NHS Thurrock Clinical Commissioning Group Operational Plan

Transcription

1 NHS Thurrock Clinical Commissioning Group Operational Plan

2 Contents Executive Summary... Error! Bookmark not defined. Operational Plan Must Dos... 4 Our Commitment... 6 Transformation Plan and Integration... 7 Financial Plan Standards and Outcomes Prevention and Early Intervention Improving Quality and Experience Enquiries about this plan should be directed to: NHS Thurrock CCG, Civic Offices, 2nd Floor, New Road, Grays, RM17 6SL Mandy Ansell, (Acting) Interim Accountable Officer mandy.ansell@nhs.net Ade Olarinde, Chief Finance Officer ade.olarinde@nhs.net Jane Foster-Taylor, Chief Nurse jane.foster-taylor@nhs.net 2

3 Executive Summary Our Vision Statement - The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together - has never been more salient than it is at the moment. We know that we operate within one of the most challenged health and social care economies in the country. We therefore remain committed to working collaboratively with stakeholders to improve the quality of care for the people of Thurrock. The key to success in 2016/17 will be ensuring that our local vision runs through the many layers of transformation. The health and care system is faced with challenging financial, quality and demand pressures. Our main acute hospital provider, Basildon and Thurrock University Hospitals NHS Foundation Trust (BTUH), posted a significant financial deficit in 15/16. This is replicated across Essex with both providers and commissioners facing difficult financial choices. The challenges are not limited to health. The Local Authority has also had to deliver significant savings in social care and public health expenditure. The system has struggled to make sustained improvements on key targets such as A&E, Ambulance, Psychological Therapies and Cancer. Finally, we need to plan for the fact that demand is growing as the population of Thurrock grows and gets older. The Five Year Forward View asked systems to produce a five year Sustainability and Transformation Plan (STP). Within mid and central Essex, our STP will be the Essex Success Regime (ESR) plan. This is a national support programme to help the most challenged health systems in the country. The ESR has brought together the system leaders across this area to create a whole system plan to enable organisations to deliver high quality care for patients, reduce local health inequalities and deliver financial balance by 18/19. This is therefore both a challenging and exciting opportunity to really make a difference. We are keen to ensure that Thurrock people are at the heart of our commissioning. This is why we are working with our Local Authority colleagues to embark on an ambitious piece of work to ensure health and care services are integrated, by being co-located or delivered jointly, and we develop neighbourhood based enhanced primary care delivered from purpose built facilities and buildings. We will continue to ensure that the patient voice is at the centre of our commissioning decisions and that robust engagement with our citizens, stakeholders, partners and providers runs throughout all of our transformation work. This Operational Plan shows that we are being extremely ambitious and this will require careful financial planning to ensure that we deliver within our financial means. We are particularly proud of the fact that we have consistently delivered our financial targets within the challenging health landscape that we find ourselves in. Many other CCGs are not in the same position. As Thurrock CCG we understand the challenge that is faced in Essex and pride ourselves on our ability to work effectively with partners to deliver change at pace. Dr Anand Deshpande, Chair, NHS Thurrock Clinical Commissioning Group 3

4 Operational Plan Must Dos Develop a high quality Sustainability and Transformation Plan the mid and central Essex system is one of three areas in the country which are part of a national Success Regime programme. The Success Regime Plan will be the Sustainability and Transformation Plan for mid and central Essex. We have collaborated with the Success Regime team to develop a system plan to improve the Essex health and social care system. Section One of this Operating Plan describes our Transformation Plan. System Aggregate Financial Balance We have a strong track record of delivering financial balance and Section Two of this plan shows how we will continue to do so in 16/17. However, we recognise that the Essex system is not in aggregate balance. Therefore we will work with the Success Regime to co-ordinate efforts to deliver aggregate financial sustainability. Sustainability and Quality of General Practice Section Two of this plan includes our transformation plans for General Practice. Thurrock is recognised as having poor access to primary care due to the low numbers of doctors and practice nurses in the area. The plan therefore focusses on a number of key issues including developing the Primary Care estate, delivering extended access, developing the out of hospital service model (Multispecialty Community Provider MCP), and supporting practices for Care Quality Commission/Local Enhanced Service delivery, and workforce issues. Access Standards and Ambulance delivering the access standards has been challenging despite on-going system wide plans. Section Three shows how the System Resilience Group is planning to support delivery of the A&E targets. This includes the trajectories for delivering targets from April We continue to work with system colleagues through the Ambulance Improvement Board to deliver the ambulance improvement trajectory. The Essex locality is considering the business proposals from EEAST to formalise the use of Hospital Ambulance Liaison Officers (HALOs) and the Intelligent Conveyance Pilot, or whether there should be other proposals to support Ambulance turnaround and reduce delays. Referral to Treatment (RTT) delivering the RTT targets continues to be challenging. Section Three describes our achievements to date, our approach to managing the performance and the trajectory to recover this position by May Day Cancer Waiting Standards our aim is to improve early detection and timely treatment within waiting times standards. We have completed a Cancer Deep Dive to fully understand the causes of the current performance and to help us work across the system to bring performance back on track. The Thurrock Cancer Action Plan will focus on a system wide approach to improving cancer outcomes. For example, we are working with our GP colleagues to roll out the e-referral system; we are working with our BB CCG colleagues regarding performance management of BTUH pathways and are keen to work with the ESR on the intra-trust issues. Mental Health Access Standards Thurrock continues to perform well on the dementia diagnosis target. Section Three shows how we are working with South Essex Partnership Trust (SEPT) on new mental health targets to agree 4

5 trajectories. We have also recently re-procured our psychological therapy service (IAPT) and are looking forward to working with our new provider in 16/17. Transform Care for People with Learning Disabilities the Essex system has formed a Transforming Care Partnership board to lead this agenda. We have submitted our plans to NHS England. Our aims are to reduce the need for inpatient services to within the agreed framework over the next three years. From April 2016, we will enter into co-commissioning arrangements with NHS England to deliver Learning Disability Health checks to ensure the percentage delivered is in the upper quartile for England. Improvements In Quality Section Five shows how we will continue to drive local improvements in quality through the commissioning agenda. From April 2016, we will have an in house Continuing Health Care (CHC) service that will allow for enhanced collaboration with the Local Authority in the support of patient care and management. 7 Day a Week Working - we have applied a local CQUIN to the main acute provider, Basildon Hospital for 15/16, focusing on four of the 10 NHS England clinical standards and will continue to expand 7 day a week services in 2016/17. Improvements in community 7 day services is a key focus of our 16/17 Better Care Fund. 5

6 Delivering against Our Five Commitments Our first Five Year Strategic Plan ( ) set out five commitments. We have made excellent progress against these and will continue to take these forward as part of this Operational Plan, in tandem with the Success Regime. Commitment 1: Ensuring that citizens are able to engage and be included in all aspects of service design and change, and that patients will be fully empowered in their own care through avenues such as the Commissioning Reference Group and our relationship with Healthwatch Thurrock. Progress: The Commissioning Reference Group (CRG) remains a key forum to have meaningful engagement with local stakeholders on service redesign and change. The CRG is chaired by one of our Lay Board Members, ensuring direct access to our decision makers. We continue to actively work with Healthwatch including on local engagement For Thurrock in Thurrock and our Health and Wellbeing Strategy. Commitment 2: Wider primary care provided at scale that will be developed through the Primary Care Strategy. Progress: We have made significant progress towards delivering wider primary care provided at scale. We have developed four primary care hubs which now offer 7 day a week primary care access. Our primary care strategy is well developed and detailed within Section One: Transformation. We have invested in a primary care development team to support practices to prepare for CQC and ensure good quality locally enhanced services. Commitment 3: A modern model of integrated care through the strong partnership working with the Council embedded in the Better Care Fund and as evidenced by integrated models thus far developed e.g. RRAS (Rapid Response and Assessment Service). Progress: We have further developed our integrated models including (RRAS) and the Joint Reablement Team. We have secured an 18 million joint fund with Thurrock Council to enable further integration. In the first year of this pooled fund, we delivered a 3.2% reduction in non-elective admissions to Basildon Hospital. Commitment 4: Access to the highest quality urgent and emergency care. We work in partnership with Basildon and Brentwood CCG and North East London Foundation Trust to ensure that the 7 day urgent and emergency care services are integrated into those pathways that support the local community needs. Progress: some progress has been made towards 7 day a week services within BTUH and the local community. However, high quality urgent and emergency care remains challenging for the Essex healthcare system. For example, A&E performance against the A&E hour standard remains difficult. Commitment 5: A step-change in the productivity of elective care through the development of innovative pathways e.g. musculoskeletal care, and ambulatory emergency care. Progress: We have a new musculoskeletal care service which is able to provide a more comprehensive service offer. In addition, we have set up an ambulatory care service within Basildon Hospital which is focussed on reducing non-essential hospital admissions. 6

7 Section one: Transformation Plan and Integration

8 Transformation overview We understand that our plans for service transformation have to be robust and match the scale of the task before us. Our transformation plan will need to deliver quick wins as well as long term solutions. In 15/16, we delivered a 3.2% reduction in non-elective admissions. In 16/17 and beyond we are building on this success by investing more into community services and prevention. Within the Better Care Fund we have set ourselves targets to further reduce non-elective admissions, reduce residential placements, increase the effectiveness of re-ablement, reduce delayed transfers of care and reduce A&E attendances. We have an excellent relationship with our local authority colleagues, with a growing number of services being co-located or jointly delivered. Our Thurrock vision is based on our ambition to support good quality neighbourhood-based enhanced primary care, delivered from purpose built estates. As we are part of the Essex Success Regime (ESR) plan, we will not have to develop a separate Sustainability and Transformation Plan. The ESR plan will show how we will meet our challenges over the next five years. In 16/17 we are focussed on ensuring that our organisation can work effectively through the different layers of planning whilst keeping true to our original mission statement. We will ensure that patients are central to our transformation plans. As our patients sit at the heart of our commissioning work, they will also be fully involved in our transformational plans as described in our on-going engagement plan. The Essex Success Regime is a huge opportunity to address the entrenched systemic problems such as the financial deficits and A&E performance. Equally, the new model of care for people with learning disabilities requires an Essex planning footprint so that we can ensure the full range of services are available for this group of people. We have therefore organised Section One of our Operating Plan into three headings: Our Thurrock Transformation For Thurrock in Thurrock Essex Success Regime Transformation plan Essex Wide Transformation We recognise that there is overlap and interconnectivity between the layers of transformation. The diagram below is a visual representation of the interconnected and overlapping work streams which form the Thurrock Transformation Priorities. 8

9 Our transformation plan is underpinned by the Thurrock JSNA which has identified that we need: 1) Improvements in our Primary Care Offer a. Thurrock as a whole is under-doctored, particularly in the areas of Tilbury and Purfleet. Patients find it difficult to get an appointment. This is thought to be having an impact on the use of Accident and Emergency services where we estimate that significant amounts of activity could be more appropriately dealt with in a primary care setting. b. Development of the Primary care workforce could help to relieve some of this pressure by redistributing the workload of GPs to more appropriate professionals (such as pharmacists and physiotherapists), freeing up GP time for patients who need a clinical assessment and who may otherwise use A&E. c. Have a more pro-active approach in the clinical management of patients with long term conditions in order to reduce unplanned activity in secondary care. 2) Thurrock has an ambitious regeneration plan which includes the building of new homes. We expect that with this will create increased population with different health needs. Anything that we plan now needs to: a. Have the ability to grow with our population. b. Have the ability to be flexible, so that we can meet the changing needs of our population. 3) More integrated services and patient pathways to make efficiencies and deliver a more sustainable health and social care system. 9

10 For Thurrock in Thurrock Model Description of the New Model of Care For Thurrock in Thurrock is an ambitious programme of work to align its health and care system vision for older people with the primary care transformation programme already underway. It will involve changing the way we currently plan and buy services, how we manage that process, who we buy it from, and how we make that happen. The programme of work largely sits within our Better Care Fund as we are delivering most of the work in partnership with our Local Authority colleagues. Our patients find the current system overwhelmingly complex and we aim to address this by bringing care closer to home by developing locality (neighbourhood) based integrated community health and care teams which will be extended and enhanced to increase current staff numbers and to provide a wider skill mix to enable care closer to or at home whenever it is clinically possible. Our vision for the future The work plan involves a number of interconnecting elements or work streams which come under the umbrella of our For Thurrock in Thurrock banner: New Models of Care Intermediate Care Primary Care Transformation 10

11 Thurrock estates plan Better Care Fund and service integration Information and Communications Technology (ICT) strategy Underpinned by our Engagement Plan New models of Care The NHS England s Five Year Forward View invites local systems to propose co-creating new models of care and organisation locally. The document identifies (but does not limit us to) four possible models: Multispecialty community providers (MCPs), including a number of variants Integrated primary and acute care systems (PACS) Additional approaches to creating viable smaller hospitals. This may include implementing new organisational forms such as specialist franchises and management chains Models of enhanced health in care homes. Our model of care, whilst not designed specifically as such, does predominantly match the makeup of a Multispeciality Community Provider (MCP) and as such organically take us into the realms of the types of models currently being tested through the national vanguard sites. Under this new model of care outlined in the Five-Year Forward View, groups of practices would expand bringing in nurses and community health services, hospital specialists and others to provide integrated out of hospital care. These practices would shift the majority of outpatient consultations and ambulatory care to out of hospital settings. Over time, these providers might take on delegated responsibility for managing capitated NHS budgets (or combined health and social care budgets) using a place based commissioning model to commission outcomes based services for their registered patients. 11

12 This model also offers the opportunity to reduce the number of contracts and thereby, the associated administration, monitoring and management costs incurred in keeping them on track. Whilst we are still in the early stages of our journey to developing an MCP we recognise that an Accountable Care Partnership may offer the right vehicle to help us get there in a more collaborative way. Accountable Care Partnerships are new organisational forms, which integrate care around patients - and are accountable for the delivery and quality of that care. The partners include a range of providers working together to develop new ways of integrated working, governed by a form of partnership agreement. Within this model, each partner organisation retains their own identify, autonomy and governance, but agrees to work in partnership to achieve a desired outcome. For us, the first step to progressing this approach would be to establish the basic legal framework for an ACP and to decide the detail of what sits within that framework. This would give time to build trust and to work through any problems, before developing into a full MCP. Better Care Fund and Health and Social Care Integration In 15/16, along with Thurrock Council we set up a single pooled fund to support the integration of health and social care. The Better Care Fund (BCF) has been very successful. In Thurrock, we achieved 3.2% reduction in nonelectives in Q1-3. The BCF is built on excellent working relationships with our co-terminus Local Authority colleagues. We have formalised the governance of the management of the fund by establishing an Integrated Commissioning Executive (ICE) with respective senior leadership overseeing the implementation and execution of the fund and the projects it contains. The ICE formally reports into the Health and Wellbeing Board at regular intervals. We are committed to improving identification of patients at risk of non-elective episodes of care; aiding the development of a provider landscape that realises improved reporting and referral and interfaces with all tiers of health and social care provision. Together with the Local Authority we continue to review integrated health and social care data opportunities; including information architecture and patient consent to facilitate future reporting requirements. In 16/17 the value of the BCF will be 18m. We will be taking forward four key projects: Out of hospital community integration see New Models of Care (page 9). This project aims to improve the risk stratification, multi-disciplinary reviews and care co-ordination of our most vulnerable patients. We are aiming to align all parts of the health and social care system to prioritise this objective. Therefore this objective also forms part of our GP incentive scheme and contract negotiations with providers. Delayed transfer of care plan one of the new objectives for the BCF in 2016/17 will be further reduce delayed transfers of care. Intermediate Care Review (see below). We will lead this project in partnership with Thurrock Council. Integrated Data Set (agreed by ICE) working to develop integrated data set to support strategic planning. 12

13 We see our transformation programme For Thurrock in Thurrock being the vehicle through which the BCF will be delivered. Therefore to support the model outlined above our transformation plan includes significant investment from the BCF (approved by our Integrated Care Executive (ICE), to enhance locality based Integrated Community Teams (ICTs) and to build additional capacity and capability across our 4 localities. The investment in the enhanced ICTs includes additional dementia nurses, community carers/support workers, additional Physio and OT support to enhance MDTs, additional medical cover to facilitate 7 day admission and discharge, consultant psychiatrist/pharmacy input (and to care homes), and stronger links to local area coordinators (LACs) and our community hubs through more defined 'social prescribing type' links between our practices and local VSOs. The enhanced ICT will include community, mental health and local authority staff members working in partnership to deliver a joined up service, which will be co-located within Thurrock. This additional capacity and capability will help build the foundations of our integrated locality model albeit on a virtual basis until the new healthy living centre buildings are complete. We are working on the basis that the enhanced community solution will be in place by September 2016 and will be refined over time as the blueprint for each of the respective integrated Healthy Living Centres (Tilbury/Purfleet) are firmed up. We are also, through the BCF, increasing our support to care homes. We have completed a deep dive to understand the most problematic areas. Currently the pressures in the system from the Acute Hospital are around delayed transfers of care andhigh admissions from care & residential homes. In Thurrock our DTOC levels are very low. We are, nonetheless, working jointly with our local authority to improve these levels through our DTOC plan set out within the BCF. This includes: Jointly commissioning 5 additional beds in a care home Agreeing a pathway for discharge to assess Supporting care homes out of hours to facilitate admission July specialist dementia NHS care home beds will be available for South Essex To prevent admissions:- Developing a Care Home support service Developing a Falls prevention service Increasing community pharmacy support to increase capacity to undertake medication reviews for the frail elderly Increasing RRAS support for crisis Redesigning the community geriatrician role to support the new mode of care Mental Health and Physical Health nurses to support & deliver education to the workforce to include IV fluids Whilst there are no formal plans for devolution in 16/17, we continue to progress towards greater integration through joint working and joint investments. The issue of further integration and devolution will be further explored through the STP process. 13

14 Intermediate Care Review Our vision is based on shifting patient flows into appropriate beds (clinically), where a bed is needed, and into the right environment to meet each patient s needs (a key factor of good quality care for people with dementia or challenging behaviour). Where a bed is not the best solution in helping to maintain independence and wellness, patients will be given support, by neighbourhood (locality based) integrated health and care community teams. These teams will provide the right care, in the right place, at the right time, every time. This new care model will be facilitated by existing community health and care teams which will be developed and enhanced to increase capacity and capability to provide a wider skill mix to enable the ethos and delivery of care closer to or at home whenever clinically possible. Map of south west Essex Before top image Thurrock adults who do not need to be in a hospital bed, but are not fit to be discharged home (intermediate care) can find themselves in any one of six locations across south west Essex. After lower image The first phase of the transformation programme will involve moving Thurrock intermediate care provision, which is currently spread across six locations in south west Essex, to provide it on a Thurrock-only basis For Thurrock in Thurrock, making the best use of existing Thurrock resources. Primary Care Transformation The cornerstone of the For Thurrock in Thurrock vision is good primary care. Thurrock has had a number of quality issues within primary care during 2015/16. Several practices have received poor Care Quality Commission (CQC) ratings. Major concerns have focussed on the Tilbury area. Tilbury has a very low number of GPs per head of population. As a response, we have been working with NHS England to develop a plan to transform primary 14

15 care in this locality. Whilst we do not wish to take on Co-commissioning responsibility of primary care in the near future we are committed to work alongside NHSE to help deliver their future primary care commissioning intentions for Thurrock and ensure it aligns withour wider commissioning and transformational plans. In 15/16 we have: Developed four primary care health hubs which are helping to deliver 7 day a week primary care access to patients. Developed a new IT system to improve booking into the new health hubs. Supported NHS England to re-procure a number of practices where GPs have retired. Developed a Joint Strategic Needs Assessment (JSNA) for Tilbury and Purfleet (Grays and Corringham to follow) incorporating all elements of health care including mental health Begun planning with the Local Authority to build two new primary care healthy living centres. Following a consultation, decommissioned the walk in centre in Grays because it was not offering an equitable service to the Thurrock population. Developed a CCG primary care development team to focus on quality and governance support to practices in preparation for the forthcoming Locally Enhanced Services - Any Qualified Provider (AQP) process. Achieved 100% sign up to the End of Life Gold Standards Framework. 15

16 In 16/17 we have ambitious plans to further develop primary care. We will: Work with primary care in the development of the Multispecialty Community Provider (MCP) model. We will bring system leaders from across health and social care to develop new ways of providing and commissioning health and social care (known as a structured dialogue process). Along with patient engagement, develop the blueprint for the new Tilbury independent living centre and take this though the planning process. Develop the primary care health hubs and improve links with NHS 111 to ensure the hubs are fully utilised. Develop the primary care workforce. Re-procure our Local Enhanced Services (LES). Improve primary care led risk stratification, primary care Multi-Disciplinary Teams (MDT) and the integration of care for the most vulnerable patients in Thurrock. Explore potential for use of technology to support access to primary care advice and support. Develop the primary care workforce, by ensuring the security of supply of the local health and care workforce providing NHS funded services and supporting national workforce priorities through work with Health Education England (HEE) and Local Education and Training Boards (LETB). This includes: o o o o Workforce planning and identifying local priorities for education and training. Holding and allocating funding for the provision of education and training. Commissioning education and training on behalf of member organisations, securing quality and value from education and training providers in accordance with the requirements of professional regulators and Education Outcomes Framework. Securing effective partnerships with clinicians, local authorities, health and well-being boards, universities and other providers of education and research and providing a forum for developing the whole healthcare workforce. Estates Strategy Our vision is that the estate within Thurrock will provide safe, secure, high quality healthcare buildings that will be capable of supporting current and future service needs. Our Estate Strategy is being developed in accordance with guidance in the Local Estates Strategies - A Framework for Commissioners (2015), published by the Department of Health. It will be our first Estate Strategy and is therefore a vital first step to delivering some very real transformation to the way care is delivered. We will be engaging with the public on a local estates vision based around the development of four localities (see image below) and the development of Thurrock Community Hospital. 16

17 The plan is to develop independent living centres in each of the four localities to support extended primary care. We envisage that these centres will provide a range of enhanced health and social care services based on locality based needs assessments. The structured dialogue process will refine this model over the next 12 months. Thurrock Community Hospital is centrally located in Thurrock. We are working with South Essex Partnership Trust (SEPT), the landlord, to develop joint plans to fully utilise this valuable site and explore opportunities to consolidate our Thurrock out of hospital services at this site. For example, we are looking at the possibility of offering a 7 day a week X-Ray service that cannot be provided in primary care but may not need to be at Basildon Hospital. Our plans are at an early stage and 16/17 will be the year to engage with the public and stakeholders to refine and develop these ideas within the context of the Essex Success Regime. In 15/16 we achieved a number of objectives. We established a Local Estates Forum with membership from relevant stakeholders to ensure that the strategy is robust and takes into account and complements our future commissioning agenda. As part of the strategy development, we have held a stakeholder engagement workshop to help identify key focus areas which has been submitted to NHS England. There are plans to hold a second stakeholder workshop and patient engagement programme in Feb 16 to inform the final draft of the estates strategy. In 16/17 our key plans are to: Submit the final draft of our Estates Strategy in quarter 1. Support practice bids to develop their premises improvement plan in line with the Estates Strategy. Complete the planning process on the Tilbury and Purfleet Estates Development Plan. Continue to align Transformation and Estates Review. Information and Communication Technology (ICT) Strategy We recognise the importance of ICT as an enabler that underpins the delivery of cost and clinically effective services and we believe there are better ways for delivering the personalised and coordinated care that patients need. Technology is a key enabler for transforming services and breaking some of the organisational boundaries that get in the way of delivering genuinely coordinated care that people need and want. The approach set out in the ICT strategy will enable us to meet these requirements and support delivery of our Five Year Strategic Plan. 17

18 In 15/16, North East London Commissioning Support Unit (NELCSU) as the provider of the pan Essex ICT system has developed an overarching Essex wide strategy with subchapters for each individual CCG to detail their organisation s own ICT strategy. The primary purpose of this overarching strategy is to describe an overall collaborative purpose and approach to ICT across Essex and as part of this to pull together common themes from the CCGs strategic views. Therefore, it acts as a framework and catalyst for whole system dialogue and to enable wider system planning. We have completed the first draft of our individual strategy which will feed into the wider Essex ICT framework. This has been through our Finance and Performance committee. In 16/17 we will complete the strategy and begin mobilising the plan. For Thurrock in Thurrock Engagement Plan We have already been working closely with our Local Authority partners and neighbouring Basildon and Brentwood CCG as well as provider organisations: Basildon and Thurrock University Hospital NHS Foundation Trust (BTUH), our acute provider; North East London Foundation Trust (NELFT), our community provider, and South Essex Partnership Trust (SEPT), our mental health provider. We will continue to work in partnership with each of them to develop capacity, capability and the best skills mix to provide care closer to home to deliver our new models of care for the future. To ensure we do this well, we have developed an engagement plan which considers our key partners/stakeholders and summarises planned engagement and communication with them. The aims of our engagement plan are: To explain who we are and what we do (for those that do not already know), and what, why, and how we arrived at our vision. To begin what will be an ongoing dialogue throughout the development of our vision and its delivery (if it is agreed that this is the right way to go). To give a consistent and coordinated message to reduce misinformation and rumour. To establish a joint message with partners where this is relevant. To invite staff, service users/members of the public and key stakeholders to share the vision and help us to develop it through to implementation. To continue to develop the engagement plan (including any formal consultation process(es) throughout the course of programme implementation. Our stakeholders include the public at large, service users, their carers and families, MPs, our staff and those in our neighbouring Basildon and Brentwood CCG. Our Health and Wellbeing Board is a key forum for formal engagement with stakeholders and representation and includes Basildon and Thurrock University Hospital NHS Foundation Trust, North East London Foundation Trust, South Essex Partnership Trust, local authorities (Essex County Council and Thurrock Council), Healthwatch Thurrock, Thurrock Coalition, and Thurrock local Council for Voluntary Services (CVS). In the first instance, we have produced a public facing engagement document For Thurrock in Thurrock which outlines our vision. We want to give people the opportunity to tell us whether they think that our vision of care closer to or at home is right for our population. We have also asked for comments/feedback, which we will use to inform future service planning. We will use the Health and Social Care Engagement Group which includes members of Thurrock Council, Thurrock Coalition, our staff, Healthwatch Thurrock and Thurrock CVS as our sense check and as a sounding board to ensure we continue to get the message right and communicate it in the best way possible. We will also 18

19 work with them to engage our local population, tapping into and learning from engagement currently underway to gauge views on the refreshed Health and Wellbeing Strategy. As part of this process we will be commissioning support from Healthwatch Thurrock and Thurrock Coalition to help us gain feedback from a widely representative group of our local population. The results of our engagement will be published on our website. 19

20 Essex Success Regime (ESR): The Thurrock Footprint The ESR was launched in June 2015 and covers the mid and south Essex health and social care system. The ESR has brought together the system leaders across this area to create a whole system plan to enable organisations to deliver high quality care for patients, reduce local health inequalities and deliver financial balance by 18/19. It aims to build and extend existing strategies and collaborations which are consistent with Five Year Forward View (5FYV). The ESR is overseen by the national system leadership known as the tripartite (NHSE, Monitor and the Trust Development Authority (TDA)). This is important, as this oversight will help to unblock barriers to enable delivery at pace. One of the key drivers for the ESR is the growing financial deficit in Essex. If we do not change, the current NHS deficit in mid and south Essex could rise to over 216 million by 18/19; and we would not be able to meet year on year growing demands. The ESR system needs to modernise to keep pace with changes in modern healthcare so that we can do more for patients now and in the future. We have worked in partnership with our wider system colleagues to develop the ESR plan. Our approach has been to ensure that our local vision for transformation is aligned with and supports the delivery of the ESR plan. This will be further refined as the ESR engagement process progresses and our transformation programme gains pace. Rather than re-producing the ESR plan we have used this section to make the links with our local vision to ensure a coherent delivery of the ESR. The ESR identified six areas for change to sustain local services and improve care. These are described below: Block Thurrock Alignment Address clinical and financial sustainability of local hospitals by: o Increasing collaboration and service redesign across three sites. o Sharing back office and clinical support services Accelerate plans for changes in urgent and emergency care, in line with national recommendations e.g.: o Doing more to help people avoid problems and get the right help. o Developing same day services and urgent care in communities, to reduce unnecessary visits and admissions to hospital. o Designating hospital sites for specialist emergency care. Join up community-based services GPs, primary, community, mental health and social care around defined localities or hubs. Thurrock supports the efforts to increase collaboration and service redesign and will engage with the process as detail develops over the course of the programme. Thurrock supports the focus on improving urgent and emergency care whilst recognising that there may not be a one size fits all solution. Our BCF achievements in 15/16 show we made good progress on reducing non elective attendances. Our 16/17 transformation plans reflect that there is more to be done. Thurrock supports the need to join up community based services. This is described more fully in our For Thurrock in Thurrock section. 20

21 Simplify commissioning, reduce workload and bureaucracy e.g.: o Reduce the number of contracts from around 300 to around 50. o Commission services on a wider scale e.g. with one lead provider where several may be involved. o Agree a consistent and common offer to focus on priorities and identify limits of NHS funding. Develop a flexible workforce that can work across organisations and geographical boundaries. Improve information, IT and shared access to care records. For Thurrock, this is likely to be the most challenging aspect of the ESR plan. Therefore we are keen to engage with the consultation process to understand the detail. The Thurrock Health and Wellbeing Board members, in particular, will have strong views on commissioning at scale and delivering a common offer. Thurrock, as a unitary authority, has a strong local identity and will wish to preserve this whilst recognising that some aspects of commissioning are best done at scale. Skilled, motivated and engaged workforce are the key to good patient care. Therefore we welcome the focus on this within the ESR. Poor integration of data is often a barrier to understanding problems and finding solutions. We welcome the focus on information as set out within our prevention and early intervention section of the operational plan. 21

22 Transforming Care for People with Learning Disabilities Description In April 2015, the Pan Essex CCG and Local Authorities agreed to work collaboratively to deliver the requirements of transforming care to improve the outcomes of people with a learning disability across the Pan Essex region. This is with a specific focus on reducing the number of adults with a learning disability and or autism with behaviours that challenge who accesses inpatient hospital settings. Significant progress has been made across the partnership in the development of the service model that is designed around the ethos of prevention and early intervention; the reduction in the use of hospital in patient settings for people with a learning disability; and the development of community services for people with learning disabilities and behaviours that challenge. In addition, there has been positive engagement with families and people who have experience of services and professionals which provides us with good foundations to continue to make significant strides in the delivery of the National Transforming Care programme. On 30 October 2015, NHS England, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) published Building the Right Support and a New Service Model (Appendix 1) which sets out a national programme of change for Learning Disability services - both for health and social care. This announcement forms the continued response to the abuse that took place at Winterbourne View. This sets out the expected outcomes and changes to be implemented and delivered nationally and regionally. The overarching outcomes that the transformation is expected to achieve are: Reduced reliance on inpatient services (closing hospital services and strengthening support in the community). Improved quality of life for people in inpatient and community settings. Improved quality of care for people in inpatient and community settings. In Essex we are reconfiguring our LD partnership board into the Transforming Care Partnerships (TCPs) to build up community services and close unnecessary inpatient provisions over the next 3 years. Our Transforming Care Plan will deliver whole system transformation to all people (including children and young people) who have a learning disability, or who have autism. Our Transforming Care plans will have strong links to local Autism Strategies; the implementation of Special Educational Needs Reforms as part of the Children and Families Act, and demonstrate links to Mental Health strategies, Liaison and Diversion and Criminal Justice services. 22

23 In 16/17 the focus will be on: We will work with partners from local authority, individual placements team, specialist commissioning and children s services to undertake the detailed mapping of five cohorts identified within transforming care. The mapping will enable us to complete the transforming care action plan and submission to NHSE Establish several sub groups to mobilise implementation, these include co-production group, professional reference group, finance sub group, communications group, market testing group, and continuing healthcare group. Development of Essex wide virtual commissioning team to progress agenda. Development of service model and procurement options to develop community services. Co-commissioning of LD Health Checks with NHSE Public Health England. With the Local Authority, we will establish a joint working group that will undertake a needs assessment to ensure that robust evidence base supports the Thurrock footprint, redesigns pathways, and builds capacity and resilience for a localised service model. This work will also identify and inform areas that will require commissioning at scale to manage risk. We will ensure that all people with Learning Disabilities are offered and encouraged to take up an annual Health Check and that meaningful and comprehensive Health Action Plans are developed with appropriate support to improve their health outcomes. Whilst we are engaged in the wider 3 year Transforming Care programme, work is being undertaken locally with SEPT to improve services being delivered by the LD Intensive Support and Health Facilitation Teams in the community to better support people in the community and prevent avoidable admissions Information Governance processes will be agreed to facilitate sharing of information between community, primary care and acute to ensure people with a Learning Disability receive holistic care. Patient Choice and Personal Health Budgets The 15/16 planning guidance sets out an expectation for CCGs to have an expansion in the offer and availability of personal health budgets to All Age Pathways who would benefit from having more choice, flexibility and control over their care and support needs. Our vision for personal health budgets is to enable people with Long Term Conditions (LTCs) and disabilities to have access to personal health budgets as an option to maximise control and choice in meeting their assessed care needs. There is an expectation to offer and encourage the uptake of personal health budgets as part of implementing Building the Right Support and a New Service Model. Adults eligible for NHS Continuing Healthcare and children in receipt of continuing care have had a right to have a personal health budget since October From April 2015 all people known to secondary care mental health services in Thurrock have had a right to ask for an assessment for and have a personal health budget to meet their social inclusion assessed needs. Building on this, in collaboration, as part of the Essex Transforming Care Partnership, we will be extending the offer for personal health budgets to people with Learning Disabilities and/or Autism classified in the Transforming Care Cohort 5 i.e. Adults with a learning disability and/or autism who have a mental health condition or display 23

24 behaviour that challenges who have been in hospital settings waiting resettlement and/or been in hospital a long period of time, who have not been discharged when NHS campuses or long-stay hospitals were closed. Thurrock is not a Demonstrator Site for Integrated Personal Commissioning, however we retain a watching brief to understand the opportunities this approach could offer to people with Learning Disabilities. 24

25 Section two: Financial Plan

26 Introduction By the end of 15/16 we will have been operating for three years and in that time we have established a strong track record of achieving our financial targets. The forecast outturn for the year is an additional surplus of 100k, thereby increasing the cumulative surplus to 2.09m. However a significant proportion of this was delivered in the first year of operation as the challenging local health economy has impacted the rapid accumulation of surplus reserves. NHS England s CCG Allocations policy has seen Thurrock end 15/16 marginally below its target allocation per head of population by 0.7%. The 2016/17 allocation per head of population is 1,163 against a target of 1,169 resulting in a reduction in the distance from target of 0.7% at the end of 2015/16 to 0.5% at the end of 16/17. The programme allocation has been confirmed as 200m, implying a headline growth of 4.2% whilst the net uplift to NHS contracts accounts for 1.8% for acute and 1.1% for non-acute contracts. However, when allowance is made for other expenditure commitments (confirmed as additional in-year funding streams in previous years) the real increase in allocation is just over 1%. Our local health and care economy has also faced major challenges in delivering constitutional quality standards within available funding and the Essex Success Regime has been established to tackle systemic issues and transform services, and we are actively engaged with this work. Financial Plan Our Allocation for 16/17 is 206m, comprising 200m of Programme Allocation, 2m Surplus brought forward from 15/16 and 3.7m Running Cost Allowance. The summary financial plan shown below indicates the anticipated outturn for 15/16 together with the planned expenditure for individual portfolios in 16/17, demonstrating the achievement of NHS England s business rules. The plan implies a QIPP requirement of 7m, representing 3.4% of its allocation and good progress is being made in identifying schemes to be implemented. In previous years, we have been able to achieve an 80% yield on our QIPP projects and efforts are being made to ensure alignment with the Transformation Plan being developed as part of the Essex Success Regime. 26

27 Summary 2016/17 Financial Plan 27

28 Planning Assumptions The high-level assumptions used to develop our financial plan are set out in the table below. As contract negotiations are progressed with main provider organisations, the financial implications will be modelled in order to assess impact on the control total. CCG Planning Assumptions 2016/17 % Tariff Change - Acute (%) 1.8% Tariff Change - Non Acute (%) 1.1% Demographic Growth (%) 1.4% Non Demographic Growth - Acute (%) 1.6% Non Demographic Growth - Continuing Healthcare (%) 3.0% Non Demographic Growth - Prescribing (%) 5.0% Non Demographic Growth - Other Non Acute (%) 1.6% Business Rules Contingency 0.5% Non-Recurrent Reserve 1.0% Surplus 1.0% Tariff Allocation Acute Tariff Increase 3.1% CNST Increase 0.7% Less: Efficiency Requirement -2.0% Net Tariff Increase 1.8% 28