NorthCentralLondonSustainabilityandTransformationplan

May2016

N C LNorthCentral LondonSustainability andTransformation Plan

1. ThedevelopmentoftheSTPinvolvesfivekeyaspects:• Localleaderscomingtogetherasateam• Developingsharedvisonwiththelocalcommunitywhichalsoinvolveslocalgovernment• Programmingacoherentsetofactivities tomakeithappen• Execution againstplan• Learningandadapting

2. Accesstofuturetransformationfunding• TheSTPswillbecomethesingleapplicationandapprovalprocessforbeingacceptedontoprogrammeswith

transformationalfundingfor2017/18onwards• Thisstepisintendedtoreducebureaucracyandhelpwiththelocaljoin-upofmultiplenationalinitiatives.

3. ThemostcompellingandcredibleSTPswill securefundingfromApril2017onwards.Theprocesswillbeiterative.NHSEnglandwill consider:• thequalityofplans,particularly thescaleofambition andtrackrecordofprogressalreadymade.Thebest

planswillhaveaclearandpowerfulvision.Theywill createcoherenceacrossdifferentelements,forexampleapreventionplan;self-careandpatientempowerment;workforce;digital;newcaremodels;andfinance.Theywill systematicallyborrowgoodpracticefromothergeographies,andadoptnationalframeworks;

• thereachandqualityofthelocalprocess,includingcommunity,voluntarysectorandlocalauthorityengagement;

• thestrengthandunityoflocalsystemleadershipandpartnerships,withcleargovernancestructures todeliverthem;and

• howconfidentareNHSEnglandthataclearsequenceofimplementationactionswillfollowasintended,throughdefinedgovernanceanddemonstrablecapabilities.

ThebackgroundtotheSTP N C LNorthCentral LondonSustainability andTransformation Plan

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ThereareanumberofobjectivesfortheNCLSTP

Thegoals ofourSTPare:• Toimprovethequalityofcare,wellbeingandoutcomesfortheNCLpopulation• Todeliverasustainable,transformedlocalhealthandcareservices• Tosupportamovetowardsplace-basedcommissioning• Togainaccesstoashareofthenationaltransformationfundingwhichwillensureourhospitalsgetbacktobeingviable,tosupportdeliveryoftheFiveYearForwardView,andtoenablenewinvestmentincritical priorities

Goals

Outputs

Process

TheSTPneedstodeliver severalkeyoutputs:• Acompellingclinical caseforchangethatprovidesthefoundationfortheprogrammeandisembeddedacrossthework,andsupportstheidentificationofpriorities tobeaddressedthroughtheSTP

• Asingleversionofthetruthfinancial ‘donothing’basecasewithquantifiedopportunityimpactsbasedonthepriorities identified

• Arobustandcredible planforimplementationanddeliveryoverfiveyears• AgovernanceframeworkthatsupportspartnershipworkingacrosstheSTPandcollective decisionmaking

• Theresourceinplace todeliver transformationatscaleandpaceinthekeyareasidentified

Theprocess todevelopingourSTPneedsto:• Becollaborative,andownedbyallprogrammepartnersinNCL• Bestructuredandrigorous• Moveatpace,ensuringquickwinsareimplementedandtransformationisprioritised• InvolveallareasofCCG,localauthorityandNHSEnglandcommissionedactivity,includingspecialisedservices,primarycareandreflecting localHWBstrategies

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N C LNorthCentral LondonSustainability andTransformation Plan

Wherewearenow:currentstatus

BuildingrelationshipsacrossNCL

• Wearecontinuingtobuildrelationshipsacrosstheprogrammepartnerstoensurethathealthandcarecommissioners andproviders arealignedinourambitiontotransformcare

• Ourgovernanceframeworksupports effectivepartnershipworking• TheSROsareworkingtobringCCGs, providers andlocalauthoritiestogetheracrossthe5

boroughs togetherrecognisingthehistoryandcontextthatunderliesworkingtogetherinanewway

Developingthecaseforchange

• Wehaveundertakenanalysis toidentifythegapsinhealthandwellbeing,andcareandqualityinNCL inordertoprioritise areasweneedtoaddress

• Wenowneedtofocusonensuringthereislocalbuy-inandownership ofthecaseforchangewhichwewillachievethroughaprogrammeofwidespread engagementfromnowuntilJune

• Theclinical cabinetwhichwillmeetforthefirsttimeon5th Maywillleadthiswork

Understandingourfinancialposition

• Financedirectorsfromallorganisations havebeenworkingwell togethertoidentify theNCLposition in20/21should wekeepgoingasweare

• Thisincludes someassumptionsaroundQIPPandCIP,whichweneedtodevelopinfurtherdetailtoremovetheriskofdoublecountingwhenwecometoquantify opportunities,particularlyaroundproductivity

Mobilisingtheprogramme

• Wehavedeveloped ahighlevelroadmaptotheendofJune, basedaroundthemobilisation ofopportunityworkstreams ineachofourkeythemes:population health,productivity,consolidation andspecialisation andenablers

• Weareintheprocessofrecruitingaprogrammedirectorandclinicalleadbasedonasharedunderstanding ofwhatweneedtodrivethisworkforwards

• AkeyriskishowwemanagetheimpactofspecialisedservicesinourpatchwhichwewilllooktoaddressthroughworkingcloselywithNHSEnglandtoidentifywhatmightbebestconsidered atapan-London level

N C LNorthCentral LondonSustainability andTransformation Plan

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ProgrammeDirector:AliceHopkinsonPMOLead:AbiHollandProgrammesupport:JulieChanJonesCommsandengagementlead:TBC

NCLTransformationBoardChair:DavidSlomanSROs:DavidSloman(Convenor),DorothyBlundell,MikeCookeMembers•SROs•NHSCCGreps•NHSAcuteProvidersreps•NHSCommunityProvidersreps•NHSMentalHealthProvidersreps•Localauthorityreps•LAS•HENCEL

NCLCCGs

NHSPROVIDERS

HENCEL

NHSENGLANDLONDON

HEALTHYLONDONPARTNERSHIP

LACEOs

DsPH

CCGCOs

DASSs

HWBs

HARINGEYANDISLINGTONWELLBEING

ALLIANCEBOARD

NCLSTPPMO

Currentoverarchinggovernanceframework

FinanceandActivityModellingGroupLead:TimJaggard

ClinicalReferenceGroupLead:TBC

TransformationGroupLead:DavidSloman

Clinicalwork-streams

WorkforceSRO:MariaKaneCathyGritzner

Furtheropportunity areastobeconfirmed

EstatesSRO:CathyGritznerDawnWakeling

Systemenablers

Sustainabilityandtransformationplanpriorities

DRAFT

MentalHealthSRO: DorothyBlundell

PrimaryCareSRO: AlisonBlair

Furtheropportunity areastobeconfirmed

UrgentandemergencycareSRO:DeborahMcBeal

CancerSRO:CathyGritzner

ClinicalCabinetLead:TBC

N C LNorthCentral LondonSustainability andTransformation Plan

•UCLP•NHSspecialisedcommissioning•NHSEngland•NHSImprovement•Healthwatch•Clinicallead•Financelead•ProgrammeDirector

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DRAFT

DevelopingtheNCLcaseforchange

• ThecaseforchangeisundergoinganiterativedevelopmentprocesswithfeedbackbeingprovidedfromallhealthandsocialcareorganisationsthatareinscopeoftheNCLSTPprogramme.

• Thefourthinaseriesofworkshopswasheldon20th AprilwithcliniciansandsocialcarepractitionersfromacrossNCL,particularlythose intheouterboroughs.Theworkshop focusedonanalysingthedata,agreeingtheemerginghypothesesandidentifyinggapstoaddressinthecaseforchangesofar.

• Keythemesdiscussedincludedafocusonprimary,secondaryandtertiaryprevention,selfmanagementofminorillnesses,earlydiagnosis,LTCs,investmentinprimarycare,andworkforce.

• BetweennowandJune,energywillbefocusedonaddressingthegapsandbroadeningtheengagementsuchthatwidespreadcollectiveownershipofthecaseforchangeisachieved.

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Developmentand

engagementprocess

Clinicalcabinet

Finalsubmission

• TheNCLSTPClinicalCabinet,responsibleforthecaseforchange,willleadthefurtherdevelopmentofthisworkthroughtotheSTPsubmission inJune.

• TheclinicalcabinetwillsignoffthecaseforchangewithultimateresponsibilityfallingtotheNCLSTPclinicallead.

• TheSTPsubmission inJunewillincludethefinalversionoftheNCLcaseforchange.

N C LNorthCentral LondonSustainability andTransformation Plan

DRAFT

5keypriorityworkstreamshavebeenidentifiedandmobilised N C LNorthCentral LondonSustainability andTransformation Plan

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Primarycare(SRO– Alison

Blair)

Urgentandemergencycare(SRO– Deborah

McBeal)

MentalHealth(SRO– Dorothy

Blundell)

Estates(SRO–CathyGritzner,DawnWakeling)

Description NextstepsCurrentlyhasamediumtermfocusondeliveringaplanwhichsetsoutthevision oftheCCGstotransformPrimaryCareinNCL.Thefocusisondrivingupthequality ofprimarycare,recognisingtherearedifferencesandopportunities totacklevariationinthequality andoutcomesdelivered toourpatientsProgrammetosupport people toaccessurgentandemergencycareappropriately, intherightplaceattherighttime.Theaimistoprovideconsistently highqualitycaretopatients, significantlyreducingvariationacrossNCLprovidersaswellasacrossthedaysandtimesoftheweekDevelop a MoC and support to enable our population to live well in theleast restrictive setting; by breaking down barriers between mentaland physical health, delivering consistent and better outcomes thatmatter to service users and carers, and reducing inappropriate use ofacute inpatient beds. This 5 year, all age approach programme has afocus on early interventionTheestatesworkstreamisanenabler.Itaims,attheNCLlevel, tosupport thedevelopment ofremodelledestatefortransformedhealthandcareservices, secureefficienciesandreleasecapital,releaselandforhousing. Theworkstreamisalsoadevolution pilotprojectaspartoftheLondonprogramme.

Forall5workstreams to:

• Clarifythescope• DetermineSMART

objectives• Identifytimelineand

keymilestones• Definetheimmediate

priorities fordelivery• Articulatethe

quantifiable impactanticipatedattheendofyear1andattheendofyear5

• Specify thesupportand/orresourcerequirements

• Identifyanyaskstoputforwardtothenationalleaders

Workforce(SRO–CathyGritzner,MariaKane)

Definetheworkforcerequirementsrequiredtodeliver theSTPacrossNCLanddeterminehowwewilltrain,recruit,retain,developandsupport thehealthandcareworkforceofthefutureinNCL

Furtheropportunitiesneedtobeidentifiedandanalysed toclosethekeygapsidentifiedintheclinicalcaseandthefinancebasecase.Together,wehaveagreedanumberofprinciplesforselectingadditionalprioritiesinordertofullyaddressthegaps:• Weshouldberadicalinourapproach andnotconstrictourselvestoopportunitiesavailablewithintheconstraintsofthecurrent

system• Weshouldbeconsideringmoreeffectivevehiclesfortakingchangeforwardsincludingtakingadvantageofopportunitiestoshare

resources• Weshouldbeabletoarticulatetheopportunitiestoallaudiences,includingpatients,healthcommissionersandproviders,local

authoritiesandNHSEngland• Weshouldbelookingtoreducedemandthroughnewopportunities• Newopportunitiesshouldbefocusedaroundeliminatingvariationandaddingvalue

Wehaveestablishedfourkeythemesthatwillenableustodeliverthechangesneededtocreateviableandsustainablesystem,including:• Populationhealth:understandingourpopulation,segmentingintodifferentgroups,understandingwhatdifferentinterventionsare

requiredforeach,andshiftingthebalanceofcarefromreactivetoproactive,startingwithpreventionandselfcare.Thislensisimportantbecauseitwillenableustodosomethingradicalandensurewearenon-institutionalinourapproach.

• Productivity:leveragingproductivityopportunitiesbothwithinorganisations,butalsothroughexploringopportunitiesforefficiencyandsavingsthroughcollaborationacrossorganisations

• Consolidationandspecialisation:inordertodeliverimprovedsafety,betteroutcomesandvalueformoney• Stoppingthings:stoppingservicesorinitiativesthataren’tworking

Werecognise thatasetofkeyenablerswillbevitalfortransformation,including:• information• estates• workforce• newpaymentmodels• governanceandorganisationalmodels

OurTransformationGroupwillreviewtheadditionalopportunitiesandrecommendandprioritisewherefurthereffortcanbemade

DRAFT

N C LNorthCentral LondonSustainability andTransformation Plan

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Ouridentifiedpriorityworkstreamsmaximise leverageofexistingworkbutweknowweneedtodomore

DRAFT

N C LNorthCentral LondonSustainability andTransformation Plan

HighlevelroadmaptoSTPsubmissioninJuneindevelopmentApril May June

w/c 11/04 18/04 25/04 02/05 09/05 16/05 23/05 30/05 06/06 13/06 20/06 27/06

Governance&

mileston

esPo

pulatio

nhealth

Prod

uctivity

Consolidation

&specialisation

Enablers

STP

developm

ent

PMOsetup

Draftc4cdevelopment

FinaliseSTPsubmissionOngoingreviewandinputcheckpoints

DevelopoverarchingSTPdeliveryplanandsubmissionforJune

30/6FinalSTPsubmissiontoNHSE15/04NHSEsubmission22/04NHSEstocktakemeeting

TransformationGroup 6/05 20/05 3/06 14/06TransformationBoard 25/04 26/05 22/06

20/4Clinicalworkshop Iterativedevelopmentofc4c

DevelopplanApril- June

25/04Pop.HealthworkshopRefreshNCLpopn segmn &reviewexistingworkContinueestablishingpriorityworkstreamswithleadership

Starttomodelfinance& activityimpact

Revieworg.assumptionsConductSAFEanalysis

Establishpriorityworkstreams&ensureleadershipinplace

Recruitclinicallead&mobilise clinicalcabinet

Developlonglistofpotentialservicesinscope

Reviewandrefinelistagainstcriteria

Mobiliseworkforce&estatesMobiliseIMTandintegratedDigitalRoadMap

Begintodevelopoptionsfornewmodelsofcare

Begintodevelopdeliveryplans

Begintodesignnewconfigurationoptions

Exploregovernancerequirements,deliverymodelsandpaymentmechanisms

Bringtogetherworkstreams toidentifyinterdependencies

Ongoingcommunicationsandengagement

OngoingPMOsupporttoSTPdevelopment,meetingsandwiderprogramme 9

12/5Nationaldevelopmentday

Workinprogress

Nextsteps:priorityactionspriortoSTPsubmissioninJune

qMobilise clinicalcabinet

qDevelopstructureofthe30th Junesubmissionandrefinetheroadmap

qAgreetheshapeofthefullprogramme architecture

qClarifyscope,plansandquantifythepotentialimpactforeachworkstream

qProgresspopulationbasedapproachtohealth

qIdentifypan-NCLproductivityopportunities

qMapoutexistinglocalandcollaborativeworkandensurealignmentwithSTPplans

qAgreeprogrammebudgetandfundingbeyondJune

qDevelopcommunicationsandengagementstrategyandrolloutacrossNCL

N C LNorthCentral LondonSustainability andTransformation Plan

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