QIPP, Turnaround & Right Care

What is ‘Turnaround’ and QIPP? Our Turnaround program relates to the work that the CCG has to do to ‘turnaround’ its financial position. The QIPP program or Quality, Innovation, Productivity and Promotion program is a program of work that the CCG has always used to assure it commissions for quality and value for money. Turnaround is being achieved through the value for money elements of existing QIPP projects and through the systematic and methodical identification of new QIPP projects.

Right Care - a methodology Right Care is a methodology that has been developed nationally. NEW Devon CCG has adopted this methodology for the development, implementation and delivery of new QIPP projects for Turnaround. We are the first CCG to use the approach in the way we describe here. The approach is one that NHSE intend rolling out to all CCGs and NEW Devon CCG is included in the first 60 CCGs to do this. In effect we are a year ahead of the other 59 CCGs in this wave and are therefore leading the way in its use.

How does Right Care help? The Right Care methodology helps the CCG to: Ensure a standardised approach to our Quality Innovation Promotion and Productivity (QIPP) Program Define and select evidence-based areas of commissioning opportunity highlighted by high levels of variability from the national norm. Examine existing pathways using national and local data and where appropriate to redesign them to improve care and assure value for money.

How does Right Care work?

Commissioning for Value Where we look Phase Activity Output Duration Where to look Triangulation of value by benchmarking: commissioning for value, atlas of variance, programme budgeting National data verified by local interpretation QIPP themes Gold Target Draft Mandate 1 week Commissioning for Value Atlas of Variance Programme Budgeting Local Interpretation Benchmark, value, rank and prioritise themes using agreed national and local data. Identify gold target of top ranked themes. Produce a mandate per theme. Present mandate to steering group for go/no go decision. Themes ranked by gold target Mandate per theme

What to change NHS Right Care deep dive is completed (4 weeks) Phase Activity Output Duration What to Change Unpack gold target to determine prioritised areas to focus: NHS Right Care deep dive Analysis of deep dive findings Priority setting and phasing of approach Planned targets Outline business case Draft PID 5 weeks NHS Right Care deep dive is completed (4 weeks) Detailed deep dive is analysed and prioritised and planned targets defined (3 days ) Implementation plans are drafted, business cases defined and draft PID produced (2 days) Draft Business case assessed at steering group for go/no go decision

How we change A system-wide analysis An in depth consideration of evidence (a ‘Deep Dive’) A service design workshop to identify themes or areas of work. This is followed by the: Production and approval of a Business Case Production and approval of a project mandate The resulting new projects of work are then added to our Turnaround and QIPP programs.

Governance of the process The CCG has two mechanisms for assuring the effectiveness of the methodology and monitoring the progress on identified QIPP projects these are: Turnaround steering group The Turnaround working group

Timetable for change This year (2015/16) we managed this process in waves as follows: Wave 1 – MSK, circulation, cancer, mental health Wave 2 – Gastrointestinal, neurology, respiratory Wave 3 – Maternity and neonatal, skin, vision, hearing Wave 4 – Poisoning, infectious diseases, disorders of the blood We have completed all the ‘Deep Dives’ in all 4 waves and by mid December will have completed all of the service design workshops.

Achievements to date There are currently 32 ‘live’ QIPP projects with approval: 2 are in the planning stage 4 are in the implementation stage (laying the foundations for delivery of the improvements identified in the business case) 25 are in delivery (delivering the improvements described in the business case) 1 project has closed In addition, a suite of information has been developed to support those engaged in Right Care activity and is held on the CCG intranet site. Publicly available web pages are currently in development and should go live by the end of the year.

Achievements to date In addition to the QIPP projects currently in implementation or delivery, there are mandates and business cases in development for the following. Which will be considered for approval by the Turnaround Steering Group on 25 November 2015. Mandates Maternity and neonates project Skin / dermatology Vision Hearing Disorders of blood Infectious diseases Poisoning Project business cases Acute admissions to mental health units Emergency mental health admissions to acute hospitals Primary care prescribing for mental health Cancer pathways – urological, haematological and skin

Goals and plans for 2016/2017 As a response to the organisation’s need to address Turnaround, the Right Care process we have been engaged in has, by necessity, been significantly accelerated. We have learnt from that experience and are in the process of outlining our use of and cycle for Right Care for the next year. If that outline is approved, we will be looking at a process timetable that uses a 20 week cycle. We are looking to strengthen stakeholder involvement (including patient and public stakeholders) by embedding specific involvement opportunities into that 20 week cycle and beyond.

More information More information on this topic can be found on the CCG intranet site and will soon also be available on the CCG website. http://www.newdevonccg.nhs.uk/intranet/pmo/turnaround-qipp-right-care-and-the-new-devon-way-------------/101696