Walsall NHS by liaoqinmei

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									                                                      Appendix A




          Transforming Community Services


        Assurance Process for PCT Proposals on
                 Community Services


PCT Name: NHS Walsall
Name of Service Line/Pathway/Sector: Learning Disability
Proposed Option For Organisational Form: Integration with
another community provider
    Overview: brief description:

    –What tests the SHA is looking for:
    The three crucial tests to be applied by the SHA as highlighted in Eamonn Kelly’s letter on each
    submission will be:

    • delivery of quality improvement and service integration
    • increased efficiency
    • sustainability of solution

    -Options for Organisational Form:

    • Integration with an acute or mental health provider;
    • Integration with another community-based provider;
    • Social Enterprise.

    Other options, exceptional in a few places are:
    • Community Foundation Trust;
    • Care Trust which includes provision;
    • Continued PCT direct provision.

    Any proposal on provider form will be tested against the criteria below, (set out in the Operating
    Framework 2010/11)
    • are needs and pathway-driven;
    • provide more integrated and sustainable primary, community and secondary care services, which have
      the support of primary and social care;
    • deliver improved quality, including better patient experience as well as increased productivity;
    • are affordable, reducing management costs and transaction costs;
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    cont…

    • help to manage the demand for services more effectively (for example, reducing acute admissions and
      lengths of stay);
    • demonstrate that potential providers have a track record of leadership capability, governance structures
      and culture to engage and empower staff to lead service transformation;
    • support a viable provider market across the local health economy in light of the drive for greater quality
      and productivity;
    • represent an appropriate level of contestability.

    -Timescales:
    22nd January 2010           SHA issued proforma based on the assurance tests set out in the draft
                                guidance.
    19th February 2010          PCTs to submit draft by 9:00 a.m. Organisational Form Summary Sheet to
                                SHA for DH Peer review process (informal feedback to follow after the 24th
                                February 2010).
    12th March 2010             PCTs to submit completed proformas and final Organisational Form
                                Summary Sheet to SHA for assurance and approval in principle (by close of
                                play).
    12th to 31st March 2010     SHA to review returns and feedback to PCTs.
    All returns to claire.kemp@westmidlands.nhs.uk

    -NHS West Midlands assurance and approval:

    The SHA will either approve in principle the proposals for the future organisational structure or will where
    appropriate offer constructive challenge to the PCT for reconsideration.


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    •   Quality Improvement
    •   Increased Efficiency of Solution
    •   Sustainability of Solution




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    Quality Improvement

    Areas to be assured by the PCT in considering rationale for the
    decision

        Q.1 Improving Outcomes

    •   The fit with the PCT Commissioning Strategy and priority
        outcomes as identified in World Class Commissioning, including
        joint commissioning plans;
    •   That Choice is safeguarded by the proposals;
    •   That there are robust plans which show how patient experience
        for all groups will be significantly improved, and assess the
        impact on inequalities.




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1. Please state how the proposed solution will improve outcomes?


Will it meet patient needs and deliver improved local health outcomes as identified in the PCT strategic commissioning plan and Local
Area Agreement (LAA), and significantly better patient experience (including Choice)?

Rationale for decision                                                                             Implementation Plans and   Dependencies
                                                                                                   Milestones                 and Risks

•       Key Outcomes impacted:                                                                     Not yet agreed             Not yet scoped
          –     Patient Experience
          –     Infant Mortality Rates
          –     Life Expectancy
          –     Health Inequalities
•       Individuals with a Learning Disability often struggle to access mainstream health
        services and experience difficulties during acute hospital admissions. Through a
        comprehensive range of LD specialist health services we will aim to reduce health
        inequalities for people with Learning Disabilities. This will build on the work within
        Walsall through the Pacesetters Programme which has improved access to screening
        and training delivered to GPs and primary health care staff as part of the Directed
        Enhanced Services (DES) and annual health checks.
•       Bringing services together will strengthen the focus and profile of health promotion and
        awareness of the needs of people with learning disabilities within mainstream health
        services.
•       Bringing services together across a wider patch can help resolve the inevitable
        boundary issues that sometimes impede patient access to services. This includes
        working in partnership with the private sector to develop care pathways in and out of
        specialist services.




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    Quality Improvement

    Areas to be assured by the PCT in considering rationale for the
    decision

        Q.2 Improving Quality

    •   That there are identified improvements in quality of service
        outcomes to be delivered;
    •   That there is a clear plan and capability to shift from acute to out
        of hospital care;
    •   That the improvements in quality will be sustained.




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2. How would the proposed changes improve Quality?


Will it deliver significant improvements in quality of service and outcomes delivered?


Rationale for decision                                                                             Implementation Plans and   Dependencies
                                                                                                   Milestones                 and Risks

•       Local services within Walsall and Sandwell are highly valued but are clearly challenged    Not yet agreed             Not yet scoped
        in the current financial climate. A partnership approach would give greater economies of
        scale ensuring that gaps in current provision could be addressed more cohesively. This
        would provide an exciting opportunity to enhance and ensure the continued delivery in a
        sustainable way. In bringing the services together, the key benefits will be:
           –     Local Learning Disability services in both Boroughs are maintained and
                 improved working closely with local Commissioners;
           –     Address gaps in provision by extending access to the range of specialist
                 learning disability services and reducing the need for out of area placements;
           –     Inequalities in access to mainstream physical health services for people with
                 learning disabilities are tackled;
           –     Reduce length of stays and inappropriate admissions of people with learning
                 disabilities in acute hospitals;
           –     The adoption of best practice consistently across both Boroughs;
           –     Clinical governance arrangements are enhanced;
           –     Clinical capacity is increased.




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    Quality Improvement

    Areas to be assured by the PCT in considering rationale for the
    decision

        Q.3 Service Integration

    •   The proposals demonstrate at patient and pathway level how
        service integration will be enhanced to improve care;
    •   Show how the proposal supports primary, community, secondary,
        children’s services and social care partners to increase
        prevention through more integrated approaches.




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3. How would the proposed option deliver service integration?


Will it deliver significant improvements in service integration and quality of health and social care?


Rationale for decision                                                               Implementation Plans and   Dependencies
                                                                                     Milestones                 and Risks

Services within Walsall and Sandwell have different strengths, expertise and         Not yet agreed             Not yet scoped
     experience. An integrated service model hosted by the Trust will aim to
     adopt best practice from each area of the care pathway. For example,
     within Walsall there has been strong focus on enhancing LD nursing
     roles in the management of long terms conditions, dementia, epilepsy
     and establishment of LD nursing posts in hospital liaison and dementia
     care. There has been joint working with GPs and other primary care
     staff to ensure people with learning disabilities have annual health
     checks and access to a range of screening tests. Within Sandwell, we
     have a broad range of inpatient services, including some highly
     specialist Regional services (Gerry Simon Low Secure Unit).




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     Quality Improvement

     Areas to be assured by the PCT in considering rationale for the
     decision

         Q.4 Stakeholder Engagement

     •   The extent of engagement to date with all key stakeholders
         including clinicians, workforce, SPF, patients, the public, OSCs,
         LINKs and local service partners and their relevant partnership
         Boards;
     •   Specific plans for workforce engagement to deliver transformed
         services;
     •   Specific plans which demonstrate how the proposals will bind in
         the support of primary and social care and children’s services;
     •   Evidence of robust planning involving all key stakeholders for:
          – future engagement and involvement;
          – any necessary consultation.
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4. What stakeholder engagement has been sought for the proposed option?


Has it got engagement and support of key stakeholder groups?


Rationale for decision                                                                                        Implementation Plans and       Dependencies
                                                                                                              Milestones                     and Risks

The following engagement activity has been undertaken in order to specifically address the issue of           Not yet finalised for future   Not yet scoped
        organisational form:
                                                                                                                engagement
Public Engagement
           –      Presented at NHS Walsall Public Board 28th January 2010
           –      Discussed at MyNHS Walsall Parliament meeting 28th January 2010
Stakeholder Engagement
           –      Listening Event for Walsall Local Health and Social Care economy 11th February 2010
           –      TCS Programme Board meetingd held on 10th February 2010 and 17th February 2010 to
                  discuss the proposals
Staff Engagement
•       Discussed at JNCC Agenda 17th February 2010
•       Presented at NHS Walsall Protected Learning Time Event 19th February 2010
Walsall Community Health staff consultation:
           –      18th February 2010
           –      4th March 2010
           –      5th March 201
Detailed plans for future workforce and wider stakeholder engagement have not yet been finalised but a
        full consultation process with staff will be undertaken.

In terms of general staff engagement on service transformation, our programme management
       mechanisms and business cycles dictate that all programme commissioning plans have a
       stakeholder engagement and communication plans before they move to implementation. These
       plans include staff engagement.

As highlighted within our Strategic Plan, the integration of care has become a key value and principle in
       the way that we are seeking to commission and procure services. To that end we have established
       an ‘Integrate to Improve’ programme which will work across the health and social care economies
       in order to steer through the transformation task required to deliver an integrated care economy. It
       has been identified that the Board will need to address issues concerning behaviour, culture and
       values as a priority in order to embed the concept of integration. The Integrate to Improve
       programme is currently being configured.


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     •   Quality Improvement
     •   Increased Efficiency of Solution
     •   Sustainability of Solution




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     Increased Efficiency of Solution

     Areas to be assured by the PCT in considering rationale for the
     decision

         Q.5 Efficiency Improvements

     •   The proposals will help deliver the efficiency improvements set
         out in the Operating Framework 2010 / 2011;
     •   The proposals explain how, and the extent to which, they will
         deliver technical efficiencies in 2010 / 2011 and 2011 / 2012;
     •   The proposals set out how allocative efficiencies will be delivered
         in 2011 / 2012 and thereafter;
     •   Identified reductions in fixed costs including management and
         transaction costs.




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5. How would the proposed option deliver efficiency improvements?


Will it delivery substantial improvements in the technical and allocative efficiency of the services being delivered?


Rationale for decision                                                                 Implementation Plans and         Dependencies
                                                                                       Milestones                       and Risks

•        We don’t have the specific detail worked through which will provide us        Not yet agreed                   Not yet scoped
         with a quantified level of efficiency that can be released through this
         proposal. At this stage, there is an initial opportunity to make efficiency
         savings on management overheads.
•        As a commissioning organisation NHS Walsall seeks to gain
         sustainable quality and efficiency improvements through the strength of
         its commissioning and contracting processes. Our Strategic and
         Organisational Development plans place emphasis on the development
         of programme commissioning to deliver improvements in health, quality
         of services and efficiency. We intend to embed the commissioning cycle
         within our business planning processes and combine that with robust
         procurement, contracting and performance management processes.
         This will be the main vehicle that will ensure that we sustain
         improvements in quality and efficiency.
•        To support this process, the PCT has commissioned work to review
         efficiency and cost savings opportunities across our commissioning
         budgets. This work is scheduled to take place over the next three
         months.




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     Increased Efficiency of Solution

     Areas to be assured by the PCT in considering rationale for the
     decision

         Q.6 Infrastructure Utilisation

     •   The proposals will identify steps to increase utilisation and
         efficiency of back office estate and other infrastructure. To
         identify scope to share use of assets more efficiently with other
         partners, including local authorities;
     •   How will the proposal improve the utilisation of all NHS owned or
         use estate and infrastructure?
     •   The proposals will identify any surplus assets and infrastructure
         that will be released by the proposals.




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6. How would the proposed option maximise infrastructure utilisation?


Will it maximise utilisation of own (and any integration partners) estate and infrastructure?


Rationale for decision                                                               Implementation Plans and   Dependencies
                                                                                     Milestones                 and Risks

•        An initial assessment of services suggest that there are opportunities to   Not yet agreed             Not yet scoped
         maximise the utilisation of estate. Detailed work to support this has not
         yet been completed and will also be the subject of the efficiency and
         cost saving review that the PCT has commissioned (see above)




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     •   Quality Improvement
     •   Increased Efficiency of Solution
     •   Sustainability of Solution




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     Sustainability of Solution

     Areas to be assured by the PCT in considering rationale for the
     decision

         Q.7 Sustainability

     •   Show how proposals will be sustainable in the long and short
         term, clinically, financially and in terms of infrastructure;
     •   Show how the proposals will give PCTs with LA and PBC
         partners the leverage in the local health economy to deliver;
          – strategic commissioning plans;
          – continued service transformation and realignment;
          – continuing contestability and service innovation;
     •   Show how the proposals will ensure that the local health
         economy has and retains a sufficiently skilled workforce to lead,
         develop and deliver new service models.

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7. How would the proposed option support sustainability? Note: If any proposal for continued direct provision is,
exceptionally, being considered, then the host PCTs would have to demonstrate very strong commissioning skills, including
performance in WCC assessments equal to the thresholds set in the Operating Framework 2010 / 2011. If those performance levels
were not sustained then the DH and SHAs would reserve the right to review any continued direct provision.

Will it be clinically and financially sustainable?
Rationale for decision                                                                Implementation Plans and     Dependencies
                                                                                      Milestones                   and Risks

•        The relatively small and discrete Learning disability services within the    Not yet agreed               Not yet scoped
         Black Country threatens future sustainability in the current financial
         climate. The Trust is also in similar discussions with Dudley PCT and
         Wolverhampton PCT which could move towards a Black Country-wide
         Specialist LD service. Whilst the latter is focused on providing interim
         management support to Wolverhampton City PCT’s mental health
         services dialogue regarding Learning Disabilities services is distinctly
         possible.
•        The potential of bringing together Learning Disability services across the
         Black Country would raise the profile of this important client group and
         reduce service fragmentation. It also opens up career opportunities for
         staff working within these services and supports staff to share best
         practice and lead the further development of specialist health provision.
         Ultimately, the synergies from a joined up approach overcome many of
         the difficulties of operating separate small specialist services.




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     Sustainability of Solution

     Areas to be assured by the PCT in considering rationale for the
     decision

         Q.8 Whole System Fit

     •   Demonstrate how solution will deliver whole health economy
         effectiveness and efficiency;
     •   Show how the proposals will fit into current and future patterns of
         acute and out of hospital provision;
     •   Show how the proposals will contribute to delivering significant
         wider health system improvements in allocative efficiency;
     •   Have any potential adverse impacts of the proposals elsewhere
         in the local or wider health economy been identified and are
         there proposals for the management of those impacts?


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8. How would the proposed option deliver whole system fit?


Will it fit into and enable delivery of wider health economy service transformation and shifts in care?


Rationale for decision                                                                 Implementation Plans and   Dependencies
                                                                                       Milestones                 and Risks

•        As stated above, there are opportunities for efficiency and greater           Not yet agreed             Not yet scoped
         utilisation of estate. These will be tested through the work that we have
         commissioned which will provide greater detail regarding the level of
         savings that currently sit within our systems as well as expected
         timescales for delivery. At this stage, that detail is not available but we
         have clear plans for addressing this over the next three months. Once
         the savings opportunities have been identified, we will use our
         programme commissioning structures and processes in order to deliver
         target cost savings at programme and pathway level




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