Presentation title Healthy Ambitions by liaoqinmei


									NHS XYZ

Briefing on Delivering Healthy

Briefing material
Delivering Healthy Ambitions
‣   Delivering Healthy Ambitions, published on 5
    March 2009 – sets out how the regional
    strategic service framework “Healthy
    Ambitions” will be taken forward.

‣   Culmination of work by all PCTs in Y&H
    together with the SHA and explains what will
    happen locally, sub regionally and regionally
    for each of the eight NSR pathways

‣   Also sets out how supporting work will be
    taken forward e.g. on workforce, IM&T,
    clinical leadership, metrics and social

‣   Explains the governance arrangements for
    the programme as a whole.
Healthy Ambitions - 8 Clinical Pathways
   Healthy Ambitions (the outcome of the Next
   Stage Review in Y&H) was published in May          Overall clinical lead
   2008, it involved over 150 clinicians from              Chris Welsh
   across Y&H and made recommendations            Maternity and newborn care
   about 8 clinical pathways and also about        Dotty Watkins - Sheffield Teaching
   primary care.                                                 Hospital
                                                 Ian Lewis - Leeds Teaching Hospitals
                                                         Staying healthy
                                                     Wendy Richardson - Hull PCT
                                                          Mental health
                                                Nick Morris - Bradford District Care Trust
                                                          Planned care
                                                Mark Baker - Leeds Teaching Hospitals
                                                    and Ian Jackson - York Hospitals
                                                            Acute care
                                                David Dawson - Mid Yorkshire Hospitals
                                                      Long term conditions
                                                 Vicky Pleydell - North Yorkshire & York
                                                   and Eileen Burns - Leeds Teaching
                                                         End of life care
                                                David Levy - Sheffield Teaching Hospital
                                                   and June Toovey - Leeds Teaching
                  Primary Care
Work to take forward Healthy Ambitions
‣   A quick recap on activity since the launch of
    Healthy Ambitions:

‣   14 May 2008 : Publication and launch of Healthy Ambitions

‣   June to August: Discussion and agreement with PCTs on
    levels of delivery i.e. who will be responsible for which
    recommendation – most for local delivery.

‣   Sept to Oct:

‣   PCTs submitted report on delivering Healthy Ambitions to SHA
    – sets out levels of delivery and next steps

‣   PCTs developed strategic plans to incorporate approach to
    local priorities from Healthy Ambitions. (Clinical reference
    panel reviewed initial drafts)

‣   Nov to Jan: – work on regional enablers – governance, clinical
    leadership, development of metrics and performance
    management regime, IM&T, workforce, primary care. Start on
    scoping vascular review

‣   Feb: – work to bring all of this together in “Delivering Healthy
    Ambitions” and present back to clinical leads
Care Pathways – regional and local levels of delivery
                      Planned             Acute               Children’s            MH                  EoL                 Staying
                  Oversight of           Identification of:   Review and                                                   Bariatric
                  Reviews:               • Hyper acute        network                                                      surgery
                  • Critical care        stroke units         specialist
  Regional          provision            • Major trauma       surgical care
                  • Vascular surgery     centres              provision
                  • Urological surgery   • Primary
                  • GI surgery           Angioplasty          Y&H approach to
                  • Interventional       centres              asthma and
                  radiology                                   diabetes –
                                                              develop through
                                                              clinical summits

                  Sub regional           New Service
                  review                 Models For: -
                  infrastructure –       • Stroke                                   Y&H
                  e.g. networks          • Heart Attack -                           Commissioning
  Collaboration                          1° angioplasty
                                         • Trauma
                                                                                    network and
                                                                                    CRG already

                  Most                    Most                 Most                Most                Most                Most
                  recommendations         recommendations      recommendations     recommendations     recommendations     recommendations
                  need local action       need local action    need local action   need local action   need local action   need local action

Care Pathways – regional and local levels of delivery
                   Maternity &               LTC               Primary Care          Delivery                  Enablers
                   Newborn                                                           Models
                                                              Specialist training                              •Clinical leadership
                                                              requirements                                     development
                                                                                                               •Social marketing
   Regional                                                                                                    •IM&T
                                                                                                               •Performance and
                                                                                                               •Quality and
                                                                                                               •Health Intelligence

                  Y&H commissioning                                                 Major trauma centres,
                  network already                                                   critical care facilities
                  formed to take action                                             as per acute and
                                                                                    planned pathways.
  Collaboration   Y&H SCAP will
                  address any inter                                                 Future for smaller
                  PCT reconfig                                                      DGHs where impact
                  implications of local                                             extends beyond PCT
                  service change to                                                 boundaries
                  meet 2500 standards

                  Most                    Most                Most
  Local           recommendations         recommendations     recommendations
                  need local action       need local action   need local action
Making it happen – an example of levels of delivery
Making it happen example – Staying Healthy
                                                                         Halt in the rise of
    Pathway Pledge        One key high-level pledge per pathway                obesity

       Pathway                                                             e.g. Commissioning
                         Detailed pathway recommendations
  Recommendations                                                      weight management services

                         Agreed with PCT CEs – local delivery               Localised
   Level of Delivery
                         wherever possible, sub-regional or               commissioning
                         regional where required

  Local Prioritisation   Recommendations prioritised according to
                         local circumstances. PCT Strategic Plans       PCT Strategic Plan
                         outline local delivery & are assured by the

 Annual Operating Plan   Details of local initiatives, funding and     Annual Operating Plan
                         timescales to deliver local priorities

                         Pathway metrics developed and local              Obesity Prevalence
  Metrics / Dashboard
                         trajectories agreed. Healthy Ambitions        Reception & Year 6 Children
                         Dashboard shows progress against

      Oversight          Local monitoring/Pathway Delivery
                         Board and Strategic Commissioning             Staying Healthy PDB
 An example of local action
‣ Our pledge in the
  Maternity and
  Newborn pathway
  was to support an
  increase in
  breastfeeding rates,
  with reduced
  variation across the
Cross cutting workstreams (1)
 Cross cutting themes support delivery of the pathways:

 ‣   Primary care – aimed at improving quality and reducing variation. Phase 1 of a primary care
     dataset already delivered – Healthy Intelligence Practice Profiles – already being used
     locally. Available via a link in the primary care section of the Healthy Ambitions website

 ‣   Social marketing – region-wide marketing on priority projects, primary care access, obesity,
     end of life, stroke, mental health all sponsored by a PCT CE (plus education and training and
     marketing services)

 ‣   IM&T – NPfIT activity in response to the recommendations of the clinical pathway groups

 ‣   Workforce and education – new and different roles for staff will be needed to support the
     delivery of Healthy Ambitions

 ‣   Finance – 2009/10 onwards new rules to support innovation and improvement. In Y&H the
     new Quality Assurance and Improvement Scheme (CQUIN) starts. In 2009/10 this has a
     range of indicators built around the pathways set out in Healthy Ambitions. 0.5% quality
     premium payable against these indicators.

 ‣   Performance and metrics – Healthy Ambitions indicators have been agreed with PCTs who
     will set trajectories for improvement in much the same way as for vital signs. This makes use
     of existing data wherever possible (more detail later).
Cross cutting workstreams (2)
 Cross cutting themes support delivery of the pathways:

 ‣   Quality and Innovation – work underway on development of a Quality
     Foundation to fulfil the national expectation that all SHAs will support
     innovation and improvement across the region

 ‣   Health Intelligence –Y&H PHO will support local organisations with
     intelligence relevant to each of the Healthy Ambitions pathways

 ‣   Clinical leadership – five strands of regional activity to support clinical
     leadership and involvement in the delivery of Healthy Ambitions (more
     detail later)

 ‣   Specialised commissioning – SCG will support the delivery of Healthy

 ‣   Governance – a regional governance structure for Healthy Ambitions
     which will be put in place over the coming months (see next slide)
Delivering Healthy Ambitions - Governance
   Key Elements

   ‣   Strategic Commissioning Board – oversight – SHA and PCT CEs

   ‣   Pathway Delivery Boards – One for each Healthy Ambitions pathway and
       one for cancer and primary care. Each chaired by the lead CE supported by
       clinical lead(s)

   ‣   Composition of PDBs will vary (some of the regional groups already put in
       place e.g. for MH could migrate to become the MH PDB)

   ‣   Core terms of reference – which include e.g.:

       ‣   Maintaining an overview of delivery and advising on progress

       ‣   Overseeing review work – done by Task Groups or workstreams reporting
           to PDBs

       ‣   Identifying good practice

       ‣   Refining and re-appraise the regional model of care as new evidence

       ‣   Advising SHA and PCTs as requested
Key roles by pathway
 Pathway               Lead CE          Clinical Leads           SHA Lead Manager

 Staying Healthy       Simon Morritt    Wendy Richardson         Kay French
                                        Co-chair to be appointed
 Maternity and         Andy Buck        Dotty Watkins            Jean Hawkins
 Newborn                                Co-chair to be appointed
 Long Term             Ivan Ellul       Eileen Burns             Jane Rutter (from
 Conditions                             Vicky Pleydell           Y&H Collaborative -
                                                                 with Colin McIlwain)
 Children’s Services   Chris Outram     Ian Lewis                Jean Hawkins
                                        Co-chair to be appointed
 Planned Care          Jan Sobieraj     Ian Jackson              Colin McIlwain
                                        Mark Baker

 Acute Care            Jane Lewington   David Dawson             Ian Holmes
                                        Co-chair to be appointed
 Mental Health         Ailsa Claire     Nick Morris              Heather Raistrick
                                        Co-chair to be appointed
 End of Life           Alan Wittrick    June Toovey              Cath Wardle
                                        David Levy
 Primary Care          Rob Webster      To be appointed          Helen Parkin
Delivering Healthy Ambitions - Metrics

   ‣ Indicators developed to support the pledges and
     recommendations in Healthy Ambitions – using existing data
     and matching vital signs where possible

   ‣ Will need some refinement – particularly MH metrics
   ‣ Link with CQUINs, WCC outcomes and vital signs – all have
     been mapped against Healthy Ambitions pathways

   ‣ Healthy Ambitions dashboard – local trajectories will be
     performance managed alongside vital signs – and in the
     same way – but 2009/10 a development year

   ‣ Start from April 2009 – examples follow…..
Delivering Healthy Ambitions - Metrics
Delivering Healthy Ambitions – Clinical leadership
   5 strands of work to widen and deepen clinical leadership:

   ‣   Increasing the regional cohort of senior clinical leaders – up to 30

       ‣   Existing NSR leads – plus recruitment so that there at least two clinical leads
           for each pathway plus specialist(s) in key areas for regional work e.g. stroke

       ‣   20 of the 30 would be recruited through a competitive process (as envisaged
           in HQC4A) – the 30 will sit on their relevant Pathway Delivery Board and
           collectively these clinicians would become the Y&H Clinical Advisory Group

   ‣   120 clinicians take part in regional development programme (Clinical Leadership
       Network) and help drive forward HA models of care within their organisations

   ‣   Promoting high quality clinical advice to commissioning; e.g. by spreading the
       best models identified in the WCC Assurance process

   ‣   Ensuring high quality clinical advice supports strategic development and delivery
       of key national targets, such as 18 weeks

   ‣   Ensuring high quality clinical advice and peer challenge to local service reviews,
       reconfiguration proposals
Key messages
‣ Healthy Ambitions – the vision

‣ Delivering Healthy Ambitions –
  the framework for

‣ Your everyday commitment to
  delivering the best for patients
  – together we can make it
Healthy Ambitions for Y&H
Workforce Ambitions
‣   Workforce Ambitions will be published
‣   In 2007 we published Working for Health and
    Education for Health, a five year strategic
    framework for workforce development and
    education in Yorkshire and the Humber. The
    objectives are still relevant and significant
    progress has been made towards them.

‣   Since then Healthy Ambitions has described an
    ambitious vision for improving health in
    Yorkshire and the Humber, and Delivering
    Healthy Ambitions has set out the SHA’s
    approach to implementation.

‣   Workforce Ambitions outlines our five year
    workforce strategy and development plan to
    ensure we can successfully deliver Healthy
    Ambitions. It has been written following
    extensive consultation with all our stakeholders.

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