Black Country Cluster Board Development Session The System Plan The System Plan Content Rob Bacon 28 November 2018 Strategy and System Planning Black Country Cluster

Strategy and System Planning Black Country Cluster Vision Improve the health of our populations, reducing health inequalities Improve quality – safety, outcomes, access Increase value for money Transform commissioning and public health 28 November 2018 Strategy and System Planning Black Country Cluster

Cluster Achievements and Priorities 2011/12 2012/13 Transition : Clinical leadership through Senate CCG development Single Cluster Board Health and Well Being Boards Community services staff transfers Transition: All 4 CCGs authorised Robust CSS in place Public Health services working in shadow Commissioning Board arrangements in shadow Quality: Deliver quality strategy, including Mortality rates reducing No ‘never’ events Infection rate targets achieved Five SHA target areas Delayed transfers of care (with local authorities) Primary care – agreed standards for quality, audit, demand and referral Quality : Low waiting times Diabetic retinopathy Stroke service improved Cancer waits improved Reducing unplanned admissions for long term patients Grip on activity Quality strategy agreed RTT waits 4 to 5 weeks lower than target (95th centile) LTC admissions 5.1% lower than target Service Development: Vascular surgery and AAA screening Trauma units Maternity capacity Financial position and QIPP Right Care Right Here Service Development: Quality of stroke services Pathology reconfiguration Quality and Sustainability Review Mental Health and Learning Disabilities Review QIPP delivery and planning for 2013/14 and 2014/15 110,000 outpatient attendances 100,000 urgent care attendances 39,000 community bed days 13,000 avoided admissions 28 November 2018 Strategy and System Planning Black Country Cluster

CCGs leading Dudley Sandwell and West Birmingham 2011/12 Achievements Engagement QIPP delivery Alignment - money and work Referral Facilitation Experience Led Commissioning - End of Life Care Outpatient service redesign e.g. Rheumatology, Dermatology 2012/13 Priorities Quality Prime Minister Financial Diabetes Manage and prevent non-elective attendance / admissions Roll out End of Life strategy across the CCG CCGs leading Dudley Sandwell and West Birmingham 28 November 2018 Strategy and System Planning Black Country Cluster

CCGs leading Walsall Wolverhampton 2011/12 Achievements Wolverhampton Delegated authority for system plan, on course to exceed targets Alignment of commissioning priorities with GP contracting - QOF Quality and Productivity Indicators and commissioning engagement LES Urgent Care and Out of Hours project Wolverhampton Urgent care event Rebirth of Team W – clinical training Engagement of all practices in commissioning intentions 2012/13 Priorities Demand management, development of integrated services Clinical Decision Support Team: to support GPs manage demand using medicines management methodology Intermediate Care: step-up/step-down beds for GP direct admissions Redesign of urgent care Embedding quality Transition towards leading/owning the contracting process CCGs leading Walsall Wolverhampton 28 November 2018 Strategy and System Planning Black Country Cluster

QIPP From allocative/technical efficiency to service reconfiguration 2010/11 £59.8m delivered Price Efficiency £30.2m Prioritisation £5.5m Need Reduction £4.8m Service Re-design £16.4m Running Costs £3m 2011/12 £110.4m forecast Above target Price Efficiency and Cost Avoidance £65.3m Corporate £16m Meds Man £6m Planned Care £7.6m Urgent Care £6m Primary Care £3.1m Other incl. LTC and MH £6.5m 2012/13 £90.9m planned Planned care £12m Corporate £8m Urgent care £7m Medicines management £4m Primary care £3m Mental Health £1m Long Term Conditions £1m Price efficiency £53m 2013 to 2015 £147.7m needed Quality and Sustainability Review Less activity Reduced beds Reduced inpatient bases for specialist services Mental Health and Learning Disabilities Review Urgent care Long Term Conditions Frail elderly Stroke From allocative/technical efficiency to service reconfiguration £349m requirement 2011/12-14/15 28 November 2018 Strategy and System Planning Black Country Cluster

Quality and Sustainability Review History of failed strategic change for acute care in Black Country Preparedness to change: Vascular surgery, AAA screening, Trauma Different approach agreed objectives – clinically and financially sustainable services sustainable providers pursuing profitability not growth effective demand management by primary care coherent planning and provision with local authorities ‘edgy’ partnership approach as in Right Care Right Here agreement from Clinical Senate, Chief Executives, Cluster Board clinical leadership and care pathway approaches critical 28 November 2018 Strategy and System Planning Black Country Cluster

Quality and Sustainability Review Scale of change reducing from 5 to 4 hospitals (as planned in RCRH) modelling based on upper quartile indicates beds could reduce in range of 537 (top down) to 608 beds (bottom up) Clinical interdependencies important to establish core ‘dgh’ offer in each locality Consider clinical networks from reduced inpatient bases for more specialised services eg vascular, stroke Areas to work on, prioritised by Senate stroke, urgent care, long term conditions frail elderly, fractured neck of femur, paediatrics Similar approach with Mental Health and Learning Disabilities Review 28 November 2018 Strategy and System Planning Black Country Cluster

Quality and Sustainability Review Timeframe: Stakeholder event January 2012 PID agreed March NCAT and Gateway Review April Debate with OSCs May Public consultation June Cluster Board decisions October Implement decisions November Legacy for CCGs March 2013 28 November 2018 Strategy and System Planning Black Country Cluster

Mental Health and Learning Disabilities Review Similar approach Agreed objectives – clinically and financially sustainable services Sustainable providers pursuing profitability not growth Effective demand management by primary care Coherent planning and provision with local authorities ‘Edgy’ partnership approach as in Right Care Right Here Agreement from Clinical Senate, Chief Executives, Cluster Board Clinical leadership and care pathway approaches critical Emerging Issues Adult mental health – bed variability Older people’s mental health Early on-set dementia Transition in CAMHS Use of size to develop networks of more specialised services across Black Country Capacity and capability in primary care Extension of RAID – style services (Rapid Assessment Interface and Discharge) 28 November 2018 Strategy and System Planning Black Country Cluster

How it works Leadership increasingly taken by CCGs From allocative efficiency to result of transformation Service transformation QIPP Clinical leadership Risk sharing and new forms of contract Quality and Sustainability Review Mental Health/Learning Disabilities Review 28 November 2018 Strategy and System Planning Black Country Cluster

Critical Milestones for 2012/13 - QIPP QIPP Area 2011 2012 December January March April May June July September October November Quality and Sustainability Review Stakeholder workshop Programmes of work in PID agreed NCAT and Gateway reviews OSC discussions and decision on public consultation Public consultation commences Public consultation closes Cluster Board decisions Implement decisions Mental Health/ Learning Disabilities Review Implement decisions Service Changes Review of performance in stroke services and decision Designation process for trauma units completes Strategic Change Programmes eg urgent care, LTC, frail elderly, paediatrics Vascular Surgery hub and AAA screening commences Acute trusts designated as Trauma Units 28 November 2018 Strategy and System Planning Black Country Cluster

Critical Milestones for 2012/13 - Reform Reform Area 2012 2013 February March April July August September October November Clinical Commissioning Groups Staff identified for transfer Begin operating in shadow form Authorisation applications submitted NCB to undertake authorisation decisions Full operation Commissioning Support Service Outline business case Staff transfers identified Full business case Prepare for ‘go live’ Go live National Commissioning Board Primary Care Contract and premises, FHS stocktakes Staff transfers identified Staff transfer to NCB and CCGs Staff and contracts transferred Local Authorities Transfer of Public Health functions Public Health England established Provider Development Dudley and Walsall MH Trust submit FT application Walsall Healthcare Trust submit FT application Sandwell and West Birmingham Trust submit FT application Cluster All PCT staff aligned to final destinations Health Watch England /local Health Watch established First iteration of System Plan System Plan signed off by SHA Cluster SHAs and PCTs abolished 28 November 2018 Strategy and System Planning Black Country Cluster

Strategy and System Planning Black Country Cluster Next Steps Further iteration 31st January 2012 Sign off by SHA Cluster March 2012 Board approval March 2012 Publish public-facing document April 2012 28 November 2018 Strategy and System Planning Black Country Cluster

Alignment of System Plan to Operating Framework 2012/13 Higher quality with less £ growth Strong performance Preparedness to change QIPP from service change Transition to clinical leadership Transition to new system Collaboration Privacy and dignity action plan Mortality collaborative CCGs more prominent Promote NHS constitution Safeguarding Learning from others’ QIPP Personal budgets AQP and elective choice 28 November 2018 Strategy and System Planning Black Country Cluster

Strategy and System Planning Black Country Cluster Questions? 28 November 2018 Strategy and System Planning Black Country Cluster

Strategy and System Planning Black Country Cluster 28 November 2018 Strategy and System Planning Black Country Cluster