nw london sustainability & transformation plan · da2 primary care • access – harrow ccg...

NW London Sustainability

& Transformation Plan

STP Highlight Report

November 2017

Contents 2

• Executive Summary (pages 3 - 6)

• STP NW London STP Programme Lifecycle (page 7)

• Risk Framework (page 8)

• Issue Framework (page 9)

• Delivery Area 1 report: Improving health and wellbeing (pages 13 & 12)

• Delivery Area 2 report: Better care for people with long term conditions (pages 13 - 17)

• Delivery Area 3 report: Better care for older people (pages 18 - 20)

• Delivery Area 4 report: Improving mental health services (pages 21 - 24)

• Delivery Area 5 report: Safe, high quality and sustainable hospital services (pages 25 - 28)

• Workforce workstream update (pages 30 - 32)

• Digital workstream update (pages 33 & 34)

• Business Intelligence (pages 35 & 36)

• Estates workstream update (pages 37 - 42)

• Glossary (page 43)

• Contents and key messages for NWL project work book updates (page 44)

• NW London project work book – Risk framework (page 45)

• NWL project updates ( DA1ai, DA1di, DA5b, DA5ci & DA5ciii)

Executive Summary:

DA Overall what went well this month in your area? (one sentence)

(Good news that JHCTG /communications can share)

Overall what is the main action needed across your area? (one

sentence)

How can JHCTG help? (Share/act as lever/ note)

DA1 • Making Every Contact Count programme continues to be rolled out across NW London- with particularly strong

engagement across probation services, the voluntary sector and primary care.

• Discussions are progressing well at an STP level regarding the approval fro the alcohol business case –

Reducing Harmful Drinking will report via the NWL workbook (DA1ai)

• MECC training has commenced in Hounslow- Making Every Contact Count will report via the NWL workbook

(DA1di)

• Reprioritise and refocus the DA1 Prevention workstream.

• Support in obtaining commitment from key stakeholders across

health and care to the programme.

• Ealing, Brent and Harrow CCGs to agree to fund the alcohol

business cases and the JHCTG to act as a lever to prioritise alcohol

prevention work and support this decision making progress (DA1ai)

• Further recruitment drive needed to fill spaces as there has been

reduced appetite in some of the boroughs (DA1di)

DA2 Primary Care

• Access – Harrow CCG are now offering full extended Access in to their hubs

• Provider Maturity – First provider maturity evaluation held Ealing and dates for other CCG launch events and

evaluation also arranged for H&F and Brent.

• 30 Expressions of interests made by NW L for international GP recruitment programme

NW L Diabetes Programme : Winner of 3 awards at the Quality in Care Diabetes 2017.

Self Care

• PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over

12,000

• Received approval to proceed with myCOPD digital project from DA2 Programme Board.

Cancer Recovery: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds

IAPT-LTC

• 200 practitioners (50 from NWL) have registered for the PWP/ counsellors online training on LTCs. Online

training to be reviewed by the IAPT Education Expert Reference Group (Skills for Health) with a view to

recommending the resource nationally. Long Term Conditions/IAPT service staff recruited and the service

launched across 7 Boroughs (DA2c)

• DA2 is the most diverse delivery area and therefore it is not possible

to pull out one main action common to all areas.

• Work across the system to promote patient behaviour change away

from UCCs to available capacity that can meet their requirements

within the primary care centres where utilisation averages 57%.

• Support in engaging with CareUK in relation to direct booking roll-out

and alignment with NW London timelines.

• Joint working to promote work and ensure enduring clinical pathway

change on diabetes and other right care areas of focus.

DA3 • Integrated commissioning-The project team has focussed on providing clarity to local areas about which

deliverables can occur across all local areas.

• Enhanced care in care homes- Consultation on the leadership care home manager programme was

completed. Local delivery groups were established for the roll out of the red bag scheme in Brent, Ealing,

Hillingdon with implementation initiated.

• Intermediate care & rapid response- An London Ambulance Service (LAS) training session on accountable

care partnerships (ACPs) was delivered at the Brent Ambulance Station, attended by 50+ paramedics on

04/10 to increase referrals and reduce Accident & Emergency (A&E) conveyances.

• Response at time of crisis- At Northwick Park Hospital a fully staffed and operating Multidisciplinary Team

(MDT) model was agreed for w/c 30/10.

• Home first- 501 patients have been discharged on the Home first pathway across North West London (NW

London) (as of 23/10).

• Last phase of life-Telemedicine- Three business cases were developed on time and localised to each individual

CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10 - 24/10, Brent CCGs business case

was approved.

• Integrated commissioning- The project team aim to work with each

local area, however, may need some direction on whether to

prioritise support to local areas that are fully engaged or those areas

needing further persuasion.

• Enhanced care in care homes- Local CCGs need to identify named

support and the capacity to implement the schemes.

• Home First- The project team will need to engage with local

authorities to validate the financial model.

• Last phase of life-Telemedicine- Harrow and Hillingdon CCGs

business cases will go to executive committee for approval.

3

Executive Summary: continued

Enabler Overall what went well this month in your area? (one sentence)


Overall what is the main action needed across your area? (one

sentence)


DA4 • PCMHT Evaluation, jointly run with HLP, is on track to go to procurement on

13/11 (DA4a). Out of Hospital Contract for GPs, to provide enhanced physical

health care for people with Serious Mental Illness (SMI) is on track to be

implemented across NWL in 18/19 (DA4a)

• Early Discharge Planning tool is gaining traction and having desired effect across

CNWL; similar DTOC-reducing initiatives are bringing results in WLMHT. Service

spec and Service Operating Procedure for WLMHT Rehab presented with minor

queries to be endorsed over email. Agreed investment in detailed flow modelling,

bed modelling, and implementation decision-making analysis to take place across

NWL (DA4a).

• NWL is on course to achieve 5 years plus inpatient discharges for people with

learning disability/autism and challenging behaviour (DA4b).

• Children and Young People Transformation Plan has been refreshed and new

priorities for 2018/19 have been set. The new crisis pathway and community

outreach service has been launched to provide support in the community (DA4c)

• Can we agree the principle across the system that services likely to

yield return on investment and reduction in need for beds, may be

funded for 6-12 months using transformation funding as a “bridging”

fund; until such time as the service is self-sustaining. (DA4a)

• Urgent and crisis care pathway integration discussions to begin

requiring input from all agencies. Partners are encouraged and asked

to participate and prioritise. (DA4c)

• The funding flow model for specialised commissioning patients will be

shared by NHSE through ADASS forum which require system level

response from health, social care and housing stakeholders. DASS’s

and Director of Corporate Resources/Finance to engage in the

debate.

DA5 • Official opening of the North West London Ultrasound Academy is due on

01/11/2017; this will take in a cohort of five sonographers. A paper was produced

to show how seven successful pilots have demonstrated clear evidence of length

of stay reduction, and have been implemented in various hospitals. Radiology

and diagnostics/ inpatient model of care will report via combined the NWL

workbook (DA5bi & DA5bii)

• Assurance of SOC 1 continues - SOC 1 will report via the NWL workbook

(DA5ci)

• New pilot models implemented at Hillingdon. Launch of personalised postnatal

care plan at all sites - Early Adopters will report via the NWL workbook (DA5ciii)

• Paediatric review was taken to Ealing Health and Adult Social Services Scrutiny

Panel (HASC) meeting on 24/10. Project is now officially closed (DA5c)

• Successful proof of concept of added value of new renal pathway supported by

STP Clinical Board. Project team is in place to deliver outpatient transformation.

There is good progress and clinical engagement for cardiology and MSK

(DA5a&d)

• Support in implementing the development of outline business cases

for both hubs and Trusts as far as possible without confirmed funding

(DA5ci).

• DA5a & d – A formal agreement of Business Principles has been

agreed by CFOs and is being discussed by Provider Board and CCG

Collaboration Board. This is a key enabler to transformation by

removing the current payment system which acts as a disincentive to

improving care and reducing costs.

4


Enabler Overall what went well this month in your area? (one sentence)


Overall what is the main action needed across your area? (one sentence)


Workforce • HEE Workforce Observatory now in operation; the Observatory will

provide workforce intelligence and planning support to the 5

London STPs, making more effective and efficient use of existing

data sets, participate in new collections and will have the capacity

to assist in appropriate workforce modelling approaches.

• NW London response to the national Mental Health Workforce

Plan will be shared for agreement at the Mental Health

Transformation Board on 24th November. The first draft report of

analysis of pay rates for substantive and bank clinical staff

at WLMHT and CNWL has been produced, to enable greater

transparency around pay and incentives and understand where

there could be opportunities to create a coherent pay strategy.

• Revised savings target for NW London staffing project have been

agreed at £1.9m for 17/18 and £6.7m for 18/19.

• There is a need for a NWL-wide Organisational Development plan to support the

delivery of the STP. This will require a significant amount of engagement from

the outset to identify needs, establish ownership and gain buy in from the sector.

Digital • Continued good progress with Primary Care Digital Programme

(already funded through Estates & Technology Transformation

Fund – ETTF).

• CCGs and Trusts working well together on existing project

initiatives (e.g. e-Referrals)

• Improved progress with interoperability in some areas, but full

realisation of the digital vision for shared records to support

integrated care will require capital funding.

• NHSE have confirmed that no STP/LDR funding will be received during 2017/18;

details of funding 2018/19 to 2020/21 will be confirmed after the Budget.

• The transformational step change required to fully automate clinical operations

and build shared care records, as set out in the STP and LDR vision, will not occur

without the required capital funding, especially in LNWHT and THH. NHSE have

recognised that the Five Year Forward View target of “Paperless by 2020” is no

longer achievable.

• Prioritisation of investment will occur at Technical Design Authority and Digital

Portfolio Board once funding amount and guidance are confirmed.

• JHCTG should consider alternative sources of funding for STP digital enablers.

Business

Intelligence (BI) • Recruitment to 2 substantive transformational informatics roles in

BI team progressing well.

• To try to get reliable feeds for project related data, either from social care, or other

parts of the health sector.

Estates • OPE expression of interest submitted across the WLA supported

with follow up information provided by 3 November deadline.

• The NHSE London Capital Committee confirmed partial funding for

Parson’s Green (the relocation of Lilyville practice) and for the

reconfiguration of the first floor at Belmont Health Centre, Harrow.

• Heston OBC submitted to NHSE for approval.

• Positive meeting held with NHSE London Region Finance team and

PAU to discuss progression of pipeline of scheme. Joint review of

Heston OBC to take place in Nov.

• Brent joint public sector asset review completed and due to report

imminently.

• Reaffirming partner support and engagement with delivering the NWL Hub

strategy

5


Delivery

Area

Key issue/risk across the whole programme (one sentence)

What do they needed to be sighted on - How can JHCTG help?

DA1 Key stakeholders have not committed to the prevention agenda as previously stated in the STP, due to lack of strong financial modelling and ROI evidence.

There is still a resistance to commitment in the presence of strong and robust evidence. IMPACT: focus gets shifted/momentum drops meaning we cannot

complete planned projects, we are unable to make detailed plans/fund projects, and/or we are unable to realise any predicted savings. Note: Alcohol Prevention

(DA1ai) - key issue is the on-going uncertainty of funding for the alcohol work and the consequential delays in implementation.

Risk of causing damage to relationships between the STP and funding providers due to being overly ambitious in project development and setting unachievable

targets (DA1di)

DA2 No risk to escalated this period

DA3 There is a risk that the pace of implementation for the DA3 Programme is compromised due to significant dependencies on other delivery areas, such as DA5,

e.g. re-investment into community services is dependent on shifting resources from other areas in the system.

Staffing – Staffing constraints are delaying the implementation of an emergency frailty model at Ealing hospital. Similar constraints are likely to be encountered at

other sites.

DA4 There is a risk across the programme that significant transformation required across multiple workstreams does not have sustainable funding streams, and that

we are unable to generate re-investable savings from benefits realised elsewhere in the health and care system. JHCTG is asked to support developing views

on where our priorities should lie and what has most impact.

There is a risk that there is an unknown financial exposure as individuals with learning disability/autism and challenging behaviour are discharged from NHSE

funded care to locally funded care and no confirmation has been received of funding flows. JHCTG is asked to continue to support efforts to understand the

financial impact – with particular support needed from CFOs.

DA5 Clinical Decision Support (CDS): there is an issue with the integration of CDS with ICE. The delay is because of Sunquest, who have integrated the wrong

version of ICE into CDS (DA5b).

Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not considered for autumn capital announcement.

Trusts OBCs are also on hold until the approval of SOC Part 1 and funding being available to commence the necessary work. (DA5ci).

Some delays to programme due to accessibility of data sets. Delays in advertising / recruitment to CW and Imperial teams has resulted in a risk to launch in Jan

'18 (DA5ciii).

Need financial models to support programmes with system benefits but where there are interim provider stranded costs. CFOs have developed business

principles and this work should be supported by JHCTG (DA5a&d).

Workforce

There is a risk that the GP targets (set out in the GPFV) may hamper innovative workforce planning for new models of care. Primary care transformation

initiatives and programmes are more focused on retaining and developing existing staff and ways of working to build resilience in the primary care workforce,

than recruitment alone.

Digital

Further delay and reduction in NHSE STP/Local Digital Road map (LDR) funding will impact on many of the digital enabling projects for the STP. Funding will be

at a much lower level than required to enable the STP and national clinical objectives. Digitisation of provider records, and automated transfers to support

integrated care, will be delayed.

BI Access to Whole Systems Integrated Care (WSIC) data is key to progressing many Business Intelligence Unit (BIU) development projects.

Estates

Risk to delivery of Hub programme if external consultancy support cannot be secured. Lack of resource internally to deliver the programme of work within the

timescales required and subsequent risk to delivery of SoC 1. Following delays to reconfirming funding for support and the associated governance processes

that need to be followed there is an expected two – three month delay to the programme.

6

NW London STP Programme Lifecycle 7

Implementation of all solutions;

troubleshooting, monitoring and

reporting

Our portfolio management approach creates an

environment in which teams, resources and

activities are optimised to best achieve our

clinical, operational and financial goals and

identify and manage our key risks. It is

supported by the Strategy & Transformation

Project Management Framework. It is designed

to be a scalable framework suitable for all

audiences.

The Framework has been designed to ensure

that projects and programmes:

• remain aligned in their approach to

delivering transformation activity

• can easily access and learn from best

practice and experience from across the

sector

• follow a structured and proven methodology

for delivering projects and programmes.

To ensure consistency in our approach to

delivery and assurance, each of our

transformation initiatives is based upon an

agreed project lifecycle which takes a gated

approach. Gateway reviews will be undertaken

by an independent panel composed of:

• Clinicians

• Lay partners

• Technical experts from within the

sector

Note: There will be a minimum of two

gateway reviews for each programme,

however depending on the scale of change,

additional gateway reviews may be added.

NWL STP programme lifecycle

Risk framework 8

Risks are score as a multiplication of the risk likelihood and risk severity (1-25)

Issues framework 9

Severity Rating

5

4

3

2

1

Issues are scored only on severity (1-5)

ExtremeIncapable to deliver service

MajorSignificantly impairs ability to deliver service

ModerateImpairs ability to deliver service

MinorNo effect on critical path (within float)Some effect on ability to

MinimalNo effect on critical path (within float)Minimal effect on ability

STP Highlight Report

Delivery Area

10

10

Delivery Area 1 report 11

PROJECT AREA LIFECYCLE

STAGE

DATE

DUE TO

ENTER

NEXT

STAGE

RAG

RATING PROGRESS NEXT STEPS

Supporting

local people to

live healthier

lives

(DA1a)

Reducing

harmful

drinking

(DA1ai)

Report via NWL

workbook – see

section below

Promoting

mental

wellbeing and

reducing

loneliness

(DA1b)

Health

benefits of

employment

(DA1bi)

Project

identification

Jan

2018

AMBER

(Due to

slippage)

• IPS for Substance Misuse Project to receive 46%

match funding from Life Chances fund assuming we

can agree remaining 54% funding from CCGs and

LAs. Continuing to work with Social Finance to

develop a payment by health outcomes model that

reduces risk for CCGs.

• NHSE target to double IPS for SLTMH by 2020-

future funding to be released in Jan 2018

• Continue to work with Social

Finance to agree payment by

health outcomes model.

• Continue to liaise with NHSE

for updates and information

on funding application

process for SLTMH IPS

models.

Helping

children get

the best start

(DA1c)

Parenting

Programme/

Conduct

Disorder

(DA1ci)

Implementation Mar

2018

GREEN

(on

track)

• 7 Recruited schools in Ealing have been matched

to health supervisors.

• Training for multidisciplinary teams began in

September.

• Initial data collection with schools taking place.

• Continue implementation and

evaluation.

Roll out of the

National MECC

Programme

(DA1d)

Making

Every

Contact

Count

(DA1di)

Report via NWL

workbook – see

section below

AMBER

HEADLINES

• NHSE target to double IPS for SLTMH by 2020- funding to be released in Jan 2018 to enable the expansion of our existing Individual Placement

Support schemes, with funding to develop new models released in 2019. (DA1b)

• Delivery in schools of parenting programme training started in November (DA1c)

RAG key: On track Risk of delay – management in hand Delayed or unmitigated risk of delay –

immediate action required IMPROVING HEALTH AND WELLBEING

12

Delivery Area 1 report (continued)

IMPROVING HEALTH AND WELLBEING RAG key: On track Risk of delay – management in hand Delayed or unmitigated risk of delay –

immediate action required

KEY AREAS FOR DISCUSSION

none

12

KEY OUTSTANDING ISSUES THIS PERIOD

DA Issue Score Mitigation (latest progress) Score

DA1

There is an issue that there is insufficient resource within the

DA1 STP team available to progress work within DA1

IMPACT: unable to complete/continue planned projects/

existing work

4

Interim measures have been put in place however there is currently no

longer term plan. 4

DA1

Programme wide - we are unable to obtain sufficient support

and buy in from the system to take forward prevention at a

NWL wide level 4

The DA1 Programme Board is revising its function, and has been exploring

alternative ways of working for the Programme. The programme is currently

looking to review the level of commitment to prevention across NWL, asking

for revised commitment to prevention from the NW London system.

4

DELIVERY RISKS FOR NEXT PERIOD

DA Risk Score Mitigation (latest progress) Score

DA1

Key stakeholders have not committed to the prevention

agenda as previously stated in the STP, due to lack of strong

financial modelling and ROI evidence. There is still a

resistance to commitment in the presence of strong and

robust evidence. IMPACT: focus gets shifted/momentum

drops meaning we cannot complete planned projects, we are

unable to make detailed plans/fund projects, and/or we are

unable to realise any predicted savings. Note: Alcohol

Prevention work and the significant delay to progress.

20

Looking to source match funding from Social Investment Bond to reduce

cost and risk to CCGs. Reviewing the DA1 programme and

representation, challenging system commitment to the prevention agenda.

Concerns that national published guidance is misleading in terms of RoI-

will be cautious to fully review and explore figures in relation to all project

work.

16



STAGE

DATE DUE TO

ENTER NEXT

STAGE

RAG


Primary Care

Investment

and support

for GPs and

their teams -

delivering

the national

GP Forward

View (DA2a)

DA2ai

Primary Care

Access -

Hubs

Implementation Evaluation

(Jan 2019)

GREEN

(Running

to Plan)

• Harrow CCG is now offering full extended access in

to primary care hubs.

• Ealing have been successful with direct booking in

to hubs and all 5 inner CCGs expected to be

offering this in the next fortnight.

• Current efforts are now on IT and Integration to

install direct booking in to UCCs in time for winter

pressures.

• Implement direct booking IT solution in place

across all Access Hubs and UCCs to enable

direct booking and progress patient

redirection.

• Create outcomes and metrics dashboard for

all 8 CCGs.

DA2aii

Provider

Development

Solution Design

Implementation

Planning

(TBC)

GREEN

(Running

to Plan)

• Progress made across all project outcomes –

individual practices now receiving practice resilience

support.

• Groups of practices working at scale are beginning

to participate in the Provider Maturity Evaluation.

• Ealing and H&F have both had provider maturity

launch events with a very good response.

• Roll out of additional Provider Maturity

evaluations in at least two more CCGs, likely

to be Hammersmith and Fulham and Brent.

• Pull together the tools and guidance that

support transformation in the commissioning

of primary care at scale.

• Hold workshops/sessions with primary care

leads and NHS E.

• Start to look at how we will measure impact of

£3ph investment.

DA2aiii

Workforce Solution Design

Implementation

planning

(Jan 2018)

GREEN

(Running

to Plan)

• Primary care workforce strategy is close to

completion and the process for reviewing and taking

the strategy through CCGs governance is

underway.

• International GP recruitment programme is

underway and guidance has been shared by NHS

E. 30 Expressions of interest have been received

from NW London across all 8 CCGs.

• Develop project plans aligned to the primary

care workforce strategy.

• Progress review of workforce and strategy with

CCGs.

• Undertake thorough gap analysis of current

CCG PC workforce work.

• Confirm final number for expressions of

interest post 10th Nov deadline.

BETTER CARE FOR PEOPLE WITH LONG

TERM CONDITIONS RAG key: On track

Risk of delay – management in

hand

Delayed or unmitigated risk of

delay – immediate action required

AMBER

HEADLINES

• GPFV: Full extended access in to hubs available in Harrow; National guidance on Online Consultations has been released and shared with primary care leads (DA2ai)

• Progress made across all project outcomes – individual practices now receiving practice resilience support. (DA2aii)

• Expressions of interest have been received from NW L across all 8 CCGs for the International GP recruitment drive (DA2aiii)

• Cancer: Recovery of 62 day standard agreed with all Trusts supported by Transformation funds (DA2b)

• Mental Health: 200 practitioners (50 from NW L) have registered for the Psychological Wellbeing Practitioner/ counsellors online training on LTCs (DA2c)

• Diabetes: Diabetes programmes won 3 Quality in Care awards (DA2d)

• Self Care: PAM 17/18 activity for quarter two totals 5,502 across NW London bringing totals assessments to over 12,000 (DA2e)

Delivery Area 2 report (continued) 14


STAGE

DATE DUE TO

ENTER NEXT

STAGE

RAG RATING PROGRESS NEXT STEPS

Investment &

support for

GPs & their

teams -

delivering the

national GP

Forward View

(DA2a)

DA2aiv

Practice

Infrastructure

Implementation

Planning

Implementation

(TBC)

AMBER

(Way forward

to be

determined

following

decision to

halt pilot with

Babylon)

Online Consultations

• National guidance for online

consultations released and discussed

with primary care leads.

• Online consultation planning meeting

held with leads, from across NW London

to agree recommended approach.

• Two small GP engagement workshops

held by ICHP to gain GP views.

Practice Infrastructure - Digital

• IT exhibited several stalls at the

Transforming Primary Care conference

in Brent on 19th October. Feedback

from GPs was very positive and due to

the high level of interest this “roadshow”

may be rolled out to other CCGs.

• Identify project team and set up

online consultations project

delivery group.

• Develop plans for and begin GP

and patient engagement.

• Commence development of plans

for pan-NW London approach to

be submitted to HLP on 1st

December.

• Complete mapping of digital

programme to DA2a delivery

areas.

Saving lives

by Improved

cancer

outcomes

(DA2b)

Improving

cancer

outcomes

Diagnostic Solution Design

(TBC)

AMBER

(Concentrated

efforts on 62

day standard

& less

assurance on

STP priorities

in primary

care.

However, now

transformation

funding has

been

released,

planning is

developing at

greater pace)

• Hillingdon went live with Prostrate

pathway.

• Safety netting tool to enable

identification of at risk patients and

earlier diagnosis and prevention of

emergency presentations in A&E will be

rolled out across practices in Q4.

• Transformation funds released to

Hillingdon; ChelWest; Imperial and

London NW Trust to implement optimal

lung, prostate and colorectal

performance to enable sustainable

approach.

• Governance still to be agreed regarding

reporting lines and accountability to STP

for acute standards.

• Confirm achievement of 62 day

standard.

• Agree governance and reporting

lines to STP for acute standards.

RAG key: On track Risk of delay – management in

hand


delay – immediate action required BETTER CARE FOR PEOPLE WITH LONG

TERM CONDITIONS


BETTER CARE FOR PEOPLE WITH LONG

TERM CONDITIONS RAG key: On track

Risk of delay – management in

hand




STAGE

DATE DUE TO

ENTER NEXT

STAGE


Long term

conditions and

mental health

(DA2c)

Implementation Monitoring

(Mar 2018) GREEN

• IAPT LTC service promotion amongst

physical health clinicians continue.

• Clinical models have been developed. The

intention is to standardise the model across

NWL.

• Evaluation framework methodology and

proposed KPIs are being developed.

• NWL clinical model to be agreed between the

two Trusts.

• Co-location discussions to begin.

• Evaluation framework to be shared with

physical health commissioners and Acute

Trust to gain consensus on KPIs.

Providing the

right care every

time to prevent

serious illness

(DA2d)

Implementation

Evaluation

(Jan 2022)

GREEN

(Running to

plan)

• The NW London STP Diabetes

Transformation programme won 3 awards at

the Quality in Care Diabetes 2017.

• Successful engagement event took place on

October 19 for the Diabetes Footcare

delivery group.

• Commenced developing baselines and

dashboards for effective measurement of

the AF/Hypertension programme.

• Launch of the Know Diabetes website.

• Hold digital interoperability workshop for call

centre launch in April 2018.

• Meet with British Heart Foundation Strategic

Engagement Lead to discuss partnership

working re: AF and Hypertension.

Supporting

people to take

control of their

own health

(DA2e)


(Jan 2019)

GREEN

(Running to

plan)

• PAM 17/18 activity for quarter two totals

5,502 across NW London bringing totals

assessments to over 12,000.

• PAM activity presented at Virtual Primary

Care meeting to promote best practice and

encourage CCGs with low activity (H&F,

Ealing, Central London and Hillingdon).

• Received approval to progress with

myCOPD digital project from DA2

Programme Board.

• Successful kick off workshop held with leads

from across NW London to establish

myCOPD workstream.

• Four CCGs developing business cases for

DoH fund on Social Prescribing supported

by HLP.

• Establish plan to determine trial for myCOPD.

• Identify and support CCG expressions of

interest in DoH Social Prescribing fund.

• Hold Carer PAM workshop to establish Harrow

project.

• Increased PAM activity following targeted

support.

15



hand



BETTER CARE FOR PEOPLE WITH LONG TERM

CONDITIONS


DA2c: How can we promote an integrated shared agenda of mental & physical health commissioners?

DA2d: How we can encourage and gain traction with CCGs to pursue Hypertension?



DA2ai

Primary Care

Hubs

Regional team have asked that CCGs use part of their

allocation to fund London-wide communications.

CCGs access fund has been fully committed & they

are unlikely to be able to meet this ask.

4 This has been escalated to the NHSE regional team for solution.

N.b. other STP areas have also raised a similar issue. 3

DA2aii

Provider

Development

Primary care providers across NW London have

different levels of readiness & capacity to work at

scale or deliver new models of care. The change

programme underway is resource & time intensive.

4

Substantial work underway on the development of at scale providers.

A number of CCGs have clear & well developed primary care strategies which

outline their journey to delivering primary care at scale.

Many CCGs have used some of their £3ph investment in 17/18 & 18/19

specifically to support at-scale provider development.

Specific Local Services resource is available to support CCGs directly.

3

DA2aiii

Workforce

CCGs do not have a consensus/agreement on what the

workforce priorities are for NW London. 3

Strategy in development and close to being finalised. Mapping activity to

showcase gaps in workforce activity is also underway and once completed will

inform some of the priorities. 2

DA2d Right

Care

AF - There is a lack of resource to ensure programme

rollout at pace and scale, and to take advantage of

potential opportunities.

Business case shows cost pressure due to

anticoagulation medicines cost, and savings will

mainly be made in social care therefore CCGs are

keen to identify opportunity for programme wide

resource.

3

Request made for extension of funding.

Learn lessons from diabetes programme and develop case for resource based

on potential savings across the whole health economy.

3

DA2d Right

Care

CCGs all engaged on AF activity but not yet pursuing

hypertension. 3

Use ‘Size of the Prize’ to reinforce need for addressing hypertension. Work with

Cardiac & Stroke Transformation Board on pan London Stroke Prevention plans

which align with AF/Hypertension/Cholesterol.

3



hand


delay – immediate action required BETTER CARE FOR PEOPLE WITH LONG

TERM CONDITIONS

17



DA2ai

Primary Care

hubs

There is a risk that Brent, Hillingdon and Harrow will not have

direct booking from 111 in place by 1-Nov as CareUK 111

are only agreeing to go live with Ealing hubs and 1 Hounslow

Hub by 1 Nov 2017.

16

This has been escalated to NHS England National as this is a

national issue and conversations with Care UK are on-going. 16

DA2b

Cancer

There is no administration or project management resource

for the programme from within NW London; without managed

timelines & plans, there will be slippage in delivery or the

desired outcomes may not be achieved.

15

Resource from NW London still to be secured; Vanguard are

providing project management for most of the primary care

programmes but requires support for NW London governance &

to support delivery within each CCG.

12

DA2b

Cancer

There is a risk that the increased national scrutiny on

delivery of 62-day target, by end Q1, in addition to delivery of

cancer transformation commitments may result in significant

system overload.

15

Revision of secondary care cancer board membership to ensure

executive engagement across NW London. Regular

communication underway between Vanguard, NW London & NHS

E regarding scope & deliverability of key programmes. Increased

input & oversight for any Trusts at high risk of non-delivery.

12

DA2c Long

Term

Conditions

and

Mental Health

The fragmented way of working between physical health and

mental health commissioning and delivery minimises

opportunities for better utilisation of resources and improved

outcomes for vulnerable people.

20

Creating opportunities for commissioners and clinicians to come

together to change practice and encourage joint working and co-

location.

Identifying referral points in pathways to develop joint practices.

16

DA2c Long

Term

Conditions

and

Mental Health

The cultural shift in physical health environment required is

significant and is being slowly addressed which may impact

on longer term benefit realisation.

12

Discussions between physical health and mental health

commissioners to encourage joint/integrated commissioning as

well as integrated delivery.

8

DA2d

Self Care

Lack of investment in social prescribing prevent sustained

roll out across NW London. 12

Scoping of social prescribing across NW London to identify gaps

has commenced and the Roll out of i5Health tool will support

economic case.

Also Identifying additional funding opportunities beyond CCG and

LA.

12

DA2d

Self Care

H&F, Hillingdon, Hounslow, Central London and Ealing PAM

activity within 2nd quarter highlights risk to CCG 17-18 PAM

targets.

12

CCGs engaged via NW London PAM Working Group to identify

support requirements. Monthly reporting provided. Number of

CCGs embedding PAM within local primary care contracts.

Engagement with community, acute and local authority to expand

use beyond primary care.

9



STAGE

DATE DUE TO

ENTER NEXT

STAGE


Commissioning

high quality and

effective care for

older people

Integrated

commissioning

(DA3ai)

Implementation

planning

Implementation

(April 2018)

GREEN (Due to

deliverables

running to time

and to scope)

• A project plan and implementation brief have been prepared.

• Senior stakeholder engagement has been completed.

• Senior responsible officers (SROs) need

to agree the project plan and

implementation brief.

• Local implementation project teams are

to meet on a regular basis.

• Local areas are to all agree on work

that can be delivered once across the

eight areas e.g. pricing.

Enhanced care

in care homes

(DA3aii)

Implementation

planning

Implementation

(Dec 2017)

AMBER (Due to delays in

agreeing CCG

specific

approach)

• There was positive feedback on the draft care home managers

leadership programme specification from care home managers,

NW London CCG/Local authority (LA) commissioners, Care

Quality Commission(CQC) and Health watch.

• A test comprehensive NW London care home dashboard has

gone live with CCG and LA commissioners.

• Local delivery groups were established to progress the red

bag scheme in Brent, Ealing and Hillingdon. Implementation

has commenced.

• Discussions were initiated with London North West Healthcare

NHS Trust (LNWHT) and Hillingdon Hospital Trust to develop

internal processes regarding the transfer pathway.

• Roll out of the joint intelligence working

guidance and a NW London care home

dashboard.

• Undertake procurement of the training

provider (Nov – Dec 2017).

• Engage stakeholders on the

development of the standardised

hospital transfer pathway.

• Audit compliance against joint

intelligence working guidance.

Getting the whole

health and care

system working

together for older

people

Improved

Intermediate

Care Services

(IC) and Rapid

Response (RR)

(DA3ci)

Solution Design/

Implementation

Planning (various

workstreams are

at various stages).

Implementation

Planning/

Implementation

(various

workstreams are

at various

stages).

AMBER (Due to review of

IC&RR working

group priorities

underway)

• An LAS training session on ACPs was delivered at the Brent

Ambulance Station, attended by 50+ paramedics on 04/10 to

increase referrals and reduce A&E conveyances.

• Urgent & emergency care (UEC) conditions data has been

refined to focus on rapid response (RR) top referral reasons.

• A decision was made by RR providers and commissioners to

focus on falls and urinary tract infections (UTIs) as an

opportunity identified to reduce <2days admissions (65yrs+).

• The intermediate care and rapid response (IC&RR) working

group decided to review medical accountability variation

across the eight NW London boroughs to mitigate risk.

• Providers and commissioners agreed to consider accepting RR

referrals directly from the LAS control centre.

• The LAS protocol communications strategy was developed to

ensure wider communication engagement by the LAS crew.

• Sign off the RR dashboard prototype

with the IC&RR working group.

• Agree triggers and mitigating actions for

rapid response services pan NW London

to continue to meet demand at times of

low capacity.

• Deliver the LAS protocol

communications strategy.

AMBER

HEADLINES

• The project team has focussed on providing clarity to local areas about which deliverables can occur across all local areas (DA3a).

• Consultation on the leadership care home manager programme has been completed, local delivery groups have been established for roll out of the red bag scheme in Brent, Ealing

and Hillingdon (DA3a).

• A London Ambulance Service (LAS) training session on accountable care partnerships (ACPs) was delivered at the Brent Ambulance Station and was attended by 50+ paramedics

on 04/10 to increase referrals and reduce A&E conveyances (DA3c).

• At Northwick Park Hospital a fully staffed and operating multi disciplinary team (MDT) model was agreed for w/c 30/10 (DA3c).

• 501 patients have been discharged on the Home first pathway across North West London (NW L) (as of 23/10) (DA3d).

• Three business cases were developed on time and localised to each individual CCG area (Brent, Harrow and Hillingdon). Within reporting period, 11/10 - 24/10, Brent CCGs business

case was approved (DA3e).

BETTER CARE FOR OLDER PEOPLE RAG key: On track Risk of delay – management in

hand





hand




STAGE

DATE DUE TO

ENTER NEXT

STAGE

RAG


Getting

the whole

health

and care

system

working

together

for older

people

(DA3c)

Response in

time of crisis

(DA3cii)

Implementation

Planning

Implementation

(March 2018)

AMBER

(Due to

variation in

uptake of

the model

across the

different

sites)

• There was a soft launch of the Northwick Park

hospital project with an extension of locum

geriatrician post whilst substantive recruitment

continues.

• An extension till the end of November was agreed

for occupational therapist input to the project at the

Ealing site.

• Agree metrics and evaluation

processes, staff resources and

governance structures at Northwick

Park hospital.

• Determine a plan of action and

implementation in the Hounslow frailty

conversation on the 25/10.

• Agree to increase hours of operation

for the Ealing pilot.

Home

from

Hospital

(DA3d)

Home first

(DA3di) Implementation

BAU

(March 2018)

AMBER

(Due to

variation in

uptake of

the model

across the

different

sites)

• 501 patients have been discharged on the Home

first pathway across NW London (as of 23/10).

• A Memorandum of Understanding (MoU) was

agreed in principle between health and social care

partners in Hillingdon to enable the full roll out of

Home first.

• Validation of financial model.

• A communication plan to include all

pathways out of hospital (including

front door discharges) aligned to

Home first’s ethos.

• Continued delivery and spread of

Home first pathways.

Last

phase of

life

(DA3e)

Telemedicine

(DA3ei)

Implementation

Planning

Implementation

(Dec 2017)

AMBER

(Due to

the

delays in

awarding

the

contract)

• Brent, Harrow and Hillingdon (BHH) chairs and

managing directors (MDs) have agreed in principle

to participate in the programme with Executive

Committees to review and approve the business

case in October.

• Three business cases were developed on time and

localised to each individual CCG area (Brent

Harrow and Hillingdon).

• The Brent business case was presented and

approved at executive committee.

• Sign funding agreement between

Central London, West London,

Hammersmith & Fulham, Hounslow

and Ealing (CWHHE) CCGs and

Social Finance.

• Pre-mobilisation to commence with

Provider Alliance and Social Finance.

• Harrow and Hillingdon CCGs business

cases will go to executive committee

for approval.

BETTER CARE FOR OLDER PEOPLE



hand


delay – immediate action required BETTER CARE FOR OLDER PEOPLE


None



DA3b

There is a risk that constraints from CCGs/LAs to prioritise

capacity and funding to support initiatives will restrict the Strategy

& Transformation’s team ability to transform care delivered in care

homes.

15 Work with local CCGs/LAs to influence prioritisation of efforts for 2017/18

and alignment with business planning for 2018/19. 12

DA3b

There is a risk that there will be resistance to implement

standardised approaches across a diverse spectrum of care home

providers (140 providers) across the sector.

15 Work with a spectrum of diverse care home representatives to agree

standardised approaches. 12

DA3b

There is a risk that the pace of implementation for the overall

project is compromised due to significant dependencies on other

sector and local projects e.g. setting up of ACP, transforming

primary care, market management and telemedicine.

15

Maintain close links with linked projects via regular meetings – DA3 team

level, DA3 board level, NW London S&T local services team, long term

needs clinical reference group (CRG), Older Peoples CRG, workforce

transformation group and any other key meetings.

6

DA3c There is a risk that the proposed model of care will be resourced

using existing staff groups with known supply shortages. 16

Seek support from providers and CCGs to identify resources which could

be reallocated and look at alternative staffing options . 9

DA3c

The counting, coding and financial impact that this change will

have on all organisations, will present a barrier to the model going

live or moving from pilot stage to business as usual.

12

Up front conversations to ensure that all providers are operating with the

same expectations and that there is a plan to address these issues prior to

moving to a sustainable model.

9

DA3c There is a risk that RR teams do not have sufficient capacity to

expand to the numbers of patients required. 20

Early evaluation to understand the baseline capacity within services. Early

sector wide modelling to understand requirements and investment

decisions. Sector-wide conversations throughout. 15

DA3d

There is a risk that the rapid assessment function required to

support the Home first model does not have sufficient capacity to

expand to the numbers of patients required.

16

Initial phase of pathway testing is designed specifically with

comprehensive evaluation to understand the baseline capacity within

services early. Sector wide modelling then allows scaled up values to be

understood and investment decisions to be made early. Local A&E Boards

and CCGs are involved throughout the process to increase likelihood of

investment.

12

DA3d

There is a risk that the required care provision to support

discharge to assess pathways can not be provided, particularly

due to reductions in social care funding, which will delay progress

and increase scale in implementation.

12

Evaluation process of the initial phase gives evidence for on-going care

needs and the new NW London Home. The first activity model will enable

translation of the evidence to "at scale" values. Work is also on-going with

LA colleagues to improve data quality in order to test.

9


AMBER

HEADLINES

• Investment in detailed flow modelling and implementation decision-making analysis has been agreed, which will take place across NW London (DA4a)

• Review of selected inpatients cohort has been completed to inform future model development (DA4b)

• Urgent care evaluation recommendations are being taken forward by Trusts (DA4c)

• Refresh of the NWL Children and Young People’s Transformation plan submitted to NHSE 31 October, will be used to agree work plan and priorities (DA4d)

IMPROVING MENTAL HEALTH SERVICES RAG key: On track Risk of delay – management in

hand




STAGE

DATE DUE

TO ENTER

NEXT

STAGE

RAG


Supporting

adults with

serious and

long term

mental health

needs

(DA4a)

New Model of

Care for

SLTMHN

(DA4ai )

Implementation

Planning

Implementation

Jan 2018

AMBER

(due to

slippage)

• Needs mapping at a local level has been

completed with information gleaned from

GP Clinical Leads, MH Commissioners,

Trust management and Trust clinical staff;

and presented to Programme Exec. An

investment plan was not endorsed as

funding specific services is not in the remit

of transformation.

• Agreed investment in detailed flow

modelling and implementation decision-

making analysis to take place across NW

London.

• Out of Hospital services on track to be

implemented across NWL in 18/19.

• Progressing with bed modelling; PCMHT

Evaluation and Out of Hospital across-NWL

roll-out.

• Commencing a review and optimisation of

Community Mental Health Teams, together

with HLP Embedded Resource.

Targeted

support for

specific

groups of

people

(DA4bi)

Supporting

people with

learning

disabilities

and/or autism

with

challenging

behaviour

(DA4bi)

Diagnostics

Mar 2018

AMBER

(delays in

receiving

funding

model and in

completion of

forensic

patient

reviews)

• NWL is on track to achieve its discharge

trajectory for CCG patients.

• Review of selected inpatients cohort has

been completed to inform future model

development.

• Development of options for community

forensic services has began.

• Meetings have taken place with specialist

assessment and treatment inpatient unit in

to discuss NWL bed usage and future

need.

• Meeting with NHSE, SRO, CFOs and TCP

took place on 20/11 to review and test the

assumptions made in finance submissions

including transition costs, future costs of

care packages and assumptions

surrounding block contracts.

• Development of the future operating model to

inform commissioning intentions.

• Recommendations for future Community

Forensic Service for NWL to be discussed.

• Local engagement and possible workshop to be

set up to discuss Autism Spectrum Disorder

pathways and services for diagnostic and

diagnostic support.

• Further roll out of behaviour support to begin in

December. Additional training sessions to be

confirmed.

• Social Supervision Training to begin in Jan, Feb

2018.


STAGE

DATE

DUE TO

ENTER

NEXT

STAGE

RAG


Targeted

support

for

specific

groups of

people

(DA4bi)

Mental health

support for

new mothers

during and

after

pregnancy

(perinatal)

(DA4bii)

Now closed -

reported within

Trusts and in

BAU

N/A

GREEN

(on track)

(BAU)

• BAU • BAU

Crisis

Care

(DA4c)

Section 136

Pathway

(DA4ci)

Planning December

2017

GREEN

(on track)

• Availability of capital funding for S136 related

initiatives/ innovations has been launched.

Conversations underway to determine local interest for

developing a bid.

• In order to continue local discussions and develop a

business case for reconfiguration of health based

places of safety, further data and analysis of demand

and patient flows are required. Healthy London

Partnership to progress with the data analysis.

• Develop costed capital bid application.

Liaison

Psychiatry

Service

(DA4cii )

Now closed -

reported within

Trusts and in

BAU

N/A

GREEN

(on track)

(BAU)

• LPS is now managed by the Trusts and the S&T team

no longer manages this workstream.

• BAU

Urgent Care

Pathway

(DA4ciii)

Phase1-

Evaluation

Phase 2-

Feasibility

November

2017

GREEN

(on track)

Phase 1

• Trusts and CCGs have developed plans to address

areas of concern as part of the crisis care concordat

• Evaluation recommendations are being taken forward

by Trusts.

Phase 2

• Scoping work started to define an integrated approach

to urgent and crisis care across NWL. This will feed

into the development of the new programme of work

that manage demand in ED.

• Meeting is taking place in early December to agree

and implement Crisis Care Concordat plan.

• An approach to redesign of the urgent and crisis

care to be developed and discussed with MH and

Acute stakeholders.

• Governance to be established to oversee this new

work programme.

Delivery Area 4 report continued


hand


delay – immediate action required IMPROVING MENTAL HEALTH SERVICES

22



hand



23

IMPROVING MENTAL HEALTH SERVICES


STAGE

DATE DUE TO

ENTER NEXT

STAGE

RAG


Children

and

young

people

(DA4d)

Vulnerable

groups

(DA4di)

Project

identification March 2018

AMBER

(Due to

slippage)

• Mapping of Autism and LD completed across NW

London. The recommendations have been

discussed between commissioners and clinicians,

both mental health and paediatrician.

• Further discussions to determine local

level work vs the work that can be

completed across NWL as Autism and LD

landscape is complicated due to different

social care and education infrastructure.

• Short listed ideas to be discussed and

prioritised for delivery in 2018/19.

Specialist

community

eating

disorder

(DA4dii)

Evaluation/ BAU BAU

Jan 2018

AMBER

(Due to

slippage)

• Service evaluation is underway. Collation of data

has been problematic due to Trusts’ reporting

systems and resulting in the delay of completion of

the evaluation.

• Provider/commissioning event planned

for Dec to identify quality of service, action

plan to address issues and adapt to

ensure service meets local needs.

Crisis and

urgent care

(DA4diii)

Phase 1-

Implementation

Planning

Phase 2-

Scoping

Dec 2017 GREEN

(on-track)

Phase 1

• New NWL CAMHS Crisis and Liaison Team

across both MH Trusts have now been launched

to provide intensive support for young people in

mental health crisis.

Phase 2

• Work began to develop and agree a long term

crisis pathway with representatives from young

champions, the Metropolitan police, clinicians and

commissioners.

Phase 1

• Governance for service monitoring and

evaluation framework to be developed.

Phase 2

• Following the workshop work to begin to

define the new pathway.

Redesigning

the system

(DA4div)

Diagnostics March 2018 GREEN

(on-track)

• The refresh of the Local Transformation Plan

gave an opportunity to review local and NWL

priorities to develop a new work programme.

• Priorities and work plan to be agreed

specifying which elements will be carried

out at local level and which will be carried

out at system level.



hand


delay – immediate action required IMPROVING MENTAL HEALTH SERVICES


None



DA4a Fidelity to the ambition of the model is compromised given the

non-availability of the significant funding required. 20

Ongoing commitment to optimising existing elements of the model;

and in addition focussing our limited resource on the most

significant blockage, CMHT, should enable flow and better delivery

of the model’s aims.

15

DA4b Specialised commissioning funding following the patient upon

discharges will be subject to bed de-commissioning. NHSE has not

yet confirmed how this is to be achieved.

IMPACT; CCGs not receiving the funding required for community

packages therefore LAs and CCGs having increase in their

operating costs.

25

Conversations have been held with NHSE regarding funding,

following the de-commissioning of beds in London. NHSE to provide

clarification on funding specific to London. This will help determine

impact on cost of services and investment requirements to manage

demand for inpatient beds.

20

DA4b Lack of housing availability for the TCP cohort may result in our

inability to reduce overall need for inpatient beds.

25

Review the needs of this cohort and the range and scope of existing

services, specifically for people with complex and challenging

behaviour across residential care. Engage with social care and

housing departments of LAs and provider sector to identify

opportunities.

20

DA4c Fragmented approach to pathway redesign will result in missed

opportunities to better utilise resources to reduce demand in ED

and specialist services. 20

An integrated urgent and crisis pathway has been proposed to key

stakeholder group.

A proposal is being developed to be shared with Acute

stakeholders.

Joint governance will be in place to minimise fragmentation and

promote integration.

8

DA4d Insufficient workforce to meet the new service delivery CYP roles

(volume and skills/ capability) within the new service delivery

framework may result in delays in implementing new services 16

A workforce strategy is in development which sets out the plans to

ensure the wider CYP workforce have the right skills to deliver the

right intervention at the right time. We are aligning to National HEE

education and training directives and implementing designated

initiatives across NW London.

9

DA4d Fragmented crisis service commissioning with numerous

interdependent services being developed by different agencies

(Crisis pathway, Forensic London CAMHS Service, New Models of

Care).

12

Linking up the various system components and agencies will ensure

there is seamless pathway in place enabling children to access the

right help at the right time. 9


PROJECT AREA LIFE CYCLE

STAGE

DATE DUE TO

ENTER NEXT

STAGE


Improving

commissioning

of specialist

services

(DA5a)

Improving

commissioning

of specialist

services

(DA5a)

Solution

design TBC

RED

( no strategic

mitigating plans

for £188m gap)

• Renal: successful proof of concept of added

value of new renal pathway supported by STP

Clinical Board.

• HIV: ICHP supporting multi-trust discussions

around consolidation opportunities.

• Cardiac: Good progress bringing together

CCGs and NHSE and providers to develop a

cardiology transformation programme.

Successful launch workshop on 2nd

November. Clinical leads identified and

priorities identified. Dates set for redesign

workshops January-March.

• Renal: model and agree new funding flows to

accelerate adoption for all renal patients.

• HIV: Multi-stakeholder event to be held and

proposal developed.

• Cardiac: agree tertiary redesign priorities with

NHSE mid November.

• Overall:. Only 0.5 post dedicated to support

specialised commissioning despite £188m

forecast gap.

Getting hospital

patients better,

quicker

(DA5b)

Radiology and

Diagnostics

(DA5bi)

Report via

NWL

workbook –

see section

below

Inpatient model

of care

(DA5bii)

AMBER

HEADLINES

• Ongoing work around Renal, HIV and early exploratory work around Cardiac (resource constrained) No strategic plan to close forecast £188m gap (DA5a)

• Outpatients – secured mandate in STP Clinical Board for the work, with a view of starting clinical working groups in November (subject to funding/resourcing agreements and

mandate at Collaboration Board) (DA5d)

SAFE, HIGH QUALITY SUSTAINABLE

HOSPITAL SERVICES RAG key: On track Risk of delay – management in

hand





hand




STAGE

DATE DUE TO

ENTER NEXT

STAGE


Organising

Hospital

services

(DA5c)

Capital

business cases

to support

clinical

improvements

(DA5ci)

Planning

Report via NWL

workbook – see

section below

Organising

Hospital

services

(DA5c)

Improvements

to children

services

(DA5cii)

Transition to

BAU N/A CLOSED

• Paediatric review was taken to Ealing Health and

Adult Social Services Scrutiny Panel (HASC)

meeting on 24/10

• Project is now officially closed.

• N/A

Improvements

to women’s

services

(DA5ciii )

Planning

Report via NWL

workbook – see

section below

Development

of local hospital

models of care

(DA5civ)

Planning

TBC – depends

on ImBC

approval

?Q1 2018/19

AMBER

(due to

dependency with

SOC approval)

• Engagement around developing older people’s care

services in Ealing started on 1 August 2017 and is

expected to run until November 2017.

• Ealing Transformation Steering Group on 10/11/17

• On-going work to develop frail elderly model

of care.

• The following areas have been agreed as

priority work packages :

1. ambulatory care sensitivity map for

LNWHT;

2. outpatient activity analysis by age group;

3.diabetes as well as respiratory activity

analysis by age group.

• The next step with the estate feasibility study

is to consider whether this is a viable option

worthy of further investigation to OBC level.


HOSPITAL SERVICES


27


STAGE

DATE DUE

TO ENTER

NEXT

STAGE


Hospital

productivity

programme

(DA5d)

Muscular

Skeletal

(MSK)

(DA5di)

Rolling

programme

N/A

because of

rolling programme

AMBER

(due to funding

flows causing

blocks to

progress)

• Programme has been reprioritised to deliver most

savings in 18/19 and to fit within 0.5 support post.

• MSK is a priority for the outpatient programme,

clinical leads have been identified.

• Identified that model of care for fracture clinics

needs to offer higher value.

• Agree new model for fracture clinic .

• Set up redesign groups for outpatients.

• Identify overlap between Harrow CCG MSK work and

sector work .

• Identify facilitator for community MSK pathway.

Procurement

(DA5dii ) N/A N/A

AMBER

(due to

Resource

demands)

• NWL Procurement Director started this month:

market activity around Continence and Advanced

Woundcare, evaluating the opportunities to

aggregate demand, standardise products and swap

to clinically equivalent products.

• Invitation to tender (ITT) to be finalised to identify

expertise to support procurement opportunities in

specialist technical areas.

Staffing

(DA5diii) N/A N/A

AMBER

(Based on the

fact that the

agreed £3.1m

benefits will

not be realised

in 17/18 and

we do not yet

know how

much will be

saved in 17/18)

Pan London Medical Locums:

• Break glass ceiling rates for medical locums have

gone live and monitoring process put in place.

Occupational Health

• Baseline of current OH services at each of the

trusts carried out to identify opportunities.

• Deep dive into Imperial OH service with action plan

to address £390k 2016/17 overspend.

• A lead HR director is to lead the Shared Bank -

Options Appraisal/ Business Case on behalf of the

sector

Medical Locums:

Plan to extend break-glass ceiling rates to medical bank 1st

April 2018 . Team working with NWL Trusts to calculate

savings for each Trust.

Occupational Health:

Cost savings for Imperial in 2017/18 and for all Trusts in

18/19 (savings targets are being calculated). Plan process

mapping workshops to develop standardised processes for

sickness absence an pre-employment checks.

Shared bank:

• Develop Business Case to evaluate options for

temporary staffing – in-house vs. outsourcing vs. shared

service vs. virtual bank – and identify financial savings.

• Develop break-glass ceiling rates for nursing bank staff

in NW London (building on pan-London medical locum

methodology).

• Develop work to consider priorities for 18/19.

DA5div

Outpatients

(DA5div)

Project

Identification

N/A

AMBER

(due to start

delay in

securing

Resource)

• Developed business case with specific work plan.

• Programme mandate from Outpatient Board, STP

Clinical Board.

• Agreed five priority specialties.

• Identified clinical lead s on all five specialties .

• Should have permanent band 5 administrator in

post March 2018.

• Chief Transformation Officer (CTO) drafted

business rules for discussion with CFOs on

financial models which incentivise providers and

deal with stranded costs.

• Identification of resources and funding to carry out the

work from November.

• Brief clinical leads on their role.

• Set up all clinically led meetings.

• Agree change process to facilitate radical solutions.

• Work with FRG to explore how this transformation

programme fits with CCG CIPs for 18/19.

• Identify two further facilitators.

• Take business rules to Nov/Dec Provider Board for

discussion and agreement.



hand



SAFE, HIGH QUALITY SUSTAINABLE HOSPITAL

SERVICES

27



hand




HOSPITAL SERVICES



DA5d

Financial systems to support system transformation, to incentivise

providers during transition of interim stranded costs and to identify

investment where there is a strong ROI. 4

Chief Transformation Officer (CTO) drafted business rules for

discussion and agreement with Provider Board and with CCG

Collaboration Board. 3



DA5a

This programme has limited NWL and NHSE resources, over and above

BAU within providers. Successful delivery requires engagement and

prioritisation across a range of stakeholders. 20

The risk of the forecast £188m gap has been accepted for now.

CTO working with CFOs to develop options for November provider

Board to agree. 20

DA5d Outpatients: 2/5 pathways delayed as we have not yet identified

facilitator of clinical redesign groups. 8

Outpatient: Discussions with CLARC and other stakeholders 6

DA5d

Procurement: Resources within procurement departments are limited,

driven by the demands of BAU, local CIP and Collaboration. There is

limited capacity to undertake work in non-traditional opportunity areas. 8

Procurement: ITT being developed for approval by CFOs which

would support additional specialist resource to focus on non-

traditional opportunity areas.

Appointment of NWL Procurement Director will also support this

activity.

6

Enabler workstream

29

29

AMBER

HEADLINES

• As of October the new HEE Workforce Observatory is in operation and is starting to organise its operating model with the aim of providing workforce intelligence

and planning support for the 5 London STP's. This team will work closely with the HEE central team and Information Development to make more effective and

efficient use of existing data sets, participate in new collections and will have the capacity to assist in appropriate workforce modelling approaches.

• Mental Health: Initial meeting held to agree approach to agreeing the NW London response to the national Mental Health Workforce Plan. First draft report of

analysis of pay rates for substantive and bank clinical staff at WLMHT and CNWL produced, to enable greater transparency and understand where there could be

opportunities to create a coherent pay strategy. There can be seen significant differences in the overall approaches to both the way that staff banks operate and

approaches to bonus schemes and other initiatives across both trusts.

• Change Academy: Provider has been appointed for the Change Coach Development programme, 36 strong applications were received, the programme is due to

launch in December.

• Organisational Development: Scoping meeting held on 7/11 to agree approach to develop a NW London-wide Organisational Development Strategy across

health, social care and voluntary sector to support delivery of the STP.

• Staffing project: Revised savings target for NW London staffing project has been agreed: £1.9m for 17/18 and £6.7m for 18/19.


hand



Enabler workstream report: Workforce 30

PROJECT AREA/

WORKSTREAM

LIFECYCLE

STAGE

DATE DUE

TO ENTER

NEXT

STAGE

RAG


1

STP Delivery

Area 1: Health

coaching – Self

care


Q3

GREEN

(on track)

• Evaluation report for the carers

programme in development.

• Held first leaders and champions event

in October inviting past participants of

our training who are currently integrating Coaching for Health into systems.

• Completion and review of evaluation report of Health Coaching for

Carers

• Agree the on-going provision of embedding activities for around 300

people already trained as well as other approaches for shared

learning.

2

STP Delivery

Area 2: Primary

Care

Transformation

projects

Project initiation

& start-up

Diagnostics

Q3

GREEN

(on track)

• Medical Assistant training

(Correspondence Management and

Signposting) delivered via 8 local pilots

to over 600 existing members of practice

staff. 70 GP Practices are participating in

the pilot across NW London.

• NWL currently has 13 Partnership

Innovative Education (PIES) projects, to

increase sustainability and address

current issues in the workforce. PIEs

bring together health & social care

service providers, community groups and

education providers to create innovative

educational models to support local

workforce transformation. The funding

for 7 of these has just been awarded.

• Joint workshop with CLAHRC planned

for early November to discuss

challenges of PAs in primary care.

• Activity and capacity benchmarking – launch of initiative to provide

support to practices to understand their future capacity issues and

subsequent workforce requirements.

• Locum booking platforms – exploring potential NW London roll-out of

locum booking platforms, this is designed to release similar benefits to

staffing banks with considerably reduced costs.

• Action on indemnity – dependent on progression of national work, this

aims to reduce the financial burden of indemnity on GPs through e.g.

helping GPs to “shop around” and target training to address specific

factors driving up indemnity costs.

• Sharing best practice - We are identifying areas of best practice locally

that will benefit from dissemination across North West London and

action scaling of these interventions. These will potentially include such

examples as e.g. the Brent and Ealing digital training platforms, and

the H&F practice support teams.


hand



Enabler workstream report: Workforce 31

PROJECT AREA/

WORKSTREAM

LIFECYCLE

STAGE

DATE DUE

TO ENTER

NEXT

STAGE

RAG


3

STP

Delivery

Area 3:

Achieving

better

outcomes

and

experiences

for older

people

Initiation Diagnostics

Q3

AMBER

(funding

secured,

identifying

sites)

• Agreed the workforce support for Acute Frailty teams. • Analysis of consultant geriatrician workforce across

NW London and identify opportunities to use the

workforce more effectively to support strategic

priorities.

4

STP

Delivery

Area 4:

Improving

outcomes

for children

& adults with

mental

health needs

Diagnostics

for SLTMHN

Identification

for

collaborative

programmes

Initiation Q3

AMBER

(Due to

being in

scoping

phase)

• Held initial meeting 6/11 to discuss and agree the NW London

approach and response to the HEE the Mental Health Workforce

Plan, and alignment with Workforce delivery plans to support

DA4.

• First draft report of analysis of pay rates for substantive and bank

clinical staff produced. This will help WLMHT and CNWL to have

greater transparency and understand where there could be

opportunities to create a coherent pay strategy.

• Findings and recommendations report from pay

rate review to be presented at CNWL and WLMHT

board meetings in November.

• Begin developing STP level response to inform

regional plan and approach. This will be presented

at the Mental Health Transformation Board meeting

on 24/11.

• Continue development of workforce delivery plans.

5

STP

Delivery

Area 5: NW

London

Staffing

Project

Project

initiation &

start-up

Diagnostics

Q3

AMBER

(not all 8

priorities

have

traction)

• The project board have agreed the savings targets for agreed

areas of focus and identified additional opportunities for further

savings to be quantified.

• Local London rates have been live since 2 October, intelligence

to date across London suggests these rates are reducing very

high cost medical locum shifts.

• Provider appointed to support collaborative process improvement

for occupational health services.

• Develop work plan and resource requirements for

18/19 to deliver programme

• Commence planning to introduce local London

rates for medical bank staff from 1 April 2018

• Set up process improvement workshop to be ready

to implement new processes by 1 April 2018

• Agreement from trust on collaborative bank

working scope for agreement at next project board,

4 December.

6

Recruitment

and

Retention

Project

initiation &

start-up

Diagnostics

Q3

AMBER

(strategy

to meet

GPFV

targets required)

• GPFV targets to increase GP numbers for NW London by 218

currently confirmed (targets are not yet fully fixed and could

potentially be modified).

• GP international recruitment programme established –

participation is mandatory, a single London-wide application is

due for 30th November, it will include a NW London

chapter. Formal guidance has still not been released.

• PC retention workshops/focus groups completed alongside draft

retention strategy – initial meeting of retention T&F group met to

set the agenda and prioritisation for delivery moving forwards.

• PC workforce strategy initiatives including activity

and capacity benchmarking & locum booking

platforms scoping is underway.

• S&T coordinating NW London approach to GP

International Recruitment – CCGs have sent EOI

forms and outline communications to practices,

follow-up engagement planned.

• Retention T&F group currently being formed, with

ToR, membership and key work streams currently

under review.

32 32 Enabler workstream report: Workforce (continued) 32


hand




None

PROJECT AREA/

WORKSTREAM

LIFECYCLE

STAGE

DATE DUE

TO ENTER

NEXT

STAGE

RAG


7

HEE NW London -

supporting future

workforce growth


(various)

GREEN

(on track)

• Capital Nurse Programme - recruitment to rotation

programmes for September has been concluded with a lower

uptake than anticipated.

• CEPNs have taken up an extended role to develop

relationships with education providers and work

collaboratively to increase placement capacity in primary

care.

• Discussion needs to happen around the

impacts of lower numbers recruited to the

Capital Nurse Programme in NW London.

• Participation in London-wide bid for

international GP recruitment. Currently

engaging with practices to obtain

expressions of interest.

8

Change Academy

High Performing

Care (HPC) &

Leading

Transformation

programmes (LTP)

Commissioning for

Outcomes

programme (C4O)


Q4

AMBER

(tailoring

coproduction

to

readiness)

• Cohort 2 (6 teams) of Commissioning for Outcomes and

Integration programme completed their third workshop on

31/10. HPC Change Coaches are being flexible in their

approach and support offers to meet needs of the 9 project

teams.

• Final preparation for the Change Coach Development

programme to launch in December with a cohort of

approximately 40 Change Coaches, who will use their

training to support local transformation projects.

• Change Coach programme launch in

December.

• C4O programme; final workshops to be

held and follow on support to be agreed.

• HPC nd LTP programmes to continue.

• evaluation report will be completed this

month to show progress.



All Relationships with local government colleagues needs be maintained and strengthened

to address social care workforce challenges and improve integration. 3

Workforce strategy encompasses workforce challenges and implications. Health

and Social Care Workforce Lead role to be re-advertised for permanent

recruitment. 2



2

There is a risk that the GP targets (set out in the GPFV) may hamper innovative

workforce planning for new models of care. Primary care transformation initiatives and

programmes are more focused on retaining and developing existing staff and ways of

working to build resilience in the primary care workforce, than recruitment alone.

9

Work with Local Services Team and forums including the Workforce & Provider

Development Delivery Group, Workforce Transformation Delivery Board and

Advisory Council to develop a Primary Care Workforce Strategy and Delivery Plan

to address the challenges. Dedicated resource in place to lead on the strategy.

6

AMBER

HEADLINES

• STP/ Local Digital Roadmap – no funding will be received during 2017/18; funding 2018/19 to 2020/21 likely to be announced after the Budget in

November; NHSE guidance will follow. This will delay paperless records in providers, and shared digital records to support better integrated

care. NHSE has accepted that the FYFV target of “Paperless by 2020” will not now be achieved.

• Digital Portfolio/ Primary Care/BI – good progress against agreed plan

• Provider Digital Projects – continued progress with Care Information Exchange, but slow

• Digital CQUINs – work on e-Referrals and Advice & Guidance CQUINs under way in all Trusts

Enabler workstream report: Digital 33


hand



PROJECT AREA/

WORKSTREAM

RAG


1

STP/ Local

Digital

Roadmap

RED

(due to delay

and

reduction in

STP/LDR

funding)

• NHSE have confirmed that no STP/LDR digital funding will be received during the current FY. NHSE will ask the Treasury in

November 2017 for £800m of funding over 2018/19 to 2020/21. This is expected to be distributed to STP footprints on a capitation

basis, suggesting an allocation to NWL of £32m (4% of £800m) over three years, which compares with the original LDR request for

£146m over five years (based on the Secretary of State’s announcement in February 2016 of a £4.2bn technology fund) and the

previous planning assumption of £32m in the first two years, with more in the subsequent two years. However, NHSE have stated

that the allocation will be reduced to reflect the Global Digital Exemplar funding already awarded to Imperial (£10m) and Chelwest

(£5m) – so the final number will be less than £32m.

• Existing projects are proceeding, but the step change required to fully automate clinical operations and build shared care

records, as set out in the STP and LDR vision, will not occur without the required capital funding. This will impact LNWHT

and THH especially, since their clinical processes remain paper-based and the funding will be insufficient to implement systems

such as Electronic Prescribing and Electronic Document Management. The Five Year Forward View target of “Paperless by 2020”

is no longer achievable and this has now been explicitly recognised by NHSE (Will Smart, CIO, speech at EHI, 31 Oct).

• Projects will need to be re-prioritised once final guidance has been received from NHSE.

• Final funding

guidance to be

received from

NHSE

• LDR Digital

Programme

Plan to be

developed for

high priority

projects – likely

deadline is Feb

2018.

2

Digital

Portfolio/

Primary

Care/BI

GREEN

(proceeding

as planned)

• Planning for 17/18 GP Practice Hardware Refresh is under way, with the bids submitted to NHS England. Approval from the

London Capital Committee is expected early November. Video Conferencing project is under way, reviewing As-Is and To-Be.

• Health Help Now patient application has been assured as being SCCI0129 compliant and is now included in the NHS app library.

Working with the Cabinet Office, NHSD, LCIE on patient verification authentication by Feb 2018.

• Patient Online making good process with the patient facing campaign. Target is 85% of practices to have 20% of patients with an

on-line account by end October.

• GP practice Wi-Fi: pilot practices have been established, testing the capacity to manage network traffic and additional

infrastructure resilience. Phase 1 of the deployment is now under way.

• Whole Systems Integrated Care continues to make good progress with GP sign up, deployment, training and establishing GP data

flows and release 11. Diabetes population health RADAR pilot completed. Population health views development work started.

• Personalised Integrated Care Planning Standards carried out its expert group review, draft 3 of the design standards is now the

focus.

• Data Quality Framework is progressing defining local standards and local tools. SNOMED planning work continues on governance,

stakeholder engagement and resource review.

• The E-Learning Hub - the system is on track to be procured in October, with deployment plans now being developed.

• BI Re-procurement – NWL CCGs working with London LPF team to procure a BI system for 32 CCGs to include population health

functionality. Sep 17 ITT date has been delayed, but the London programme reports that mobilisation for Sep 18 is still on target

• NHSMail2 work is well underway with communications being released, deployment and support being made available for the

migration.

• Work is progressing well for Infrastructure & IT Operations, disaster recovery testing, moving databases to the NWL environment,

developing the business case for the Data Centre.

• Continue with

planning and

deployment

phases

• Development

of the

Corporate

Infrastructure

Strategy

Enabler workstream report: Digital continued 34


hand



PROJECT AREA/

WORKSTREAM

RAG


3

Provider

Digital

Projects

and

Digital

CQUINs:

GREEN

(proceeding

as planned)

• Continued progress with NW London Care Information Exchange – development of further interfaces (see above), but

deployment to clinicians has been slow (e.g. care planning pilot in Hillingdon – delayed again pending EMIS interface) and

there is no agreement on funding for the CIE beyond March 2018 – though Imperial’s Charity, which has funded the CIE to

date, may be prepared to fund it for a further year if the care community as a whole is supportive.

• NWL Digital Programme is providing support for the digital elements of national clinical CQUINs for 2017/18 (e-Referrals,

Advice & Guidance): planning is under way in all acute Trusts, being managed by lead CCGs as a commissioning and

contracts issue since digital enablement via e-RS is in place.

• Providers are participating strongly in Digital governance, with partners working together on core system-wide plans and

capabilities, though delivery is dependent on STP/LDR funding (see above)

• Current resourcing for PMO is not sufficient to collate Provider project progress for STP reporting purposes.

• Care Information

exchange (CIE)

options analysis

• Ongoing support of

e-RS and Advice &

Guidance CQUINs

• Continued work

between CCGs and

providers through

joint governance


No Issue

Score Mitigation (latest progress) Score

1 STP/LDR funding has been delayed and will be insufficient to fully automate clinical

operations and build shared care records, as set out in the STP and LDR vision. It is

unlikely that there will be funding for an overall Digital PMO for NWL – so it will be

difficult to report consolidated progress.

5

• JHCTG to consider alternative sources of funding for STP enablers

• Prioritisation of investment at Technical Design Authority and Digital

Portfolio Board re priorities, once funding amount and guidance are

confirmed.

4

2

Integrated care requires shared patient records – but currently our GP and community

systems (SystmOne and EMIS) do not have open interfaces and progress towards

interoperability is slow. NHS Digital’s GP Connect interfaces will fill this gap, but are still

in pilot stage. 3

• Extracts from EMIS and SystmOne to WSIC implemented using third party

product (Apollo).

• EMIS interfaces are improving (primary/community sharing pilot in

Hillingdon, links to Care Information Exchange being tested, CMC interface

now in place).

• Positive news – Technology partnerships TPP has announced it plans open

interfaces for SystmOne (details of scope and timescales are awaited).

3


No Risk Score Mitigation (latest progress) Score

1

The further delay in NHSE STP/LDR funding will impact many of the digital enabling

projects for the STP. Funding will be at a much lower level than required to enable the

STP and national clinical objectives.

20

• JHCTG to consider alternative sources of funding for STP digital enablers

• Prioritisation of investment at Technical Design Authority and Digital

Portfolio Board, once funding amount and guidance are confirmed.

16


JHCTG to consider alternative sources of funding for STP digital enablers

In meantime, be aware that existing projects will continue, accepting that there will be delays in digital enablement of STP Delivery Areas, especially automation of clinical operations and shared

care records

PROJECT AREA/ WORKSTREAM RAG RATING PROGRESS NEXT STEPS

DA2

DA2e - Supporting people

to take control of their own

health

GREEN

On track • Handover of BAU reporting on PAM measures routine report

now complete.

• Automate labour intensive process and provide second line

cover to produce each month.

• Request for new Atrial Fibrillation and Hypertension

dashboard. Work in progress to understand requirements.

DA3

DA3 – Better care for older

people

GREEN

On track

• Further developed opportunity analysis for Rapid Response

services using Ambulatory Care Directory and activity in low

acuity ED attendances

• Work up routine Low Acuity ED analysis and Ambulatory

analysis for Falls and UTI pathways to help group better

understand cohort.

• Taken a version of the programme dashboard to the DA3

programme board. Featured context data for older peoples

urgent care usage in NWL, and SPC charts to show

progress against outcome metrics.

• A live data feed has been requested for Care Home activity

and is currently being developed by Kavitha S in BIU.

• Combine ASCOF data and data available from WSIC to

include in programme dashboard.

• New request for a frailty dashboard to cover Northwick Park

and Ealing Hospitals

DA4

DA4a - Supporting adults

with serious and long

term mental health needs

AMBER

(Previous

identification

of BI resource

has delayed

development)

• Resource now in place to develop dashboard. Some

revision to original data requirements but good engagement

with WLMHT

• Review options for additional datafeeds for workforce and

quality data. Will need similar conversations with CNWL.

DA4 – Improving mental

health services • Routinely producing Grenfell attempted suicide and self-

harm reporting. • Looking into how we could identify where patients may

now be in other localities.

DA5 DA5 - Acute

Transformation

GREEN

On track

• GP Hubs and 111 dashboard development continues with

some additional requirements identified • Incorporate UCC capacity and staffing grades into current

report.

• Developed further areas of potential QIPP and produced

materials to facilitate and engage providers. Working closely

with WLCCG colleagues and provider transformation team.

• On-going work with stakeholders to determine true QIPP

potential

QIPP Opportunity assessment

templates GREEN

• Some initial work on MSK, admissions from care homes /

end of life, emergency ED attendances,

• BI support as necessary to support production of OATs for

dermatology, ENT/audiology, gastroenterology,

ophthalmology, cardiology, mental health prescribing and

diabetes.

GREEN

HEADLINES

• S&T team now taken on reporting from previous interim staff (DA2)

• Development of prototype programme, rapid response and frailty dashboards (DA3)

• Continued working on MH dashboard previously identified as risk by DA4 programme (DA4)

• Produced datasets and doing continued work to support GE Healthcare in their assurance of SOC1/SaHF (DA5)

• Supporting Delivery Areas to produce OATs for QIPP schemes across NWL (QIPP)


hand



Enabler workstream report: Business Intelligence 35

36 36 Enabler workstream report: Business Intelligence (continued) 36


hand




None



Unexpected complexity in backend SQL server tables causing

delay in being able to use WSIC data to support S&T 6

Discussions with WSIC team about data structures and run through of tables 6



Delay to development of MH dashboard 6

Dedicated analyst capacity identified, risk with providers ability to provide

necessary data fields. Meeting arranged with WLMHT. 3

Enabler report: Estates 37

CCG PROJECT PROJECT

TYPE

FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAME

FOR

DELIVERY

PROGRESS

Brent

Wembley

Centre for

Health and

Care

Hub increase

utilisation and

reduce voids

NHS Capital 2.45

Year 1 – 7

(Aligned to

CMH)

Work continues to commission out of hospital services from the site and work is starting

on looking at the possibility of reducing HQ costs at Wembley by consolidating the CCG

space to reduce the cost of the accommodation. The opportunity to co-locate the CCG

HQ with Brent Council is also being explored. NHS Property Services (PS) is leading

a review of the current occupation of the site to establish the future clinical space

required to support Hub delivery. This information will feed into a proposed OPE

project to establish the potential mixed use development opportunity of the site with

Brent Council and other adjacent land owners. This will also identify potential capital to

be generated from land release.

Willesden

Centre for

Health and

Care

Hub increase

utilisation and

reduce voids

NHS Capital 4.46

Year 1 – 7

(Aligned to

CMH)

Work continues to introduce new providers to deliver out of hospital services from the

site. An improvement grant bid to relocate Burnley Practice to larger vacant

accommodation was successful and the project has been initiated and work is

underway to complete NHSE due diligence. The CCG is working with providers and

the Council to develop a long term strategy for the use of the site linked to the

emerging plans for Central Middlesex Hospital.

Central

Middlesex

Hospital PC

Hub increase

utilisation and

reduce voids

ETTF 1.90 Year 1

The ETTF bid to create a primary care facility at Central Middlesex Hospital was

successfully funded and due diligence has been completed. The London Capital

Committee approved the enhanced PID in July and the CCG received national sign off

in August and work has commenced on site. NHSE has completed the procurement of

a new APMS practice with a new contract awarded. Some internal LNWHT delays has

pushed back completion of the works to 1 Feb 2018.

Central

Central

Westminster

Hub

New build NHS Capital 4.92 Year 3-4

Hubs and Spoke Workshops have been undertaken to test the original assumptions

and re-focus models of care that are deliverable. The CCG is now exploring alternative

options for a Central Hub .

Church

Street

Hub

New build

NHS

Capital/

Westminster

City Council

14.73 Year 5+

Dialogue continues with Westminster City Council to develop a community hub on a

site at Lilestone Street as part of the Church Street regeneration. Phase 1 works to

create new housing units at Lisson Arches has been delayed and this is having a knock

on effect to vacating the Lilestone Street site. Alternative options are being considered

AMBER

HEADLINES

• BRENT – NHS Property Services review of occupation being undertaken to feed in to proposed One Public Estates project.

• CENTRAL LONDON – Refresh of current space /demand is being undertaken

• EALING – Mattock Lane PID drafted for submission to F&P in November

• HAMMERSMITH & FULHAM – PID for Phase 1 redevelopment at Parsons Green was approved by NHSE London Capital Committee in October

• HARROW – NHSE London Capital Committee has approved funding for improvement works to first floor of Belmont Health Centre

• HILLINGDON – PIDs for both the North Hillingdon Hub and Uxbridge and West Drayton Hub approved by F&P and GB

• HOUNSLOW – Community Health Partnerships (CHP) approved capital funding PID for £400k for improvements/reconfiguration at Heart of Hounslow. Heston OBC approved by

F&P and GB in September

• WEST LONDON – ETTF funding secured to the value of £4.4m relating to the South Hub


hand



Enabler report: Estates (continued) 38

CCG PROJECT PROJECT

TYPE

FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAM

E FOR

DELIVERY

PROGRESS

Ealing

Ealing East Hub

New build LIFT 21.15 (£23m) Year 2

The PID and Options Appraisal (OA) have been approved by the CCG

and following NHSE approval of the PID the OA has been submitted to

NHSE for approval. The preferred option is to rebuild Acton Health Centre

which is a LNWHT owned site. Work now to commence on OBC.

Ealing North Hub

New build 3PD 14.613m Year 2

The PID and Options Appraisal (OA) have been approved by the CCG

and following NHSE approval of the PID the OA has been submitted to

NHSE for approval. The preferred option is a new health centre on the

former Glaxo (GSK) site. The GSK developer has successfully obtained

planning consent for the scheme which includes a 2,000 m2 of health

facility (subject to commercial terms and necessary approvals being in

place). Work now to commence on OBC.

Mattock

Lane

Non-Hub

New build TBC TBC Year 3-5

Proposal to develop Mattock Lane as a large primary care centre for

central Ealing to serve a registered patient list of circa 50,000, plus

community services. A feasibility report was commissioned to

demonstrate how the site could potentially be redeveloped to provide a

health facility of between 2,000 and 2,500 m2. Several local GP practices

have expressed an interest in collaborating to consolidate primary care

services on this site. The recommendation from the feasibility report is

now informing the development of the PID which is due to be submitted to

the Finance Committee in December 2017

Hammersmith

and Fulham

Parsons

Green

Health

Centre

Hub

Reconfiguration

of existing site

NHS

Capital/

ETTF

4.81 Year 2-3

Partial funding of £794k via ETTF was expected to be confirmed at

London Capital Committee in July 2017 to support the relocation of

Lilyville Surgery, however this decision was not confirmed until the LCC in

October 2017. Work will now progress on completing the due diligence

required for the project.

Bridge

House

Non-hub

Reconfiguration

NHS

Capital 0.25 Year 1

ICHT are now delivering Cardiology and Respiratory services from the

newly reconfigured accommodation and ICHT has also agreed to facilitate

a new IAPT pilot service from this space. Minor works to convert two void

rooms on the ground floor as accommodation for the IAPT Service

displaced from Charing Cross has completed. IAPT due to move in during

November.


hand




CCG PROJECT PROJECT

TYPE

FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAME

FOR

DELIVERY

PROGRESS

Harrow

The Pinn

Medical

Centre

Hub

increase

utilisation and

reduce voids

NHS

Capital 0.68 Year 1-2

A utilisation review of the site has been undertaken and further

opportunity to accommodate services was identified. The site houses a

practice with a patient list of 23,000 and a walk-in centre (WiC). This is

an operational Hub offering a range of OOH, community and primary

care services. X-ray and ultrasound services are also offered from the

site. The opportunity to reorganise some space at the site to create

additional clinical capacity will now be explored..

East

Harrow

Hub

New build

NHS

Capital

15.19 (£2.9m-

£7.8m) Year 3-4

The PID for this scheme has been approved by the CCG and NHSE.

The Options Appraisal (OA) has been completed for the scheme and

has identified the preferred option as the redevelopment of the existing

Belmont Health Centre. CCG F&P and GB approval was obtained in

August 2017. The project has also been Identified as a possible One

Public Estate scheme to maximise development potential with Harrow

Council and release surplus public sector land for residential

development.

Belmont

Health

Centre

Non-hub

Reconfiguration

NHS

Capital 0.7 Year 1

NHSE operational capital had been approved to convert the void first

floor office accommodation into clinical space to address overcrowding a

lack of capacity at the site. NHS PS has undertaken the tendering for the

detailed design for the work and engagement with the existing tenants

and PPG continues. Concept design ready is being reviewed with the

tenants week of the 13 November.

Alexandra

Avenue

Hub

increase

utilisation and

reduce voids

LIFT 2.70 Year 1-2

Following a space utilisation review and a piece of targeted work all

admin and clinical space on the lower ground floor is now occupied and

void space at this site has been reduced to less than 3%. Utilisation has

increased from 44% in 2016 to a current rate of 75%. Minor works to

meet current Infection Control requirement is currently underway and

once completed Tissue Viability will commence from this site. Alexandra

Avenue currently provides most of the core services identified in the

OOH hub strategy.


hand




CCG PROJECT PROJECT

TYPE

FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAM

E FOR

DELIVERY

PROGRESS

Hillingdon

Hesa

Health

Centre

Hub

increase

utilisation and

reduce voids

NHS

Capital TBC Year 1 - 3

The re-procurement of primary care services at the site has triggered a

requirement to look at the primary care space at the site. This may also

create an opportunity to release further space for the delivery of out of

hospital services at the site.

Yiewsley

Health

Centre

Non-hub

Reconfiguration

of existing site

ETTF 0.5 Year 1

The ETTF scheme to convert void space into clinical space is progressing

with the design agreed. Practices have agreed the allocation of space

and will now enter into lease negotiations with NHS PS in order to satisfy

NHSE due diligence. The ETTF investment will negate any revenue

increase. There remains a significant risk with respect to the delivery of

this scheme, and all ETTF schemes in NHS PS properties as currently

there is no mechanism for NHSE to transfer capital to NHS PS. This

matter has been escalated and is being dealt with by DH. Tender for

works has commenced with tenders due 21 November. Additional s106

funding sought to improve entrance, lobby and reception areas.

North

Hillingdon

Hub

New build

NHS


Discussions continue with THH to include the provision of the Hub space

requirement in its new build skin clinic on the Mount Vernon site. An

alternative scheme has been worked up with NHSPS for the combined

Northwood & Pinner Community Hospital and Northwood Health Centre

sites. These two site options will be analysed at Options Appraisal. The

PID was approved by F&P in August and GB in September 2017 and has

been submitted to NHSE for approval. The PID was approved by F&P in

August and GB in September 2017 and has been submitted to NHSE for

approval.

Uxbridge

and West

Drayton

Hub

New build

3rd party

developer

/ NHS

Capital

11.05 Year 3-4

Having been unable to secure a site on the St Andrews site with St

Modwen, the redevelopment of the Uxbridge Health Centre is being

assessed with CNWL. A feasibility study has been undertaken for input to

the Options Appraisal. The PID was approved by F&P in August and GB

in September 2017 and has been submitted to NHSE for approval.


hand



Enabler report: Estates (continued)

41

CCG PROJECT PROJECT TYPE FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAME

FOR

DELIVERY

PROGRESS

Hounslow

Heart of

Hounslow

Hub

increase

utilisation and

reduce voids

LIFT 1.72 Year 1-2

CHP has secured £400k capital funding for 17/18 to reconfigure space

that will lead to further improvement in utilisation, including bringing

void space back into use. A PID for the additional work has been

approved and the project is due to commence shortly with works

expected to complete by end of the financial year.

Heston Hub

New build LIFT 15.89 (£1.9m) Year 2-3

Stage 1 (OBC) document approved by Hounslow GB on 14 March

2017 subject to further cost reduction measures being explored as part

of design development. Stage 1 (OBC) document was approved by

Hounslow F&P and GB in September. Due to the six month delay, due

to affordability concerns and logic model requirements, the FBC is now

expected to be completed in May 2018.

Chiswick

Health

Centre

Hub

Reconfiguration

of existing site

ETTF 1.00 Year 1-2

ETTF PID for Chiswick Health Centre has been submitted to London

Capital Committee and approved. The proposed scheme has been re-

presented to GP practices, HRCH and NHS PS to ensure that key

stakeholders are engaged. All parties are positive about the proposed

scheme that will deliver additional clinical space through an internal re-

configuration/refurbishment. NHS PS has completed a competitive

procurement process and has appointed a design consultant to

progress the scheme. The CCG and NHS PS is considering the short-

term opportunity versus the medium-term redevelopment option and in

parallel with the Brentford approach NHS PS has appointed a design

team who have recently completed a feasibility and viability study. This

approach was discussed with NHSE at the recent ETTF Surgery held

on 3 October 2017. A draft paper is being prepared collaboratively with

NHS PS that will re-state the consistent objectives and benefits

Brentford/

West

Middlesex

Hub

New build

NHS


Early discussions with West London Mental Health Trust have

identified an opportunity for a collaborative redevelopment of the site,

which could include both Brentford Lodge and the Brentford Health

Centre. This is being explored further with WLMHT and NHS PS who

have appointed a design team who have recently completed a

feasibility and viability study. Draft PIDs have been prepared for both

sites and are expected to be presented to F&P in November. OA list

from NHS PS still awaited.


hand



42

CCG PROJECT PROJECT TYPE FUNDING

TYPE

ESTIMATED

INVESTMENT

(£m)

TIMEFRAME

FOR

DELIVERY

PROGRESS

West

South

locality

Hub

Refurbishment

and extension

3rd party

developer/

NHS

Capital/

ETTF

12.71

(£10.4m) Year 2-3

Dialogue continues with The Cadogan Estate with respect to the

refurbishment and extension of the Violet Melchett Clinic to determine

how the scheme can be taken forward and the associated

costs/delivery route. Cadogan has commenced pre-application

discussions with the Local Authority and Cadogan have recently

advised that a planning application is unlikely to be submitted before

January 2018. The Options Appraisal (OA) was approved by CCG GB

in March 2017, subject to financial alignment with SOC1, which was

completed in June 2017. The OA has now been submitted to NHSE for

approval. Partial funding of £4.4m via ETTF was confirmed at London

Capital Committee (LCC) in July 2017.

St Charles

reduced

Hub

Reconfiguration

of existing site

and reduce voids

NHS


Initial discussions have commenced with NHS PS relating to options to

utilise space at St Charles Centre for Health and Care. CNWL has

withdrawn its interest in leasing space in Courtfield House due to the

poor general condition of the building and thus overall scheme viability.

A workshop is being planned for Nov 2017 to allow the CCG to define

its commissioning intentions for the site.

Enabler report: Estates (continued)

42


Reaffirming partner support and engagement with delivering the NWL Hub strategy


hand



Glossary

Acronym Term in Full Acronym Term in Full

A&E Accident & Emergency iBCF Improved better care fund

ACP Accountable care partnership IC Intermediate care

ADASS Association of Directors of Adult Social Services ICHP Imperial college health partners

APMS Alternative provider medical services ITT Invitation to tender

ASD Autism spectrum disorder JHCTG Joint Health Care Transformation Group

BAU Business as usual LAS London Ambulance Service

BHH Brent Hillingdon and Harrow LA CYP Local authority children and young people

BI Business Intelligence LDR Local digital road map

BIU Business Intelligence Unit LNWHT London North West Healthcare NHS Trust

CAMHS Child and adolescent mental health services MSK Muscular Skeletal

CEPNS Community Education Provider Networks (CEPNs) NHSE National Health Service England

CIPs Continuous improvement process NHSI NHS Institute for Innovation and Improvement

CFO Chief Finance Officer OPE One Public Estate

CLARCH CLAHRC - Collaboration for Leadership in Applied Health

Research and Care

PAM Patient Activation Measures

CNWL Central and North West London NHS Foundation Trust PBS Positive behavioural support

COOs Chief Operating Officers PID Project Initiation Document

COPD Chronic obstructive pulmonary disease QIPP Quality innovation productivity prevention

CQUINs Commissioning for Quality and Innovation ROI Return on investment

CRG Clinical reference group RR Rapid response

CTO Chief Transformation Officer SLTMHN Supporting adults with serious & long term mental health needs

CTPLD Community team for people with learning disabilities SNOMED Systematised nomenclature of medicine

EMIS (Egton medical information system) a supplier of electronic patient

record software systems for primary care

SOC Strategic outline case

EOI Expression of interest SQL Structured query language

F&Ps Finance & Procurement STARRS Short-term assessment, rehabilitation & reablement service

GPFV General Practice Forward View THH The Hillingdon Hospitals NHS Foundation Trust

HASC Health & Adult social care select committee TPP The Phoenix Partnership a Government accredited clinical

computer system used in Primary Care

HEE Health Education England UCC Urgent Care Centre

HEENWL Health Education England North West London WLA West London Alliance

HLP Healthy London Partnerships WSIC Whole Systems Integrated Care

IAPT-LTC Improving Access to Psychological Therapies (programme) - long

term conditions

WTAC Workforce Transformation Advisory Council

IAPTUS Improving Access to Psychological Therapies a Clinician online

patient management system

WTDB Workforce Transformation Delivery Board

43

Contents for NWL work book updates 44

• NWL project workbook- Risk Framework

• Supporting local people to live healthier lives (DA1a) - Reducing harmful drinking (DA1ai)

• Roll out of the National MECC Programme (DA1d) - Making Every Contact Count (DA1di)

• Getting hospital patients better, quicker (DA5b) - Radiology and Diagnostics (DA5bi) & Inpatient model of

care (DA5bii)

• Organising Hospital services (DA5c) Capital business cases to support clinical improvements (DA5ci)

• Organising Hospital services (DA5c) - Improvements to women’s services (DA5ciii)

• Transition to using the NWL project workbook is underway across S&T

• The workbooks presented in this section are the first projects to transfer and are being developed

• We are awaiting the development of programme level work books

• This is the GANTT chart key used in the workbooks

GANTT Chart Key Completed

milestones: 0

Completed

tasks: 0

Incomplete

milestones: 3

Incomplete

tasks: 6

Key messages for NWL work book updates

NWL project workbook - Risk framework 45

Taken from CWHHE policy (CWHEE/GOV/003-(Source: National Patient Safety Agency)

Highlight_report Report generated on 17/11/2017 at 14:08 hours

All CCGs | Highlight report (DA1ai | Reducing Harmful Drinking)

Roles

Year to date | Year: 2017/18 | Month: 6 | Financial performance Full year forecast | Year: 2017/18 | Month: 6 | Financial performance

Narrative updates | Updated on:

Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP 0 0 0 0 0 -

0 0 0 0 -

0 0 0 0 0 -

Net saving 0 0 0 0 0 - Net saving 0

Ops plan All plans Actual Reported Variance to all plans

QIPP

Gross saving 0 0 0 0 0 -

QIPP


0 - Investment

SRO

07/11/17

R RPlanning and Delivery Outcomes and Benefits

1. Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications

can share)

Discussions are progressing at an STP level regarding the approval for the alcohol business case

2. Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act

as lever/ note)

Ealing, Brent and Harrow CCGs to agree to fund the alcohol business cases and the JHCTG to act as a lever

to prioritise alcohol prevention work and support this decision making progress.

3. Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How

can JHCTG help?

Key issue is the on-going uncertainty of funding for the alcohol work and the consequential delays in

implementation.

PROGRESS:

- We have submitted an EOI for a social impact bond to part fund the business case

- The business cases have been esclated to the STP leads

NEXT STEPS

- As the JHCTG was cancelled last month, we are awaiting Novembers meeting

- Awaiting the outcomes of the social impact bond.

Rebecca Hall

Melanie Smith

Supporting Local People to live Healthier LivesProgrammeProject manager

Clinical leadClare Parker

£000's Ops plan All plans Actual Reported Variance to all plans £000's

0 0Investment 0 0

Source file: DA1ai Alcohol PW 301017 PW Page 1 of 3


Planning

92% 8%

22/1

2

29/1

2

05/0

1Revised

start

00/01/00

End

(date)

01/11/16

01/1

2

03/1

1

10/1

1

17/1

1

24/1

1

Done?

06/1

0

13/1

0

20/1

0

27/1

0

12/0

1Revised

end

00/01/00

1.03 0

1.02 M 00/01/0000/01/00 30/01/17

01/07/17 02/10/17

1.08

Preliminary business case developed for the STP 0 01/12/16

01/09/17

1.09 0

Review of best practice and literature relating to alcohol care teams 0

1.01

Mile

-

sto

ne

M

Ref.

0The increasing consequences of probelmatic drinking and its cost to hospital identifed as a key

priority by the NW London STP and RCP, PHE and NICE supported intervention with ACT

recommended

01/09/16

80% 20%■ Milestone progress ■ On time | ■ delayed

08/1

2

15/1

2

OwnerTask / milestone descriptionStart

(date)

1.05 M Establishment of the NW London Alcohol Steering Group with key stakeholders across NW London

to develop the ACT model and evaluation

0 01/04/17

1.04 M Mapping of current community and hospital alcohol care services 0 15/01/17 00/01/00 01/04/17 00/01/00

01/04/17 00/01/0001/01/17 00/01/00

.

1.07 0 ACT model developed and approved 0 01/04/17 00/01/00 01/07/17 00/01/00

0 Finanical modelling and estimated ROI completed 0 01/04/17 00/01/00

Data analysis of impact on alcohol related A&E attendances and admissions 0 01/03/17 00/01/00

01/08/17 00/01/00

01/06/17 00/01/00

00/01/00 01/09/17 01/12/17

1.10 0 Businsess case developed for Ealing, Harrow and Brent CCG 0 01/05/17 00/01/00 01/08/17 00/01/00

||| . .1.11 0 Business case awaiting approval by CCGs

■ On time | ■ delayed■ Task progress> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

. . . . . .0 10/07/17

È



Risks and issues

Rating

Severe

RH

RH

Severe

Severe

Risk distribution (active) Issue distribution (active)

Description of risk / issue and potential consequence(s)

It is an issue that the delay in the alcohol business case

signoff by Ealing and Brent CCGs have impacted and

delayed the anticipated start of the teams in October has

been missed and therefore missing the beginning of the

winter pressure. Brent CCG is awaiting approval from

Ealing CCG before signing off and the approval of Harrow

CCG is under jeopardy.

IMPACT with an estimated four to six months needed to

recruit and implement teams, it is unlikely that without a

funding decision shortly, that the teams are unlikely to be

implemented this year and the increasing rates of alochol

related harm and costs to the NHS is likely to continue to

rise.

Date

added

30/10/17

Type

I

30/10/17 I

30/10/17 I Engagement has commenced to understand any

amendments required for full agreement. Additional external

funding sources also being explored.

Discussion at the JHCTG Board

There is an significant issue that the Harrow alcohol

business case has been approved by Harrow CCG on the

provision of a Harrow LA funded worker however with the

significant changes to Harrow LA and cuts (£0.5 million),

Harrow LA are no longer able to contribute to this service

therefore making the current approved business case

unviable.

IMPACT without the additional funding, the Harrow business

case is not viable and therefore nor is the wider business

case

There is an issue that Ealing and Brent CCG are only

proposing to fund the alcohol service for one year rather

than the 18 months requested

IMPACT as the ROI relies on the preventing re-attendances

and re-admissions, this is unlikely to demonstrate a

significant benefits with the shorter pilot time frame. This

will detrimentally effect outcomes and consequent further

funding into alcohol services importantly sustaining the

service and scale up across NW London.

Clear communication with CCGs and development of the

business case to provide as strong a case for investment as

possible.

Esclated to STP leads.

Looking to source match funding from Social Investment

Bond to reduce cost to CCGs

Action still to be taken (planned) to mitigate impact further

0

Action taken to date to mitigate impact of risk / issue

Escalated within Harrow CCG and to DA1 Programme

Board and to STP leads.

Owner

RH



All CCGs | Highlight report (DA31di | Making Every Contact Count )

Roles



0Planning and Delivery Outcomes and Benefits

JHCTG November 2017

Overall what went well this month in your area? (one sentence) (Good news that JHCTG /communications can

share) - MECC training has commenced in Hounslow.

Overall what is the main action needed across your area? (one sentence) How can JHCTG help? (Share/act

as lever/ note) - Further recruitment drive needed to fill spaces as there has been reduced appetite in some of

the boroughs.

Key issue/risk across the whole programme (one sentence) What do they needed to be sighted on - How can

JHCTG help? - Risk of causing damage to relationships between the STP and funding providers due to being

overly ambitious in project development and setting unachievable targets.

PROGRESS THIS MONTH (planning and delivery) - Training has taken place in Central London, West

London, H&F, Brent and Harrow and has now commenced in Hounslow.

NEXT STEPS (Planning and delivery) - Second recruitment drive taking place to fill spaces where there has

been reduced apetite. Further trainings to take place and to be booked for January, February and March 2018.

Alexandra Blowers

Fiona Butler

Improving Health and WellbeingProgrammeProject manager



0 0Investment 0 0

SRO

08/11/17

A


QIPP


QIPP


0 - Investment 0 0 0 0 0 -


0 0 0 0 0 -

0 0 0 0 -

Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP

Source file: DA1di MECC PW Page 1 of 2


Planning

Risks and issues

È



Develop plan with HLP, HEE and borough's Public Health

leads to ensure programmes of work are sustainable and

deliverable.


Engage with HEENWL to highlight an awareness of

unrealistic targets and continue to work with boroughs to

ensure that programmes of work are sustainable.

Owner

SS

Date

added

08/11/17

Type

R

08/11/17 R Paper has been developed and taken to DA1 Programme

Board to establish next steps- this will go to the JHCTG for a

system wide decision.

The Making Every Contact Count project has facilitated the

development of strong relationships with each of the 8

Borough's Public Health teams. There is a risk that these

relationships will be lost should the work discontinue.

IMPACT prevention as a system becomes much more

challenging.

Unmitigated L: 3

Unmitigated C: 3

Unmitigated risk: 9

Reviewing the DA1 programme and representation,

challenging system commitment to the prevention agenda

and working with boroughs to ensure that they continue with

projects in train.

31/08/18 00/01/0016/06/18 00/01/00

08/1

2

15/1

2


(date)

. . . 6.01

Mile

-

sto

ne

M

Ref.

0Roll out of MECC training 01/06/17


Revised

end

00/01/00

7.01 M



We have been ambitious in our project development and

have set ourselves targets that are unachievable. IMPACT:

This may cause damage to relationships between the STP

and funding providers

Unmitigated L: 3

Unmitigated C: 3

Unmitigated risk: 9

6.02 0 00/01/0000/01/00 14/11/17Recruitment push for Q3 and Q4 2017/18 0 01/11/17

Evaluation completed with reports from trainer 0

Done?

|||. .

06/1

0

13/1

0

20/1

0

27/1

0

. .

12/0

1Revised

start

00/01/00

End

(date)

16/06/18 .

01/1

2

. . . . .

03/1

1

10/1

1

17/1

1

24/1

1

. ||| .

100% 0%

22/1

2

29/1

2

05/0

1

.

Rating

6

SS 6

Source file: DA1di MECC PW Page 2 of 2


All CCGs | Highlight report (DA5bi & DA5bii | Radiology and Diagnostics (DA5bi) & Inpatient Model of Care (DA5bii))

Roles

Year to date | Year: | Month: 6 | Financial performance Full year forecast | Year: | Month: 6 | Financial performance


Non-QIPP Investment 0 0 0 0 0 - InvestmentNon-QIPP 0 0 0 0 0 -

0 0 0 0 -

0 0 0 0 0 -



QIPP


QIPP


0 - Investment

SRO

10/11/17

A APlanning and Delivery Outcomes and Benefits

November 2017 JHCTG


share)

Official opening of the North West London Ultrasound Academy is due on 01/11/2017; this will take in a cohort

of five sonographers.

A paper was produced to show how seven successful pilots have demonstrated clear evidence of length of

stay reduction, and have been implemented in various hospitals.


JHCTG help?

Clinical Decision Support (CDS): there is an issue with the integration of CDS with ICE. The delay is because

of Sunquest, who have integrated the wrong version of ICE into CDS.

PROGRESS THIS MONTH

- A paper was taken to Provider Board which outlines the impact of work of 7DS and trust flow initiatives. The

paper showed the evidence generated through the 7 Day Services programme, the implementation in trusts,

and subsequence impact on length of stay and patient flow.

- Official opening of the North West London Ultrasound Academy on 01/11/2017; this will take in a cohort of

five sonographers.

NEXT STEPS

- Some actions were required from Provider Board before the trust flow project can be moved to BAU.

- Radiology MRI project originally due to begin in Summer 2017 is still delayed due to issues with IT systems

and Information Governance (IG) implications. Awaiting new start date - this has been escalated to senior staff

at Chelsea and Westminster hospital

- Radiology Clinical Decision Support pilot will begin in early 2018.

Xiao Cai

Susan La Brooy

DA5: Safe, high quality and sustainable hospital servicesProgrammeProject manager



0 0Investment 0 0

Source file: DA5b_Inpatient MoC_(NWLPWv 3 1) FV Page 1 of 2


Planning

Risks and issues

Rating

High

75% 25%

22/1

2

29/1

2

05/0

1

. .

. . .

Revised

start

00/01/00

End

(date)

09/11/17

01/1

2

03/1

1

10/1

1

17/1

1

24/1

1

.

Done?

P

. P

06/1

0

13/1

0

20/1

0

27/1

0

12/0

1Revised

end

00/01/00

3.20 M



SDS03a - Clinical Decision Support (CDS) there is a delay in

the start of pilot due to Sunquest integrating CDS into wrong

version of ICE

3.10 M 00/01/0000/01/00 01/11/17

01/11/17 00/01/00

Official opening of the NWL Ultrasound Academy GS 01/11/17

00/01/00

Clinical Decision Support (CDS) pilot (for Radiology & Diagnostics) GS

10.10

Mile

-

sto

ne

M

Ref.

XCProject closure report to Provider Board 09/11/17


08/1

2

15/1

2


(date)

7.40 0 Seven day therapy proposal review by ICHT XC 01/11/17

3.30 M MRI pilot (for Radiology & Diagnostics) at CWFT **delayed** GS 01/07/17 01/01/18 31/12/17 30/06/18

30/09/18 00/01/0031/03/18 00/01/00

P .

7.30 0 Seven day therapy proposal review by CWFT XC 01/11/17 00/01/00 01/11/17 31/12/17 .. .. ||| ..

Date

added

01/08/17

Type

I


0


Conversations and engagement with Sunquest to develop a

patch for the current version within the Trusts. Pilot should

be able to begin in early 2018

Owner

RK


È

Source file: DA5b_Inpatient MoC_(NWLPWv 3 1) FV Page 2 of 2


Highlight report (DA5ci | Strategic Outline Case 1 )

All CCGs | Highlight report (DA5ci | Strategic Outline Case 1 )

Roles



RPlanning and Delivery Outcomes and Benefits

JHCTG November 2017


share)

Assurance of SOC 1 continues


as lever/ note)

Support in implementing the development of outline business cases for both hubs and Trusts as far as

possible without confirmed funding.


JHCTG help?

Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not

considered for autumn capital announcement.

PROGRESS THIS MONTH (planning and delivery)

SOC Part 1 was considered at the NHSI Board meeting on September 28 - the Board have asked for

additional assurance information.

Due to the complexity of queries being generated by the National Team, there is a risk that SOC Part 1 is not

considered for autumn capital announcement.

Programme team working with Trusts to plan OBC production and mitigate slippage.

Strategic Estates leading on developing Hub OBCs.

NEXT STEPS (Planning and delivery)

Developing responses to all NHSE and NHSI additional assurance requests as appropriate.

Conversation with the National team will continue while SaHF programme team continues to actively work with

NHSI colleagues to clarify and produce the additional information needed by the NHSI Board, to progress DH

and treasury approval.

Cerith Lewis

Mark Spencer

Organising Hospital ServicesProgrammeProject manager



0 0Investment 0 0

SRO

10/11/17

R


QIPP


QIPP


0 - Investment 0 0 0 0 0 -


0 0 0 0 0 -

0 0 0 0 -


Source file: Copy of DA5ci SOC1 PW Page 1 of 2


Planning

Risks and issues

È



Continue monthly Trust OBC progress calls


Actively engaging with Trusts, NHSE, NHSI and DH to

address issues being raised.

Owner

KN

Date

added

00/01/00

Type

I

30/11/17 00/01/0030/11/17 00/01/00

08/1

2

15/1

2


(date)

.

4.14

Mile

-

sto

ne

M

Ref.

0SOC1 approved by NHSE Investment Committee 18/07/17


Revised

end

00/01/00

4.15 m



Due to the delay to SOC Part 1 assurance process by NHSI,

Trusts OBCs are delayed and/or on hold until the approval of

SOC Part 1 and funding made available to commence the

necessary work.

4.12 M 00/01/0000/01/00 18/09/17SOC 1 to NHSI Resources Committee 0 18/09/17

SOC 1 draft timeline response to NHSI 0

Done?

P

P

06/1

0

13/1

0

20/1

0

27/1

0

12/0

1Revised

start

00/01/00

End

(date)

18/07/17

01/1

2

03/1

1

10/1

1

17/1

1

24/1

1

22/1

2

29/1

2

05/0

1

Rating

Severe

Source file: Copy of DA5ci SOC1 PW Page 2 of 2


All CCGs | Highlight report (DA5ciii | Maternity Early Adopters)

Roles



0Planning and Delivery Outcomes and Benefits

Victoria Lyon

Pippa Nightingale

Improving Women's ServicesProgrammeProject manager

Clinical leadPippa Nightingale


0 0Investment 0 0

SRO

16/11/17

A


QIPP


QIPP


0 - Investment 0 0 0 0 0 -


0 0 0 0 0 -

0 0 0 0 -


Source file: DA5Ciii Early Adopters PW Page 1 of 3


Planning È


.. . .

00/01/00 00/01/00 P

31/01/18 00/01/00 . . .

6.01 M Hillingdon launch of Model 2: Birth Centre Continuity 0 00/01/00 00/01/00 00/01/00 00/01/00 P

M Hillingdon launch of Model 3a: Group Practice (Amber Team) 0 00/01/00 00/01/00

Evaluation of personalised postnatal care plan across all sites 0 01/12/17 00/01/00

5.03 0 West Mid recruitment to Model 1: caseloading teams 0 00/01/00

5.01 0 Chelsea and Westminster recruitment to Model 1: caseloading teams 0 00/01/00 00/01/00 00/01/00 00/01/00

01/08/17 00/01/00 P01/05/17 00/01/00

JHCTG November 2017


share)

New pilot models implemented at Hillingdon. Launch of personalised postnatal care plan at all sites.


as lever/ note)

N/A


JHCTG help?

Some delays to programme due to accessibilty of data sets. Delays in advertising / recruitment to CW and

Imperial teams has resulted in a risk to launch in Jan '18.

PROGRESS THIS MONTH (planning and delivery)

Launch of personalised postnatal care plan at all sites

Launch of midwifery led care in birth centres at Hillingdon

Launch of Group practice - team continuity in amber team at Hillingdon

Launch of photobooklet at Hillingdon

Continuity of Care baseline audit complete

Evaluation approach signed off with academic panel

NEXT STEPS (Planning and delivery)

Recruitment to caseloading teams Chelsea and Imperial

Re launch of reconfigured group practice model at LNWHT

Baseline established (quantitative and qualitative elements)

08/1

2

15/1

2


(date)

. . . 3.02

Mile

-

sto

ne

M

Ref.

0Establish quantative baseline (ICHP) 18/07/17


Revised

end

31/12/17

4.02 M

3.03 M 30/11/1700/01/00 29/09/17

00/01/00 00/01/00

6.02

Establish qualitative baseline (OneplusOne) 0 18/07/17

00/01/00

7.01 0

Codesign models of care 0

Done?

||| . . . .

06/1

0

13/1

0

20/1

0

27/1

0

. .

12/0

1Revised

start

00/01/00

End

(date)

29/09/17 .

.

01/1

2

. . . . .

. .

03/1

1

10/1

1

17/1

1

24/1

1

.

. ||| .

100% 0%

22/1

2

29/1

2

05/0

1



Risks and issues


Use Better Births as recruitment tool into sector.

Attending midwifery events (e.g. RCM conference) to

promote NWL sector and use as recruitment opportunities

Work with NWL university partners to promote Trusts and

recruitment cycles

Hold recruitment day at CWFHT (where majority of new

teams are being developed)


Co-design all models with workforce and early engagement

to ensure buy in.

Offer mix of models to ensure satisfaction for all maternity

workforce (different types of role)

Owner

VL

Date

added

00/01/00

Type

R



There is a risk that recruitment of maternity workforce

(internal and external) at each Trust is insufficient to pilot /

test the new models of care and there are insufficient

midwives to run the new models

Rating

16


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