TRANSFORMATION PROGRAMME HIGHLIGHT REPORTdemocracy.rochdale.gov.uk/documents/s58676... · A...

TRANSFORMATION PROGRAMME HIGHLIGHT REPORT

Aim

This paper provides the ICB with an update on the following:

Transformation Delivery – delivery is starting to pick up pace but concern remains re

the delivery of deflections in line with the plan. The paper aims to quantify this at high

level and describes future steps to further develop understanding.

LCO Development – paper describes the key decisions made at the LCO Board in

terms of development

Performance against Locality Plan high level indicators – high level overview is

provided

Risk – describes the development of an integrated risk management strategy and

details the risk register that has been shared with the Greater Manchester Health and

Social Care Partnership.

The overall rating of the programme for this period is Amber.

Financial

The Transformation Delivery Board agreed in September to a realignment of expenditure and deflections, within the constraints of the agreed financial envelope and deflection targets, accepting however that rephrasing and in some cases re assigning of deflection targets will be inevitable. The process for this financial realignment focused on nominated Project Delivery Managers meeting with Finance and the Project Management Office team to review and refine plans. Significant work has taken place in the month of October to meet with Project Managers across organisations and with Theme Leads to review expenditure and benefits phasing. Financial plans are now more reflective of anticipated operational plans. Benefits have been significantly pushed out to future years and reattributed to more appropriate interventions where possible. Risks highlighted are around provider ability to cover internal corporate overheads (not allowable under transformation), effective evaluation and accurate monitoring of all

Programme Director Sandra Croasdale

Period of Report November 2017

Date 3rd January 2018

Overall Programme Rating This period - November Last Period – October


providers’ expenditure, activity and crucially deflections and other KPIs. Finally the ability to realise these deflection savings, in terms of cashable benefits and contract negotiations. The focus now is on mitigating these risks and working through robust financial processes to allow for a multi-organisational transparent view of investment expenditure and performance in both the reduction of Acute activity and High Cost Care Packages.

Programme Delivery

A detailed progress report for all themes is provided in Appendix 1 – Theme Highlight

Report.

Whilst delivery has started to pick up pace across all themes, there is considerable concern

in relation to delivery of deflections. The outcome of the re-alignment to financial plans has

identified a shift in the delivery of benefits from 17/18 to 18/19.

Programme Level

Work has progressed to quantify any slippage and to understand the overall impact of

delivery. Appendix 2 gives a high level summary of progress at programme level against the

overarching deflections targets. It is important to note the comments in relation to the data in

this appendix. It is also important to note that data consistency from various sources is not

yet assured and we are working to understand the variances between the PAHT source data

and our own system reporting. The weekly KPIs in this report is sourced from PAHT.

The following is a high level summary:

Non-Elective Admissions – Currently 16.1% above the year to date (YTD) Dec

target.

NEL performance is currently undergoing a review to understand the impact of new

Sepsis coding and the apparent increase in admissions attributed to Sepsis, the

ambulatory coding/pathway change which is affecting all GM localities and an impact

assessment of the increased opening hours of the Paediatrics’ centre at Oldham to

understand if this has increased NEL admissions. Work is ongoing locally to

accurately quantify these issues. GM are also working to resolve the ambulatory

issue.

A&E attendances are 1.5% below YTD Dec target, however, are 0.4% above target

in December. Further work needs to be undertaken to understand the increasing

disconnect between A+E attendances and NEL Admissions performance. We are

working with theme leads to understand if the transformation deflections are out

performing target or if there is another factor.

Elective Admissions are 6.5% above YTD Dec target and this will be heavily

affected by IECP referrals/coding issue. Work is underway to quantify and

understand the impact of this issue.

Outpatient appointments (based on October SLAM data) are 2.5% above target

YTD. This data is not yet available weekly but work is ongoing to achieve this.


Theme Level

Work is continuing to determine a series of Transformation Performance Indicators (TPI’s) at

intervention and theme level to understand the impact of each intervention on programme

level target delivery. This will focus on agreeing intervention level activity measures which

directly link with the assumptions made in the development of the bid. These assumptions

will need to be tested once interventions are established. There are information governance

issues associated with this which have been escalated to GM. It is recognised that this will

not be an exact science and interdependencies between interventions will need to be taken

into account. A workshop has taken place with theme leads to take this work forward and an

example of how this could work is shown in Appendix 3. Workshops for each theme are

currently being set up to take this forward. The Neighbourhoods theme will take place in

January.

At present the only way to quantify delivery is to consider the re-aligned deflections as a

more accurate reflection of what will be delivered. Comparing this to the original £25m bid

gives an indication of the level of slippage.

The themes that have deflection targets associated with them in 17/18 are:

Neighbourhoods

Urgent Care

Planned Care

Children’s

Figure 1 shows the shift in deflection delivery (activity not finance) in 17/18 comparing the

July bid position with the recent realignment:

Figure 1: Shift in Deflection Delivery

Whilst Figure 1 shows a significant reduction in deflections, particularly in relation to A&E

attendances and non-elective admission, the overall level of deflections over the four year

transformation programme has remained almost static, as shown in figure 2. This is because

in the majority of cases the deflections have been shifted to later years, not removed. There

are financial implications to this which have been factored into the 18/19 financial plans.

Figure 3 below shows the spread of benefits across the transformation programme by

Partnership Board, highlighting the importance of delivering the neighbourhood and primary

care theme and the key role that the LCO will play in delivery.

Theme Bid

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Neighbourhoods -1,651 -270 1381 -1248 -270 978 -1086 0 1086 -143 0 143

Urgent Care -1116 -756 360 -195 -420 -225 -195 -195 0 -860 -860 0

Planned Care 0 -800 -800 0 -2601 -2601 0

Childrens -906 0 906 -100 0 100

Length of StayOutpatientsElective AdmissionsNon- Elective AdmissionsA&E


Figure 2: Four Year Deflection Shift following Realignment

Figure 3: Deflections by Partnership Board

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T O T A L T R A N S F O R M A T I O N P L A N - G R O S S B E N E F I T S F O R K E Y F I N A N C I A L O U T C O M E S

R E F O R E C A S T V S B I D T A R G E T S 2 0 1 7 / 1 8 T O 2 0 2 0 / 2 1

Realignment July Bid


Local Care Organisation

The LCO has appointed an LCO Development Team to support “go live” by 1 April 2018, made up of the following:

Sheila Downey, HMR LCO Interim Chief Officer (3 days per week)

Heather Crozier, HMR LCO Programme Director

Deborah Lyon, Head of Service Transformation – Community and Social Care

John McAlister, Temporary HMR LCO Project Manager (2 days per week)

LCO Coordinator (post currently being advertised)

The PMO are working closely with the team to ensure that transformation delivery continues throughout this time.

The LCO Development Board was stepped down in December and is replaced as of January with the new shadow Board. Letters have been sent by the Independent Chair of the LCO Board to all members of the old and new Boards to clarify the position.

The new Board will meet in shadow form from January until April 2018 with a plan to be fully operational from April 2018. Whilst in shadow form this provider board membership will be supplemented by colleagues from HMR CCG and RBC who will provide guidance and expertise to achieve the due diligence requirements necessary for the LCO to go live by April 2018. The Board will continue to be led by an Independent Chair until Go live in April, and beyond for a transitional period of up to 6 months.

The due diligence process is ongoing. Key lines of enquiry (KLOE’s) have been sent to LCO colleagues for completion by 31st January 2018. The following timelines will be followed to meet the requirements of the process:

KLOEs shared with LCO representatives on 22.12.17

Submission of portfolio of evidence to Charlotte Booth Wednesday by 31.01.18

Review via internal governance, development of clarification questions where necessary by 14.02.18

Submission of clarification answers by 28.02.18

ICB presentation and decision before 31.03.18

Measures of Success

Current performance of the Tier 2 Measures of Success is as follows and the detail of the

September positon is provided at Appendix 4:

7 Indicators are GREEN – (improvement/in line with target); 10 indicators are RED - (worsening position):

o A&E waiting times (4 hour and 12 hour) o Non-elective admission to hospital o Total Bed Days (Specific Acute) o Number of Planned Hospital episodes - Total Elective Spells o Rate of children in care - the rate of new children becoming cared for o Smoking at delivery o Under 75 mortality rate – Cardiovascular disease o Under 75 mortality rate – Respiratory disease o Improving Access to Psychological Therapies (IAPT) recovery rate


4 Indicators - There is no update from the previous reported position. Risk

Work is under way within the CCG and the Local Authority to align the risk management

strategies. The Project Management Office has started to collate the Transformation risks,

from intervention level to system wide risk on behalf of the Programme and will work with

Project Delivery Managers and Theme Leads to ensure that their risks are aligned to the

new strategy.

A transformation wide risk update was sent to Greater Manchester in early November which

highlighted all prominent risks to our programme. This is provided in Appendix 5 –

Transformation Risk. This has also been presented to the LCO Board which has agreed to

hold a risk workshop to ensure that all risks are appropriately identified and mitigating

actions agreed.

Interventions

November October 6 RED: 0 AMBER: 3 GREEN: 3 This Month Last Month

1.4 - Self Care

1.9 - Behaviour Change N/A

Interventions RAG


Interventions


Interventions RAG


4.2 - Expansion of ITS and Day ITS

4.3 - Mental Health

4.5 - Domiciliary Care INT

4.6 - Care Homes and Nursing Homes INT

4.7 - Palliative Care & End of Life

4.9 - Complex Dependency Mini Hub

2.0 - Modes of Access Directory of Service

2.1 - Modes of Access Hubs

2.6 - Housing Triage

3.1 - Clinical Pharmacists

3.4 - Focus Care Workers

3.5 - Primary Care Academy

3.8 - CORE +

RAG

4.1 - Expansion of Integrated

Neighbourhood Teams

4.10 - Substance Misuse

Overall Delivery

Confidence

1.5 - Reducing Diabetes

7.2 - Children's Prevention

The Access theme is progressing well. The Directory of Services (DoS) project is still on track and the preferred provider and quote has been secured. The DoS should be ready mid-February. To refresh

expectations by April the DoS will be an effective information reference point and will contain a health and wellbeing needs assessment tool, further development of that will need to be in phase 2 of the project

and would need additional resource. The hub development and the development of the community connector team is progressing well. The housing triage project is in place and delivering. As this project has

previously received funding from the neighbourhood theme (and still has some non-recurrent funding left) work is ongoing with neighbourhood colleagues to clarify the benefits realisation associated with this

project.

Finances – Confirmation of full GM Reform funding of £2.74m has been received. Funds for 2017/18 will be received in December 2017.

Clinical Pharmacists: One Band 8B clinical pharmacist in place (employed by CCG via agency) for remainder of 2017/18. COPD pharma pilot initiated with aim to make additional savings of £500k by Q2

2018/19.

Focused Care Workers: Successful recruitment process for Phase 1 complete and focused care workers in place to support go live of 10 practices in December. Launch event successfully completed with

phase 1 practices. Success criteria and reporting metrics being developed.

HMR Academy : Funding agreed for Nurse mentorship training in 2017/18. Academy spec and outcomes in development.

Key risks in delivering the programme:

One Project manager vacancy remains, interviews to take place Friday 22nd December.

Primary Care Provider market testing may cause delay in testing stage of Core + however this will not effect the go live date.

NeighbourhoodsOverall Delivery

Confidence

Access

Overall Delivery

Confidence

Overall Delivery

Confidence Primary Care

Overall Delivery

Confidence

Overall Delivery

Confidence

Overall the Neighbourhood Theme is rated as Red with,3 projects rated as Red, 3 projects rated as amber and 4 rated as Green. The delivery of the majority of projects in the theme is progressing and

mobilisation has improved in the last two reporting periods. There is an issue in relation to the Substance Misuse and Complex Dependency projects because key personnel are absent from work. This will be

escalated to Senior Management before the next reporting period.

Intervention Progress:

4.1 Integrated Neighbourhood Teams (INT) incorporating falls – This service delivery of the project is progressing well. However, a risk has been identified in relation to the level of overall funding to

Pennine Acute which has been flagged as a red risk. A risk has also been identified in relation to the achievement of the deflections required from this project. Expansion of the neighbourhood service has 2

parts, the development of an Enhanced Respiratory service and a Neighbourhood Falls Service. The Enhanced Respiratory Service mobilised in Jan 2017 and is realising significant outcomes. The

Neighbourhood Falls Service is due to mobilise in April 18 and recruitment is due to commence in December. Dependent upon recruitment success there is a risk that full mobilisation may be delayed which

will impact on the achievement of the deflections. This is being closely monitored. A workshop is planned in January to review the achievement of the deflections and benefits relating to the whole

neighbourhood theme including the INT.

4.2 Intermediate Tier Service (ITS) incorporating ITS day service - the project is progressing well. Recruitment to 8 Trainee Advanced Practitioners has concluded with 6 posts offered and post holders

due to commence in post by Feb 18 when their Master programme will commence. Additional recruitment to qualified 8a APs and Band 7’s has commenced .A risk has been identified in relation to this project

as the expansion of the ITS service has been reconfigured to focus on the development of the Care Home extra Support Service part of the urgent care team which is already part of the Care Home project.

The theme lead has concerns about the impact this has on deflections and has arranged a meeting in the new year to understand the implications. Scoping of opportunities regarding the ITS Day Case offer

has commenced however decision re the scope of the offer will be held until shortfalls identified in funding for Pennine Acute have been resolved.

4.3 Mental Health – some elements of this project are in place and are delivering as the posts have already been recruited to and are operational. The meeting regarding finances has been held and the

position in relation to contract variations and overheads has been clarified. Recruitment of additional Approved Mental Health Professionals has commenced. Following a meeting on 14th December a risk was

raised that the Crisis Cafe may not be able to be housed in Rochdale Infirmary as planned due to lack of capacity. Actions are in place to find a temporary solution to enable the intervention to stay on track.

4.5 Domiciliary Care – This project is progressing well. The tender process is progressing and further work has taken place to progress with the development element of the contract. Discussions have taken

place with the End of Life provider regarding the development of an integrated night support service that covers end of life support, personal care support and care support overnight.

4.6 Care Homes and Nursing Care –Progress is on track in relation to the key elements of this project. The governance for the various interventions has been reviewed and the project plan has been

reviewed in light of this. Work has commenced on monitoring the achievement of the deflections for this project.

4.7 Palliative Care and End of Life – a comprehensive project plan has been developed for this project and project meetings are taking place. An issue has arisen regarding the delivery of this project and

options are being considered combining the night support element with other night support services and producing a business case for the most appropriate option. A report will be brought to the

neighbourhood programme board setting out the options. Recruitment of the project officer will take place in January 2018.

4.9 Complex Dependency mini hub – - the overall project status is amber because the Project lead is absent from work. Alternative arrangements will be in place to cover the role from January.4.10

Substance misuse project- the overall project status is amber because the Project lead is absent from work. Alternative arrangements will be in place to cover the role from January.

4.12 Care Home – high cost placements – A meeting is planned with shared lives plus and GM to agree an integrated approach to the delivery of this project. A detailed project plan will be developed

following the meeting.

4.13 Enhanced Carers offer – Meetings with stakeholders are planned. The project plan is in place and tasks are on track. Work is to be taken to ensure there is no duplication regarding the reporting of

hospital admission avoidance. Better Information Sharing with GP Practices to assist in the implementation is being developed

Key risks for this theme.

• Social care provider development - resource has been identified to appoint an independent representative onto the LCO Board for the Care Sector who will work towards federating the sector. Regular

meetings are taking place with providers which include updates on the transformation plan and the LCO

• Partnership arrangements not being mature enough to implement the scale of change required - work is taking place to develop partnership working.

• Communication - a draft overall communication plan has been developed

• Resource/ capacity to deliver the transformational change - resources are being deployed as effectively as possible to deliver the transformation plan.

4.12 - Care Home High Cost Placements

Theme Progress Report for November 2017

1.1 - Health & Wellbeing

1.3 - Elderly Oral Health

Work is progressing well within the Prevention theme. The elderly oral health and health and wellbeing coaches projects are progressing well. The self-care post development is progressing, sample job

descriptions have been sent to the provider and the scope is being finalised. There is a moderate level confidence that the post will be in place by the end of Jan / beginning of Feb which is why it has been

changed to an amber rating. The behaviour change project (1.4a) has been included in the prevention theme reporting this month and will be regularly reported going forward. This project is not funded by GM

transformation funding however has key interdependencies with other projects within the plan. This is currently rated amber in terms of confidence due to having to realign the provider with the original brief.

The children’s prevention project has moved to amber due to ongoing discussions to finalise the contract variation with NHSE England for the oral health project – discussions are ongoing and there is still

confidence that we will finalise the variation but a contingency plan of contracting independently is in place.

Overall Delivery

Confidence

Overall Delivery

Confidence Prevention

RAG

Overall the Neighbourhood Theme is rated as Red with,3 projects rated as Red, 3 projects rated as amber and 4 rated as Green. The delivery of the majority of projects in the theme is progressing and

mobilisation has improved in the last two reporting periods. There is an issue in relation to the Substance Misuse and Complex Dependency projects because key personnel are absent from work. This will be

escalated to Senior Management before the next reporting period.

Intervention Progress:

4.1 Integrated Neighbourhood Teams (INT) incorporating falls – This service delivery of the project is progressing well. However, a risk has been identified in relation to the level of overall funding to

Pennine Acute which has been flagged as a red risk. A risk has also been identified in relation to the achievement of the deflections required from this project. Expansion of the neighbourhood service has 2

parts, the development of an Enhanced Respiratory service and a Neighbourhood Falls Service. The Enhanced Respiratory Service mobilised in Jan 2017 and is realising significant outcomes. The

Neighbourhood Falls Service is due to mobilise in April 18 and recruitment is due to commence in December. Dependent upon recruitment success there is a risk that full mobilisation may be delayed which

will impact on the achievement of the deflections. This is being closely monitored. A workshop is planned in January to review the achievement of the deflections and benefits relating to the whole

neighbourhood theme including the INT.

4.2 Intermediate Tier Service (ITS) incorporating ITS day service - the project is progressing well. Recruitment to 8 Trainee Advanced Practitioners has concluded with 6 posts offered and post holders

due to commence in post by Feb 18 when their Master programme will commence. Additional recruitment to qualified 8a APs and Band 7’s has commenced .A risk has been identified in relation to this project

as the expansion of the ITS service has been reconfigured to focus on the development of the Care Home extra Support Service part of the urgent care team which is already part of the Care Home project.

The theme lead has concerns about the impact this has on deflections and has arranged a meeting in the new year to understand the implications. Scoping of opportunities regarding the ITS Day Case offer

has commenced however decision re the scope of the offer will be held until shortfalls identified in funding for Pennine Acute have been resolved.

4.3 Mental Health – some elements of this project are in place and are delivering as the posts have already been recruited to and are operational. The meeting regarding finances has been held and the

position in relation to contract variations and overheads has been clarified. Recruitment of additional Approved Mental Health Professionals has commenced. Following a meeting on 14th December a risk was

raised that the Crisis Cafe may not be able to be housed in Rochdale Infirmary as planned due to lack of capacity. Actions are in place to find a temporary solution to enable the intervention to stay on track.

4.5 Domiciliary Care – This project is progressing well. The tender process is progressing and further work has taken place to progress with the development element of the contract. Discussions have taken

place with the End of Life provider regarding the development of an integrated night support service that covers end of life support, personal care support and care support overnight.

4.6 Care Homes and Nursing Care –Progress is on track in relation to the key elements of this project. The governance for the various interventions has been reviewed and the project plan has been

reviewed in light of this. Work has commenced on monitoring the achievement of the deflections for this project.

4.7 Palliative Care and End of Life – a comprehensive project plan has been developed for this project and project meetings are taking place. An issue has arisen regarding the delivery of this project and

options are being considered combining the night support element with other night support services and producing a business case for the most appropriate option. A report will be brought to the

neighbourhood programme board setting out the options. Recruitment of the project officer will take place in January 2018.

4.9 Complex Dependency mini hub – - the overall project status is amber because the Project lead is absent from work. Alternative arrangements will be in place to cover the role from January.4.10

Substance misuse project- the overall project status is amber because the Project lead is absent from work. Alternative arrangements will be in place to cover the role from January.

4.12 Care Home – high cost placements – A meeting is planned with shared lives plus and GM to agree an integrated approach to the delivery of this project. A detailed project plan will be developed

following the meeting.

4.13 Enhanced Carers offer – Meetings with stakeholders are planned. The project plan is in place and tasks are on track. Work is to be taken to ensure there is no duplication regarding the reporting of

hospital admission avoidance. Better Information Sharing with GP Practices to assist in the implementation is being developed

Key risks for this theme.

• Social care provider development - resource has been identified to appoint an independent representative onto the LCO Board for the Care Sector who will work towards federating the sector. Regular

meetings are taking place with providers which include updates on the transformation plan and the LCO

• Partnership arrangements not being mature enough to implement the scale of change required - work is taking place to develop partnership working.

• Communication - a draft overall communication plan has been developed

• Resource/ capacity to deliver the transformational change - resources are being deployed as effectively as possible to deliver the transformation plan.

4.13 - Enhanced Carers Offer


InterventionsNovember October 3 RED: 3 AMBER: GREEN: This Month Last Month

6.3 - Discharge to Assess

6.1 - HEATT Car

7.1 - One System Approach

The Urgent Care programme is currently reporting as Red mainly due to ongoing discussions to determine funding agreements.

HEATT Car is currently reporting as Red due to a shortfall in funding. In mitigation, a meeting has taken place with the provider to agree a way forward in terms of costings. At this meeting, agreement was

reached that PAHT and NWAS would jointly present the HEATT car proposal via the new NWAS service review process. A meeting with PAHT and NWAS will now take place in the New Year following a

delay. A multi stakeholder task and finish group is now in place for HEATT Car. The deflection target assumptions are on track and sufficient activity is taking place to meet the deflection targets originally set.

Discharge to Assess is progressing well and is currently reporting as amber. It is worth noting that Rochdale remains in the top 10 CCGs in the country. This Discharge to Assess scheme is part funded via

the Transformation Bid fund and the funding is now secured for the extended service for the Home in a Day Service which will be established to support the ROH and NMGH sites. This would be one resource

shared across both sites.

A&E Front Door Streaming is currently reporting as Red due to deflection delivery as well as the Streaming scheme not yet being implemented across other NES sites . Progress is being made however and

GP A&E streaming is live at RI. A multi stakeholder task and finish group is being put into place to oversee this project to ensure traction. On-going discussions have taken place across NES and funding has

now been identified and agreed for ROH and FGH sites.

It is important to note that there are significant deflections attached to both HEATT Car programme (in year 17/18) and A&E Front Door Streaming (in year 18/19), therefore non-delivery of these interventions

would impact on the whole transformation programme.

At a programme level, the ICB agreed governance arrangements are being integrated into the existing HMR Locality Urgent Care Board which involves all urgent and emergency care partners. This group will

begin to pick up the business of the agreed ICB governance arrangements as well as the local performance management of the urgent care system including SRG funds. Revised ToR will be agreed at the

next meeting in January.

6.5 - A&E Front Door Streaming

Overall Delivery

Confidence

Overall Delivery

Confidence

Overall Delivery

ConfidenceUrgent Care

Overall in terms of delivery of actions and milestones (including recruitment) against plan progress is good – though challenges in recruitment to specific clinical posts continue. Work has commenced to

develop transformation performance indicators (TPI) for the theme, with the intention that these will be signed off and reported for both interventions from January 2018.

7.1 One System – Recruitment position for previously reported outstanding posts is as follows:

• SPOA Healthy Young Minds Practitioner (Band 7)- commences in post January 2018

• FSM Strategic Lead – appointed 22 November 2017, start date tbc

• 1.5 wte # Thrive locality link – start date January 2018 (remaining 3.5wte back out to recruitment)

• SPOA Healthy Young Minds Practitioner (Band 6) - did not appoint, back out to recruitment but with an interim plan to utilise an existing B6 Healthy Young Minds post and backfill that – to ensure SPOA

functionality is not compromised.

The LA OD lead has commenced work with all practitioners in the SPOA to support culture and workforce behaviour change, to support integration and new ways of working.

The connectivity of the FSM and LCO was considered by ICB, and the recommendation to develop the FSM separately initially but with the ultimate a plan being to bring the two together was supported.

The Family Services Model Partnership Board held its inaugural meeting 28 November, and the Family Services Model and Transformation Operational Group is due to meet 11 December. TOR for both have

been drafted and will be ratified at the next meetings.

Comms has gone out across the workforce in relation the formal launch of the early help locality teams (update 13 December – take up of places has been excellent, waiting lists are now being held, and we

may need to consider further sessions).

A paper recommending contracting options for the FSM has been drafted and will be considered by ICB 12 December 2017.

Benefits delivery for this intervention commences in Q1 2018-19, and there is confidence that as the majority of staff will be in post from January, and the SPOA and Early Help Locality Teams are formally

launched week commencing 22 January, new working practices will be become established during Q4 2017-18, with early impact being evidenced in Q1. We will utilise the TPI to provide an initial proxy

indicator of this.

7.5 Paediatric Nurse Clinics- the previously reported delays in recruitment have now been resolved. Two of the five posts have been recruited to (start dates of January 2018), remaining three posts to be re-

advertised working toward full mobilisation in March 2018. Transformation performance indicators and activity targets have been agreed with the provider and we will start reporting on them from January

2018. As previously reported due to the delays in recruitment deflections were moved from Q4 into 2018-19, with agreed activity targets reflecting this, with the impact of an additional quarter’s activity spread

across the year. A project group is in place to monitor/manage performance.

The theme lead presented the FSM and PNP model to GM paediatric avoidable admission steering group in response to their request of us to pilot elements of the Connecting Care for Children Model- our

proposal was well received and supported, generating a lot of interest. Support is being sought via GM in relation to evaluation and understanding impact (possibly through existing work the University of

Salford are doing for GM)

Children Overall Delivery

Confidence

7.5 - Paediatric Nurse Practice

RAG

Interventions RAG

November October 5 (1 on hold) RED: 2 AMBER: 2 GREEN: This Month Last Month

On Hold On Hold

5.3 - Long term conditions acute

Interventions

November October 1 RED: 0 AMBER: 1 GREEN: 0

RAG

Planned CareOverall Delivery

Confidence

Overall Delivery

Confidence TM

The Planned Care programme is currently Red for overall theme status.

The Cancer Pathways intervention is on hold - GM Cancer Board are currently in discussion about how to cascade the requirements / expectation of full implementation of the cancer recovery package and

how localities should work together. They are trying to identify what funding is required where i.e. not all localities will get the same funding as this will be based on need. At the last GM Cancer Managers

meeting it was intimated that a decision would be made in November but this is not definite.

The IECP intervention is reporting as amber as there is still considerable work needed to deliver the full transformation as described in the specification. Additional resource has been recruited to support this

mobilisation for the locality. Some of the areas for change concerns behaviour and culture change, and therefore we are concerned on the in-year (17/18) deliverability of benefits for this intervention.

The IECP2 intervention is currently reporting as red for overall project status and this is mainly due to pressures within General Surgery and this may impact on the overall deflection delivery, mitigations are in

place to reduce the impact on progress. The remainder of the planned care interventions have some minor delivery issues, but mitigation plans have been put in place to address these issues. Finally, project

delivery managers are currently assessing the framework to evidence the in-year deflections associated with both the Pain intervention and IECP, this work will need to be completed by Q3. The Pain

intervention currently has two identified red risks in regards to the sedation of patients and the repatriation of patients back into IPMS and the mitigating actions of reducing these risks are ongoing.

The LTC Acute / RightCare intervention is reporting as amber and work to develop detailed project plans is underway in line with the financial plans for monitoring deflection delivery. There is a red risk

associated with the RightCare data and translating this into meaningful change projects – a review of this data will provide direction for the key areas of focus for this intervention.

5.1 - Cancer Pathway

5.2A - IECP

5.2B - IECP2

Overall Delivery

ConfidenceEnablers - IM&T

Overall Delivery

Confidence

5.4 - Pain

HMR’s GM Digital Bid, submitted in September 2017, focused on community based working and the integration of systems to support multi-disciplinary teams to work from any care setting. The digital bid has

a cost of £3.9m over 4 years and £4.4m over 5 years (this figure includes capital and revenue). Following the submission of the bid GM advised that there is an allocation of only £10m capital for 17/18 which

must have a focus on the digitisation of secondary care providers (including acute, community, mental health and ambulance) or information sharing involving secondary care providers in a direct care context.

HMR has been allocated £575k which covers all of the 17/18 capital submitted in our bid. We are currently working with GM H&SCP and PAHT to draw the funds from NHS England.

Aligned to the above HMR CCG submitted an Estates and Technology Transformation Fund bid to request funding for the Graphnet system that will be a key enabler for the Rochdale Nerve Centre concept.

We have been successful in this bid and have been awarded approx. £203k in 2017/18 and a further £237k in 2018/19. The focus now will be on system implementation (i.e. the infrastructure and frameworks

required) with the aim of being able to introduce the system into clinical pathways from April 2018. Phase 1 will focus on data sharing for direct patient care. Phase 2 will focus on business intelligence.

There have been separate discussions around the IT system being used by the Integrated Neighbourhood Teams. The current system is not fit for purpose and a new system has been proposed for use which

will better align to the interoperability requirements as set out in our digital bid. A financial proposal had been presented to PAHT to support this system change. This has now been accept by PAHT who are

now working to deliver the system in this financial year.

Interventions

November October 1 RED: 1 AMBER: 0 GREEN: 0

Interventions

November October 1 RED: AMBER: 1 GREEN:0

RAG

RAG

The Rochdale Workforce Transformation Group has been re-established following consultation to confirm the membership profile and ensure that all appropriate partners and stakeholders are represented

and the Terms of reference of this group have now been refreshed to ensure that the group is clear as to it’s role in enabling the three pillars of transformation and to link with the GM workforce agenda . It was

agreed that in the coming months it’s role will be more action focussed and at the December meeting we invited the theme leads to present their plans and requirements in terms of workforce with a view to

developing workforce action plans and corresponding task and finish groups for each theme. At the December session we were able to pull together common themes and requirements and a workshop has

been arranged for early in the new year to pull this together to get a plan for a way forward.

In January our new team members will take up post as follows:-

• 1 x HR Business Partner – to backfill the HR BP post currently supporting the integrated commissioning agenda so that their focus can be fully directed towards implementing the transformation plan. The

new post holder will also provide support directly to the transformation agenda when required.

• 1 x Workforce Development & Strategy Officer - reflecting the predicted volume of consultative support and programme design and delivery anticipated to enable the integration and transition of Services to

the new model together with a need to produce a workforce strategy directly aligned to the locality plan.

• 1 x HR /WD Support Officer to provide flexible administrative support for the new roles across HR, WD and Recruitment and selection including post establishment and data gathering. (This post holder has

already joined the team)

Enablers - WorkforceOverall Delivery

Confidence

Overall Delivery

Confidence

Estates expenditure was excluded from transformation funding, but the locality is intending to fund costs associated with the estates enabling work ‘at risk’. Due to the shortfall in GM funding all enablers were

required to review spend, to ensure best value and to ensure requests directly benefit the locality plan. A revised request was made (detail as per previous update). The revised request has been shared with

all the theme leads. Theme leads have had the opportunity to input into the update of the estates workplan. The revised workplan will be tabled at the 15/01/18 Strategic Estates Group (SEG) for sign off.

The Community Connectors need to be in place as part of the ‘EASY’ offer by April 2018 so there will be a two staged approach with stage 1 being 2 community connectors located in 2 consult rooms in each

of the 4 locations by April 2018 and stage 2 being the full brief accommodated once capital funding has been secured. For stage 1, potential space in each of the locations has been identified apart from the

Rochdale Infirmary, this is to be confirmed by the next Steering Group meeting on 9/1/18. Site visits are being arranged at the other locations.

PAHT has advised that there is no current capacity at the Rochdale Infirmary site to accommodate mental health crisis café and Living Well Hub, this needs exploring and taken through appropriate

governance. PCFT may need to identify suitable alternative accommodation as a short term solution e.g. Whitehall Street Clinic, which is on the boundary of the Rochdale Infirmary site. The mental health

crisis café and Living Well Hub will need to be considered as part of the Rochdale Infirmary Master Planning exercise so that it can be part of an integrated long term solution.

The key risks are:

1) A shortfall in the recruitment/training of new staff leads to a skills shortage and additional burden on existing staff. Some support will be external to alleviate risk.

2) Capital funding associated with the EASY hubs has not been identified as yet. Although NHS England has approved the PID and provided some funding to take forward to Outline Business Case, the

capital is not guaranteed. As a result alternative funding options are being explored in parallel e.g. BCF. The decision relating to the use of the BCF has been delegated within the council and a report has

been drafted to help support this decision.

3) Space needs to be identified at the Rochdale Infirmary for the stage 1 requirement of the ‘EASY’ offer - this is to be confirmed by the next Steering Group meeting 9/1/18

4) Occupancy costs for each of the four locations as part of the ‘EASY’ offer are unknown - this is to be confirmed by the next Steering Group meeting 9/1/18 and revenue funding will need to be identified. NB.

The CCG is currently charged for void space so there may be an opportunity for the funding to be re-allocated – to be explored further.

5) A short term solution for the mental health crisis café and Living Well Hub needs to be identified

Overall Delivery

Confidence

Overall Delivery

ConfidenceEnablers - Estates

Week No (pick) 39 Week Ending: Month (auto)

Actual Target Variance Var % Actual Target Variance Var % Actual Target Variance Var %

465 365 100 27.5% 2,506 1,952 554 28.4% 18,803 16,191 2,612 16.1%

% Deflection on Base

1,908 1,977 (69) -3.5% 9,642 9,605 37 0.4% 74,358 75,455 (1,097) -1.5%


189 80 109 137.2% 1,998 1,808 190 10.5% 18,893 17,734 1,159 6.5%


Month (auto)

Actual Target Variance Var % Actual Target Variance Var % Actual Target Variance Var %

0 0.0% 0 0.0% 111,328 108,616 2,713 2.5%


0 0.0% 0 0.0% 0 0.0%


Comments

Snap shot report data is taken from weekly actuals PAHT report and Baselines are contract values with adjustments for Oasis Unit expected NEL activity reduction.

All deflection activity for A+E, NEL and Elective are assumed to be PAHT. This has been based on either the fact that PAHT perform nearly all local urgent care presentations and in the case of Elective Admissions, all transformation plan

interventions, where outcomes are to reduce elective admissions are interventions solely aimed at PAHT.

NEL actuals are affected by the ongoing Ambulatory Care issue and work is ongoing to quantify the size of the issue to give a better understanding of underlying performance.

We are in the process of obtaining weekly Out Patient data from PAHT, until then the numbers shown are from the CCG SLAM monthly data, which is available up to October.

OP deflections attributed to PAHT are 90% of the total.

We aim for the next ICB to have excess bed days reported formally with Out Patients.

Appendix 2: ICB Financial KPI Report - 'Snap Shot' PAHT

31/12/2017 December

Metric Description Week Month To Date Year To Date Full Year BaselineFull Year

DeflectionsFull Year Target

Non Elective Admissions 22,377 -690 21,687

ICB Financial KPI Report - SLAM YTD PAHT

-3.1%

A+E Attendances 101,772 -1,026 100,746

-1.0%

Elective Admissions 24,320 -800 23,520

-3.3%

Out Patients Appointments 185,404 -2,516 182,888

October

Metric Description Year To Date Full Year BaselineFull Year

DeflectionsFull Year Target

-1.4%

Excess Bed Days

C:\Users\Sandra.Croasdale\Downloads\ICB KPIs Jan 16th 1 of 1 11/01/2018 14:25

Development of TPI’s - Example 7.2 Paediatric Nurse Practitioner Clinics Intervention concept • Building on PNP service and evidence base • Create additional PNP clinics with approximately 30 appointments at each clinic =300 appointments per week. Over 50 weeks

that would give in the region of 15,000 available appointments.

Assumptions • C&YP triaged as non-urgent and standard do not need to attend an urgent care setting - we could therefore predict that 66% of

all UCC/A&E attendances could be managed in the community. Based on all PAHT site attendances this would be a potential deflection of 20,605 attendances

• 11.5% of all A&E attendance result in NEL Admission – national/local evidence • Current service kept 99% of services users managed in the community. Therefore on this basis the service could be expected to

deliver and AE deflection -14,850 • Alternatively – the team looked at the deflection though by the parents who would have gone to A&E/UCC if they could not of

attended a PNP clinic - 45% of the 15,000 – (6,750) attendances. • Therefore service agreed to a A&E deflection reduction of approx, 5500pa, which would then deliver 11.5% NEL reduction

(600pa). Phasing the deflection was then established over the 4 years. As shown below.

PNP community service

Capacity- 2 clinics daily (Mon-Fri 10am-10pm

300 appointments per week

15,000 available appointments PA

5500 reduction A&E attendances for under 18 A&E

600 reduction in NEL for under 18s

Intervention delivery Deflections reduction

Intervention KPI – examples • 75% take up rate of clinic appointments (sliding scale from Q4

– to year 4) • 10% - DNA rate threshold

KPI

April May June July August September October

A&E waiting times – total time in the A&E department - 4hrs 82.15% 80.87% 86.42% 83.47% 84.46% 85.01% 85.05% 88.54% 84.98%

A&E -time 12 hours 786 40 9 1 22 3 6 5 86

No of attendances at A&E departments(Type 1) 84,315 6952 7491 7226 7741 6998 7178 7643 51229

Total A&E Attendances (Excluding Planned Follow-Up Attendances) 101,462 8389 9056 8651 9255 8364 8572 10481 62768 52,927 105,121

Non-elective admission to hospital - Total Elective Spells (Specific Acute - CCG Scorecard) 27,269 2,268 2,482 2,343 2,442 2,405 2,519 14,459 12,827 25,902

Total Bed Days (Specific Acute) 111,662 10,456 11,116 10,501 9,991 10,106 10,318 62,488 53,298 106,770

Number of Plannd Hospital episodes - Number of elective care attendences - Total Elective Spells (Specific Acute - CCG Scorecare) 31,786 2,401 2,790 2,949 2,749 2,798 2,934 16,621 14,937 30,190

Effective Long Term Condition Management - Number of emergency admissions Due to Long Term Conditions - GM Indicator 2,976

Social Care and DTOC

Social care outcomes quality of life measure - This measure is an average quality of life score based on responses to the Adult Social Care Survey. It is a composite measure using

responses to survey questions covering the eight domains identified in the Adult Socail Care Outcomes Framwork. 19.4

Number of people discharged from hospital into Reablement - Number of people discharged from hospital into Reablement services who were still at home 91 days after discharge -

This tracks Reablement success of people who access stars service from hospital who are aged 65 and overQ3 16/17 -

87.5%84%

Delayed Transfers of care (DTOC) per 100,000 population (attributable to NHS, social care or both) 3,599 178 183 141 261 286 259 1308 1410

Children being supported through early help - Increase the number of Early Help Assessments closed with outcomes achieved 1126 1500

Rate of children in care - Reduce the rate of new children becoming cared for (Per 10,000 population) 89.1 89.1 89.1

Hospital admission rate of under – 18s - Reduce the number of emergency hospital admissions of under 18yrs. (SEM Data) NA 378 454 384 403 503 NA NA

Smoking at delivery - rate - The percentage of women who currently smoke at the time of delivery per 100 maternities 16.30% 15.50%

Childhood obesity rate - Childhood Obesity Rate - % of Children at Year 6 23.00%

Under 75 mortality rate (disease considered preventable) from Cardiovascular disease - Rate per 100,000 Population (quarterly data) 78.0

Under 75 mortality rate (disease considered preventable) from Respiratory disease - Rate per 100,000 Population (quarterly data) 25.5

Under 75 mortality rate (disease considered preventable) from Cancer - Rate per 100,000 Population (quarterly data) 109.7

Elective and Non Elective

2017/18

TargetTarget YTDYTD

2016/17

Year EndIndicator

Q2

0

95%

Continued achievement of the 95% waiting time standard at Rochdale Infirmary throughout Quarter 2 and an improved position at Fairfield General Hospital led to an overall improvement in position across all Pennine Acute sites in August and September. However, the system remains precarious at both Royal Oldham Hospital and North

Manchester General Hospital, with reliance upon locums to support cover in A&E’s and an increase in attendances throughout December due to the recent inclement weather and general winter pressures adding to the already fragile position.

Greater Manchester Health and Social Care Partnership have tasked Pennine Acute with improving performance to a position of consistently hitting above 90%, which is being supported via the North East Sector A&E Delivery Board and Locality Groups. As reported within recent media reports, the achievement of the 95% standard continues to be

an issue nationally.

The pilot to introduce GP streaming across Pennine Acute is in its infancy with the Programme Management Office at Pennine Acute who are working with all North East Sector partners to collate a framework to ensure service resilience is effective and providing expected outcomes for patients. Data from Rochdale Infirmary is now being collected

to analyse demand of the streaming service, which has highlighted specific times of the day when GP streaming may not be required. This has resulted in a meeting with BARDOC to look at all out of hours service provision and look at how we can provide a more robust and efficient service.

Locally we continue to support deflection away from A&E with HEATT Car, GP deflection schemes, GP 7 Day Access offering, Living Well campaigns and other schemes described throughout the locality plan which will continue to be mobilised throughout 2017/18. Work also continues across the North East Sector to resolve the ambulatory care

model issues linked to the coding of activity, hospital mortality rates and SHMI data.

HMR CCG commissioners are undertaking work with Pennine Acute with regards to the Operational Pressures Escalation Framework (OPEL) in order to find ways to collect all necessary information to give a full perspective of pressures on a daily basis which will feed in to the recently established Greater Manchester Urgent Care hub. All Greater

Manchester CCG’s are requested to provide 4 daily updates on pressures across its acute providers, community services, social care partners and out of hours offerings. HMR CCG is currently an outlier for this as only submitting 1 status update per day.

For all service resilience schemes, we are currently working to identify appropriate outcome targets which are being discussed through the local urgent care board. This data will inform any future funding for 2018/19.

Q3Q1

Childrens

Prevention

Further work needed with GM

91.7

A&E

Q1 17/18- 89.4%

Reduction

16.30%

29

96.4

91.9

27.6

93.8

Appendix 2 - Measures of Success - October 2017 Data

91.1

Elective and Non Elective Care pathways are closely monitored through the Elective Care Tactical Group (NES Wide), which is a monthly meeting between senior commissioners and PAHT. At Month 7 a reported underperformance of 2 million for activity has been reported by PAHT, for HMR. The main PODs contributing to the over-performance of

£2m to the end of October are Non-Elective Admissions £1.2m, Ad Hoc £1.2m, A&E Attendances £346k and Day Cases £341k. This is partially offset by under-performances in Non Elective Threshold (£908k), Critical Care Bed Days (£283k), Elective Admissions (£246k) and Non-Elective Excess Bed Days (£186k). Work is being under taken to establish

the variance from baseline on activity and its implications.

350

16.70%

As highlighted in recent media reports, our locality continues to be one of the best performers with the lowest rates for DTOC in England. We have shared our good practice with localities across GM and are in the process for writing up the finer detail of this work to ensure it is robust and sustainable in the longer term and included in a summary

report for the GM Health & Social Care Partnership in response to a query raised at the Q4 assurance visit. Work continues to assess the potential impact of a new way of counting DTOC across the NES. July & August 2017 has seen an increase in delayed days across both PAHT and PCFT. The days at PAHT have been attributable to delays due to

NHS, namely patient or family choice, non acute NHS care (including intermediate care & rehab). We are working with partners to introduce a patient choice policy to reduce this type of DTOC. PCFT have provided responses to the CCG and Public Health around the individual cases for both months. Work continues across all NE sector sites to

develop Integrated Discharge Teams to further improve DTOC/Medically Optimised Assessment Transfer performance.

Early Help Assessments (EHA)

To reach the stretched annual target of 1500, 375 early help assessments need to be initiated per quarter. Quarter 1 was 350 and Quarter 2 was 153. To allow for the seasonal reduction we usually experience during the summer months (as schools are the biggest initiator) we need to achieve over this in Qtr 1, 3 and 4. This figure is likely to increase

for Q1 as we receive some data retrospectively however we need agencies to prioritise EHA’s in order to reach the stretched target. These numbers have increased on each of the last 4 years and are still increasing but not at the rate we have targeted. To meet this year’s target of 1500 we do need some new agencies to initiate EHA's or for some

lesser initiators to significantly increase their initiation rates. To date the Q2 figure has already risen from 153 to 224. As of 5th November there was 641 EHAs initiated to date.

Rate of Children in Care

This quarter Children's Social Care has seen more children starting to be cared for than ceasing. The majority of young people entering care have done so via an application to the Court for an Interim Care Order, evidencing that threshold for becoming looked after was met. 1 young person remanded into custody and three voluntarily

accommodated under Section 20. Of 38 children made subject to Interim Care Order in Q2 a significant number were sibling groups including one sibling group of six, and two sibling groups of 4, which has further added to the rise in numbers. There is evidence that children and young people are exiting the care system via care leaver status and a

small number have achieved permanence by a different legal order. A detailed analysis of the assessed need of the cohort of new entrants into the cared for system is currently being progressed to further inform our edge of care support offer. The previously successful discharge project is being re-shaped to align complexity of need with a more

targeted approach. The rate per 10,000 population of cared for children at 91.7 is higher than the England average of 62.0 but below our statistical neighbours at 93.5.

153

Annual

Annual

Q4 16/17- 93.5%

93.6

April May June July August September October 2017/18

TargetTarget YTDYTD

2016/17

Year EndIndicator

Q2 Q3Q1

Appendix 2 - Measures of Success - October 2017 Data

Improving Access to Psychological Therapies (IAPT) recovery rate 44.16% 50.00% 51.85% 50.00% 48.28% 40.74% 48.15%

IAPT 6 week finished 79.82% 92.31% 93.10% 88.46% 89.66% 85.19% 89.78%

IAPT 18 week finished 98.38% 96.15% 100.00% 100.00% 96.55% 68.41% 98.54%

Estimated diagnosis rate for people with dementia 67.59% 67.0% 66.9% 67.3% 67.4% 67.4% 68.38% 67.58% 67.6%

50%

75%

95%

IAPT

Published data demonstrates that the CCG and its main psychological therapies provider, Thinking Ahead, continue to perform well against the majority of constitutional waiting time targets for IAPT. Assurances have been sought through contract meetings around the need for improvement of the monthly roll-out target which has failed to achieve

for July and August. The provider has advised that a number of factors have impacted on the number of clients entering treatment across these months, including workforce and recruitment issues impacting upon capacity to deliver appointments and the non-recording of certain psychological therapeutic activities on IAPT data systems. Following

the commencement of an investment plan in September, the provider has given assurances that recruitment to fill vacancies is progressing well through rolling recruitment programmes, overall workforce reviews and assistance from an external recruitment consultant, whilst new staff are starting in post in the coming months. A group co-ordinator

has now started in post and will look at the development of a group offer, with a calendar of events set for December and January aimed at targeting an increase in those accessing IAPT services.

NHS England has confirmed that achievement of the 16.8% prevalence rollout target for 2017/18 will be based on delivery 4.2% of prevalence in Quarter 4. The CCG has also worked with the provider to develop an activity plan for Quarter 4 which provides assurance that the provider will be in a position to meet the 16.8% IAPT roll-out target for

2017/18. The activity plan affords significant service capacity in excess of target requirements.

The service reported a Recovery rate of 40.74% in August which indicates a decline against previous performance. The service experienced a number of staff losses in August which the provider felt had impacted significantly upon recovery target performance. Local reporting indicates that Recovery rate performance has been achieved for

September and November demonstrating an improvement in this position. The provider has also advised that it maintains active supervision approaches to support consistent recovery performance achievement.

The CCG continues to actively work with this provider as part of the on-going service mobilisation phase for the pathway, through contract governance routes in order to secure sustained target delivery and robust data quality performance.

Early Intervention in Psychosis

The target of 50% of those referred with suspected psychosis being treated with a NICE compliant package has not been achieved for five out of six months reported in 2017/18 year to date. Performance for September indicates a 0% performance rate.

The Locality is committed to delivery of required performance targets for Early Intervention in Psychosis targets and has actively worked with the provider to develop an improvement plan which combines performance management processes, with an investment plan designed to support target delivery. The investment plan was approved by CCG

Governance in December. Implementation will commence as soon as possible, however due to recruitment timescales it should be noted that it is not anticipated that this will impact on target performance until the next financial year. It is also recognised that delivery of the ambitions of the Five Year Forward View will require an ongoing

implementation approach. This will be supported by a PCFT footprint-wide approach to understanding this matter in further detail and identifying a resolution which is being progressed at a senior strategic level within the Contract Governance framework and a provider deep dive which is being progressed at GM level. Areas for consideration

within this approach include activity across Greater Manchester being significantly in excess of anticipated prevalence, along with the impact which managing access timescales along with ongoing review and management requirements for an increased cohort has upon overall service capacity.

Dementia Diagnosis

The latest reported data for Dementia diagnosis (October) shows achievement at 67.58%. This indicates sustained delivery across the year. The Q2 YTD average (68.06%) is also higher than the 16/17 average of 67.59%. Dementia remains a high strategic priority for the CCG. Work to improve the diagnosis rate performance is on-going including

work to improve Dementia diagnosis coding at GP practice level and developments within the Dementia pathway.

66.70%

Mental Health and Learning Disability

Smoking at Delivery

Rate has increased from 15.4% in Q4 2016/17, to 16.7% in Q2 (provisional figure) and this is above the 2017/18 target of 15.5%. Q1 (confirmed) is 16.3%, compared to 12.4% for GM and 10.8% for England. The provider continues to work on a recovery plan and have strengthened the pathways between the maternity service and the provider. The

overall percentage of women smoking at time of delivery has fluctuated throughout 2015/16 and 2016/17, with Quarter 1 2017/18 showing an increase of 0.9% on the Quarter 4 2016/17 rate. On the basis of Quarter 1 2017/18, HMR CCG is the worst performing CCG across Greater Manchester by 1.2% to the next worst performing CCG and 3.9%

above the GM average. However, whilst the overall numbers of smokers at time of delivery has remained approximately the same, the total number of maternities has differed each quarter contributing to the overall fluctuation.

Obesity in Year 6

Year 6 obesity figures increased from 21.0% in 2015/16 to 23.0% in 2016/17. This compares to 20.8% for the North West and 20.0% for England, both of which increased. Preventing and reducing childhood obesity is a key public health priority for the council and one we are actively working on; the council and our partners have signed up to take

responsibility and work together to tackle obesity, by encouraging more physical activity like the Daily Mile in schools, raising awareness of healthy diets through our new Healthy Heroes campaign and even signing up to the local government declaration on healthy weight, to name just a few actions.

Premature Mortality

Rates for CVD and Respiratory Disease have increased in Q1, although the rate for Cancer fell. CVD has improved historically from a relatively high position, however it has shown signs of increasing recently, particularly amongst the Borough’s more deprived communities and in the male population within these especially. This is by no means a

Rochdale-specific issue as the increase in life expectancy seen in recent years, both in the Borough and in England, has stalled over the past 3 years. There remains a gap in life expectancy between the most and least deprived communities in the Borough of around 8 years. Actions to address this are embedded in the Locality Plan and focus on

improvements to lifestyle factors impacting on health and premature mortality such as smoking, alcohol and obesity. However, it must be noted that our interventions delivered through the locality plan will start to impact on these indicators, but only over the medium to long-term.

Ris

k R

ef

Risk Owner Risk Description Risk Cause Risk Consequence Risk Proximity Risk Controls Actions Action Owner

Completion

Date for

Actions

Action

StatusUpdate on Action Status Last reviewed

A unique coding

that allows the risk

to be easily

identified

Job title of the person

responsible for the

management,

monitoring, control and

escalation where

appropriate, of the

identified risk

A statement describing the potential risk What will cause the risk to occurWhat are the consequences of the risk

occurring

Like

liho

od

Imp

act

RA

G S

tatu

s

Timescale as to when the

risk will occur

Controls that are

currently in place

The actions and activities planned to take place that will when

implemented or completed reduce, eliminate or minimise the

risk

Job title of the

person

responsible for

completing the

action

Each action

should have a

completion date

set

For each

action state

if it is Open

or Closed

Comment on risk status,

environmental changes etc.

Like

liho

od

Imp

act

RA

G S

tatu

s

Date when the

risk was last

reviewed and/or

updated

LCO 12 SW/SE

Failure to close the collective financial gap Current financial position of PCFT and PAHT

"Do Nothing" financial base numbers could

deviate from submitted plan.

Capital and Revenue Funding from various GM

sources will not be as required

GM Themes will not deliver savings

Partner Efficiencies will not deliver savings

Failure to close the financial gap

5 5 B

Working closely with both providers to establish a strong relationship

to ensure a consistent focus on the Transformation /Locality Plan

while they work on their business as usual and strategy to close their

gaps.

Establish decommissioning strategy. Increasing the efficiency

expectations across all the partners.

Robust financial planning and governance of all financial pressures of

all providers including early identification of pressures.

Actions to address pressures to be taken via ICB in line with

decommissioning principles and strategies

Increased level of efficiencies across all providers above current plan

for in year savings

SMI/SE Ongoing Open

Early stages of development of

decommissioning principles

3 4 AR

24/11/2017

FIN 15 All Partners

18/19 Locality Gap (post TF Programme) currently

stands at £12.7m and will need to be closed subject

to normal business rules.

In addition further pressures have been

identified by Partners (CCG +£4m, LA +£2.7m

with pressures at PAHT and PCFT still to be

confirmed) and these will also need to be

closed.

Failure to deliver agreed closure of gap

5 5 B present to 31.03.2019

See governance structure A report will be taken to ICB in Jan 18 detailing further options that

could be used to close the locality gap for 18/19.

N/A - System wide

Changes31.03.17 Open 3 4 AR

LCO 10 SC

Failure to have appropriate workforce in place

across the whole system to deliver transformation

Significant new workforce and shift in

workforce required to operate new delivery

models

Unable to deliver new service models

4 4 R 3-6 months

1. Workforce mapping exercise - action delegated to LCO Provider

Board.

2. Recruitment to key post in transformation plan

3. Detailed workforce plan to be developed by Rochdale Locality

Workforce Development Group

4.Membership of the GM Workforce at an Exec level and Senior HR

Representative level 5.Work has

commenced with local further education colleges to develop a health

and care apprentices.

6. A single Rochdale wide offer to encourage all sector recruitment

and retention in development

LCO/

SCOngoing

1. Open

2. Open

3. Open

1. Not started

2. Majority of key posts now recruited.

Concerns re specific providers reluctance

to recruit without contract variation

3. Group re-established in November.

Detailed planning session taking place in

December 20173 4 AR

24/11/2017

LCO 11 SW

Risk that capital funding for A&E developments will

not be forthcoming preventing the development of

an Urgent Front Door and effective integration of

services.

National funding decisions Failure to deliver activity shifts as set out in

the transformation plan

4 4 R

Plans fully developed and ready for immediate implementation

should capital be forthcoming.

Should national funding not be available the alternative funding will

be explored or urgent care service offer will be developed

Discussions continue with NHSI

Support for this capital received from

GM H&SCP3 4 AR

24/11/2017

LCO 13 SW/ST

Risk that the focus on the Single Hospital System and

development of the Northern Care Alliance could

impact on the capacity to develop the Rochdale LCO

and deliver transformation.

Single Hospital System development Failure of LCO to develop and deliver

4 4 R

Working closely with both providers to establish a strong relationship

to ensure a consistent focus on the Transformation /Locality Plan

during the development of the single hospital system. Regular

discussion at LCO board to ensure that all are aware of current

situation and to establish any mitigating actions.

Strong North East Sector governance arrangements established

including oversight of the clinical services strategy for Pennine Acute

Hospital Trust, Chief Executive Rochdale Borough Council, Chief

Officer Bury CCG are members of the single hospital service board.

Full locality engagement with an emerging single hospital service

transaction board.

Transformation bid monies to support North East Sector governance

agreed to support the governance infrastructure and oversight of this

service change.

SW/ST Ongoing Open 3 3 A

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FIN 6 All Partners

Cashability release could not be delivered per plan Model assumes PAHT ability to release savings

as per Oldham negotiations and assumes Yr. 4

will release 100% of benefits.


4 4 R present to 31.12.17

See governance structure A Rochdale cashability strategy for Acute deflections is in formation

and will be agreed by 31.12.17N/A - System wide

Changes31.03.17 Open 2 3 A

FIN 7 All Partners

Transformation Benefits could not be delivered per

plan

Buy in was obtained from all partners but is

yet to be realised.


4 5 R present to 31.03.21

See governance structure Ongoing monitoring arrangements will continue to review underlying

demand (and therefore deflections) across both health and social care

sectors to understand if these align with TF assumptions, and if not,

determine what needs to be done to mitigate any unexpected

demand issues. Separate to that, the LCO, Transformation and

Integrated Commissioning Boards all review performance of

outcomes versus plan. Work continues to leverage the wealth of data

across organisations and turn into meaningful performance

monitoring and evaluation outputs.

N/A - System wide


LCO 2 SC

Failure to deliver specific LCO outcomes, deflections

and subsequent financial cashable savings as part of

the Transformation Bid

Potential delays in delivering milestones

Reliance on other NES localities to deliver in

order to realise cashable savings

Potential for GM H&SCP to stop funding

interventions if they do not demonstrate

delivery of the required outcomes

3 5 R 12+ months

1. Remodel of benefits on actual funding being offered by GMHSCP

2. Establish NES LCO links

SC Q4 2017/18

1. Closed

2. Open

Residual risk remains high due to

potential delays in receiving money,

practicalities of recruiting to key posts

quickly and the complexities of the NES

and impacts on converting benefits into

cashable benefits

2 5 AR

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Inherent Risk

Score

Residual Risk

Score

Appendix 3 - HMR Risk Register - November 2017

FIN 1 All Partners

Demand Assumptions - Bid Based on 2015/16 data Affects assumptions for all partners of income

and expenditure


5 3 AR present to 31.12.17

See governance structure Ongoing monitoring arrangements will continue to review underlying

demand across both health and social care sectors to understand if

these align with TF assumptions, and if not, determine what needs to

be done to mitigate any unexpected demand issues. Specifically, a

sensitivity analysis will be conducted to update base to 2017/18 and

see how this affect assumptions. Completion of this analysis will be

done by 31.12.17.

N/A - System wide


LCO 7 AF

Failure to fully realise the benefits of the plan that

are related specifically to public behaviour change

Lack of buy in from the public for the

importance of using health and care service

resources wisely and appropriately

Benefits in the plan may not be realised

3 4 AR 12+ months

1. Detailed communications and engagement plan with specific

intervention level actions linked to behaviour change and action to

gain clinical and political buy-in to have a more assertive relationship

with the public regarding utilisation of services.

2. Behaviour change programme to be implemented

3. Consideration to be given to mechanism for a more assertive

approach to the public

S Crutchley1. Q4 2017/18

2. Ongoing

1. Open

2. Open

Communications and engagement plan

under development with close links to

LCO communications.

Behaviour change programme on track2 4 A

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LCO 3 SMI/SD

Failure to gain public and wider stakeholder support

for Locality Plan interventions and to not adequately

consult where appropriate

Lack of engagement with the public and wider

stakeholders

Reputational damage to all parties of the LCO

and potential blocks on delivery of key

interventions3 4 AR 12+ months

Communications and

Engagement plan in place

1. Establishment of Communications and Engagement Plan including

any requirements for formal consultationSC Q1 2019

1. Open

2. Open

Communications and engagement plan

under development with close links to

LCO communications.1 4 A

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LCO 4SMI

Failure to establish appropriate commissioning

arrangements for the LCO by April 2018

Delay in establishing the organisational form

and late consideration of ISAP

LCO not established fully by April 2018

resulting in transformation bid funds not

continuing beyond March 20182 5 AR 3-6 months

Host Provider identified

pending due diligence

process

1. Implementation of Due diligence process by January 2018

CB Q4 2017/18 Open 1 5 A

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LCO 6

CLOSEDCLOSED

Failure of GM contribution via GM funds to be

realised both in terms of delivery and closing the

financial gap

Lack of clarity around GM funds availability,

accessing funds and impact of GM

programmes on closing the financial gap

Insufficient funding available to deliver

programmes and negative impact on closing

the financial gap 3 4 AR 3-6 months

1. New risk to be included on closing the collective financial gap

TBA Q2 2017 Closed

Benefits reduced in the new model

based on the agreed level of funding.

GM recognise that the net result is that

the benefits will not fully close the gap

C

24/11/2017

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