Specialised Services for Value

Specialised Services for ValueThe five-year strategy for specialised services

Programme of Care Event

NHS England

• A stronger patient voice in specialised services;

• More robust governance arrangements;

• Proper costing of care pathways;

• Better linkages between specialised and non-specialised services;

• Uniform monitoring of patient activity;

• Horizon scanning as a way of informing future commissioning plans;

• Truly integrated care and a seamless patient pathway;

• The involvement of clinicians in the development of service standards and outcome measures.

Carter recommendations

Carter ‘Review of Commissioning Arrangements for Specialised Services’, published in 2006, went some way towards introducing consistency across specialised services. Its recommendations included:

• Creation of 75 multi-disciplinary Clinical Reference Groups (CRGs) to provide expert advice on specific services;

• Development of more than 130 service specifications and more than 40 clinical commissioning policies

• Recruitment of patient and public representatives on to each CRG, along with a wide network of stakeholders, with whom to share ideas and test out new approaches to the way services are commissioned.

• The development of a model of engagement for specialised services, co-designed with NHS England’s Patient and Public Engagement Steering Group.

• The establishment of 10 area teams with a specific responsibility for local service delivery in partnership with providers.

NHS England achievements

The NHS has made significant progress in implementing the Carter recommendations, but there is still some way to go. Since April 2013, NHS England has achieved the following in specialised commissioning:

The Five-Year Strategy

NHS England’s document “The NHS Belongs to the People: A Call to Action” describes why the NHS needs to be transformed to meet the health needs of the future and to address an economic gap that is expected to emerge over the coming years. The Call to Action has initiated the development of a five year strategy for the NHS.

Specialised services, like other NHS services, face both a quality and funding gap. Under the Call to Action, the five-year strategy for specialised services is an invaluable opportunity to articulate a vision for the future shape of specialised care.

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Introduction to the Five Year Strategy - Outputs

One of 6 work streams for the NHS England Call to Action 5-year Strategy

England’s response to the Department of Health Rare Diseases Strategy Deadline Feb 28, Rare Diseases Day

Delivery of service specific change projects for 2014/15 to support QIPP

Major part of the 2-year Operating Plan - The financial plans for specialised services

Delivery of the strategy for ‘specialist centres of excellence’ one of the six characteristics

The Scope of the Strategy

Quality & SafetyMoney

Accountability Innovation IntegrationGeneral

Principles

NHS England has now published the scope of the five-year strategy for specialised services. This covers general principles, along with five key themes.

Overarching themes – not specific services

A strategy for the whole of England

Complementing the UK Strategy for Rare Diseases

The focus for the strategy’s mission and vision is on:

Five Year Strategy Development Process

We wish to produce a strategy which is aspirational in its goals and achievable in its objectives. Developing a five year strategy for specialised services is vitally important to drive forward the promotion of equity and excellence in the commissioning of specialised services.

Strategy (Mission and

Vision)

Service Level Plans

Overarching strategy to set the direction of specialised commissioning2014/15 – 2018/19

Plans to set the priorities for individual services, including consideration of the transactional and transformational projects needed to deliver cost savings.

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2

Five year strategy for Specialised

Services

A National Strategy Responsive to Local Priorities

• NHS England is gathering views from different stakeholders across the country in order to develop a national strategy that is responsive to local priorities.

• Engagement events have been held by the 10 NHS England Area Teams responsible for the commissioning of specialised services. These events have included patients, carers, patient groups, CCG’s, Local Authorities and representatives from industry.

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Mission and Vision Themes

Statement of Principles

Integration

• A clear articulation of how specialised services will look in five years.

• A statement of underlying principles for decisions to be taken to get there

• Statement of core overarching priorities for specialised services

• Measures to ensure patients experience seamless care, as between specialised and non-specialised components

• Details of how networking arrangements should work in future• Commitments on joint working with CCGs• Evidence of alignment of specialised strategic goals with

strategic planning for the rest of the health service

Money

• An assessment of cost drivers in specialised services and any required actions

• Recommendations on improved alignment of specialised commissioning with the payment system

• A clear approach to disinvestment from less valuable treatments and services to achieve best value

Below is an overview of the themes of the mission and vision. This includes a description

of some of the commitments that might be made within each theme.

Mission and Vision Themes

Quality and Safety

Innovation

• A description of the essential components and criteria for quality• Commitments to ensuring robust informatics to measure and

evaluate quality and safety across specialised services• Clear expectations of quality and safety levels across each

service and for all providers of specialised services

• A description of how specialised services will proactively seek out and take up effective innovations

• Measures to ensure that innovative approaches to delivering specialised services can be tested and rolled out nationally

• Commitments to processes and criteria which allow beneficial innovation to be taken up more swiftly

Accountability

• Commitments on improving transparency within specialised commissioning

• A clear description of roles and responsibilities across the system

• Consideration of how patients and the public are involved in governance and holding the system to account

Six future models or characteristics

Healthy & well

At risk

Episodic needs or single LTC

Polychronic and vulnerable elderly

Severe illness & specialist needs

Acu

ity

Active & engaged

patients & citizens

Wider primary care at scale

Modern models of integrated

careHigh value

elective care

Specialist centres of excellence

High quality

urgent & emergency

care networks

Summary of Five Year Strategy Process

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Five year strategy for Specialised

Services

All workstreams will come together to help define the strategy

Service Delivery Plans

Operational Plans (Service & Financial)

Specialised Services for Value - Five year strategy for specialised services

Patient and Public voice throughout

Strategy public facing and

accountable

Continual progress

appraisal during five years

Transparent process

Strategy (Mission and Vision)

Incorporation of existing and new strategies (e.g. Rare Disease strategy)

Reconfiguration

A3 Proposals

Consultation

Specialised Services Strategy for Value Financial

Strategy - An Overview

Programme of Care Events

February 2014

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A Call to Action

• If we continue with the current model of care it is likely we will face a funding gap between

projected health spending requirements and NHS England resource of around £30bn between

2013/14 and 2020/21.

• This estimate is before taking into account any productivity improvements and assumes the

NHS England resource remains protected at flat real.

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90.095.0

100.0105.0110.0115.0120.0125.0130.0135.0140.0

FY 13/14 FY 14/15 FY 15/16 FY 16/17 FY 17/18 FY 18/19 FY 19/20 FY 20/21

£bns

Projected Resource vs. Projected Spending Requirements

Total ProjectedCosts

ProjectedResource

£30bn gap

How today fits inThis morning we will:

• Hear how the key themes identified at the Area Team (AT) events are informing the development of the Mission and Vision for Specialised Services in the context of finance and QIPP

• Hear short presentations from each CRG outlining the strategic vision for their services

This afternoon we will:

• Consider the AT theme alongside A3 proposals submitted so far to help further develop each CRGs vision

• Hear how all this will feed into the overall development of the Specialised Services Strategy

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Specialised Services Strategy for Value

Next Steps

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Developing the Service level Strategic Plan-Plan on a PageOutput: Defining a Service level (CRG or spec level) outline of the ambition for how the service should look by 2019. CRGs producing a single plan on a page for each service/spec which will form part of the final strategy document in July for consultation.

What: Takes us from where we are now (baseline) to where we want to be considering A3s and strategic planning guidance. High level summary of the vision, future delivery model and case for change.

Why: shares with our stakeholders our vision for how we will develop services going forward considering the strategic opportunity and challenges to ensure continued improved outcomes for patients and sustainability of services.

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Developing the Service level Strategic Plan-Plan on a Page

How: Standard template, timeline and guidance pack issued in March.

When:

Final Plans submitted end of May

Assurance and prioritisation of plans in June

Sign off through governance steps June/July

Public Consultation on full strategy expected July-September

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The Case for ChangeWhy does the service need to move from its current state to that described in the vision? What outcomes will it deliver as a result) box belowWhy should moving to this model should be the strategic intention?Consider SWOT and PEST. What strengths in the baseline position does this improve? What weaknesses and threats does it mitigate? How will it capitalise on the opportunities? How does it take account of the national and local priorities identified in the PEST analysis?How goes the new service model bring improved benefits in terms of Accountability, Money, Integration, Quality & Safety and Innovation. Use the output from the strategy day and the consideration of the A3s to help describe this.Will outcomes be improved and if so in what way? Include improvements in clinical outcomes, patient experience etc.How will the vision improve equity of access to the service?How will changing to your strategic vision contribute to meeting the recommendations set out in the Carter review?How will achieving the vision contribute to achieving the rare diseases strategy, if this is appropriate?What will be the effect on providers (e.g. move to 7 day service, one stop provision, more community care, move to telemedicine, requirements for co-location with other services)What will the delivery model look like? (e.g. fewer centres, services bundled and delivered in centres of expertise, networks)In the context of the financial climate and QIPP, what efficiencies will the vision deliver?Will reconfiguration be needed?What are the consequences of not moving to this vision?

CRG/Service Specification Level: Specialised Services Programme

The Vision

Describe briefly how your service looks in 2014, what you would like it to look like in around 5 years time and why. Explain which of the five domains would be addressed by moving from the current service description to the proposed vision. Try to describe how the service will look and why it would be better than it is now. The aim here is to create something short, descriptive and memorable. The detail will be in the Ambition box belowThe domains are set out below as an aide memoire

Care delivered in a safe environment

Ensure positive experience of care

Help recover from ill health/injury

Prevent premature deathDomainsQuality of life for patients with

LTCs

The Strategic Ambition

Describe your vision in more detail. What are the problems with the current state?Put some more detail about what the service will look like when the vision has been achievedWhen will the vision be delivered?If this is more than 5 years, why?What are the key changes that will be seen after 1 year, 2 years, 3 years etc?What will the key standards and core service to patient look like- use of telemedicine, technology, streamlining of services, one-stop?What will be the key quality improvements to patients?How will the service be integrated and work with key partners? How will the service interface with other services from your/other Programmes of Care? Operational delivery networks, potential for prime contractor delivery, part of a bundled pathway of interdependent services?How will the service be engagement in research and innovations? Alignment to Academic Health Science Networks (AHSN)s?How are patient accessing the service? How are patient exiting and supported in a seamless transition to the next part of the care pathway for their treatment?

Quality & Safety[Using your vision and the case for

change describe the key Quality and Safety strategic goal that will be

achieved]

Accountability[Using your vision and the case for

change describe the key Accountability goal that will be

achieved]

Money[Using your vision and the case for

change describe the key Money strategic goal that will be achieved]

Innovation[Using your vision and the case for

change describe the key Innovation strategic goal that will

be achieved]

Strategic Goals

Integration[Using your vision and the case for

change describe the Integration strategic goal the at will be

achieved]

Clinical and Patient Outcomes

Quality & Safety[i.e. reduction in pressure ulcers]

Clinical Outcomes[i.e. increased 1 year survival rates]

Sustainability[Ie economic, infrastructure,

financial]

Access and Equity[ie waiting times, time to treatment,

increased use of telemedicine]

Patient Experience[i.e. hand held records, one stop

MDT care, 7 day access,