1. NHS Yorkshire & the Humber Major service change and the Service Change Assurance Process 2010

2. NHS Yorkshire and the Humber recognise ‘major service change’ as change programmes where one or more of the following criteria applies:  The proposals constitute substantial variations to or developments of health services and the local Overview and Scrutiny Committee require a formal public consultation in line with section 244 of NHS Act 2006  Proposals are likely to be contentious  The scheme will see significant change in use of NHS buildings e.g. closure  The scheme is of significant financial size and/or procurement In all these cases the NHS Yorkshire and the Humber Service Change Assurance Process should be applied. What is major service change?

3. Who has responsibility in service change? OrganisationResponsibility Commissioners  Lead the planning and consultation on reconfiguration & major service change proposals  Ensure the implementation is undertaken in an efficient and effective manner NHS Providers (including FTs)  Work with commissioners to take forward major service change to benefit patients SHA  Ensure there is sufficient capability & capacity in NHS to develop robust evidence based proposals, undertake consultation processes & successfully implement service change  Ensure all PCT led consultations are robust in terms of content, timing & process & comply with legislation, follow good practice, are open transparent and fair  Ensure the wider impact of service change (implications for other SHAs, providers (ambulance)) and sustainability of the system has been considered and addressed Overview & Scrutiny Committees  Scrutinise the planning, provision and operation of health services.  Hold NHS organisations to account for their decisions & refer contested proposals to SoS Gateway Team  Provide an independent assessment of the scheme and proposals. National Clinical Advisory Team  Provide an independent clinical assessment of the scheme and proposals. Secretary of State (SoS)  Power to endorse or reject proposals referred by the OSC to ensure the effective provision of comprehensive health services in accordance with NHS Act 2006. Independent Reconfiguration Panel (IRP)  Advise the Secretary of State on proposals that have been contested locally

4.  SHA has a duty to assure all major reconfiguration schemes – the vehicle for which is the Service Change Assurance Process (SCAP)  Established in 2007 the SCAP is mandatory for all schemes seeking to progress to formal public consultation  The SCAP has been regularly refreshed to ensure it remains fit for purpose (latest October ‘10) What is the SCAP?

5.  To ensure best practice standards  To minimise the risks for NHS organisations in particular the risk of judicial review and OSC referral of service change to Secretary of State.  To meet all recommendations set in national policy and guidance, including: The Sir Ian Carruthers review (February 2007); ‘Our NHS, our future’ (October 2007); ‘Leading Local Change’ (May 2008); ‘Changing for the Better’ (May 2008); and the refreshed Operating Framework 2010-11 (2010).  The SCAP assures stakeholders that service change and reconfiguration programmes are in line with national and regional policy, managed effectively and realise their expected benefits An organization which does not achieve all required standards will not be supported to proceed by the SHA Why have a SCAP?

6. Pre-service change Aim: To ensure the NHS Yorks and Humber key tests for service reconfiguration are met Process: Submit documents for SHA assessment against key tests for service change, National Clinical Advisory Team review visit & Gateway review visit. Consultation Aim: To ensure the consultation plan and documentation meet best practice standards Process: SHA formal review of documentation (This phase can be done simultaneously with phase one ‘pre service change’ ) Post- consultation Aim: To ensure the post consultation analysis and decision making are robust and comply with best practice Process: SHA advice and guidance (Note: post consultation analysis & decision making within 3 months) Implementation Aim: To ensure the implementation planning and execution is robust and achieves stated benefits Process: SHA ongoing monitoring / involvement – scale proportionate to scheme Pre-change discussion with SHA Lead How does the SCAP work?

7. Key Test Secretary of State’s tests  Support from GP commissioners  Strong engagement, including local authorities, public and patients  A clear clinical evidence base underpinning proposals  The need to develop and support patient choice QIPP / Finance  The reconfiguration should improve quality and reduce cost (e.g. reduced duplication, increased efficiency)  Financial savings clearly identified  Any capacity reductions identified  Clarity about how, when and where savings are made. State if savings are real (cash releasing).  Transitional costs (inc. non-recurrent revenue and capital) are identified, properly accounted for and funded.  Finance links consistently to workforce and activity models Clinical quality / Strategic fit  Clear articulation of patient benefits, quality benefits and financial benefits  Clinical case fits with national best practice  Aligned with PCT strategic plan  Aligned with Healthy Ambitions recommendations  Options appraisal (inc consideration of a network approach, cooperation and collaboration with other sites and/or organisations)  Macro-impact is properly considered  Alignment with QIPP workstreams Key tests for service change Activity  All relevant patient flows and capacity are properly modelled, assumptions are clear and reasonable  Changes in bed numbers are clear  Activity and capacity modelling clearly linked to reconfiguration objectives  Activity links consistently to workforce and finance models  Modelling of significant activity, workforce and finance impacts on other locations / organisations Workforce  Workforce plan is integrated with finance and activity plans  Proposal makes most effective use of workforce for service delivery and is it compliant with all appropriate guidance  The implications for the future workforce are considered  Staff have been properly engaged in developing the proposal

8. Key Test Resilience  Consideration of how will the proposed change impact on the Major Incident Plan and associated plans.  A business impact analysis has been conducted for all impacted organisations and appropriate changes made to the Business Continuity Plan Ambulance services  The implications for ambulance services (emergency and PTS) have been identified, impact assessed and appropriate discussions have been held with ambulance service providers Comms and Engagement  Plans exist to appropriately and effectively engage and involve all stakeholders (to include: staff, patients, carers, the public, LINks, GPs, media, Scrutiny Boards, Local Authority, MPs, other partners and organizations) and fulfil the PCT’s commitments under s.242 of the NHS Act Equality Impact  An appropriate assessment of the impact of the proposed reconfiguration on relevant diverse groups  Engagement has taken place with any groups that may be affected  Actions identified to eliminate any adverse impacts the assessment has identified TCS  Proposal aligned to the PCT’s TCS strategy Others  Proposals is consistent with DH rules for cooperation and competition Key tests for service change

9.  We will ensure proportionality of the process to the scale of the service change (whilst fulfilling the requirements of national policy). We will work with health communities on a one to one basis to ensure that involvement and engagement of the local population is undertaken in the most appropriate way.  The SHA process will not slow major service change down (schemes will be turned around within a fortnight of full documentation being submitted.  However we are reliant on the services of NCAT and Gateway teams and the more notice we can give the teams the more likely we are to ensure the review(s) fit with the timescales of local commissioners. Issues / Assurances

10. ‣ Early service change conversations with the SHA can help test ideas, share best practice from other schemes and enable effective planning ‣ SCAP summary document and a detailed guide are available on the SHA website ‣ SHA lead for reconfiguration is Tim Barton, Strategy Lead, 0113 2953636 tim.barton@yorksandhumber.nhs.uk tim.barton@yorksandhumber.nhs.uk How do I find out more?