Commissioning programme delivery plan

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					                                                      Strategic Plan update
Maternity and Newborn Programme

Goal (high level   Initiative   Project             Time-        Measurable            Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones          scale for    Benefits              Requested         investment/
                                (deliverables in    Delivery                           2009/10           Savings
                                each project)                                          onwards (as per
                                                                                       investment
                                                                                       plan)
Improved Access Improve Pre-    Work with a         March 2011   Improved patient      £60,000 from                    Risks of not
for BME         conception      range of                         experience by         CCA HI monies                   delivering the
communities     Care            providers,                       increasing            to support                      project:
                                including the                    knowledge and         community                       Infant mortality
Improved Access                 Regional                         understanding of      development on                  rates will not
to Midwifery                    Genetics                         life-changing         reducing infant                 drop in line with
Services                        Service, to raise                situations.           mortality                       PSA target.
                                awareness
Improved Quality                around genetics                  Improved access to                                    CCA for the
of Provision                    in the                           local sources of                                      district red flag
                                community and                    expertise in                                          will not be lifted.
Improved                        primary care                     Urdu/Punjabi to
Stakeholder                                                      ascertain personal                                    NST will report
Perceptions                                                      risk.                                                 on slow
                                                                                                                       progress on
                                                                 Improved level of                                     implementing
                                                                 understanding of                                      the BDIMC
                                                                 genetic inheritance                                   recommendatio
                                                                 patterns.                                             ns.

                                                                                                                       Communities at
                                                                                                                       risk will not use
                                                                                                                       the tertiary




                                                                                                                                  1
Goal (high level   Initiative   Project              Time-        Measurable               Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones           scale for    Benefits                 Requested         investment/
                                (deliverables in     Delivery                              2009/10           Savings
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                                                                           services thus
                                                                                                                           increasing
                                                                                                                           inefficiencies.

                                                                                                                           Mitigation:
                                                                                                                           Progress
                                                                                                                           continually
                                                                                                                           reviewed via
                                                                                                                           Every Baby
                                                                                                                           Matters and
                                                                                                                           issues resolved
                                                                                                                           or raised to
                                                                                                                           Programme
                                                                                                                           Board.


                                To train health      March 2011   All frontline staff to   £48,000                         As above.
                                and other                         receive relevant
                                frontline staff on                training around
                                communicating                     communicating
                                accurately on                     accurately on risks
                                risks associated                  associated with
                                with                              consanguinity and
                                consanguinity                     autosomal
                                and autosomal                     recessive
                                recessive                         inheritance of




                                                                                                                                     2
Goal (high level   Initiative   Project            Time-        Measurable             Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones         scale for    Benefits               Requested         investment/
                                (deliverables in   Delivery                            2009/10           Savings
                                each project)                                          onwards (as per
                                                                                       investment
                                                                                       plan)
                                inheritance of                  serious congenital
                                serious                         disorders as part of
                                congenital                      their mandatory
                                disorders                       training –
                                                                monitored through
                                                                ESR.
                                Increase the       March 2011   Improved access        Estimate that                   Risks of not
                                uptake of                       for pregnant           £70,000                         delivering
                                Healthy Start                   women before,          investment                      project:
                                vitamin                         during and after       would ensure                    Increased nos
                                supplements                     pregnancy to           universal                       of children
                                during                          Vitamin D              distribution –                  admitted to
                                pregnancy and                   supplements in line    funding source                  paediatric
                                breastfeeding                   with NICE              not identified                  wards with
                                                                guidance.                                              frank rickets (13
                                                                                                                       inpatients in a
                                                                To double the                                          two year period
                                                                number of Vitamin                                      admitted with
                                                                D distribution                                         serious Vit D
                                                                centres and to                                         deficiency).
                                                                increase the
                                                                number of Vitamin                                      Increased
                                                                D doses distributed                                    primary care
                                                                by 100% based on                                       and
                                                                2009 baseline                                          paediatrician
                                                                position.                                              attention to Vit




                                                                                                                                 3
Goal (high level   Initiative    Project            Time-        Measurable             Investment        Dis-          Risks/Mitigation
benefit)           (project)     Milestones         scale for    Benefits               Requested         investment/
                                 (deliverables in   Delivery                            2009/10           Savings
                                 each project)                                          onwards (as per
                                                                                        investment
                                                                                        plan)
                                                                                                                        D deficiency
                                                                                                                        related
                                                                                                                        conditions.

                                                                                                                        Mitigation:
                                                                                                                        Education,
                                                                                                                        advice and
                                                                                                                        signposting to
                                                                                                                        existing
                                                                                                                        distribution
                                                                                                                        points by
                                                                                                                        midwives at first
                                                                                                                        booking appts
                                                                                                                        agreed with
                                                                                                                        maternity
                                                                                                                        services.
Improved Access Improve          Encourage and      March 2011   Increased use of       Quality                         Capacity to
for BME         Routine          enable women                    direct booking         improvement                     support project
communities     Antenatal Care   to book directly                system through         service                         – review of
                                 with a midwife                  marketing and          developments                    priorities by
Improved Quality                                                 communication of       will be funded                  maternity and
of Provision                                                     the direct telephone   within tariff –                 newborn
                                                                 number.                may be a                        programme
Improved                                                                                requirement for                 network.
Stakeholder                                                      Proxy measure:         funding for
Perceptions                                                      Development of         publicity




                                                                                                                                  4
Goal (high level   Initiative   Project            Time-        Measurable              Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones         scale for    Benefits                Requested         investment/
                                (deliverables in   Delivery                             2009/10           Savings
                                each project)                                           onwards (as per
                                                                                        investment
                                                                                        plan)
                                                                data collection of      materials
Improved Value                                                  number of direct
for Money                                                       referrals.
                                Increase the       March 2011   90% of all women        Share of                        If funding not
Implement                       percentage of                   will present for full   £40,000 for                     available will
Maternity                       pregnant                        health and social       community                       risk not meeting
Matters                         women having                    needs assessment        development to                  targets.
                                full health and                 by 12 weeks and 6       reduce Infant
                                social care                     days as a standard      Mortality                       If project not
                                assessments by                  for local maternity                                     delivered – risk:
                                12 weeks and 6                  services                                                Impact of
                                days of                                                                                 increasing nos
                                pregnancy                                                                               of complex birth
                                                                                                                        (reduced nos of
                                                                                                                        midwifery led
                                                                                                                        care)
                                Increase the       March 2011   All women will be       Quality                         Capacity to
                                percentage of                   able to choose          improvement                     support project
                                women in                        midwifery led care      service                         – review of
                                receipt of                      where clinically        developments                    priorities by
                                midwifery-led                   safe via current        will be funded                  maternity and
                                care where                      service provision as    within tariff                   newborn
                                clinically safe                 a result of the                                         programme
                                                                development of a                                        network.
                                                                bespoke midwifery
                                                                facility.                                               Capital




                                                                                                                                  5
Goal (high level   Initiative   Project            Time-        Measurable            Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones         scale for    Benefits              Requested         investment/
                                (deliverables in   Delivery                           2009/10           Savings
                                each project)                                         onwards (as per
                                                                                      investment
                                                                                      plan)
                                                                                                                      development
                                                                                                                      required by
                                                                                                                      BHTFT.
                                Increase the       March 2011   Increase in number    Share of                        Capacity to
                                number of                       of women              £40,000 for                     support project
                                pregnant                        accessing             community                       – review of
                                women in the                    antenatal education   development to                  priorities by
                                general                         - baseline position   reduce Infant                   maternity and
                                population                      required.             Mortality                       newborn
                                accessing                                                                             programme
                                antenatal                                                                             network.
                                education
                                                                                                                      If project not
                                                                                                                      delivered –
                                                                                                                      Risk: Impact on
                                                                                                                      LBW numbers,
                                                                                                                      pre-term
                                                                                                                      numbers,
                                                                                                                      complex birth
                                                                                                                      numbers
                                Increase the       March 2011   Increase in number    Share of                        Capacity to
                                number of                       of women in the       £40,000 for                     support project
                                pregnant                        BME population        community                       – review of
                                women in the                    accessing             development to                  priorities by
                                BME population                  antenatal education   reduce Infant                   maternity and
                                and where the                   - baseline position   Mortality, plus                 newborn




                                                                                                                               6
Goal (high level   Initiative   Project             Time-        Measurable            Investment        Dis-              Risks/Mitigation
benefit)           (project)    Milestones          scale for    Benefits              Requested         investment/
                                (deliverables in    Delivery                           2009/10           Savings
                                each project)                                          onwards (as per
                                                                                       investment
                                                                                       plan)
                                first language is                required.             the cost of                         programme
                                not English                                            maternity                           network.
                                accessing                                              assistants from                     Impact on LBW
                                antenatal                                              CCA.                                numbers, pre-
                                education                                                                                  term numbers,
                                                                                                                           complex birth
                                                                                                                           numbers

                                Increase the        March 2011   Increase in use of    Quality                             Capacity to
                                uptake and use                   antenatal screening   improvement                         support project
                                of antenatal                     by at risk            service                             – review of
                                screening by at                  populations -         developments                        priorities by
                                risk populations                 baseline position     will be funded                      maternity and
                                                                 required.             within tariff                       newborn
                                                                                                                           programme
                                                                                                                           network.
                                Reduction in        March 2011   All pregnant          2009/10           Need to           Will impact on
                                smoking                          women who smoke       £100,000          establish ‘cost   complex birth
                                antenatally and                  have access to                          to quit’ for      numbers, pre-
                                at delivery                      quality smoking                         pregnant          term births and
                                across the                       cessation services                      women.            average
                                population,                      on accessing                                              birthweight.
                                targeting hard-                  midwifery services.
                                to-reach
                                groups.                          Proxy measure:
                                                                 Number of referrals




                                                                                                                                    7
Goal (high level    Initiative      Project            Time-        Measurable             Investment        Dis-          Risks/Mitigation
benefit)            (project)       Milestones         scale for    Benefits               Requested         investment/
                                    (deliverables in   Delivery                            2009/10           Savings
                                    each project)                                          onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                    into Smoking
                                                                    Cessation Service.

                                                                    2008/09 NHSBA
                                                                    quit rate for
                                                                    pregnant women
                                                                    was 18% against a
                                                                    minimum threshold
                                                                    of 35%. NHSBA
                                                                    worst performing
                                                                    PCT in England for
                                                                    this measure.
Not an identified   UNICEF          To attain stage    2012         54% of all children    £100,000                        Failure to
project under       accreditation   2 accreditation                 will be breastfed at                                   implement will
programme           across the      within                          6-8 weeks by 2012.                                     lead to
board               District        community                                                                              increased
                                    health centres                  A 2% increase                                          infection rates
                                    and children’s                  annually on the                                        in infants and
                                    centres in                      breastfeeding                                          increased
                                    Bradford                        continuation rates                                     admissions to
                                                                    at 6-8 weeks                                           paediatric
                                                                                                                           services
Improved Access Improve             Roll out the use   March 2011   Increase in number                                     Capacity to
to Midwifery    Complex             of You’re                       of services                                            support project
Services        Antenatal Care      Welcome                         achieving You’re                                       – review of
                - Teenage           Quality Criteria                Welcome Quality                                        priorities by




                                                                                                                                    8
Goal (high level   Initiative   Project            Time-        Measurable             Investment        Dis-              Risks/Mitigation
benefit)           (project)    Milestones         scale for    Benefits               Requested         investment/
                                (deliverables in   Delivery                            2009/10           Savings
                                each project)                                          onwards (as per
                                                                                       investment
                                                                                       plan)
Improved Value     Parents      across                          Mark - baseline                                            maternity and
for Money                       midwifery                       position required.                                         newborn
                                services                                                                                   programme
Improve services                                                                                                           network.
for Teenage                     Increase           March 2011   Teenage                                                    Failure to
Parents                         breastfeeding                   breastfeeding rates                                        implement will
                                rates amongst                   are equal to rates                                         lead to
                                teenage                         for mothers 18+.                                           increased
                                mothers                                                                                    infection rates
                                                                2008/09 – 48% of                                           in infants and
                                                                teens breastfed                                            increased
                                                                compared to 645 of                                         admissions to
                                                                mums 18+.                                                  paediatric
                                                                                                                           services
                                Increase           March 2011   Increased                                Need to
                                smoking                         birthweight on                           establish ‘cost
                                cessation rates                 average 200g.                            to quit’ for
                                amongst                         Reduced neonatal                         pregnant
                                teenage                         deaths. Increased                        women.
                                mothers and                     QALYs throughout
                                fathers                         the life for infants
                                                                born to mothers
                                                                who do not smoke.

                                                                Proxy measure:
                                                                SATOD for teenage




                                                                                                                                    9
Goal (high level   Initiative    Project            Time-       Measurable             Investment        Dis-          Risks/Mitigation
benefit)           (project)     Milestones         scale for   Benefits               Requested         investment/
                                 (deliverables in   Delivery                           2009/10           Savings
                                 each project)                                         onwards (as per
                                                                                       investment
                                                                                       plan)
                                                                mums 2008/09
                                                                32% compared with
                                                                14% of mums 18+
                                                                years. Reduce by
                                                                50%.
Improved Access Improve          Monitor the        November    The programme                                          Failure to
to Midwifery    Complex          progress of the    2012        has evidence from                                      implement will
Services        Antenatal Care   Family Nurse                   the USA that for                                       affect delivery
                                 partnership and                every £1 spent a                                       of the Every
Improved Access                  learn lessons                  saving of £5 can be                                    Child Matters
for BME                          for the future                 made during                                            Outcomes
communities                                                     childhood in                                           (including Be
                                                                reduced hospital                                       Healthy).
Improved Quality                                                admissions,
of Provision                                                    reduced need for
                                                                social services
                                                                interventions
                                 Develop Family     December    A reduction in child   £37,000                         Additional
                                 support            2009        deaths                                                 investment not
                                 Assistants                     Fewer low birth                                        currently
                                 within the South               weight babies                                          available –
                                 and West                       More infants                                           opportunities to
                                 Alliance                       breastfed                                              re-design
                                                                Fewer women and                                        existing
                                                                partners smoking in                                    services being
                                                                pregnancy and                                          explored.




                                                                                                                                10
Goal (high level   Initiative         Project            Time-            Measurable            Investment        Dis-          Risks/Mitigation
benefit)           (project)          Milestones         scale for        Benefits              Requested         investment/
                                      (deliverables in   Delivery                               2009/10           Savings
                                      each project)                                             onwards (as per
                                                                                                investment
                                                                                                plan)
                                                                          postnatal period
                                                                          More women have
                                                                          seen a midwife by
                                                                          12 weeks of
                                                                          pregnancy
                                                                          Reduction in
                                                                          Vitamin D
                                                                          deficiency
                                                                          Improved uptake of
                                                                          childhood
                                                                          vaccinations
                                                                          Resources
                                                                          available to
                                                                          vulnerable families
                                                                          are maximised
                                                                          (including state
                                                                          benefits, Health in
                                                                          Pregnancy grant
                                                                          and Healthy Start
                                                                          vouchers)
Reduced service    Improve            Working with       On-going –       Service               Quality                         Clarity re. role
costs              women’s            the MSLC and       first stage to   specification         improvement                     of the MSLC
                   experience of      other              be completed     developed, agreed     service                         required by
Improved Quality   labour and birth   stakeholders,      March 2010       and implemented.      developments                    commissioners
of Provision                          design services                                           will be funded                  and providers -
                                      that meet                           Increased patient     within tariff.                  Review of




                                                                                                                                         11
Goal (high level   Initiative   Project            Time-        Measurable            Investment        Dis-              Risks/Mitigation
benefit)           (project)    Milestones         scale for    Benefits              Requested         investment/
                                (deliverables in   Delivery                           2009/10           Savings
                                each project)                                         onwards (as per
                                                                                      investment
                                                                                      plan)
Implementation                  women’s needs                   satisfaction –                                            current ToR
of Maternity                    and manage                      monitoring                                                and support for
Matters                         expectations                    arrangements to be                                        Chair
                                during                          agreed.
                                pregnancy, birth
                                and the
                                postnatal period
                                Increase the       March 2011   Increase in           Quality                             Capacity to
                                percentage of                   numbers of women      improvement                         support project
                                women in                        in labour receiving   service                             – review of
                                labour receiving                one-to-one care -     developments                        priorities by
                                one-to-one care                 baseline position     funded through                      maternity and
                                                                required.             tariff.                             newborn
                                                                                                                          programme
                                                                                                                          network.
                                Reduce             March 2011   Proxy Measure:                          Difference        Capacity to
                                inappropriate                   10% reduction in                        between cost of   support project
                                caesarean                       expected C-section                      C-section         – review of
                                section rates                   deliveries (based                       £2579 and         priorities by
                                                                on 6 months of                          normal delivery   maternity and
                                                                2009) = 152 births                      £1174 –           newborn
                                                                                                        difference of     programme
                                                                                                        £1405 per         network.
                                                                                                        delivery. Based
                                                                                                        on 10%
                                                                                                        reduction of




                                                                                                                                  12
Goal (high level   Initiative      Project             Time-           Measurable       Investment        Dis-              Risks/Mitigation
benefit)           (project)       Milestones          scale for       Benefits         Requested         investment/
                                   (deliverables in    Delivery                         2009/10           Savings
                                   each project)                                        onwards (as per
                                                                                        investment
                                                                                        plan)
                                                                                                          expected
                                                                                                          deliveries for
                                                                                                          2009 could lead
                                                                                                          to cost saving
                                                                                                          of £214,000.
Improved Quality   Services for    Engagement in       To become       Not applicable
of Provision       sick neonates   SCG and             business as
                                   collaborative       usual with
                                   commissioning       projects
                                   that leads to       identified as
                                   best outcomes       and when
                                   for sick            required.
                                   neonates and
                                   their families.
                                   Delivery of care
                                   locally or in
                                   tertiary services
                                   as appropriate.
Improved Access Reduce Infant      Support             To become       Not applicable
for BME         Mortality Rates    implementation      business as
communities                        of the Infant       usual.
                                   Mortality
Improve Access                     Commission
to Midwifery                       recommendatio
Services                           ns
                                   Development of      September       Increase the     £40,000 from                        As funding




                                                                                                                                    13
Goal (high level   Initiative   Project             Time-         Measurable            Investment         Dis-          Risks/Mitigation
benefit)           (project)    Milestones          scale for     Benefits              Requested          investment/
                                (deliverables in    Delivery                            2009/10            Savings
                                each project)                                           onwards (as per
                                                                                        investment
                                                                                        plan)
Improved Quality                a range of          2010          number of women       CCA HI monies                    requirements
of Provision                    community                         presenting before     to reduce infant                 have not yet
                                development                       12 weeks.             mortality                        been
Improve Patient                 workers to work                   Decrease the                                           ascertained
Experience                      with families at                  number of low                                          there is a risk
                                high risk of poor                 weight babies born.                                    that funding will
                                birth outcome                     Increase the                                           not be available
                                within Citycare                   number of women                                        to the project.
                                Alliance                          accessing pre-natal                                    The complex
                                                                  education.                                             commissioning
                                                                                                                         arrangements
                                                                                                                         surrounding
                                                                                                                         community
                                                                                                                         development
                                                                                                                         worker could
                                                                                                                         delay the
                                                                                                                         project.
                                Work                To become     Not applicable.       £40,000
                                strategically to    Business as
                                support             Usual
                                Children’s
                                Centres and
                                other suitable
                                community
                                centres to
                                provide




                                                                                                                                  14
Goal (high level   Initiative   Project            Time-       Measurable   Investment        Dis-          Risks/Mitigation
benefit)           (project)    Milestones         scale for   Benefits     Requested         investment/
                                (deliverables in   Delivery                 2009/10           Savings
                                each project)                               onwards (as per
                                                                            investment
                                                                            plan)
                                localised,
                                personalised
                                interventions to
                                women and
                                families in line
                                with the
                                recommendatio
                                ns of the
                                BDIMC.




                                                                                                                    15
Children’s Programme

Goal (high level   Initiative        Project            Time-scale for   Measurable             Investment         Dis-investment/     Risks/Mitigation
benefit)           (project)         Milestones         Delivery         Benefits               Requested          Savings
                                     (deliverables in                                           2009/10
                                     each project)                                              onwards (as per
                                                                                                investment
                                                                                                plan)
Reduce service     Staying Healthy   Continued          2009/2011        A reduction in the     2009/10            This                The fluoride
costs                                implementation     (phased          prevalence of          £140,600           programme has       varnish
Improve access                       of the fluoride    implementatio    dental disease         (without uplift)   been reviewed       programme
to services                          varnish            n)               amongst 5 year                            within 2009/10.     relies upon
Improve Quality                      programme                           olds. The                                 With the use of     access to
of Service                           (Community                          effectiveness of       2010/11            skill mix savings   different early
Provision                            Programme for                       fluoride varnish has   £235,468           have been           years settings
                                     2 to 4 year olds                    been established       (without uplift)   made with the       to reach
Improve                              applied in                          with twice yearly                         same activity       significant
Patient/Carer                        community                           applications                              and outcomes        numbers of
Experience                           venues,                             associated with        2011/12            costing less.       children .
                                     Children’s                          reductions in          £263,068
Improve                              Centres and                         decayed services       (without uplift)                       Consent from
Stakeholder                          nurseries).                         of 46% in                                                     parents or
Perceptions                                                              permanent and          from 2012                              carers to take
                                                                         33% in primary         onwards                                part in the
Improve Staff                                                            teeth.                 £263,068                               programme
Satisfaction                                                                                    concurrently
                                                                         To reduce the          with uplift
Ensure Value for                                                         extent of dental
Money                                                                    disease (dmft) in 5
                                                                         year olds.
Improve Services
for Young People                                                         To address oral




                                                                                                                                                16
Goal (high level   Initiative   Project            Time-scale for   Measurable              Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits                Requested         Savings
                                (deliverables in                                            2009/10
                                each project)                                               onwards (as per
                                                                                            investment
                                                                                            plan)
                                                                    health inequalities
Children’s Trust                                                    with a greater %
priority                                                            reduction dmft
                                                                    amounts in the
                                                                    most socially
                                                                    deprived groups

                                                                    A reduction in the
                                                                    impact of acute
                                                                    dental infection in 5
                                                                    year olds (e.g. pain,
                                                                    swelling.

                                                                    Increased
                                                                    knowledge
                                                                    regarding
                                                                    maintaining good
                                                                    oral health amongst
                                                                    parents/carers of
                                                                    young children.

                                                                    March 2010
                                                                    1500 children
                                                                    recruited to the
                                                                    programme
                                                                    (consents), 1200




                                                                                                                                        17
Goal (high level   Initiative   Project            Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits               Requested         Savings
                                (deliverables in                                           2009/10
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                    receiving 1st
                                                                    applications and
                                                                    1600 applications
                                                                    for children
                                                                    recruited within the
                                                                    target age range.

                                                                    By March 2011
                                                                    7500 children
                                                                    recruited to
                                                                    programme
                                                                    6000 receiving 1st
                                                                    application within
                                                                    previous 24 months

                                                                    9000 applications
                                                                    for children
                                                                    recruited within the
                                                                    target age range

                                                                    Agree total number
                                                                    of applications in
                                                                    2011/12
                                                                    Report on numbers
                                                                    of
                                                                    Children with




                                                                                                                                       18
Goal (high level   Initiative   Project            Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits               Requested         Savings
                                (deliverables in                                           2009/10
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                    completed
                                                                    applications.
                                                                    Report on numbers
                                                                    of children
                                                                    identified as
                                                                    requiring treatment
                                                                    and referred for
                                                                    further dental care.

                                                                    By March 2012
                                                                    15000 children
                                                                    recruited to the
                                                                    programme
                                                                    (consents) within
                                                                    the previous 24
                                                                    months

                                                                    12000 receiving 1st
                                                                    application within
                                                                    previous 24
                                                                    months.

                                                                    Number of
                                                                    applications as
                                                                    agreed 2011/12




                                                                                                                                       19
Goal (high level   Initiative   Project            Time-scale for   Measurable               Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits                 Requested         Savings
                                (deliverables in                                             2009/10
                                each project)                                                onwards (as per
                                                                                             investment
                                                                                             plan)
                                                                    Report on numbers
                                                                    of children with
                                                                    completed
                                                                    applications.

                                                                    Report on numbers
                                                                    of children
                                                                    identified as
                                                                    requiring treatment
                                                                    and referred for
                                                                    further dental care.


                                Review of          March 2011       It is anticipated that   Quality                             Capacity to
                                School Nursing                      children and their       improvement                         support project
                                including                           carers will receive      service                             – review of
                                specialist                          timely access to         development to                      priorities by
                                provision in                        appropriate levels       be realised                         programme
                                educational                         of school                within existing                     board.
                                settings                            nursing/carer            funding.
                                                                    support. Schools                                             Unrealistic
                                                                    understand how to                                            expectations of
                                                                    access school                                                stakeholders,
                                                                    nursing services.                                            including
                                                                    Improved                                                     schools – close
                                                                    satisfaction levels                                          working with




                                                                                                                                         20
Goal (high level   Initiative   Project            Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits               Requested         Savings
                                (deliverables in                                           2009/10
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                    for Special School                                         stakeholders to
                                                                    Head Teachers                                              agree a joint
                                                                    around provision of                                        approach to
                                                                    special school                                             service delivery.
                                                                    nursing. Supports
                                                                    the need to
                                                                    improve patient
                                                                    experience of
                                                                    services for
                                                                    children with
                                                                    disability and their
                                                                    families.
                                Review of          June 2010        Increased clarity      Quality                             Unrealistic
                                Health Visiting,                    between                improvement                         expectations of
                                including                           commissioners,         service                             stakeholders –
                                readiness to                        service providers      development to                      close working
                                delivery the                        and other key          be realised                         with
                                Healthy Child                       stakeholders           within existing                     stakeholder to
                                Programme                           around the role of     funding.                            agree a joint
                                                                    Health Visitors                                            approach to
                                                                    including their role                                       service delivery.
                                                                    in supporting the
                                                                    Safeguarding
                                                                    agenda and
                                                                    delivery of the
                                                                    Healthy Child




                                                                                                                                       21
Goal (high level   Initiative   Project            Time-scale for   Measurable             Investment        Dis-investment/     Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits               Requested         Savings
                                (deliverables in                                           2009/10
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                                                    Programme.
                                Young People’s     December         A reduction in         £45,000           For every £1        Additional
                                services:          2009             teenage                                  spent on sexual     investment not
                                provide support,                    pregnancy.                               health services     currently
                                information and                     Proxy measure:                           £11 is saved –      available –
                                advice about                        44% of the districts                     £45,000             opportunities to
                                lifestyle issues                    identified hot spots                     investment          re-design
                                and deliver                         lie within South and                     should release      existing
                                healthcare                          West Alliance                            £495,000.           services being
                                where                               boundaries.                                                  explored.
                                appropriate                         Monitoring of local                      As a minimum,
                                (S&WA)                              ward date will                           for the PCT
                                                                    highlight the impact                     population of
                                                                    of this focused                          540,000
                                                                    work.                                    implementing
                                                                                                             NICE guidance
                                                                    An increase in                           re use of LARC
                                                                    Chlamydia                                should save
                                                                    screening. South                         £1,074,627.
                                                                    and West Alliance                        For the three
                                                                    performance on                           target areas this
                                                                    Chlamydia                                equates to
                                                                    Screening is in line                     £101,963 per
                                                                    with PCT                                 annum.
                                                                    performance. PCT
                                                                    performance is




                                                                                                                                         22
Goal (high level   Initiative       Project            Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)        Milestones         Delivery         Benefits               Requested         Savings
                                    (deliverables in                                           2009/10
                                    each project)                                              onwards (as per
                                                                                               investment
                                                                                               plan)
                                                                        below the local
                                                                        trajectory at
                                                                        12.87% against
                                                                        18.9% as at
                                                                        December 09.
                                                                        Increased
                                                                        screening across
                                                                        the patch is
                                                                        required in order to
                                                                        achieve 25% 09/10
                                                                        outturn position.
                                    Dietetics                           Improve access to      £45,500 Sure                        Reduction in
                                    Support for                         dietetic expertise.    Start Pick Up                       investment
                                    Early Years (2-                     Develop resources      +                                   available to
                                    5) via                              for communities        £100,000                            support service
                                    Children’s                          who don’t have                                             development –
                                    Centres *former                     English as a first                                         work with
                                    Staying Healthy                     language.                                                  service
                                    Programme                           Promotion of                                               providers to
                                    Project                             healthy eating                                             agree interim
                                                                        during pregnancy                                           service model.
                                                                        and infancy –
                                                                        baseline position
                                                                        required.
Improve access     Improve End of   Review of          June 2010        Improved patient       Quality                             Capacity to
to services        Life Care        existing service                    and carer              improvement                         support project




                                                                                                                                           23
Goal (high level   Initiative     Project            Time-scale for   Measurable            Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)      Milestones         Delivery         Benefits              Requested         Savings
                                  (deliverables in                                          2009/10
                                  each project)                                             onwards (as per
                                                                                            investment
                                                                                            plan)
                                  provision to                        experience of         service                             – discussions
Improve Quality                   maximise                            service as reported   development to                      amongst
of Service                        existing                            via NI54 – health     be realised                         commissioning
Provision                         resource across                     services element      within existing                     colleagues to
                                  the Children’s                      (detailed             funding.                            identify a
Improve                           Trust                               breakdown                                                 possible way
Patient/Carer                                                         available March                                           forward.
Experience                                                            2010).

Improve
Stakeholder
Perceptions

Improve Staff
Satisfaction

Ensure Value for
Money
Reduce service     Long Term      Review of          November         Improved patient      2009/10                             Complexity of
costs              Conditions :   existing service   2009             and carer             £75,000                             the task has
                   CDC and        provision to                        experience of                                             resulted in a
Improve access     Community      maximise                            service as reported   2010/11                             failure to meet
to services        Paediatrics    existing                            via NI54 – health     £75,000                             the agreed
                                  resources                           services element                                          timescale –
Improve Quality                                                       (detailed                                                 additional
of Service                                                            breakdown                                                 project




                                                                                                                                        24
Goal (high level   Initiative   Project            Time-scale for   Measurable            Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits              Requested         Savings
                                (deliverables in                                          2009/10
                                each project)                                             onwards (as per
                                                                                          investment
                                                                                          plan)
Provision                                                           available March                                           manager time
                                                                    2010)..                                                   allowed to
Improve                                                                                                                       finalise report.
Patient/Carer
Experience
                                Improve the        February         Improved patient                                          Dependent on
Improve                         patient            2010             and carer                                                 output from
Stakeholder                     experience                          experience of                                             above project.
Perceptions                     (both children                      service as reported
                                and carers)                         via NI54 – health
Improve Staff                   around access                       services element
Satisfaction                    to service                          (detailed
                                provision                           breakdown
Ensure Value for                                                    available March
Money                                                               2010).

Children’s Trust
priority

Reduce service     Long Term    Develop patient    February         Reduction in length   2009/10                             Capacity to
costs              Conditions   pathways which     2010             of wait, improved     £230,000                            support project
                                improve access                      patient experience                                        – review of
Improve access                  to therapy                          – baseline position   2010/11                             priorities by
to services                     services and                        required.             £250,000                            programme
                                reduce waiting                                                                                board.
Improve Quality                 times.                                                    2011/12




                                                                                                                                       25
Goal (high level   Initiative   Project            Time-scale for   Measurable            Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits              Requested         Savings
                                (deliverables in                                          2009/10
                                each project)                                             onwards (as per
                                                                                          investment
                                                                                          plan)
of Service                                                                                £531,000                            Reduction in
Provision                                                                                                                     funding to
                                                                                                                              support service
Improve                                                                                                                       expansion as
Patient/Carer                                                                                                                 identified in
Experience                                                                                                                    JAR– redesign
                                                                                                                              within existing
Improve                                                                                                                       finances.
Stakeholder
Perceptions                     Develop            June 2010        To reduce the                           £500,000          Lack of support
                                children’s                          number of                                                 from PB - full
Improve Staff                   community                           unscheduled                                               business case
Satisfaction                    support multi-                      admissions and re-                                        to be developed
                                disciplinary                        admissions to                                             to demonstrate
Ensure Value for                team (A&WA)                         hospital by 10% in                                        benefits,
Money                                                               year 1, increasing                                        disinvestment
                                                                    to 30% at the end                                         and savings.
Children’s Trust                                                    of year 3. Reduce
priority                                                            A&E attendance by                                         Lack of
                                                                    30% at the end of                                         engagement by
                                                                    year 3, reduce                                            all
                                                                    hospital lengths of                                       organisations
                                                                    stay and excess                                           and
                                                                    bed days, reduction                                       professionals to
                                                                    in childhood                                              support full
                                                                    accidents,                                                integration –




                                                                                                                                      26
Goal (high level   Initiative   Project             Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones          Delivery         Benefits               Requested         Savings
                                (deliverables in                                            2009/10
                                each project)                                               onwards (as per
                                                                                            investment
                                                                                            plan)
                                                                     reduction in                                               use previous
                                                                     childhood accidents                                        experience of
                                                                     by 25% and                                                 integrating
                                                                     reductions in                                              organisations.
                                                                     childhood obesity
                                                                                                                                Public
                                                                                                                                consultation
                                                                                                                                does not
                                                                                                                                provide support
                                                                                                                                for proposed
                                                                                                                                changes – work
                                                                                                                                with service
                                                                                                                                users, their
                                                                                                                                carers and
                                                                                                                                professionals to
                                                                                                                                agree proposals
                                                                                                                                for service
                                                                                                                                redesign.
                                Development of      December         Proposals: A
                                a care pathway      2010             reduction of X% of
                                for children with                    children admitted to
                                complex health                       hospital. Improved
                                needs (Citycare                      transition. Clear
                                Alliance)                            pathways for
                                                                     children and
                                                                     professionals.




                                                                                                                                        27
Goal (high level   Initiative      Project             Time-scale for   Measurable               Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)       Milestones          Delivery         Benefits                 Requested         Savings
                                   (deliverables in                                              2009/10
                                   each project)                                                 onwards (as per
                                                                                                 investment
                                                                                                 plan)
Improve access     Learning        Improve access      March 2010       Proposals:               2009/10                             Unavailability of
to services        Disabilities    to specialist                        Improved access to       £103,000                            funding has
                                   paediatric                           service provision.                                           prevented
Improve Quality                    learning                             Reduced waiting                                              expansion of
of Service                         disability                           times. Improve                                               this service –
Provision                          nursing                              patient experience                                           information
                                   provision within                     for children with                                            shared across
Improve                            educational                          disabilities and their                                       the Children’s
Patient/Carer                      settings                             families - baseline                                          Trust.
Experience                                                              position required.

Improve
Stakeholder
Perceptions

Children’s Trust
Priority
Reduce service     Mental Health   Review of           March 2010       Increased                None required                       Capacity to
costs                              existing                             awareness of             for review                          support project
                                   CAMHS                                CAMHS services to                                            – to be
Improve access                     provision –                          inform future                                                reviewed by
to services                        including tier 4                     commissioning                                                Healthy Mind
                                                                        decisions.                                                   Strategy Group.
Improve Quality                    Identify service    March 2010       Development of           Shortfall in                        Timescale will
of Service                         redesign                             ‘Comprehensive           Healthy Minds                       change as
Provision                          priorities across                    CAMHS’ in line with      committed                           Healthy Minds




                                                                                                                                              28
Goal (high level   Initiative   Project            Time-scale for   Measurable             Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits               Requested         Savings
                                (deliverables in                                           2009/10
                                each project)                                              onwards (as per
                                                                                           investment
                                                                                           plan)
                                CAMHS                               national guidance      budget over                         Strategy Group
Improve                         provision                                                  income £85,000                      proposes
Patient/Carer                                                                                                                  review to
Experience                                                                                                                     include budget
                                                                                                                               commitments
Improve                                                                                                                        between April –
Stakeholder                                                                                                                    July 2010. Post
Perceptions                                                                                                                    April 2011
                                                                                                                               public funding
Improve Staff                                                                                                                  expected to be
Satisfaction                                                                                                                   significantly
                                                                                                                               less than at
Ensure Value for                                                                                                               present.
Money                           Ensure age         March 2010       Preferred model        Business plan     Business plan     Preferred model
                                appropriate                         will provide X         in development    will identify     requires
Improve Services                environment for                     number of in-          by BDCT in        savings to PCT.   commitments
for Young People                mental health                       patient CAMHS          collaboration     Investment will   from
                                patients under                      beds; ensure           with              reduce out-of-    neighbouring
Children’s Trust                18.                                 compliance with        commissioner      area spend by     commissioners
priority                                                            age-appropriate                          more than the     who may
                                                                    legislation; improve                     level of          withdraw.
                                                                    service user                             investment.       Interim
                                                                    experience by                                              arrangement
                                                                    ensuring in-patient                                        will be required
                                                                    accommodation in                                           from April 2011
                                                                    local area; reduce                                         to opening of




                                                                                                                                       29
Goal (high level   Initiative   Project            Time-scale for   Measurable            Investment        Dis-investment/    Risks/Mitigation
benefit)           (project)    Milestones         Delivery         Benefits              Requested         Savings
                                (deliverables in                                          2009/10
                                each project)                                             onwards (as per
                                                                                          investment
                                                                                          plan)
                                                                    number of out-of-                                          preferred
                                                                    area commissioned                                          pathway – still
                                                                    bed days by                                                to be agreed
                                                                    minimum 200 from                                           and may
                                                                    current position.                                          require
                                                                                                                               commitment
                                                                                                                               from adult
                                                                                                                               mental health
                                                                                                                               services.
                                Work with the      March 2011       Propose: 40-50%       Re-investment     Reduction in       Failure to
                                SCG to transfer                     reduction in out of   of some out-of-   use of out-of-     deliver age-
                                Tier 4 CAMHS                        area CAMHS tier 4     area spend in     area               appropriate
                                commissioning                       Placement             local solution    placements will    project (above).
                                to SCG.                             expenditure by        (see-age          reduce the
                                                                    April 2012            appropriate       amount to be
                                                                                          environments      transferred from
                                                                    Baseline position     project above).   SCG from
                                                                    required.             Business plan     current levels.
                                                                                          in development.   Work and
                                                                                          As part of        experience of
                                                                                          business          2010/11 will
                                                                                          planning          provide greater
                                                                                          commissioners     detail.
                                                                                          should be able
                                                                                          to identify a
                                                                                          limited out-of-




                                                                                                                                       30
Goal (high level   Initiative      Project             Time-scale for   Measurable               Investment        Dis-investment/   Risks/Mitigation
benefit)           (project)       Milestones          Delivery         Benefits                 Requested         Savings
                                   (deliverables in                                              2009/10
                                   each project)                                                 onwards (as per
                                                                                                 investment
                                                                                                 plan)
                                                                                                 area budget.
                                   Improve the         March 2011       Propose: 50%             2009/10                             Unavailability of
                                   Autistic                             reduction in waiting     £12,000                             funding in
                                   Spectrum                             times by April 2011.                                         2009/10
                                   Condition                                                                                         prevented pilot
                                   Pathway                              Baseline position                                            of a proposed
                                                                        required.                                                    assessment
                                                                                                                                     care pathway.
                                                                                                                                     Work has
                                                                                                                                     started to
                                                                                                                                     identify new
                                                                                                                                     solutions.
Improve access     Planned Care:   Develop co-         March 2011       Improved patient         2009/10                             Review of
to services        Discharge Co-   ordinated                            experience for           £83,000                             proposed
                   ordination      service                              children with                                                service
Improve Quality                    provision which                      disabilities and their   Plus element of                     development
of Service                         facilitates early                    families.                £167,000 to                         required in light
Provision                          discharge.                                                    support                             of Alliance
                                                                        Baseline position        development of                      projects to
Improve                                                                 required.                community                           reduce acute
Patient/Carer                                                                                    nursing                             admissions.
Experience

Improve
Stakeholder
Perceptions




                                                                                                                                              31
Learning Disabilities Programme


Goal (high level     Initiative    Project            Timescale for   Measurable             Investment     Disinvestment /   Risks and
benefit)             (project)     milestones         delivery        benefits                              savings           mitigation
                                   (deliverables in
                                   each project )
People have as        People as     Sponsor &          By March        No. of adults with    Within local                      Difficulty in
much choice and      Individuals   create             2013            LD in settled          authority                        collecting
control as                         accommodation                      accommodation          resources                        information by
possible over                      , support,                         2008/09 figure                                          Bradford District
their lives and                    employment                         74.5%                                                   Care Trust from
are actively                       and daytime                                                                                Community
involved in all                    activity &                         No. of adults with                                      Team for
decisions                          transport                          LD in employment                                        Learning
affecting how                      commissioning                      2008/09 figure                                          Disabilities.
they live                          partnerships.                      4.4%                                                    Penalties for
                                                                      Good performance                                        failure to collect
                                                                      is classed as a                                         and present
                                                                      positive increase in                                    information
                                                                      figures. Targets for                                    currently under
                                                                      09/10 not yet set.                                      negotiation
                                                                                                                              between local
                                                                                                                              authority and
                                                                                                                              BDCT

People are           People as     Learning           By March        More adults with       Within local                     Limited
treated with         Citizens      Disability         2011            LD in leadership       authority                        knowledge of
dignity and                        Parliament                         roles in council       resources                        programme and
respect as                                                            structures.                                             project
valued citizens of                 Self Advocate                      No. of reports                                          management
Bradford. People                   and Carer Led                      produced by                                             approaches




                                                                                                                                        32
Goal (high level    Initiative         Project            Timescale for   Measurable           Investment     Disinvestment /   Risks and
benefit)            (project)          milestones         delivery        benefits                            savings           mitigation
                                       (deliverables in
                                       each project )
know their rights                      Quality                            Quality Assurance                                     across the
and                                    Assurance                          Team                                                  programme
responsibilities                       Team                               Baseline                                              team.
and how to                                                                information to be                                     Mitigated
exercise them.                                                            collected in first                                    through the
                                                                          year of scheme,                                       provision of
                                                                          thereafter targets                                    Managing
                                                                          for improvement                                       Successful
                                                                          will be set.                                          Programmes
                                                                                                                                training
                                                                                                                                Absence of
                                                                                                                                baseline
                                                                                                                                information
                                                                                                                                prohibits setting
                                                                                                                                of performance
                                                                                                                                targets.
                                                                                                                                Mitigated
                                                                                                                                through
                                                                                                                                collection of
                                                                                                                                data in first year
                                                                                                                                of scheme and
                                                                                                                                by making
                                                                                                                                comparisons
                                                                                                                                with similar
                                                                                                                                schemes in
                                                                                                                                other areas
People are able     Fulfilling Lives   Employment &       By March        No. of adults with   Within local                      Difficulty in
to participate in                      Volunteering       2011            LD in employment     authority                        collecting




                                                                                                                                          33
Goal (high level      Initiative     Project            Timescale for   Measurable            Investment     Disinvestment /   Risks and
benefit)              (project)      milestones         delivery        benefits                             savings           mitigation
                                     (deliverables in
                                     each project )
the communities                      Project                            No. of adults with    resources                        information by
that matter to                                                          LD in employment                                       Bradford District
them the most,                       My Community                       2008/09 figure                                         Care Trust from
whether these                        Project                            4.4%                                                   Community
are local, cultural                                                                                                            Team for
or spiritual or                                                         No. of day centres                                     Learning
based on chosen                                                         transformed into                                       Disabilities.
lifestyles or                                                           community hubs                                         Penalties for
personal                                                                run by local                                           failure to collect
interests – and                                                         partnership                                            and present
communities will                                                        management                                             information
be enriched in                                                          committees                                             currently under
turn by their                                                           including service                                      negotiation
contributions.                                                          users and carers.                                      between local
                                                                        Targets not yet set                                    authority and
                                                                                                                               BDCT

People have           Where People   New,               By March        No. of adults with    Within local                     Timescales may
more choice and       Live           personalised       2011            LD in settled         authority                        not be achieved
control in who to                    accommodation                      accommodation         resources                        due to the
live with, what                      options via.                       No. of adults with                                     complexity of
type of home to                      integrated                         LD in settled                                          contract
live in and where                    commissioning.                     accommodation                                          transfers from
and how to live.                                                        2008/09 figure                                         BDCT to the
                                                                        74.5%                                                  Council.
                                                                        2009/10 targets not                                    Contract transfer
                                                                        yet agreed                                             managed
                                                                                                                               through




                                                                                                                                         34
Goal (high level      Initiative      Project            Timescale for   Measurable           Investment      Disinvestment /   Risks and
benefit)              (project)       milestones         delivery        benefits                             savings           mitigation
                                      (deliverables in
                                      each project )
                                                                                                                                Business
                                                                                                                                Assurance
                                                                                                                                Group.

                                                                                                                                 Difficulty in
                                                                                                                                collecting
                                                                                                                                information by
                                                                                                                                Bradford District
                                                                                                                                Care Trust from
                                                                                                                                Community
                                                                                                                                Team for
                                                                                                                                Learning
                                                                                                                                Disabilities.
                                                                                                                                Penalties for
                                                                                                                                failure to collect
                                                                                                                                and present
                                                                                                                                information
                                                                                                                                currently under
                                                                                                                                negotiation
                                                                                                                                between local
                                                                                                                                authority and
                                                                                                                                BDCT

 Better health,        Equal Access   Effective           By June        No. of adults with    £440,000 per                     Current role of
quality of life and   to Health       delivery of a      2010            LD who are           annum                             learning
longevity for         Services        health                             supported to meet                                      disability nurses
people with                           facilitation                       their health needs                                     diluted by care
learning                              service                                                                                   management




                                                                                                                                          35
Goal (high level      Initiative   Project            Timescale for   Measurable            Investment        Disinvestment /   Risks and
benefit)              (project)    milestones         delivery        benefits                                savings           mitigation
                                   (deliverables in
                                   each project )
disabilities                                                          Baseline                                                  responsibilities.
                                                                      information to be                                         Mitigated
                                                                      collected in first                                        through
                                                                      year of scheme,                                           introduction of
                                                                      thereafter targets                                        an action plan to
                                                                      for improvement                                           revalidate the
                                                                      will be set.                                              LD nurse role
                                                                                                                                within CTLD
  Better health,      Increased     Effective         By July 2010    No. of adults with     £450,000 per                        Difficulty
quality of life and   Therapies    delivery of                        LD whose              annum                               recruiting to
longevity for                      increased                          specialist health                                         specialist
people with                        specialist                         needs are met                                             therapy posts.
learning                           therapy                            within specified                                          Mitigated
disabilities with                  services                           timescales                                                through targeted
profound and                                                          No. of people                                             advertising and
complex health                                                        provided with                                             willingness to
needs                                                                 health action plans                                       repeat
                                                                                                                                recruitment
                                                                                                                                process
 People have      Improved GP      Improvements        By June         No. of adults with   Within existing                      Incomplete LD
equal opportunity Services         in LD registers    2010            LD on LD register     NHS Bradford                        register.
to experience                                                                               and Airedale                        Mitigated by
health and                         Provision of       Ongoing         Percentage of         resources                           comparison with
wellbeing, and to                  annual health                      people on LD                                              local authority
support to                         checks                             register receiving                                        database.
sustain a healthy                                                     annual health                                             Lack of
lifestyle.                                                            checks                                                    awareness of
                                                                                                                                needs of people




                                                                                                                                         36
Goal (high level   Initiative     Project             Timescale for   Measurable           Investment   Disinvestment /    Risks and
benefit)           (project)      milestones          delivery        benefits                          savings            mitigation
                                  (deliverables in
                                  each project )
                                                                      2008/09 1.66%                                        with LD lead to
                                                                      2009/10 65%                                          ineffective
                                                                                                                           interventions.
                                                                      World Class                                          Mitigated
                                                                      Commissioning                                        through
                                                                      target set at 5%                                     provision of LD
                                                                      improvement per                                      Awareness
                                                                      annum until 90%                                      training
                                                                      achieved in
                                                                      2013/14

Improved           Intensive      People who          Project         No. of adults with                To achieve this    Current CTLD
community          Support Team   have                dependent on    LD in specialist                  the NHS            practice is to
integration        Project        behaviours          outcomes of     residential                       Bradford and       seek specialist
                                  which challenge     Health          placements                        Airedale and       residential
People will be                    services will be    Facilitation                                      the Council will   placements.
treated with                      supported to        and Increased   Baseline                          manage a           Change in
greater dignity                   live in their own   Therapy         information to be                 change             values and
and respect                       homes.              projects        collected in first                programme to       practices
                                                                      year of scheme,                   move               addressed
                                                                      thereafter targets                investment         through People
                                                                      for improvement                   from current       as Individuals
                                                                      will be set.                      provision to a     project.
                                                                                                        more person
                                                                                                        centred             Difficulty in
                                                                                                        process            collecting
                                                                                                                           information by
                                                                                                                           Bradford District




                                                                                                                                    37
Goal (high level   Initiative   Project            Timescale for   Measurable   Investment   Disinvestment /   Risks and
benefit)           (project)    milestones         delivery        benefits                  savings           mitigation
                                (deliverables in
                                each project )
                                                                                                               Care Trust from
                                                                                                               Community
                                                                                                               Team for
                                                                                                               Learning
                                                                                                               Disabilities.
                                                                                                               Penalties for
                                                                                                               failure to collect
                                                                                                               and present
                                                                                                               information
                                                                                                               currently under
                                                                                                               negotiation
                                                                                                               between local
                                                                                                               authority and
                                                                                                               BDCT




                                                                                                                         38
Mental Health Programme

Goal (high level   Initiative     Project            Timescale for   Measurable             Investment   Disinvestment /   Risks and
benefit)           (project)      milestones         delivery        benefits                            savings           mitigation
                                  (deliverables in
                                  each project )
To reduce the      MH Promotion   The audit of       March 2011      The reductions in
incidence of       and suicide    suicides locally                   suicide will deliver
suicide by the     prevention     will provide                       improved life
people of                         evidence of the                    expectancy and
Bradford and                      ‘at risk’ groups                   quality of life; the
Airedale.                         and                                feasibility of the
                                  geographical                       measurement of
                                  localities. This                   this through locally
                                  will be used to                    determined
                                  deliver public                     measure of ‘Life
                                  health                             Years’ needs
                                  interventions to                   further exploration
                                  reduce the                         with Public Health
                                  incidence of                       colleagues once
                                  suicide by the                     needs assessment
                                  people of                          available and
                                  Bradford and                       capable of
                                  Airedale. The                      informing MH
                                  suicide rate in                    Promotion plan.
                                  Bradford and
                                  Airedale will
                                  reduce to 7.65
                                  per 100,000 in
                                  2011/2012
                                  (from 9.31 per
                                  100,000 in




                                                                                                                                   39
Goal (high level     Initiative     Project            Timescale for   Measurable             Investment   Disinvestment /   Risks and
benefit)             (project)      milestones         delivery        benefits                            savings           mitigation
                                    (deliverables in
                                    each project )
                                    2005/2007).
 Develop and          Non-urgent     The non-urgent    April 2011       The existing                       £398,857           Stakeholder
provide a non-       care pathway   care pathway                       resource deployed                                     buy in to model
urgent care                         will deliver a                     more effectively                                      requires testing
pathway that                        single access                      across the mental                                     and stakeholder
delivers local                      point and                          system for primary                                    management
aspirations in                      assessment                         and secondary                                         plan to be
responding to                       that removes                       non-urgent mental                                     developed to
the vision set out                  duplication from                   health care will                                      ensure
in Healthy                          the patient’s                      improve patient                                       successful
Ambitions.                          journey and                        satisfaction by 5%                                    engagement
                                    provides a                         from baseline                                         with project and
                                    single                             position.                                             its deliverables.
                                    information flow
                                    based on a                         412 DNA first
                                    single patient                     appointment (appt)
                                    record.                            @ £194 per appt. =
                                                                       £79,928
                                    Users will                         2458 DNA follow
                                    benefit from a                     up appt. @ £115
                                    seamless                           per appt. =
                                    journey and it                     £282,670
                                    will provide
                                    efficient use of                   a reduction of first
                                    resources                          appt. DNA by 10%
                                    across the                         = a savings of
                                    mental health                      £7992
                                    economy




                                                                                                                                      40
Goal (high level   Initiative   Project             Timescale for   Measurable           Investment   Disinvestment /   Risks and
benefit)           (project)    milestones          delivery        benefits                          savings           mitigation
                                (deliverables in
                                each project )
                                                                    a reduction of
                                The key high                        follow up DNA by
                                level outcome                       10% = a savings of
                                of the pathway                      £28,267
                                is ‘zero’ waiting
                                times for all
                                mental health
                                referrals.
                                Using ‘choose
                                and book’
                                methodologies,
                                to allow rapid
                                access with no
                                queues,
                                dependent
                                upon need.

                                Less anxiety
                                through quicker
                                diagnosis and
                                 less disruption
                                to normal life
                                through prompt
                                attention and
                                convenient
                                appointments.
                                This can lead to
                                a reduction in




                                                                                                                                41
Goal (high level   Initiative      Project            Timescale for   Measurable              Investment   Disinvestment /   Risks and
benefit)           (project)       milestones         delivery        benefits                             savings           mitigation
                                   (deliverables in
                                   each project )
                                   the number of
                                   unnecessary
                                   outpatient
                                   appointments
                                   and reduction in
                                   the number of
                                   service users
                                   that Did Not
                                   Attend.
 Improve the        Improving       There will be     March 2011      Through High            £500,000     £550.000          Uncertainty
quality and        Access to       access to                          Intensity therapy                                      over additional
accessibility of   Psychological   evidenced                          the IAPT                                               funding.
mental health      Therapies       based                              programme will                                         Discussions
therapies          (IAPT)          treatments for                     prevent 349 people                                     with Regional
through the                        common mental                      from unnecessarily                                     IAPT team to
delivery of the                    health problems                    accessing                                              secure further
Improving                          within primary                     secondary care                                         funding. If no
Access to                          care settings                      services resulting in                                  additional
Psychological                      across Bradford                    an efficiency                                          funding
Therapies (IAPT)                   and Airedale.                      equivalent to £250k                                    available
programme.                         IAPT will enable                   within the                                             targets and
                                   the support of                     secondary care                                         outcomes will
                                   49 people with                     contract per                                           require revision.
                                   mild to                            annum.
                                   moderate                           Through the Low
                                   anxiety or                         Intensity Therapy
                                   depression from                    IAPT programme
                                   benefits back to                   500 less




                                                                                                                                      42
Goal (high level   Initiative     Project            Timescale for   Measurable              Investment   Disinvestment /   Risks and
benefit)           (project)      milestones         delivery        benefits                             savings           mitigation
                                  (deliverables in
                                  each project )
                                  work every                         antidepressant
                                  year. IAPT will                    prescriptions will be
                                  provide                            provided delivering
                                  therapies to                       a cost efficiency of
                                  5134 adults and                    approximately
                                  older people                       £300k.
                                  per annum
                                  (3,738 Low
                                  Intensity
                                  Therapy and
                                  1396 High
                                  Intensity
                                  Therapy).
Review of the      Day Services    The review of     Jul 2010        100% of CMHT
current services   review         day care will                      clients referred to
providing day                     provide a plan                     day services will
care to meet the                  for service                        have an identified
needs of people                   redesign that                      key worker and
with severe and                   enables                            agreed support
enduring mental                   commissioners                      plan
health problems.                  to describe the                    There will be
                                  increased                          increased % of
                                  numbers of                         service users
                                  people with                        involved in
                                  mental health                      mainstream social,
                                  problems who                       leisure, education,
                                  can access                         training,
                                  meaningful day                     volunteering and




                                                                                                                                    43
Goal (high level   Initiative       Project            Timescale for   Measurable           Investment        Disinvestment /   Risks and
benefit)           (project)        milestones         delivery        benefits                               savings           mitigation
                                    (deliverables in
                                    each project )
                                    time occupation                    employment,
                                    through                            compared to
                                    mainstream                         baseline data
                                    education and                      position (to be
                                    employment as                      identified during
                                    well as leisure                    review)
                                    opportunities.                     150 adults
                                                                       receiving
                                                                       secondary mental
                                                                       health services in
                                                                       receipt of self-
                                                                       directed support
                                                                       (individual
                                                                       accounts/direct
                                                                       payments) by
                                                                       31.03.10.

Focus on care      CMHT for Older   Enhanced            Project not                         (£1.5m)           £291,600-
closer to home,    People           CMHTs will         yet started     A reduction in       Part of overall   £437,400
through the                         provide                            admission and        OPMH
development of                      increased                          length of stay to    investment
multi-agency and                    community                          OPMH acute
inter-agency                        based activity,                    inpatients could
working within                      with fewer                         equate to a
core services                       people needing                     savings of
through                             to be seen in                      £1620 per stay if
enhancement of                      outpatient                         length of stay is
current                             departments,                       reduced by 10%




                                                                                                                                        44
Goal (high level   Initiative   Project              Timescale for   Measurable          Investment   Disinvestment /   Risks and
benefit)           (project)    milestones           delivery        benefits                         savings           mitigation
                                (deliverables in
                                each project )
community                       with more                            £2430 per stay in
mental health                   individuals                          length of stay is
teams.                          receiving                            reduced by 15%
                                holistic care
                                packages in the                      Annually with an
                                home                                 average of 180
                                environment.                         admission this
                                This should                          equates to
                                lead to reduced                      10% = £291,600
                                admission rates                      15% = £437,400
                                and a decrease
                                in length of
                                stay.

                                Increase in use
                                of telecare
                                facilities leading
                                to people
                                staying in the
                                community
                                longer.

                                There will be an
                                increase in the
                                number of new
                                referrals seen
                                by the CMHT
                                (OP)




                                                                                                                                45
Goal (high level     Initiative      Project            Timescale for   Measurable              Investment        Disinvestment /   Risks and
benefit)             (project)       milestones         delivery        benefits                                  savings           mitigation
                                     (deliverables in
                                     each project )
Develop              Housing         Increased          Project not
housing-related      Related         housing-related    yet started
support via the      Support for     support from
Local Authority      Older People    Supporting
Supporting                           People to
People                               improve
programme to                         discharges from
assist individuals                   acute care (A &
to return to their                   E and inpatient
homes after a                        care) and
hospital                             improve quality
admission, as                        of life
well as
promoting early
discharge
packages.

 Promote early        Memory          Increased          Project not     Phase 1.                (£1.5m)          -£621,500
diagnosis and        Assessment      numbers of         yet started     This will result in a   Part of overall
assessment of        and Treatment   people                             disbenefit as a         OPMH
people with          Services        accessing                          consequence of an       investment
memory                               memory                             increase in
problems, with a                     assessment                         prescription of anti
multi-agency and                     and treatment                      dementia
multi-                               services at an                     medication from
professional ‘one                    earlier stage.                     £621,500 per
stop shop’ for                                                          annum and an
assessment and                       Increase in the                    increased cost to




                                                                                                                                            46
Goal (high level   Initiative   Project            Timescale for   Measurable            Investment   Disinvestment /   Risks and
benefit)           (project)    milestones         delivery        benefits                           savings           mitigation
                                (deliverables in
                                each project )
access to                       number of                          imaging services
support for                     assessments
anyone with                     undertaken to                      Phase 2.
memory                          identify memory                    National guidance
problems who                    problems                           suggests that early
may have                        leading to early                   intervention can
dementia or                     interventions                      reduce care home
Alzheimer’s                                                        admissions by 22-
disease.                        Increased                          28%.
                                numbers
                                attending                          395 admissions at
                                wellbeing cafes                    a cost of £31296 =
                                                                   £12,361,920
                                An increase in                     a reduction of 22%
                                assessments,                       would equate to
                                prescription of                    £2,719,622
                                medication and                     savings but this
                                referral to                        would not all be
                                imaging                            Healthcare savings
                                services (CT
                                scans).

                                Each FTE
                                Dementia
                                Advisor and
                                their team of
                                volunteers will
                                support 200




                                                                                                                                47
Goal (high level    Initiative   Project            Timescale for   Measurable          Investment   Disinvestment /   Risks and
benefit)            (project)    milestones         delivery        benefits                         savings           mitigation
                                 (deliverables in
                                 each project )
                                  people at any
                                  one time. In
                                  2010/2011 this
                                  will amount to
                                  400 people
                                  being
                                  supported,
                                  growing to 800
                                  people in
                                  2011/2012

                                 Improved
                                 quality of life,
                                 with increased
                                 independence
                                 and care closer
                                 to home,
                                 prevention of
                                 unnecessary
                                 admissions to
                                 care homes

Develop and         Acute Care    All inpatient      Project not     A reduction in                                     MH Payment
provide an acute    Pathway      admissions will    yet started     admission and                                      by Results
care pathway                     have received a                    length of stay to                                  Tariff
that delivers                    gatekeeping                        AMH acute                                          mechanism not
local aspirations                assessment                         inpatients could                                   due to be
in responding to                 from CRHT.                         equate to a                                        implemented




                                                                                                                               48
Goal (high level     Initiative   Project             Timescale for   Measurable              Investment   Disinvestment /   Risks and
benefit)             (project)    milestones          delivery        benefits                             savings           mitigation
                                  (deliverables in
                                  each project )
the vision set out                                                    savings of                                             until
in Healthy                        Average                             £1310 per stay in                                      20111/2012
Ambitions that                    admissions to                       length of stay is                                      financial year.
ensures                           acute specialist                    reduced by 10%                                         Reassess
admission to                      inpatients                          £1965 per stay in                                      likelihood of
hospital is                       services will                       length of stay is                                      benefits being
appropriate and                   reduce, with                        reduced by 15%                                         realised/risk
discharge is                      savings being                                                                              once basis of
timely. Where                     reinvested to                       Annually with an                                       tariff clear
home treatment                    improve                             average of 828
is the norm,                      community                           admission this
refocusing in-                    services                            equates to
patient services                                                      10% = £1,085,011
around more                       Average length                      15% = £1,627,516
acutely ill                       of stay for acute
patients and                      inpatients will                     Realising such
shorter lengths                   reduce , with                       benefits will require
of stay.                          savings being                       changes to contract
                                  reinvested to                       currencies not
                                  improve                             currently agreed.
                                  community
                                  services

                                  1298 Home
                                  Treatment
                                  episodes per
                                  annum will be
                                  undertaken.




                                                                                                                                      49
Goal (high level      Initiative        Project            Timescale for   Measurable             Investment        Disinvestment /   Risks and
benefit)              (project)         milestones         delivery        benefits                                 savings           mitigation
                                        (deliverables in
                                        each project )

Specialist social     Crisis response   The social care    Project not     The social care        (£1.5m)           £138,876
care enablement       and admissions    Community          yet started     Community Mental       Part of overall
services produce      avoidance (OP)    Mental Health                      Health Enablement      OPMH
positive                                Enablement                         Service will prevent   investment
outcomes in                             Service will                       13% of all referrals
relation to quality                     provide support                    from being
of life, mental                         to prevent                         admitted to acute
well-being,                             admission to                       hospital
support to                              inpatient                          @ a cost of £213
carers, and cost                        services and                       with average length
savings within                          promote early                      of stay as 8 days
the wider service                       discharge from                     £17,040 savings
network.                                inpatient                          Promoting early
                                        services.                          discharge for 26%
                                                                           of all referrals,
                                        Access to                          equating to a
                                        intermediate                       reduced length of
                                        care/crisis                        stay of 28 days
                                        response                           £121,836
                                        services for
                                        older people
                                        with mental
                                        health problems
                                        during extended
                                        hours.

                                        Admissions to




                                                                                                                                              50
Goal (high level   Initiative     Project             Timescale for   Measurable           Investment        Disinvestment /   Risks and
benefit)           (project)      milestones          delivery        benefits                               savings           mitigation
                                  (deliverables in
                                  each project )
                                  acute specialist
                                  mental health
                                  care will be
                                  reduced

                                  Lengths of stay
                                  in acute
                                  specialist
                                  mental health
                                  care will be
                                  reduced

                                  Admissions to
                                  care homes of
                                  older people
                                  with dementia
                                  and other
                                  functional
                                  mental health
                                  problems will be
                                  reduced.
There will be a Care in general   Specialist          Project not     Lengths of stay in   (£1.5m)           £1,047162
more integrated hospitals (OP)    mental health       yet started     acute general        Part of overall
approach to the                   staff will have                     hospital care of     OPMH
care needs of                     specific links to                   people with          investment
individuals                       general hospital                    dementia will be
admitted      to                  wards and to                        reduced by 25%
general hospital                  care homes to




                                                                                                                                       51
Goal (high level    Initiative   Project           Timescale for   Measurable            Investment   Disinvestment /   Risks and
benefit)            (project)    milestones        delivery        benefits                           savings           mitigation
                                 (deliverables in
                                 each project )
and care homes,                  support                           Average stay
who        either                generalist staff                  reduced to 6 days =
already                          to provide a                      savings of
experience                       more holistic                     £782,562
mental     health                approach to
problems, or who                 care, ensuring
experience them                  that people’s
as              a                mental health
consequence of                   needs are                         25% fewer people
the admission.                   treated equally                   with dementia
                                 to their physical                 staying in hospital
                                 health needs.                     for 63-74 days
                                 Delayed                           (n=54): £264,600
                                 discharges and                    saving
                                 length of stay
                                 will be reduced.
                                 The number of
                                 incidents
                                 responded to by
                                 the Yorkshire
                                 Ambulance
                                 Service in the
                                 general
                                 community and
                                 from care
                                 homes will be
                                 reduced
                                 Admissions to




                                                                                                                                52
Goal (high level     Initiative        Project             Timescale for   Measurable              Investment   Disinvestment /   Risks and
benefit)             (project)         milestones          delivery        benefits                             savings           mitigation
                                       (deliverables in
                                       each project )
                                       acute general
                                       hospital care of
                                       people with
                                       dementia and
                                       other functional
                                       mental health
                                       needs will be
                                       reduced by
                                       12% = 66
                                       preventable
                                       admissions at
                                       any given time
Specialist,          Specialist,       Specialist          March 2011      Reduction in                         £200,000
tertiary mental      tertiary mental   tertiary care                       number of out of
health care will     health care       pathways and                        area placements
provide high                           contracts are                       for secure
quality, value for                     clearly specified                   rehabilitation by
money treatment                        and their use is                    recommissioning
options as close                       regularly                           these services
to the Bradford                        reviewed to                         more locally will
locality as                            ensure that                         result in a saving of
possible. The                          where possible                      £200k per annum.
commissioning                          needs are met
and contracting                        as close to
will be carried                        Bradford as
out on a region                        possible.
wide basis to
ensure




                                                                                                                                          53
Goal (high level    Initiative        Project            Timescale for   Measurable             Investment   Disinvestment /   Risks and
benefit)            (project)         milestones         delivery        benefits                            savings           mitigation
                                      (deliverables in
                                      each project )
opportunities for
delivering these
benefits is
provided by
collaborative
commissioning
arrangements.

The programme       Personalisation   150 adults         Apr 2011        Local Authority
will deliver                          receiving                          need to review
services that are                     secondary                          likely benefits that
recognised as                         mental health                      will accrue to them
personalised.                         services in                        as part of wider
                                      receipt of self-                   programme
                                      directed support
                                      (individual
                                      accounts/direct
                                      payments) by
                                      31.03.10.
                                      By 31.03.11
                                      30% of service
                                      users and
                                      carers to have
                                      received
                                      packages of
                                      care through
                                      self-directed
                                      support process




                                                                                                                                       54
Goal (high level    Initiative        Project             Timescale for   Measurable            Investment   Disinvestment /   Risks and
benefit)            (project)         milestones          delivery        benefits                           savings           mitigation
                                      (deliverables in
                                      each project )
The programme       Delivering Race   Develop an          Mar 2011        The satisfaction of
will deliver        Equality          agreed                              people from BME
services that are                     mechanism for                       communities in
recognised as                         collecting                          realising their
delivering race                       service                             expressed
equality.                             outcomes                            outcomes from
                                      based on the                        mental health
                                      BME Service                         services as
                                      Outcome                             assessed by the
                                      Framework.                          BME Outcomes
                                      The outcome                         Framework will
                                      data will deliver                   improve by 3%
                                      the information                     each year.
                                      to design an
                                      annual
                                      programme of
                                      service
                                      improvement to
                                      deliver
                                      improved
                                      service
                                      satisfaction in
                                      BME service
                                      users and
                                      reduce
                                      inequalities in
                                      service uptake.
Those who           MH and            MH and LD           Mar 2011        Benefits to be




                                                                                                                                       55
Goal (high level    Initiative     Project            Timescale for   Measurable      Investment   Disinvestment /   Risks and
benefit)            (project)      milestones         delivery        benefits                     savings           mitigation
                                   (deliverables in
                                   each project )
experience          Learning       Service                            measured from
mental health       Disabilities   Specifications                     Pathways work
problems and a                     will have the
learning disability                aims of Green
will have their                    Light for Mental
needs met by the                   Health included
most appropriate                   in their service
service.                           specifications
                                   and compliance
                                   with these will
                                   be reflected in
                                   the relevant
                                   performance
                                   schedules. CPA
                                   policy will also
                                   be in operation
                                   within LD
                                   services.




                                                                                                                             56
Planned Care Programme

Goal / high level                       Project         Timescale for       Measurable                        Disinvestment /      Risks and
                       Initiative                                                            New Investment
    benefit                            Milestones          delivery          benefits                             Savings          Mitigation
                                                                                                                                     Effort will
                                                                                                                                      improve
Address             Model referral                                                                                              appropriateness
inequalities by     behaviour with   Quarterly peer                      Reduction in                                               of referrals,
benchmarking        subsequent       review of                           variation,                                                however, no
                                                        Ongoing
referral            Alliance-led     referrals - June                    movement towards                -                 -    real reduction in
                                                        programme
behaviour and       improvements     10, Sept 10,                        national                                               spend - as over
reducing            in referral      Dec 10, Mar 11                      benchmarks                                             referrers reduce
outliers            management.                                                                                                    rates, under
                                                                                                                                   referrers will
                                                                                                                                     increase.
Improve Patient     Electronic                                           A 5% shift in the                                         Acute Trust
Experience with     Advisory                                             number of                                                engagement.
                                     Establish
a 1 in 20           Service for                                          OPFA/OPFU to                                              Slow start =
                                     project team       March 2010 -
reduction in        avoidable                                            non-face-to-face                                        less chance of
                                     within             Multi-
outpatient          outpatient                                           consults during            75,000           250,000      savings. Take
                                     parameters set     organisational
appointments        appointments                                         2010/11 in BTHFT.                                       through CMBs
                                     by SHA RIF         board formed
for a range of      and developing                                       Associated                                             for exec signoff.
                                     panel
chronic             integrated                                           reduction in OP                                            RIF project
conditions          models of care                                       clinics                                                       funding
                    Intermediate
                                     Business case
Commission          Clinical
                                     to BACHS SDG
high quality        Assessment &
                                     in Jan '10, CMB
services using      Treatment                           April 2010              tbd                      -                 -         [Ben]
                                     Feb '10 and
integrated          Service and
                                     operational
models of care.     Pathway
                                     April '10
                    Developments




                                                                                                                                        57
Goal / high level                           Project       Timescale for        Measurable                             Disinvestment /      Risks and
                        Initiative                                                                   New Investment
    benefit                                Milestones        delivery           benefits                                  Savings          Mitigation
                    in MSK
                    conditions



                                                                                                                                          Represents
Improve clinical
                    Improving                                                                                                            2010/11 only.
outcomes
                    Clinical Quality:                                                                                                   Needs intensive
commissioning
                    Pathway,                                                                                                            managerial and
evidence-based
                    Threshold and                                                                                                          back room
pathways of
                    Commissioning              tbd             tbd                  tbd                          -           240,000        support.
care. Reduce
                    Policy for                                                                                                              Alliances
spend by 2% in
                    Procedures of                                                                                                       agreed to share
2010/11,
                    Limited Clinical                                                                                                        work and
moving to 20%
                    Value                                                                                                                ensure clinical
over 5 years
                                                                                                                                         engagement.
                                                                          Increased                                                      Only one IPG
                    Improving
                                                                          percentage of                                                   quantified to
                    Clinical Quality
                                        Draft policy                      patients whose                                                      date.
Evaluate            through
                                        done. For                         care is managed                                                  Alternative
services quality    implementation                        January 2010                                           -           150,000
                                        ratification by                   under special                                                      patient
and outcomes        of Policy for
                                        CPC                               arrangements                                                   management
                    Interventional
                                                                          should an IFR be                                                 not costed.
                    Procedures
                                                                          approved                                                       Policy drafted.
Evaluate            Adopt regionally                                      Shift to consistent                                             No specialist
services quality    developed                                             commissioning and                                                  weight
                                        Range of          Ongoing
and outcomes,       service                                               eligibility criteria for               -           600,000     management
                                        services tbd      programme
benchmarking        specification                                         increasing range of                                           service for BMI
against similar     and eligibility                                       interventions                                                  >40. Review




                                                                                                                                                58
Goal / high level                      Project     Timescale for       Measurable                          Disinvestment /      Risks and
                       Initiative                                                         New Investment
    benefit                           Milestones      delivery          benefits                               Savings          Mitigation
organisations       criteria                                       reducing 'postcode                                           total obesity
                    adapting/modify                                lottery'                                                     programme
                    ing local                                                                                                finances and re-
                    services where                                                                                                prioritise.
                    needed eg IVF,
                    Bariatrics
                    Speciality work
                                                                   5% reduction in
                    - Orthopaedics:
Procure                                                            lower limb joint
                    managing
resources                                                          replacements                                                 Work to
                    variation in                   2010/11
efficiently                              tbd                       generating a saving                -           350,000    implement not
                    surgical                       contract
reducing spend                                                     in IP care of £350k                                          started.
                    thresholds eg
by 5%                                                              on current spend
                    Lower limb
                                                                   £7m
                    arthroplasty
                                                                                                                                 Clinical
                                                                                                                              agreement to
                    Speciality work
Improve the                                                                                                                       model.
                    - Gynaecology:                                 100% reduction in
patient                                                                                                                        Contractual
                    streamlining                                   routine double
experience                                                                                                                    resistance to
                    pathways for                   2010/11         follow-ups following
through the                              tbd                                                          -          tbd          change. Use
                    the                            contract        colposcopy. Patient
reduction of                                                                                                                   contractual
                    management of                                  care delivered by
unnecessary                                                                                                                     levers to
                    common                                         their own GP.
follow-ups and                                                                                                                 commission
                    conditions
                                                                                                                                 pathway
                                                                                                                                 change




                                                                                                                                     59
Goal / high level                         Project        Timescale for      Measurable                          Disinvestment /      Risks and
                        Initiative                                                             New Investment
    benefit                              Milestones         delivery         benefits                               Savings          Mitigation
Improve patient
experience
through the
reduction of
                                                                                                                                    [Kath - after
unecessary
                    Ophthalmology            tbd              tbd                tbd                       -           110,000       Eye Care
follow-ups and
                                                                                                                                  Strategy Group]
deliver care
closer to home
where
appropriate
                                                                                                                                   Reluctance by
                    Speciality work                                                                                                 consultants to
                                                                         xx% shift in care
Commission          - Neurology:                                                                                                    triage work to
                                                                         delivered by tier 2
primary care to     divert                                                                                                            GPSIs. May
                                                                         community-based
provide high        appropriate        Business case                                                                                    withdraw
                                                                         services from acute
quality services    patients to        to HMAP           April 2010                                        -                 -        governance
                                                                         services with
with improved       intermediate       January                                                                                    support if model
                                                                         associated
access meeting      services for                                                                                                       not to their
                                                                         reduction in OP
individual need     diagnosis and                                                                                                  liking. Working
                                                                         clinics.
                    management                                                                                                      closely across
                                                                                                                                   1° and 2° care
Achieve                                Clinical                          % take-up of                                                    Clinical
financial                              Advisory Group                    loQOF by practices                                          resistance to
                    Osteoporosis:
balance by                             established Jan   Guidance        and points                                                 change. Slow
                    screening tools,
reducing the                           '10. PACE         completed       achieved.                                                       shift in
                    diagnosis,                                                                             -           100,000
referral rate,                         guideline         and launched    Reduction in low                                            behaviour in
                    treatment and
follow-up and                          revised and       April 2010      trauma fragility                                             response to
                    follow-up
price of DXA                           loQOF agreed                      fractures since                                           new guidance.
screening by                           end Feb '10.                      loQOF launch.                                                  Contract




                                                                                                                                          60
Goal / high level                           Project          Timescale for   Measurable                    Disinvestment /     Risks and
                        Initiative                                                        New Investment
    benefit                                Milestones           delivery      benefits                         Savings         Mitigation
1,000                                                                                                                         negotiation
attendances.                                                                                                                 might be only
                                                                                                                                saving.


                    Blueprint PwSI                           June 2010 -                                                     No deliverable
Understand our                          Desktop review
                    services and                             Blueprint of                                                    contribution to
local population                        of full range of
                    identify                                 current                                                           achieving
needs and plan                          services.                               tbd                   -                 -
                    opportunities for                        service                                                            financial
services to meet                        Prioritisation for
                    productivity and                         provision                                                       balance in the
them                                    in-depth review.
                    efficiency                               completed                                                        short term.

                                                                                                           1,800,000




                                                                                                                                    61
Acute Care Programme

Goal (high level   Initiative         Project            Timescale for   Measurable            Disinvestment/s   Investment   Risks and
benefit)           (Project)          milestones         delivery        benefits              aving                          Mitigation
                                      (deliverables in
                                      each project)
Reduce Non-        Increasing the                                        1. Provide support                                   Stakeholder
Elective           capacity of                                           community                                            ‘buy-in’ Risk of
admissions to      ‘step-up’ beds                                        intermediate care                                    ‘double-
acute care         in the District,                                      services                                             counting re
                   including                                             2. Prevents                                          actual
                   community                                             avoidable                                            savings/reducti
                   hospitals and                                         admissions to                                        ons in activity.
                   local authority                                       acute hospital or                                    Mitigation
                   care home                                             residential care.                                    requires all
                   beds.                                                 3. Reduction in                                      Programme
                                                                         conveyance rate to                                   Managers to
                                                                         acute hospital.                                      fully explore the
                                                                                                                              synergy
                                                                                                                              between
                                                                                                                              projects.
Reduction in      Streamlining of                                        1. Prevents                                          Risk of ‘double-
delayed transfers discharge                                              unnecessary                                          counting re
of care           processes in                                           delays in                                            actual
                                                                         discharge.                                           savings/reducti
                  acute hospital
                                                                                                                              ons in activity.
                  settings.                                              2. Improved patient                                  Mitigation
                                                                         experience.                                          requires all
                                                                                                                              Programme
                                                                         3. Integrated                                        Managers to
                                                                         discharge                                            fully explore the
                                                                         pathways across                                      synergy




                                                                                                                                       62
Goal (high level   Initiative         Project            Timescale for   Measurable             Disinvestment/s    Investment   Risks and
benefit)           (Project)          milestones         delivery        benefits               aving                           Mitigation
                                      (deliverables in
                                      each project)
                                                                         health, social care                                    between
                                                                         and the third sector                                   projects.
                                                                         will be developed
Reduce Non-        Development of                                        1. Reduce the          1 Reduction in                  Risk of ‘double-
Elective           integrated                                            amount of non-         delayed                         counting re
admissions to      health and                                            elective admissions    transfers of                    actual
acute care         social care                                           and premature                                          savings/reducti
                                                                                                care
                   community-                                            admission to care                                      ons in activity.
                   based                                                 by providing           2 20%                           Mitigation
                   intermediate                                          increased              Reduction in                    requires all
                   care services.                                        assessment and         non-elective                    Programme
                                                                         support in the                                         Managers to
                                                                                                admissions and
                                                                         community, with an                                     fully explore the
                                                                         emphasis on            A&E                             synergy
                                                                         rehabilitation and     attendances                     between
                                                                         regaining optimal      from care                       projects.
                                                                         independence.          homes

                                                                         2. Improved patient
                                                                         experience.

Reduce Non-        Development of                                        1. Increasing the      1 Increase the                  Risk of ‘double-
Elective           integrated falls                                      number of people       percentage of                   counting re
admissions to      and bone-                                             treated at and         falls treated at                actual
acute care         health services.                                      supported to                                           savings/reducti
                                                                                                the scene from
                                                                         remain at home                                         ons in activity.
                                                                         after a fall;          c. 25% to 50%                   Mitigation
                                                                         2. Development of      with associated                 requires all




                                                                                                                                         63
Goal (high level   Initiative   Project            Timescale for   Measurable              Disinvestment/s   Investment   Risks and
benefit)           (Project)    milestones         delivery        benefits                aving                          Mitigation
                                (deliverables in
                                each project)
                                                                   specialist multi-       reduction in                   Programme
                                                                   disciplinary out-       attendances at                 Managers to
                                                                   patients falls          A&E.                           fully explore the
                                                                   assessment                                             synergy
                                                                   services, including     2 Reduction in                 between
                                                                   specialist triage       delayed                        projects.
                                                                   and Fracture            transfers of
                                                                   Liaison Service;        care
                                                                   3. Development of
                                                                   evidence-based
                                                                   strength and
                                                                   balance classes in
                                                                   primary and
                                                                   community health
                                                                   and social care
                                                                   services;
                                                                   4. Increasing the
                                                                   use of assistive
                                                                   technology and
                                                                   implementation of
                                                                   the Best Practice
                                                                   Tariff for hip
                                                                   fractures.
                                                                   5 This group of
                                                                   projects will deliver
                                                                   planned savings.
                                                                   6. Improved patient
                                                                   experience.




                                                                                                                                   64
Goal (high level   Initiative         Project              Timescale for   Measurable            Disinvestment/s   Investment         Risks and
benefit)           (Project)          milestones           delivery        benefits              aving                                Mitigation
                                      (deliverables in
                                      each project)
Reduce             Redesign BRI       1. Develop           Mar 2010 to     1. Improved patient   Approx 900K       A&E activity -     Stakeholder
inappropriate      A&E ‘front-end’    project team         complete        outcome                                 £10.5M pa          ‘buy-in’ is a
attendances at     to ensure that     and sub-groups       scoping and     (measurement tbc)                                          likely risk;
A&E.               patients receive   2. Scope model       redesign of                                             Cost associated    however the
                   the right          of service           model.          2. Planned                              with alternative   development of
                   treatment from     3. Develop           Service         reduction of A&E                        service/pathway    a Strategic
                   the right person   project initiation   improvements    attendance by                           redesign (eg -     Change Board
                   at the right       documentation        will be         approximately                           re-deployment      (CE level) and
                   place.             (tbc).               measured        15000 by Mar 11.                        of Community       the integration
                   Considering:                            through FY.                                             Matrons in to      of providers on
                   admission                                               3. Reduction of                         A&E (tbc)          the Acute Care
                   avoidance/disch                                         breaches to 4 hour                                         Programme
                   arge from                                               target (tbc).                                              Board should
                   attendance;                                                                                                        enhance
                   triage/signposti                                                                                                   provider
                   ng to                                                                                                              engagement.
                   PHC/PDC; AHP
                   input.                                                                                                             The impact of
                                                                                                                                      the revised
                   Improve access                                                                                                     Operating
                   to PHC                                                                                                             Framework
                                                                                                                                      needs to be
                                                                                                                                      assessed in
                                                                                                                                      terms of these
                                                                                                                                      benefits, and in
                                                                                                                                      terms of the
                                                                                                                                      ‘buy-in’ from
                                                                                                                                      providers.




                                                                                                                                              65
Goal (high level    Initiative        Project            Timescale for   Measurable             Disinvestment/s    Investment       Risks and
benefit)            (Project)         milestones         delivery        benefits               aving                               Mitigation
                                      (deliverables in
                                      each project)

                                                                                                                                    Risk of
                                                                                                                                    destabilising
                                                                                                                                    ED. Joint
                                                                                                                                    planning and
                                                                                                                                    flexibility of tariff
                                                                                                                                    should mitigate
                                                                                                                                    this risk.

                                                                                                                                    Risk of ‘double-
                                                                                                                                    counting re
                                                                                                                                    actual
                                                                                                                                    savings/reducti
                                                                                                                                    ons in activity.
                                                                                                                                    Mitigation
                                                                                                                                    requires all
                                                                                                                                    Programme
                                                                                                                                    Managers to
                                                                                                                                    fully explore the
                                                                                                                                    synergy
                                                                                                                                    between
                                                                                                                                    projects.
Reduce              Develop an        1. Collate         Mar 10          1. Contribute to the   Contribution tbd   NEL activity -   Possible need
inappropriate       accurate and      service details                    reduction in BTHFT                        £113.3M pa       for Invest to
attendances at      current           (Mar 10)                           A&E attendances.                          across B&A       Save in terms
A&E and             Directory of      2. Agree                                                                                      of IM&T
contribute to the   Services          distribution                       2. Contribution to                        A&E activity -   development,
reduction in NEL.   identifying all   model                              reduction in NEL                          £13.5M pa        and need for




                                                                                                                                               66
Goal (high level    Initiative          Project            Timescale for   Measurable              Disinvestment/s   Investment      Risks and
benefit)            (Project)           milestones         delivery        benefits                aving                             Mitigation
                                        (deliverables in
                                        each project)
                    existing            (Feb 10)                           across both Acute                                         dedicated
                    alternatives        3. Develop                         Trusts.                                   Possible need   resources to
                    including:          maintenance                                                                  for Invest to   manage and
                    access criteria.    process                                                                      Save in terms   maintain the
                    Project would       (Mar 10)                                                                     of IM&T         system.
                    include:            4. Develop and                                                               development,
                    development;        test directory                                                               and need for    Risk of ‘double-
                    Version             (tbc)                                                                        dedicated       counting re
                    control/mainten     5. Distribute                                                                resources to    actual
                    ance;               directory (tbc)                                                              manage and      savings/reducti
                    distribution/mar                                                                                 maintain the    ons in activity.
                    keting.                                                                                          system (cost    Mitigation
                                                                                                                     tbc)            requires all
                                                                                                                                     Programme
                                                                                                                                     Managers to
                                                                                                                                     fully explore the
                                                                                                                                     synergy
                                                                                                                                     between
                                                                                                                                     projects.
Reduce              Whole system        1. Scoping         Phased:         1. a. Planned           1.tbd                             Stakeholder
inappropriate       pathway review      group                              reduction of non-                                         ‘buy-in’ is a
attendances at      of the non-         developed.         1. a. Planned   elective activity to                                      likely risk;
A&E and             elective activity                      reduction of    09/10 baseline          2. tbd                            however the
contribute to the   above baseline.     2. Project Brief   non-elective    levels by 10/11;                                          development of
reduction in NEL.                       developed by       activity to        b. Planned                                             a Strategic
                                        03 Feb 10.         09/10           reduction to 08/09                                        Change Board
                                                           baseline        baseline levels (in a                                     (CE level) and
                                        3. Present to      levels by       time to be                                                the integration




                                                                                                                                              67
Goal (high level   Initiative      Project             Timescale for   Measurable           Disinvestment/s    Investment        Risks and
benefit)           (Project)       milestones          delivery        benefits             aving                                Mitigation
                                   (deliverables in
                                   each project)
                                   ACPB – 05 Feb       10/11;          determined).                                              of providers on
                                   10.                    b. Planned                                                             the Acute Care
                                                       reduction to                                                              Programme
                                   4. Undertake        08/09                                                                     Board should
                                   systematic          baseline                                                                  enhance
                                   whole system        levels (in a                                                              provider
                                   (clinically lead)   time to be                                                                engagement.
                                   pathway             determined).
                                   reviews,
                                   particularly
                                   around high
                                   spend and
                                   overtrade HRG
                                   (inc ambulatory
                                   care sensitive).
Improve YAS        Consider        1. Scope            Mar 10 (for     1. Contribute to a   Net saving of      ?29K for new      Stakeholder
performance to     benefits of     project plan        pilot study)    reduction in         approx 150K,       service           ‘buy-in’ – police;
meet national      commissioning                                       demand for           although           provision from    YAS; BRI.
targets.           a Paramedic     2. Develop                          emergency            indirect saving    YAS.
                   Response        project group                       ambulance vehicles   in YAS contract.                     Reliable data
Reduce alcohol     Initiative                                          from 7% to 5%                           (YAS contract -   on alcohol-
related A&E                        3. Outline pilot                                                            £15M pa)          related
attendances at                     study /                             2. Decrease by                                            ambulance and
BRI.                               Investment                          30% the number of                                         A&E activity is
                                   Appraisal                           DMA vehicles                                              not routinely
                                                                       attending alcohol-                                        available at
                                                                       related incidents.                                        present. Acute
                                                                                                                                 Care




                                                                                                                                          68
Goal (high level   Initiative        Project            Timescale for   Measurable            Disinvestment/s    Investment        Risks and
benefit)           (Project)         milestones         delivery        benefits              aving                                Mitigation
                                     (deliverables in
                                     each project)
                                                                        3. Reduction of                                            programme will
                                                                        A&E attendances                                            work with
                                                                        by xx (tbc)                                                specialist
                                                                                                                                   alcohol
                                                                                                                                   commissioner
                                                                                                                                   to share
                                                                                                                                   available data
                                                                                                                                   and specify
                                                                                                                                   additional
                                                                                                                                   requirements
Improve Hospital   Hospital          1. Facilitate      Mar 10          Reduce percentage     Minimal            (YAS contract -   Stakeholder
Turnaround to      Turnaround        project group                      of turnarounds >25    financial saving   £15M pa)          ‘buy-in’
achieve national   action planning   mtg                                mins to <20% at                                            including YAS
targets.                                                                both trusts by                                             capacity to
                                     2. YAS to                          March 2010.                                                contribute due
                                     outline pilot                                                                                 to REAP level
                                     study                                                                                         activity.




tbd                Unscheduled       tbd                tbd             tbd                   tbd                                  tbd
                   PTS
Reduce             Improve           To be              Mar 11          1. Improved patient   tbd                YAS contract -    Stakeholder
inappropriate      responsive        confirmed                          outcome                                  £15M pa           ‘buy-in’
attendances at     pathways in                                                                                                     including YAS
A&E and            order to reduce                                      2. YAS                                                     capacity to




                                                                                                                                           69
Goal (high level    Initiative        Project            Timescale for   Measurable            Disinvestment/s   Investment       Risks and
benefit)            (Project)         milestones         delivery        benefits              aving                              Mitigation
                                      (deliverables in
                                      each project)
contribute to the YAS                                                    performance                                              contribute due
reduction in NEL. conveyance                                             meeting                                                  to REAP level
                  rates.                                                 national/local                                           activity.
                                                                         targets

                                                                         3. Reduced
                                                                         inappropriate A&E
                                                                         attendances.

                                                                         4. Reduced
                                                                         inappropriate NEL.
Reduce              Improve           tbd                Mar 11          1. Improved patient   tbd               YAS contract -   Stakeholder
inappropriate       responsive                                           outcome                                 £15M pa          ‘buy-in’
attendances at      pathways in                                                                                                   including YAS
A&E and             order to reduce                                      2. YAS                                                   capacity to
contribute to the   number of                                            performance                                              contribute due
reduction in NEL.   requests from                                        meeting                                                  to REAP level
                    GPs for                                              national/local                                           activity.
                    emergency                                            targets
                    ambulance                                                                                                     Risk of ‘double-
                    support.                                             3. Improved                                              counting re
                    (GP Reds)                                            resource/capacity                                        actual
                                                                         management                                               savings/reducti
                                                                                                                                  ons in activity.
                                                                         4. Improved inter-                                       Mitigation
                                                                         relations/communic                                       requires all
                                                                         ations between                                           Programme
                                                                         stakeholders                                             Managers to




                                                                                                                                          70
Goal (high level   Initiative        Project            Timescale for     Measurable            Disinvestment/s   Investment      Risks and
benefit)           (Project)         milestones         delivery          benefits              aving                             Mitigation
                                     (deliverables in
                                     each project)
                                                                                                                                  fully explore the
                                                                          5. Improved                                             synergy
                                                                          productivity and                                        between
                                                                          efficiency                                              projects.



Reduce             Whole-system      1. Stakeholder     Initial project   1. Improved patient   Approx 70K by     Individual GPs  Stakeholder
inappropriate      redesign of the   Project Group,     completed by      outcome               Mar 11            have funded the ‘buy-in’
emergency          urgent/emergen    patient            Apr 10 but                                                procurement of
admissions for     cy pathway for    information        benefits to be    2. Reduce number                        O2 monitors.
children with an   a child/young     group, Audit       measured          of NEL spells from
acute wheezy       person            group              thereafter.       2008/09 total by
episode.           presenting with   2. Clinical                          25% by March
                   an acute          guidelines and                       2011.
                   wheezy            pathway
                   episode.          3. two PACE                          3. Reduction in
                   (Supported by     (Promoting                           A&E attendances
                   the Rapid         Action on                            (tbc)
                   Improvement       Clinical
                   Programme for     Effectiveness)
                   urgent/emergen    events
                   cy support for    4. Data
                   children and      collection and
                   young people      analysis
                   with NHS          5. Patient Care
                   Institute).       Management
                                     plan




                                                                                                                                           71
Goal (high level   Initiative         Project            Timescale for   Measurable            Disinvestment/s   Investment     Risks and
benefit)           (Project)          milestones         delivery        benefits              aving                            Mitigation
                                      (deliverables in
                                      each project)
                                      6. Pathway
                                      information
                                      available
                                      electronically
                                      through IT
                                      system (Apr 10)

Provide a safe     Continued          Ongoing but                        1. Improved patient   tbc               Currently:     Joint providers
and efficient      monitoring and     need to decide                     outcome                                 £4.195M pa     with no lead
OOH service.       management of      the PCT future                                                             between both   commissioner.
                   existing WYUC      intention by Sep                   2. Reduction in                         providers
                   Out of Hours       2011.                              unnecessary NEL                                        Risk of ‘double-
                   service outputs                                                                                              counting re
                   (including joint                                      3. Reduction in                                        actual
                   role in contract                                      A&E attendances                                        savings/reducti
                   management of                                                                                                ons in activity.
                   new contract),                                                                                               Mitigation
                   specifically                                                                                                 requires all
                   dealing with:                                                                                                Programme
                   WY lead                                                                                                      Managers to
                   responsible for                                                                                              fully explore the
                   Clinical Quality                                                                                             synergy
                   Review Board,                                                                                                between
                   performance                                                                                                  projects.
                   monitoring,
                   managing/monit
                   oring clinical
                   risk, delegated




                                                                                                                                         72
Goal (high level    Initiative          Project            Timescale for   Measurable            Disinvestment/s     Investment   Risks and
benefit)            (Project)           milestones         delivery        benefits              aving                            Mitigation
                                        (deliverables in
                                        each project)
                    authority for
                    contractual
                    matters
                    (Bradford and
                    Airedale) -
                    ensuring that
                    the OOH
                    service is of
                    high quality, fit
                    for purpose and
                    clinically safe.

                    Consider future
                    PCT
                    requirements
Reduce              Develop a                                              1. Improved patient   Potential saving                 Risk of ‘double-
inappropriate       Community                                              outcome               of £1500 per                     counting re
attendances at      Intravenous                                                                  patient (based                   actual
A&E and             service                                                2. Reduction in       on Warrington                    savings/reducti
contribute to the                                                          unnecessary NEL,      PCT figures) –                   ons in activity.
reduction in NEL.                                                          with financial        Actual                           Mitigation
                                                                           savings               quantification to                requires all
                                                                                                 be determined.                   Programme
                                                                           3. Reduction in                                        Managers to
                                                                           A&E attendances,                                       fully explore the
                                                                           with financial                                         synergy
                                                                           savings                                                between
                                                                                                                                  projects.




                                                                                                                                           73
Long Term Conditions Programme


                                        Project
                                     Milestones
Goal (high level      Initiative   (deliverables in   Timescale for      Measurable                           Disinvestment /   Risks and
    benefit)          (Project)     each project)        delivery         benefits           Investment          Savings        Mitigation
Contribute to
the reduction in
mortality rates                    Stroke working
by 2010 from                       group to review
heart disease,                     stroke services
COPD, stroke                       delivered and
and CVD by at                      undertake gap
least 40% in     Implementation    analysis against
people under     of the Stroke     stroke strategy
75.              Strategy          requirements              Mar-10 TBA                                 £0
                                                                    Patient benefits -
                                                                    patients who are
                                                                    identified at high
                                                                    risk of CVD in the
                                                                    community (within
                                                                    the 3 wards based
                 Increase the                                       on deprevation) will
                 uptake of                                          be encouraged to
                 vascular risk                                      attend their GP.
                 assessments                                        Patients will be
                 undertaken by     Pilot project to                 placed on lipid
                 raising           raise                            lowering
                 awareness in      awareness in                     medication as           Projects funded
                 the community     the community                    appropriate and        by the
                 using 12 pilot    based around                     their risk             Improvement
                 practices         12 practices.             Jun-10 monitored. To          Foundation




                                                                                                                                     74
                                        Project
                                     Milestones
Goal (high level      Initiative   (deliverables in   Timescale for      Measurable                       Disinvestment /   Risks and
   benefit)           (Project)     each project)        delivery          benefits          Investment      Savings        Mitigation
                                                                      undertake 700
                                                                      community risk
                                                                      assessments by
                                                                      June 2010.



                                                                      PCT Performance
                                   Commission a                       Benefits
                                   new practice-
                   Redesign of     based model                      Implementation of
                   whole system    for Level 2                      the new pathway         £
                   diabetes care   service delivery          Mar-10 for diabetes           2,624.00
                                   Commission a                     supports the
                                   Level 3 GP-led                   achievement of the
                                   service across                   following vital sign
                                   a number of                      targets within the
                                   geographical                     2009/10 Operating       £
                                   locations                 Mar-10                        90,000.00




                                                                                                                                 75
                                      Project
                                   Milestones
Goal (high level   Initiative    (deliverables in   Timescale for     Measurable                       Disinvestment /   Risks and
   benefit)        (Project)      each project)        delivery          benefits         Investment      Savings        Mitigation
                                Redesign and                      Framework:
                                recommission                      • Patients with
                                Diabetes Nurse                    Diabetes in whom
                                Support Service                   the last HbA1c is
                                to support Level                  7.5 or less from
                                2 providers,                      QoF (VSC27)
                                deliver X-PERT                    • Self-reported
                                programme and                     experience of
                                support                           patients and users
                                educational                       (VSB15)
                                delivery of Year                  • Proportion of       £
                                of Care                    Mar-10 people with long-    118,930.00
                                Review and                        term conditions
                                redesign                          supported to be
                                Community                         independent and in
                                Development                       control of their
                                Workers with                      condition (VSC11)
                                specific remit                    • Rates of hospital
                                on diabetes,                      admissions for
                                increasing                        ambulatory care
                                diagnosis in                      sensitive conditions
                                hard to reach                     per 100,000           £               £
                                groups                     Mar-10 (VSC26)              -               -
                                Commission                        • Proportion of
                                additional                        people where
                                dietetic service                  health affects the
                                to support Level                  amount/type of        £
                                2 providers                Mar-10 work they can do     160,000.00



                                                                                                                              76
                                     Project
                                  Milestones
Goal (high level   Initiative   (deliverables in   Timescale for       Measurable                      Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery            benefits        Investment      Savings        Mitigation
                                                                   (VSC28)
                                Develop IT                         • Self reported
                                systems that                       measure of
                                facilitate care                    peoples overall
                                planning                           health (VSC31)
                                (SystmOne)                Mar-10
                                                                   World Class
                                                                   Commissioning
                                                                   performance
                                                                   measures for
                                                                   diabetes mortality
                                                                   and blood sugar
                                                                   control are also
                                                                   supported by the
                                                                   implementation of
                                                                   this pathway.

                                                                   Patient benefits

                                Continue Year                    • Empowered
                                of Care                          service users will
                                programme,                       experience an
                                ensuring care                    improved quality of
                                planning is                      life through
                                central to                       education,
                                delivery of all                  involvement and
                                Level 2                          self management         £
                                services                  Oct-10 of their diabetes      5,000.00




                                                                                                                              77
                                     Project
                                  Milestones
Goal (high level   Initiative   (deliverables in   Timescale for        Measurable                      Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery            benefits         Investment      Savings        Mitigation
                                                                   through ongoing
                                                                   support;
                                                                   • Patients will
                                                                   experience
                                                                   improved access to
                                                                   high quality
                                                                   services to enable
                                                                   them to manage
                                                                   their diabetes;
                                                                   • Patients will
                                                                   experience
                                                                   reduced waiting
                                                                   times for services
                                                                   to aid self
                                                                   management of
                                                                   their diabetes;
                                                                   • Patients will be
                                                                   able to choose the
                                                                   professional that
                                                                   they see
                                                                   (according to
                                                                   clinical/social need)
                                                                   at a convenient
                                                                   venue and time for
                                                                   their diabetes care;
                                                                   • The Bradford and
                                                                   Airedale Diabetes
                                                                   Service will provide




                                                                                                                               78
                                     Project
                                  Milestones
Goal (high level   Initiative   (deliverables in   Timescale for        Measurable                      Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery            benefits         Investment      Savings        Mitigation
                                                                   all service users
                                                                   with high quality
                                                                   equitable care,
                                                                   delivered by
                                                                   appropriately
                                                                   trained and
                                                                   competent health
                                                                   and social care
                                                                   staff;
                                                                   • The continued
                                                                   delivery of
                                                                   structured patient
                                                                   education
                                                                   programmes
                                                                   across all localities
                                                                   using a model of
                                                                   patient
                                                                   empowerment will
                                                                   aid service users in
                                                                   self management
                                                                   delivering lifestyle
                                                                   advice and ongoing
                                                                   support.
                                                                   • Patients in the
                                                                   Airedale area of
                                                                   Bradford will
                                                                   receive equitable
                                                                   diabetes dietetic




                                                                                                                               79
                                     Project
                                  Milestones
Goal (high level   Initiative   (deliverables in   Timescale for       Measurable                       Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery           benefits          Investment      Savings        Mitigation
                                                                   services with
                                                                   Bradford

                                                                   Service
                                                                   Improvement
                                                                   Benefits

                                                                   • This service
                                                                   model aims to
                                                                   support the
                                                                   provision of
                                                                   diabetes
                                                                   management to
                                                                   more people in
                                                                   primary
                                                                   care/community
                                                                   settings – to be
                                                                   delivered by
                                                                   appropriately
                                                                   trained and
                                                                   competent staff.
                                                                   This is an essential
                                                                   pre-requisite for the
                                                                   required shift
                                                                   towards
                                                                   primary/community
                                                                   care for people
                                                                   with Long Term




                                                                                                                               80
                                     Project
                                  Milestones
Goal (high level   Initiative   (deliverables in   Timescale for        Measurable                     Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery             benefits       Investment      Savings        Mitigation
                                                                   Conditions;
                                                                   • To enable and
                                                                   empower practices
                                                                   to provide services
                                                                   for service users
                                                                   with diabetes in
                                                                   accordance with
                                                                   DH Long Term
                                                                   Conditions
                                                                   strategic direction;
                                                                   • To professionally
                                                                   develop and re-
                                                                   structure the
                                                                   workforce to
                                                                   facilitate a whole
                                                                   system approach
                                                                   to effectively
                                                                   support patients
                                                                   with diabetes in the
                                                                   community with an
                                                                   emphasis on
                                                                   maintaining health;
                                                                   • To develop more
                                                                   appropriate training
                                                                   places and
                                                                   programmes as
                                                                   accredited work
                                                                   based learning




                                                                                                                              81
                                         Project
                                      Milestones
Goal (high level      Initiative    (deliverables in   Timescale for      Measurable                       Disinvestment /      Risks and
   benefit)           (Project)      each project)        delivery          benefits          Investment      Savings           Mitigation
                                                                     within the health
                                                                     economy in order
                                                                     to provide
                                                                     equitable high
                                                                     standards of care
                                                                     for patients across
                                                                     the health
                                                                     economy;
                                                                     • To reduce length
                                                                     of stay of
                                                                     necessary hospital
                                                                     admissions.
                                                                     Total extra
                                                                     investment =
                                                                     £376,554
                                                                     This is a reduction
                                                                     of £76,451 from
                                                                     Board agreed
                                                                     expenditure
                                                                     1) Reductions in                      Committed to
                                                                     clinical risk due to                  savings of at     1) Delay in
                   Community        Procurement of                   inappropriate                         least £50k.       procurement
                   Oxygen and       Community                        prescribing or over                   Potential for     means tPCT
                   Respiratory      Oxygen and                       prescribing of                        savings of 1/3    missing
                   Support          Respiratory                      oxygen therapy                        to 1/2 of         opportunity for
                   Services (Prev   Support                          and lack of                           oxygen            substantial
                   COPD)            Services                  Jun-10 specialist support     200k           expenditure of    savings




                                                                                                                                      82
                                          Project
                                       Milestones
Goal (high level      Initiative     (deliverables in   Timescale for        Measurable                              Disinvestment /   Risks and
   benefit)           (Project)       each project)        delivery            benefits           Investment            Savings        Mitigation
                                                                        2) Reduction in                             £83 000 per
                                                                        oxygen                                      month
                                                                        expenditure
                                                                        3)Improved quality
                                                                        of care, quality of
                                                                        life and feelings of
                                                                        well being for
                                                                        respiratory COPD
                                                                        patients
                                                                                               No resources to
                                                                                               develop
                                                                                               strategy.
                                                                                               Resources
                                                                                               required for
                                                                      Production of a          implementation
                                                                      multi agency self        - prioritised from
                                                                      care strategy to be      agreed LTC
                   Self Care                                          implemented by all       Programme
                   Strategy         Develop Self                      participating            Investment
                   Development      Care Strategy              Dec-10 groups                   Funding                            0 None identified

                                     Awaiting
                                     publication due
                                     April 2010 -
                   Implementation Development of
                   of the National   a Respiratory
                   Clinical Strategy Working Group
                   for COPD          to undertake a                     TBA




                                                                                                                                             83
                                     Project
                                   Milestones
Goal (high level   Initiative   (deliverables in   Timescale for   Measurable                Disinvestment /   Risks and
   benefit)        (Project)     each project)        delivery      benefits    Investment      Savings        Mitigation
                                baseline review
                                of services




                                                                                                                    84
Primary Care Programme

Goal (high level   Initiative        Project            Timescale for   Measurable             Investment   Disinvestment /   Risks and
benefit)           (project)         milestones         delivery        benefits                            savings           mitigation
                                     (deliverables in
                                     each project )
Improved access a. Development       1. Training of     2009-2011       Increased              £200k        N/a               Difficulties of
to advanced        of DPwSI          providers                          accessibility of                                      making
restorative dental network                                              advanced                                              appropriate
treatment                            2. Development                     restorative                                           governance
leading to better                    of service                         treatment up from 0                                   arrangements
oral health in                       specification                      appointments                                          due to lack of
local population                                                        available in 2009 to                                  capacity of local
as measured by                       3. Development                     at least 12 per                                       restorative
patients’                            of AWP                             week by April 2011                                    consultants.
perceptions in                       contract                                                                                 Mitigated by
dental survey (eg                                                                                                             possibility of
ability to eat,                      4. development                                                                           looking to other
willingness to                       of governance                                                                            providers for
smile etc)                           arrangements                                                                             clinical
                                                                                                                              leadership.
                                     5. Provision
                                     starts
                   b. Expansion of   1. Development     2009-2011       Increased              £100k        N/a               1. Lack of
                   secondary care    of service                         accessibility of                                      capacity in
                   restorative       specification                      advanced                                              commissioning
                   services                                             restorative                                           team delays or
                                     2. Agreement of                    treatment,                                            prevents
                                     tariff                             treatment planning                                    development of
                                                                        and advisory                                          new service.
                                     3. Provision                       service in                                            Mitigation: work
                                                                        secondary care up                                     will be led by



                                                                                                                                       85
Goal (high level    Initiative       Project             Timescale for   Measurable             Investment         Disinvestment /       Risks and
benefit)            (project)        milestones          delivery        benefits                                  savings               mitigation
                                     (deliverables in
                                     each project )
                                     starts                              from 0 clinics per                                              primary care
                                                                         week to at least 1                                              team
                                                                         clinic per week by
                                                                         April 2011                                                      2. Preference in
                                                                                                                                         secondary care
                                                                                                                                         to divert
                                                                                                                                         available
                                                                                                                                         investment into
                                                                                                                                         head and neck
                                                                                                                                         cancer
                                                                                                                                         services.
                                                                                                                                         Mitigated by
                                                                                                                                         clear service
                                                                                                                                         specification
                                                                                                                                         setting out
                                                                                                                                         explicit
                                                                                                                                         expectations
Demonstrable        1.               1. Process          2009-2011       1. At least 12,000     Improvements       There will be no      1. Lack of
high quality care   Implementation   developed                           patients benefit in    will be carried    disinvestments.       capacity of
in primary          of robust                                            2010 from more         out within         While contracts       primary care
medical services    performance      2. Timetable                        effective, better      primary care       may be                team to
leading to          management       agreed                              organised, higher      budget. Cost of    terminated as         undertake
improved health     process                                              quality primary care   visits in region   part of this          reviews,
of population in                     3. Visits carried                   (measured by           of £34000          process, they         oversee
deprived areas                       out and reports                     increase in QOF                           will need to be       improvements
and decrease in                      written                             scores from below                         reprocured and        and where
health                                                                   to above 900                              it is unlikely that   necessary step
inequalities                         4.                                  points)                                   they can be           in to run




                                                                                                                                                 86
Goal (high level   Initiative        Project             Timescale for   Measurable              Investment         Disinvestment /   Risks and
benefit)           (project)         milestones          delivery        benefits                                   savings           mitigation
                                     (deliverables in
                                     each project )
                                     Improvements                                                                   procured more     practices.
                                     demonstrated                                                                   cheaply           Mitigated by
                                     or remedial                                                                                      need to
                                     action taken                                                                                     reprioritise
                                                                                                                                      workload
                   2.                1. Service          2010-2011       1. 14,000 patients      Likely             N/a               1. Additional
                   Procurement/re    specification                       benefit from            investment of c.                     cost of new
                   procurement of    agreed,                             proactive, risk-        £200k in                             premises,
                   primary medical   developing new                      based preventative      premises in                          mitigated by the
                   services in       model of health                     primary medical         Lidget Green.                        improved
                   Buttershaw/Lidg   promoting                           care, tailored to the                                        quality of
                   et Green/Great    practices                           specific needs of       Likely                               primary care
                   Horton                                                their local             investment of c.                     this will enable.
                                     2. Procurement                      communities             £200k in
                                     process                                                     Buttershaw
                                     undertaken                          2. 0.5 WTE freed
                                                                         up capacity in
                                     3. New                              primary care team
                                     providers take                      to focus on other
                                     over services                       projects within
                                                                         primary care
                                                                         programme as
                                                                         PCT-provided
                                                                         practices are
                                                                         returned to
                                                                         independent status
                   3. 20%            1. Identification   2009-2012       Financial saving of     No additional      Saving of £105k   Improvement in
                   Reduction in                                          £105k                   investment         by 2012           quality of




                                                                                                                                               87
Goal (high level   Initiative        Project            Timescale for   Measurable   Investment      Disinvestment /   Risks and
benefit)           (project)         milestones         delivery        benefits                     savings           mitigation
                                     (deliverables in
                                     each project )
                   A&E               of practices                                    required from                     primary care is
                   attendances by                                                    NHSBA                             not met by
                   patients from 5   2. Highlight                                                                      equivalent
                   lowest-           issue and need                                                                    reduction in
                   performing GP     for                                                                               A&E
                   practices         improvement                                                                       attendances
                                                                                                                       Mitigated by
                                     3. Link to need                                                                   other
                                     to improve                                                                        improvement
                                     primary care                                                                      work ongoing in
                                     access and                                                                        other
                                     patient                                                                           programmes.
                                     education

                                     4. Publicity
                                     campaign
                                     highlighting
                                     improvements
                                     in primary care
                                     access

                                     5. Patients
                                     choose to
                                     attend practice
                                     rather than A&E




                                                                                                                               88
End of Life Programme

      Goal               Initiative         Project       Timescale for       Measurable         Investment   Disinvestment/       Risks and
                                         Milestones          delivery          Benefits                          Savings           Mitigation
    (High level          (project)     (deliverables in
     Benefit)                           each project)
Improved             Equity of         Development        Phase One       Improved patient,    COPD Clinic    Unable to be       Compliance
patient, family      Access            of electronic      April 2010      family and carer     (3hours per    specific at this   from GP’s and
and carer                              register -         Phase Two       experience of        week)          time – further     others to
experience of        Improved          pathway and        April 2011      service across all   £35,000.00     work required      populate –
service across all   access and        baseline data                      groups               over a three   regarding data     need to
groups               equity for both   for future                                              year period    collection and     engage with
                     cancer and        commissioning                                                          current costs      Alliances to
                     non cancer        decisions          Phase Two                            Psychologist                      secure
Increased            patients who                         April 2011      Increased numbers    Post 0.5 wte                      commitment to
numbers of           require end of                       Phase Three     of patients on the   £30,000.00                        project
patients on the      life care                            2012            LCP
LCP                                    Primary and
                                       secondary          Phase One
                                       clinically led     2011
                                       groups – case      Phase Two       Reduced non-
Reduced non-                           finding within     2012            elective hospital
elective hospital                      each speciality    Phase Three     admissions - all
admissions - all                                          2013            groups
groups
                                       Provision of
                                       flexible support
                                       services for all
Improved                               patient groups     Phase One
stakeholder                                               2011
perceptions of                                            Phase Two       Improved




                                                                                                                                        89
      Goal              Initiative        Project       Timescale for       Measurable         Investment     Disinvestment/     Risks and
                                       Milestones          delivery          Benefits                            Savings         Mitigation
   (High level          (project)    (deliverables in
    Benefit)                          each project)
end of life care                                        2012            stakeholder
process                                                 Phase Three     perceptions of end
                                                        2013            of life care process
Reduced number
of deaths                                                               Reduced number of
occurring in                                                            deaths occurring in
Acute Trusts of                                                         Acute Trusts of
those who do not                     Transition of                      those who do not
wish to die there                    children to                        wish to die there
                                     adults services
Improvement in                       pathway                            Improvement in
quality of service                                                      quality of service
provision as                                                            provision as
measured                                                                measured through
through end of                                                          end of life care
life care                                                               standards
standards
                                                                        Reduced numbers
Reduced                                                                 of complaints/SUI
numbers of
complaints/SUI                                                          Reduced numbers
                                                                        accessing CHC
Reduced                                                                 Funding
numbers
accessing CHC
Funding
Improved             Last Days of    Primary care       Phase One       Improved patient,      1 wte Band 6   Unable to be
patient, family                      led health and     April 2010      family and carer          Nurse       specific at this




                                                                                                                                      90
      Goal                  Initiative        Project       Timescale for       Measurable          Investment     Disinvestment/   Risks and
                                           Milestones          delivery          Benefits                             Savings       Mitigation
   (High level              (project)    (deliverables in
     Benefit)                             each project)
and carer            Life                social care        Phase Two       experience of          1 wte band 3    time – further
experience of                            redesign group     2011            service across all     Administrator   work required
service across all                                                          groups                                 regarding data
groups               Integrated 24/7                        Phase One                                              collection and
                     Care Pathway                           2011            Increased numbers                      current costs
                     to Care             Review of          Phase Two       of patients on the
Increased            Pathway to          interagency        2012            LCP
numbers of           support             processes –        Phase Three
patients on the      preferred place     decision           2013
LCP                  of care             making/rapid                       Reduced non-
                                         discharge/OO       Phase One       elective hospital
                                         Hrs/Drugs          April 2010      admissions - all
                                                            Phase Two       groups
Reduced non-                                                2011
elective hospital                                                           Improved
admissions - all                                                            stakeholder
                                         Care Co-           Phase One       perceptions of end
groups
                                         ordinater Role –   April 2010      of life care process
                                         specialist/gener   Phase Two
                                         alist              2011            Reduced number of
                                                                            deaths occurring in
Improved                                                                    Acute Trusts of
stakeholder                                                                 those who do not
perceptions of                                                              wish to die there
end of life care                                                            Improvement in
process                                  Review of local                    quality of service
                                         priorities for                     provision as
Reduced number                           end of life care                   measured through




                                                                                                                                         91
      Goal           Initiative        Project       Timescale for       Measurable        Investment   Disinvestment/      Risks and
                                    Milestones          delivery          Benefits                         Savings          Mitigation
    (High level      (project)    (deliverables in
     Benefit)                      each project)
of deaths                                                            end of life care
occurring in                                                         standards
Acute Trusts of
those who do not                                                     Reduced numbers
wish to die there                                                    of complaints/SUI

Improvement in                                                       Reduced numbers
quality of service                                                   accessing CHC
provision as                                                         Funding
measured
through end of
life care
standards                                                                                                                Insufficient
                                                                                         £59,000.00                      capacity in
Reduced                                                                                                                  provider
numbers of                                                                                                               services
complaints/SUI                                                                                          £1,038,960.00

Reduced
numbers
accessing CHC
Funding




                                                                                                                                  92
      Goal               Initiative          Project        Timescale for       Measurable         Investment   Disinvestment/     Risks and
                                          Milestones           delivery          Benefits                          Savings         Mitigation
   (High level           (project)      (deliverables in
    Benefit)                             each project)



                     Last Year of       Integrated care     Phase One       Improved patient,
Improved             Life -Integrated   for the last year   2011            family and carer
patient, family      Care               of life through a   Phase Two       experience of
and carer                               joined up           2012            service across all
experience of        A health and       commissioning       Phase Three     groups                              Unable to be
service across all   social care        strategy            2013                                                specific at this
groups               workforce to                                                                               time – further
                     ensure patients,                       April 2010      Increased numbers                   work required
                                                                            of patients on the                  regarding data
                     carers and their
Increased                                                                   LCP                                 collection and
numbers of           families are       Primary care        Phase One                                           current costs
patients on the      able to access     led redesign        2010
LCP                  care to meet       group               Phase Two       Reduced non-
                     their individual                       2012            elective hospital
                     needs              Review of           Phase Three     admissions - all
                                        Standards in        2013            groups
Reduced non-                            Care Homes –
elective hospital                       performance/im      Phase One
admissions - all                        provement           2011            Improved
                                        measures            Phase Two       stakeholder
groups
                                                            2012            perceptions of end
                                                                            of life care process
                                                            Phase One
                                                            2011            Reduced number of
Improved                                Review service      Phase Two       deaths occurring in




                                                                                                                                        93
      Goal           Initiative        Project        Timescale for       Measurable       Investment   Disinvestment/   Risks and
                                    Milestones           delivery          Benefits                        Savings       Mitigation
    (High level      (project)    (deliverables in
     Benefit)                      each project)
stakeholder                       specifications –    2012            Acute Trusts of
perceptions of                    contract            Phase Three     those who do not
end of life care                  management          2013            wish to die there
process
Reduced number                                                        Improvement in
of deaths                         Joint Review of                     quality of service
occurring in                      local                               provision as
Acute Trusts of                   priorities/plans                    measured through
those who do not                  for end of life                     end of life care
wish to die there                 care -                              standards
                                  Flexibility/Respi
Improvement in                    te Care/                            Reduced numbers
quality of service                Intermediate                        of complaints/SUI
provision as                      care
measured                                                              Reduced numbers
through end of                                                        accessing CHC
life care                                                             Funding
standards

Reduced
numbers of
complaints/SUI

Reduced
numbers
accessing CHC
Funding




                                                                                                                              94
      Goal              Initiative          Project       Timescale for       Measurable         Investment      Disinvestment/     Risks and
                                         Milestones          delivery          Benefits                             Savings         Mitigation
   (High level          (project)      (deliverables in
    Benefit)                            each project)




Improved             Education Of      Education          Phase One       Improved patient,       Education      Unable to be
patient, family      Workforce         Strategy and       2010            family and carer        Facilitators   specific at this
and carer                              Delivery Plan      Phase Two       experience of          3 wte Posts     time – further
experience of        All those who                        2010            service across all      Band 6 x 2     work required
service across all   deliver end of                       Phase Three     groups                  Band 7 x 1     regarding data
groups               life care will                       2012                                                   collection and
                     have the skills                                      Increased numbers      £150,000,00     current costs
                     and knowledge                        Phase One       of patients on the
Increased                                                 2011            LCP
                     to do so
numbers of                             Central co-        Phase Two
patients on the                        ordination -       2012
LCP                                    Care Homes         Phase Three     Reduced non-
                                       and wider          2013            elective hospital
                                       workforce                          admissions - all
Reduced non-                                              One 2010        groups
elective hospital                                         Phase Two
admissions - all                                          2011            Improved
groups                                                    Phase Three     stakeholder
                                                          2012            perceptions of end
Improved                               Establish a                        of life care process
stakeholder                            health and       One 2011
perceptions of                         social education Phase Two         Reduced number of
end of life care                       development      2012              deaths occurring in




                                                                                                                                         95
      Goal               Initiative        Project       Timescale for       Measurable       Investment   Disinvestment/     Risks and
                                         Milestones         delivery          Benefits                        Savings         Mitigation
   (High level           (project)    (deliverables in
    Benefit)                           each project)
process                               group – Needs      Phase Three     Acute Trusts of
                                      analysis &         2013            those who do not
Reduced number                        Monitoring                         wish to die there
of deaths
occurring in                                                             Improvement in
Acute Trusts of                       Preferred                          quality of service
those who do not                      Place of Care                      provision as
wish to die there                     - custom and                       measured through
                                      practice within                    end of life care
Improvement in                        workforce -                        standards
quality of service                    competencies
provision as                                                             Reduced numbers
measured                                                                 of complaints/SUI
through end of
life care                                                                Reduced numbers
standards                                                                accessing CHC
                                                                         Funding
Reduced
numbers of
complaints/SUI

Reduced
numbers
accessing CHC
Funding
Improved             Minority and        Improved        Phase One       Improved patient,                 Unable to be
patient, family      easily ignored    access to end     2011            family and carer                  specific at this




                                                                                                                                   96
      Goal              Initiative           Project       Timescale for       Measurable         Investment   Disinvestment/   Risks and
                                         Milestones           delivery          Benefits                          Savings       Mitigation
   (High level          (project)      (deliverables in
     Benefit)                           each project)
and carer            groups             of life care for   Phase Two       experience of                       time – further
experience of                             BME and          2012            service across all                  work required
service across all   Improved          easy to ignore      Three 2013      groups                              regarding data
groups               access for BME    patient groups                                                          collection and
                     and minority                          Phase One       Increased numbers                   current costs
Increased            and easily                            2010 Phase      of patients on the
numbers of           ignored patient                       Two 2011        LCP
patients on the      groups            Consult with        Phase One       Reduced non-
LCP                                    communities –       2011            elective hospital
Reduced non-                           Pacesetters         Phase Two       admissions - all
elective hospital                      Pilot               2012            groups
admissions - all                                           Phase Three
                                                           2013
groups
                                       Language
                                       support
                                       services –
                                       access to
Improved                               skilled workers
stakeholder                                                                Improved
perceptions of                                                             stakeholder
end of life care                                                           perceptions of end
process                                                                    of life care process

Reduced number                                                             Reduced number of
of deaths                                                                  deaths occurring in
occurring in                                                               Acute Trusts of
Acute Trusts of                                                            those who do not
those who do not                                                           wish to die there




                                                                                                                                     97
      Goal               Initiative          Project       Timescale for       Measurable       Investment   Disinvestment/     Risks and
                                          Milestones          delivery          Benefits                        Savings         Mitigation
   (High level           (project)      (deliverables in
    Benefit)                             each project)
wish to die there
                                                                           Improvement in
Improvement in                                                             quality of service
quality of service                                                         provision as
provision as                                                               measured through
measured                                                                   end of life care
through end of                                                             standards
life care
standards                                                                  Reduced numbers
                                                                           of complaints/SUI
Reduced
numbers of                                                                 Reduced numbers
complaints/SUI                                                             accessing CHC
                                                                           Funding
Reduced
numbers
accessing CHC
Funding
Support to           Carers             Joint              Phase One       Improved patient,                 Unable to be
manage the care                         commissioning      2011            family and carer                  specific at this
                     Will have          group to review    Phase Two       experience of                     time – further
of end of life
                     support to         home based         2012            service across all                work required
patients at home
                     manage the         services           Phase           groups                            regarding data
Improved             care of end of                        Three2013                                         collection and
patient, family      life patients at                                                                        current costs
and carer            home                                                  Increased numbers
experience of                                                              of patients on the




                                                                                                                                     98
      Goal           Initiative        Project       Timescale for       Measurable         Investment   Disinvestment/   Risks and
                                    Milestones          delivery          Benefits                          Savings       Mitigation
   (High level       (project)    (deliverables in
     Benefit)                      each project)
service across all                                   Complete        LCP
groups
                                  Local Carers       Phase One
                                  Strategy           2011
Increased                                            Phase Two       Reduced non-
numbers of                        Engagement         2012            elective hospital
patients on the                   with Carers –      Phase           admissions - all
LCP                               education          Three2013       groups
                                  required
Reduced non-
elective hospital
admissions - all
                                                                     Improved
groups
                                                                     stakeholder
Improved                                                             perceptions of end
stakeholder                                                          of life care process
perceptions of
end of life care                                                     Reduced number of
process                                                              deaths occurring in
                                                                     Acute Trusts of
Reduced number                                                       those who do not
of deaths                                                            wish to die there
occurring in
Acute Trusts of                                                      Improvement in
those who do not                                                     quality of service
wish to die there                                                    provision as
                                                                     measured through
Improvement in                                                       end of life care




                                                                                                                               99
      Goal              Initiative          Project       Timescale for       Measurable       Investment   Disinvestment/       Risks and
                                         Milestones          delivery          Benefits                        Savings           Mitigation
     (High level        (project)      (deliverables in
      Benefit)                          each project)
quality of service                                                        standards
provision as
measured                                                                  Reduced numbers
through end of                                                            of complaints/SUI
life care
standards                                                                 Reduced numbers
                                                                          accessing CHC
Reduced                                                                   Funding
numbers of
complaints/SUI

Reduced
numbers
accessing CHC
Funding


Improved             Bereavement       Bereavement        Phase One       Improved patient,                 Unable to be       Scoring Amber
patient, family      Services          Services will      2010            family and carer                  specific at this   on Y&H
and carer                              meet the           Phase Two       experience of                     time – further     Dashboard –
experience of        Services will     needs of           2011            service across all                work required      need to take
service across all   meet the          families/carers    Phase Three     groups                            regarding data     urgent action to
groups               needs of family   of all ages.       2012                                              collection and     address areas
                     members and       Including                                                            current costs      of inequality
                     carers of all     cultural and                       Increased numbers
Increased            ages and from     religious          Complete        of patients on the
numbers of           all patient       differences                        LCP
patients on the      groups,




                                                                                                                                      100
      Goal              Initiative          Project       Timescale for       Measurable         Investment   Disinvestment/   Risks and
                                         Milestones          delivery          Benefits                          Savings       Mitigation
  (High level           (project)      (deliverables in
    Benefit)                            each project)
LCP                  including those                      Phase One
                     with cultural                        2011
                     and religious     Partnership        Phase Two       Reduced non-
                     differences       working with       2012            elective hospital
                     across BME        BMDC               Phase           admissions - all
                     and socially                         Three2013       groups
Reduced non-         excluded/easily   Accessible
elective hospital    ignored groups    electronic and     Phase One
admissions - all                       written            2010
groups                                 information for    Phase Two
                                       carers and the     2011            Improved
                                       bereaved                           stakeholder
Improved                                                                  perceptions of end
stakeholder                                                               of life care process
perceptions of
end of life care                                                          Reduced number of
process                                Review of                          deaths occurring in
                                       Chaplaincy                         Acute Trusts of
Reduced number                         services                           those who do not
of deaths                                                                 wish to die there
occurring in
Acute Trusts of                                                           Improvement in
those who do not                                                          quality of service
wish to die there                                                         provision as
                                                                          measured through
Improvement in                                                            end of life care
quality of service                                                        standards
provision as
measured



                                                                                                                                   101
      Goal              Initiative           Project       Timescale for       Measurable       Investment   Disinvestment/     Risks and
                                          Milestones          delivery          Benefits                        Savings         Mitigation
     (High level        (project)       (deliverables in
      Benefit)                           each project)
through end of                                                             Reduced numbers
life care                                                                  of complaints/SUI
standards
                                                                           Reduced numbers
Reduced                                                                     accessing CHC
numbers of                                                                     Funding
complaints/SUI
Reduced
numbers
accessing CHC
Funding
Improved             Unscheduled        Review of          Phase One       Improved patient,                 Unable to be
patient, family      End of Life        current            2010            family and carer                  specific at this
and carer            Care               provision –        Phase Two       experience of                     time – further
experience of        Transport          response times     2011            service across all                work required
service across all                      DNACPR -                           groups                            regarding data
groups               Flexible and       Policy                                                               collection and
                     responsive to                                         Increased numbers                 current costs
                     the needs of                                          of patients on the
Increased            those in the end                                      LCP
numbers of           stages of life.
patients on the                                                            Reduced non-
LCP                                                        Phase One       elective hospital
                                                           2011            admissions - all
                                         Care Homes -      Phase Two       groups
                                          reduction in     2012
Reduced non-                             unnecessary       Phase




                                                                                                                                    102
      Goal           Initiative         Project       Timescale for       Measurable         Investment   Disinvestment/   Risks and
                                     Milestones          delivery          Benefits                          Savings       Mitigation
   (High level       (project)     (deliverables in
     Benefit)                       each project)
elective hospital                    A&E visits       Three2013
admissions - all                  Out of Hours
groups                            Services -
                                  response

                                                                      Improved
                                                                      stakeholder
Improved                                                              perceptions of end
stakeholder                                                           of life care process
perceptions of
end of life care                                                      Reduced number of
process                                                               deaths occurring in
                                                                      Acute Trusts of
Reduced number                                                        those who do not
of deaths                                                             wish to die there
occurring in
Acute Trusts of                                                       Improvement in
those who do not                                                      quality of service
wish to die there                                                     provision as
                                                                      measured through
Improvement in                                                        end of life care
quality of service                                                    standards
provision as
measured                                                              Reduced numbers
through end of                                                        of complaints/SUI
life care
standards                                                             Reduced numbers
                                                                      accessing CHC




                                                                                                                               103
     Goal        Initiative        Project       Timescale for      Measurable   Investment   Disinvestment/   Risks and
                                Milestones          delivery         Benefits                    Savings       Mitigation
   (High level   (project)    (deliverables in
    Benefit)                   each project)
Reduced                                                          Funding
numbers of
complaints/SUI

Reduced
numbers
accessing CHC
Funding




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