shaping our future assurance report to transformation...

Shaping our Future Assurance report to Transformation Board Progress update for the October meeting

Contents

Shaping our Future in 18/19

Current status

SoF projects summary overview

Headline messages

Exception Report: Amber and Red Projects

Key SoF Risks

Significant Actions in Next Reporting Period

Conclusions

Appendix

1 - Quantifying Benefits

2 - System financial and operational performance

Shaping our Future in 2018/19

2016

/17

2017

/18

2018

/19

– Ye

ar 3

20

19/2

0 20

20/2

1

Phase 1: Clinical and financial sustainability plan • Design and engage on a strategic sustainability plan for Cornwall & the Isles of Scilly (Outline Business Case) • Integration of community and mental health services into a single provider

Phase 2: Start planning and implementing the longer term clinically and financially sustainable models of care • Co-production of new service model of care shaped around integrating primary and community services, creating a strong and resilient community-

based system of planned and urgent care that better meets local needs • Partner commitment to work towards the development of an integrated care system • Establish new integrated 111 and Out of Hours service • Agree 3 year financial framework for achieving financial sustainability across NHS and move to single local NHS control total

• …

Phase 3: Take major steps towards joining up how care is provided through the development of an integrated health and care system • Develop, subject to gateways, the model for strategic, outcome based, health and social care commissioning • Establish an integrated care partnership, subject to gateways, with a strong locality focus, using 2018/19 to design and refine the model, ensuring that

it facilitates providers being able to respond more flexibly to local need and improves how we function as a system • Agree a set of system priorities to be delivered at pace in 2018/19 to support our system sustainability and demonstrate early success • Establishing local integrated care teams to increase the capacity, capability and resilience of community-based care • Support the development of primary care networks and GP Practices to deliver primary care at scale • Components of new care model to be assessed through ‘test and learn’ approach to bolster capacity ahead of winter 2018 and build local evidence

for reconfigured service model • Further develop three year financial recovery plan, in line with agreed financial framework, and Implement year 1, meeting regulator control totals and

better aligning with local authority finances • Production of system workforce transformation plan to support care model delivery and development of other enabling strategies including estates

and digital

Phase 4: Secure the benefits of reduced variations in care with efficient pathways of care for people, improving quality and performance and continue transition to new out of hospital service model • Deliver system wide efficiencies and remove unwarranted variation, starting with making care more effective and efficient for people who have

musculoskeletal problems; cardiovascular problems; people with complex needs or have fallen or are at risk of falling. • Consult (if necessary) on reconfigured service model for community services • Implement new governance and leadership arrangements for the Integrated Care System • Implement agreed approach to transforming our enabling (back office) services to support our operation as an integrated care partnership

Phase 5: Clinical and financial sustainability secured • Deliver 3 year financial recovery plan • One plan, one system, aligned budgets • Realisation of new out of hospital service model

3

Current status SoF projects summary overview

Programme Project System Lead SRO RAG

Jun Jul Aug

Integrated Community Services (Model of Care)

Urgent & Emergency Care

Jackie Pendleton & Helen Charlesworth-May Tryphaena Doyle

Improving Access to General Practice

Rehab, Reablement & Recovery

Multi-agency Multi-disciplinary-team meetings

Integrated Care Teams Proposal and timelines to be shared at future ICP Mobilisation Board.

Personalised Care Planning

Single Point of Access

Rapid Frailty Response

Self-management

Healthy Weight

Social Prescribing

Isles of Scilly Health and Social Care Integration

Community Hospitals

Integrated Care Area Plans

Suicide Prevention

Pathways

MSK (Hip & Knee implementation)

Phil Confue Ethna McCarthy Coronary Heart Disease

Falls

Outpatients

Complex patients Jackie Pendleton Adrian Flynn Reporting to commence September

Integrated Care System

ISC Mobilisation Kate Kennally Helen Childs

ICP Mobilisation Phil Confue (interim) Tracey Lee

Enabling Services review Phil Confue Karl Simkins

Workforce Phil Confue Adrienne Murphy

Estates Jackie Pendleton Karl Simkins

Digital Kate Kennally Dave Thompson

Current status Headline messages

Integrated Community Services/Model of Care • A process and timeline for decision making about the future of the temporarily closed inpatient and other services at Fowey, Saltash and St.

Ives community hospital sites has been proposed. This will be described in more detail at the October Transformation Board meeting. • A high level strategic model for future urgent care services has been set out. This will also be described in more detail at the October

Transformation Board meeting. • Cornwall Council have commissioned Newton Europe Ltd to support work on improving community-based reablement services. An optimum

model is being tested initially in St. Austell ahead of countywide roll-out. • A pilot to test a rapid access frailty clinic at West Cornwall Hospital Urgent Care Centre, with access to short stay assessment beds,

continues. To date, demand has been lower than expected and work has started to review and refine the model ahead of Winter 18. • A pilot to test a rapid frailty response service has started in St. Ives and Hayle. • The new domiciliary care contract for the Cornwall health and social care system went live on 9th June 2018, using the Dynamic Purchasing

System (DPS) framework. This will support the Shaping our Future strategic aim of building additional capacity in communities. • Frailty - work is underway across a number of interventions (e.g. rapid response service, integrated care teams, personalised care plans, and

frailty assessment clinics) that will contribute to the frailty model of care. An initial Gateway 1 review has been held but further work is required to outline service model and approach to delivery.

• A system wide clinical strategy is being developed.

Pathways • The Programme Board overseeing the Pathways work stream has confirmed that the immediate priorities are improving care and support for

people with joint problems, people at risk of having coronary heart disease, and people at risk of falling, who have fallen or who have fragility fractures.

• Consideration is needed of what resources are required to enable changes in detection and management of conditions that lead to coronary heart disease.

• Plans for taking forward the work have been agreed in principle and set out the key actions. • Work is underway to determine whether there is potential for improving care and support for people with respiratory problems and how

improvements might be made to care and support for people with mental health issues related to their long terms conditions or medically unexplained symptoms. This work is to be discussed with the Clinical Practitioner Cabinet.

Test & Learns underway

• Rapid Frailty Assessment Service – West Cornwall Hospital

• Improving Access to General Practice – St. Austell & 3 Harbours

• MDT framework – St. Austell

NB: Further test & learns being mobilised

5

Current status Headline messages continued…

Outpatients • A multi-agency Outpatient Transformation Board is now established.. • A formal Outpatients Strategy has been developed which holds at its core the theme of “Valuing Patients’ time”, and sits in line with the national

remit of transforming service delivery, appropriate referral assurance, and supporting patients to self-manage conditions. • Preliminary discussions are now taking place with nominated clinical representatives to develop plans to tackle outpatient waiting lists and

cancellations within services identified as a priority. • Plans are being developed to ensure closer working relationship, and information sharing between GPs and clinicians with regards to outpatient

needs. • Preparation is underway to present the Outpatient programme to Gateway 1 by the end of October 2018. Integrated Strategic Commissioning (ISC) mobilisation A single issue Workshop was held in August for the ISC project team to progress the development of the ISC plan for the ‘gateway 2’ paper Section 75/Continuing Health Care/Supported Living Service • Progress has been made in strengthening the NHS Act 2006 Section 75 agreements (which allow budgets to be pooled between local health

and social care organisations and authorities) and discussions are continuing for the integrated equipment service. An approach has been agreed for the redesign of services in the Better Care Fund s75 agreement.

Governance • The Health and Wellbeing Board scheduled for 18th October has been identified for a focussed meeting on developments for the governance of

Integrated Strategic Commissioning. Agreement has been confirmed from the Health and Adult Social Care Overview and Scrutiny Committee Chairman for a development session with the Committee on the ISC (ideally as part of a wider discussion on the Integrated Care System)..

Population Health Management • The Joint Strategic Needs Assessment paper was presented to the Cornwall Health and Wellbeing Board on 6 September. A risk has been

identified around the population health management system, beyond using routine data sources, is dependent on data sharing and data management across the ICP. Some work is being led by the South West Academic Health Science Network and NHS England but there may be some delay before a system is in place.

Primary Care Delegation • At NHS Kernow’s Governing Body meeting on 4th September the decision was made to progress towards taking on delegated responsibilities

for primary care commissioning. This has resulted in a period of engagement and consultation with the GP practice membership of NHS Kernow. This period commenced on the 13th September and will end on the 19th October with a vote for the NHS Kernow GP practice membership. The outcome of the vote will determine how this progresses. 6


Integrated Care Partnership mobilisation • An outline proposal has been developed for mobilisation during 2018/19 which is being discussed with all key provider organisations. There are

three main strands: integrating services; building a common platform; and developing a shared view of financial and quality performance. • The proposal is for a multi-stage process adopting an incremental and developmental approach: provider organisations working together in

2018/19 to test the concept, design, review and refine the operating model and agree the progression through a series of phases, with each phase seeing progressively closer working between partner organisations, supported by the appropriate governance and assurance arrangements.

• A System Health and Care Partnership Board, has been established consisting of Chairs, Chief Officers and Lead Members across health and care organisations to drive the transformation programme for the Integrated Care System in its entirety, as well as providing system wide assurance through a new partnership model with the regulators. At its inaugural meeting a number of leadership actions were discussed to ensure pace and impact over the coming months. These actions were shared with the SoF Health and Care Leadership Forum in September.

• Discussions continue with the regulators with regard to system leadership. Workforce • The latest update to the Workforce Transformation Plan was presented at the Workforce Strategy Board in July, reflecting feedback from across

the system. • Focus will now move to the development of a System Organisational Development Plan, including interventions, to be presented to the

Workforce Strategy Board during Autumn. Leadership Academy support is available to support. • The King’s Fund Leadership programme commenced in September. The successful applicants will work in close association with the King’s

Fund throughout the programme, with the opportunity to develop their leadership skills through their engagement with the selected transformation projects across the model of care footprint. Three multi-agency groups are participating and applying learning to three project areas, one in each Integrated Care Area. The expected benefits and outcomes for the clinical leads will be to: • Increase their visibility in the delivery of strategic model of care outcomes • Enhance leadership capability through a programme of leadership development • Develop important relationships with other system leaders, and contribute to the successful transformation of the model of care for patients

within Cornwall and IOS • Successful bids to Health Education England (HEE) included the continuation of additional change capacity via the Workforce Transformation

Clinical Leads for a further twelve months and additional Community Makers to support community connectivity.

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Enabling Services • The STP continues to develop a strategic case for an option appraisal for the integration of enabling services across health partners. • The non-financial evaluation of options and methodology to assess benchmarking information has progressed through a stakeholder group. • The development of the strategic case remains on track for completion by the end of October and final report for the consideration of

organisational boards in November 2018 which will help determine the direction of travel for this work stream. Estates Strategy • A key focus area for the Strategic Estates Group is enabling the transformation of the primary care estate; to work towards improved facilities

being available to meet rising demand, enable service change and to support clinical and financial sustainability. • Work is progressing well with Local Planning Authority colleagues to make sure that major housing developments fully account for the required

health infrastructure. • Good progress has been made across Cornwall and the wider South West Peninsula in achieving estates and facilities efficiencies in line with

Lord Carter targets. • Estates planning work for how to optimise and improve the community estate continues with close links to the Model of Care and core STP

workstream groups. • Continued working with One Public Estate partners is ensuring a joined up approach across local authority, NHS and social care, leading to an

integrated approach to strategic estates planning. • A key risk remains the access to capital resource to transform the estates across the health system. Announcement of STP capital resource as

part of ‘Wave 4’ STP capital is expected in November 18.

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Digital • Over the past two months, the IT Digital Provider Stakeholder Group (representation from all stakeholder organisations) have been working

on prioritising Cornwall’s IT programmes based on national Health System Led Investment (HSLI) guidance, A draft system Digital Strategy has been developed setting out an approach to digital investment prioritisation. This was presented to the Digital Transformation Board on Friday 14th September.

• The Secretary of State for Health & Social Care has recently announced a new funding stream for STP digital technology. Under the HSLI initiative £4.2m will be made available to CIoS over the next three years. Detailed work and planning is underway under a recently established digital sub-group to review the programmes of work and align priorities to this funding work stream.

• Submissions are due on 5th October 2018 and focused on priority areas that dovetail with the national strategy e.g. deploying Electronic Patient Record solutions and sharing health and care information across health care professionals

• Once approved by the Board, the Stakeholder group will provide monthly updates on progress against the digital programmes of work.

Communications and Engagement • Communications and Engagement activities have continued with attendance at many events and meetings. System senior communications

support has been secured for the next six months, whilst the mobilising Integrated Care System considers its more substantive needs. • A further meeting of the SoF Health and Care Leadership Forum took place in September 2018. As well as providing an update on progress

there was an opportunity to reflect on what we have learnt to date about wider system leadership, and consider the collective leadership role over the next six months in progressing our system priorities. In particular a set of system leadership actions were endorsed to support integration at all levels: from the frontline to Boards.

• Some of the key upcoming engagement events include: • SoF partners and the EPIC Project – the local EDRF eHealth Productivity and Innovation in Cornwall and Isles of Scilly Project – are co-

hosting a large staff event on 9th October at County Hall: Technology Enabled Care in our Region – What does it mean for me?, to see, touch and interact with how Technology Enabled Care (TEC) can support their work now and into the future.

• Hosting an event with Arms Length Bodies in October to share SoF progress and seek their support, for example with additional capacity and expertise.

• Addressing the League of Friends at their AGM • Endeavouring to fill the geographical gaps on the Citizens’ Advisory Panel. The new Chief Executive of Healthwatch has also indicated

her interest in joining.

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Devolution • Our current set of Devolution ‘asks’ have been assessed to determine the best route for securing our ambitions, in the context of the

national policy drive for Integrated Care Systems and the potential convergence in policy aims.. From the assessment undertaken locally three conclusions have been drawn:

• Funding – ‘Asks’ in relation to transformation funding and capital funding to support delivery of the new placed bared model of care should be progressed through STP funding channels in the first instance;

• ICS developments – The following ‘asks’ should be pursued through our local plans to develop an Integrated Care System • “Development of a single local outcomes framework for CIoS and a more unified regulatory approach” • “Move to a devolved, place based five year settlement enabling local co-ordination of budgets and plan across the whole

system” • HM Government – The following ‘asks remain appropriate to progress with HM Government under the Devolution agenda.

• “Work with government to reduce harm from alcohol, pilot alternative models to reduce affordability and accessibility of high strength alcohol.”

• “Work with government to explore best use of the winter fuel payments to further tackle fuel poverty” • “Pilot increased activity in schools through healthy pupil programme”

PMO • The PMO will start to coordinate early planning work across the system for 2019/20. • An executive workshop is taking place on 1st October to consider system objectives and to make proposals about the system’s risk

appetite ahead of a workshop with Transformation Board members. A verbal update will be provided at the meeting. • An initial Gateway 1 Frailty review has been held, further work to be completed for a second review later in the year • The outpatient programme group is now well established with a significant programme of work under way. A gateway review is planned for

the end of October. • An initial meeting of a task and finish group relating to the development of a System Assurance Group has been held with a work

programme agreed. • Following recent changes in the PMO team, there are significant capacity gaps at present, which we are working across the system to

progress. • The benefits realisations framework continues to develop with specific outcomes expected of work streams to be determined through the

gateway process – see Appendix 1: Quantifying benefits - methodology.

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Exception report Amber and Red projects

Project RAG Summary Path to green

Rehab, Reablement & Recovery

There is a risk that the design and implementation of test and learn sites will take longer than originally planned due to resource availability.

Continued discussions with partners to develop recovery plan. Newton Europe work in St. Austell proceeding well.

Multi-agency Multi-disciplinary (MDT) team meetings

There is a risk that partner organisations do not have the necessary systems and processes to provide required information on high intensity users to inform MDT discussions

Continued discussions with partners, escalation to Programme Director as required.

Self-management Project lead left in August and replacement yet to be identified. Model of Care Programme Director meeting with existing lead, to identify options and to make proposal to SROs and in turn ICP Mobilisation Board

Healthy weight There is a project lead gap until December and therefore a risk of delay Mitigation to be identified by Public Health team.

MSK

Delay in funding and then agreement on how to take forward appointments has resulted in significant delay in implementation. IT infrastructure is a particular issue. Procurement still to commence for physiotherapy noting and outcome software.

Support Transition to CFT – focus on clinical leadership from therapy Continue to identify where practices and localities are willing to implement parts of the proposed pathway to build momentum. The September implementation date will not be met.

Coronary Heart Disease

Complexity of working on a programme that interfaces with multiple other work streams means actions and outcomes are difficult to track.

A multi-disciplinary/multi-agency task group has been established bringing together all the work on cardiovascular risk factors under a GP clinical lead. Other work across the pathway needs to be defined through the gateway process and leads and support allocated as required.

ISC Mobilisation Good progress has been made, as highlighted in this report, but some timeline slippage has occurred in the governance work stream. To be reviewed by the ISC Steering Group in October

ICP Mobilisation Progress being made. Route to securing endorsement for approach from sovereign Boards, and timeframe, still under discussion. Capacity to take forward delivery milestones is challenging.

To be discussed at October meeting of System Health and Care Leadership Board.

Digital Programmes of work are currently being prioritised as part of the Health Service Led Investment (HSLI) Bid for 5th October submission. There is a risk around the timing of funding becoming available.

Digital Transformation Board to approve HSLI Bid and NHSE to identify timing of funding. Once approved by NHSE (Digital) the prioritised programmes will report on a monthly basis through a business case development process through to delivery.

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Key SoF Risks 1

Programme Risk Risk score

Risk owner

Controls Planned actions

Like

lihoo

d

Impa

ct

Prio

rity

Integrated Community

Services

There is a risk that that the wave 4 STP public capital funding will not be prioritised due to the model of care being iteratively developed and our relatively early stage of development as a maturing ICS. This will limit the ability to implement transformational estates change in support of service transformation over the next 3 years

4 4 16 Jackie Pendleton & Karl Simkins

• Capital Programme Group includes MOC programme director.

• Workshops/regular meetings held to develop alignment of key service ‘change for change/service strategy implications to estate’

• Inclusion and alignment with key strategies

• Regular dialogue & liaison with key senior colleagues

• Draft estates strategy will continue to be refined as the MoC develops

• Produce pipeline of future bids to work up for upcoming bidding rounds.(Wave 5 & 6)

• Development of detailed service strategy following evaluation of test & learns

• ICP Mobilisation plans being finalised for discussion with key partners, including in relation to prioritised community hospital reviews and UTCs

• MPs engaged in supporting plans to secure funds

Digital

There is a risk to delivering the system’s strategic digital priorities as a result of Insufficient digital funds, resource and strategic capability. This will limit the pace of transformational change

4 4 16 Kate Kennally & Karl Simkins

• Digital Lead in place • Digital Transformation Board

established • Digital stakeholder group

established

• Projects to be prioritised at STP level through the Digital Transformation Board pending 5/10/18 HSLI funding submission

• Capacity requirements under review

Pathways

There is a risk that system change will be more difficult to achieve where the pathway changes require investment in one organisation to deliver savings in other parts of the system.

4 4 16

Ethna McCarthy

Agreed finance framework and leadership from finance leads

Specific cases will be presented as appropriate Development of system risk appetite to guide decision making

Pathways

There is a risk that complex IT and IG issues will deplete the realisation of benefits of pathway changes, as silo working will continue and new MSK MDT will have limited impact

4 4 16

Ethna McCarthy

Recruitment and deployment of IT project manager CFT (as host) IG policies

Confirm plan once IT PM in post Escalated IG issues to CFT Executive

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Key SoF Risks 2

Programme Risk Risk score Risk owner Controls Planned actions

Like

lihoo

d

Impa

ct

Prio

rity

Shaping Our Future

There is a risk that capacity will be diverted from transformational work due to operational priorities and major recovery programmes within organisations. This risks impacting on the capacity to support the planning and delivery of the transformational changes under SoF

4 4 16 Tracey Lee

• SoF budget in 18/19 better targeted to focus on transformation priorities

• Refresh workshop held with SROs for system priorities in July 2018 to reinforce expectation of delivery in 18/19. Timelines for next steps subsequently agreed with each project.

• A plan to deliver system wide OD is under development to support the cultural shift on which transformation depends, with input from a range of national bodies

• Oversight by mobilising ICP recognised as important for all prioritised work streams – system wide and organisational

Shaping Our Future

There is a risk of decisions needing to be prioritised about individual components of the future model without the context of a fully worked up service strategy. Early prioritisation is a result of operational/quality reasons/to secure available transformational funding (revenue and/or capital). This could lead to unwarranted variation and inconsistency or have a disproportionate impact on the overall service model, leading to a less than optimal service model overall.

4 4 16

Jackie Pendleton & Helen Charlesworth- May

• Local co-production underway

• High level blueprint developed and well supported

• Test & Learn pilots underway to further inform blueprint

• Locally tailored co-production outline approach and timeframe to be submitted to scrutiny committee

• ICP to determine timeframe for service strategy

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Significant actions in next reporting period (Sep to Nov)

Integrated Community Services

General

• Continue work to align programme with System Winter plan, System Urgent and Emergency Care Plan, CFT and Adult Social Care programmes and Right Care Frailty work in anticipation of one system plan.

• Refinement of meeting governance. • Edward Hain, Fowey, Saltash - identifying next steps and timescales to inform HASCOSC in October

• All project leads to identify key milestones and intended impacts. The development of the detailed project plans for the

Community Hospital services and sites, the learning from various iterations of test and learn cycles and the Newton Europe work on Community based reablement will all help improve the clarity of the programme plans.

Urgent Care

• Position statement produced re current thinking about optimal location of UTCs • West Cornwall Hospital Frailty Assessment pilot test and learn checkpoint meeting with all stakeholders to agree scope of

next phase. • Planning for lab in a bag, • Continue GP MIU LES review • Planning for CRCH Frailty Assessment Service

Community based rehab and reablement

• Steps & Voluntary Sector Test and Learn starts in Helston • Newton Europe St. Austell redesign continues

Bed-based reablement

• Community Hospital & West Cornwall Hospital staff mapping continues • Clinical acuity review and comparison Community Hospital and West Cornwall Hospital • Drafting criteria for identifying which current community hospital sites could become rehabilitation centres

Integrated Care Teams

• Strategy document for integrated community teams drafted and being refined with key stakeholders. To be considered at Transformation Team Meeting 12thSeptember ahead of discussion with SROs and presentation to ICP Mobilisation Board..

Pathways

• Ensure any issues with MSK implementation are unblocked and look to accelerate wider benefits of MDT working, including review of patients already listed for surgery. Confirm governance arrangements within CFT and resolve information governance issue.

• Cardiovascular disease – develop implementation and benefits realisation plans for improving detection and management of atrial fibrillation, clarify any resource requirements, in particular with regard to the prescribing work under NHSK leadership

• Falls – further analysis of the current state pathways and develop implementation and benefits realisation plans for falls prevention. Confirm specific actions, leads and oversight of delivery

• Discuss Pathway elements with Devon STP

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Significant actions in next reporting period (Sep to Nov) continued

Outpatients

• Under the Transforming Delivery work stream, all identified priority services to have developed outline project plans for their areas of concern. • Ensure fit of Outpatient Priorities to overall Elective Care Programme • Extend full assessment to all providers and link with Devon • Resource needs defined and agreed by the Outpatient Transformation Board • Stakeholder engagement strategy formalised and begin implementation • Agreement on the further roll out of information library to CFT with licencing investment terms clarified. • Agree Gateway 1 date and prepare documentation, including confirmation of quality and financial goals.

ICP Mobilisation

• Secure organisational support for progressing Integrated Care Partnership. • Prepare for next gateway review • ICP Governance refreshed • Commence work on Single System plan for 19/20 • Continue the detailed focus on planned care to strengthen and enhance recent improvements and move towards the achievement of constitutional

standards

ISC Mobilisation • Deliver a Gateway 2 paper to partner organisations • Draft commissioning priorities/intentions for 2019/20

Enablers

• Organisational Development Plan to be presented to the Workforce Strategy Board. • System leadership development programme delivery to commence • Prioritisation of digital projects and development of investment case for NHSE funding by 5/10/18 • Strategic outline case for Integrated enabling services

PMO

• Gateway 1 reviews for Outpatients, Falls and CHD; Gateway 2 reviews for ICP Mobilisation, ISC Mobilisation and Enabling Services • Progress establishment of System Assurance Group • Continued development of the benefits realisations framework with the specific SoF Programme outcomes expected and timescales to be

determined through the gateway process. • Host event for Arms Length Bodies • Agree our system planning process for 19/20 • Coordinate STP stocktake with NHS England • Financial framework for 2019/20 plans to be updated to reflect recent discussions with Cornwall Council regarding alignment of the financial

planning assumptions.

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Conclusions

• Much focused and positive discussions have taken place over the last reporting period in support of mobilising as an Integrated Care System, with a much greater focus on collaborative planning and design across commissioners and providers than originally envisaged.

• Board engagement continues to be strengthened: • the establishment of a new System Health and Care Leadership Board to drive delivery

and assure progress; • more reciprocal arrangements at Board level; • more active engagement with the SoF System Leadership Group; and • an executive workshop to discuss system strategic objectives and the system’s risk

appetite, in support of integrated planning and delivery. • The components of integrated, place based care continue to be developed, with more test

and learns underway as well as plans being established for the review of services provided by community hospitals in St Ives, Fowey and Saltash, and proposals for Urgent Treatment Centres being set out, in the context of wider proposals for urgent care. Work to transform outpatient care is also now under way.

• Good progress continues to be made in developing the underpinning enabling strategies: including draft estates and digital strategies, the development of a workforce transformation plan and external support commissioned to support the development of an options appraisal and business case for shared enabling services.

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Appendix 1

17

Quantifying Benefits – methodology

18

• For each measure of longer term impacts, understand how we compare nationally and with our most similar clinical commissioning group or local council areas. Take account of demographic and population health trends and our workforce capacity and then decide whether our ambition is to achieve the same as our peers, as the national average or to stretch beyond the national average.

• To quantify our ambition for system benefits we can make use of benchmarking nationally and compared to our peers to understand variation in quality, activity and costs. It will also include understanding variation within our system.

• To quantify the benefits our programmes/projects will deliver we also need to segment our population and understand how different population groups use our system now, the impact of changes on demand and capacity and how each group they will use health and care services in the future.

Appendix 2

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2018/19 Financial Position Update System Summary 2018/19 Year To Date at M5

(5 months to August 18)

• The year to date system financial position at end of August

2018 is a deficit of c£14.5m which is just below plan; • RCHT and CFT Provider Sustainability Funding of £2.7m to

date which is on plan; • NHS nationally 2018-19 approved control total at system level

is a c£9.2m deficit; • Approved national sustainability and transformation funding is

c£29.6m (CCG £20m, RCHT £8.9m, CFT 0.7m) receipt pending performance delivery;

• Cornwall Council (adult social care and public health) is yet to report its latest financial performance.

System Summary 2018/19 Forecast Outturn

• The Cornwall health and social care system forecast outturn based on performance at end of August 2018 (M5) is a deficit of c£10.8m including NHS sustainability funding (NHS £9.2m deficit as per plan, Council adult social care £1.6m net deficit);

• For the NHS the deficit before sustainability funding of c£29.6m is c£38.8m; • Financial performance to date across the system continues to highlight

financial risk relating to delivery of challenging efficiency targets, cost pressures due to quality/patient safety investment and pricing volatility. The implications of the cost for NHS ‘new pay deal’ is under review;

• The system remains one of deficit although forecast to be significantly improved compared to the last two financial years;

• Adult social care and public health forecast net deficit year end position of £1.9m incorporates the overspend on the two services offset by underspends on the 15 other council services and corporate budgets.

Kernow CCG RCHT CFT NHS

Total

£m £m £m £m

YTD Plan surplus / (deficit) (8.3) (7.0) 1.2 (14.1)

Current YTD actuals (8.3) (7.4) 1.2 (14.5)

Variance to Plan 0.0 (0.4) 0.0 (0.4)

Net financial performance surplus / (deficit) (8.3) (7.4) 1.2 (14.5)

One-off Funding (off-set) 0.0

Net I&E surplus / (deficit) after reserves (8.3) (7.4) 1.2 (14.5)

18-19 YTD (M5)Kernow

CCG RCHT CFT NHS sub-total

Council (ASC +

PH)Total

£m £m £m £m £m £mPlan surplus / (deficit) Pre-CSF/PSF (20.0) (20.8) 1.9 (38.8) 0.0 (38.8)

Current forecast (20.0) (20.8) 1.9 (38.8) (3.6) (42.4)

Variance to Plan 0.0 0.0 0.0 0.0 (3.6) (3.6)

STF financial performance funding (CSF/PSF) 20.0 8.9 0.7 29.6 29.6

Net financial performance surplus / (deficit) 0.0 (11.9) 2.7 (9.2) (3.6) (12.8)

One-off Funding (off-set) 0.0 2.0 2.0

Net I&E surplus / (deficit) after reserves 0.0 (11.9) 2.7 (9.2) (1.6) (10.8)

18-19 FOT

System Performance 18/19 Executive Summary

Area Key points: 18/19 Benchmark Performance to date (Month 5) • The purpose of the dashboard is to provide the most recently updated benchmarked system level data on a range of key metrics,

including key metrics across health and social care(including wider than Cornwall providers). • It should be noted more up to date organisational level data is available through organisational performance reports.

Overall

• Of the 39 RAG rated indicators, 22 are red for the most recent month, 8 amber and 9 green. • For the year to date, 18 are red, 12 amber and 9 green. • Trends included a relative worsening in ED and cancer 62 day performance, whilst RTT wait times improved. In social care, the

proportion of older adults supported at home 91 days post rehabilitation has worsened. • Consistent with previous analyses, the Friends and Family Test recommendation rates were generally better than the national

average with the exception of mental health, with variable comparative response rates.

Emergency care

• ED 4hr performance was lower for the most recent month than last year and the national average, reflecting a relative worsening of the position over the summer months compared with Q1, with the impact of Gold Command.

• Ambulance response rates improved compared with the year to date, and were better than the same months last year albeit above national benchmarks. Referrals from 111 to ambulances and A&E were lower than the national averages.

• Overall safety thermometer harm free rates were almost exactly the same as last year, and remained slightly better than the national average.

Planned care • The local trajectory for RTT was met for July and RCHT also met its 52 week wait reduction trajectory in Month 5. As anticipated performance remained below last year and the national average.

Mental health and community

• The IAPT recovery rate remained above all the relevant benchmarks • The dementia diagnosis rates remained below all the relevant benchmarks. • The proportion of new instances of psychosis seen within 2 weeks was lower than both last year and the local trajectory. • The proportion of population coverage of evening and weekend GP appointments remained below all relevant benchmarks.

Social care • Delayed transfers of care remain lower than last year, but above the national average and local trajectory.

SHAPING OUR FUTURE – ACUTE SCORECARD

Metric National Target Local Target (latest month) Apr-18 May-18 Jun-18 Jul-18 Aug-18 YTD

ED 4 hour target ( Type 1 ED Depts only) 95.00% 80.26% 81.25% 83.91% 83.65% 78.17% 76.27% 80.59%

ED 4 hour target (All Depts) 95.00% 90.65% 90.43% 92.07% 92.10% 89.23% 88.52% 90.43%

ED Re-Attendance Rate 7.96% 7.98% 8.05% 9.67% 8.92% 8.28% Information in arrears

8.97%

Total Cornish emergency presentations to hospitals compared with last year (ie ED attenders + emergency admissions)

9724 10530 10713 11467 11120 11280 Information in arrears

11145

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral

92.00% 80.70% 80.12% 80.55% 80.74% 81.95% Information in arrears

81.11%

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

99.00% 94.70% 91.99% 91.07% 88.73% 87.71% 89.92% 89.88%

Max 2 months (62 days) wait from urgent GP referral to first definitive treatment for cancer


80.66%

Max two week wait for first outpatient appointment for patients referred urgently with suspected cancer by GP


95.09%

DTOCS Days per 100k Population 461.90 184.79 540.00 542.96 458.60 542.96 592.44 535.39

Superstranded Patients (LOS > 21 days) 336 149 270 289Information in arrears

Information in arrears 236

30 Day PbR Emergency Readmission Rate 7.20% 6.52% 7.12% 7.20%Information in arrears

Information in arrears

Information in arrears 7.16%

Summary Hospital-Level Mortality (SHMI)1.00







Cancelled Operations 28 day breaches 16 32 54 29 24 29 52 38

MRSA per 100k Beddays 1.64 0.00 0.00 0.00 0.00 Information in arrears

0.00

C Difficile per 100k Beddays 24.42 30.24 25.0 8.41 27.17 Information in arrears

22.69

% of people who spend at least 90% of their time on a stroke unit 82.00% 83.80% 91.38% 86.62% 88.06% 84.14% 82.47% 82.21%

Safety Thermometer - Harm Free % 93.94% 94.90% 95.70% 94.87% 95.01% 94.14% 94.64% 94.87%

Safety Thermometer - Pressure Ulcers % 4.55% 3.82% 3.42% 3.60% 3.98% 4.63% 3.60% 3.85%

Safety Thermometer - Falls (with harm) % 0.56% 0.28% 0.36% 0.31% 0.55% 0.39% 0.29% 0.38%

Safety Thermometer - Catheter UTI (new & old) % 0.69% 0.92% 0.29% 0.84% 0.62% 0.77% 1.17% 0.74%

Friends & Family Test - A&E Response Rate 12.79% 15.92% 9.37% 9.00% 9.08% 6.69% Information in arrears

8.51%

Friends & Family Test - A&E Not Recommended Rate 7.69% 0.85% 0.88% 0.99% 1.35% 0.86% Information in arrears

1.04%

Friends & Family Test - Inpatients Response Rate 25.17% 29.89% 35.93% 32.77% 37.60% 31.23% Information in arrears

34.30%

Friends & Family Test - Inpatients Not Recommended Rate 3.15% 0.66% 0.63% 0.65% 0.69% 0.80% Information in arrears

0.69%

Friends & Family Test - Maternity Response Rate 20.82% 28.88% 29.83% 26.17% 28.90% 18.81% Information in arrears

25.94%

Friends & Family Test - Maternity Not Recommended Rate 1.18% 1.85% 2.04% 0.00% 1.05% 0.81% Information in arrears

1.02%

SHAPING OUR FUTURE – NON-ACUTE SCORECARD

Metric National Target Local Target (latest month) Apr-18 May-18 Jun-18 Jul-18 Aug-18 YTD

Ambulance Category 1 Mean Response Time00:07:00 00:07:02 00:10:25 00:10:45 00:09:53 00:08:07 00:08:19 00:09:30

Ambulance Category 1 90th Centile Response Time00:15:00 00:13:00 00:19:26 00:20:19 00:18:35 00:15:02 00:16:23 00:17:57

IAPT: People discharged from services who achieved recovery 50.00% 46.47% 53.86% 52.64% 52.04% 51.31% 51.71% 52.31%

Dementia diagnosis rate 66.70% 55.36% 52.39% 52.13% 51.18% 50.96% 51.93% 51.48%

More than 50% of people experiencing a first episode of psychosis will receive treatment within 2 weeks

53.00% 90.70% 100.00% 90.91% 88.89% 100.00% 80.00% 91.96%

NHS 111 calls resulting in ambulance referrals <10% 14.40% 13.40% 12.79% 13.44% 13.43% 12.22% 13.04%

NHS 111 calls resulting in A&E referrals < 5% 5.52% 5.58% 7.12% 7.33% 8.40% 7.08% 7.10%

Friends & Family Test - Community Response Rate 4.13% 8.03% 4.41% 4.00% 3.66% 4.13% Information in arrears

3.93%

Friends & Family Test - Community Not Recommended Rate 2.56% 0.83% 1.04% 1.61% 1.86% 2.53% Information in arrears

2.00%

Friends & Family Test - Mental Health Response Rate 2.85% 1.89% 1.18% 1.71% 0.94% 1.06% Information in arrears

1.23%

Friends & Family Test - Mental Health Not Recommended Rate 3.88% 3.36% 6.74% 6.16% 13.92% 7.69% Information in arrears

8.16%

% population coverage evening and weekend GP appointments60.00% 60.00% 0.00% 0.00% 5.40% 11.04% 11.04% 5.50%

Social Care DTOCS per 100,00 18+ population 7.4 7.4 10.5 6 6.7 10.5 11.1 9.0

The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services

- 84% 86.24% 88.37% 80.19% 76.53% 77.17% 81.7%

Long-term support needs of older adults (65 and over) met by admission to residential and nursing care homes, per 100,000 population

- 487 482.13 511.31 521.52 503.69 499.32 503.59

The proportion of adults with a learning disability who live in their own home or with their family

- 70% 79.6% 80.2% 79.4% 78.6% 77.3% 79.0%

EMERGENCY ACTIVITY, IN HOSPITAL

Emergency Activity, In Hospital

• ED performance for the year to date has been better than last year, but August performance was lower. This was the case for both type 1 and all type performance. August all-type performance was also lower than the national average.

• Emergency presentations are higher than planned. This pattern has continued throughout the year to date. • Delayed transfers continued to remain lower than in 2017-18, but higher than the national average and local trajectory.

Emergency Activity, In Hospital - Continued

• The ED re-attendance rate was almost exactly the same as the national average and as 2017-18 in month, having been worse for most of the year to date.

• Emergency readmissions closely tracked the national average, but were slightly higher than last year. • For the Friends and Family Test, the situation remains that the response rate is lower than the national average but the recommended rate

is better for those that responded.

EMERGENCY ACTIVITY, OUT OF HOSPITAL

Emergency Activity, Out of Hospital

• 111 calls resulting in ambulance referrals and resulting in A&E referrals were both lower than the national average in month. For ambulance referrals, this was above the national standard but below last year’s rate. For A&E, the in-month referral rate was almost exactly the same as last year in month.

• Ambulance mean response rates largely sustained the improvements seen in July and remained below last year, but above the national benchmark.

PLANNED CARE

Planned Care

• The RTT local trajectory was met for July (and the RCHT 52 week trajectory was also met for August, as was the national aim of holding waiting list size steady). Performance remained below the national average and last year as anticipated.

• 6 week diagnostic performance improved slightly but remained below the relevant benchmarks. Improvement is expected in September. • Cancer 62d performance sharply deteriorated and was worse than national benchmarks (unusually for Cornwall) and also last year. However, 2ww

cancer access improved compared with all relative benchmarks, reflecting that the pressures on 62d (treatment) waits are occurring in later parts of the pathways (e.g. diagnostics, surgery and tertiary access).

OTHER KEY INDICATORS

Other Key Acute Indicators

• Following an improvement with the patient flow improvements in Q1, Cornwall’s performance on cancelled operations rebookings again worsened and it remains a national outlier.

• There were no cases of MRSA. Instances of C Difficile are volatile, but remain similar to last year overall. • Stroke unit access, in common with most acute patient flow indicators, has become more challenging over the last 2 months with

increasing distance from the benefits of Gold Command, though performance here remains better than last year.

Other Key Acute Indicators - Continued

• SHMI mortality data is not yet available at a system level for 2018/19 (this indicator is usually in arrears). • The number of long stay patients remains lower than last year at a system level. • For the Friends and Family Test (inpatients), the not recommended rate was lower but so was the response rate (as for A&E). For

maternity, the response rate was slightly higher than the national average and the not recommended rate lower.

2018/19 DATA NOT YET AVAILABLE

SAFETY THERMOMETER

Safety Thermometer

• Overall safety thermometer harm free rates were almost exactly the same as last year, and remained slightly better than the national average.

• The rate of pressure ulcers was below last year and the national average. • The rate of falls with harm was below the national average, and almost exactly the same as last year. • Catheter UTI rates were slightly higher in month than both the national average and last year.

MENTAL HEALTH & COMMUNITY

Mental Health & Community

• The IAPT recovery rate remained above all the relevant benchmarks. • The dementia diagnosis rates remained below all the relevant benchmarks. • The proportion of new instances of psychosis seen within 2 weeks was lower than both last year and the local trajectory, though numbers are

low on this indicator. • The proportion of population coverage of evening and weekend GP appointments remained below all relevant benchmarks..

0%

10%

20%

30%

40%

50%

60%

Apr-18 May-18 Jun-18 Jul-18 Aug-18

31) % population coverage evening and weekend GP appointments

% Population Coverage Evening and weekend GP Appointments National Target 17-18 Performance Local Trajectory

Mental Health & Community - Continued

• For community services, the response and not recommended rates are almost exactly the same as the national averages. • For mental health services, as in previous months, both the response rate and the rate of recommendation are worse than the national

averages.

ADULT SOCIAL CARE

Adult Social Care

• Social care DTOCs remained below last year but above the local trajectory. The proportion of older adults still at home 91 days post discharge into rehabilitation has worsened over the last 2 months and is worse than the local trajectory and last year.

• Admissions to residential and nursing homes per 100k are lower than last year but higher than the local trajectory. • The proportion of patients with a learning disability who live in their own home or with their family is slightly lower than last year but above the

local trajectory.

shaping our future assurance report to transformation...

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