NHS Lambeth Draft Operating Plan 2012/13 Draft Lambe… · DRAFT NHS Lambeth Operating Plan 2012-13...

NHS Lambeth

Draft Operating Plan 2012/13 Version 1 .0 27 Feb 2012

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DRAFT NHS Lambeth Operating Plan 2012-13

NHS Lambeth

Version: 2.0 28_2_2012 MM

Key Contacts: Title Name Telephone Email

Clinical

Commissioning

Collaborative Chair:

Dr Adrian McLachlan 0203 049 4444 [email protected]

Managing

Director:

Andrew Eyres 0203 049 4444 [email protected]

Executive Lead

for operating planning:

Moira McGrath

Director of Care Pathway

Commissioning

0203 049 4481

[email protected]

Finance: Christine Caton

Chief Financial Officer

0203 049 4444 [email protected]

Workforce: Una Dalton

Director of HR and Corporate

Affairs


Performance: Emma Smith

Performance and

Information Manager


Engagement/ Sign off:

Supporting statement outlining process of consultation and engagement with stakeholders in development of Operating Plan for 2012-13.

Lambeth Clinical Commissioning Collaborative Board (LCCCB) is working as a sub-committee of Lambeth

Primary Care Trust with fully delegated responsibility for commissioning healthcare services for the

population of Lambeth and other patients registered with Lambeth GP practices.

The Operating Plan for 2012/13 builds on the work undertaken in the development of the NHS Lambeth

Commissioning Strategy Plan for 2012/13-2014/15: The development of clinical commissioning in

Lambeth has been a key means by which we have been able to enhance clinical involvement in the

development of our CSP refresh. While clinical design and involvement has always been part of our

strategic planning in Lambeth, through the leadership of the LCCCB we have increased the depth of

clinical involvement. As part of the development of the CSP we have undertook a series of clinical

discussions

31 August 2011

Lambeth & Southwark clinical leads meeting

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Discussed high level priorities and possible joint QIPP

Attended by clinical commissioning board members from Lambeth & Southwark

14 October 2011

Informal LCCCB board seminar

Joint Strategic Needs Assessment (JSNA) refresh presented and discussed

Confirmed health improvement priorities and identified further areas for testing.

Attended by clinical board members.

5 October 2011

Formal LCCCB meeting

Progress update on Strategic Plan updating on areas identified for further work and agreed engagement

process.

Attended by clinical board members.

12 October 2011

Lambeth practice event

Half day workshop for practices to discuss Strategic Plan priorities and implementation. Discussions

helped shape our programmes of work.

Attended by representatives from 34 of our 52 practices.

7 Dec 2011

The LCCCB agreed the draft Commissioning Strategy Plan at its meeting in public

11 Jan 2012

LCCCB reviewed the NHS Operating Framework guidance and implications for Lambeth

31 Jan 2012

Lambeth Practice event

Half day workshop for practices to consider locality and practice development and information needs

Attended by representatives from 36 of our 52 practices.

1 Feb 2012

LCCCB reviewed the proposed content of the Operating Plan

7 March 2012

LCCCB reviewing first draft of Lambeth Operating Plan

4 April 2012

Final draft of Lambeth Operating Plan to be reviewed by LCCCB alongside SEL Plan

The development of the Strategic Plan had been informed by work within each of our 4 programmes :

Planned care, Unplanned care, Mental Health and Staying Healthy

Each of these programmes has a clinical lead from the clinical commissioning board. The memberships

include a range of clinical engagement including hospital consultants, nurses, AHPs, GPs, Practice nurses,

Pharmacists, Dentists and Optometrists, social workers, paramedics and voluntary sector providers. They

have been engaged in pathway redesign work to inform our priorities, QIPP assumptions and work

programmes.

Our programme boards include senior representatives from our local provider organisations (through

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Lambeth & Southwark Urgent Care Network for Unplanned Care) who have been involved in developing

our plans as part of the CSP and in developing the Operating Plan. We presented our plan to Strategy

leads from Kings Health Partners in January 2012 in a joint session with NHs Southwark and ran 2

sessions to share our QIPP plans across Lambeth and Southwark to Kings and Guy’s & St Thomas in Dec

2011 and Jan 2012. The plans led by the Integrated Care Programme have been agreed by the multi

agency Programme Board representing all health and social care statutory organisations across Lambeth

and Southwark.

As part of the refresh of the CSP in 2011 we have undertaken a specific programme of engagement with

Lambeth residents, voluntary and community organisations and elected representatives involving a

discussion of ideas and principles of the Plan:

11 October 2011 partnership event with Lambeth LINk

Presentation and workshops on key aspects of the Strategic Plan. Feedback given on availability and

access to urgent care and primary care including pharmacies, staying healthy, outpatients, engagement

and communications.

20 October 2011 Health and Wellbeing Voluntary and Community Sector Forum

Question and answer session on the role of Lambeth clinical commissioning group, strategic priorities and

plans.

Feedback on older people and the Integrated Care Pilot, cancer services and screening, mental health and

diabetes. Discussion of co-creating principles across a wider range of care pathways.

16 November 2011 LINk Steering Group

Review of actions and input on the Strategic Plan

21 November 2011 Children’s Trust Board

Aligning approaches with the Children’s partnership

28 November 2011 Health & Wellbeing Partnership Workshop

Aligning the JSNA and the development of a health & wellbeing strategy across the partners working with

our communities.

7 December 2011 Lambeth Health and Adult Services Scrutiny Sub-Committee

Presentation of Strategic Plan to elected members of local authority

20 March 2012 Lambeth Health and Adult Services Scrutiny Sub-Committee

Paper on the Lambeth Operating Plan to be discussed

March 2012 (to be confirmed)

Proposed workshop with Lambeth LINk and voluntary sector on equality delivery scheme and Lambeth

plans

Patient and public participation plans for the workstreams described are in development and will be set

out in the April 2012 final version of the Operating Plan.

Dr Adrian

McLachlan, Chair of Lambeth Clinical

Commissioning Collaborative

Enter signature here

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Section One: Strategic Overview NHS Lambeth has agreed health outcomes as p[art of ots 3 year Commissioning

Strategy Plan ‘Improving Health, Improving Quality’. These are set out on te next

page

In addition, as part of the process across South East London, Lambeth has

contributed to and agreed a series of goals:

Better for You – Our vision for 2015

More people In South East London will stay healthy, and every patient will

experience joined-up healthcare which meets their needs in the most effective

way.

South East London strategic goals – In South East London we commission physical and mental healthcare across

home, primary, community and acute settings from a variety of NHS, voluntary

and independent sector providers. In every case, our ambition is to meet the

same strategic goals, that:

1. In every contact with the NHS and local public service partners, people are

encouraged and enabled to positively manage their own health, in partnership

with health professionals and their carers.

2. Patients experience the NHS as a joined-up personalised service, rather than a

disconnected set of services they are required to navigate.

3. Patients are treated with dignity and the respect due to them at all times.

4. Clinical decision-making and healthcare delivery is in line with evidence-based

best practice and takes account of value for money.

5. The logistics of healthcare delivery, within and across different care settings,

are

designed to meet patient needs, whether long-term or acute, in the most

effective way.

More effective clinical decision-making and healthcare delivery logistics will drive

a significant increase in productivity and enable the health and social care system

in South East London to manage increasing levels of demand without an

equivalent increase in resources. We have set an ambitious target for our health

economy of productivity improvement to the value of £117m over four years.

Through monitoring execution of plan and the achievement of our strategic goals,

we will be able to ensure and demonstrate to our population that we have been

able to make savings without compromising our ambition, or patients’

expectations, for care quality.

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NHS Lambeth Strategic Vision and Goals

Mission

Vision

Health

goals

Outcomes 2010-15 as

reviewed

To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

Health: Men will live 17 months longer and women 7 months longer; and the gap in life expectancy between most and least deprived will be reduced by 2 months Access: Comprehensive, round the clock access to integrated pathway based care, general and specialist; delivered through neighbourhood networks Affordability: A thriving, financially viable health economy delivering safe, effective, high quality care.

Cutting edge: Local services grounded in world class research, innovation and clinical education; in partnership with Kings Health Partners

Serious mental illness

Enable 1000 people with people with serious mental illness to move on from secondary care by accessing a new asset / recovery based service offer.

Cardio Vascular Disease

Improve hypertension control of 1000 more people in Lambeth

Diabetes

Help 5000 more people with diabetes bring their blood sugar under control

HIV

Halve the proportion of Lambeth residents diagnosed very late with HIV (<200 CD4 cells/mm3)

Smoking

Help over 12500 more people in Lambeth quit smoking

Childhood obesity

Help 900 more children overcome or avoid obesity; and help over 10000 children maintain a healthy weight

Life expectancy Health Inequalities Patient experience

98% users in CPA with

HONOS

76% of people with hypertension with BP <=

150/90

74.5% for

HbA1c <8

26% (2009) to

13% (by 2015)

1062 smoking quitters per

100,000

22.3% Year 6 obesity prevalence in

children

Alcohol (to be confirmed)

Increase the number of frontline staff who have received training in screening and brief intervention for alcohol misuse

90% of the identified frontline staff have received training in screening and brief intervention for alcohol

misuse

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Overview of case for change

Lambeth is an inner London borough with a growing population. Key features include high relative

deprivation, population mobility, diversity and density. It has a breadth of ethnic and cultural traditions

which have established their presence in particular town centre areas and quarters. The census area

classifications describe Lambeth as a London Cosmopolitan area similar to Southwark, Lewisham,

Hackney, Islington, Haringey and Brent.

Population Key Facts

The resident population was estimated at 283,300 with projected growth by a further 15% to 317,000 by

2028. The General practice registered population is estimated at 370,000. There is an even split of

males / females. Lambeth has a much younger population than seen nationally with over 50% aged 20-

44. Approximately 37% of the population is from Black & Minority Ethnicity (BME) communities. About

80,000 residents are classified as Black African or Caribbean and the Black African population is projected

to increase till 2031. There are about 137 different first languages spoken by children in schools

Deprivation - Poverty and social exclusion are some of the social challenges in the borough. Lambeth is

the 9th most deprived borough in London in 2010. In England, Lambeth is the 29th most deprived.

Income deprivation is relatively worse in both older people and children compared to London and England

as a whole as shown below.

Deprivation index Lambeth London England

Income Deprivation

Affecting Older People

Index

37%

27%

21%

Income Deprivation

Affecting Children Index

38% 30% 20%

Source: IMD 2010

Health Status of Lambeth Population

Progress overall

Life expectancy – Overall NHS Lambeth is one of the few spearhead areas to have increased life

expectancy in both men and women as a result of reduced premature deaths from cardiovascular

diseases, cancers, infant deaths and other causes. Between 1995-97 and 2007-09 life expectancy at

birth increased

- for men by 4.7 years to 76.4 years

- for women by 2.7 years to 81.1 years

- Compared to England the gap in life expectancy has reduced in the same timeframe for both men (by

37%) and women (by 7%).

Infant mortality – Infant mortality (deaths of infants aged under 1 year) has reduced by 39% (from 8.8

per 1000 live births in 1995-97 to 5.4 per 1000 live births in 2007-09).

Premature deaths from circulatory diseases –A three-year average mortality rate for circulatory

diseases (< 75 years) has fallen by 49% since the baseline, from 175.3 deaths per 100,000 in 1995-97 to

90.2 in 2007-09. The absolute gap in mortality rates between England and Lambeth has reduced by 42%

from a baseline gap of 34 deaths per 100,000 in 1995-97 to 20 in 2007-09.

Premature deaths from cancer – The three year average premature mortality (< 75 years) from all

cancers has fallen by 15% from a baseline 161.8 per 100000 in 1995-97 to 137.9 per 100000 to 2007-

09. However for the latest period the overall absolute gap between Lambeth and England has worsened

by 25%.

Despite this progress in key areas the health burden and inequalities remains a challenge. The main

causes of death leading to the life expectancy gap are heart disease, stroke, cancer of the lung,

respiratory disease and peptic ulcers and liver cirrhosis. In addition to the mortality gap people in

Lambeth are living longer with one or more long term conditions. Mental illness forms the largest

component of this burden but people are also living longer with cardiovascular disease, cancers, and

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chronic respiratory and digestive system disorders as survival improves. It is thus important to consider

early active case-detection, case management, medicine’s management and referral quality to avoid

unnecessary hospital admissions and improve quality of life. It is also important to consider end of life

care provision and support. People in Lambeth currently develop health conditions at a younger age and

live with these conditions for longer, often undetected until their condition is well advanced.

Key strategic priorities

Smoking

Lambeth has made good progress in reducing smoking prevalence with the development of a Lambeth

wide tobacco control strategy and sustained efforts to support smokers to quit. However smoking related

deaths and hospital admissions remain high and smoking remains an important priority for Lambeth.

Sexual Health

Lambeth has significant numbers of STIs diagnosed in local residents, high rates of teenage conceptions

and high rates of terminations. Therefore we have invested significantly in developing local services to

meet these needs. In the last five years we have made significant progress. Lambeth has the highest

Chlamydia screening uptake rates in England, has increased numbers of TOPs before 10 weeks gestation

and has introduced successful HIV testing pilots in primary care.

Teenage Conceptions

The under 18 conception rate is 59.5 per 1000 females aged 15-17 (267 conceptions). The under 18

conception rate has declined by 30.2% since 1998, the baseline and by 42.1% since 2003 when the rate

was at its highest. Lambeth has traditionally had one of the highest rates of under 18 conceptions.

However, data from 2009 shows that Lambeth has now the 11th highest rate in England

HIV

NHS Lambeth has identified HIV as a strategic priority. Lambeth Southwark and Lewisham have one of

the highest prevalence of HIV in the UK. Two main affected population groups are men having sex with

men (MSM), and black African heterosexuals. Late diagnosis of HIV is the most important factor

associated with HIV related morbidity and mortality and inpatient care in the UK. HIV testing is key to

reducing late diagnosis of HIV and in preventing secondary transmission. NHS Lambeth has set up an HIV

testing pilot in primary care and aims to expand this pilot to all practices.

Obesity, physical activity and healthy eating

The level of obesity in Lambeth adults (18.6%) is lower than the England average (23.6%) but is

worsening. Obesity in children aged 10-11 is high with up to 1 in 4 obese. 13.3% of children at reception

level are obese in Lambeth compared with 11% in London, and 9.9% in England.

Long Term Conditions

Diabetes

− Diabetes is a key strategic priority

− There are 13600 people with diabetes in Lambeth and the prevalence and numbers of detected cases

is increasing. Obesity is a major risk factor for type 2 diabetes.

− Key issues are the lower detection (see primary care services below) and the variation in

management of diabetes.

− NHS Lambeth is working with the Diabetes Modernisation Initiative to improve the detection and

management of diabetes.

− Early detection and reduced variation in the management and control of risk factors (secondary

prevention) remains an important challenge. Capacity to deal with the rising prevalence will also be

an important challenge.

Cardiovascular disease

− Cardiovascular disease is a key strategic priority

− There are just over 5000 detected cases of heart disease and over 3000 detected cases of stroke in

Lambeth. Other areas of importance in this condition include heart failure and heart arrhythmias

(particularly atrial fibrillation)

− Premature mortality is reducing significantly especially among men.

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− Key issues are under detection and variation in the management and control of people with CVD.

− Early detection and reduced variation in the management and control of risk factors (secondary

prevention) remains an important challenge and in particular implementation of NHS Health checks

for early detection and management of risk.

Mental Health

Mental health is a key strategic priority in Lambeth for two reasons

- Mental ill health is the biggest cause of years of life lost to disability locally. It is also a leading

contributor to premature death in people with other long term conditions such as diabetes and

cardiovascular disease.

- The costs of disability due to mental ill health are very high, not only to the NHS and social care but

also to the wider economy and to families and individuals on a social level.

- Lambeth partners (including voluntary sector and service users and carers) are collaborating on a

substantial service redesign ‘the Lambeth Living Well Collaborative’ (LLWC) for people with severe

mental illness (SMI) which has been awarded £100k by NESTA as one of six pilot projects in their

People Powered Health Programme. The aim of the LLWC is to ‘change the rules’ about services and

use co-production to develop a culture where people receiving services are at the heart of strategic

direction and decision making as well as planning their own recovery.

Other key issues

Alcohol

Alcohol and substance misuse is an important problem in the borough. It is estimated that 23%-24% of

Lambeth’s population (~70,000) drink excessively and Lambeth has higher levels of alcohol-related

hospital admissions than both London and England.

Cancer

Cancer is a South East London wide priority and iLambeth works on this with the South London wide

Cancer Network. Cancer accounts for approximately 25% of deaths in Lambeth. Over the last decade

there has been a steady in decline in the rate of cancer death in those aged under 75 in line with the

national target with the exception of a rise in 2008. There is a focus on preventing premature death from

cancer.

The uptake of cervical, breast and colorectal screening is below the national average although improving

slowly. Initiatives to improve uptake, targeted at Primary Care, are planned.

Raising awareness of cancer and it’s early detection are priorities. Lambeth has had a number of

successful bids from the National Raising Awareness and Early Detection Initiative (NAEDI) and run a

social marketing campaign for head and neck cancer. Plans are being formulated for the national bowel

cancer campaign which will be launched in January 2012.

Priorities and Opportunities

Priority outcome

Latest performance (and date) Trajectory for 2012/13

Serious mental illness

Cardio Vascular Disease

Diabetes

HIV

Smoking

Childhood Obesity

Alcohol

To deliver against these target priorities within the resources available Lambeth has set up 4 programmes

of work:

• Integrated Care: Planned

• Integrated Care : Unplanned

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These programmes are run jointly with NHS Southwark and are underpinned by the Integrated Care

Programme across NHS Lambeth, NHS Southwark, London Boroughs of Lambeth and Southwark and

Kings Health Partners

• Mental Health (linked to 4 borough commissioning approaches with Southwark, Lewisham and

Croydon and our partner London Boroughs)

• Staying Healthy (part of joint planning with London Borough of Lambeth)

Lambeth also works in the following commissioning partnerships:

Sexual Health (with Lewisham and Southwark)

Heart and Stroke (through the South London Cardiac and Stroke Network)

Cancer (through the South London Cancer Network)

Integrated Care: Planned Care

The Planned Care programme focuses on the development and delivery of an outpatient strategy to

reduce the risk of premature mortality and improve quality of life by:

• supporting patients to manage their own condition

• patient-centred care, with a shift in service provision along the care pathway, for identified

priorities, from treatment to prevention

• early detection of long term conditions (including HIV) to avoid preventable unplanned admissions

to hospital

• securing equity of access to services

• securing the quality and productivity in the management of elective condition and identifying the

most appropriate settings for support and treatment

• promoting appropriate referrals to specialist care

• reducing inappropriate variation in care

• reduce waiting times for patients for planned care

Our strategy will inform and be informed by work with local providers of care including Kings Health

partners. The strategy will include infrastructure planning across our three localities, including centres at

Akerman Road (due to open in July 2012) , Norwood Hall (due to open in 2013 subject to scheme

approval) and a review of Gracefield Gardens Neighbourhood Resource Centre. The programme will

oversee implementation of appropriate referral management processes. The programme is supported by

valuable resources from Guy’s & St Thomas’ Charity which funds the Diabetes Modernisation Initiative

across Lambeth and Southwark and has previously supported similar work in kidney care and sexual

health.

Key metrics for 2012/13

Outpatient referrals by source (GP/GDP/Consultant to consultant/other)

Numbers and waits for referral to treatment (RTT)

Outpatient attendances (first and follow up)

Diabetes HbA1c measures

Hypertension and cholesterol measures

Integrated care: Unplanned Care

The Unplanned Care Programme spans the organisational boundaries of acute, community, primary and

social care services to prevent avoidable hospital admission, support timely discharge and maximise

independent living by:

• Improving the quality of care and reducing the number of avoidable hospital admissions and

readmissions for frail older people

• Reducing the number of avoidable hospital admissions for conditions that can be managed in the

community by earlier identification and management of people at risk of admission

• Reduce avoidable readmissions to hospital

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• Reduce A&E attendance by people whose conditions can be self-managed or supported by a

pharmacist, nurse or GP

• Support hospital A&E departments to reduce waiting times

• Reviewing the virtual hospital and rapid response services piloted during 2011/12 and links to

intermediate care

• Rolling out of the reablement programme

• Reducing the number of people dying in hospital who would prefer to die at home

• Improving cost effectiveness of care including continuing care and moving people into planned

care pathways and development of the 111 access point for unscheduled care

Key metrics for 1012/13:

A&E attendances

A&E waiting times

Emergency admissions and length of stay

Numbers of people dying in their place of choice

Ambulance conveyance times

Mental Health

The Mental Health Improvement Programme was formed in 2010-11 to take forward NHS Lambeth’s

strategic priorities for MH including delivery of QIPP. A multi agency programme board co-chaired by

LCCCB clinical commissioner is focused on five key priority areas as outlined below which fully support

delivery of No Health Without Mental Health (NHWMH) strategy and Operating Framework.

• Serious Mental Illness (SMI) service redesign based on co-production principles via the Lambeth

Living Well Collaborative

• Integration of talking therapy services

• Criminal justice/forensic service redesign

• Implementation of Payment by Results (PBR) and Self directed support

• Implementation of Lambeth dementia strategy.

a) SMI redesign via LLWC

The Collaborative aims to use “co-production” as the operating framework for the delivery and

commissioning of services and support provided for people with long term mental illness. It has

undertaken extensive engagement with users, carers and partners. This has resulted in broad agreement

on a much improved service offer which it is currently implementing. This includes building capacity

within primary care via the new primary care mental health support service (PASS); recovery focused

provision within the Voluntary sector via the Community Options service; a more responsive and easier to

navigate secondary care (SLaM) supported by CQUINs; extensive development of peer support networks

and the expansion of time banking across the borough. The overall aim is to support people to take

control over their lives through recovery orientated personalised care and support and reduce the

dependency on (especially) secondary care services that this a common feature of mental health systems

nationally as well as in Lambeth. The Collaborative is working toward developing integrated service

arrangements via the development of an Alliance Contract Framework across the whole system, i.e.

primary care, social care, secondary care and the Voluntary sector. Key to this will be system wide

workforce training and development to support the significant culture change required to support “co-

production” in the delivery of public services in with the ambitions set out by Lambeth’s Cooperative

Council initiative, of which the Collaborative is an early adopter project. Whilst initially focused on people

with long term mental illness the Collaborative is of the view that the approach taken is equally

applicable to all people with long term conditions and as such will be seeking to widen its scope in future.

b) Criminal justice and forensic services care pathway redesign

This project focuses on developing early intervention and diversion (where appropriate) to address the

high number of people with untreated mental illness (especially amongst the BME population) in the

criminal justice system. A new criminal justice mental health support service is due to start in January

2012 (funded by Guy’s and St Thomas’ Charity) targeting people in police custody and the courts.

Agreement has been reached with SLaM on a stepped reduction in low/med secure beds from 12-13

onwards supported through application of triage; improved case management including speedier

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discharge and application of more flexible hospital/

c) Implementation of Payment by Results (PbR)

NHS Lambeth instigated and now facilitates the four borough/SLaM wide project group taking this work

forward. Key milestone shave been for 11/12 with implementation plans for the introductory year being

worked up. Allied to PbYR is the Self Directed Support/Personalisation workstream which will support

integrated health/social care packages . Lambeth is a Personal Health Budget pilot site for MH and is

currently processing 50 referrals with 11 people in receipt of budgets. It is expected this will be rolled out

further during 12-13.

d) Integrated talking therapies / counselling services

This project aims to improve access to, and the clinical effectiveness of, primary care talking therapies

commissioned by NHS Lambeth. An integrated talking therapy service specification has been developed

which covers the current IAPT (Improving Access to Psychological Therapy) and primary care counselling

services. As well as improving access, this will reduce fragmentation, duplication and overall cost. The

service is out to procurement and it is planned that a new contract for services will be in place from

August 2012.

e) Implementation of Dementia strategy

Service redesign aimed at supporting more effective community based services is the priority of the

Lambeth dementia strategy. It is planned to reduce the number of SLaM continuing care beds and

reinvest the savings to help more people remain in their own homes. Additional investment has been

targeted towards the expansion of the memory service, new day centre and the development of assisted

technology.


Improving Access to Psychological Therapies (IAPT) performance

HONOS scores

Staying Healthy

People in Lambeth have relatively lower life expectancy than other areas in London and are a population

at higher risk of morbidity. The greatest contributors to premature mortality are cardiovascular disease

and cancer, which can be prevented by addressing some common risk factors through an integrated and

systematic approach.

The key objective of the Staying Healthy Programme is to improve health outcomes for Lambeth

residents through the commissioning of systematic health promotion and prevention services that have

the effect of improving mortality rates, reducing morbidity and reducing the prevalence of key risk

factors. The Programme aims are to:

• Reduce health inequalities and improve health, identifying the need for interventions that improve

population health such as environment (physical activity) nutrition, etc and linking these wider

determinants to the delivery and management of preventable Long Term Conditions

• Develop Tobacco control measures including increasing the numbers of people stopping smoking

• Promote sensible drinking including ensuring all first contact health professionals deliver brief

intervention training and support work in A&E

• Prevent infant mortality (e.g. screening, immunisation, maternal health, childhood poverty

strategy)

• Integrate approaches to addressing the needs in Early Years, including increasing capacity and

skills of Early Years workforce to ensure implementation of Healthy Child Programme

• Develop early intervention and prevention for adolescent health. To reduce risk-taking behaviour:

sexual health & teenage pregnancy, youth violence, substance misuse, emotional & mental well

being and obesity

• Wellbeing programme


Smoking cessation

Childhood height and weight measures at reception & Y6

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Immunisation rates

Breastfeeding rates

Vascular health checks

Sexual Health

Lambeth has some of the highest levels of sexual ill health nationally as indicated by the local HIV

prevalence and high rates of HIV late diagnosis and local teenage conception and repeat abortions rates.

Sexual Health Commissioning seeks to reduce health inequalities and barriers and increase service access

for the three main at risk target groups; Young people, BME communities and Gay Men / men who have

sex with men (MSM).

The following are Sexual Health & HIV priorities in the coming year

HIV -reduction of HIV late diagnosis

a) HIV Screening

• Ongoing expansion of HIV testing sites beyond 10 is planned although dependent on an evaluation

of the current pilot sites that have been in place since Jan 2010. An evaluation framework is in

development and will have been finalised by April 2012 with the planned completion of the

evaluation in Q1 12/13 with expansion to 10 additional sites in Q2 12/13 onwards

• Develop KPI for the core GP contract

• The ongoing development of communication and information sharing with the local population

through campaigns, publication and social networking - to be developed for 2012/13 as part of the

normalisation of HIV and to reduce HIV related stigma

• Expansion of Sexual Health in Practice (SHIP) training programme within 70% of the Lambeth

screening practices by Q3 2012/13. This programme has shown to be successful in Birmingham

and in improving HIV testing rates within the new patient registration cohorts but also for

delivering a high positive patient yield in targeted HIV screening following training. This training

would also provided a stronger foundation on which to build 'HIV shared care' models to maximise

the uptake of primary care services bp people living with HIV.

b) HIV care and support

HIV can now be managed as a long term treatable condition if diagnosed and treated early. Prevalence

rates in Lambeth are the highest nationally and this presents one of the highest risk areas in sexual

Health.The HIV care and support review completed in 2011 has provided a service model defining a long

term activity shift agenda, that will develop capacity within mainstream services and develop the

interface between HIV specialist services and primary care. The 3 month public consultation is completed

and the response drafted but the major milestones for 2012/13 are the development of a robust

implementation plan and defining of multiple projects of work that will drive re-design in care pathways

and release efficiencies to support the ongoing expansion of HIV testing. There will be a defined work

stream to focus on mental health & HIV and a phased shift activity out of the CASCAID.service into IAPT

services starting in 2012/13. Exact shift percentages are to be defined

c) Sexual Health tariff

To improve patient experience and service outcomes through the Implementation of the integrated

Sexual Health Tariff in year across Lambeth services. Work with providers to drive service re-design and

the optimal staff alignment according to tariff and to review the service landscape in year in relation to

the KHP agenda. Mitigate against service destabilisation throughout the implementation process.

d) HIV Prevention

Release savings from re-tender of the Pan London HIV prevention programme for re-tender in 2012/13

and through the re-tender of the African HIV prevention programme, ensure clearer linkages and

synergies between the regional and local provision and clearer linkages to HIV testing.

e) Strategy

Refresh of the Sexual Health & HIV Strategy in advance of transition to the London Borough of Lambeth

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Primary Care

High quality primary care underpins the successful delivery of all of our plans for out of hospital care and

primary and community services transformation, being the foundation of each care pathway (e.g. safe

care, right care, end of life care, urgent and emergency care, long term conditions) and our vision for

integrated care networks. Our ambition is to achieve continuous improvements in quality, productivity,

patient experience and health outcomes of primary care and produce a legacy for our Pathfinders to build

upon.

Primary care contracting is led by one team across South East London working with LCCCB to improve the

quality and cost effectiveness of services.

To drive efficiency and productivity improvements we have commenced Primary Medical Services (PMS)

reviews for Lambeth with the aim of commissioning services to match the identified health needs of the

population through a core offering to be delivered by each practice.

There is a strong need for greater transparency of performance information. Using the London-wide List

Maintenance policy, we will ensure that all practices have accurate and validated registered lists. This will

enable monitoring of practices’ actual performance regarding, for example, immunisation levels,

screening coverage and prevalence levels of long term conditions. This information will feed into the pan-

London dashboard for quality outcomes and contract compliance that we will utilise to support improved

performance in 2012/13. We will continuously monitor contract performance and quality of services

delivered. The performance framework reviews on infection control, health and safety, business

continuity, child protection, employment checks and clinical governance domains. We will continue to,

proactively managing instances of poor performance in south east London, including the issue of breach

and remedial notices as required. Opportunities are being taken on retirement of practitioners to review

the current provision and to agree new arrangements such as list dispersal.

We will roll out EMIS Web (a GP practice information system) to practices across Lambeth which will allow

the delivery of the electronic transfer of patient records between GP practices, the uploading of the

summary care record and the next iteration of the electronic prescription service (EPS2). EPS2 will allow

patients to nominate their pharmacy for prescription pickup and assist practices in reducing repeat

prescription workload. Unplanned care in SEL London is provided through a complex network of services,

including primary and secondary care services. We have an opportunity to build upon existing services

and developments to ensure quality and value for money.

We aim to:

• Understand the current issues regarding the delivery of unplanned care both in and out of hours

• Understand what is driving demand

• Review how services are commissioned and develop best practice consistent approaches to support

future contractual arrangements, where appropriate

• Understand future changes and their impact, including but not exclusive to the implementation of 111

• Map potential duplication in provision of unscheduled care services within and across boroughs and

make recommendations for cost effective commissioning of services to future CCGs and the NHS National

Commissioning Board.

Milestones / Key Actions Achievement Date

See Appendix 1

15

Section Two: London Health Programmes 2.1 Summarise the key outstanding actions that need to be taken in 2012/13 in your cluster to

ensure completion of the cardiovascular, stroke and trauma programmes (NB a core set of

metrics on these 3 London programmes will be agreed with the clinical networks in advance of

2012/13). [Wording from SEL Plan]

The cardiovascular programmes have been focused on improving patient access and management to

ensure equal access to specialist services. In the case of cardiac surgery vascular surgery NSTEACS and

complex arrhythmia this has involved improvements in local networks, changes to patient pathways and

consolidation of services and specialist care on to a single site within the network.

The Stroke programme has been focussed on the acute aspect of the pathway for all stroke and TIA

patients and is nearing completion. For stroke patients the area of focus is now shifting to improving

discharge and rehabilitation services.

Cardiovascular and Stroke Milestones specific to South East London are to be developed and included in

later versions of the Operating Plan.

The major trauma system for London is now fully operational with four Trauma Networks, each consisting

of a Major Trauma Centre and a number of Trauma Units. The Major Trauma Centre for SEL is King’s

College Hospital.

Activity is monitored by completion and submission of reports to TARN, (Trauma Audit & Research

Network) which is a contractual requirement for all Major Trauma Centres and Trauma Units.

The London Trauma Office hosted by the London Specialised Commissioning Group is responsible for

developing, implementing and monitoring a performance framework supported by in-year onsite

assessments. The performance framework will be managed through the London SCG specialised services

contract with the Major Trauma Centre (King’s College Hospital). Payment of the quality premium

(c£2.5M per Major Trauma Centre to support the additional costs of meeting the higher service and

quality standards) is linked to evidencing compliance/achievement with the performance framework and

Major Trauma Centre service specification, with payment managed through the London SCG contract.

In 2012-13 the priority areas for inclusion in the performance framework will be

o Completion of a ‘rehabilitation prescription’ for each patient

o Completion and submission of the TARN data set to TARN for each eligible patient

o Specific areas of clinical care as described in the framework

The Trauma Office is developing a Performance Framework and from this will be developed milestones

specific to South East London. These will be available in a later version of the Operating Plan.


1. All NSTEACS centres will be delivering all A2 quality standards September 2012

2. Direct LAS transfers of emergency arrhythmia to centrally commissioned units,

that meet the quality care standards for management of emergency on 24/7 basis

November 2012

3. All devices and EP/ablations procedures are being delivered at units that meet

the devices and EP/ablations quality standards

April 2012 through to March 2013

4. Non-emergency mitral valve operations will only be undertaken cardiac surgeons

with a specialist interest and training in mitral valve surgery. All units and surgeons

will provide audit data to demonstrate they meet the quality standards for care

delivery

March 2013

5. Complex arterial vascular surgery centralised on to designated site that meets

all commissioning standards for 2011/12

June 2012

6. Systematic assessment process against all the standards set out in London

Stroke Tariff completed

April 2012

7. Annual assessment process for stroke introduced with regular monitoring of

standards via SINAP/SSNAP and visits, where necessary. Completion of SLHT

HASU assessment (April 2013) and SU assessments (November 2012)

April 2012

8. All stroke rehabilitation providers will have met the 5 recommendations set out

in the Commissioning Support for London Stroke Rehabilitation Guide

April 2013

16

9. ‘Life after stroke: commissioning guide’ - progress in implementing

recommendations in the Life after stroke: commissioning guide

April 2013

10. Improvements have been made to the cardiac surgery, vascular surgery,

NSTEACS and complex arrhythmia local networks, changes to patient pathways

and consolidation of services and specialist care on to a single site within the

network

April 2012

Section Three: Performance and Quality 3.1 Performance in 2011/12 against the Headline and Supporting Measures

During 2011/12 (based on April to December) where NHS Lambeth performed well against a

number of the acute performance measures, notably:

• PCT on target to meet the MRSA target

• Overall Cancer targets (2 week urgent referrals, 31 day referral to treatment, 31 day subsequent

chemotherapy, 62 day referral from screening)

• Access to stroke services

During 2011/12 (based on April to October) where NHS Lambeth performed well against a

number of the non acute performance measures, notably:

• Smoking quitters

• Breastfeeding (improvement in prevalence and coverage)

• Immunisations (improvement in update)

• NHS Health Checks (improved recording resulting in the target being exceeded)

• IAPT – Proportion of people with depression referred for and receiving psychological therapy.

• The number of new cases of psychosis served by early intervention teams.

• Access to dentistry

• Carers Breaks (plans and budgets in place to support carers)

In 2011/12 there have also been some acute areas which have performed below the expected

levels:

• A&E 4 hour waits (subject to conformation of Quarter 4 figures 2011/12)

• Referral to Treatment Times

• CDifficile (improving)

In 2011/12 there have also been some non acute areas which have performed below the

expected levels:

• Cervical screening Test results.

•

3.2 Summarise the Cluster's performance priorities and challenges for 2012/13:

Lambeth’s priorities and challenges for 2012/13 :

• Referral to Treatment – Guy’s & St Thomas’ current plan is to eliminate the admitted backlog by

quarter 2, 2012/3. The focus will be on sustaining a specialty level monthly performance. Both

trusts have made significant improvements in reducing the number of patients on incomplete

pathways and will continue to reduce these in 2012/13. They have also made significant inroads

in addressing diagnostics backlogs. The Cluster is working with trusts to establish a suitable level

of capacity to manage the increased in workload expected from the Bowel Cancer Awareness

Campaign and screening age extension.

• Emergency Access- NHS Lambeth is working through the Integrated Care Programme to develop

the following during 2012/13:

o Urgent (24/48 hour) access to holistic older people’s assessment on an outpatient basis at

St Thomas’ and Kings

o Developing registers at GP practice level of older people at risk of admission

17

o Annual holistic review of older people in primary care

o Commissioning community based urgent access provision for patients with COPD

In addition NHS Lambeth will be undertaking the following urgent care initiatives:

o Re-commissioning the urgent care centre at St Thomas’

o Commissioning the 111 unscheduled care service in partnership with other South East

London CCGs

o Commissioning diversion schemes from St Thomas’ including patient advisory and liaison

services and piloting diversion to local practices.

o Reviewing the 8am-8pm primary care service at Gracefield Gardens

o Developing further the ‘Choose Well campaign to support patients to make informed

choices about services they use

• The 2012/13 objectives for healthcare associated infection (HCAI) are challenging both at acute

trust and PCT level (hospital cases). Initial trajectories for delivering both MRSA and CDI

(clostridium difficile Infection) objectives have been set with acute trusts and BSUs. Following the

recently published guidance on CDI testing, the trajectories for CDI may be amended. The new

guidance proposes a dual testing process in acute trusts, similar to that already undertaken by

GSTT.

With the introduction of a new double testing regime for CDiff at GSTT in September 2010 more

cases are being detected than the originally set baseline. This is impacting on local targets and will

prove challenging during 2012/13. Lambeth’s CDiff target for 2012/13 is 73 and 4 for MRSA. Local

commissioners and public health leads and working together with Trusts to consider alternative

approaches to management and monitoring for 2012/13.

• 62 day urgent referrals to treatment – GST has made improvements in the urology pathway

earlier in the year and more recently in the pathway for Lower GI, particularly access to

colonoscopies through the use of the additional endoscopy capacity on the St Thomas’ site. Early

indications are that this has resulted in improved performance (Oct 2011). If this level of

performance is maintained then this performance threshold should not present an issue in

2012/13.

• Ambulance service CAT A emergency calls - key events that could impact upon performance in

2012/13 are as follows:

o Olympics – separate funding has been agreed with the DH in order to maintain business as

usual and includes funding for a expected general rise in activity.

o Other large events – Queen’s Jubilee, Public Demonstrations

o Implementation of 111 – ambulance activity could potentially rise while new providers bed

in.

o Further Industrial Action

Plans are already underway to mitigate against the risks identified above.

• Immunisation - Lambeth's priority for 12/13 is to improve performance in immunising hard to

reach children including those over the age of 5. A CQUIN is proposed in the 12/13 Provider

contract to ensure this targeted work is prioritised and supported and monitored effectively. A

new database, GPIUS will be used from March 2012 which will improve data quality and free up

health visitors to concentrate on improving performance. This includes engagement with primary

schools and early years providers to implement standardised collection of information on the

immunisation status of new entrants, exploring options for offering vaccinations to under-

vaccinated children, and identify opportunities to promote immunisation. A detailed Action plan

has been reviewed and amended for 12/13 onwards and implementation is overseen by the

Lambeth & Southwark childhood immunisation strategy group, which reports to the executive lead in each BSU. Targets remain at 90% for all childhood immunisations for 2012/13.

• Breast feeding - Although performance has improved there is still some way to go in 2012/13.

Lambeth is implementing improved ways of working including data collection by health visitors in

order to increase prevalence at 6-8 weeks, taking into account learning from colleagues in

Southwark where performance is good. Lambeth is undergoing the UNICEF Baby Friendly

18

Initiative (BFI) and is in the process of finalising the detailed action plan and community

breastfeeding policy which will be implemented in a range of community settings including

children Centres and GP practices. Lambeth is on track to receive the certificate of commitment

by April 2012 and will work towards Level 1 accreditation throughout 12/13. This will focus on

developing and implementing an effective multi-agency training strategy; reviewing all

breastfeeding policy and procedures in a range of community settings and developing and

implementing a communication strategy with parents. There is good governance for breastfeeding

with an operational group overseeing BFI implementation and a Lambeth Breastfeeding strategy

group established which is attended by the clinical commissioning lead. The target remain at 90% for breastfeeding prevalence and 95% for coverage.

• Smoking Quitters -In line with the 2012/13 Operating Framework Public Health Quality Smoking

Quitters performance measure, this area will be a priority moving forward. Lambeth made huge

progress during 2011/12 and exceeded Department of Health targets. Target performance will be

maintained during 2012/13 and a further local stretch target has been set. King's Health Partners

has developed a Stop Smoking Focus Group, which involves key stakeholders across the health

care community. The group is developing innovation that will enhance smoking cessation services

across Lambeth and Southwark. This proactive approach ensures there is the opportunity to focus

on individual cohorts of patients that historically have been difficult to engage. The 2012/13 target

for Lambeth is 1910 patients quitting at the 4 week stage.

• Cervical Screening Test Results - Lambeth performance on this target improved considerably

during 2011/12 Q3 reaching 99% in December, however performance has not always been

consistent and remains an area that requires ongoing attention. Guy's and St Thomas' Trust has

acknowledged that it has been understaffed in the laboratories and has provided a commitment to

staff up to sufficient levels to maintain the improvement in performance

• Bowel Screening - The bowel cancer national awareness which runs for 8 weeks from the end of

January will pose a risk to performance in 2012/13 as projected demand increases. The roll out of

the age extension for the Bowel Cancer Screening Programme was due to commence Q4 2011/12

however this will be delayed until Q1/2 2012/13 due to impact of national awareness programme.

Planning with the Acute Trusts to increase capacity has commenced and performance leads will

continue to work with the Cancer Screening Lead for South East London and the South East

London Cancer Network. Work streams have been identified and are currently being worked

through and the recently formed South East London Cancer Screening Board will be reviewing

performance and progress.

• Health Checks – Lambeth has exceeded targets for 2011/12 and will be embedding good practice

during 2012/13 in primary care and through targeting harder to reach people through the Lambeth

Early Intervention and Prevention services (LEIPS) Lambeth, Southwark and Lewisham have

developed a joint service specification, which will ensure more consistency of provision. A

comprehensive programme of evaluation will take place during 2012/13.


See Appendix 2 (in development) to contain trajectories agreed for targets above:

19

Section Four: Priority areas Priority areas

To be inserted by

NHSL once Op

Framework is out

DH Requirement Delegation to

CCGs

(yes/no)?

Actions required to maintain or achieve requirement.

Please include key risks and mitigations.

Achievement

Date

Health

visitors/Family

Nurse

Partnerships

• Clusters to work towards delivering

provider-based 2012/13 trajectories due

to be issued by NHSL w/c 5th December.

This is in line with the Government

commitment of an additional 4200 by

April 2015.

• Maintain existing delivery and continue

expansion of the Family Nurse

Partnership programme in line with the

Government commitment to double

capacity to 13,000 places by April 2015.

(Section 2.13 of Operating Framework)

Based on the most recent trajectory from NHSL based on

the deprivation model, Lambeth is on course to meet the

target for number of staff in post as at April 2012 (42.2).

We are working closely with GSTT to ensure effective

recruitment & retention in subsequent years and have

identified funding to support this commissioning process for 2012/13.

Lambeth will be undergoing our FNP annual review in

Jan/Feb 2012. In line with recommendations from the

previous Southwark annual review we are establishing a

S&L Advisory Group to oversee key developments and

ensure continued delivery and expansion in line with the Government directive.

April 2013

Olympic-

Paralympic

Games-time

delivery

[SEL Plan

wording]

• Deliver business as usual performance

levels, whilst meeting any increase in

demand associated with the Games

(“Games Effect”) at Games-time.

• Meet the bid commitments by providing

LOCOG with the necessary ambulance and

paramedic resources at all LOCOG Events

and through the Designated Hospitals

(Non-designated hospitals if clinically

appropriate) providing free healthcare for

the accredited members of the Games

Family.

• Provide appropriate contingency for

health resilience at Games Time in

compliance with DH guidance as part of

A pan Cluster Olympics and Paralympics co-ordinating

group, chaired by the deputy CEO, was established in

Summer 2011. The approach is to focus on borough

working with pan-SEL co-ordination.

This group recognises that it is the Cluster’s role to co-

ordinate a system response to Games time planning across

SE London and it is working to the requirements and

timescales of the of the London wide games time delivery

group and overseeing the delivery of a comprehensive

project plan with six priority work streams :-

• Emergency planning and response

• Human resources and staffing

• Communications and engagement

• Readiness of Acute Hospital services

20

the contribution to the Olympic Security

and Safety Programme.

A comprehensive NHS Games Planning

toolkit and reference pack has been

produced by NHS London, this can be

accessed at:

http://www.london.nhs.uk/getting-fit-for-

the-2012-games.

Games time is between the 9th of July 2012

and the 12th September 2012.

• Readiness of Primary, community and non acute

hospital services

• Legacy

The key risks identified that we are working to mitigate are

:-

• Transportation : Ensuring Staff in Cluster and NHS

providers can get to work/manage their work

remotely etc

• Workforce : Ensuring staff leave properly planned,

that staff are prepared to minimise disruption and

that all guidance on volunteering followed

• Emergency response : Ensuring responses robust

and fit for purpose with clarity of communications

between NHS bodies

• Greenwich : Ensuring we can manage the ‘pinch

point’ in Greenwich where many significant

Olympics events are being held

• Transformation : Ensuring we can handle an event

of this scale whilst also undergoing very significant

multi dimensional organisational change with

potential for key staff to ‘move on’ before and

during event.

Innovation

• Evidence the PCT Cluster is preparing to

implement the Innovation Review. Please

outline the key milestones that will

ensure implementation of the review with

particular reference to compliance with

list of high impact innovations and

accelerating adoption and diffusion of

innovative best practice.

http://www.dh.gov.uk/prod_consum_dh/

groups/dh_digitalassets/documents/digita

lasset/dh_131784.pdf

A baseline review will be undertaken on the high impact

innovations. The expectation is that this will have been

completed by the end of March 2012 for implementation

during 2012/13.

31 March 2012

Informatics

• Include evidence of consideration of

informatics capability and capacity

The Cluster is reviewing its informatics capability

(including information management, technology and

21

[SEL Plan

wording]

necessary to support the transition.

• Include a credible proposal for giving

patients on-line access to their medical

records, starting with their GP records.

• Provide an achievable trajectory for

providing Summary Care Records by

March 2013 to all residents who have

been written to.


governance) to ensure that it remains fit for purpose

for current and emerging organisations. The Cluster

Management Board is responsible for considering

informatics capacity and capability, and considering

proposals for strengthening this key service area. The

South London Commissioning Support Service

programme will oversee the specific development of a

capable informatics service to support emerging

Clinical Commissioning Groups. This programme will

also oversee the provision of ICT services to a range of

other third parties, such as the South East London

health Protection Unit, to assure service provision

through 2012/13 and beyond. The ICT service will

dovetail with Estates services to ensure collaboration

and the development of complementary strategies.

The Primary Care Directorate are working with primary

care contractors, emerging Clinical Commissioning

Groups and the LMC to ensure that giving access for

patients to their GP records, and moving forwards to

their full medical record, is considered a key priority.

The ICT function is and will continue to engage with

clinical system providers to ensure that a) the technical

capability is in place across all GP practices within

South East London, and b) that a deployment plan will

be created in partnership with GPs and patients to

ensure that access is granted in line with national,

regional and locally agreed timetables. Progress in

delivering this capability will be overseen by the

Cluster’s ICT Steering Group, supported by a Primary

Care ICT Programme Board.

There are 267 practices of which 114 practices have

uploaded SCR covering 768,000 patients (41%). SEL

has a project board set up to oversee SCR which meets

monthly to review progress against plans. Resource

has been authorised to deploy SCR to LSL-G has the

necessary required staff allocated to deliver EMIS Web

and SCR with dedicated project managers, clinical

22

transformation leads and technical leads, and RA.

Bexley & Bromley manage their deployment with

current resources. SEL has a Communications Strategy

that sets out the comms plan with the key

stakeholders. There remains a further 153

deployments to be completed by 31st March 2013 with

19 being deployed by 31st March 2012.

Public Sector

Equality Duty

(PSED)

• Include assurance that due regard is

given to the Public Sector Equality Duty

(PSED), both specific and general, and

that equality objectives are integrated

into the plan considering using the

Equality Delivery System as the

framework.


LCCCB has signed up to the EDS as well as signing up to

the EDS as part of the Pathfinder Delegation application

process. Progress and equalities information was

published at the end of January 2012 as required by the

national timetable.

Lambeth is proposing to hold a workshop during March

2012 subject to agreement and further discussions with

Lambeth LINk to undertake a scoring exercise and seek

input into current plans.

We are in the process of developing equality targets for

each of our strategic outcome objectives for the final

version of the CSP.

March 2012

April 2012

Safeguarding

Children and

adults

• Ensure a sustained focus on robust

safeguarding arrangements (to include

how the Board assures itself).

• To work in partnership through Local

Safeguarding Children Boards (LSCBs)

and ensure ongoing access to the

expertise of designated professionals.

• Work with developing CCGs to ensure

they are prepared for their safeguarding

responsibilities.

• (Section 2.43 of Operating Framework)

Ensure a sustained focus on robust

safeguarding arrangements.

• Work with developing CCGs to ensure

they are prepared for their safeguarding

responsibilities.


Executive leads for Adult and Children’s safeguarding are

in place. A commissioning policy for children’s

safeguarding and a guide for GPs has been agreed by

LCCCB. The Clinical Network Lead co-chairs the Adult

Safeguarding Board. Designated professional leads for

children’s safeguarding are in place and in addition LCCCB

has funded a GP to support safeguarding advice and

training for children’s and adult safeguarding. Escalation

procedures in place with designated professionals to

ensure that executive and board members are aware of

safeguarding issues. Training numbers and serious case

review recommendations and implementation monitored

by LCCCB. A LCCCB seminar on safeguarding is planned

for March 2012. LCCCB leads for children and adult

safeguarding are identified.

March 2012

Military and • Work with the London Armed Forces South East London cluster is linked to the London Armed

23

veterans’

health

[SEL plan

wording]

Network to ensure the principles of the

Armed Forces Network Covenant are met

for the armed forces, their families and

veterans.

• Ensure that the Ministry of Defence/NHS

Transition Protocol for those who have

been seriously injured in the course of

their duty is implemented in any

commissioned service.

• PCT Clusters, and organisations they

commission from, should be supportive

towards those staff who volunteer for

reserve duties.


Forces Network which has four key work programmes on

veterans community mental health, reservist terms &

conditions, primary care engagement and access for

veterans to NHS care.

Mental health

• Continue to meet expectations within No

Health Without Mental Health and NHS

Outcomes Framework.

• IAPT to meet 15% prevalence with

recovery rate of at least 50%.

• Focus needed on minority groups, older

people, people with serious mental

illness and long term conditions.

• Reduction of mortality from physical

illness in those with mental illness.

• Focus on joint working with National

Offender Management Service.

• Focus on mental health prevention in

looked after children and other young

people at risk.

• QIPP achievement monitored against MH

Performance Framework covering new

cases of psychosis served by EIT,

gatekeeping of acute admissions by crisis

teams, 7-day post discharge follow up for

those on CPA.

• Elimination of mixed sex accommodation


• Minority groups – Lambeth’s various initiatives are

addressing needs of minority groups as outlined

here

• Mortality – CQUIN physical health targets are being

met by SLaM ; the improved primary care and

secondary care interface through the primary care

mental health support service will further sustain

improvements in this key target area.

• Offender health - NHS Lambeth works with NOMS

and other criminal justice agencies in a number of

ways. The re-role of HMP Brixton is being

undertaken in a planned, collaborative way with the

Prison, the providers, NHS Wandsworth (in relation

to HMP Wandsworth transfers) and NOMS to ensure

a smooth transition for patient health care. NHS

Lambeth is involved in development and operation

of the Integrated Offender Management (IOM)

programme in Lambeth. The Lambeth MHIP

Criminal Justice Pathway project (as above)

involves the entire criminal justice pathway, per the

Bradley Report, including prisons and Probation.

• Looked After Children (LAC) - range of Tier 2 and

Tier 3 community services in place for 2012/2013,

including a LAC CAMH Service (CLAMHS), YOS

24

CAMH Service and an integrated Early Intervention

Service. Implementation of CAMHS IAPT service in

Lambeth is in process, which will be integrated with

existing parenting programmes.

• QIPP Key performance targets - CPA, HONOS, EI

and HTT are being met together with MH QIPP

savings target

• SLaM continue to comply with the Mixed sex

accommodation policy with no breaches during

2011-12

Carers

• Publication by 30 September 2012 of

Local Authority and PCT Cluster joint

needs assessment with agreed plans

policies and identified budgets with Local

Authorities and voluntary groups to

support carers.

• To include identification of total budget

to support carers breaks and indicative

number of breaks available within the

budget.


Following the publication of the Refreshed National Carers

Strategy, the Lambeth Carers Strategy was refreshed in

2011. The Refreshed Lambeth Carers Strategy which took

into consideration the needs of carers outlined agreed

plans and identified budgets to support carers till the end

of the financial year 2012/2013 including the number of

available breaks. The Carers Strategy is a joint LB

Lambeth/NHS Lambeth document.

A major piece of work is currently being carried out to

review all forms of respite provision for carers in Lambeth.

The intended outcome is to develop policy proposals

leading to new models of care, direct payment for carers

and ensuring investment equity for carers of all types.

Dementia and

care of older

people

• Ensure providers are compliant with NICE

quality standards and information

published in provider quality accounts.

• Work with GPs to ensure improvements

in general practice and community

services including improvement of

diagnostic rates.

• Ensure participation in and publication of

national clinical audits.

• Outline initiatives to reduce inappropriate

antipsychotic prescribing.

• Continued drive to eliminate Mixed Sex

Providers are required to comply with NICE quality

standards and to publish as part of Quality Accounts as

part of our contractual requirements We will continue to

monitor this through a well established process of quality

outcome review meetings and challenging providers to

improve quality and improve efficiency.

We are seeking to improve participation in national audit

and would hope to confirm a programme of participation in

national audits over the coming year.

We propose that participation in national clinical audit

should form part of contractual requirements for 2012/13.

It is part of the national Quality Accounts template.

25

Accommodation. Reporting of

inappropriate admission rates.

• Non payment for emergency

readmissions within 30 days of discharge

from elective admission.


The Lambeth & Southwark Dementia workplan will ensure

Lambeth and Southwark participate in and publish results

of national clinical audits.

To participate in NHS London Primary Care Audit on use of

antipsychotic medication

To develop and implement an action plan following

outcome of audit working with local GPs, specialist mental

health services, voluntary and third sector providers.

To continue to raise awareness of dementia amongst

health and social care workers

To monitor the impact of the Southwark and Lambeth

Memory Service.

To analyse referral by GP practice targeting those who

refer fewer than expected numbers of patients

To improve awareness and diagnosis of dementia for

people in acute hospital setting by the implementation and

monitoring of National Dementia CQUIN across all sectors

of care

Local mental health services are compliant with privacy

and dignity requirements and elimination of mixed sex

accommodation. Any breach in same sex accommodation

requirements is received in the reporting data from

providers and monitored through the course of our

contract monitoring arrangements.

We have agreed proposals in 2011/12 contracts for non

payment for emergency readmissions within 30 days of

discharge from elective admissions and propose a similar

agreement for 2012/13 with commensurate re-investment

in schemes to prevent inappropriate readmission.

TBC

Action plan in

place by (TBC)

Implemented

by end March

2013

Ongoing

Ongoing

CQUIN to be in

place by end

March 2012

Implementatio

n 2012/13

Any Qualified

Provider

• Extend patient choice of community and

mental health services to AQP in 3

service lines per Cluster between April

Arrangements for Any Qualified Provider are being taken

forward by NHS South East London. An Implementation

Group has been established to cover the three areas which

26

[SEL Plan

wording]

and September 2012.

• Outcome-based service specifications

should be developed with input from

CCGs and patients.

• The nationally developed provider

qualification questionnaire should be

used to qualify providers.

• Include further service lines as per

Government announcement (expected in

December).


have been selected for market testing across the cluster.

The Implementation Group with have the following remit:

a. To oversee the implementation of AQP implementation

across SEL

b. To actively seek to improve the quality of local

healthcare through provision of extended choice to

patients

c. To ensure that the specifications are outcome focused

and relevant to local needs

d. To ensure the programme is within procurement

guidelines

The three areas selected for AQP implementation across

SEL are:

• Hearing Services

• Continence Services

• Wheelchairs

There will be Working Groups for each of the service areas,

with input from boroughs, and the Working Groups will

adapt the national specifications to reflect local pathways,

and determine the detailed process for commissioning the

chosen services on an AQP basis.

Lambeth is engaging with the Cluster process, working

jointly with Southwark to share lead input for the three

working groups.

27

Section Five: Commissioning Development PCT Clusters have an important role in the development of commissioning structures and

processes in their area during 2012/13. This includes:

o successful establishment of the new commissioning architecture to ensure effective clinical commissioning and handover by April 2013, comprising; commissioning support

organisations, or the transfer of commissioning responsibilities to the NHS Commissioning

Board, and nurturing clinical leadership through emerging CCGs, o and delivering full authorisation of as many CCGs as possible by April 2013 wherever emerging CCGs are ready and willing to achieve this.

The following areas are subject to change depending on the passage of the Health and Social

Care Bill and the drafting of the commissioning development section of the NHS Operating

Framework 2012/13.

5.1.

Summarise the PCT Cluster’s commissioning development priorities for 2012/13 and how

these will be implemented:

The sections below outline how Lambeth will transition to full CCG authorisation, support the development

of the South London Commissioning Support Organisation and contribute to the establishment of the

:Lambeth Health and Wellbeing Board.

We plan to work with and support the emerging NHS Commissioning Board to ensure an effective

transition of functions, along with local authorities for public health and the CCGs.

Once the timetable is known plans will be put in place for the transfer of staff and where required,

contract novation to all receiving bodies

5.2.

A. Summarise how the PCT Cluster will oversee and ensure the delivery of commissioning

responsibilities that have been delegated, during 2012/13, including; setting out the

approach to delegation including eligible commissioning budgets allocating non pay

running costs and staff: [SEL Plan wording]

- How delegated responsibilities will operate during 2012/13

- How the experience of delegated responsibilities will be captured to support

emerging CCGs in developing a track record for Authorisation, and

- Summarising plans for the transition of all commissioning responsibilities to

CCGs and others by the end of March 2013.

From April 2012 Lambeth will take on responsibility for commissioning all delegated budgets, and in

accordance with the South East London governance arrangements.

Additionally, the planning round for 2012/13 has been jointly delivered by the cluster and clinical

commissioners

A programme of work has commenced which will ensure that we successful transition to full authorisation

by April 2013, with support from the cluster team.

It is proposed that a full shadow year of running takes place from April 2012, with the central cluster

team continuing to support as required. The commissioning support offer to CCGs for south London has

been designed in order to be delivered, in shadow form, from April 2012.

Current arrangements for performance management of delegation are through the borough stocktake

meetings, and the emphasis and remit of these will change from April 2012 as the CCG has full

28

responsibility for delegated budgets.

Summarise, including key milestones, how the PCT Cluster will support and develop its

pathfinders/emerging CCGs to prepare for and navigate the authorisation process. This

includes developing the ‘track record’ in preparation for authorisation. (e.g. on QIPP,

primary care, tackling health inequalities, relationships with local partners including

participation in emerging health and wellbeing boards, patient engagement and public

involvement). [SEL Plan wording]

Lambeth is working with South East Cluster colleagues to align the latest draft guidance “Towards

Authorisation” with local timescales and to further support developing CCGs going forward. Following this

session, Lambeth is developing a detailed Authorisation Plan in order to ensure that:

• A robust evidence log of the Lambeth’s track record is available to support authorisation;

• Progress in relation to Health & Well-being Boards is captured; and

• Key milestones are agreed and set (see below).

Lambeth CCG has signalled the intention to apply for authorisation sooner rather than later.

Milestones / Key Actions Milestones / Key Actions

1. Have delegated authority for 100% of commissioning budgets. 1. Deecmber 2011

2. Understand and agree do/buy/share options for commissioning

support – feeding in to CSS offer for south London.

2. January 2012

3. Have an agreed Organisational Development Plan in place which

supports the development needs for authorisation

3. January 2012

4. Agree plans for sourcing and managing the external

commissioning support service

4. March 2012

5. Draft CCG Constitution including, conflict of interest policy. 5. March 2012

6. Ensure development plans. Confirm relationship between CCG

and its constituent practices including arrangements for membership

and voting

6. March 2012

7. Have discussed and agreed with PCT cluster the transition plan

for staff and infrastructure support.

7. March 2012

8.Have an agreed authorisation plan 4. April 2012

9. Be leading the local health system – including finance,

performance, quality and activity for commissioned services.

9. April 2012

10. Prepare for authorisation application. 10. April - July 2012

11. Implement the Authorisation Plan. 11. May 2012

12. Have staff formally allocated to manage and support the

development of the emerging CCG.

12. May 2012

13. Agree collaborative commissioning arrangements and formalise

(likely LSL arrangements).

13. April 2012

14. Confirm the identification of CCG senior leaders either through a

local or national process.

14. June 2012

15. Work with NHS CSS to ensure the local and national offers

reflect Lambeth needs

15. June 2012

16. Have determined and agreed CSS option, and working to agree

SLA(s) associated with this.

16. June 2012

17. Clarify involvement of patients, carers and local communities in

CCG executive decision making process.

17. March 2012

18. Agree and adopt Equality and Diversity Scheme. 18. July 2012

19. Agree Lambeth CCG Constitution. 19. July 2012

20. Finalise authorisation application. 20. July - September 2012

21. Work with SHA and PCT cluster to shape and refine further the

NHS CSS offer, ahead of final business review checkpoint.

21. August 2012

29

22. Signal intention for commissioning support for 2013/14 to

enable completion of business plans by NHS CSS.

22. August 2012

23. Agree risk sharing arrangements between practices/localities in

CCG.

23. September 2012

24. Complete formal CCG authorisation process. 24. December 2012 (at latest)

25. Have SLA in place with hosted NHS CSS ahead of taking on full

responsibilities from 1 April 2013.

25. January 2013

26. Be operating and preparing to take on full statutory

responsibilities.

26. March 2013 (at latest)

5.3.

Summarise, including key milestones, the PCT Cluster’s plan for the development of a

Commissioning Support Organisation to provide the required commissioning support for the

local market. This includes identifying local need, mapping the scope and scale of services to

be provided and developing cost models to ensure that the overarching strategic approach to

commissioning support will be affordable. [SEL Plan wording]

NHS SE and SW London have worked closely with emerging clinical commissioning groups and with local

authorities to produce an overarching plan for the development of a South London CSS.

By transforming current working practice it is believed that a SL CSS will be able to provide significant

benefits to Clinical Commissioning Groups the NHS Commissioning Board (NHS CB) and other potential

customers in delivering both improved health outcomes and value for money. It will also support CCGs in

their application for authorisation as they demonstrate access to robust and cost effective commissioning

support arrangements. Although complex and challenging to deliver, a South London solution provides

stability and opportunities for the development of commissioning support services and staff during the

transition and beyond, thus retaining NHS expertise.

Development work has been led by the directors of transition from SE and SW London supported by a

programme director and a development group of 10 service heads drawn from both clusters. Building on

this, and following the appointment of an interim managing director in December 2011, a core leadership

team is being established. Recruitment for a substantive managing director and head of acute contracting

are underway.

The service offering for the SL CSS has been guided by local CCGs. This has been achieved by CCGs and

NHS SE and SW London through their commitment to the joint development of this organisation through a

varied engagement strategy. Through this engagement, the PCT cluster has mapped the scope and scale

of all the services to be offered by the CSS. The CCG requirements can be summarised as detailed below:

• Core commissioning delivery support e.g. Contracting support , IT & Informatics

• Additional expertise e.g. Strategy development , business planning , QIPP planning and project

management

• Corporate support e.g. Governance support, Finance, and other back office functions.

The operating model for the SL CSS has been designed to reflect the expectations of CCGs. Each seeks a

strong local focus and close working relationship so that the needs of their local population remain the

priority whilst maintaining access to high levels of technical expertise. Services will also be delivered with

the help of a number of partner organisations as the benefits will allow SL CSS the:

• Ability to quickly build expertise / gain capabilities

• Scale for transactional elements of service delivery

• Flexibility to obtain right resources quickly for services with cyclical or unpredictable demand

Developing and commissioning new models of integrated care will be a priority for all CCGs across South

London. The SL CSS service offer will support existing and proposed joint commissioning arrangements

through its locally focused teams and integrated performance framework and contract support.

Discussions are currently underway with local authorities including public health to consider how a

collaborative structure with improved partnership working can develop. This will be further reflected in

Outline Business Case in March. Key to the success of the SL CSS will be the development of effective

partnerships between Primary, Secondary and the tertiary sector.

30

Work is underway to ensure the overall affordability of the CCG and CSS structures within the £25/head

target. SE and SW London clusters are leading this work of both support and challenge for CCGs and the

CSS. Running Costs

The key risks identified include; securing people with the right skills to support transformation, insufficient

buy in to the business, failure to deliver business as usual, overwhelmed by cluster activities and loss in

flexibility for deciding end state of the organisation. These risks will be mitigated through; marketing,

tendering, buying in additional expertise and developing staff within the organisation with potential;

regular communication and feedback, tight central and internal performance management, identifying

separate capacity to drive the changes – introducing an interim MD, an arms-length advisory board and a

development team as well as buying in outside consultancy support and working closely with DH and NHS

London to understand the shape of centralised services.

Prior to the submission of the Outline Business Case (OBC) in March 2012, progress will be made in the

following areas:

• Greater consensus on the level of support CCGs require from SL CSS.

• Further challenge and scrutiny of SL CSS costs to achieve profit margin and lower unit costs.

• Development of business strategy for SL CSS and consequential financing requirements.

• Complete mapping and transition from current state to future state.

To achieve a balanced position on running costs and so match the national target of £25/head, the next

phase of development will focus on the following issues:

• Further iteration on the balance between running cost provided CCG in-house versus outsourced to SL

CSS.

• Further test the ability of all services to deliver the required quality and capacity and an understanding

of how CSS core services integrate with CCG services

• Explore further opportunities for joint working with other CCGs and LAs.

• Clarify the ability of CCGs to invest in new services that are not part of the current system (e.g.

Integration of primary care data to data warehouse, risk stratification of patients).

• More detailed modelling of the transition to end state.

The service offering will continue to evolve over the next few months as discussions further shape the

CSS strategy and offer. As CCGs determine which services they will subscribe for, this will be reflected in

updated financial modelling. However, given the emerging consensus between the CCGs around the core

offering, SL CSS has been able to develop a pricing model reflecting three bundled packages. – Core,

additional, and bespoke/negotiated services (bought on a one off basis). This model provides a significant

amount of flexibility for CCGs when considering the support required to deliver their commissioning and

business priorities. A detailed pricing package for the three bundled packages of support will be developed

in more detail within the OBC in March, recognising the costs of business development, both to secure

new business and to defend existing income streams.

Developing the SL CSS will be achieved through the already established SL CSS transformational

programme. The priorities for this programme build on feedback from all pathfinders and local

authorities and include a focus on:

• Delivering a huge cultural change

• Setting a pace for the transition which will involve trade-offs e.g. long-term structure by 2012 vs. 2013

• Improving the quality of services providing the architecture, tools, products and services to deliver the

new clinical model of commissioning

• Access to new skills and capabilities (obtained either by building internally or sourcing from outside) to

secure a customer base which ensures the organisation as commercially viable

Alongside this programme of work the SL CSS will, over the next 15 months, drive forward its business

planning with the support of a number of enabling strategies including:

• Marketing & Business Development strategies

• An Organisational Development plan

• A Communications and Engagement strategy

31

• A HR strategy

• IT and Estates strategies


1. South London CSS design, prospectus & stakeholder

support

1. September to December 2011

2. OBC, CCG sign up to prospectus and pricing, transition plan

including organisation structure

2. January to March 2012

3. FBC and staged implementation, subject to HR framework

3. April to August 2012

4. South London CSS fully operational

4. October 2012

5.4.

Summarise, including key milestones, the PCT Cluster’s provision of development support and

leadership development for pathfinders, which will be delivered during 2012/13.

This section should describe the activities in addition to that which is being provided through

NHS London’s development support offer and include what the PCT cluster will undertake to

provide development support to pathfinders during 2012/13. This should include:

• Development support provided and achievements to date

• Detail on the development plans in place.

• The plans in place for development support during 2012/13

Enter text here outlining risks and mitigations where necessary.

To be completed


1. Enter text here

NB. ensure actions listed are not business as usual activity

NHSL will pre-populate milestones and dates where possible.

Have an updated Development Plan in place.

1. Enter text here

NB. ensure actions listed are not

business as usual activity

NHSL will pre-populate

milestones and dates where

possible.

5.5.

Summarise, including key milestones, the PCT Cluster’s role in the development of the single

operating model for the direct commissioning responsibilities the NHS Commissioning Board

will have (including primary care, dental services, armed forces etc.), and plans for handover

to ensure a safe and proper transfer of responsibilities in 2013 through an agreed process of

convergence. [SEL Plan wording]

Over the last nine months, the cluster has proactively supported the “Once For London” Pan-London

Operating Principles and chaired the development of the PMS Review Principles within this work. The

Cluster has developed through its Joint Standing Liaison Committee with the LMC, cluster wide policies

for:

32

Primary Care Performers List Management

GP Locum Reimbursement

GP Premises Cost Reimbursements & Rent Reviews- Application and Review Process

2011/12 QOF Process

GP Performance Management (incorporating Pan London GPOC)

Infection Control and Prevention Programme

GP Site Surveys

Cluster wide policies developed for other contractor groups include:

Primary Care Performers List Management Policy agreed with the LDC, LPC and LOC.

Optometry Contract Compliance Arrangements

Optometry PVV arrangements

Pharmacy Contract Performance Management Arrangements

Pharmacy Application Process

Dental Performance Management Arrangements

Initial discussions have been held with NHS South West Primary Care colleagues on joint programmes of

work and sharing best practice to the advantage of both clusters. Directorate representation at DH/SHA

events has assisted the development of policy.

The above activity is assisting in creating a single operating model within NHS South East London which

will assist in the transfer to the NCB model.

The Cluster has commenced the stocktake stage of the contracts transition PCT Implementation Plan and

will complete the sign off of the transition controls data capture tool and risk assessment for primary care

contracting by the 16th January 2012. This has been achieved with the recruitment of interim support and

it is intended to continue with this support through to the end of March 2012.

Circa 1,200 contracts have been identified during this stocktake stage and a risk assessment is being

completed to inform a development programme to provide a comprehensive and consistent contract

portfolio for transfer to the NCB. This will address the regularisation of contract documentation and

financial sign off of contract values by commissioner/provider.

The Cluster will undertake a GP premises survey to ensure statutory compliance and to assist practices to

prepare for CQC registration from April 2013. An application for improvement grant funds forms part of

the 2012/13 capital bids to address highlighted issues. The issue of leases for those practices occupying

PCT premises will be addressed and appropriate charging mechanisms put in place.

The cluster has approved capital monies to rollout EMIS web with SCR and EPS2 capability to 138

practices in LSLG with a similar programme in Bromley.

Early discussions have been had with local representative groups and cluster clinical advisors to form pilot

LPNs and to work through this grouping to develop fully functioning LPNs to assist in commissioning

decisions for the planning round 2013/14.

The cluster is developing plans based on the “Once for London” List maintenance policy to undertake a

review with practices of their registered lists. This work is aimed to set FP69 flags by the 1st October 2012

to regularise lists for the 1st April 2013.


1. Completion of Stocktake. 1. 16/01/2012

2. Risk Assessment and development of Action Plan. 2. 31/01/2012

3. Stabilisation of contract documentation and financial

signoff within resource envelope.

3. 31/03/2012

33

4. Development of Local Professional Networks Pilots to fit

for purpose vehicles.

4. 30/09/2012

5. Regularisation of Premises Issues. 5. 30/09/2012

6. List Maintenance Exercise. 6. 30/09/2012

7. EMIS Web Rollout with SCR and EPS2 capability. 7. 31/03/2013

5.6.

Summarise, including key milestones, how the PCT Cluster will develop with emerging CCGs

and local authorities the Joint Strategic Needs Assessment, Joint Health and Well Being

Strategy, and joint/integrated commissioning arrangements during 2012/13. How will the

PCT Cluster ensure successful handover to CCGs, NHS CB, and local authorities for these

responsibilities? –

Health and Wellbeing

Lambeth has been designated as an Early Implementer Health and Wellbeing site and with local partners

we have the H&WBB has held a series of workshops, facilitated by the Kings Fund, to discuss the priority

areas for joint working. LCCCB members are taking a leading and very active role in the development of

our health and wellbeing arrangements in Lambeth. The Health & Wellbeing Board H&WBB will develop

the Joint Strategic Needs Assessment (JSNA), a borough-wide Health and Well-being Strategy and for

overseeing health improvement in our local community. All partners are committed to ensuring that the

work of the Board has practical benefits for the people who live in Lambeth. Two further areas of

importance have been identified as enhancing the involvement of our communities and the role of Public

Health. The shadow Board will be operational from April 2012.


1. Shadow Health and Well Being Board in operation 1. April 2012

2. Refreshed JSNAs

2. July 2012

3. Health and Wellbeing strategy agreed

3. Sept 2012

4. Full Health and Well Being Boards operational

4. By March 2013

5.7.

Summarise, including key milestones, the PCT Cluster’s plan for the development of a Public

Health transition plan to ensure successful handover of responsibilities to local authorities and

Public Health England. – [SEL Plan wording]

Across South East London (SEL), each borough has identified a lead officer in relation to the transition of

the Public Health function. In each borough there are ongoing conversations about the transition between

the DPH, lead officer and a number of other relevant senior people of both the council and the BSU. The

boroughs are currently considering local design solutions for managing Public Health in the future. One

Borough is already in shadow arrangement using a section 75 agreement (Bromley). This will form the

basis of the design for the final structures in Bromley.

In addition there is work under way looking at the potential for sharing public health services across

boroughs, specifically between the four boroughs of Lambeth, Southwark, Lewisham and Greenwich.

These discussions are still in an early stage. To inform this piece of work the Directors of Public Health in

these four boroughs have undertaken a review of all services to transfer to the local authorities, analysed

where there is potential for work to be shared and put forward proposals about sharing of services. The

four councils that are considering sharing are currently discussing their approach or process for agreeing

what can be shared and how this might be designed. Bexley council has also expressed some interest in

the potential to be involved sharing of some services with these four.

The cluster has established a Public Health Transition Group with the role of coordinating all aspects of

transition of Public Health functions to local authorities, Public Health England and NHS Commissioning

Board. The Group includes all DsPH, representatives from the 6 local authorities, 2 Managing Directors of

34

BSUs, with HR, finance and communications representatives. The SEL HPU is also represented. A draft

work programme is in place and this will be refined in the light of further emerging national guidance and

financial allocations. The group will continue to meet and oversee all aspects of transition throughout the

transition period. The role of the group is not to supplant local (trans-) borough-based design and

planning but to support, inform and coordinate it, with the transition processes for other services. The

group will work to support 6 local transition plans in accordance with annex 6 of national guidance on

transition.

As part of the PH Transition Board the Cluster has established a HR working group consisting of Cluster

NHS lead on HR and a HR representative from each of the local authorities, with a public health

representative.

Information is being collected on all contracts as part of the wider cluster and national information

collection. The findings will feed into a transition workstream on transfers of contracts for all current

public health services. This will be overseen by the cluster Public Health Transition Group with local

discussions of the implications of transfer of each contract.

In recognition of the expected publication of the shadow budgets the SEL Public Health Transition group

plans to devote a considerable amount of the February agenda to the subject of finance and budgets. This

will complement local borough based work on understanding of the implications of the shadow budgets

and their relationship to the functions and contracts that will transfer from NHS to local authority.


1. NHS SEL Public Health Transition Group established

1. Underway

2. Design processes for each borough underway

2. Underway

3. Assessment of implications of Shadow budgets

3. February 2012

4. Borough based plans for Transition of the Public Health functions

4. March 2012

5. Implementation of Transition Plans

5. Throughout 2012/13

6. Transfer of functions, staff and responsibilities

6. By end March 2013

5.8.

Summarise, including key milestones, how the PCT Cluster will develop plans for the transition

of specific responsibilities to local authorities , for example in addition to Public Health above,

the known areas of, Complaints and advocacy, information and signposting, and Independent

Mental Health Advocates (IMHA). –

This section should describe any planning to date and activities the PCT Cluster will undertake

to agree and plan jointly with Local Authorities to ensure a safe and proper transfer of

responsibilities during 2012/13.

Enter text here outlining risks and mitigations where necessary.

To be completed


1. Enter text here

NB. ensure actions listed are not business as usual activity

NHSL will pre-populate milestones and dates where possible.

1. Enter text here

NB. ensure actions listed are

not business as usual activity

35

NHSL will pre-populate

milestones and dates where

possible.

2.

2.

3.

3.

4.

4.

5.

5.

36

Section Six: QIPP Summarise the CCG's key QIPP priorities and challenges for 2012/13 Lambeth faces continuing growth in demand and cost of secondary care services, driven by population

growth, demographic changes and the expansion of available health technologies. People are living

longer in Lambeth – in the past 10 years average life expectancy for men has increased by 4 years and

women by 2 years.There is also an increased expectation of the quality and extent of health service

delivery as a consequence of advances in medicine. At the same time the rate of increase of funding for

the NHS has considerably slowed down to just above inflation. This means that the underlying rate of

deficit will increase if no action is taken.

It is clear that the level of financial challenge facing the NHS over the next few years is unprecedented,

especially when compared to the significant levels of financial growth enjoyed by the NHS over the last

decade. A step change in how we approach the development and delivery of QIPP plans is therefore

required to address the level of financial deficit in the “do - nothing” scenario.

The financial challenge facing NHS Lambeth is therefore to secure significant QIPP delivery over the

course of the next three years to provide the financial resource to support delivery of our vision, health

goals and supporting strategies. If no action is taken then the underlying financial positions will

deteriorate, year on year resulting in a worsening in the current cumulative position. The plans to

achieve this are set out in Section 7.

Governance

Lambeth has developed a programme approach to the delivery of QIPP supported by formal contract

management arrangements. The programme structure is set out overleaf.

37

Joint Lambeth and

Southwark Clinical Leads Groups Leads

Planned care joint with Southwark

• management of long

term conditions

(including HIV)

• early detection

• secondary prevention

• management of elective

care in the most

appropriate settings

• shifting service

provision promoting

appropriate referral

• reducing inappropriate variability in care

Unplanned Care joint with Southwark

• Urgent Care • Frail Older People

Mental Health • Lambeth Living Well

Collaborative

• Forensic services

• Payment by Results

• Talking Therapies/

Counselling • Dementia

Staying Healthy • Tobacco and alcohol

• Adult and Childhood obesity

• Physical activity

• Health Checks

• Access to prevention

• Mental well-being

PCT Boards

Lambeth Clinical Commissioning Collaborative Board

38

Section Seven: Finance Planning Please complete the financial planning spreadsheets attached as Annex A.

7.1. Overview of financial position

Delivery in 2012/13, including FCOT, risks, opportunities, non-recurrent matters, etc.

Lambeth CCG has developed plans to deliver surpluses in line with the 1% surplus requirement, although

it should be noted that this is dependent on the return of 2011/12 surpluses. The underpinning plans that

enable the delivery of 2012/13 surplus requirements have been developed using robust processes,

modelling and methodologies for assessing underlying demand and service pressures, price pressures and

issues and QIPP initiatives and delivery plans. In doing so we have reviewed historic performance and

trends and also ensured lessons from 2001/12 processes and delivery have been learnt.

In addition we have focussed specifically on risks and opportunities in finalising our plans for 2011/13,

including ensuring that we have taken proactive steps to mitigate risks where feasible at this stage of the

planning process. The key risk risks and opportunities are summarised below:

• Over performance against 2012/13 start plans. Our modelling of underlying demand has been

more sophisticated for 2012/13, using an approach that moves away from a straight line outturn

projection to one that models on the basis of seasonality and working days. We consider that this

approach provides a more realistic baseline for our contracts. In addition we have worked with

providers to assess the further activity impact of meeting key targets for 2012/13, particularly

RTT, to enable these to be quantified up front for start contracts. Finally we have set aside

population and incidence reserves to fund further expected increases in demand over 2012/13.

• Pace and scale of change associated with the delivery of QIPP savings. Key mitigations have been

: learning lessons form 2011/12 QIPP delivery in terms of allowing within our plans for the phased

delivery of savings over the year, the development of plans in excess of the bottom line savings

requirements to mitigate against under delivery, collaborative work with providers over 2011/12

on 2011/12 plans, a contractual approach that makes explicit the responsible owner and risk

holder for each QIPP initiatives.

• The impact of PbR tariff in 2012/13, including for mental health providers. We have been prudent

in our assumptions and have established reserves to cover prices pressures such as Best Practice

Tariffs and to mitigate against areas of the contract where national average assumptions are not

delivered due to case mix. In addition we have worked with providers to complete as much work

as possible on expected and known tariff issues, across both PbR and local prices, to ensure prior

agreements have been reached at an early stage, thus enabling accurate assumptions to be

reflected in our 2012/13 plans.

• Return of 2012/12 surpluses, thus providing the flexibility to ensure delivery of 2012/13 surplus

requirements.

• Successful negotiation of 2012/13 contractual agreements. Our intention is to sign contracts in a

timely manner, thus providing financial certainty in relation to contractual agreements and

commitments for the start of the year. To facilitate this we have been working with providers since

the summer to enable early agreement on approaches to key issues. Agreed contract terms

represent an opportunity in terms of enabling effective risk mitigation, particularly in relation to

QIPP, as above.

• Access to 2% non-recurrent funds – providing opportunities for delivery and risks if funds are not

forthcoming to facilitate the delivery of QIPP initiatives. As this stage CCGs have been prudent in

committing 2% non-recurrent funds while we await confirmation of the proposed NHS London

approach in 2012/13. However at this stage some assumptions have been made and these are

listed in section 7.2.

7.2. Key assumptions in 2012/13

Including but not limited to:

- Service developments

- Tariff impact / changes

- Workforce

- Commissioning intentions

39

- N/R items

- Cluster access to 2% N/R funds

- Readmissions and reablement funds - Cluster risk pooling fund (CTB) - sources and applications

Lambeth CCG has been working closely together with other CCGs and with Cluster colleagues in

developing robust and consistent budgetary assumptions for 2012/13 in line with Operating Framework

guidance, building on and updating previous plans and sharing intelligence across boroughs as well as

learning the lessons from 2011/12.

Service developments - a range of service developments are planned for 2012/13 focussed specifically

on supporting the delivery of Lambeth CCG Commissioning Intentions and agreed service redesign

initiatives to support QIPP delivery. Over and above these locally-initiated service developments the SEL

Cluster will be implementing though contracts London Commissioning Intentions, new NICE guidance and

new cancer drugs. The key focus of our agreed service developments is agreement and implementation of

developments that further our strategic intention of shifting work from acute to community based settings

and delivering care pathway redesign to do so.

Tariff impact/changes - Looking back on 2011/12, it is clear that PCTs’ assumptions around the level

of underlying growth, particularly in the acute sector, were in line with expected population and incidence

growth but that price pressures had limited the ability of PCTs to ensure adequate investment in volumes

to meet underlying demand.

In developing 2012/13 budgets and in preparing for the negotiation of 2012/13 contracts, contracting

teams have agreed up front a number of assumptions relating to price changes in 2012/13 and these

assumptions are included in CSPs and Operating Plans. In terms of the impact of the 2012/13 PbR tariff,

while a national -1.8% tariff deflator was expected and this is built into budget, past experience would

suggest that such as assumption is risky and CCGs have therefore assumed a further 0.5% cost pressure

relating to the acute tariff. In addition, QIPP savings plans have not been delivered in full in 2011/12,

which has contributed to financial pressures faced by PCTs. The Cluster is mitigating against this by the

development of additional QIPPs in 2012/13, allowing the establishment of QIPP risk reserves as a

contingency should the pace of delivery be slower than planned.

Commissioning Intentions – Lambeth CCG has developed its own local commissioning intentions as

part of the SEL Cluster CSP and in addition the CSP incudes a number of Cluster wide priorities and

commissioning intentions. For the 2012/13 operating Plan we will be implementing year 1 deliverables,

focussing specifically on implementing agreed service and care pathway redesign to support QIPP and on

supporting the delivery in SEL of London and national commissioning priorities. From a financial

perspective where commissioning intentions require investment or pump priming these have been

accounted for within our plans for 2011/12 and where it is anticipated that they will deliver savings these

have been reflected in our plans, but with mitigation with respect to QIPP particularly also built in to our

plans.

40

• Recurrent Uplifts, Tariff and Generic Uplifts, Demographic & Non-Demographic Growth

and Primary Care Prescribing Uplifts

Lambeth CCG’s uplift assumptions are set out below:

Lambeth

Recurrent uplift 2.80%

Reablement 0.18%

Total Uplift 2.98%

demographic Growth 0.51%

Non-demographic growth 1.10%

Total population & incidence growth 1.60%

Prescribing growth 5.00%

Tariff/Inflation Uplift 2.03%

Tariff efficiency assumption/Price Efficiency applied -3.21%

Net Tariff/Inflation Uplift -1.19%

Further details on uplift assumptions are provided below:

° Recurrent Uplifts

The PCT Revenue Resource Limit (RRL) uplifts are as per confirmed allocation uplifts of 2.8%

plus a further 0.18% in respect of reablement.

° Tariff and Generic Uplifts

Tariff uplifts have been assumed at a net -1.8%, including a built in 4.0% efficiency

assumption. This has been applied to acute, mental health and community spend. Funds have

also been earmarked to fund the expected impact of the ending of the MFF payment cap,

applied to Guy’s & St Thomas’ in 2011/12.

° Demographic & Non-Demographic Growth

Detailed work has been undertaken to review planning assumptions related to demographic

and non demographic acute growth for the CSP. The objective has been to ensure robust and

realistic borough based planning assumptions related to population and incidence factors,

which take account of demographic growth estimates and historic acute demand trends. To do

so the following process has been undertaken :

− A review of population growth assumptions by borough (including GLA and ONS figures) for

acute services.

− A review of historic demand trends by borough for acute services, with supporting trend

analysis completed for the following key areas of acute activity – outpatients, elective, A&E

attendances, and emergency admissions, maternity and other.

− The development of proposed demographic and non demographic growth assumptions by

CCG by admission method, applied on a consistent basis across the six SEL boroughs.

− The testing of assumptions with SEL clinical commissioners, CCGs and CSP leads, to

confirm proposed planning assumptions.

This process has resulted in a consensus agreement, supported by robust analytics, on the

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demographic and non demographic assumptions to be utilised for the CSP.

• Brought Forward Surpluses

Forecast surpluses for 2011/12 have been assumed to be carried forward into 2012/13.

• Full Year effect of 2011/12 outturn

The full year recurrent impact of 2011/12 forecast outturn expenditure has been included within

2012/13 expenditure plans, including the costs of reinstating PCT contingencies at 0.5% of

recurrent resource limits.

• Investment Proposals and Cost Pressures

Borough investments and cost pressures have been included in financial plans for 2012/13. While

detailed expenditure plans are in place for 2012/13, these remain draft pending the release of all

detailed planning guidance for 2012/13 and also further progress in the negotiation of 2012/13

contracts.

• QIPP Savings Initiatives

Lambeth CCG has reviewed its existing detailed QIPP savings plans with support from Cluster

teams. New QIPP schemes have been initiated and included in financial plans. Our total QIPP

savings schemes in 2012/13 are £22.883m. However schemes have been RAG rated to deliver

savings of £15.256m and it is this total that is assumed to be delivered within financial plans.

A summary of QIPP initiatives and their impact by expenditure area over 2012/13 are set out

below:

Lambeth

£'000

Planned QIPP Savings

Acute 7,134

Client Groups 6,542

Primary Care 7,407

Corporate 1,000

Other Budgets and Reserves 800

Total QIPP Savings Before Risk Rating 22,883

Risk Rating (7,627)

Total QIPP Savings After Risk Rating 15,256

• 2% Non-Recurrent Funds

Plans assume that 2% funds will be made available in full as an enabler for QIPP delivery and to

effectively manage the transition to the new commissioning environment. However, at this stage

CCGs have been prudent in committing 2% non-recurrent funds while we await confirmation of the

proposed NHS London approach in 2012/13. Lambeth CCG is however assuming that commitments

including the following:

o Primary and Community Care Estates enablers – specifically the non recurrent costs of the

Norwood and Akerman Road developments

o Planned Care Programme Implementation

o Mental Health Programme - including PbR Implementation

o Primary Care QIPP – project/transition costs

o Unplanned Care Programme

o Community Services transformation – enabling costs

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• Emergency, Readmissions and reablement funds

No assumptions have been made relating to the reinvestment of 70% emergency over-performance

funds transferred to NHS London, noting that these funds are minimal across South East London,

due to the high 2008/09 emergency baseline and the fact that emergency admissions have reduced

since 2008/09 in most areas.

New reablement funds allocated to PCTs in 2012/13 have been earmarked for investment in agreed

whole system initiatives.

National guidance for emergency readmissions has recently been confirmed. We will be reflecting

the guidance in our contracts with SEL providers for 2012/13 with an agreed clinically led audit over

Q1 to agree appropriate non-funding agreements and targets with providers. However a number of

local commitments have already been made in relation to investment in admissions avoidance

schemes and where this is the case all parties have agreed that existing commitments will be

honoured.

• Risk Pooling

No new assumptions have been made in terms of pooling of risk across CCGs in 2012/13 to date but

it should be noted that CCGs agreed a policy of mutual financial assistance in 2011/12 so

understand the importance of ensuring financial balance and legacy across the local commissioners

as CCGs move towards full authority by 1st April 2013.

• Running Costs

QIPP plans assume the delivery of running costs reductions in 2012/13. The Cluster is in the process

of assessing the redundancy provisions requirement to include in 2011/12 PCT accounts.

7.3. Key bridging movements from 2011/12 FCOT to 2012/13 plan

Including changes by revenue type, cost type, QIPP, overall surplus/deficit and underlying

surplus/deficit.

Key bridging movements for Lambeth CCG are set out below:

Income and Expenditure changes 2012/13

Lambeth

£'000

Income

Recurrent Uplift 18,262

Prior Year Surplus brought forward 6,605

Total Income Changes 24,867

Expenditure

Full year effect of 2011/12 outturn 17,065

Net Generic Uplifts

Tariff and generic uplifts 12,781

Efficiency with Tariff (20,271)

Net Tariff/ Generic Uplift (7,490)

43

Demographic & Non-Demographic Growth

demographic Growth 3,150

Non-demographic growth 6,841

Total Demographic & Non-Demographic Growth 9,991

Investment Proposals and cost pressures 13,556

QIPP Savings Initiatives (15,256)

Change in Recurrent Expenditure 17,867

Surplus/ (Deficit) 7,000

Surplus as % of Recurrent RRL 1.10%

7.4. Delegation of budgets to pathfinders / CCGs

Including commentary on:

- £2/head GP development

- Budgets delegated to pathfinders / CCGs at 1st April 2012 - Timeline for delegation of budgets (if not fully delegated at 1st April 2012)

The Cluster and Lambeth CCG achieved full delegation of budgets in December 2012. The active

involvement of Lambeth Clinical Commissioners in the 2012/13 acute contracting round is part of the

process of embedding full responsibility for these budgets. This builds on our experience in 2011/12 and

2010/11 working with Practice Based Commissioning and clinical commissioning

Lambeth CCG is planning on £2/head GP development funds being available in full in 2012/13. These

funds are included within the 2012/13 Operating Plan and will be used to support the development of

Lambeth CCG. This includes meeting the cost of supporting organisational development and systems of

governance, developing a strong local clinical network and taking forward practice level information

analysis.

Planned outcomes for delegated commissioning activities are incorporated within the Operating Plan and

Business Plans. Outcome measures cover:

• Delivery of Financial balance and our QIPP plans

• Quality assurance of ongoing safety of services

• Patient reported outcomes and improved patient experience of services

• Enhanced effectiveness of services and care pathways

• Shift of care to out of hospital settings and from treatment to prevention

• Delivery of performance standards.

It should be noted that Operating Plan budgets include specialist commissioning and public health

budgets in full. Specialist commissioning budgets have been set in line with agreed LSCG budgets and

therefore the impact on other CCG held budgets has been built into assumptions.

7.6. Triangulation

Describe the triangulation activity that has taken place to ensure robustness in respect of:

- Activity

44

- SLA values - Workforce

Enter text here [this should include a specific link between the QIPP schemes, activity and

SLAs] outlining risks and mitigations where necessary.

Activity and QIPP schemes are covered in detail in Section 7.5: Activity.

Contracts for 2012-13 have not been finalised as yet and this information will be included in a later

version of the Operating Plan.

7.7. Key capital schemes

Include scheme name, values, purpose, funding source, etc.

Akerman Road – Lambeth

This £13.1m, 5200m2 LIFT funded development is under construction and will be completed in July 2012

and provides a local neighbourhood resource centre hub for 3 general practice, community health

services, dental services and a base for adult social care services. This is a key development in a highly

deprived part of Lambeth.

Norwood Hall – Lambeth

Subject to approval this £14.2m, 5402m2 LIFT development will reach financial and commercial close in

2012. This development is being carried out jointly with Lambeth Council, who will take the head lease,

and will provide a customer service centre, swimming pool and other sports facilities as well as health

services covering 2460m2 of space including general practice, community health services and a specialist

dental school. Norwood is scheduled to open in 2014/15.

7.8. Liquidity / cash flow / loan requirements

All the PCTs in the SEL Cluster are on target to achieve their 2011/12 cash target by drawing down their

cash limits in full with minimal cash balances at 31 March 2012. It is, therefore, assumed that the

availability of cash resources in 2012/13 will not be impacted by adjustments relating to 2011/12.

The Cluster PCTs’ cash assumptions in 2012/13 are based on the availability of cash resources in line with

both recurrent and non-recurrent revenue and capital resources, with the exception of carry forward

surpluses from 2011/12. Cash in 2012/13 will be managed through the movement in working balances. It

is, therefore, anticipated that the Cluster PCTs will not require additional cash support from NHS London.

7.9. Key financial risks and opportunities in 2012/13

All NHS organisations are facing ongoing financial pressures, after many years of unprecedented growth

in available funds. Further details of these risks are outlined below:

• 2011/12 Outturn

Outturn assumptions have been updated since submission of the CSP and in the Operating Plan we

have funded 2011/12 outturn based on the latest forecasts, taking into account the use of non

recurrent savings or sources of funds and the impact of this in 2012/13, as well as seasonality,

working days and Referral to Treatment requirements. The extent to which actual outturn deviates

from this may provide some financial risks, which will present itself as over-performance against

contracted levels of activity in 2012/13, which would need to be funded from contingency

reserves.

• QIPP

45

All QIPP initiatives have been risk-assessed to give increased confidence that the savings that will

be achieved in 2012/13. GP Leads and Project managers are clear that their objective is to aim for

the stretch QIPP plans in 2012/13. Implementation plans have been developed and signed-off by

individual CCGs. For those initiatives that are owned by the provider we expect our contract terms

to mitigate the risk of non-delivery from the PCT/CCG perspective and Trusts are equally

committed to ensuring full delivery of agreed targets. Each local health economy has in place

processes to ensure the effective monitoring and management of QIPP delivery in year.

• 2% Non-Recurrent Funds

Plans assume and include use of the 2% funds in full as an enabler for QIPP delivery and to

effectively manage the transition to the new commissioning environment. This represents both a

risk and opportunity in 2012/13 and the Cluster and Lambeth CCG will that ensure robust plans

are in place to ensure access to funds at an earlier stage in the financial year. The 2% Non

Recurrent Investment Fund is recognised as being important to deliver QIPP targets and ensure

the achievement of underlying financial balance over 2012/13 and the strategic period.

• Return of 2011/12 Surpluses

The remains uncertainty on the return of our planned 2011/12 surpluses in 2012-13. This is

current Treasury policy but there is the risk that this may be used to manage overall NHS cost

pressures. The Operating Plan assumes that this surplus is returned in full. If this was not the

case our QIPP plans would need to increase accordingly and/ or planned surpluses in 2012/13 are

reduced.

• The impact of PbR tariffs in 2012/13, including for mental health providers.

We are currently assessing the impact of the final acute PbR tariff – the impact of the new tariffs

will differ by provider and for each CCG and any deviation from the assumed -1.8% could present

financial risks. However our financial plans have assumed under delivery of the -1.8% and we

consider therefore that in aggregate terms the impact of 2012/13 acute PbR tariffs will be

manageable within our existing plans.

The impact and timing of the introduction of Mental Health Payment by Results (PbR) remains

unclear. Commissioners have agreed principles for rebasing contract baselines in negotiation with

SLAM associated with the introduction of PbR full implementation of responsible commissioner

guidance, to minimise risk across both commissioners and provider. Work is jointly being

undertaken during 2011/12 and in 2012/13, the introductory year to ensure that activity and

financial information is robust and forms a strong base for the implementation of PbR.

• Successful negotiation of 2012/13 contractual agreements.

For acute providers we have now received costed proposals for the majority of our key providers

and negotiations are progressing well. We expect to have achieved early signing of the contract

with LHNT (end February 2012), ad also to reach a timely agreement with GST and KCH. A

successful negotiation in terms of securing early agreement and financial certainty in relation to

SLHT however remains a risk – we are working with SLHT, with senior level Chief Executive

involvement, to try to mitigate against SLHT related risks. Good progress is being made with non-

acute provider negotiations for 2012/13 and we expect to be able to reach timely agreement

within the parameters set out in our 2012/13 plans.

• Ensuring Financial Delivery

Financial balance and the delivery of the PCTs’ planned financial positions is a core priority and a

statutory requirement for NHS SE London. Lambeth CCG, working in conjunction with the Cluster

plays a vital leadership role in this.

The financial position is reviewed regularly by Lambeth CCG, the Cluster Joint Board and the

46

Cluster Performance, Finance & QIPP Committee. Quarterly Joint Cluster and CCG QIPP Stocktake

meetings provide executive assurance of financial and service performance including QIPP delivery

and review progress against the achievement of full authorisation. Internal and external audit

review the PCTs’ financial management, reporting and controls. Further external assurance is

also put in place where this is needed.

The achievement of in-year and underlying financial balance is supported by the delivery of

Recovery Plans. These plans are kept under Board review as part of the agreed overall financial

reporting arrangements. Savings proposals are developed through a process of budget challenge

across all areas of activity.

Lambeth CCG is implementing an Organisation Development Plan that takes account of the NHS

London Roadmap recognised by the Department of Health as a means of achieving full

authorisation. The Roadmap’s eight domains include finance and governance, and development

programmes will strengthen Lambeth CCG’s skills in these areas. This work is underpinned by a

detailed Authorisation Work Plan.

Organisational change and the associated period of transition bring significant changes in the

responsibilities of individual staff members, different reporting lines and changes in key personnel

and represents an organisational risk. The Cluster and NHS Lambeth finance teams is working with

senior staff to ensure changes to the budgetary framework are quickly embedded, including:

o Revised budgetary framework

o Refreshed budgetary delegation to budget holders

o Refreshed authorised signatory lists

o Enhanced reporting arrangements

o Budget holder guidance and training

The Cluster is actively pursuing debtor management to ensure all the income due to the PCTs is

recovered. Processes are in place to ensure that creditors are paid efficiently and on time so that

the Better Payment Practice Code (BPPC) can be met and outstanding creditor balances are,

wherever possible, minimised. This involves regular reporting of outstanding invoices supported by

staff training in the use of electronic workflow systems.

The Cluster has implemented a new Sollis information system across all boroughs and is continuing to

develop opportunities to improve data validation, claims management and forecasting.

7.10. Overall contingency / reserves

All CCGs within the SEL Cluster have set aside the following reserves and contingencies in 2012/13 initial

budgets and plans:

• Contingency reserves of 0.5%, in line with NHS London guidance.

• Funds to deliver surpluses equivalent to 1.0% of recurrent resource limits. This will however be

dependent on the carry forward of surpluses from 2011/12.

• Earmarked sums for population & incidence growth. These will be released to fund activity above

2011/12 forecast outturn, as agreed with providers. These may also need to be used, in part, to

fund any unanticipated cost pressures in 2012/13, including the impact of final PbR tariffs.

• Reserves relating to the difference between 150% QIPP savings and the 100% required. These

reserves will be released to fund reductions in agreed QIPP savings, closer to the 100%, should

savings be guaranteed to CCGs.

47

Section Eight: Workforce 8.1. Workforce impact of strategic goals

Will your service vision for the cluster have a workforce impact for your

providers?

Please provide a description of the anticipated impact for workforce

within local provider Trusts and Community providers as a result of the

cluster’s strategic initiatives e.g. describing anticipated increases /

decreases for your main providers and services that may see significant

change.

Yes

To be completed

8.2. Effective communication with providers

Does your organisation have a process in place by which it can assure the

workforce strategies of its provider organisations are fully integrated

with service and financial plans; have clinical ownership and aligned with

the cluster’s vision as highlighted in its commissioning intentions communicated to its providers?

Yes / No

(delete as

appropriate)

To be completed

8.3. Quality of service / education considerations

8.3.1 Has the cluster made clear to their provider organisations that their

education and training funding should be used to transform their

workforce to support the delivery of the cluster’s service vision, and does

the cluster have mechanisms in place to assess whether provider

organisations have appropriate plans to support this objective?

No

To be completed

8.3.2 Does the cluster have processes in place to ensure that provider

organisations carry out appropriate workforce risk assessments and

address capability or capacity issues ahead of the changes that the

Cluster’s local service vision will require?

Yes / No

(delete as

appropriate)

To be completed

8.4. Statutory workforce obligations

Does the organisation have a process in place by which it can assure

statutory workforce obligations (e.g. EWTD, mandatory training, %

appraisal rates, quality of appraisals, medical revalidation) are delivered

within its provider organisations?

Yes / No

(delete as

appropriate)

To be completed

48

8.5. Monitoring and performance management

Does the cluster include workforce metrics, benchmarking, trends and

plans within its contract performance process with its providers? Are

these metrics incorporated with related quality metrics and intelligence,

and used to identify and raise concerns about future trends and

performance? Where the workforce indicators of a provider raises

concern, please describe the process that the cluster will take to resolve

the risk identified? How will the cluster ensure that CQC and Monitor

have been involved as appropriate?

Yes / No

(delete as

appropriate)

The expectation here is that Clusters monitor workforce in their providers to ensure that any

issues are highlighted in relation to workforce before patient safety is put at risk.

E.G. The Cluster has negotiated as part of its contract with its providers the provision of the

following data on a quarterly basis: 12-month rolling sickness and turnover rate, vacancy

rate, agency usage as part of its total staff pay bill, progress against training plan and

progress against its staff health and well-being plan. If any of these areas reported on are

rated red, they form part of the discussion for example in the quarterly workforce review

session which we hold with each of our providers. Please see a copy of the template which

shows this information is submitted to the Cluster as evidence.

To be completed

8.6. Managing of workforce risk

Where workforce changes have been identified, please describe the risks

that these changes may have to patient care standards during the

transition and the process by which the Cluster will mitigate these risks

with the providers?

Yes / No

(delete as

appropriate)

To be completed

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Appendices Confirmation of upload of 2012/13 UNIFY planning templates

Please attach the operating plan 2012/13 Workforce return

Please attach the operating plan 2012/13 FIMS Operating Plan

Please attach the 2012/13 QIPP milestone tracker return

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