1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

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