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NHS Rotherham CCG Governing Body – September 2015 CHIEF OFFICER’S REPORT

Lead Director: Chris Edwards Lead Officer: n/a

Job Title: CCG Chief Officer Job Title: n/a

Purpose This report informs the Governing Body about national/local developments in the past month.

Reselection of Strategic Clinical Executive (SCE) Members Following interviews held last month Dr Kitlowski & Dr Brynes have been reselected for a further 4 years. Two New Members of the Governing Body This month welcomes two new members to the Governing Body: • Dr Robin Carlisle who is the Lay Member with a lead role for overseeing Primary Care. His focus will

be strategic and impartial, providing an external view of the work of the CCG that is removed from day-to-day running of the organisation.

• Dr Jason Page who will share responsibility with other members of the Governing Body for all aspects of the Governing Body’s business. In addition Dr Page will bring a broader view of health and care issues to underpin the work of the group. In particular, he will bring to the Governing Body specific understanding of patient care/engagement in the primary care setting in Rotherham.

Each member of the Governing Body shares the responsibility as part of a team to ensure that the Group exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience. I welcome both new members to the Governing Body. Yorkshire & Humber Academic Health Science Network Annual Report and Business Plan Attached are updates from the Yorkshire & Humber Academic Health Science Network, including a link to their Business Plan and Annual Report.

Appendix(1)

The future of the Academic Health Science Networks (AHSNs) Following Ed Smith’s (Deputy Chair NHS England) review with reference to Leadership Development and Improvement. The following links give details of the findings and next steps: Joint statement from the Yorkshire & Humber AHSN and Yorkshire & Humber SCN Joint statement from Dr David Black and Professor Graham Venables Introduction by Ed Smith to the Improvement and Development Leadership Review The Improvement and Development Leadership Review Update for Staff & Partners following the Improvement and Development Leadership Review Assurance Operating Manual NHS England has published the CCG Assurance Operating Manual, including details of the new special measures regime and a CCG quarterly self-certification for delegated functions. Queries can be directed to NHS England regional teams in the first instance or by emailing england.ccgassurance@nhs.net CCG Assurance: Delegated Functions Self-Certification 2015/16 The CCG Assurance Framework for 2015 /16 sets out a new assurance process that takes account of the need for NHS England to have specific additional assurances from CCGs who have taken responsibility for the commissioning of primary medical care services under delegated authority (‘Delegated Functions’) or a joint commissioning arrangement with NHS England. The Governing Body are asked to agree the attached assurance document on delegated commissioning of Primary care which will be required to be submitted to NHS on a quarterly basis. The Chief Officer and Chair of the Audit Committee are asked to sign on the CCGs behalf.

Appendix(2)

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Dame Barbara Hakin, NHS England Letter to all CCGs - Assurance required NHS England has requested assurance from all CCGs that appropriate systems and processes are in place to ensure that conflicts of interest or potential conflicts of interest are declared and mitigated. Rotherham CCG has responded to the request

Appendix(3)

Amendments to The NHS Constitution It was first published in March 2012 and is due to be refreshed fully in March 2023. However the Constitution was updated in July 2015; this paper notes those changes.

Appendix(4)

Communications Update • Pulse magazine are publishing a feature on Personal Health Budgets following a Freedom of

Information request in August. A media statement, from Sue Cassin, was been provided to Pulse on behalf of NHS Rotherham CCG

• There has been significant local and regional media interest in the first anniversary of the Alexis Jay Report into Child Sexual Exploitation in Rotherham. The main focus of media interest is on the police and local authority services.

• An Emergency Centre website has been developed and will be launched to the public in early September. The web link when the site is live will be www.rotherhamemergencycentre.nhs.uk

Recommendation The Governing Body is asked to note the Chief Officer’s Report and agree the assurance document on delegated commissioning of Primary Care.

ANNUAL REPORT2014/15

Testimonials 3

Chairman’s Foreward 5

Managing Director’s Foreward 6

Strategic Overview 7

Developing the Ecosystem 8

Delivering patient and population benefits 10

Delivering efficiency and supporting enterprise 14

Our Work Revisited: Patient Falls 18

Our Work Revisited: Workplace Wellness 20

Our Work Revisited: PADs 22

Financial Report 24

Matrix of Metrics 2015 26

Registered Directors: Biographies 30

Content

Look out for factsand figuresrelating to ourImprovementAcademy

3

TestimonialsWe have been delighted with the work we have been

doing with the Yorkshire & Humber AHSN Improvement

Academy on safety huddles. The whole ward team have

really embraced the safety huddle concept. We have

reached the milestone of 30 days without a fall today,

which given the history of falls on this ward is really

significant. We don’t often get a chance to say ‘Well done!’

Dr Alan Hart-Thomas, Clinical Director,

Calderdale & Huddersfield NHS Trust

The Y&H AHSN has provided invaluable

support through provision of industry

expertise, contacts and resources. This has

enabled the comprehensive testing and roll-

out of our highly efficacious staff wellbeing

service, which simply would not have been

possible for a higher education institution, thus

benefiting both the NHS and the university.

This support is enabling the programme to

progress into a viable business proposition.

Professor Ian Maynard, PhD, C.Psychol,

F.BASES, F.AASP

Input from the Yorkshire Y&H AHSN had been

pivotal in allowing Selex to get the programme

underway by demonstrating a commitment from

the AHSN to the work that communicated the

importance of the collaboration with Selex to the

larger Selex corporate body. CFHealthHub has

the potential to empower young people with

cystic fibrosis to manage their own care and we

hope that this will improve quality as well as

duration of life at the same time as enabling

significant cost savings across CF care.

Dr Martin Wildman, MSc, PhD, MRCP

Honorary Senior Clinical Lecturer

Health Services Research, ScHARR,

University of Sheffield

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Active safetyimprovement workwith 35 frontlineteams that haveestablished regularteam safetyhuddles

Yorkshire & Humber

The AHSN Network

5

Chairman’s Foreward

At the beginning of the year leading into 2014/15 the Yorkshire & Humber

Academic Health Science Network (AHSN) was initially hosted by Sheffield

Teaching Hospitals NHS Foundation Trust, for which we are very grateful.

During the year, with the unanimous support of the interim steering group, the

AHSN became a Company Limited by Guarantee (CLG), appointed four

registered directors and established an accountable and strategic Board of

Directors, which ratified the CLG decision. The Board, having run extensive and

intensive competitions, then appointed Andrew Riley as its first Managing

Director and subsequently as its first executive directors Richard Stubbs, Dawn

Lawson and Sally-Anne Naunton. Governance and set-up of the CLG continued

at pace during 2014/15, with the subsequent appointment by the Board of

accountants, auditors and lawyers for the business.

The Managing Director has gone on to fully embed and establish the talented

senior management team that has delivered a broad and complex programme

through year one. It was pleasing to note the unqualified positive opinion of

NHS England for the quarter four and year-end quality assurance rating. The

production of the business plan for 2015/16 evolved from the lessons learned

throughout the year, and the canvassing of stakeholders through regionally held

stakeholder events, and hence reflects the support our members have told us

that they need from the AHSN to deliver their complex agendas.

The AHSN is pleased to have developed good and trusting partnerships with its

key stakeholders, in particular with the Strategic Clinical Network (SCN), with

whom integrated plans have been developed. We have also worked closely

with Medilink and Medipex who have supported our economic growth agenda,

Bradford Teaching Hospitals who host our (now) nationally recognised AHSN

Improvement Academy, and Sheffield Hallam University who are key strategic

partners in delivering the workplace wellness programme that has also been so

well received at national level.

We have been delighted to host a number of visits from key national and

international leaders and to form new and exciting relationships with

complementary organisations around the world, with the support of UKTI,

Healthcare UK, BIS and the Office of Life Sciences.

The challenge for 2015/16 is going to be maintaining and stepping up delivery of

the business plan and key objectives and evidencing the impact we are making

for patients, but based on this year I am excited and encouraged by the

prospects for the coming year.

I would like to express thanks to all our stakeholders, employees and Board

members for their support, commitment and hard work during the last year and look

forward to great outcomes this year from the work and plans which are in train.

Professor William Pope

Chairman

Y&H AHSN

6

The AHSN has, in its first year of operation, made considerable progress in

delivering its five-year objectives of contributing to the improvement in public

health, improving health service delivery and its cost-effectiveness and supporting

both regional and national economic growth. My executive director team and I

have developed our capacity and capability over the year and recruited some very

experienced leaders to deliver the exciting agenda which has been recognised by

NHS England through the quarterly review feedback we have received.

Although the AHSN is now a CLG with the benefits this brings, it remains firmly

positioned as a member organisation completely subscribing to NHS values and

with a clear focus on supporting members in improving patient outcomes and

experience.

At the outset, we identified how important achieving sustainable behaviour

change was and the need to create improvement capacity and capability locally.

We established our Improvement Academy and over 150 frontline improvement fellows embedded in member

organisations are now leading complex improvement programmes.

As an organisation working mainly through networks and across systems, developing strong partnerships with

public and private organisations has been an essential feature of the year. There is still uncertainty about the

configuration of the ‘improvement tier’ at regional level, with discussions currently taking place on the future roles

and configuration of Strategic Clinical Networks, Clinical Senates, NHS Leadership, NHSIQ and AHSNs. So we

have worked closely with the senior team at the SCN to ensure we have complementary plans that will enable

integration whatever the final decisions on future configuration might be. The key thing is not to pause

implementation and delivery.

We have had some important successes in our first year that have made a significant impact, and you will find some

of the highlights in this report, but specifically our key successes have been our workplace wellness programme,

establishing our Improvement Academy, re-launching the regional NHS CEO meetings, and working with Yorkshire

& Humber Medlink and Medipex to establish a well respected small-medium enterprise (SME) programme.

Just as important as delivery is ensuring that the work we undertake is both evidence based and its impact is

thoroughly and independently evaluated. To this end we have developed very important strategic partnerships

with both York Health Economics Consortium (YHEC) and the School of Health and Related Research (ScHARR) at

the University of Sheffield, which are supporting our evaluation programme and providing valuable health

economics advice for the start-up companies with which we are working.

We have used our NHS England core income to leverage matched funding through both membership income and

very importantly also from other external funding sources. In total, including additional funds secured by our

Improvement Academy, we generated more than £1.7 million of matched funding in the year which represents over

50% of our NHS income against a target of 20%.

Although we have achieved a lot in this, our first year of operation as a CLG, we have also learned a lot too.

Particularly ensuring that our future plans are carefully aligned to those of our members and key stakeholders such

as NHS England, UKTI, Healthcare UK, BIS and OLS. Our plan for 2015/16 reflects the many discussions and

outcomes from planning events we held across the region, and whilst it remains a broad and ambitious

programme, we are confident that it reflects the needs of our members’ as articulated to us, and that we are

building the infrastructure (in both our members organisations and in the senior central leadership) needed to

deliver it. We also realise that we need to be better at communicating what we are achieving and have recently

expanded our communications team to enable this.

In conclusion, our first full year as a CLG has been eventful, we have grown as an organisation and learned a lot. I believe

that we are now very well positioned to continue adding value and having an impact as a trusted regional organisation

helping our members lead the significant delivery and change agenda facing the NHS over the next five years.

Andrew Riley

Managing Director

Y&H AHSN

Managing Director’s Foreward

OverviewOur strategic priorities asan remain focussed onthree core objectives:

• Improving Population Health

• Improving Healthcare

• Generating Economic Growth

In October 2014, NHS England released a five-year strategy

document, The Five Year Forward View, with significant implications

for the NHS, establishing Vanguards, Test Beds and new models of

care that are being supported by AHSN.

We have aligned our 2015/16 business plan to reflect the priority

areas of the Five Year Forward View.

Throughout the year we have worked hard to ensure that we

understand local needs and priorities. We held three regional

workshops for members and our business plan for 2015/16 reflects

members’ input.

One of the strengths of the AHSN is our ability to work in

partnerships and we have engaged extensively with regional

stakeholders such as the Strategic Clinical Network, Health

Education England Leadership Academy for Yorkshire & Humber,

Public Health England, and National Institute Health Research

Clinical Research Networks.

We have also aligned our programme of work to the needs of our

members and the priorities of other national stakeholders, including

The Office of Life Science, Strategy for UK Life Sciences, UK Trade

and Investment Life Science Organisation Strategy and Healthcare

UK Strategic Business Plan.

We work closely with the Northern AHSNs and the broader AHSN

system to achieve common goals aligning education, clinical

research, informatics, innovation, training and education, and

healthcare delivery. We are working to improve patient and

population health outcomes by translating research into practice,

and developing and implementing integrated healthcare services.

The AHSN is supporting knowledge exchange to build alliances

across internal and external networks and actively share best

practice, and provide for rapid evaluating and early adoption of

new innovations. We are also working with YHEC and ScHARR

who are evaluating the impact of our work.

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Developing the Ecosystem

The past 12 months have been a period of successful

transformation for the AHSN following a successful first

year in operation. Initially hosted by Sheffield Teaching

Hospitals NHS Foundation Trust we became a

Company Limited by Guarantee in February 2014. We

have four Registered Directors, legally responsible for

the lawful transaction of business and to ensure that

the CLG is a going concern. Our Interim Project Board

has been replaced with a Strategic Board that meets

every three months to discuss strategic direction and to

assure delivery of the operational plan. The Board

consists of nominated and invited directors

representing CCGs, NHS, industry, universities,

CLARHC, CLRN, LETB and SCN.

In 2013/14, our first year of existence, we launched a

series of successful programmes, with highlights

being our NHS Staff Workplace Wellness programme,

our Inpatient Falls Reduction programme and the

economic growth programme.

In 2014/15 we have continued to build upon our key

achievements of the previous year, extending

successful programmes and expanding our range of

work into other areas. We have achieved this whilst

simultaneously strengthening the foundations of the

organisation through major works including:

Member and stakeholderengagement We are developing our stakeholder engagement as a

means of describing a broader, more inclusive, and

continuous process between the AHSN and those

potentially impacted by our activities. Although the

Yorkshire & Humber region is geographically

extensive we invest in face-to-face meetings between

member CEOs and partners of the AHSN. We

regularly meet with other stakeholders and business

contacts with the aim of developing a true

understanding of the region and the people within it.

We have recently commenced a programme of

regular updates and newsletters to increase

awareness of our programmes and extend our reach

across the region.

More than 30

partner

organisations are

represented in our

Quality Improvement

Training Advisory

group

9

Expanding our core team During the past 12 months we have recruited to strengthen our delivery capacity, with significant additions to

the programme office and commercial teams. We have ensured we build our work around our expertise of

system leadership, open innovation and international engagement. We have also strengthened our corporate

team to ensure that we have the appropriate support functions to run our business successfully.

Developing the scale of work of our ImprovementAcademyOur Improvement Academy continues to deliver real step changes for our member organisations. The success

of our Inpatient Falls Reduction, Patient Flow, and mortality reduction programmes has been scaled up,

receiving grants from the Health Foundation and others and recognised as national examples of best practice.

The methods used in delivering these programmes have been extended across other areas.

Building key partnerships underpinning our workAs a network it is important that the AHSN builds extensive partnerships with academia, industry, research and

the health sector. These partnerships underpin our work and ensure we can deliver against our strategic

objectives. During the past 12 months we have formed significant partnerships with a number of organisations

including ScHARR, YHEC, Yorkshire & Humber SCN and Yorkshire & Humber Leadership Academy. The

Director of the SCN attended all of the AHSN planning meetings in the year and sits on the AHSN Strategic

Board. The COO from the AHSN is a member of the SCN Board, ensuring understanding and alignment of

key priorities.

Delivering patient andpopulation benefits

Urgent & Emergency Care(UEC)

BackgroundIn 2014, the AHSN commenced work on our urgent and

emergency care project. The project was initiated following

feedback from our members regarding local challenges.

Both CEOs and Chief Accountable Officers formed a consensus

that urgent & emergency care is a critical challenge.

The AHSN was asked to support a project to develop a better

understanding of UEC care demand within the region.

Why is this work important?In addition to being a project that serves the needs of our

members, the UEC care project is supportive of NHS England

and the Five Year Forward View. In the winter of 2014/15

Accident & Emergency Departments suffered from excessive

demands with most organisations falling short of the four hour

wait time target. Our work in this area will support both our local

and national stakeholders as they plan for winter 2015.

Over 800 attendees

at master classes,

workshops and

roundtables held

around Leeds, York,

Sheffield & Hull

10

Our contributionThis project commenced in November 2014 with a

conference that brought clinicians, managers,

commissioners, providers and academics to identify a

better understanding of the system and identity key

challenges.

The project uses a collective, connected and

co-ordinated ‘systems thinking’ approach with experts

in the region participating in four task and finish groups

that will develop resources to;-

• Map the UEC system surrounding pilot CCG areas to

identify flow; demand; misalignment; and system

blockages

• Identify predictors which give a window for

intervention and avoid A&E attendance via practiced

intervention

• Predict tomorrow’s Urgent Emergency Care (UEC)

demand – collect GP practice level data to support

near real-time prediction of UEC demand and

support capacity planning in the acute sector

• Promote UEC access to patient records by bringing

data together for direct patient care and use of the

Frailty Index to better understand patient flow

What’s next? During 2015/16 the AHSN will be confirming up to

three pilot sites and working with them to develop

local project objectives. One of the region’s vanguard

sites has come forward as an initial pilot site to identify

their specific system challenges and solutions. Work

has now begun to tailor the project requirements for

each pilot site area to their local needs.

The outputs from the task and finish groups together

will be brought together in order to generate and

prioritise ideas for testing followed by wider

implementation across the region.

PatientsThe King’s Fund

reported that EmergencyDepartment

attendances reached14.2 million in 2013-2014, a 12% increasefrom 2003-2004.1 2

TargetsThe four hour waittarget is 95%, but

departments struggle tomeet this. The number

of patients waitingbeyond four hours

reached its highest levelof 9% in the final quarter

of 2013/2014.2

BedsEmergency admissions

have increased by 47% over the past

15 years.3

StaffingThe College of

Emergency Medicinereported a less than

50% fill rate into highertraining for the

speciality in 2011-2012.4

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1 Department of Health (2011) Total time spent in accident and emergency (pre-2011/12 Q2) (online)

2 NHS England (2014) A&E waiting times and activity (online)3 Emergency admissions to hospital: managing the demand. London: NAO, 20134 College of Emergency Medicine. Emergency medicine taskforce interim report. London:

CEM, 2012

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Delivering patient andpopulation benefits

Patient Flow

BackgroundMeeting daily demand for admissions is a challenge

faced by all NHS organisations with an inpatient bed

base. Hospital trusts experience problems with

patients backing up for admission when the hospital

is ‘full’ and sick patients need to be admitted. Some

of the major reasons why this happens are related to

the ‘flow’ of patients through the hospital.

For example:

1. Most discharges happen in the afternoon or early

evening whilst admissions happen throughout the

day, resulting in patients waiting until the later part of

the day to get a bed.

2. There are a significant proportion of patients who

do not need to be in a bed. Estimates suggest that

this is generally about 30%.

Why is this work important?Patient flow is a priority for many hospitals. Rapid

access to a hospital bed is important for the safety of

sick patients. It is also true that staying longer than

necessary in hospital is not good for patients who may

risk losing confidence or their independence. In

addition, hospitals which do not have effective patient

flow may also have difficulty in meeting the national

four-hour standard for patients waiting in A&E.

Our contributionWe have worked with patient flow experts Operasee

to implement operational management tools ‘Visual

Hospital’ and ‘Plan for every patient’ in Scarborough

Hospital. Building on the learning and our

experience of Calderdale and Huddersfield NHS

Trust, who demonstrated a 30% reduction in length of

stay on medical wards, we have systematically

introduced the same tools into Scarborough Hospital.

Through our Improvement Academy we have

provided:

• Experienced project management to guide and

facilitate Scarborough Hospital in their learning

and in the implementation of patient flow tools.

• The analytical skills to evaluate both the results

and the learning from this project so that other

hospitals can take steps to address their own

patient flow issues.

Mapping a patient’s inpatient journey shows that the

majority of time is spent waiting. This project

demonstrates that when we design processes to

provide what patients need when they need it,

they’re satisfied, and length of stay reduces making

patient flow much easier for us to manage.

Whilst this is still very much work in progress early

length of stay results at Scarborough are very

encouraging and show a result in the order of 20%

reduced length of stay.

44 NHS partner

organisations

visited at top team

level

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What’s next?The lessons from initial implementation sites will be shared through facilitated and targeted regional

Roundtable and Masterclass events, which will be opened up to interested trusts in the region. Following on

from this we will support wider and sustainable spread through a rigorous and supported Train the Trainer

approach. The exciting synergy with the Patient Safety Collaborative work programme will be fully exploited

to support the implementation and embedding of this approach, to deliver safer and more efficient care, and

to enhance the value of this work programme for member organisations.

“…. unlike previous years, we have been able to review every single patient, every two hours and targetresources appropriately to effect an increased number of discharges.”

Mandy McGale, Director of Operations, Scarborough Hospital

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Delivering efficiency andsupporting enterprise

Open InnovationProgramme

BackgroundDelivered in partnership with Medilink Yorkshire &

Humber, 2014/15 saw the AHSN work closely with

colleagues from across the region to deliver a

unique Open Innovation programme for regional

SMEs, academics, clinicians and other leading

experts.

The programme was designed to trigger the

development of new projects and consortia

to cultivate new products and meet unmet

clinical needs.

Why is this workimportant?The Open Innovation programme has provided

opportunities for industry to create meaningful

dialogue with the healthcare system to identify

specific clinical needs. This has allowed a demand

pull for innovation to take place, rather than the

traditional supply side push. As a consequence

projects have been developed resulting in new

products, secured funding and a call from both sides

of the relationship to continue this work in 2015/16.

Our ContributionDuring the past 12 months the AHSN has hosted a

series of workshops both nationally and

internationally; highlights of just three of those

programmes are shown:

Workshop 1: Diagnosis of disease,

trauma and pathology of the

gastrointestinal system

Run in June 2014, this workshop was delivered in

partnership with the Colorectal Therapies Healthcare

Technology Cooperative. It brought together

expertise across the region including 20 academics,

12 clinicians and five companies. The outcome was

fantastic and generated 10 new collaborative projects

using innovation in biosensing, nanotechnology,

biomaterials and engineering. The workshop was a

huge success and these projects have gone on to

secure more than £100k of funding to support further

development.Our Open Innovation

Workshop has seen the

development of 24 new

innovations and

generated over £100k

of additional investment

into the region

Workshop 2: Diagnosis and treatment

of wound infection

Workshop 2 was run later in the year and brought

together eight academics, two clinicians and six

companies. This time we partnered with the

WoundTec Healthcare Technology Collaborative to

generate 14 new innovation projects. Projects from

this workshop have generated significant interest

from national partners and at the time of writing we

are awaiting the outcome of several bids that are

expected to generate significant funds to support

continued project development.

UK/China Open Innovation

In 2014, the AHSN worked in partnership with the

University of Bradford’s Health Tech Open Innovation

Team to deliver our inaugural UK/China Open

Innovation Programme. The programme was

delivered in the Chinese province of Guangzhou

during November of 2014, pairing UK SMEs from the

health and care sector with strong partners in China.

This enabled the development and successful

commercialisation (in China and the rest of the world)

of potential and existing health technologies within

the NHS, SMEs and academia. The workshop

focussed on opportunities capable of realising a

commercial return (either through sale or out-

licensing) inside four years. As part of the

programme the UK/China collaboration has secured

more than £850k of funding at the time of writing,

with more expected.

What’s next?The Open Innovation programme continues to

expand: further international partnerships have been

developed with Canada and a second workshop in

China with a focus on Point of Care Diagnostics is

being planned, with up to £2 million of ring-fenced

funding assigned by the Chinese municipal

government for the workshop.

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16

Over 10 newinternationalcollaborationsgenerating morethan £850k ofinvestment

Delivering efficiency andsupporting enterprise

Industry Engagementand InnovationAdoption

BackgroundThe strength of our industry engagement programme

has been a key part of our success during 2014/15.

Driven by our commercial team, with a remit for

regional economic growth and wealth creation, we

have developed strategic partnerships and delivery

programmes in collaboration with SMEs and

multinational organisations. During 2014/15 we have

met and engaged with over 100 industry

organisations and supported more than half of those

with further development and support.

Why is this work important?The UK has one of the strongest and most productive

life science sectors in the world, generating an

annual turnover of over £50 billion. The sector

comprises nearly 5,000 companies, and employs an

estimated 175,000 people. The NHS benefits greatly

from the groundbreaking innovations that are created

in the sector. Our industry engagement programme

builds stronger relationships between the NHS and

industry resulting in better, more effective solutions

for our patients, as well as safeguarding and creating

life science sector jobs.

Our contributionA diverse range of projects and partnerships have

been created through our Industry Engagement and

Innovation Adoption programme. Our support

includes a variety of solutions, from providing funding

for our members, to supporting their engagement

with industry partners, to forging a network of over

150 innovation scouts, driving innovation within our

member organisations. Detailed are just two of our

many projects within this programme of activity.

Blackbox

The AHSN has developed a commercial partnership

with Yorkshire-based company Blackbox Medical

(BBM). The partnership sees both the AHSN and

BBM financially supporting CCGs to adopt BBM’s

innovative and unique data validation toolkit, which

identifies the level of patient discharge errors

occurring within a practice and the subsequent errors

in SUS episode coding and tariffs. The technology

has been proven to dramatically increase patient

safety whilst providing financial accuracy for NHS

organisations.

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National Innovation Accelerator

We have continued to support national programmes

aimed at promoting the spread and adoption of

innovation. The NHS National Innovation Accelerator

is one of these and we are one of six AHSNs who are

supporting the programme.

The programme invites healthcare pioneers from

around the world to apply to develop and scale their

tried and tested innovations across the NHS. The

programme focusses on the conditions and cultural

change needed to enable the NHS to adopt

innovations at scale and pace, aiming to improve

outcomes and give patients more equitable access to

the latest products, services and technology.

Whats next?In 2015/16 we have a number of programmes aimed

at further developing our offerings to industry and

building lasting partnerships between the NHS and

Industry to better support patient care, improve NHS

operating efficiency and generate regional and

national growth.

Industry Engagement Portal

This project will see the development of a

comprehensive support programme for UK

businesses and NHS entrepreneurs . It will create a

single point of access to the NHS, and a pipeline of

validated innovation for frontline delivery that creates

growth for UK plc and increases quality in NHS

provision. It will allow for fast, effective engagement

across all sectors, providing information and support

on procurement advice, system education,

consultancy support, signposting, health economics

expertise and market access strategy creation.

Commercial Partnership Programme

The Yorkshire & Humber Commercial Partnership

Programme began in 2014 with engagement with

Black Box Medical. The 2015/16 period will see an

extension of this programme with a core focus on:

• Supporting regional/UK SMEs with improving

market access and increasing sales

• Identifying innovation solutions and enabling the

opportunity for NHS bodies to adopt them

• Generating a commercial return for the AHSN

• Proof of Concept

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Our work revisited

Reducing InpatientFalls on HospitalWardsBackgroundFalls are a common and serious problem estimated to

cost the NHS more than £2.3 billion per year. 1

The human cost of falling includes distress, pain,

injury, loss of confidence, loss of independence and

mortality. Impact can also be seen on family

members and carers of people who fall.

Inpatient groups who are seen as being at most risk

of falling are:

• All patients aged 65 and older

• Patients aged 50 to 64 who are judged by a

clinician to be at higher risk of falling because of

an underlying condition.

Inpatient falls can lead to hip fractures and other

injuries, whilst even falls without harm can lead to

loss of confidence and increased length of stay.

Through our Improvement Academy, the AHSN is

working with 20 frontline teams across the region to

reduce patient falls. The work has resulted in

impressive results, including:

• Teams achieving a significant reduction in inpatient

falls evidenced by at least one step change

reduction in run charts plotting “falls per week”.

A group of four wards has reduced the combined

average number of falls per week by 60%.

• Sustained periods of time without any falls. One

ward has moved from an average of one fall per

week to repeatedly achieving 30 days between

falls and up to 60 days. .

A preliminary health economics evaluation is showing

this work as providing savings of £185k with costs of

running the programme at £39k. Work to scale this

programme is already underway. In March 2015 a

falls summit in collaboration with three other AHSNs

in the north was held. The event was attended by

over 200 delegates.

Why is this work

important?NHS England has identified the need for harm

reduction associated with falls. The Francis report

highlighted the importance of culture when

addressing the safety of patients.

Among older adults, falls are the leading cause of

both fatal and nonfatal injuries.2

1NICE Falls: Assessment and Prevention of Falls in Older

People (CG161). London: Nice 2013.

www.nice.org.uk/guidance/cg161

2Centers for Disease Control and Prevention, National Center

for Injury Prevention and Control. Web–based Injury Statistics

Query and Reporting System (WISQARS) [online]. Accessed

August 15, 2013

Our contributionHands on support to frontline staff to test implementation

interventions with staff supported in the introduction of daily safety

huddles to identify patients at risk of falling.

Assessment of teamwork, safety culture and measurement support

of impact is provided. Analysis of small test of change using PDSA

cycles and easy to understand visual display of data for teams.

Celebrating success and positive reinforcement of actions by

recognising achievements.

The AHSN also provides a forum for different teams to link and

learn from each other through regular meetings and

communication.

What’s next?In 2014 a Health Economics Evaluation was conducted on the safety huddle intervention provided by the AHSN

Improvement Academy. This showed that the intervention had sustained a reduction in falls over a period of six

months. The evaluation calculated the cost of the intervention at £38,704 annually, with over 50% of that being

additional time for the safety huddle to take place in order to brief staff on patients at risk of falling. Total annual

savings from the evaluation were calculated at £185,690, giving an ROI of 388%. Sensitivity analyses indicate the

expected ROI is robust to changes in event rates, costs and savings.

Due to the impact this work has had, the AHSN is scaling up this work in the region and beyond so that 80% of

organisations within the region engagewith the projec,t including Acute, Mental Health and Primary Care

providers.

The Improvement Academy is working in partnership with Leeds Teaching Hospitals NHS Trust to be part of the

Health Foundation Scaling Up Improvement Programme. The Scaling Up Improvement Programme will run for

2.5 years and receive up to £500,000 of funding to support the implementation and evaluation of the impact of

the patient safety huddle work at whole hospital level.

Beyond the Yorkshire & Humber region the work on scaling up has commenced: a recent falls prevention

summit was held in conjunction with the three other AHSNs in the north of England attended by over 200

delegates. Meanwhile the Improvement Academy has been engaged with Kent, Surrey and Sussex AHSN as

part of a training programme that showed the impact of the safety huddle intervention and how it could be used

to improve patient safety culture and impact on a much wider scale beyond falls prevention.

19

Our work revisited

Workplace Wellness BackgroundThe health and wellbeing of NHS staff is crucially

important in delivering first-class patient care, with

workplace incentives identified as a priority of 5 Year

Forward View, with a need for the NHS to set a

national example.

Poor staff health and wellbeing is estimated to cost

the UK economy around £100 billion a year. In 2009,

Boorman reported the annual cost of absence per

employee per year within the public healthcare

sector as £1,153. With 1.3 million employees, reducing

NHS staff absence by one-third could save the NHS

£500 million per year.

The AHSN partnered with Sheffield Hallam University

and the National Centre for Sport and Exercise

Medicine to develop a Workplace Wellness

programme which has now been rolled out into three

NHS Trusts: Sheffield, Bradford and Airedale.

In a study of 277 participants across the programme

the Workplace Wellness programme delivered the

following results:-

• 98% agreed that staff health and wellbeing was a

valuable workplace benefit

• 97% rated their experience of the programme as

excellent or very good

• 95% reported making changes to their health or

lifestyle

• 45% were identified as having one or more risk

factors for cardiovascular disease (CVD), of which

• 42.9% improved their health by reducing at least

one risk factor within six months of starting the

programme

• The programme has shown that for every £1 spent

on the programme, the NHS as an employer saved

£3 in costs.

Over 100

consultants and

junior doctors

trained as gold

standard mortality

case note reviewers

20

A health economics evaluation has shown that

reductions in CVD risk factors are linked to improved

productivity and patient outcomes, with a potential

ROI for the project, based on absenteeism data

estimated from the Sheffield Teaching Hospitals pilot

and the Boorman report, at between 302% and 571%.

Why is this workimportant?The Five Year Forward View set out a need “in

extending incentives for employers in England who

provide effective NICE recommended workplace

health programmes for employees. We will also

establish with NHS Employers new incentives to

ensure the NHS as an employer sets a national

example in the support it offers its own 1.3 million

staff to stay healthy, and serve as “health

ambassadors” in their local communities.”

Our contributionThe AHSN has worked in partnership with Sheffield

Hallam University and the National Centre for Sport

and Exercise Medicine to roll out the Workplace

Wellness programme across different NHS

organisations in the region.

The AHSN is now working to identify the

opportunities to scale up the project further, including

with NHS organisations beyond the Yorkshire &

Humber region, and the business opportunities

available in delivering the programme to the private

sector and other public sector bodies.

What’s next?Work is well underway in scaling this programme

throughout the Yorkshire & Humber region and

beyond. Over 60% of trusts within our region have

expressed an interest in starting the programme

within their organisations and further enquiries have

been received by NHS organisations outside of the

region.

A feasibility study is also underway investigating the

business opportunities that exist outside of our core

audience of the NHS. A number of public and private

sector organisations have approached the AHSN for

delivering this work to their organisations, with the

potential scope of engaging with over 20,000

citizens.

Sophisticated software and hardware devices are

also being developed and patented which will look to

revolutionise this workspace.21

22

Our work revisited

Location andIntelligent Mapping ofPADs in Yorkshire &Humber BackgroundThe AHSN is working with the Yorkshire Ambulance

Service (YAS), British Heart Foundation (BHF) and

NHS England to determine the location and details of

all Public Access Defibrillators (PADs) in the region.

The recent Cardiovascular Disease Outcomes

Strategy from the Department of Health (2013)

recognised the need to prioritise resuscitation from

out of hospital cardiac arrest as an area for

improvement. It is estimated that up to 75,000

OHCAs occur each year in the UK. Ambulance

services attempt resuscitation in approximately

36,000 (40%) of cases per annum. At present, only a

small number of individuals survive. There is,

however, significant variability between ambulance

services in rates of successful initial resuscitation (13-

27%) and survival to hospital discharge (2-12%)

following an OHCA. Scrutiny of international data

reveals that regions in Scandinavia and the United

States have survival rates of over 50% for some

patients who have a cardiac arrest in the community.

If survival rates were increased from the overall

national average (around 7%) to that of the best

reported (12%), it is estimated that an additional 1,000

lives could be saved each year.

Why is this workimportant?When someone has a sudden cardiac arrest (SCA),

every minute without CPR and defibrillation reduces

their chances of survival by 7-10%. More individuals

with SCA will survive to hospital discharge if

laypersons undertake cardiopulmonary resuscitation

for and employ a PAD. As a result of the

‘Defibrillators in Public Places to Initiative’, PADs were

placed in airports, railway stations and other public

places. PADs have been shown to be safe and can be

used without first aid training. The use of a

defibrillator prior to the arrival of ambulance services

has shown to approximately double rates of survival

after OHCA.

Over 200

Improvement

Fellows and

Innovation Scouts

supporting

improvements in

healthcare22

However, this is currently often dependent on

Emergency Medical Dispatchers directing bystanders

to the nearest accessible device. A recent audit

carried out by the BHF for ambulance trusts within

the UK showed that there is no standardised way of

collecting, storing, using or cleaning the data on the

location of PADs within each ambulance trust’s

catchment area. Currently there is patchy

intelligence on the number of PADs per trust, with

registered numbers ranging between 65 and 2000.

In addition to problems locating all available-to-use

PADs, information on where best to deploy the

devices is not routinely available.

Our contributionTo assist in determining the location and details of all

PADs in Yorkshire & Humber where defibrillators

should be placed in the community. The overall goal

will be to increase the use of PADs in OHCAs and

increase survival rates. The AHSN will assist in

bringing together data from across the region, using

our members, our partners and promoting

crowdsourcing campaigns to identify the location of

PADs across the region.

What’s next?Following the detailed crowdsourcing campaign to

identify the location of PADs across the Yorkshire &

Humber region cardiac arrest data will be overlaid

and cross-referenced against PAD location and

analysed to determine whether there are patterns or

hotspots that will allow the intelligent deployment of

subsequent devices. Work will then take place to

understand barriers to the use of identifiable PADs

(because current usage of existing devices is low,

even when OHCA occurs in the vicinity of the PAD).

The project will significantly increase public

awareness of resuscitation and use and location of

PADs, thus leading to:

• Increased use of PADs

• Increased rates of survival to hospital discharge

from OHCA

• Increased rates of successful initial resuscitation

• Reduction in the average time to CPR and

defibrillation

23

24

Financial Report

The 2014/15 financial year, to 31st March 2015, was

the first period the AHSN was established as a

company limited by guarantee.

The AHSN brought forward a balance of £1.218m from

2013/14. The income received for 2014/15 was

£4.853m; 70% of this income was derived from NHS

England funding of £3.375m. The remaining 30% of

income was made up of £0.92m membership fees

from 44 members and £0.558m from other sources

including RIF funding and commissioned work.

The Executive Team were appointed in May 2014,

including Dr Dawn Lawson as Chief Operating Officer,

Richard Stubbs as Commercial Director and Sally-

Anne Naunton as Director of Corporate Services,

joining the Managing Director Andrew Riley. Further

appointments were made during the course of the

period via a combination of employment and

secondment arrangements as the team was

established. At the period end the team is made up

of 11 staff and four Directors which accounts for the

£0.943m of pay expenditure for the year.

During the period, £2,771m of funds was spent on

programmes, representing financial support for a

number of partners, including the Improvement

Academy, Sheffield Hallam University, YHEC and

ScHARR.

Other non pay expenditure has been incurred during

the period of £0.309m, including the establishment of

an office in Wakefield.

During the period changes have been made to the

company’s Articles of Association to clarify the

objectives of the company as a not-for-profit

organisation. As such the only surplus subject to

corporation tax is the interest received balance of

£4,067. The company is seeking clarification from HM

Revenue & Customs regarding the tax status;

however, in the event that no further guidance is

provided the company will continue to apply this tax

treatment on a self-assessment basis.

The AHSN has an acceptable level of general

deferred income of £2.043m going into the new

financial year, which provides sufficient working

capital in order to cope with funding historically

received up to four months in arrears, and enables

the company to meet all necessary contractual

obligations. The AHSN is financially stable and

confirms that with the forecast trading position it

remains a going concern for the foreseeable future.

£1.7m additional

funding attracted

through competitive

grant applications

for improvement

work with NHS and

academic partners

25

Yorkshire & Humber Partners AHSNSummary Finance Report 2014/15 £ Actuals

Balances b/fwd from 2013/14

Balance transferred from AHSN Host 350,000

Income from NHS England 1,192,400

Less: Late costs invoiced to Y&H AHSN (323,819)

1,218,581

Income for 2014/15

Income from NHS England 3,375,682

Income from Y&H AHSN Members 919,830

Transfer from Manchester Uni Recharge 404,416

Defibrillator project 80,000

GMC Project 49,126

Inspiring Leaders Network 20,417

Interest receivable 4,067

4,853,537

Less: general deferred income (2,043,424)

Income Sub-total 4,028,694

Expenditure

Programmes expenditure 2,771,433

Pay expenditure 943,926

Non pay expenditure 309,268

Total expenditure 4,024,627

Surplus before tax 4,067

Corporation tax provision 813

Surplus for the year 3,254

N.B. Figures are unaudited at the time of production of the report

£ Actuals

26

Matrix of Metrics 2014/15

StrategicObjective

Programme Commentary

Population

Health

Move More Risk Assessment:

Olympic Games Legacy

The AHSN worked with Sheffield Hallam University to submit their successful

application for additional funding of £14m to extend the scope and remit of the

National Centre for Sport and Exercise Medicine.

Tour de France Legacy

The AHSN worked with TDF Ltd, Leeds Partners and Sheffield Hallam University to

sponsor the Yorkshire leg of the Tour de France. This included developing a "move

more" app that allowed users to ride the TDF route and measure performance.

Health & Wellbeing

programme

The AHSN worked with Sheffield Hallam University to develop the NHS wellness

programme, which was rolled out to three hospitals in Sheffield, Bradford and Airedale,

with over 300 staff recruited to the programme. The programme has been externally

evaluated, demonstrating a 3:1 ROI, significant improvement to participating

staff biometrics (95% of staff reporting lifestyle change) and additional benefits of

improved team performance and friends and family ratings.

AssociatedDiseases

Risk Assessment:

Cardiovascular

The AHSN has worked closely with the Y&H SCN and regional CCGs to develop

the atrial fibrillation programme across the region. This programme audited the use of

atrial fibrillation (AF) anticoagulation and the potential advantage of NOACs, quickly

recognising that the biggest challenge was identifying and supporting people with

undiagnosed atrial fibrillation (AF). Specifically, the programme co-created the West

Yorkshire Stroke Prevention strategy, worked jointly to transform anticoagulation

services in Leeds, and bought together pharmaceutical companies and Harrogate

CCGs to support their anticoagulation and stroke prevention work.

MSK Review was completed and decision made not to proceed with this programme.

Cancer Working with the Y&H SCN to support the Cancer Network.

Neurodegenerative

diseaseReview was completed and decision made not to proceed with this programme.

EffectiveReablementProgramme

Risk Assessment:

IA Frail Elderly

programme

The Improvement Academy (IA) established a network across the region to develop an

electronic frailty index, which is being implemented widely.

Mental Health

Programme

This programme comprises the Care Pathways and Packages Project and a

programme improving the physical health of people with severe mental illness . These

projects were scheduled to start by September 2014, but due to resource shortage

actually started in January 2015. Both projects are now sponsored by NHS Mental

Health CEOs and have associated project management teams in place, approved

project plans and are now delivering changes.

Low or no risk

27

StrategicObjective

Programme Commentary

Improving

Healthcare

Diagnostic Pathway

The AHSN is working with CCGs and providers across the region and the national

diagnostics programme to run a diagnostics programme that covers the following:

duplicated use of diagnostics, appropriate referral protocols and point of care

diagnostics to support new models of care. The AHSN is running a national

diagnostics symposium later in the year, working with 10CC and Sheffield CCG

and the NIHR DEC in Leeds.

Peptest Adoption &

Spread

Peptest is a novel diagnostic for gastro-oesophageal reflux disease (GORD) and in as

many as 50% of patients replaces gastroscopy, improving patient safety and

experience and significantly reducing costs. The AHSN supported RD Biomed’s launch

of Peptest and introduced them to several CCGs in the region. This resulted in three

large-scale pilots sponsored b the AHSN and RD Biomed. The AHSN also supported

RD Biomed in developing their evidence base and completing a health economics

assessment, which led to Peptest and complete a health economics assessment which

led to Peptest being assessed by NICE. To date RD Biomed have seen sales increase

by 85% and early assessment confirms potential large-scale savings for NHS partners.

E-Health

This programme comprises the eHRC and Qtool projects. The eHRC programme is a

partnership between Manchester University, Leeds University, TPP Ltd and the AHSN to

establish a prospective research database based on the TPP ResearchOne system. The

project has been successful in working with GPs to identify suitable cohorts of patients for

clinical trials and will be rolled out across the region by the AHSN and nationally by TPP.

The QTool project is implementing a web-based patient experience and outcome

information capture system. The information is used to feedback to staff to improve the

quality of services experienced by patients. It is currently rolled out to three pilot sites. The

AHSN also coordinated an Small Business Research Initiative competition in the telehealth

sector and delivered five roadshows across the region and has established a CEO led e-

health board for the region.

Quality & Safety Risk Assessment:

Patient Safety

Collaborative

The AHSN was awarded an NHSIQ Patient Safety Collaborative franchise during the year

and incorporated its patient safety programme into the PSC programme so please see

separate PSC summary.

NICE TA

ImplementationIncorporated into the MO programme, see below.

High Impact

Innovations

Responsive Wheelchair Services: The programme extended to all

wheelchair service providers across the region and has led to significantly improved

(63%) wheelchair access times. Collaborative work led by the AHSN has resulted

in the development of national wheelchair measures with NHS England.

IOFM: Regional audit completed, workshops to introduce IOFM benefits carried out

across the region, all trusts demonstrating increased use of IOFM.

Dementia carers: The AHSN working with the University of York produced; an

effectiveness matters review on supporting dementia carers, and a regional

conference was held in June 2014 on improving access to information for carers.

Digital First: The AHSN developed greater understanding of how to combine

electronic recording of physiological national early warning score (NEWS)

to aid clinical decision makin;, this was shared at a regional conference in

June 2014.

Medicines Optimisation

The MO programme has incorporated the AHSN’s NICE TA Implementation project.

The programme includes: Patient experience of medicines use, NOACs, safer

dispensaries, safer GP prescribing, establishing a safe prescribing community of

practice and collaborating with partners, the production of a project brief for the

development of a Centre for Medicines Optimisation Translational Research.

Low or no risk

28

Matrix of Metrics 2014/15

StrategicObjective

Programme Commentary

Improving

Healthcare

Clinical Risk Assessment:

Cystic fibrosis

The AHSN invested proof of concept funding in this project to develop a device to track

and record the use of antibiotic inhalers used by patients with CF. This is being

developed jointly with the D4D HTC.

Urgent Care

The AHSN is leading a project to develop a better understanding of urgent and

emergency care demand across the region. It is delivering in the following areas:

* Developing near real-time data analytics

* Developing algorithms to better predict routes to access services

* Understanding patient choices and experience

* Generating new models of care

Currently the AHSN is running the programme, including the steering group and four

task and finish groups, and is working with the Y&H CLAHRC and SCN to roll the

programme out and evaluate responses. A well attended regional conference

took place in November 2014.

LTC

The AHSN is running a diabetes care programme working with the SCN and some of the

regional CCGs. The objectives are to better support newly-diagnosed diabetics and work

with the SCN to reduce lower limb amputations for people with established diabetes.

Dementia

The AHSN is establishing a memory support worker programme with Leeds city

Council, West Yorkshire CCGs and NHS providers in the City. The AHSN is developing

the economic business case for the establishment of the MSW service.

Economic

Growth

SME & MNOProgrammes Risk Assessment:

The AHSN established an account management function that has been operating for just

over six months and provides comprehensive support of engagement, advice and sign

posting to SMEs and MNOs. The programme is supporting the rapid uptake and

adoption of new innovative products and technologies that support care delivery. This

has resulted in over 110 contacts with industry, successful partnerships with a number

of businesses, increased sales for partners, successful delivery of successful delivery of

a POC programme, funding four new med-tech innovations from within the region,

delivery of regional procurement clinics and workshops and continuing business assists.

InternationalOffice Risk Assessment:

The AHSN International Office provides support for regional and national SMEs, NHS

providers and HEI to generate revenue and knowledge enhancing opportunities through

import/expor, innovation collaboration and implementation of best practice. The AHSN

has run a number of open innovation workshops supporting combinatorial innovation in

the UK and internationally. This has resulted in strategic partnerships with FICCI to

support the delivery of the UK Bioconclave working closely with the Indian government,

UBI in France to identify UK distributers for game changing innovation across Europe,

and supporting UKTU and HUK to promote export opportunities for UK plc.

NHS IP Risk Assessment:

AHSN, working with Medipex Ltd, has established a network of over 100 innovation

scouts embedded in NHS organisations who have two main function: to act as

"innovation magnets" working with NHS staff to identify and scope emerging

innovations and where appropriate secure IP for the NHS, secondly to support the

development, adoption and spread of new innovation within their own NHS

organisation. Fifteen members have signed up to the Network and the programme is

now continuous professional development accredited. This coincides with a 14%

increase in NHS generated innovations across the region. The programme is being run

with our business partner 3M.

Low or no risk

29

StrategicObjective

Programme Commentary

Patient Safety

Patient Safety

CollaborativeRisk Assessment:

The AHSN established an Improvement Academy (IA) to support the system and

behavioural changes that underpin all significant change. The initial core patient safety

programme was subsumed into the PSC programme and is reported here. The IA

established a ‘Foundation for Safety’ programme, which is a team-based approach to

improving safety culture and making significant improvements in reducing patient

harm. This is scaling up the successful core programme, which not only demonstrated

significant improvements in safety but a 388% ROI evaluated by YHEC.

* The IA has established 35 multiprofessional frontline teams across 15 member

organisations to improve safety culture

* The programme has focussed on reducing falls, pressure ulcers, improving

discharge. The programme has been run in wards and departments across the region

and is demonstrating significant improvements.

* The IA has run three behavioural change workshops for 150 staff, focussed on hand

hygiene, toileting interventions, and improved drug dispensing.

* Safety culture for boards programme has been run in a number of boards and is

planned to roill out in 2015/16.

* Medicines safety collaborative (reported above).

* Mortality, and morbidity case note review has 11 acute members who all use a

standardised data collection tool. More than 50 consultants and 60 senior registrars

have been trained and are using the tool. Additional funding has been awarded to

allow the review to extend into primary care records.

* The IA has run a number of mortality conferences and master classes through the

year.

* A quality improvement training programme has been developed with Y&H Health

Education to support members develop effective QI training programmes. More than

60 training events have taken place through the year.

* The improving patient flow programme has been run in Huddersfield and

Scarborough; it is an operational tool to improve patient flow through hospitals, and

includes a component called plan for every patient. The implementation at

Scarborough started in December 2014.

Establishing aY&H GenomicsMedical Centre

(GMC)

Risk Assessment:

Following initial feedback from NHS England, the three NHS organisations involved in

the GMC (Sheffield Teaching, Sheffield Children’s and Leeds Teaching) asked the

AHSN to bring together a single proposal for Y&H. This is now underway and the plan

is to submit a second wave GMC proposal by June 2015. The AHSN has established

the programme governance, setting up and chairing the programme steering group,

establishing and chairing the operational board and the five workstream groups.

Establishmentof the

Co-creationnetwork

Risk Assessment:

Working collaboratively with Health Education Yorkshire & Humber the IA has

established a network to develop the improvement capability of staff, including an

online platform for Quality Improvement Training, supporting communities of practice

and delivering a series of round table events to address areas of common learning

need.

Low or no risk

30

Registered Directors: Biographies

Professor Pope has a wealth of experience,

leadership and expertise gained from senior roles

within industry, the NHS and academia, including at

chairman and chief executive level. He has significant

experience of working with world-leading companies

including BAE Systems, BBC, BP, Ford,

GlaxoSmithKline, Huawei and Unilever, and was CEO

of the UK’s largest integrated health, safety and

environmental business for 10 years. He has been

one of the UK’s leaders in managing and developing

environmental companies over the last 25 years, and

is a four times winner of the ‘Technology Fast 50’

awards for the fastest growing companies. He has

been awarded numerous business, environmental

excellence, bioscience and innovative biotechnology

awards and has previously been a business

innovation support person of the year..

Amongst other appointments he was previously

Chairman of the East of England Regional

Development Agency and Northamptonshire and

Milton Keynes Primary Care Trusts, and is now

Chairman of the Board at University Campus Suffolk,

Chairman of Healthwatch Northamptonshire and Vice

Chairman of East Midlands Pathology.

Other appointments and interests: Visiting Professor

at the University of the West of England; Professor of

Bioenterprise and Health at UCS; co-founder of the

Centre for Health & Wellbeing Research at the

University of Northampton; current Chairman of the

Environmental Policy Forum; a past member of the

Advisory Board of the Institute for Sustainability,

Health and Environment; and past Chairman of the

Society for the Environment and the Institution of

Environmental Sciences.

Professor Will Pope

31

Andrew has more than 15 years experience as a

Board Director in the NHS and commercial sector,

with an additional 10 years experience as an NHS

Chief Executive.

He has clinical experience with direct patient care

responsibility as a diagnostic radiographer and has

effectively engaged with patients and clinical

professionals.

He has many years experience at a national level

working in the NHS, Department of Health and UK

biopharmaceutical Industry

He brings an extensive working knowledge and

experience of operational delivery and business

strategy in the NHS and commercial sectors to the

awards evening. He also has wide-ranging business,

capital planning, programme/project management

and marketing experience in both expanding and

contracting business environments.

Andrew has an extensive track record of building

successful, cross cutting partnerships with key

stakeholder groups as well as experience managing

multi-million pound revenue budgets and capital

projects, including private finance initiatives.

Andrew Riley

32

Registered Directors: Biographies

Sir Andrew is Chief Executive of the Sheffield

Teaching Hospitals NHS Foundation Trust, one of the

largest NHS foundation trusts in England with an

annual budget in excess of £1 BN and 16,000 staff.

Sheffield Teaching Hospitals NHS Foundation Trust

has been awarded the independently assessed

‘Hospital of the Year’ three times in the last six years.

Andrew was the founding Chair of the Foundation

Trust Network (FTN) and has undertaken three spells

in the Department of Health, England – the most

recent a secondment for a year as a Director General

for developing health service providers. He is a

visiting Professor in Leadership and Development at

the Universities of Sheffield and York. He chairs the

NHS Employers Policy Board, is Deputy Chair of the

NHS Confederation, a member of the Innovation,

Health and Wealth Implementation Board, and a

member of the Shelford Group (the top 10 university

hospitals in England).

He was appointed an OBE in 2001 and knighted in

2009 for services to the NHS.

Sir Andrew Cash OBE

33

Christine Outram was appointed as Chair of The

Christie NHS Foundation Trust in October 2014. She

also joined the AHSN Board as a non-executive

director in December 2014. Chris has had a long

career in the NHS, with over 20 years' experience at

CEO level.

Leadership positions she has held include CEO of the

North Central London strategic health authority and

chief executive of NHS Leeds. At national level, in

2009 she successfully established Medical Education

England, a new Department of Health body with the

aim of developing and improving the education and

training of NHS doctors, dentists, pharmacists and

healthcare scientists. She went on to lead the

establishment of Health Education England in

2011/2012.

In 2004 Chris was appointed Director General at the

Department of Health, where she led the review of its

arm's length bodies, reducing their number from 38

to 21 and producing £0.5 billion in savings annually

for reinvestment in NHS services.

Chris continues to be passionate about working with

clinical staff and patients to deliver excellent services,

and to drive forward the quality of health research,

innovation and education.

Christine Outram

E: info@yhahsn.comw: www.yhahsn.org.uk

t: @AHSN_YandH

Unit 12 Navigation Court, Calder Park, Wakefield, WF2 7BJ

A company limited by guaranteeregistered in England and Wales No 08887451

Licensed by NHS England

BUSINESS PLAN2015/16

Content

3 Foreward

4 Introduction

8 Governance

16 Yorkshire & Humber AHSN

Programme and Project Detail

72 Risks

73 Appendix

3

Professor William Pope

Chair

Andrew Riley

Managing Director

ForewardLast year, being the first fully operational

year of the Yorkshire & Humber Academic

Health Science Network (YHAHSN), we

necessarily focused on securing the

capacity and capability to deliver our

operational plan, recruiting our team,

establishing an independent base,

becoming a Company Limited by Guarantee

and engaging members. However, we did

establish nationally recognised

programmes including our Improvement

Academy, NHS Staff Workplace Wellness

programme, regional Improvement Fellows

and Innovation Scout Networks, each

having over 150 members. We also

established and delivered our Open

Innovation programme in the UK and

internationally. It is pleasing to note that our

Board of Directors and delivery teams are at

full capacity.

We have evaluated our core competencies

and how best we can apply them for the

benefits of our members and partners, and

these are set out in section 2.4. We realise

that we need to communicate and engage

more effectively with our members and

partners and are working hard to ensure we

do this.

We are a membership organisation with

governance arrangements in place to

ensure that every NHS organisation and

health community has a fair and equal input

into developing our plans for regional

benefits. We pride ourselves on being an

honest broker and a safe place for difficult

conversations, holding dear our core NHS

values of being citizen and patient focused,

whilst at the same time being more

business-like and systematic in the way we

support members, implement plans and

deliver benefits. Working with partners

during 2014/15, our Improvement Academy

secured more than £1.5m in additional

external funding, while several of our

members commissioned us to undertake

specific work on their behalf.

Our business plan has been developed with

the help and input of our members and with

the involvement of key partners. We have

reviewed their strategic objectives and,

where appropriate, reflected together how

we can best add value. Our focus is to

support the regional health economy and to

connect people, organisations and

resources to develop new solutions that

can transform the NHS, allowing it to meet

its future challenges. Our plan for 2015/16

builds on our five-year strategic objectives

and the foundations that were put in place

last year. We have aligned to the Five Year

Forward View, Office of Life Science;

Strategy for UK Life Sciences, UK Trade and

Investment Life Science Organisation

Strategy and Healthcare UK Strategic

Business Plan.

Although precise income is yet to be

finalised with NHS England, two planning

scenarios have been modelled. We will

implement the prudent plan until income

numbers are confirmed; once this

information is provided we will then re-

assess our position. This approach allows

us to continue to deliver existing

programmes and develop new ones.

We are working effectively with our

colleagues in the other 14 Academic Health

Science Networks (AHSN) to share and

spread learning, and are partnering closely

with the other three northern AHSNs to

complement work establishing the northern

innovation and research ecosystem.

As the health sector goes through a period

of change during the next few years we are

confident that the YHAHSN is well placed to

support members and partners adopt

innovation and best practices that deliver

improvements to the quality of patient care,

support system transformation and

generate economic growth.

1 INTRODUCTIONThe Yorkshire & Humber Academic Health ScienceNetwork (YHAHSN) was authorised to operate inJuly 2013, becoming a Company Limited byGuarantee (CLG) in February 2014. The CLGArticles set out the purpose of the YHAHSN:

• to create and harness strong, purposeful partnerships between

patients, health services, industry and academia in the healthcare

sector;

• to create significant improvements in the health of the population by

reducing variability and improving experiences of the healthcare

system;

• to ensure the development of new innovative products and services,

which have the potential to transform lives and become part of routine

clinical practice;

• to stimulate economic growth for the Yorkshire & Humber region,

nationally and internationally supporting inward investment projects

for health sector businesses.

Figure 1: Geographic area covered by the Yorkshire & Humber Academic Health

Science Network

1.1 LICENCE AGREEMENTThe YHAHSN was granted a licence to operate by NHS England that

focuses on delivering three strategic objectives:

• Improving Population Health

• Improving Healthcare

• Generating Economic Growth

The key objectives set out in the Five Year Forward View, published in

October 2014, along with members’ priorities, have also been reflected

in the YHAHSN’s 2015/16 business plan.

1.2 VISION“Adopting excellence, creating opportunity for healthcare innovation.”

York

Leeds

Doncaster

BradfordKingston Upon Hull

Sheffield

Huddersfield

Barnsley

Selby

SkiptonHarrogate

Malton

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1.3 MISSION STATEMENTThe YHAHSN is a member organisation acting as an honest broker to build networks and connect people,

organisations and technology.

Using evidence to inform decision making the YHAHSN drives the adoption and spread of innovation at

pace and scale, creates change capability and leadership, and supports system redesign and improvement.

1.4 STRATEGIC OBJECTIVESThe YHAHSN has three strategic objectives:

1. Contribute to improving population

health across the Yorkshire & Humber region.

2. Support service improvement, transformation

and delivery of new models of healthcare.

3. Generate regional and national economic

growth by creating strong partnerships

between the NHS, HEIs (higher education

institutions) and business.

1.5 SUMMARY OF PROGRESS TO DATE Improving Population Health: in 2014 the YHAHSN, in partnership

with Sheffield Hallam University, supported the development of the

“Move More” and Tour de France legacy programmes.

An NHS Staff Workplace Wellness programme was established and

rolled out to three of the region’s hospitals. Evidence indicates that

there has been a 2% reduction in sickness absence for enrolled staff,

a significant improvement in key biometric indicators for participants,

an investment ratio of 3:1 and a 95% staff approval rating.

A joint programme, run with the Yorkshire & Humber Strategic Clinical

Network (SCN) and a group of regional Clinical Commissioning

Groups (CCGs), reviewed the management of atrial fibrillation (AF)

and in particular, the use of novel oral anticoagulants (NOACs).

The YHAHSN Improvement Academy (IA) initiated a frailty

programme supporting the improvement of services for frail,

elderly people.

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Figure 1-4: Strategic Objectives

Transforming Healthcare: the YHAHSN established the IA to create

change capability and capacity in front-line clinical and managerial staff,

and provide ongoing support for all member organisations to take on

increasingly more complex transformation projects within their

organisations and across systems. This included establishing an

Improvement Fellows’ Network, which currently has more than 150

members with the capability to support the delivery of front-line

improvement projects within their own organisations from falls reduction

to a nationally recognised reduction in hospital mortality project. The IA

also delivered six high-impact innovations and established a nationally

recognised patient safety programme.

NHS IQ awarded the YHAHSN the contract for delivery of the Patient

Safety Collaborative for Yorkshire & Humber in September 2014.

RD Biomed’s Peptest innovation is now running in two large-scale pilots

where it is demonstrating the opportunity of significant patient benefit

and reduced cost while offering reconfiguration opportunities for upper

gastrointestinal gastroscopy services.

Working with the Universities of Leeds and Manchester, TPP Ltd and

EMIS Ltd, the YHAHSN has expanded a primary care research system to

prospectively identify patients suitable for participation in clinical trials,

greatly improving trial delivery.

Work commenced on a regional urgent care programme supported by

NHS member CEOs and Accountable Officers to gather workflow and

demand data from all members in order to create a data model of

urgent care flows.

Economic Growth: the YHAHSN established an SME (small and

medium sized enterprise) development programme that currently has

more than 100 members, providing proof of concept funding, access to

front-line clinicians, product development and procurement workshops,

system navigation and connection to national and international

manufacturing and distribution partners.

The YHAHSN set up a successful Innovation Scout Network, which

currently has more than 120 scouts embedded in member organisations

and acting as innovation magnets. They are responsible for identifying

potential innovation, completing initial due diligence and registering IP

(intellectual property).

We have established and run Open Innovation programmes connecting

innovators, business and finance with a focus on solving specific

problems. These have run in the region and more recently in China,

working with UK Trade and Investment (UKTI) to connect UK and

Chinese companies and academics, creating new collaborations with

the aim of attracting inward investment and, in time, lower prices for

new technology for the NHS.

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7

We have worked closely supporting UKTI, Healthcare UK (HUK) and Office for Life Sciences (OLS) to export

NHS excellence to international markets and have established the YHAHSN International Office to work with

colleagues in the EU and internationally.

Key national documents and reference to members’

planning priorities have been considered to produce

this business plan, including:

• The AHSN licence agreement

• The NHS Outcomes framework

• The Five Year Forward View

• The OLS: Strategy for UK Life Sciences

• UKTI Life Science Organisation Strategy

• HUK Strategic Business Plan

For the purpose of the programme summary

strategic alignment is shown to the AHSN core

licence objectives and the Five Year Forward View

themes.

Three regional workshops have taken place for

member CEOs and subsequent working versions of

the business plan as it developed have been shared

and comments from members have been

incorporated.

The YHAHSN has extensively engaged with regional

stakeholders, such as the SCN, Health Education

England Leadership Academy for Yorkshire &

Humber, Public Health England and National

Institute Health Research Clinical Research

Networks, to identify their priorities.

1.6 2015/16 PLANNING PROCESS

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2 Governance2.1 COMPANY SET UPThe YHAHSN is a Company Limited by Guarantee (CLG), registered at Companies House in the UK. It has

four Registered Directors (see Appendix) legally responsible for the lawful transaction of business and to

ensure the CLG is a financial going concern.

The Registered Directors established a Board which meets every three months to discuss strategic direction

and to assure delivery of the operational plan. The Board consists of 18 NHS CEOs and senior leaders from

HEIs and industry.

The Board has established two sub-committees, an Audit Committee and a Remuneration Committee, both

chaired by Non-Executive Directors.

Figure 2-1: Board Structure

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2.2 ORGANISATIONAL STRUCTUREThe YHAHSN team has expanded to the proposed arrangement of 15 core central staff with additional staff

seconded for specific projects or employed by the IA. The following chart summarises the current structure:

2.2.1 Commercial Director Responsible for:

• Identifying and spreading industry-led healthcare innovation into NHS and related care pathways to

improve patient outcomes and productivity

• Facilitating regional and national economic growth through SME and MNO (multinational organisation)

engagement, support and development

• Identifying and achieving new sources of funding for the region to enable rapid growth of new healthcare

technologies and innovations

• Providing commercial expertise to NHS, industry and academic regional partners

• Establishing and running the YHAHSN International Office to attract inward investment and increase

export opportunities and partnerships in key overseas markets, for the region and the UK

Figure 2-2: Organisational Structure

2.2.2 Chief Operating Officer

Responsible for:

• Establishing and creating partnerships and networks to design and

deliver transformational programmes at scale across the region

• Leading the YHAHSN’s health community improvement and

transformation projects, such as supporting the development of new

models of care, digital health, e-health, urgent and emergency care,

diagnostic and imaging programmes

• Identifying new business opportunities, working with NHS, HEI and

commercial partners to attract funding to the region

• Managing delivery of YHAHSN programme based sub-contractors

• Leading the improvement and innovation team who provide support

for the YHAHSN and members.

2.2.3 Corporate Services Director

Responsible for:

• Operational management of the head office and satellites

• Planning

• Customer relationship management

• Contract management for all YHAHSN contracts

• Human resource management

• Quality control and health and safety

• Marketing and communications

• Financial management, including liaison with company accountants.

2.2.4 Director of the Improvement Academy

Responsible for:

• Leading delivery of the 2015/16 IA operational plan

• Leading the delivery of the Patient Safety Collaborative contract

• Establishing effective collaborative relationships with other regional

improvement bodies across England and the UK.

2.3 STRATEGIC PARTNERSHIPSAs an organisation that brings together people, organisations,

technology and finance, our preferred modus operandi is to develop

productive networks and partnerships and co-create solutions and

plans. We have developed close working relationships with regional,

national and international organisations, with local partners being

represented at the YHAHSN Board. This section focusses on some

specific partnerships where we are working jointly to plan and deliver

programmes or evaluate outcomes.

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2.3.1 Directors of Public Health (DspH) and

Health & Wellbeing Boards

Following discussions in 2014 the DsPH identified a lead DPH to

work with the YHAHSN and identify public health priorities. The

Improving Air Quality project being run by the IA is an example of

one such collaboration. Although the Workplace Wellness project is

focused on supporting NHS staff manage their own health and

wellbeing more effectively, the longer term intention is to expand the

programme across other employers in the region and, subject to

funding, extend the programme to include communities across the

region where there is evidenced variability in life expectancy and

quality of life indicators.

2.3.2 Strategic Clinical Network Yorkshire & HumberThe YHAHSN has worked closely with the SCN in developing its

2015/16 plan, with the Director of the SCN participating in all three

planning workshops and contributing to discussions that have taken

place at the YHAHSN Board. The YHAHSN COO is also a member of

the SCN Board. The specific project that both organisations have

contributed to during the year is improving services for people with

atrial fibrillation (AF), including anticoagulation by introducing NOACs

and, in the longer term, aiming to reduce the incidence of acute

stroke. The YHAHSN and SCN are proposing to participate in the

following areas through 2015/16:

• Assistive technology and telehealth

• Management of people at risk from type 2 diabetes and for those

people who already have diabetes

• Urgent care

• Stroke and atrial fibrillation

• Dementia programmes

2.3.3 York Health Economics Consortium (YHEC)/School of

Health and Related Research (ScHARR)An important aspect of the YHAHSN’s plan for 2014/15 was the

evaluation of the benefits delivered through programmes and

projects. Contracts with the Universities of York and Sheffield allow

the YHAHSN to call on the academic rigour of the two universities in

evaluation. The partnerships support the quarterly delivery

assurance meetings scheduled with NHS England.

A further benefit of the partnerships is that they provide an

opportunity for SME partners to access health economics advice at an

affordable entry point. This provides SMEs with emerging innovations

for the health sector with access to high-quality health economics

advice in order to make informed decisions on product development

and market access.

2.3.4 Yorkshire & Humber Clinical Research Network (CRN)The Clinical Director for the CRN is a member of the YHAHSN Board

and the YHAHSN participates in the CRN Management

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Board. The main focus of joint working has been in

aiming for single sign-off for multi-centre clinical

trials and in improving responsiveness to calls to

participate in commercial clinical trials, where the

YHAHSN has been working with commercial

partners and the University of Leeds to develop a

prospective primary care research system.

2.3.5 Yorkshire & Humber Leadership

Academy

The YHAHSN has been working with, and

supported financially by, the Leadership Academy

to develop the Improvement Fellows Network and

the Inspiring Leaders Network. We are planning to

extend this moving into 2015/16.

2.3.6 Health Education Yorkshire & Humber

(HEYH)

HEYH are jointly funding work to develop quality

improvement skills training for the region, and a

number of Clinical Leadership Fellows, taking a year

out of medical training on the HEYH scheme, are

working with the IA to lead change programmes.

2.3.7 CLAHRC Y&H

The CLAHRC (Collaboration for Leadership in

Applied Health Research and Care) Director is a

member of the YHAHSN Board and the YHAHSN

MD is a member of the CLAHRC Partnership Board.

Both organisations have been working to integrate

plans with the YHAHSN and CLAHRC particularly

working collaboratively in the telehealth area.

2.3.8 National Centre for Sport and Exercise

Medicine/Sheffield Hallam University (SHU)

The YHAHSN has partnered with the National

Centre for Sport and Exercise Medicine and SHU to

provide a tailored lifestyle support programme to

NHS employees. The project, commissioned by the

YHAHSN and delivered by SHU, is currently being

used at Sheffield Teaching Hospitals NHS

Foundation Trust, Bradford Teaching Hospitals NHS

Foundation Trust and Airedale NHS Foundation

Trust and encourages NHS employees to boost

fitness levels whilst improving morale and wellbeing

through individualised lifestyle checks.

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2.4 YHAHSN CAPABILITIESOver the last year, in addition to delivering a range of specific programmes, the YHAHSN has been building

leadership and change capability and capacity in NHS member organisations, in anticipation of scaling up

the pace of change. The YHAHSN identified early last year the capabilities that it has to offer to members.

This section sets out what our value offer is to members:

2.4.1 System leadership

This role is particularly prevalent where cross

cutting, health economy wide, complex change is

being considered or where there are

provider/commissioner tensions. Our role here is

not to lead the system through change, but to bring

relevant people and organisations together, unpick

some of the often long-held views, and underpin the

decision-making process with quality-assured data,

information and evidence. We help develop diverse

solutions across the system to ensure genuine and

tangible transforming change that has the potential

for significant impact and scale.

Once we have established the project machinery,

helped define the issues and identified the key

people to resolve those issues, our role evolves to

deliver the process until the health economy feels

confident enough to take on that role itself. This a

role we are playing in the Urgent Care and GMC

(Genomics Medicines Centre) projects.

2.4.2 Developing change leaders

We have recruited, trained and are developing more

than 300 front-line leaders through our

Improvement Fellows and Innovation Scouts. With

the support of the NHS Leadership Academy we will

continue to invest in creating large-scale change

leader capacity. This brings a range of benefits

including re-engaging front-line staff and building

communities of improvement at ward, department

and system level. We are creating a cadre of leaders

that balance patient safety, outcome and

experience, and cost/value and effectiveness.

2.4.3 Collaboration

Our principle leadership role is to be able to quickly

access the CEO and Board level leaders in the HEI,

business and NHS members and bring key opinion

and knowledge leaders together to discuss

innovative solutions to complex cross cutting

problems. We have been told we are seen as an

honest broker with no vested interests, always trying

to find acceptable solutions for all parties through

careful use of data, information and evidence.

Figure 2-4: YHAHSN Capability Wheel

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2.4.4 Creating time to think

The operational agenda for most organisations is

crowded and senior leaders tend to be focused on

the operational agenda. We create opportunities to

consider the longer view options, bring new

evidence, information and analysis to their

attention, complete due diligence of incoming

business innovation, and bring peers together to

consider new solutions.

2.4.5 Health economics

Our experience to date has shown that one of the

barriers to the development of early-stage innovation

is the lack of affordable and quick turnaround health

economics. We have developed partnerships with

two of the region’s recognised leaders in health

economic analysis, as detailed in section 2.3.3

2.4.6 Membership organisation

The YHAHSN is a membership organisation, with a

clear governance arrangement and a single

accountable board that includes CEOs and senior

leaders from the NHS, HEIs, business and other

stakeholders.

2.4.7 Research evidence

There are 12 HEIs in the region, three of which have

medical schools. It can be confusing for a small or

newly formed company to know how to access the

research capability within the region’s universities.

The YHAHSN is in the process of appointing an

Academic Director with an objective of connecting

members to the most appropriate academic contact

or unit in the region.

2.4.8 Data, intelligence and analysis

Our experience from the programmes we ran

through 2014/15 is that one of the barriers for SMEs

trying to share their innovative ideas with NHS

organisations is the lack of information or evidence

available. We have established partnerships with

some of the region’s leading ICT (information and

communications technology) companies and

university teams to support the collation of research

and evidence and to generate new information to

enhance the value of an innovation. Our

improvement programmes include measurement

and data analytical support. We also evaluate the

programmes that we run and make that information

available to members. The YHAHSN Commercial

Team carry out due diligence on commercial

organisations and their innovations to support

member engagement with minimum risk.

2.4.9 Patient and public involvement

Working with the SCN and other delivery partners,

we are developing positive public and patient

engagement. The IA involves patients or citizens in

all programmes from initial scoping through to

implementation, using research methods to identify

the most effective and appropriate engagement

methods to apply.

2.4.10 Leveraging additional resource

Although our resources are limited compared with

our members, we are developing a capability of

using our available resource, be it cash or staff, to

match fund joint projects. This is often the deciding

factor in starting a programme. We regularly submit

bids to grant-awarding bodies, the EU and

corporate boards to financially support programmes

and we have invested in commercial business

opportunities that contribute a financial return on

our investment.

2.4.11 NHS values, business discipline

The value of working together for patients is a

central tenet guiding service provision in the NHS.

Patients are central and the YHAHSN acts and

collaborates in the interests of patients. As well as

working with health service organisations,

providers, academia and business the YHAHSN

involves staff, patients, citizens and local

communities to ensure potential solutions are

tailored to local needs.

The delivery of high-quality care is dependent on

feedback; as an organisation that welcomes

feedback the YHAHSN is able to identify and drive

areas for improvement. We are focused on

delivering patient quality and safety benefits and

addressing the need to transform systems and

reduce costs, by introducing best practice and

leading edge technologies. We can quickly check

the views of our members through direct contact

and social media channels, dealing responsively

with issues or problems. We include patients or

citizens on our programme boards and invite them

to attend seminars and workshops to provide a

clear view on the matters we are addressing.

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2.4.12 Quality and training

The YHAHSN developed the IA to support safety and quality improvement across member organisations.

A team of improvement scientists, patient safety experts and clinicians work with front-line services,

patients and the public and have delivered measurable and lasting quality and safety improvements across

the region. In 2014/15 the IA worked with members and regional experts to agree a regional Quality

Improvement Training Framework, established a network of 150 Improvement Fellows and initiated a

number of collaborative improvement programmes, including our flagship falls project and nationally

recognised hospital mortality review project.

Figure 2-4.1: YHAHSN Capability Wheel & Strategic Objectives

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3 Yorkshire & Humber AHSN Programmeand Project Detail

The YHAHSN has 12 programmes. Each strategic objective, PopulationHealth, Improving Healthcare and Economic Growth, has four programmeseach with detailed project plans.

This section of the business plan provides more detail for each programme,including:

• Programme description

• Financial resource being allocated to the programme

• Alignment to national strategies

• Project description and outcomes

• The YHAHSN’s role

• A summary project plan and key performance indicators.

Figure 3 demonstrates how the YHAHSN will employ its strengths and capabilities to deliver 2015/16

programmes.

Figure 3: YHAHSN Capability Wheel, Strategic Objectives and Programme Detail

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AHSN CoreLicence Objectives

Five Year Forward View Themes

Page A B C D E F G H I J K

POPULATION HEALTH

Health & Wellbeing 18 3 3 3 3 3Workplace Wellness 18

Improving Diabetes Care 20

Digital Health 22 3 3 3 3 3 3 3 3Establishing Digital Health Record Test Beds 23

Creating An E-health Ecosystem 24

Better Data 25

Enhancing Quality Of Life For People With Long Term Conditions 28 3 3 3 3 3 3 3Healthy Ageing Collaborative 29

Memory Support Workers 30

Improving Air Quality 31

Preventing People From Dying Prematurely 32 3 3 3 3 3Physical Health For Those With Serious Mental Illness 33

Mortality Reduction 34

IMPROVING HEALTHCARE

Current Systems 36 3 3 3 3 3 3 3 3 3Urgent & Emergency Care 37

Medicines Optimisation 40

Diagnostics 41

Future Systems 42 3 3 3 3 3 3 3Genomics Medicines Centre 43

Transforming Primary Care 44

Safety & Quality 46 3 3 3 3 3 3 3Patient Safety Collaborative 46

Patient Falls 48

Capacity Building For Quality Improvement 50

Efficiency & Productivity 52 3 3 3 3 3 3 3 3Patient Flow 53

Evaluating Currency Implementation For Mental Health 54

ECONOMIC GROWTH

Industry Investment 56 3 3 3 3 3 3 3 3New Source of Inward Investment 57

Investment To Accelerate Innovation 58

Industry Engagement 60 3 3 3 3 3 3 3 3Connecting Industry To Healthcare 61

Identifying & Adopting Innovation 62

Open Innovation 63 3 3 3 3 3 3 3 3 3Innovation Scouts 64

Innovation Accelerator 66

Generating Growth From Overseas Markets 68 3 3 3 3International Inward Investment 68

Exporting UK Healthcare Excellence 70

KeyA - Focus on the needs of patients and local populations: support and work in partnership with commissioners and public health bodies to identify and address unmet

medical needs, whilst promoting health equality and best practice.B - Build a culture of partnership and collaboration: promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities.C - Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid spread of research

and innovation at pace and scale to improve patient care and local population health.D - Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services.E - Prevention and public health.F - Providing patients with greater control and autonomy.G - Breaking down barriers to how care is provided.H - Urgent and Emergency Care redesign.I - Diverse solutions and local leadership.J - Improving the NHS' ability to undertake innovation and research.

K - Sustaining and improving a tax-funded system.

Yorkshire & Humber AHSN Strategic Alignment & Plan on a Page 2015/16

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HEALTH AND WELLBEING

The Five Year Forward View clearly sets out theimportance of supporting citizens to make informeddecisions about their own health and wellbeingthroughout their lives. The goal is to improve quality of life and increase the life expectancy of the

population, whilst reducing their reliance on health services. The YHAHSN

Health & Wellbeing programme has two projects, Workplace Wellness and

Improving Diabetes Care.

• Currently the NHS employs more than 100,000

staff in the Yorkshire & Humber region. The

YHAHSN has a long-term goal to improve the

health and wellbeing of those staff. Initial

evaluations of the Workplace Wellness pilots have

shown that participants have achieved significant

and quantifiable improvements in their physical

and mental health, whilst staff sickness and

absence levels have reduced. The project is also

showing a return on investment ratio of 3:1.

• The Improving Diabetes Care project will improve

the support for people who might be prone to, or

who have been recently diagnosed with, type 2

diabetes. The project will allow individuals to

make choices to reduce their risk of developing

the disease in the first instance, while those who

are diagnosed will be well informed about their

disease status and supported to take

responsibility for managing their diabetes, only

accessing health services as appropriate.

POPULATION HEALTH

WORKPLACE WELLNESSWithin the Five Year Forward View, NHS England prioritises the

development and support of new workplace incentives that

promote employee health and wellbeing and contribute

to reducing inequalities in health.

The Workplace Wellness programme will

work with NHS staff to improve their health

outcomes and reduce sickness and

absence levels. The programme will

also focus on reducing operating costs for

members by reducing sickness absence costs

and costs of agency staff.

OUTCOMES • Deliver an evidence-based Workplace

Wellness programme for NHS staff

• Contribute to the ‘evidence base’ and

‘economic case’ for the role of physical activity

in achieving good workforce health

• Increase the number of NHS Trusts in the

Yorkshire & Humber region who adopt the

programme

THE ROLE OF THE YHAHSN Will be to work in partnership with SHU and The

National Centre for Sport and Exercise

Medicine. Providing a supporting role as the

Workplace Wellness programme is rolled out to

NHS organisations across the Yorkshire &

Humber region.

• The commissioning of SHU to deliver an

evidence-based Workforce Wellness

programme for NHS staff

• Agreed outcomes identified with monthly

performance monitoring in place

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OUTCOMES • To allow the earlier recognition of

hypoglycaemic unawareness

• Assist people with diabetes and clinicians to

identify evidence-based strategies that will

improve self-care and avoid further episodes

impacting on urgent care demand

• Improved patient confidence in disease

management

o Fewer patients will attend A&E for

hypoglycaemic episodes

o Fewer patients will call ambulance

services to assist in hypoglycaemic

episodes

THE ROLE OF THE YHAHSN • Production of a ‘hypo toolkit’ (online; app;

paper-based)

• Pilot the implementation of the toolkit

• Develop and deliver a ‘diabetes master class’

across Yorkshire & Humber

o Raising awareness with primary care

clinicians and pharmacies and

promoting use of the toolkit at scale

• Develop an evaluation process for pilot sites

to demonstrate a reduction in severe

hypoglycaemic episodes

IMPROVING DIABETES CARE

Diabetes UK estimate that the NHS is alreadyspending approximately £10bn a year on diabetes.Almost three million people in England are alreadyliving with diabetes and another seven millionpeople are at risk of becoming diabetic. Working in partnership with the SCN and with clinical leads for

hypoglycaemia, the YHAHSN is leading an initiative to promote the

effective use of care strategies to assist people at risk of hypoglycaemia to

live longer and better lives.

POPULATION HEALTH

21

DIGITAL HEALTH

The case for e-health as a transformationalhealthcare solution receives a mixed reception.Despite numerous pilot programmes, large-scaleadoption is at best limited and current healtheconomic appraisal often describes marginal gains. One of the YHAHSN’s strategic objectives is to support healthcare

organisations access more accurate and complete health information with

a view to establishing and developing a way of pooling information from

different sources to improve clinical decision making and enable more

effective system-wide working.

We will also bring together HEIs, the NHS and business

to develop the e-health and digital economy

agenda in Yorkshire & Humber. There is

considerable strength across the region

in all sectors, with Airedale Hospital being

the only 3* EU telehealth site in England.

The YHAHSN is in a good position to

support members and partners

exploiting new technologies to

create new models of care that

transform healthcare delivery.

The YHAHSN is exploring test

bed opportunities in the e-health

sector working with the NHS England

national team and will develop an EU E-health

Ecosystem in 2015/16 to support resourcing

and implementation.

POPULATION HEALTH

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Digital Health Record Test Beds The NHS generates millions of records containing billions of data items, and a significant proportion of

these are held in paper-based systems. This brings a number of challenges: patient records held by

many providers contain incomplete and inaccurate medical information and records are not accessible

by clinicians when patients present for diagnosis and treatment. There have been numerous reviews

which have identified that the NHS could save billions of pounds by becoming digital, and NHS England

has set two relevant targets: that patients should have access to their GP records by the end of 2015

and that the NHS should be paperless by 2018. This is a new project that is being co-developed with

the 10CC group (10 CCGs from West Yorkshire and Harrogate & Rural District) and Sheffield CCG to

build on existing work in the two economies and work undertaken last year by the YHAHSN to develop

a cloud- based digital record.

OUTCOMES • Establishing and supporting programme

boards in the two test bed communities

• A programme feasibility report for the two

health communities setting out the

opportunities, risks and potential cost of going

digital in the first instance at GP practice level

• A second feasibility report examining the

opportunity of broadening the two test beds to

include cloud-based, fully integrated medical

records

• Agreed implementation plans for the two test

beds to commence the GP digital economy

project

• At key milestones, robust evaluation of

progress, benefits delivery and health

economics impact

THE ROLE OF THE YHAHSN • To work with 10CC, Sheffield CCG and our

academic partners to develop and write the

feasibility studies for both the GP practice

level test beds and the longer term paperless

milestone in 2018

• To project manage the test beds in

partnership with 10CC and Sheffield CCG

• To set up and run programme governance

• To commission robust evaluation at regular

intervals throughout the programme

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24

CREATING AN E-HEALTH ECOSYSTEM

We will coordinate a regional e-health Board acrossNHS provider organisations, CCGs, public healthand academia. The priorities contained within Five Year Forward View will be a key focus.

We will establish an EU e-health ecosystem programme that supports large

health economies in creating telehealth, assistive technology test beds

and spreading and adopting emerging learning. The intention is to work

with Airedale Hospital, which is EU 3* rated, and also a recently

announced Vanguard programme site and two other health systems, to

share learning from the EU e-health ecosystem programme, support the

development of plans, and evaluate delivery of benefits.

POPULATION HEALTH

OUTCOMES • To provide leadership to the region to

maximise full range of assets for implementing

e-health technologies at pace and scale

• A single EU e-health ecosystem across

Yorkshire & Humber

• Support for the Vanguard site in Airedale to

share learning across the region

• Three health communities that have

implemented agreed aspects of telehealth or

assistive living

• Robust academic evaluation of the potential

benefits of e-health to support delivery of new

models of care

THE ROLE OF THE YHAHSN • Agree and deliver a strategic plan with the e-

health Board

• To join the EU e-health ecosystem programme

on behalf of members and share their

experience

• Establishing an EU e-health ecosystem

• Arrange at least one EU e-health symposium

in the Yorkshire & Humber region during

2015/16

• To support at least two health systems

establish and roll out a good sized e-health

programme

25

BETTER DATA: RESEARCHONE ResearchOne is a health and care research database developed by TPP in partnership with the

University of Leeds. The ResearchOne database contains non-identifiable patient record information

from over four million people from more than 330 health and social care organisations. It is particularly

strong in the Yorkshire & Humber region where, for example, more than 60% of GP practices use the

TPP system.

OUTCOMES • An extensive research database made

available to researchers and academics

• Up to 15 research projects commissioned and

concluded in key areas of health and

healthcare

THE ROLE OF THE YHAHSN • To manage the contract already in place with

the University of Leeds and TPP to make the

research database available for academic

review

• To issue a call for research proposals that

would use the ResearchOne database as a

key data source

• To ensure that the research is published, peer

reviewed and that it contributes to the

innovation agenda in the region

26

BETTER DATA: QTOOL

QTool is a web-based electronic form systemdesigned to easily capture data from patients andsupply this to healthcare staff via the Internet.

The YHAHSN have funded the University of Leedsto manage the deployment of QTool questionnairesto obtain:

• anonymous feedback on care received as an in-patient

• patient identifiable data regarding previous medical history prior to

an intervention

• patient identifiable feedback on outcomes following an intervention.

POPULATION HEALTH

OUTCOMES • Improve the quality of patient-generated

data by piloting the implementation of a

web-based patient data collection tool

• If the tool evaluates positively, support the

development of a sustainable business

model for successful uptake by NHS

organisations

THE ROLE OF THE YHAHSN • Manage the contract with the University of

Leeds to ensure delivery and evaluation of

QTool and the production of patient-based

outcome measures

• To use the outputs from the QTool survey to

support members make changes to improve

service delivery, working with the IA

27

ENHANCING QUALITY OF LIFE FOR PEOPLE WITH LONG-TERM CONDITONS

Evidence indicates that as life expectancy increases,people tend to suffer from one or more long-termconditions that significantly reduce their quality oflife, requiring them to regularly access healthservices. With more effective self-management, better use of health information,

greater service delivery co-ordination and effective use of wearable

biometric and environmental telemetry, it is possible to change the way in

which people access health services. The result of this is that patients

remain in their own homes and communities rather than being admitted to

hospital. The YHAHSN will support existing regional Vanguard sites and

spread learning across the rest of the region.

The YHAHSN has three projects in this programme: The Healthy Ageing

Collaborative project will build partnerships to enable the design of the

new systems of primary and community care for older people; the Memory

Support Worker project will work with Primary Healthcare Teams and

specialist memory services to offer a ground-breaking service for people

who either have a diagnosis of dementia, or are showing signs and

symptoms that may indicate dementia; finally the Improving Air Quality

project is working with four local authorities supporting a priority of the

Directors of Public Health.

POPULATION HEALTH

28

HEALTHY AGEING COLLABORATIVE The Healthy Ageing Collaborative is building partnerships to enable the design of new systems of

primary and community care for older people with different severity grades of frailty based on an

electronic frailty index (eFI). A collaborative network of clinicians, academics, CCGs, local authorities

and industry partners has been established to implement evidence-based interventions, such as

supported self-management, and medication review protocols.

OUTCOMES • A well-tested package of care, incorporating

knowledge and skills for implementing the eFI into

routine GP care

• The creation of case studies demonstrating how the

eFI has been used to identify older people with

frailty and to more effectively manage their care

• In participating GP practices metrics will include:

improvement in numbers of frail older people

identified; improvement in number of frail older

people with evidence of a medication review;

improvement in uptake of physical activity/hearing

tests/podiatry/eye tests. These will serve as proxy

measures for primary outcome measures, which

include unplanned hospital admissions, stopping

inappropriate medications, and older people better

enabled to use supported self-management.

• The improvement case studies will be used to

inform an analysis of return on investment

THE ROLE OF THE YHAHSN • To disseminate the research evidence around

the management of frailty to general practice

staff

• Clinical utility testing of the eFI in two GP

clinical systems (SystmOne and EMIS)

• To support volunteer GP practices testing use

of the eFI to implement evidence-based

interventions, including a supported self-

management tool and implementation of a

STOPP protocol (screening tool for older

people’s potentially inappropriate

prescriptions) for medication review

• To support the testing of new ways of working

and different models of care, including the use

of clinical care coordinators and frailty

services to improve management of frailty

29

30

POPULATION HEALTH

MEMORY SUPPORT WORKERS (MSW)

Under the auspices of the Better Care Fund, LeedsCCGs, Leeds City Council and the voluntary sectorare working in partnership to implement a newMemory Support Worker Service. The MSW service is a ground-breaking development working with Primary

Healthcare Teams and specialist memory services to offer a service for

people who either have a diagnosis of dementia, or are showing signs and

symptoms that may indicate dementia. The workers will offer information,

advice, and meaningful, practical steps to connect people to opportunities

for activities and support – e.g. community-based activities, carers groups

and advocacy. The MSW service will be delivered by The Alzheimer’s

Society. The expectation is that the MSW service will deliver better

outcomes for patients and make efficiency and productivity gains for the

local health economy.

OUTCOMES • Following the delivery of the new project a

comprehensive evaluation of the impact of the

MSW service for Leeds will take place.

Pending the results of the evaluation roll-out

opportunities for MSWs beyond Leeds will be

identified.

• The economic evaluation will assess whether

the MSW service is likely to result in an overall

benefit, and what the associated costs will be.

The evaluation will demonstrate any out of

improvements in clinical care, reductions in

unnecessary hospital admissions, cost

effectiveness, return on investment and

improved patient outcomes.

THE ROLE OF THE YHAHSN Will be to work in partnership with Leeds CCGs,

Leeds and York Partnership NHS, Leeds City Council

and The Alzheimer’s Society to:

• Secure and fund expertise in health economics

from ScHARR

• Work alongside ScHARR to agree a consistent,

coordinated and coherent framework for economic

evaluation of this redesigned MSW service model

• Adopt a coordination role to project manage all

aspects of delivery of the health economics

evaluation

• Review and disseminate the findings to regional

stakeholders and the SCN

31

IMPROVING AIR QUALITYAir pollution is associated with low birth weight, ill health and an increase in the development andexacerbation of many life-limiting conditions. The YHAHSN is working with Directors of Public Health inYorkshire & Humber to improve air quality. In 2014/5 a study of best practice across all local authorities in theregion was undertaken and access provided to health economic modelling of air quality impact on health. In2015/6 the YHAHSN will build on that initial work to support four local authorities in the region through aseries of learning events to spread best practice and improve outcomes. The project will also examine therelationship between air quality and the incidence of COPD (chronic obstructive pulmonary disease).

OUTCOMES • Each of the four local authorities will

demonstrate impact in their chosen area of

evidence-based improvement using a credible

proxy measure. Example proxy measures are

percentage of fleet vehicles that are low

emission vehicles and proportion of school

children/staff using active travel to

school/work.

THE ROLE OF THE YHAHSN Will be to lead a collaborative approach with the four

local authorities to effect positive changes.

• Teams will attend a series of three learning

workshops during 2015/6, building on Learning

Event 1 which took place in December 2014

• The IA will provide one-to-one coaching support for

the teams to test changes and measure impact

• The IA will support the teams to access other major

stakeholders, including health economists

(University of York), behaviour change experts

(Universities of Leeds and Hull), and air quality

experts (Bradford District Council and Public Health

England)

• Commission a research study into the links

between air quality and COPD

PREVENTING PEOPLE FROM DYING PREMATURELY

Evidence suggests that people are dyingprematurely for avoidable reasons and the YHAHSNhas an objective to address this as part of our five-year strategy. The two priority projects in thisprogramme are:

POPULATION HEALTH

• Improving physical health for people with serious

mental illness, a project being run in collaboration

with Bradford District Care Trust.

• Reducing mortality via a thorough audit of case

notes, sharing the learning emerging from this to

better recognise and manage early signs of

deterioration, which if caught early enough could

prevent death. Shared learning about the

characteristics of good care will also improve

hospital mortality.

.

32

PHYSICAL HEALTH FOR THOSE WITH SMIPeople with diagnoses of serious mental illnesses (SMIs) such as schizophrenia and bipolar disorder die

15-20 years earlier than the general population, mainly from natural causes. The Yorkshire & Humber

NHS Mental Health Chief Executives’ Forum identified a need to reduce regional variation in both the

quality of annual healthcare checks and the number of people with SMI who receive an annual

healthcare check. Bradford District Care Trust has achieved national recognition in this area of care and

will be used as an exemplar site to guide best practice.

OUTCOMES This project supports the ambitions of the Five

Year Forward View, ensuring that:

• People with an SMI diagnosis received

improved physical healthcare

• New models of care are evaluated to establish

which produce the best experience for

patients and the best value for money

THE ROLE OF THE YHAHSN • Will be to work in partnership with the seven

NHS trusts across Yorkshire & Humber to

develop local improvement plans:

• Sharing the learning from the model of care

implemented by Bradford District Care Trust

• Support the trusts to adopt, adapt and

implement local approaches that will reduce

variation in the quality of annual health checks

and increase the numbers of people with SMI

who receive an annual health check

• We will fund health economics expertise to

review the evidence of impact for

implementing models of care that aim to

improve the physical healthcare of people

with SMI

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34

MORTALITY REDUCTION

This is an area where the IA has already establisheda national reputation. The IA is working with trusts in the region to develop a standardised,

systematic evidence-based mortality review programme using case note

review. This project enables members to identify contributory factors to

suboptimal care. The IA supports learning and improvement within front-

line teams, sharing regional themes arising from anonymised findings.

POPULATION HEALTH

OUTCOMES • A cadre of clinical staff trained in a systematic,

structured judgement method of case note

review in hospitals across the region

• A greater understanding across healthcare

providers in Yorkshire & Humber of major

themes around safety and quality of care

arising from systematic analysis of case notes

from deceased patients

• Case study examples of organisations that

have used the information to make

improvements in care and reduce mortality

THE ROLE OF THE YHAHSN Will be to lead:

• An ongoing programme of training for

volunteer clinical reviewers, led by a leading

expert in the field

• Ongoing development of the Regional

Mortality Steering Group with representatives

from each trust forming a strong network of

clinical leads in collaborating organisations

• Master classes and events to educate, engage

and learn

• Involvement of trainees as recommended by

NHS England’s Medical Director

• Input at board level in participating

organisations

• A system for shared learning, including

learning from positive practice and good

quality care

• Strong academic input for understanding

mortality statistics, led by a leading expert in

the field

• Links to national level mortality reduction work

35

CURRENT SYSTEMS

The YHAHSN has an emerging facilitation andleadership role in system level transformation anddevelopment. We provide support as an honestbroker to resolve differences and to deliverintegrated business cases that are underpinned byrobust evidence. Through our IA and extensive networks of Improvement Fellows and

Innovation Scouts we have created improvement capability and capacity

across the region and are leading improvement throughout the region.

Within this programme the YHAHSN is working on three intensive projects:

Urgent and Emergency Care, Medicines Optimisation and Diagnostics.

IMPROVING HEALTHCARE

36

OUTCOMES • Accelerate collaboration between regional

stakeholders to identify priorities for action and

support before winter 2015

• Improve understanding of patient flow into and

through the urgent and emergency care system

• Improve understanding of the patient experience of

urgent and emergency care

• Engage with the newly announced Vanguard sites

in support of their ambitions for urgent and

emergency care

THE ROLE OF THE YHAHSN • Work collaboratively with SCNs, Urgent Care

Networks and local leaders

• Establish four task and finish groups that will

develop resources to:

o Map the UEC system surrounding pilot

CCG areas to identify flow, demand,

misalignment and system blockages

o Identify predictors that give a window for

intervention and avoid A&E attendance via

practiced intervention

o Predict tomorrow’s UEC demand – collect

GP practice level data to support near

real-time prediction of UEC demand and

support capacity planning in the acute

sector

o Promote UEC access to patient records by

bringing data together for direct patient

care and use of the Frailty index to better

understand patient flow

• Bring outputs from the task and finish groups

together in order to generate and prioritise ideas

for testing followed by wider implementation across

the region

URGENT & EMERGENCY CAREYorkshire & Humber CEOs and Chief Accountable Officers formed a consensus that urgent and

emergency care is a critical challenge. The YHAHSN has been asked to support a project to develop a

better understanding of urgent and emergency care demand in the region.

This project commenced in November 2014 with a conference that brought together clinicians,

managers, commissioners, providers and academics to identify a better understanding of the system

and identity key challenges. The project uses a collective, connected and co-ordinated ‘systems

thinking’ approach with experts in the region participating in four task and finish groups. Sheffield and

Harrogate (PACS (integrated primary and acute care systems) Vanguard) CCGs have come forward as

initial pilot sites to identify their specific system challenges and solutions. Work is now ongoing to tailor

the project requirements for each pilot site area to their local needs.

37

IMPROVING EMERGENCY DEPARTMENTS

As part of our Urgent Care work, this project issupporting Emergency Departments in memberorganisations to review and improve theiroperational processes, implementing effectivetriage systems for timely and appropriate care. The project is enabling Emergency Departments to access research

evidence and to learn from the experience of effective systems both within

the region and beyond. This project builds on work undertaken in 2014/5,

which established a strong network of Emergency Department contacts

interested in learning with and from each other. In 2015/6 the IA will

deliver support to three Emergency Departments to implement

recommendations in relation to senior doctor triage and share the learning

with other members.

IMPROVING HEALTHCARE

38

OUTCOMES • Improved speed and appropriateness of

treatment in Emergency Departments,

including improved performance on the A&E

four-hour target

• An economic evaluation will provide further

evidence of impact and cost effectiveness of

implementing triage systems.

THE ROLE OF THE YHAHSN Is to build on a regional survey of 16

participating Emergency Departments in the

Yorkshire & Humber region and collated

research evidence to:

• Support the development of a strong network

of ED contacts

• Facilitate the sharing of research evidence

across the network of ED contacts

• Support implementation of recommended

evidence-based change in up to three EDs in

the region

• Provide access to behaviour change methods,

measurement for improvement and economic

evaluation

• Support the development of impact case

studies to demonstrate results

39

40

MEDICINES OPTIMISATION

Medicines, used to best effect, benefit both patients and

the NHS but all too often medicine use is sub-optimal,

leading to lost benefit and preventable harm and waste. Medicines Optimisation (MO) brings together the concepts of patient

centred care, self-management, shared decision making and evidence-

based medicine. More could be done to shift the prevailing paradigm of

‘medicines management’ to one of ‘medicines optimisation’.

IMPROVING HEALTHCARE

OUTCOMES • Facilitate improved patient experience through

patient activation and adherence

• Improve medicines safety

• Improve patient outcomes in our exemplar

areas (frailty, stroke prevention in atrial

fibrillation, glycaemic control in diabetes,

symptom control in asthma, and physical

health of people with mental health conditions)

THE ROLE OF THE YHAHSN Will be to work in partnership with the SCN,

academia, pharmaceutical industry, commissioners

and providers to:

• Co-produce behavioural guidance for clinicians and

patients to embed MO in clinical consultations

• Increasing joint working initiatives with

pharmaceutical industry and the digital technology

sector

• Demonstrate how the use of data and health

economics can identify “positive deviance” in the

field of MO

• Use data to highlight opportunities for CCGs to

invest in MO strategies

• Establish a Yorkshire & Humber Academic and

Clinical Translational Research Community

• Build an active Community of Practice for

medication safety

• Work with community pharmacy teams to improve

the safety of dispensing

• Work with primary care and community teams to

improve medicines interventions at transitions of

care

• Work with CCGs and medicines safety officers to

increase the number and quality of medicine-

related patient safety incident reports on NRLS

(National Reporting and Learning System) and carry

out the associated root cause analysis or significant

event audit

OUTCOMES • Patients have access to world-class

diagnostics and imaging services, provided

both sustainably and effectively

• New technologies will be identified for

implementation at scale through a phased

three-year approach

• Implement new technologies to generate the

expertise of working at scale across the

region. This learning will be used to develop

additional technologies that support early

intervention and upstream care

• Position Yorkshire & Humber as the national

leader in the effective use of diagnostics and

imaging technologies

THE ROLE OF THE YHAHSN • Review the current diagnostics work,

alongside the associated evidence base

• Provide academic and health economic

support to both groups via YHEC and ScHARR

• Work with partners to plan and deliver

symposium in north of England

• Support the work with 10CC and Working

Together in relation to demand optimisation

for radiology services, looking at new models

for workforce, standardisation of protocols

and any inappropriate demand on services

• Identify existing point of care diagnostic

technologies that would support earlier

diagnosis or prevention, cash release, align

with CCG priorities and support

implementation at scale

DIAGNOSTICSMember organisations have identified diagnostics and imaging capacity and capability as a key

challenge. There are significant opportunities to work collaboratively across the region with

commissioners, providers and industry to co-create solutions to the challenges, which include:

commissioning of services; capacity and capability; variation in pathways and quality; inconsistency in

delivery and data-sharing; duplication of tests; sustainable workforce; barriers to implementation of new

innovations; and supporting behaviour change.

There is a need to improve access to, and productivity of, diagnostic services across the region. The

reason this is important is to ensure the NHS is able to meet and better manage increasing demand. A

key part of this is ensuring timely access to diagnostics services in a way that directly impacts upon

patient management to improve outcomes. There is a commitment from existing networks to engage

with this programme of work, including the 10CC and Working Together groups, NIHR DEC (National

Institute for Health Research, Diagnostic Evidence Co-operatives) and NICE (National Institute for Health

and Care Excellence). Experts from across the region have met at two steering group meetings and are

currently developing the work programme supported by three task and finish groups (North of England

Symposium Event; Demand Optimisation; Technology Implementation).

41

IMPROVING HEALTHCARE

FUTURE SYSTEMS

Healthcare needs to transform in order to manage the

demands of a growing and ageing population. Emerging technologies are having a significant impact on supporting

individual citizens to manage their own health and wellbeing and make

more informed decisions about their healthcare. The NHS needs to adopt

the latest information technologies to significantly improve service

quality and operational performance at a faster pace than has been

achieved to date. Advances in diagnostics and genomic medicine will

revolutionise the way people experience health services. Citizens are

used to easier access to services in other sectors and are demanding

change in the way they access health services; this has significant

implications for transforming primary care.

Within this programme the YHAHSN is currently engaged in two projects:

supporting the development of a Yorkshire & Humber Genomics Medical

Centre (GMC) and supporting the transformation of primary care. Working

with existing regional EU telehealth leaders and SMEs, the YHAHSN is

engaged in establishing an e-health eco-system and developing

partnerships with leading ICT businesses. Our role is to bring together

NHS members, leading edge academics and businesses to deliver

practical solutions that deliver benefits to patients in the region, with the IA

creating the change-enabled organisational culture needed for sustained

improvement.

42

OUTCOMES • Programme management infrastructure

established and functional

• Resources in place with the capacity and

capability to deliver the project to time

• Full business proposal submitted by the

deadline in July 2015

• Preparation of the project team for the

evaluation visits by NHS England

• Successful GMC operating in Yorkshire &

Humber region by December 2015

THE ROLE OF THE YHAHSN • Appoint Programme Director, set up project

governance arrangements and convene all

project working groups

• Provide all programme management functions

and support

• Lead the GMC operational group and

participate on the GMC steering board

• Write the GMC business proposal

• Coordinate and prepare the team for the NHS

England evaluation visit

GENOMICS MEDICINES CENTREThe 100,000 Genomes Project is a world-leading programme with the aim of ensuring that the UK will

be the first country to introduce this technology in its mainstream health system. The aim of the

Genomics Medicine Centre (GMC) project is to support a successful application to be designated as a

Wave 2 NHS England Genomics Medicine Centre in Yorkshire & Humber. The YHAHSN is facilitating a

collaboration between three Yorkshire-based NHS Trust organisations (Sheffield Teaching, Leeds

Teaching and Sheffield Children’s Hospitals) to submit an application to NHS England to become a GMC

delivery centre.

43

IMPROVING HEALTHCARE

TRANSFORMING PRIMARY CARE

NHS primary care is the recognised gateway to the NHS.

The majority of patients access hospital and specialist

services following referral from primary care so

transforming primary care at scale is a prerequisite to

major hospital and system change. The project will learn

from existing communities where a more integrated out of

hospital service has been wrapped around primary care. The project will be designed in partnership with the regions CCGs’ leaders

and seek to address establishing new models of integrated primary,

community and out of hospital care for health communities. It will look to

solve the problems caused by a significant proportion of the GP workforce

approaching retirement whilst the recruitment of new GPs struggles to

keep pace. Transforming primary care was identified as a priority by

members during the YHAHSN regional planning meetings.

44

OUTCOMES • Project steering groups and governance in

place to deliver long-term changes includingclinical and wider systems inclusion

• Produced and consulted on plans to establishnew models for primary and community care

• Processes in place to spread new modelsacross the region to support early adopters

• Implementation plans ready to commenceimplementation with agreed timeframes

• Involvement of the YHAHSN commercial andIA teams to support the process

• A review of emerging primary care models inthe UK and Europe

THE ROLE OF THE YHAHSN • To appoint a GP and Project Director to

support member CCGs initiate the programme

• To support local health communities as theybegin delivering changes

• Support the regional Vanguards

• To bring the IA and YHAHSN’s CommercialTeam’s expertise on change management andICT support

• Examine opportunities for additional resourceand funding to support change projects

• To bring key individuals together in projectsteering groups and teams

• To arrange workshops to scope theprogramme

• To producing PIDs and project plans andcommission programme evaluation

45

46

IMPROVING HEALTHCARE

SAFETY & QUALITY

In 2015/6 the IA will continue to be a regional focus for

quality improvement, working with partners and members

to provide access for all healthcare staff in Yorkshire &

Humber to online quality improvement training, as well as

resources to support quality improvement projects

throughout the region. The IA will work collaboratively with Health Education Yorkshire and

Humber (HEYH), Yorkshire and Humber Leadership Academy and SCNs,

and is one of the founding members of the UK Improvement Alliance.

All NHS organisations in Yorkshire & Humber have access to the support,

training and resources provided by the IA.

PATIENT SAFETY COLLABORATIVE (PSC)The PSC mobilises front-line teams to focus on areas of safety that are important to members, including

pressure ulcers, medicines safety, physical health of mental health patients, improving outcomes from

high-risk surgery and acute kidney injury. The IA will support knowledge and evidence sharing between

organisations, through facilitated networks of patient safety leads and Improvement Fellows. This

project draws on structured summaries of research evidence and provides support to our members to

become High Reliability Organisations for safety, improving care ‘bottom up from the top’. The PSC will

draw on learning from other areas of the IA portfolio, including the use of the Measurement and

Monitoring of Patient Safety framework with front-line teams and boards, and a research project to

extend the national early warning score (NEWS) to include biochemical data in a computer-assisted risk

score, and funding to scale-up team huddle and acute kidney injury interventions. This project draws on

and involves our regional network of Improvement Fellows.

47

OUTCOMES • Reduced patient harm: falls, pressure ulcers,

AKI, physical health checks, medication errors

• Improved team safety culture measured usingvalidated tool

• Increased capability for independent safetyimprovement for participating teams

THE ROLE OF THE YHAHSN • Host roundtable meetings with patient safety

leads in acute trusts, mental health trusts, andin primary and community care, setting theagenda for working together to tackle some ofthe common priority problems

• Create a TAPS (Training and Action for PatientSafety) programme focusing on safermedicines dispensing

• Use our network of Improvement Fellows andlinks to other PSCs through the YHAHSNnetwork

• Draw on resources that include access toresearch evidence, quality improvementtraining, behaviour change methodology,measurement for improvement, team cultureimprovement and training in human factors

48

IMPROVING HEALTHCARE

PATIENT FALLS

A pilot project in 2014/5 for supporting front-line teams in

Leeds Teaching Hospitals to reduce falls was positively

evaluated, showing 50% reductions in falls in engaged

ward teams, and a return on investment of 388%. For 2015/16 this programme will be offered to all members. The project is

planned to extend into community services and GP surgeries. This project

will draw on and involve our regional network of Improvement Fellows and

build on our successful Falls Summit held jointly with other northern

AHSNs. Quality improvement training is available to actively encourage

improvement across all member organisations.

OUTCOMES • Reduction in falls to levels equivalent to those

achieved in the pilots

• Improvement in team safety culture

• Capability at team level to deliverimprovement in other areas of care

THE ROLE OF THE YHAHSN • Offer light touch team level support from the

IA using a tried and tested model ofimprovement

• ‘Bottom up from the top’ delivery withexecutive support for working with front-lineclinical teams

• A pilot project will be established in eachmember organisation, to include:

o Initial meeting with member ofexecutive team of interested partnerorganisations to agree which team tostart with in their organisation

o Initial team meeting with seniorclinician and senior manager inidentified teams

o Team culture survey in each newteam

o Ongoing light touch, hands-onfacilitation with each team

o Measurement processes establishedin each team

• The initial pilot projects in each organisationwill be a basis for further spread and scale up

• All teams reporting bronze, silver, gold,platinum and diamond achievements reportedon a regional roll of honour

49

50

IMPROVING HEALTHCARE

OUTCOMES • Dedicated Quality Improvement online training

portal

• Entry-level online training accessible to allhealthcare staff in Yorkshire & Humber, free ofcharge

• Quality improvement skills training deliveredthrough core skills workshops (20-50participants)

• Specialist training that will equip organisationsto develop and maintain a sustainableimprovement culture

• A supported network of 150 ImprovementFellows in Yorkshire & Humber

• Support for the development of “communitiesof practice” through the Co-Creation Network

THE ROLE OF THE YHAHSN • Sustain strategic engagement with the QI

Training Advisory Group

• Test the online training resources withvolunteer member organisations

• Develop and deliver the face-to-face QItraining in response to identified needs

• Support a group of QI training experts througha Train the Trainer (‘gold’ level) programme

• Publicise and administer access to QI trainingproducts, both online and face-to-face

• Develop access to a range of online tools andresources

• Sustain and nourish the Improvement Fellowsnetwork

• Work with NHS Leadership Academy todevelop communities of practice through theCo-Creation Network

CAPACITY BUILDING FOR QUALITY IMPROVEMENT

The Quality Improvement (QI) training programmes help

to develop capability for improvement. In 2014/15 a

Quality Improvement Training (QIT) Advisory Group was

established from member organisations to steer the

development of a regional framework for QI training. In 2015/16 this work will continue in order to provide access for all

healthcare staff in Yorkshire & Humber to online ‘entry-level’ QI training, as

well as delivering face-to-face core skills workshops, and highly specialist

training, including a Train the Trainer programme. The Improvement

Fellows scheme supports those who are already leaders of improvement in

their own organisations.

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IMPROVING HEALTHCARE

EFFICIENCY & PRODUCTIVITY

NHS organisations are used to making annual efficiency

targets and considerable improvements have already

been achieved. Through the Five Year Forward View the NHS has challenged itself to

achieve further significant efficiencies. This programme focuses on how

current services can be redesigned to improve quality and reduce cost.

This programme will principally be led by the IA through the Improvement

Fellows Network and is focusing on priorities identified by members. The

programme will bring organisations and technology together to take

practical steps to implement evidence-based improvements and achieve

associated patient benefits.

The projects making up this programme consist of Patient Flow and

Evaluating Currency Implementation for Mental Health: Care Pathways &

Packages Project.

52

OUTCOMES • Reduced length of stay by the equivalent

levels achieved in the pilot

• Reduced waits in Emergency Departments forpatients being admitted to hospital beds

• Improved control for staff

• A potential test bed initiative

• Evaluation of the programme

THE ROLE OF THE YHAHSN • Systematic implementation of operational

management tools designed to support betterpatient flow in hospitals

• Sharing lessons from initial implementationsites through facilitated and targeted regionalroundtable and master class events

• Support wider and sustainable spread througha Train the Trainer approach

• Ensure synergy with the Urgent Care andPatient Safety Collaborative projects in orderto exploit the implementation and embeddingof this approach

PATIENT FLOWThis project supports hospitals and community-based services to better understand and manage

patient flow. Through the introduction of operational management tools, this project aims to support

member organisations in reducing hospital length of stay (LOS) and Emergency Department (ED) waits.

One early implementation site is demonstrating a reduction in LOS of 20%, and implementation is

currently taking place at a second hospital site. The work in 2015/16 will include a roundtable discussion

with representatives from interested member organisations of the evidence and learning to date, a

master class, and further training support. We will support member organisations to demonstrate impact

on key outcome indicators, including LOS and patient waits in EDs.

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IMPROVING HEALTHCARE

CURRENCY IMPLEMENTATION FOR MENTAL HEALTH

The Care Pathways & Packages Project (CPPP) is a

consortium of organisations in Yorkshire & Humber and the

North East who are working together to develop national

currencies and local tariffs for mental health services.

The currencies, known as ‘care clusters’, cover most mental health services

for working age adults and older people. The care clusters were mandated

for use from April 2012.

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OUTCOMES In February 2015, the Yorkshire & Humber NHSChief Executives’ Forum for Mental HealthServices requested YHAHSN’s support for theCare Pathways & Packages Project in order to:

• Produce a health economics focused analysisof the impact upon patient, clinical andfinancial outcomes from implementing themental health clustering tool

• Improve commissioner and service providerunderstanding of implementing the costingmethodology and using mental health datamore effectively

• Achieve commissioner approval to proceedwith the CPPP programme

THE ROLE OF THE YHAHSN Work in partnership with representatives fromthe Care Pathways & Packages Project and theSCN, in order to:

• Complete a scoping exercise with mentalhealth commissioners and providers to gatherevidence, opinion and information, and reviewcurrent procedure. Review of the scopingwork completed in 2014/15.

• Discuss and agree the requirement andtimetable for delivery with a view tosupporting the production of two eLearningresources that meet the needs of the targetaudience and complement the existing suiteof resources developed for the CPPPprogramme. The e-learning resources willhave a focus on:

o Guidance for implementing thecosting and pricing methodology

o Guidance for using quality andoutcome data

• Secure health economics expertise toundertake an evaluation of implementing themental health clustering tool across twolocalities. Adopt a co-ordination role to projectmanage all aspects of delivery of the healtheconomics evaluation.

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ECONOMIC GROWTH

INWARD INVESTMENT

External funding is often the key to unlocking innovation

implementation within the NHS, especially when clinical

trials necessitate the costly dual running of services or

pathways.

This programme is focused on two main goals. The first is creating and

facilitating an innovation investment funding function that de-risks

investment for both the NHS and SMEs. The second is investing in

emerging and potentially game-changing innovations that require initial

seed funding to accomplish proof of concept evidence, but that

demonstrate a future positive impact for our patients in addition to

generating returns to be reinvested into further supporting projects.

The funding function will horizon scan to identify a range of funding

options for Yorkshire & Humber companies and NHS organisations to

apply for, including, but not limited to, European and national innovation

funds (e.g. EU programmes, Innovate UK, Research Council and NIHR

initiatives), additional government assistance (especially through

engagement with Local Enterprise Partnerships), and private equity

financial investments (working with venture capital, private equity and

angel investment communities).

NEW SOURCES OF INWARD INVESTMENTMaximising the potential of available funding and investment streams is crucial to regional growth

across 2015/16. This project will continue the work of leveraging UK, European and global funding to

increase regional investment. The YHAHSN will support organisations to drive innovation into front-line

use care delivery and support access to key lines of funding inclusive of SBRI (Small Business Research

Initiative), Horizon2020, NHS Challenge Prizes and Regional Innovation Funds. Additional funding will

provide proof of concept funding and other investment opportunities to sustain innovative SME

partners, and reduce the burden on central NHS budgets.

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OUTCOMES • Increased opportunity and access to efficientusage of UK funding opportunities

• The YHAHSN will provide supportmechanisms to access and ensure efficientusage of EU and global funding opportunities

THE ROLE OF THE YHAHSN • Establish a clear understanding of UK, EU and

global funding opportunities available

• Work closely with key stakeholders at alllevels to support organisations seeking toidentify funding opportunities, including butnot limited to: Local Enterprise Partnerships,NHS European Office and local authorities

• Develop a ‘route to funding’ pathway toprovide clear steps and advice

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ECONOMIC GROWTH

INVESTMENT TO ACCELERATE INNOVATION

Throughout 2015/16 the YHAHSN will build upon the

regional and national growth of UK organisations and

capitalise on the economic development across the

Yorkshire & Humber region through 2014/15.

We will continue with the creation of an environment for business that

encourages them to establish and/or grow in the region, working closely

with HEI, industry and the NHS. The aim is to create public/private

partnerships and other business models that deliver value to the NHS

and industry by providing investment that supports ground breaking

innovators, SMEs and MNOs in order to provide innovation directly into

the NHS.

OUTCOMES • The provision of technical, financial and

clinical support to new innovations that willbenefit the NHS

• Identification and funding of proof of conceptprojects

• Identification of risks that act as barriers to theinnovation pathway and identification ofmitigation actions

• Generation of a financial return to theYHAHSN for future investment opportunities

THE ROLE OF THE YHAHSN • Roll out a proof of concept funding

programme, which will provide predominantlyfinancial support to innovators from public andprivate sector organisations to develop andtest new innovations

• Build and engage commercial partnershipswith public and private sector organisations tosupport the delivery of ground breakinginnovations

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ECONOMIC GROWTH

INDUSTRY ENGAGEMENT

The UK has one of the strongest and most productive life

sciences sectors in the world, generating an annual

turnover of more than £50bn.

The sector comprises nearly 5,000 companies, and employs an estimated

175,000 people. The NHS benefits greatly from the ground-breaking

innovations that are created in the sector. Our industry engagement

programme will build stronger relationships between the NHS and industry

that will result in better, more effective solutions for our patients, as well as

safeguarding and creating life science sector jobs.

Within this programme the YHAHSN will work as market makers: opening

doors and creating a more conducive environment for relevant industries

to work more effectively with the NHS and other parts of the UK

healthcare sector. We will work with the healthcare sector to help make

the NHS a better customer to industry, supporting them to better articulate

their needs. We also work with industry to help them better understand

NHS requirements and how to access the healthcare market, moving away

from a purely transactional way of working to a partnership model.

60

OUTCOMES • Enhanced partnerships between UK industry

and the NHS

• Quicker and more widespread use ofinnovation in front-line care

• Extension of the UK’s reputation for deliveringgame changing innovation to the health andcare sector

• Support for NHS organisations in overcomingprocurement barriers

• Support for the private sector to generateincreased sales, revenue and improved jobopportunities

THE ROLE OF THE YHAHSN • Develop a single point of access (SPA) portal

to support and develop a pipeline ofinnovations for the NHS

• Establish an industry engagement pathwaythat builds relationships between UK industryand the NHS

• Provide procurement and commissioningclinic for industry partners to overcomecurrent market barriers

• Provide leadership across the region toprovide a coherent, joined up approach toSME support, inclusive of engagement withLocal Enterprise Partnerships, regionalinnovation hubs, local authority economicdepartments, Healthcare TechnologyCollaborative, and Diagnostic Evidence Co-operatives

• Delivery of Regional Open Innovationworkshops to connect HEI, industry and NHSpartners to create and develop newintellectual property, products andopportunities

CONNECTING INDUSTRY TO HEALTHCAREThe project will build a comprehensive support programme for UK businesses and NHS entrepreneurs

that creates a single point of access to the NHS. A pipeline of validated innovations for front-line

delivery will be established that creates growth for UK industry and increases quality in NHS provision.

This includes procurement advice, system education, consultancy support, signposting, health

economics expertise and market access strategy creation.partners, and reduce the burden on central

NHS budgets.

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62

ECONOMIC GROWTH

IDENTIFYING & ADOPTING INNOVATION

Advances in technology and medicine require the NHS to

be more nimble in identifying and implementing

innovations that will allow it to deliver better care more

efficiently.

In the coming decade technological innovations such as smart phones,

wearable devices, the “Internet of things”, remote monitoring, cloud

computing and big data have the ability to create a seismic effect on

healthcare delivery. In addition medical breakthroughs such as genomics,

proteomics, personalised and stratified medicines and regenerative

medicine will also change our fundamental notion of healthcare services.

With this backdrop it is essential that the NHS becomes better at

identifying and refining the technological opportunities that will make the

biggest improvements to patient care, with a recognised pathway towards

mainstream front-line use.

This programme harnesses the creativity of the region by encouraging the

NHS to work more directly with industry and academic partners to develop

new IP and innovations that enable the rapid adoption of new technology

into the NHS front line. Open innovation is a major programme for the

YHAHSN that results in new partnerships between UK and international

organisations, developing new IP suitable for the delivery of a 21st Century

healthcare service, in addition to maximising growth opportunities for UK

industry by creating new joint ventures designed to exploit both UK and

overseas markets.

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OUTCOMES • The delivery of an International Open

Innovation Programme in 2015/16

• The delivery of Regional Open InnovationWorkshops

THE ROLE OF THE YHAHSN • Working closely with UK industry partners and

HEIs to generate investment and growthopportunities

• Collaboration and joint delivery with expertpartners from Yorkshire & Humber, bringingtogether regional expertise and skills todevelop and explore new innovations, IP andhealthcare solutions

• Working collaboratively with the Departmentfor Business Innovation and Skills and othernational bodies to explore the potential andscope for a UK Open Innovation Programme

• Working with international partners to identifynew territories in which to deliver future OpenInnovation Programmes

OPEN INNOVATIONThe 2015/16 financial year will bring the continuation of the successful Open Innovation programme

piloted in 2014/15. The programme will support our additional objectives of connecting UK business,

the NHS and UK HEIs with potential funding sources, including venture capital and international

government investment funds, to speed up adoption and evidence generation and reduce NHS

unit costs.

ECONOMIC GROWTH

INNOVATION SCOUTS

The barriers to successful innovation across the health and

care sector are widely recognised, none more so than our

ability to sufficiently recognise and reward the innovators

within our healthcare delivery system.

The Yorkshire & Humber Innovation Scout Network has grown during

2014/15 and this next year will see the ‘scout’ network grow further. In

collaboration with delivery partners, we will support NHS staff across the

region to innovate, collaborate and develop new commercial opportunities

within and between NHS organisations. Plans for 2015/16 activity include

cross-border networking events and significant partnerships with UK

business.

64

OUTCOMES • Expansion of the Innovation Scout Network

across the region and beyond

• The identification, spread and adoption of newcommercial IP and best practice innovationacross the NHS

THE ROLE OF THE YHAHSN • Work with our key delivery partners to

strengthen the current programme forYorkshire & Humber Innovation Scouts that issuitable for cross border application also

• Work closely with, and provide leadershipacross, the four northern AHSNs to create acoherent brand and aligned objectives foreach Innovation Scout Network

• Build into the programme a series of exclusivedevelopment opportunities to reward andrecognise the efforts and impact of NHSinnovators; this will involve working closelywith industry partners, HEIs, NHSorganisations and other bodies to ensure wecreate informative and rewardingexperiences.

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66

OUTCOMES • Supporting the identification and awarding of

the 20 Innovation Fellows

• Working with associates to deliver the NIAprogramme with reference to the followingoutcomes:

o Focusing on patients and populations

o Learning from elsewhere

o Selecting the best nationally andinternationally

o Tailored support to fellows

o Delivering through partnership

o Effective communication

THE ROLE OF THE YHAHSN • Act as co-developers of the programme and

partner with NHS England, UCL Partners, TheHealth Foundation and successful applicantsto ensure the programme is delivered to thehighest quality

• Support the application and assessmentprocess and programme delivery

• Ensure learning and development is broughtback to the Yorkshire & Humber Region,providing regular update summaries, sharingkey learning and developing informationsessions to promote and spread the identifiedbest practice

ECONOMIC GROWTH

INNOVATION ACCELERATOR

As a founder member of the National Innovation

Accelerator programme, the YHAHSN will work in

partnership with other AHSNs, the Health Foundation, NHS

England, patient groups, mentors and experts from across

the health sector to support new and emerging innovators

and maximise their impact on patient care.

“NHS Innovation Accelerator (NIA) is to help deliver on the commitment

detailed within the Five Year Forward View – creating the conditions and

cultural change necessary for proven innovations to be adopted faster and

more systematically through the NHS, and to deliver examples into

practice for demonstrable patient and population benefit.” (NHS Innovation

Accelerator: Call for Applications 2015)

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68

ECONOMIC GROWTH

GENERATING GROWTH FROM OVERSEAS MARKETS

The Government’s Plan for Growth (2011) identified greater

inward investment and exports as a route to a more

balanced economy.

This programme supports that ambition within a healthcare context and is

focused on the twin ambitions of greater inward investment for Yorkshire &

Humber in the form of Foreign Direct Investment (FDI), and promoting our

services, innovations and expertise overseas, working in partnership with

industry and creating opportunities for healthcare and UK-based

companies to generate new revenue streams, particularly in the BRICS

(Brazil, Russia, India, China and South Africa) and MINT (Mexico, Indonesia,

Nigeria and Turkey) markets.

The NHS’s unique position as a national provider means it can lead the

world as an ‘intelligent customer’; this programme is aimed at harnessing

the collective skills and expertise of the region to promote ourselves

internationally and support the “northern powerhouse” to be the best

place in Europe to start, finance and grow a business. Success in this

programme requires close strategic alignment with our Local Enterprise

Partnerships (LEPs) as well as key government departments, particularly

Healthcare UK and the UKTI Life Sciences Organisation

INTERNATIONAL INWARD INVESTMENTIn 2015/16 the work of our International Office will be closely aligned to all our ongoing projects. There

will be a focus on creating opportunities for regional industry partners, NHS providers and key

stakeholders to generate value-enhancing engagements and inward investment opportunities. Working

in partnership with BIS (Department for Business, Innovation & Skills), Local Enterprise Partnerships and

other key regional stakeholders, the YHAHSN will showcase to international parties the strengths and

opportunities available across the UK and specifically the Yorkshire & Humber region.

69

OUTCOMES • Successful identification and marketing of the

key strengths, skills and opportunitiesavailable within the Yorkshire & Humberhealthcare sector

• Increased opportunities for the Yorkshire &Humber region to benefit from new sources ofinvestment

THE ROLE OF THE YHAHSN • Work with NHS commercial directorates to

understand the key strengths and capabilitiesof regional provider organisations. Supportthe identification of high-value opportunitiesavailable to NHS organisations.

• Work collaboratively with internationalhealthcare and trade organisations to promotethe Yorkshire & Humber region as ‘open forbusiness’. Use these relationships to translatethe wider strategic ambitions andopportunities from the international healthsector into tangible opportunities for regionalindustry partners.

• Work closely with, and provide a leadershiprole for, our four Local Enterprise Partnershipsin order to provide a coherent inwardinvestment strategy for the entire region

70

OUTCOMES • Identify, in collaboration with HUK, UKTI and

international colleagues, high-value exportopportunities for regional stakeholders

• Delivery of a successful value-enhancingstrategy for NHS organisations, exploring howthey can capitalise on expertise, IP, skills andlearning available within the NHS. Supportingincreased income to offset the reliance on tax-funded monies for core operational delivery.

THE ROLE OF THE YHAHSN • Work with NHS commercial directorates to

understand the key strengths and capabilitiesof regional provider organisations. Supportthe identification of high-value opportunitiesavailable to NHS organisations. Support thedelivery of international market accesstraining for NHS provider organisations.

• Work collaboratively with internationalhealthcare and trade organisations to promotethe Yorkshire & Humber region as ‘open forbusiness’. Use these relationships to translatethe wider strategic ambitions andopportunities from the international healthsector into tangible opportunities for regionalindustry partners.

• Work with HUK and UKTI to translateinternational healthcare need into tangibleopportunities for UK healthcare organisations

ECONOMIC GROWTH

EXPORTING UK HEALTHCARE EXCELLENCE

Working in partnership with Healthcare UK, UKTI and FCO

(Foreign & Commonwealth Office) the YHAHSN will

mobilise the UK healthcare sector to identify high-value

international opportunities that support growth, income

generation and export opportunities for industry partners,

healthcare providers and leading academic institutes from

across the region and the UK.

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4 RISKS

Risks Mitigation

A constantly changing environment: The environment in which the YHAHSN isoperating is changing. Five Year Forward Viewhas set out the direction of travel and changewithin the NHS, but additional external influencessuch as the political landscape and economicclimate are harder to predict.

We have worked hard to ensure that our plans arealigned with the long-term strategy of NHSEngland and are working with members in aparallel method, improving current systems, whilstsupporting future systems and methods of care.Whilst political and economic influences cannot bepredicted, as an organisation we need to ensurewe are flexible and respond quickly to situations.Our company, board and organisational structureis set up to allow us to react quickly and withoutthe restrictions that being hosted by a third partycould impose.

Overcoming barriers to change: In order to implement improvements, areas toimprove have to be identified. For front-line staffthis could be discouraging and have negativeconsequences, one of which could be resistanceto change. Changing the culture within anorganisation, whether it be within a team or wider,is a complex and difficult issue.

The IA has already shown its ability to implementchange within small teams and at scale and has anexcellent track record. The opportunities createdby the YHAHSN through our Improvement Fellowand Innovation Scout Network create positivereinforcement and ensure change is broughtabout from within and not forced on teams. Theprojects within the plan have been aligned tomembers’ needs and requirements, which shouldhelp ensure organisational buy-in.

Lack of stakeholder engagement: There are a number of projects within the businessplan that require stakeholder engagement,whether that be from delivery partners or memberorganisations. We know financial, personnel andtime resources are stretched within the systemand that is an obstacle which must be overcomefor the success of many projects.

One of the YHAHSN’s capabilities is our ability toengage with partners and create time to think forour members. Communication with partners willneed to show that additional pressures on finance,staff and time in the short term will be for long-term gain. The use of robust evidence, casestudies, health economics and testimonials fromlive pilot sites will be key tools in overcoming thisobstacle.

Standing out from the system noise: There are many organisations that have suggestedthey have answers to problems within the NHS,from both the public and private sectors. Ensuringthat the work of the YHAHSN stands out from thesystem noise and is viewed as integral to theneeds of the regional health economy is crucial forthe plan to succeed.

Throughout the planning process the YHAHSNhas engaged with members to ensure the planmatches the region’s needs. Our role as “honestbroker” is key to ensuring that our offering is seenas different to that of others. Our ability to providehealth economics and an evidence base tosupport decision making will help ensure that ourservices are viewed as integral to the system.

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5 APPENDIX

5.1 COMPANY INFORMATION

Yorkshire & Humber Partners Academic Health Science Network

Company Number: 08887451

Registered office address:

12 Navigation Court

Calder Park Business Park

Wakefield

West Yorkshire

WF2 7BJ

Directors registered at Companies House:

Andrew Cash

Christine Outram

William Pope

Andrew Riley

E: info@yhahsn.comw: www.yhahsn.org.uk

t: @AHSN_YandH

Unit 12 Navigation Court, Calder Park, Wakefield, WF2 7BJ

A company limited by guaranteeregistered in England and Wales No 08887451

Licensed by NHS England

Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

Appendix(2)

CCG Assurance Framework 2015/16 Delegated Functions - Self-certification

CCG Name or joint committee of CCGs Rotherham Quarter/year to which certification applies Q1 15/16 1. Assurance Level To support ongoing dialogue, CCGs are asked to provide a self-assessment of their level of assurance for each Delegated Function (as appropriate) . Assurance Level Change since last period Delegated commissioning Assured as good Not applicable OOH commissioning Assured as good Not applicable 2. Outcomes Briefly describe progress in last quarter towards the objectives and benefits the CCG set out in taking on delegated functions, in particular the benefits for all groups of patients <maximum 200 words> Since delegated in April 2015, the CCG has developed a GP strategy and workforce plan, consulting with patients and carers via events and PPGs and GPs via protected learning time and commissioner events. The strategy and workforce plan have been approved at the Primary Care Sub-committee. Rotherham is now working on the estates strategy with NHS property co. with focus on specific projects. 3. Governance and the management of potential conflicts of interest in

relation to primary care co-commissioning (this section should be completed by those CCGs which undertake joint commissioning with NHS England as well as those that have delegated commissioning arrangements)

Co-commissioning OOH commissioning Have any conflicts or potential conflicts of interest arisen during the last quarter?

Yes No

If so has the published register been updated?

Yes No

Is there a record in each case of how the conflict of interest has or is planned to be managed?

Yes Not applicable

Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

Please provide brief details below and include details of any exceptions during the last quarter where conflicts of interest have not been appropriately managed <maximum 200 words> 4. Procurement and expiry of contracts Briefly describe any completed procurement or contract expiry activity during the last quarter in relation the Delegated Functions and how the CCG used these to improve services for patients (and if and how patients were engaged). <maximum 250 words per Delegated Function> The GP OOH contract is currently scheduled to terminate in November 2015. Rotherham CCG has taken the decision to extend the contract for a further three years with an intention to procure the service in 2018. Rotherham CCG is currently developing a new service model for urgent and emergency care based around a new-build Emergency Centre. It is currently unclear what the final service model for OOH services will look like so it would be difficult to procure a new service at this stage. Also, Care UK, our GP OOH provider, is one of the key partners involved in the development of the Emergency Centre. It would be disruptive to the Emergency Centre programme if RCCG were to go out to procurement and potentially change provider. There is a need to create a contracting environment where provider partners are totally focused on the emerging service model. Local Incentive Schemes Is the CCG offering any Local Incentive Schemes to GP practices?

Yes

Was the Local Medical Committee consulted on each new scheme?

Yes

If any of those schemes could be described as novel or contentious did the CCG seek input from any other commissioner, including NHS England, before introducing?

No

Do the offered Local Incentives Schemes include alternatives to national QOF or DES? If yes, are participating GP practices still providing national data sets?

No Choose an item.

What evidence could be submitted (if requested) to demonstrate how each scheme offered will improve outcomes, reduce inequalities and provide value for money? <maximum 250 words for each Delegated Function> The Local schemes are primarily driving appropriate activities from secondary to primary care e.g. dermatology, joint injections, phlebotomy, anti-coagulation facilitating care closer to home. Care home assignment and case management are also central to Rotherham’s strategy for improving and providing consistency in patient care.

Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

5. Availability of services Briefly describe any issues raised during the last quarter impacting on availability of services to patients (include if and how patients were engaged). <maximum 250 words for each Delegated Function> Delegated

commissioning OOH commissioning

How many providers are currently identified by the CCG for review for contractual underperformance?

0 0

And of those providers, how many have been reviewed and there is action being taken to address underperformance?

N/A N/A

During the last quarter were any providers placed into special measures following CQC assessment?

No No

If yes, please provide brief details of each case and how the CCG is supporting remediation of providers in special measures <maximum 50 words per case> In the last 12 months has the CCG published benchmarked results of providers OOH performance (including Patient experience)

No

If yes, please provide link to published results: 6. Internal audit recommendations Co-commissioning OOH commissioning Has internal audit reviewed your processes for completing this self-certification since the last return?

No No

If so, what was their conclusion and recommendations for improvement? <maximum 200 words for each Delegated Function> Use this space to detail any other issues or highlight any exemplar practice supporting assurance as outstanding Rotherham has encouraged central NHS England review of Rotherham’s general practice arrangements since delegation. This commenced however has had to cease

Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

due to work commitments at NHS England. Feedback had been positive in relation to the primary care sub-committee arrangements and strategic direction.

Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

7. CCG declaration

I hereby confirm that the CCG has completed this self-certification accurately using the most up to date information available and the CCG has not knowingly withheld any information or misreported any content that would otherwise be relevant to NHS England assurance of the Delegated Functions undertaken by the CCG. I confirm that the primary medical services commissioning committee remains constituted in line with statutory guidance. I additionally confirm that the CCG has in place robust conflicts of interest processes which comply with the CCG’s statutory duties set out in the NHS Act 2006 (as amended by the Health and Social Care Act 2012), and the NHS England statutory guidance on managing conflicts of interest. Signed by [insert name] CCG Accountable Officer / Chair of joint committee (delete as appropriate) Name: Position: Date: Signed by [insert name] Audit Committee Chair Name: Position: Date:

Please submit this self-certification to your local NHS England team and copy to england.primarycareops@nhs.net using the email subject ‘Delegated functions self-certification.’

High quality care for all, now and for future generations

Publications Gateway Ref No. 03863

Dear Colleague As you will be aware, allegations have been made that a number of individuals in the NHS may have acted inappropriately in dealings with pharmaceutical companies. Whilst recognising that this is not solely an issue for CCGs, I am writing to seek your assurance that within your CCG:

• You have in place and operate appropriate systems and processes to ensure that conflicts of interest or potential conflicts of interest are declared and mitigated.

• You have appropriate registers in place to register any declared conflicts of interest, gifts and hospitality, and that these are kept up to date.

• You have a code of conduct (or similar code) in place for your CCG which defines required standards of behaviour for individuals working within your organisation, and those performing or authorising activities or advisory duties on your behalf, and that this has been properly communicated to all relevant personnel.

• That your code of conduct specifically covers an employee/member’s responsibility in relation to hospitality and gifts, and has regard to the Professional Standards Authority document Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England, and the NHS Business Services Authority guidance Standards of Business Conduct Procedure, (HSG (93)5), as well as the Nolan principles.

• In making your arrangements and discharging your functions, you have due regard to NHS England’s published guidance on conflicts of interest.

• The arrangements you have in place ensure that the integrity of CCG decision-making processes is not affected.

• All of the above are appropriately and regularly monitored and assured by your audit committee and form part of your regular assurance.

• No individual employed by the CCG, including members of the CCG Governing body, is currently acting outwith your policies.

Whilst I know you will want to assure yourself that there are no issues which require your immediate attention, I am sure you will also want to undertake a more comprehensive review of all your systems and process.

28 July 2015

Office of the National Director:

Commissioning Operations Quarry House

Quarry Hill LEEDS LS2 7UE

CCG Accountable Officers in England

High quality care for all, now and for future generations

I would be grateful if, as Accountable Officer, you could provide your assurance on the above points after that full and comprehensive review to your local NHS England Director of Commissioning Operations, or to David Mallett (copied to Simon Weldon) for CCGs in London, by Friday 28 August 2015, in order that we can have confidence nationally that all appropriate systems and processes are in place and they are actively being utilised. I have asked for the same assurance from all CSU Managing Directors and in addition, working with other parts of the NHS, we are reviewing the current guidance and will provide an update if it would appear that is necessary.

Best wishes

Dame Barbara Hakin National Director: Commissioning Operations Copy: Moira Dumma, Director of Commissioning Operations, NHS England North, (Yorkshire & the Humber) Graham Urwin, Director of Commissioning Operations, NHS England North, Clare Duggan, Director of Commissioning Operations, NHS England North, (Cheshire & Merseyside) Tim Rideout, Director of Commissioning Operations, NHS England North, (Cumbria & the North East) Wendy Saviour, Director of Commissioning Operations, NHS England Midlands & East, (North Midlands) Andrew Pike, Director of Commissioning Operations, NHS England Midlands & East, (East) Andrew Reed, Director of Commissioning Operations, NHS England Midlands & East (West Midlands) Elliott Howard-Jones, Director of Commissioning Operations, NHS England Midlands & East (Central Midlands) Anthony Farnsworth, Director of Commissioning Operations, NHS England South (South West) Felicity Cox, Director of Commissioning Operations, NHS England South (South East), Rachel Pearce, Director of Commissioning Operations, NHS England South (South Central) Dominic Hardy, Director of Commissioning Operations, NHS England South (Wessex) Simon Weldon, Regional Chief Operating Officer, NHS England London David Mallet, Head of Reconfiguration, NHS England London Richard Barker, Regional Director, NHS England North Paul Watson, Regional Director, NHS England Midlands & East Anne Rainsberry, Regional Director, NHS England London Andrew Ridley, Regional Director, NHS England South

Conflicts of Interest – RCCG Assurance Return

Name of CCG – Rotherham CCG

Requirement Response Comment

1a There are systems & processes in place within the CCG to ensure conflicts of interest are declared and mitigated

Yes

All Employees (including GPs) and member practices submit the declaration of interest form in April each year. This is compiled and sent to Governing Body and Published on the website. Governing Body in public session receive Quarterly updates through the corporate assurance report.

1b The CCG’s systems and processes have due regard to NHS England’s guidance on conflicts of interest Yes

The COI policy was updated in January 2015 and is based on NHSE guidance. It was approved by Governing Body in February 2015

2a There is a conflict of interest, hospitality and gifts register in place Yes

Guidance for staff is in the standards of business conduct policy

2b Frequency with which the register is updated?

Quarterly updates to Governing Body

3a There is a code of conduct for employees and governing body members Yes

3b The code of conduct covers hospitality and gifts Yes

3c The code of conduct has due regard to the three national documents referenced in the Barbara Hakin letter

Yes

4 The overall arrangements (1-3) do not impact on the integrity of the CCGs decision making

Yes

Every decision making meeting records conflicts of interest and excludes conflicted members from decision making

5 These arrangements (1-3) are subject to monitoring by the Audit Committee and are reviewed as part of the CCG’s overall assurance processes.

Yes

6 All individuals employed by the CCG or on the Governing Body are currently acting within these policies and procedures

Yes

The CCG is currently reviewing how policies are being implemented to ensure best practice is followed at all times. Refresher training for all staff will be completed during August.

Name of Accountable Officer completing this template

Chris Edwards

Date 31/07/2015

Page 1 of 1

Changes to NHS Constitution The NHS constitution was first published in March 2012 and It is due to be refreshed fully in March 2023. However the Constitution was updated in July 2015; this paper notes those changes. 1.1 ‘with equal regard ‘ added in respect of mental health

1.4 ‘the patient will be’ at the heart (changed from aspire to be). Also a sentence has been added re Armed forces covenant, ensuring Veterans will not be disadvantaged Section 3a contains several additional legal rights • ‘you have the right to receive care and treatment appropriate to you, meets your needs and

reflects your preferences’. This right reflects the new fundamental standard about person-centred care, which is set out in regulation 9 of the Health and Social Care Act 2008. The purpose of the ‘person-centred care’ fundamental standard is to ensure that providers of health and adult social care services, plan and provide patient care and treatment by meeting the following criteria: be appropriate, meet their needs, and reflect their preferences.

• Waiting times are detailed in the Handbook to the Constitution, alongside the Mental Health ‘waits’ from

March 2016. It also notes the exception to waiting times for obese patients where ‘weight loss’ will improve prognosis

• You have the right to be ‘cared for in a clean safe secure and suitable environment’; And ‘to receive suitable and nutritious food and hydration to sustain good health and wellbeing’. The latter is based on the new fundamental standard about nutrition and hydration, which is set out in regulations 9, 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• You have the right ‘to be protected from abuse and neglect and care and treatment that is degrading’. This new right is based on the fundamental standard requiring providers registered with CQC to protect people from abuse and improper treatment set out in regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The standards are legal requirements that all NHS providers, must meet.

• You have the right to ‘transparent, accessible and comparable data on the quality of local health care providers and on outcomes as compared nationally’. This is likely to be addressed through NHS Choices data, Friends and Family Test data, MY NHS, and the requirement that providers display CQC quality ratings.

• You have the right ‘to be involved in planning and making decisions about your health and care with your care provider this includes ‘being given the chance to manage your own care if appropriate’.

• Also ‘you have the right to an open and transparent relationship with the organisation providing your care. You must be told about any safety incident relating to your care which has or….. could cause harm or death, etc’ This came into force for FTs and trusts last year, and is now rolled out to all providers.

Section 4b – there are no changes to the legal duties for staff, but there are additional ‘expectations’; staff should aim ‘to provide all patients with safe care and do all they can to protect patients’; ‘follow guidance, standards etc’ and ‘find alternative sources of care or assistance for patients when you are unable to provide this, including for those patients who are not receiving basic care to meet their needs’