project initiation document [pid] transforming
TRANSCRIPT
Transforming Commissioning in Learning Disabilities
Project Initiation Document [PID]
Transforming Commissioning in Learning Disabilities
Version: 0.6
Date: 04/04/2013
Project Owner: David Trousdale/ Caroline Fryer
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 2 of 23
Document Purpose:
The purpose of the Project Initiation Documentation is to define the project, in order to
form the basis for its management and an assessment of its overall success. The Project
Initiation Documentation gives the direction and scope of the project and (along with
the Project Plan) forms the "contract" between the Project Management team and the
Governance Boards.
Version history:
Date Version No. Author Summary of changes
04/04/20
13
V0.1
David
Trousdale
First Draft
26/04/20
13
V0.2 Phil Brown Amendments
1/05/201
3
V0.3 Phil Brown &
Francis Ma
Amendments
16/05/20
13
V0.4 David
Trousdale
Amendments following the first North Essex Transforming
Commissioning in Learning Disabilities Executive Board
23/05/20
13
V0.5 David
Trousdale
Tweak to language across document and amendments
30/05/20
13
V0.6 Phil Brown Amendments following Executive Board Meeting
Document Approval:
Name of Approver Role Version No. Date approved
People:
Role Amend as appropriate Name
Project Sponsors (and Joint Chairs) Clare Morris (North CCG Cluster) and Nick Presmeg (ECC)
Project Manager/s David Trousdale/Caroline Fryer
Programme Manager – Integrated
Commissioning
Phil Stephens
Workstream Lead (Integrated
Commissioning in Practice)
Steve Allen/Steve Thumpston
Workstream Lead (Finance) Francis Ma/ Helen Chittock
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 3 of 23
Workstream Lead (Strategies) Steve Allen / Steve Thumpston & Francis Ma
Workstream Lead (Contracting) Steve Allen /Steve Thumpston
Workstream Lead (User Engagement
and Communication)
Chris Gee
Workstream Lead (Information and Data
Sharing)
Phil Brown / Francis Ma
Workstream Lead (Winterbourne) Steve Thumpston / Phil Brown
Workstream Lead (LD Self Assessments) Chris Gee
Subject Matter Experts (SMEs)
LD Clinical Lead (West Essex CCG) Miranda Roberts
LD Clinical Lead (Mid Essex CCG) Iain Tweedlie
LD Clinical Lead (North East Essex CCG) Mark Roberts
Commissioning Support Unit Lead Steve Thumpston
Commissioning Support Unit Lead Francis Ma
CCG Regional Lead for Managed
Clinical Network
Caroline Dollery
Quality Lead for LDMH Alexina Weston
Programme Director – Adults, Health
and Community Wellbeing
Peter Tempest
All Age Adults Lead Barbara Herts
Finance Lead Helen Chittock
Strategy Lead Helen Terry
Communications and Engagement
Lead
Rob field
Commercial Lead James Wilson
Governance Lead TBC
HR Lead TBC
HRA Advice TBC
Legal Lead TBC
See also Roles & Responsibilities
1. Background:
‘Valuing People’ describes the importance of effective partnerships in promoting holistic services and
social inclusion for people with learning disabilities. The aim of this project is to strengthen the partnership
between health and social care commissioners in Essex to deliver improved outcomes for our citizens
with learning disabilities. The financial situation of the public sector is well understood and integrated
commissioning should yield efficiencies that will help both the County Council and the Clinical
Commissioning Group’s manage the demand for services within the budget constraints that are faced.
However the financial situation should not dampen our aspirations to improve services through working
together. Instead the economic challenges should be viewed as a catalyst to take the bold steps
required to reconfigure and improve our existing model of services.
There is a strong history of integrated commissioning of learning disability services in Essex. Prior to the
recent NHS and Local Authority restructures, joint commissioning arrangements included joint
appointments; a Health & Social Care Commissioning Board; and a shared strategy articulated through
the Joint Investment Plan. This enabled the successful closure of the long stay hospitals and NHS campus
provision with many people who lived as in-patients moving to their own homes in the community.
However some areas remained fragmented. The commissioning of specialist health in-patient and
community services were never fully integrated with social care and a succession of restructures within
both the NHS and the County Council led to deterioration in integrated commissioning arrangements.
The architecture to provide health and social care system leadership and coordination across public
services is being established through the statutory Health and Wellbeing Boards. Alongside this the
Integrated Planning process for the new Clinical Commissioning Groups has resulted in stronger working
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 4 of 23
relationships between health and social care services. Mid, North and West Clinical Commissioning
Groups (3CCG’S) have stated their intention within their integrated plans to align commissioning
arrangements for learning disability services. West Essex CCG will act as the coordinating commissioner
on behalf of the three CCG’s, and the County Council has provisionally offered to take on lead
commissioning responsibilities for the partnership. Initial conversations have also been held with the
South Essex CCG’s about the potential for integrated commissioning arrangements in South Essex.
These conversations are still at an early stage and there are complexities around their relationships with
the unitary authorities and CCG’s of Southend and Thurrock that will need to be considered.
The Council is developing an All Age approach to disability to improve the experience of people with
disabilities, particularly at the time of transition into adulthood. The overall aspiration of this project will
be to encompass the All Age approach so that the integrated commissioning arrangements for
learning disability services will cover adult and children’s services, including health services across North
and South Essex. As part of this there may also be opportunities to incorporate the commissioning
undertaking by local authorities and CCG’s of Southend and Thurrock within these arrangements. To
ensure progress is made it is proposed that the work is progressed in phases. The first phase will involve
implementing the agreement between the North Essex CCG’s and the County Council to integrate
commissioning for adult learning disability services. Subsequent phases will look to involve the South
Essex CCG’s and to include children’s services, with an open invitation to Southend and Thurrock to
participate in these arrangements.
The combined health and social care expenditure by the County Council and North Essex CCG’s on
adult learning disability services is in the region of £185 million (the council’s expenditure covers all of
Essex). This consists of:
Social Care Expenditure (Essex Wide) - £171 million gross – includes £44m that has transferred from
health, of which:
• £75 million registered care
• £50 million community support and supported living
• £16 million direct payments
• £10 million employment and inclusion services
• £9 million assessment and care management
Specialist Health LD Services in North Essex - £14 million
• In Patient and Specialist Community Services - HPFT £10.1 million
• Learning Disability Allied Health Professionals - ACE £2.4 million
• Individual Placements - £700K
• West Essex AHPs, S256, QIPP and miscellaneous historical expenditure - £800K
Increasing demographics is placing significant demands on both health and social care services for
people with learning disabilities. More people with learning disabilities are surviving into adulthood, and
people are living longer. There has been an annual growth of 2.5% per year in people with learning
disabilities aged 18-64, and 6.5% for those aged 65+. Furthermore people’s needs are increasingly
complex. The overall impact of these demographic changes is estimated to be an £8.5million annual
demographic pressure on council funding. If we also take into consideration the pressures on CCGs
across Essex, this figure increases even further. The Council cannot continue to increase funding to meet
this level of demand and future savings plans are being developed, but are still to be agreed, to meet
any new demand within the current level of spending. In addition the CCG’s have efficiency targets
within their QIPP programmes that need to be delivered.
There are also several national drivers that require an integrated response from health and social care
services. The abuse that took place at Winterbourne View highlighted the potential consequences of
fragmented commissioning. The resulting action plan tasks CCG’s and Local Authorities with
commissioning local integrated services for people with challenging behaviours, with an expectation
that this will be supported by financial arrangements. The recent publication of the “Confidential Inquiry
into premature deaths of people with learning disabilities” by the University of Bristol reported that
people with learning disabilities continue to experience poorer health than the general population.
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 5 of 23
Over a quarter of the deaths they examined were amenable to better quality health care (i.e. they
could have been delayed or avoided).
To manage the increasing demographics and respond effectively to these national drivers, partners will
have to think radically about how to manage demand and commission services together. Services will
need to be prioritised, commissioned, designed and delivered in an integrated way to support people
with learning disabilities to enjoy good health and lead independent fulfilling lives. The journey towards
integrated commissioning will require the development of a shared plan; agreement on how resources
including staff and finances are best utilised; and on how risks and benefits are shared.
2. Objectives, Desired Outcomes and Priorities: The overarching objective of this project is to firstly explore what Integrated Commissioning in Learning
Disabilities could look like through a number of options appraisals. Once this is completed the next step
will focus on the establishment of a single integrated commissioning approach to learning disability
services across North Essex, with the eventual aim to roll this out across the whole of Essex. This will take
the form of a partnership with the three North Essex CCGs and ECC.
To achieve the above objective this project will deliver the following outputs. These are the creation of:
A Transforming Commissioning in Learning Disabilities Executive Board with representation
from CCGs and ECC; A set of the governance arrangements and delegated decision-making mandates; A set of priorities for service transformation that reflect current local and national
imperatives; An agreed and published joint health and social care strategy; An exploration of the financial options available to support integrated commissioning and
the adoption of one of those financial options; Joint arrangements for commissioning and contracting with health & social care providers.
The objectives and outputs will feed into the ‘deliverables’ section of this document. These objectives
are underpinned by a number of project activities which will need to be completed:
The development of a unified All Age Learning Disability Register. An analysis of need including current & future demand. The development of a Market Position Statement for learning disability services. The development of the model for engaging with citizens with learning disabilities and their
families. The development of an integrated health and social care approach to people who challenge
services. The development of an integrated approach to supporting family carers.
All of these activities will require full and active engagement with people with learning disabilities and
family carers. There is a strong infrastructure in Essex for user engagement which includes the Partnership
Board, Local Action Groups, The Essex People’s Parliament and the Essex Carer’s Network. The project
will use these existing networks rather than create new ones to ensure the voices of service users and
carers are represented.
The overarching outcomes of what we aim to achieve as a result of the establishment of a single
integrated commissioning approach to learning disability services across North Essex is that people with
learning disabilities will have improved health and wellbeing through:
• Having access to good quality information, advice, and guidance.
• Having choice and control over the support they receive.
• Being supported to maximise their work capacity and skills and to enter employment.
• Being supported to access positive activities within their communities.
• Being able to maintain and strengthen friendships and relationships.
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 6 of 23
• Being supported in accommodation that gives them maximum independence.
• Making healthy choices and adopting healthy lifestyles.
• Having equitable access to health services.
• Learning to manage their own health and social care needs.
• Feeling safe in their local communities.
• Being supported with dignity and respect.
• Supporting families and informal carers.
There are a number of priorities that have already been agreed through the Integrated Plans. These
are:
• Improving access to primary and secondary health services:
Annual health checks, health action plans, access to screening programmes, and ensuring
reasonable adjustment by mainstream health services
• Developing an approach for people whose behaviour challenges services:
Aligned to the Winterbourne response, develop integrated health and social care pathways
and integrated commissioning of specialist services for people whose behaviour challenges
services. A focus of this project will be to consider the needs of all people currently living in
closed communities, and to develop appropriate community based solutions so people are
supported in the least restrictive environment possible.
• Responding to Winterbourne:
Ensuring those people currently living in in-patient services are reviewed, that person centred
plans are in place, and that people are discharged to their local communities if they no longer
require in-patient services.
• Development of an All Age Approach to Commissioning
3. Critical Success Criteria:
Description of CSC How will success be
measured
Associated Deliverable (and
date) Who signs off?
A new joint health
and social care
strategy for people
with learning
disabilities
Publishing of strategy
and demonstration of
delivery of strategy
Joint Health and Social Care
Strategy
TBC
Clare Morris, Nick
Presmeg
A cross
organisational
approach to
commissioning
services for people
with learning
disabilities
Publishing the joint
health and social care
strategy
Regular commissioning
reports delivered to the
Integrated
Commissioning Board
Regular board
meetings which
produce regular
actions
A combined data set of
information about
people with learning
disabilities.
Learning disability
services no longer
duplicated across
Health and Social Care
Transition to Integrated
Commissioning
Completion 11/09/2013
Sign off 25/09/14
Clare Morris, Nick
Presmeg
A consistent service The publication of the Joint Health and Social Care Clare Morris, Nick
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 7 of 23
Description of CSC How will success be
measured
Associated Deliverable (and
date) Who signs off?
offer to people with
Learning Disabilities
strategy will describe
the “service offer” that
people with learning
disabilities can expect
from health and social
care services.
User engagement
forums will be used to
monitor user and carer
satisfaction with
learning disability
services against this
offer.
Strategy
TBC
Engagement and
communication plans
Draft
TBC
Presmeg, James
Wilson
Efficiencies as a
result of integrated
commissioning
The efficiencies can be
seen as mitigating the
impact of increased
demand.
Options Appraisal
TBC
Clare Morris, Nick
Presmeg, Helen
Chittock
Successful merging
of benefits of both
QIPP (Quality,
Innovation,
Productivity and
Prevention) and Best
Value in Social Care
Increase in quality of
services
Increase in value of
services
Current contracts &
commercial arrangements
TBC Steve Allen, Francis
Ma
The financial options
available to support
integrated
commissioning are
explored and
assessed on merits
Completion of an
options appraisal
Design of what financial
arrangement will look like
Plan for how financial
arrangement will operate
when in place
TBC
Francis Ma, Helen
Chittock
Delivery of
Recommendations
from Winterbourne
View
Report demonstrating
evidence of delivery
against each
recommendation
The required actions in the
Winterbourne View action
plan are completed on
time.
Completed 1/06/2014
Steve Allen, Steve
Thumpston
Development of
robust integrated
service specification
which can be taken
to market
TBC TBC TBC
4. Benefits:
Integrated commissioning arrangements will help ensure that services provide best quality and value
through:
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 8 of 23
• Taking a whole-system approach to the health and social care needs of people with learning
disabilities.
• Reducing dependency by encouraging and supporting people to develop skills and capabilities
to do as much as possible for themselves.
• Maximising use of low level interventions, equipment, technology and adaptations that increase
independence and reduce the need for more intensive support.
• Maximising use of community and mainstream facilities and services that allow people to lead
as ordinary a life as possible.
• Closer collaboration of specialist health and social care services and integrated care and
support pathways.
• Improving access to primary and secondary health services.
• Improving support to those people whose behaviours challenge services, and through doing so
respond to the requirements of the Winterbourne View action plan.
• Improving the experience of people during the transition from children’s services to adult
services through developing an All Age Approach to commissioning learning disability services.
• Supporting family carers to care for their family members, and ensuring that they enjoy a good
quality life whilst maintaining their caring role.
5. Costs:
As this project focuses on establishing an integrated approach to commissioning learning disability
services through the establishment of an integrated commissioning board with new governance
arrangements a vast majority of the costs centre around officers providing their time to get the new
structures in place. There may also be legal costs relating:
Establishing the board;
Working through the governance arrangements;
Drafting and agreeing Partnership Agreements;
Working through the financial arrangements
The table below summarises the costs expected as part of this project.
A breakdown of the FTE for the project is demonstrated below along with associated costs.
Resource Opportunity /
New FTE Cost
Programme Manager Opportunity 0.1 None
Project Manager Opportunity 0.5 None
Workstream Leads Opportunity 5 None
CCG Clinical Leads Opportunity 1 None
SCF Lead Opportunity 0.1 None
Financial Specialist Opportunity 0.4 None
Policy and Strategy
Resource Opportunity 0.2 None
Communication and Opportunity 0.2 None
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 9 of 23
Resource Opportunity /
New FTE Cost
Engagement Resource
Commercial Lead Opportunity 0.1 None
Governance Lead Opportunity 0.1 None
HR Lead Opportunity 0.4 None
HRA Advice Lead Opportunity 0.2 None
Clinical Leads Opportunity 1.5 None
Legal Lead (In two
stages. The first relates to
legal advice in
developing integrated
commissioning
approach. The second
relates to legal advice
around procurement)
New 0.1 TBC
Financial specialist Opportunity 0.2 None
Total 10.1 TBC
6. Approach:
In establishing a single integrated commissioning approach to learning disability services in Essex, the
project will be divided into phases. This PID outlines the details relating to phase one, which will focus on
integrating the commissioning of adult learning disability services in the North CCG cluster and ECC. To
achieve this each workstream will explore what integrated commissioning means with regards to their
specific workstreams and then outline what will need to be done to develop an integrated
commissioning approach to Learning Disabilities. Later phases will explore the integration of learning
disability services in South Essex, and integrating children’s learning disability services within the
commissioning approach established in phase one.
Phase one will involve the establishment of a Learning Disabilities Executive Board to oversee the
running of the project. A project team will be established below this, comprised of a project manager
and a number of project leads. Each workstream lead will be tasked with setting up a project action
plan for each of the workstreams, detailing how they will deliver their deliverables over the period April
2013-14. They will then be expected to manage this plan. Workstream leads will be drawn from the
Working Age Adults Team (in ECC) and the NHS Essex Commissioning Support Unit.
The Executive Board will meet monthly to be kept up to date on the developments of the project. The
project team will meet twice a month to update the project manager on the progress made to date.
The workstreams for the programme are shown below along with a detailed description of the
approach for each.
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 10 of 23
Governance
(including
establishing
new board)
Structure
(including
human
resources)
Integrated
Commissioning
in practice
Contracting &
Commercial
LD Pathway
Strategies
Current
Contracts &
Commercial
arrangements
Information and
Data Sharing
Processes,
challenges,
governance and
approach
Integrated
Commissioning
Processes
Transition to
integrated
commissioning
Future
contracts &
commercial
arrangements
Joint Health and
Social Care
Strategy
User
Engagement
and
Communication
Communication
plan
Engagement
plan
Transforming Commissioning in
Learning Disabilities Project
Executive Board
Project Team
Financial
Arrangements
Design of what
the financial
arrangements
might look like
Current LD
budgets across
CCG Cluster
and ECC
Governance
Workstream
Deliverable
Needs Analysis
& Priorities for
Service
Transformation
Winterbourne Recommendations
Options
appraisal
Sign off of
whole approach
to integrated
commissioning
Sign off
(ECC/CCG
Governance)
including s151
Sign off by
ECC/CCG
Governing
bodies
Memorandum of
Understanding
signed
LD Self
Assessments
Strategies
This workstream will focus specifically on the production of ‘The Joint Health and Social Care Strategy for
people with Learning Disabilities’. It will also develop the Learning Disabilities Pathway for Integrated
Commissioning.
User engagement and communications
This workstream will aim to produce a user engagement and communication plan. This will
communicate the key changes as part of transition towards integrated commissioning and will ensure
that key stakeholders are engaged with.
The Winterbourne View Recommendations
This workstream will oversee the implementation of the recommendations from the Winterbourne View
action plan.
Integrated Commissioning in practice
The approach of this workstream is firstly to explore what integrated commissioning might look like
through an options appraisal. Once this is completed the next step is to adopt one of the approaches
and then to establish the structures, governance and working practices to support integrated
commissioning across North Essex. The workstream will establish a joint commissioning Executive Board
with governance arrangements and processes enabling it to commission joint services across the North
Essex Cluster. This will involve setting out the governance arrangements for this new approach to
commissioning, the priorities it will focus on as well as other areas including membership of the board,
how regular it will meet, and setting the legal basis for the partnership arrangements. This workstream
will explore whether there will be any human resource implications as part of the new structure. It will
also cover the sign off of the approach through ECC and CCG governance processes. A Memorandum
of understanding will also need to be signed before integrated commissioning can be delivered
Financial Arrangements
Through an option appraisal this workstream will explore what financial arrangements need to be put in
place to support Integrated Commissioning. Once a suitable option has been determined this
workstream will then set out the work that needs to be completed to put in place the financial
arrangements to support integrated commissioning. It will also cover the sign off of the financial
arrangements (including the s151 officer) through ECC and CCG governance processes.
Contracting and Commercial
This workstream focuses specifically on the commercial aspects of joint commissioning. It will look at the
current contracts and commercial agreements, map the timelines for each contract, and explore the
potential for efficiencies through joint commercial arrangements going forward. This will include the
development of an integrated Essex Market Position Statement for learning disability services.
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 11 of 23
Information and Data Sharing
This workstream will explore the information and data sharing challenges of integrated commissioning
including an establishment of a unified all age register, and will seek to put in place measures to ensure
that the new integrated commissioning approach adheres to all information and data sharing protocols
across Essex County Council and the North CCG Cluster. It will also establish the processes and
governance for the sharing of data across ECC and the North CCG Cluster. The deliverables in this
workstream will need to be signed of ECC and CCG governance bodies.
LD Self Assessments
This workstream will focus on aligning LD Self Assessments across CCGs and ECC
Project Plan:
The below project plan shows the key milestones and workstreams as well as the associated
deliverables.
The following deliverables and indicative timescales were agreed as part of the project: A Transforming Commissioning in Learning Disabilities Executive Board with representation
from CCGs and ECC (to be set up in shadow form from 1st May to oversee the project); Agreed governance arrangements and delegated decision-making mandates (to be
agreed by September 2013); A set of priorities for service transformation that reflect current local and national imperatives
(to be agreed by September 2013); An agreed and published joint health and social care learning disability strategy (to be
completed by September 2013); Completion of an options appraisal outlining the financial arrangements required to support
integrated commissioning where possible. The preferred option will need to be signed off by
both ECC and CCG governance processes(agreement in principle by September 2013 for
implementation by 1st April 2014) Joint arrangements for commissioning and contracting with health & social care providers
(by 1st April 2014)
A detailed project plan will be built following the completion of workstream action plans by each
workstream lead however a high level timeline has been included below outlining key milestones:
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 12 of 23
Workstream2013 2014
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Integrated Commissioning in
practice
Financial
Arrangements
Contracting and
Commercial
Strategies
Communication and Engagement
Plan
Information and
Data Sharing
Winterbourne Recommendations
LD Self Assessments
Other
Deliverables signed off
25/09/2013
25/09/2013
Deliverables
signed off
25/09/2013
Deliverable signed
off
25/09/2013
Deliverables
signed off
Key Milestone Key Milestone
31/03/2014
Implementation of
approach
31/03/2014
Implementation of
approach
31/03/2014
Future contractual
arrangements outlined
17/04/2013
PID Draft
completed
15/05/2013
First Exec
Board Meeting
25/05/2013
Key Exec
Board Meeting
01/04/2014
Go-live
01/06/2013
Review and person centred plan
31/03/2014
Strategy Developed
Key Milestone
29/11/2013
Governance sign off
29/11/2013
29/11/2013
29/11/2013
29/11/2013
Governance sign off
(including s151)
Governance sign off
Governance sign off
Governance sign off of entire
project by CCG/ECC governance
7.1 Scope – Inclusions:
The following areas are in scope of phase one of this project:
Adult learning disability services commissioned on behalf of the North Essex CCGs
Adult learning disability services commissioned and provided by ECC.
Learning disability services for younger people (14+) commissioned and provided by ECC.
Governance arrangements for Learning Disability services in both North CCGs and ECC
Processes relating to the commissioning/de-commissioning of Learning Disability services in both
North CCGs and ECC
Learning Disabilities information and data held by both North CCGs and ECC
The current Learning Disabilities priorities in both North CCGs and EEC
Financial arrangements for commissioning LD services in both North CCGs and ECC
Current North CCG/ECC partnership arrangements across North Essex
Learning disability strategies either published or in the process of being written in both North
CCGs and ECC.
The current Essex Market Position Statement.
Current User engagement and communications arrangements in both North CCGs and ECC.
Office accommodation and human resources involved in learning disability commissioning
across North CCGs and ECC.
The following areas will be in scope as part of the next phases for the project:
Adult learning disability services commissioned on behalf of the South Essex CCGs
Children’s learning disability services commissioned on behalf of the CCGs
7.2 Scope – Exclusions:
The following areas are not in scope of phase one of this project:
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 13 of 23
Learning Disability services commissioned on behalf of the South CCG Cluster (including services
commissioned by Thurrock and Southend CCGs). This includes contracts, grant agreements,
governance arrangements, processes, information and data, financial resources, partnership
arrangements, strategies, user engagement and communications.
Other services provided to adults by North CCG and ECC.
Learning disability services provided by Thurrock and Southend Councils.
8. Constraints:
Constraint Description of Constraint Owner
Time This project must be delivered by 1 April
2014
David Trousdale/Caroline Fryer
Resources
Neither ECC nor the North CCGs have
unlimited resources to deliver this project.
Resources must be managed carefully.
Resources refer both to the finances and
time of staff to run the project.
David Trousdale/ Caroline Fryer
Contractual
Arrangements
The North CCGs and ECC may be locked
into a number of contractual
arrangements with regards to the provision
of services. This may limit the ability to
integrate approaches to LD commissioning
Clare Morris/ Nick Presmeg
9. Assumptions:
Assumptions How will it be validated? By When By Who
The political will of both ECC and North
CCGs to integrate their commissioning
approaches.
Through formal
agreement of this PID by
the Executive Board
End of April
2013
Nick
Presmeg/Clare
Morris
There is potential for Efficiencies
Tracking of financial
expenditure once
integrated
commissioning approach
is in place. This will then
be compared to
financial expenditure
prior to integrated
commissioning approach
End of 2014
and on
going
Francis Ma/
Helen Chittock
Initial arrangements will be between
ECC and the North Essex CCG Cluster.
Discussions with the South Essex CCGs
will continue as the project progresses.
Through formal
agreement by the
Executive Board
End of May
2013
Nick
Presmeg/Clare
Morris
Commissioned CCG LD services for
children are outside the scope of this
project (ECC Children’s LD services from
14+ are, however, in scope)
Through formal
agreement of this PID by
the Executive Board
End of May
2013
David
Trousdale/
Caroline Fryer
Project resources are available to
support the project The Executive Board will
identify resources for the
End of May
2013 Nick
Presmeg/Clare
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 14 of 23
Assumptions How will it be validated? By When By Who
project Morris/ Phil
Stephens
10. Deliverables:
Workstream Deliverable Deliverable Description Owner Date
Integrated
Commissioning in
practice
Governance
arrangements
for the new
board
This deliverable outlines the
governance arrangements
for the new integrated
commissioning executive
board.
Steve Allen/
Steve
Thumpston
Sign off
25/09/13
Implementation
31/03/2014
Needs Analysis
& Priorities for
service
transformation
This deliverable will establish
the priorities for the
integrated commissioning
board. This will build on
current priorities and data
gathered through a needs
analysis.
Steve Allen/
Steve
Thumpston
Sign off
25/09/14
Transition to
Integrated
Commissioning
This deliverable sets out the
steps involved in combining
LD commissioning functions
in North Cluster CCGs and
ECC.
Steve Allen/
Steve
Thumpston
Sign off
25/09/13
Implementation
31/03/2014
Integrated
Commissioning
Structure
This deliverable sets out the
new structure of the
Integrated Commissioning
Executive Board including
who will sit on the board and
responsibilities of board
members.
Steve Allen/
Steve
Thumpston
Sign off
25/09/2013 then
implementation
31/03/2014
Integrated
Commissioning
Processes
This deliverable will focus on
the processes involved in
commissioning integrated
services for people with
learning disability.
Steve Allen/
Steve
Thumpston
Sign off
25/09/2013
Implementation
31/03/2014
Sign off of
overall
approach
Sign off of approach by ECC
and CCG governance
processes (including s151
officer where appropriate)
Steve Allen/
Steve
Thumpston
By 29/11/2013
Memorandum
of
Understanding
signed
Document signed ensuring
all partners buy into the
approach
Steve Allen/
Steve
Thumpston
By 29/11/2013
Financial
Arrangements
Options
appraisal
exploring
financial options
to support
integrated
commissioning
This deliverable will look at
what options exist to support
integrated commissioning,
including exploring risks and
benefits
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 15 of 23
Workstream Deliverable Deliverable Description Owner Date
Identification of
current LD
budgets
across North
CCG Cluster
and ECC
This deliverable focuses on
current budgetary
arrangements.
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
Design of what
financial
arrangements
will look like
This deliverable will focus on
how pooled budgets will
look like.
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
Plan for how
Financial
arrangements
will operate
when in place
This deliverable outlines how
pooled budgets will operate
and the transition to get
there.
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
Sign off of
approach
Sign off by ECC/CCG
governing bodies (including
s151 officer)
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
Memorandum
of
Understanding
signed
Document signed ensuring
all partners buy into the
approach
Francis Ma/
Helen
Chittock
Sign off
25/09/2013
Contracting and
Commercial
Current
contracts &
commercial
arrangements
This workstream will draw
together the current LD
contracts and commercial
arrangements in ECC and
the North CCG Cluster. It will
also look at opportunities to
commission services jointly in
the future.
Steve Allen
/Steve
Thumpston
Sign off
25/09/2013
Future contracts
& commercials
arrangements
This workstream focuses on
the future contractual and
commercial arrangements
for integrated
commissioning.
Steve Allen
/Steve
Thumpston
Implementation
31/03/2014
Strategies
Joint Health and
Social Care
Strategy
This workstream focuses on
writing the Joint Health and
Social Strategy.
Steve Allen
/ Steve
Thumpston
& Francis
Ma
Sign off
25/09/2013
LD Pathway
This deliverable will set out
the new LD Pathway for
integrated commissioning of
LD services for Service Users
in the North Essex Cluster
and ECC.
Steve Allen
/ Steve
Thumpston
& Francis
Ma
Sign off
25/09/2013
User engagement
and
communication
Communication
plan
This workstream sets out how
integrated commissioning
will be communicated to
Service Users and key
partners.
Chris Gee
Sign off
25/09/2013
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 16 of 23
Workstream Deliverable Deliverable Description Owner Date
Engagement
plan
This workstream sets out who
will be engaged with as the
North Cluster and ECC move
towards integrated
commissioning.
Chris Gee
Sign off
25/09/2013
Information and
Data Sharing
Information and
Data Sharing
processes,
challenges,
governance
and approach
This workstream will set out
the processes, governance
mechanisms and challenges
for sharing information and
data between the North
CCG Cluster and ECC.
Phil Brown /
Francis Ma
Sign off
25/09/2013
Sign off of
Information and
data sharing
approach
Sign off by ECC/CCG
governing bodies
Phil Brown /
Francis Ma
Sign off
25/09/2013
Winterbourne
View Actions
The required
actions in the
Winterbourne
View action
plan are
completed on
time.
These actions include:
All people with learning
disabilities in in-patient
services have a review and
person centred plan by
June 1st 2013.
All people who no longer
need in-patient services are
supported to move to local
community based services
by 1st June 2014.
Local authorities and CCG’s
have developed a strategy
for people with behaviours
that challenge services by
March 31st 2014. This strategy
should include a market
development strategy to
develop appropriate local
solutions.
Steve
Thumpston /
Phil Brown
June 1st 2013
June 1st 2014
March 31st 2014
11. Key Milestones:
Milestone Description of Milestone Owner Date
Initial Project Meeting This milestone marks the initiation
of the project
David
Trousdale/
Caroline Fryer
09/04/2013
Project Initiation Document first
draft
This milestone will mark the
completion of the first draft of
the PID
David
Trousdale/
Caroline Fryer
17/04/2013
Initial Transforming
Commissioning in Learning
Disabilities Executive Board
Meeting*
This milestone will involve the
sign off of the approach to
integrated commissioning and
give the ‘green light’ for the
project to progress
Clare Morris/
Nick Presmeg 15/05/2013
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 17 of 23
Milestone Description of Milestone Owner Date
All people with learning
disabilities in in-patient services
have a review and person
centred plan
N/A
Steve Allen,
Steve
Thumpston
1/06/2013
Options appraisal exploring
financial arrangements to
support integrated
commissioning
N/A Francis Ma/
Helen Chittock
Sign off
25/09/2013
Engagement Plan signed off N/A Chris Gee
Sign off
25/09/2013
Communication Plan signed off N/A Chris Gee
Sign off
25/09/2013
First draft of an agreed joint
health and social care learning
disability strategy
This milestone will mark the
completion of the agreed joint
health and social care learning
disability strategy
Steve Allen/
Steve
Thumpston &
Francis Ma
TBC
Needs Analysis completed N/A
Steve Allen/
Steve
Thumpston &
Francis Ma
TBC
Integrated Commissioning LD
Pathway
This milestone will mark the sign
off of the Integrated
Commissioning LD Pathway
Steve Allen/
Steve
Thumpston &
Francis Ma
TBC
Information and Data Sharing
processes, approach and
governance paper signed off
N/A Phil Brown /
Francis Ma
Sign off
25/09/2013
Document outlining Priorities for
Service Transformation signed off N/A
Steve Allen /
Steve
Thumpston &
Francis Ma
Sign off
25/09/2013
Document outlining new
governance arrangements and
delegated decision-making
mandates for April 2014 onwards
This milestone will mark the
completion of the first draft of
the documentation outlining
new governance arrangements
and delegated decision-making
mandates for April 2014 onwards
Steve
Allen/Steve
Thumpston
Sign off
25/09/2013
Design of integrated
commissioning structure
completed
N/A
Steve
Allen/Steve
Thumpston
Sign off
25/09/2013
Integrated Commissioning
business processes outlined in
document
N/A
Steve
Allen/Steve
Thumpston
Sign off
25/09/2013
Identification of current
contractual and commercial
arrangements completed
N/A
Steve Allen
/Steve
Thumpston
Sign off
25/09/2013
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 18 of 23
Milestone Description of Milestone Owner Date
Transforming Commissioning in
Learning Disabilities Executive
Board Meeting*
This milestone will involve sign off
of above documents including:
governance arrangements
and delegated decision-
making mandates
set of priorities for service
transformation that reflect
current local and national
imperatives
approach to financial
arrangements where
possible with appropriate
governance
an agreed and published
joint health and social care
learning disability strategy.
This milestone will mark a critical
point in the project as it will act
as a ‘green light’ to start rolling
out integrated commissioning. It
will involve the actioning of the
various documents signed off at
this meeting
Clare Morris /
Nick Presmeg 25/09/2013
Overall sign off of Integrated
commissioning approach by
ECC and CCG governing bodies
(including CLT, Cabinet and
s151)*
This includes sign off of key
deliverables as part of all
workstreams
Clare Morris /
Nick Presmeg
By
29/11/2013
Signing of Memorandum of
Understanding* N/A
Clare Morris /
Nick Presmeg
By
29/11/2013
Joint arrangements for
commissioning and contracting
with health & social care
providers in place
This milestone will mark the
finalisation of joint
arrangements for commissioning
and contracting with health
and social providers
Clare Morris /
Nick Presmeg 1/04/2014
Local authorities and CCG’s
have developed a strategy for
people with behaviours that
challenge services
N/A
Steve Allen/
Steve
Thumpston &
Francis Ma
31/03/2014
Completion of transition to
integrated commissioning and
Go- live*
This milestone marks the
beginning of integrated
commissioning
Clare Morris /
Nick Presmeg 1/04/2014
All people who no longer need
in-patient services are supported
to move to local community
based services
N/A Clare Morris /
Nick Presmeg 1/06/2014
*Bold text mark critical milestones which must be reached for the project to be a success.
12. Stakeholders:
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 19 of 23
Stakeholders (Named)
Clare Morris – Chief Officer for West Essex NHS CCG and Joint Chair of Executive Steering Group
Nick Presmeg – Commissioning & Delivery Director - North East Essex and Joint Chair of Executive Steering Group
Phil Stephens – Programme Manager – Integrated Commissioning
Steve Allen – Senior Commissioning Manager for Working Age Adults, ECC
Phil Brown – Commissioning Manager for Working Age Adults
Stephen Thumpston – Transition Project Manager, Learning Disabilities, NHS Central Eastern
Commissioning Support Unit
Francis Ma - Transition Project – LD Transformation Project Lead, Mental Health and Learning Disabilities
Team, NHS Central Eastern Commissioning Support Unit
Peter Tempest – Programme Director – Adults, Health and Community Wellbeing
Miranda Roberts – LD Clinical Lead (West Essex CCG)
Iain Tweedlie – LD Clinical Lead (Mid Essex CCG)
Mark Roberts – LD Clinical Lead (North East Essex CCG)
Caroline Dollery - CCG Regional Lead for Managed Clinical Network
Alexina Weston – Quality Lead for LDMH
Barbara Herts – All Age Lead
Helen Chittock – Finance Lead
Helen Terry – Strategy Lead
Rob Field – Communications and Engagement Lead
James Wilson – Commercial Lead
HR Lead - TBC
Joanna Killian – Chief Executive - ECC
Dave Hill – Executive Director for Schools, Children and Families
Sally Burton – Interim Director for Adult Social Care
Margaret Lee – Executive Director for Finance
Stakeholders (Unnamed)
Lead LD Nurses
People with learning disabilities and their carers
HealthWatch
ECC Councillors
Senior Managers across Mid, North and West CCGs
13. Dependencies:
Dependency description Owner Type (Inward
or Outward)
Transformation MKII David Trousdale/
Caroline Fryer Inward
ECC’s All Age approach to commissioning David Trousdale/
Caroline Fryer Inward
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 20 of 23
Dependency description Owner Type (Inward
or Outward)
Wider work on integrated commissioning Clare Morris/ Nick
Presmeg Inward
Department of Health action plan around Winterbourne Steve Allen and
Clare Morris Inward
LD services provided to adults and children by ECC and to adults
by the North Cluster CCGS
David Trousdale/
Caroline Fryer Outward
14. Key Risks:
Key Risks Risk description Owner
Financial arrangements
There are a range of risks around whether both the
CCGs and ECC have the appetite to adopt new
financial arrangements around integrated
commissioning when there are major pressures on
the budget currently.
Francis Ma/ Helen
Chittock
Political will of CCGs and
ECC to integrate
commissioning
There is a risk that both the North CCG cluster and
ECC lose the appetite to integrate LD services
Nick Presmeg/
Clare Morris
Additional financial
pressures arising from the
action plan for
Winterbourne View
There are 23 people from North Essex funded by the
Specialist Commissioning Group (SCG) that currently
live in in-patient services of which 10 have been
identified as no longer requiring in-patient services.
There is a high financial risk to the partnership if the
funding for these people does not transfer to the
CCG’s / local authority.
Nick Presmeg/
Clare Morris
The Winterbourne View
Recommendations are
not fully implemented
There is the risk that there may not be sufficient local
resources to meet the needs of those people who no
longer require in-patient services to ensure people
are discharged by the 1st June 2014. There is also a
risk around the financial implications of Winterbourne
as described above.
Nick Presmeg/
Clare Morris
Transformation MkII means
that it is not clear where
LD services will sit in ECC
once it has been
transformed or who will be
managing LD services
The ECC restructure might result in a change of
personnel which would impact on the current
established working relationships.
Nick Presmeg
Resourcing the project The resources are not available (in terms of man
power) to support the project going forward
Nick Presmeg/
Clare Morris
Partners do not sign-up to
the ‘lock-in’ contracts for
the project
Partners may not want to lock in to long term LD
contracts
Steve Allen/ Steve
Thumpston
Partners withdraw if the
suggested benefits do not
accrue
There are a number of suggested benefits which
may not materialise due the complex nature of the
work programme.
Clare Morris/ Nick
Presmeg
15. Key Issues:
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 21 of 23
Key Issues Description of Issue Mitigating Factor Owner
It is difficult to
demonstrate the cost-
benefits of integrated
commissioning
The cost benefits of
integrated commissioning
are complicated and may
not be easy to evidence
Set out a clear plan for
cost-benefit analysis at
the start of the project
showing how evidence
will be gathered.
David Trousdale/
Caroline Fryer
16. Governance:
The governance for this project is outlined below:
Transforming Commissioning in
Learning Disabilities Project
Executive Board
Decision Making
Process
Delivery
of Project
Project Team
Health and Wellbeing Board Business Management
Group
ECCGovernance
Mid
CCG Governance
North
CCG Governance
West
CCG Governance
Health and Wellbeing Board
Learning Disabilities
Partnership Board
Key decisions for the Transforming Commissioning in Learning Disabilities Project are made by the
Transforming Commissioning in Learning Disabilities Project Executive Board. These decisions are then
signed off by the Health and Wellbeing Business Management Group which feeds into the Health and
Wellbeing Board, and by the individual organisations involved in the partnership. Navigating the
governance in both the CCGs and ECC will be the responsibility of lead officers from the various
organisations. Throughout the project the Learning Disabilities Partnership Board will be involved in
helping shape the integrated commissioning approach.
17. Communications/Engagement:
Communication and engagement will take place through existing LD partnership board. The
communication and engagement plans will be developed as part of the project
18 Roles & Responsibilities
Name Role Amend/delete as
appropriate Responsibilities
Clare Morris/ Nick
Presmeg
Project Sponsors
(and Joint Chairs)
Setting the project vision, chairing the Executive Board,
Has overall responsibility for project success
David Trousdale/
Caroline Fryer Project Manager/s
Responsible for managing the project and ensuring it is
delivered on time and on budget
Phil Stephens Programme
Manager –
Integrated
Responsible for providing strategic direction and
ensuring the project aligns to the overarching integrated
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 22 of 23
Name Role Amend/delete as
appropriate Responsibilities
Commissioning commissioning approach
Steve Allen/ Steve
Thumpston
Workstream Lead
(Integrated
Commissioning in
Practice)
Responsible for delivering the Integrated Commissioning
Workstream
Francis Ma/ Helen
Chittock
Workstream Lead
(Financial
Arrangements)
Responsible for delivering the Workstream
Steve Allen / Steve
Thumpston, Francis
Ma
Workstream Lead
(Strategies) Responsible for delivering the Strategies Workstream
Steve Allen/ Steve
Thumpston
Workstream Lead
(Contracting and
Commercial)
Responsible for delivering the Contracting and
Commercial Workstream
Chris Gee
Workstream Lead
(User Engagement
and
Communications)
Responsible for delivering the User Engagement and
Communication Workstream
Phil Brown/ Francis
Ma
Workstream Lead
(Information and
Data Sharing)
Responsible for delivering the Information and Data
Sharing Workstream
Steve Thumpston/
Phil Brown
Workstream Lead
(Winterbourne) Responsible for delivering the Winterbourne Workstream
Chris Gee
Workstream Lead
(LD Self
Assessments)
Responsible for delivering the LD Self Assessments
Workstream
Miranda Roberts LD Clinical Lead
(West Essex CCG)
Responsible for representing the West Essex CCG
throughout the project and at Executive Board Meetings
Iain Tweedie LD Clinical Lead
(Mid Essex CCG)
Responsible for representing the Mid Essex CCG
throughout the project and at Executive Board Meetings
Mark Roberts LD Clinical Lead
(North East Essex)
Responsible for representing the North East CCG
throughout the project and at Executive Board Meetings
Caroline Dollery
Regional Lead for
Managed Clinical
Network
Responsible for providing SME knowledge throughout the
project
Alexina Weston Quality Lead for
LDMH
Responsible for providing SME knowledge throughout the
project
Peter Tempest
Programme
Director – Adults,
Health and
Community
Wellbeing
Responsible for providing SME knowledge throughout the
project
Barbara Hetrs All Age Lead Acting as the link with SCF and responsible for providing
SME knowledge throughout the project
Helen Chittock Finance Lead Responsible for providing financial advice throughout
PID: Transforming Commissioning in Learning Disabilities
Transforming Commissioning in Learning Disabilities v0.6
Page 23 of 23
Name Role Amend/delete as
appropriate Responsibilities
the project
Helen Terry Strategy Lead Responsible for providing SME knowledge throughout the
project
Rob Field
Communication
and Engagement
Lead
Responsible for providing SME knowledge throughout the
project
James Wilson Commercial Lead Responsible for providing SME knowledge throughout the
project
TBC Governance Lead Responsible for providing advice on the governance
process
TBC HR Lead Responsible for providing HR advice throughout the
project
TBC HRA Advice Lead Responsible for providing HRA advice throughout the
project