Enclosure: DAgenda item: 6

GOVERNING BODY

Title of paper: Commissioning Intentions and Planning for 2015/6Date of meeting: 28 January 2015Presented by: Simon Hall Title: Deputy Chief Officer/Director of Strategy

& PerformancePrepared by: Chris Soltysiak Title: Associate Director, Strategy and

Performance

Summary of Corporate Objectives Supported by this Report (X)

1. To commission high quality, cost effective services to meet the needs of localpeople which improve health outcomes and reduce inequalities developing moreintegrated services for patients.

X

2. To ensure that the patients’ and public’s voice is heard so that we improve thequality of the services that we commission for the diverse needs of our population

X

3. To develop Greenwich CCG as a clinically driven organisation that can attract andretain excellent staff, deliver effective governance and its full statutory and financialduties

X

4. Create & optimise a data rich environment to inform commissioning decisions atCCG, Transformation Steering Group, Syndicate and practice level

X

5. To develop a long term approach to improving healthcare for the population ofGreenwich delivered by sustainable providers through partnership working with RBG,local providers, the community and voluntary sector.

X

This paper sets out the strategic planning context from which the CCG’s commissioning intentionshave been formulated, and provides the Governing Body with detailed information on the nextsteps in developing and finalising our Commissioning Plans for 2015/16, which have to besubmitted to NHS England on 27 February 2015.

The Commissioning Plan will clarify and refine the existing commissioning work streams within theCCG into a document which then becomes the framework for clinically led service improvements,provides clarity on priorities and delivery of services, and transparency on the financialassumptions that are being made to ensure implementation. This Plan links to the Health andWellbeing Strategy, and the priorities developed for this Strategy are attached at Appendix 1 foragreement and inclusion in our Commissioning Plan.

In parallel to the Commissioning Plan the CCG needs to decide whether or not to submit aproposal to become a “Vanguard” site to develop new models of service delivery andcommissioning, and submit an application by 2 February 2015. National guidance has not yetbeen published, but discussions are taking place with our local GP Syndicates, their providerorganisations, Oxleas NHS Foundation Trust, Lewisham & Greenwich NHS Trust, the RoyalBorough of Greenwich, and with our partner CCG in south east London. There will be a verbalupdate given on this at the Governing Body meeting.

Page 2 of 2

Summary of Impact Assessment and Risk Management Issues (x)

Impact on Risk Assurance Framework (x) Yes X No N/AImpact on Environment (x) Yes X No N/ALegal Implications (x) Yes No X N/AResource implications (x) Yes X No N/AEquality impact assessment (x) Yes X No N/AImpact on current NHS Outcomes Framework areas (x) Yes X No N/APatient and Public Involvement (x) Yes X No N/ACommunications and Engagement (x) Yes X No N/AImpact on CCG Constitution (x) Yes No x N/A

Brief Summary of Recommendations

The Governing Body is asked to:

1. Note the timetable for delivery of the Commissioning Plan for 2015/16.2. Provide comments on the emerging themes for incorporation into our draft submission.3. Agree to delegate signing off of the draft Commissioning Plan submission (due at the end

of February) to the CCG Chair, noting that the final draft will be presented to the MarchGoverning Body).

4. Agree the priorities for the Royal Borough of Greenwich’s Health and Wellbeing Strategy(as outlined in Appendix 1).

5. Agree to the submission of an Expression of Interest for Greenwich to be a “Vanguard” site(new models of care) by 9 February 2015 in line with Guidance (when published), in linewith the discussion that will take place at this meeting.

Commissioning Intentions & Planning, 2015/16

1. Background

This paper gives the Governing Body a summary of the strategic context that we are operating in toundertake commissioning for next year, a summary of the key objectives and planned areas ofwork, and information on the steps to take the work forward in the coming months.

The purpose of commissioning intentions is to make our providers and stakeholders aware of:

Any significant changes we plan to make over the next year(s). Map out our key work streams and projects by programme areas. Identify those commissioning issues we wish to address through either service redesign or the

contracting process (e.g. service improvements, technical adjustments, etc.).

Commissioning intentions for 2015/16 build on our two year Commissioning Plan submitted in2014/15, to be revised in the last quarter of this year for 2015/16, which in turn responds to andsupports the developing borough Health and Well-Being Strategy.

Commissioning intentions for 2015/16 also build on our current delivery of strategy such as:

Development of key strategic programmes such as integrated care, primary care, mental healthand so on;

Responding to new legislation and national guidance, for example the Better Care Fund,Personal Health Budgets, the “Forward View Into Action: planning for 2015/16” and othercommissioning plan guidance as it is published;

An on-going financial challenge, approximately £7.3m QIPP required in Greenwich for 2015/16to meet national NHS finance requirements for CCGs;

Quality and performance issues as highlighted in the outcomes framework, needs assessmentprovided by the JSNA, national priority areas, service alerts, Provider data and patient feedbackfrom monitoring existing contracts.

There are a number of competing and different work drivers for the CCG prioritising what we wish tocommission, and to inform work plans to make the changes required on the ground in 2015/16.

These in summary include:

CP = national commissioning plan and NHS England (NHSE) requirements BCF = major scheme agreed with NHSE and the Royal Borough of Greenwich (RBG) LP = Local Priority proposed by planning and innovation groups linked to the SEL strategy and

local JSNA with RBG MD = Must do delivery which the CCG must prioritise and ensure is achieved as a national

planning priority or requirement QP = Quality Premium Target in which the CCG in the past has agreed it will deliver added

value in return for an incentive with the NHSE BAU = Business as usual - where we know from monitoring and contract discussion with

providers or patients that further change or service redesign is important to provider quality care OF = where Greenwich is an outlier on commissioning for value and local outcomes

frameworks, so further review is required SEL = South East London Strategy (“Our Healthier South East London” – refer to the specific

item on the agenda of this Governing Body to which this paper intrinsically relates)

In order to help identify where the priority for work has come from, including the source of work, thiscategorisation has been identified by work area within this document.

2. The NHS National Context

The 2013 NHS reforms saw a dramatic change in the commissioning landscape. CCGs becamethe statutory and accountable bodies for the bulk of healthcare commissioning at local level. Thenational guidance published in conjunction with the development of clinical commissioning groupssuch as the NHS England Guidance “Everyone Counts: Planning for Patients 2013/14” highlightedthe need for CCGs to focus on health outcomes underpinned by pathways of care which ensurepatients receive the best possible care when they need it and at the right time.

Everyone Counts provides the key strategic challenges from which we have been developing ourGreenwich specific plans and strategy:

3. Local Context

The South East London CCGs at a sector level have a history of strong collaborative working, andare in the process of developing the strategy “Our Healthier South East London” (see updateelsewhere on this Governing Body agenda). The initial draft high level five year South East London(SEL) strategy was shared with NHS England in December. This included the emerging vision,case for change, scale of ambition / priorities, improvement interventions, approach, programmegovernance, and risks.

The emerging themes across South East London are: Transforming primary care Delivering integrated care for physical and mental health Transforming urgent and emergency care services to drive quality, experience and sustainability

-Transforming cancer services Achieving compliance with London Quality Standards as well as broader standards of quality

and scrutiny – Improving productivity whilst delivering financial balance across all services. Thiswill be against a climate of increasing financial pressure within the South East London healtheconomy.

Greenwich CCG’s operational plan and related commissioning intentions therefore need to beconsistent with the five year SEL strategic direction, and need to take account of the NHS Englandplanning guidance. Locally, we also have to take into account our own financial position and thejoint strategic needs assessment (JSNA) of the population. Greenwich is the 19th most deprivedborough in England with 45% of areas among the most deprived 20% England. There are greatchallenges for health and social care services in reducing avoidable morbidity and mortality. Therehave been recent improvements, but life expectancy is 55.8 years for men against an average inEngland of 78.3 and 81.9 years for women, against an average of 82.3. The population is alsodiverse and changing with a lot more housing being built along the Thames river front. There is aneed to focus on equal and easy access to health and social care services which must also bedelivered in acceptable ways for Greenwich’s multi-ethnic community.

Greenwich has 42 GP Practices, some with additional branch surgeries, and a mixture of singlehanded and multi partner practices. The smallest patient list size is approximately 1,500 and thelargest approximately, 24,000. As of June 2014, the historic clusters of GPs in Greenwich re-aligned to become 4 geographical syndicates:

Syndicate Patient PopulationEltham 56,785Excel 66,056Network 68,445Blackheath and Charlton 79,475

Our strategy is to develop collaborative working and services with the 4 syndicates at thecornerstone of developing primary care and pathways back into secondary care – each syndicateundertaking a programme of work to improve outcomes for the whole syndicate patient population.Syndicates have set up LLP provider arms as a building block for future local care networks and thepotential for new delivery models of care. The CCG is also working develop a detailed primary carestrategy which includes the development of primary care co-commissioning with NHSE.

During 2014/15 we have undertaken further work on what its medium term strategy is and this willbe further crystallised within the publication of the CCG’s Commissioning Plan in April 2015.Locally, but using the national and sector strategic planning context, we can argue that the followingare the main challenges which require high priority for action and delivery by the CCG:

i. Wider primary care, provided at scale: The CCG as a “membership organisation” has todevelop and improve primary care. This includes developing “federations” or primary carenetworks where GPs can cluster together as providers to offer services to commissioners. Keythemes will be to improve primary care services including access to services, co-ordination ofcare, training and development, and continuity of care. This includes seven day working, usingtechnology and managing more work outside hospital settings. The development of co-commissioning with NHSE will also be important and from this will follow better demandmanagement, access and treatment at the “right place and time” by better collaboration

between wider primary care teams. The GPs and their related services are part of thetransformation of the whole system economy and it will be important to engage with allmembers in the CCG and the wider primary care community to make this a reality.

ii. A modern model of integrated care: This includes working with the council on the Better CareFund to improve pathways into the acute hospital setting and manage more work out of hospital.The impact of the BCF is to be measured against the following: Delayed transfers of care,emergency admissions, admissions to residential and nursing care, effectiveness of reablement,and patient/service user experience. Balancing emergency and elective demand with all theproblems local acute providers have in meeting quality targets and financial balance will need tobe addressed. This will involve implementing Community Based Care Strategy and improvingintegration and co-ordination of services. As part of this management of long term conditions,using risk stratification, integrated care co-ordination and ensuring both physical and mentalhealth are managed by GPs in primary care is critical for providing care at the right place andtime and ensuring the system is financially sustainable. A decision has to be taken about theCCGs view on emerging new models of delivery as set out in the “Five Year Forward View”which outlines the options for multispecialty community providers [MCPs] or Primary and AcuteCare Systems [PACs]. The Governing Body will receive a verbal update on this development atthis meeting, but at the time of finalising this paper it appears that a consensus is developingamongst GP Executives, Syndicate Leads, and the CCG membership around the developmentof a bid (with our local providers) to be a “Vanguard site” and it is likely that the MCP model willbe our model of choice should we opt to make this bid.

iii. Developing Financial Balance in the context of maintaining quality in terms of access tourgent care, productivity of elective care and ensuring that all services are safe andeffective: Greenwich has an above average deprived population, expected to increase overtime, with a growing elderly population. In addition the CCG needs to maintain balanced healtheconomy post TSA which means there is a reducing subsidy to the local health economy overtime to fund transition of services with Lewisham and Greenwich NHS Trust. This puts pressureon budgets and the local providers have already struggled to meet key national quality targets.In order to meet rising demand the forecast is for a requirement for QIPP efficiencies of £32mover the next 5 years. The CCG will be setting robust commissioner financial plans (includingachievement of control totals, 2% underlying recurrent surplus, and operating within runningcosts limits); robust contracts with providers; close management of commissioner QIPPinitiatives and provider CIPs and managing financial risk across the health economy. At thesame time we need to meet the NHSE quality assumptions including access targets, safety andavoidable harm, action on Francis, Berwick and Winterbourne Reports, and measuring andcoproduction from patient experience. In addition, clinical effectiveness evidence to commissionservices that respond to identified need (JSNA) and embedding quality in service redesign andprocurement (e.g. clinically effective evidence based pathways) is essential. Overall thischallenge requires the development of clinically led services where patient experience isconstantly measured and assessed, with a strong focus on best practice and innovation tosecure change.

iv. Parity of esteem and “No health without Mental Health”: The fourth strategic area is mentalhealth. We spend a large proportion of our budget on this programme area [approximately 19%]with Oxleas NHS Foundation Trust and importantly mental illness is known to shape andinfluence the costs of physical health – hence “No Health Without Mental Health” is the title ofthe national strategy. The 2014 NHS “Five Year Forward View” and recent Commissioning Planguidance for 2015/16 from NHSE also gives mental health increasing importance for CCGs toprioritise in terms of resources and focus on transformation going forward into 2015/16. This isalso reflected in the Greenwich Health and Wellbeing Board’s prioritisation of mental health asone of its top local priorities for action and improvement. We wish to invest in mental health

services further in 2015/16 and are keen to support the implementation of the new mental healthaccess and service provision performance indicators.

v. Improving health and reducing inequalities: Within our overall strategic aims is the

aspiration to reduce years of life lost by supporting people to lead healthier lives, using publichealth JSNA and primary prevention information to target healthy wellbeing (e.g. obesity,exercise, smoking, alcohol, drug use); improving cancer services, especially screening and earlydetection best practice commissioning pathways; supporting resilience in families. Developing

prevention across health and social care especially for children and families. Developing socialresilience within communities to develop self-help and navigation around the system will beimportant as a challenge. This saves resources in the longer term and makes strategic sense.The recent Commissioning Plan guidance makes it clear that we must have clear plans forhealth living and prevention with the engagement of the local community on implementing thisdirection. We have been working extensively through the Health and Wellbeing Board todevelop such plans already, and the agreed priorities are attached as Appendix 1 to this report.

vi. Enabling workstreams for our strategy: Key to all these challenges is the need to develop

good information and data access, backed up by strong health analytics and financial planningto make leadership decisions on how best to implement change. Workforce and estate plansare being developed to support the transformation of services. We have also commissionedwork in developing a new information strategy which will be presented to the Governing Body forapproval in March 2015. Importantly, we will also work to develop partnerships further andengage, consult and take stakeholders with us, in what will be a major transformation agenda todeliver better patient experience and clinical outcomes.

4. Developing the Commissioning Plan

The CCG has three main strategic and transformational drivers: Continue to develop co-ordinated or integrated care with the council [including delivery of the

BCF plans] Develop and improve primary care delivery models as a member organisation; Develop innovation and the Alliance model of commissioning with providers which focuses

more on outcomes and pathways of care.

These are enabled by three delivery processes:

1 Effective contracting;

2 Developing an information strategy;

3 Developing a quality strategy that counterbalances the need to achieve financial targetswith ensuring that patients (and patient safety) are at the centre of everything we do.

These objectives are informed by the wider context of the CCG operating within the South EastLondon sector of London; the changing population and health needs of the area and nationalplanning initiatives such as the Better Care Fund.

Figure 1 (next page) provides a view of all the key strategic objectives that enable delivery of theCCGs strategy and provides the context for all the commissioning work streams and intentions for2015/16:

Figure 1: NHS Greenwich CCG Commissioning Strategy:

Informed by this, and by existing and emerging strategies, we have identified key areas, orprogrammes of work, where improvement and transformation of services is required and has set upthe following strategic planning groups to develop work forward, transform services for the localpopulation and ensure alignment to the wider South East London and national strategic directionthat the CCG operates within.

5. Commissioning intentions 2015-6

The Strategy and Performance Directorate has mapped out all the commissioning intentionsoutlined in our two-year plan for 2014-16 and all commitments that we have made in previousdocuments or where strategic planning groups within the organisation have started work to changeservices. These have informed our Commissioning Plan and will be included in our final submissionto NHS England in April 2015. These are listed at a high level below, but the Governing Body areasked to note that behind these broad brush areas here there are more detailed plans.

South East London5 Year Strategy

IntegratedCare forAdults &Children

Allianceswith

providers

Better Care Fund

PrimaryCare

Strategy

Health andWellbeing Strategy

QualityAssurance

BusinessIntelligence

&Information

Children &Maternity

PlannedCare

MentalHealth

Right CareFirst Time

Long TermConditions

Cancer &End of Life

Contracting

5.1 Our “Big Three” Strategic/Transformational Priorities

Primary care strategy Alliance contracting Integrated care (with the RBG and other stakeholders)

(A) Primary Care Strategy

A4 Key Task or Service Development Key strategicdriver

A1 Develop the CCG as a Pioneer site which includes roll out ofenhanced primary care support for residents with complexconditions

BCF

A2 Long Term Conditions [LTCS] – increasing the scale of availablesupport services within primary care including implementing a testand learn pilot in primary care that will improve diabetes care andthe main physical health LTCs over a 2 year period

BCF

A3 Review referral management & booking service to ensure outpatientreferrals are optimised by GPs. Increase the efficiency of pathwaysin line with the South east London treatment and access policy(TAP)

CP – 2014/15

A4 Support practices in improving the quality of their services offered topatients by having clear practice development plans

LP

A5 Develop commissioning incentive schemes for primary carefocusing on the top 8 Commissioning Plan targets

LP and CP

A6 Pilot new ways to access general practice including telephone triageand e-consultations

LP

A7 Develop extended hours on a 7 day working basis across thesyndicates and implement the Urgent Care changes (RCFT)

LP

A8 Develop syndicates as LLPs about to be commissioned for providerwork developing the LCNs

LP and CP

A9 Roll out the national initiative to award £5 per head of population todeliver co-ordinated care and year of care programmes includingself-management and help for patients to achieve goals and not usethe secondary care sector

LP and CP

A10 Develop risk stratification tool to be used in GP practices to targetcare so patients are more managed out of hospital with more thanone long term condition

LP and BCF

A11 Work with RBG to develop web based Greenwich CommunityDirectory for professionals and non- professionals on voluntarysector, social services and statutory support

LP

A12 Develop community engagement and build resilience in partnershipwith patient representatives and community groups

LP and CP

A13 Develop a plan to improve patients getting registration with GPs andpromote change

LP

A14 Develop community engagement and build resilience in partnershipwith patient representatives and community groups

LP and CP

A15 Develop a primary care strategy agreed by the HWB LP

A16 Develop and rollout a work force education alliance strategy for theborough; this to include PLT events for GPs to develop increasedskills and for improve management of services

LP

(B) Working through an “Alliance” contractual framework

Key Task or Service Development Key strategicdriver

B1 Set up a Project Board to develop new contracting andcommissioning models within 2 years based more on outcomes andworking collaboratively and in an open book basis. This includesdeveloping a clear programme plan and revised financial model withinthe Greenwich Health economy.

LP

B2 Transform the Frail Pathway, MSK [ for all elective pathways intrauma and orthopaedics, rheumatology, podiatry, physiotherapy andchronic pain for 16 years and over, Cardiology pathway and COPDPathway

LP + BCF.Cardiology alsoCP. JNSA showsmortality fromheart diseaseneeds focus inGreenwich;COPD and hipreplacement [MSK] is an outliercompared toother CCGs

C. Integrated Care

Key Task or Service Development Key strategicdriver

C1 Develop the Virtual Patient Record – allows shared access to patientinformation across all providers

BCF

C2 MECC – ensuring every contact with services includes aconversation to improve health

BCF

C3 Develop community hospital model e.g. Eltham to supportintegration and innovation including developing as a hub for frailelderly services

CP

C4 Review the consolidation of intermediate care capacity through theRBG bed finding service and patient management services, includingthe most effective use of resources in the Hospital IntegratedDischarge and Joint Emergency Teams. This recognises thatintermediate care and the managed pathway will be operating acrossNHS Oxlea’s and Lewisham and Greenwich Trust

LP+ BCF

C5 Support efforts to promote co-production and self-management,including the development of schemes such as the Greenwichvolunteer patients support scheme in consultation with GreenwichCarers services

CP

C6 Review the performance of the integrated community equipmentservices contract with the RBG to identify efficiencies and improvepatient care

LP - Wheelchairsmentioned in CP– link also toAlliance.

C7 Develop better identification and management of patients in primarycare

LP – but alsomentioned in2014/15 CP.

5.2 Our seven key strategic transformation groups (which link to the SEL strategy and

our local Health and Wellbeing priorities)

Planned Care

Urgent/Unscheduled Care

Children and Maternity

Cancer and End of Life

Mental Health and Learning Disabilities

Staying Health and Wellbeing [linked to HWB Strategy development]

Key local priorities defined as business as usual

(D) Planned care

Key Task or Service Development Key strategicdriver

D1 Review the use of Tele-health : better use of technology for remotemonitoring and commission better services

BCF

D2 Review MRI and primary care imaging for dermatology [ enablingGPs to send pictures to dermatology consultants for early opinionand also support better cancer waits]

CP

D3 Review Ophthalmology elective care model and support a reductionin a reduction in variation – pathway redesign and commission arevised specification

CP

D4 Develop a planned care centre at Eltham to improve access forlocal people

CP

D5 Deliver on diagnostic test waiting times with local acute providers –use of national protocols and best practice and adopt newinnovative approaches to diagnostics

MD

D6 Undertake Continence Service review and redesign BAUD7 Review of gastroenterology pathway with a focus on quality

improvementLP

D8 Review of neurology pathway with focus on headaches and painmanagement

LP

D9 Re-commission direct access phlebotomy services LPD10 Review the urology pathway based on patient feedback LPD11 Under take a review of the gynaecology pathway and review AQP

as an optionLP

D12 Anticoagulation: transfer of service more to community basedsettings

LP

(E) Urgent/unscheduled care

Key Task or Service Development Key strategicdriver

E1 Implementation of right care, first time – strategy for urgent careincluding improving capacity and the pathway for Greenwichresidents. This includes completing the out of hours procurement

MD and CP

E2 Deliver on A&E waits – 95% in 4 hours MD and CPE3 Ensure that LAS meets urgent ambulance calls within 8 minutes MD and CPE4 Review a business case for improved ambulatory care at LGT and

implement it during 2015/16LP

(F) Children and Maternity

Key Task or Service Development Key strategicdriver

F1 In the light of the report from the Centre of mental health about investto save opportunities, undertake a review of the perinatal mentalhealth service

LP

F2 Undertake a joint procurement of children’s community service withRBG including self- care with an improved service specification

LP

F3 Review the urgent pathway for children at L&G to provide more careback in the community.

LP

F4 Ensure HV workforce is 75 WTEs by 2015 and that the local HealthVisitor service meets the needs of the local population.

MD

F5 Work with key stakeholders to develop a more effective pathway totackle Childhood Obesity to ensure better health outcomes

LP

F6 Ensure that families with disabled children and complex and lifelimiting health needs in Greenwich have the support they need to liveordinary lives as a matter of course. This includes updating the shortbreaks specification and implementation of the SEN reformsincluding personal health budgets, requiring preparation for a singleassessment process with respite, and pooled funding mechanisms tosupport a Resource Allocation Tool.

LP and MD

F7 Paediatric asthma/allergy – review of the pathway and provision ofbetter support and care in primary care – not have children go toA&E.

LP

F8 Develop better choice and service pathways for women needingmaternity. This to include developing a new monitoring framework forachieving the London Quality Standards for maternity Services.

LP and CP

F9 Develop a social prescribing pilot which includes development ofnavigators and third sector support

LP

(G) Cancer and end of life care

Key Task or Service Development Key strategicdriver

G1 Fully implement the national programme “co-ordinate my care” whichallows patients to die with support more at home

LP and BCF

G2 Deliver on the national Cancer 2 week target, the 31 day target and62 day target

CP and MD

G3 Review access to the pathway for services across community andinpatient provision with Greenwich and Bexley Community Hospice.This includes more joint working with Bexley CCG.

LP

(H) Mental Health and Learning Disability

Key Task or Service Development Key strategicdriver

H1 Improve dementia diagnosis rates and scale up support to ensure67% + targets are met

MD and CP

H2 Undertake a review of the Dementia pathway to establish a virtualward in the community

BCF

H3 Develop a more outcomes based contract with Oxleas NHS FTincluding introduction of MH tariff

CP

H4 Deliver on IAPTs 50% recovery, 15% of prevalence targets and 28days waits; develop IAPTs into the federations so the service cansupport physical LTCs

CP and MD

H5 Improve single point of access and treatment –deliver on newnational waits and EIP standards

CP and MD

H6 Deliver on national Winterbourne targets– reduce out of areaplacements to zero and review challenging behaviour pathwaydesigned to support the repatriation of Greenwich residents

MD

H7 Develop a respite and recovery service with Oxleas and the thirdsector

LP

H8 Map how MH services can deliver the national crisis concordat CPH9 Develop a new recovery college and monitor impact/outcomes LPH10 Undertake a review of Inpatient Rehabilitation with Bromley and

Bexley CCGsLP

H11 Develop protocols for Dual Diagnosis to improve joint clinicalworking between MH and substance misuse

LP

H12 Develop improved service user consultation in relation to theDementia Alliance including a focus on carers assessments andregular reviews taking place with RBG

LP

H13 Review how the Time to Talk services can support the preventionand early detection of mental health problems.

LP

H14 In the light of “achieving better access to MHS by 2020” review howpsychiatric liaison services can be developed to provide RAID withthe acute services

CP

H15 Review business case with Oxleas to provide step down and stepup IP care for LD clients [either from out of area or via transitionarrangements]

LP

H16 Develop personal budgets for patients with complex and challengingbehaviours

MD

H17 Take forward the procurement exercise including new servicespecification for CAMHs; this includes a single point of access,better management of transition and early intervention.

LP

H18 Review transitions for patients with complex needs and LTCsincluding mental health and learning disabilities

LP

H19Develop patient choice in MH in the light of new national guidance

MD – singlepoint of accesswhich will askpatients wherethey would liketo receive theirinitialassessment.

H20 Develop Autism Diagnostic Pilot into 2015. This includes developinga local ADHD and brief intervention service in the borough

LP

H21 Extend the benefits of the Dementia training Programme throughoutGreenwich care homes and develop a Dementia friendly boroughthroughout the community

LP

H22 Under take a review of the acute mental health pathway to ensurethere is more focus on managing patients closer to home with hometreatment.

LP

(I) Staying health/prevention (refer to Appendix 1 of this report for agreed joint Health &

Wellbeing Strategy priorities)

Key Task or Service Development Key strategicdriver

I1 Social Isolation – increase support to live healthily for the isolatedand lonely. This includes reviewing the potential of piloting a socialprescribing model involving navigators and third sector social support

BCF

I2 Nutrition – improving nutrition services especially in care homes BCFI3 Undertake a review of the obesity pathway including tier 4 services CPI4 Commissioning Support for resilience in families CPI5 Prevent people from dying prematurely QPI6 Improve Under 75 mortality from CVD QP.I7 Develop a business case for tackling obesity including a tier 3

serviceLP

I8Ensure there is less delayed diagnosis for HIV/infectious diseases

LP and JNSA –high burden

(J) “Business as usual”: Improving services as part of work with RBG or providers to

respond to local need

Key Task or Service Development Key strategicdriver

J1 Meeting the 18 week RTT for all specialities and ensure no one everwaits over 52 weeks.

MD and QP[must achieve92% in 14/15 toget QP]

J2 Carers – increase assessment and support for carers. Finalise anew strategy for carers in the light of the new Carers Act.

BCF

J3 Protecting Social Care to ensure support in the community BCFJ4 Implementation of personal budgets for all patients with LTCs CPJ5 Review the continuing care process in the light of integrated

commissioning guidance. This includes expanding the benefits ofthe London Procurement project to encourage more care homes toapply for AQP (currently only 5); develop a service specification thatwill apply across health and social care and undertake a review of allcontinuing healthcare funded placements.

LP but also inthe light of newlegalrequirements

J6 Reducing alcohol and drug dependency – joint work with RBG CP and OFJ7 Care Homes – invest in training and development of care home staff BCFJ8 Pressure Ulcers – reducing their number of severity BCFJ9 Review of Gastroenterology pathway with a focus on improvement

that embeds Calprotectin in the pathwayLP

J10

Deliver £1m QIPP from Medicines Management

CP – Led by theIntegratedGovernanceDirectorate

J11 Develop further the SEL Treatment Access Policy CPJ12 Ensure re-commissioned phlebotomy and anticoagulation services

are effectively monitored in contractsCP

J13 Deliver Friends and Family Test QPJ14 Improve reporting of medicine safety incidents QPJ15 Reduce Cancelled operations with offer of new appointment in 28

daysMD

J16 Ensure Healthcare Associated Infections reduce MDJ17 Develop a more effective pathway for ESD/Stroke and Neuro

Rehabilitation to improve patient flows from HASU and the strokeunit to the community and efforts to improve the co-ordination of thephysical health needs of patients with Mental Health Problemsparticularly with Dementia

LP

J18 Develop the extension of the podiatry model to include the provisionof social care interventions for vulnerable adults who fulfil theeligibility criteria for the service

LP

There are over one hundred outline commissioning intentions. Our next step over the next twomonths is to refine and prioritise. Delivery of these intentions and turn them in to programmes ofwork for the clinical leads on the Governing Body to take forward with the transformation directorate.This includes refreshing the work of the various transformation groups with the support of theorganisational development consultants (Change FX) who have been procured by the GoverningBody to support us in growing success in the organisation.

6. Refining our Commissioning Intentions and finalising the Commissioning Plan

Guidance on the Commissioning Plan for 2015/16 was issued on 19 December. The delivery of theplanning process also links into negotiation with providers and the contracting processes so that allcontracts are negotiated, signed off and implement final commissioning intentions with agreedbudgets by 1st April 2015. This means that the next two months will mean an intensive period ofwork for staff teams. We have agreed that the broad commissioning intentions as outlined abovewill be reviewed, made concrete in terms of delivery, and then refreshed so that the as we enter thenew financial year we will be very clear about how we will implement service changes for localpeople going forward into 2015/16.

The planning timetable for 2015/16 is as follows:

DATE MILESTONE

23 December 2014 Publication of Final 2015/16 Planning Guidance,including provisional tariff assumptions, to befollowed in January by:

Standard Contract for 2015/16 Revised Contract Dispute Resolution

ProcedureJanuary 2015 Contract negotiations start which must be

concluded by 11 March.Revised publication of national tariff published. Ifthis is delayed the national timetable may bereconsider

13 January 2015 CCGs have to submit initial headline data usinginformation from 2014/15 and current businessplanning assumptions

29 January 2015 CCGs have to submit their UNIFY submissionwhich outlines their expected trajectories on the“top 8” and other must do performance targets for2015/16

29 January 2015 Weekly contract tracker submitted each Thursdayto NHSE

9 February 2015 Submissions of interest by the CCG to NHSE on

Forward View new models of care [Vanguards]13 February 2015 Checkpoint for progress with planning measure

and trajectories and progress in developing theplan

20 February 2015 National contracts stocktake – to check the statusof contract negotiations

27 February 2015 Submission of draft PlansMarch 2015 Assurance of draft plans both internally and

externally6 March 2015 Checkpoint from NHSE for progress with planning

measures and trajectories11 March 2015 Contracts expected to be agreed post any

mediation. Arbitration activated between 12 Marchand 25th March as needed

25 March 2015 The CCG Board reviews latest CommissioningPlan and gets and update report on contracts

10 April 2015 Full Submission of full final plansFrom April 2015 Assurance and reconciliation of plans [ this may be

effected by the General Election ]May – June 2015 CCG reviews and refreshes its governance and

delivery structure for strategic planning andtransformational groups to reflect the need toimplement the plan and its priorities

End September 2015 Revised draft commissioning intentions for 2016/7formulated and produced for Q3.

In order to meet this ambitious timetable we have set up a “Planning Task and Finish SteeringGroup” which is meeting weekly to programme manage the work needed to meet the timetable. Wemet the first key milestone on 13 January, and are on track to complete the Unify performancesubmission for the 29 January. We are confident that we will be able to meet all the deadlines, andall teams across the CCG are already involved and engaged in the delivery of the Plan.

7. Recommendations

The Governing Body is asked to:

1. Note the timetable for delivery of the Commissioning Plan for 2015/16.2. Provide comments on the emerging themes for incorporation into our draft submission.3. Agree to delegate signing off of the draft Commissioning Plan submission (due at the end of

February) to the CCG Chair, noting that the final draft will be presented to the MarchGoverning Body).

4. Agree the priorities for the Royal Borough of Greenwich’s Health and Wellbeing Strategy (asoutlined in Appendix 1).

5. Agree to the submission of an Expression of Interest for Greenwich to be a “Vanguard” site(new models of care) by 9 February 2015 in line with Guidance (when published), in line withthe discussion that will take place at this meeting.

“Healthy Greenwich, Healthy People”

A Strategy to improve the health and wellbeing of people in Greenwich, andmake Greenwich a place that supports good health and wellbeing

Background (high level overview) Greenwich as a place, its strengths, challenges and opportunities The people of the borough Health needs in Greenwich JSNA priorities (‘causes of the causes’, risk factors, clinical priorities)

About this strategy The strategy of the Health and Well-being Board How it has been developed / how the 4 x priorities have been arrived at How we intend to work across agencies and organisations to develop

action plans to implement the strategy / next steps

The priorities

1) Good physical health (tackling obesity) – making the borough a placethat provides advice, services and an environment that support people tochoose good, healthy food and to be physically active as part of their dailylives

‘Living streets’ and healthy regeneration: environments that supportgood mental & physical health

Active travel (walking/cycling) Commercial determinants Involving wider partners such as planning, TFL, GLA, GYPC Tackling child and adult obesity Improving diet Increasing physical activity for health

2) Good mental health – ensuring a strong focus on services andenvironments that support the development and maintenance of goodmental health throughout the life-course, from birth to older age

First 1001 days of life Building resilience & social connections Improving the mental health of people with physical health conditions Improving the physical health of people with mental health conditions Ensuring service effectiveness and strong user involvement

3) A healthy workforce; a workforce that promotes good health – usingthe workplace across all our organisations in the borough to promote andsupport good health and wellbeing of employees. Developing all of our

Appendix 1

employees as agents of good health and wellbeing amongst the widerGreenwich population

Focus on encouraging and supporting employers to adopt the LondonHealthy Workplace Charter and the kinds of activities involved in thecharter work

Development and implementation of a major cross agency ‘Make EveryOpportunity Count’ initiative

4) Overseeing the effectiveness of the health and care system inGreenwich – overseeing and monitoring the effectiveness of programmesto improve all JSNA priorities, and the changes to the health and caresystem in the borough

Making sure all JSNA priorities have effective programmes in place todeliver improvements

Monitoring outcomes to check that improvements are being made Keeping an overview of the major challenges to the health and care

system (an ageing population, population growth, increasing costs ofhealth and care services, A&E and primary care access, etc.)

Keeping an overview of the impact of changes to the system(integrated care, community based care, Care Act implementation,NHS Commissioning Strategy, NHS 5-Year Forward View)

Monitoring how these factors are having an impact on healthoutcomes for the population

Get involved Consulting on the actions we need to take to implement the strategy How organisations and individuals can find out more How organisations and individuals can get involved