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1 Accountable Director: Jan Ditheridge, Chief Executive

Board Meeting: 20 March 2014

SUMMARY REPORT

Meeting Date: 20.03.14 Agenda Item: 6 Enclosure Number:

4

Meeting: Trust Board

Title: Chief Executive Report

Author: Jan Ditheridge Accountable Director:

N/A

Other meetings presented to or previously agreed at:

Committee Date Reviewed Key Points/Recommendation from that Committee

N/A

N/A N/A

Purpose of the report

To update the Board on key issues at national and local level.

Decision/ Approval

Assurance Discussion X Information X

Strategic Priorities this report relates to:

To exceed expectations in the

quality of care delivered

To transform our services to offer more care closer to home more productively.

To deliver well co-ordinated effective

care by working in partnership with

others.

To provide the best services for patients by

becoming a more flexible

and sustainable organisation

Summary of key points in report

A number of national reports and guidance have been issued which directly relate to our clinical strategy: o Community Services: How they can Transform Care. Kings Fund, February 2014. o Safe, Compassionate Care for Frail Older People using an Integrated Care Pathway.

NHS England, February 2014 The Department of Health is keen to remind Trusts of their obligations following the estate

transfer through the Transforming Community Services process. This is to ensure that assets remain available for use by the NHS.

2 Accountable Director: Jan Ditheridge, Chief Executive

Board Meeting: 20 March 2014

Strong leadership is cited as a key component of organisational success. The Department of Health has appointed two senior successful leaders, Sir Stephen Dalton and Sir Stuart Rose, to help the NHS to maintain, support and refresh its leadership capability now and in the future.

The Trust has submitted the next stage of its 2 year plan, on time, to the Trust Development Authority with a much improved level of detail compared to the first draft submission in January 2014.

Telford and Wrekin and Shropshire Health and Wellbeing Boards have approved the first Better Care Fund plans which align to commissioner priorities and plans. The Trust is engaged in the design and development of these plans.

Future Fit – the Board is asked to support the Future Fit Board Programme Execution Plan (PEP) and to note the revisions since its approval in January 2014.

The Chief Executive asks that the Board formally thank all our staff for continuing to provide great services through the adverse weather experienced over the last couple of months.

Key Recommendations

The Board is asked to: 1. Note the strategic significance of the national reports. 2. Note the triggers and conditions relating to our Estate. 3. Support the Future Fit programme Execution Plan. 4. Formally thank our staff for providing safe, effective services through the bad weather. Is this report relevant to compliance with any key standards? YES OR NO

State specific standard or BAF risk

CQC Yes

NHSLA No.

IG Governance Toolkit No.

Board Assurance Framework

No.

Impacts and Implications? YES or NO

If yes, what impact or implication

Patient safety & experience Y Plans should reflect improved patient outcomes.

Financial (revenue & capital) Y Plans impact on/drive financial activity.

OD/Workforce Y

Workforce planning key to national and local plans.

Legal Y

Plans and guidance are part of the legal/governance framework of the NHS.

Accountable Director: Jan Ditheridge 1 Board Meeting Date: 20 March 2014

CHIEF EXECUTIVE REPORT – MARCH 2014

1. Executive Summary 1.1 A number of national reports and guidance have been issued which directly relate to

our clinical strategy: Community Services: How they can Transform Care. Kings Fund, February 2014. Safe, Compassionate Care for Frail Older People using an Integrated Care

Pathway. NHS England, February 2014 1.2 The Department of Health is keen to remind Trusts of their obligations following the

estate transfer through the Transforming Community Services process. This is to ensure that assets remain available for use by the NHS.

1.3 Strong leadership is cited as a key component of organisational success.

The Department of Health has appointed two senior successful leaders Sir Stephen Dalton and Sir Stuart Rose, to help the NHS to maintain, support and refresh its leadership capability now and in the future.

1.4 The Trust has submitted the next stage of its 2 year plan, on time, to the

Trust Development Authority with a much improved level of detail compared to the first draft submission in January 2014.

1.5 Telford and Wrekin and Shropshire Health and Wellbeing Boards have approved the

first Better Care Fund plans which align to commissioner priorities and plans. The Trust is engaged in the design and development of these plans. 1.6 Future Fit – the Board is asked to support the Future Fit Board Programme Execution

Plan (PEP) and to note the revisions since its approval in January 2014. 1.7 The Chief Executive asks that the Board formally thank all our staff for continuing to

provide great services through the adverse weather experienced over the last couple of months.

2. National Issues 2.1 Community Services: How they can Transform Care.

Kings Fund, February 2014 This important document was published in February this year, providing one of the first

national papers which sets out a framework for the future of community services. The Board will be familiar with much of its content, as its production was developed by

Nigel Edwards with extensive input from members of the Foundation Trust Network’s Aspirant Community Foundation Trusts of which we are an active member.

The key messages from the report are: The ambition to move care closer to home has resulted in some reduction in length

of stay in hospital, but further significant changes are needed in the way community care is delivered.


A key first step will be to remove the complexity that has resulted from different policy initiatives over the years.

A simple pattern of services should be developed based around primary care and natural geographies and with a multi-disciplinary team. These teams will need to work in new ways with some new skills, in the community and in hospitals to create better services for patients and their carers.

New models need to include both mental health and social care. Services need to be capable of a very rapid response and to work with hospitals to

speed up discharge. Access to community or nursing home beds for short stays can make an important difference.

Significant numbers of patients presently in hospital beds could be cared for in other settings if services are available and easy to access.

Community services could do more to reach communities and individuals to avoid crisis, maintain independence and help keep people at home – combatting social isolation and improving preventative action.

Contract and payment mechanisms will need to change to support the ambitions described in this document.

The Board will be familiar with both the key messages and content of this report,

recognising the development of our refreshed strategy and service transformation is in alignment with the report.

Examples of some of our service developments that support the vision for this

document include the development of the Integrated Care Service in Shrewsbury & Atcham; the work to develop our community hospitals and our plans to modernise our IT systems and equipment.

The local health and social care economy recognises that it will require significant

system change to deliver transformed community care as described in this report. Through strategic programmes such as Future Fit and potential levers such as the Better Care Fund, the economy is developing plans accordingly.

Our organisation is playing a key role in leading the development of the community

offer, but cannot deliver it in isolation. A copy of the full report can be found at: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/community-

services-nigel-edwards-feb14.pdf 2.2 Safe, Compassionate Care for Frail Older People using an Integrated Care

Pathway Published in February 2014 this practical guidance supports commissioners,

providers and professional leaders to ensure: “Care ….is as important as treatment. Older people should be properly valued and

listened to and treated with compassion, dignity and respect at all times. ….cared for by skilled staff who are engaged, understand the particular needs of older people and have time to care”. Hard Truths – the Journey to putting Patients First – Governments response to Francis Report November 2013

This is another key document for our organisation as many of the people we work with

are over 75 and often present with frailty. The pathway and tools in this guidance can support us to further develop our contribution to the needs of older frail people and to work with commissioners to develop end to end frailty pathways that meet the needs of our ageing population.


We are presently considering how this document should support the shape of our strategy and plans, and how the tools can help us develop care now.

A copy of the this guidance can be found at: http://www.england.nhs.uk/wp-content/uploads/2014/02/safe-comp-care.pdf 2.3 Department of Health Guidance: Conditions to Transfer NHS Estate The Department of Health is keen to remind NHS Trusts of their obligations following

the transfer of estate through the Transforming Community Services process in 2011. The overriding principle on transferring estate into NHS organisations from

Primary Care Trusts (PCTs) was to keep assets available for use by the NHS. For this reason, the transfer schemes impose an obligation on receiving Trusts to

transfer property to the Secretary of State, on the occurrence of various triggers, although the Secretary of State has the discretion to refuse the transfer.

The triggers are broadly: A liquidator has been appointed The property, or any part of it, is no longer being used for service provision A decision has been made to dissolve the trust Any service contracts have been terminated or expired The Trust wishes to dispose of the property, or any part of it In the case of FTs, Monitor has not approved a satisfactory risk rating The property is part of a larger site where a split of title has not been approved The transfer was made in the basis of incorrect or misleading information, or in

error There has been a breach of the scheme’s provision There are also additional conditions that apply to leaseholders. Generally, where the Secretary of State refuses a transfer, the trust may dispose of

the property; the scheme includes overage provisions, which entitle the Secretary of State to 50% of profits on disposal. Additionally, overage provisions may also apply to successors in title to the property, which may impact on any potential disposal.

Whilst these conditions are imposed by the transfer schemes, they are secured by the

registration of a restriction on the Land Registry title for each property in favour of the Secretary of State. This means that the property cannot be disposed of either in full or part, without the consent of the Secretary of State for Health. A disposal is a sale or granting of a lease for over three years but could include a number of other property transactions which a Trust is considering in relation to the estate it has received.

This direction from the Department of Health has been particularly important recently

in conversations with the public, who sometimes find it difficult to understand why we are not in a position to sell NHS property.

The Board is asked to note these triggers and conditions.


2.4 Review of Leadership within the NHS Two senior, experienced and successful leaders Sir Stephen Dalton and

Sir Stuart Rose have been asked to help the NHS to maintain, sustain, support and refresh its leadership capability now and in the future.

Sir Stephen Dalton (Chief Executive, Salford Royal NHS Foundation Trust) will lead a

review to understand how to enable the best performing NHS organisations and Chief Executives to support under-performing, isolated, failing hospitals. He will look at how hospitals or services could be grouped into beacons of excellence under one leadership team.

Sir Stuart Rose (former Chairman of Marks & Spencer) will focus on the problems

faced by the 14 Trusts currently in ‘special measures’ in the programme to turn around failing hospitals, where strong leadership was identified as key to improvement.

Locally, Steve Gregory, Director of Nursing, Dr Alastair Neale, Medical Director and

Tessa Norris, Director of Operations are leading a piece of work to consider if we have leaders in the right positions to operate effectively, to optimise the leadership talent we have, and importantly that clinicians are in decision-making positions and enabled to exert clinical leadership. This is in its early stages and will be explored further with the Board once themes emerge.

3. Local Issues/Activity 3.1 Securing Sustainability – Planning Guidance for NHS Trust Boards 2014/15 –

2018/19 Last month the Board discussed the strategic approach to planning, directed in our

case, by the Trust Development Authority (TDA). To remind the Board the key milestones for submission of plans are:

13 January 2014 - First draft of operating plans 5 March 2014 - Full 2-year plan 4 April 2014 - Final 2-year plan 20 June 2014 - Five Year Board signed-off and commissioner aligned

integrated business plan and LTFM

Following the first submission on 13 January 2014 the Trust was required to meet with the TDA as at that point our projected financial situation was risk rated red. This was mainly due to the fact that our cost improvement plans did not have the level of maturity to provide the detail required.

This position improved significantly before the review with the TDA and we were able

to articulate plans in greater detail, giving assurance we are addressing the financial gap. The meeting was supportive and positive, with recognition there is significant work to do to deliver our financial plan.

3.2 Better Care Fund The Better Care Fund plans have now been formally agreed at Telford & Wrekin and

Shropshire Health and Wellbeing Boards. Both Telford & Wrekin and Shropshire have aligned the Better Care Fund to their

respective Health & Wellbeing Board priorities and individual organisations’ commissioning plans.


Telford and Wrekin The Telford and Wrekin vision for the Better Care Fund is “to empower people in

Telford & Wrekin to take control of their own health; to support them in caring roles and to keep everyone as healthy and independent as possible”.

The focus of the fund will be to transform public services for adults needing high levels

of health and social care support, particularly frail older people at risk of and or suffering as a result of:

Falls Dementia Long-term conditions/End of Life High risks or admission to hospital/care home Discharged from hospital with high need for rehabilitation and/or reablement.

The focus will be on two main themes: 1. Develop community capacity to support people to live independently. 2. To deliver viable alternatives to hospital care for people who can be cared for

closer to home. Value for pooled budget 2014/15 £13,114,000 2015/16 £14,674,000 Shropshire CCG Better Care Fund Shropshire state that they will use the Better Care Fund as a lever to support

“more flexible provision, increased choice and more appropriate care settings being provided locally…also improved outcomes (for patients) with better provision for long term conditions and an agenda focused on prevention…ensuring higher quality of life years for our younger generations”.

The focus for the Better Care Funding will be broadly around the themes of: 1. Prevention 2. Living Independently 3. Long-term conditions 4. Managing and Supporting People in Crisis Value for pooled budget 2014/15 £9, 358,613 2015/16 £21,451,000 It is worth noting that themes for Telford & Wrekin and Shropshire are similar and align

with the national report priorities already discussed earlier in this report. The Trust is actively engaged in designing services and delivering commissioning

plans as they relate to our services now and in the future. A copy of the plans can be found at: http://www.shropshire.gov.uk/committee.nsf/0/C2666A5D2A0CFA4680257C61004E039C?op

endocument

http://apps.telford.gov.uk/demservice/DisplayDocument.asp?type=pdf&ref=16124


3.3 Future Fit Since the last Board meeting Future Fit activity has been focused on the clinical

redesign and analysis/evidence gathering elements of the programme. This means that many of our clinicians have been involved in working groups looking

at pathways of care and how they can be developed for the future. This work will ultimately inform and underpin the clinical model for the Future Fit programme.

At January’s Future Fit Programme Board, the Programme Execution Plan (PEP) was

presented for approval. The PEP document forms the basis for the development of an agreed model of care

for Excellent and Sustainable Acute and Community Hospitals that meet the needs of urban and rural communities in Shropshire, Telford and Wrekin and Mid Wales.

It sets out the systems and processes by which the programme will be planned,

monitored and managed and is owned, maintained and used by partner organisations to ensure the successful day to day operational management and control of the programme and the quality of its outputs.

The purpose of the Programme Executive Plan is to: Define the programme and brief. Define the roles and responsibilities of those charged with delivering the

programme. Set out the resources available and the budgetary control processes. Identify the risks relating to the programme and the risk management processes. Define the programme management and issue control arrangements. Set out the approval processes. Define the administrative systems and procedures. Set out the controls assurance process. A copy of the full PEP document is attached at Appendix A. It should be noted that since the approval of this document a small number of

revisions have been or are being considered. 1. Steve Gregory – Director of Nursing is our representative on the Clinical Design

Group 2. Further guidance on decision making – “Programme Board and Commissioner

Decision Making is attached at Appendix B. 3. Timeline and Milestones – this is presently under review and a decision will be

made regarding any changes within the next couple of weeks. 3.4 Infection Outbreak We have seen one small outbreak of confirmed influenza at Whitchurch Hospital

affecting staff and patients. This resulted in short-term ward closure and some staffing issues due to sickness absence issues, but this matter is now resolved.


Jan Ditheridge Chief Executive

3.4 Winter Weather Hopefully we have now seen the end of the unprecedented wet and windy weather. I would personally like to thank staff for doing a tremendous job to keep “business as

usual” through some very difficult weeks weather wise. We used our business continuity plans on a number of occasions to ensure vulnerable patients were identified and risk assessed and to arrange alternatives when buildings became inaccessible or unusable as was the case for the Multi-Agency Child and Family Support Centre services based at the Child Development Centre, Monkmoor Campus, Shrewsbury. A particular thank-you to that group of staff for responding quickly and responsibly to that situation.

Draft Version 1.0

20th January 2014

Future Fit Shaping healthcare together Programme Execution Plan

Future Fit - Shaping healthcare together Programme Execution Plan

VERSION CONTROL

Version Date File Name Status Version 0.1 12th Nov 2013 131112 Shrop CSR PEP V0.1 Initial draft prepared by Paul Elkin for

review by Programme Team on 14th Nov

Version 0.2 22nd Nov 2013 131122 Shrop CSR PEP V0.2 Updated draft prepared by Paul Elkin & Peter Spilsbury for review by Programme Team on 26th Nov

Version 0.3 27th Nov 2013 131127 Shrop CSR PEP V0.3 Updated draft prepared by Paul Elkin for review by Programme Board on 2nd Dec

Version 0.4 6th Dec 2013 131206 Shrop CSR PEP V0.4 Updated draft for review by Programme Team on 12th Dec

Version 0.5 2nd Jan 2014 140102 Shrop CSR PEP V0.5 Updated draft for review by Programme Team on 9th Jan

Version 0.6 14th Jan 2014 140114 Shrop CSR PEP V0.6 Final draft for approval by Programme Board on 20th Jan

Version 1.0 20th Jan 2014 140120 Shrop CSR PEP V1.0 Final version incorporating changes identified by Programme Board for approval by Sponsor Boards

140120 Shrop CSR PEP V1.0 i


TABLE OF CONTENTS

1. INTRODUCTION .................................................................................. 1

1.1 Background .................................................................................................. 1

1.2 Document Status .......................................................................................... 1

1.3 Document Scope .......................................................................................... 2

1.4 Document Audience ..................................................................................... 2

2. THE CASE FOR CHANGE....................................................................... 3

2.1 Background .................................................................................................. 3

2.2 The Challenges ............................................................................................. 4

2.3 Call to Action ................................................................................................ 5

3. PROGRAMME DEFINITION & SCOPE ................................................... 7

3.1 Definition ..................................................................................................... 7

3.2 Scope ............................................................................................................ 7

3.3 Our ‘Moral Compass’ - Principles for Joint Working.................................... 10

4. GOALS AND OBJECTIVES ................................................................... 13

4.1 Goals .......................................................................................................... 13

4.2 Objectives ................................................................................................... 13

5. ROLES AND RESPONSIBILITIES .......................................................... 15

5.1 Introduction ............................................................................................... 15

5.2 Programme Structure ................................................................................. 15

5.3 Programme Sponsors ................................................................................. 15

5.4 Programme Owners ................................................................................... 15

5.5 Programme Board ...................................................................................... 15

5.6 Programme Director ................................................................................... 18

5.7 Senior Programme Manager ...................................................................... 18

5.8 Programme Team ....................................................................................... 18

5.9 Workstreams .............................................................................................. 19

5.10 Advisory Team ............................................................................................ 27

140120 Shrop CSR PEP V1.0 ii


5.11 Other Roles................................................................................................. 27

6. TIMETABLE ........................................................................................ 286.1 Milestones .................................................................................................. 28

7. RESOURCES ....................................................................................... 307.1 Resources ................................................................................................... 30

7.2 Programme Budget .................................................................................... 30

8. PROGRAMME MANAGEMENT ......................................................... 328.1 Approach .................................................................................................... 32

8.2 Methodologies & Standards ....................................................................... 32

8.3 Issues Management ................................................................................... 33

8.4 Monitoring & Audit .................................................................................... 33

8.5 Administrative Systems & Procedures ........................................................ 34

8.6 Communications and Stakeholder Engagement ......................................... 34

8.7 Conflicts of Interest .................................................................................... 35

8.8 Confidentiality ............................................................................................ 35

8.9 Gateway Reviews ....................................................................................... 35

9. ASSUMPTIONS, CONSTRAINTS, RISKS .............................................. 369.1 Assumptions ............................................................................................... 36

9.2 Constraints ................................................................................................. 36

9.3 Risks ........................................................................................................... 36

APPENDIX 1 PROGRAMME STRUCTURE ............................................... 38

APPENDIX 2 PROGRAMME PLAN .......................................................... 39

APPENDIX 3 PROGRAMME DIRECTORY ................................................ 49

APPENDIX 4 ENGAGEMENT & COMMUNICATION PLAN ...................... 50

APPENDIX 5 RISK REGISTER .................................................................. 51

140120 Shrop CSR PEP V1.0 iii


LIST OF TABLES

Table 1 Programme Scope ...................................................................................................... 7

Table 2 Programme Board .................................................................................................... 16

Table 3 Programme Team .................................................................................................... 19

Table 4 Workstream 1: Clinical Design .................................................................................. 20

Table 5 Workstream 2: Activity & Capacity .......................................................................... 21

Table 6 Workstream 3: Engagement & Communications ..................................................... 24

Table 7 Workstream 4: Finance ............................................................................................ 25

Table 8 Workstream 5: Assurance ........................................................................................ 26

Table 9 Programme Plan – Target Milestones ...................................................................... 28

Table 10 Programme Budget .................................................................................................. 31

LIST OF FIGURES

Figure 1 Process for Managing Issues ..................................................................................... 33

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1. Introduction

1.1 Background There are significant challenges faced by the NHS both locally and nationally in planning for the future sustainability of its services. Shropshire, with its two CCGs, also faces unique challenges in securing sustainable hospital services. Shropshire CCG covers a large geography with issues of physical isolation and low population density and has a mixture of rural and urban aging populations. Telford & Wrekin CCG has an urban population ranked amongst the 30% of most deprived populations in England. Both are dependent on in-county acute and community care provision operating across multiple sites with the challenges that that can bring. Both commissioners are also aware of the needs of the Powys population who are dependent on utilising services from the same local hospital trusts.

Shropshire CCG, Telford and Wrekin CCG, Shrewsbury and Telford Hospitals Trust (SaTH), Shropshire Community Health Trust and Powys LHB have committed to work collaboratively to undertake a Clinical Services Review (CSR), engaging fully with their patient populations, to secure long-term high quality and sustainable patient care.

The Clinical Services Review (CSR) will focus on acute and community hospital services in Shropshire and Telford & Wrekin. It will need to involve all communities who use those services, particularly across Shropshire, Telford & Wrekin and mid Wales. The aim will be to develop a clear vision for excellent and sustainable acute and community hospitals - safe, accessible, offering the best clinical outcomes, attracting and developing skilled and experienced staff, providing rapid access to expert clinicians, working closely with community services, focused on those specialist services that can only be provided in hospital.

1.2 Document Status This Programme Execution Plan (PEP) forms the basis for the development of an agreed model of care for excellent and sustainable acute and community hospitals that meet the needs of the urban and rural communities in Shropshire, Telford and Wrekin and Mid Wales. It sets out the systems and processes by which the Programme will be planned, monitored and managed, and is owned, maintained and used by the partner organisations to ensure the successful day-to-day operational management and control of the Programme and the quality of the outputs.

The purpose of the PEP is to:

Define the Programme and the brief;

Define the roles and responsibilities of those charged with delivering the Programme;

Set out the resources available and the budgetary control processes;

Identify the risks relating to the Programme and the risk management processes;

Define the programme management and issue control arrangements;

140120 Shrop CSR PEP V1.0 - 1 -


Set out the approvals processes;

Define the administrative systems and procedures;

Set out the controls assurance processes.

1.3 Document Scope The scope of this PEP covers:

Phase 1 (October 2013 - January 2014)

o Programme Set-up

o Determining the High-Level Vision and Overall Model of Service

Phase 2 (February 2014 - April 2014)

o Identification and quantification of the levels of activity in each component of the service model

Phase 3 (April 2014 - September 2014)

o Identification of options and option appraisal

Phase 4 (September 2014 - January 2015)

o Public consultation on preferred option(s)

o Preparation of Outline Business Case(s)

Phase 5 (February 2015 - February 2016)

o Full Business Case(s)

Phase 6 (To be Determined)

o Capital Infrastructure work

o Full Implementation

Phase 7 (To be Determined)

o Post Programme Evaluation

This is a live document and will be progressively developed by the Programme Board as the project progresses, and will be formally reviewed and updated at the conclusion of each Phase.

1.4 Document Audience The PEP is a public document and may be viewed by anyone interested in the Programme or in how it is being managed and delivered. However, as the prime audience are those directly involved with the programme, it assumes a degree of technical knowledge and understanding of programme management and the relevant procurement processes used by the NHS.

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2. The Case for Change

2.1 Background There are already some very good health services in Shropshire, Telford and Wrekin. They have developed over many years to try to best meet the needs and expectations of the populations served, including that of Mid-Wales. Nevertheless, when we look at the changing needs of the population now and that forecast for the coming years; when we look at the quality standards that we should aspire to for our population, as medicine becomes ever more sophisticated; and when we look at the economic environment that the NHS must live within; then it becomes obvious that the time has come to look again at how we design services so we can meet the needs of our population and provide excellent healthcare services for the next 20 years.

When considering the pattern of services currently provided, our local clinicians and indeed many of those members of the public who have responded to the recent Call to Action consultation, accept that there is a case for making significant change provided there is no predetermination and that there is full engagement in thinking through the options. They see the opportunity for:

Better clinical outcomes through bringing specialists together, treating a higher volume of cases routinely so as to maintain and grow skills

Reduced morbidity and mortality through ensuring a greater degree of consultant-delivered clinical decision-making more hours of the day and more days of the week through bringing teams together to spread the load

A pattern of services that by better meeting population needs, by delivering quality comparable with the best anywhere, by working through resilient clinical teams, can become highly attractive to the best workforce and can allow the rebuilding of staff morale

Better adjacencies between services through redesign and bringing them together

Improved environments for care

A better match between need and levels of care through a systematic shift towards greater care in the community and in the home

A reduced dependence on hospitals as a fall-back for inadequate provision elsewhere and instead hospitals doing to the highest standards what they are really there to do (higher dependency care and technological care)

A far more coordinated and integrated pattern of care, across the NHS and across other sectors such as social care and the voluntary sector, with reduced duplication and better placing of the patient at the centre of care

They see the need and the potential to do this in ways which recognise absolutely the differing needs and issues facing our most dispersed rural populations and our urban populations too.

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This then is the positive case for change.…. the opportunity to improve the quality of care we provide to our changing population.

2.2 The Challenges Our local clinicians and respondents to the Call to Action also see this opportunity to systematically improve care as being a necessary response to how we address the many challenges faced by the service as it moves forward into the second and third decades of the 21st century.

These challenges are set out below - they are largely outside our control and we have to adapt our services to meet them:

Changes in our population profile - The remarkable and welcome improvement in the life expectancy of older people that has been experienced across the UK in recent years is particularly pronounced in Shropshire where the population over 65 has increased by 25% in just 10 years. This growth is forecast to continue over the next decade and more. As a result the pattern of demand for services has shifted with greater need for the type of services that can support frailer people, often with multiple long-term conditions, to continue to live with dignity and independence at home and in the community.

Changing patterns of illness - Long-term conditions are on the rise as well, due to changing lifestyles. The means we need to move the emphasis away from services that support short-term, episodic illness and infections towards services that support earlier interventions to improve health and deliver sustained continuing support, again in the community.

Higher expectations - Quite rightly, the population demands the highest quality of care and also a greater convenience of care, designed around the realities of their daily lives. For both reasons, there is a push towards 7-day provision or extended hours of some services, and both of these require a redesign of how we work given the inevitability of resource constraints.

Clinical standards and developments in medical technology - Specialisation in medical and other clinical training has brought with it significant advances as medical technology and capability have increased over the years. But it also brings challenges. It is no longer acceptable nor possible to staff services with generalists or juniors and the evidence shows, that for particularly serious conditions, to do so risks poorer outcomes. Staff are, of course, aware of this. If they are working in services that, for whatever reason, cannot meet accepted professional standards, morale falls and staff may seek to move somewhere that can offer these standards. It is also far more difficult to attract new staff to work in such a service. Clinicians are a scarce and valuable resource. We must seek to deploy them to greatest effect.

Economic challenges - The NHS budget has grown year on year for the first 60 years of its life ……in one decade across the turn of the 21st century its budget doubled in real terms. But now the world economy and the UK economy within that is in a different place. The NHS will at best have a static budget going forward. And yet the changing patterns of population and resultant need, the increasing costs of ever improving medical technology, the difficulties in simply

140120 Shrop CSR PEP V1.0 - 4 -


driving constant productivity improvements in a service that is 75% staff costs and that works to deliver care to people through people, mean that without changing the basic pattern of services then costs will rapidly outstrip available resources and services will face the chaos that always arises from deficit crises.

Opportunity costs in quality of service - In Shropshire and Telford and Wrekin the inherited pattern of services, especially hospital services, across multiple sites means that services are struggling to avoid fragmentation and are incurring additional costs of duplication and additional pressures in funding. The clinical and financial sustainability of acute hospital services has been a concern for more than a decade. Shropshire has a large enough population to support a full range of acute general hospital services, but splitting these services over two sites is increasingly difficult to maintain without compromising the quality and safety of the service.

Most pressingly, the Acute Trust currently runs two full A&E departments and does not have a consultant delivered service 16 hours/day 7 days a week. Even without achieving Royal College standards the Trust currently has particular medical workforce recruitment issues around A&E services, stroke, critical care and anaesthetic cover. All of these services are currently delivered on two sites though stroke services have recently been brought together on an interim basis. This latter move has delivered measurable improvements in clinical outcomes.

Impact on accessing services for populations living in two urban centres and much more sparsely populated rural communities - In Shropshire, Telford and Wrekin there are distinctive populations. Particular factors include our responsibility for meeting the health needs of sparsely populated rural areas in the county, and that services provided in our geography can also be essential to people in parts of Wales. Improved and timely access to services is a very real issue and one which the public sees as a high priority. We have a network of provision across Community Hospitals that can be part of the redesign of services to increase local care.

2.3 Call to Action In November 2013 we ran a major consultation exercise with public and clinicians under the national Call to Action for the NHS. The response was very clear in saying that the public wanted full engagement in thinking through options for the future and that nothing should be predetermined. Nevertheless, in the light of the factors described above, there was real consensus between public and clinicians about the following:

An acceptance of there being a case for making significant change;

A belief that this should be clinically-led and with extensive public involvement;

A belief that there were real opportunities to better support people in managing their own health and to provide more excellent care in the community and at home;

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An agreement that hospitals are currently misused. This is not deliberate but as a result of poor design of the overall system and the lack of well understood and properly resourced alternatives;

A belief that it is possible to design a new pattern of services that can offer excellence in meeting the distinctive and particular needs of the rural and urban populations of this geography - but if we are to succeed we must avoid being constrained by history, habit and politics.

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3. Programme Definition & Scope

3.1 Definition The programme is Future Fit - Shaping healthcare together.

3.2 Scope The CCGs commission services from a number of providers locally. The Programme will focus on the services provided by Shrewsbury & Telford Hospital NHS Trust and Shropshire Community Health NHS Trust, particularly as those organisations are facing specific challenges which require potential wider reconfiguration. There are other providers of services to the CCGs who will be involved in the redesign of services in terms of any impact on improving quality for patients as stakeholders, however these organisations’ services in full will not be part of this programme and are outside the scope of this exercise. These organisations provide services to other commissioners locally and more widely as specialist providers which are outside of the health economy. All of the organisations represented on the Programme Board are committed as stakeholders to the redesign of services to improve quality and will support this programme.

The following parameters have been identified to delineate the scope of the activities that fall within the scope of the Programme:

Table 1 Programme Scope

Within Programme Remit Outside of Programme Remit

General

Hospital services physically located within the geography covered by Shropshire and Telford & Wrekin CCG’s

Services currently provided by Robert Jones & Agnes Hunt Hospital NHS FT

Acute and community hospital services which are not physically located in the geography covered by Shropshire and Telford & Wrekin CCGs

The impact on other providers, particularly in terms of changed patient flows, of the potential options for improving hospital services within the patch, including:

• Primary Care Services

• Robert Jones & Agnes Hunt Hospital NHS FT

• Social Care

• Mental Health

• Community Health Services

• Other providers outside of the county

• Ambulance Services

Re-design of Primary Care Services1

Re-design of Community Health Services1

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Within Programme Remit Outside of Programme Remit Development of key/main integrated care pathways, including both rural and urban models to reflect the differing needs of the populations served

Care pathways outside of those key/main pathways defined within the Programme

‘Virtual' hospital services in the community (these ‘virtual’ services are community services that might substitute for ‘traditional’ hospital services

Local Authority Integrated Care services

Services provided from community hospitals which are not related to the key/main integrated care pathways defined by this programme

Phase 1a - Programme Set-Up

Finalisation of Case for Change and Programme Mandate

Preparation and approval of Programme Execution Plan

Preparation and approval of programme timetable and plan

Securing key programme resources

Establish panel of external clinical experts

Development of Benefits Realisation Plan

Development and approval of Engagement & Communications Plan

Development of Assurance Plan

Phase 1b - High Level Vision and Overall Service Model

Securing clinical consensus on overall model of care Preparation of plan for sustaining A&E services in short to medium-term *

Analysis of Community Hospital services and utilisation Existing Powys community hospital services

Existing Mental Health services

Acute Hospital services activity projections and categorisation

Robert Jones & Agnes Hunt Hospital services

Stakeholder engagement on high-level vision and model of care

Re-design of Ambulance Services

Assessment of recurring affordability envelope & capital investment capacity

Gateway Review 0

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Phase 2 - Development of Models of Care

Refinement of acute hospital activity projections Development of CCG Commissioning Strategies *1

Activity projections for other services Re-design of Social Care services

Development of whole LHE financial models

Agreement of non-financial appraisal criteria and process

Phase 3 - Identification and Appraisal of Options

Development and agreement of long-list of options

Selection of short-list of options

Financial and non-financial appraisal of short-listed options

Selection and approval of preferred option

Preparation for public consultation

Gateway Review 1

Phase 4 - Public Consultation & OBC

Formal public consultation

Preparation of Outline Business Case(s)

Partner organisations’ approval of OBC and consultation outcomes

Securing all necessary NHS & HM Treasury approvals for the OBC

Preparation and submission of any necessary planning applications

Gateway Review 2

Phase 5 - Full Business Case(s)

Procurement processes

Preparation and partner organisations’ approval of FBC(s)

Gateway Review 3

Phase 6 - Implementation

Capital infrastructure developments

Implementation of service changes

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Phase 7 - Post Programme Evaluation

Evaluation of Programme against key objectives and benefits

*1 Key interdependencies requiring close coordination with the Programme. It is assumed that all other items listed as being outside of the scope of the Programme will be encompassed within the development of CCG and NHS England commissioning strategies and of the Better Care Fund.

3.3 Our ‘Moral Compass’ - Principles for Joint Working Given the ‘Case for Change’ set out in Section 2 above and the goals and objectives of the Programme set out in Section 4 below, it is recognised by all parties that complex and difficult decisions lie ahead if this Programme is to succeed in delivering the improvements to care and to health that we seek for the populations we serve. There are several potential trade-offs which cannot be avoided. In every one of these there will be a balance to be found, but one which can never satisfy every individual interest:

The ‘common good’ (for all who look to services in this geography for their health care) versus the individual or locally specific good ( the preferences of sub groups );

The present versus the future;

Organisational interest versus public interest;

One priority versus another when resources are limited.

It is the role of leaders to reach decisions on these, and to do so transparently and objectively.

The Programme is a collective endeavour because all who are party to it - sponsors and participants - recognise that this is the only way that the scale of the challenge and opportunity for this whole geography can be met. But working collectively, whilst still acting as separate statutory organisations, requires agreement on what we have called a ‘Moral Compass’ - ways of working designed to help navigate through when it gets difficult and when the ‘trade-offs’ have to be decided jointly.

We have agreed the following principles for our Programme - we will hold ourselves to account against them, and would ask others to do the same:

We are concerned with the interests of all of the populations in England and Wales who use hospital services provided within the territories of Shropshire and Telford and Wrekin. We desire to maximise benefit for that whole population. Whilst our decisions seek to deliver the greatest benefit to the whole population we serve, we will always consider the consequences

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of any options for either specific local populations or for the needs of minority and deprived groups and will be explicit about how we weight these and our rationale for so doing.

Participant organisations will individually sign up to the single version of the Case for Change and, at the appropriate point, to a single shared strategic vision and high level clinical model that arises out of the Programme and its response to the Call to Action and other engagement processes. This will be in addition to the collective sign-up represented by the Programme Board agreeing the PEP.

The Programme will agree, in advance of its key decision–making on the selection of options, an objective set of criteria that will be employed, and these will also be signed-up to by individual constituent organisations at that stage. These will explicitly address the basis for considering the trade-offs referenced earlier.

We will make shared decisions on which innovations to roll out at scale, recognising that any one might not always favour all parties and that some sacrifice for the common good will be necessary.

We will openly consider all options that can enhance our ability to reach collective decisions on key issues, including governance arrangements which are designed to bind our respective boards together.

We will work collectively with our stakeholders, including politicians, to invite agreement from them to the case for change, the clinically –led model and the principles for decision making.

We recognise that we will need to find ways that can meet our programme objectives within current levels of overall expenditure. We cannot add costs, instead we need to redistribute resources to achieve a better overall outcome for the populations we serve.

We will ensure that we develop a shared financial model so that any plans or changes can be assessed on whether they deliver authentic economic benefit i.e. we will not plan to deliver savings in one part of our system if the inevitable consequence is (unplanned) cost increases in another.

We will develop ways to share the financial risk when implementing major change…we recognise that national payment formulae may not support what we are agreeing to do and we will adjust for that where appropriate.

We will share all information necessary to allow the Programme to deliver our objectives and will do so in line with the laws and guidance on Information Governance.

We will share organisational plans and be transparent re budgets.

We will deliver our individual contributions to the work of the Programme to the highest quality possible and on-time.

We will all use a single version of documents pertaining to the Programme and these will be prepared for us by the Programme Office. We will coordinate consideration of key documents so that we avoid the issues (of fact and perception) that can arise when key considerations or decisions are taken sequentially rather than simultaneously.

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We will work together to ensure that public and patient engagement in our Programme is extensive, timely and meaningful and that we engage in the formulation of options as well as in response to recommendations on them - we want this Programme to be characterised by co-production with patients and public.

The response to Call to Action told us that the public, whilst wanting full engagement at all stages and no predetermination of outcomes, want and respect clinically-led development of strategies and options. We will ensure that this happens.

Whilst partnership and collective working on the Programme is essential, so too at times will be the need for organisations to pursue their own objectives (e.g. in relation to competition amongst service providers). Where this is felt by any constituent to be the case, then we agree to making that explicit to our partners, to explain our position, and to work with the Programme to enable continued collective decision making to continue.

The response to the Call to Action asked us to avoid being constrained by history, habit and politics and to look to do ‘the right thing’. We will explain any decisions we make clearly and in that light.

Being part of the CSR Programme represents a clear commitment, and we will take collective responsibility for making progress towards a shared vision for improved services and health.

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4. Goals and Objectives

4.1 Goals The key benefits to be secured from the programme are:

Highest quality of clinical services with acknowledged excellence in our patch;

A service pattern that will attract the best staff and be sustainable clinically and economically for the foreseeable future;

A coherent service pattern that delivers the right care in the right place at the right time, first time, coordinated across all care provision;

A service which supports care closer to home and minimises the need to go to hospital;

A service that meets the distinct needs of both our rural and urban populations across Shropshire, Telford & Wrekin and in Wales , and which anticipates changing needs over time;

A service pattern which ensures a positive experience of care; and

A service pattern which is developed in full dialogue with patients, public and staff and which feels owned locally.

The key benefits to be achieved will be set out in a Benefits Realisation Plan which will be developed as part of Phase 1 of the programme. This plan will set out the measurable benefits and key performance indicators to be realised under the following headings:

Improved clinical effectiveness (outcomes);

Improved experience of care, including environment;

Reduced harm;

Better support for people with long term conditions, minimising their need to rely on hospital based care;

Better support for people to live independently;

Most effective use of resources across the whole care system;

Equitable access to the full range of services; and

Improved staff recruitment, retention and satisfaction.

4.2 Objectives The key objectives of the programme are:

To agree the best model of care for excellent and sustainable acute and community hospital services that meet the needs of the urban and rural communities in Shropshire, Telford and Wrekin, and Mid Wales;

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To prepare all business cases required to support any proposed service and capital infrastructure changes;

To secure all necessary approvals for any proposed changes; and

To implement all agreed changes.

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5. Roles and Responsibilities

5.1 Introduction This section details the programme management structure, the roles and responsibilities of the personnel responsible for delivering the Programme, and the terms of reference for the teams, committees and groups responsible for individual aspects of the Programme.

5.2 Programme Structure The overall programme structure is set out in Appendix 1.

5.3 Programme Sponsors The Programme Sponsors are the Boards of:

Shropshire CCG

Telford and Wrekin CCG

Shrewsbury and Telford Hospital NHS Trust

Shropshire Community Health Trust

Powys LHB

5.4 Programme Owners The joint Programme Owners and Senior Responsible Officers are:

Dr Caron Morton, Accountable Officer, Shropshire CCG; and

David Evans, Chief Officer, Telford and Wrekin CCG.

5.5 Programme Board The Programme Board will oversee the programme on behalf of the Programme Sponsors and will:

Agree, lead and coordinate the actions and deliverables in progressing the programme;

Oversee and ensure the implementation of the programme, ensuring alignment with individual provider Trusts and local health system change plans;

Have delegated authority for capital and revenue expenditure in line with the Programme Budget;

Approve the Programme Execution Plan for the Programme;

Approve the appointment of the Programme Advisory Team;

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Receive regular progress reports from, and consider any recommendations made by, the Programme Director;

Approve and sign off the outputs from each stage of the Programme;

Report progress on a monthly basis to all Programme Sponsor Boards and the Chief Officers’ meeting, and seek relevant Programme Sponsor Board approvals of outputs where appropriate;

Oversee the management of risk and issues within the programme and support the risk mitigation plans;

Ensure the quality and safety impact of any service change is assessed and all necessary actions delivered;

Ensure that a communications and engagement programme is developed that secures meaningful engagement and consultation with patients, public and other stakeholders at all stages of the programme;

Ensure that effective and independent clinical and programme assurance processes are put in place, including

o Strong links with the Joint HOSC & CHC;

o Gateway Reviews;

o Effective and timely Local Assurance Processes (LAP); and

o National Clinical Assurance Team (NCAT) reviews

Ensure that the key areas of work which are outside of the remit of, but are interdependent with, the programme are progressed as required by the relevant members of the Programme Board.

A schedule of meetings of the Board will be arranged to meet key programme plan requirements and milestones. The Board will be jointly chaired by the two Programme Owners/SROs and will comprise the following core membership:

Table 2 Programme Board

Name Role Organisation

Programme Sponsors

Dr Caron Morton (Jt Chair) Accountable Officer Shropshire CCG

Paul Tulley Chief Operating Officer Shropshire CCG

Dr Bill Gowans Vice Chair Shropshire CCG

David Evans (Jt Chair) Accountable Officer Telford and Wrekin CCG

Dr Mike Innes Chair GP Board Telford and Wrekin CCG

Andrew Nash Chief Finance Officer Telford & Wrekin CCG

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Peter Skitt Locality General Manager Powys LHB

Dr Andy Raynsford Chair, North Locality GP Cluster Powys LHB

Peter Herring Chief Executive Shrewsbury and Telford Hospital NHS Trust

Dr Edwin Borman Medical Director Shrewsbury and Telford Hospital NHS Trust

Debbie Vogler Director of Business & Enterprise Shrewsbury and Telford Hospital NHS Trust

Adrian Osborne Communication Director Shrewsbury and Telford Hospital NHS Trust

Jan Ditheridge Chief Executive Shropshire Community Health NHS Trust

Tessa Norris Director of Operations Shropshire Community Health NHS Trust

Julie Thornby Director of Governance Shropshire Community Health NHS Trust

Dr Alastair Neale Medical Director Shropshire Community Health NHS Trust

Stakeholder Members

Vanessa Barrett Board Member Healthwatch Shropshire

Dag Saunders Chair Healthwatch Telford & Wrekin

Jayne Thornhill Deputy Chief Officer Montgomeryshire CHC

Stephen Chandler Director of Adult Services Shropshire Council

Paul Taylor Director of Care, Health & Well Being

Telford and Wrekin Council

Anthony Marsh Chief Executive West Midlands Ambulance Service NHS FT

Heather Ransom Head of Service Resourcing Welsh Ambulance Services NHS Trust

Wendy Farrington-Chadd Chief Executive Robert Jones & Agnes Hunt Hospital NHS FT

Neil Carr Chief Executive South Staffs & Shropshire Healthcare NHS FT

Ian Winstanley Chief Executive Shropshire Doctors Cooperative Ltd (Shropdoc)

Richard Chanter Nominated Representative Shropshire patients

Christine Choudhary Nominated Representative Telford & Wrekin patients

Dawn Wickham Director of Operations and Delivery

NHS England Shropshire & Staffordshire Area Team

In Attendance

Peter Spilsbury/Mike Sharon Programme Director Central Midlands CSU

David Frith Senior Programme Manager Central Midlands CSU

Lorna Cheesman Programme Administrator Central Midlands CSU

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A quorum will consist of a minimum of one of the joint SROs, one representative from each of the Programme Sponsors and one Programme Team member.

The decision-making processes to be adopted by the Board and the Programme Sponsors will be developed during Phase 1 of the Programme as part of the Assurance Plan and will be included in a future update to the PEP.

5.6 Programme Director The Programme Director provides the interface between programme ownership and delivery, and is responsible for defining the Programme objectives and ensuring they are met within the agreed time, cost and quality constraints. The Programme Director is also the link point for all major stakeholders at a strategic level.

The Programme Director will report to, and be accountable to, the Programme Owners, will attend the Programme Board, will chair the Programme Team and will support designated workstreams.

5.7 Senior Programme Manager The Senior Programme Manager will run the programme on a day-to-day basis on behalf of the Programme Board within the constraints laid down by them.

The Senior Programme Manager will report to and be accountable to the Programme Director and will support the Programme Board, Programme Team and designated workstream meetings.

5.8 Programme Team The remit of the Programme Team is to:

Manage the overall Programme;

Ensure that structures, processes and resources are in place to enable delivery of the Programme’s aims and objectives;

Develop monitoring and reporting mechanisms;

Ensure documentation and audit trails are maintained;

Commission external support as necessary;

Develop Programme Plans and report on progress of those plans;

Establish and support the Programme workstreams;

Develop and maintain the Risk Register;

Develop, maintain and review the Benefits Realisation Plan;

Develop and maintain the Programme Assurance Plan;

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Ensure the effective engagement of and communication with staff, service users and other stakeholders;

Undertake Post Programme Evaluation.

The Programme Team will be chaired by the Programme Director and will comprise the following membership:

Table 3 Programme Team


Peter Spilsbury (Chair) Programme Director Central Midlands CSU


Dr Bill Gowans Workstream Lead, Clinical Design Shropshire CCG

Dr Jim Hudson/

Mr Mark Cheetham

Jt Workstream Leads, Activity & Capacity

Telford & Wrekin CCG

Shrewsbury & Telford Hospital NHS Trust

Adrian Osborne Workstream Lead, Eng & Comms Shrewsbury & Telford Hospital NHS Trust

Andrew Nash Workstream Lead, Finance Telford & Wrekin CCG

Paul Tulley Workstream Lead, Assurance Shropshire CCG

Tessa Norris Representative Shropshire Community Health NHS Trust

Julie Thornby Representative Shropshire Community Health NHS Trust

Fran Beck Representative Telford & Wrekin CCG

Julie Davies Representative Shropshire CCG

Debbie Vogler Representative Shrewsbury & Telford Hospital NHS Trust

The Programme Team will normally meet on a fortnightly basis and notes of its meetings will be produced and made available in the Programme Library.

The Programme Team will routinely be attended by members of the appointed support team as necessary.

5.9 Workstreams The remit, leadership and membership of the programme’s 5 workstreams are detailed below.

5.9.1 Workstream 1: Clinical Design

The remit of the Clinical Design Group will be to:

To develop the high level clinical model and clinical consensus for that model, including the development of key/main integrated care pathways, taking into account the scope for the use of assistive technologies;

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To support the translation of this model into clinical algorithms amenable to quantitative modelling;

To ensure that there are defined evidenced standards against which to assess options for viability (and ‘accreditation’ where applicable);

To develop the evidence base to assess the clinical effectiveness of options;

To determine the impact of options on clinical workforce recruitment and retention; and

To identify the benefits and risks in relation to clinical services and ensure effective strategies for benefits realisation and risk management, including:

o contributing to the Benefits Realisation Plan

o contributing to the Programme Risk Register

The Workstream will be led by Dr Bill Gowans, with support from the Programme Director, and will comprise the following membership:

Table 4 Workstream 1: Clinical Design


Dr Bill Gowans (Chair) Vice Chair Shropshire CCG

Dr Mike Innes Chair Telford & Wrekin CCG

[Steve Gregory] [TBC] Shropshire Community Health NHS Trust

Dr Edwin Borman Medical Director Shrewsbury & Telford Hospital NHS Trust

Mr Steve White Medical Director Robert Jones & Agnes Hunt Hospital NHS FT

Dr Simon Smith Clinical Director South Staffs & Shropshire NHS FT

Matthew Ward Head of Clinical Practice West Midlands Ambulance Service NHS FT

Paul Taylor Director of Care, Health & Well Being

Telford & Wrekin Council

Stephen Chandler Director of Adult Services Shropshire Council

George Rook Service User Representative Healthwatch Shropshire

Peter Spilsbury/Mike Sharon

Programme Director Central Midlands CSU


The workstream will initially establish three sub-groups to develop specific aspects of the model of care:

Acute & Episodic Care

Long Term Conditions & Frailty

Planned Care

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Other working groups will be established as required as the Programme develops.

5.9.2 Workstream 2: Activity & Capacity

The translation of the overall vision and model of care requires that forecasts are made concerning the level of demand for services in the future, their location, and the capacity required to deliver them. These forecasts are based on assumptions concerning growth in demand and the potential impact on demand and capacity of a range of proposed service changes. This work provides a health economy-wide basis for all service and facilities change projects.

The remit of the Activity & Capacity workstream will be to:

Develop the key planning assumptions for future service delivery models in conjunction with the Clinical Leaders Group;

Assess the future capacity and patient activity level requirements in health and social care, based on the agreed service models and planning assumptions;

Assess the impact of the Programme on patient flows within and outside of the county, taking into account other known developments.

Develop a comprehensive model which will enable analysis of the future activity and capacity projections in ways which are meaningful for clinicians, commissioners and individual provider organisations, and which will facilitate the financial evaluation of identified options.

To identify the benefits and risks in relation to activity and capacity and ensure effective strategies for benefits realisation and risk management, including:



The Workstream will be led jointly by Dr James Hudson and Mr Mark Cheetham, with support from Steve Wyatt (Central Midlands CSU), and will comprise the following membership:

Table 5 Workstream 2: Activity & Capacity


Dr James Hudson

(Joint Chair)

GP Lead Telford & Wrekin CCG

Mr Mark Cheetham

(Joint Chair)

Scheduled Care Group Medical Director Shrewsbury & Telford Hospital NHS Trust

Jon Cook Head of Strategic Transformation Central Midlands CSU

Steve Wyatt Head of Strategic Analytics Central Midlands CSU

Jake Parsons Strategic Analytics Senior Manager Central Midlands CSU

Julie Davies Director of Strategy & Redesign Shropshire CCG

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Dr Bill Gowans Vice Chair Shropshire CCG

Donna McGrath Chief Finance Officer Shropshire CCG

Andrew Nash Chief Finance Officer Telford & Wrekin CCG

Fran Beck Executive Lead, Commissioning Telford & Wrekin CCG

Teresa Smith Ward Manager, Ludlow Community Hospital Shropshire Community Health NHS Trust

Julie Thornby Director of Governance & Strategy Shropshire Community Health NHS Trust

Dr Emily Peer Associate Medical Director Shropshire Community Health NHS Trust

Dr Subramanian Kumaran

Clinical Director Shrewsbury & Telford Hospital NHS Trust

Dr Kevin Eardley Unscheduled Care Group Medical Director Shrewsbury & Telford Hospital NHS Trust

Debbie Vogler Director of Business & Enterprise Shrewsbury & Telford Hospital NHS Trust

Mr Andrew Tapp Women’s & Children’s Care Group Medical Director

Shrewsbury & Telford Hospital NHS Trust

5.9.3 Workstream 3: Engagement & Communications

The overall goal of the workstream will be to empower patient and community leadership at the heart of the Programme, ensuring the creation and delivery of a compelling vision for Excellent and Sustainable Acute and Community Hospital Services.

The remit of the Engagement & Communications workstream will be to:

Engage with relevant and representative stakeholders to develop a robust engagement and communications plan

Ensure delivery of the engagement and communications plan for each phase of the Programme, including:

o supporting all workstreams to ensure that their programmes are shaped and influenced through stakeholder engagement

o commissioning products and materials as required for the delivery of the plan

o ensuring compliance with key statutory and mandatory guidance (national reconfiguration tests, NHS Act 2006, Freedom of Information Act 2000 etc.)

Relevant engagement that has impact Provide leadership for patient, community, staff and stakeholder engagement on behalf of the

Programme, including:

o developing the stakeholder analysis, maintaining this and keeping under review;

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o ensuring that plans are in place to address agreed priorities that will put patients, communities, staff and stakeholders at the heart of the development of plans to improve outcomes, reduce health inequalities and deliver more efficient models of care.

Patient and community leadership To ensure effective engagement through planning and development of the Programme from

proposal through to implementation:

o co-production of a shared understanding of the challenges facing health services

o co-development of proposals to address those challenges

o patient and community leadership in options appraisal

o robust consultation on options for change

o full engagement in implementation and review

Engagement-led communication Working with members to develop, agree and implement the overall visual and community

identity for the Programme, including:

o establishing the programme name and identity

o reinforcing this through programme, organisational and external communications

Maximising engagement and communication opportunities, minimising risks To identify the benefits and risks in relation to engagement and communication and ensure

effective strategies for benefits realisation and risk management, including:



Assured engagement, robust delivery To contribute to the Governance and Assurance Workstream, particularly in relation to

engagement with key statutory bodies such as Health Overview and Scrutiny Committees and Community Health Councils, including:

o Reporting to HOSCs and CHCs

To contribute to the overall Programme leadership and governance arrangements, including:

o reporting to Programme Board and Programme Team

o supporting openness and transparency, including through the publication of programme documentation

The Workstream will be led by Adrian Osborne, with support from Selina Lavictoire (Central Midlands CSU), and will comprise the following membership:

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Table 6 Workstream 3: Engagement & Communications


Adrian Osborne (Chair) Communications Director Shrewsbury & Telford Hospital NHS Trust

Selina Lavictoire Communications & Engagement Manager

Central Midlands CSU

Jane Randall-Smith Chief Officer Healthwatch Shropshire

Kate Ballinger Chief Officer Healthwatch Telford & Wrekin

Nick Hitchins Patient Representative Shropshire Patient Groups

Ian Roberts Patient Representative Telford & Wrekin CCG

Maxine Roberts Patient Representative Powys Patient Groups

David Parton Young Health Champion Health Champion Network

Abi Fraser Young Health Champion Health Champion Network

Hannah Davies Young Health Champion Health Champion Network

Cathy Briggs Staff Engagement Representative Shrewsbury & Telford Hospital NHS Trust

Lynne Weaver Staff Engagement Rep Shropshire Community Health NHS Trust

Matt James Communications Lead Shropshire Community Health NHS Trust

Bharti Patel-Smith Director of Governance & Involvement

Shropshire CCG

Christine Morris Executive Lead Nursing, Quality & Safety

Telford & Wrekin CCG

Tin Wheeler Communications Lead Powys LHB

Paul Honeghan Communications Lead for CCGs Staffordshire & Lancashire CSU

Rachel Wintle VCS Assembly Board representative Shropshire Voluntary & Community Sector Assembly

Debbie Gibson Head of Projects/Service Manager for Local Carers

Telford & Wrekin CVS

Trish Buchan Health & Social Care Facilitator Powys Association of Voluntary Organisations

5.9.4 Workstream 4: Finance

The model of care developed through the Programme is likely to lead to substantial shifts in costs and to have a significant impact on the total cost of the services delivered across the system as a whole. It is essential that robust systems are in place to forecast and monitor the impact of these changes, in order to ensure that they constantly remain affordable for all the partner organisations.

The remit of the Finance workstream will be to:

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Oversee the assessment of the financial impact on all partner organisations of the identified options for the Programme;

Develop and maintain a financial model to support the identification of financial and affordability envelopes;

Undertake an assessment of the financial and economic impact of the changes arising from all options identified by the Programme;

Complete the financial and economic aspects of all Outline Business Cases and Full Business Cases in line with NHS and HM Treasury guidance;

To identify the benefits and risks in relation to finance and affordability and ensure effective strategies for benefits realisation and risk management, including:



The Workstream will be led by Andrew Nash, with support from the Central Midlands CSU, and will comprise the following membership:

Table 7 Workstream 4: Finance


Andrew Nash (Chair) Chief Finance Officer Telford & Wrekin CCG

Donna McGrath Chief Finance Officer Shropshire CCG

Neil Nisbet Finance Director Shrewsbury & Telford NHS Trust

Trish Donovan Director of Finance & Performance Shropshire Community Health NHS Trust


5.9.5 Workstream 5: Assurance

The purpose of Workstream 5 is to develop for Programme Board approval, and to ensure the effective implementation of, a comprehensive Programme Assurance Plan which will provide assurance to the Programme Board, sponsor Boards, the Joint Health Overview and Scrutiny committees and other external parties regarding the governance, management and decision making within the programme. This will include:

Ensuring that there is proactive engagement with Health and Wellbeing Boards throughout the programme so that service change proposals can reflect joint strategic needs assessments and joint health and wellbeing strategies, and so that Health and Wellbeing Boards are given an opportunity to comment on and be involved in the development of plans.

Ensuring that decisions taken by the Programme Board are ratified by the appropriate governance structures within each of the partner organisations.

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Development and implementation of effective and independent clinical and programme assurance processes, including:

o Development and maintenance of strong links with the Joint HOSC & CHC;

o Planning and coordination of Gateway Reviews;

o Effective and timely Local Assurance Processes (LAP);

o National Clinical Assurance Team (NCAT) reviews.

Ensuring best practice and value for money in the management of the Programme.

Ensuring the appropriateness and effectiveness of all evaluation processes and decision-making.

Ensuring processes are in place to ensure collective decision making can be achieved, including the development of a dispute resolution process.

In conjunction with the Engagement & Communications workstream ensuring that patients and the public are appropriately involved in the Programme, and that involvement and consultation has covered equitably the different geographies affected by the programme.

Identifying the benefits and risks in relation to governance and assurance and ensuring effective strategies for benefits realisation and risk management, including:



It will be the responsibility of each individual workstream to secure any external assurance which the Programme Board or Programme Team deems to be required for work which that workstream has undertaken or commissioned.

The Workstream will be led by Paul Tulley, with support from Chris Bird (Central Midlands CSU), and will comprise the following membership:

Table 8 Workstream 5: Assurance


Paul Tulley (Chair) Chief Operating Officer Shropshire CCG


Chris Bird Corporate Affairs Lead Central Midlands CSU

Bharti Patel-Smith Director of Governance & Involvement Shropshire CCG

Alison Smith Executive Lead, Governance & Performance Telford & Wrekin CCG

Julie Thornby Director of Governance Shropshire Community Health NHS Trust

Julia Clarke Director of Corporate Governance Shrewsbury & Telford Hospital NHS Trust

Martin Stevens Committee Officer Shropshire HOSC

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Fiona Bottrill Scrutiny Group Specialist Telford & Wrekin HOSC

[TBC] [TBC] Healthwatch Shropshire

Paul Wallace Vice Chair Healthwatch Telford & Wrekin

[TBC] [TBC] Montgomeryshire CHC

Giles Tinsley/Kay Fradley [TBC] NHS Trust Development Authority

[TBC] [TBC] NHS England Shropshire & Staffordshire Area Team

5.10 Advisory Team The Programme Director, Programme Team and Workstreams will be supported by an experienced team of advisors to be appointed as necessary to meet specific identified needs.

5.11 Other Roles

5.11.1 Design Champion

A Design Champion will be appointed at an appropriate point in the Programme, who will be responsible for ensuring that any capital investment proposals deliver high quality products that meets the needs of patients, staff and local people. The Design Champion will be directly involved in the production of briefing information on design quality, consulted at regular intervals during the design development process and be a part of the design evaluation teams.

140120 Shrop CSR PEP V1.0 - 27 -


6. Timetable

6.1 Milestones An outline timetable for the programme has been determined as follows:

Table 9 Programme Plan – Target Milestones

Key Tasks Target Completion Date

Phase 1a - Programme Set-Up End January 2014

Finalisation of Case for Change and Programme Mandate

Preparation and approval of Programme Execution Plan

Preparation and approval of programme timetable and plan

Securing key programme resources

Establish panel of external clinical experts

Development of Benefits Realisation Plan

Development and approval of Engagement & Communications Plan

Development of Assurance Plan

Gateway Review 0

Phase 1b - High Level Vision and Overall Service Model End January 2014

Securing clinical consensus on overall model of care

Analysis of Community Hospital services and utilisation

Acute Hospital services activity projections and categorisation

Stakeholder engagement on high-level vision and model of care

Assessment of recurring affordability envelope & capital investment capacity

Phase 2 - Development of Models of Care End April 2014

Refinement of acute hospital activity projections

Activity projections for other services

Development of whole LHE financial models

Agreement of non-financial appraisal criteria and process

140120 Shrop CSR PEP V1.0 - 28 -


Key Tasks Target Completion Date

Phase 3 - Identification and Appraisal of Options End September 2014

Development and agreement of long-list of options

Selection of short-list of options

Financial and non-financial appraisal of short-listed options

Selection and approval of preferred option

Gateway Review 1

Phase 4 - Public Consultation & OBC End January 2015

Formal public consultation

Preparation of Outline Business Case(s)

Partner organisations’ approval of OBC and consultation outcomes

Gateway Review 2

Phase 5 - Full Business Case(s) End January 2016

Procurement processes

Preparation and partner organisations’ approval of FBC(s)

Gateway Review 3

Phase 6 - Implementation To be determined

Capital infrastructure developments

Implementation of service changes

Phase 7 - Evaluation To be determined

Post Programme Evaluation

A more detailed programme plan for Phase 1 of the programme, and an outline programme for Phases 2-7, is attached as Appendix 2.

140120 Shrop CSR PEP V1.0 - 29 -


7. Resources

7.1 Resources 7.1.1 Core Partners

The following resources will be made available from within the core partners’ existing resources:

Programme Board members

Programme Team members

Workstream Leads and members

Design Champion

Programme Auditor

7.1.2 External Support

External consultancy support will be provided by NHS Central Midlands Commissioning Support Unit, and the following additional appointments will be made to support the Programme:

Programme Director

Senior Programme Manager

Programme Manager

Programme Administrator

Additional specialist consultancy support will be commissioned by the CSU as required.

7.2 Programme Budget The initial budget for the Programme is summarised in Table 10 below:

140120 Shrop CSR PEP V1.0 - 30 -


Table 10 Programme Budget

Element 2013/14 Budget

2014/15 Budget

2015/16 Budget

TOTAL

£000s £000s £000s £000s

Programme Management Office 138 330 330 798 Strategic Analytics 64 75 TBA 139 Communications & Engagement 28 100 (est) TBA 128 External Clinical Reference Group 20 40 TBA 60 Knowledge Management (Evidence Reviews) - 20 TBA 20

Technical Advisory Team - TBA TBA - Integrated Impact Assessment - TBA - -

TOTAL PROGRAMME BUDGET 250 565 330 1,145

FUNDING £000s £000s £000s £000s

NHS England, Area Team 90 - - 90 Shropshire CCG 96 339 198 633 Telford & Wrekin CCG 64 226 132 422

TOTAL FUNDING 250 565 330 1,145 The programme budget will be reviewed and updated as the programme progresses and changes will be submitted to the Programme Board for approval.

140120 Shrop CSR PEP V1.0 - 31 -


8. Programme Management

8.1 Approach The Programme will be managed in accordance with the PRINCE2 (“Programmes in a Controlled Environment”) and “Managing Successful Programmes” methodologies, suitably adapted for local circumstances in order to meet the needs of this Programme.

The programme management arrangements will therefore be driven by outputs - or in the PRINCE 2 terminology, “Products”. All Products will be formally signed off by the appropriate workstream before being approved by the Programme Team or Programme Owners as required.

The PEP includes all the management controls required to ensure the partner organisations meet their fiduciary obligations with respect to the development and implementation of the Programme, and the management of the Programme within a framework of acceptable risk. This governance framework will ensure that:

Local health services are modernised through the controlled and measured management of a wide range of risks;

Decisions on the strategic direction and future needs of local health care are only made after proper consideration;

The views and interests of stakeholders are considered;

Appropriate behaviour with respect to the codes of corporate governance, policy guidance and good management practice;

Open reporting of Programme progress and performance.

To ensure the quality of the outputs is maintained and the objectives are met, the PEP and the implementation of the Programme will be managed and undertaken on the basis of:

Proven methodologies and standards;

Effective monitoring procedures;

Effective change/issues/problem management;

Review and acceptance procedures; and

Appropriate documentation and record keeping.

8.2 Methodologies & Standards The Programme will only use standard and prescribed methods for service and financial modelling.

140120 Shrop CSR PEP V1.0 - 32 -


All documents and publications will be based on standard DoH documents where available. Any deviation from the standards will be referred for approval to NHS England as required.

The Programme will use a standard set of protocols and templates.

8.3 Issues Management The management process for dealing with issues and concerns identified during the execution of the Programme is illustrated in Figure 1 below. The Programme Team will undertake an initial assessment of the nature and impact of the issue, drawing on appropriate technical support as necessary.

Figure 1 Process for Managing Issues

Enter issue in Register

Add to risk matrix and analyse

Issues register

Can issue threatenSuccess of project?

Yes

No

Investigate and determine action & cost

Is decision outsidescope of project

team?

Is action and cost agreedand approved?

Adjust budget and add to work plan or

Issue instructions

Review and update issues

register

Refer to Project Board

Yes

No

Yes

No

Where the matter does not involve a change in Programme cost, is not at variance to the clinical service models and strategies and is supported by all core partners, the Programme Team will have authority to approve and implement any necessary changes.

Issues that are outside the scope or authority of the Programme Team will be referred to the Programme Board.

8.4 Monitoring & Audit The Programme documents, processes, outputs and progress will be monitored by the Programme Board and through continuous audit by the Programme Auditor.

140120 Shrop CSR PEP V1.0 - 33 -


8.5 Administrative Systems & Procedures 8.5.1 Meetings

Notes will be produced of all meetings of the Programme Team and Workstreams and will be kept in the Programme Library.

8.5.2 Records

A copy of all Programme communications originating in the Programme Team and Workstreams or from the Programme advisors will be sent to the Programme Office for record keeping. All electronic data and computer files produced by the Programme Team are to be stored on a system that is the subject of daily back-ups. All Programme Team advisors are to have suitable data security and back-up arrangements in place.

8.5.3 Progress Reports

The Workstream Leads and the designated programme manager will prepare and issue a programme task status report to each meeting of the Programme Team. The report is also to be made available to other interested parties as required.

8.5.4 Programme Library

In order to ensure key programme documents are made available as swiftly as possible, an electronic Programme Library will be established. The library will be managed by the Programme Manager.

8.6 Communications and Stakeholder Engagement

8.6.1 Communications

A Programme Directory will be established, detailing the contact details for all members of the

Programme Board, Programme Team, Workstreams and Advisory Team (see Appendix 3). The Programme Directory will be maintained by the Programme Administrator.

The Programme Team will provide advice and support on all communications relating to the Programme, and will act as the Programme’s interface with the media.

The specific inputs into the Programme include:

Communications link to the Partner Organisations’ communications systems;

Internal partner organisations’ communication links;

Advice on external communications support;

Link to other external communications, including NHS publications;

Identification of communications opportunities that can be used to keep the local population informed and up-to-date.

140120 Shrop CSR PEP V1.0 - 34 -


8.6.2 Stakeholder Engagement

A detailed Stakeholder Engagement & Communication Plan will be prepared by the Engagement & Communications workstream as part of Phase 1 of the Programme, and will form Appendix 4 once completed.

8.6.3 Freedom of Information

All Programme information will be made public except where it would be in breach of patient or staff confidentiality and commercial interests.

8.7 Conflicts of Interest A Register of Interests of all Programme staff and advisors will established and will be formally updated and reported to the Programme Board on a regular basis.

Where a person is found to have a conflict of interest they will not be given access to such information and will be required to take no active part in the programme, or the relevant part of the programme.

8.8 Confidentiality All Programme staff, advisors and other persons who may have privileged access to information that is considered to be commercially confidential will be required to sign a confidentiality agreement before gaining access to such information.

8.9 Gateway Reviews Elements of the Programme may be subject to OGC Gateway reviews as required by NHS England and in accordance with the prescribed OGC process. Programme Team and Advisory Team members will co-operate fully with the review process.

140120 Shrop CSR PEP V1.0 - 35 -


9. Assumptions, Constraints, Risks

9.1 Assumptions The programme is proceeding on the basis of the following assumptions:

Sufficient human and financial resources continue to be made available by the partner organisations;

The Programme Sponsors will continue to work jointly and will ensure that their governance systems and processes allow for collective decision-making;

The continued engagement in the Programme of all stakeholder organisations; and

Any changes required to maintain the safety and sustainability of services in the short-term will be consistent with the longer-term service model to be developed by the Programme.

9.2 Constraints The key constraints within which the programme must proceed are considered to be as follows:

The programme’s goals must remain demonstrably affordable to the health economy as a whole and to individual partner organisations;

The availability of capital funding. However, it has been agreed that a single-site new-build solution should be included in any long-list of potential options, and it would be for the option appraisal to determine if this could be a short listed option; and

Timescales: the urgency to achieve the quality benefits including safety, effectiveness and clinical sustainability, require significant service change to be implemented and the longer-term service model will therefore need to be agreed by the end of 2014.

9.3 Risks The key risks to the success of the programme are considered to be in the following areas:

Affordability of the agreed service models;

Availability of capital funding for any changes to facilities and physical infrastructure;

Public / stakeholder resistance and objections to plans; and

Failure to meet project timescales.

An initial high-level Risk Register has been established (see Appendix 5) and will be developed during Phase 1 of the programme, using qualitative and quantitative measures to calculate the overall level of risk according to their impact and probability.

Those risks which are considered to be both High Probability and High Impact will considered in depth by the Programme Team and risk containment plans prepared. The Risk Register will be

140120 Shrop CSR PEP V1.0 - 36 -


formally reviewed and updated on a monthly basis by the Programme Team and will be reported to the Programme Board.

140120 Shrop CSR PEP V1.0 - 37 -

Future Fit - Shaping healthcare together Programme Execution Plan Appendix 1 Programme Structure

Programme Sponsor Boards

Programme Board

Programme Director

Peter Spilsbury

Programme Team

Clinical Design Dr Bill Gowans

Clinical Reference Group

Activity & Capacity Dr Jim Hudson

Mr Mark Cheetham

Eng & Comms Adrian Osborne

Finance Andrew Nash

Assurance Paul Tulley

CSU Support Team

140120 Shrop CSR PEP V1.0

- 38 -


Appendix 2 Programme Plan


- 39 -

ID Task Name Duration Start Finish Predecessors Resource Names

1 PHASE 1a ‐ Programme Set‐up 382 days Fri 01/11/13 Mon 20/04/152 Programme Appointments 40 days Fri 01/11/13 Thu 26/12/133 Appoint CSU & Programme Director 0 days Fri 01/11/13 Fri 01/11/13 CCG Boards4 Commission interim programme support 5 days Fri 01/11/13 Thu 07/11/13 3 Programme Director5 Appoint Programme Manager 5 days Fri 01/11/13 Thu 07/11/13 3 Programme Director6 Appoint Snr Programme Manager 8 wks Fri 01/11/13 Thu 26/12/13 3 Programme Director7 Appoint Programme Administrator 8 wks Fri 01/11/13 Thu 26/12/13 3 Programme Director8 Programme Mandate 22 days Thu 14/11/13 Fri 13/12/139 Document Case for Change 22 days Thu 14/11/13 Fri 13/12/13 Programme Director

10 Document Clinical Workshop 17 days Thu 21/11/13 Fri 13/12/13 Programme Director11 Document Call to Action event 15 days Mon 25/11/13 Fri 13/12/13 Programme Director12 Programme Execution Plan 57 days Fri 01/11/13 Mon 20/01/1413 Prepare initial draft 8 days Fri 01/11/13 Tue 12/11/13 Snr Programme Manager14 Review initial draft 2 days Wed 13/11/13 Thu 14/11/13 13 Programme Team15 Prepare updated draft 6 days Fri 15/11/13 Fri 22/11/13 14 Snr Programme Manager16 Prepare initial draft Programme Plan 6 days Fri 15/11/13 Fri 22/11/13 14 Snr Programme Manager17 Review updated draft PEP & Programme Plan 0 days Tue 26/11/13 Tue 26/11/13 36,16 Programme Team18 Update draft PEP & Programme Plan 1 day Wed 27/11/13 Wed 27/11/13 17 Snr Programme Manager19 Programme Board review of PEP & Programme Plan 0 days Mon 02/12/13 Mon 02/12/13 25 Programme Board20 Finalise PEP & Programme Plan 4 wks Tue 03/12/13 Mon 30/12/13 19 Snr Programme Manager21 Programme Team sign‐off 0 days Thu 09/01/14 Thu 09/01/14 38 Programme Team22 Programme Board sign‐off 0 days Mon 20/01/14 Mon 20/01/14 26 Programme Board23

24 Programme Board Meetings 361 days Mon 02/12/13 Mon 20/04/1525 Meeting #1 1 day Mon 02/12/13 Mon 02/12/13 Programme Board26 Meeting #2 1 day Mon 20/01/14 Mon 20/01/14 Programme Board27 Meeting #3 1 day Mon 10/03/14 Mon 10/03/14 Programme Board28 Meeting #4 0 days Mon 12/05/14 Mon 12/05/14 27FS+9 wks Programme Board29 Meeting #5 0 days Mon 16/06/14 Mon 16/06/14 28FS+5 wks Programme Board30 Meeting #6 0 days Mon 11/08/14 Mon 11/08/14 29FS+8 wks Programme Board

31 Meeting #7 0 days Mon 06/10/14 Mon 06/10/14 30FS+8 wks Programme Board32 Meeting #8 0 days Mon 26/01/15 Mon 26/01/15 31FS+16 wks Programme Board33 Meeting #9 0 days Mon 20/04/15 Mon 20/04/15 32FS+12 wks Programme Board34 Project Team Meetings 301 days Thu 14/11/13 Thu 08/01/1535 Meeting #1 0 days Thu 14/11/13 Thu 14/11/13 Programme Team36 Meeting #2 0 days Tue 26/11/13 Tue 26/11/13 Programme Team37 Meeting #3 0 days Thu 12/12/13 Thu 12/12/13 Programme Team38 Meeting #4 0 days Thu 09/01/14 Thu 09/01/14 Programme Team39 Meeting #5 1 day Thu 23/01/14 Thu 23/01/14 38FS+10 days Programme Team40 Meeting #6 0 days Thu 06/02/14 Thu 06/02/14 39FS+10 days Programme Team41 Meeting #7 0 days Thu 20/02/14 Thu 20/02/14 40FS+10 days Programme Team42 Meeting #8 0 days Thu 06/03/14 Thu 06/03/14 41FS+10 days Programme Team43 Meeting #9 0 days Thu 20/03/14 Thu 20/03/14 42FS+10 days Programme Team44 Meeting #10 0 days Thu 03/04/14 Thu 03/04/14 43FS+10 days Programme Team45 Meeting #11 0 days Thu 17/04/14 Thu 17/04/14 44FS+10 days Programme Team46 Meeting #12 0 days Thu 01/05/14 Thu 01/05/14 45FS+10 days Programme Team47 Meeting #13 0 days Thu 15/05/14 Thu 15/05/14 46FS+10 days Programme Team48 Meeting #14 0 days Thu 29/05/14 Thu 29/05/14 47FS+10 days Programme Team49 Meeting #15 0 days Thu 12/06/14 Thu 12/06/14 48FS+10 days Programme Team

01/11

Programme Director

Programme Director

Programme Director

Programme Director

Programme Director

Programme Director

Programme Director

Snr Programme Manager

Programme Team



26/11


02/12


09/01

20/01

Programme Board

Programme Board

Programme Board

12/05

16/06

11/08

06/

14/11

26/11

12/12

09/01

Programme Team

06/02

20/02

06/03

20/03

03/04

17/04

01/05

15/05

29/05

12/06

Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct2014

Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task

Rolled Up Critical Task

Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline

Shropshire Clinical Services Review

Page 1

Project: 140120 Shrop CSR Project Plan V0.4Date: Tue 21/01/14

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50 Meeting #16 0 days Thu 26/06/14 Thu 26/06/14 49FS+10 days Programme Team51 Meeting #17 0 days Thu 10/07/14 Thu 10/07/14 50FS+10 days Programme Team52 Meeting #18 0 days Thu 24/07/14 Thu 24/07/14 51FS+10 days Programme Team53 Meeting #19 0 days Thu 07/08/14 Thu 07/08/14 52FS+10 days Programme Team54 Meeting #20 0 days Thu 21/08/14 Thu 21/08/14 53FS+10 days Programme Team55 Meeting #21 0 days Thu 04/09/14 Thu 04/09/14 54FS+10 days Programme Team56 Meeting #22 0 days Thu 18/09/14 Thu 18/09/14 55FS+10 days Programme Team57 Meeting #23 0 days Thu 02/10/14 Thu 02/10/14 56FS+10 days Programme Team58 Meeting #24 0 days Thu 16/10/14 Thu 16/10/14 57FS+10 days Programme Team59 Meeting #25 0 days Thu 30/10/14 Thu 30/10/14 58FS+10 days Programme Team60 Meeting #26 0 days Thu 13/11/14 Thu 13/11/14 59FS+10 days Programme Team61 Meeting #27 0 days Thu 27/11/14 Thu 27/11/14 60FS+10 days Programme Team62 Meeting #28 0 days Thu 11/12/14 Thu 11/12/14 61FS+10 days Programme Team63 Meeting #29 0 days Thu 25/12/14 Thu 25/12/14 62FS+10 days Programme Team64 Meeting #30 0 days Thu 08/01/15 Thu 08/01/15 63FS+10 days Programme Team

65 Workstreams 50 days Thu 14/11/13 Wed 22/01/1466 Clinical Design 26 days Thu 14/11/13 Thu 19/12/1367 Develop draft project plan for Phases 1 and 2 21 days Thu 14/11/13 Thu 12/12/13 35 Snr Programme Manager68 Agree workstream membership 26 days Thu 14/11/13 Thu 19/12/13 35 Programme Team69 Initial Workstream meeting 17 days Wed 27/11/13 Thu 19/12/13 67 Clinical Design70 Review draft project plan 0 days Thu 19/12/13 Thu 19/12/13 69 Clinical Design71 Agree schedule of meetings 0 days Thu 19/12/13 Thu 19/12/13 69 Clinical Design72 Activity & Capacity 20 days Thu 14/11/13 Thu 12/12/1373 Confirm workstream membership 9 days Thu 14/11/13 Tue 26/11/13 35 Activity & Capacity74 Prepare draft project plan for Phases 1 and 2 7 days Wed 27/11/13 Thu 05/12/13 73 Activity & Capacity75 Review draft project plan 0 days Thu 12/12/13 Thu 12/12/13 37,74 Programme Team76 Engagement & Comms 9 days Thu 14/11/13 Tue 26/11/1377 Agree workstream membership 9 days Thu 14/11/13 Tue 26/11/13 35 Engagement & Comms78 Finance 50 days Thu 14/11/13 Wed 22/01/1479 Agree workstream membership 9 days Thu 14/11/13 Tue 26/11/13 35 Programme Team80 Initial Workstream meeting 1 day Wed 15/01/14 Wed 15/01/14 79 Finance81 Prepare draft project plan 5 days Thu 16/01/14 Wed 22/01/14 80 Finance82 Agree schedule of meetings 0 days Wed 15/01/14 Wed 15/01/14 80 Finance83 Assurance 9 days Thu 14/11/13 Tue 26/11/1384 Agree workstream membership 9 days Thu 14/11/13 Tue 26/11/13 35 Programme Team85

86 Risk Register 281 days Thu 14/11/13 Thu 11/12/1487 Establish Risk Register 6 days Thu 14/11/13 Thu 21/11/13 35 Snr Programme Manager88 Review Risk Register 0 days Tue 26/11/13 Tue 26/11/13 36 Programme Team89 Review Risk Register 1 day Thu 12/12/13 Thu 12/12/13 37 Programme Team90 Review Risk Register 1 day Thu 09/01/14 Thu 09/01/14 37FS+4 wks Programme Team91 Review Risk Register 0 days Thu 06/02/14 Thu 06/02/14 90FS+4 wks Programme Team92 Review Risk Register 0 days Thu 06/03/14 Thu 06/03/14 91FS+4 wks Programme Team93 Review Risk Register 0 days Thu 03/04/14 Thu 03/04/14 92FS+4 wks Programme Team94 Review Risk Register 0 days Thu 01/05/14 Thu 01/05/14 93FS+4 wks Programme Team95 Review Risk Register 0 days Thu 29/05/14 Thu 29/05/14 94FS+4 wks Programme Team96 Review Risk Register 0 days Thu 26/06/14 Thu 26/06/14 95FS+4 wks Programme Team97 Review Risk Register 0 days Thu 24/07/14 Thu 24/07/14 96FS+4 wks Programme Team98 Review Risk Register 0 days Thu 21/08/14 Thu 21/08/14 97FS+4 wks Programme Team99 Review Risk Register 0 days Thu 18/09/14 Thu 18/09/14 98FS+4 wks Programme Team

26/06

10/07

24/07

07/08

21/08

04/09

18/09

02/1

1


Programme Team

Clinical Design

19/12

19/12

Activity & Capacity

Activity & Capacity

12/12

Engagement & Comms

Programme Team

Finance

Finance

15/01

Programme Team


26/11

Programme Team

Programme Team

06/02

06/03

03/04

01/05

29/05

26/06

24/07

21/08

18/09


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

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Project Summary

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Deadline


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100 Review Risk Register 0 days Thu 16/10/14 Thu 16/10/14 99FS+4 wks Programme Team101 Review Risk Register 0 days Thu 13/11/14 Thu 13/11/14 100FS+4 wks Programme Team102 Review Risk Register 0 days Thu 11/12/14 Thu 11/12/14 101FS+4 wks Programme Team103

104 Benefits Realisation Plan 75 days Tue 26/11/13 Mon 10/03/14105 Prepare BRP template 20 days Tue 26/11/13 Mon 23/12/13 36 Snr Programme Manager106 Review BRP template 0 days Thu 09/01/14 Thu 09/01/14 38 Programme Team107 Prepare initial draft plan 17 days Thu 09/01/14 Fri 31/01/14 106 Programme Manager108 Review initial draft plan 1 day Fri 07/02/14 Fri 07/02/14 107,40 Programme Team

109 Update draft plan 7 days Mon 10/02/14 Tue 18/02/14 108 Programme Manager

110 Finalise plan 0 days Thu 20/02/14 Thu 20/02/14 109,41 Programme Team

111 Approve Benefits Realisation Plan 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board112

113 Engagement & Communications 83 days Thu 14/11/13 Mon 10/03/14114 Programme Branding 48 days Thu 14/11/13 Mon 20/01/14115 Prepare initial proposals for name and visual identitiy 20 days Thu 14/11/13 Wed 11/12/13 35 Engagement & Comms116 Review initial proposals 1 day Thu 12/12/13 Thu 12/12/13 115 Programme Team117 Prepare updated proposals 15 days Fri 13/12/13 Thu 02/01/14 116 Engagement & Comms118 Review updated proposals 5 days Fri 03/01/14 Thu 09/01/14 117 Programme Team119 Finalise and sign off Programme name and identity 8 days Fri 03/01/14 Tue 14/01/14 117 Engagement & Comms120 Approve Programme Name and Visual Identity 0 days Mon 20/01/14 Mon 20/01/14 26 Programme Board121

122 Eng & Comms Plan 83 days Thu 14/11/13 Mon 10/03/14123 Prepare initial draft plan 20 days Thu 14/11/13 Wed 11/12/13 35 Engagement & Comms124 Review draft plan 1 day Thu 12/12/13 Thu 12/12/13 37 Programme Team125 Update Plan 16 days Fri 13/12/13 Fri 03/01/14 124 Snr Programme Manager126 Review updated Plan 4 days Mon 06/01/14 Thu 09/01/14 125 Programme Team127 Finalise draft plan 25 days Mon 06/01/14 Fri 07/02/14 125 Engagement & Comms128 Review and sign‐off plan 0 days Thu 20/02/14 Thu 20/02/14 41

129 Approve Eng & Comms Plan 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board130

131 Assurance Plan 46 days Mon 06/01/14 Mon 10/03/14132 Prepare initial draft plan 10 days Mon 06/01/14 Fri 17/01/14 84 Assurance133 Review and sign off initial draft plan 2 days Mon 20/01/14 Tue 21/01/14 132 Assurance134 Review initial draft plan 0 days Thu 23/01/14 Thu 23/01/14 39 Programme Team135 Update Plan 16 days Fri 24/01/14 Fri 14/02/14 134 Assurance136 Review and update Plan 0 days Thu 20/02/14 Thu 20/02/14 135,41 Programme Team137 Approve Assurance Plan 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board138

139 Gateway Review 0 63 days Thu 12/12/13 Mon 10/03/14140 Arrange Review 21 days Thu 12/12/13 Thu 09/01/14 37 Assurance141 Gateway Review 3 days Mon 03/03/14 Wed 05/03/14 140,21 Assurance142 Programme Team review of feedback 0 days Thu 06/03/14 Thu 06/03/14 42 Programme Team143 Programme Board sign‐off of action plan 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board144

1


09/01

Programme Manager

Programme Team

Programme Manager

20/02

10/03

Engagement & Comms

Programme Team

Engagement & Comms

Programme Team

Engagement & Comms

20/01

Engagement & Comms

Programme Team


Programme Team

Engagement & Comms

20/02

10/03

Assurance

Assurance

23/01

Assurance

20/02

10/03

Assurance

Assurance

06/03

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Task

Critical Task

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Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

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145 PHASE 1b ‐ High Level Vision & Overall Service Model 106 days Mon 14/10/13 Mon 10/03/14146 Activity & Capacity Projections ‐ Acute Hospital Services 106 days Mon 14/10/13 Mon 10/03/14147 Data Preparation 30 days Mon 14/10/13 Fri 22/11/13148 Confirm baseline position 1 day Fri 01/11/13 Fri 01/11/13 Activity & Capacity149 Create packs for Sessions 1 & 2 ‐ Inpatients 15 days Mon 14/10/13 Fri 01/11/13 Activity & Capacity150 Create packs for Session 3 ‐ Demographics 20 days Mon 14/10/13 Fri 08/11/13 Activity & Capacity151 Create packs for Session 4 ‐ Outpatients & A&E 15 days Mon 04/11/13 Fri 22/11/13 Activity & Capacity152 Reference Group workshops 55 days Mon 11/11/13 Fri 24/01/14153 Workshop 1 ‐ Objectives, Conceptual Model, Inpatients 5 days Mon 11/11/13 Fri 15/11/13 149FS+5 days Activity & Capacity154 Workshop 2 ‐ Inpatients 5 days Mon 25/11/13 Fri 29/11/13 149FS+15 days Activity & Capacity155 Workshop 3 ‐ Demographics 5 days Mon 16/12/13 Fri 20/12/13 150FS+25 days Activity & Capacity156 Workshop 4 ‐ Outpatients, A&E 5 days Mon 06/01/14 Fri 10/01/14 151FS+30 days Activity & Capacity157 Workshop 5 ‐ Review initial results, adjust parameters 10 days Mon 13/01/14 Fri 24/01/14 153,154,155,156 Activity & Capacity158 Modelling Parameters 49 days Mon 18/11/13 Thu 23/01/14159 Document outputs from Workshop 1 5 days Mon 18/11/13 Fri 22/11/13 153 Activity & Capacity160 Document outputs from Workshop 2 5 days Mon 02/12/13 Fri 06/12/13 154 Activity & Capacity161 Document outputs from Workshop 3 5 days Mon 23/12/13 Fri 27/12/13 155 Activity & Capacity162 Document outputs from Workshop 4 5 days Mon 13/01/14 Fri 17/01/14 156 Activity & Capacity163 Prepare report on all workshop outputs 5 days Mon 13/01/14 Fri 17/01/14 156 Activity & Capacity164 Sign off modelling parameters 0 days Thu 23/01/14 Thu 23/01/14 39,163 Programme Team165 Analysis 55 days Mon 02/12/13 Fri 14/02/14166 Build bespoke elements from Workshop 2 10 days Mon 02/12/13 Fri 13/12/13 154 Activity & Capacity167 Build bespoke elements from Workshop 3 10 days Mon 23/12/13 Fri 03/01/14 155 Activity & Capacity168 Dry run of of IP model with Demographics 10 days Mon 30/12/13 Fri 10/01/14 167FS‐5 days Activity & Capacity169 Build bespoke elements from Workshop 4 10 days Mon 20/01/14 Fri 31/01/14 162 Activity & Capacity170 Dry run of OP & A&E Model with Demographics 5 days Mon 03/02/14 Fri 07/02/14 169 Activity & Capacity171 Prepare report on initial results 5 days Mon 10/02/14 Fri 14/02/14 168,170 Activity & Capacity172 Sign‐off 12 days Thu 20/02/14 Mon 10/03/14173 Programme Team sign‐off of initial results 0 days Thu 20/02/14 Thu 20/02/14 41,171 Programme Team174 Programme Board sign‐off of initial results 0 days Mon 10/03/14 Mon 10/03/14 27,173 Programme Board175

176 Activity & Capacity Projections ‐ Community Hospital Services 66 days Mon 09/12/13 Mon 10/03/14177 Determine workshop participants 5 days Mon 09/12/13 Fri 13/12/13 Activity & Capacity178 Establish model and gather data 10 days Mon 16/12/13 Fri 27/12/13 Activity & Capacity179 Workshop 1 ‐ Agree change factors and modelling parameters 1 day Tue 14/01/14 Tue 14/01/14 178,177 Activity & Capacity180 Produce initial modelling outputs 15 days Wed 15/01/14 Tue 04/02/14 179 Activity & Capacity

181 Workshop 2 ‐ Review initial outputs 1 day Thu 06/02/14 Thu 06/02/14 180 Activity & Capacity

182 Produce revised outputs 6 days Fri 07/02/14 Fri 14/02/14 181 Activity & Capacity

183 Programme Team sign‐off 0 days Thu 20/02/14 Thu 20/02/14 41 Activity & Capacity184 Programme Board sign‐off 0 days Mon 10/03/14 Mon 10/03/14 27 Activity & Capacity185

186 Model of Care 57 days Fri 20/12/13 Mon 10/03/14187 Prepare description of future overall model of care 25 days Fri 20/12/13 Thu 23/01/14 70 Clinical Design188 Define key clinical constraints and opportunities 25 days Fri 20/12/13 Thu 23/01/14 70 Clinical Design189 Review and confirm the activity modelling parameters 25 days Fri 20/12/13 Thu 23/01/14 70 Clinical Design

190 Review and confirm the activity modelling assumptions 25 days Fri 20/12/13 Thu 23/01/14 70 Clinical Design

191 Prepare material for Clinical Reference Group 1 day Fri 24/01/14 Fri 24/01/14 187,188,189,190 Clinical Design

192 Clinical Reference Group review 1 day Wed 29/01/14 Wed 29/01/14 191 Clinical Design

193 Finalise description of future overall model of care 10 days Thu 30/01/14 Wed 12/02/14 187,192 Clinical Design

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

23/01

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

20/02

10/03

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

20/02

10/03

Clinical Design

Clinical Design

Clinical Design

Clinical Design

Clinical Design

Clinical Design

Clinical Design


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline


Page 4


- 43 -


194 Finalise key clinical constraints and opportunities 10 days Thu 30/01/14 Wed 12/02/14 188,192 Clinical Design195 Review outputs from modelling 4 days Mon 17/02/14 Thu 20/02/14 171,182 Clinical Design

196 Programme Team sign‐off of model of care 0 days Thu 20/02/14 Thu 20/02/14 41 Programme Team197 Programme Board sign‐off 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board198

199 Finance 38 days Thu 16/01/14 Mon 10/03/14200 Establish recurring affordability envelope 22 days Thu 16/01/14 Fri 14/02/14 80 Finance201 Establish capital investment capacity 22 days Thu 16/01/14 Fri 14/02/14 80 Finance202 Establish financial & economic model 22 days Thu 16/01/14 Fri 14/02/14 80 Finance

203 Programme Team sign‐off 0 days Thu 20/02/14 Thu 20/02/14 41 Programme Team204 Programme Board sign‐off 0 days Mon 10/03/14 Mon 10/03/14 27 Programme Board205

Clinical Design

Clinical Design

20/02

10/03

Finance

Finance

Finance

20/02

10/03


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline


Page 5


- 44 -


206 PHASE 2 ‐ Development of Models of Care 137 days Fri 01/11/13 Mon 12/05/14207 Activity & Capacity Modelling 137 days Fri 01/11/13 Mon 12/05/14208 Acute Hospital Services 61 days Mon 17/02/14 Mon 12/05/14209 Populate and run model 5 days Mon 17/02/14 Fri 21/02/14 171 Activity & Capacity210 Summarise initial outputs 5 days Mon 24/02/14 Fri 28/02/14 209 Activity & Capacity211 Re‐populate and re‐run model 5 days Mon 03/03/14 Fri 07/03/14 210 Activity & Capacity212 Summarise final outputs 5 days Mon 10/03/14 Fri 14/03/14 211 Activity & Capacity213 Prepare final results pack 5 days Mon 17/03/14 Fri 21/03/14 212 Activity & Capacity214 Programme Team sign‐off 0 days Thu 03/04/14 Thu 03/04/14 44 Programme Team215 Programme Board sign‐off 0 days Mon 12/05/14 Mon 12/05/14 28 Programme Board216

217 Other Services 137 days Fri 01/11/13 Mon 12/05/14218 [Workplan to be defined] 20 wks Fri 01/11/13 Thu 20/03/14 Activity & Capacity219 Programme Team sign‐off 0 days Thu 03/04/14 Thu 03/04/14 44 Programme Team220 Programme Board sign‐off 0 days Mon 12/05/14 Mon 12/05/14 28 Programme Board221

222 LHE Financial Model 137 days Fri 01/11/13 Mon 12/05/14223 [Workplan to be defined] 20 wks Fri 01/11/13 Thu 20/03/14 Finance224 Programme Team sign‐off 0 days Thu 01/05/14 Thu 01/05/14 46 Programme Team225 Programme Board sign‐off 0 days Mon 12/05/14 Mon 12/05/14 28 Programme Board226

227 Evaluation Process 45 days Tue 11/03/14 Mon 12/05/14228 [Workplan to be defined] 6 wks Tue 11/03/14 Mon 21/04/14 143 Programme Team229 Programme Team sign‐off 0 days Thu 01/05/14 Thu 01/05/14 46 Programme Team230 Programme Board sign‐off 0 days Mon 12/05/14 Mon 12/05/14 28 Programme Board231

232 Preparation for Phase 3 45 days Tue 11/03/14 Mon 12/05/14233 Review and update PEP 6 wks Tue 11/03/14 Mon 21/04/14 143 Snr Programme Manager234 Commission Technical Team 6 wks Tue 11/03/14 Mon 21/04/14 143 Snr Programme Manager


Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

Activity & Capacity

03/04

12/05

Activity & Capacity

03/04

12/05

Finance

01/05

12/05

Programme Team

01/05

12/05



01/05

12/05


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

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Project Summary

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Deadline


Page 6


- 45 -


238 PHASE 3 ‐ Option Appraisal 105 days Tue 13/05/14 Mon 06/10/14239 Identification of Options 25 days Tue 13/05/14 Mon 16/06/14240 Identify long‐list of options 2 wks Tue 13/05/14 Mon 26/05/14 236 Programme Team241 Select short‐list of options 2 wks Tue 27/05/14 Mon 09/06/14 240 Programme Team

242 Programme Board sign‐off 0 days Mon 16/06/14 Mon 16/06/14 29,241 Programme Board243

244 Development of short‐listed options 80 days Tue 17/06/14 Mon 06/10/14245 Confirm activity & capacity projections 2 wks Tue 17/06/14 Mon 30/06/14 242 Programme Team246 Develop physical solutions to 1:200 scale 6 wks Tue 01/07/14 Mon 11/08/14 245 Technical Team

247 Prepare workforce projections 6 wks Tue 01/07/14 Mon 11/08/14 245 Finance

248 Financial & Economic Appraisal 5 wks Tue 12/08/14 Mon 15/09/14 247 Finance

249 Non‐financial Appraisal 5 wks Tue 12/08/14 Mon 15/09/14 246 Programme Team

250 Identification of Preferred Option 2 wks Tue 16/09/14 Mon 29/09/14 248,249 Programme Team


254 Gateway Review 1 10 days Tue 16/09/14 Mon 29/09/14255 Gateway Review 1 2 wks Tue 16/09/14 Mon 29/09/14 248,249 Programme Team256

257 Preparation for Phase 4 75 days Tue 24/06/14 Mon 06/10/14258 Review and update PEP 12 wks Tue 24/06/14 Mon 15/09/14 236FS+6 wks Programme Team259 Programme Team sign‐off 0 days Thu 18/09/14 Thu 18/09/14 56 Programme Team260 Programme Board sign‐off 0 days Mon 06/10/14 Mon 06/10/14 31 Programme Board261

Programme Team

Programme Team

16/06

Programme Team

Technical Team

Finance

Finance

Program

Progra

18/09

06/

Progra

Program

18/09

06/


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline


Page 7


- 46 -


262 PHASE 4 ‐ OBC & Public Consultation 263 days Wed 22/01/14 Mon 26/01/15263 OBC 85 days Tue 30/09/14 Mon 26/01/15264 Preparation 13 wks Tue 30/09/14 Mon 29/12/14 250 Programme Team265 Programme Team sign‐off 0 days Thu 08/01/15 Thu 08/01/15 64 Programme Team

266 Programme Board sign‐off 0 days Mon 26/01/15 Mon 26/01/15 32 Programme Board267

268 Public Consultation 263 days Wed 22/01/14 Mon 26/01/15269 Preparation 2 wks Tue 30/09/14 Mon 13/10/14 250 Programme Team270 Consultation 13 wks Tue 14/10/14 Mon 12/01/15 269 Programme Director

271 Assimilate results and document 1 wk Tue 13/01/15 Mon 19/01/15 270 Programme Director

272 Programme Team sign‐off 0 days Wed 22/01/14 Wed 22/01/14 65 Programme Team273 Programme Board sign‐off 0 days Mon 26/01/15 Mon 26/01/15 32 Programme Board274

275 Gateway Review 2 10 days Tue 13/01/15 Mon 26/01/15276 Gateway Review 2 2 wks Tue 13/01/15 Mon 26/01/15 270 Programme Team277

278 Preparation for Phase 5 80 days Tue 07/10/14 Mon 26/01/15279 Review and update PEP 12 wks Tue 07/10/14 Mon 29/12/14 260 Snr Programme Manager280 Commission Advisory Team 12 wks Tue 07/10/14 Mon 29/12/14 260 Programme Director


Pro

22/01


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline


Page 8


- 47 -


284 PHASE 5 ‐ Full Business Case(s) 255 days Tue 27/01/15 Mon 18/01/16285 Procurement(s) 145 days Tue 27/01/15 Mon 17/08/15286 [To be defined] 26 wks Tue 27/01/15 Mon 27/07/15 282 Programme Team287 Programme Team sign‐off 0 days Mon 10/08/15 Mon 10/08/15 286FS+2 wks Programme Team

288 Programme Board sign‐off 0 days Mon 17/08/15 Mon 17/08/15 287FS+1 wk Programme Board289

290 Full Business Case 110 days Tue 18/08/15 Mon 18/01/16291 Preparation 8 wks Tue 18/08/15 Mon 12/10/15 288 Programme Team292 Programme Team sign‐off 0 days Mon 19/10/15 Mon 19/10/15 291FS+1 wk Programme Team293 Programme Board sign‐off 0 days Mon 26/10/15 Mon 26/10/15 292FS+1 wk Programme Board294 CCG & Trust Board approvals 2 wks Tue 27/10/15 Mon 09/11/15 293 CCG Boards,SaTH Board,SCH Board

295 NHS England & NHSTDA approvals 10 wks Tue 10/11/15 Mon 18/01/16 294 Programme Director

296

297 Gateway Review 10 days Tue 13/10/15 Mon 26/10/15298 Gateway Review 3 2 wks Tue 13/10/15 Mon 26/10/15 291 Programme Team299

300 Preparation for Phase 6 50 days Tue 10/11/15 Mon 18/01/16301 Review and update PEP 8 wks Tue 10/11/15 Mon 04/01/16 294 Snr Programme Manager302 Programme Team sign‐off 1 wk Tue 05/01/16 Mon 11/01/16 301 Programme Team303 Programme Board sign‐off 1 wk Tue 12/01/16 Mon 18/01/16 302 Programme Board304

305 PHASE 6 ‐ Implementation 260 days Tue 19/01/16 Mon 16/01/17306 [To be defined] 52 wks Tue 19/01/16 Mon 16/01/17 295 Programme Team

307

308 PHASE 7 ‐ Post Programme Evaluation 65 days Tue 17/01/17 Mon 17/04/17309 [To be defined] 13 wks Tue 17/01/17 Mon 17/04/17 306 Programme Team


Task

Critical Task

Progress

Milestone

Summary

Rolled Up Task


Rolled Up Milestone

Rolled Up Progress

Split

External Tasks

Project Summary

Group By Summary

Deadline


Page 9


- 48 -


Appendix 3 Programme Directory


- 49 -


Appendix 4 Engagement & Communication Plan

[To be appended once finalised]


- 50 -


Appendix 5 Risk Register


- 51 -

Shropshire Clinical Services ReviewRisk Register - 14th January 2014

Score Frequency Cum. 29 Number of Risk Items

0 0 0

1 0 0 203 Aggregate Risk Scores

2 0 0 7.00 Average Score

3 1 1 8 Middle Score

4 5 6 8 Most Common Score

5 0 6

6 2 8

8 21 29

9 0 29

10 0 29

12 0 29

15 0 29

16 0 29

20 0 29

25 0 29

29

Summary

0

5

10

15

20

25

1 2 3 4 5 6 8 9 10 12 15 16 20 25

Number

of

Risks

Risk Scores

- 52 -

140114 Shrop CSR Programme Risk Register 14/01/2014


Risk Commentary

Ref. Description Impact Likelihood Overall Risk Level Action Required to Mitigate

1Structural and organisational change in health and social

care delays Programme4 2 8 AMBER

Commitment to continued engagement of all stakeholder

organisations confirmed in the PEP

2

Delay in agreeing or implementing plan for sustaining A&E

services over the interim period adversely affects

Programme

4 2 8 AMBER Progress to be monitored by Programme Board

3Re-design of Primary Care Services adversely affects the

Programme4 2 8 AMBER Progress to be monitored by Programme Board

4Re-design of Community Health Services adversely affects

the Programme4 2 8 AMBER Progress to be monitored by Programme Board

5Development of CCG Commissioning Strategies constrains

or conflicts with the Programme4 2 8 AMBER Progress to be monitored by Programme Board

6Operational imperatives pre-empt or conflict with

Programme aims and objectives4 2 8 AMBER Progress to be monitored by Programme Board

7 Programme resources / staffing inadequate 4 1 4 GREENProgramme Budget for Phases 1 and 2 agreed; key Programme

appointments underway

8 Inability of stakeholder organisations to release key staff 4 2 8 AMBERStakeholder organisations to agree with key staff the time and

capacity required

9 Failure to properly establish Programme 4 1 4 GREEN Programme Execution Plan developed

10 Inadequate programme management 3 1 3 GREEN Programme Execution Plan developed; Programme support team

in place; Gateway Reviews

11Loss of key partner organisation and/or Programme

personnel leads to delay3 2 6 AMBER

12The number and/or complexity of options identified for

appraisal delays the Programme3 2 6 AMBER

13 Inadequate clinical engagement 4 2 8 AMBERClinical Design workstream and Clinical Reference Group

established

14 Insufficient sign off of proposed models of care 4 2 8 AMBERClinical Design workstream and Clinical Reference Group

established

Risk Area Risk Assessment

External Inter-dependencies

Programme Management & Resources

Clinical Design

- 53 -



Risk Commentary



15Accuracy/completeness of information to support

modelling of non-acute hospital services and activity4 2 8 AMBER To be taken into account in deveoping the model

16Time required to robustly model future service levels delays

the Programme4 2 8 AMBER Activity & Capacity workstream to control the process

17 Lack of stakeholder sign-off of modelling methodologies 4 2 8 AMBERSign-off to be sought from Activity & Capacity and Clinical Design

workstreams

18Lack of ownership of plans within health and social care

community4 1 4 GREEN Programme Board sign-off of all key outputs from each stage

19 Inadequate patient and public engagement 4 1 4 GREEN Comprehensive engagement & comunications plan to be

developed

20 Public resistance and objections to plans 4 2 8 AMBER

21 Lack of political support for large-scale service changes 4 2 8 AMBER Local political compact to be sought

22 Failure to identify all key stakeholders 4 1 4 GREEN Stakeholder analysis to be undertaken and signed-off

23Recurring affordability of the programme to the local health

and social care economy4 2 8 AMBER Clear financial envelope to be established

24 Unavailability of transitional funding required 4 2 8 AMBER

25Future changes in national tariff prices or payment systems

adversely impact the affordability of service changes4 2 8 AMBER

26 Lack of capital to fund required capacity/improvements 4 2 8 AMBER Capital investment capacity to be defined in Phase 1

27 Lack of suitably trained staff for new models of care 4 2 8 AMBER

Activity & Capacity

Engagement & Communications

Finance

- 54 -



Risk Commentary



28Failure to secure necessary NHS approvals at key

milestones4 2 8 AMBER

29Failure to secure stakeholder sign-off of key outputs from

each Phase4 2 8 AMBER

Assurance & Governance

- 55 -


Likelihood Narrative Possible Quantification

1 Very unlikely to occur May occur only in exceptional circumstances

2 Unlikely to occur Could occur at some time

3 As likely to occur as not Might occur at some time4 Likely to occur Will probably occur at some time5 Very likely to occur Is expected to occur in most circumstances

Impact Narrative Possible Quantification

1 Minimal Impact

Revenue impact <£20,000; Capital impact <£0.5m; Delay <1 month

2 Low Impact

Revenue impact >£20k <£100k; Capital impact >£0.5m <£1.0m; Delay >1 month <3 months

3 Medium Impact

Revenue impact >£100k <£500k; Capital impact >£1.0m <£3.0m; Delay >3 months <9 months

4 High Impact

Revenue impact >£500k <£2.0m; Capital impact >£3.0m <£6.0m; Delay >9 months <24 months

5 Very High Impact

Revenue impact >£2.0m; Capital impact >£6.0m; Delay >24 months

Risk Level Definition Action Plan1 - 4 GREEN No need for specific action plan

5 - 10 AMBER Prepare outline action plan

12 - 25 RED Detailed action plan required

- 56 -

Programme Board and Commissioner

Decision Making

Programme Board and Commissioner Decision-making

Introduction

1. This paper sets out issues and options in relation to the process by which the Programme Board and Shropshire and Telford & Wrekin (“T&W”) CCGs (“the CCGs”) will make decisions regarding the Future Fit Programme.

Background

2. The FutureFit programme was formally established by the CCGs in December 2013 following a period of informal discussion and development over the preceding year.

3. The programme is led by a Programme Board comprising representatives from five ‘Sponsor’

organisations and representatives from a number of other ‘non-voting’ partner organisations. The five sponsor organisations are:

a. Telford & Wrekin CCG b. Shropshire CCG c. Powys Local Health Board d. Shropshire Community Health Services NHS Trust e. Shrewsbury & Telford Hospital NHS Trust

4. A Programme Executive Plan has been approved by the Programme Board. This does not

set out how the Programme Board will make decisions. It was agreed at the Programme Board meeting on 20 January that there needs to be greater clarity about how decisions will be made by the Programme Board.

5. A good practice guide for commissioners on the development of proposals for major service

change and reconfigurations – Planning and delivering service changes for patients (gateway 738) (“the guidance”) – was published by NHS England on 20 December 2013.

The guidance

6. The guidance includes a section on clinical commissioner leadership and collaborative decision making (pp19-21). It says that a major service change could be proposed by a number of bodies but that, irrespective of which organisation proposes a service change, commissioners should play a leading role in the planning and development of proposals.

7. The guidance defines the organisation or group of organisations leading the development of

the proposal as the ‘proposing body’. The proposing body is the body which makes the decision on the option chosen. The guidance states that “the decision on the options chosen rests with commissioners, reflecting their legal responsibility to secure services to meet the reasonable needs of the people for whom they are responsible” (p40).

8. Regarding collaborative commissioning the guidance states:

CCGs should be clear in advance what responsibilities they have, individually and together, for ensuring full support for a collective decision … CCG should set up an oversight board (or similar) on which each of the CCGs would be represented and through which decisions are reached. It is also important that all parties should understand what happens when there is a lack of consensus on a proposal. There should be advance agreement regarding how these circumstances will be handled and any conditions that should apply. (p20)

9. Two or more CCGs can make arrangements to exercise any of the commissioning functions

jointly. Although Section 14(Z)(3) [of the NHS Act 2006 as amended by the Health and Social Care Act 2012] does not allow CCGs to exercise functions jointly by way of a joint committee, each CCG can delegate any functions required for developing service reconfiguration proposals to a committee which, for each CCG, has the same membership. This would enable all involved CCGs to have Committees consisting of the same people and those committees could then meet in common for the purposes of decision making. This is informally referred to as the ‘committee in common’ model.

10. Regarding the involvement of other organisations in an advisory capacity that guidance

states:

It is also good practice that the CCGs consider whether they establish a separate programme (or advisory) board consisting of commissioners, providers, local authorities and other relevant stakeholders to make sure that all relevant information is fed into the reconfiguration process. It is important to note that such a programme board would not be able under the terms of Section 14(Z)(3) to exercise any function on behalf of any CCG, but could be invaluable for the development of shared proposals and in providing recommendations to the ‘committee in common’ or CCG Governing Bodies. (p21). The FutureFit Programme Board was established on the basis that it reports to the boards of the Sponsoring organisations. In the terms of the guidance it is an advisory committee (as described above) with no authority to exercise any function on behalf of the CCGs.

Reaching a decision: Options

11. There are two principle questions to be addressed to provide clarity about how the preferred

option will be determined when the process of option evaluation has been completed:

• How will the Programme Board decide what recommendation it will make in the event that there is not a consensus on a preferred option.

• How will the commissioners decide which option is chosen.

12. There are two ways in which the Programme Board could proceed in the event that there is no consensus on a preferred option.

• Agree voting arrangements which enable a decision to be made in the absence of

consensus; or

• Agree a report to the commissioners which sets out the results of the option evaluation and any other relevant information without selecting a preferred option

13. The Programme Board membership identifies separately membership from the five sponsor

organisations and from other organisations. These latter are referred to in the Project Executive Plan as “non-voting members”. It is suggested that this should be read to mean that the Programme Board will be able to reach a decision on a preferred option, for recommendation to commissioners, if there is a consensus amongst the sponsor members.

14. If the Programme Board is not able to reach a consensus, at least among its sponsor

members, then to make a firm recommendation on a preferred option would require voting arrangements to be agreed. The sponsor members comprise three commissioning organisations and two providers. Individual representation includes both clinical and executive leaders of the organisations.

15. Membership of the Programme Board was determined on the basis of what was required to

ensure effective oversight and delivery of the programme rather than with a view to ensure the most appropriate mix of individuals to decide on the preferred option:

• If it was decided that the Programme Board should have individual voting to determine a

preferred option then the membership of the Board would need to be reviewed and, probably, revised to reflect this responsibility.

• If it was decided that the Programme Board voting should be based on one or more votes for each organisation (rather than nominated individuals) then, for a question of this importance, it is reasonable to assume that individual Boards would want to discuss and mandate the voting. To make a decision they would need the full report from the Programme Board and would probably need, in the interests of transparency and openness, to make the decision at a full public meeting. This would have the potential to compromise the subsequent Commissioner decision-making process, particularly if the two CCGs have mandated their representatives on the Programme Board to support different options.

16. In the light of the issues outlined above it is suggested that the Programme Board should

make decisions by consensus between its sponsor members and that any significant issues on which a consensus cannot be reached should be referred to the CCG Boards (or, if established, the Committee-in-Common). Regarding the option appraisal, in the absence of consensus the Programme Board would report to the CCG Boards the outcome of the option development and appraisal process, including the results of public consultation, but without recommending a preferred option.

17. There are two ways in which the Commissioners could decide which option is chosen:

• To hold separate meetings which receive the same report on the outcome of the

programme (with or without a recommendation being made on a preferred option)

• To establish a committee in common which would have authority to make the decision on behalf of both CCGs and would have agree voting arrangements which would ensure that the committee was able to make a decision in the absence of a consensus.

18. The CCGs could hold separate meetings at the same time and in the same place, a model

that might be termed “separately but together”. However, whilst this would have some advantages over separate meetings held at different times it would, in formal terms, still be two separate decisions with no guarantee that they would reach the same decision.

Options for Decision-Making Structures

19. Three options for decision making are set out below:

Option 1: three-tier structure

Option 2: two-tier structure – two separate CCG Boards Option 3: two-tier structure – committee in common

20. The obvious question to address in option 1 is the purpose of the committee in common if it does not have decision-making authority. The Programme Board should ensure, before it makes a report/recommendation to commissioners, that all points of information and clarification which the CCG Boards will want to consider in making their decision have been addressed. There should, therefore, be no need for an intermediate committee in common to review the report before it is considered by the CCG Boards.

21. However, if the Programme Board has not reached a consensus, then the committee-in-

common could, in option 1, have a role in determining a preferred option to be recommended to the CCG Boards. Its membership would need to be established with this core responsibility in mind.

Committee in Common

Shropshire CCG Board T&W CCG Board

Programme Board

(Decision)

(Advisory)

(Advisory)

Programme Board

Shropshire CCG Board T&W CCG Board (Decision)

(Advisory)

Committee in Common

Programme Board

(Decision)

(Advisory)

22. For option 2, there is clearly a risk that the CCGs will reach different decisions if the

Programme Board has not been able to reach a consensus decision on a preferred option and thus (noting the recommendation para 16 below) the report from the Programme Board has gone to each CCG Board separately (whether meeting together or otherwise) without a recommended preferred option. The implications of the CCGs not reaching a decision on which they agree are discussed below.

23. In option 3 the CCGs have delegated responsibility to the make the decision to a committee-

in-common. The benefit of this option is that, providing voting arrangements are clear and effective, there is very little risk that the CCGs, through the committee-in-common, will not made a decision. Also, membership of the committee can be constructed with this specific responsibility in mind.

24. The CCGs are currently considering these options and will inform the Programme Board

when the decision has been made. Dispute Resolution

25. It was noted above that either option 1 or option 2 could result in a situation where the two CCGs had made different decisions. The national guidance does not cover the eventuality that commissioners are not able to reach a decision.

26. It is reasonable to assume that, in the event that CCGs were agreed that the current service

configuration is not clinically or financially sustainable but were not able to agree on the solution, then NHS England would step in and would establish a process through which a decision would be made. Further advice is being sought on this matter.

Wales

27. The guidance issued by NHS England does not consider a circumstance in which service change is proposed which affects a substantial population in Wales or Scotland. Under option three the committee in common could include representatives from Powys Health Board. Options one and two do not include NHS Wales in the decision making process other than through their representation on the Programme Board. Further guidance is being sought on this matter.

Providers

28. The two NHS provider organisations principally affected by the programme (SaTH and SCHT) are not involved in the decision making process outlined in this paper other than through their representation on the Programme Board. This appears to be consistent with the national guidance.

29. It is suggested that it would be not be helpful to the process for providers to determine a

preferred option out-with the programme. It would therefore be essential that the programme ensures that relevant provider boards would be willing to implement any of the options subject to evaluation and put forward for decision to CCGs.

Recommendation

30. The Programme Board is asked:

1. To consider for approval and recommendation to the boards of sponsor organisations the decision-making arrangements set out in paragraph 16.

2. To identify any other issues raised by this report which require further consideration and decision by the Programme Board and/or the boards of sponsor organisations.

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