Luton Health and Social Care
System Five Year Strategy
2014-15 to 2018-19
Version 5.1 September 30th 2014
V5.1 for September re-submission
1
Contents
Version History
Chapter
Page
Version
Reviewed By
1. Context of Plan
3
0.3
CCG Executive 13th March 2014
2. System Vision
14
1.0
CCG Board March 25th 2014
1.0
Health and Wellbeing Board March 31st 2014
2.0
Submitted to NHS England April 4th 2014
3. Improving Quality and Outcomes
21
4. Sustainability
32
2.0
CCG Members Forum May 14th 2014
5. Improvement Interventions
44
2.2
Healthier Luton Partnership May 19th 2014
2.2
Health and Wellbeing Board June 2nd 2014
4.1
Approved by Chair of Health and Wellbeing Board June
18th 2014
4.1
Sent to CCG Board on June 17th in advance of Board
meeting on June 24th 2014
4.2
Submitted to NHS England Area Team on June 20th
5.0
Reviewed by CCG Executive September 25th
5.1
Submitted to NHS England Area Team on September 30th
6. Citizen and System Engagement
87
7. Developing the Workforce
96
8. Governance
99
9. Risk
104
10. Plan on a Page
110
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1. Context of Plan
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1. Context of Plan
National Context
National Planning Guidance requires that individual units of planning develop a five year system strategy 2014/15 to
2018/19 with key deliverables for the first two of those years articulated via:
 A CCG Operating Plan
 A CCG Financial Plan
 A Better Care Fund Plan
 Individual Provider Plans
 An NHS England Area Team Direct Commissioning Plan
This Five year strategy represents the Luton Health and Social Care Systems approach to delivering improved outcomes
for local people via a sustainable, joined up , collaborative system.
The need for a cohesive system planning programme is essential to meet the sustainability issues posed by the
imbalance between rising demand and supply pressures
Our unit of planning (Luton CCG, Luton Borough Council, Luton and Dunstable Hospital, Cambridgeshire Community
Services, South Essex Partnership Trust and the Luton Health and Wellbeing Board) first published this five year
strategy to deliver a Healthier Luton through a sustainable health and social care system in June 2014.
This current version was refreshed in September 2014 in order to take account of feedback received from NHS England
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1. Context of Plan
Local Planning Context
The diagram on the next page shows how local plans fit together to support the Luton Health and Wellbeing Strategy. The
Health and Wellbeing Strategy makes a number of commissioning recommendations based on a in depth analysis of local
needs based on the local JSNA1 and highlights three major outcome goals:
Health and Wellbeing
Goal 1. EVERY CHILD AND
YOUNG PERSON HAS A
HEALTHY START IN LIFE
Health and Wellbeing
Goal 2. REDUCED
HEALTH INEQUALITIES IN
LUTON
Health and Wellbeing
Goal 3. HEALTHIER AND
MORE INDEPENDENT
ADULTS AND OLDER
PEOPLE
The Children and Young People’s Plan articulates how Goal 1 and elements of Goal 2 are being addressed. The System
Five Year Strategy with its focus on adults will articulate plans to address Goal 3 and elements of Goal 2.
This Five Year System Strategy has been developed by the Luton Unit of Planning which is made up of the following
partners: Luton Health and Wellbeing Board, Luton CCG, Luton Borough Council, Luton and Dunstable Hospital
Foundation Trust, NHS England Area Team (South Midlands and Hertfordshire), South Essex Partnership Trust,
Cambridgeshire Community Services.
This current version (v5.1) has been resubmitted to NHS England to reflect feedback from the Area Team and to
articulate changes to our plans that have been put in place since the original submission in June 2014. Not least of this is
the fact that Luton CCG is now formally in Financial Turnaround and a full turnaround plan is being finalised which must
be implemented to bring the CCG back to financial balance during the next 18 months in order to place the system on a
firmer financial footing. A further iteration of this strategy will be necessary during the next 6 months to reflect progress
against turnaround.
1 JSNA 2011 and JSNA Core Dataset
http://www.luton.gov.uk/Community_and_living/Luton%20observatory%20census%20statistics%20and%20mapping/Pages/Join
t%20Strategic%20Needs%20Assessment%20-%20JSNA.aspx
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1. Context of Plan
System Engagement
Whilst the development of this Five
Year Plan has been led and driven by
Luton CCG, it is owned by the Health
and Wellbeing Board and has emerged
from an intensive programme of
ongoing engagement across all
stakeholders who are part of the Luton
Health and Social Care System.
Additional engagement has taken
place with potential future providers in
the form of competitive dialogue
which has taken place as part of the reprocurement of mental health and
community health services
Some of the key platforms of
engagement are shown in the diagram
on this slide and every opportunity has
been taken to share understanding,
pool ideas and overcome
organisational barriers to progress
Better
Together
Programme
Board
Whole
System
Leadership
Summits
Healthier
Luton
Partnership
Workforce
Planning
System
Resilience
Group
(HEEoE)
Luton CCG
Five Year
Strategy
CCG
Members
Forum
Board to
Board
Events
Strategic
Clinical
Networks
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Completive
Dialogue
Clinical
Leadership
Forums
6
1. Context of Plan
Outputs of System Engagement
As a system we are all agreed that we cannot continue to operate as we always have and that there
must be a switch of funding away from the traditional acute care model to prevention, early
intervention and care at or near to the home. The L&D Hospital are agreed and signed up to the
understanding that routine activity will move away from the hospital and that integrated working
through the delivery of the Better Together Programme will lead to the closure of two wards in
2015/16. This approach is reflected in the L&Ds five year strategy which describes a step change to
become a “hyper acute” hospital in the future as clinical expertise increasingly becomes available in
the community as an integral part of multidisciplinary practice Cluster based teams. Its broad vision
also incorporates being a “women’s and children’s hospital” and “elective centre” and an academic
teaching unit. The L&D’s vision embraces the hospital being an integrated partner for healthcare
outside the hospital.
The current re-procurement programme of mental health and community health services has
enabled the system to reshape provision through a competitive dialogue process that allows the
introduction of best practice from elsewhere to shape our overall plan.
See also pages 90 to 93 for examples of how stakeholder engagement has influenced the
development of this plan.
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The Relationship Between the Health and Wellbeing Strategy and other System Plans
HWB
Commissioning
Recommendations
Health and Wellbeing Strategy 20122019
Local Outcome
Priorities
EVERY CHILD AND YOUNG
PERSON HAS A HEALTHY
START IN LIFE
Strategies to
deliver Local
Priorities
Children and Young People’s
Plan 2012-13 (to be updated
REDUCED HEALTH
INEQUALITIES IN LUTON
2014/15 – 2018/19)
HEALTHIER AND MORE
INDEPENDENT ADULTS
AND OLDER PEOPLE
Five Year System Strategy
2014/15-2018/19
Locally defined
measures from HWB
Strategy
Seven Priority Outcome
Ambitions
CCG Two Year Operating Plan 2014/15 – 2015/16
BCF National and Local
KPIs
1-2 year KPIs; Quality
Premium; Activity Plans
CCG Two and Five Year Financial Plans
Nationally Defined Surplus
Area Team Two Year Direct Commissioning Plan 2014/15 – 2015/16
Direct Commissioning
Measures
Provider Two Year Plans 2014/15 – 2015/16
NHS Constitution, Activity
CCG Primary Care Strategy
7 Outcome Ambitions
Joint Mental Health Strategy
7 Outcome Ambitions
Better Care Fund Two Year Plan 2014/15 – 2015/16
Delivery Plans
Outcome Measures
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Key
To be Updated
8
1. Context of Plan
Local Need
Luton’s Population and Health Profile at a glance1
• Population 204,000
• BME equals 55% of the population and 66% of school children
• High levels of deprivation – 12,000 children live in poverty. Life expectancy lower than
England average
• Life expectancy gap for most deprived areas is 8.9 years for men, 6.4 years for women
• 23.2% of Year 6 children are obese, worse than the England average. Breast feeding and
smoking in pregnancy worse than England. Teenage pregnancy and alcohol specific hospital
stays among the under 18s are better than the England average.
• Infant mortality is above the England average
• Low rates of adult physical activity and high levels of adult obesity
• CVD mortality worse than England
• Dementia in over 65’s to increase by 10% between 2012 and 2016
1Based
on JSNA 2011 and JSNA Core Dataset
http://www.luton.gov.uk/Community_and_living/Luton%20observatory%20census%20statistics%20and%20mapping/Pages/Join
t%20Strategic%20Needs%20Assessment%20-%20JSNA.aspx
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1. Context of Plan
Local Views
The Luton system has undertaken an extensive programme of patient and public engagement in order to seek
inputs to improving the health of the local population. This has included:
•
Patient Reference Groups / Practice Patient Participation Groups
•
Deliberative events
•
Citizen surveys
•
CCG Public launch event
•
Is A&E for me? Marketing campaign
•
Social media
•
Neighbourhood Governance Programme
•
“The Big Conversation” engagement programme related to the reconfiguration of mental health and
community services
There are a number of themes that have emerged repeatedly:
1. Communication needs to be improved directly with patients/carers and between organisations that are
having interactions with patients/carers.
2. Better access to primary care – GPs
3. Quicker referrals onto hospitals/other specialists
4. More care nearer the home
5. Accessing all the communities that live in Luton and adapting services to the needs of those communities;
both in terms of ethnicity and communities of health.
The key themes have informed the planning and delivery of our major transformational programmes
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1. Context of Plan
Financial Context 1
The Luton System faces a significant financial challenge over the next five years. Historic underfunding , the demands of an
ageing population , high levels of deprivation and serious health inequalities mean that we have to work in a different way to
make sure that every penny spent goes as far as possible.
The CCG is currently in financial recovery due to ongoing increases in demand that have outstripped available funding. This has
resulted in the CCG breaching its statutory responsibility of achieving financial balance and financial recovery plans have been
put in place. The CCG is also taking a stricter approach with providers regarding how they provide and charge for services
commissioned. The issue of the underfunding of the Luton health economy is widely recognised and the CCG has, and will
continue to, receive above average increases in financial allocations. However the scale of increase in financial allocations will
not fully address the underfunding situation for some years to come and the CCG is putting in place plans to drive financial
recovery in the short to medium term.
The CCG’s current financial plan predicts a deficit of £6.9m at the end of 2014/15. However the current rate of acute activity
during 2014/15 (April to July) predicts deficit significantly greater than this, which means that plans must urgently be put in
place to address the current activity growth. The implementation of these plans will continue into 2015/16 and beyond.
Luton Borough Council also faces a tight resource allocation and Adult social care has a £56m net budget in 2014/15 with
demographic pressures of £11.5m to 2017/18 and a savings target of £22m.
Given our financial position and the potential gap we face over the next five years, we know that as a system we need to work
closer together so that we can help each other to create high quality, value for money services that are tailored to the needs of
individual patients and their carers. We also need to deliver services in a different way. We know that we have relied too much
on hospitals to deliver care to our patients. Our local hospital is good at what it does but over reliance on this does not make
the best use of limited funding. Consequently we need to ensure that General Practice works closely with community nurses,
hospital specialists, social workers and other professionals to effectively wrap services around the patient so that they can stay
in their homes for as long as possible.
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1. Context of Plan
Financial Context 2
In Year Outturn & Net QIPP Savings £m
£8.0
In Year Net QIPP Savings
£6.0
£5.3
£5.6
Forecast Outturn
£4.0
£2.0
£0.0
13/14
14/15
£0.2
16/17
15/16
£2.6
£2.7
17/18
18/19
The chart on the left shows
how a CCG surplus is
achieved by 2016/17
onwards through the
effective delivery of our
strategy
-£2.0
-£4.0
-£5.3
-£6.0
-£5.4
-£6.9
Forecast Outturn
-£8.0
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1. Context of Plan
Local Opportunities
In addition to the JSNA. we have utilised a variety of resources to understand both the challenges and potential opportunities
facing us as a system. These resources include the Outcomes and Benchmarking Support Pack1, Commissioning for Value Insight
Pack2 and the “Anytown” model3 developed by NHS England.
For example the table below is based on our review of the Commissioning for Value Insight Pack which identifies opportunities for
both quality and financial improvements based on a comparison of local performance with similar areas in England.
Commissioning for
Value Insight Pack
Quality
Opportunity
Cardiovascular
Disease

Endocrine /
Metabolic Disorders

Genitourinary

Value
Opportunity

Case management and coordinated care
Palliative Care – Consultant – led community services
24-hour asthma services for children and young people
Mental Health Service user network

Respiratory


Cancer


Gastrointestinal
Opportunities identified in the Anytown Suburban Module
Reducing elective caesarian sections
Electronic palliative care coordination systems (EPaCCS)
Hyper Acute Stroke provision
GP Tele-consultation

1 http://www.england.nhs.uk/wp-content/uploads/2014/02/LApack_E06000032-luton.pdf
2 http://www.england.nhs.uk/wp-content/uploads/2013/11/CfV-luton2.pdf
3 http://www.england.nhs.uk/wp-content/uploads/2014/01/at-suburban-rep.pptx
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2. System Vision
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2. System Vision
Development of a System Vision
As part of Luton’s Better Together Integration programme, system leaders
contributed to the development of a system vision by participating in a
Leadership Summit which took place on December 13th 2013. The purpose of
the Leadership Summit was for health and care organisations in Luton to share
priorities over the next 2-5 years and to consider how we can collectively lead the
whole care and health sector to meet integration challenges over the same
period.
The group was tasked with articulating what the Health and Social Care System
will look like in 2019 and the outcomes of those deliberations are summarised in
this section.
Leaders from the following organisations were represented at the Summit:
Luton and Dunstable Hospital, Luton Borough Council, East of England Ambulance
Services Trust and Luton CCG.
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2. System Vision
Our System Vision and Principles
In 2019 Luton residents will benefit from integrated
health and care that has four elements: a person
centred approach enabled by a focus on PREVENTION
that helps people to keep themselves well; a shared
PERSONAL PLAN for patients and service users;
BETTER USE OF SHARED EVIDENCE AND DATA; A
MULTI-DISCIPLINARY, MULTI-PROFESSIONAL TEAM
APPROACH to service delivery built on Four GP
clusters in the town. We will work in partnership with
patients, their carers, providers and other partners to
deliver a high quality and cost effective health and
social care system to the people of Luton, empowering
them to lead healthy and independent lives.
Principles
Integration and collaboration
Service Innovation
Services around the patient
Safeguarding the vulnerable
Early intervention
Value for money
Citizen engagement
Quality and Safety
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2. System Vision
How will the system be different in 2019? Summary
A focus on Prevention
• Delivering a wellness programme rather than a focus on treating illness
• Early intervention driving improved outcomes and reduced need for specialist intervention
A Personal Plan
• An e-plan that is personalised and can be shared across the system
• Care co-ordinated by the GP
One Multidisciplinary Team
• Multi-disciplinary teams that will include social workers, district nurses, hospital at home
nurses, hospital consultants and home help
• Planning around the person will take account of both physical and mental health needs and
mental health professionals will be an integral part of the multi-disciplinary team.
Using the Evidence Well
• Accurately predicting risk of a crisis and putting in place appropriate services to prevent
hospital admission
• Putting the right services in place appropriate to the evidence
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2. System Vision
How will the system be different in 2019? Key Elements
Prevention
•Balance towards early
intervention and prevention
•People understand how to
keep well and do it
•Realistic understanding and
taking ownership of peoples
barriers to health issues
Personal Plan
•Assessment for complex
needs within good time
•Key Coordinator worker
•Fewer professionals- better
sharing info
•Single assessment and plan
across organisations
•Existence of a personal planperson feels able to
change/develop/reassess
their plan.
•People feeling in control and
confident of “their” plan
supported by professionals
•A key contact – someone to
trust/get to know. Someone
to help and support the plan
to be delivered
•New roles- carers initiative
across health, social care,
voluntary sector etc
Multi-Disciplinary
Team
•New Roles- Carers, Social Care,
Voluntary Sector etc
•Community based care
services- Health, Social,
Voluntary all together.
•Single point of contact for
patients
•Health/well being/social
prescription- all equally
important
•Services aren’t hidden away or
discreet
•Mental health services
integrated within every service
•Early customer access to
‘knowledge’
•Points of Access- Hospital,
Shopping Centre, Police Station,
Town Centre
•Care and support is no longer
buildings based
•People can access universal
services
•Caring community
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Using the
Evidence Well
•System is better at predicting
crisis and has put appropriate
timely services around them
•Appropriate interflow
between providers;
information/physical
experience
•Use data to deliver and
organise services in different
communities
•IT systems aligned
18
2. System Vision
Our system vision embraces the six characteristics of
a high quality and sustainable system1
Patient and Citizen Involvement
The system is signed up to the Luton Community Involvement Strategy which is fully embedded in the Health and
Wellbeing Strategy and this Five Year Strategy.
Wider Primary Care provided at scale
The need for high quality consistent primary care is a key commissioning recommendation in the Health and
Wellbeing Strategy. The CCG is currently developing a specific strategy for primary care in partnership with the
Area Team with a focus on increasing the range of services available, driving a reduction in variation, improving
access, driving clinical leadership, workforce development and training, commissioning of enhanced services,
estates, informatics and IT
A modern model of integrated care
The Luton system has commenced delivery of its “Better Together” Programme to drive the delivery of joined up
care based around personal needs to create a shift towards prevention, early intervention and treatment at home
with reduced reliance on specialist care.
Access to the Highest Quality Urgent Care
An urgent care system working group has been in place for a significant period of time in Luton driving a
collaborative approach to ensuring that unscheduled care is deliver through the most appropriate routes
A Step Change in the Productivity of Elective Care
The system is driving the delivery of non complex elective care out of the hospital to deliver more care nearer to
the home via primary and community care
Specialised services concentrated in centres of excellence
Whilst driving non-complex care away from the acute trust we will enable the repatriation of specialist
interventions such as acute stroke and percutaneous coronary intervention (PCI Angiography)
1.
Planning Guidance http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf
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2. System Vision
Vision for services – progress through Better
Together Programme1
Current Balance of Services
Prevention (keeping people
well)
Early intervention
Help at home
Specialist
and
acute
Service model has
high spend in
specialist services
1-2 Years Vision
Prevention (keeping
people well)
3-5 Years Vision
Prevention (keeping people
well)
Early
intervention
Help at
home
Specialist
and
acute
Provision shifted towards
community capability in
the medium term
Early intervention
Help at home
Specialist
and
acute
Spend strategically
aligned to a prevention /
early intervention model
1 See also Better Care Fund Plan
http://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Better%20Care%20Fund%20plan.pdf
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3. Improving Quality and
Outcomes
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3. Improving Quality and Outcomes
Improving Quality and Outcomes
Introduction
National Planning Guidance requires CCGs to submit trajectories to support the seven outcome ambitions (see
System Five Year Strategy):
 Securing additional years of life or people with treatable mental and physical health conditions
 Improving the quality of life of people with Long Term Conditions
 Reduce the amount of time spent avoidably in hospital
 Increasing the proportion of older people living independently at home following discharge from hospital
 Increasing the proportion of people with a positive experience of hospital care
 Increasing the number of people with mental and physical health conditions having a positive experience
of care outside hospital
 Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in
care
Process to Develop Outcome Ambitions
The initial proposals articulated in this document were developed by CCG Clinical Directors and Public Health
utilising benchmarking data and in particular the performance of Luton in comparison to the national average
and similar populations of Redbridge, Hillingdon, Wolverhampton and Birmingham East and North. The Levels
of Ambition Tool enables benchmarking for the above outcomes and demonstrates that Luton outcomes are
below the national average for many outcomes but is broadly performing in line with other populations with a
similar make up to Luton.
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3. Improving Quality and Outcomes
Benchmarking Outcomes
Potential Years of Life Lost
Luton Current Position: Baseline 2012 – 2630
Luton – Bottom Quintile
Quality of Life for people with LTCs
Luton Current Position: Baseline 2012/13 – 74.1
Luton – Middle Quintile slightly better than England
Avoidable Hospital Admissions
Luton Current Position: Baseline 2012/13 – 2599
Luton – Bottom Quintile
Patient experience in hospital
Luton Current Position: Baseline 2012 – 124
Luton – Quintile 4
Patient experience out of hospital
Luton Current Position: Baseline 2012 – 8.1
Luton – Bottom Quintile
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3. Improving Quality and Outcomes
Health Inequalities in Luton
Research into the health of local people published in
the Joint Strategic Needs Assessment (JSNA), in 2011,
clearly identifies the key health challenges and
highlights the inequalities in life expectancy which
exist in Luton.
Although life expectancy in Luton has shown a steady
increase since 1999, average life expectancy for both
males (now 77.9 years) and females (at 81.9 years)
remains below the national averages which are 79.2
years and 83.0 years respectively.
However significantly more worrying, these statistics
mask the very serious inequalities that exist between
areas within Luton with an 8.9 years life expectancy
gap for males and 6.4 years for females between the
most and least deprived areas of the town (see maps
opposite).
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3. Improving Quality and Outcomes
Driving a Reduction in Health Inequalities
As discussed earlier in this document , the Luton Health and Wellbeing Strategy articulates 3
major priority outcomes goals: 1. EVERY CHILD AND YOUNG PERSON HAS A HEALTHY START IN
LIFE, 2. REDUCED HEALTH INEQUALITIES IN LUTON and 3.HEALTHIER AND MORE INDEPENDENT
ADULTS AND OLDER PEOPLE. The Children and young people’s plan has been put in place to
address Goal 1 and part of Goal 2. This Strategy addresses Goal 3 and part of Goal 2 and
therefore implementation of this Five Year Strategy has a major role to play in driving a reduction
in health inequalities through the following recommendations from the Health and Wellbeing
Strategy
• Systematic programmes to reduce the variability of General Practice in Luton to ensure that
all members of the Luton population are able to easily access high quality and safe primary
care.
• A risk based approach to identify all patients on their lists with long term conditions who are
at increased risk of exacerbation or admission and take proactive steps to ensure these
patients are supported to minimise unnecessary admissions to hospital or complications.
• integration of health and social care services to improve health outcomes and seamless
support to the individual
• Integrated wellness service
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3. Improving Quality and Outcomes
Seven Outcome Ambitions: 5 Years
1 Securing additional years of life
• Improve by 18% from baseline
• 2630 (2012) to 2162 in 2018/19
2 Health Related QOL for people with
LTCs
• Improve by 6% from baseline
• 74.1 (2012/13) to 80 in 2018/19
3 Reducing the amount of time spent
avoidably in hospital
• Improve by 12.4% from baseline
• 2599 (2012/13) to 2276 in 2018/19
4 Increasing the proportion of older
people living independently at home
following discharge
• There is no indicator currently available
5 Positive experience of hospital care
• Improve by 6% from baseline
• Poor responses 124 2012/13 to 117 2018/19
6 Positive experience of out of hospital
care
• Improve by 10% from baseline
• Poor responses 8.1 2012/13 to 7.1 2018/19
7 Eliminating avoidable deaths in
hospital
• There is no indicator currently available
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3. Improving Quality and Outcomes
Ambitions 1 and 2: Five Years
1 Securing additional years
of life
Indicator: Potential Years of
Life Lost (PYLL – Rate per
100,000 from causes
considered amenable to
healthcare (adults and
children)
DSR per 100,000 European
population
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
2003
2005
2007
2009
2011
2013
2015
2017
2019
Year
82
80
78
76
EQ5D
2 Health Related QOL for
people with LTCs
Indicator: Weighted EQ-5D
values for all responses from
people identified as having a
long term condition – GP
Patient Survey
74
72
70
68
66
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2011/12
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
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2018/19
3. Improving Quality and Outcomes
Ambitions 3 and 5: Five Years
3 Reducing the amount of
time spent avoidably in
hospital
Indicator: Composite
Indicator – Avoidable
Admissions
Avoidable Emergency Admissions per
100,00
4000
3500
3000
2500
2000
Luton Historic
1500
Luton Forecast
1000
500
Linear (Luton Historic)
0
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
5 Positive experience of
hospital care
Indicator: Number of
negative responses per
100,000 – hospital inpatient
survey
Number of negative responses er 100
160
155
150
145
140
135
130
125
120
2012/13
2013/14
2014/15
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2015/16
2016/17
2017/18
2018/19
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3. Improving Quality and Outcomes
Ambition 6: Five Years
6 Positive experience of out of
hospital care
Indicator: Poor responses per
100 patients – GP Patient
Survey
Poor Responses per 100 Patients
8.2
8
7.8
7.6
7.4
7.2
7
6.8
6.6
2012/13
2013/14
2014/15
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2015/16
2016/17
2017/18
2018/19
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3. Improving Quality and Outcomes
Drivers of Delivery of Seven Outcome Ambitions
Five Year
Ambition
Five Year
Improvement
1. Securing
additional
years of life
2. Health
related QoL
for people
with LTCs
3. Reducing
the amount of
time spent
avoidably in
hospital
18%
6%
12.4%
Prevention
Early
Intervention
Early
Intervention
Integrated
Pathways
Early
Intervention
Projects and
programmes
driving
improvement
Early
detection of
cancer
Live Well
Luton
Integrated
Pathways
Vaccination
and
Immunisation
5. Positive
experience of
hospital care
6. Positive
experience of
out of hospital
care
6%
10%
Early
Intervention
Integrated
Pathways
Workforce
Development
Programme
Integrated
Pathways
Integrated
Pathways
CQUIN
7 day working
7 day working
7 day working
Homecare
Plus
Homecare
Plus
Homecare
Plus
Transforming
Primary Care
Projects
Transforming
Primary Care
Projects
Transforming
Primary Care
Projects
IAPT
Transforming
Urgent Care
Projects
4. Increasing
the proportion
of older
people living
independently
TBC
Transforming
Urgent Care
Projects
Quality
Monitoring
L&D Trans formation
Programme
Improved
Discharged
Process
Primary Care
IT
Infrastructure
Co-Commiss -- ioning
Primary Care
Estates
7. Eliminating
avoidable
deaths in
hospital
TBC
Prevention
Early
Intervention
SI Processes
Complaints
Processes
Quality
Monitoring
Enhanced
Services
IAPT
V5.1 for September re-submission
30
3. Improving Quality and Outcomes
Additional (Local) Outcome Ambitions: 5 Years
Reduction in Infant Mortality Rate (per
1,000 live births)
• Baseline 7.2 (2009-11)
• Reduce to 5.0 by 2017-18
Increased life expectancy at birth and
narrowed inequality gap with England
- Males
• Baseline 77.9 (2009-11)
• Increase to 80.3 by 2017-18
Increased life expectancy at birth and • Baseline 81.9 (2009-11)
narrowed inequality gap with England • Increase to 82.7 by 2017-18
Females
Life Expectancy gap between the most • Baseline 8.9 (2006–10)
and least deprived areas in Luton - Males • Reduce to 7.9 by 2017-18
Life Expectancy gap between the most
and least deprived areas in Luton Females
• Baseline 6.4 (2006-10)
• Reduce to 5.6 by 2017-18
Disability Free Life Expectancy (DFLE)
- Males
• Baseline 9.1 (2011-12)
• Increase to 10.0 by 2017-18
Disability Free Life Expectancy (DFLE) Females
• Baseline 9.9 (2011-12)
• Increase to 10.9 by 2017-18
V5.1 for September re-submission
31
4. Sustainability
V5.1 for September re-submission
32
4. Sustainability
The Sustainability Challenge
Demand
Supply
Ageing Population
Increasing costs of care
Increasing prevalence of
long-term conditions
Reducing gains in
productivity
Increasing expectations
Constrained public
resources
NHS England’s “A Call for Action1” describes the future trends which threaten the sustainability of a high quality NHS. It is the
potential impact of these trends summarised in the diagram above that means that while a new approach is urgently
needed, we must take a longer-term view when developing it. The Luton system understands that in order to overcome the
impact of these trends, we need to shift the balance of health and social care spend away from specialist care and towards
prevention, wellness, early intervention and care at home so that specialist care is reserved for more complex interventions
for the more severely ill.
V5.1 for September re-submission
1 http://www.nhs.uk/NHSEngland/thenhs/about/Documents/nhs-belongs-to-the-people-call-to-action.pdf
33
4. Sustainability
Over the first two years of this strategy, the CCG needs to
drive financial recovery
Financial Recovery Plan
Luton CCG was formally identified as being in Financial Recovery during the early part of 2014/15. A turnaround
plan has been developed and immediate actions are being implemented, overseen by a robust PMO, to ensure
that the CCG is back on track with its rolling financial plan agreed with NHS England in Quarter 1 2014/15. Our
turnaround plans require the delivery of a range of short term measures; however it is important that recovery
should be seen as a range of corrective actions which will yield benefits at different points of time over the next
one to two years.
There are a number of reasons for the CCGs current financial position
 Hospital activity, both elective and non-elective / A&E attendances, is performing significantly above plan.
This requires the CCG to implement appropriate processes and controls to influence expenditure, primarily
through the contracting function
 Over performance in mental healthcare. This primarily due to the cost of placements out of area in the
private sector
 There are some weaknesses and areas of variation in the local GP infrastructure
 The CCG has a shortfall of funding against its weighted capitation target of £14.2m in 2014/15. Whilst this is
being addressed centrally through greater than average funding increases, the pace of change on funding is
not sufficient to meet the pace of increasing healthcare demands
V5.1 for September re-submission
34
4. Sustainability
How the System will meet the sustainability challenge
The focus of the CCGs Commissioning Intentions for 2015/16 is on the delivery of the Financial Recovery Plan.
The diagram on the next page outlines the key programmes of work required to deliver progress financially
whilst at the same time delivering improvements in clinical and safety outcomes.
Our plans are phased so that the immediate deliverables are focused upon the management of GP elective
referrals and robust contractual management. At the same time we must put in place the building blocks of
plans to improve the quality of primary care and the effective implementation of the Better Care Fund to drive a
reduction in emergency admissions in the longer term.
The CCG has begun to work with clusters and practices to implement peer review of GP referrals to ensure that
all referrals are of high quality and appropriate. In a parallel process by December 2014 the CCG will develop GP
referral protocols for key specialities and closely monitor their implementation.
In the medium term (18 months) the CCG will develop the maturity of the clusters through management
support, training and the roll out of the locality infrastructure. The CCG will work with the NHS England Area
Team to performance manage non-complaint or poor performing practices.
V5.1 for September re-submission
35
4. Sustainability
How the System will meet the sustainability challenge:
Summary of Key Programmes
Programme Management Office (PMO)
Programme
Objective
BCF/Whole System
Transformation
Reduce emergency
admissions/ length of stay
Strengthen capability and
ensure current initiatives
are implemented
Eradicate the abnormal
increase in activity through
cluster initiatives and
contractual challenges
Develop cluster led
initiatives to reduce the
rate of new referrals.
Prioritise the roll out of
activity reporting and
budgetary controls to
clusters.
Drive through full year
effect of 14/15 initiatives
and use the BCF initiative as
a lever to drive more
ambitious changes to
pathways.
Review opportunities to
streamline the pathway and
incentivise changes in
system behaviours. Use
procurement as a lever for
change.
Ensure rapid transition to a
mature cluster
accountability framework
supported by strengthened
referral protocols which aim
to formalise 14/15
initiatives.
14/15 plan
15/16 plan
Proactive Primary Care
Reduce A&E attendance and
related short stay
admissions
Elective Care Run Rate & GP
Referrals
Ensure standardisation of
practice to reduce avoidable
referrals
V5.1 for September re-submission
Robust Contractual
Processes
Develop processes and
infrastructure to ensure that
contracts are delivered to
plan
Address over performance
and risks through process
improvement and
challenge. Develop
additional extra-contractual
challenges
Develop fresh challenges
for 2015-16 and explore
opportunities for
procurement.
36
4. Sustainability
How the System will meet the sustainability challenge:
Robust Contractual Processes
The purpose of this programme is to ensure that the CCG has the appropriate contracting architecture to
respond to areas of over performance, address key business risks, deliver existing contractual mechanisms and
raise fresh challenges. The target for these measures is to reduce run rate and unresolved risks by £xM in year.
This programme is the single most important delivery vehicle in the short term, partly because of the size of
potential savings and partly because it is a basic enabler of subsequent actions. This programme will be the key
focus of the Interim Turnaround Director, which in turn will be enabled by the establishment of a PMO, which
will be led by of an individual who has been operating at Director level externally.
Key Actions
2014/15 Build In-House
Contract Management
Function
 Quickly embed best practice
 Build capacity and capability
•
•
•
•
Ensure existing contractual levels are utilised so that the
relationship with providers is managed according to the
contract
Ensure that activity data and pricing is validated according to
best practice
Generation of a series of extra contractual challenges based
on PbR guidance
Revised contracts from 15/16 to yield on-going benefits
V5.1 for September re-submission
37
4. Sustainability
How the System will meet the sustainability challenge:
Elective Care and GP Referrals
The purpose of this programme is to provide a framework to ensure that referral practice across the clusters is
standardised through adherence to protocols which aim to ensure compliance with best practice. In the
medium term, the focus is largely upon the development of locality clusters as mature entities and ensuring
that they have the necessary infrastructure to work in this way. This will particularly include the roll out of
information and addressing areas of variation from best practice.
Key Actions
•
•
•
•
•
•
2014/15
Ensure full implementation of PoLCE and C2C
referral policies
Implement Cluster and Practice level referral
management
Highlight areas of high practice variation and
address
Practice level clinical validation of provider
invoices
Implementation of referral protocols for
enhanced recovery
Implement detailed reviews of specific
services
•
•
•
•
•
2015/16
Formalise full range of referral protocols and
monitor implementation.
Develop maturity and accountability of Clusters
Further review of individual pathways where
there is high practice variation
Drive full budget ownership at practice level
Revised contracts from 15/16 to yield on-going
benefits
V5.1 for September re-submission
38
4. Sustainability
How the System will meet the sustainability challenge:
Proactive Primary Care
The purpose of this programme is to address the recent stepped change in A&E attendances and associated
admissions and to implement longer term measures to reduce demand for this service. In the first quarter of
2014/15, we have seen a 22% increase in A&E attendances by Luton patients compared with the same period in
2013/14. There is also enormous variation in the relative contribution of each practice to this growth, with
some practices showing an increase of over 70%.We must therefore enable and encourage practices to take a
proactive approach to managing patients who might otherwise go to A&E
Key Actions
•
•
•
•
•
2014/15
2015/16
Ensure that A&E streaming protocols are used
• Fundamentally reassess whether the current
effectively
multi-layered approach to unscheduled care
In depth review of admissions to the Paediatric
provides the most effective solution.
Assessment Unit
Furthermore, the requirement to reprocure may
Implement awareness campaign on the correct
also provide a mechanism for introducing new
use of NHS services with those entering the UK
incentives to the system or force multiple
for the first time
providers to work more closely with each other,
Implement protocols to ensure that
potentially through some form of prime vendor
unscheduled care services such as the Walk in
contract.
Centre, Urgent GP Clinic and GP Out of Hours are
• integrate this programme into the wider
used appropriately
BCF/whole system transformation
Utilise Clusters to drive reductions in practice
V5.1 for September re-submission
39
variation in A&E attendance
4. Sustainability
How the System will meet the sustainability challenge:
Better Together (BCF) / Whole System Transformation
The purpose of this programme is to ensure that the CCG is able to deliver the requirements of the wider
system transformation process. This has a number of interconnected elements (Co- commissioning, Better Care
Fund, Better Together Care Team project, the DES and the development of locality cluster infrastructure). Whilst
a number of these initiatives are developing on track, it is recognised that the breadth and complexity of the
individual elements involved requires strengthened programme management with PMO support.
Key Actions
•
•
2014/15
Ensure that existing commitments are
sufficiently resourced so that savings initiatives
start to gain traction before the year end.
Build a tracking capability to ensure that savings
are being delivered in practice.
•
2015/16
The system has already initiated a number of
interconnected and phased workstreams all of
which have detailed plans. The key issue for
2015/16 is to ensure that these various
workstreams are delivered in an integrated
manner with the appropriate alignment of CCGs
resources.
For further detail on this programme see pages 46-58
V5.1 for September re-submission
40
4. Sustainability
How the System will meet the sustainability challenge:
Robust Governance Driving Delivery
The CCG has put in place robust governance to ensure that
programme sponsors, owners and individuals responsible for
delivering elements of the Recovery Plan are held to account.
The plan delivery will be driven forward by a PMO to ensure
that there is a robust performance management framework in
place to deliver each of the programmes.
The principle of this process is that smaller issues and barriers
to progress are addressed at the bottom of the pyramid and
progressively larger but fewer issues are escalated as move
upwards towards the Board
PMO
The pyramid diagram on this page represents the flow of
assurance from points of delivery through to the CCG Board and
onward to NHS England.
CCG Board
Finance and Performance
Committee
Executive Committee
Practice Clusters and
Implementation Groups
V5.1 for September re-submission
41
4. Sustainability
Meeting the sustainability challenge
Shifting the Balance of Spend over 5 years
This graph is a
stylised
representation of
the relative shift
in the balance of
spend, primarily
driven by the
Better Together
Programme
100%
90%
45%
50%
80%
60%
70%
60%
35%
50%
33%
40%
30%
30%
13%
10%
20%
9%
5%
3%
2%
5%
5%
8%
2013/14
2015/16
2018/19
10%
0%
Prevention
Wellness
Early Intervention
V5.1 for September re-submission
Help at Home
Specialist
42
4. Sustainability
Goals for sustainability
 LCCG to achieve financial balance during 2015/16
 All organisations within the health economy
report a financial surplus in 18/19
 Delivery of the system outcome ambitions
 No provider under enhanced regulatory scrutiny
due to performance concerns
 With the expected change in resource profile
V5.1 for September re-submission
43
5. Improvement Interventions
V5.1 for September re-submission
44
5. Improvement Interventions
Summary of Key Interventions
Better Together – Integration of Health and Social Care
Implementation of the Better Care Fund Plan to:
• Build personalised services around the needs of patients
• Switch the focus towards prevention and early intervention
Transforming Primary Care
• Driving a transformation in the capacity and capability of primary care
to deliver a broader range of high quality and safe services in the
community.
Reconfiguring Mental Health and Community Services
• Redesign of community and mental health services to drive improved
health outcomes, system integration and financial sustainability
Transforming Urgent Care
• Redesign of unscheduled care provision to ensure the right level of care
delivered appropriate to the needs of the patient.
V5.1 for September re-submission
45
5. Improvement Interventions
Better Together1
Introduction
The government spending review in June 2013 created
the Better Care Fund “a single pooled budget for health
and social care services to work more closely together in
local areas, based on a plan agreed between the NHS
and local authorities”.
At a national level, the Health and Social Care Act 2012
puts a responsibility on Health and Wellbeing boards to
promote integration .
There is a considerable body of evidence that supports
the idea that holistic health and care services organised
around a person (patient, service user or carer) leads to
better health outcomes and has the potential to cost
less. Luton Council’s prospectus says: “We know that
achieving good health outcomes comes from more than
having good health services and that housing, education,
work, diet, lifestyle and social activities make a big and
sometimes decisive difference to health inequalities.”
This view is supported in the public health white paper
2010 and Marmot report “Fair Society, Healthy Lives”,
also 2010.
Integration in Luton
Integration in Luton is being driven through the Better
Together programme, which brings together the NHS,
comprising Luton CCG, Luton and Dunstable University
Hospital Foundation Trust, Cambridgeshire Community
Services NHS trust (CCS) and South Essex Partnership
university NHS foundation trust (SEPT), with Luton
borough council (LBC), Luton’s voluntary and community
sector (VCS) and Luton residents represented by
Healthwatch. A key element of the Better Together
Programme is the delivery of the local Better Care Fund
plan which was resubmitted on September 19th following
revised national guidance.
At a local level, integration is identified in the joint health
and wellbeing strategy as one of the key factors in
improving health and reducing health inequalities.
Additionally the JSNA sets out the health and care
pressures and needs in Luton, identifying areas where
integration is likely to be most urgently needed, such as
care for people with dementia or older people
unnecessarily staying in hospital and residents with long
term conditions.
1 See also Better Care Fund Plan
V5.1 for September re-submission
46
http://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Better%20Care%20Fund%20plan.pdf
5. Improvement Interventions
Better Together
The proposition at the heart of this programme is that services designed and delivered around the person enable them
and their family to stay independent for longer and that this not only improves their immediate and longer term health
outlook, it also costs the public purse less money because it delays or avoids the need for expensive residential or
hospital in-patient care.
Evidence Base
Our collective vision for integrated health and social
care in Luton includes making better use of shared
evidence and data. Research into the health of local
people published in the Joint Strategic Needs
Assessment (JSNA), in 2011, clearly identifies the key
health challenges and highlights the inequalities in life
expectancy which exist in Luton.
The Better Together programme is informed by a review
of evidence, looking at work undertaken by the Kings
Fund to review literature on studies of a number of
health and social care integration projects in this
country and abroad. The review of the evidence base
indicates the following as good practice
recommendations for developing and implementing the
Better Care Fund in Luton
• Establish a shared leadership between the
organisations
• Develop a shared narrative and vision
• Pool resources
• Innovate in the use of commissioning, contracting
and payment mechanisms and the use of the
independent sector
• Engaging with primary and secondary care to ensure
smooth transition from hospital to home
• Single point of access, single assessment and sharing
clinical records
• Supporting individuals to change behaviours such as
smoking, for example, through advice during a
consultation
• Well-developed, integrated services for older people
Integrating primary and social care has been shown
to reduce admissions,
V5.1 for September re-submission
47
5. Improvement Interventions
Better Together – changing the way
services are delivered
We recognise that delivering our 5 year vision will require significant change across the whole of the current health and social
care provider landscape. Better Care funded work will see :
 The redeployment of funds from existing NHS services in the acute sector to community and primary care
 Protection of adult social care to support more people at home
 Targeting resources to best effect which means constant review of services to ensure investment plans deliver outcomes
required
Service changes will be developed by building on our existing integrated services, for example joint equipment services, jointly
commissioned community based rehabilitation beds, integrated discharge team. More of these services will expand to
become 7 day a week services where there is clear evidence of patient benefit for doing this.
A complete list of schemes and work is included in this plan on pages 51- 54, though more detail is available in the full BCF
plan.
Our intention is to create Better Care Teams which are multi-disciplinary teams which include social workers, integrated
nursing care , specialist nurses, Community Psychiatric Nurses, hospital consultants and help at home. Planning around the
person will take account of both physical and mental health needs and mental health professionals will be an integral part of
the multi-disciplinary team. Professional accountability for the overall coordination of care for each individual will be held by a
GP and a personal electronic plan will enable resident information to be shared across the whole system as necessary,
including the ambulance service. Additionally, home care services will play an increasingly important role within the multidisciplinary teams and will be trained to provide a broader range of services than on offer currently. This will enable them to
support clinical care and to provide assistance in some areas such as pressure care, changing dressings and hydration. A
clearer and simpler system should help all professionals to signpost people towards “healthier‟ services, strengthening the
September
48
early intervention and self-management modelV5.1
thatfor
is an
importantre-submission
part of our shared vision
5. Improvement Interventions
Better Together – Better Care Teams
Referrals from GP OOHS, 111, My
Care co-ordination, Ambulance
Larkside
No Of
GP Cluster
Cluster
2
Kingsway
No Of
GP Cluster
Cluster
2
Practice
Clusters
Medics
No Of GP Cluster
United
2
Cluster
Referrals
South East
No Of GP Cluster
Luton
2
Cluster
Crisis Response Team
• Manager to manage team and ward 7
days week
• Social Care: SW plus support workers
• Nurses per day
• MH CPN
• OT/ Physio + 2.5 Therapy Assistants
• HCA
• Admin support per week
• Aligned DME consultants
Nurse
Navigation
Hospital
@ Home
Unplanned
Nursing
Team
ACCT
Step
Up /
Step
Down
Beds
Emergency duty
Team (coordination of
care)
(Crisis Response)
49
5. Improvement Interventions
Better Together – Focus of the Better
Care Fund
The overarching areas of focus of Better Together as articulated in the Better Care Fund Plan are listed below
Reducing the number of emergency admissions and consequent hospital beds and used to fund the
expanded home and community based services.
Identify those people within the local population where the maximum impact can be made, using risk
stratification tools.
create multi-disciplinary teams (Better Care Teams) that will include social workers, district nurses, hospital
at home nurses, hospital consultants and home help, with clinical navigators.
Planning around the person will take account of both physical and mental health needs and mental health
professionals will be an integral part of the multi-disciplinary team .
Professional accountability for the overall coordination of care for each individual will be held by a GP and
a personal electronic plan will enable resident information to be shared across the whole system
A clearer and simpler information system should help all professionals to signpost people towards
“healthier” services, strengthening prevention, early intervention and self-management.
V5.1 for September re-submission
50
5. Improvement Interventions
Better Together – Defining the key
programmes 1
Enabling Programmes
BCF
Scheme
ID
Enabler 1
Scheme Name
Description of project/s
Project
Manager
Project
Sponsor
Enhancing joint
commissioning
Enhance existing joint
commissioning
arrangements.
Nicky
Poulain
(CCG)/Pam
Garraway
(LBC)
Existing
resources
(LBC, C&L
and CCG)
Workforce Skills
Development of a joint
workforce strategy across
health and social care.
More generic roles e.g.
Home care plus role and
commissioning roles
Development of portal.
Reduce duplication,
improved joint
assessment/joint care plans.
Data sharing use of NHS
number
Jackie
Barker
(LBC)
Marisa
Rose
(CCG &
LBC)
TBC
Pam
Garraway
(LBC)
Existing
TBC
LBC- TBC
Existing
Resources
(LBC, L &
D & CCG)
additional
investment
(LBC, L & D &
CCG)
£120.000
£120,000
Enabler 2
Enabler 3
Improving
Technology for Joint
Working/Improving
information sharing
CCG John
Webster
14/15
£
V5.1 for September re-submission
15/16
£
TimescalesStart Date
TimescalesFinish Date
On-going
Phase 1
31/03/2015
Now
31/03/2015
Now
TBC
51
5. Improvement Interventions
Better Together – Defining the key
programmes 2
Programmes 1 - 3
BCF
Scheme ID
Scheme Name
Description of project/s
Project
Manager
Project
Sponsor
14/15
£
15/16
£
TimescalesStart Date
Timescales- Finish
Date
Scheme 1
Proactive and
Integrated Primary
Care services
Improve clinical pathways within
primary care cluster GPs
Paul
Lindars
(CCG)
Nicky
Poulain
(CCG)
Existing
Resources
(CCG)
Existing
Resources
(CCG)
On-going
On-going
Implementing the
Better Care
integrated team
Reconfigure existing
physical/mental health and social
teams around GP clusters.
Improve joint assessments.
Proactive care developments.
Calene
Vanzyl
(CCG)
Nicky
Poulain
(CCG)/Maud
O’Leary
(LBC)
Existing
Existing
Resources Resources plus
plus
additional
additional
investment
investment
(LBC & CCG)
(LBC &
£5,982,000
CCG)
£2,732,830
On-going
Phase 1
01/12/2014
Improving 7 day a
week
working/Discharge
Support
Integrated management of
discharge process.
Not
required
as already
in place
Maud
Existing
Existing
O’Leary
Resources Resources plus
(LBC)/Karen
plus
additional
Ward (LBC & additional
investment
CCG)
investment (LBC, L & D &
(LBC, L & D
CCG
& CCG)
£579,000
£200,000
Complete
Complete
On-going
Phase 1
31/03/2015
Scheme 2
Scheme 3
Appropriate 7 day working across
health and social care system.
TBC
V5.1 for September re-submission
52
5. Improvement Interventions
Better Together – Defining the key
programmes 3
Programmes 4 & 5
BCF
Scheme
ID
Scheme 4
Scheme Name
Description of project/s
Project
Manager
Project
Sponsor
14/15
£
15/16
£
TimescalesStart Date
TimescalesFinish Date
Rapid Response
New pathways for crisis and rapid
response.
Calene
VanZyl
Maud
O’Leary
(LBC)/Nic
ky
Poulain
(CCG)
Existing
Resources
plus
additional
investment
(LBC, L & D
& CCG)
£50,000
Existing
Resources
plus
additional
investment
(LBC, L & D &
CCG)
£565,000
Jan 2015
Phase 1
31/03/2015
Maud
O’Leary
(LBC)/Nic
ky
Poulain
(CCG)
Existing
Resources
plus
additional
investment
(LBC, L & D
& CCG)
Existing
Resources
plus
additional
investment
(LBC, L & D &
CCG)
Jan 2015
£375,000
£764,000
Reablement
Scheme 5
Additional step-up beds,
improved transport
arrangements, responsive home
care and reablement service
Janet
Chase
(LBC)
/Marisa
Rose
(CCG and
LBC)
V5.1 for September re-submission
Phase 2
TBC
Phase 1
31/03/2015
Phase 2
TBC
53
5. Improvement Interventions
Better Together – Defining the key
programmes 4
Programmes 6 & 7
BCF
Scheme
ID
Scheme 6
Scheme Name
Description of project/s
Project
Manager
Project
Sponsor
14/15
£
15/16
£
TimescalesStart Date
TimescalesFinish Date
Mental Health
MH service currently being
re-procured potential start date
after April 2015 : new integrated
models of care
Natalie
MilesKemp
(CCG)
John
Webster
(CCG)
Existing
Resources
Existing
Resources
Mobilisation
planning
from Oct 14
New contract
start 1st April 15
Scheme 7
Reducing
Children’s
emergency
admissions
Reduction of children’s
emergency admissions and
improvement on variation of
admission from GP practices.
Paula
Doherty
(CCG/LB
C)
Sally
Rowe
(LBC)
Existing
Resources
Existing
Resources
Now
TBC
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5. Improvement Interventions
Better Together – Defining the key
outcomes
Key Indicator: The system has agreed a goal to deliver a 3.5% reduction per year in
emergency admissions for 2015/16, 2016/17 and 2017/18. The total reduction of
three years is therefore 10.5%
Supporting Indicators
Baseline
2013/14
Target 2014/15
Target 2015/16
Residential admissions to residential and nursing
care homes. Rate per 100,000
449
443.5
443.2
Reablement. Proportion of older people still at
home 91 days after discharge from hospital
80.3
81.4
83.2
Delayed transfers of care per 100,000
3547
3344
Change -4.3%
3210
Change -2.8%
Proportion of people feeling supported to
manage their condition
63.3
64
64
Adult social care survey - % of people who are
satisfied with their social care
60.1
64
64
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5. Improvement Interventions
Better Together – Key Measures of
Success1
2015/16
2016/17
•Better Together Teams in Place
•7 Day Working in Place
•Integrated workstreams for LTCs
•Integrated Mental Health / Community Services
•Homecare plus programme implemented
•Better Together Teams in place for LTCs
•Single Point of Access in Place
•Integrated Commissioning in place
Patient
Experience
•Improved patient and carer experience
•Deaths in place of choice
•Reduced EOLC patients dying in
hospital
•Patients feeling able to manage their
condition
•Elderly patients living independently at
home after discharge
Clinical
Outcomes
•Improved diagnosis – disease
registers
•Reduced incidence of late diagnosis
•Reduced MRSA / C Diff / Never
events
•Reduced child and adult obesity
•Increased child immunisations
Demand
Management
•Reduced emergency admissions
•Reduced permanent admissions to
care homes
•Reduced delayed transfers of care
Key Performance Indicators
Major Milestones
2014/15
•Frail elderly plan delivered through 4 Clusters
•Disabled children plan in place
•Information sharing plan in place
•Risk share agreement with system in place
•Formal sharing of back office functions
2017/18
•Evaluation and consolidation
2018/19
1Further detail
on specific KPIs can be found in theV5.1
BCFfor
Plan
September re-submission
http://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Better%20Care%20Fund%20plan.pdf
56
5. Improvement Interventions
Better Together – Spend aligned to
specific outcomes
Outcome
BCF
Spend*
2014/15
£3478k
2015/16
£13021k
Saving
2014/15
(£k)
Saving
2015/16
(£k)
Programmes Driving Outcome
Reduction in
Permanent residential
admissions
13
50
Workforce Skills, Implementing the Better
Care Integrated Team, Improving 7 Day a
Week Working / Discharge Support,
Reablement, Mental Health
Increased effectiveness
of reablement
3
23
Reablement,
387
588
Improving Technology for Joint Working /
Improving Information Sharing, Improving 7
Day a Week Working / Discharge Support
422
Workforce Skills, Proactive and Integrated
Primary Care Services, Implementing the
Better Care Integrated Team, Improving 7
Day a Week Working / Discharge Support
Reduced Delayed
Transfers of Care
Reduced Emergency
admissions
*For spend on specific programmes see pages 51 to 54
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5. Improvement Interventions
Better Together – Modelling Activity
Changes - Example
We have extensively modelled the impact of the Frail Elderly workstream, with activity reductions based on those aged > 60
All activity has been categorised into Primary Care Clusters based upon GO LIVE dates of Aug 1st 2014 (Cluster 1); Oct 1st 2014 (Cluster 2); Dec 1st 2014
(Cluster 3); Mar 1st 2015 (Cluster 4)
There are 3 components to activity: Emergency Admissions (EA); A&E Attendances and Outpatient appointments (first and follow ups)
EAs have been reviewed at HRG level to identify those areas where admissions can be avoided through the Frail Elderly work. These are
calculated at the marginal rate which is 30% of the full PbR tariff
For EAs we assume for Clusters 1, 2 and 3 a 20% reduction will take place in the first year from the go live dates. We assume a 25% reduction for
Cluster 4. For each subsequent month we then assume an additional 2% reduction with a celing of 32% on the total cohort of EAs
EAs have been reviewed to evaluate how many were admitted via A&E. Where this is the case A&E attendances have been reflected in
activity reductions
We have assumed a 10% reduction in outpatient appointments (first and follow ups) across all treatment function codes
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5. Improvement Interventions
Transforming Primary Care
Our vision for Primary Care is that we develop an offering that is comprehensive,
person-centered, population oriented, coordinated, accessible, safe and high
quality
Introduction
Primary Care has critical role to play in the delivery of a high quality sustainable health and social care
system. Due to historical unacceptable variations in the outcomes and accessibility of primary care in Luton
together with the need to ensure that primary care as a whole is able to drive a decreased reliance on the
hospital, we have identified the need to transform Primary Care as an essential building block of future
success.
Whilst there are excellent examples of good Primary Care in Luton, we know that there is considerable
variation in access to care and in health outcomes across Luton. Using the Primary Care Web Tool1 we know
that a number of practices are outliers for a number of indicators such as diagnosis and outcomes of Long
Term Conditions, flu vaccinations and emergency admissions to hospital.
The need to improve overall quality and to reduce variation was a clear recommendation in the 2011 JSNA
and the Health and Wellbeing Strategy.
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy
The CCG is working in close partnership with the NHS England Area Team on a local strategy and the Area
Team’s Primary Care Strategy has provided the framework for this
Our strategy has two key objectives:
1. Improving and reducing the variation in patient experience and access, which builds on our partnership
working with Healthwatch which conducted an in depth survey of patient opinion in early 2014
2. Improving health outcomes and reducing inequalities
The programme structure to support the implementation will be via a primary care strategic implementation
group led by a Clinical Director.
The overarching work streams for the programme include:
 Development of practice Clusters
 Collaboration with patients
 Co-Commissioning (Improving patient access to primary care and quality improvement )
•
•
•
•
•
Utilising Primary Care contracts (local and national enhanced services to improve quality)
Premises
Procurements / mergers
Workforce planning
Driving improved quality and performance through schedule of quality visits
 New Models of Care (Integration of services for the elderly and vulnerable people )
 IM&T
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 Workforce Development
60
5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Practice Clusters
A key enabler to transforming primary care is the establishment of Practice
Groups “Clusters” that are integrated within the LCCG governance structure (see
diagram on page 62). This initiative will support the development of local clinical
leadership to address variation via peer review and to also build commissioning
capacity
Four Clusters covering populations of approx. 40,000 to 65,000 have been
agreed. The significant change will be the alignment of community services
(initially with a lead nurse for each cluster), adult social care, and mental health
and medicines optimisation services.
Our vision is that current practices develop collaborative working or group
together to provide primary care services at scale, resulting in:
LUTON PRIMARY CARE CLUSTER GROUPS
Medics United
Cluster
7 Practices
list size: 55468
GP Chair: Dr Baz Bahey
Kingsway Cluster
Larkside Cluster
9 Practices
list size: 43095
GP Chair: Dr Abbas Zaidi
list size: 58237
GP Chair: Dr Haydn Williams
8 Practices
South East Luton
Cluster
7 Practices
list size: 64549
GP Chair: Dr Anitha Bolanthur
 Improved access, and equity of access, to services for Luton’s population
 Efficient streamlined integrated services utilising latest technology to improve
the patient experience
 A well-developed motivated workforce offering safe quality services in
convenient out of hospital locations
 New or improved services focusing on: health & wellbeing (prevention),
collaborative care teams, urgent care
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5. Improvement Interventions
Luton CCG Governance Structure - Practice Clusters
CCG Board
Patient Safety & Quality Committee
Clinical Commissioning Committee (CCC)
Finance & Performance
Cluster Meeting
Cluster Clinical Chairs/ Clinical Directors
General practice
Primary Care &
other
Strategic
Implementation
Groups (SIGs)
1.Terms of Reference
2.Practice Agreements
3.Cluster level Reports
Quality/Performance
4. Cluster level
Indicative Budgets
Commissioning
Management
Resource
Community Services- Green Team
Commissioned Social Care
Commissioned Social Care
Larkside
Kingsway
8 Practices
9 Practices
Primary Care
Development
Manager
Community Services- Blue Team
Commissioned Social Care
Medics United
7 Practices
Better Integration
with
Health and
Social care
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Commissioned Social Care
South East Luton
7 Practices
Structure Services
to align with
Practices in each
Cluster
e.g. demographics
Patient Engagement
Practice
Cluster
Representation
62
5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Co-Commissioning
Luton CCG will build upon the established working partnership with the Local Area Team, thereby sharing information and
ensuring that local primary care services receive targeted support. Recent successes of this partnership work include:



Shared decision making with NHS England related to primary care premises
Increasing practice engagement to implement Enhanced Services commissions by the AT
Agreed implementation plans for local practice quality improvement visits
Co-commissioning offers the opportunity for further pro-active working with the Area Team to influence commissioning
decisions that affect the health and wellbeing of our population. Where appropriate, the primary care strategy will formalise
joint commissioning arrangements to enable LCCG to deliver the 2 year operational plan.
The immediate key areas identified as critical to enable us to transform Primary Care include joint working with the Area Team
support on the following projects:
• Practice procurements and potential mergers
• Primary Care premises
• Workforce and planning
• Improved quality and performance
These projects are discussed in more depth on the following 9 pages
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Co-Commissioning
Practice Procurements and potential mergers
The CCG is collaborating with the Area Team during 2014/15 to ensure we are able to inform and influence commissioning
decisions for the 4 APMS practices out to tender in 2014/15. The CCG will ensure that the following issues are factored in
procurement decisions:
•
APMS flexibilities and content of local contracts
•
Practice mergers and size and location of premises
•
Innovative new providers and use of premises
Workforce Planning
GP and Practice Nurse Recruitment & retention are a significant issue for Luton. We will work with the Area Team to understand
what the data is telling us , to agree:
•
Capacity Planning
•
Training requirements
•
Recruitment and Retention
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Co-Commissioning
Improved quality and performance
The CCG is committed to work with the Area Team via constructive collaborative working with practices (and the support of the
LMC) to drive up the quality of primary care services. A schedule of quality visits will facilitate quality improvement with a
strong focus on patient experience focusing specifically on areas where experience is below average, subsequent improvement
will lead to a more positive patient experience.
The sharing of local and national high quality data and information are at the heart of this work. The programme of visits will be
undertaken following analysis of the national NHS England Primary Care Web Tool; the currently under development Primary
Care Web Plus tool will soon be available providing more up to date qualitative and quantitative information about challenged
practices.
There is a variation in quality in GP services across Luton. The Primary Care Web Tool has identified 13 practices (4%) across the
Hertfordshire and South Midlands AT that require quality assurance visits i.e. those practices that have 6 or more outlying
indicators. 4 of these are Luton practices. A co-commissioning approach is imperative if this improvement work is to have the
legitimacy needed to bring about fundamental sustainable quality improvements. This joint work has already resulted in
development of a standardised approach, bringing strong commitment to the visits from the CCG and the Area Team.
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Co-Commissioning
Primary Care Premises
Luton’s Primary Care Estate requires improvement. An architectural review tells us the following:
• 4 premises are not fit for purpose and should be replaced
• 13 practices do not have sufficient space, of which
• 5 practices have potential for extension, and a further
• 3 practices are prepared to join with another practice
• 5 practices require refurbishment
In partnership with the Area Team and local planning authorities, we will agree a strategic plan over the next 6-9 months to
consider how best to meet the growing population and to support changes to service models across health and social care. This
plan would take into consideration the options for new GP models: Vertical Integration, Merged Delivery, Combined Delivery
and Bigger Delivery
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Collaboration with Patients
Driving Improvements in Collaboration with Patients
Many practices in Luton do not currently have an active Patient Participation Group (PPG) and therefore do not have a
mechanism in place to receive constructive feedback from their patients. The CCG has implemented a ‘Big Push’ campaign to
help practices launch or re launch their PPG. As part of this initiative a toolkit will be provided that can be used by practice
managers to help support them in setting up an effective group. Smaller practices will be encouraged to “buddy up” and have
joint PPGs where appropriate. These groups help the focus to remain on patient centred care and the general principle of ‘no
decision about me, without me’. PPG members are then invited to sit on the CCG wide Patient Reference Group (PRG) to allow
feedback to flow into the decision making processes for the CCG.
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: New Models of Care
New Models of Care
Integration is driven through the Better Together programme aligning health, local authority, voluntary and community sector.
The first key work-stream included in the Better Together programme has been the design a new integrated model of care for
the frail and elderly population of Luton. This is intrinsically linked with our vision to transform primary care services and the
two go hand in hand. The following page shows how the Frail and Elderly new model of care overlaps and builds on the work
practices are already completing for over 75s (core GMS) and the avoiding unplanned admissions enhanced service.
Currently the Larkside GP cluster is leading the design principles for patients identified as frail and elderly. Phase 1 work to date
includes:
•
•
•
•
•
•
Design and formation of multidisciplinary team model
A standard approach to implementing health and social care plans
Re-configuring hospital ward management to ensure patients are aligned with the Clusters allocated geriatrician
Risk stratification to identify a cohort of patients at risk of a hospital admission
A Single Point Of Contact (SPOC) for patients identified for case management
Development of an acute trust ‘community geriatrician’ offer
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How the Frail & Elderly Workstream builds on the NHS England Transforming Primary Care
Agenda
(3) Frail elderly workstream
•
(1) Named GP- ≥75 (GP Contract 2014/15)
•
•
•
•
~12,000 population in Luton
Likely to mean the majority of frail elderly
will have:
A named accountable GP who will work
with health & social care to deliver a multidisciplinary package
Access to health check
•
•
(1) 75s and over
(2) Avoiding unplanned admissions (DES)
•
•
•
•
•
•
•
•
•
~3,500 population in Luton (2% adult list)
Likely to mean the majority of frail elderly
will be included on the practice case
management register & have:
A named accountable GP
A named care co-ordinator
Personalised, proactive care & support plan
informed by multi-disciplinary teams
Regular review of care plan (at least 3
monthly)
Patient (& professional) hotline to practice
clinician
Timely follow up after discharge
Retrospective audit of those with an
unplanned admission/ A&E attendance –
leading to proactive change
(3)Frail
elderly
(2) Case management
register (DES)
•
•
•
•
•
•
•
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Identification of frail elderly
(likely to be on practice case
management register)
Clinical frailty scale 5-9?
Comprehensive
(multidisciplinary) geriatric
assessment/ MDT
•
Geriatrician
•
GP, Practice Nurse/ HCA
•
CM, DN, Macmillan
•
Mental health
professional
•
Pharmacist/ technician
•
Dietician
•
Social worker
•
Voluntary sector
(eg age concern)
Wrapped around practice cluster
Focus on diabetes/ respiratory/
H&F?
Personalised, proactive care &
support plan informed by multidisciplinary teams
Care plan shared with all
agencies involved (electronic)
Named care co-ordinatoraround practice clusters
Falls prevention
Telecare/health
69
5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Primary Care and Community Contracts
Extended primary care and community contracts (building capacity and capability –primary care at scale)
The CCG is committed to ensuring the appropriate mechanisms such as population based and outcome-focused contracts,
incentives and risk sharing agreements are developed and in place to allow the commissioning of innovative new models of
care. Our aim in the medium to long-term is for Luton practices to form well governed provider organisations to manage and or
deliver community/ primary care extended contracts at scale. These provider organisations might include Limited Liability
Companies, CICs or super-partnerships and could take 'make or buy' decisions taking a prime contractor role- sub contracting
where appropriate.
As part of the transition from Local Enhanced Services (LESs) to NHS standard contract Luton CCG have already placed an
emphasis on practices being in a position to offer a phlebotomy service for patients who are registered with a practice who are
not able or willing to provide this service.
Once Luton’s community and mental health procurement is complete the next step is to consider development of outcome
focused extended primary/ community contracts that encourage vertical integration, including:
• General practice working with non GP providers (acute, local authority)
• More collaborative working across primary, secondary, community and voluntary sector
• Extended services (up to 7 days a week)
These new services will complement services commissioned from acute, community and mental health providers.
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: IM&T
Information Management and Technology (IM&T)
The CCG is committed to working with the IM&T team, LMC and NHS England Hertfordshire & South Midlands Area Team to
support practice compliance with the 2014/15 GMS IM&T contract obligations. These include:
•
•
•
•
Appointments online - offering the facility for patients to book, view, amend and cancel appointments
e-Referral – to provide better and more targeted information to patients and carers to facilitate choice of service or clinician
Repeat prescriptions – the ability to order, view and print a list of repeat medications
Summary Care Record – automated practice clinical system upload allowing patients to view online, export or print their
summary
• GP2GP - facility for transfer of all patient records between practices, when a patient registers with another practice
The following initiatives are also in progress:
• Electronic Prescription Service – EPS2. Phased rollout across Luton
• The purchase of an integrated portal to improve interoperability and support the implementation of a shared Health and
Social Care Plan
Another aspiration is to modernise clinician to clinician consultation and to support practices to address variation is through
establishing online collaborative workspaces to enable groups of clinicians to discuss patients. In effect this would be a
multidisciplinary healthcare ‘professional social network’ to facilitate clinical collaboration.
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5. Improvement Interventions
Transforming Primary Care
Primary Care Strategy: Workforce Development
Workforce Development: Clinical Leadership
There is a critical need to build local leadership and organisational capabilities to support and drive the
changes highlighted above with GPs leading service planning and quality improvement.
Succession planning and developing future GP leaders is crucial for Luton. The CCG, in collaboration with the
University of Bedfordshire and Health Education East of England, is implementing an innovative scheme to
recruit high-calibre GPs with leadership potential. The recruits (2 per year) will receive mentoring and higher
professional learning (MBA or MEd) over their 3-year contract, while gaining paid experience in
commissioning or medical education to equip them for future leadership and also undertaking 2 ½ days per
week clinical work in a local practice.
Workforce Development: Professional Development
Multi-speciality medical practice providing new models of care closer to home will require the support of
specialists. As part of the new frail and elderly model of care, geriatricians from the local acute trust will align
with practice Clusters offering clinical advice for complex patients within a multidisciplinary environment.
This process will enable the continued professional development of community and practice based clinicians
across Luton.
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5. Improvement Interventions
Transforming Primary Care – Key
Measures of Success
2015/16
•GP Leaders Programme Phase 1 Complete
•IT Infrastructure Phase 2
•Extended Primary Care Contracts Delivery
2016/17
•Informal Federations in place
•GP Leaders Programme Phase 2 Complete
•IT Infrastructure Phase 3
2017/18
•Formal Federations in place
•GP Leaders Programme Phase 3 Complete
•IT Infrastructure Phase 4
•Improved Estates in place
Patient
Experience
Clinical
Outcomes
Demand
Management
•Evaluation and consolidation
•Ease of Access
•Overall Satisfaction with service
•Deaths in place of choice
•Patients feeling able to manage
their condition
•Increased use of NHS number
Key Performance Indicators
Major Milestones
2014/15
•Primary Care Clusters in place
•IT Infrastructure Phase 1
•Extended Primary Care Contracts Plan
•Commence practice procurements / mergers
•Reduced outliers on key
primary care outcomes
•Number on disease / EOLC
registers reflecting prevalence
•Increased smoking quitter rates
•Increased child immunisations
• Reduced avoidable
emergency admissions
• Achievement of acute
activity plan
2018/19
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5. Improvement Interventions
Reconfiguring Mental Health and
Community Services
Introduction
We are reconfiguring mental health and community services to support the drive towards integration and therefore this
programme has close links with the Better Together Programme. In 2013/14 the CCG identified an opportunity to recommission community health and mental health services simultaneously as current contracts were coming to an end, as well
as identify future providers who will embrace the integration model being developed through the Better Together programme
National Context – Mental Health
The profile of mental health has rightly moved up the
national agenda over the past five years. Our overall strategy
for mental health is closely aligned to the following key
publications:
• No Health Without Mental Health – DH 2011
• Talking Therapies, a Four Year Plan of Action – DH 2011
• Closing the Gap : Priorities for Essential Change in Mental
Health – DH 2014
Locally we support the National goal of achieving parity
between mental and physical health and the need to
overcome the significant health inequalities for those with
mental ill-health. That is why we have aligned transformation
of mental health with the transformation of other services
and in particular Community Services
1http://www.nepho.org.uk/cmhp/index.php?pdf=E0600003
2
Mental Health in Luton
Based on the Luton Community Mental Health Profile 20131
there are certain characteristics of the local population that
suggest that strategic focus on mental health will address
currently unmet needs of our communities. Luton has a
worse than England Average:
• Percentage of 16-18 year olds not in employment,
education or training
• Rate of violent crime per 1,000 of the population
• Percentage of the population living in the 20% most
deprived areas in England
• Rate of statutory homeless households
• Number of first time entrants to the youth justice system
• Percentage of adults participating in physical activity
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5. Improvement Interventions
Reconfiguring Mental Health and
Community Services
Local Need – Mental Health
A Mental Health Needs Assessment1 published in 2012
made the following recommendations:
• Commission services on the basis of need
• Improve use of data to monitor and evaluate services
• Ensure community services are accessible to all
• Increase routes of access into services
• Increase depression case finding
• Focus on physical health of those with mental health
issues
• Develop a mental health promotion strategy
• Develop a care pathway
• Understand community mental wellbeing
Community Services Context and Goal
Community Services are commissioned through two
organisations; South Essex Partnership University NHS
Foundation Trust (SEPT) and Cambridgeshire Community
Services (CCS). The significant majority of the Community
services are provided within the CCS Portfolio, with a range
of therapies, including those for children, provided by the
SEPT contract. The SEPT Contract provides for Luton some
services which are also provided to Bedfordshire and are
therefore part of a county wide service.
Our goal for community services is to make sure that
services work more effectively and with better alignment
to Primary and social care services and with considerably
reduced system barriers that will support the seamless
delivery of holistic services that are characterised by earlier
prevention and planned care for our most vulnerable
populations.
Beyond Procurement
Our procurement strategy is to procure new providers
through competitive dialogue . This means that we will
work with potential providers, as experts in service
provision, to map out future service configuration in line
with our overarching goal to wrap services holistically
around the needs of people. For this reason we cannot
1 Luton Adult Mental Health Needs Assessment: 2012
accurately define future service configuration though an
example of how services might look is depicted on the next
page
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5. Improvement Interventions
Reconfiguring Mental Health and
Community Services
The diagram below represents a potential final integrated care Pathway , dependent on the outcomes of the competitive dialogue with
potential providers
Access
Referral
GP
Social Care
Carers and
Family
Other
Professionals
Integrated Teams
Community Hub
Single point of
access – physical
/ mental health
assessment
Signpost other
support agencies
Mental Health
(Community
and inpatient)
Physical Health
Early Intervention
& Emotional
Wellbeing Services
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Outcomes
Different
Pathway
Goal Based
Intervention
Plan
Discharge
Return to GP
(Shared Care
Protocol)
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5. Improvement Interventions
Reconfiguring Mental Health and
Community Services
The System has identified the following key workstreams to drive forward this programme of transformation
Prevention and Early Intervention. Delivering a cost-effective impact “downstream”, helping people to
recover more quickly from illness and maximising independence for those with long term conditions
Integration and Collaboration. Driving system collaboration and an approach embedded in the principle
“the needs of patients are more important than the needs of the organisation”
Workforce. Attracting the right talent to Luton and establishing a world class workforce which places
patients at the heart of all we do
New Pathways of Care and Innovation. Driving innovative services build around patients with GPs as the
central point within an integrated model
Value for Money. Effective use of resources across the health, social care and other public services in Luton
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5. Improvement Interventions
2014/15
•Completion of procurement of Mental Health and
Community Services and transition
•Implementation of full IAPT Service
•Implementation of Luton Live Well Service
2015/16
•Stroke Early Supported Discharge
•Complete implementation of enhanced dementia
services
2016/17
2017/18
•Service Transformation complete
•Early supported discharge for LTCs
•Integrated Care Pathways in place for LTCs /
Mental Health
Patient
Experience
•Patient experience measures of
individual services
•Friends and family test
•Use of NHS Number in
Communications
Clinical
Outcomes
•Dementia Diagnosis
•IAPT treatment and recovery
rates
•Reduced gap in mortality for
people with MH diagnoses
•Increased smoking quitter rates
•Reduced child and adult obesity
•Health related quality of life
Demand
Management
• Reduced avoidable
emergency admissions
• MH bed days per weighted
population
Key Performance Indicators
Major Milestones
Reconfiguring Mental Health and
Community Services
•Review of service implementation and ensure system
alignment
•Evaluation and consolidation
2018/19
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5. Improvement Interventions
Transforming Urgent Care - Context
Context
Pressures on A&E have been managed effectively by the system over the past 18 months, with the 4 hour wait target being
achieved month on month. However Luton has seen unacceptable increases in avoidable emergency admissions since
2007/08 when compared to the England average
Emergency
admissions for acute
conditions that
should not usually
require admission 1
Admissions per 100,000
LCCG
England
The effective management of the flow of patients through the health system is at the heart of reducing unnecessary
emergency admissions and managing those patients who are admitted.
• Primary, community and social care can reduce admissions through improving management of long-term conditions;
• Ambulance services can reduce conveyance rates to accident and emergency (A&E) departments, for example by conveying
patients to a wider range of care destinations;
• Hospitals can reduce emergency admissions by ensuring prompt initial senior clinical assessment, prompt access to
diagnostics and specialist medical opinion; and
• Once admitted, hospitals working with community and social care services can ensure that patients stay no longer than is
necessary and are discharged promptly.
1
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Levels of Ambition Tool http://ccgtools.england.nhs.uk/loa/flash/atlas.html
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5. Improvement Interventions
Transforming Urgent Care - Aims
Overarching Goal for Urgent Care
To respond to urgent care needs of people of Luton through the provision of the most appropriate care in a timely and cost
effective way.
Aims
1. To promote self-management of care need
2. To give patients speedy access to care services
3. To provide care nearer to patients’ home
4. To support the role of the GP as coordinator of patient
care
5. To reduce hospital attendance and admission, ensure
speedy discharge
6. To support the delivery of national and local standards
of care
7. To improve cost-effectiveness of services
8. To make good use of data to inform decisions
9. To ensure integration of services through partnership
working
10. To adopt good practice, encourage innovation and
ensure sustainability
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Managing Winter Pressures
Hospital at Home
Delivered
Through
Acute GP Visiting Service
Ambulatory Care
Mobile Care Service
Clinical Navigation
Meet & Greet Discharge
Social Marketing
1
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5. Improvement Interventions
Transforming Urgent Care – Key
Work Streams
111. Driving improved signposting to the right services to meet the individual needs, reducing pressure on
A&E attendances and short stay admissions.
Hospital at Home. Supporting early discharge through a Hospital-at-Home nursing team under the
direction of the consultant.
Acute Home Visiting Service. Supporting General Practice by undertaking home visits to patients early in
the day, addressing care needs in the home.
Ambulatory Care. Patients attending A&E who are mobile are streamed early to a dedicated service which
can provide speedy resolution of care needs, and discharge patient, with follow-up as required.
Ambulance Response – Mobile Care Service. Ambulance paramedics supporting people at home where
appropriate
Clinical Navigation. Clinical Navigator Nurse Team providing holistic direction to patients being discharged
from A&E and EAU to ensure that appropriate follow up care is in place
Winter Pressures. to provide additional services to meet the additional pressures that occur in the local
health system during the winter months, with a focus in sustained patient care and achievement of A&E
waiting time and other standards
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5. Improvement Interventions
Transforming Urgent Care
2015/16
2016/17
•Substantive Provider of 111 in place
•Social marketing during winter months
•Ambulatory Care Unit Extension
•System procurement of unscheduled care
•Further Ambulatory Care Pathways
•Social marketing during winter months
Patient
Experience
Clinical
Outcomes
•Patient experience measures of
individual services
•Friends and family test
•Four hour waits for A&E
services
•Ambulance response and
handover times
Key Performance Indicators
Major Milestones
2014/15
•Implementation of Acute Visiting Service
•Extension of Meet and Greet Service
•111 Procurement commences
•Urgent Care Strategy in Place
•Survival from major trauma
•Improved recovery from stroke
•Improved recovery from
fragility fractures
•Emergency admissions within
30 days discharge
•Social marketing during winter months
2017/18
2018/19
•Social marketing during winter months
•Evaluation and consolidation
Demand
Management
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• Reduction in A&E
attendances
• Reduced avoidable
emergency admissions
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5. Improvement Interventions
Intervention Outcomes
Better Together
Transforming
Primary Care
• Shift of spend towards prevention, early intervention, and
care closer to the home.
• Securing additional years of life; increasing QoL for LTCS;
Reducing unnecessary hospitalisation; independent living
• Delivery of range of low complexity “acute” services in the
community; Reduced variation in primary care outcomes;
enhanced patient experience; reduced unnecessary
admissions to hospital
Reconfiguring Mental • Integration of mental health and community services;
Health and
Community Services
Transforming
Urgent Care
Securing additional years of life, QoL for people with LTCs,
reduced unnecessary admissions, improved post-discharge
outcomes, improved patient experience
• Supporting the integration of health and social care;
reducing unnecessary admissions to hospital; reducing
demand on A&E; improving experience of out of hospital
care.
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Programme Plan
2015/16
2014/15
AMJ
JAS
OND
JFM
AMJ
JAS
OND
JFM
AMJ
Operational Plan / BCF Plan2014/15 to 2015/16
JAS
OND
JFM
JAS
OND
JFM
Operational Plan / BCF Plan 2016/17 to 2017/18
System Buy-In
to BCF Plan
BCF Plan Development
AMJ
JAS
OND
JFM
Operational Plan 2018/19
Key:
Single Health and Care
Plan
Information Sharing Workstream
Integrated Mental Health and
Community Services
Better Together Teams in place
Frail Elderly / Disabled Children Workstreams
Single Point of Access
in place
All appropriate
services with 7 day
working
Milestone:
All appropriate back office
services shared
Shared Services Workstream
Home Care Plus
Programme Go Live
Home Care Plus Workstream
Development
of Practice Clusters
Clusters in
place
IT Infrastructure Phase 1
Build Informal Federative Working
Plan in
Place
Develop Co-Commissioning Plan
e-referrals
IT Infrastructure Phase 3
Implement Co-Commissioning Plan
Federations in
place
GP Leaders
programme phase 3
Remote access
IT Infrastructure Phase 4
Full Programme of
technology enabled care
Co-Commissioning
Agreement in place
Plan
Approved
Enhanced Services Evaluation
Formalise Federative Working
GP Leaders
programme phase 2
IT Infrastructure Phase 2
EPS in place1
Dependency:
Informal
Federations in
place
GP Leaders
programme phase 1
/workforce plan in
place
Workforce Development Programme
Activity:
Integrated Commissioning
Better Together
Teams in place
Integrated Diabetes / Respiratory / CVD Workstreams
7 Day Working Workstream
Transforming
Primary Care
AMJ
2018/09
Five Year System Strategy 2014/15 to 2018/19
Programme
Better
Together
2017/18
2016/17
Extended Primary Care and Community Contracts
Improving Primary Care Quality and Accessibility in Partnership with NHSE
Plan in
Place
Review of Primary Care Estates
MHCS Procurement
Reconfiguring
Mental Health
and
Community
Services
Early Supported Discharge 1
Stroke ESD Live
Early Supported Discharge 2
LTCs ESD Live
Integrated Care Pathways – LTCs / MH
Live Well Service
Fully Mobilised
Implement Luton Live Well Service
National Diagnosis
Target for Dementia
Achieved
111 Procurement
National Diagnosis
Target for Dementia
Achieved
Go Live Date
Social Marketing
Acute Visiting Service development
Social Marketing
Social Marketing
Social Marketing
Social Marketing
Implementation Starts
Ambulatory Care Unit Extension
Develop System Approach to Urgent Care
Stepped Model of
Care Live
National IAPT
Standards Achieved
Continue Implementation of Full IAPT Service
Meet & Greet Extension
Service
Transformation
Complete
Mobilisation of new providers
Go Live Date
Implement Enhanced Services for Dementia
Transforming
Urgent Care
Improved Estates in Place
Implementation of Primary Care Estates Plan
Go Live with new
Pathways
Go Live with new
Pathways
Go Live with new
Pathways
Urgent Care
Strategy in Place
System Procurement – OOHs / WiC/UGPC
Go Live with new
Service
84
5. Improvement Interventions
Major Milestones
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5. Improvement Interventions
Interdependencies
Better
Together
Transforming Primary
Care
Reconfiguring Mental
Health and Community
Services
Transforming Urgent Care
Information Sharing
Better Care Team Project
Disabled Children
Disabled Children
Disabled Children
Seven Day Working
Shared Services
Primary Care Access and Quality
Extended Primary Care Contracts
MHCS Procurement / Transition / Mobilisation
Integrated Pathways
Unscheduled Care Procurements
Ambulatory Care
System Resilience
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6. Citizen and System
Engagement
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6. Citizen and System Engagement
Citizen Engagement
In Luton we want the key transformation programmes to be open,
clear and transparent. The local people of Luton are an integral part
of our strategy and they are seen as joint architectures for this
strategy. Their voices will help shape the Integrated Health and
Social Care services here in Luton.
To us ‘local involvement’ means more than just engaging people in a
discussions about services, it means having their voice heard at
every level of the service.
Luton is a diverse town and we recognise that to reach out to the
variety of groups of people in Luton we will have to have in place
flexible plans and adapt engagement methods, thus to enable us to
capture the real voices and lived experiences of our local people.
Evidence shows that patient safety improves when patients are more
involved in their care and have more control. Patient involvement is
crucial to the delivery of appropriate, meaningful and safe
healthcare and is essential at every stage of the care cycle: at the
front line, at the interface between patient and clinician; at the
organisational level; at the community level; and at the national
level. The patient voice should also be heard during the
commissioning of healthcare, during the training of healthcare
personnel, and in the regulation of healthcare services. The heart of
integrated health and social care is person centred planning and this
proposal draws on a wide range of national and local evidence and
experience to set its principles around resident engagement and the
importance of listening and responding to the real life stories that
tell local residents’ experiences.
In order to ensure that Luton residents’ views are taken into
account, LBC has developed six principles for public
consultation:
•
Community involvement should be at the heart of how
partners improve services, set priorities and use resources.
•
There should be a range of opportunities for involvement that
are well publicised, link to local democracy and in which all
citizens are encouraged to participate.
•
Methods for involvement should be regularly reviewed to
ensure they are cost effective, and meet the preferences and
needs of all citizens
•
Citizens should receive clear and prompt feedback on how
their involvement has helped to shape services, places and
communities.
•
Partners should work in a joined up way to avoid duplication.
•
Involvement should be the basis on which partners increase
satisfaction, build trust and confidence in their organisations.
[Community Involvement Strategy. LBC, 2010]
We aim to build on work that has already happened and to value
the input from residents that has already taken place
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6. Citizen and System Engagement
Citizen Engagement “Your Say, Your Way”
LBC and LCCG are active members of the “your say, your way” programme which enables a robust feedback
cycle between community concerns and system response to those concerns. We describe this as an example of
one of our mechanisms of citizen engagement
The programme delivers a range of community involvement, development and grant funding opportunities which are adapted to
identify the priorities for and meet the needs of each neighbourhood, including:
•
•
•
•
•
•
•
Community festivals
Neighbourhood mapping/Community surveys (R&I)
Local neighbourhood networks
Area Board partnership work programmes and reporting arrangements
Participatory budgeting/ community project support
Volunteer development and community learning opportunities
Community planning decision days
These platforms provide unique opportunities for reaching large numbers of local people for the purposes of public information
and health promotion, community empowerment, consultation, accountability and direct local involvement. Diversity profiling of
community involvement in the programme consistently shows significant increases and improvements in community involvement
matching the diversity of local populations – in other words, the programme makes a major contribution to social inclusion
reaching communities that much conventional public engagement does not.. Although the programme now provides coverage
across the Borough, it continues to maintain a focus on neighbourhoods and LSOAs with relatively higher levels of deprivation and
health inequalities.
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6. Citizen and System Engagement
Luton Engagement Map
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6. Citizen and System Engagement
What has our engagement programme told us?
“I want people to listen to
me and understand my
needs”
“There are a number of
organisations involved in
my care, I want them to
talk to each other and
share information to help
coordinate my care”
“I value being able to see
one GP who I know and
trust”
“I need to be able to easily
make an appointment to
see my GP and see him or
her at a time convenient to
me”
“When I leave hospital I
need to have information
about what happens next
and what I am expected to
do”
“I don’t always want to be
referred, I want more of
my care in my surgery or in
the community”
“I want my practice to do
simple things like my blood
tests”
“If I am referred, I want to
be seen as quickly as
possible”
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“I would like my mental
health needs to be met as
effectively as my physical
needs”
“Treat me like a human
being and not as a
collection of certain
symptoms”
“When I am seen in
hospital I expect the
Doctor to know what my
problem is without me
having to remember
everything I have discussed
with my GP”
“When I go to hospital I
want to know what to
expect”
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6. Citizen and System Engagement
How has this impacted on our strategy?
We have listened to what our residents think and have put in place the following
design principles to address their concerns
The Patient must be at
the centre of the
solution
Keeping people at home
when it is safe to do so,
in their own bed
Co-location of teams to
improve joint working
and patient care
Single point of contact
for call triage
Shared health and care
plan, one joint
assessment and
integrated IT
Governance around one
team, organisational
boundaries are
secondary
Build a new culture for
integrated teams with a
common vision and goals
The GP will play the key
role as risk owner and
leader
Harness all organisations
(including voluntary
sector) to bring the right
expertise to the patient
Put in place the
commissioning and
contracts to deleiver the
right care
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Design must support the
uniqueness of Luton –
one size does not fit all
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6. Citizen and System Engagement
Clinical Engagement
General Practice
Clinical Commissioning places GPs and other Clinicians at the heart of commissioning. The CCG has a well developed programme
of on-going communication channels for practice engagement such as practice visits, the Members Forum, Practice Managers
Group and Protected Learning Time. As a result almost 40% of our local GPs are actively involved in leadership roles in the CCG.
Additionally, as part of the development of practice Clusters we have further strengthened our collaboration with members by
delegating delivery of key elements of the strategy to the Clusters and a powerful feedback loop has been established between
the chairs and the CCG’s Clinical Commissioning Committee enabling our plans to be further strengthened as we move forward.
Wider Clinical Engagement
The development of this strategy has also been strongly informed by the views of clinicians working outside of
the GP Community. A programme of clinical engagement has been delivered via the following routes
 Luton and Dunstable Hospital “Grand Round”
 Clinical Engagement Suppers
 Board to Board meetings with key providers
 CCG Clinical Commissioning Committee – which includes members from Community Pharmacy, Optometry
and Dentistry
 Integrated Diabetes Local Implementation Group
 Respiratory Local Implementation Group
The system is currently also putting in place a formalised Clinicians Forum comprising members from L&D
Hospital and Luton, Bedfordshire and Hertfordshire CCGs.
Further engagement has taken place with the Strategic Clinical Networks , the University of Bedfordshire and
Health Education East of England in the development of our plan
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6. Citizen and System Engagement
How has Clinical Engagement informed our strategy?
Clinical Engagement has been critical in the development of this five year plan.
Three examples are articulated below
Example 1 : Better Care Teams
The Better Care Team project is a key component of the
Better Together Programme and was developed through in
depth clinical engagement with the L&D. Following the
establishment of a similar project in the South Bedfordshire
area it was agreed to utilise positive outcomes their to
shape a Luton specific programme through the creation of
multi-disciplinary teams aligned to practice Clusters.
Clinical service design workshops involving system clinicians
have enabled robust service design with buy in from all
parties.
The programme has been implemented in one of the four
clusters utilising a named hospital based geriatrician as a
dedicated resource for the coordination of the care of frail
elderly patients.
The project will shortly be rolled out across the remaining
three clusters.
Example 2: The Reconfiguration of Mental Health and
Community Services
The process of Competitive Dialogue was selected as the
method of procurement most likely to enable the market
and the Commissioning Organisations to bring together
their individual knowledge and expertise to develop
solutions that can meet the needs of the people of Luton
All key dialogue has incorporated clinical engagement as a
major component in the development of new models of
integrated care which will begin implementation following
the commencement of new contracts.
As part of the re-procurement process there has been indepth clinical engagement between LCCG and SEPT
(current Mental Health provider) clinicians and this has
informed the development of new services for personality
disorder and autism.
Example 3: System Resilience Group (SRG)
As part of the newly established SRG a gap analysis has
highlighted the need for Step up beds and the drivers for
the paediatric increase in A+E and PAU prompted a review
of pathways . out of this there may be increased capacity in
rapid response nurses needed.
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6. Citizen and System Engagement
Engagement Objectives
1. Further develop a patient and community engagement model for Luton which is underpinned by a
transparent and inclusive governance infrastructure which will ensure that patients, the public and partners
are actively engaged with and feel they can influence commissioning decisions to improve local health and
social care services
2. Ensure that every Luton General Practice has an active Patient Participation Group in place which is able to
ensure a feedback loop is in place to drive improved commissioning decision-making
3. Provide all staff with the tools and knowledge to ensure that patient and community engagement is at the
heart of commissioning and service provision
4. Drive behavioural changes in the general public to ensure that they understand the need to act in order to
a) Maintain a healthy lifestyle b) Understand the importance of early intervention c) Access the right services
to meet their needs when they are ill
5. Ensure full system-wide clinical engagement to ensure decision making is clinically-led and as effective as
possible.
6. Ensure that “early-warning” systems are in place so that issues regarding quality and safety of services can
be addressed immediately
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7. Developing the Workforce
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8. Developing the Workforce
Workforce Transformation
The Luton System is developing 5 year workforce plan for Luton with key partners across the health and social care
system including Heath Education East of England, Skills for Care, Skills for Health and the University of
Bedfordshire. This takes into account the current difficulties in recruiting into Adult Community Nursing and
Specialist Services.
In order to provide higher acuity care for adults older people and those with long term conditions , the community
nursing and social care workforce will need to be enhanced both in terms of numbers and skills.
Forecasted workforce requirements are an integral part of the procurement process for Community health services
and the Better Together integration programme for Luton
The CCG is implementing its Organisational Development Plan which includes the development of primary care
clinicians and attracting primary care leadership talent to the area. A scheme is being developed by the CCG to
recruit GPs into Luton, working with the GP Tutor, Health Education England and University of Bedfordshire. The
scheme will take 2 GPs per year for a three year programme, with sessions in practices, the CCG and the University.
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8. Developing the Workforce
Seven Day Working
Nationally, NHS England board has committed the NHS to “move towards routine services being available seven
days a week. This is essential to offer a much more patient-focused service and also offers the opportunity to
improve clinical outcomes and reduce costs.
Our priority for the first two years of this strategy will be to extend services across the health and social care
system where this will enable admission prevention, reduce the risk of emergency re-admission, speed up hospital
discharge and ensure everyone can leave within 24 hours of being “ready to go”
A review of hospital discharge processes undertaken in 2013 identified a number of areas where improved access
out of office hours would help us to deliver improved outcomes. These include:
• Adult social care services to work with residential / care homes to overcome barriers to receiving patients back
at weekends and after 4.30pm
• Exploring the provision of a jointly resourced social work service with Central Bedfordshire to cover weekend
work
• Integrated discharge team to work seven days to ensure that CHC assessments involve carers and families ,
supporting them to make early decisions on discharges
• Community nursing covers seven day working, the intermediate care services supported by social care will
move to a similar pattern to support rapid assessment and early supported discharge for stroke patients back
into the community and into rehabilitation services.
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8. Governance
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8. Governance
Introduction
The challenges and ambitions we have set for ourselves for the next Five Years can only be delivered through
a robust system of Programme Governance through which those responsible for delivery of key elements of
our strategy are called to account by System Leadership.
Fortunately the Luton System has pre-existing Governance Structures in place to ensure that the Strategy is
delivered on time and within budget.
•
•
•
•
•
•
•
The Health and Wellbeing Board is the “Owner” of the Strategy .
The Better Together System Transformation Programme Board with membership comprised of system
leaders across all partners is the Programme Delivery Board and will assure the delivery of the Strategy
through reporting from the Strategy Delivery Groups.
These delivery groups include the Better Together Working Groups, the CCG’s Strategic Implementation
Groups, the Practice Clusters and the Urgent Care Working Group
The CCG Clinical Commissioning Committee has clinical decision making responsibilities and will drive
the development of business cases for service change . The Committee will also hold the Strategic
Implementation Groups and Cluster Clinical Chairs Committee to account on delivery of key elements of
the Strategy
The CCG Finance and Performance Committee is the key forum for ensuring the delivery of the financial
recovery plan and on-going financial sustainability of the system (See pages 34-41)
There is a process in place for the escalation of system blocks and major issues to CEO level across key
system partners.
The Programme Management Office takes responsibility for ensuring that all elements of the plan are
delivered and that escalations are generated where there are issues in delivery.
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8. Governance
Five Year Strategy Delivery Vehicles
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8. Governance
System Programme Governance Structure
Our Strategy is delivered through a wide variety of collaborative delivery groups, some of which are listed above. Progress is assured
through reporting to the Better Together Programme Board as this group has senior system leaders as its membership.
Additionally formal reporting lines from the delivery groups
theSeptember
CCC and Health
and Wellbeing Board Delivery Boards will continue
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8. Governance
Holding Partners to Account
The pyramid diagram on this page is a simplified
representation of the flow of assurance from
points of delivery through to the Health and
Wellbeing Board.
The principle of this process is that smaller issues
and barriers to progress are addressed at the
bottom of the pyramid and progressively larger
but fewer issues are escalated as move upwards
towards the Board
PMO
The is strong system representation at each level
of the pyramid which means that a collaborative
approach can be taken to strategy delivery. Where
there are significant conflicts between strategy
delivery and organisational considerations , there
is a process which allows escalation to CEO level to
enable resolution.
Health and Wellbeing
Board
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Health and Wellbeing
Delivery Boards
Better Together
Programme Board
Implementation
Groups
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9. Risk
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9. Risk
Risk Register 1
Risk Title
Weakness and
Consequences
Failure to deliver
agreed planned year
end position
Failure to deliver
QIPP and demand
management
leading to failure to
deliver FRP
25
High
Lack of system
ownership of
strategy
System members
continue to
prioritise
organisational needs
leading to a failure
to deliver system
transformation
20
High
CCG capacity and
capability and focus
on FRP
15
High
Failure to achieve
safety and quality
objectives
Inherent Risk
Priority
Controls
•
•
•
•
•
•
•
•
•
•
•
Residual Risk
Priority
Rigid monitoring of FRP
delivery
Robust PMO
Turnaround Director
AT support
Capacity and capability
in place
25
High
Hold members to
account at BT
programme Board and
SRG
Board to Board meetings
HWBB ownership
Maintain productive
dialogue and visibility
15
High
Process for monitoring
performance & quality
through PSQC, F&P and
Board
Revised quality strategy
10
Medium
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9. Risk
Risk Register 2
Risk Title
Weakness and
Consequences
Inherent Risk
Priority
Significant failure of
a major provider
Unforeseen
financial, quality or
safety issues leading
to failure to deliver
NHS Constitution,
QIPP, FRP and Five
Year strategy
15
High
Failure to achieve
objectives for
safeguarding
children and
vulnerable adults
Failure to ensure
appropriate systems
ate in place leading
to safety, legal and
financial issues
15
High
System instability
due to transition to
new mental health
and community
health providers
Staff instability
leading to failure to
deliver required
outcomes and
potential quality /
safety failures
15
High
Controls
•
•
•
•
•
•
•
Residual Risk
Priority
Annual contracting
process
Intelligence from
Practice Clusters
Robust contract
management
10
Medium
Increased safeguarding
capacity
Training
Policy adherence
10
Medium
Close collaboration with
current providers to
ensure all transition risks
are being effectively
managed
10
Medium
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9. Risk
Risk Register 3
Risk Title
Weakness and
Consequences
Insufficient practice
engagement
Failure to engage
leading to lack of
strategy ownership
and role clarity
16
High
Poor capacity and
capability leading to
a failure to inability
to manage contracts
and deliver change
programmes
16
High
Failure to manage
increase in demand
or validate invoiced
activity leading to a
failure in delivery of
FRP
16
High
Lack of capacity and
resources to deliver
key objectives
Acute sector overperformance
Inherent Risk
Priority
Controls
•
•
•
•
•
•
•
•
•
Residual Risk
Priority
Practice clusters to drive
change and delivery
Improved ICT – Intranet
Members forum and
other key platforms
12
Medium
Additional short term
resource
(BI/Contracts/PMO)
Performance
management processes
(staff)
12
Medium
Increased contracts
capacity and capability
Referral management
Clinical validation
Enhanced recovery
programme
12
Medium
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9. Risk
Managing the Risks Associated with Strategy Delivery 1
Risk Title
Weakness and
Consequences
Failure to meet
objectives regarding
health and
safeguarding of LAC
Health of LAC not
safeguarded due to
lack of health checks
and screening
12
Medium
•
Children In Care
Operational Group
12
Medium
Legal and statutory
duties may not be
delivered
Failure to monitor
leading to lack of
delivery of statutory
duty
12
Medium
•
•
Complaints process
Monitoring against NHS
Constitution
Mapping of function to
delivery mechanism
8
Medium
Due to FRP priorities
insufficient
engagement occurs
leading to nondelivery of statutory
responsibility and
failure to meet need
12
Medium
Senior Board PPE
responsibilities
Comms and Engagement
Steering Group
LBC delivery of
engagement function
8
Medium
Insufficient patient
and public
engagement
Inherent Risk
Priority
Controls
•
•
•
•
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Residual Risk
Priority
108
9. Risk
Risk Register 4
Risk Title
Weakness and
Consequences
Inherent Risk
Priority
Controls
Failure of MHCS
Procurement for
one or more lots
Failure to award
contract s leading to
serious gap in
service provision
16
High
•
Provider options
developed with advice
from Attain and Monitor
(co-operation and
competition)
Failure to effectively
transition services
from current to new
providers of MHCS
Failure in transition
leading to serious
quality and safety
issues
20
High
•
Exec level transition
committee
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Residual Risk
Priority
16
High
12
Medium
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10. Plan on a Page
In 2019 Luton residents will benefit from integrated health and care that has four elements: a person centred approach enabled by a shared personal
plan for patients and service users; prevention that helps people to keep themselves well; better use of shared evidence and data; a multi-disciplinary,
multi-professional team approach to service delivery built on three GP clusters in the town. We will work in partnership with patients, their carers,
providers and other partners to deliver a high quality and cost effective health and social care system to the people of Luton, empowering them to lead
healthy and independent lives.
System Objective One
To reduce potential years of life
lost by 19%
System Objective Two
Increasing the proportion of
older people living
independently at home
following discharge
System Objective Three
To improve the quality of life
people with LTCs by 6%
System Objective Four
To stop the increase in
unnecessary hospital admissions
System Objective Five
To increase patient experience
of care outside of hospital by
10%
Delivered through Better Together Programme
Whole system integration programme
-driving the effective use of shared evidence and data -shifting
the balance towards wellness (prevention and early
intervention)
-delivering personal plans to build the right services around the
needs of individuals
-creating a multi-disciplinary team to deliver personalised care
Delivered through the Reconfiguration of Mental Health and
Community Services: Redesign of community and mental health
services to drive improved health outcomes, system integration
and financial sustainability
Delivered through the Transformation of Urgent Care
Redesign of unscheduled care provision to ensure the right level
of care delivered appropriate to the needs of the patient.
• NHS 111
• Hospital at home
• Acute visiting service
• Clinical Navigation
• Ambulatory Care
Delivered through The Transformation of Primary Care : Driving
a transformation in the capacity and capability of primary care
to deliver a broader range of high quality and safe services in the
community.
V5.1 for September re-submission
Overseen through the following governance
arrangements
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Health and Wellbeing Board and Better Together
Programme Board overseeing implementation of
the improvement interventions
Individual organisations leading on specific
projects
Measured using the following success criteria
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All organisations within the health economy
report a financial surplus in 18/19
Delivery of the system objectives
No provider under enhanced regulatory scrutiny
due to performance concerns
With the expected change in resource profile
Our System Principles
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Integration and collaboration
Service Innovation
Services around the patient
Safeguarding the vulnerable
Early intervention
Value for money
Citizen engagement
Quality and Safety
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