Download Northern Derbyshire Unit of Planning

Strategy
template
2014/15 –
2018/19
20th June 2014
1
Northern
Derbyshire
Unit of
Planning:
Hardwick CCG
and North
Derbyshire
CCG
Northern Derbyshire Unit of
Planning Five Year Strategic Plan
(2014/15 – 2018/19)
Developed with the support of local stakeholders including:
2
NORTHERN DERBYSHIRE UNIT OF PLANNING VISION
‘Get the best possible outcome for our patients with the limited resources that we have’.
The strategic vision for the North Derbyshire Unit of Planning is a health and care system which focuses on prevention of ill-health and disease, reduces health inequalities and
provides high quality integrated care that enables people to retain independence for as long as possible supported by their local community. Where required services will be
responsive, safe, caring and provide a good experience of care still within the local community in the majority of cases. Where exceptionally more urgent, emergency or
specialised services are required these will be accessed easily and people will be supported to return to their local community as quickly as possible.
OUR AMBITIONS
DELIVERED THROUGH THE FOLLOWING INTERVENTIONS
Overseen through the following
governance arrangements:
 Reduce by 489 the number of years
of life lost by the people of Northern
Derbyshire from treatable conditions
(e.g. cancer, stroke, heart disease,
respiratory disease, liver disease).

 Improve by 5% the quality of life of
the people in Northern Derbyshire
living with one or more long term
condition.
Existing system wide structures:
o Adult Care Board
o Health and Well Being Board
o Children’s Trust Board
o Joint Commissioning Co-ordinating
Group
Northern Derbyshire Unit of Planning
structures (under review):
st
o 21 Century Transformation
Programme Board
o Internal CCG governance structures
o Urgent Care Working Group

 Reduce the number of avoidable
hospital admissions by 1905 over the
next 5 years through improving the
quality of primary and community
care and people’s ability to selfmanage.
Measured using the following
success criteria:
 Reduce the proportion of people
reporting a poor experience of
inpatient care by 6%
 The health and wellbeing of the Northern
Derbyshire population will be maximised
and health inequalities reduced
 Material changes in patient outcomes
across the 7 outcomes ambitions
 All organisations within the health
economy will meet their financial targets
year on year
 Robust planning, assurance and early
warning arrangements support
no/limited regulatory scrutiny.
 Reduce the proportion of people
reporting a very poor experience of
primary care by 11%.
Achievement of the improving outcomes
ambitions will be used as the key set of
measures to determine whether the above
criteria have been met.
ENABLERS
Prioritisation
IM & T
3
Not one size
fits all
Estates
Commitment
to work
together
Commissioning &
Contracting
Learning as
we go
Workforce
7 day
working
Governance
System values and principles:





Person centred
Flexibility
Constructive challenge
Partnership working
Services within resources
Section Two | Key lines of enquiry (KLOE)
The following table template asks key lines of enquiry and contains space for the organisation to add their responses.
Segment
Submission
details
Key Line of Enquiry
Which organisation(s) are completing
this submission?
Organisation response
This strategic plan template is submitted by:
Hardwick CCG
Scarsdale
Nightingale Close
Newbold
Chesterfield
Derbyshire
S41 7PF
North Derbyshire CCG
Scarsdale
Nightingale Close
Newbold
Chesterfield
Derbyshire
S41 7PF
It should however be noted that this plan has been
developed in partnership with the following local
organisations and as such synergies with plan
submissions across the health sector will be seen:


4
Chesterfield Royal Hospital NHS Foundation
Trust
Derbyshire County Council:
 Health and Wellbeing Board
 Adult Care Services
 Public Health
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
 Derbyshire Community Health Services NHS
Trust
 Derbyshire Healthcare NHS Foundation Trust
 Derbyshire Health United (Out of Ours and 111
services)
 East Midlands Ambulance Service NHS Trust
 North Derbyshire Voluntary Association
In case of enquiry, please provide a
contact name and contact details
Hardwick CCG
Andy Gregory
Chief Officer
Email: [email protected]
Tel: 01246 514076
North Derbyshire CCG
Joanne Ross
Head of Strategic Planning and Performance
Email: [email protected]
Tel: 01246 514222
a) System
vision
What is the vision for the system in five
years’ time?
The Northern Derbyshire Unit of Planning has been Derbyshire
heavily involved in developing the Derbyshire Integration Strategy:
Integration Strategy and the vision for Derbyshire, as
articulated in the Better Care Fund Plan, which focuses
Derbyshire Accord
on achieving a seamless health and care service.
Doc.pdf
The Derbyshire Integration Strategy (attached) aims to
describe the desired vision for the Derbyshire health
and care system by 2018/19. The Better Care Fund
Plan for Derbyshire is based on this strategy. The
direction of travel is to place the local person at the
centre of our actions so that all services will be personcentred. The Derbyshire system will work in
5
Segment
Key Line of Enquiry
Organisation response
Supported by:
partnership with the people needing care and their
families and carers and provide care as close to the
person’s home as possible and when appropriate
support them to access the right care away from home.
Above all the aim wherever possible and appropriate is
to encourage people to self-care with the support of
their community before they come into contact with or
need public services.
The health and care system in Derbyshire pursues this
goal in a time of challenge and flux. The national
challenges to the NHS and Local Government are well
understood and include the impact of the ageing
society, rise of long-term conditions, increasing patient
expectations, increasing costs of providing care, limited
availability of productivity gains and constrained public
resources. In addition we have local challenges and
drivers for change. In Northern Derbyshire there is a
multiplicity of providers with overlap, duplication and
fragmentation leading to frequent patient hand offs
between providers.
Patient and public engagement has told us that there is
a lack of joined up services locally which has a
negative effect on patient outcomes. Patients are
falling through the gaps between services and
struggling with organisational boundaries, geographical
boundaries and generic standardised services which
are not personalised around the patient.
Underpinning the Derbyshire vision is the strategic
vision for the Northern Derbyshire Unit of Planning,
which is clear and definite: get the best possible
6
Segment
Key Line of Enquiry
Organisation response
Supported by:
outcome for our patients with the limited resources that
we have. It is recognised that in order to better meet
the needs of our people, within the resources we have
available, requires major changes to the way in which
care is provided.
The Northern Derbyshire Unit of Planning envisages a
health and care system which focuses on prevention of
ill-health and disease, reduces health inequalities and
provides high quality integrated care that enables
people to retain independence for as long as possible
supported by their local community. Where required
services will be responsive, safe, caring and provide a
good experience of care still within the local community
in the majority of cases. Where exceptionally more
urgent, emergency or specialised services are required
these will be accessed easily and people will be
supported to return to their local community as quickly
as possible.
The following statements have been developed in
consultation with the public to describe the vision from
a patient’s perspective:





7
Services will feel seamless and coordinated
The person will be treated as an individual
The person will be supported to live
independently and encouraged to self-care
where appropriate
Any care required will be discussed and agreed
in partnership with the person
The person will be cared for in their own home
or as close to home as their condition allows
Segment
Key Line of Enquiry
Organisation response
Supported by:
 Where acute need or specialism is required it
will take place as quickly and safely as possible.
 Fundamentally the needs and wishes of the
individual will be at the centre of care delivery
and planning at all times.
To direct the changes required, a statement of ‘what
good looks like’ for the future system in five years’ time
has been defined. Fundamentally we want the system
to keep people:



Safe and healthy – free from crisis and
exacerbation
At home – out of social and health care beds
Independent – managing with minimum support
In order to reduce the demand for reactive episodic
care we will:



Continue to improve the impact of primary
prevention
Better meet the needs of people who require
complex ongoing care
Eliminate unwarranted variation in access to
care
When episodic care is needed:


8
The right care will be provided in the right
setting by the right people
Care will be provided efficiently through
improved care pathways
Segment
Key Line of Enquiry
Organisation response
The overall implications for the system include:

Supported by:
Delivering integrated care at scale to
proactively support the needs of the ‘top 20%’ c.
80,000 people
 Shifting care out of bedded services and into
team based community care
 Aligning the system to work differently –
beyond
existing
organisation/professional Northern Derbyshire
Unit of Planning
boundaries.
System Plan
The statement of ‘what good looks like’, the headline
changes to the system and how we propose to deliver
these changes are summarised in the attached
ND UoP System Plan
‘Northern Derbyshire Unit of Planning System Plan’ on v1 final 19.6.14.pdf
pages 4 to 6.
How does the vision include the six
characteristics of a high quality and
sustainable system and transformational
service models highlighted in the
guidance? Specifically:
1. Ensuring that citizens will be fully
included in all aspects of service
design and change, and that patients
will be fully empowered in their own
care
2. Wider primary care, provided at
scale
3. A modern model of integrated care
4. Access to the highest quality urgent
and emergency care
5. A step-change in the productivity of
9
The Northern Derbyshire Unit of Planning System Plan
has been aligned to the six characteristics of a high
quality and sustainable system and the improvement
interventions grouped according to the transformational
service models. This is illustrated in the attached
System Plan on page 6.
The System Plan is founded on the development of
integrated care to better meet the ongoing care needs
of the people of North Derbyshire, where services are
person centred, enable people to self-care, thereby
keeping themselves well for longer and reducing the
level of unplanned care they receive. For this reason
integrated care is placed at the centre of the
transformation programme.
This reflects that
integrated models of care are being developed across
Segment
Key Line of Enquiry
elective care
6. Specialised services concentrated in
centres of excellence (as relevant to
the locality)
Organisation response
Supported by:
the age and need spectrum including for the frail and
elderly, for children and young people and for those
with mental health conditions.
Besides the development of integrated care the system
will also improve and align other aspects of care, which
are represented in terms of the characteristics of a high
quality, sustainable health and care system. These
include:





Prevention and self care
Primary care
Emergency and urgent care
Elective care
Specialist care
The decision has also been taken locally to add a
number of other workstreams including mental health,
children’s services and adult social care as it was
believed that these too presented opportunities to
further improve and align the system.
It is anticipated that the collective impact of these
improvement interventions will deliver the Northern
Derbyshire Unit of Planning strategic vision and the
improving outcomes ambitions contained within the
individual CCG’s operational plans. This will in turn
enable each CCG to meet its financial obligations and
ensure providers remain sustainable and financially
sound.
How does the five year vision address
the following aims:
10
a) From a resources perspective, what will the position
be in five years’ time? Is this position risk
Segment
Key Line of Enquiry
a) Delivering a sustainable NHS for
future generations?
b) Improving health outcomes in
alignment with the seven
ambitions
c) Reducing health inequalities?
Organisation response
assessed?
The strategic vision and plan presented in the
Northern Derbyshire Unit of Planning will result in a
significantly different future state. From a
resources perspective a planning scenario that best
matches the system plan narrative has been used
to estimate the potential impact on the whole
system and also impact by individual care area.
This is represented in financial terms in the bridge
diagram on page 7 of the Northern Derbyshire Unit
of Planning System Plan.
This diagram has been developed with the input of
providers and commissioners and the scale of
impact signed up to. Whilst this represents the
current direction of travel, it should be recognised
that the next steps are that a strategy for
implementation developed will be developed and
agreed. Once this strategy is agreed all
organisations (commissioners and providers) will
develop individual plans to operationalise the
strategy. Until these plans are fully developed and
agreed the individual organisation finance plans will
not fully reflect the current vision. Our aspiration is
that the finance and activity plans submitted for
2015-16 by both commissioners and providers will
fully reflect the implications of the North Derbyshire
vision.
The bridge diagram describes the current state, i.e.
funding across the system of £503m in 13/14. If we
were to adopt a ‘do nothing’ approach as a system,
11
Supported by:
Segment
Key Line of Enquiry
Organisation response
based on the forecast growth and cost pressures,
we are estimating that there would be a £150m gap
in funding within 5 years’ time.
The bridge diagram describes the disinvestments
we plan to undertake by care area over the next
five years, i.e. reduce demand through introducing
integrated care and referral management, providing
care in the right setting, reducing length of stay and
creating pathway efficiencies. This is balanced
against reinvestment in improved pathways of care,
providing care in the right setting and investment in
integrated models of care. The net result of this is
a care system that is high quality and sustainable.
The bridge diagram therefore illustrates a balanced
aiming point for 2018/19 representing the scale of
impact and investment. In comparison to the
‘default’ planning assumptions of 4% per annum
provider CIP plus 2% commissioner QIPP this plan
is based on delivering the equivalent of 4% per
annum demand management and care setting
improvements plus 2% efficiency across the whole
system.
It should however be noted that the bridging
diagram as shown states that the cost of the
system by 2018/19 will be £566m against forecast
funding of £555m, thereby suggesting a gap of c.
£11m. This is because it does not include the
benefits that may be realised over the duration of
the plan, which are dependent on the prioritisation
and phasing of big impact transformational
interventions. The prioritisation and phasing of key
12
Supported by:
Segment
Key Line of Enquiry
Organisation response
transformational interventions is yet to be defined,
but is estimated that benefits could equate to c.
£20m. The diagram also does not include the cost
of delivering the transformation required.
A full risk assessment has been undertaken on the
financial plan, which contains appropriate
mitigations and a number of alternative planning
scenarios have been considered to determine the
planned impact on the system. These are detailed
on page 41 of the Northern Derbyshire Unit of
Planning System Plan. The bridge diagram
contained on page 42 represents the default view
and is considered to include a conservative view of
the potential impact of integrated care. This view is
represented in the system’s financial plan
submissions, which will continue to be refined over
the coming months as our System Plan is
developed and better understood.
Quality impact assessment will also be undertaken
on the key transformational interventions identified
as priority, which will ensure that any disinvestment,
reinvestment and changes we make to services
over the next five years will not be detrimental to
the quality of care provided.
b) You should explain how your five year strategic
plan will improve outcomes in the seven areas
identified, within the context of the needs of your
local population and what quantifiable level of
improvement you are aiming to achieve.
13
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
The system plan describes why Northern
Derbyshire must change the way it delivers care
and shows how integrated care is at the heart of this
response, both in terms of what this will mean for
patients as well as the system. In addition it
describes what good looks like for the other key
elements of the health and care delivery system
together with the necessary ingredients for delivery.
How these elements fit together and how success
will be measured is illustrated in the diagram on
page 13 of the System Plan.
This diagram demonstrates that by transforming the
system, changing patterns of consumption and
responding to the health and care needs of the
population we will be able to deliver significantly
improved outcomes for the Northern Derbyshire
population. The success of this planned
transformation will be measured against the national
improving outcomes ambitions, which can be
quantified as follows:



14
Reduce by 489 the number of years of life
lost by the people of Northern Derbyshire
from treatable conditions (e.g. cancer, stroke,
heart disease, respiratory disease, liver
disease)
Improve by 5 percentage points on average
the quality of life of the people in Northern
Derbyshire living with one or more long-term
conditions
Reduce the number of avoidable hospital
admissions by 1905 over the next 5 years
Segment
Key Line of Enquiry
Organisation response
through improving the quality of primary and
community care and people’s ability to selfmanage.
 Reduce the proportion of people reporting a
poor experience of inpatient care by 6%.
 Reduce the proportion of people reporting a
very poor experience of primary care by
11%.
The Northern Derbyshire Unit of Planning System Plan
identifies a number of planned changes within each of
the key characteristics of a high quality, sustainable
health and care system. These initiatives have been
mapped against the nature of the impact in terms of:
 Managing demand: prevention and referral
management
 Right Care, Right Setting: Right Care, Right
Setting and reduced length of stay
 Efficiency: improved pathways
The initiatives and their planned impact are detailed on
page 38 of the System Plan. The financial impact of
these initiatives is defined in the bridge diagram on
page 42 and is based on the planned changes and
reductions in activity that will result, which links back to
the seven improving outcomes ambitions. For
example, by introducing integrated models of care
such as community based teams and increasing the
use of care plans it is anticipated that emergency
admissions will reduce across the system by 22% in 5
years time. The Unit of Planning has undertaken
detailed modelling on the changes we are planning to
15
Supported by:
Segment
Key Line of Enquiry
Organisation response
make in order to arrive at the ambitions contained
within the Plan.
c) Reducing health inequalities
The Northern Derbyshire Unit of Planning System
Plan identifies the case for change (pages 14 to 20)
and highlights some of the most significant health
inequalities experienced by the Northern Derbyshire
population. These include:
 An ageing population – significantly higher than
the national average
 High prevalence of long term conditions
(Coronary Heart Disease, Diabetes and
Hypertension
 Significant variation in deprivation and associated
determinants of health
The JSNA and public health profiles for Hardwick
and North Derbyshire CCGs show a variation
across Northern Derbyshire Unit of Planning as a
whole. Due to the health status of the population of
Hardwick CCG and parts of North Derbyshire CCG,
reducing inequalities is a central theme to the
Northern Derbyshire Unit of Planning Plan, which
seeks to address these inequalities and rebalance
the way resources are currently used to best meet
the needs of the population.
To address the inequalities that exist there are a
range of initiatives contained within the Plan aimed
at reducing unwarranted clinical variation across
16
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
primary and secondary care, improving equity of
access, initiatives to ensure parity of esteem and
targeted preventative measures to improve lifestyle
choices and reduce premature mortality. These
initiatives are reflected in the ambitious targets to
improve outcomes for the next 5 years, particularly
in the areas of securing additional years of life for
the people with treatable mental and physical health
conditions and improving the health related quality
of life for those with long term conditions.
Who has signed up to the strategic
vision? How have the health and
wellbeing boards been involved in
developing and signing off the plan?
The Northern Derbyshire Unit of Planning engaged GE
Healthcare Finnamore in April 2014 to support the 21st
Century
Programme
Board
(representing
all
stakeholders across Northern Derbyshire) to pull
together existing strands of work and develop a whole
system plan for a safe, clinically and financially
sustainable health and care system for North
Derbyshire.
Over the past three months GE Healthcare Finnamore
have bought together a wide range of stakeholders
from across the system to discuss and agree the
strategic vision including Accountable Officers/Chief
Executives, Clinical Leads, Directors of Finance and
Planning Leads from the following organisations:


17
Chesterfield Royal Hospital NHS Foundation
Trust
Derbyshire County Council:
 Health and Wellbeing Board
 Adult Care Services
 Public Health
Segment
Key Line of Enquiry
Organisation response
Supported by:
 Derbyshire Community Health Services NHS
Trust
 Derbyshire Healthcare NHS Foundation Trust
 Derbyshire Health United (Out of Ours and 111
services)
 East Midlands Ambulance Service NHS Trust
 North Derbyshire Voluntary Association
The Health and Wellbeing Board is identified above as
a key stakeholder and have been involved from the
beginning in the development of the strategic vision
and formally ratified previous iterations. The Health
and Wellbeing Board will receive the final Strategic
Plan submitted on 20th June, and recognising that it will
continue to evolve over time it will be discussed at the
next development session in July 2014.
The Strategic Plan is fully aligned with the Derbyshire
Health and Wellbeing Strategy (2012-2015) and meets
all key outcomes identified by the Health and
Wellbeing Board as being strategic priorities for
Derbyshire County.
The development and progression of the vision is
under the remit of the Derbyshire Health and Wellbeing
Board Task and Finish Group which reports to the
Derbyshire County Health and Wellbeing Board.
The Northern Derbyshire Unit of Planning Strategic
Plan has been reviewed by the East Midlands Clinical
Senate who have provided valuable feedback. In
summary the feedback stated that the plan contained
‘laudable aims’, but required more detail on ‘how the
18
Segment
Key Line of Enquiry
How does your plan for the Better Care
Fund align/fit with your 5 year strategic
vision?
Organisation response
Supported by:
aims will be achieved and how success will be
measured’. This feedback has been considered and
very much informed this final submission.
The
Plan
has
also
been
considered
by
Derbyshire/Nottinghamshire Area Team and feedback
received. Again this feedback has been incorporated
within this latest submission. Reciprocally the Northern
Derbyshire CCGs have been fully engaged in
development of the Area Team’s Direct Commissioning
Plans, in particular the plans for Primary Care. The
Northern Derbyshire Unit of Planning strategic
vision/Plan incorporates the strategic direction of the
Direct Commissioning plans, which are essential to the
achievement of the overall aims contained within the
strategic plan.
The Better Care Fund Plan has been developed jointly
by the LA, all 4 Derbyshire CCGs and in conjunction
with Tameside and Glossop CCG with regards their
Glossop population.
The Northern Derbyshire Unit of Planning five year
Strategic Plan builds on this work and recognises that
the Better Care Fund Plan, Primary Care Strategy and
5 year strategic plan are intrinsically linked and
collectively pivotal to achieving the outcomes required.
The key elements described within the Better Care
Fund documentation have been formally agreed as
integrated care, community integrated working, 7 day
working and other areas which require evaluation or
development during 2014/15. These workstreams
directly support the key programme areas contained
19
Segment
Key Line of Enquiry
Organisation response
within the Northern Derbyshire Unit of Planning’s 5
year strategic plan and will therefore contribute to the
delivery of the 5 year strategic vision.
Supported by:
It should also be noted that the CCGs have been
heavily involved in discussion with providers and lead
commissioners in mid Nottinghamshire, Greater
Manchester and South Yorkshire on their system wide
transformation plans to ensure that any potential
impact on the Northern Derbyshire population/services
is understood and influenced.
What key themes arose from the Call to
Action engagement programme that
have been used to shape the vision?
Patients have been engaged in the development of the
strategic direction of the Northern Derbyshire Unit of
Planning for many years and have worked with us to
develop our integration vision, through personal
involvement in pilot schemes and through our patient
reference groups.
Building on previous engagement activity undertaken
as part of the ‘21st Century Health and Care’ work, the
CCGs held a range of Call to Action events including
locality based stakeholder forums, clinical meetings for
primary care staff, events for the public to contribute
their views about how to address the challenges that
need to be faced in primary care and an event linked to
Children’s Takeover Day where students from local
secondary schools were invited to participate in the
CCGs’ Lay Reference Group meetings in November.
At these events stakeholders were asked to comment
on the CCGs’ draft commissioning intentions and the
strategic priorities identified from the health needs
20
NDCCG Feedback
collection template CTA.docx
Hardwick CCG C2A
Summary.docx
Segment
Key Line of Enquiry
Organisation response
assessment undertaken.
Feedback varied slightly by locality, however
stakeholders were largely in support of the priorities
identified with a particular emphasis on strengthening
primary and community care, encouraging more
integrated working and introducing more multidisciplinary teams to provide person centred care.
There were three clear overall themes, communication,
integration and self-care.
Communication:
Communication between clinicians and patients and
their carers but also between health and care
organisations was a concern. Communication and
integration between organisations was seen as way of
keeping people out of hospital and improving patient
care. We were asked to give some focus to the role of
carers.
Integration:
Integration as an approach to reducing non-elective
admissions was seen as a positive step to improve
quality, however people thought we should ensure
there’s capacity in the community to support this vision
and we should ensure we make good use of the
voluntary and community sector. Concerns were raised
around how county council funding issues will affect
their ability to support our vision.
Self-care:
Self-care, including helping people to stay health was a
21
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
key theme; concerns included getting health messages
to young people particularly around alcohol use, but
also practical issues such as cooking and budgeting
skills.
This feedback, combined with other analysis available
to the CCG has informed the development of the
Northern Derbyshire Unit of Planning strategic vision
and the priorities contained within the two year
operational plan.
The summary reports from events are attached for
further information.
Is there a clear ‘you said, we did’
framework in place to show those that
engaged how their perspective and
feedback has been included?
Both CCGs use existing processes for ensuring that
the public can see a direct link between their feedback
and our strategy, this will include information on CCG
websites and information provided directly to our
patient reference group and Patients’ network. Clear
links have been made within our strategy documents.
Both CCGs also have stakeholder forums/ patient
reference groups which have been influenced by the
Francis Report. These groups provide an opportunity
for the CCGs to hear feedback from service users to
ensure patient centred quality services. Feedback and
corresponding actions are discussed regularly within
these arenas and the information is also available to
the wider public on the CCGs websites.
The CCGs have also adopted a ‘You Said, We Did’
approach, with stakeholders told how their feedback
has been included in the CCGs’ operational plans, as
22
Segment
Key Line of Enquiry
Organisation response
Supported by:
well as driving the Northern Derbyshire Unit of
Planning strategic vision. This ‘closing of the loop’
continues to be a regular feature of the stakeholder
forums.
The stakeholder meetings held in autumn 2013
delivered the Call to Action themes as well as testing
out the CCGs’ draft commissioning priorities. The
response to these events has strongly influenced the
CCGs’ final strategy and vision.
The system vision was presented to Derbyshire County
Council elected members, including Scrutiny
Committee members, in June 2014 and described
what we have already achieved and the impact of
these achievements on the future delivery of services.
a) Current
position
Has an assessment of the current state
been undertaken? Have opportunities
and challenges been identified and
agreed? Does this correlate to the
Commissioning for Value packs and
other benchmarking materials?
Pre consultation has already commenced to inform a
broad spectrum of the population of the vision and
during this time firm proposals will be developed which
will be used as the basis of the formal consultation that
will be undertaken over the autumn.
Yes – a review of the current state has been
undertaken and is provided in detail in the System Plan
on pages 12 to 20. This section describes the key
challenges facing the Northern Derbyshire system,
which are consistent with the national challenges
described in ‘The NHS belongs to the people: a call to
action’ (July 2013).
The Northern Derbyshire Unit of Planning recognises
and agrees that to better meet the care needs of our
people within the resources we have available requires
23
Segment
Key Line of Enquiry
Organisation response
major changes to the way in which care is provided.
The opportunities to address the challenges facing the
system have been identified as:



Delivering integrated care at scale – proactively
supporting the needs of the ‘top 20%’
Shifting care out of bedded services and into
team based community care
Aligning the system to work differently
These opportunities are supported by a statement of
what good looks like (see summary on page 4 of the
System Plan), which in turn has enabled the
identification of a range of improvement interventions
described in pages 28 to 38 of the System Plan.
The improvement interventions detailed in the Northern
Derbyshire Plan were guided by a range of
benchmarking and health needs assessment tools
including the Commissioning for Value tool, Atlas of
Variation and local JSNA. North Derbyshire and
Hardwick CCGs used this information and through
consultation with their stakeholders determined the
areas requiring prioritisation from 2014/15 onwards,
which are reflected in the System Plan.
The above sources of information were also used to
inform detailed activity, finance and capacity modelling,
which was undertaken in developing the Plan.
Examples of additional activities undertaken include:

24
GE Healthcare Finnamore were commissioned
in February to undertake an exercise to
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
triangulate CCG and provider plans to ensure
alignment and identify inconsistencies, which
were rectified in the activity, finance and
operational plan submissions in April. This
exercise was refreshed following the April
submissions
and
the
recommendations
incorporated into the System Plan. There will
be an ongoing process of refinement in the
coming
months
as
investments
and
disinvestments are better developed and
understood.


Do the objectives and interventions
identified below take into consideration
the current state?
25
Public Health has developed a prevention
strategy, which has informed the Prevention and
Self Care element of the Plan. This has helped
the Unit of Planning to understand how we
should work with public health, adult care,
voluntary sector and community themselves to
develop community resilience and capacity.
Public Health were also commissioned to
undertake a bed capacity modelling exercise to
further understand the size of the challenge for
the health and care system and how the
transformational
interventions
proposed,
including implementing models of integrated
care, may impact on the sustainability of the
system. This was presented to the 21st Century
Programme Board in May and has therefore
contributed to the Plan.
Yes – the objectives and interventions described within
this document and the attached Northern Derbyshire
Unit of Planning System Plan take into consideration
Segment
Key Line of Enquiry
Does the two year detailed operational
plan submitted provide the necessary
foundations to deliver the strategic
vision described here?
b) Improving
quality and
outcomes
At the Unit of Planning level, what are
the five year local outcome ambitions
i.e. the aggregation of individual
organisations contribution to the
outcome ambitions?
Organisation response
the current state. The interventions included in the
Plan are based on addressing the challenges that the
current state identifies.
Yes – the Northern Derbyshire Unit of Planning
believes that the two year operational plan submitted
provides the foundations required to deliver the
strategic vision. The Northern Derbyshire Unit of
Planning has undertaken detailed analysis and
modelling to ensure that the ambitions and activity
plans set are realistic and will deliver the improvement
required. This is critical as the system will be using the
ambition metrics and associated activity impacts to
determine whether the interventions described in the
Strategic Plan and Better Care Fund Plan have been
delivered successfully.
The Northern Derbyshire Unit of Planning has Northern Derbyshire
considered the respective CCG baselines and Unit of Planning
considered the individual ambitions submitted in the Ambitions:
Operational Plan templates.
We have recognised that there is varying performance
across the two CCGs for the ambition outcome
measures and therefore quite different starting points.
With this in mind we have agreed a methodology which
aggregates the outcome ambitions that we believe is
realistic (based on the improvement interventions we
have planned) yet ambitious.
The proposed level of attainment at individual CCG
and Unit of Planning level, including the anticipated
activity change, is attached.
26
Supported by:
ND UoP Ambitions 18.6.14.xlsx
Segment
Key Line of Enquiry
How have the community and clinician
views been considered when developing
plans for improving outcomes and
quantifiable ambitions?
Organisation response
Supported by:
A range of stakeholder events have been held over the
past nine months and build on the feedback that has
been obtained from stakeholders through the 21st
Century Health and Care programme over the past two
years. These events have helped to shape the
strategic vision for the Northern Derbyshire Unit of
Planning and prioritise the improvement interventions
that have been identified.
The membership of both Hardwick and North
Derbyshire CCGs have been involved in driving the
strategic direction through localised planning and also
via the CCG’s respective governance structures which
include lay and clinical representatives as permanent
members.
The strategic vision and supporting interventions have
been further informed/refined through a number of
clinically/professionally led programme groups and
events. Examples include:



27
The Northern Derbyshire Urgent Care Working
Group, consisting of representation from a wide
range of partner organisations, clinicians and
non-clinicians, has identified the key changes
that need to be made in order to redesign urgent
and emergency care.
A frail and elderly clinical workshop held in
December 2013 identified and recommended
tangible changes to pathway delivery for the frail
and elderly including more integrated models of
care.
GE Healthcare Finnamore has undertaken a
Segment
Key Line of Enquiry
Organisation response
Supported by:
range of workshops over the past three months
with a range of partner organisations, clinicians
and non-clinicians including:
o A clinical and professional reference
group including clinical leaders and nonclinical specialists commissioning and
provider organisations. This group met
three times and assisted in developing
the core narrative of the system
transformation plan and financial bridge
chart.
o Finance and Planning Leads from
commissioning
and
provider
organisations met twice in order to inform
the financial impact of the System Plan.
o Chief Executives have been meeting
fortnightly to oversee and guide the
development of the System Plan.
It is important to note that the Strategic Plan builds on
the mission, values and objectives developed by the
CCGs during the formation of both organisations.
During this period there was extensive community and
clinician engagement to agree the mission and
objectives. The direction of integrated care, approach
to sustainability and commitment to improving quality is
embedded within the organisation and dates back to
pre-authorisation.
The CCGs also have ongoing dialogue with ‘over the
border’ providers and lead commissioners both in mid
Nottinghamshire, Greater Manchester and South
28
Segment
Key Line of Enquiry
Organisation response
Supported by:
Yorkshire. The CCGs are currently heavily engaged
with the South Manchester Healthier Together
programme, the South Yorkshire Working Together
programme and the Better Together programme in
Nottinghamshire to ensure that any potential impact on
the Northern Derbyshire population/services is
understood and influenced.
Local clinicians are
represented on the governance structures of these
programmes and proposed options have been
presented to stakeholder forums in Northern
Derbyshire to ensure that members of the community
have also had opportunity to understand and influence
the proposals.
What data, intelligence and local
analysis was explored to support the
development of plans for improving
outcomes and quantifiable ambitions?
The following information sources have been used to
develop a health profile for the CCGs and determine
the key intervention areas within the 5 year strategy:






Information provided by GEM CSU
Derbyshire Joint Strategic Needs Assessment
Profile
Public Health profiles at CCG level
System opportunities modelling
PHO profiles – disease specific
Evaluation of Hardwick Virtual Ward model
To further inform the development of operational plans
to improve outcomes and realise ambitions in 2014/15
and 2015/16 the CCGs have used a series of
benchmarking tools and information sources to identify
the greatest opportunity to improve outcomes for
patients, for example the following sources have
influenced specific work-streams within the key
29
Segment
Key Line of Enquiry
Organisation response
interventions:


How are the plans for improving
outcomes and quantifiable ambitions
aligned to local JSNAs?
Right Care
- Commissioning for value pack
- Commissioning for value tool
- Commissioning for value explorer
NHS England
- Operational planning atlas
- Levels of ambition tool
- Outcomes benchmarking support pack
(CCG level)
- Primary Care tool/ practice profiles
In developing the plans, the Northern Derbyshire Unit
of Planning has considered the JSNA and used it to
help determine where the greatest area of need is, i.e.
where the CCGs are statistically significantly worse
than others in its ONS cluster. The Commissioning for
Value tool has also been used to determine where the
CCGs are in the worst quartile and worse than the
England average.
This information has guided the planned changes
within the System Plan and the improving outcome
ambitions submitted in the Operational Plan.
How have the Health and wellbeing
boards been involved in setting the
plans for improving outcomes?
30
The Derbyshire County Health and Wellbeing Board
has been heavily involved in identifying local priorities
and developing local plans and metrics to ensure
improvement in health outcomes.
This includes
developing the vision that is contained within the Better
Care Fund and is mirrored in the Northern Derbyshire
Unit of Planning strategic vision. The Health and
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
Wellbeing Board formally received and signed off the
Better Care Fund Plan on 3rd April. The draft Northern
Derbyshire Unit of Planning Strategic Plan was also
shared at this meeting and comments incorporated into
the latest iteration.
Recognising that the System Plan will continue to
evolve over time this Strategic Plan (incorporating the
System Plan document) will be shared with Health and
Wellbeing Board members on submission on 20th June
for further comment and will be discussed in detail at a
development session in July.
c) Sustainability
Are the outcome ambitions included
within the sustainability calculations? I.e.
the cost of implementation has been
evaluated and included in the resource
plans moving forwards?
Yes – the outcome ambitions are included within the
sustainability calculations in the Financial and
Operational Plans. For example the ambition to
reduce the amount of time people spend avoidably in
hospital by 22% is reflected in the Activity Plan
(Prov_Comm template) and the associated reduction in
the cost of emergency admissions is reflected in the
Financial Plan.
The bridge diagram on page 42 of the Northern
Derbyshire Unit of Planning System Plan neatly
describes the planned investment and disinvestments
over the next five years to achieve the system vision
and ensure financial sustainability going forwards.
Although the bridge diagram does not include the cost
of implementation provision has been made for this
within the Financial Plan.
31
Segment
Key Line of Enquiry
Are assumptions made by the health
economy consistent with the challenges
identified in a Call to Action?
Organisation response
Yes – the messages and themes identified through
engagement to date are consistent with the
assumptions made by the health economy and have
heavily influenced the shape the System Plan has
taken.
Feedback from the Call to Action events,
supplemented by other feedback received from
patients, public and stakeholders told us that we
should strengthen primary and community care,
encourage more integrated working and introduce
more multi-disciplinary teams to provide person
centred care. Overarching themes also included
inconsistencies in access to services, which links with
intelligence we have accessed on health inequalities all
of which the System Plan seeks to address.
Can the plan on a page elements be
identified through examining the activity
and financial projections covered in
operational and financial templates?
The key transformational interventions detailed within
the System Plan (summarised on page 38 of the
System Plan) are reflected in the Plan on a Page and
the impact of these interventions can be identified
within the activity and financial projections.
The bridge diagram on page 42 of the System Plan
details the forecast impact of the planned investments
and disinvestments, which are mirrored within the
activity and financial plans. For example, assumptions
have been made in the activity and financial plan on
reductions in demand as a result of introducing
integrated models of care and rationalising the estate
from which these services are provided.
As the System Plan continues to develop and evolve
32
Supported by:
Segment
Key Line of Enquiry
Organisation response
these projections will be revisited and refined in the
coming months and are therefore subject to change.
d) Improvement
interventions
Please list the material transformational
interventions required to move from the
current state and deliver the five year
vision. For each transformational
intervention, please describe the :
 Overall aims of the intervention
and who is likely to be impacted
by the intervention
 Expected outcome in quality,
activity, cost and point of delivery
terms e.g. the description of the
large scale impact the project will
have
 Investment costs (time, money,
workforce)
 Implementation timeline
 Enablers required for example
medicines optimisation
 Barriers to success
 Confidence levels of
implementation
The Northern Derbyshire Unit of Planning System Plan
describes the key transformational interventions, their
anticipated impact and the enablers required to support
and facilitate the changes required to the system in
order to deliver the five year vision.
The planning teams may find it helpful to
consider the reports recently published
or to be published imminently including
commissioning for prevention, Any town
health system and the report following
the NHS Futures Summit.
33
The System Plan is founded on the development of
integrated care to better meet the ongoing care needs
of the people of North Derbyshire, where services are
person centred, enable people to self-care, thereby
keeping themselves well for longer and reducing the
level of unplanned care they receive. For this reason
integrated care is placed at the centre of the
transformation programme.
This reflects that
integrated models of care are being developed across
the age and need spectrum including for the frail and
elderly, for children and young people and for those
with mental health conditions.
Besides the development of integrated care the system
will improve and align other aspects of care. These
include:







Prevention and self-care
Primary care
Emergency and urgent care
Elective care
Specialist care
Mental health
Children’s services
Supported by:
Segment
Key Line of Enquiry
Organisation response
 Adult social care
These aspects of care form the key transformational
interventions in the System Plan. Each intervention is
supported by a number of initiatives, which are
categorised according to where they will impact on the
shape of the system and can be linked to the overall
impact in financial terms (see pages 28 – 38 of the
System Plan).
Overall Aims of the Interventions
Integrated Care
The overall aim of this intervention is to: ‘better meet
the ongoing care needs of the people of North
Derbyshire, where services are person centred, enable
people to self-care, thereby keeping themselves well
for longer and reducing the level of unplanned care
they receive’.
Key initiatives include:
•
•
•
•
•
•
•
34
Identification of people with high needs
Care plans for most complex & high risk patients
Integrated community teams (including 7 day
working)
Health & Social Care Community Beds
programme
Enhanced integrated pathways for LTC patients
Tele-health & monitoring
Integrated behaviour pathway for children and
young people
Supported by:
Segment
Key Line of Enquiry
Organisation response
Prevention and self-care
Supported by:
The overall aim of this intervention is to: ‘manage the
growing demands on health and social care. A
fundamental premise to the way care should be
delivered in the future is a focus on getting out of
peoples’ lives rather than into them’.
Key initiatives include:
•
•
•
•
•
Healthy Communities Programme
Single Website Portal
Early identification of risk factors
Self-Management Programme
‘Wrap Around’ Community Resources Programme
(enhanced carer support)
Primary care
The overall aim of this intervention is to: ‘ensure
Primary Care sits at the heart of integrated care and
drives forward out of hospital care.
Increasing
expectations around access and rising quality
expectations mean that significant changes are
required’.
Key initiatives include:
•
•
•
35
Develop a shared clinical record
Develop networking/federation of
provide scale
Address & monitor clinical variation
GPs
to
Segment
Key Line of Enquiry
Organisation response
Emergency and urgent care
Whilst the emphasis of Integrated Care described by
this plan is on proactive identification and planning to
reduce the need for episodic care, it is critical that
emergency and urgent care services are integrated
and aligned 7 days a week.
Key initiatives include:
• Urgent Access to Primary Care
• Integrated urgent & emergency care response
• Acute re-ablement unit
• Optimise ED/MIU/UCC services
• 7 Day working/Keogh Standards
Elective care
The overall aim of this intervention is to: ‘drive
significant improvements in the productivity of elective
care and reduce the unnecessary use of services.
Transformation of the planned care pathway is
required to reduce the amount of time spent in contact
with services’.
Key initiatives include:
• Referral standardisation/ management
• Pathway redesign and integration
• Enhanced recovery programme
Specialist care
The overall aim of this intervention is to: ‘ensure
effective and sustainable whole system improvement in
36
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
specialist services working with local strategic clinical
networks’.
Key initiatives include:
• Review provision of Ophthalmology, ENT and
OMFS across South Yorkshire
• Review Dermatology, Rheumatology and
Paediatrics across South Yorkshire
• Consistent 7-day specialist regional pathways
Mental health
The underlying principles for Mental Health care over
the next five years are (i) to ensure parity of esteem
between physical and mental health and (ii) to deliver
care as close to home as possible.
Key initiatives include:
•
•
•
•
Increase capabilities of Primary Care Service
Intermediate/Crisis
Response
Service
Development
Psychiatric Liaison Service (RAID)
Integrated pathways for mental health & LD
Children’s services
The overall aim of this intervention is to: ‘continue to
work collaboratively with Derbyshire County Council
and the Derbyshire Children’s Trust to develop a range
of services which will achieve the outcomes required in
the Health and Wellbeing Strategy’.
37
Segment
Key Line of Enquiry
Organisation response
Key initiatives include:
•
•
Early intervention and prevention
Integrated Care for Children & Young People
Adult Social Care
The overall aim of this intervention is ‘to deliver
integrated services that are built around the principles
of independence, safety, good health and quality of
life’.
Key initiatives include:
•
•
•
•
•
•
•
•
•
•
38
Develop and roll out whole person care across
Derbyshire
Improve services through joint working with the
local NHS
Implement the social care reforms set out in the
Care Act
Improve our safeguarding procedures
Support independent living and healthier lives
for older people
Work with carers to better understand their
needs and improve support service
Improve information, advocacy and advice
services
Improve access to employment opportunities for
disabled adults
Reduce the inappropriate use of residential care
Better integrate health, housing and social care
Supported by:
Segment
Key Line of Enquiry
Organisation response
Expected Outcome of the Interventions
The expected outcome of each transformational
intervention, i.e. the scale of the impact it is anticipated
to generate is described in more detail on pages 32, 42
and 43 of the System Plan.
The impact and success of the transformational
interventions in their totality will be measured against
the improving outcomes ambitions. The Unit of
Planning has attempted to articulate the ambitions in
real numbers, so that we are able to articulate our offer
to the population of North Derbyshire. These are:





39
Reduce by 489 the number of years of life lost
by the people of Northern Derbyshire from
treatable conditions (e.g. cancer, stroke, heart
disease, respiratory disease, liver disease).
Improve by 5% the quality of life of the people in
Northern Derbyshire living with one or more long
term condition.
Reduce the number of avoidable hospital
admissions by 1905 over the next 5 years
through improving the quality of primary and
community care and people’s ability to selfmanage.
Reduce the proportion of people reporting a
poor experience of inpatient care by 6%
Reduce the proportion of people reporting a
very poor experience of primary care by 11%.
Supported by:
Segment
Key Line of Enquiry
Organisation response
Investment Costs
The bridge diagrams on page 42 of the System Plan
describes the level of disinvestment and reinvestment
that will be undertaken over the next five years in order
to deliver the strategic vision and ensure sustainability
of the system in future. This can be linked back to the
matrix on page 38 of the System Plan, which identifies
the impact each transformational intervention is
anticipated to generate.
The bridge diagram on page 43 of the System Plan
takes this one step further and shows the potential
future spend by care area (with reference to current
spend) and the planned reinvestment in ‘right care’
settings and integrated care. It should be noted that
this is deliberately not intended to represent future
spend or investment with any particular providers as
the system recognises that we will undoubtedly need to
align the system to work differently in future, i.e. work
beyond existing organisational and professional
boundaries.
Implementation Timeline
The System Plan provides a suggested roadmap of the
work that will need to happen over the next five years
to deliver the new model of care for the whole system
(see page 47), however it is recognised that in order to
focus transformation resource effectively and efficiently
the Northern Derbyshire Unit of Planning will need to
agree which interventions/initiatives will be undertaken
at which point throughout the five year transformation
40
Supported by:
Segment
Key Line of Enquiry
Organisation response
programme. Discussions are currently underway
regarding the establishment of a governance structure
that will oversee and manage the five year
transformation programme. It is likely that this
structure will be supported by a Clinical and
Professional Reference Group that will provide a key
function to help the system prioritise the initiatives that
will have the greatest impact at the right time within the
programme’s lifetime. At present there are circa 30
initiatives (and many projects within each), which will
need to be prioritised in order to create a balanced
portfolio of key transformational initiatives across the
spectrum of prevention, integration and pathway
changes/enablers. From the workshops that have
taken place to date a view of the priorities is beginning
to emerge and is detailed on page 46 of the System
Plan. Once the priorities have been identified further
work up of the detail including investment, expected
impact, etc. will be a major focus for the system in the
coming months.
Enablers Required
To ensure the successful delivery of the transformation
programme a number of key system wide enablers will
be required to support and facilitate changes to the
existing model of care. These include:


41
The ability to prioritise which interventions to
undertake and when
The understanding that not one size fits all –
certain interventions may need to be
implemented and/or delivered differently in
Supported by:
Segment
Key Line of Enquiry
Organisation response
different localities due to the needs of their
populations
 A commitment for all system leaders/partners to
work together to deliver the transformation
required
 To learn as we go – recognising that we are on
a journey and that the scale of challenge
required is significant
 7 day working – this underpins all future models
of care and requires all parts of the system to
move at the same pace
 Information management and technology
 More effective use of estate - in the future
facilities will need to be used much more flexibly
and be best located to meet people’s needs
 Workforce and skills
 Developing more effective mechanisms to
commission and contract for the desired future
model of care
 Develop an effective governance structure that
will oversee and manage the transformational
change across the system and ensure cross
system decision making is enabled and
understood.
The key enablers are summarised on page 9 of the
System Plan and described in more detail on pages 48
to 56.
Barriers to Success
The barriers to success are reflective of the enablers
described above, however two are particularly
42
Supported by:
Segment
Key Line of Enquiry
Organisation response
noteworthy and are described further below:
Workforce
One of the greatest barriers to success currently,
particularly in introducing integrated models of care, is
the workforce. Recruitment of staff in key areas such
as nursing, geriatricians for the Acute Re-ablement
Unit, A&E Consultants and GPs has been difficult and
debilitating. Re-providing care in different settings
gives providers opportunities to deliver internal savings
by back-filling vacancies, however this potentially puts
pressure on established or expanding services
elsewhere in the system. This results in difficulties in
flexing resources and providing sufficient capacity to
meet demand and also continue developing and
expanding proactive care services. The key
challenges we anticipate as a result of the strategic
vision we are working towards are:
•
•
•
43
The Northern Derbyshire model for integrated
care will have substantial implications for the
whole provider workforce.
New ways of working – staff will work in multidisciplinary teams made up of employees from
physical and mental health providers and social
care. A shared understanding across
professionals and organisations will be required
to ensure that the team has the right attributes
and all staff are making a valid contribution to
effective integrated care. Clarity of leadership
and accountability will be essential.
Development of existing roles – such as existing
Supported by:
Segment
Key Line of Enquiry
Organisation response
staff in the community providing a greater range
of services and working to ‘top of license’.
• Development of new roles and approach to skillmix – such as care co-ordinators and joint
health and social care workers, and a shift to
higher non-qualified to qualified ratios for
community based care to provide extensive low
level support.
• Primary care professionals – will need to
increase skills and work together in new ways
including multi-professional team working and
sharing skills across practices. Impact of 7 day
working understood.
• Flexible employment models will be required
together with consideration of education and
training needs of a changing workforce.
Clearly the greatest enabler will be for each provider
organisation to enable their workforce to work
differently and across boundaries in multi-disciplinary
teams. To facilitate this discussion has already
commenced across the provider organisations to make
some key changes to contract terms and conditions.
To develop this further and overcome the barriers
described above commissioners and providers across
Northern Derbyshire are engaging with the Local
Education and Training Board to develop a system
wide workforce plan, which will feed into the wider
Health Education East Midlands workforce plan.
Information Management and Technology
The current disconnected nature of health and care
44
Supported by:
Segment
Key Line of Enquiry
Organisation response
information management systems is a significant
barrier to achieving a new model of delivery which has
integrated care at its heart. In order to achieve the
required scale and pace of change the existing IM & T
infrastructure will need to be addressed.
The system plan (page 51) describes four key
capabilities that are required to deliver effective
integrated care which will need to underpin a shared
informatics strategy across all organisations. These
are:




Data control
Healthcare analytics
Care coordination and management
Patient and wellness engagement
The establishment of common, integrated social and
clinical care information, centred on the person, is an
ongoing ambition to underpin health and care
community-wide integration and transformation
initiatives. It will enable care professionals to work
within and between their respective organisations,
supporting the continuity of care across pathways and
to provide the opportunity to support the population to
access their care records so that they may more fully
participate in their care.
The health and social care organisations in Derbyshire
are at varying levels of digital maturity and as a
consequence are not able to ensure that the various
systems in use at the point of care across Derbyshire
are easily and seamlessly able to exchange the
45
Supported by:
Segment
Key Line of Enquiry
Organisation response
necessary information to support the integration and
transformation of local services.
So as not to inhibit greater service integration, the
health and social care organisations and associated
partner agencies in Derbyshire have committed to
implement a platform solution that builds on the value
of the capabilities and data contained within the current
best of breed systems to present professionals
delivering care in Derbyshire with a common and
universal access, subject to appropriate governance, to
care information from a wide variety of information
sources and to support citizens to access their
information. To ensure that the maximum value from
this can be achieved at the earliest possible
opportunity, the CCG's within Derbyshire are seeking
support from the Integrated Digital Care Technology
Fund for matched funding to accelerate the scope and
pace of this critical initiative.
Confidence levels of implementation
A great deal of progress has been made over recent
months in aligning organisational thinking and
developing a system wide vision for Northern
Derbyshire. Partnership has always been a strength in
Northern Derbyshire and will be critical in moving
forward for the scale of change that organisations have
now committed to. System partners recognise that we
are at the beginning of an evolving journey that will test
our capacity, capabilities and working relationships,
however remain confident that our plans form a solid
foundation on which to proceed and secure the future
46
Supported by:
Segment
Key Line of Enquiry
Organisation response
of services for the population of Northern Derbyshire.
e) Governance
overview
What governance processes are in
place to ensure future plans are
developed in collaboration with key
stakeholders including the local
community?
Derbyshire System Wide Governance
To date oversight and governance for delivery of the
Derbyshire vision and the Better Care Fund Plan have
taken place through existing structures such as the
Adult Care Board and Derbyshire Children’s Trust
Board to the Health and Wellbeing Board. There is a
monthly Joint Commissioning Co-ordinating Group that
also reports quarterly to the Adult Care Board and
ultimately to the Health and Wellbeing Board.
Oversight and governance of the Northern Derbyshire
Unit of Planning system vision/plan has to date taken
place through the 21st Century Transformation
Programme Board. The Board comprises the Chief
Officers of both Hardwick and North Derbyshire CCGs,
the Chief Executives of the major provider
organisations across Northern Derbyshire as well as
senior representation from public health, the voluntary
sector, adult care, the district council and the Chair of
the Health and Wellbeing Board.
It has now been recognised that a number of forums in
existence potentially overlap in terms of their decision
making authority.
21st Century Transformation
Programme Board have therefore agreed that to
support the system transformation clear cross system
decision making processes need to be established that
will ensure:

47
Clear remit and terms of reference
Supported by:
Segment
Key Line of Enquiry
Organisation response
Supported by:
 Clarity of membership and accountability
 Clear decision making processes are defined
and understood
 Decision making is enabled at the point closest
to its impact
 There is an understood and appropriate balance
between local and cross system decision
making (including input from clinicians)
 Decisions are made quickly, informed by the
right information.
The governance structure is currently being discussed
and will be agreed imminently, however it is anticipated
that it will consist of a system wide programme
structure with clear leadership and supported by a
system wide Programme Management Office to ensure
delivery. It is likely that this structure will be supported
by a Clinical and Professional Reference Group that
will provide a key function to help the system prioritise
the initiatives that will have the greatest impact at the
right time within the programme’s lifetime. At present
there are circa 30 initiatives (and many projects within
each), which will need to be prioritised in order to
create a balanced portfolio of key transformational
initiatives across the spectrum of prevention,
integration and pathway changes/enablers. From the
workshops that have taken place to date a view of the
priorities is beginning to emerge and is detailed on
page 46 of the system plan.
Continued Collaboration with Key Stakeholders
In addition to the governance structure outlined above
48
Segment
Key Line of Enquiry
Organisation response
Supported by:
the Northern Derbyshire Unit of Planning will continue
to utilise existing mechanisms to ensure collaboration
with a) membership practices and b) local community
including patients and the public. All CCG Committees
have patient representatives on them from our
respective constituted Patient Reference Groups,
which ensures direct influence and insight to inform
plan development.
CCG specific routes of Governance are described
below:
Hardwick CCG
a) Membership practices:
Membership practice views are sought and
gathered from a wide range of clinical and nonclinical staff across primary care. The CCG also has
system wide QUEST events through the year.
Following
further
development
from
the
Commissioning Delivery Group, plans are then
consulted on by the local community as described
below and lastly plans are discussed and ratified by
the Governing Body and passed to the PMO to be
operationalised.
b) Local community:
The CCG has a Communications and Engagement
Strategy which details the approach and
mechanisms for engagement with key stakeholders
including the local community. The CCG has a
strong patient voice including an active and mature
Reference Group and a wide and diverse Patient
49
Segment
Key Line of Enquiry
Organisation response
Supported by:
Network Group. The CCG has strong links to the
community, district councils and councillors, Youth
councils, the voluntary sector, Parish councils and
councillors.
North Derbyshire CCG
a) Membership practices:
Member practices are grouped into five localities in
North Derbyshire CCG.
Each locality is
responsible for developing a 2 year operational
plan based on the health needs and requirements
of their local population. These plans feed the
CCG’s operational and strategic plan and are
ratified by the Governing Body.
b) Local community:
The Patient and Public Engagement Plan and
associated work plan provides the detail and focus
for the involvement of local people in the CCG's
decision making process. The CCG has a strong
patient voice via its 21st Century Lay Reference
Group, Patient Participation Groups (PPGs),
Locality Network PPGs, Health Panel, Stakeholder
Meetings and lay representation on committees
and project groups. The CCG has strong links
with Health Watch, voluntary sector organisations,
county, district and borough councils. The CCG
has also developed productive relationships with
vulnerable and hard to reach groups and those
covered by the 9 protected characteristics of the
Equality Act 2012.
50
Segment
f) Values and
principles
Key Line of Enquiry
Please outline how the values and
principles are embedded in the planned
implementation of the interventions
Organisation response
The Northern Derbyshire Unit of Planning will work to
the following principles to guide service change. It
should be noted that these principles have been
subject to consultation and agreed with stakeholders
and the public.


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51
All services will be person-centred
We will work in partnership with the people
needing care and their families and carers to
provide care as close to the persons home as
possible, and when appropriate support them to
access the right care away from home.
Care will be provided flexibly
We will listen to and understand the person’s
complete needs and meet them by using all
services and resources available. We will
ensure that we will co-ordinate care across
health, social care and voluntary services to
ensure people receive the right care from the
right service at the right time.
Assumptions will be challenged
We will have the courage to make changes for
the better that will improve the patient
experience and obtain the best value for money.
We will embrace innovation and find new
approaches to care based on sound evidence.
We will commit to monitoring and publishing
patient experience data to be accountable to
those who use our services.
People will be treated with dignity and
respect
We respect and value the people who use and
work in health and care services in Derbyshire
Supported by:
Segment
Key Line of Enquiry
Organisation response
and we will invest resources to support the
health and well-being of our communities.
 We will plan and deliver services in
partnership
We will actively seek and listen to the views of
people who use and work in health and care in
Derbyshire so that we can plan and deliver
services in partnership and be accountable to
them.
 Healthy lifestyles will be promoted
We will support people to help them to make an
informed choice about lifestyle and services and
identify and provide extra support for those who
need and want to make positive lifestyle
changes.
Each organisation will also continue to be guided by its
own values, which are provided below for information.
Hardwick CCG values:








Responsive to local needs
Listening organisation
Visionary
Forward thinking and creative
Adaptive
Courageous
Inclusive
Empowering
North Derbyshire CCG values:
Patient Focus
52
Putting patients at the centre
Supported by:
Segment
53
Key Line of Enquiry
Organisation response
of all we do
Integrity
Being honest, fair and open
Courage
Being empowered to make
positive change
Responsiveness
Working together, committed
to delivery
Supported by: