1. Healthy Lives, Healthy Futures Programme Update NLAG Trust Board 27 th October 2015

2. A Common Purpose

3. Sep Jan MCE Workforce and OD Oct Nov Dec IM&T Estates Finance In hospital Model Out of hospital Model Progress to date presented 3 rd September Workshop Outline Plan - 30 th October Pathway Redesign programme - process agreed - 30 th October Community Finance Plan – 18 th Sept Community Activity Model – 30 th Sept C&E Plan –End Sept Stakeholder Framework – 30 th Sept Property Register 30 th - Sept Workforce info – 30 th Sept OD plan – 30 th Sept Staff Engagement Commences Baseline Position - 31 st Oct Community Estates Review – 30 th Oct Aspirational Model - 30 th Oct Cost impact of models – 30 th Oct Workforce role review and design – End Nov Community Workforce Plan - 30 th Oct In and out of hospital models aligned through Pathway Redesign Stakeholder Event - End Nov IM&T drivers for transformation - End Nov Community Estates Plan - End Nov Finance Plan, 1 st Cut – 13 th Nov Finance Plan, Final Cut – 27 th Nov Engagement/ Consultation Planning IM&T Strategy – 31 st Dec Estates Strategy - 31 st Dec Recovery Plan Submission – 18 th Dec Workforce and OD Strategy – 31 st Dec HLHF system model agreed Monitor and NHSE System Review Immediate Tasks Generally, work is on track. Key milestones are being delivered

4. - Community activity model produced - “Care Network” Summit held in North Lincs with unprecedented number of health and care professionals in attendance - Further clarity on key schemes that constitute the out of hospital models in NL and NEL - Modelling underway to assess the impact of the out of hospital models on NLaG - Workforce assessment completed to inform service model development - Revised programme governance structure in place Progress since last time

5. NEL Out of Hospital NLaG In Hospital NL Out of Hospital 7 day service delivery will be a struggle to deliver while maintaining/improve in: - Haematology/Oncology - Respiratory - Some surgical specialities – Colorectal & Urology Current Thinking: - MDT Urgent & Emergency both sites - W&C Service both site - Potential for core outreach - Move “front door” backwards Significant change required to care for people across a Northern Lincolnshire footprint – demand outstrips capacity COPD is priority LTC - will be blueprint for other LTC. Cardiology likely next. Integrated teams to support patients in care homes with multiple LTCs. Single assessments/sharing of care plans/sharing protocols Urgent and Emergency Care/SPA: keep/treat people in the community - walk ins/blue light - support/turn them around/take them home - moving the front door backwards. - HIT team - make sure beds are not blocked behind the front door More integrated/pro active planning of care. Elements of staffing in existence but needs bolstering. Social care/primary care/mental health/allied health professionals - Primary care home support - Primary care leading the services - Enhanced dementia care - increased prescribing links to well being hubs - Hubs commissioned fall services - Primary care MTD discharge to help support early discharge - Pro active care - risk stratification but below the 2%. Shared urgent care - GPs to share across the patch. - Step up facilities - Stretch the better care fund schemes. - New approaches to support the better care fund teams - 3 “menus“ for Care Networks to focus on. LTC to move into 3 “Care Networks”, models will look different in NEL/NL - need to look at the commonalities

6. NLaG NEL COPD SPA/URGENT CARE Support to Care Homes NL Care Networks BCF Schemes LTC Model Support to Care Homes ACTIVITY SHIFT ESTATELTCsPREVENTION SELF CARE TRANSPORT IM&T ? ? SINGLE APPROACH Work is on-going to define how the out of hospital models in NL and NEL will impact the trust

7. ACTIVITY SHIFT ESTATES COMMUNICATION TRANSPORT WORKFORCE/OD New Model of Care Is there unused capacity in the current estate Is it fit for purpose now and how far into the future? Is there estate to relocate activity in the Northern Lincolnshire footprint? Have we got the key messages Can a picture be built that explain the rationale to all people? How do we involve the public and stakeholders? Can a shared system across all Organisations be achieved? How can IM&T support MDT set up? IG & Data protection? Any additional costs to be considered? Staff training? Interoperability between GP system? Will enough activity be relocated to support changes to public routes? Are people now disadvantaged through the changes Have we got enough staff to deliver the services? Do we have the right skills available? How do we effectively recruit and retain? How do we ensure training for meeting skills gaps? Is it enough to meet the gap? What is enough? Have we avoided double counting? Can coding/currency be agreed consistently? Checking out Sustainability of new models! IM&T

8. Current Task Risk Assessment High Risk Organisations working unilaterally on new models of care Securing wider public, political and clinical support to plans Capacity in teams to complete work Time for key staff to complete work Missing data Not radical enough Medium Risk New models of care development Patient pathway design Local capability to undertake modelling IM&T alignment Estate alignment Workforce information skills assessment for new models of care Communications and engagement plan Low Risk First cut on “do nothing position” finance assessment Outline model shared by providers & CCGs Activity model for “do nothing position” Baseline workforce data

9. Emerging thinking 3 components of Integrated Leadership and delivery Joined up Commissioning Health and Local Authority Building on devolution opportunity Balance local place with benefits of scaling up Well-being Board/s? JSNA Outcomes Quality and Safety Financial Framework Assurance Joined up Provision Accountable Care System/s Provider models Local Networks – Multi Specialty Community Providers? Acute networks? Primary, Community and Acute? Devolved capitation budget Involving 3 rd Sector Sub contracting – specialist (and tertiary?) HLHF Services transformations Portfolio Current pipeline Emerging pipeline by end December Significant gap Leadership and Resources Until March 2016 For future years Dependant on other two parts Joined up Commissioning Joined up provisions

10. By End NOVEMBER Develop leadership thinking HLHF into the future/Integrated provision/Integrated commissioning Define the activity shift enabled by new models of care Complete cost impact assessment of new models of care Develop approach to workforce engagement Further develop approach to stakeholder engagement, raising programme profile By End DECEMBER Immediate - develop draft whole system plan – for submission in Dec 2015 By end MARCH 16 – agree future resources for HLHF – leadership, PMO etc agree shape of Integrated Commissioning and Integrated Provision Next Steps – November 15 through March 16