MANSFIELD AND ASHFIELD CCG GOVERNING BODY TITLE: Better Together Programme update DATE OF MEETING: 19th May 2016 PAPER REF: MAB/16/66 AUTHOR: Dawn Atkinson PRESENTER: Amanda Sullivan

SUMMARY:

• The Better Together monthly summary as prepared for the April Alliance Leadership

Board is attached for information. The report provides a brief progress report on each of the projects under the clinical and enabling programme areas.

• The programme stocktake report provides an overview of the programme key performance indicators used to track delivery of the six key strategic objectives. The information is presented as Mid Nottinghamshire total and at CCG level activity at Sherwood Forest Hospitals NHS Foundation Trust Programme. The information is also available for all provider organisations.

ACTION:

To note to approve To agree the recommendation (see details below)

HOW DOES THIS CONTRIBUTE TO THE OUTCOMES AND OBJECTIVES OF THE CCG:

Quality Health Financial Clinical Performance Other (specify) (tick as appropriate)

RISK ASSURANCE:

CONFLICTS OF INTEREST:

This is a recommended action to be agreed by the Chair at the beginning of the item. No conflict identified Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate (see below) Conflicted party is excluded from discussion (see below)

CONFIDENTIALITY:

Is the information in this paper confidential? No Yes

Better Together Programme April Summary Report – Alliance Leadership Board

15.1% reduction in A&E attendances

19.% reduction in non-elective admissions

30.5% reduction in non-elective bed days

25% reduction in admissions to nursing and residential homes

9.8% reduction in secondary care elective referrals

20% reduction in paediatric non-elective admissions

Better Together

Programme Area

Workstream

Sponsor/PM/Clinical Lead

April summary progress

Remedial action

RAG

status

Urgent and Proactive Care Local Integrated Care Teams – an integrated health and social care model for the Mid-Notts footprint Specialist Intermediate Care Team & crisis Response – will

Dr Andy Haynes Siobhan McKenna/Ruth Willis Dr James Mills

Dr Andy Haynes Siobhan McKenna

The pilot between LICT and START has now started in Hardwick. The pilot will run for 6 months with evaluation to take place in Sept 16. Recruitment remains challenging although there has been some progress with some community nursing posts recruited to and awaiting start dates. N&S will not achieve full year trajectory for proxy avoided admissions - action plan in place. M&A has over-achieved (although worth noting their target was smaller than N&S) A review of the LICT specification has started to take place with the goal of refreshing the specification to take into account changes within the service and the operating landscape. Benchmarking for the medical responsibility element of the changed SICT model is being developed.

No additional action required at this stage. SFHFT senior lead required.

Amber Red

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support patients requiring intensive intermediate care and rehabilitation on discharge Single Front Door – improved patient triage/streaming protocols to ensure patients received the most appropriate care in the right setting

Dr James Mills

Dr Andy Haynes Siobhan McKenna Dr Benjamin Owens

Significant issue with change of personnel at SFHFT. The Trust needs to identify a senior lead to support and facilitate the development of the trajectory to rationalise Transfer to Assess Beds (T2A) to enable investment into SICT. Single Assessment template is complete expected to go live in June. Meeting with EDASS and SFH to review current performance and transition to an urgent response mid-notts team. A more detailed spec is being written in line with the new requirements (as detailed in the blue print) to ensure the service is actively monitored against performance and quality standards. King’s Mill Hospital SFD -Number of actions are underway to remove system and logistical barriers to moving to joint-streaming at the front door. Staffing continues to be challenging for PC24 both for PC nurses and GP cover. This is impacting on the effectiveness of the front door model and the ability to move to joint-streaming. CNCS are out to recruitment. Paediatric pathway business case is being developed. SFD teams and the Women’s & Children's directorate meeting to ensure that the pathway and model for paediatrics is aligned. Newark Hospital SFD - Estates work is on plan. Phase 1 due to be completed at the end of April. Roz Howie, Acting Deputy COO, SFHFT, facilitated a clinical workshop to look at the clinical model for Newark with involvement of David Ainsworth to inform the development of the primary care urgent care hub. Output from the workshop is awaited.

Analysis of ED and PC24 activity is underway.

Red

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Call for Care (Care Navigation Service) – single point of access for health professionals to have access to quick and effective care co-ordination Self-Care Hub – targeted approach and support for patients and families to self-care

Dr Andy Haynes Jayne Birch-Jones Dr James Mills Dr Andy Haynes Siobhan McKenna/Ruth Willis Dr James Mills

The Call for Care number is now going to be combined with Single Point of Access (SPA) for access to routine Health Partnerships adult community services. This will reduce referrer’s confusion over what number to ring. It will be important to continue to report separately the number of calls to routine services (SPA) and urgent response (Call for Care) separately. Evaluation of Bronze phase of the project is now complete. Project closure report has been issued. The numbers through the self-care hub are slowly increasing and traffic through the self-care website is encouraging. More work is needed to reach target. An engagement plan has now been implemented, alongside new marketing materials to provide greater clarity about the role of the hub and referral routes for GP’s and other health professionals. An events calendar has also been produced that is integrated with NHS and other community national and local events. The calendar maps out the intended engagement and promotion activity throughout the year and is a ‘live’ document which is updated weekly. Links have been made with the new leisure centre in Newark to build a partnership approach to developing supported self-care interventions in Newark. The first of these is planned for national diabetes awareness week in June. Self-care are involved in the cancer Better Together Workstream and are working together to strengthen the self-care pathway for patients with cancer providing information and support to Cancer Specialist Nurses within secondary care so they know how to refer patients onto access wellbeing support and self-care.

No additional action required at this stage.

Green

Amber

Elective Care Review

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Ophthalmology – redesign of the Ophthalmology pathway to support demand and capacity constraints Integrated Musculoskeletal (Trauma and Orthopaedics workstream) – improve referral management and increase the management of patients in a community setting

Dr Gavin Lunn/Jane Thornley/Dr Hilary Lovelock Dr Gavin Lunn /Jane Thornley/Dr Andy Sommers

Delays in the transaction of the One Stop Cataract pathway. Financial assumptions reduce follow up appointments, but pay higher OPA rate. SFHFT have challenged and CCG are hoping to resolve. Transfer suitable activity from secondary care to a community setting – this will include stable Wet AMD and Stable Glaucoma and suitable post op Cataract follow ups. Wet AMD training programme approved by CCG Quality & Risk Cte – with recommendations on monitoring and training provider. Alternative training provision is being sourced. Pathways and processes being refined. Focus on referral process and community provision with intention to develop a Minor Eye Condition Service (with support from NHS England and HEEM). MSK Workstream developing approach for a multidisciplinary integrated MSK service for patients across Mid Notts. Integrated care providers to manage the MSK health of patients within Mid Notts. This combines orthopaedics, rheumatology (exc DMARD), MSK pain management, podiatry and physiotherapy services. The service will co-ordinate and manage the healthcare pathways of patients to deliver high-quality care, good clinical outcomes and excellent patient experience whilst also meeting the needs of the patients carers. Where onward referral to secondary care is indicated, the provider will manage both the work-up of the patient, offer choice of provider, direct listing and early supported discharge planning as appropriate, and will act as the single point of access through which the patient’s care is co-ordinated before and after the secondary care episode. This will include follow-up care and

No additional action required at this stage. None required.

Amber

Green

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Urology – shift of activity to community setting and improved service delivery models Templates and Guidelines – development of specialty specific guidance to improve referral management

Dr Gavin Lunn/Jane Thornley/Dr Nigel Marshall

Dr Gavin Lunn/Jane Thornley/Dr Nigel Marshall

rehabilitation and support from the patient’s GP to manage the patient at home wherever possible. Scoping of current physiotherapy and therapies provision has been undertaken, with on-going engagement with pain management teams. Engagement with T&O, Diagnostics, Rheumatology and primary care to take place shortly. Scoping paper to describe Integrated MSK model and possible procurement approaches, within Alliance model, to be presented to the Oversight Group for decision. Work to refine and extend the scope of the pathway across Mid Notts has been undertaken. Issues over historical utilisation of the service, and viability of SFHFT delivery. Financial and activity assumptions have been revisited and options paper (including risks) to be shared with Elective Steering group for approval Clinical Pathways Web Page – Phase 2 is now live. Targeted upload of educational videos to be phased over the next 12 months.

Referral Templates - Orthopaedic, Urology and Generic templates to be launched.

Gateway Re-Procurement - N&S Gateway model, to be extended for 18 month period. M&A CCG will continue with partial use of the gateway for triaged services – 12m extension agreed.

Referral Facilitation Model (M&A): Further development of the proposed M&A referral

None required. None required.

Green

Green

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facilitation model is in progress. This model will cover the main elements of the original referral facilitation model; peer review, and clinical partnership. This is a locality based model which would be clinically led by a team of Clinical Referral Advisor. Initial implementation will be in one locality area, with phased implementation in remaining areas through the year. Locality identified and work progressing to go live in May.

IM&T Medical Interoperability Gateway (MIG) - a county wide initiative to help support improvements in unplanned and urgent care Enhanced Data Sharing Model - Nottinghamshire wide consent sharing model CNSC SystmOne – supporting the single front door shared patient records

Dr Mark Jefford/ Andy Peers Dr Mark Jefford/Andy Peers Dr Mark Jefford/Andy Peer

MIG phase 2 is currently in the planning stage and a proposal is due to be published in early January 2016. The current percentage of patient records shared out across the practices for M&A is 88% and N&S is 97%. CNCS have given notice on their Care Home Service and future plans to migrate the service over to SystmOne will no longer proceed.

None required. None required. None required.

Green Green Amber

Cancer Earlier Diagnosis of Cancer – analysis of the impact of the national recommendations for early diagnosis

Dr Thilan Bartholomeuz/Julia King

2nd meeting of Early Diagnosis work stream arranged for 3 May 2016 following the meeting of the NUH SFHFT Cancer Partnership Board, for comment and agreement of the Earlier Diagnosis clinical pathways and protocols proposals. Once agreements are reached with the Partnership Board, the Earlier Diagnosis work stream will start to progress the action

None required.

Green

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Cancer Pathways - phased programme of redesign and risk stratification of key tumour site

Dr Thilan Bartholomeuz/Julia King

plans, and report to the work stream meeting that will be held quarterly. Clinical Reference Group met on 25th Feb and agreed initial workplan of 3 key areas of development. Third Pathway model and pathways shared with clinical colleagues at NUH and received positive feedback, with agreements to share learning and progress to support a collaborative approach across Notts for the delivery of Earlier Diagnosis. The Programme submitted a bid to EMSCN for resource to support the Earlier Diagnosis Third Pathway. The programme has secured £42,000 to support the information sharing required to monitor progress through access to timely data collection across the system. Governance arrangements and monitoring to be led by the EMSCN. Agreement reached with SFHFT and NUH to review and redesign prostate and lung cancer pathways. Redesign of Breast Cancer Pathway to be reviewed over the next 6 months. Partnership between NUH and SFHFT positively received by the Pathways Workstream Membership. The meeting recognised that NUH and SFHFT have commenced development of transition plans across the Cancer Unit and Cancer Centre, which it is anticipated will need to be completed by Oct 16. THe Clinical Partnership Board will require further development to support the merging of the two Trusts in respect of Cancer and Oncology services, including review of the membership to include Commissioner representation. The Pathways workstream is delayed until the meeting of the Partnership Board on 15th April to gain formalised cross county agreement of the pathways priorities and agree the establishment of site specific groups to take the workstream forward,

None required.

Green

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Living with Cancer - deliver coordinated care through systematic assessment, care planning and proactive care for patients from the point of diagnosis, through their cancer pathway

Dr Thilan Bartholomeuz/Julia King

as subgroups of the Partnership Board. Next pathways meeting planned for 3rd May. Work is underway to confirm the outcomes, evaluation and KPIs of the Pathways workstreams, and the Living with Cancer Worksteam is working up the aftercare support to be in place at the end of treatment. Last Living with Cancer meeting held 30th March 2016. Next meeting scheduled 11th May 2016 Terms of Reference signed off Pathway mapping session held to scope workstream remit and areas of focus. Action plan progress reviewed, including milestones and risks Draft KPIs identified, to be reviewed by the group and feedback shared prior to next meeting. Feedback mechanism identified for work area updates, to be tested as part of next meeting. Mid Notts Patient & Carer Refererence Group will support completion of localised patient questionnaire to establish local views and experience. Questionnaire development due to start Health & Wellbeing Event planning meeting scheduled Model for Cancer care planning and self-care services under development Initial kick off meeting for eHNA rollout meeting scheduled Review of current programme Comms & Engagement plans ongoing - workstream enabler Workforce Review planning in progress - workstream enabler Data mapping and baselining underway - workstream enabler

None required.

Green

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1

April 2016

1

PROGRAMME STOCK TAKE

KPI & Benefit Tracking OBJECTIVE 1- 15.1% REDUCTION IN A&E ATTENDANCES

2

Observations The chart above shows the detail of ED attendances data for the Mid Notts CCGs with FY 14 actuals (baseline) and target trend lines, showing the current year compared with the targets for the FY15 and the CCG 5 year target. • The dotted redline shows the CCG 5yr Strategic Objective as per the original model. • The dotted black line shows our FY14 actuals which is our baseline for the model

Go Live Dates Social Marketing & Communications: Urgent Primary Care: Care Navigator : Readmission reduction:

KPI & Benefit Tracking OBJECTIVE 2 - 19.5% REDUCTION IN EMERGENCY ADMISSIONS

3

Observations The chart above shows the detail of Emergency Admissions data for the Mid Notts CCGs with FY 14 actuals (baseline) and target trend lines, showing the current year compared with the targets for FY15 and the CCG 5 year target. • The dotted red line shows the CCG 5yr Strategic Objective as per the original model

Go Live Dates Social Marketing & Communications: Urgent Primary Care: Care Navigator : Single Front Door:

KPI & Benefit Tracking OBJECTIVE 3 - 30.5% REDUCTION IN ACUTE BED DAYS

4

Observations The chart above shows the detail of acute bed days data for the Mid Notts CCGs with FY 14/ actuals (baseline) and target trend lines, showing the current year compared with the targets for the FY15/16 and the CCG 5 year target. • The dotted red line shows the CCG 5yr Strategic Objective as per the original model.

Go Live Dates Social Marketing & Communications: Urgent Primary Care: Care Navigator: Single Front Door: Community Discharge: Readmission reduction:

KPI & Benefit Tracking OBJECTIVE 4 - 25% REDUCTION IN ADMISSIONS TO NURSING AND RESIDENTIAL HOMES

5

Observations The chart above shows the detail of older people admissions into long term care for the Mid Notts with an actual and target trend line, showing the current year compared with the previous financial year, and targets for the FY15/16 and the CCG 5 year target. • The red dotted line shows the CCG 5yr Strategic Objective as per the original model.

Go Live Dates Reduction in long term residential care:

KPI & Benefit Tracking OBJECTIVE 5 - 9.8% REDUCTION IN SECONDARY CARE OUTPATIENTS REFERRALS

6

Observations The chart above shows the detail of GP outpatient referrals data for the Mid Notts CCGs with an actual and target trend line, showing the current year compared with the previous financial year, and targets for the FY15 and the CCG 5 year target. • The red dotted line shows the CCG 5yr Strategic Objective as per the original model.

Go Live Dates Referrals - Peer to Peer Review: Referrals - Templates and Guidelines: Referrals - Clinical Triage: Service Review – Cardiology: Service Review – Rheumatology:

KPI & Benefit Tracking OBJECTIVE 6 - 20% REDUCTION IN PAEDIATRIC ADMISSIONS TO HOSPITAL

7

Observations The chart above shows the number of spells of paediatric admissions for Mid Notts. • The red dotted line shows the CCG 5yr Strategic Objective as per the original model.

Go Live Dates Social Marketing & Communications: Urgent Primary Care: Care Navigator: Single Front Door: Community Discharge: Readmission reduction:

KPIs split by CCG

8

CCG Split OBJECTIVE 1- 15.1% REDUCTION IN A&E ATTENDANCE OBJECTIVE 2 - 19.5% REDUCTION IN EMERGENCY ADMISSIONS

9

Attendances at any A&E type 1-3 for Mid Notts CCGs: all providers. Source: SUS (CCG) Emergency admissions data for Mid Notts CCGs: all providers. Source: SUS (CCG)

10

CCG Split OBJECTIVE 3 - 30.5% REDUCTION IN ACUTE BED DAY OBJECTIVE 4 - 25% REDUCTION IN ADMISSIONS TO NURSING AND RESIDENTIAL HOMES

Number of non-elective bed days at Mid Notts. Source: Medway PAS (SFH) The number and proportion of people who were still at home 91 days after discharge from hospital into re-ablement / rehabilitation services. Source: Notts County Council

CCG Split OBJECTIVE 5 - 9.8% REDUCTION IN SECONDARY CARE OUTPATIENTS REFERRALS OBJECTIVE 6 - 20% REDUCTION IN PAEDIATRIC ADMISSIONS TO HOSPITAL

11

Number of referrals from Mid Notts GPs to Outpatient services: all providers. Source: SUS (CCG) Number of paediatric admission spells at SFHFT. Source: Medway PAS (SFH)