Contents

NHS Lambeth CCG

Business plan for 2013/14

Contents

1.

INTRODUCTION

4

2.

Our Mission, Vision, Values and Objectives

5

2.1

Mission

5

2.2

Vision

5

2.3

Values

5

2.4

Strategic Objectives

6

2.5

Strategic Health Priorities

7

2.6

Mapping our objectives and priorities

8

2.7

Working in partnership with others

10

2.8

2013/14 – ‘Plan on a Page’

11

3.

GOVERNANCE & PERFORMANCE

12

3.1

Committee Structure

13

3.2

Oversight of delivery

15

3.2.1

Operations Group

15

3.2.2

Management Team

15

3.2.3

Finance & QIPP Group

15

3.2.4

The PMO

16

3.3

Equalities

17

4.

OPERATIONAL DELIVERY

20

4.1

Planned care programme

21

4.1.1

Long term conditions

21

4.1.2

Elective

22

4.1.3

Sexual Health

23

4.1.4

Contract management & monitoring of acute services

25

4.1.5

Contract Management GST

26

4.1.6

South East London Community Based Care

27

4.1.7

Lambeth & Southwark Integrated Care Programme

27

4.2

Unplanned Care Programme

29

4.2.1

Frail Elderly (admissions avoidance)

30

4.2.2

Urgent Care

30

4.3

Mental health improvement programme

31

4.3.1

Continuing Care

34

4.4

Children & maternity improvement programme

34

4.5

Medicines optimisation

36

4.6

Staying Healthy

37

4.7

Cardiac & Stroke

38

4.8

Cancer services

38

4.9

Specialised Commissioning

39

4.10

Estates

40

5.

ORGANISATIONAL DEVELOPMENT

41

5.1

Organisational development

41

5.2

Engagement and Communications

42

5.3

Human Resources

43

6.

GOVERNANCE AND ASSURANCE

43

6.1

Quality and safety

43

6.2

Finance

45

6.3

Information governance

46

7.

ENABLERS

46

7.1

Primary Care development

46

7.2

Business Intelligence & ICT

48

7

9

1. Introduction

This Business Plan sets out how the key objectives for 2013/14 will be delivered under the leadership of the Governing Body. These key objectives are described in the Clinical Commissioning Group’s Prospectus; and, based on both the local NHS Lambeth Commissioning Strategy for 2012-15; and, national mandatory requirements described in ‘Every patient counts: planning for patients 2013/14’.

The business plan is divided into three key areas:

1. Operational Delivery

2. Organisational Development

3. Governance and Assurance

This plan is written for the CCG to provide clarity on the work of NHS Lambeth Clinical Commissioning Group for the year 2013/14. Lambeth CCG will refresh and update this plan for 2014/125. The Business Plan forms the basis for individual objective setting for every member of staff and performance review. Each programme within the Business Plan has designated Clinical and Director / Executive leads and sets out the key areas of business for 2013/14. Within each programme key objectives are assigned to Assistant Directors through the individual objective setting as part of establishing work plans, and personal developments plans.

2. Our mission, vision, values and objectives

2.1 Our Mission

To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

2.2 Our Vision

(1)

Health improvement is at the heart of all we do. We will increase life expectancy for all and reduce the difference in life expectancy between the most and least deprived in our diverse communities.

(2)

We will maintain a thriving, financially viable, health economy delivering safe and effective high quality care.

(3)

We will commission comprehensive integrated care that meets the needs of local people. We will value diversity amongst providers, but will expect excellent outcomes.

2.3 Our values

· We will always tell the truth

· We are fair

· We are open

· We recognise our responsibilities to service users and the wider public

· We act responsibly as a public sector organisation

2.4 Our Strategic Objectives

(1)

Develop and deliver planned care which reduces premature mortality and improves quality of life, reducing reliance on hospital services and improving the quality of primary care.

(2)

Improve the integration and quality of care for older people and reduce the number of avoidable hospital admissions and readmissions.

(3)

Deliver good quality mental health services and improve patient outcomes.

(4)

Implement the Secretary of State Trust Special Administrator (TSA) recommendations.

(5)

To support the new Health and Wellbeing arrangements and commission Health and Wellbeing services on behalf of London Borough Lambeth

(6)

To deliver our annual operating and medium term financial plans to ensure an ongoing sustainable financial position that delivers our strategic health goals for the Lambeth population.

(7)

To ensure systems and processes are in place to support individual, team and corporate accountability for delivering patient centred, safe and high quality care.

2.5 Strategic Health Priorities

(Goal 6 – Childhood Obesity22.3% Year 6 obesity prevalence in childrenProgress Year 6 obesity in children has reduced from 24.7% in 2009/10 to 23.7% in 2011/12) (Goal 7 – Alcohol90% of the identified frontline staff has received training in screening and brief intervention for alcohol misuse.This is a new goal and we will report back on progress as soon as we can. (up to 80% in 2011/12)) (Goal 5 – Smoking1190 smoking quitters per100,000 population Progress The number of people quitting smoking per 100,000 increased to 2,354 in 2011/12 (up from 1097 in 2009/10)) (Goal 4 – HIV13% Lambeth residents diagnosed very late with HIVIncrease awareness of HIV, promote testing and halve the number of Lambeth residents diagnosed very late with HIVProgress The proportion of people diagnosed very late with HIV has reduced to 17% in 2011/12 from 26% in 2010/11) (Goal 3 – Diabetes74.5% of people withdiabeteswith blood sugar HbA1c <8Progress 2000 more patients detected earlier and more patients with diabetes are managing their HbA1c levels(HbA1c is a measure of diabetes controlled blood sugar)) (Goal 2 – Cardiovascular Disease76% of people with hypertension with blood pressure <=150/90Progress More patients with Cardiovascular Disease are getting better controlledblood pressure readings(up to 88% in 2011/12)) (Goal 1 – Serious Mental illness98% of users in care programme approach with Health of the Nation Outcome ScalesProgress We are delivering more nationally recognised assessments (up to 80% in 2011/12))

2.6 Mapping our objectives and priorities

(To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.)

(Objectives & Priorities) (Delivering the NHS Constitution, NHS Outcomes Framework and NICE Guidance) (Alcohol90% of the identified frontline staff has received training in screening and brief intervention for alcohol misuse.) (Vision) (Mission) (Strategic ObjectivesHealth PrioritiesDiabetes74.5% of people with diabetes with blood sugar HbA1c <8Cardiovascular Disease76% of people with hypertension with blood pressure <=150/90Serious Mental illness98% of users in care programme approach with Health of the Nation Outcome ScalesHIVReduce no. of Lambeth residents diagnosed very late with HIV to 13%Increase awareness of HIV, promote testing and halve the number of Lambeth residents diagnosed very late with HIVEqualities ObjectivesImprove the detection and control of diabetes in Lambeth, specifically to reduce the between practice variationImprove control of high blood pressure in Lambeth, specifically to reduce the between practice variationImprove the physical health of people known to have mental health problems especially people with severe mental illnessSmoking1190 smoking quitters per 100,000 population Childhood Obesity22.3% Year 6 obesity prevalence in childrenEnsure the revised HIV treatment and support services are informed both by detailed evidenceEnable all smokers to have equal opportunity to quit through the Lambeth stop smoking service Reduce any inequality experienced by different population groups benefiting from the Childhood Obesity ProgrammeHealth improvement is at the heart of all we do. We will increase life expectancy for all and reduce the difference in life expectancy between the most and least deprived in our diverse communitiesWe will maintain a thriving, financially viable, health economy delivering safe and effective high quality care.We will commission comprehensive integrated care that meets the needs of local people. We will value diversity amongst providers, but will expect excellent outcomes.Develop and deliver planned care which reduces premature mortality and improves quality of life, reducing reliance on hospital services and improving the quality of primary care.Improve the integration and quality of care for older people and reduce the number of avoidable hospital admissions and readmissions.Deliver good quality mental health services & improve patient outcomes.Support the new Health and Wellbeing arrangements & commission Health and Wellbeing services on behalf of LambethTo deliver our annual operating and medium term financial plans to ensure an ongoing sustainable financial position that delivers our strategic health goals for the Lambeth population.Promote equity of access to information on alcohol and safe drinkingImplement the Secretary of State Trust Special Administrator (TSA) recommendations.Ensure systems and processes are in place to support individual, team and corporate accountability for delivering patient centred, safe and high quality care.)

2.7 Working in partnership with others

NHS Lambeth CCG is the new clinical commissioning organisation made up of the 49 general practices that deliver primary health care services to the population of Lambeth. As a new CCG commissioning health services for Lambeth we build on a long history of partnership and multi agency working. This includes a working with local clinician teams and patients to develop innovative approaches to service redesign seeking to promote excellence in service quality, patient access and productivity through more integrated services operating at scale. The way of working for the CCG strengthens this partnership approach, and the establishment of the Clinical Network and locality forums provides the architecture to continue to do this in the new commissioning landscape.

Existing partnerships and relationships continue to be built on and strengthened, including those with London Borough of Lambeth, Guy’s and St Thomas’ Hospital (GST), Kings College Hospital (KCH), St George’s and South London and Maudsley. New relationships and partnerships will need to be formed with other new commissioning bodies such as NHS England who have taken on the role of commissioning services from GPs, pharmacists, opticians, dentists and 0-5 community services for including health visiting, immunisations, screening services and specialised services for Lambeth. Existing partnerships that have served us well will now include new areas of joint working and a different role for the CCG. London Borough of Lambeth, with whom we have worked in partnership for many years jointly commissioning services including those for older people, people with learning disabilities, physical disabilities and some mental health services will now also cover sexual health, school nursing, drug and alcohol, and health promotion. A key new partnership for Lambeth is the Health and Well Being partnership with the strategic objective of improving health and social care services through joint commissioning arrangements and joint monitoring or outcomes and performance.

We also recognise the importance of the partnership we have with local people, patients, and other organisations (Lambeth HealthWatch and community groups). These partnerships are key to us being able to improve the health and wellbeing of Lambeth citizens reduce health inequalities in the borough.

Achieving the Lambeth mission of improving health outcomes will also require Lambeth CCG to continue its work with other CCGs. The partnership approach with Southwark CCG on both planned and urgent care will continue through the Planned Care and Urgent Care Programme Boards and includes the Integrated Care Pilot across Lambeth and Southwark CCGs in partnership with Kings Health Partners (KHP). Work across south east London (SEL) on the community based care strategy involves a partnership of all six south east London CCGs through the SEL Clinical Strategy Group supported by a shared Programme Management Office. Lambeth CCG also has a new partnership with the South London Commissioning Support Unit who host a shared multi-disciplinary contracting team for the acute contract covering GST.

10

(Alcohol90% of the identified frontline staff have received training in screening and brief intervention for alcohol misuse To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalfHealth: Men will live 17 months longer and women 7 months longer; and the gap in life expectancy between most and least deprived will be reduced by 2 monthsAccess: Comprehensive, round the clock access to integrated pathway based care, general and specialist; delivered through neighbourhood networksAffordability: A thriving, financially viable health economy delivering safe, effective, high quality care.Cutting edge: Local services grounded in world class research, innovation and clinical education; in partnership with Kings Health Partners^Diabetes% of people with diabetes with HbA1c <8 = 71% HIV % Lambeth residents diagnosed very late with HIV (<200 CD4 cells/mm3) = 14%Smoking1186 smoking quittersPer 100,000 population^Serious mental illness% of users in care programme approach with HONOS = 90%^Cardio vascular disease73% of people with hypertension with BP <= 150/90  Childhood obesity Year 6 obesity prevalence in children 23.25%Our mission & our visionAchieving Lambeth health goals and associated equality targets in partnership with National Commissioning Board and London Borough of Lambeth^ = Local priorities for Quality PremiumManaging our resources£416m budget including £9m (2.3%) growth £12m QIPP ProgrammeRequirement to achieve 1% target surplusCCG running costs £25 per head of populationInvestment in new facilitiesFinancial risk share across South East LondonDelivering the NHS Constitution18 week non urgent referral to treatment90% admitted 95% non admitted92% incompleteNo 52 week waits99% diagnostic waits of < 6 weeks95% of patients admitted, discharged or transferred within 4 hours of arrival at A&EPatients referred urgently for cancer wait no more than 2 weeks for first outpatient appointmentMax 31 day wait from cancer diagnosis to treatmentAll cancers – 96%For surgery – 94%Anti cancer drugs – 98%Radiotherapy – 94% Max 62 days wait from urgent referral to cancer treatmentGP referral – 85%Screening – 90%Cat A ambulance calls responseWithin 8 mins – 75%Within 19 mins – 95%No hospital mixed sex accommodation breachesPatients who have operations cancelled on day of admission offered new date within 28 days95% of adults with mental illness on care prog approach followed up within 7 daysMonitoring against NHS Outcomes Framework and NICE guidelinesPreventing people dying prematurelyUnder 75 mortality rates for CVD, respiratory & liver disease & cancerQuality of life for people with long term conditions% people feeling supported to manage their conditionUnplanned hospitalisation ratesDiagnosis rate for dementiaHelping people recover from episodes of ill health or injuryEmergency admissions to hospitalEmergency readmissions within 30 daysHealth gain assessed by patients – hips, knees, hernias, varicose veinsEnsuring people have a positive experience of carePatient experience of GP and out of hours carePatient experience of hospital careFriend & Families TestTreating & caring for people in safe environment & protecting from harmIncidence of healthcare associated infection – MRSA & C.diffCCG response to Francis report & Winterbourne ViewSafeguardingLambeth & Southwark Planned CareRedesign of LTC pathwaysMoving from unplannedImproving care for people with multiple LTCsDeveloping non face to face consultationsLambeth & Southwark Unplanned Care24/7 emergency careImplementation of 111Urgent Care Centres at St Thomas’ & KingsAdmissions avoidance and care at homeUrgent access to specialist care without admissionMental Health with LB LambethLambeth Living Well CollaborativeTalking therapies Community based alternatives to forensic servicesProvision of dementia servicesStaying Healthy led by LBLChildhood healthy weightSmoking cessationHealth ChecksPreventing harm from alcoholHealthy Living PharmaciesHealth & wellbeing in LambethLambeth & Southwark Integrated CareSouth East London Community Based Care StrategyEasy access to high quality, responsive primary & community care * Integrated care * Timely, convenient & effective planned careDelivering the PlanLambeth Health & Wellbeing Board and Strategy supported by Joint Strategic Needs assessmentWorking with people in Lambeth Co-production in service redesign* Online access to GP records* Real time patient experience of services and development of patient participation groups* Patient held budgets* Developing HealthWatchEnablers for Innovation & changeSupporting people to manage their own conditionWorkforce development & educationClinical leadership & engagementInformation & IT including TelemedicineMedicines optimisationProcurement & contracting incl AQPCollab working with NCB, SEL CCGs, LETB & Acad Health Sci Network)2.7 2013/14 Plan on a Page

3. Governance and Performance

NHS Lambeth CCG comprises 49 Member Practices across three localities.

The Governing Body of NHS Lambeth CCG, (the Lambeth Clinical Commissioning Governing Body LCCGB) is responsible for ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG Constitution and our principles of good governance. Membership of the Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and nominees from our key Lambeth partners.

The Lambeth Clinical Commissioning Governing Body is supported by the NHS Lambeth CCG Collaborative Forum made up of all Lambeth member practices. The Collaborative Forum held its first meeting in April 2013. This built upon a range of events with Member Practices over the past two years. Under the CCGs agreed Constitution the Collaborative Forum has a number of specified responsibilities, including agreeing the election process for elected members of the Governing Body and changes to the NHS Lambeth CCG Constitution.

The Governing Body is also supported by the Clinical Network of clinical leads for each area of work being taken forward. The purpose of the Clinical Network is to provide the CCG Board members with sound clinical advice on commissioning care services, care/clinical pathways and best practice. The Clinical network consists of care and clinical “subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists, opticians and social care colleagues.

15

49

3.1 Committee structure

(Lambeth CCG Governing BodyHealth & Wellbeing BoardAudit CommitteeEmployment & Remuneration CommitteeEquality, Engagement & Comms. CommitteeStaying Healthy Programme Board*Children’s Trust BoardSafer Lambeth PartnershipIntegrated Governance CommitteePan London CommitteesLondon Clinical Commissioning Council London Cancer NetworkPan London Urgent Care Programme BoardSee follow chart)

(Integrated Governance CommitteeJoint Boards with Southwark CCGLambeth CCG specific CommitteeSEL wideJoint with LB LambethLearning Disabilities Programme BoardMental Health Programme BoardOlder Peoples PartnershipPrimary Care Commissioning & Quality GroupSerious Incident Review GroupFinance & QIPP Working GroupPlanned Care Programme BoardUnplanned Care Programme Board(Includes Integrated Care PilotUrgent Care NetworkLSL Integrated Performance Safeguarding Working Group(SE London)Health & SafetyGroupInformation Governance GroupLSL Infection Control CommitteeSEL Area Prescribing Committee(SE London)SEL Commissioning Strategy Group )

3.2 Oversight of Delivery

The Governing Body is ultimately responsibility for the delivery of the 2013/14 Business Plan and oversees delivery through a comprehensive Integrated Performance and Governance report at each Board meeting addressing:

· The Board Assurance Framework,

· Key risks to delivery, including zero tolerance risks, and

· Performance against our Business Plan objectives.

In order to support the delivery of the business plan three management groups have been set up supported by a Programme Management Office (PMO):

3.2.1 Operations Group

The Operations Group is chaired by the Chief Officer, with membership comprising of all NHS Lambeth Directors and Assistant Directors. This group meets twice a month with the role sharing information and best practice, providing peer support and review and challenge both within and across health programmes including equalities action plans and QIPP delivery.

3.2.2 Management Development Team

The Management Development Group is chaired by the Chief Officer, with membership comprising all NHS Lambeth Director’s. This group meets weekly with the role of enabling ongoing organisational development and oversight of key issues of assurance and governance. This meeting reviews and quality assures the governance of and reporting to the governing body and its committees.

3.2.3 Finance & QIPP Working Group

The Finance and QIPP Working Group is a working group of the Integrated Governance Committee for the Lambeth CCG Governing Body. It is accountable for overseeing a robust organisation-wide system of financial management that enables the CCG to deliver its statutory financial targets at the same time as securing Value For Money (VFM). This includes monitoring of the CCG’s QIPP programme which is an integral part of the annual business plan. The successful delivery of the 2013/14 QIPP has an impact on our ongoing financial sustainability.

The Group ensures that the finances of the CCG are scrutinised to ensure budgets are set and managed in an appropriate and timely manner. It ensures that the Governing Body is fully aware of any financial risks which may materialise throughout the year. The Group will also be responsible for reviewing the Medium Term Financial Strategy (MTFS) of the Governing Body.

It reports to the Integrated Governance Committee to ensure financial probity within the organisation.

The Group has, on behalf of the Governing Body, an overview of all aspects of finances (including capital spend and cash management), which involves work relating to commissioning of health services, including detailed review of the CCG’s contractual position.

3.2.4 The Programme Management Office

Clinical lead: Dr Adrian McLachlan

Executive lead: Andrew Parker, Director Governance & Development

Programme lead: Kathryn MacDermott, AD PMO, Transformation & QIPP

The PMO has been established to enable Lambeth CCG to take a consistent and rigours approach to monitoring the implementation of the key priorities, strategic goals and objectives. To provide expertise and support across the CCG as required to enable delivery.

· Development and agreement of the five year commissioning strategy plan for Lambeth CCG

· Development and agreement of the annual Business Plans

· Development and monitoring of the Lambeth QIPP plans

· Development and implementation of a PMO approach to Lambeth CCG business

· Support to the Clinical Leads

· Performance monitoring and reporting on all QIPP plans

· Working with Finance ensure monitoring of all QIPP savings

The Programme Management Office (PMO) will have responsibility for monitoring and reporting on the performance of the CCG against its corporate objectives and programmes of work as set out in the business plan. Reporting on performance will be collated through the PMO on a monthly basis with exceptions, risks, slippage and/or action plans highlighted to the Governing Body through the Integrated Performance and Governance report.

The business plan is structured to reflect the programmes of work. Whilst each programme has a named clinical and director lead many programmes will not be delivered unless there is significant working across teams. These interdependencies will be listed in the PMO documentation.

3.3 Equalities

NHS Lambeth CCG has adopted an equality objective for each of its seven health priorities which are the responsibility of the respective programme boards to drive, monitor and report on. The objectives are set out over the page:

7 Equalities Objectives

Serious mental illness

To improve the physical health of people known to have mental health problems especially people with severe mental illness (SMI) as measured by:

· Reducing the numbers who smoke and narrow the gap between people with SMI (44.2% known to be smokers according to GP records) and the general adult population of Lambeth (23% smokers)

· Improving diabetic control from the beyond the Lambeth average (66% achieving good control as measured by HbA1C) towards that of the highest performing practices in Lambeth of 80% or above for people with SMI and diabetes

· Increase access to talking therapy services to those people over 55 and who have long term conditions

· Increase access to the memory service for people from ethnic minority communities

Cardio Vascular

Disease

To improve control of high blood pressure (defined as less than 150/90) in Lambeth, specifically to reduce the between practice variation by achieving measurable change in the poorest performing practices towards the Lambeth average of blood pressure controlled in at least 75% of people known to have hypertension, and to improve the quality of care for all.

Diabetes

To improve the detection and control of diabetes in Lambeth (as defined by achieving HbA1c of less than 8), specifically to reduce the between practice variation in control achieving measurable change in the poorest performing practices towards the Lambeth average of 66% of people known to have diabetes achieving good control and between different population groups focusing on some ethnic minority populations and people with mental health problems known to have increased prevalence, earlier onset and higher rates of complications.

HIV

To ensure the revised HIV treatment and support services are informed both by detailed evidence on which populations are experiencing the highest prevalence, the highest transmission rates and the highest social needs profile, and by a diverse Service User Reference Group (SURG) indicative of the different communities affected in Lambeth

Smoking

To enable all smokers to have equal opportunity to quit through the Lambeth stop smoking service focusing particularly on particularly on lower socio economic groups who are more likely to smoke

Childhood Obesity

To reduce any inequality experienced by different population groups in their ability to benefit from the Childhood Obesity Programme and to promote equality and equity as a key element to successful delivery of the Programme overall

Alcohol

To promote equity of access to information on alcohol and safe drinking, and to alcohol misuse services for population groups at higher risk of alcohol related harm.

In partnership with and the active support of the local Public Health service the CCG undertakes to:

· Be more transparent about equality in health services commissioning

· Ask more specific questions about equality and human rights in engagement activity

· Advocate on behalf of populations that are historically marginalised and/or discriminated against

· Promote more comprehensive equality monitoring; patients asked (with explanations and assurances about confidentiality) to give more information that assists services to demonstrate whether they are providing an equitable service

· Commission primary and secondary care services that are competent and considerate on equality and human rights e.g. staff do not make assumptions and address their own prejudices

MILESTONES / KEY ACTIONS

DATE DUE

Publish an updated review of the evidence the CCG has on equality and the CCG’s impact on equality including progress against equality objectives

31st January 2014

Stakeholder (particularly equality groups) engagement on progress against equality objectives and agreement of ‘grading’ of progress

31st March 2014

Publication of the stakeholder grading and updates to equality objectives.

NB: This will be the 3rd annual update of a 4 year cycle.

4th April 2014

4. Operational Delivery

Operational delivery includes:

· Planned care

· Long Term Conditions

· Elective

· Sexual Health

· Contract management

· Community Based Care

· Integrated Care Programme

· Unplanned care

· Frail Elderly (admissions avoidance)

· Urgent Care

· Mental Health Improvement

· Continuing Care

· Children & Maternity

· Medicines Optimisation

· Staying Healthy

· Cardiac & Stroke

· Cancer

Monitoring and reporting on operational delivery is structured through the work programmes of the CCG – planned care, unplanned care, mental health improvement with some areas of operational delivery reporting to the Equality, Engagement and Communications Committee or directly to the Integrated Governance Committee.

4.1 Planned care programme

Clinical lead: Drs John Balazs and Ruth Jeffrey

Executive lead: Moira McGrath, Director of Care Pathway Commissioning

Programme lead: Sara White /Sally Rickard, Joint Acute Commissioning & Redesign Manager

Purpose

To develop and deliver an outpatient strategy which reduces premature mortality and improves quality of life, reducing reliance on hospital services and improving the quality of primary care by:

· Improving the control of long term conditions (including HIV)

· Preventing risk of acute events in people with a Long Term Condition (LTC)

· Early detection

· Secondary prevention

· Securing the quality, equity and productivity in the management of elective conditions

· Identifying the most appropriate settings for treatment i.e. local v hospital based

· Facilitating patient-centred care, with a shift in service provision along the care pathway, for identified priorities, from treatment to prevention

· Educating Primary Care Clinicians

· Promoting appropriate referral

· Reducing variability in care

· Developing multi-disciplinary teams to look after patients closer to home

· To agree patient involvement objectives and monitor achievement against them

The Planned Care Programme operates across three main work streams:

· Long Term Conditions

· Elective

· Sexual Health

The strategy will inform and be informed by the developing South East London Community Based Stratgey and be developed and managed jointly with Southwark Clinical Commissioners.

4.1.1 Long term conditions

1. Development of South East London Out of Hospital Programme as part of South London Healthcare Trust (SLHT) Trust Special Administrator (TSA) process.

1. Patient involvement to shape redesign of services and implementation of changes in identified pathway redesign work.

1. Equalities work –implementation of baselines and monitoring of key objectives in Cardiac Vascular Disease (CVD) and diabetes programmes to:

2. reduce variation between practices,

2. support better diabetes control in key ethnic minority populations

2. support better diabetes control in people with mental health problems

2. develop equality impact monitoring of services

1. Reduce variation in referrals including further development of peer review, referral checklists, primary care education and use of choose and book including advice and guidance.

1. Implementation of the 2012/13 redesign work incorporating some decommissioning of diagnostic services, e.g. Ambulatory Blood Pressure Monitoring (ABPM) in acute settings.

1. Continue to work in collaboration with the Diabetes Modernisation Initiative to develop robust mechanisms for Self-Management, including innovative structured education

1. Develop Primary and Community pathways of care for Diabetic patients

1. Work with King’s Hospital Trust colleagues to deliver Centre of Excellence in Diabetes for children and the diabetes tariff

1. Re-commission diabetes service incorporating evaluation outcomes from 2012/13

1. Review impact of commissioning of medicines management within planned care pathways, specifically anticoagulation (Spring 2013)

1. Through Integrated Care Programme review provision for people with multiple long terms conditions, incorporating development of risk based care plansand develop tariff for Year of Care as part of national Early Implementer process

1. Through Integrated Care Programme review provision for people with multiple long terms conditions, incorporating development of risk based care plansand develop tariff for Year of Care as part of national Early Implementer process

1. Evaluate implementation and re-commission where required for :

12. Community Cardiology Service (service implemented Quarter 3 2012/13) -  evaluation Quarter 3 2013/14

12. Community Respiratory Services – evaluation Q3 2013/14

1. Dependant on outcome of evaluation in 2012/13, re-commission as required for Community Renal Service (Evaluation Quarter 3 2012/13).

4.1.2 Elective

1. Development of South East London Out of Hospital Programme as part of South London Health Trust Special Administrator (TSA) process.

1. Patient involvement to shape redesign of services and implementation of changes in identified pathway redesign work.

1. Reduce variation in referrals including further development of peer review, referral checklists, primary care education and use of choose and book including advice and guidance.

1. Evaluate implementation and re-commission where required for :

17. Optometrist Service (2 year pilot to be implemented Quarter 3 2012/13) - part year evaluation Quarter 2 2013/14, full evaluation Quarter 1 2014/15

17. Inflammatory Arthritis – review implementation of Disease-modifying antirheumatic drugs (DMARDs) Enhanced Service Quarter 3 2013/14

1. Dependant on outcome of evaluations in 2012/13, re-commission where required for:

18. Community Dermatology  (Evaluation Quarter 3 2012/13)

18. Eczema Education  (Evaluation Quarter 3 2012/13)

18. Headache Service (Evaluation Quarter 3 2012/13)

18. Ultrasound (Evaluation Quarter 3 2012/13)

1. Review impact of commissioning of medicines management within planned care pathways, specifically biologics for dermatology (Spring 2013)

1. Tender community Musculoskeletal Clinical Assessment, Triage and Treatment Service (MCATTS) and all musculoskeletal physiotherapy services for borough wide provision for new service in Autumn 2013

1. Implementation of  2012/13 redesign work in:

21. Paediatric primary/secondary interface (2013/14 pilot phase for full commissioning likely in 2014/15)

21. Pain - pilot of new care pathway models in Spring 2013/14

21. Gastroenterology – develop pilot community hepatitis service in Spring 2013/14

1. Develop non patient contact tariffs to support outpatient redesign for April 2013

1. Ensure delivery of 18 week Referral to Treatment target for admitted, non admitted care and diagnostic services along planned care pathways.

4.1.3 Sexual Health (Joint with London Boroughs of Lambeth, Southwark and Lewisham and Southwark and Lewisham CCGs)

Lead Clinicians: Drs Ray Walsh and Stephanie MayLead Director: Helen Charlesworth-May, Director of Integrated Commissioning

Programme Lead: Sara White /Sally Rickard, Joint Acute Commissioning & Redesign Manager

Work with London Borough of Lambeth and CCG/borough partners on:

HIV

· Ongoing implementation of the HIV care and support review recommendations; consolidating activity shift of 30% from specialist mental health services into primary care provision from April 2013

· Finalise shared care model between specialist and primary care for people with HIV with a focus on long term conditions (LTC) management by July 2013

· Monitoring peer support redesign from June 2013

· Further development of the case management model by March 2014

· Scope transition services for young people into adulthood By March 2014

Sexual health service redesign

· As part of the Sexual Health & HIV strategy refresh (2012/13) and consolidation Kings Health Partners (KHP) undertake a service site review across the whole system in light of the opening of the new Burrell Street site (GST); non implementation of the integrated sexual health tariff in 2012/13 and non parity in sexual health income streams and public health transition

· Develop a viable service model across Kings Health Partners (KHP) with a viable staff configuration to effectively support the shift on asymptomatic activity onto online / telephone support provision through the GST charity bid for the virtual sexual health service. Link this work through the South East London Workforce strategy

· Deliver a model of psychosexual service provision across KHP and a stepped model of care and pathways initiated from primary care that link effectively into the talking therapies re-design effectively

· Ensure medical gynaecology provision is reviewed as part of the service redesign above

Tariff implementation

· In light of public health transition implementation has not been possible in 2012/13 or for the beginning of 2013/14.

· Reduce the risk of a return to Genito-uniary Medicine (GUM) block contracts, reduction in access and cost pressures for boroughs who are net importers of GUM activity through ongoing work across the CCG /Local Authority interface and the Health Wellbeing Board to make the case for integrated tariff implementation in 2013/14 or 2014/15. To ensure the ongoing delivery of public health outcomes, reduction in late diagnosis, Teenage Pregnancy reduction and reduction of repeat Terminations of Pregnancy (through contraception) and reduction in Sexually Transmitted Infection’s (STI’s) through ongoing access to open access and high quality sexual health services

Termination of pregnancy services (TOPS)

· Ongoing development of the follow up care pathways post procedure to address repeat TOPs usage

· QIPP efficiency plans for early medical TOPs (currently constitute >50% of TOPs procedures) through the development of an agreed and separate tariff price

· Retender central booking service to ensure best cost efficiency as Lambeth, Southwark & Lewisham will have leverage in terms of the high volumes of TOPs activity Ongoing engagement with service users to identify barriers to contraception uptake following TOPs amongst specific community groups where TOPs service usage is high

Sterilisations & vasectomies

· Re-design female sterilisation pathway to support an activity shift into independent provision and promote increased use of long acting contraception

· Vasectomy- ensure ongoing shift out of acute provision through collaboration with primary care clinicians

Patient involvement

· Ongoing use of mystery shopping mechanisms to evaluate sexual health service development, this will need to be a composite element of the sexual health service redesign

· Ongoing development of SURG function to support co-production in the ongoing implementation of the HIV care and support recommendations

Equalities work

Ongoing development and monitoring of the equalities objective across sexual health & HIV service pathways

4.1.4 Contract management & monitoring of acute services

Guys’ & St Thomas’ - Lead clinician: Dr John BalazsKings – Lead Clinician: Dr Gillian EllsburyExecutive Lead: Sarah Cottingham, Head of Acute Contracting, South London CSU

Purpose

To ensure that all commissioned services are procured and performance managed appropriately, including building and maintaining relationships with all providers and ensuring local and national health care requirements are delivered through robust contracts with providers. Where services are commissioned either jointly with the Local Authority or as part of shared service agreements or any other delegated arrangements, NHS Lambeth will work jointly with partners in order to ensure the needs of patients are met and appropriate, co-ordinated care is commissioned throughout all aspects of the patient pathway.

· Work with trusts to improve performance on national referral to treatment (RTT) targets for admitted and non admitted and diagnostics

· Work with trusts to meet maximum waiting times in accident & emergency (A&E) and the development of further quality measures in emergency services

· Work with trusts to ensure delivery of maximum waiting times for cancer services

· Ensure trusts deliver requirement on hospital acquired infections

· Trusts to meet national standards on Mixed Sex Accommodation

· Trusts to deliver no ‘Never Events’

· To work with trusts on process for auditing emergency readmissions learning from 2012/13 work

· To ensure delivery of the acute QIPP actions and associated risk sharing arrangements, including robust monitoring of the underlying position to understand the implications for the 2013/14 contract

· Implement post discharge tariffs in partnership with GST Community Services, ensuring overall cost neutrality

· Agree arrangements for implementation of sexual health tariffs in partnership with London Boroughs of Lambeth, Southwark & Lewisham and Southwark & Lewisham CCGs

· Commission new anti cancer drugs in line with recommendations from the South London Cancer Network and agree appropriate funding arrangements for non Cancer Fund drugs

· Work with acute trusts to reduce ambulance turnaround times in partnership with London Ambulance Service and LAS coordinating commissioners.

· Agree process for implementation of paediatric diabetes best practice tariff

· Agree CQUINs in line with CCG strategic priorities

4.1.5 Contract management & monitoring of GST Community services

Lead Clinician: Dr. Ruth JefferyExecutive Lead: Moira McGrath, Director of Care Pathway Commissioning

Programme Lead: Therese Fletcher, AD Primary & Community Commissioning / Liz Clegg, AD Older People & Client Groups / Emma Stevenson, AD Children & Maternity

Purpose

To ensure that community health services are procured and performance managed appropriately, including building and maintaining relationships with all providers and ensuring local and national health care requirements are delivered through robust contracts with providers.

· Continue to lead contract on behalf of Lambeth, Southwark, Lewisham & Wandsworth CCGs. Work with Bexley, Bromley and Greenwich CCGs to determine if they wish Lambeth to coordinate commissioning for them.

· Work with NHS England, London Borough of Lambeth (LBL) and provider trusts to ensure effective pathway approach to safeguarding and children's services

· Work with neighbouring CCGs in Southwark, Lewisham, Bromley, Wandsworth, Croydon, Merton & Sutton to review cross border flows with Guy’s & St Thomas, Lewisham, Royal Marsden and Bromley and agree future commissioning arrangements post April 2013

· Use improved information to develop practice based understanding of service utilisation and variation and next steps on patient based community information dataset – new dataset in place for April 2013 and plans to improve over the year

· Design and implement Intermediate Care and community nursing redesign as part of next steps for Integrated Care programme in partnership with London Boroughs of Lambeth & Southwark, Southwark CCG and acute trusts. Phased programme 2013-15

· Review and decommission continuing care provision at Minnie Kidd house

· Roll out of admission avoidance schemes

· Increase patient facing contact time for community nurses and health visitors through agreeing and implement next stage of estates rationalisation and mobile working for community staff. Plans as part of 2013/14 contract.

· Implementation of post discharge tariff in partnership with acute services for April 2013

· Work with NHS England and LB Lambeth to re-commission and extend the Lambeth Family Nurse Partnership Programme

· Work with NHS England to increase numbers of Health Visitors in line with planned trajectory and Health Visitor Improvement Programme

· Work in collaboration with LB Lambeth to commission an early intervention/early help offer including increased home-based interventions (in line with Ofsted/CQC Inspection, Munro and Marmot)

· Review and re-commission Paediatric Therapies as part of Special Educational Needs Inclusion Policy

· Continue to commission equipment pathway to support increased access to short breaks for children with a disability

· Work with NHS England on:

· Recommissioning of Family Nurse Partnership

· Increasing numbers of Health Visitors

· Work with London Borough of Lambeth on:

· Sexual Health redesign across Kings Health Partners and tariff implementation

· Agree CQUINs in line with CCG strategic priorities

4.1. 6 South East London Community Based Care

Clinical lead: Dr Adrian McLachlan

Executive lead: Moira McGrath, Director of Care Pathway Commissioning

Programme lead: Therese Fletcher, AD Primary & Community Commissioning

Purpose

To enable better ways of team working and consider changes in the traditional roles of primary care practitioners, creating the opportunity to design new ways of working which will reshape the boundaries between primary care, hospital and other associated services.

· Effective partnerships developed

· Integrated teams working together

· Have access to primary care service/ advice 24 hours a day, 7 days a week for urgent needs through a combination of appointments and walk in services, telephone appointments, 111/NHS Direct or same day urgent care etc.

· Patients receive high-quality care that meets agreed quality standards and outcomes, provided through teams working in networks across primary care, community and specialist services

4.1.7 Lambeth and Southwark Integrated Care Programme

Clinical lead: Dr Adrian McLachlan

Executive lead: Andrew Eyres, Chief Officer

Programme lead: Therese Fletcher, AD Primary & Community Commissioning / Liz Clegg, AD Older People & Client Groups

· Re-commission HomeWard and extended Enhanced Rapid Response Service

· Review implementation of Integrated Care Frail Elderly GP Local Enhanced Service and extend across Lambeth

· Further develop GP access to urgent outpatient provision in medicine subject to review of geriatric model in place from July 2012

· In phase two of the Integrated Care Programme review provision for people with multiple long terms conditions and co-morbidities

· Develop tariff for Year of Care as part of national Early Implementer process

· Implement new information sharing system across primary, community, secondary and social care

· Use of innovative technology as part of the frail older people and long term conditions pathways

· Develop and extend the use of risk stratification, reviewing its use in identifying older people for holistic health checks and determine re-commissioning options by October 2013

· Develop incentives, risk sharing approaches and governance to better deliver integrated care

4.2 Unplanned care programme

Clinical lead: Drs Patricia Kirkman and Gillian Ellsbury

Executive lead: Moira McGrath, Director of Care Pathway Commissioning

Programme lead: Therese Fletcher, AD Primary & Community Commissioning / Liz Clegg, AD Older People & Client Groups

Purpose

Lambeth continues to have a high number of non-elective admissions compared to London and England and a high level of reliance on hospital based care. Local audits show that between 40-60% of people attending A&E could have their care provided safely and appropriately in primary and community settings. The major service challenge includes the need to improve equitable access, quality and capacity/capability of primary care services to manage care more effectively including out of hours, to identify areas that need require whole system pathway redesign

The Unplanned Care Programme operates across two main work streams:

· Frail Elderly, (including admission avoidance and intermediate care)

· Urgent Care, (including Urgent Care Centres and Out of Hours)

The Programme will continue to be developed and managed jointly with Southwark clinical commissioners and will be further supported through the King’s Health Partners Integrated Care Project.

The aim of the Unplanned Care Programme to is to design and implement improved unplanned care services across the two boroughs that support improved health outcomes through greater planned and co-ordinated care. This will be reflected in lower A&E attendances and subsequent emergency admissions, fewer readmissions, enhanced quality of care and the delivery of national standards. This is a key area of QIPP delivery in enhanced quality and improved productivity of care.

This programme gives us the opportunity to work closely with acute trust colleagues and jointly develop robust systems that give secondary care the ability to manage surges in demand, impact on 4 hour waits and ambulance turnaround times. We will continue to analyse the reasons for increased pressure on A&E and develop innovative access schemes to reduce inappropriate attendance.

The programme will agree patient involvement objectives and monitor achievement against them.

· Ensure at least 95% of patients wait no more than 4 hours in A&E

· Adjust programme to reflect outcomes from report carried out by Public Health and Urgent Care Network on increased A&E pressures over Winter 2011/12. This includes detailed analysis of admissions and readmissions from care homes. This will inform actions required for Winter Planning 2013/14 and beyond.

· Re-commission HomeWard and extended Enhanced Rapid Response Service from April 2013

· Review implementation of Integrated Care Frail Elderly GP Local Enhanced Service and extend across Lambeth

· Further develop GP access to urgent outpatient provision in medicine subject to review of geriatric model in place from July 2012

· Embed A&E diversion scheme at St Thomas’ into contract by April 2013

· Agree business case for primary care front end for St Thomas’ A&E and extend to King’s. Business case completed September 2012 for potential procurement with new service in place by October 2013.

· Involve patients in the procurement of primary care front end for both acute trusts

· Engage with NHS Wandsworth to ensure successful implementation of the new UCC at St George’s Hospital

· Implement new 111 service for 2013 and re-commission GP Out of Hours Services accordingly.

· Commission alcohol recovery service currently provided through London Ambulance Service (LAS) in partnership with other London commissioners learning from current ambulance CQUIN. New service from April 2013.

· Work with King’s Health Partners to review medical pathways to improve pathways and ensure more advice to GPs for heralding patients and re-direction of patients to urgent outpatients and diagnostics by September 2013

· Equalities work –implementation of baselines and monitoring of key objectives within QOF QP:

· reduce variation between practices,

· develop equality impact monitoring of services

· Involve patients in identifying the reason for inappropriate attendance at A&E

· Commission improved paediatric pathway as a result of findings from the 2012/13 Paediatric A&E audit

4.2.1 Frail Elderly (admissions avoidance)

The programme aims to improve the cost effectiveness of care and move people into planned steams of care. It aims to reduce numbers of and length of stay for emergency admissions and readmissions; ensure increased numbers of people supported at home; ensure trusts can continuously meet waiting times targets in A&E; reduce A&E attendances; and increase the number of people supported to die at home.

The programme includes a range of projects: review of implementation of pilot of Virtual Ward and commission extension if evidence of impact; develop single point of access for community based services; review implementation of population health management tool and recommission/extend if evidence of impact develop community based long term conditions support (See planned care -LTCs); review commissioning and provision of adult continuing care; work with Kings Health Partners to improve admitted emergency pathways and further alternatives to admission based on emerging findings of integrated care pilot; recommissioning end of life care based on the findings of the end of life care modernisation initiative work across Lambeth & Southwark.

4.2.2 Urgent Care

NHS Lambeth’s aim is to shift 60% of all A&E minor treatments in to primary care by 2014. The CCG stated aim is to make savings on the current costs of A&E attendances including those which attract mid rate tariffs (attendances with investigations) and short stays. This will be achieved by front ending A&E at Guy's and St Thomas' Hospital (GST) and Kings College Hospital (KCH) with a primary care Urgent Care Centre. Working with social care, intermediate care teams and community nursing, with an emphasis on admission avoidance and improved discharge.

A key function of the front-end A&E facility will be its links to community, General Practice, Out of Hours, existing EAC and to demonstrate a reduction in non-elective admissions via A&E; as a result of primary care staff expertise and knowledge of community services. In addition to clinical redirection at the front door of A&E NHS Lambeth will introduce a non-clinical navigator at the front door of A&E at St Thomas' who, where clinically appropriate will redirect patients back to their own GP or register them with a local GP if they are a Lambeth or Southwark resident.

4.3 Mental health improvement programme

Clinical lead: Drs Ray Walsh and Raj Mitra

Executive lead: Helen Charlesworth-May, Director of Integrated Commissioning

Programme lead: Denis O’Rourke, AD Integrated Commissioning Mental health / Liz Clegg, AD Older People & Client Groups

Purpose

To redesign mental health care pathways (severe mental illness & common mental illness) in order to improve patient outcomes.

The Mental Health Improvement Programme is a continuation of the work that has been carried out to redesign mental health services. It includes people with severe mental illness (SMI), people in contact with criminal justice system and older people experiencing poor mental health, including dementia.

The collaborative has been formed as a platform to include users and carers to radically improve outcomes.

Transforming primary and community mental health services (for people with severe mental illness)

The 2013/14 work programme continues to build on the work initiated by the Lambeth Living Well Collaborative, a partnership platform that brings the whole system together (including users and carers) during 2011/12 which focused on developing (through co-production) a new improved service offer for people with Serious Mental Illness (SMI). During 2013/14 the focus will be on ensuring an integrated whole system (across primary care, voluntary and community sector and South London and Maudsley SLaM) service approach.

Criminal Justice Mental Health

This programme will continue to support the remodelling of criminal justice/forensic pathways with the overall aim of reducing current (above average) investment levels within low/medium secure provision and investing in community based support in collaboration with NHS England. This will be done through a focus on recovery, improved case management, early assessment and diversion and the use of more flexible court/hospital orders and the development of more appropriate community based provision.

Payment by Results (PbR)

This project focuses on the preparation for payment by results in mental health, which will go live in shadow form from April 2013. This will provide commissioners with improved activity and financial data for most of the adult services within the SLaM contract.

Integrated Talking Therapies/Counselling services

This project is a continuation of the work which commenced last year aimed at improving the quality and effectiveness of primary care based talking therapies (counselling and IAPT Improving Access to Psychological Therapies) through a competitive tender process.

Mental Health and Older Adults (including dementia)

The programme will build on the 2012/13 priorities which includes the delivery of the National Dementia Strategy. This will include increasing awareness and diagnosis of dementia, better support to people with early dementia and their carers, development of shared care protocols for the prescribing and monitoring of cognitive enhancers and the delivery of national and locally agree CQUINS. Other priorities will be the redesign of continuing care and day care services and working with South London & the Maudsley (SLaM) and other stakeholders to pilot a Home Treatment Team for older adults.

Serious Mental Illness (SMI) including forensic services

· Continue with work led by Lambeth Living Well Collaborative (LLWC) to apply “co-production” to the delivery and commissioning of services for people with long term severe mental illness including the ongoing stakeholder engagement programme and inform other related programmes i.e. Long Term Conditions and with other CCGs in South East London.

· Health of the Nation Outcome Scales (HoNOS) outcome target – ensure full achievement of 95% HoNOS target for number of patients with a paired number HoNOs score, supporting the implementation of PbR in Mental Health

· Implement on a phased basis from July 2013 a newly designed “ front end” to the Adult Mental Health support system, the “Living Well Network” which aims to provide support to people much earlier (based on enablement/recovery practice) in order to avoid crisis and unnecessary use of specialist /secondary care services .

· Implement an asset based connection communities programme with Lambeth Council and the Voluntary & Community Sector aimed at supporting improved community connections especially for people with long term mental illness as part of the Living Well Network implementation – from September 2013.

· Work with SLaM to reduce demand for acute psychiatric beds by supporting redesign of Adult Mental Health secondary care services aimed at an improved focus on relapse prevention.

· Prototype a crisis retreat service from August 2013 (via Lambeth Living Well Collaborative).

· Implement a co-production culture change programme across primary care; voluntary care sector, South London & the Maudsley (SLaM) (and its evolving Recovery College) in collaboration with people who use services and carers from September 2013.

· Implement an Integrated CQUIN across primary care / voluntary sector and SLaM to support new model of support from April 2014.

· Enable 100 people with long term mental illness access a personal budget in support of the recovery goals by March 2014.

· Develop an integrated approach within primary care to meeting the physical health and support needs for people with Serious Mental Illness (SMI) and Common Mental Illness (CMI).

· Develop a comprehensive range of spot purchase accommodation which provides personalised and recovery-focused support for people leaving residential care and secure care which (a) is appropriate for the patient’s needs at each stage of their recovery pathway and (b) is provided at reduced overall cost subject to agreement with NHSE on transfer of resources to support community pathways.

· Deliver the Mental Health Payment by Results (PbR) programme in accord with Department of Health timescales and introduce effective levers to ensure continued expansion of community based support.

· Deliver £3m QIPP programme across Mental Health including Mental Health older Adults and Child Adolescent Mental Health Services (CAMHS).

Mental Health Older Adults

· Implementation of Day Centre Services redesign across health and social care

· Dementia Strategy - commissioners will continue to focus implementing the Dementia Strategy, and specifically ensuring carers’ needs are addressed in advance of Care and Support Bill legislation.

· Commissioners, medicines management and health partners will focus on establishing an integrated formulary across health organisations and embed the principles of shared care for people with dementia for June 2013

· To evaluate the memory service and adjust the specification if required by September 2013.

· To evaluate the Home Treatment Team Pilot and use outcomes to inform QIPP proposals for 2013/14 which could include full role out of the pilot and reduction in acute bed by June 2013

· Continue the review of SLaM continuing care provision and to work with commissioners from Southwark and Lewisham to develop services to better meet the needs of people with challenging behaviour by April 2014

· Ensure the needs of people with dementia are embedded as part of the Lambeth and Southwark Integrated Care Programme

· Further development of primary/secondary care pathway for people with dementia and their carers

Common Mental Illness (CMI), CAMHS and autism

· Develop a CMI strategy for people with long term mental illness including the development of infrastructure such as improved recording in relation to recovery by March 2014.

· Review impact of new Integrated Talking Therapy Service within primary care and agree action plan by December 2013.

· Reduce Adolescent Tier 4 In-Patient and Out Patient activity through increased access to community Child Adolescent Mental Health Services (CAMHS)

· Develop an integrated plan across primary and secondary care for improving the smoking quit rate amongst people with long term mental illness (inequality objective) by August 2013

· Develop a strategy with Lambeth Council for meeting the needs of adults with autism – September 2013.

4.3.1 Continuing Care [note need to agree where this reports to]

Lead clinician: Dr Gillian EllsburyLead Director: Helen Charlesworth-May, Director of Integrated Commissioning

Programme Lead: Liz Clegg, Assistant Director Older People & Client groups

Purpose

Evaluation of Continuing Care pathways ensuring patient centred care.

· Monitor impact of Continuing Care Appeals

· Develop joint quality monitoring mechanism with London Borough Lambeth

· Set up a new internal appeals panel in line with equity and cost effective policy developed by CCG

· Minnie Kidd and SLaM block provision – commissioners will review the commissioned block beds at Minnie Kidd House, to determine value for money and best utilisation of resources by March 2014

· Roll out of personal health budgets - commissioners will continue to roll out the option of a personal health budget for patients identified as being eligible for fully funded NHS Continuing Health Care

· Work across Lambeth, Southwark and Lewisham on commissioning of specialist SLaM continuing care beds and development of behaviour support services from September 2013

· Work to retender domiciliary care provision with London Borough of Lambeth, ensuring quality and value for money September 2013.

· To continue with National Retrospective Appeals work in accordance with Department of Health timescales.

4.4 Children & maternity improvement programme

Clinical lead: Dr Patricia Kirkman

Executive lead: Helen Charlesworth-May, Director of Integrated Commissioning / Moira McGrath, Director Care Pathway Commissioning

Programme lead: Emma Stevenson, AD Children & Maternity

Purpose

Service redesign of children’s service to achieve quality, value for money services.

Review of community paediatric services

To explore the current high volume activity for paedicatric developmental assessment ensuring referral criteria and skill mix is appropriate and efficient

Paediatric ASD diagnostic service:

To establish a joint Lambeth/Southwark Autistic Spectrum Disorders (ASD) diagnostic service with horizontal integration with the Evelina Children’s Hospital

Designated Roles

To review the designated paedicatrician roles including, Safeguarding, Special Education, Looked after Children and rapid response to death to ensure appropriate consultant time dedicated to each area with effective outcomes

CAMHS

Review the current 4-Tier model, ensuring a step-down service model is in place with reduced Tier 4 activity and increased access to community Child Adolescent Mental Health Service (CAMHS)

GSTT Charity Bid - paediatric ICP:

30 month project to identify possible model of service delivery in the community via a Paediatric 'Children's Health Centre' with acute paediatricians working alongside primary care

Breastfeeding:

Implement UNICEF Baby Friendly Initiative and Peer Breastfeeding Programme (as part of child healthy weight programme)

4.5 Medicines optimisation

Clinical lead: Drs Di Aitkin and Dr Gillian Ellsbury

Executive lead: Moira McGrath, Director of Care Pathway Commissioning

Programme lead: Vanessa Burgess, AD Medicines Management

· Support the management and governance of controlled drugs in line with national policy and good practice.

· Development of a commissioner led Area Prescribing Committee for managed entry of new drugs working in partnership with Southwark and Lewisham CCGs and to include patient engagement.

· Secondary care QIPP delivery – work in partnership with acute providers to enable high cost drugs management. Specifically to optimise London Procurement Project initiatives with GST and KCH, implement repatriation of immunosuppressant in line with London SCG initiative and review of biologics in Rheumatoid Arthritis with GST, KCH and University Hospital Lewisham (UHL). Monitor acute trust Key Performance Indicators for Prescribing and Drugs and Devices Policy Adherence.

· Primary care QIPP delivery – ensure break even on the prescribing budget via the medicines optimisation Local Enhanced Service, primary care prescribing dashboard and locality support for medicines.

· Improve patient outcomes from medicines, specifically via a medicines waste campaign (in partnership with other CCGs in South East London), a review of practice repeat prescribing policies to reduce medicines errors and a medicines optimisation in heart failure initiative.

4.6 Staying Healthy (Joint with London Borough of Lambeth)

Lead Clinicians: Drs John Balazs and Ruth JefferyExecutive lead: Helen Charlesworth-May, Director of Integrated Commissioning

Programme Lead: Therese Fletcher, AD Primary & Community Commissioning

Smoking

· Improve the quality of smoking cessation services through ensuring good practice and promoting equitable access to quit.

· Use the findings from the health equalities assessment of the Lambeth Stop Smoking Service to inform commissioning of an equitable service to further enable all smokers to have equal opportunity to quit through the service focusing particularly on lower socio economic groups who are more likely to smoke.

Vascular Prevention

· Increase the number of people on GP disease registers with controlled hypertension Increase numbers of vascular health checks to identify people at risk of disease and improve the quality of checks.

Alcohol

· Review CQUINs from 2012/13 and commission ongoing brief intervention provision for alcohol

Healthy Weight

· Further implement the childhood healthy weight prioritised interventions with ongoing review and appropriate evaluation, to maximise the effectiveness of these interventions, promote the ability of different population groups to benefit from the overall Childhood Obesity Programme and to contribute to a local and national evidence base

· Extend the current pilot Level 3 Childhood Healthy Weight Service contract which ends in March 2013 to allow for meaningful evaluation.

· Extend the Level 2 Childhood Healthy Weight Contract from June 2013 to March 2014.

· Ensure the implementation of the mandated National Child Measurement Programme in line with national guidance and good practice in partnership with London Borough of Lambeth and provider partners

· Conduct robust evaluation at key stages of the Childhood Obesity Programme and use findings to promote equality and equity as a key element to the successful delivery of the Programme overall

Baby Friendly Initiative

· Develop a business case for the next stages of the Baby Friendly Initiative in partnership with London Borough of Lambeth and provider partners

Breastfeeding

· Develop a business case to further develop the Breastfeeding Peer Support Programme

Health Promotion

· Review provision of Southwark Health promotion to avoid duplication and procure revised specification Subject to 2012/13 evaluation outcomes, commission early intervention for Children & Young People’s physical, mental health and sexual health needs at the innovative Wells Centres (GP practice in youth Centre)

Healthy Living Pharmacy

· Embed Phase one of the Healthy Living Pharmacy initiative, which focuses on Smoking Cessation and Emergency Hormone Contraception

· Develop Phase two of the Healthy Living Pharmacy Scheme, which focuses on Alcohol Screening and NHS Vascular Health Checks

Health & WellbeingPro-active signposting to non-health services through:

· Promote ‘5 ways to well-being’ with primary care staff particularly to support delivery through NHS Vascular Health Checks 

· Deliver training of primary and community workforce to deliver the message

· Develop Healthy Living Champions to promote ‘5 ways to well-being’

4.7 Cardiac and Stroke

Clinical Lead: Dr John Balazs

Director Lead: Moira McGrath, Director of Care Pathway Commissioning

Programme Lead: tbc

· Work with the National Commissioning Board and Cardiac and Stroke Network to implement children’s cardiac surgery review with a focus on Evelina Hospital at Guy’s & St Thomas’ Trust (GST) including the wider emergency and pathways impact.

· Review community heart failure and Atrial Fibrillation services

· Implementation of changes to South London vascular pathway with a focus on GST.

· Review recommendations from the national Cardio Vascular Disease (CVD) outcomes strategy to be published in 2013 and local implications.

· Reviewing the pathway for stroke survivors and implementation of the national post stroke review in partnership with the Stroke Association

4.8 Cancer Services

Clinical Lead: Cathy Burton

Executive Lead: Andrew Eyres, Chief Officer

Programme Lead: Liz Clegg, Assistant Director Older People & Client Groups

Purpose

· Review variation in 2 week cancer waits and feedback to GPs on inappropriate 2 week referrals. Increasing GP awareness of cancer and training in diagnostics.

· Campaign to improve awareness of cancer in disadvantaged groups specifically for colorectal and lung cancer

· Improving patient experience for out of hospital care particularly communication with patients about transition to palliative care

· Improving advance care planning across all sectors

· Work with NHS England on commissioning and delivery of and access to screening services, particularly cervical.

· Scope management of chronic cancer patients and supporting those in survivorship.

· Agree funding and contractual requirement for anti cancer drugs including those through the Cancer Drugs Fund

4.9 Specialised Commissioning

Lead clinician: Dr Adrian McLachlan (through SEL Clinical Strategy Group)Executive Lead: Sarah Cottingham, Head of Acute Contracting, South London CSU

Programme Lead: ??

NHS England in its Statement of Intent for Collaboration identified the following issues that the CCG is working with them to address:

· Ensuring that the 2013/14 commissioning round is organised to prevent costs rising, present a unified approach to providers and commission new and exacting national specifications which have implications for primary and secondary services.

· Managing a safe transfer of commissioning from PCTs, to CCGs and NHS England. This is both a consequence of being able to accurately define specialised from non-specialised workload to ensure the correct activity and finance is identified and then monitoring the system to ensure that work is accurately coded and invoiced by providers.

· Organising care for the group of patients who move between tertiary services and primary and secondary care

· Reducing the number of patients requiring tertiary care.

Specific local issues for NHS Lambeth CCG are:

· Work with NHS England to deliver ongoing demand management savings in mental health

· Work with NHS England on developing pathway and quality standards for care of people with HIV.

NOTE: [We will still have specialist commissioning (i.e. as opposed to being specialised commissioning remaining with SLaM – these are services that have been developed by SLaM but don’t fit the identification rules – we have a QIPP for this.

4.10 Estates [note: need to confirm lead roles]

Clinical lead: Adrian McLachlan

Executive lead: Christine Caton, Chief Finance Officer/Moira McGrath (Estates Strategy)

Programme lead: Therese Fletcher, AD Primary & Community Commissioning

Purpose

· Commission planned services for West Norwood (opening November 2013)

· Review use of Gracefield Gardens Urgent Care Centre (opened 2009) and Akerman Road (opened August 2012)

· Review requirements and develop locality strategy for Vauxhall Nine Elms Battersea in North Lambeth

· Work with NHS Property Services and NHS England on assessing need for GP estates developments

· Develop plan for estates rationalisation with Guys & St Thomas Community Health Services for 2013/4 contract and key milestones.

· To monitor, review and oversee the delivery of the Action Plan of the Sustainable Development Management Plan.

5. Organisational Development

5.1 Organisational Development

Clinical lead: Dr Adrian McLachlan

Executive lead: Andrew Parker, Director Governance & Development

Programme lead: Janie Conlin / Lucy Day, Joint AD Organisational Development

Purpose

Improving commissioning skills and expertise to deliver our commissioning further developing our capacity to innovate and to harness innovation into our Commissioning approaches to secure improved service quality.

To continue to develop a highly effective Governing Body with clear succession plans:

· Organisational development plan agreed by Organisational Development Steering Group

· Governing Body selection and election process completed

· Mid year development review undertaken

· Personal Development Plans (PDPs) and Objectives delivered for Governing Body members

To establish the Collaborative Forum in line with the Lambeth Constitution

· Collaborative Forum Chair appointed and support provided for first meeting

· Relationship with Chair established and support arrangements agreed

· Support provided for Collaborative Forum meeting

· Collaborative Forum supported to operate in line with Constitution

To increase clinical leadership and succession plan for future clinical commissioning

· Work and development plans for Clinical Network members established

· Clinical network engagement input and relationship with Board agreed

· Systematic and effective working across managerial and clinical commissioning roles in place

· Clinical network fully embedded and utilised

To support staff in understanding the requirements of the new organisation and to further develop commissioning capability and capacity

· Objective and PDP process completed

· CCG business system, and the way we work, reflect the new organisation and our values

· Delivery of commissioning objectives managed through CCG PMO arrangements

To identify and develop relationships with key stakeholders in order to deliver commissioning responsibilities

· Commissioning relationships defined

· Action plan to manage stakeholder arrangements agreed

· Action plan implemented

· Improvements in stakeholder perceptions measured through survey

5.2 Engagement & communications

Clinical lead: Dr Raj Mitra

Executive lead: Andrew Parker, Director Governance & Development

Programme lead: Catherine Flynn, Head of Engagement

Purpose

Ensure the CCG fulfils its duty to engage members, stakeholders, patients and the wider public.

Implementing Communication’s and engagement strategy:

· Website launched and membership communications review undertaken

· Support arrangements for localities embedded

· Actions for continued improvement in communications/engagement at practice and locality level agreed

· Increased engagement with member practices

· Regular briefings held with Scrutiny and HealthWatch; presence of and presentation by clinical members at Scrutiny

· Engagement is part of new Governing Body members' PDPs and part of development plan for Governing Body as a whole

· Systematically involve patients, their carers and communities in the commissioning of health services for local people

· Support the Big Lambeth Health Debate

Patient & Public Involvement

· Develop and embed choice for patients including implementing Any Qualified Provider and choice of hospital/consultant team supported by increased use of Choose and Book

· Extend the use of the co-production model to other areas of commissioning using patients as experts in the management of their condition

· Review, develop and monitor patient involvement goals by programme

· Work with Health Overview and Scrutiny, HealthWatch and local people to ensure support and understanding of developments and changes in healthcare.

· Work to support practices Implementation effective PPGs.

5.3 Human Resources

Clinical lead: Dr Adrian McLachlan

Executive lead: Andrew Parker, Director Governance & Development

Programme lead: Caroline Linden, HR Business Partner, South London CSU

Human resource services are provided by South London Commissioning Support Unit. This includes:

· Recruitment and selection

· Payroll and pensions

· Employment policies and procedures

· Staff survey

· Workforce reporting

· Learning and development

· Expert advice and support

6. Governance and Assurance

6.1 Quality and Safety

Clinical lead: Dr Adrian McLachlan

Executive lead: Andrew Parker, Director Governance & Development

Programme lead: Marion Shipman, AD Governance & Quality

Purpose

To ensure systems and processes are in place to support individual, team and corporate accountability for delivering patient centred, safe, high quality care within resource limits.

To ensure that corporate and clinical governance process are embedded in CCG working practice

· Quality action plan developed in response to Francis Report

· Governance framework embedded and evaluated, including Constitution

· Approach to risk appetite embedded

· Review of governance arrangements undertaken

Ensure the Lambeth Clinical Commissioning Collaborative Board (Clinical Board) receives appropriate information to obtain assurance on issues of patient safety

· Ensure relevant items are presented to the Clinical Board for review and discussion.

· Ensure serious incidents (SI) for Lambeth and providers are investigated, reviewed and signed off in line with agreed SI Policy and reported to Board.

Ensure the Lambeth Clinical Board receives appropriate information to obtain assurance on the management of risks and the quality of commissioned services

· Develop the Lambeth Board Assurance Framework and Risk Register

· Update the Risk Register on an on-going basis

· Deliver commissioner quality reports

· Deliver Integrated Governance reporting

· Continue to monitor providers through contract and quality meetings

· Review information systems for performance and quality and develop an integrated system to support robust reporting and monitoring

Ensure compliance for internal safeguarding children structures and processes and those in providers from whom we commission services

· Provide the strategic health lead in inter-agency planning

· Ensure health services and health care workers contribute to inter-agency working

· Ensure all trusts are linked into the Local Safeguarding Children Board and that there is appropriate representation

· Co-ordinate health component of serious case reviews

· Include clear standards in commissioning arrangements

· Manage designated nurse and doctor for child protection to take strategic leadership responsibility for the child protection functions across Lambeth

Provide safe care for adults through the delivery of robust safeguarding systems and processes

· Ensure safeguarding policies and procedures are kept up to date and fully implemented

· Ensure HR systems for Criminal Records Bureau (CRB) checks continue

· Training strategy – each member of staff to have specific objective around the level of safeguarding training required

· Ensure providers are held to account for safeguarding requirements within provider contracts

· Establish independent contractor monitoring for adult safeguarding in line with the contract specifications

Ensure complaints, Patient Advice and Liaison Service (PALs) and incident information is used to develop quality services

· Provide robust complaints and PALs user service

· Continue to provide complaints, PALs and incident reports for consideration by the Board

Comply with statutory Freedom of Information (FOI) requirements

· Ensure communication of process as led by South London Commissioning Support Unit

· Ensure delivery of FOI requests in most efficient manner and within statutory deadlines

6.2 Finance

Clinical Lead: Dr. Gillian Ellsbury

NED Lead: Graham Laylee

Executive Lead: Christine Caton, Chief Financial Officer

Delivery of statutory financial duties:

(i) Ensure expenditure within a financial year is within the allocated revenue resources

(ii) Ensure that capital resources use does not exceed the limit set for capital

(iii) Ensure that revenue resource use on prescribed matters relating to admin costs (i.e. not relating to healthcare services) does not exceed the running cost allowance set by NHS England

Achieve compliance with the Better Payments Practice Code (BPPC).

Financial Planning: agree budgets for 2013/14.

· Work in collaboration with NHS England to resolve CCG baseline issues whilst mitigating the financial risk to the CCG.

Provide financial support to develop the CCG’s Five Year Commissioning Strategy Plan. This includes producing the Medium Term Financial Strategy that underpins Lambeth CCG’s Commissioning Strategy Plan. To ensure that strong financial governance and reporting is in place and foster a culture of accountability around our financial decision making.

· To ensure that proper records are kept and annual accounts are prepared and are subject to Audit and that we comply with any directions with regard to the accounts. The CCG should also ensure that its charitable funds are managed effectively.

· Review Board, practice and other monthly reporting to ensure that they are fit for purpose and supports financial and performance delivery

Support the delivery of QIPP programmes through robust finance and activity monitoring through the Programme Boards and ongoing financial support the review and generation of QIPP schemes. Ensure effective monitoring as part of the responsibilities of the Finance and QIPP Working Group.

Provide financial support to the implementation of the Trust Special Administrator (TSA) recommendations including the development of the Community Based Care Strategy

· Develop risk mitigation strategy for 2013/14 with ongoing financial reporting including QIPP delivery, risk assessment and recovery planning in line with internal and external reporting deadlines.

· Provide ongoing financial support to the commissioning of non acute contracts.

· Provide training and ongoing support to Clinical Board Members and non finance staff

· Work with the NHS Property Services, NHS England and GST Community to ensure the effective management, monitoring and delivery of 2013/14 Capital Plan.

Maintain strong internal financial controls and achieve a clean bill of audit health.

· Provide system/other training for non finance staff where appropriate

· Develop and ensure the effective delivery of CCG’s Internal Audit Plan and gain strong assurance in audits undertaken.

· Ensure that effective internal audit arrangements are established and operate for services provided by the South London Commissioning Support Unit (SLCSU)

· Ensure that understanding and ownership of internal and external reporting is embedded withi