2018/19 Sheffield CCG Priorities and Development of Commissioning Intentions 2019/20

Governing Body meeting E 1 November 2018

Author(s) Sandie Buchan, Head of Information, Performance & PMO Jackie Mills, Deputy Director of Finance Cath Tilney, Deputy Director of Contracting

Sponsor Director Brian Hughes, Director of Commissioning and Performance Purpose of Paper

This paper is a returning paper that incorporates the queries that were made at the September Governing Body meeting in order to agree the list of CCG objectives and priority areas for 2018/19.

The paper details the process by which the priorities and Commissioning Intentions for 2019/20 will be developed which will be presented back to the Governing Body in January 2019.

The paper notes that NHS England has recently published guidance on the approach to planning for 2019/20. This guidance is summarised in this paper, including the key deadlines.

Key Issues

Nine priority areas have been developed by the senior team for 2018/19. The objectives and priority areas are what the CCG are operationally focusing on within 2018/19 in order to deliver our goals and aims.

Development of the 2019/20 priorities and Commissioning Intentions are currently undergoing a process which aligns the workstreams and objectives of the Integrated Care System (ICS) and the Accountable Care Partnership (ACP) to the delivery of the CCG’s aims and goals. This plan will anticipate the requirements of the 10 year plan and will need to be refreshed as and when national information is received eg CCG allocations.

Guidance on the Approach to Planning issued by NHS England notes that the expectation is that governing bodies will oversee the development of financial and operational plans, against which they will hold themselves to account for delivery, and which will be a key element of NHS England’s performance oversight.

Is your report for Approval / Consideration / Noting

Approval

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Recommendations / Action Required by Governing Body

The Governing Body is asked to approve the presented list of priorities for NHS Sheffield CCG for 2018/19.

The Governing Body is also asked to approve the proposed process to develop the CCG’s Commissioning Intentions for 2019/20 and subsequent plans.

The Governing Body is asked to note the guidance on the Approach to Planning that has been issued by NHS England.

Governing Body Assurance Framework

Which of the CCG’s objectives does this paper support? This paper supports the achievement of all of the CCG’s objectives.

Are there any Resource Implications (including Financial, Staffing etc)?

Yes, a focus of clinical and managerial time on programmes and projects in order to deliver the priorities.

Have you carried out an Equality Impact Assessment and is it attached?

Please attach if completed. Please explain if not, why not Not required.

Have you involved patients, carers and the public in the preparation of the report?

Patients, carers and the public will be involved and engaged through individual programmes and projects that inform the priorities as detailed within this paper.

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2018/19 Sheffield CCG Priorities and Development of 2019/20 Commissioning Intentions

Governing Body meeting

1 November 2018

1. Introduction

1.1. At September 2018 Governing Body meeting, a summary of the priority areas for NHS Sheffield CCG were presented. The work areas were designed to ensure the CCG focuses on organisational, ACP and ICS objectives as well as taking into account the latest intelligence on the national direction of travel. At the meeting, a number of queries were raised regarding how well the priorities link to the CCG’s five aims and 8 strategic goals, alongside seeking assurance that they also will meet the ACP and ICP objectives. On reflection, it is recognised that the presentation did not make it completely clear that this was the case and a clearer method of communication is planned for 2019/20. This paper details the amendments to the priorities with the intention of these being agreed in order for the 2019/20 priority areas to be developed.

1.2. This paper also details the process that will be taken in order to develop the CCG Commissioning Intentions and priorities for 2019/20. It is acknowledged that whilst we are moving into new, more integrated ways of working with partners, the production of commissioning intentions for 2019/20 continues to focus on the CCG as an individual statutory organisation. This is partly because the partnership arrangements are still evolving. This also recognises that the CCGs constitution states that the Governing Body is responsible for the approval of the CCG’s annual commissioning plan and supporting financial plan,

1.3. The CCG Commissioning Intentions will build upon what we currently know from the ACP Sheffield Place Based Plan, incorporating the key objectives and work areas that are currently being developed via the ACP and the ICS. This will be presented to the January 2019 Governing Body for approval. Alongside this we plan to carry out a ‘bottom up’ project management approach, by recording all the key CCG work areas and identifying the projects that will help in achievement of the 2019/20 Commissioning Intentions. We will then look to review any work areas that will not contribute to the Commissioning Intentions and/or are not considered to be statutory duties.

1.4. Guidance was issued on 16th October by NHS England which outlines the approach for planning for 2019/20. This is very timely, as the development of the 19/20 plan requires critical information from central bodies (the 10 year Plan, 19/20 Planning Guidance, CCG Allocations, National Tariff Proposals), the timing of which is included in the recent guidance. Information in this guidance has been incorporated into the planning for production of the 2019/20 plan.

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2. 2018/19 Priorities

2.1. Appendix 1 shows the CCG’s plan on a page which summarises the vision, aims, goals, objectives, priority areas and transformational programmes. The objectives and priority areas are what the CCG are operationally focusing on within 2018/19 in order to deliver our goals and aims. These have been developed with the intention of sitting across both adult and children services and incorporate all of our programmes of work.

2.2. This is not an exhaustive list of areas that the CCG is working on, however what is presented is a definitive list of our main priorities. Priorities are what we class as the areas of work that ensure we deliver and achieve our aims. Where we put our resources and capacity in order to achieve the identified outcomes. Other areas are also part of our operational workload but these are the areas that for 2018/19, were identified as being the main areas of work. These are detailed further in Table 1.

2.3. On reflection, it is felt that for 2019/20, a, more simplified version of how the CCGs priorities link to the CCG aims is designed to not only present the operational priorities and what we are going to deliver, but also the benefits that are realised which will measure the impact and change. This will provide a more transparent picture of what will be achieved through the transformational work.

Table 1: 2018/19 Sheffield CCG Priorities

Objective Priority Area

1 Care Closer to Home

2 Cancer

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4 Mental Health, Learning Disabilities and Autism

Review community provision and opportunities to move care closer to home. Ensure services are delivered in a patient centred way. This will include a review of children's community nursing and therapies, opportunities to increase community clinic provision and continuing healthcare service redesign. Patient and carers will be involved in the review. Explore alternative contract mechanisms to help unlock change.

Ensure pathways and services are designed and developed to support early diagnosis, better treatment and aftercare for people with cancer.

Begin to create all age mental health, learning disability and autism pathways which will help promote earlier intervention and preventative approaches. This will also help address the current mortality gap for people with severe mental health and learning disabilities and enable us to deliver national priorities with the maximum impact. Service redesign is planned for CAMHS, eating disorders, autism and enhance community learning disability.

City Wide Integration

Work collaboratively with our partner organisations to deliver integrated services, particularly focusing on Continuing Health Care (CHC), delivery of the Mental Health Five Year Forward View and Children's partnership arrangements.

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5 Patient Review patient pathways and flows to improve patient experience, increase efficiency Pathways and maintain or improve performance. This will help to reduce excess bed days, DTOCs

and inappropriate emergency admissions. Review of key elective specialities to identify opportunities to reduce demand (self‐care, referral criteria) and increase system efficiencies (virtual clinics, upskilling, standard discharge letters). Commission the agreed revised pathway for Hyper Acute Stroke care as the nominated lead commissioner for HASU. Respond to the findings of the South Yorkshire and Bassetlaw Hospital Services Review.

6 Person Centred Commission health services that promote person‐centred, asset based approaches to Care care delivery. Support the workforce development required to deliver person‐centred

care / services

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3. Developing 2019/20 Priorities and Commissioning Intentions

Primary care transformation

To deliver primary care transformation to enable; neighbourhood development, high quality long term conditions management and the safe, effective and efficient use of medicines (e.g. polypharmacy and de‐prescribing, Prescribing Quality Improvement Scheme). To deliver the GP Five Year Forward View and the associated workforce planning.

Urgent Care in Primary Care

Deliver a new model of urgent care in primary care that ensures patients receive the most appropriate same day urgent care by the most appropriate clinician in the right setting, first time. This relies on significant interdependencies with the primary care transformation programme.

Financial Sustainability

Ensure that the CCG is able to deliver the financial plan for 2018/19 as agreed with NHS England, a large part of which is dependent on delivering the identified savings (QIPP) associated with the priorities outlined above.

3.1. During Governing Body’s development session in October 2018, it was decided that the CCG’s aims and objectives will be reviewed and updated to reflect the changing landscape within Sheffield. This will ensure a coordination of CCG programmes and priorities alongside the ACP and ICS. This will be completed as part of the development of the operational plan for 2019/20.

3.2. The Sheffield Place Based Plan, which was signed off in December 2016 by the CCG’s Governing Body builds on the successes that Sheffield already has across the city, strengthens our collaborative single system approach to working and builds on the strategic case for change set out by the South Yorkshire & Bassetlaw Integrated Care System. It sets out the ambition of what we aim to achieve by 20/21. In early 2019, a series of ACP workshops for staff and the public are planned to inform the production of the ACP plan for 2019/20 and beyond. The aim is to have a refreshed version of the Shaping Sheffield plan by April 2019.

3.3. Each of the ACP work streams has identified three priorities for 2018/19. The CCG portfolios have subsequently mapped their priority work areas to the ACP objectives ensuring that there is alignment. These will be shown within the 2019/20 priorities and operational plan, highlighting where the programmes fit into the ACP and ICS objectives so that we can see how all of the work meets not only the objectives and requirements of the CCG but also meets our wider obligations.

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3.4. In 2018/19, the CCG worked alongside all of our partner Health and Social Care organisations on integrated programmes of work. This includes areas such as the Better Care Fund programme which included the priority of aligning efficiency requirements as well as joint transformational service changes. It is envisaged that this joint working approach will continue and strengthen in 2019/20 and beyond. Sheffield Health and Social Care partners continue to commit to working together to design an infrastructure which can evolve further and to support new ways of integrated working.

3.5. Work has therefore commenced on looking at the 2019/20 priority work areas which will be developed alongside the Commissioning Intentions. The process will adopt a ‘bottom up’ approach which initially details all of the programmes of work and aligns them to the CCG aims, as well as the ACP and ICS objectives. It will also quantify the expected level of efficiency savings which will accrue from effective delivery of the programmes of work (i.e. the bottom up QIPP plan).

3.6. The process will be led by the CCG’s Programme Management Office and working with the Deputy Directors of each of the Portfolios and operational departments to firstly identify what existing programmes will be continuing into 2019/20 and any new areas of work that is planned for the coming year and beyond. The information that will be captured will be used for a number of different purposes such as:

CCGs Commissioning Intentions CCG’s QIPP plan CCG’s Contracting Intentions including the SDIPs for each of the Provider

contract CCG’s Operating plan

4. Contracting Intentions

4.1. In order to achieve contract signature for 2019/20 by the national deadline (21 March 2019) the CCG’s Contracting Approach will need to be issued in draft in December 2018. The Contracting Approach will therefore need to recognise what we currently understand is likely to be included in the Commissioning Intentions, as well as what is anticipated in the national NHS Long Term Plan. However, these are likely to need to be refreshed once all the relevant national guidance has been incorporated into the Commissioning Intentions.

5. Financial Plan

5.1. Given the significant amount of change trailed in the approach to planning guidance for 2019/20 noted in section 6 below, and the uncertainty regarding allocations from 2019/20 onwards, the current draft financial plan for 2019/20 will require significant updating once national guidance is received. This will build upon the on-going work to monitor our underlying financial position as well as the development of the Commissioning Intentions and QIPP plan as outlined in section 3 above.

5.2. The first draft of the updated 2019/20 financial plan will be presented to Governing Body in January, alongside the draft of the Commissioning Intentions.

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6. National Guidance and Planning Timetable

6.1. Guidance was issued on 16 October by NHS England which outlines the approach for planning for 2019/20. Individual organisations will be asked to submit one-year operational plans for 2019/20, which will also be aggregated at ICS level and accompanied by a local system operational plan narrative. ‘Organisations, and their boards / governing bodies, will need to ensure that plans are stretching but deliverable and will need to collaborate with local partners to develop well-thought-out risk mitigation strategies. These will also create the year 1 baseline for the system strategic plans, helping forge a strong link between strategic and operational planning.’ The expectation is that governing bodies will oversee the development of financial and operational plans, against which they will hold themselves to account for delivery, and which will be a key element of NHS England’s performance oversight.

6.2. The guidance also confirms the following:

As previously trailed, the NHS Long Term Plan is expected to be published late November/early December

The planning guidance, with confirmation of the detailed expectations, will be published in early December.

5-year commissioner allocations will be published in mid December.

NHS England and NHS Improvement have also published a document on ‘NHS payment system reform proposals’ which sets out the options that they are considering for the 2019/20 National Tariff. One of the key proposals is to move to a blended payment approach for urgent and emergency care from 2019/20.

In addition to this, they will start the process of transferring significant resources from the provider sustainability fund into urgent and emergency care prices.

From 1 April 2019, the current CQUIN scheme will be significantly reduced in value with an offsetting increase in core prices. It will also be simplified, focussing on a small number of indicators aligned to key policy objectives drawn from the emerging Long Term Plan.

The approach to quality premium for 2019/20 is also under review to ensure that it aligns to the strategic priorities;

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6.3. The guidance outlines a joint provider and commissioner timetable and the main dates are:

14 January 2019 Initial plan submission – activity and efficiency 12 February 2019 Draft 2019/20 organisation operating plans 5 March 2019 2019/20 contract plan alignment submission 21 March 2019 Deadline for contract signature 29 March 2019 Organisation Board/Governing Body approval of 2019/20

budgets 4 April 2019 Final 2019/20 organisation operating plan submission 11 April 2019 Aggregated 2019/20 system operating plan submissions and

system operational plan narrative Summer 2019 Systems to submit Five-Year plans signed off by all

organisations

7. Recommendations

The Governing Body is asked to approve the presented list of priorities for NHS Sheffield CCG for 2018/19.

The Governing Body is also asked to approve the proposed process to develop the CCG’s Commissioning Intentions, Contracting Intentions and Financial Plan for 2019/20.

The Governing Body is asked to note the guidance on the Approach to Planning that has been issued by NHS England.

Paper prepared by: Sandie Buchan, Head of Information, Performance & PMO Jackie Mills, Deputy Director of Finance Cath Tilney, Deputy Director of Contracting

On behalf of: Brian Hughes, Director of Commissioning and Performance

October 2018

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Appendix 1:

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