cheshire and wirral lds - labournet stp no.8_final cheshire... · 2016-10-10 · cheshire and...

Cheshire and Wirral LDS

1. Executive Summary: Our Plan on a Page.

The Cheshire & Wirral Plan has been drawn from four well established Local Delivery Service Plans (LDSP). Each LDSP has well established governance arrangements reflecting their local population flows across an area of 2200 square kilometers and over 1 million people. The LDP has now developed from four local plans into a single agreed LDP which reflects the high level commitment from all partners in coming together to identify and drive forward those areas of highest priority that we collectively believe has the greatest benefit for our population. The 4 transformation programmes within Cheshire and Wirral are as follows: 1. Caring Together 2. Connecting Care 3. West Cheshire Way 4. Healthy Wirral Whilst each programme is distinct in its own right, the Cheshire & Wirral region has a track record of working together at scale including the CWW CCG Alliance, the Cheshire pioneer programme, and use of innovative digital technologies. The local economies are strong, with generally good health outcomes, but significant variation. There is a strong track record of building economic growth including the recent development of enterprise zones, HS2 and the Wirral regeneration project. Analysis supported from each of the 4 programs, together with STP Data packs indicate challenges in respect of Better Health, Better Care and Better Value. These are recognized and are being addressed at levels that balance scale and subsidiarity – Level 1 initiatives are devolved to each LDP, Level 2 initiatives will be delivered through collaboration across Cheshire & Wirral and Level 3 will be aggregated or cross cut across the Cheshire & Merseyside STP The financial challenge in Cheshire & Wirral is significant with all CCGs and Trusts being in projected deficit, all CCGs are below DFT (by £43M), Specialised acute services all take place in areas outside C&W and are significantly above DFT (£23M) – These financial challenges mean that balance is not possible within each LDP, but can only be addressed over a larger geographical and population footprint and drive our commitment to reduce variation, explore new provider models, and drive down costs in both provision and commissioning.

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1. Executive Summary: Our Plan on a Page.

Summary of Priorities : As the current provision of secondary care is financially unsustainable and given the lack of capital, we believe that we can implement new models of care across the existing four sites by reviewing the urgent and planned care service models. This will include the cross cutting themes from the C&M STP and be undertaken with population health, demographics, growth opportunities and access in mind. From this evidence we will reconfigure services on existing sites so as to provide single and integrated services across C&W and within our local communities. This evidence base will also drive primary, community and mental health transformation so as to mitigate the costs of growth through demand management so as to integrate services and avoid the need for increased bed capacity. A do nothing scenario in respect of growth would indicate circa 400 additional acute beds by 2020. Our triple aim is to mitigate the costs of growth, greater reliability and efficiency and reduce duplication of services and sites by vertical integration, horizontal integration and reconfiguration. The C&W plan builds upon examples of best practice including the model hospital which will develop into a model system, with a focus on reducing variation and waste, increased efficiency through greater operational transparency and control, and increased safety through high reliability processes driven by real-time clinical and operational technology platforms. This work is already underway with clinical alliances being formed both within and outside of Cheshire & Wirral, for example the MCHFT and UHNM formally embarking on five year programme for partnership and collaboration called `Stronger Together` and clinical integration between COCH and WUTH. We believe that this demonstrates our ability to undertake secondary care transformation in the wider context of integrate services out of hospital. We also believe that we need to undertake a dedicated piece of work to develop a shared understanding of the characteristics of accountable care as a natural consequence of integration.

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31

53/58

66

48

66 Populations

Mid 2014

PopArea km2

People per

km2 2014

% of total pop

in rural location

% of total pop in

Urban City and Towns

% of total pop in

urban (major and

minor conurbation)

Eastern Cheshire 196,501 626 314 18% 58% 23%

South Cheshire 177,678 541 329 19% 81% 0%

Vale Royal 102,008 249 410 24% 76% 0%

West Cheshire 230,202 668 345 26% 74% 0%

Wirral 320,914 157 2,043 0% 0% 99%

Rural Vs Urban

33

34/28

1,027,303

Areas of significant growth • Northern gateway

partnership • Wirral Waterways • Devolution • Economic Growth • Redevelopment

Need to consider wider determinates of health and care and how this impacts on the population health as a whole system

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Specialist Services• Major trauma • Burns• Complex internal medicine• Specialist Cancer• Neonates• Complex cardiac

& neurosciences• Tier 4 CAMHS• Genetics

15 30 60 90

15

Primary Care• Improved access • Antenatal / post natal care• Pre op assessment• Post op care• Virtual Wards• Tele Health/ Medicine• Diagnostics• Dementia Care• GPs with Special

Interests.• LTC Management• Risk Stratification

Community/Hospital Services• Minor Injuries / Minor Surgery• Rehabilitation / Re-ablement• Palliative Care• New outpatients• Follow up outpatients• Diagnostics• Programmed Investigations• Integrated CRTs• Community Pharmacy• Acute Response Team• Specialist Nurses• Social Care• Mental Health• Frailty Services• CAMHS

30

60

Hospital Services• Emergency Departments• Acute Medical Treatment• Emergency Surgery• Trauma services• Elective surgery• Complex diagnostic Imaging• Low risk obstetrics • Oncology

90

Cheshire & Merseyside Health and Care Services Illustrated

0Time in minutes

Moving care closer to home

Pop circa 1 million

Pop circa 20,000

Pop circa 250,000

Pop circa 500,000

Exploratory Model of care

‘Virtual’ Single

Hospital

(4 hospitals acting as

one)

Years 2-3 Year 4-5 Year 5+

Unsustainable

acute provider

landscape

Today

Reduction in

Variation and

demand to

Meet Financial

Balance ACS

ACS

ACS

ACS

Population health & demand

management managed by

ACO/ACS/ACPs to be agreed

An evidenced

And agreed

model of

provision for

Cheshire and

Wirral

Provider Reconfiguration (Service line review)

Zero Tolerance to Unwarranted Variation

Mental Health &

Community Primary Care

Providers

Integrated Out of Hospital Care

Prevention and Intervention

Accountable Care Systems (Enable this Change)

East Cheshire Trust

Acting and behaving as One system and Cost Avoidance

Changing Role of Commissioning

Potential ACO

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiA0djwt53NAhUBLcAKHWeVB9sQjRwIBw&url=http://www.srcl.com/news/east-cheshire-nhs-trust-outsources-all-its-waste-management-to-srcl/&psig=AFQjCNEx6Wld5td8ypmWTMGwTPIqS3deKQ&ust=1465647317368746

2. Starting Point [as set out in April submission]: a. Our underlying position on health, quality and finance now and in 2020/21 and b. key factors driving the pressures to be accommodated moderated.

Improving care and quality of services In order to achieve the Cheshire & Wirral plans the following areas will be transformed (and is illustrated on the next slide) We expect every person in C&W to be able to access the highest standards of specialist and acute care 24 hours a day, 7 days per week . This will

require our hospitals to be reconfigured, consolidated with less sites and clinicians and consultants working increasingly in new emerging networks. We expect our growing elderly population to be able to access the best integrated health and social care systems, locally in our communities. New out-

of-hospital care models supported by enhanced primary care will improve access to self care, early interventions and support a move to risk based preventative care that reduces demand for urgent care services.

Every new mother to be and child will be able to access improved maternity and paediatric services through our comprehensive redesign of these services in-line with the better births report and our Vanguard programme, delivering financially and clinically sustainable better care.

We commit to improving the Mental Wellbeing of every person in C&M including our own NHS staff. Delivery of NHS mental health priorities are paramount in order to ensure parity of esteem with physical health, treating individuals on the basis of need not condition to enable the right care at the right time in the right place.

More specifically in Cheshire and Wirral we have specified the following.

• Provider Services lines will be reviewed for both clinical and financial sustainability. This will require services to be reconfigured so that they are clinically

and financially sustainable, based on levels of demand and the appropriate level of geographic access. • Primary Care: the enhancement of Primary care as the centre of community models is critical to delivery of new models of care. This includes the

improvement of infrastructure (primary care estates, IT etc.) and the opportunity for practices to work together in hubs/clusters to provide 7 day primary care services. The STP will includes the enhancement and reconfiguration of Primary Care.

• Mental Health Services: Mental Health: delivery of NHS mental health priorities are paramount in order to ensure parity of esteem with physical health. Collaborative work across providers and commissioners to enable right care at the right time in the right place. Particular focus on patients’ treated closer to home, reducing variation and out of area treatments.

• Urgent Care: by taking a whole system approach to deliver an urgent and emergency care pathway that is simple and responsive and clear to all. To deliver the right care in the right place and first time, large scale system change is required, which will include co-location of services and changes to the payment system irrespective of service demand. The STP will include supporting older people differently out of hospital, in hospital and in care homes such as the AVS and Elder Care Services.

• Models of care delivery: with the large transformation in Primary and Community services and philosophy based on care closer to home, the shape and size of the hospital ‘s bed base will need to be reconfigured to ensure the sustainability in the future. With clinicians driving this change in the system this will reduce variation and improve quality in all clinical services but particurly in vascular, cancer , maternity, stroke and care of older people.

The planning of this transformation and the clinical priorities identified have been identified in the Joint Strategic Needs Assessment (JSNA) and the use of benchmarking data (Right care). Creating a change in culture and placing the individual in the centre with a focus on prevention will create an environment of continuous improvement.

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LDSP Systems Better Health Better care Better Value Better Systems

Leadership

Caring together Connecting Care Healthy Wirral West Cheshire Way

Promotion of empowerment, self care and coproduction

Re-Configuration of Acute and Mental Health Services (Service line review)

Zero tolerance to unwarranted variation Operational transparency and control

Accountable Care membership Systems

Diabetes (building on national pilot)

Out of hospital primary and community care transformation

Delivery of NHS right care

Integrated commissioning structures / governance

Hypertension (CVD) Delivery of Core Standards with high reliability

Whole systems financial plans Driving out waste

Public sector enablers and infrastructure

All the above are at a Level 2 (C&W wide) and assumes that engagement is undertaken at a local level. Variation could be adopted at a Level 3


Priorities Continued

The contents of the previous slide have been reviewed in the context of the 3 key themes

coming from the C&M Workshop C&W LDS has identified 5 Programmes as follows:

Provider Reconfiguration

Integrated OOH Care

Unwarranted Variation

Prevention and Intervention.

Accountable Care

Model Hospital Demand Management

Right Care (not inc in demand man)

Diabetes Capitated Budgets

Back Office Functions

Vertical Integration of all Aspects of Care

Prescribing Hypertension Reduced Mment Costs

Productive Provider Collaboration

Mental Health CHC/LD Complex Care

Smoking Spec Comm

Streamlining Hospital Services

Primary Care at Scale

Cancer Dental/Optom/Pharmacy

Site and Estate Rationalisation

Neurology Accountable Care (staff transfer)

Procurements

3.Priorities and Transformation Schemes: a. Our Critical decisions: the few big decisions that will need to be made if we are to shift the dial, including strategic commissioning decisions that are needed to support incentivising the right behaviours and supporting new models of care b. How our priorities address the ’10 big questions’ [as set out in April submission] and c. Our underpinning story (narrative, data) per priority/solution, describing what will be different for patients.

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3.Priorities and Transformation Schemes: a. Our Critical decisions: the few big decisions that will need to be made if we are to shift the dial, including strategic commissioning decisions that are needed to support incentivising the right behaviours and supporting new models of care b. How our priorities address the ’10 big questions’ [as set out in April submission] and c. Our underpinning story (narrative, data) per priority/solution, describing what will be different for patients.

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Cheshire And Wirral Local Delivery System (LDS)

System Wide Solution 2016/17 2017/18 2018/19 2019/20 2020/21

£m £m £m £m £m

Do Nothing Scenario

NHS Providers normalised position (95.0) (121.2) (147.6) (175.8) (210.4)

CCG Commissioner normalised position (exc Social care / specialised / primary care) (60.4) (65.5) (79.9) (94.2) (92.98)

Specialised Services (5.2) (13.4) (20.3) (27.5) (35.02)

Total Do Nothing Scenario (160.6) (200.1) (247.8) (297.5) (338.4)

Business as Usual (BaU)

Business as Usual - CCG efficiencies from non community/ secondary / mental health provision 1 2.0% 8.7 17.3 26.2 35.4 45.1

Business as Usual - Provider efficiencies 2 2.0% 24.3 49.4 75.6 102.8 131.4

Business as Usual - Specialised Services 8 5.2 13.4 20.3 27.5 35.0

Total Business as Usual 38.2 80.1 122.1 165.7 211.5

Remaining Gap (122.3) (120.0) (125.7) (131.8) (127.0)

Non-Recurrent Solutions

STF Funding 24.5

Total Transformational delivery 24.5 0.0 0.0 0.0 0.0

Transformational Solutions (cumulative)

Acute Hospital Reconfiguration 3 1.0 7.0 17.0 35.0 53.0

Integrated out of hospital care 4 1.0 4.0 9.0 15.0 20.0

Unwarranted Variation 5 2.0 5.0 8.0 11.0 14.0

Accountable Care 6 0.0 0.0 1.0 3.0 6.0

Prevention and Intervention 7 0.0 0.0 1.0 5.0 9.0

4.0 16.0 36.0 69.0 102.0

Investment Required (cumulative)

Acute Hospital Reconfiguration 0.0 0.0 0.0 0.0 0.0

Integrated out of hospital care 2/4 0.0 -27.0 -37.0 -55.0 -55.0

Unwarranted Variation 0.0 0.0 0.0 0.0 0.0

Accountable Care 6 0.0 0.0 0.0 0.0 0.0

Prevention and Intervention 0.0 0.0 0.0 0.0 0.0

0.0 (27.0) (37.0) (55.0) (55.0)

Total Transformational delivery 4.0 (11.0) (1.0) 14.0 47.0

Residual Gap (93.8) (131.0) (126.7) (117.8) (80.0)

STP Funding 80.0

Cheshire and Wirral LDS Health (93.8) (131.0) (126.7) (117.8) 0.0

Social Care and Public Health Funding Gap (7.2) (21.7) (43.1) (56.3) (69.0)

Total Cheshire and Wirral LDS (101.0) (152.6) (169.8) (174.1) (69.0)

4. Solutions that taken together close the gaps, and its impact quantified - health and care being described as concretely as possible in terms of expected effect on metrics: a. for 2020/21 (financial envelope), for 2016/17 and years in between (bridge), including forecasted impact of solutions [partially set out in April submission] b. Phasing of the impact and link to operational plans and c. Financial impact on the system as a whole and consequential impact on i. providers ii. Commissioners and iii. local authroities

a. The “Do Nothing” Gap for 2020/21 (financial envelope), for 2016/17 and years in between (bridge) The estimated Do Nothing Gap for Cheshire & Wirral (C&W) Unified LDS in 2020/21 is £338m based on the application of the STP planning guidance. This is compared to STP ‘Health ‘Resource s available of £2.05bn by 2020/21financial year (excludes social care). The below bridge chart describes the key aspects between allocation and expenditure assumptions. Further work is currently being undertaken by respective organisations to validate these assumptions and ensure consistency of approach amongst respective commissioner and provider planning assumptions This gap is made up of £128m for commissioners (includes specialised but not including delegated primary care pressures ) with £35m relating to specialised services as per below) and £208m for providers . An estimated impact of £69m do nothing challenge has been included for Adult Social Care and Public Health Local Authority budgets across Cheshire and Wirral (not included within below bridge chart)

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STP 'Do Nothing' NHS 2020/21 Bridge - Providers and Commissioners only

(1,000,000)

(500,000)

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

CC

G A

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CC

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b. Phasing of the impact and link to operational plans

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The phasing and impact of the solutions of £258m are as per table across the system, these consist of ‘business as usual’ circa 2% efficiency savings across commissioner and provider and the net effect of transformational savings. Additional investment Being Required in Out of Hospital Service provision and accountable care system to enable these solutions to be delivered 2020/21 includes the additional STP funding allocation of £80m

STP 'Do Nothing' v 'Do Something' Outturn

(400,000)

(350,000)

(300,000)

(250,000)

(200,000)

(150,000)

(100,000)

(50,000)

-

2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

£'0

00s

'Do Nothing' Surplus/(Deficit) 'Do Something' Surplus/(Deficit)

Solutions 2016/17 2017/18 2018/19 2019/20 2020/21

Total Impact 42,232 69,136 121,077 179,668 258,354

£338m

£0m


c. Financial impact on the system as a whole and consequential impact on i. Providers ii. Commissioners iii. local authorities The delivery of the proposed solutions delivers a revised deficit position of £80.0m (including specialised services deficit), inclusion of the indicative STF allocation in 2020/21 of £79.9m provides a balanced position by 2020/21 and could be further mitigated through distance from target allocation increases of £43m to CCG allocation

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Do Something 2016/17 2017/18 2018/19 2019/20 2020/21

Footprint NHS Surplus / (Deficit) £000s (118,319) (130,995) (126,683) (117,824) (80,073)

Indicative STF Allocation 2020/21 £000s 79,998

Footprint NHS Surplus / (Deficit) after STF Allocation £000s (118,319) (130,995) (126,683) (117,824) (75)

Gross Impact £ Re-Investment Net Impact £

Solution 1Business as usual efficiencies -

Commissioner

Tariff and Prescribing Efficiency

Assumptions(45,068) (45,068)

Solution 2Business as usual efficiencies - Provider

Delivery of Cost Improvement

Programmes(131,364) 41,000 (90,364)

Solution 3Footprint level system transformational

solutionsAcute Hospital Reconfiguration (53,000) (53,000)


solutionsIntegrated out of hospital care (20,000) 14,000 (6,000)


solutionsUnwarranted Variation (14,000) (14,000)


solutionsAccountable Care (6,000) - (6,000)


solutionsPrevention and Intervention (9,000) (9,000)

Solution 8Business as usual efficiencies -

Commissioner (Specialised)

Tariff and Prescribing Efficiency

Assumptions(35,022) (35,022)

(313,454) 55,000 (258,454)

4c Continued. Solutions that taken together close the gaps, and its impact quantified - health and care being described as concretely as possible in terms of expected effect on metrics: a. for 2020/21 (financial envelope), for 2016/17 and years in between (bridge), including forecasted impact of solutions [partially set out in April submission] b. Phasing of the impact and link to operational plans and c. Financial impact on the system as a whole and consequential impact on i. providers ii. Commissioners and iii. local authorities

c. Financial impact on the system as a whole and consequential impact on i. Providers ii. Commissioners iii. local authorities

The approach described in the finance section and in the overall plan reflects some valuable insights gained from our experience gained reviewing various models of care with partners/consultancies who have studied and implemented the various models. IF C&M could deliver at a level of 80/1000 pop it could potentially reduce expenditure by circa £40M -£50M per annum, however it does not drive low provider costs unless the estates/stranded costs are reconfigured. The work that NHS Eastern Cheshire undertook with EY found that service rationalisation (i.e. reduce site but not demand) has had virtually no economic benefit (stranded costs and capital off set economies of scale), but do improve clinical sustainability / clinical standards. The GM Healthier Together programme has concluded largely the same. As NHS provider transaction costs are typically £20-30M excluding deficit funding and balance sheet repair (net of capex).The establishment of a hospital chain could remove management costs of about 5% -8% of turnover (and potentially circumvent some of the transaction costs) Closure of a hospital site carries a risk that it yields significant short term non-recurrent savings, but significant recurrent costs – one of the key findings from the Challenged health economy work.

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5. How to deliver our plan: a. Long term (3-5 year) and short term (this year) milestones for further development/delivery of the plan and b. Risks and actions to take in the short term, including what you can do yourself and how you’ll need help from national bodies.

a. Long term (3-5 year) and short term (this year) milestones for further development/delivery of the plan The Cheshire and Merseyside STP big themes and the Cheshire and Wirral priorities (previous slide) are articulated in Cheshire and Wirral through 5 Programmes of Work. (See table below) 4 out of 5 measures commence in 2016/17. The financial and care benefits of Accountable Care would not commence until 2018/19 as they will be informed by progress on the other measures.

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Measures to Meet Triple Aim

Local Delivery Systems Summary for the Cheshire and Merseyside Geography (All NHS and Local Authority Commissioning and Provider organisations represented)

North Mersey

The Alliance Healthy Wirral West Cheshire Way

Connecting Care

Caring Together

Liverpool South Sefton Southport and Formby Knowsley

St Helens Warrington Halton Knowsley Southport and Formby

Wirral

West Cheshire

South Cheshire Vale Royal

Eastern Cheshire

Katherine Sheerin Steve Cox Jon Develing Jerry Hawker

Louise Shepherd C&M STP Executive Lead C&M STP Membership Group

• Chair Neil Large • All Local Authority Chief Executives • All CCG Chief Executives • All NHS Provider Chief Executives • NHSE Specialised Commissioning Director • NHSE Commissioning Director C&M STP Working Group –

• Chair Louise Shepherd • CCG AO Leads x 4 • Local Authority Ch-Exec x 2 • Provider Trust Ch-Exec x 4 • Provider Trust Chair x 1 • NHSE Specialised Commissioning Director • Link to NHSE Director of Commissioning Operations

Cheshire & Merseyside STP Membership Group

This Governance structure reflects arrangements for the development of the STP. The membership group will review Governance for the delivery of the STP by 30 June 2016.

Clinical Congress

CCG AO Leads

Annex A) Governance arrangements [as partially set out in the April guidance]: i. Our structure, effective decision making, system leadership and ii. Our work streams and delivery vehicle (evidence how to deliver change on the ground)

i. Our structure, effective decision making, system leadership

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Cheshire & Wirral Transformation Group

http://www.bing.com/images/search?q=nhs+logo&id=2D9317D8477CD80819A1295E9E09A7680A21799E&FORM=IQFRBA

Annex B) Engagement process [as partially set out in the April guidance]: i. Our plan to engage more formally with boards and partners after the July conversations ii. How our footprint has engaged organisations and other key stakeholders so far, and who is still to be engaged with and iii. Our evidence or plan to involve staff, clinicians, patients, HWBs, etc.

iii. Our evidence or plan to involve staff, clinicians, patients, HWBs, etc.

ALL ENGAGEMENT TO DATE HAS BEEN THROUGH LOCAL PLANNING DEMONSTARTED BY EACH OF THE FOUR TRANSFORMATIONAL PROGRAMS All engagement to date has been through local planning demonstrated by each of the four transformation programmes.

1. Caring together in Eastern Cheshire 2. Connecting care in Central Cheshire 3. West Cheshire Way in West Cheshire 4. Healthy Wirral in Wirral The following slides reflect an approach that could be taken across the four parts of Cheshire and Wirral to ensure that the STP is lead locally but with a consistent Cheshire and Wirral approach.

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i. Our plan to engage more formally with boards and partners after the July conversations

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All LDS’s will take an integrated approach to engagement. Three layers of engagement have been identified:

• Partners – those involved in delivering the plan

• Key influencers – those who will formally scrutinise the plan

• Patients & public – whose understanding & support is required to effect the changes

Objectives: • To inform – communicating the context, financial challenge, the proposed

solutions, impact and timescales • To engage – to obtain feedback, address issues & concerns • To involve – to lead a call to action to support and advocate the actions in the

STP, to ensure financial and clinical sustainability

Principles: • Transparent – Open and honest about the challenges and the scale of change

required • Inclusive – solutions require collective buy-in and involvement from boards,

other stakeholders and patients & public • Pro-active and planned – continuous communications and engagement over the

life of the plan • Robust - ensure communications and engagement meet statutory

requirements, particularly with regard to formal scrutiny and major service reconfiguration

Leadership: • C&M & LDS lead officers to be accountable for engagement • C&M Engagement lead to be responsible for delivering the engagement plan , working with LDS engagement leads

Timing: • Anticipate key milestones and dependencies that will inform engagement

and communications

Partner Stakeholders –

Provider Boards

CCG Governing Bodies

Local Authority Leadership

Key Influencers –

Health & Wellbeing Boards

OSCs

MPs

Healthwatch

Patients & Public


iii. Our evidence or plan to involve staff, clinicians, patients, HWBs, etc.

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Action Detail Action By Timescale

STP vision and Big ideas Agree a plan to engage on the big ideas for our region and for LDS’s. Content to be positive, although clear about the case for change, quantifying the challenge and the benefits

Engagement lead September

Hub and spoke engagement plan

When specific deliverables are understood, develop a C&M engagement plan which sets out the geography and plans for specific engagements linked to service change and population health initiatives. Principle of subsidiarity – local where possible.

Engagement lead 16/17

C&M STP Engagement & Communications Plan Patients & Public

The patient and public engagement plan will be influenced by national expectations and instructions about levels of communication and engagement delivered nationally and /or by STP areas. We assume there will be national guidance on key messages about the rationale for STPs and the impact of plans on the NHS and social care. We assume there will be a requirement for C&M and LDS level communications and engagement relating to the specific details and impact of our plan. We anticipate there will be an initial requirement to engage on the ‘big ideas’ contained in the C&M STP. Over time, as plans are further developed there will be a requirement to engage on specific service change proposals and population health initiatives. We will use the content and channels detailed in the stakeholder plan, but adapt to patient and public stakeholders.

Digital Section

Within the Cheshire and Merseyside STP, there are 4 Local Digital Roadmap (LDR) footprints namely Cheshire, Merseyside, Warrington and Wirral. We have a strong track record of digital achievements including advanced shared care records programmes, European leaders in assistive technology adoption, population health management, high penetration of NHS number across health and social care, a single radiology system and national pioneers in citizen identity and verification management. Our joint high level digital ambitions for the future are: To deliver our digital ambitions there are a range of programmes within each LDR, the below are themes demonstrating how we will achieve them with some cross cutting areas:

1. A set of Digital Principles

2. Information Sharing / Governance Framework

3. Digital Maturity of all Health and Social Care Providers (including Primary Care Digital Transformation)

4. Rationalisation of systems in and out of hospital

5. Interoperability between systems

6. Upscaling of Assistive Technology

7. Advanced Analytics / Population Health

8. Consolidated infrastructure at LDR level and connectivity between LDRs where clinical services overlap

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Digital Ambition Scope That Means

1. Digitally Empowered Individuals

Enable people to utilise digital technologies to manage their own care

Enabling people to take control and work in partnership in relation to their health

and wellbeing

Ensuring digital inclusion for all

Digital skills for workforce & citizens

Individuals interacting with their care services digitally through a ‘digital no

wrong door’ and a ‘personalised front door’ Patients can access online services using their choice of device and app to

manage their care Use assistive technology to manage their care and interact with professionals Access information about their own health and conditions to support them

to self care Single approach to citizen identity

2. Connected Health and Social Care Economies

Ensure that information is available to the right people, in the right place, at the right time Improve quality, safety and patient experience by eliminating paper processes

and records that cause inefficiency and delays in care resulting in orgnisations

operating paper free at the point of care Reduce fragmentation & duplication Eradicate unwarranted variation Support a technologically enabled workforce to fully benefit from digital solutions Enhancing care and quality, whilst ensuring greater system efficiency

Every health and social care practitioner will have the ability to directly

access the information they need, in near real time, wherever it is held, digitally on a 24x7 basis We will have further consolidated and rationalised our Electronic Patient

Record systems in and out of hospitals

We will have structured, digital clinical records across all providers in the

pathways of care

Our workforce will be digitally skilled with the appropriate technology and culture to enable rather than disable effective working through technology

3. Exploiting the Digital Revolution

Move towards ‘intelligence led healthcare’ by utilising advanced analytics,

greater industrial partnership and engaging Information Governance as a

structure for safe development rather than a blockage to progress

Build on the work of the North West Coast Genomic Medicine Centre to embed

and normalise genomic medicine into heath and care services

A direction towards intelligence led services allowing care to be delivered in the most efficient and effective manner Closer working relationships with academia and industry to take advantage

of new, cutting edge innovation and expertise Exploitation of population health capabilities

SUMMARY

Each LDSP has transformational plans that will over the five year period deliver benefits in respect of the Triple aim. However it apparent that in order to make gains into the financial gap systems will need to collaborate at scale. This collaboration will be evident in

1. Acute care reconfiguration. A dedicated piece of work needs to be undertaken that would inform

• Current and future patient flows • Sustainability of current provision and estates • Future workforce requirements • Options appraisal for acute care reconfiguration - • Impact of single clinical teams working at scale. • Use of real time data system • Development of Acute Hospital Chain across CW • Development of robust clinical governance across the chain • Development of operational transparency single control systems • Focus of the needs of the CW population not that of organisation's • Return on investment on mental health with CW consuming its own smoke in terms of patient flows • Integration of the acute ‘model hospital’ with other areas of the patient pathways, community and general practice

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SUMMARY


2. Out of hospital primary and community care transformation

• Development of integrating community teams at a larger scale • Development of well being centers • Cohesive step up step down / Intermediate care offer • Lesson leant from MCPs and PACS models • Digital roadmap – respective care records • Population health management – unplanned admission avoidance • Consideration for the impact of the Five year forward view for Mental Health • Consideration for the impact of the Five year forward view for Primary care with primary care • Consideration for economic growth arising from High Speed Rail Link / Wirral Waterways / Devolution • Consideration of housing development – frailty villages etc.

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SUMMARY


3. Reducing unwarranted variation • Develop and evidence base that demonstrate variations inn care so these can be addressed • Cheshire and Wirral Medical Formulary – drive out prescribing / referral variation • Establish C&W clinical outcomes to support ACO development • Establish C&W value propositions and standards (similar approach taken in Manchester) • Agreeing standard operating procedures • Agreeing new to follow up ratios • Agreeing clinical criteria for admissions • Developing central control rooms so as to reduce LOS • Explore partnership with intermountain healthcare USA.

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SUMMARY


4. Accountable care

• Develop a shared understanding of what Accountable care is and its potential both local in each LDSP or pan C&W • Develop a narrative for how this will deliver our ambitions for C&W • Value and goal alignment of ACO / ACS members • Agree the elements of ACO its principles / membership and presence of primary care? • Outcome base capitated budgets with new contract mechanism • New governance arrangements across a bigger footprint • Reduced management costs • Develop the outcome metrics for the ACO to be governing and measured against

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cheshire and wirral lds - labournet stp no.8_final cheshire... · 2016-10-10 · cheshire and...

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