Clinical Commissioning Group, Adult Social Care …...Kingston’s CCG, Adult Social Care and Public...
Transcript of Clinical Commissioning Group, Adult Social Care …...Kingston’s CCG, Adult Social Care and Public...
Kingston’s
Clinical Commissioning Group,
Adult Social Care and
Public Health Services
Integrated Operating Plan
2014/15 – 2015/16
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 2
CONTENTS
Page
1. Introduction 3
2. Quality and Patient Safety 4
3. Patient and Citizen Voices 5
4. Children and Young People 6
5. Integrated Health and Care Services for Adults 7
6. Mental Health 8
7. Primary Care 9
8. Urgent and Emergency Care 10
9. Cancer and End of Life Care 11
10. Socially Excluded and Disadvantaged Groups 12
11. Health promotion and disease prevention 13
12. Integrated Commissioning of Health and Adult Social Care 14
Appendix 1 How this plan addresses the fundamental elements of commissioning as identified in NHSE’s Operating Framework
15
Appendix 2 Outcomes we will use to measure our success 17
Appendix 3 2014/2015 Kingston CCG and Adult Social Care Budgets and saving plans 19
Appendix 4 Related Documents 22
Appendix 5 Kingston Draft Better Care Fund Plan
Appendix 6 Draft Kingston CCG 5 Year Plan-on-a-Page
23
24
Appendix 7 Draft SW London 5 Year Plan-on-a-Page 25
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 3
1. Introduction
Kingston Clinical Commissioning Group (the CCG) and the Royal Borough of Kingston (RBK) have been exploring ways in which
to collaborate on commissioning for the benefit of the population of Kingston.
This plan brings together priorities that Kingston’s CCG, Adult Social Care and Public Health have identified for the next 2 years
into a single document for the first time. These priorities have been derived from previously published documents such as the Joint
Strategic Needs Assessment (JSNA), Health and Well Being Strategy and the CCG Commissioning Intentions. This Plan should
be read alongside these and the other documents listed in Appendix 4.
Following the transfer of public health responsibilities from the health service to the local authority, the Royal Borough of Kingston
upon Thames recognises that to fully deliver its new responsibilities as a Public Health organisation all aspects of council business
need to be influenced by Public Health. The Public Health Team will continue to ensure that mechanisms are in place to enable
Public Health specialists to work with all council services to ensure that this occurs. The delivery of the third domain of Public
Health, which is that of commissioning support, will be a priority for RBK which will assist in maintaining the excellent working
relationship with the Kingston Clinical Commissioning Group.
The priorities identified in this plan are deliberately described at a high level so that the document acts as an easy reference guide
for our population, partners and staff. The delivery of the priorities is supported by detailed implementation service plans.
This document will be reviewed regularly to ensure that it reflects the priorities identified by our population and partners. We
welcome any feedback on the document – please email to [email protected]
David Smith
Director of Health and Adult Services, Royal Borough of Kingston upon Thames and
Chief Officer, Kingston Clinical Commissioning Group
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 4
2. Quality and Patient Safety
Aim: To achieve visible leadership in quality improvement across health and care commissioning and provision,
embedding the learning from Francis, Berwick and Winterbourne into local services.
What we will do
Establish a regular health & social care quality information sharing meeting using SBAR (Situation, Background, Assessment and Recommendation) tool
Mature relationships with providers include ‘15 steps’ (quality from a patient’s perspective) and walk rounds
Focus attention on smaller less developed contracts and providers to establish quality reporting
Be an active member of the London Quality Surveillance Group and work collaboratively with other CCGs and Local Authorities on issues of quality and patient safety
Ensure requirements and good practice in Adult and Children’s Safeguarding are rigorously applied
Extend the use of focused user outcome measures to all Adult Safeguarding investigations
Reduce the number of Health Care Acquired Infections being reported by our providers
Ensure the 6 action areas and ‘6 Cs behaviours’ of Compassion in Practice are rolled out across providers
Continue and expand the current projects to improve medicines safety optimisation in care homes
Improve access and sharing of data across health and social care
Implement a local quality framework for residential and nursing homes in Kingston
Deliver the London Quality Standards and equivalent in cooperation with other commissioners and providers
Outcomes we will realise
Establish a culture where health and care providers raise their own concerns with commissioners which triangulate with other information to enable intelligent decision-making and appropriate action
Kingston CCG’s Integrated Governance Committee receives quality reports from all health and care commissioned providers
Commissioners gain assurance from providers against a set of agreed standards and early warning systems are in place
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3. Patient and Citizen Voices
Aim: To ensure that the voices of patients, carers and the wider population are central to the development and delivery
of both their own health and care and the health and care services provided in Kingston
What we will do
Establish a Patient Experience Group across health and care services to monitor and drive improvements in service quality based on service user feedback data
Ensure providers involve patients in the Root Cause Analysis arising from any Serious Incident
Integrate learning from complaints and feedback into practice
Continue to commission Kingston Voluntary Action (KVA) to disseminate health and social care information and support and contribute to the development of local strategies
Roll out personal health budgets for NHS Continuing Health Care and plan for widening the opportunity to people with long term conditions, using processes in place in Adult Social Care for direct payments
Build on current strategies and plans to develop and implement a Joint Engagement Strategy
Establish a formal link between the PLD Parliament and Kingston Healthwatch, to ensure independence of the Parliament
Ensure that the JSNA incorporates the views of patients and the public
Outcomes we will realise
A measured improvement in service users’ experience of health and care services
Real involvement of patients and carers in the development of individual care plans and wider service planning and development
Feedback is used to inform commissioning processes
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4. Children and Young People
Aim: Children and Young People are able to access the right service in the right place and the right time and have a
positive experience of care.
What we will do
Support the implementation of MASH (Multi-agency Safeguarding Hub)
Implement the new statutory duties of the Children and Families Bill and review and update existing transition protocols focusing on vulnerable groups
Implement the recommendations of the CAMHS (Children’s Mental Health Service) Tier 2 review including the introduction of a Single Point of Access with streamlined onward referral arrangements, and support the implementation to IAPT (Improving Access to Psychological Services)
Offer children, young people and families Personal Health Budgets and continue to improve the quality of the continuing care service
Identify approaches to ensuring that children and young people are involved in the design and delivery of local services e.g. ensuring that there is a health section included in the Local Authorities annual Young People’s School Survey
Extend health assessments on school entry from September 2014
Deliver targeted prevention and education at secondary school age via 5 Young People’s Health Link Workers
Continue with the established collaborative commissioning arrangements with the Children’s Joint Commissioner working across the CCG and Local Authority and continue to develop the multi-agency Children’s Health Commissioning Board
Work with the newly established ‘Achieving for Children’ social enterprise, supporting it to achieve its aims and objectives
Outcomes we will realise
Children and young people have a positive experience of care, feel empowered in decisions about their care or treatment and have improving levels of health and wellbeing
Support children and young people to achieve their full potential
Improve the experience of transition for those service users moving between children and adult services
Collaborative working across professions and integrated commissioning
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5. Integrated Health and Care Services for Adults
Aim: To improve choice, outcomes and experience of care for vulnerable adults, people with long term conditions and
the frail elderly within our population
What we will do
Under the leadership of the Health and Wellbeing Board, develop and deliver Kingston’s Better Care Fund Plan
Consolidate the Kingston at Home service model to further integrate health and care services
Develop and adopt Multi-disciplinary Team (MDT) and Multi-provider Team (MPT) approaches to managing those most in need of health and care services in our population
Review and redesign of community (district) nursing and community matrons service model and care pathways in light of the caseload profiling project
Review, specify and implement an Older People’s Mental Health service model by April 2015, particularly a comprehensive Dementia Service with associated Carer Support and Community Development
Implement the changes brought in by the new Care Bill from April 2015
Review and re-commission the meals service and accompanying transport services
Explore the requirement for step-up and step-down community beds (including Cedars Unit)
Emphasise the need for an holistic approach to the care of older people using the comprehensive geriatric assessment tool and a recovery and rehabilitation philosophy
Pursue opportunities for increased 7 day working and delivery of the 10 x 7 day service clinical standards
Continued support for the provision and expansion of dedicated support to care homes (IMPACT team)
Outcomes we will realise
Provide more care closer to and in the home
Establish a single point of access to community based services
Reduce the number of avoidable admissions into hospital
Reduce the length of stay in hospital and delayed transfers of care by supporting early discharge
Reduce the number of nursing home and residential placements made in Kingston
Improve support available to carers
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6. Mental Health
Aim: Improve mental health and wellbeing, extend local mental health services and support for carers, and provide
effective mental health commissioning leadership for a wider area
What we will do
Be fully engaged and committed to the ‘No health without mental health programme’ – cross sector work to aid recovery, reduce stigma and enhance positive outcomes
Value mental health equally with physical health (‘parity of esteem’) so that all those for whom we have responsibility can say ‘I have access to services which enable me to maintain both my mental and physical wellbeing’
Continue to support the development of the Kingston Community Wellbeing Service, particularly refocusing services towards prevention and early intervention; improving access to treatment for service users with a dual diagnosis; supporting the expansion of the substance misuse element of the service to meet the increase in people accessing the service
Develop in-Borough adult rehabilitation services with the 3rd Sector, ensuring effective links and reducing bed days
Contain out of area placements including review, repatriation and demand management arrangements
Finalise future arrangements for personality disorder services
Support the delivery of a range of mental wellbeing initiatives across the population of Kingston from children and young people and their families, through the adult years, to older people
Continue with the collaborative commissioning approach both locally through a joint commissioning approach between the CCG and the Local Authority as well as providing the leadership for South West London and St George’s Mental Health Trust for 5 of the CCGs in South West London
Outcomes we will realise
Increased numbers or people accessing IAPT (improving access to psychological therapies) services
Progress a single point of entry to both primary and secondary care mental health services
Better support for Carers including carer network established and carer engagement in mental health programmes
Seek to achieve continually improving levels of mental health and wellbeing
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 9
7. Primary Care
Aim: Support primary care in core provision and in tackling new requirements, seek to assure quality and consistency
in patients’ experience and help establish a longer term plan for primary care in Kingston
What we will do
Support GPs to provide continuity of care to the over 75s and meet the new obligations under the contract to provide an ‘accountable GP’ for those individuals; support GPs in a similar role for people with complex needs
Enable GPs to play a central role in delivery of the Better Care Fund Plan, including implementation of risk stratification, extension of multidisciplinary team (MDT) working, specific arrangements around mental health and end of life care in primary care
Work with primary care to assure appropriate access and consistent quality provision; work with primary care to tackle unexplained variability in aspects of primary care provision, including referral management
Further improve prescribing efficiency and the uptake of medicines optimisation initiatives in primary care through the investment in a Medicines Management Incentive Scheme and support the reduction of unexplained variations in GP prescribing practice
Assist primary care in exploring the options around the future models and ways of working for primary care, focusing on areas of change highlighted in ‘Improving General Practice – A Call to Action’ and recommendations that emerge from the Strategy for Primary Care for London being developed by NHS England
Review the portfolio of Locally Commissioned Services exploring the potential for change in order to meet health and care priorities in Kingston
Outcomes we will realise
Positive patient experience of primary care (including via extension of Friends and Family Test)
Changing requirements of primary care effectively and consistently implemented
A clear direction of travel for primary care development and provision across Kingston
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 10
8. Urgent and Emergency Care (U&EC)
Aim: To build on the achievement of the Kingston Urgent Care Working Group in actively engaging all key partners in
the development and implementation of a whole system Urgent Care Plan
What we will do
Evaluate the Acute Care Physician and Older People / Psychiatric liaison pilots with a review to mainstream services if demonstrably effective
Procure an integrated GP Out of Hours and NHS 111 service
Develop and implement local alternatives to A&E attendance; options include improving access to other timely advice and support, potential for urgent care front end at KHT A&E, GP-led health centre provision at Chessington, potential for Urgent Care service at Surbiton Health Centre
Enhance the NHS 111 Directory of Services to signpost service users to right services not just A&E
Ensure cross-system plans are in place early to manage winter pressures and adapt them to manage pressures throughout the year
As part of the BCF develop plans for seven day working for Adult Social Care
Outcomes we will realise
Reviewed and refreshed membership of the Urgent Care Working Group and Kingston Urgent Care Plan; assurance of delivery of the 5 key elements of the national Urgent and Emergency Care Review; assurance of quality of U&EC services outside hospital across 7 day working
Improved patient satisfaction with Kingston’s U&EC services
Reduce patients’ reliance on A&E to gain access to urgent treatment
Achievement of outcome measures associated with urgent and emergency care including the 4 hour A&E waiting time target
Increase choice and access in urgent care services
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9. Cancer and End of Life Care
Aims: Ensure a comprehensive range of cancer prevention and treatment services are in place, and ensure they are fit
for the future.
Continue to improve provision and coordination of end of life care services, enabling an increasing number of
people to die in their place of choice
What we will do
Continue to commission and provide prevention services and work with the South London Commissioning Support Unit and NHS England to ensure a full range of Cancer treatment services are in place and accessible for Kingston residents
Provide local leadership to review Cancer prevention and treatment services in light of the London Cancer Strategy launched in January 2014; revise local plans accordingly
Review and update Kingston’s End of Life Care Strategy
Continue to promote partnership working, ensure comprehensive service information shared across health and social services, champion joint education programmes
Make progress in extending 7 day and 7 night provision for end of life care patients, particularly working with NHS111
Outcomes we will realise
Maintain high levels of public awareness of issues around cancer and increase early detection rates
Implement ‘living with and beyond cancer’ best practice
Improve patient experience of cancer services, especially at the primary / secondary care interface
Increased use of coordinate my care, particularly for patients near or at end of life
Implement an out of hours pharmacy dispensing service
Increase the number and proportion of people who die in the place of their choice
Reduce the number of palliative care patients dying in hospital
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10. Socially Excluded and Disadvantaged Groups
Aim: For people who are disadvantaged or socially excluded to have similar opportunities for good health and
wellbeing as the wider population in Kingston
What we will do
Via the Equalities and Community Engagement Team (ECET):
Provide targeted initiatives in disadvantaged areas and to disadvantaged population groups in Kingston
Continue to undertake participatory needs assessments so that a detailed understanding of local needs and assets can be developed
Continue to implement the Joint Refugee and Migrant Strategy including commissioning Refugee Action Crisis Support to provide 1:1 advice, information, and support sessions for Refugees and Asylum seekers
Focus on homeless people and ensure they can access all relevant services
Implement (if finally agreed) the planned PLD transfer of specific elements of provision (supported living, residential, work activities) to a social enterprise, to increase user involvement and enable more flexibility, innovation and development
Deliver the CCG’s obligations in relation to the Armed Forces and Veteran Health. These include
responsibility for commissioning all secondary and community services required by Armed Forces’ families where registered with NHS GP Practices and services for veterans and reservists when not mobilised
commissioning bespoke services for veterans, such as veterans’ mental health services
Outcomes we will realise
Increased engagement with and improved health and wellbeing of people who are disadvantaged or socially excluded
Ensure that universal services are more sensitive and responsive to the specific requirements of these groups within our population
Seek, receive and act on feedback from these groups, and increase the range of intelligence available to commissioners to inform future planning and commissioning
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 13
11. Health and Prevention
Aim: Make sure that there is an accessible range of information and opportunities which promote health and wellbeing
and prevent illness, which are suited to the varying needs of Kingston residents
What we will do
Specify and tender a range of early intervention and support services with the independent / voluntary sector, to include services such as case finding and combating isolation for older people, support to manage personalisation / personal health budgets, support to carers
Continue to upscale obesity prevention and physical activity promotion services and focus on increasing utilisation of these services by men
Support London wide health improvement initiatives including Healthy Schools and the Healthy Workplace Charter
Promote our tobacco control and smoking cessation services by both discouraging people (including young people) to take up the habit as well as providing a range of service to support people who want to quit smoking
Ensure there is a high level of awareness of the issues regarding shisha use
Promote safe and sensible drinking and provide education around illegal substances and substance misuse
Deliver the Health Check programme, ensuring that it targets disadvantaged populations within Kingston
Undertake a review of local sexual and reproductive health services
Prepare for the transfer of commissioning responsibilities for children’s public health services for 0 to 5 year olds from NHSE to RBK
Ensure that the adolescent health link workers programme is fully embedded in local schools
Review the range of self-care and self-management provided and develop a plan fit for future ambitions
Establish demonstrator projects for clinical coaching
Outcomes we will realise
Tender for early intervention and support services let, achieving better use of available resources, simplification of commissioning arrangements and clearer and increased provision
Increase uptake across the full range of health promotion and disease prevention services available
Increase the coverage of the Health Checks programme
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 14
12. Integrated Commissioning of Health and Adult Social Care
Aim: To improve alignment and efficiency of health and social care commissioning, with the aim of ensuring seamless
provision and best use of resources
What we will do
Bring together under a single leadership team commissioners from health, and adult social care
Increase the level of funding that is pooled between health and adult social care
Establish an organisational development (OD) programme to foster a culture of collaborative and cross boundary working to support the integration of the respective teams
Consolidate and better align staff development arrangements
Seek opportunities to improve information sharing to address both local and national requirements
Foster an innovation culture, to enable and enhance integrated working and optimise commissioning
Apply best practice in procurement
Align the Adult Social Care and CCG saving plans to ensure that a decision in one area does not adversely impact on another part of the system
Outcomes we will realise
Improve patient and service user experience particularly where they require both health and social care services
Optimise the commissioning capacity in Kingston, with an efficient, motivated integrated commissioning team streamlined where appropriate to help offset the reduction in running costs that the CCG and RBK face
Ensure the resources spent on services by the CCG and RBK are used in the most effective way possible, optimising value for money
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 15
Appendix 1 How our Plan addresses the Fundamental Areas identified in NHSE’s Operating Framework
Fundamental Elements of Commissioning How these are addressed in this Plan
Ou
tco
mes
Delivery of outcomes set out in the NHS, Adult Social Care and Public Health Outcomes Frameworks
Throughout
Improving Health
Aims and actions throughout are generally aimed at improving health and wellbeing through promotion, prevention and intervention
Promotion and prevention actions particularly emphasised in section 4, via the BCF in section 5, sections 6, 9, 10, and particularly section 11
Reducing Health Inequalities Section 10
Parity of esteem Sections 5, 6, 7, Appendix 5
Pati
en
t S
erv
ices
Citizen involvement, patient empowerment Sections 3, 4, 5, 6
Wider primary care provided at scale Section 7
A modern model of integrated care Section 5
Access to highest quality urgent and emergency care Section 8
Step-change in productivity of elective care Appendix 3 – commitment to duties to deliver balanced budgets incorporating national requirements including PbR changes
Specialised services concentrated in centres of excellence Section 2 ref London Quality Standards
Acces
s
Convenient for everyone Sections 4, 5, 6, 7, 8, 9, 10, 11
NHS Constitution pledges Addressed through contracts, covered by performance
management arrangements including Appendix 2
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 16
Qu
ality
Francis, Berwick, Winterbourne View Section 2
Patient safety Section 2
Patient experience Sections 3, 4, 5, 6, 7,12
Compassion in practice Section 2
Staff satisfaction Addressed through NHS standard contracts
Section 12
7 day services Sections 5, 8
Safeguarding Sections 2, 4,
Research and innovation Section 12
De
liv
eri
ng
valv
e
Value for money Throughout, Appendix 3
Effectiveness Throughout, esp. Section 12
Efficiency Throughout, esp Section 12
Procurement Section 12
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 17
Appendix 2 Outcomes we will use to measure our success
For joint, high level reporting we will use the following indicators which are broadly shared across the Health, Adult Social Care
and Public Health Outcomes Frameworks:
Outcomes Frameworks: Core Domains 2014/15 – 2015/16
Adult Social Care (A) NHS (N) Public Health (P) Performance Measures A N P
Preventing people from
dying prematurely
Measures in blue required for the Better Care Fund Plan
Enhancing quality of life for people with care and support needs
Enhancing quality of life for people with long term conditions
Health Improvement
Improving the
wider
determinants of
health
1 Proportion of adults with LD in paid employment (NHSOF – employment of people with long term conditions)
1E 2.2 1.8
2 Proportion of adults with MH in paid employment 1F 1.8
3 Estimated diagnosis rate for people with dementia** 2.6 4.16
4 Local social care dementia measure? (* = Placeholder in ASCOF) *
5 Proportion of people who use services and their carers who reported they had much social contact as they would like / social isolation (survey measure)
1L 1.18
6 Self Directed Support and Direct Payments 1C
7 Personal Health Budgets – local measure? ?
Delaying and reducing the need for care and support
Helping people to recover from episodes of ill health or following injury
Healthcare public health and preventing premature mortality
8 Delayed Transfers of Care (We can disaggregate this measure to show health as well as social care delays)
2C
9 Permanent admissions to residential/nursing care 2A
10 Proportion of older people (>65) still at home 91 days after discharge from hospital into reablement / rehabilitation (part 2 of this measure also captures proportion of people offered reablement at discharge from acute or community hospital – NHSOF 3.6ii)
2B 3.6
11 Local measure – outcome of reablement
12 Avoidable emergency admissions 3B 4.11
13 Successful completion of drug treatment 2.15
Ensuring that people have a positive experience of care and support
Ensuring that people have a positive experience of care
14 Improving people’s experience of integrated care (Survey measure) 3E 4.9
15 Overall satisfaction of people who use services with their care and support / Patient experience of primary and hospital care
3A 4A
4B
Safeguarding adults … and protecting from avoidable harm
Treating and caring for people in a safe environment and protecting them from avoidable harm
Health protection
16 Local measure – percentage of adult discharges from hospital
over the weekend
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In RBK these high level measures will be reported as part of the Council-wide performance reporting arrangements.
In the CCG, performance against the full range of NHS (CCG) Outcome Framework indicators and a range of other local
measures is regularly reported to the CCG’s Integrated Governance Committee (IGC) - monthly in summary and quarterly in detail
- with significant exceptions identified supported with relevant commentary. The IGC in turn reports monthly to the Governing
Body.
The CCG, Adult Social Care and Public Health have in place more detailed plans which underpin this high level plan, and which
have their own performance measures and milestones which are the focus of regular internal / departmental performance
management. We regularly review the contractual and quality performance of providers.
The Kingston Commissioning Collaborative has in place an overarching governance structure, and certain programmes have their
own governance arrangements. For example the Better Care Fund programme will be reporting on a number of inter-
organisational programmes, using a variety of indicators and outcome measures, to the Health and Wellbeing Board.
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Appendix 3 2014/2015 CCG and Adult Social Care Budgets and Saving Plans
CCG Expenditure Plan 2013/14 Total
Budget
Run Rate Adj
Conting Release
ITF Transfer
Non Rec Adjust
2014/15 Baseline
Budget
Tariff & Growth
%
Tariff & Growth
Non Rec Adjust
Other Costs
Sub Total
QIPP Net Save
2014/15 Total
Budget
APPLICATION OF FUNDS £,000 £,000 £,000 £,000 £,000 £,000
£,000 £,000 £,000 £,000 £,000 £,000 Acute Commissioning
General Acute (FTs & Non FTs) 103,262 2,041 105,303 2.60% 2,738 108,041 (2,700) 105,341 Non Contract Activity 1,509 84
1,593 2.60% 41
1,634
1,634
Non SLAs/Acute Other 1,648 (18) 1,630 2.60% 42 1,672 1,672
Total Acute (before reserves) 106,419 2,107 0
0 108,526 0 2,822 0 0 111,348 (2,700) 108,648
Non Acute Commissioning
Mental Health 19,601 362 (140) 19,823 1.80% 357 20,180 (400) 19,780 Continuing Care 11,261 1,702
12,963 8.00% 1,037
14,000 (400) 13,600
Children with disabilities 2,000 598
2,598 1.80% 47
2,645
2,645 Learning Difficulties 1,062 (53)
1,009 1.80% 18
1,027
1,027
Community Health Services 16,196 (31)
16,165 1.80% 291
16,456 (500) 15,956 Reablement
0 1.80% 0
0
0
Vol Sector Grants
0 1.80% 0
0
0 Other Non Acute 4,699 (477) (932) 3,290 1.80% 59 3,349 (222) 3,127
Total Non Acute 54,819 2,101 0 (1,072) 0 55,848 1,809 0
57,657 (1,522) 56,135
Primary Care
0
Prescribing 19,611 (146) 19,465 6.00% 1,168 20,633 (400) 20,233 Enhanced Services 1,478 (1)
1,477 1.50% 22
1,499
1,499
Out of Hours 1,475 (66)
1,409 1.50% 21
1,430
1,430 Other Primary Care 306 74 380 1.50% 6 386 386
Total Primary Care 22,870 (139) 0
0 22,731 1,217 0 0 23,948 (400) 23,548
Sub Total 184,108 4,069 0 (1,072) 0 187,105
5,848 0 0 192,953 (4,622) 188,331
Running Costs 4,610 0
4,610
85 4,695
4,695 Non Running Costs 577 (192)
385
385
385
Reserves
Non-Recurrent Reserve (2% in 2013/14) 3,937 (1,268) 1,118 3,787 1,094 4,880 4,880 0.5% Additional Contingency 962 (962) 962
962
962
962
Acute Commissioning reserves 1,647 (1,647) 1,647
1,647
1,647
1,647 Cost Pressure Reserve 0 0 0
Total Reserves 6,546 (3,877) 3,727
0 6,396 0 1,094 0 7,489 0 7,489 0
Total Applications 195,841 0 3,727 (1,072) 0 198,496 0.00% 5,848 1,094 85 205,522 (4,622) 200,900 0 In Year (Deficit)/ Surplus 2,013 2,041 1.0% 1.0%
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 20
Kingston CCG Quality, Innovation, Productivity and Prevention (QIPP) Plan 2014/15
Preliminary v3
Better Care Fund pump-priming year including e.g.
risk stratification, MDT & MPT working, proactive intervention with high risk patients
End of life care programme
IMPACT team - expansion in care homes, extension to sheltered housing
Respiratory services development – expand community services, clinical coaching, oxygen services
Reduce cost of A&E attendances e.g.
reducing attendances (range of initiatives)
reducing cost of attendances (e.g. urgent care f/e?, local tariff?)
GP referral management scheme
Musculoskeletal pathway redesign
Patient centred angina management service - FY effect of 13/14
Continuing care incl. implement Newton review recommendations
Medicines management programme e.g.
Care Homes: Commissioning support for reviews
Commissioning discharge scheme for community pharmacists
Specialist clinics to assist to manage high cost medicines and patients requiring pharmacist, that provide educational
information and outreach services to reduce prescribing and monitoring errors among high-risk patients
Mental health - service reviews and efficiencies
Contained provision growth – acute, community, mental health, NHS continuing care
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RBK Health & Adult Social Care planned net expenditure 2014/15
Health & Adults Social Care (Net Expenditure)
Base Budget 2013/14
Adjustments to Base Budget
Base Budget 2014/15
Inflation Growth Budget Reductions
Budget 2014/15
By service £'000 £'000 £'000 £'000 £'000 £'000 £'000
Concessionary Travel, Safeguard & ASC Other 4,685 662 5,347 612 178 -640 5,497
Commissioning Long-Term 7,000 6,582 13,582 211 0 -34 13,759
Mental Health 4,120 84 4,204 18 0 -300 3,922
Commissioning Short-Term 18,330 -6,383 11,947 26 1,000 -60 12,913
Public Health 303 635 937 0 0 -400 537
Supporting People 3,428 -607 2,822 75 0 -170 2,726
Provider Services Long-Term 12,115 -7 12,109 56 0 -265 11,899
ADULT SOCIAL CARE 49,982 965 50,947 998 1,178 -1,869 51,254
Subjective Analysis Adult Social Care 2014/15- Summary
Base Budget 2013/14
Adjustments to Base
Budgets
Base Budget 2014/15
Inflation Growth Budget Reductions
Budget 2014/15
£'000 £'000 £'000 £'000 £'000 £'000 £'000
Depreciation & Impairment losses 793 -12 781 0 0 0 781
Direct Employee Costs 14,809 -459 14,350 148 0 -340 14,158
Indirect Employee Costs 118 -2 117 0 0 0 117
Premises related expenditure 1,034 7 1,041 0 0 0 1,041
Supplies & Services 1,565 13 1,579 400 0 -605 1,374
Support Services 6,938 524 7,462 0 0 0 7,462
Third Party Payments 39,504 425 39,929 495 1,329 -942 40,811
Transport related expenditure 451 -10 442 0 0 -8 434
Transfer Payments 9,226 -335 8,891 0 0 0 8,891
Expense Reporting Classes 74,439 152 74,591 1,043 1,329 -1,895 75,069
Fees & Charges for Services -7,061 749 -6,312 -46 -60 22 -6,396
Grants & Contributions Income -15,110 -256 -15,366 0 -91 4 -15,453
Other Income 0 0 0 0 0 0 0
Recharge credits -2,310 321 -1,989 0 0 0 -1,989
Income Reporting Classes -24,481 813 -23,668 -46 -151 26 -23,839
Reserve Movements 24 0 24 0 0 0 24
Total Reserves 24 0 24 0 0 0 24
HEALTH & ADULT SOCIAL CARE TOTAL 49,982 965 50,947 998 1,178 -1,869 51,254
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 22
Appendix 4 Related Documents
NHS Planning Guidance – Everyone Counts: Planning for Patients 2014/15 to 2018/19
The Care Bill 2013
The Children and Families Bill 2013
The NHS Belongs to the People: A Call To Action
A Call To Action – Commissioning for Prevention
Improving General Practice – A Call to Action
Securing excellence for Armed Forces – NHS England
London – A Call To Action
SW London Better Services Better Value Case For Change
5 Year Cancer Commissioning Strategy for London
Kingston Joint Strategic Needs Assessment
Kingston Joint Health and Wellbeing Strategy
Annual Public Health Report for Kingston 2013
Kingston CCG Commissioning Intentions 2014/15
Kingston Adult Social Care Plan 2013/14
Kingston Health and Wellbeing Board Commissioning Mandate for Mental Health
SW London Dementia Conference Report Dec13
Kingston Carers Strategy
Kingston Carers Action Plan
Kingston Voluntary and Community Sector Strategy
Kingston Better Care Fund Plan April 2014
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 23
Appendix 5 Kingston’s Better Care Fund Plan (April 2014)
Expected BCF allocations National Kingston
£m
14/15
£m
15/16
£000 14/15 (Established
funding routes)
£000 15/16 (BCF pooled
budget)
Existing transfer from health to
adult social care 1100 1100 2627 2627
Carers’ breaks funding 130 140 140
CCG reablement funding 300 932 932
Capital funding (including
Disabled Facilities Grant)+
354 859 859
Additional transfer from health
to pooled Better Care Fund 1900 6183
^
Totals 1100 3800* 4558 10741
CCG non-recurrent pump-
priming funding TBC
= contribution from adult social care budgets
= aggregate allowing for rounding etc
^ = expected to be made up 50 / 50 : rebadged / released from current spend
Kingston Draft BCF Plan – Key Elements
1. Multi-disciplinary working
1.1. MDT working
1.2. Kingston at Home extension (phase 1)
1.3. 7 day and 7 night working
1.4. Enhanced community support and development
1.5. Self-care and self-management
1.6. Housing (options and adaptations)
1.7. Information sharing
2. Out of Hospital Dementia Service (=Kingston at Home
extension phase 2)
3. Care and Support Reform (The care Bill)
4. Modified RAID Model (psychiatric liaison – rapid
assessment, interface, discharge)
5. Carers Support
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 24
Appendix 6 Draft Kingston CCG 5 Year Plan-on-a-Page
1: Im
pro
ve Q
ual
ity
esp
. Del
iver
Lo
nd
on
Qu
alit
y St
an
da
rds
(LQ
S); 7
day
/nig
ht
wo
rkin
g; o
pti
mis
e ac
cess
to c
on
sult
ant-
led
an
d s
up
po
rt s
ervi
ces;
imp
rove
d in
tegr
ated
wo
rkin
g o
ut
of
ho
spit
al
2: F
inan
cial
Su
stai
nab
ility
esp
ref
SWL
CC
Gs
‘do
no
thin
g’ t
arge
t sa
vin
g o
f 12
%; C
CG
tra
nsf
er o
f
£9.9
m t
o B
ette
r C
are
Fun
d in
15/
16 w
ith
aim
of
incr
easi
ng
sub
seq
uen
tly;
fin
anci
al p
ress
ure
s o
n T
rust
s es
pac
ute
se.
g. fr
om
ou
t o
f h
osp
ital
pre
ven
tio
n a
nd
ear
ly in
terv
enti
on
, an
d s
hif
ts o
f p
rovi
sio
n o
ut
of h
osp
ital
Kingston CCG – 5 Year Plan on a Page – March 2014 - DRAFT
Children - LQS esp specialists undertaking sufficient work to maintain specialist
skills, sufficient paediatric trained staff in all settings; improved CAMHS , single point of access and IAPT; improved Transition; assured Safeguarding; targeted prevention and education widespread and mainstreamed
Integrated Care - widespread, mainstreamed integrated working across
primary, community health and social, independent, voluntary and acute sectors facilitated by expanded, enhanced Better Care Fund and Kingston at Home programmes; mental health provision, esp. dementia care embedded; 7 day/night working as routine
Maternity – LQS: all consistently met for Kingston residents; extended midwife-
led provision; enhanced family-focussed, ante & postnatal community maternity service fully established; outcome-based commissioning implemented where beneficial; improved patient experience
Mental Health – extended, enhanced IAPT , ‘Community Wellbeing’ and adult
rehabilitation services; a range of mental wellbeing initiatives, all ages, mainstreamed; measurable delivery of the ‘Closing the Gap’ priorities
Planned Care – separation of planned and unplanned surgery; Kingston part of
SW London ‘Centre of Excellence’ model for planned care, using ‘multi-specialty elective centre’ (MSEC) for elective inpatients; clinical networks effective in support of MSEC incl. emergency cover
Transforming Primary Care – primary care established roles at core of BCF
implementation esp. risk stratification, MDT and multi-prof. team working; other new roles embedded e.g. for >75s; enhanced and extended self-care options; enhanced ‘federated working’ between GP practices extended and demonstrably beneficial
Urgent and Emergency Care – Kingston part of 2-level acute emergency
arrangements - major emergency centres, emergency centres; re-commissioned NHS111 and out of hours provision established; enhanced out of hospital capacity and capability in place; continued public information and education re. options C
: IT
–im
pro
ved
info
rmat
ion
sh
arin
g an
d g
ove
rnan
ce in
pla
ce t
o s
up
po
rt in
div
idu
al p
atie
nt
care
an
d w
ider
pla
nn
igan
d p
erfo
rman
ce m
anag
em
ent,
esp
acro
ss h
ealt
h a
nd
so
cial
car
e se
cto
rs
A:
Wo
rkfo
rce
–p
lan
nin
g an
d d
evel
op
men
t o
f w
ork
forc
e to
su
pp
ort
tra
nsi
tio
n o
f ex
isti
ng
staf
f fro
m a
cute
to p
rim
ary
and
co
mm
un
ity
sett
ings
; dev
elo
pm
ent
of
hyb
rid
hea
lth
/ s
oci
al c
are
role
s; in
tegr
ate
volu
nta
ry /
in
dep
end
ent
sect
or
wo
rkfo
rce
and
su
pp
ort
th
eir
dev
elo
pm
ent
to a
dd
ress
cle
ar r
equ
irem
ents
D:
Org
anis
atio
nal
Dev
elo
pm
ent
–fu
rth
er p
rogr
ess
on
bo
th f
orm
al a
nd
info
rmal
inte
grat
ed
wo
rkin
g –
bo
th c
om
mis
sio
ner
s an
d p
rovi
der
s
B:
Res
ou
rcin
g –
mo
re c
om
mis
sio
nin
g o
n o
utc
om
es b
asis
; no
vel f
un
din
g ar
ran
gem
ents
like
ly o
tb
e in
pla
ce
to r
ewar
d m
ult
i-p
rovi
der
arr
ange
men
ts fo
r jo
int
del
iver
y, in
itia
l fo
cus
aro
un
d B
CF
Drivers Enablers
PC, 28/3/14
Kingston’s CCG, Adult Social Care and Public Health Integrated Operating Plan 2014/15-2015/16 – Final v6 - April 2014 Page 25
Appendix 7 Draft NHS SW London 5 Year Plan-on-a-Page
For information: SWL SPG System plan on a page v.07 submitted to NHSE on 20th December 2013
People in south west London can access the right service, when and where they need it. Many services are delivered close to or in people’s homes, and innovation in service delivery is encouraged. Our hospitals are centres of excellence.
All care is safe, consistently of a high quality, and delivered by a suitably trained and experienced workforce. Patients are involved in their care, value their NHS and feel valued by it.
Improve safety, clinical quality and patient experience• We will address the issues in our Case for Change and will
agree the scale and pace of change in spring ‘14• As a minimum, we will commission:• full London Quality Standards (LQS) from [date TBA] &• Full implementation of the 10 Keogh key standards re: 7
day working by 2018/19
Overseen through the following governance arrangements• CCG Governing Bodies• Strategic Commissioning Group (SCG) composed of CCGs
and NHSE with LA representation• SWL Partnership Group: commissioners, providers and LAsWe will set up a number of subgroups eg:
• Patient and Public Advisory Group• OOH Programme Board• Clinical Advisory Group• Finance and Activity Group
Financially sustainable providers of NHS care• By 2018/19 all our providers of NHS care will be delivering
quality services in a financially sustainable way
Financially sustainable commissioners of services in SWL • By 2018/19 all commissioners of services in SWL will be
delivering a financial surplus
Delivery of the Out of Hospital Programme• Our CCGs will support each other in delivering individual
OOH strategies, focused on improving patient outcomes, integration and access.
• We will track our progress against our OOH metrics
Measured using the following success criteria• All providers of NHS care delivering high quality and safe
services in a financially sustainable way• All our commissioners delivering a financial surplus• Delivery of the agreed priorities• Health and wellbeing boards to have signed off all BCF
plans by March 2014• Demonstrable improvements in patient outcomes and
experience
Improve Out of Hospital (OOH) care, as a minimum, the following changes (from 10/11 baseline):
NHSE levers and enablers for primary care
Priorities for primary care• NHSE’s objective(s) for primary care in SWL to be agreed with
local commissioners and incorporated in the plan.
NHSE levers and enablers for specialised commissioning
Closer working between health and social care• We expect providers of NHS services to work closely
together, to share information and to work across the boundary between health and social care
Delivery of the Better Care Fund (BCF)• A significant shift of resources from institutionally based
services into services that support patients in their own homes and communities & agreed with acute providers
• CCGs will agree with LAs a set of common principles to be applied across SWL
• CCGs to develop BCF plans by March 2014
• 10% fewer A&E attendances
• 50% of remaining A&E attendances seen in an Urgent Care Centre
• 15%* fewer NEL admissions
• 5% reduction in overall outpatient appointments
• 12%* of outpatient appointments to be undertaken not on an acute hospital site
Priorities for specialised commissioning• NHSE’s objective(s) for specialised commissioning in south
west London to be agreed with local commissioners and incorporated in the plan.
Risk Mitigation(s)
CCGs and trusts run into deficit
•Demand management•Providers to reduce fixed costs
Acute providers differentially meet LQS with worsening unacceptable variation in safety and quality
•Providers to develop joint plans to be agreed with SCG•Contractual penalties/rewards egCQUINs•FT applications will be reviewed to ensure consistency with this plan.
Acute, MH and community providers do not work together
•A binding agreement between providers and commissioners to deliver the agreed changes •Contractual levers across different sites – eg CQUIN incentives
Recruitment and retention of appropriately skilled workforce
•Workforce engaged in co-designing new models of care and developing the necessary changes to education and training to meet the needs of the new system.
VIS
ION
Priorities Levers and enablers Governance
Priorities for Mental Health• High quality standards, care focused in the community,
reduced reliance on in patients beds and fewer sites for theseWorkforce transformation• Support local initiatives which engage the workforce in
meeting the dual challenge of delivering the necessary shifts in activity out of hospital whilst meeting the Keogh and LQS standards.
Key risks
Success criteria
Transparency re comparative performance• Increased provision of publically available information
*Targets vary by CCG
Development of a Joint Commissioning framework which will specify the pace of change to implement our priorities and be delivered through:• The commissioning process, specifically a shared approach
to contractual T&Cs and:1. Development of clinical networks to reduce variation in standards of care•Continued support for the Maternity Network•Development of a Children’s Network•Expectation that acute providers will work in networks eg: cancer, pathology, urgent care etc2. Provider development of clinical pathways•Providers to work together to redesign clinical pathways to deliver 7 day working and LQS – this may require proposals for changes in service configuration to be agreed at SCG