SHA Integrated Business Plan

Document Sample
SHA Integrated Business Plan Powered By Docstoc
					Our vision and strategy for
health and healthcare in
south east coast
Our vision and strategy for health and healthcare in south east coast

This document provides a high-level summary of the vision and strategy of
NHS South East Coast to inform the SHA assurance process. It represents
the distillation of a number of key strategic documents, in particular Healthier
people, excellent care (HPEC) and the NHS South East Coast Corporate Plan
2009/10. Both documents are provided as annexes for further background

                                                                        Page 2 of 11
Our vision and strategy for health and healthcare in south east coast


1.     Introduction and summary                                                   4

2.     Consultation                                                               5

3.     Key elements of the strategy and vision                                    5

4.     The pledges                                                                6

5.     The new economic context                                                   7

6.     Implementation                                                             8

7.     The SHA assurance framework                                                8

8.     Developing the organisation to deliver                                     9

9.     Strategic framework for workforce development                           10

10.    Conclusion                                                              11

                                                                        Page 3 of 11
Our vision and strategy for health and healthcare in south east coast

1.     Introduction and summary
NHS South East Coast has a clear and compelling vision, Healthier people, excellent
care, which was published in June 2008. The vision is to ensure that people living in
Kent, Surrey and Sussex experience better health and enjoy greater confidence in
the quality of care the NHS provides and commissions on their behalf. It builds upon
our ongoing work in the region to improve health and care including the Regional
Health Strategy, the Health Inequalities Strategy, Creating an NHS Fit for the Future
as well as the national Next Stage Review, Our NHS, Our Future.

Since the publication of Healthier people, excellent care, the economic downturn is
expected to result in a significant reduction in resources available to the NHS. In our
strategic leadership role, we are creating an ambitious programme of
transformational change ‘Delivering Healthier People, Excellent Care in Economically
Challenged Times’. This will bring together the major programmes which will deliver
improvements in productivity and quality through innovation and prevention.

We will ensure the delivery of our region-wide vision through PCTs as
commissioners. We have set clear expectations for PCTs to develop Strategic
Commissioning Plans that articulate the strategy for delivering the vision. This has
been strengthened as part of the World Class Commissioning assurance process
with the SHA providing support and development to PCTs in forming their plans.
PCT Strategic Commissioning Plans are being refreshed currently in light of the new
economic climate, which we are leading through the development of our revised
strategy ‘Delivering Healthier People, Excellent Care in Economically Challenged
Times’ The diagram below shows our approach to strategic planning in the region.

                                      Set national policy direction
                                      National Operating Framework
                   National           Next Stage Review
                                      WCC Assurance framework

                                                Set regional vision/leadership
                   Regional                     Healthier people, excellent care
                    (SHA)                       Regional Operating Framework
                                                Delivering HPEC in economically
                                                challenging times

                   Local                                  Set local strategy and
                (PCTs/Trusts)                             implementation
                                                          Strategic Commissioning Plans
                                                          Annual Operational Plans

                                                                                   Page 4 of 11
Our vision and strategy for health and healthcare in south east coast

2.     Consultation
Our vision and strategy have been discussed and refined over two years and on the
basis of extensive consultation. Clinicians, experts from social care, and the
voluntary sector worked in eight clinical pathway groups. They identified good
practice throughout the region, examined gaps and barriers and described what
needed to happen locally and nationally to deliver optimal care. More than 100,000
staff, service users and organisations were informed about or involved in developing
the vision and more than 2,500 people and groups provided feedback or took part in
consultation events.

The consultation document was widely distributed throughout the region and more
than 2,000 people and organisations were involved in 15-week consultation.
Feedback from the public, NHS staff and members of partner organisations informed
the revision of our pledges. Local and regional organisations, including local
authorities, the Government of the South East, the South East England Development
Agency and the Third Sector were closely involved. We conducted a workshop for
regional leaders with Lord Darzi, NHS Chief Executive David Nicholson and other
national leaders of the NHS to focus on implementing our vision. This was followed
by discussions with PCTs to refine our pledges and plan how they could be

3.     Key elements of the strategy and vision
Healthier people, excellent care consolidates the recommendations of this
consultation and sets out the SHA’s vision. It explains the work already done to
improve services and describes the changes required that will lead to real
improvements in health and health care for everyone across Kent, Surrey and

A set of guiding principles underpins all the recommendations contained within the
vision. These are that:

       •   care should be personalised according to an individual’s needs
       •   patients should have more choice and control over their care
       •   services should conform to best practice
       •   prevention is better than cure
       •   services should seek to reduce inequalities
       •   patients will be treated in the right place at the right time - services should
           be localised where possible, but centralised when or where necessary
       •   no existing services will change before new services are in place
       •   services should make best use of taxpayers’ money and be sustainable
           into the future to enable better patient care.

In the South East Coast region we recognise that some fundamental changes are
needed to create a more forward-looking health service. That is why we have set in
motion an ambitious programme to improve the quality and safety of the care we

                                                                              Page 5 of 11
Our vision and strategy for health and healthcare in south east coast

In some areas our Creating an NHS Fit for the Future programme will reshape
maternity and acute services. Our regional public health strategy will reduce
inequalities and ensure that all our people benefit from services that will help them
stay healthier. Additionally, through strategic planning, we are developing our clinical
leadership; improving the skills of all our workforce; harnessing the power of
knowledge, data and information to drive our agenda on safety and quality;
generating surpluses to reinvest in developing services; and ensuring services
provide value for money.

4.       The pledges
There is more to do and that is why we welcomed the Our NHS, our future review
and set up eight clinical pathway groups led by over 200 local clinicians to plan
further changes in our region. The eight pathway groups looked at maternity and
newborn care, children’s health, planned care, mental health, staying healthy, long-
term conditions, acute care and end of life care. Their recommendations form the
basis of the pledges below that we are committed to delivering by 2018:

     •   There will be no avoidable hospital acquired infections
         -   by 2011, there will be no avoidable cases of hospital acquired MRSA
         -   and less than 2,000 cases of C. difficile
     •   By 2010, strokes, heart attacks and major injuries will always be treated in
         specialist centres
     •   Patients will be able to have medical tests to help diagnose and manage your
         illness on your local high street or at home
     •   We will turn the tide on the rising numbers of obese people
     •   Special programmes to help you cope better with long-term conditions such
         as diabetes will be widely available
     •   Most dying people will be able to die where they prefer - at home, in a
         hospital or hospice
     •   We will reduce the differences in life expectancy seen in the South East
         Coast area so that all men can expect to live at least 78.6 years and women
         82.5 years
     •   All patients will hold their own medical records.

Healthier people, excellent care looks at each of the pathways in turn, closely
examining the case for change. The recommendations and the detail for each
pathway are drawn from a variety of sources, with the reports from each of the
clinical pathway groups being combined with feedback from patients, the public, staff
and stakeholders to shape the final vision. Each of the pathways contains a number
of key recommendations with a date for implementation. The final vision was signed
off by the South East Coast Management Board (the SHA Executive Team and PCT
Chief Executives) as well as the SHA Board.

                                                                             Page 6 of 11
Our vision and strategy for health and healthcare in south east coast

5.       The new economic context
Since the publication of Healthier people, excellent care, it has become apparent that
future NHS growth monies will be considerably lower than was anticipated. Whilst
the future level of funding of the NHS from 2011 onwards remains unclear, it is widely
expected that it will be significantly less than the levels of growth we have seen in
recent years. It is estimated that 15-20% savings will be required over the three
years from 2011/12.

In order to prepare for this and to plan effectively, we have undertaken economic and
financial modelling, which has considered a number of future scenarios. These
indicate that the NHS in South East Coast may need to save somewhere between
£1.2 and £1.6 billion over the three years from 2011/12.

We are working closely with PCTs and other partners and leaders across the health
system in the region to address this challenge through improved quality, innovation,
productivity and prevention. By focusing on improvements in productivity and
efficiency through the spread of innovation and best practice and through effective
commissioning and changes in workforce, the financial gap facing PCTs will be
closed. We are developing, in partnership with PCTs, a delivery plan ‘Delivering
HPEC in an Economically Challenged Environment’ which sets out the programmes
and actions which will have the biggest impact and the leadership and governance
arrangements for effective delivery.

We have set in train a number of urgent actions to address this economic challenge.
These include:

     •   The implementation of a communications and engagement strategy including
         a clear narrative for South East Coast to describe the challenges and
         ambitions behind the quality innovation, productivity and prevention agenda.
         This will be aimed at influencing and motivating key groups through examples
         of the kinds of changes needed, and which will create a sense of urgency and
         purpose across South East Coast.
     •   A rapid completion of the work at the SHA to identify the key programme
         areas and who will lead on them, and to ensure that all have the capacity and
         capability to deliver effectively in the context of the organisational
         development work already underway and set out in the SHA’s Corporate
     •   A focus on quick win areas, such as the spread of existing innovation and
         best practice; reducing unnecessary variation in clinical services; focus on
         those areas where Better Care, Better Value indicators tell us there is most
         scope for improvement; and make progress in key aspects of workforce
         productivity. The priority areas for this have already been established
     •   Identification of the outcomes and timescales for each programme, with clear
         metrics, and that the leading programmes are equipped with the skills and
         resources to do so effectively.
     •   Clarity about governance and accountability for the delivery of the plan at
         SHA, county and local levels.
     •   Preparation for this year’s commissioning round with clear expectations of
         what PCTs will deliver in 2010/11.

                                                                             Page 7 of 11
Our vision and strategy for health and healthcare in south east coast

6.     Implementation
Our approach to implementation focuses on purposeful action now and long term
sustainability. The NHS in the region faces significant challenges and we need to act
quickly and decisively if we are to avoid serious financial problems in two or three
years time.

The enablers for delivering HPEC are our programmes to deliver quality, innovation,
productivity and prevention. These will be set out in a delivery plan, which, together
with our regional Operating Framework and Medium Term Financial Strategy, will
determine what PCTs and the SHA will be expected to do to continue to improve
quality whilst meeting the economic challenges facing us.

We have employed eight clinical leads, one for each of the pathways, to act as
clinical champions for their pathway. The leads will be a catalyst for change, drive
service improvement and ensure a high level of clinical engagement across the

The Quality Board will play a key role in advising the SHA and PCTs on how to
spread best practice and innovation. It will continue to identify actions which can be
built in to this delivery plan. The Quality Observatory will continue to provide high
quality analytical support to this.

We will also be using the innovation fund to encourage innovative approaches to
delivery. The Innovation Fund for 2009/10 is £1.94 million. The process for bidding
for innovation funding has now been promoted widely. The process is designed to
prioritise high impact and to encourage people to consider the evaluation of current
innovations and their potential for spread. This is where the majority of the fund will
be invested. The South East Coast Management Board has established a Taskforce
for Innovation and Improvement co- chaired between PCT and SHA to ensure our
investment in innovation is delivering tangible benefits.

7.     The SHA assurance framework
We are ensuring delivery of our vision and strategy through a combination of
leadership, assurance and development. We are clear that PCTs, as commissioners,
must be in the driving seat of change and we will be leading, supporting and assuring
PCTs to ensure that they fulfil the expanded, ambitious role envisaged as World
Class Commissioners using a wide range of levers for change. We will be both
supportive and facilitative of change, but interventionist and proactive as necessary.

An essential element of ensuring delivery is the production of a South East Coast
Operating Framework. This framework sets out the specific, measurable actions
required of PCTs as commissioners. For 2009/10 this articulates the clear
requirements of PCTs in delivering HPEC. The framework specifies what needs to be
achieved to deliver the SHA vision but, where appropriate, leaves PCTs to decide
how they are to go about achieving the requirements. A South East Coast Operating
Framework for 2010/11 will be produced following publication of the national
Operating Framework to clearly outline commissioning requirements from 2010/11
onwards. The framework will articulate the SHAs role as system manager, making
clear our expectations for market management, backed up by a set of
‘commissioning rules’.

                                                                           Page 8 of 11
Our vision and strategy for health and healthcare in south east coast

PCTs are expected to clearly demonstrate their commitment to HPEC through the
production of Strategic Commissioning Plans which are subject to review by the SHA
and assured through the World Class Commissioning process. On an annual basis,
PCTs in the region each produce an Operational Plan which demonstrates how they
intend to deliver the priorities and targets for the coming year. These plans are
closely assessed by the SHA to ensure that they demonstrate how the PCT will
deliver the requirements set out in the South East Coast Operating Framework.
Operational Plans for 2009/10 for each PCT in the region were signed off by 31
March 2009. The plans form the basis of the SHA’s performance agreement with
PCTs for 2009/10, with PCTs held to account for delivering their Operational Plans
and as such the SHAs strategy and vision. This is undertaken through a
proportionate assurance and performance regime; the SHA meets with PCTs on a
monthly or a quarterly basis, assuring delivery of the PCTs’ Operational Plans.

The diagram below sets out the framework for planning and implementation.

                                          HIGH QUALITY CARE FOR ALL

                                   HEALTHIER PEOPLE EXCELLENT CARE

                                 SEC Operating        QIPP Delivery        Medium Term
                                  Framework               Plan           Financial Strategy

                                 NHS SOUTH EAST COAST CORPORATE PLAN

                                   Tomorrow’s         Performance        Health Inequalities

                                    Workforce          Framework              Strategy


                                      PCT Strategic              PCT Operational
                                         Plans                       Plans

                                    COMMISSIONER LED IMPLEMENTATION
                                           Quality                    Workforce
                                         Frameworks                    Plans

8.                    Developing the organisation to deliver
We have undertaken a major redesign and realignment in the light of Lord Darzi’s
Next Stage Review and the new statutory duties around quality, innovation and
productivity. Rather than focusing predominantly on performance management, our
focus has moved to a culture which empowers and holds organisations to account for
their actions focusing on performance improvement.

                                                                                               Page 9 of 11
Our vision and strategy for health and healthcare in south east coast

Clinical leadership and innovation are central to this new approach; a director of
innovation and medical director have been appointed as well as the eight clinical
pathway leads described in Healthier people, excellent care. The quality agenda now
runs through every facet of our operations, starting with the board which has
developed its objectives for 2009-10 alongside this agenda.

We have established a clear baseline and platform for talent management and
leadership through our talent and leadership plan, including a clear picture of supply
and demand figures for senior leaders. We are seeking to promote and embed the
right leadership and talent through:

     •   the establishment of a faculty for innovation and improvement
     •   greater support and use of clinical networks across the region
     •   a second cohort of the clinical leaders network, to engage and empower
         clinicians in the wider issues facing the NHS
     •   an aspirant directors programme to ensure that the NHS in the region has the
         strength in depth to deliver on the challenges we face. This has been
         recently redesigned to align with the QIPP agenda.

9.       Strategic framework for workforce development
We have recently published our workforce framework: Tomorrow’s workforce: a
strategic framework for the future. This is one of the central pieces of work within our
region that will help us achieve our vision and realise the national plan set out by
Lord Darzi in High Quality Care for All.

The 98,000 strong workforce across the region is united by an ambition to improve
quality, but there are significant workforce challenges, including the implications of
the European Working Time Directive, the changing health needs of an ageing
population, the need for structured training and the move toward care closer to home
with all that implies for enhanced roles for nurses, team-based working and social
care integration.

In order to better plan our workforce, we are working with PCTs to develop
forecasting tools for education commissioning and making better use of the electronic
staff record to understand future demand and supply. We are also working with
trusts across the region to identify strategies for promoting leadership that tie in with
our equality, diversity and human rights commitments; and we are working through
various initiatives to identify potential leaders and ensure they have the skills and
opportunities to develop.

We are committed to implementing the widening participation agenda and developing
the workforce within bands one to four. This is reflected in our commitment to
increasing apprenticeships in the NHS. Doing so will help achieve a number of key
objectives including improving patient safety, developing a workforce that is
competent and appropriate to current and future patient needs, developing an
affordable, flexible workforce, and making the NHS a model employer. We are an
active partner working with the Learning Skills Council, Skills for Health, and Skills
South East Skills Brokers through the Joint Investment Framework (JIF) to progress
this agenda.

                                                                           Page 10 of 11
Our vision and strategy for health and healthcare in south east coast

10. Conclusion
The SHA has clearly outlined its strategy and vision for health and health care in
South East Coast through Healthier people, excellent care. The delivery of this has
been assured through the SHA’s Operating Framework and sign off of PCT Strategic
Commissioning and Annual Operational Plans.

We will be using the SHA assurance process as a learning opportunity to reflect on
our approach to strategy, governance and implementation, in order to seek to
improve our performance in the coming years.

Quality, innovation, productivity and prevention were already vital threads running
through Healthier people, excellent care. The new economic conditions we face,
however, have reinforced the need for these aspects to be at the forefront of our
strategic planning. We have therefore embarked on a process, in conjunction with
NHS organisations across the region, to review our vision and strategy against this
backdrop. ‘Delivering HPEC in Economically Challenging Times’ is the emerging
vehicle for this.

                                                                         Page 11 of 11