1. society
2. welfare
3. healthcare
4. hospital

A meeting of NHS Bromley CCG Governing Body
19 March 2015
ENCLOSURE 3
System Transformation Programme (2015-2020)
DIRECTOR RESPONSIBLE: Mark Needham, Director of Commissioning
AUTHOR: Mark Needham, Director of Commissioning
SUMMARY:
This discussion paper offers the Governing Body an overview of the system
transformation challenges we face as a local health and social care
economy.
The local health and social care economy faces a number of significant challenges
in relation to national performance agreements for patient outcomes. These should
be read as indicative of our challenges and not solely definitive of the whole
system transformation issues we wish to address.
Summary
The CCG, along with the London Borough of Bromley and our partners, have
proactively been working on a clinically led whole system Transformation
Programme since October 2014; including the procurement of a credible provider
to support the local system and stakeholders in developing an Out-of-Hospital
strategy which will improve outcomes for patients.
Whilst the winter of 2014 has been very challenging for the local economy there
have been a number of success stories through joint commissioning with London
Borough of Bromley – these are outlined in Appendix 1.
We will continue with our transformation journey by building on our strengths Bromley has a strong sense of place; a clear vision within our Health & Wellbeing
Strategy and a commitment to patient and stakeholder engagement.
Our current clinical leadership is well respected across our membership of 45
practices and able to shape and deliver our commissioning intentions, supported
by an experienced management team with robust organisational governance,
alongside effective joint working partnerships.
KEY ISSUES:
Summary of whole system issues: The view of the Clinical Executive Committee
and the whole system Executive Leaders Group consisting of our main providers,
is that no one single provider, or partner, is responsible for the system
performance as this is a whole system issue. For example:
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Referral to treatment (18 weeks)
A&E (4 hour target)
Diagnosis rates for dementia
Improving Access to Psychological Therapies – number of patients in treatment
6 week waits for direct access diagnostics
Please see the CCG Performance report for more details.
Our local challenges:
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Developing Local Care Networks to ensure more care is available closer to
home
Supporting the development of Primary Care through co-commissioning
Ensuring people are able to die in their preferred setting of care
Improved outcomes in key disease areas such as cardiovascular disease,
diabetes and dementia
There is also a significant portfolio of work, some 28 initiatives at present, with key
success stories to tell:
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Rapid improvement in dementia care in care homes
Redesign of elective care pathways – MSK, diabetes, gynaecology
Commitment to improving peri-natal care
An integrated health and social care approach to enabling discharge from
hospital
Award winning end of life care services
King’s has worked hard to improve quality of care at the PRUH and there have
been many excellent improvements, such as within the hyperacute stroke unit
and the improved recruitment of a wide range of clinical staff.
The CCG has invested in additional capacity to help bring waiting lists down for
Bromley patients and to manage the extra demand that winter brings. This has
enabled local health and social care organisations to increase the supply and
range of services available to patients.
BACKGROUND:
After an extensive engagement process with partners and stakeholders, both the
CCG and London Borough of Bromley, feel this programme is required to develop
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an Out-of-Hospital strategy and model of care, complete with service
specifications, for the next 5-10 years. The programme has been jointly funded
and is now out to tender with a new contract to be awarded for 1st April 2015.
Excellent clinical practice and leadership are evident within all providers, but
this is often in spite of the constraints of the current system rather than because of
it. The challenges are exacerbated by three unilateral contracting models, based
on partnership working with our main providers, that inhibit a more alliance based
approach to commissioning and provision, such as preventing avoidable hospital
admissions and discharge from hospital. In preparation for this scenario the CCG
and LBB have set out a robust programme of work in October 2014:
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Exec Leaders Group (ELG): The clinically led group chaired by Dr Parson
was formed in November 2014 to facilitate strategic leadership and integrated
planning to deal with immediate challenges in the economy, as well as facilitate
the development of a 5-10 year strategic vision for integrated care. The group
produced the ‘One truth’ paper with agreement on the key challenges faced by
the system.
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Local Programme Delivery Boards: The CCG has recently reconfigured its
transformation programmes. Future Boards will have multi-disciplinary clinical
and stakeholder involvement to deliver the outcomes of the Transformation
Programme through the Urgent Care Board and Community Based Care
Board.
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South East London Strategy (SEL): Governing Body members and Patient
Advisory Group members are fully active in the SEL Strategy Programme,
that will ensure local developments are connected and talk to the broader SEL
work.
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Winter community plan and strategic resilience planning: An ambitious
plan was successfully put into place this winter with the London Borough of
Bromley (LBB) to improve patient flow, including discharge from hospital and
care in the community. The learning will inform future commissioning decisions
for resilience planning throughout the year and particularly in winter.
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Integrated health and social care: The CCG and LBB have aligned
commissioning and contracting strategies, which has led to LBB exploring the
integration of social care staff within BHC.
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RECOMMENDATIONS
1. The CCG is confident that a new model of care can be established within
the two next two years, noting other CCGs in London have delivered a
credible transformation programme within the same or shorter
timeframes.
2. A timetable of activity has been established through to 1st April 2017,
which is outlined in the appendix with a brief overview of the
Transformation Programme.
COMMITTEE INVOLVEMENT: This paper follows an extensive period of
engagement on assessing the right option in respect to the contract.
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Executive discussion in relation to commissioning priorities (Oct 2014- March
2015)
Members event with representation from all 45 practices on the future of key
contracts linked to system transformation (November 2014)
Engagement with London Borough of Bromley – Joint Integration Committee
Executive (October- March 2014-15)
Executive Leaders Group & Operations Group (Oct 2014- March 2015)
PUBLIC AND USER INVOLVEMENT: As outlined above with debate in public at
this Governing Body and plans for future engagement in the Transformation
Programme including engagement events and participation in the Programme
Boards.
IMPACT ASSESSMENT:
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The proposed arrangements for the Transformation Programme have the
support of providers who are participating in the programme
The combination of our participation in SEL Strategy, partnership working with
LBB and the Transformation Programme further improves the opportunity to
develop a more integrated model of care for Bromley patients
RECOMMENDATIONS:
The Committee (s) is asked to:1. Note the developments to date and the opportunity to engage in the
Transformation Programme and Programme Boards
ACRONYMS – As outlined in the paper
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DIRECTORS CONTACT:
Name: Mark Needham
E-Mail: m.needham@nhs.net
Telephone: 01689 866544
AUTHOR CONTACT:
Name: Mark Needham
E-Mail: m.needham@nhs.net
Telephone: 01689 866544
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Appendix 1
Overview of the Transformation Programme
The programme includes 7 domains:
Domain 1: Integrated Information Systems
Reliable information to enable joint working across organisations
Domain 2: Integrated service specifications / model of care for Bromley
Agreed access and threshold criteria across integrated services and the local health and
social care system - areas within scope:
Domain 3: Operational assessment processes
Clear, agreed and trusted assessment processes and protocols across community, acute
and social care:
Domain 4: Finance and activity models
Outline model of care across these services and all sectors
Domain 5: Quality & performance outcomes
Standardised quality and performance with the best possible outcomes for patients
Domain 6: Contracting models
Appropriate contracting models with incentives to ensure an integrated model of care
Domain 7: Prevention
Prevention and self-management to promote independent living and wellbeing aligned to
priorities of Health & Wellbeing Board
Winter Programme
The benefits to patients over winter include:
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Seven day working. Services that before only ran during the week now operate over the
weekend such as hospital pharmacy, urgent scans, more senior doctors in the emergency
department and senior doctors. Of particular success has been the London Borough of
Bromley’s provision of social care assessments. Social workers have increased the
number of assessments completed over the weekend which is helping patients return
home from hospital quickly.
An ambulatory care unit opened last May for patients with urgent medical conditions, is
seeing around 280 people a month.
Expansion of the medical response team, run by Bromley Healthcare to provide urgent
care to people at home. Many people would have been admitted to hospital if this type of
Clinical Chair: Dr Andrew Parson
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Chief Officer: Dr Angela Bhan
home care was not available.
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A new service to support people who live in extra care housing. A visiting medical officer
is able to provide medical help to manage health emergencies in tenants own homes.
More intensive support is available to families and patients who are in their last few weeks
of life. More nursing and personal care is available to help people die in the place of their
choice.
Over the winter, two specialist dementia nurses offered assessments to people living in
residential homes to help improve the diagnosis rates and care for people with dementia.
Mental health support available to people in a crisis has been doubled and includes
provision for children and young people.
Additional investment has also enabled people to return home from hospital sooner than they
might otherwise have done:
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A fast response personal care package is offering patients extra support when they are
discharged from hospital to help them get back on their feet.
An intensive personal care package is offering patients on average 150 hours of support
on discharge from hospital and is providing a genuine alternative to long term residential
care.
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Additional investment in the ‘Take Home and Settle’ service provided by Age UK.
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Getting people the right equipment they need to remain independent on discharge.
Clinical Chair: Dr Andrew Parson
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Chief Officer: Dr Angela Bhan
Appendix 2
Transformation Programme - provisional delivery timeframe:
Milestone
Dates
1. Launch Transformation Programme with
stakeholder engagement
1st April – 30th June 2015
2. Launch Programme Boards with stakeholder
engagement
1st April onwards 2015
3. Vary service specifications – where there is an
immediate opportunity to improve system
performance for patient care
1st July 2015
4. Presentation of Out of Hospital Strategy
5. Enhanced engagement period on new model of
care
16th July 2015
1st July – 30th August
2015
6. Approve new model of care at Governing Body
24 September 2015
7. Development of contracting options
8. Development of procurement options (open
competitive tender or other procurement
process as appropriate)
9. Completion of final specifications for new model
of care
September 2015 – March
2016
10. Notice of commissioning intentions (and tender
notice if applicable)
1st April 2016
11. Future providers identified
1st October 2016
12. Mobilisation of new service model including
provider options
1st October 2016 – 31st
March 2016
13. New model of care to go live (and/or providers)
1st April 2017
Clinical Chair: Dr Andrew Parson
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Chief Officer: Dr Angela Bhan
Clinical Chair: Dr Andrew Parson
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Chief Officer: Dr Angela Bhan