steve Allen – Senior Commissioning Manager for Working Age Adults, ECC

Phil Brown – Commissioning Manager for Working Age Adults

Stephen Thumpston – Transition Project Manager, Learning Disabilities, NHS Central Eastern

Commissioning Support Unit

Francis Ma - Transition Project – LD Transformation Project Lead, Mental Health and Learning Disabilities

Team, NHS Central Eastern Commissioning Support Unit

Peter Tempest – Programme Director – Adults, Health and Community Wellbeing

Miranda Roberts – LD Clinical Lead (West Essex CCG)

Iain Tweedlie – LD Clinical Lead (Mid Essex CCG)

Mark Roberts – LD Clinical Lead (North East Essex CCG)

Caroline Dollery - CCG Regional Lead for Managed Clinical Network

Alexina Weston – Quality Lead for LDMH

Barbara Herts – All Age Lead

Helen Chittock – Finance Lead

Helen Terry – Strategy Lead

Rob Field – Communications and Engagement Lead

James Wilson – Commercial Lead

HR Lead - TBC

Joanna Killian – Chief Executive - ECC

Dave Hill – Executive Director for Schools, Children and Families

Sally Burton – Interim Director for Adult Social Care

Margaret Lee – Executive Director for Finance

Stakeholders (Unnamed)

Lead LD Nurses

People with learning disabilities and their carers

HealthWatch

ECC Councillors

Senior Managers across Mid, North and West CCGs

13. Dependencies:

Dependency description Owner Type (Inward

or Outward)

Transformation MKII David Trousdale/

Caroline Fryer Inward

ECC’s All Age approach to commissioning David Trousdale/

Caroline Fryer Inward



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Dependency description Owner Type (Inward

or Outward)

Wider work on integrated commissioning Clare Morris/ Nick

Presmeg Inward

Department of Health action plan around Winterbourne Steve Allen and

Clare Morris Inward

LD services provided to adults and children by ECC and to adults

by the North Cluster CCGS

David Trousdale/

Caroline Fryer Outward

14. Key Risks:

Key Risks Risk description Owner

Financial arrangements

There are a range of risks around whether both the

CCGs and ECC have the appetite to adopt new

financial arrangements around integrated

commissioning when there are major pressures on

the budget currently.

Francis Ma/ Helen

Chittock

Political will of CCGs and

ECC to integrate

commissioning

There is a risk that both the North CCG cluster and

ECC lose the appetite to integrate LD services

Nick Presmeg/

Clare Morris

Additional financial

pressures arising from the

action plan for

Winterbourne View

There are 23 people from North Essex funded by the

Specialist Commissioning Group (SCG) that currently

live in in-patient services of which 10 have been

identified as no longer requiring in-patient services.

There is a high financial risk to the partnership if the

funding for these people does not transfer to the

CCG’s / local authority.

Nick Presmeg/

Clare Morris

The Winterbourne View

Recommendations are

not fully implemented

There is the risk that there may not be sufficient local

resources to meet the needs of those people who no

longer require in-patient services to ensure people

are discharged by the 1st June 2014. There is also a

risk around the financial implications of Winterbourne

as described above.

Nick Presmeg/

Clare Morris

Transformation MkII means

that it is not clear where

LD services will sit in ECC

once it has been

transformed or who will be

managing LD services

The ECC restructure might result in a change of

personnel which would impact on the current

established working relationships.

Nick Presmeg

Resourcing the project The resources are not available (in terms of man

power) to support the project going forward

Nick Presmeg/

Clare Morris

Partners do not sign-up to

the ‘lock-in’ contracts for

the project

Partners may not want to lock in to long term LD

contracts

Steve Allen/ Steve

Thumpston

Partners withdraw if the

suggested benefits do not

accrue

There are a number of suggested benefits which

may not materialise due the complex nature of the

work programme.

Clare Morris/ Nick

Presmeg

15. Key Issues:



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Key Issues Description of Issue Mitigating Factor Owner

It is difficult to

demonstrate the cost-

benefits of integrated

commissioning

The cost benefits of


are complicated and may

not be easy to evidence

Set out a clear plan for

cost-benefit analysis at

the start of the project

showing how evidence

will be gathered.

David Trousdale/

Caroline Fryer

16. Governance:

The governance for this project is outlined below:


Learning Disabilities Project

Executive Board

Decision Making

Process

Delivery

of Project

Project Team

Health and Wellbeing Board Business Management

Group

ECCGovernance

Mid

CCG Governance

North

CCG Governance

West

CCG Governance

Health and Wellbeing Board

Learning Disabilities

Partnership Board

Key decisions for the Transforming Commissioning in Learning Disabilities Project are made by the

Transforming Commissioning in Learning Disabilities Project Executive Board. These decisions are then

signed off by the Health and Wellbeing Business Management Group which feeds into the Health and

Wellbeing Board, and by the individual organisations involved in the partnership. Navigating the

governance in both the CCGs and ECC will be the responsibility of lead officers from the various

organisations. Throughout the project the Learning Disabilities Partnership Board will be involved in

helping shape the integrated commissioning approach.

17. Communications/Engagement:

Communication and engagement will take place through existing LD partnership board. The

communication and engagement plans will be developed as part of the project

18 Roles & Responsibilities

Name Role Amend/delete as

appropriate Responsibilities

Clare Morris/ Nick

Presmeg

Project Sponsors

(and Joint Chairs)

Setting the project vision, chairing the Executive Board,

Has overall responsibility for project success

David Trousdale/

Caroline Fryer Project Manager/s

Responsible for managing the project and ensuring it is

delivered on time and on budget

Phil Stephens Programme

Manager –

Integrated

Responsible for providing strategic direction and

ensuring the project aligns to the overarching integrated



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Commissioning commissioning approach

Steve Allen/ Steve

Thumpston

Workstream Lead

(Integrated

Commissioning in

Practice)

Responsible for delivering the Integrated Commissioning

Workstream

Francis Ma/ Helen

Chittock

Workstream Lead

(Financial

Arrangements)

Responsible for delivering the Workstream

Steve Allen / Steve

Thumpston, Francis

Ma

Workstream Lead

(Strategies) Responsible for delivering the Strategies Workstream

Steve Allen/ Steve

Thumpston

Workstream Lead

(Contracting and

Commercial)

Responsible for delivering the Contracting and

Commercial Workstream

Chris Gee

Workstream Lead

(User Engagement

and

Communications)

Responsible for delivering the User Engagement and

Communication Workstream

Phil Brown/ Francis

Ma

Workstream Lead

(Information and

Data Sharing)

Responsible for delivering the Information and Data

Sharing Workstream

Steve Thumpston/

Phil Brown

Workstream Lead

(Winterbourne) Responsible for delivering the Winterbourne Workstream

Chris Gee

Workstream Lead

(LD Self

Assessments)

Responsible for delivering the LD Self Assessments

Workstream

Miranda Roberts LD Clinical Lead

(West Essex CCG)

Responsible for representing the West Essex CCG

throughout the project and at Executive Board Meetings

Iain Tweedie LD Clinical Lead

(Mid Essex CCG)

Responsible for representing the Mid Essex CCG


Mark Roberts LD Clinical Lead

(North East Essex)

Responsible for representing the North East CCG


Caroline Dollery

Regional Lead for

Managed Clinical

Network

Responsible for providing SME knowledge throughout the

project

Alexina Weston Quality Lead for

LDMH


project

Peter Tempest

Programme

Director – Adults,

Health and

Community

Wellbeing


project

Barbara Hetrs All Age Lead Acting as the link with SCF and responsible for providing

SME knowledge throughout the project

Helen Chittock Finance Lead Responsible for providing financial advice throughout



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the project

Helen Terry Strategy Lead Responsible for providing SME knowledge throughout the

project

Rob Field

Communication

and Engagement

Lead


project

James Wilson Commercial Lead Responsible for providing SME knowledge throughout the

project

TBC Governance Lead Responsible for providing advice on the governance

process

TBC HR Lead Responsible for providing HR advice throughout the

project

TBC HRA Advice Lead Responsible for providing HRA advice throughout the

project

project initiation document [pid] transforming

Documents