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  • 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 & Childrens 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

    Womens and

    children s services

    Unscheduled

    Care incl. UCCsand PAUs

    - Chase Farm- Barnet Hospital

    - NMUH

    Benefits Group

    Chairs Oversight Group

    Stakeholder Engagement Group

    Transport WorkforceOrganisational 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