Healthier Lancashire and South Cumbria Integrated Care ... · Care System health and economic capacities on health inequalities and economic growth across the Lancashire and South

Healthier Lancashire and South Cumbria Integrated Care System (ICS) Monthly Programme Management Office (PMO) Briefing Dec 2018 Version 1.0

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Contents

Section Title

1. Briefing Purpose

2. ICS Board Key Messages

3. ICS Executive Sponsor Updates

4. ICS PMO Overview

5. ICS Portfolio Deep-Dive Summary

6. Communications & Engagement

7. Next Month Priorities (including scheduling of documentation)

8. Contact Us

Annex.1 ICS Portfolio Monthly Highlight Reports

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1. PMO Briefing Purpose

This briefing provides a monthly overview of the activities and highlights for each of the Healthier Lancashire & South Cumbria (HL&SC) ICS Portfolios to provide assurance and enable oversight for key stakeholders. The aim is to utilise the briefing as a conduit for communication and dialogue across all partners which form the HL&SC ICS.

2. ICS Board Key Messages

The Integrated Care System (ICS) Board provides leadership and development of the overarching strategy for Lancashire and South Cumbria, oversight and facilitation of delivery of sustainability, transformation and design of the future state of health and care.

• The ICS Board members noted that LCC proposed budget cuts has implications for health and we will need to work with local authority.

• The ICS Board members noted a report on the financial position of ICPs. Cost pressures are mounting in CCGs and Trusts. Two of our trusts are flagging the possibility of not meeting their control totals. Organisational efforts continue to find ways to mitigate the risks and ICPs also must work together to identify any system opportunities that may exist.

• A cost reduction team is to be established with a remit to support organisations within their ICPs on an agreed set of strategic efficiency/savings schemes. The resources devoted to this team will need to come from within the partnership, including the Midlands and Lancashire CSU.

• The ICS Board members received a performance report and a deep dive into cancer services’ performance across Lancashire and South Cumbria. This showed that Lancashire and South Cumbria continues to perform below the 85% patients starting treatment within 62 days of receipt of urgent referral with suspicion of cancer. September performance shows the Cancer Alliance performing below both the North Region and National average. Workforce and diagnostics are noted as the pressures impacting on delivery.

• Lancashire and South Cumbria ICS has been identified as one of the four systems to go on a 20-week accelerated programme for strengthening our capacity and capability for Population Health Management starting January 2018.

• The ICS Board supported a proposal to maximise the positive impact of the Integrated Care System health and economic capacities on health inequalities and economic growth across the Lancashire and South Cumbria footprint.

• A Mental Health event is being planned for end of January 2019 which will include:

• To formally receive the outcomes and recommendations of a three-month review of the Lancashire mental health system conducted by Northumberland, Tyne and Wear NHS Foundation Trust

• An initial response from the ICS to the review and its recommendations, proposing a number of specific actions

• To enable colleagues representing the ICS partners to hold discussions about the review, its recommendations and the proposed ICS response

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3. ICS Executive Sponsor Updates

There are 12 ICS portfolios, which are categorised within the table below. Each portfolio has an assigned ICS Executive Sponsor who provides a monthly summary:

Portfolio Executive

Sponsor

Update

Commissioning

Development Andrew

Bennett The JCCCGs agreed the proposals submitted by the Adult MH and

Out of Hospital workstreams which will now proceed for

implementation. Other workstreams have been finalising their

proposals for submission to the Comm Oversight Group in January

and from there to the JCCCGs meeting on the 7th February.

Form & Structure Andrew

Bennett ICS Executive to hold initial discussion about the scope of a

governance review in early January. This will be informed by the LTP

once publication takes place. Further discussions also expected with

senior leaders.

Strategy, Planning

& Performance Jane Cass Work continues in advance of the publication of the planning

guidance. Local ICPs are working on developing their demand and

capacity plans and timelines are being developed to start the

planning for the 5-year strategic plan. Weekly planning calls have

been arranged from January with ICP planning leads in advance of

the 14th January submission date.

Out of Hospital Talib

Yaseen The proposal to support a work program within Regulated Care has

been agreed as a priority on funding for 19/20. Options to support

this work in 18/19 are being explored. Work is underway in each of

the ICP to support further development of Neighbourhoods and

supporting primary care networks. The ICS intends to ensure there

is collaborative working across the ICS partners on neighbourhood

development in the coming 8 months. The New NHS Plan is awaited

and will influence this portfolio. Palliative care will undergo a deep

dive in January and preparations are underway.

Acute &

Specialised

Services

Talib

Yaseen Additional support to the ASS portfolio has been commissioned for

the remainder of 18/19 with the aim of supporting the deliverables in

paediatrics, head and neck, stroke and vascular workstreams. In

addition, further work is underway with the cancer alliance to support

delivery and transformation.

Urgent &

Emergency Care Jane Cass All 4 systems continue to implement their winter plans during

December and targeted work to improve delay in ambulance

handovers and flow within hospital is a key priority. Pressures across

the mental health system and the impact on ED continue to be a

focus for attention.

Mental Health Andrew

Bennett Slight delay in circulation of NTW review report -caused by delays

receiving data from some partner organisations. Actions taking

place to plan for a system workshop to receive the report and its

recommendations at the end of January.

Prevention &

Population Health Andrew

Bennett PHM exemplar has now begun. Regular progress meetings taking

place including ICS and Optum leads. Final selection of

neighbourhoods being confirmed by each of the 5 ICPs.

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4. ICS PMO Overview

During December the first iteration of the ICS Portfolio Management Governance Framework was released to initiate a common approach to the management of the portfolios, and their programmes. All Portfolio teams are undertaking a retrospective gap analysis of their programmes and completing any additional aspects to align with the framework wherever necessary. The framework also contains the Healthier Lancashire & South Cumbria meeting structure which includes a newly proposed Integrated Care Delivery Management Group which is an ICS and ICP programme management group designed to oversee programmes at each level to connect any interdependencies, reduce duplication and form a collaborative approach to programme management across the footprint. The ICS is working to mobilise this group over the coming months and progress will be reported via the monthly briefing see fig.1.

Finance & Estates Gary

Raphael Finance: 1. At the December meeting of the FIG DoFs/CFOs

determined the response to the workshop held in November on

alternatives to PbR .2. ICS Board discussed financial planning

issues at its November meeting. 3. The inaugural meeting of the cost

reduction team has met and plans for a workshop on 5th February

are in hand. 4. A first draft of ICS budgets has been produced by the

NHSE finance team. 5. Further mitigation plans are being developed

to ensure L&SC can meet its financial objectives for 2018/19.

Estates - wave 4 schemes are now known. L&SC has agreement to

proceed on the BTH critical care/A&E scheme and also the Fylde

coast MH hub. All other schemes, including our first-priority (OHOC

scheme) were not supported.

Digital & IT Gary

Raphael The ICS Board paper is now scheduled for February 2019.

Workforce,

Leadership &

Organisational

Development

Talib

Yaseen Work continues across the system to develop a strategic work plan

to address the workforce shortages across L&SC. The aim is to

focus on a few large workforce initiatives whilst continuing the many

small projects that are making a local difference to workforce

recruitment and retention. It is anticipated the ICS Lead for

Leadership and OD will start in February 2019 and provide a

collaborative focus to support ICS partners with leadership and OD.

A system level strategy for workforce will also be developed in the

final quarter of 18/19 with the LWAB and partners. Communications &

Engagement Andrew

Bennett Job descriptions for additional C&E posts are being finalised. ICP

C&E leads have shared information/good practice with each other.

A third workshop being planned with them. Further discussions in

January to take place with Healthwatch leaders.

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Fig.1.

5. ICS Portfolio Deep Dive Summary This section provides a summary of the ICS Portfolio from the latest monthly deep dives explored through the Portfolio Management Group (PMG) and provides additional context to the monthly highlight reports provided in annex 1. Mental Health was reviewed at the December ICS Portfolio Deep Dive. The Portfolio lead is Rachel Snow-Miller who presented alongside the mental health team the adult, children’s and young people and the transforming care programmes. 5.1 Adult Mental Health

The Adult Mental Health Programme aims to improve adult mental health, narrowing their gap in life expectancy, and ensuring parity of esteem with physical health, improving access to Mental Health services. It does this by working with all commissioners and providers across the footprint to:

• Deliver the FYFV for Mental Health and national Mental Health Delivery Plan • Implement the actions from the 2018 L&SC Mental Health Risk Summit (including

the system review being undertaken by Northumberland, Tyne and Wear Foundation Trust (NTW), which is due to report in December 2018)

• Implement the ICS Commissioning Development Framework across Mental Health commissioning in L&SC

Key:

Joint Committee – CCG’s (JC-CCG) Health and Local Authority Statutory Decision Maker for L&SC Wide Joint Commissioning & Policies

Collaborative Commissioning Board L&SC Wide Collaborative Commissioning Decision Making

Forum for Local Action. Review & Advisory Role for Shared Risk & Impact Upon Finance, Contracting & Performance

Management

Portfolio Management Group Delivery & Transformation

Strategic Enabler

Collaborative Forum/s For the Management of ICS Portfolio Progress & Risk

ICS Executive Steering Committee Advisory Executive Focus Group for Monitoring and Prioritising

Deliverables Within The ICS Portfolios

Integrated Care Delivery Management Group Collaborative Forum for ICS & ICP Programme Progress & Risk

Monitoring

Care Professionals Board L&SC Wide Collaborative Clinical & Quality Review & Advisory Board

For Risk & Impact Upon Clinical Model Of Care, Pathway & Policy Development

12 x ICS Portfolio Steering Groups SRO & Executive Sponsor led steering groups – local specialist strategy

development, Risk & Delivery Management at Portfolio Level

ICS Workstream Operational Groups & Sub-Groups Meetings Determined Locally by Portfolio & Workstream Leads

Integrated Care System Board Collaborative Strategy Development & Executive Assurance Board

Strategy Development

Delivery Appraisal/ Advisory

Decision Making

Partnership Forum Collaborative Strategy

Development

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• Develop an interim two-year (2019-2021) Mental Health Strategy and associated Mental Health Investment and delivery plans; in anticipation of the NHS Ten-year Plan, completion of a L&SC multi-agency Strategic Needs Assessment and the outcome of the NTW review

There was also recognition that over the past year there has been a significant increase in the numbers of people accessing Mental Health Services which presents additional challenges to the teams and has a significant impact upon quality and performance. It was also highlighted that a multi-agency approach to mental health is key and the Mental Health Steering Group has made some significant progress and achievements but will require a refresh to ensure that the group remains relevant throughout transformation.

5.2 Children & Young People Mental Health

The Transformation Programme for Children and Young People’s Emotional Wellbeing and Mental Health (CYPEWMH) is well established with high levels of stakeholder engagement. In the 2 ½ years since it began, the programme has delivered a significant number of positive service improvements which are detailed within its annually re-freshed Transformation Plan. To date the Programme has covered only the Lancashire footprint. South Cumbria will be fully incorporated into the Programme from April 2019. CYPEWMH services and the programme overall continue to face a number of significant challenges including increasing demand for services, performance against targets, variations in service levels and a number of funding challenges. These are detailed further within the report and accompanying slide deck. The Transformation Board are responding proactively to these challenges, reflecting them in the Transformation Plan, working collaboratively across CCGs and other partners and driving forward key projects to address them. The report summarises these key priority areas. Work to apply the L&SC Commissioning Framework is also underway and will be used to further strengthen and support ongoing collaborative work.

5.3 Transforming Care

The Transforming Care Programme has a clear focus on rights, independence, choice and inclusion for people with a learning disability and/or autism and focus on reduced reliance on institutional care. Over recent months the programme has:

• Worked hard to expedite safe discharges, understand consistent blockages and explore reasons for admissions

• Developed 2 new models of community provision

• Developed a model of non-secure inpatient support

• Developed and enhanced housing and resettlement solutions including procurement processes

• Explored areas of good practice

The L&SC programme is under significant scrutiny from NHS England and rigorous assurance processes including regular ‘Deep Dives’ and fortnightly reporting continues. Progress has been made to establish the governance and clinical leadership. There has also been significant

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engagement with clinicians, staff and service users to inform the scope and development of the project plans in the coming months.

6. Communications & Engagement

The ICS Communications & Engagement Team maintain the Healthier Lancashire & South Cumbria website; https://www.healthierlsc.co.uk/ which is kept up to date with the latest news and events. There is also a monthly newsletter which provides a summary of the latest work across the integrated care system and its five local partnerships: Healthier Lancashire & South Cumbria Newsletter.

7. Next Month Priorities

7.1 Summary of Key ICS Activities

• Arrival of the NHS Ten Year Plan is imminent although its exact release date has not yet been confirmed.

• Partners from across the ICS will be working to formulate the NHSE 2019/20 Operational Plans and there will be a series of meetings and workshops to support the development of these plans as the first year of the Healthier Lancashire & South Cumbria ICS Strategy. More information can be found here: https://www.england.nhs.uk/deliver-forward-view/

• ICS portfolio gap analysis to be completed by portfolio teams.

• Embedment of the ICS Portfolio Management Approach Framework.

• ICS planning admin budgets are now completed and will be reviewed and approved accordingly by the ICS Executive Management Team during January.

7.2 ICS Portfolio Product Schedule

As the ICS Portfolios, and their programmes, progress through the stages of development there are programme products required for completion. The table below document all scheduled products for the month.

8. Contact Us

Month Portfolio / Programme

Product Meeting/s Purpose

February Enabler: Digital Delivery Plan

ICS Board

Appraisal & Recommendation

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The mailbox address for the Healthier Lancashire & South Cumbria ICS PMO is: [email protected] Please do not hesitate to contact us if you have any queries with regards to the content of this document or would like to get involved with the ICS portfolios.

Annex 1.

Portfolio Programme Name

Dec 18 Highlight Report

Acute & Specialised Services

Better Births Achieved this month: Digital Champion has now started. Baselining of current Choice provision across the patch continues. Postnatal Care Guideline recommendations have been delayed until January. However, work continues to improve the transition from Midwife to Health Visitor. Successfully won £27,000 monies from HEE to procure Continuity of Carer training across the patch: Planned next month: Digital Champion & PM to visit each trust to discuss next steps around digital maturity. Commence CoC training. Launch Better Births Staff Facebook Group and staff bulletin. Issues:

Acute & Specialised Services

Cancer Achieved this month: Meeting 8.1.19 with the PMO office to organise some form of reporting cancer progress into this Smart sheet format. In the interim there is a detailed RAG rated report detailing progress against all the cancer projects - RAG rated and presented to the recent Cancer Alliance Board (12.12.18) Planned next month: Issues: Compliance with the 62-day cancer target remains a high priority

Acute & Specialised Services

Diagnostics Achieved this month: • Drafted high level regional network pathway for GI Bleeds Out of Hours, ongoing work planned to refine the pathway around related imaging processes. • Regional Iatrogenic Injury Out of Hours pathways developed and agreed by Interventional Radiology (IR) Group • Stocktake of image sharing current position to identify scope and interdependencies between Diagnostics/Cancer Alliance/Digital workstreams • Workshop with Endoscopy nurses to identify challenges to workforce and training and identify regional solutions Planned next month: • Developed Regional Hepatobiliary pathway - requires engagement with ELHT HPB surgical team around pathway issues • EIA developed for newly documented regional IR pathways • Develop draft regional In-Hours IR pathways Issues: No issues to escalate

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Acute & Specialised Services

Head & Neck Achieved this month: - The first edition of the programme's Key Messages document was created after November's Steering Group meeting. The document has been shared with members of the Steering Group who confirmed the document has been disseminated further through their organisations. - At the December meeting of the Steering Group, Provider Trusts shared their Head and Neck services' strengths, weaknesses, opportunities and threats and a long list of service delivery models. The importance of retaining the identified strengths throughout the service improvement work was recognised. - A short survey has been created as one method to capture patient experience to inform the programme's Case for Change - what people think works well in Head and Neck services, what could be improved and what is important to people when receiving care and treatment. The initial findings from this engagement activity will be shared in January. - Representation from UHMBT has been resolved. Planned next month: - At the January meeting of the Steering Group the process to identify a preferred clinical service model will commence. Attendees at this meeting will finalise the long list options for service delivery and develop the hurdle and evaluation criteria. - The service planning tool exercise will be carried out to support the development of service delivery model options. - The meeting to agree what a good Network MDT meeting would look like is being arranged for January. - A patient engagement event is due to take place on 18/12/18 as another method to capture patient experience and insight. Issues: - Returns of requests for information from some Trusts remains slow. - It has not been possible to finalise the KPIs due to the cancellation of the November NSSG meeting. The next meeting of this group is due to take place in February 2019.

Acute & Specialised Services

Stroke Key deliverables this month- • Piloting of Ambulatory Model - A pilot on the ambulatory model has commenced at ELHT, the learning and evaluation of these pilots are due February- March 2019. • Staff engagement sessions have been taking place across all of the trust sites to share information on the progress being made across Lancashire and South Cumbria to make improvements to the stroke pathways for patients and carers and gain feedback from staff regarding the current work on developing an alternative ambulatory model. • Commissioning meeting on 3/12/18- this meeting focused on plans, business cases and next steps regarding the commissioning of integrated community rehabilitation service. Key deliverables for next month- • ICS Executive meeting with Programme Director and Stroke Improvement Sub-Group Chair on 17th December to look at ICS governance and assurance processes for decision making

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• Continue staff engagement sessions across the patch. • A pre-meeting will take place to look at arranging a stroke workforce task mapping event at each site across the whole pathway. • To schedule a Stroke System Event which will provide an update on the National Stroke Plan as well as the work taking place regionally within the Lancashire & South Cumbria Stroke Programme and locally within Trust/ICP service improvement programmes • Continuing development of potential local tariff arrangements going forward

Acute & Specialised Services

Urology (cancer & benign)

Achieved this month: alternate monthly meetings established for 2019 Representation from all the providers (Directorate managers and Senior Consultant Urologists. Initial work commenced on data collection on waiting times across the 4 Providers Spec Commissioners to review the option appraisal submitted in June 2018 (spec comm also liaising with local CCG contacts) Planned next month: Presentation of data collection options and feedback from the Spec Comm to be presented to the Jan 2019 meeting Issues: None to report

Acute & Specialised Services

Vascular Achieved this month: The second meeting of the Programme Board has taken place and the following progress has been made: - a digital lead has been identified for the Programme - Provider organisations have committed to providing accurate 2018 data by Jan 2019 - BI leads have been identified from ELHT, LTHT and CSU to support the provision of refined data - a set of Design Principles for the programme have been signed off by provider organisations who also agreed to disseminate as appropriate. - Spec Comm have described a process to arrive at a short list of service model options and develop hurdle and evaluation criteria. This was accepted by the group. - Representation at the Board from Wrightington Wigan and Leigh and local CCG commissioners has been resolved - Medical Directors agreed to lead meetings with the wider teams to demonstrate the aims of the Vascular Programme, the direction of travel and processes to achieve the aims, in order to bring everyone on the journey. Planned next month: - Organisations have been asked to submit their suggestions for service model options and hurdle criteria. These will be reviewed at the December meeting - Establish a patient reference group to support the development of evaluation criteria. Issues: - Continued lack of representation from UHMBT. - There is nominated representation from NWAS, but no attendance at the first two meetings of the Vascular Programme Board.

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- Some of the programme management documentation has still to go to the Programme Board due to changes in agenda items. The next availability will be February 2019 meeting.

All Age Mental Health

Adult Mental Health

Achieved this month: 1) The programme has submitted a bid for NHSE Winter Pressures funding. The bid encompasses a range of local schemes across all the 5 ICP areas, working with local Third Sector partners/community assets to deliver additional community capacity and support for the Mental Health Crisis pathway. CCGs have an agreed to supplement any funding awarded against these schemes via slippage against risk summit funding for the early implementation of the FYFV 24 Hour Crisis Resolution and Home Treatment Team model. The programme has been notified informally via a teleconference call on the 14th December 2019 that the L&SC system has been successful in obtaining around £250k with this due to be confirmed formally on the 17th December 2019. 2) The NTW system review has now concluded. A report is expected to be received for factual accuracy checking on 24th December 2018, with a system conference to formally receive the findings and recommendations of the review expected to be held in January 2019. Following this NTW have agreed to support the development and delivery of an associated implementation plan. 3) The programme presented an update paper on its Commissioning Development Framework mobilisation to JCCCG in-month. This paper provided an update on progress as well as further detail on the proposed operating model and proposals around governance structure, assurance mechanisms and Organisational Development plans. The update and proposals were accepted by JCCCG. 4) The programme continues to implement the FYFV, Mental Health Delivery Plan and Mental Health Improvement Plan with progress monitored via the agreed governance structure and assurance mechanisms. Planned next month: 1) Receive the NTW review findings and recommendations and develop an associated implementation plan (as referenced above). 2) Implement winter resilience plans alongside the continued implementation of the FYFV, Mental Health Delivery Plan and Mental Health Improvement Plan. 3) Continue to mobilise the Commissioning Development Framework, prioritising Organisational Development and the development of an interim two-year Mental Health Commissioning Strategy and Investment Strategy. Issues: it should be noted that the Mental Health system across L&SC continues to experience considerable operational capacity and demand pressures.

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All Age Mental Health

CYPEWMH Achieved this month: Progress towards the development of the new L&SC Transformation Plan remains on target. Work has been undertaken to align the key objectives for South Cumbria to current objectives for Lancashire. All objectives will then go through a check and challenge process. The draft objectives for the 2019/20 Plan will be finalised Dec/Jan in preparation for consolation with Stakeholders. The Commissioning & Finance Group are in the process of finalising the financial envelop for the programme and the alignment of financial commitments to the 2019/20 objectives. The programme management team are supporting the development of the new All Age Mental Health Strategy, to be led by Liz Dover. First draft is expected early Jan 2019. The CAMHS Redesign Model was presented to the Care Professionals Board. The Board requested that the new L&SC Transformation Plan be presented to them before final sign off at JCCCCG in 2019. Planned next month: Work will continue regarding the development of the new L&SC Transformation Plan. The L&SC Business Plan will also be drafted with a view to seek early sign off at CCB - proposal for February 2019 Issues to be escalated: None at this time

All Age Mental Health

Transforming Care

Inpatient Performance: As of 12 December 2018, the inpatient status is 102 against a Q3 trajectory of 72. The new accelerated discharge calls continue and are well attended by all CCGs. All 4 Councils have been given additional funding to provide dedicated TCP social work support and all patients now have a named discharge coordinator. CTRs CTRs delivery is now at 66% including those in MH Beds. NHSE have committed to undertaking RCA for all missed or delayed CTR/CETRs. To support an improvement in performance, a centralised CTR/CETR model has been agreed and interviews for a case manager and case officer are arranged for 17 December. It is expected that the team will prioritise and focus on the pre-admission CTRs/CETRs (LAEPS) as evidence suggests that 83% of admissions are avoided if a CTR is done prior to admission. In addition, the programme steering group has asked LCFT to explore a process to ensure that the Bed Hub do not admit patients with LD/A unless a CTR has been completed. Additionally, a letter has been sent to all CCG AOs to raise awareness of the NHSE accountability and scrutiny process. CCG Bed Development CCG bed development is on-going however we have had recent notification that the £16m capital bid was unsuccessful. Commissioners are now looking at alternative options for the 24 beds (14 A&T and 10 rehab) and an EOI PIN is under development to test market interest in providing the beds and estate.

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Community Service Development Notification has been received from MCFT that the Specialist Support Team (SST) is now fully mobilised and the service has a caseload of 116. Further discussions have been had with LCFT to understand the resource and financial gap between current and future CLDT provision. Commissioners have asked the Trust to revisit their initial gap analysis ensuring the inclusion of overheads for an all age service. A lead has been identified for the development of ASD only provision. The work-stream will need to ensure consideration is given to previous consultation and co-production with both service users and providers. Links are also being made with the CAMHS Neuro-Developmental work-stream to ensure a seamless pathway. CYP The TCP CYP project manager has now started in post and will focus on CETR performance, DSR and link with the SEND team. Annual Health Checks Overall achievement for completion of AHCs for L&SC within 2017/18 was 50.57%. In a bid to support improvement, consideration of ‘Lab in a Bag’ is currently underway which utilises a POCT approach. Blackpool are interested in piloting this concept which will enable everyone open to community services will have a health check. Additionally, based on an effective approach in Bradford, the TCP is also considering working with advocates and Partnership Boards to promote the uptake of AHCs in GP practices LEDER It is recognised that LeDeR performance needs to improve. L&SC have undertaken 14 reviews out of 124. To increase the number undertaken the programme has been awarded funding for fixed term admin and trained reviewers to complete the back log. An additional 1.0 wte 8A fixed term, up until 31/03/19 has been recruited and an additional 0.2 wte capacity has built into TCP’s Programme Support Officer role. Governance The programme's governance structure is under review. The Commissioning and Finance meetings have been combined and further consideration of the structure is underway in-line with the commissioning development framework HOSC The Programme was invited to present at the HOSC on the 10 December. A detailed presentation was delivered which was well received by the Councillors present. Several questions were posed to the exec TCP team and a request to provide some further

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written responses (due to time constraints at the meeting) was requested. The Programme has been invited back to present an update in 12 months

Commissioning Development

Commissioning Development

Two workstreams (Adult Mental Health and Out of Hospital) presented their portfolios at Joint Committee of CCGs on 6th December. All phase 2 workstreams (Planned Care, Urgent & Emergency Care, Cancer, Individual Patient Activity, Children, Young People & Maternity, Children & Young People's Emotional Wellbeing & Mental Health and Learning Disabilities and Autism) have developed draft portfolios which will be shared with workstream leads at two check and challenge sessions in December. These will then go forward to the Commissioning Oversight Group in January. No issues to report.

Digital & IT Digital Empower the person

Digital Exemplar Project update: November iPlato data due on 3rd December. Fifth bulletin set to go out at end of Nov. iPlato stats site shared with 30 exemplar members. Exemplar presentation to be given at Primary Care Transformation event. ICP and CCG stats added to project site Second event held - follow up info sent out. NHS Orb Project Update: 2700 downloads on Google Playstore.

Digital & IT Digital Estates and Technology Transformation Funds

Population Health Management Programme update: Identifying IG requirements to support the accelerator programme. The signup document/learning agreement has been signed off. Daft TOR will be reviewed on 03 Dec. We are also liaising with colleagues to establish what datasets are required for this programme which will then determine the content of the Data Sharing agreement.

Digital & IT Digital Health System Led Investment

Update: Further to the documentation received from NHSE; programme managers have expressed concerns around why these were sent at this stage of the process, the resource intensive work that will be required to complete these documents. Issues: Waiting on the finance team to offer support to complete the Value Analysis template.

Digital & IT Digital Integrate services

Audio Conferencing project update: Andrew Thompson and Mohammed Adam are evaluating a Product from Questmark and they have been given 5 licences to test the technology. Mohammed has tested the product who has fed back his recommendation to tweak the capabilities. If the changes meet our requirements; we will deploy the 5 trial licences to ICS members to test the system. We will evaluate it 2-3 months, gain feedback from users and make our final procurement decision. Image Sharing Project update: New Picture and Communication System (PACS) expected to be installed in April. Issues: Siemens to populate scoping document following VNA sign off, scoping doc expected w/c 29th October - delay in return

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Proof of concept required. Tiani/Sectra have returned scoping document. Paul Bradley checking scoping doc from technical point of view. Docman (Deployment) Project update: ICS held call with Docman to understand Docman Connect deployment. Outline specification complete x 2. Shared with Tiani and Maywoods, meeting to take place on 4th Dec to finalise document. Complete specification to be shared with Docman.

Digital & IT Digital Managing services more effectively

Artificial Intelligence in Primary Care project update: Meeting arranged with neighbourhood GP Leads on 4th Dec to scope out new workflow with AI technologies based on the data provided by the CSU on all three Practices of the West Lancs Neighbourhood leads. We have received a quote from Mobilise Cloud and a PO will be raised in due course. We have also received a quote from Mobilise Cloud for what it would look like commercially for the practices if we were to proceed to use AI technologies in practices. The pilot phase will run for 3 months and if practices feel its viable, we will deploy the commercial model. The meeting on 4th Dec will also help identify practices who are willing to be a trial out the AI solution. Updating the UC/IPT Documentation Project: Engaged with partners re: telephony/infrastructure. Mohammed to meet with Andrew Thompson and Declan Hadley to discuss what the ICS Strategy will be on unifying the infrastructure.

Digital & IT Digital Support the frontline

Digital Pioneer Scheme Update: The scheme has been oversubscribed and has exceeded registration. We are truly surprised with the quality and quantity received. In total we now have 19 Pioneers in this scheme. The next panel will meet on 3 Dec. Digital Story Telling Project update: A quote has been received by the Comms Team, from the website developers for the cost of developing the Digital Storytelling repository on www.healthierlsc.co.uk – next steps are to review this quote with the Project Manager and commission the work. Building a Digital ready Workforce (Leadership programme) update: Plan was refined at the Digital Summit in September 2018 and additional ideas added to pilot in light of the Matt Hancock statement and resultant policy paper (in which the L&SC LWAB supported programme was highlighted in case study 10) and Topol Review Follow-up board session with LTH confirmed for 17th January 2019 The Bay ICP approached to be first ICP Board pilot (lead John Glover) First Leadership Organisational RAID took place 28th Nov see: https://www.healthierlsc.co.uk/news/latest-news/digital-leadership-programme-seeing-is-believing-partnership-of-trust-event ICS wide Leadership Development programme to inspire Board leaders by connecting with thought leaders; industry partners; academia in planning with Amazon Web Services 'Envisioning approach', Microsoft 'Artificial Intelligence and Machine Learning' and Wilson Wong – Head of Future Insights at the CIPD 'Scenario Planning' – programme to commence Q4

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Digital Diabetes Prevention Programme Update: Referrals into the scheme closed on 16th November. A total of 405 referrals were made which will translate into a minimum of 280 registrations. Actual number of registrations will be available by 11/12/18

Finance & Estates

Finance Achieved this month: 1. CFOs and DoFs have agreed their approach to the issues raised at the technical PbR workshop. 2. The inaugural meeting of the cost reduction team met on the 13th December and plans for a 5th February workshop are underway, including the production of a 'bronze pack' of opportunities. 3. Draft budget estimates for the ICS teams have been delivered to GR by the NHSE finance team, pending further work to refine them by the end of December. Estates/infrastructure - wave 4 success for BTH critical care/A&E and LCFT MH hub schemes. Other ICS schemes not supported were: OHOC proposals; Community hub in CSR CCG; LD scheme; RLI scheme; HASUs for stroke services. Planned next month: 1. ICS budgets to be agreed and funding options developed. 2. Mitigation measures/application of central funds to support the achievement of ICS financial and performance objectives to be discussed and agreed by ICS executives. 3. Financial and activity aspects of operational plans to be coordinated. 4. Financial strategy work to be initiated. Estates/infrastructure - detailed plans for priority schemes, including Managed Equipment Services, approach to backlog/high risk maintenance and community hub development capabilities. Issues: Coordination of financial, activity and other technical aspects of plans with the more generic aspects. We must not allow the technical aspects to drive the general aims and objectives of the ICS and ICPs.

Involvement, Communication & Engagement

Communications and Engagement

A number of protocols and guidelines have been developed to support communications and engagement with portfolios and programmes across the ICS. Website development: £10k investment in a suicide prevention microsite which is being developed, a new workforce area has been created and additional work underway for the videos and events section Workshop of communication leads for ICPs identified a need to develop a community of practice for community engagement and mobilisation Clinical engagement session planned for 15th Jan Healthwatch report on digital health is expected to be published before end of Dec. ICS and OHOC Execs set for media training session on 20th Dec Job descriptions created for new roles in the C&E team A workshop took place for the Building Health Partnerships programme with is looking at developing the role of the VCFS in ICS' and ICPs

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Supported mental health review events which have now been completed Videos created to support general practice nursing roles and recruitment Wave 4 Capital funding announcement managed for ICS which has seen £21m investment for L&SC

Out of Hospital Palliative Care This month: worked with Macmillan to prepare a submission for L&SC to be a funded exemplar site; this is a bidding process. Continued to develop the PBNA tool and linked in with the Population Health workstream. Continued to develop the search tool for primary care to use to identify patients for inclusion on primary care supportive care registers. This has been shared nationally with both Manchester and London interested in developing this work locally. The roll out of Advance Care Planning one day education course continues; in excess of 1000 front line staff have attended the training course Next month: Prepare stage 2 of the bid to Macmillan which will include scoping current models against the exemplar model. Prepare for the deep dive presentation on 21/1. Start the EHCH project as clinical lead now fully in post issues: Macmillan have changed the criteria for bidding and the timescales are really tight to fit in with the organisation’s financial year

Out of Hospital Primary Care Achieved last month: 1. Primary Care Standards - Work has commenced to develop and finalise a set of co-produced primary care standards to be applied across the ICS. in the interim it is proposed that where appropriate CCGs and ICPs implement the stroke standard into existing quality contracts for 19/20 with the ambition to incorporate the remaining primary care standards in 20/21 following co-production and ratification by JCCCG and ICS board. 2. A £2.2m ETTF Technology investment has been approved to protect IT infrastructure against cyber-attacks. 3. The PCN development review tool which has been co-produced with stakeholders from across the system has been finalised. The tool will be used to assess the maturity of PCNs across the ICS and crucially will facilitate a discussion with each PCN to develop a bespoke plan for 19/20 to enable each PCN to further mature. The first meeting of the Task and Finish group to review the governance and remit of the Primary Care Strategic Development Group has been held and a revised draft Terms of Reference produced. Work will continue into the new year to refine and formalise the TOR which is proposed to include the population health management component of PCNs. 4. Primary Care Transformation Event delivered to 120 delegates to share the vision for primary care, clarify the investment to support development of PCNs and to show case examples of best practice from across the ICS with breakout sessions focusing on workforce. The event was well received and evaluated well with a request to show case more local examples of primary care transformation.

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Key Deliverables Next Month: 1. Review of 10-year plan and operational plan against the ICS primary care delivery plan and refresh any milestones or programmes of work accordingly. 2. Continue to support and work with the 20-week Population Health Management programme to identify appropriate PCNs and provide support accordingly 3. Review and ensure appropriate primary care provision of services of the winter period 4. Continue to support and work the Digital First team to consider wider integration of community pharmacy and the pilot Digital Referral of Minor Illness Scheme and online consultation. Key Risks: Delivery of expected outcomes of £1ph investment in PCNs in year is still a risk however the process for peer reviews linked to the development tool has now been finalised.

Out of Hospital Regulated Care * Quality of Care - 1. Procurement of the contract & quality monitoring tool is progressing; a paper is due to go to CCB on 12th December with a recommendation of preferred supplier. 2. Red bag check and challenge event held to bring together partners and highlight key issues – including standard documentation, information governance implications and tracking bags through the pathway. Task and Finish groups with leads identified 3. MOCH update – Pharmacy staff have been successfully appointed. Following completion of education programme confirmation of start date will commence October 2019. Care home pharmacists have been nominated for CPPR MOCH courses. 4. You Said, We Did – Providers have asked us to consider better alignment of meetings/forums held by each organisation to allow them to attend get the best value from as many as possible. Approach discussed and currently being developed for sharing provider forum information. 5. Data security and protection toolkit training for GDPR compliance & access to NHS mail taken place in East Lancs, awaiting ICS Executive Board confirmation about whether funding is available for further training & implementation for care providers across L&SC * Finance - 1. Agreement in Finance subgroup of outcomes relating to the Care home service specification, which means that the group is halfway through agreement of a combined L&SC service spec, and on schedule for completion in March 19. Task & finish group meeting to agree Set 5 outcomes on 14th Dec. 2. NHS England response to the ongoing service specification work in L&SC confirmed from Steve Anglin, NHSE ' The NHSE

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specs will be in the form of guidance rather than mandatory, so this should not inhibit the development by LSC. After publication of the suite of documents developed by the SIP, we will enter a review phase where we will continue to incorporate comments and feedback, which should give some assurance to LSC that any work will not be in vain.' 3. Lead for Finance workstream attended the CCG CFOs group to feedback on local authority fees and to highlight the variation in CHC fees. Discussion of commonality of approach and how prices are put together, with regards to viability, pressures to providers, and CCGs need for developing an open way of understanding CHC rates. * Workforce - 1. 4 x Pop up recruitment events planned for Lancaster shopping centre in Dec/Jan to recruit staff & raise the profile of social care. Provider engagement requests sent out & currently compiling notices of vacancies etc. Communications sent out widely across Morecambe Bay ICP. first event to take place on 12th Dec. 2. Development of DHSC adult social care recruitment campaign – getting an understanding of how to link in local development into the national social care recruitment campaign starting in Jan/Feb 2019. 3. Website updated to include further developments from all the regulated Care workstreams and include a focus on training and recruitment.

Prevention & Population Health

Prevention & Population Health

Population Health Management Programme update: Identifying IG requirements to support the accelerator programme. The signup document/learning agreement has been signed off. Draft TOR were reviewed on 03 Dec for comments from IHACS group, these will be amended accordingly ready for sign of on the 14 December 2019. We are also liaising with colleagues to establish what datasets are required for this programme which will then determine the content of the Data Sharing agreement. We have had a good response to the population health exemplar programme, deadline 03 Dec ready for the Accelerator programme commencing in January 2019.

Urgent & Emergency Care

Urgent and Emergency Care - National Priorities Urgent and

Integrated Urgent Care (IUC) - Direct booking into Extended Access technical issue with EMIS booking slots has been resolved. NHS111 Online - Draft dashboard is being developed by L&SC UEC Team & Ambulance Commissioning team ready to share with CCGs in January. UTCs - 10 UTC sites are now live, with a further site to go live next year and a further two sites being reviewed. Re-naming of sites and comms work continues with each health economy with support from Regional comms lead. Ambulances - Handover work currently taking place with the Super Six Trusts (Every Minute Matters), three sites are in L&SC. Learning will be shared and further updates will be given as this work progresses. Work is beginning to look at Patient Transport Provision and lower acuity (category 3 & 4) NWAS incidents across L&SC. Hospital - A task and finish group is currently being set up for Respiratory – an area identified as part of transforming clinical pathways. Hospital to Home - Discharge to Assess Pathways are in place across the trusts. The number of CHC assessments in acute trusts is lower than in previous years. Workforce: The first meeting was held on 20th November, and this was well attended by CCG/Trust/HEE/Regulated Care

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Emergency Care - Local Priorities

representatives. The next steps are to align with wider workforce steering groups, review membership, governance, determine what is in and out of scope and look at data availability. System Level Intelligence: This work focuses on a number of areas - standardised data reporting across L&SC, a technical solution to escalation and reporting (for e.g. EMS+), the scoping of a falls lifting service and access to Mental Health Crisis plans. The bid is in the final stages of submission. Transforming Clinical Pathways: A task and finish group is currently being set up for Respiratory. Governance: There are plans to review and refresh the terms of reference and membership for each UEC meeting group. A draft governance structure is currently being developed.

Workforce, Leadership & Organisational Development

Workforce Meeting has taken place with DONs/CCG lead Nurses to focus on nursing supply and workforce issues as part of ongoing work to develop a collaborative project to support this work. Strategic Resourcing Lead leading work on interviews for a potential first large-scale cohort of Indian nurses via the GHE programme. Undertaken an initial scoping event to look at workforce for the U&EC clinical portfolio. Mental Health Workforce Steering Group has taken place and plans being developed for the workforce programme. Stroke Workforce Steering Group has met, and further work has been done to develop the workforce plan from the recent Workforce Event. Maternity (better births) the LMS held the second maternity assembly in November. Included an outline of the national workforce strategy from HEE, due out in January. North of England Radiography/Radiology event took place in November to support transformational work in both education and workforce terms. Preparatory work is taking place for the Adult Social Care recruitment campaign, due to launch in January 2019. LWAB meeting took place and key messages have been shared. The draft Workforce Strategy was discussed and supported by LWAB and work is ongoing to finalise this and update the 2018/19 delivery plan prior to publication and further engagement is needed to develop the 2019/20 delivery plan. Detailed discussion at LWAB about workforce issues and the need to focus on developing programmes to boost supply as well as developing more transformational approaches. Next Month: Adult Social Care national recruitment campaign launches. Interviewing to take place for 2nd cohort of nurses via the GHE Programme. Health and Social Care Sector Skills Group in conjunction with the Local Enterprise Partnership (LEP) to be re-launched. CYP Mental Health – a workforce redesign group is being established to support the design of the new model of care (thrive). Meeting planned for January. Perinatal mental health – work is underway to produce a workforce and training plan for the North west coast – meeting in January. Cancer – funding has been identified to support the Cancer Alliances across the North West. It is hoped that a post will be established in the new year.

Workforce. Leadership & OD

Leadership & OD

Achieved this month: Leadership and OD lead for the ICS has been appointed and will commence in February 2019. Workforce Lead is participating in the reference group for the new High Potential Scheme, which L&SC will be piloting. Workforce Lead also part of the NW HRD reference group for the Regional Talent Board and supporting work on the RTB bid for our local activity.