Report to Powys tHB as Co-Sponsor August 2014 Peter Spilsbury Director of the Strategy Unit Midlands & Lancashire CSU

Contents Programme Execution Plan –Scope –Case for Change –Principles for Joint Working: Our Moral Compass –Timetable –Update Clinical Model of Care –Emergency & Urgent Care –Planned Care –Long Term Conditions & Frailty Process for Evaluating Options

PROGRAMME EXECUTION PLAN

Programme Scope To agree the best model of care for excellent and sustainable acute and community hospital services that meet the needs of the urban and rural communities in Shropshire, Telford and Wrekin and Mid Wales.

A significant challenge to the tHB in building a sustainable service for the residents of Powys are the clinical strategy and reconfiguration plans in neighbouring Health Boards and NHS Trusts. Powys is in a unique position in Wales in managing care over five health systems across its borders…… The tHB is, therefore, actively involved in all the potential programmes of change in respect of the South Wales Programme, Shrewsbury and Telford Programme, and the English Stroke Service Review. Powys tHB 3 Year Plan Powys

DEMOGRAPHIC MAPS

Powys North Powys represents: c.12% of the Programme’s catchment population c.8% of SaTH’s direct clinical income

Our Moral Compass Focus on whole population and consider consequences of any options for specific populations/groups Co-production with patients and public. Strategies and options to be clinically-led. Cannot add costs - redistribute for better overall outcome. Savings in one part of our system cannot lead to unplanned cost increases in another. Do ‘the right thing’, unconstrained by history, habit and politics. Take collective responsibility for making progress towards a shared vision for improved services and health..

The Case for Change - challenges Changes in our population profile Changing patterns of illness Higher expectations Clinical standards and developments in medical technology Economic challenges

The Case for Change - Opportunities Better clinical outcomes through bringing specialists together and more consultant-delivered clinical decision-making more hours of the day and more days of the week A pattern of services that can become highly attractive to the best workforce and can allow the rebuilding of staff morale Better adjacencies between services through redesign and bringing them together Improved environments for care A better match between need and levels of care through a systematic shift towards greater care in the community and in the home A reduced dependence on hospitals as a fall-back -instead hospitals doing higher dependency care and technological care to highest standards A coordinated and integrated system of care

The Case for Change This then is the positive case for change.…. ……the opportunity to improve the quality of care we provide to our changing population.

Programme Structure

Programme Timetable Key TasksTarget Completion Date Phase 1a - Programme Set-UpEnd January 2014 Phase 1b - High Level VisionEnd January 2014 Phase 2 - Development of Models of CareEnd August 2014 Phase 3 - Identification and Appraisal of OptionsEnd May 2015 Phase 4 - Public Consultation & OBCEnd January 2016 Phase 5 - Full Business Case(s)End October 2016 Phase 6 - ImplementationTo be determined Phase 7 - EvaluationTo be determined

Programme Update Phase 1 completed –Programme Execution Plan approved Jan ’14 including Case for Change & Principles for Joint Working –Acute and community hospital activity projections developed –Extensive work undertaken on emerging clinical model –Initial engagement activities held –Assurance Plan developed –Risk Register & Benefits Realisation Plan drafted –Gateway Zero Review completed

Programme Update Phase 2 Progress –Health Gateway Action Plan implemented –Programme Execution Plan updated –Timeline confirmed –Risk Management processes overhauled –Engagement and Communications Strategy approved –NHS England Sense Check successfully completed –Clinical Model approved –Emergency Centre Feasibility Study commissioned –Activity and financial modelling commenced –Evaluation Process approved

Programme Update Management of Interdependencies Process agreed for reviewing health economy plans outside the scope of the programme was agreed. Need to ensure alignment of plans and avoid prejudging Programme outcomes. Further Phases Phase 3 - Identification and Appraisal of Options Phase 4 - Public Consultation & Outline Business Case Phase 5 - Full Business Case(s) Phase 6 - Implementation Phase 7 - Evaluation

CLINICAL MODEL OF CARE

Emergency and Urgent Care

Planned Care

Long Term Conditions

EVALUATION PROCESS

1. Drivers 2. Ideas 3. Long List 4. Short List 5. Preferred Option Workshop 1 Generating Ideas Workshop 2 Proposing Criteria An infinite range of ways to implement the model needs to be reduced through over 200 potential options to a provisional long list of around 12. Criteria for evaluating the long list also need to be drafted. Clinical Model Key Benefits Demographics Current Sites Public Engagement Workshop 3 Weighting Criteria Workshop 4 Evaluating Options Public Engagement Appraisal Financial Non-financial Following extensive engagement the long list & benefit criteria are confirmed by Board, and descriptions of the options developed. Agreed criteria are then weighted and the options scored against the criteria. A recommended short list is proposed to Board. Following confirmation of the short list, options are further developed alongside more engagement on the model and the agreed list. The detail of this stage is yet to be agreed by Board. A preferred option emerges from the appraisal process – and subject to various approvals – that option will be subject to Public Consultation and fully developed within one or more Outline Business Cases. Public Consultation Decision Outline Business Case(s) Parameters EVALUATION PROCESS

DEVELOPMENT OF OPTIONS Model to be converted into a number of options Options are unique combinations of the number, location and co- location of the model’s components (e.g. EC, DTC, UCC, etc.) Panel to be formed from Programme Sponsors & Stakeholders nominees including patient representatives 4 workshops planned for June and September Final short list will be informed by: –Clinical Model –Public Engagement –Activity Modelling –Affordability –Emergency Centre Feasibility Study EVALUATION PROCESS

Public Engagement Opportunities June 2014 to March 2015: reasons for change August 2014: how the model could be implemented and how to judge the best option –Thursday 21st, 10am to 2pm, The Monty Club, 11 Broad St, Newtown, Powys. September 2014: views on the Board’s Long List of options –Monday 22nd, 5pm to 9pm, The Monty Club, 11 Broad St, Newtown, Powys. EVALUATION PROCESS

Key Milestone Work to be completed by 1Approval of short-listing process15 th May 2Clinical Model finalised28 th May 3Workshop 1: Generation of provisional long-list18 th June 4Workshop 2: Identification of provisional short-listing criteria18 th June 5Engagement on Clinical Model and Long List ideas and Evaluation CriteriaEnd August 6Finalisation of Recommendations to Programme Board2 nd & 9th September 7Programme Board confirms Long List & Evaluation Criteria17 th September 8Workshop 3: Criteria weighting30 th September 9Workshop 4: Option scoring30 th September 10Analysis of Results and identification of short-listed options8 th October 11Programme Board confirms Short List15 th October 12Engagement on the short-listed optionsEnd January

Recommendation Along with the Programme’s other sponsors, the Board is asked to support the: Programme Execution Plan including the Case for Change and the Principles for Joint Working Clinical Model of Care Process for Evaluating Options