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16.209.1
Living Healthier, Staying Well : Timeline for developing our strategy and
Integrated Medium Term Plan
1.
Purpose of report
The purpose of this report is to describe and refresh the strategic planning process
for the Health Board from November 2016 onwards and how this will support and
enable the development of a three year Integrated Medium Term Plan (IMTP) for
2018/21. The paper identifies the key milestones and outputs which will provide
assurance to the Board during the proposed process.
2.
Introduction
The introduction of Integrated Medium Term Plans (IMTPs) across Wales signalled a
move away from a focus on annual plans, towards a medium-term approach linked
to organisational strategies.
The NHS Wales Planning Framework 2017/20 confirms the requirement for every
NHS organisation to have a long-term strategy which should be a separate
document to the IMTP.
“In essence, the strategy should set out the organisation’s strategic goals; outline the
‘roadmap’ which the organisation will follow; and describe how it will address any key
strategic challenges or opportunities.”
The guidance confirms that the IMTP document should “demonstrate how the
actions to be taken during the three-year period help achieve the long term vision of
the organisation set out in the strategy.”
In July 2016, the Board received and approved the proposed approach for the
strategy – entitled Living Healthier, Staying Well. The strategy will set out the
strategic vision for the Board and will reshape how we support good health and
provide healthcare for the medium to longer term.
Our aspiration is to develop a strategy built on priorities which will be agreed with
partners – Local Authorities, other statutory organisations, third and independent
sector – and co-designed with service users and carers.
The approach will be based on three overlapping major programmes within the
overall portfolio:
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•
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Improving health and reducing inequalities
Care closer to home
Acute hospital care
Whilst there will be a specific programme to drive and deliver on the Health Board’s
contribution to improving health and reducing inequalities, the focus on addressing
inequalities will be a founding principle for all areas. Each programme will be
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required to demonstrate that improving health and well-being and reducing
inequalities is the foundation. All programmes will need to have regard to the life
course approach – understanding and addressing the needs of individuals and the
impact on health at key stages of the life course.
In addition to the three main programme areas, separate delivery frameworks will be
developed for children & young people and older people, to ensure that health and
well-being needs of these groups are addressed. A separate strategy for mental
health and well-being is also being developed in view of the priority of this area for
the Board.
The strategy will also build on the work being undertaken in respect of the Social
Services and Well-being (Wales) Act 2014 (SSWB Act) and the Well-being of Future
Generations (Wales) Act 2015 (WFG Act.) The implementation of both Acts will
require a significant cultural and behavioural shift within the Health Board, especially
in relation to the way we work with the public we serve and with our partners. Both,
however, represent a significant opportunity to create the conditions in which we can
improve the well-being of both current and future generations in North Wales.
NHS Wales Planning Framework Requirements and IMTP Core Content
The Health Board is required under the NHS Finance (Wales) Act 2014 to prepare a
three year IMTP for approval by the Cabinet Secretary for Health, Well-being and
Sport. The IMTP must set out the immediate actions that we will take towards our
strategic objectives. A three year focus allows us to set out clearly what we intend to
do in the medium term and avoids ‘start/stop’ behaviors associated with the focus
upon a single year.
Whilst the IMTP must cover three years, it is acknowledged that the level of detail for
each of the three years will be different as follows:
Year 1 (2018/19): Year 1 plan will clearly describe, the actions and milestones for
2018/19. Year 1 will also set out the preparatory work to support delivery in future
years.
Year 2 (2019/20): The IMTP will indicate priorities, actions and risks for the second
year and set out detail around key plans and metrics including performance
trajectories. Work on major challenges or opportunities will be outlined.
Year 3 (2020/21): The IMTP will show how we propose to make continued progress
towards delivery of our strategic objectives and include as much detail as possible
for year 3.
3.
Developing our Long term Strategy - Approach and Timescale
3.1 Progress update on the Living Healthier, Staying Well strategy programme
The methodology being used for the strategy development is a seven-stage model,
adapted from strategy development guidance produced by Monitor for English NHS
organisations.
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Diagnose the current
position
Forecast – develop a clear
view of the potential future
Generate scenarios –
ideas and options for
change
Prioritise ideas and build
into an overall strategy
Agree and implement the
goals of the strategy
Evolve – monitor the
impact, refresh and
recreate when necessary
2. Diagnose
Establish baseline starting position - detailed summary
of performance and drivers; evidence base and
standards; commence modelling of health needs and
population projections
3. Forecast
Create a clear view of the potential future state – the
optimum configuration for population needs
4. Generate scenarios
Develop, explore and evaluate strategic ideas and
options for change; detailed activity and capacity
modelling and pathway development
5. Prioritise
Make choices about the set of strategic ideas for
change and build into one effective coherent strategy
deliverable within sustainable resources; undertake
formal consultation; review & refine strategy proposals
in light of consultation outcomes
6. Agree and implement
Board approval of recommendations. Create and
communicate the action plan and allocate resources to
deliver the goals of the strategy. Feed into IMTP
7. Evolve
Monitor the impact of the strategy and recommit,
refresh or recreate when needed
Continuous engagement and communication throughout
Impact assessment process running alongside strategy development
Frame the strategic
questions we are seeking
to answer
1. Frame
Agree on important strategic decisions to be made, and
criteria and constraints for making them, including: what
outcomes are we seeking to achieve? What are the
“givens”? What criteria for assessment of scenarios?
The first stage is to frame the strategy by agreeing the strategic questions we are
seeking to answer; what the outcomes are which we are seeking to achieve; what
are the fixed points or “givens”. This work has commenced and is ongoing.
The programme structure has been established; the formal Programme Executive
Group (PEG) has met three times and agreed governance arrangements.
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Programme brief documents have been developed, which set out what each
programme area is expected to achieve in terms of benefits, outcomes, scope and
objectives.
A set of strategic questions which provide a guide for the programme workstreams
has also been agreed through the PEG. These questions are intended to guide the
work of the programme areas. (Appendix 1)
During the summer and early autumn a programme of general engagement,
awareness raising and listening has been taking place led by the communications
and engagement team. This has included attendance at a range of community
events, shows and fairs, as well as participation in existing forums and partnership
meetings. All the North Wales Public Service Boards (PSBs) have received a brief
awareness raising presentation on the strategy. Engagement with seldom heard
groups has begun, with attendance at a number of targeted events including the
Equality Stakeholder Forum, a discussion with representatives of black and minority
ethnic community groups and attendance at Lesbian Gay Bisexual Transgender
(LGBT) forums. This will be developed further and extended as the strategy work
progresses.
Feedback from engagement to date has been shared with the strategy workstreams
and will inform the baseline document being produced during November. This
feedback is also being shared with operational teams and will feed into the
operational planning work.
A separate paper to the Board, on three specific documents developed to address
special measures improvement milestones, also includes further detail on the
approach to the strategy development overall.
During the autumn of 2016, the Welsh Government has been seeking the views of
people throughout North Wales on how we can ensure continued sustainable and
improved health outcomes. The exercise, entitled “Delivering a Healthier North
Wales”, has involved a range of face-to-face engagement as well as an online
survey. The Cabinet Secretary for Health, Well-being and Sport will report on the
initial conclusions before Christmas 2016. The proposed approach set out in this
paper is designed to enable feedback through this process to be reflected as we
move forward. Consequently the work programme and timelines may need to adapt
to respond to this.
3.2 Next steps
The next steps in the strategy programme will include the development of a baseline
to describe the current position. Then we will begin to develop the vision for the
programme workstreams and to describe what this might mean in terms of support
for health and well-being and future delivery of healthcare.
We will be undertaking further engagement with partner organisations, stakeholders
and the population to do this. We will be seeking to respond to the assessments of
need currently being developed in response to the SSWB Act and the WFG Act. We
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will also be seeking to identify ways of working more closely together with partners
and particularly the PSBs, to avoid unnecessary duplication and to share findings.
By the summer of 2017 we will be able to describe scenarios for the future in
sufficient detail to inform the development of the broad IMTP priorities. We will
undertake a formal consultation with the population as needed and will be seeking to
produce a final strategy and submit for approval by early 2018. This timeline reflects
a small adjustment to the initial proposal presented to the July 2016 Board and has
been made in order to allow for full reflection and response to the outcome of the
Welsh Government (WG) “Delivering a Healthier North Wales” exercise described
above. This timeline will still allow for a robust link to the IMTP development.
The high level milestones for each of the stages of development are set out below.

December 2016 – diagnosis
By December 2016 we will have developed a baseline assessment setting out a
summary of population health needs; performance; drivers for change; outcomes
and quality standards. To support this work, external consultancy support is being
commissioned.
The baseline will be informed by:
- the draft Social Services and Well-being Population Assessment (to be
produced in November)
- draft Well-being Assessment for Conwy and Denbighshire PSB (November)
- a Health Board readiness assessment for the Well-being of Future
Generations Act (December)
- the statement of the Cabinet Secretary on the outcome of the WG Delivering
a Healthier North Wales exercise
By December, and taking account of the Cabinet Secretary statement, we will also
have defined detailed next-stage project plans for programme workstreams,
including key milestones; defined the next phase of engagement methodology and
timescales, including engagement with staff; and confirmed content and project
plans for enabling workstreams including impact assessment, finance, workforce,
estates and infrastructure etc.
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March 2017 – publication of Mental Health Strategy
By March the Mental Health Strategy will be published, setting out the strategic
direction for mental health and well-being together with high level priorities for action.
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May 2017 - forecasting and generating scenarios
Draft scenarios for the major elements of the strategy will be developed. These will
be informed by
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The publication of the draft Well-being Assessments for Gwynedd & Anglesey,
Flintshire, and Wrexham PSBs (December – January)
Publication of well-being objectives for the Health Board (March)
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Publication and approval of the final Population Assessment for the SSWB Act
(March)
Publication of the final approved Well-being Assessments for all PSBs
A further programme (phase 2) of engagement will run alongside the strategy work
during this phase, giving the opportunity for co-design of the scenarios for the overall
strategy and for specific areas. This will include staff, stakeholders and partners as
well as direct engagement with service users, carers and members of the public.
The engagement team is supporting the development of a detailed plan which will be
available in December alongside the next stage project plans. We will produce a
document to share widely which sets out the issues being considered and invite
feedback.
The scenarios will be supported by enabling workstreams on workforce and
organisational development, estates and capital; finance; information management
and technology; activity and capacity modelling. Assessment of transport and travel
issues, benefits realisation and a broader impact assessment (including equality
impact assessment) will inform the work.

July 2017 – prioritisation of scenarios
By July 2017 the draft scenarios will have been developed with supporting technical
details to enable recommendations to be made to the Board. An impact assessment
will have been undertaken, including equality impact, which will consider the
potential impact on people and whether the proposals will contribute to improving
well-being.
The scenarios will be brought together into a draft strategy document for
consideration by the Board. This will include the high level strategic framework
setting out how we will contribute to improving health and well-being and addressing
inequalities. It will also set out the broad picture of future service models, with key
areas identified and described in more depth. This will include Care Closer to Home
and major elements of Acute Hospital Care.
The work will reflect the findings of the joint work on population needs and well-being
of communities which is being undertaken with Local Authority partners and other
stakeholders.
At this stage, there may be elements which can be supported and implemented,
which would be fed into the IMTP development. Other elements may require formal
consultation and would not be taken forward until tested through this route.

September 2017 – potential consultation
By September we will commence formal consultation if needed on the overall
strategic approach proposed and any substantial changes which form part of the
proposals.
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
December 2017 – review and refine scenarios
Scenarios will be reviewed and refined in the light of consultation feedback and a
final impact assessment will be undertaken.

January 2018 – Board approval of strategy
By early 2018 the final strategy will be submitted to the Board for approval with
decisions taken regarding any consultation outcomes.
The strategy should reflect the priorities identified within the PSBs’ well-being plans
and the Area action plans required under the SSWB Act.
Following the submission and approval of the strategy, implementation plans will be
taken forward through the Integrated Medium Term Plan process. The strategy will
be reviewed and refreshed as it evolves.
3.3 Bringing Together the Long Term Strategy and our 2018-21 IMTP
The essence of our approach to developing the 2018/21 IMTP is to build on progress
made in 2017/18, driving continuous improvement whilst also delivering upon the
first three year commitments for implementation as identified within our longer term
strategy
The work to develop our long term strategy will therefore shape and inform our 3
year IMTP and associated planning process. For example, there are a number of
common inputs for both the long term strategy and IMTP process including the
requirements for a robust needs assessment, service baselines, outcome measures
etc. We will ensure that these processes are joined up and completed once to feed
both requirements of the long term strategy and IMTP.
We will develop and publish our planning and commissioning intentions which will be
the mechanism by which we will shape the development of our 2018/21 IMTP. This
will be aligned to our organisational strategic goals and our shred priorities with
partner organisations and will link the outputs of the long term strategy to the IMTP.
The planning and commissioning intentions will take into account the following:
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Refreshed North Wales Population health priorities
Emerging strategic priorities identified from our strategy work
Partner organisations’ priorities, in particular arising from the SSWB Act and the
Regional Partnership Board priorities, and WFG Act responses
New or emerging National policy and planning guidance for 2018/21.
A review of delivery in 2017/18 including key risks, quality and safety priorities
Outputs from our Strategy work which have been agreed can be taken forward
for implementation over the period of IMTP 2018/21
Local priorities for 2018/19 incorporating cluster plans; integrated health and
social care and wider partnership plans; delivery plans for major health conditions
e.g. cancer, respiratory, heart disease
Key productivity, efficiency and financial parameters
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Developing our Integrated Medium Term Plan
Divisional Area, Secondary Care and Mental Health teams will work closely with our
partners and through their departmental and service teams to focus on quality,
safety, sustainability and patient/user experience. The plan will be integrated,
bringing together service, workforce, infrastructure and financial elements..
There will be a continued drive to reduce variation and embed innovation across
North Wales as our strategic direction is implemented, using data and best practice
in support of all our work. Plans will be grounded in good evidence of effectiveness
and will reflect the prudent healthcare principles:
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
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Achieve health and wellbeing, with the public, patients and professionals
as equal partners through co-production
Care for those with the greatest need first, making the most effective use
of skills and resources
Do only what is needed, no more, no less and do no harm
Reduce inappropriate variation using evidence based practices
consistently and transparently
We will clearly demonstrate robust demand and capacity analysis with action plans
to achieve and maintain targets within the resources available. This will include
demand / referrals to other secondary care or tertiary services which will inform BCU
external secondary care contracts and Welsh Health Specialised Services
Committee (WHSSC) specialist services plans.
Plans will be developed at a service and departmental to underpin the Board’s IMTP.
Service and departmental plans will inform respective Area, Secondary care and
Mental Health divisional level plans. These in turn will shape the development of key
BCU Delivery Plans.
IMTP Planning Timetable
The IMTP planning timetable, key inputs and products are described in more detail
below:
April – May 2017 – Summary of population needs and baseline assessment
We will consolidate the work undertaken to support strategy development to set out
the key health challenges facing the population of North Wales and our assessment
of current service provision. This will include the SSWB population assessment. This
will clearly identify the context for the development of our IMTP

July 2017 – Identification of strategic direction and key priorities for service
change
We will identify the priority areas for action within the Board’s emerging strategy,
particularly those aspects which can be progressed over the first year of the IMTP in
order that detailed implementation planning work can commence.
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
September - October 2017 – Development of Planning Guidance and
Planning and Commissioning Intentions for 2018/21
Planning guidance / principles and a detailed planning timetable for 2018/21 IMTP
will be developed by September 2017 to support all divisions.
In September 2017, we will develop and publish our planning and commissioning
intentions linking the output of our strategy work to the IMTP.
By end September 2017, draft capital priorities for action will have been identified to
shape our Capital Plan over this period including estates, medical devices and
Information Management & Technology.
It is expected that the NHS Planning Framework for 2018/21 will have been
published by October 2017 which will reinforce national and ministerial priority areas.

November 2017 - Divisional priorities identified and draft operational plans
developed
Area Teams, Secondary Care and Mental Health Teams will have identified their
specific divisional priorities and departmental / service plans will be drafted in
response to local planning and commissioning intentions, including Area action
planning under the SSWB Act, PSB well-being objectives and national priorities.
The following departmental / service plans have been identified for development.
Departmental / Service Plans
Services
managed Services managed by
By Area Management Secondary
Care
Teams
Management Team
Primary care
Surgical Services
Community hospitals Acute Medicine and A&E
and services
Therapy services
Inpatient
therapy
services
Medical Specialties
Out of Hours Service
Children’s / Child & Cancer Services
Adolescent
Mental
Health Services
Medicines
Medicines Management
Management
Primary
and Womens Services
Community
Dental
Services
Continuing Healthcare Clinical support services;
(Radiology, Pathology,
Audiology,
EBME,
genetics)
Services Managed by MH&LD
Management Team
Primary Mental health Team
Community Mental Health Team
Inpatient mental health Services
Substance Misuse Services
Prison Services
Medicines management
Medium Secure Services
Learning Disabilities
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Dental Services

Psychological Therapies
Continuing Healthcare
December 2017
Draft Delivery plans will be developed underpinning our IMTP and subject to review
and scrutiny by the Strategy, Partnerships & Population Health (SPPH) Committee in
December on behalf of the Board.

January 2018
Draft BCU IMTP will be reviewed by Board in January 2018 prior to submission to
Welsh Government for plan scrutiny.
Importantly, at this stage, the Board are able to reflect upon the outputs from our
consultation and agree the emerging priorities for implementation over the period of
IMTP 2018/21.
Following feedback, plans will be redrafted as required for submission to Board in
March 2017.

March 2018 - 2018/21 IMTP submitted to BCU Board for approval
A high level timeline is attached at Appendix 2 which shows the proposed
programme for the development of the strategy and IMTP.
Actions to deliver the against the timeline set out above will be progressed via the
Programme Executive Group and will be monitored through the Strategy,
Partnerships and Population Health Committee of the Board.
4.
Assessment of risk and key impacts
The potential consequences of failure to develop a comprehensive strategy and
subsequently an IMTP for the Health Board are significant. Both elements are key
measures in the Special Measures Improvement Framework and failure to deliver
will compromise the Board’s ability to address the health needs of the population and
deliver improvements in health, well-being and service delivery. Furthermore, failure
to produce an IMTP would result in a breach of the Board’s statutory responsibilities
under the NHS Finance (Wales) Act 2014.
The Living Healthier, Staying Well strategy programme has established a risk and
issues log in accordance to identify and manage risks to strategy development which
will be overseen by the Programme Executive Group.
The Corporate Risk Register reflects the risks relating to both the strategy
development and the IMTP (CRR8 and CRR17).
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5.
Equality Impact Assessment
A full equality impact assessment will be undertaken on the strategy development
programme as the strategic direction develops and future scenarios emerge.
In order to ensure a robust process, gathering of evidence has commenced on
relevant equality and human rights issues. The equality profiles for North Wales will
be supported by additional evidence gathered in relation to specific workstreams. A
more integrated approach to impact assessment is being developed, which will seek
to streamline the evidence gathering and involvement process so that best use is
made of the valuable contributions of people who might be affected by proposals
under the strategy.
The Strategy & Planning Equality Scrutiny Group of the Health Board will provide
support, scrutiny and challenge throughout the process.
6.
Conclusions / Next Steps
The development of the Living Healthier, Staying Well strategy will provide clear
strategic goals for the Health Board and identify a route to the longer term outcomes
we are seeking to achieve.
The development of an IMTP for 2018/21 is instrumental to delivering ever-improving
services to meet the changing needs of the population of North Wales and a key
requirement under the NHS Finance (Wales) Act 2014 to prepare a three year IMTP
for approval by the Cabinet Secretary for Health, Well-being and Sport.
7.
Recommendations
The Board is asked to:

Receive the report and endorse the timescale and approach to the
development of its Strategy and the Integrated Medium Term Plan
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Appendix 1
QUESTIONS TO FRAME STRATEGY DEVELOPMENT
How can we work with people to improve health and well-being for all ages –
physical and mental health – both now and in the future?
What can we do to help reduce the differences in health and well-being in different
parts of North Wales or different groups?
How can we make sure our NHS always provides good, safe and effective care, and
produces good results for all, to match the best?
How will we reduce how long people wait for health services, so that people can get
the support they need, at the time they need it, in the right place?
How can we make sure we use our staff, our budgets and our hospitals, clinics and
other facilities well so we can provide better NHS services in the future?
How will we use current and new technology to help improve how we connect with
people and how others connect with us?
How do we work better together with our staff and with others in addressing these
issues?
How do we make sure we continue to listen and to learn from feedback and from
patients’ experiences in the future?