NHS XYZ Briefing on Delivering Healthy Ambitions

1. NHS XYZ Briefing on Delivering Healthy Ambitions Briefing material

2. Delivering Healthy Ambitions • Delivering Healthy Ambitions, published on 5 March 2009 – sets out how the regional strategic service framework “Healthy Ambitions” will be taken forward. • Culmination of work by all PCTs in Y&H together with the SHA and explains what will happen locally, sub regionally and regionally for each of the eight NSR pathways • Also sets out how supporting work will be taken forward e.g. on workforce, IM&T, clinical leadership, metrics and social marketing • Explains the governance arrangements for the programme as a whole.

3. Healthy Ambitions (the outcome of the Next Stage Review in Y&H) was published in May 2008, it involved over 150 clinicians from across Y&H and made recommendations about 8 clinical pathways and also about primary care. Overall clinical lead Chris Welsh Maternity and newborn care Dotty Watkins - Sheffield Teaching Hospital Children Ian Lewis - Leeds Teaching Hospitals Staying healthy Wendy Richardson - Hull PCT Mental health Nick Morris - Bradford District Care Trust Planned care Mark Baker - Leeds Teaching Hospitals and Ian Jackson - York Hospitals Acute care David Dawson - Mid Yorkshire Hospitals Trust Long term conditions Vicky Pleydell - North Yorkshire & York PCT and Eileen Burns - Leeds Teaching Hospitals End of life care David Levy - Sheffield Teaching Hospital and June Toovey - Leeds Teaching Hospitals Healthy Ambitions - 8 Clinical Pathways Primary Care

4. Work to take forward Healthy Ambitions • A quick recap on activity since the launch of Healthy Ambitions: • 14 May 2008 : Publication and launch of Healthy Ambitions • June to August: Discussion and agreement with PCTs on levels of delivery i.e. who will be responsible for which recommendation – most for local delivery. • Sept to Oct: • PCTs submitted report on delivering Healthy Ambitions to SHA – sets out levels of delivery and next steps • PCTs developed strategic plans to incorporate approach to local priorities from Healthy Ambitions. (Clinical reference panel reviewed initial drafts) • Nov to Jan: – work on regional enablers – governance, clinical leadership, development of metrics and performance management regime, IM&T, workforce, primary care. Start on scoping vascular review • Feb: – work to bring all of this together in “Delivering Healthy Ambitions” and present back to clinical leads

5. Care Pathways – regional and local levels of delivery Planned Acute Children’s MH EoL Staying Healthy Oversight of Reviews: • Critical care provision • Vascular surgery • Urological surgery • GI surgery • Interventional radiology Identification of: • Hyper acute stroke units • Major trauma centres • Primary Angioplasty centres Review and network specialist surgical care provision Y&H approach to asthma and diabetes – develop through clinical summits Bariatric surgery Regional Sub regional review infrastructure – e.g. networks New Service Models For: - • Stroke • Heart Attack - 1° angioplasty • Trauma Y&H Commissioning network and CRG already formed Collaboration Most recommendations need local action Most recommendations need local action Most recommendations need local action Most recommendations need local action Most recommendations need local action Most recommendations need local action Local

6. Care Pathways – regional and local levels ofdelivery Maternity & Newborn LTC Primary Care Delivery Models Enablers • Workforce • Clinical leadership development • Social marketing • IM&T • Finance • Performance and metrics • Quality and Innovation • Health Intelligence • Governance Specialist training requirements Regional Y&H commissioning network already formed to take action Y&H SCAP will address any inter PCT reconfig implications of local service change to meet 2500 standards Major trauma centres, critical care facilities as per acute and planned pathways. Future for smaller DGHs where impact extends beyond PCT boundaries Collaboration Most recommendations need local action Most recommendations need local action Most recommendations need local action Local

7. Making it happen – an example of levels of delivery

8. Pathway Pledge Halt in the rise of obesity One key high-level pledge per pathway Making it happen example – Staying Healthy Pathway Recommendations e.g. Commissioning weight management services Detailed pathway recommendations Level of Delivery Localised commissioning Agreed with PCT CEs – local delivery wherever possible, sub-regional or regional where required Local Prioritisation PCT Strategic Plan Recommendations prioritised according to local circumstances. PCT Strategic Plans outline local delivery & are assured by the SHA Annual Operating Plan Annual Operating Plan Details of local initiatives, funding and timescales to deliver local priorities Metrics / Dashboard Obesity Prevalence Reception & Year 6 Children Pathway metrics developed and local trajectories agreed. Healthy Ambitions Dashboard shows progress against trajectories Oversight Staying Healthy PDB Local monitoring/Pathway Delivery Board and Strategic Commissioning Board

9. An example of local action • Our pledge in the Maternity and Newborn pathway was to support an increase in breastfeeding rates, with reduced variation across the region

10. Cross cutting workstreams (1) Cross cutting themes support delivery of the pathways: • Primary care – aimed at improving quality and reducing variation. Phase 1 of a primary care dataset already delivered – Healthy Intelligence Practice Profiles – already being used locally. Available via a link in the primary care section of the Healthy Ambitions website • Social marketing – region-wide marketing on priority projects, primary care access, obesity, end of life, stroke, mental health all sponsored by a PCT CE (plus education and training and marketing services) • IM&T – NPfIT activity in response to the recommendations of the clinical pathway groups • Workforce and education – new and different roles for staff will be needed to support the delivery of Healthy Ambitions • Finance – 2009/10 onwards new rules to support innovation and improvement. In Y&H the new Quality Assurance and Improvement Scheme (CQUIN) starts. In 2009/10 this has a range of indicators built around the pathways set out in Healthy Ambitions. 0.5% quality premium payable against these indicators. • Performance and metrics – Healthy Ambitions indicators have been agreed with PCTs who will set trajectories for improvement in much the same way as for vital signs. This makes use of existing data wherever possible (more detail later).

11. Cross cutting workstreams (2) Cross cutting themes support delivery of the pathways: • Quality and Innovation – work underway on development of a Quality Foundation to fulfil the national expectation that all SHAs will support innovation and improvement across the region • Health Intelligence –Y&H PHO will support local organisations with intelligence relevant to each of the Healthy Ambitions pathways • Clinical leadership – five strands of regional activity to support clinical leadership and involvement in the delivery of Healthy Ambitions (more detail later) • Specialised commissioning – SCG will support the delivery of Healthy Ambitions • Governance – a regional governance structure for Healthy Ambitions which will be put in place over the coming months (see next slide)

12. Delivering Healthy Ambitions - Governance Key Elements • Strategic Commissioning Board – oversight – SHA and PCT CEs • Pathway Delivery Boards – One for each Healthy Ambitions pathway and one for cancer and primary care. Each chaired by the lead CE supported by clinical lead(s) • Composition of PDBs will vary (some of the regional groups already put in place e.g. for MH could migrate to become the MH PDB) • Core terms of reference – which include e.g.: • Maintaining an overview of delivery and advising on progress • Overseeing review work – done by Task Groups or workstreams reporting to PDBs • Identifying good practice • Refining and re-appraise the regional model of care as new evidence emerges. • Advising SHA and PCTs as requested

13. Key roles by pathway

14. Governance

15. Delivering Healthy Ambitions - Metrics • Indicators developed to support the pledges and recommendations in Healthy Ambitions – using existing data and matching vital signs where possible • Will need some refinement – particularly MH metrics • Link with CQUINs, WCC outcomes and vital signs – all have been mapped against Healthy Ambitions pathways • Healthy Ambitions dashboard – local trajectories will be performance managed alongside vital signs – and in the same way – but 2009/10 a development year • Start from April 2009 – examples follow…..

16. Delivering Healthy Ambitions - Metrics

17. Delivering Healthy Ambitions – Clinical leadership 5 strands of work to widen and deepen clinical leadership: • Increasing the regional cohort of senior clinical leaders – up to 30 • Existing NSR leads – plus recruitment so that there at least two clinical leads for each pathway plus specialist(s) in key areas for regional work e.g. stroke • 20 of the 30 would be recruited through a competitive process (as envisaged in HQC4A) – the 30 will sit on their relevant Pathway Delivery Board and collectively these clinicians would become the Y&H Clinical Advisory Group • 120 clinicians take part in regional development programme (Clinical Leadership Network) and help drive forward HA models of care within their organisations • Promoting high quality clinical advice to commissioning; e.g. by spreading the best models identified in the WCC Assurance process • Ensuring high quality clinical advice supports strategic development and delivery of key national targets, such as 18 weeks • Ensuring high quality clinical advice and peer challenge to local service reviews, reconfiguration proposals

18. Key messages • Healthy Ambitions – the vision • Delivering Healthy Ambitions – the framework for implementation • Your everyday commitment to delivering the best for patients – together we can make it happen

19. Healthy Ambitions for Y&H

20. Workforce Ambitions will be published shortly In 2007 we published Working for Health and Education for Health, a five year strategic framework for workforce development and education in Yorkshire and the Humber. The objectives are still relevant and significant progress has been made towards them. Since then Healthy Ambitions has described an ambitious vision for improving health in Yorkshire and the Humber, and Delivering Healthy Ambitions hasset out the SHA’s approach to implementation. Workforce Ambitions outlines our five year workforce strategy and development plan to ensure we can successfully deliver Healthy Ambitions. It has been written following extensive consultation with all our stakeholders. Workforce Ambitions