Developing Commissioning Intentions 2015-16

1. Developing Commissioning Intentions 2015-16 Council of Members September 2014 Janet Cree 12 August 2014

2. Developing Commissioning IntentionsHeadlines for this year • Key points about developing the intentions this year • A move away from the ‘annual’ approach to intentions – we will engage with staff and patients but will draw on the all the work we have done through the year • Providers are the specific audience in the first instance - more ‘contracting intentions’ than ‘commissioning intentions’ – by September • Two angles: what do we need to do this year to: • Progress the delivery of our ‘big ticket’ strategic plans? • Respond to local issues? • A separate public facing document will be produced for the end of the year

3. ‘Big ticket’ items • Framework developed by Strategy & Transformation colleagues • Allows us to consider the key planks of our strategy in turn and the actions needed to deliver • For each one, we can look at: • What’s been achieved? • What’s needed next year? • Other enablers?

4. Enablers • Lay person group established for WSIC • Co-design and co-production • Care navigator service • HCCG Patient Reference Group • HCCG PPE work plan • Hounslow Prevention Strategy • Locality PPG groups • PM Challenge Fund • Personal Health Budgets • Care Planning • Personal Care Framework Patient Empowerment Deliverables 2015/16 Development of locality PPG groups Promoting the self care agenda 100% of WSIC early adopter population have care plans Outcomes for PMCF delivered including e-prescription, improving access, extended hours Review of Hounslow clinical networks – with established patient role in ToR and workplans Extension of self-management agenda to wider hard to reach groups through outreach Patient engagement in contract monitoring of PCF providers and personal health budgets including CHC Family Patient’s own GP practice Supported to self manage and held together by resilience Community support • Deliverables 2014/15 • Whole systems integrated care toolkit • Implementation of DES and Out of Hospital contracts for care planning • Co-production of FBC for WSIC • Children and Families integral to planning for Children’s Act implementation • Diabetes Patient engagement • Patients involvement in planning health services • Review of care navigator service • Co-production of PMCF plans • Policy framework for personal health budgets Patient Carer Assistive technology

5. Enablers • Primary care strategy • PM Challenge Fund • Locality / Network development • New legal entities • 7 day working • Out of Hospital contracts • Workforce including training and development • Estates • IT • Co-commissioning Primary Care Transformation Primary Care Transformation Patients have access to General Practice services at times, locations and via channels that suit them seven days a week. • Deliverables 2014/15 • Develop HCCG primary care strategy • Primary care workforce analysis • Commission out of hospital services at network level • Locality networks established • Networks have agreed their delivery plan for 2014/15 (including OD requirements) • Initial business change in place in primary care (e.g. online appointment booking / email consultations etc) • Models of network service delivery agreed • Increase number of practices using systm1 • Increase capacity and number of trainer / facilitators for Systm1 • GP Ooh service redesign and procurement for Ealing • Heston options appraisal and OBC • EPS rollout and implementation • Deliverables 2015/16 • PMCF outcomes including - 7 day/ week primary care services in operation at practices within networks; a range of consultation methods available to patients (telephone/email/Skype); primary care appointments tailored to patients needs (e.g. urgent, continuity and convenience appointment standards met) • Community patient transport service in place • ChenMed(like) model of care implemented in pathfinder locality • Commissioning HEI to meet primary care workforce development needs • Workforce plan developed Urgent appointments Patient Continuity appointments Convenient appointments Access via range of channels

6. Whole Systems Integrated Care (1 of 2) Enablers Better Care Fund Joint governance arrangements Pooled budgets Personal Care framework Locality OD QIPP Workforce WSIC enabling infrastructure OOH hubs (covered on next slide) Whole Systems Integrated Care Patients with complex needs receive high quality multi-disciplinary care close to home, with a named GP acting as care co-ordinator. • Deliverables 2015/16 • New models of care in place • 7-day services in operation • Health and social care commissioners holding multi-provider ‘accountable care partnerships’ to account for delivery of population health outcomes • New payment model in operation • Issue contracts for accountable care provider • Capitated budgets and pooled budgets and governance arrangements in place between commissioners • Full implementation of CRS • Review ICRS role, function and capacity • Care navigator provision following evaluation • Deliverables 2014/15 • Develop full implementation plans that inform commissioning intentions • Trial new ways of working & OD • Provide linked dataset with local capitation values & analysis • Create provider and commissioner dashboards • Agree NWL-frameworks for new commissioning and provider vehicles • Provide costing tool for new models of care • integrated community recovery services • Joint homecare tenders • Community Recovery service (CRS) specification and planning • PCF procurement and provider framework place and enacted GP as lead for patient care Patient Care delivery teams and time for care plans Groups of accountable care providers Capitated budgets Local Authority and Social Care involvement Information systems and record sharing

7. Whole Systems Integrated Care (2 of 2) Enablers Better Care Fund Joint governance arrangements Pooled budgets Integrated community recovery services Joint homecare tenders QIPP Workforce WSIC enabling infrastructure (OOH hubs) Whole Systems Integrated Care Patients with complex needs receive high quality multi-disciplinary care close to home, with a named GP acting as care co-ordinator. GP as lead for patient care • Deliverables 2014/15 • OOH Hubs: • Heston Options Appraisal and LIFT Stage 1 • Deliverables 2015/16 • Hubs: • West Middlesex Hospital OBC • Stage 2 LIFT following any LIFT Stage 1 schemes (e.g. Heston) Patient Care delivery teams and time for care plans Groups of accountable care providers Capitated budgets Local Authority and Social Care involvement Information systems and record sharing

8. Service Reconfigurations (1 of 4) Enablers 7 day working Mental health transformation Diagnostic Cloud Children's Strategy Local Hospital Business Cases Major Hospital Business Cases Out of Hospital Strategies Clinical standards QIPP Service reconfigurations More health services available out of hospital, in settings closer to patients’ homes seven days a week. • Deliverables 2014/15 • 7-day services: • Complete baseline self-assessment against 10 clinical standards for 7-day services (all acute Trusts with partners) • Agree priorities and sequence for implementation of standards across the non-elective pathway/develop action plan • Achieve priority standards for 14/15 (including as per 7- day CQUINs) • Integrated mental health emergency pathway in place • Children's – strategy, pathfinder hub, Paediatric assessment unit specified, SEN local offer set out Community hubs • Deliverables 2015/16 • 7-day services: • Achieve agreed priority 7-day clinical standards for 15/16, including those included within the national acute contracts • Implement Diabetes, AEC, diagnostic contracts • Sustain reduction in OP activity with non face to face and one stop clinic • mental health and wellbeing strategy Patient More local diagnostic equipment Acute reconfiguration Less inappropriate time in hospital More specialised hospital care

9. Deliverables 2015/16 • Consolidation and evaluation of AEC care model initiated in 14/15 at WMUH • Out Patient Antimicrobial Therapy (OPAT) service at WMUH • Anti-coagulation clinics at WMUH respecified • Homecare Shared care • MSK service review (recommission / decommission) in light of CWHHE outcomes • Community Gynaecology service / pathways review & plans • Community ENT service / pathways review & plans • E-referral functionality / utilisation and interface with RFS • Sleep studies – community / secondary care pathway improvement • Minor Surgery – local minor surgery plus service • Care pathway for continence patients to facilitate transfer of care and activity out of WMUH and into the community and how to • Learning difficulties / Mental health interface • Improving funding decision process and timelines • Review forensic LD service need • Review the LD assessment and treatment service requirements and access compliance • Joint( with LBH) process for agreeing funding for patients transitioning from NHSE • Commission an LD, Asperger’s and autism needs assessment • Review Asperger’s and Autism service requirements in line with the needs assessment outcomes • Specialist Palliative Care • Establish a Macmillan GP role in the CCG and define how this will integrate with the specialist teams across secondary, community and primary care. • Consider role for a consultant working with the acute trust to support EOLC for both cancer and non-cancer patients. • Review the palliative care nursing and social worker resource • Cancer • Macmillan GP with focus on screening / early diagnosis Service Reconfigurations (2 of 4) • Deliverables 2014/15 • Diabetes – respecified and procurement completed • Children's • strategy, pathfinder hub, Paediatric assessment unit specified, SEN local offer set out • Urgent Care • AEC specified & implemented at WMUH from 1/10/14 • GP OOH respecified and procured • 111 reprocurement plans developed • Community Heart Failure • Review model and delivery • Community Transport • Specify service requirements and plans for delivery • Mental Health • IAPT – increased capacity, improved access • IAPT – new contract robust monitoring of performance • Primary Care Plus established ensuring patients do not stay with secondary services longer than necessary • Dementia Adviser Scheme • LD • Reduce out of area hospital placements in line with Winterbourne View Recommendations • Appropriate pathways developed to ensure all local responses & options are considered prior to placing people out of area. • Transition – appropriate pathways from children’s services to adult for people • Diagnostics • GP direct Access contract respecified and procured • Cancer • Chemo closer to home pilot – evaluate and roll out 15/16 as appropriate

10. Service Reconfigurations (3 of 4) Deliverables 2015/16 continued • diabetes • Continue to collaborate with NWL diabetes network, which will develop NWL clinical & prescribing guidelines and support the diabetes Out of Hospital contract;  • Review diabetes paediatric and transition care pathway at local providers; • Support co-commissioning with NHS England for Retinal screening across London; • Improve access to the Diabetes MDT Foot care clinic at WMUH; • Review adult and antenatal diabetes service provisions at local providers • Mental Health • Expanding and developing the primary care MH service (PC plus) • To include peer support worker, social worker, clinician to support physical health care in the hard to reach groups (eg non-registered, rough sleepers, hard to engage registered patients), facilitator for carers, care navigators /dementia CPN Develop and implement new model of care for recovery and improved physical HC and incorporate as part of the early adopter WSI for LTMHC • Commission a primary care consultant psychiatrist and manager across all three WLMHT CCGs in line with business case • Recovery model within the community - see model that emerges from WSI LTMHC • Urgent care - timely urgent assessment, extension of 'in hours' working, more outreach assessment in crisis, roll out of the templates for communication along the pathway of care between primary and secondary care, development of a MH SPA • IAPT • expansion to accept self-referral, more complex cases, carers, LTC • Increase use of groups and use of IT media eg Big White Wall for live therapy. to achieve 15% access and 50% recovery and reduction of waiting list to be within KPI • development of CYPIAPT • Dementia • Improve diagnostic pathway and timelines eg timely MRI • Increase number of primary care dementia nurses to 1 per locality • Commission locality community dementia CPN • increase post-diagnostic support including Information packs for patient & carers • Carers training post diagnosis to include details of personal budgets • Dementia aware Care navigators within the locality • CAMHS • Evaluate impact and effectiveness of LD CAMHS • Improved out of hours services and responses to crisis – CCGs collaborative function • Review of local Tier 2 and Tier 3 CAMHS pathway • Review of LAC CAMHS • Improved engagement and commissioning work with NHSE to ensure good pathways into and out of tier 4 – CCGs collaborative function • Ensure effective implementation of CAMHS IAPT project in Hounslow.

11. Service Reconfigurations (4 of 4) Enablers 7 day working Mental health transformation Local Hospital Business Cases Major Hospital Business Cases Out of Hospital Strategies Maternity contingency planning Clinical standards QIPP Service reconfigurations More health services available out of hospital, in settings closer to patients’ homes seven days a week. Community hubs • Deliverables 2014/15 • Local Hospital and Major Hospital Business • Cases: • Approved Implementation Business Case (by DH and HMT) • Approved Outline Business Cases for Major and Local Hospitals (by CCGs and Trust Boards • CMH A&E and HH Emergency Unit transitioned • Maternity: • Agreement on decision to proceed with implementation of maternity contingency planning (proposal for activity from Ealing Hospital Trust to five receiving trusts in NWL) • Deliverables 2015/16 • Local Hospital and Major Hospital Business • Cases: • Approved Outline Business Cases for Major and Local Hospitals (by NTDA, DH and HMT) • FBCs developed Patient More local diagnostic equipment Acute reconfiguration Less inappropriate time in hospital More specialised hospital care

12. Public Health {1 of 3} • Deliverables 2014/15 continued • Strategic • Work with NHS England, Children’s services and other partners to agree arrangements for the transfer of the Health Visiting service to the Council in October 2015. • Procurement • Joint procurement of new school nursing service with Harrow and Barnet • Funding provided to Housing Department for procurement of Winter Warmth programme for vulnerable adults • Service improvement • Work with GP localities and the CCG to ensure that all PH commissioned services have standardised clinical templates to ensure smoother data flows between GPs and PH. • Work with the local adult substance misuse service to explore the feasibility of improving /re-designing the existing clinical information system. • Work with CCG and local GPs to improve cost—effectiveness of NHS Health Checks programme by improving advice and onward referrals to interventions for high-risk patients. • Deliverables 2014/15 • Strategic • Produce a Public Health Commissioning Strategy outlining LBH’s approach to PH service provision over the next 4 years • Explore with the CCG the feasibility of commissioning a diabetes prevention programme which could include i) awareness raising with community groups at high-risk ii) pre-diabetes programme for high-risk individuals iii) review current lifestyle interventions for those with diagnosed diabetes • Explore with the CCG the feasibility of commissioning a TB prevention programme which would include latent TB testing for high-risk communities. • Produce robust multi-partner action plans to underpin delivery against Health and Wellbeing Strategy priorities and in particular lead on the following:- • Childhood obesity • Children’s oral health • Smoking cessation • NHS Health Checks programme

13. Public Health {2 of 3} Deliverables 2015/16 Contingent on further internal discussion at the Council and wider discussions with the CCG the following are draft new intentions for 2015/16 Children and young people • The smooth transfer of the Health Visitor service and the Family Nurse Partnership programme form NHS England to the Council • Strengthen the focus of the new School Nursing Service on prevention. This will include negotiating with the LCSB to agree a more efficient process for the SN team to positively contribute to child protection cases • Delivering interventions against the agreed Health and Wellbeing Strategy action plans for children’s oral health and obesity including:- • Increased investment in physical activity infrastructure (parks and schools) in the more deprived parts of the borough • A new weight management programme for children and families linked to the National Childhood Measurement programme • Working with Children’s services and the CCG to strengthen the Early Years settings and Healthy Schools offer which will include engaging with GP localities, community and voluntary groups. • Exploring the feasibility of commissioning dental outreach programmes for schools in the more deprived parts of the borough. • Improve our offer on reducing teenage pregnancy - including reviewing our community outreach intervention • Review our offer around empowering young people to make more informed decisions around drugs, alcohol, tobacco and their sexual health.

14. Public Health {3 of 3} Deliverables 2015/16 Adults • Commission a new one-stop healthy lifestyle service with strong links to the existing NHS Health Checks programme • Following on from the Adults Prevention Strategy (Autumn 14), working with Adult Social Services and the CCG we will review and recommission our primary prevention services for older people e.g. befriending service, falls prevention, older peoples volunteers • Working in collaboration with the CCG we will commission a new diabetes prevention programme • Working in collaboration with the CCG we will commission a new TB prevention programme • Following on from the production of a new Alcohol Strategy in early 2015 we will improve our offer on the prevention of alcohol misuse • Reconstitute a multi-partner DAAT board to strengthen partnership working to tackle substance misuse • Review our HIV prevention offer including • Evaluate the introduction of GP testing of new registrations (introduced 2014) • Evaluate local HIV community prevention projects

15. What are our key local issues? What are the specific quality/performance issues we want to address next year? • WLMHT • HRCH • WMUH • Imperial • ASPH • ChelWest • Nursing & residential • Primary care • Other?

16. What are our key local issues? What are the gaps in service/local pathway priorities we want to address? • Community Transport • Specialist Palliative care • MSK • End of Life Care • TB • Heart failure • Community ENT • Community Gynaecology service / pathways • Care pathway for continence • Consolidation and evaluation of AEC care model initiated in 14/15 at WMUH • OP antimicrobial service at WMUH • Anti-coagulation clinics at WMUH • Homecare Shared care • Children – hubs, PAU, SEN local offer • Sleep studies – community / secondary care pathway • Minor Surgery – local minor surgery plus service • These are ideas suggested so far. Is there anything missing? How should we decide what the priorities are for next year?

17. The Timetable CONTRACT INTENTION LETTERS SENT TO PROVIDERS

19. What do Members need to do? • Review the Draft Intentions • Schedule discussion at locality meetings • Share at Patient Groups • Feedback on current draft – identify omissions / enhance content / plans by 1st October 2014 to janet.cree@nhs.net