Board Update

Paula KahnRachel TyndallStephen Conroy

22nd March 2010

Agenda1. Programme update

• Where we are in the process• Working group updates• BEH Clinical Strategy• Governance

2. Communications and engagement• Deliberative event (30th Jan)• Stakeholder event (17th March)• Media / parliamentary activity• Other briefings (local authority, scrutiny, LINks, MPs, etc)

3. Work underway

• Workforce• Pathways – approach and timeline

4. Next steps

• Joint sessions (CAG / TAG / Steering Group and Steering Group / JCPCT)• Process between now and June• Strengthening commissioning

5. Questions and discussion

1. Programme update

Timeline

Clinical ModelClinical Model

CSPCSP

Financial ModellingFinancial Modelling

MAH OptionsAppraisal

MAH OptionsAppraisal

SevenScenarios

SevenScenarios

Public and Stakeholder EngagementPublic and Stakeholder Engagement

Options AppraisalOptions Appraisal

ReviewReview

ConsultationConsultation

Business Case

Business Case

DecisionDecision

Ge

ne

ral

Ele

cti

on

Nov

09Dec

09

Jan

10

Feb

10

Mar

10

Apr

10

May

10

Jun

10

Jul

10

Aug

10

Sep

10

Oct

10

Nov

10

Phase 1

Strategic ModellingPhase 2

Develop and Appraise Options

Phase 3

PCBC

Phase 4

Consultation

Oct

09

Sept

09

Dec

11

Jan

11

Feb

11

Mar

11

Decision

CAG Work

• “Medical emergency hospital” variant of the local hospital model

• Further discussions underway about in-patient paediatrics

• Assembling evidence pack underpinning clinical model

• Completion of work on co-dependencies for specialist / tertiary services

• Hold on the development of any further stand alone midwifery let units in NCL, pending a review of:

• Clinical and cost-effectiveness

• Survey on choice

Polysystems implementation programme board

1. Review of the proposed ‘Hubs’ – services provided; co-

location with hospitals; number required; progress

2. Complete activity and cost modelling for each PCT

3. Support pathways development

4. Consider Governance models

Mental health working group

1. Acute Care Pathway Development (Phase 1 ends at the end of April)

• The narrative Case for Change for mental health services in NCL

• The clinical model

• Detailed modelling work to establish the optimum bed capacity for the sector

Phase 2 then commences with the establishment of a Programme Board. Cameron Ward (CE NHS Barnet) has been appointed as the Chair.

2. Polysystems

Mental health working group is to be established.

Define the mental health ‘core offer’ to be replicated across our polysystems.

3. CAMHS

The terms of reference of the group are to be reviewed

An optimum bed capacity figure for Tier 4 (specialised) across the sector will be established and a clinical model for ‘step down’ provision defined.

BEH clinical strategy update

• Phase 1 business cases as NMUH and B&CFH approved

• Aiming to transfer Women & Children’s service summer (2011)

• Working on business cases for phase 2 – urgent care (2013)

- looking to see how implementation can be accelerated

• Reviewing governance and ensuring alignment with NCL SOR

PCTs x 5PCTs x 5

PCTs x 5PCTs x 5

JCPCT

SOR Steering

Group

Technical

Advisory Group

Clinical Advisory

Group

Pathway Development Groups

− Acute mental health− CAMHS − Cancer− Cardiovascular− Planned Care (Poly)

− COPD− Dementia− Diabetes− CHD - Heart failure− Screening

− Maternity− Paediatrics − Planned care (Acute)− Urgent care

Enablers − Communications & stakeholder engagement− Estates− IM&T

Mental Health Programme

Board

Polysystems Programme

Board

Acute Services Programme

Board

BEH

Implementation Programme

Board

Women’s and

children’ s services

Unscheduled

Care incl. UCCs

and PAUs

- Chase Farm- Barnet Hospital

- NMUH

Benefits Group

Chairs Oversight Group

Stakeholder Engagement Group

− Transport− Workforce−Organisational development

Implementation

Groups

PCTs x 5

Revised SOR governance (showing BEH alignment -tbc)

Planned

care

Revised SOR governance arrangements

• Steering group membership has been revised

• Local Authority representation in place

• Closer alignment with BEH clinical strategy

implementation structures

• Shifting focus to delivery

2. Communications and engagement

Events

• Deliberative Event January 30

• 50 members of the public

• Content – Urgent Care focus

• Most would use Walk-in services.………..

• As good or better than A&E

• Shorter waiting times than A&E

• High quality trained staff

• Accessible, parking; good public transport

AND

• Reassurance that in an emergency they

would still be treated quickly at a hospital

• Need more explanation of what services

are available.

• As good or better than A&E

• Shorter waiting times than A&E

• High quality trained staff

• Accessible, parking; good public transport

AND

• Reassurance that in an emergency they

would still be treated quickly at a hospital

• Need more explanation of what services

are available.

Events • Stakeholder Event March 17

• 72 stakeholders • Health scrutiny committee, neighbouring PCTs, LINKs, voluntary

and community group, clinical service managers

• Content • acute reconfiguration and shift of care to polysystems

• opportunity for attendees to rank and input into the criteria

• Clinical Panel Q&A – CAG representation• Q&A and JCPCT Report 7 April 2010

Well structured and attended events with focussed objectives and output

No ‘new’ concerns surfaced

Terminology continues to be a communication ‘blocker’

Still the need to assure on ‘no decision’ and focus on case for change

Well structured and attended events with focussed objectives and output

No ‘new’ concerns surfaced

Terminology continues to be a communication ‘blocker’

Still the need to assure on ‘no decision’ and focus on case for change

Website

• www.healthforncl.nhs.uk

• Short term

• Home for NCL documents and

basic sector review information

• Area to post media statements

• Link to organisation websites

• Long term

• Fully functioning and interactive

website that houses daily

updates, forum for opinion,

provides stakeholder

communication and provides a

vehicle to use within consultation

process

Briefings and meetings

• Public reaction

• Whittington public march held on 27th February – reports of attendance vary greatly

• Lynne Featherstone meeting (March 4th)– 300 people (approx.) attended

• Extensive media coverage across the patch

• Briefings

• Briefings being set up and follow up letters issued

• Local councillors / committees

• Other e.g. London Assembly

• 17 Clinicians put forward as Sector Clinical Ambassadors

• Media training briefings set up by NHS London

• All CAG members included

• JOSC to be establish post election

3. Work underway

Workforce

3 strategic workforce goals arising from the Strategy Plan:

• Co ordinate effective transformation of the workforce to deliverpolysystem led care

• Effectively manage the workforce impact of acute re-configuration

• Increase the productivity of the workforce across all care settings

Delivered by:

• Working with the priority pathway groups to identify competencesrequired across a pathway

• Working with Polysystem Board to build an effective and efficient workforce model for implementation

• Facilitating provider organisations to work together to effectively manage the impact of reconfiguration.

• Influencing education commissioning to meet short term and long term workforce plan

Workforce - Staffscope update

An event where 64 participants, across a mix of professional groups designed the workforce for a polysystem

Summary group discussion points:

• The majority of care in polysystems would be delivered by nurses, AHPsand other trained staff

• GPs could take clinical responsibility for complex care (patients with co-morbidities) and clinical case management, and give up some routine work

• The interface between the GP, GP with special interest and specialist doctor to be explored further particularly in an urgent care setting

Key issues to encourage the workforce change required:

• The need to identify the governance model for polysystems

• A re-focus of training and education from the acute setting to the primary care setting was seen as a key catalyst to workforce change

Priority pathways in NCL

First five pathways to be addressed:

• Urgent Care Cameron Ward

• LTCs Liz Wise

• Coronary heart disease (heart failure)

• COPD

• Diabetes

• Planned care (polysystem) (Gynaecology) Helen Petterson)

PCT CEO lead:

Process in place to review and standardise – Phase 1 by May

4. Next steps

Next steps

• Ongoing engagement; communications management; terminology

• Review scenarios and ambition for change - joint session between

Steering Group/CAG/TAG, then joint session between Steering Group

and JCPCT

• Options appraisal process following May JCPCT meeting; Finalise

consultation options in June

• Strengthening commissioning

Questions and discussion

Appendix

• Clinical Model

• 7 Scenarios

• Programme timeline

• Pathways

• Polysystem Hubs

Clinical model for acute care proposed for NCL• Two major acute hospital sites, one in the north of the sector and one in the south

• A multi-specialist acute provider from where highly specialist and tertiary services will be delivered

• Rationalisation of specialist services (e.g. cardiac, neurosurgery) across RFH and UCLH and development of networked services for surrounding areas

• Maximum of two local hospitals – three variants under consideration

• Maximum of three in-patient paediatric sites which should be co-located with a major acute site or multi specialist acute

• Four obstetric units each catering for 6,000 births with level 2 NICU either co-located with a major acute, a medical and surgical emergency hospital or a multi specialist acute

• Further consideration should be given as to the viability in workforce and financial terms of stand alone midwifery led birthing units

The seven reconfiguration scenarios

25

1 2 3 4 5 6 7

Barnet DGH

NMUH DGH

Royal Free

UCLH

Whittington

Chase Farm

Major acute

Multi-specialist acuteEmergency medicine and

surgery

Emergency medicineUrgent care and elective

“Do minimum”

Criteria

• Clinical quality and safety – the right staff and the

right facilities to deliver better outcomes

• Patient experience and access – how easy it is to

access services and how well patients and their carers

are treated

• Technical and financial – that it has enough beds, the

right facilities and does not need a lot of new

investment or expenditure. Helps to close the gap.

• Deliverable and Sustainable – will cause the least

disruption to services and can be implemented quickly.

NCL SOR –Timeline

Pre-consultation Business Case

Oct 09

Nov

09Dec

09

Jan

10

Feb

10

Mar

10

Apr

10

May

10

Jun

10

Jul

10

Aug

10

Sep

10

Oct

10

Nov

10

Dec 10

Oct – Dec 09

Phase 2 completionJan – Feb 10

Prepare for Phase 3

Mar – Aug 10

Phase 3

Sep – Nov 10

Consultation

Care pathways

Legal

Finance

Workforce

Estates

Enable

rs

= Core deliverable

Options Appraisal

Ge

ne

ral

Ele

cti

on

Pre-consultation

engagement

Stakeholder Engagement Public

Consultation

Activity Modelling

Capital & Revenue

Integrated impact assessment (health, equalities, transport etc)

Detailed Implementation Plan

Consultation

Options agreedCommissioning Strategy Plan

25th January

Sector Mental Health Sector Mental Health

Sector Polysystems Sector Polysystems Development

Priority pathways in NCL

• Diabetes

• COPD

• Coronary heart disease

• Dementia

• Maternity

• Planned care (polysystem

based)

• Urgent care

• Paediatric services

• Cancer

• Cardio-vascular

• Planned care (hospital based)

• Acute mental health inpatient care

• CAMHS

• Screening

Rationale:

- Strategic fit with Healthcare for London - Impact on quality

- Impact on performance (e.g. access, patient experience) - Value for money

Pathway development approach and key tasks

• Identified Clinical and Commissioning Leads

• Established a commissioning steering group

• Review work and draft sector pathway specification and standards

End March 2010.

• Workshop 1 for each pathway to review the first draft pathway

specification and standards April 2010

• Review and refine each pathway specification and standards

• Workshop 2 (as required) week commencing April 2010

• Finalise phase 1 pathways and specifications May 2010