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									Delivering Excellence for Ealing


 Organisational Development Plan
           2008 – 2013
PCT name


Ealing Primary Care Trust


Key contact at PCT (name, contact details)


Name          Robert Creighton

Position      Chief Executive

Ealing PCT

Tel:          020 3313 9102

E-mail:       Robert.Creighton@nhs.net


Development Plan date


21 November 2008
                                        EALING PRIMARY CARE TRUST




TABLE OF CONTENTS

1.     INTRODUCTION AND EXECUTIVE SUMMARY                            3
1.1.   Background                                                    3

1.2.   Review of Previous Organisational Development Performance     3

1.3.   Overview of Organisational Development Goals                  5

2.     ORGANISATIONAL STRUCTURE                                      6
2.1.   Our Existing Organisation                                     6

2.2.   Our Future Organisation                                       6

3.     CURRENT POSITION AND PROGRESS                                 9
3.1.   Strategic Leadership                                          9

3.2.   Workforce Development                                        10

3.3.   Our Organisational Fitness                                   12

3.4.   Our Relationships and Collaborations                         12

4.     DEVELOPMENT GOALS/PRIORITIES                                 15
4.1.   Strategic Context for our OD Priorities                      15

5.     IDENTIFYING CAPABILITY AND CAPACITY GAPS                     18
5.1.   Professional Standards Framework                             18

5.2.   Identified capability and capacity gaps                      18

6.     ADDRESSING THE GAPS IDENTIFIED                               20
6.1.   Action Plan                                                  20

6.2.   NHS London Commissioning Development Programme               20

7.     COMMENTARY                                                   22

8.     TIMESCALES                                                   23
8.1.   OD Plan Timeline Goal 1                                      23

8.2.   OD Plan Timeline Goal 2                                      24

8.3.   OD Plan Timeline Goal 3                                      25

8.4.   OD Plan Timeline Goal 4                                      26

8.5.   OD Plan Timeline Goal 5                                      27


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9.      SUMMARY                                                              28

10.     APPENDICES                                                           28
10.1.   Annex 1. Structure                                                   28

10.2.   Annex 2. NHS Ealing Commissioning High Level Structure – Long Term   29

10.3.   Annex 3. NHS Ealing Commissioning High Level Structure – Interim     33

10.4.   Annex 4. LBE and NHS Ealing Consultancy Role                         37

10.5.   Annex 5. Outline Board Improvement Plan 2008                         39

10.6.   Annex 6. Capability and capacity gaps                                41

10.7.   Annex 7. Addressing the capability gaps                              45




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1.     Introduction and Executive Summary
1.1.   Background
       Ealing Primary Care Trust (NHS Ealing) was established in 2002 and serves the
       health and healthcare needs of over 300,000 people living in Ealing, West London. It
       is coterminous with the unitary London Borough of Ealing (LBE). Ealing is generally a
       thriving borough, spanning inner and outer London, but with marked inequalities in
       social conditions and health status. Of its195 Super Output Areas (SOAs), almost a
       quarter fall within the 20% most deprived in the UK, which are clustered in three parts
       of the borough (Southall, Northolt and Acton). These inequalities are associated with
       ethnic diversity, mobility and population density. Ealing has both a high proportion
       and a great range of ethnic minorities, and high numbers of new arrivals or migrants
       from Africa, Asia and Eastern Europe.
       To respond to these challenges local public services need to work with collaboration
       and common focus. This is achieved through an increasingly effective Local
       Strategic Partnership (LSP), led by LBE, which has defined its vision for the Borough
       in the Sustainable Communities Strategy for 2016. The LSP has notably good links
       with local people, thanks to the strength of the community and voluntary sector, which
       represents effectively the many and diverse communities that make up Ealing’s
       population. Through the LSP we both make a valued contribution to local progress,
       and we are well supported by our partners in improving health.
       Given the exceptional diversity of the population we serve, we strive to demonstrate
       flexibility and innovation, while driving for high standards for all. Our vision is for
       services that are genuinely responsive and encourage responsibility, supporting
       people to make their own decisions about how they improve their lives. We want
       communities to be empowered to engage in decisions about the services they
       receive, and we want our partners and stakeholders to be confident that we
       commission high quality services that provide good value for money.
       Our Board drives our vision and values to achieve these aims, and seeks to embed
       them across the organisation and in all our relationship with key stakeholders. We
       place equal emphasis on operational delivery – continuous improvement in the quality
       of services – and strategic change.
1.2.   Review of Previous Organisational Development Performance
       We have a strong track record of organisational development for leadership, clinical
       engagement and partnership. From our formation we have conducted effective
       development of our Board and Professional Executive Committee (PEC), using
       retained OD consultants. Clinical engagement has been consistently strong, through
       an active PEC and more recently a Clinical Advisory Group (CAG), and practice
       based commissioning is well established. At senior and operational levels
       relationships with local statutory partners are close and productive, and engagement
       with voluntary and community groups is strong.
       To build on these foundations, our development plan arising out of our Fitness for
       Purpose review identified the following themes:
       a)     Improving patient experiences and public involvement;
       b)     Commissioning for Quality;
       c)     Improving care pathways;
       d)     Planning, forecasting, modelling and contracting;
       e)     Market development, particularly for care outside hospital; and
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       f)     Monitoring and management of performance.
       There has been progress in all areas, summarised as follows:
1.2.2. Improving patient experiences and public involvement
                    Regular patient satisfaction surveys for community services, monitored
                     through performance review meetings between commissioning and
                     provider arm;
                    Extensive engagement with the public on Healthcare for London;
                     “Have Your Say” strategic consultation 2007/8; and
                    Use of LBE household survey to elicit views of the local population on
                     NHS Ealing services.
1.2.3. Commissioning for Quality
                    Creation of a clinical assessment service used by the majority of local
                     GP practices;
                    Commissioning for Quality group used to introduce quality specification
                     and monitoring into our contracts; and
                    Initiation of a balanced scorecard for quality improvement in general
                     practice.
1.2.4. Improving care pathways
                    Use of programme budgeting to prioritise and guide care pathway
                     development;
                    Several examples of successful redesign, e.g. [use examples being
                     submitted]; and
                    Clinicians from acute and primary care sectors jointly involved with
                     care pathway design, along with patients.
1.2.5. Planning, forecasting, modelling and contracting
                    Financial strategy in place;
                    Contracts signed on time and monitored effectively; and
                    Capacity planning for achievement of 18 week targets.
1.2.6. Market development, particularly for care outside hosp
                    Provider development programme using Partnerships UK as support;
                    Good progress towards APO, in alliance with other PCTs; and
                    Improved contract specifications for community services.
1.2.7. Monitoring and management of performance
                    Implementation of RiO as planned;
                    Board performance committee established to improve performance
                     reporting; and
                    Continued support for creation and improvement of London
                     Commissioning Support Service.




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1.3.   Overview of Organisational Development Goals
       We followed an inclusive process to review our competencies and new organisational
       development needs for our progress towards world class commissioning. This
       involved two seminars for commissioning staff, which informed a workshop for the
       whole top team. These identified priorities for development in the following fields
       (described in more detail in section 4):
       a)     Information and intelligence for decision-making;
       b)     Public engagement;
       c)     Priority setting of investments relative to health needs;
       d)     Managing the market;
       e)     Quality improvement;
       f)     Procurement; and
       g)     System management of services.
       These development requirements were consolidated by the top team into five key
       goals for our Organisational Development (OD) Plan:
                    Goal 1. Leadership: Exercise leadership built on the trust of our local
                     population, clinicians and stakeholders.
                    Goal 2. Organisational Fitness and Governance: Ensure organisational
                     fitness through exceptional knowledge management, rigorous
                     decision-making, and effective implementation.
                    Goal 3. Commercial Acumen: Apply ever improving technical and
                     commercial acumen to achieve increased quality, efficiency and
                     responsiveness in services.
                    Goal 4. Organisational Behaviour: Embed and continuously improve
                     organisational and personal behaviours that promote a culture of
                     continuous improvement of quality in service and patient experience.
                    Goal 5. Relationships and Collaboration: Develop and extend effective
                     collaborative relationships that ensure delivery of broad strategic goals
                     for the wider health and social care communities of which NHS Ealing
                     is part.
       While these goals are not the same as those in our previous development plan, the
       overlaps and continuity are evident. We can therefore build on past experience and
       current performance to implement them, and are confident of making the step
       changes required to meet the aspirations of world class commissioning. In particular,
       we recognise the necessity of collaboration with other PCTs – for instance to
       strengthen commissioning of hospital services – and are enthusiastic supporters of
       sectoral and pan-London initiatives (e.g. the NWL JCPCT, the LCBSA).




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2.     Organisational Structure
2.1.   Our Existing Organisation
       Organograms outlining current structure, key areas of responsibility and present
       senior management team are detailed in Appendix 1.
       Currently we are organised into 7 major departments each headed by an Executive
       Director, and all reporting to the Chief Executive, and ultimately NHS Ealing Board.
       The present directorates are as follows:
       a)     Services, led by Director of Services (current post vacant and overseen by
              Director of Finance);
       b)     Commissioning and Performance, led by Director of Commissioning and
              Performance;
       c)     Public Health, led by (Joint) Directors of Public Health;
       d)     Quality, Clinical Governance and Clinical Practice, led by Director of Quality,
              Clinical Governance and Clinical Practice;
       e)     HR and Skills Development, led by Director of HR and Development;
       f)     Finance and Shared Services, led by Director of Finance and Shared
              Services; and
       g)     Corporate Governance, led by Director of Corporate Governance.
       The Professional Executive Committee (PEC), consisting of five Clinical Directors, is
       led by the PEC Chair and reports into the Board as a committee of the Board.
       Revised governance agreements were agreed to reflect the role of the PEC in 2007,
       supporting the separation of commissioning and providing functions of the PCT. The
       five Clinical Directors, 4 GPs and 1 nurse, have regular involvement in PCT business,
       each committed to 1-2 days a week, and meet informally every week. The PEC
       meets formally once a month, jointly with the Executive Directors, in a joint
       clinical/managerial Management Board.
       We also have a Clinical Advisory Group (CAG), currently composed of primary care
       clinicians and clinicians from the PCT’s provider services, which reports to the PEC.
       It meets quarterly, led by the PEC Chair and the Director of Clinical Governance,
       dovetailing with the commissioning cycle. Its most recent meeting was a half-day
       session to propose the criteria and priorities for our CSP objectives. As the
       separation of commissioning and provision becomes clearer we will revise the
       membership of the CAG and develop it as a key forum for bringing commissioning
       clinicians in NHS Ealing together with clinicians from all our main providers.
       We have long established joint commissioning with Ealing Council of services for key
       client groups. Reporting to the Director of Commissioning and Performance the
       Head of Joint Commissioning leads a team responsible for Older People, Mental
       Health, Learning Disabilities, Children, Drugs and Alcohol Services, Physical
       Disabilities and Sexual Health.
2.2.   Our Future Organisation
       We are planning the evolution of NHS Ealing into a commissioning organisation
       through the following parallel processes:
                    APO status for provider services, leading to full separation over a
                     three-year process;


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                   Development of a new organisational structure for the commissioning
                    PCT;
                   Strengthening collaborative commissioning with local PCTs and
                    building commissioning capacity across London; and
                   Determining future arrangements for support services (HR, etc).
2.2.2. Achieving APO status and eventual autonomy for provider services
      Together with partner NHS organisations, we are planning for our provider services to
      be an Autonomous Provider Organisation (APO) by March 2009. The outer NW
      London (NWL) PCTs (Ealing, Brent, Harrow and Hillingdon) have agreed to
      collaborate to examine the establishment of an APO alliance for their Provider
      Services. The Chief Executives have appointed a Project Manager to oversee this
      work and the establishment of APOs for the four PCTs. Options for a business
      transfer have been explored but the emerging consensus is for a management
      alliance for 2009/10. Further work will then continue through this alliance to
      determine the long-term future of the services.
      We have been working with Partnerships UK since 2007 [check] to understand and
      strengthen its provider services as businesses. Since September this year we have
      conducted an extensive programme of staff consultation to explore five possible
      options for long-term configuration identified by our Provider Services Committee:
      a)     Stand alone provision with shared corporate services
      b)     Horizontal integration with other PCT Providers
      c)     Vertical integration with Ealing Hospital (EHT)
      d)     Managed dispersal to multiple providers/service partners
      e)     Composite Option (combination of alliance, sub-contracting and dispersal
             options above).
The recommendations of the Provider Services Committee, based on the staff consultation
and the collaborative work with neighbouring PCTs, will be presented to the December
Board meeting, for implementation in 2009.
2.2.3. New Structure for the commissioning PCT
      We currently have clear remits and outline role definitions for three major
      directorates:
      a)     Clinical Leadership and Quality;
      b)     Strategy and Performance; and
      c)     Investment and Procurement,
      underpinned by a directorate of Corporate Systems and Governance.
      In addition, we envisage the development of a fourth major directorate growing out of
      the current Public Health Directorate and the exploration of joint working with LBE
      (described in section 3 below), tentatively described as the Directorate of Health and
      Citizen Engagement.
      A description of the four proposed directorates and the roles within them is attached
      at Appendix 2. Board endorsement of the structure will be sought in February 2009 in
      light of the feedback from the WCC assurance process and the outcome of the joint
      review with LBE. We plan for there to be staff consultation on the new structure in
      March, with a view to implementation from April and completion by September 2009.


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       In the meanwhile we are implementing an evolutionary interim structure described in
       Appendix 3.
2.2.4. Strengthening collaborative commissioning
       We strongly endorse the value of collaborative commissioning for strategic objectives
       that extend beyond our boundaries, and for commissioning/contracting with large
       providers. We are actively engaged with four collaborative groups:
       a)     The five outer NWL PCTs (Brent, Ealing, Harrow, Hillingdon, Hounslow) to
              improve the commissioning of the four local hospitals;
       b)     The eight NWL sector PCTs (including Hammersmith & Fulham, Kensington &
              Chelsea, Westminster) to develop and implement a NWL strategy consistent
              with Healthcare for London; the sector has a Joint Committee of PCTs,
              supported by a Collaborative Commissioning Group, Clinical Reference
              Group, and a Provider Reference Group; the sector’s governance and
              programme are described in detail in the NWL Collaborative Commissioning
              Intentions;
       c)     The mental health commissioning group of three PCTs (Ealing, Hammersmith
              & Fulham, Hounslow) that commission hospital services from West London
              Mental Health Trust (WLMHT);
       d)     All 31 London PCTs, to strengthen the commissioning of specialised services
              through the LSCG, and to develop a wide range of commissioning support
              services through the London Commissioning Business Support Agency
              (LCBSA).
2.2.5. Exploring a range of options for support services (e.g. HR) and hosted services (e.g.
       WLHEFM);
       NHS Ealing has hosted services for three PCTs (Ealing, Hammersmith & Fulham,
       Hounslow) since its formation in 2002. These are: estates and facilities
       management, primary care support services (FHS), and transactional finance
       services. The future governance and management of these services needs to be
       determined. Moreover, as a commissioning organisation we will be relatively small,
       and it will not be effective or efficient for it to have its own support services (e.g. HR),
       so the future of these services also needs to be determined.
       Four broad options are at an early stage of consideration:
       a)     Continued hosting of these functions on behalf of several PCTs;
       b)     Transfer to an existing or new provider trust;
       c)     Establishment of a support services agency for several PCTS; and
       d)     Outsourcing.
We plan to resolve the future of these services in parallel with and to the same timescale as
the future of our provider services.




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3.     Current Position and Progress
3.1.   Strategic Leadership
       Since our formation we have carried out a significant amount of organisational
       development work. A continuing priority has been to ensure senior leadership fit for
       evolving purposes, now to take the organisation into a commissioning role. From the
       start we have integrated the three elements of PCT leadership – executive, non-
       executive and clinical. The “three-at-the centre” have consistently worked in equal
       partnership between Chair, Chief Executive and PEC Chair, supported by our
       retained OD consultants (see below).
       We benefit from a stable senior team who have established strong working
       relationships and leadership for the organisation. Our Chief Executive, other
       executive directors and several of the non-executives have led the PCT since its
       inception in 2002. The PEC has been led by two senior and respected GPs, and is
       well connected to the body of local clinicians. Ownership of organisational
       development and this OD plan is held within the “three-at-the-centre”, rather than
       within the HR function, as it is considered integral to the our success.
       In 2002 we established a long-term relationship with the OD consultancy Mitchell
       Damon for the development of the top team, and we continue to draw on this for both
       strategic organisational development and the personal development of our leaders.
       Mitchell Damon have consistently supported and challenged us through the
       application of national and international best practice, for instance with reference to
       the NHS Leadership Qualities Framework1 (LQF), which provides standards for
       outstanding leadership and the qualities expected of board members and senior
       leaders now and in the future. Most recently Mitchell Damon have helped us define
       and test the competencies required of our leaders and decision-makers so as to
       achieve and sustain our performance as World Class Commissioners.
       During this time we have taken various steps, described below, to ensure that our
       leadership remains fit for purpose and evolves to meet new challenges. Our Board
       Self-Certification in the WCC pack describes the effectiveness of our governance
       arrangements. To ensure progress against this OD plan we are extending the remit
       of our Remuneration and Managing People Committee to be responsible for the
       ongoing review and monitoring of the Plan and to provide assurance to the Board
       through highlight reporting.
       Specific initiatives that we have taken with regards to Board development include:
3.1.2. Top team review and development days: 2002-2008
       To keep clarity and focus in our strategic direction we have held regular review and
       development days for the top team, at least annually and in some years biannually.
       This process is being extended to include senior managers and other clinical leaders
       in the commissioning PCT (e.g. PBC Leads). Typical themes include:
                     Articulating, exploring and further developing principles and values;
                     Developing aspirations and visions for our longer term future work and
                      its impact on the local population;
                     Increasing clarity about roles and contributions;



1
 Institute for Innovation and Improvement – NHS Leadership Qualities Framework.
www.nhsleadershipqualities.nhs.uk

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                     Understanding and working with financial realities and scenarios;
                     Identifying local priorities within national standards;
                     Differentiating the contributions of NEDs, Corporate Directors and the
                      PEC;
                     Strategic investment; and
                     Clinical engagement and leadership.
In addition, the Board periodically holds seminars for informal briefing and preparation of key
issues, and these are frequently open to other members of the top team.
3.1.3. Developing the new Clinical Directors during 2008
       This included 1:1 work as well as whole group work. Our Clinical Directors were
       appointed just before the Board development day last autumn, and this work has
       happened subsequently.
3.1.4. Board Evaluations
       The Board has conducted a number of self-evaluations. In 2004 we used the clinical
       Governance Development Framework to review our effectiveness and confirm our
       readiness for the Annual Health Check Declaration. In early 2008 it used an
       evaluation tool provided by NHS London, which yielded generally high scores,
       indicating “more than adequate” performance, and an Improvement Plan, attached at
       Appendix 5.
3.1.5. Look Out Not Up (Strategic Levers for World Class Performance)
       In preparation for WCC the top team took part in this development programme
       created collaboratively with other PCTs. Focussing on a three-day workshop, we
       identified strategic levers for success so that we could determine where investments
       of time, money, energy and other resources can have the greatest impact. Outcomes
       were:
       a)     Better shared understanding of which WCC competencies hold the most
              leverage to support World Class Performance;
       b)     Identification of what will help and hinder accelerated progress moving
              forward; and
       c)     Alignment of focus areas that will have the greatest impact.
3.2.   Workforce Development
3.2.1. NHS Constitution
       We have built a culture at NHS Ealing that reflects the NHS Constitution. From an
       early stage we sought to establish a “compact” with staff, particularly clinical staff,
       and building on national work led by the NHS Confederation. This was based on the
       mutual responsibilities of the organisation and its staff, so that NHS Ealing was “an
       organisation worth working for”. We are therefore in a strong position to implement
       and benefit from the staff clauses in the Constitution.
3.2.2. Workforce Development Initiatives
       To reflect our commitment to develop staff, and particularly clinical staff, to extend
       their skills and responsibilities we are making significant investment in all areas of
       training and development. Two major programmes of particular note are:
       a)     Newchurch Programme: this is a financial and management tool, consisting of
              7 modules all aimed at building the business acumen of individuals. The

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              programme was commissioned 9 months ago, and is joint initiative with 3
              other PCTs (Hammersmith & Fulham, Kensington & Chelsea, and
              Westminster). The programme has been most widely delivered amongst
              Provider Services teams and is critical to the developing autonomy of these
              services.
      b)      Clinical Leadership: this is an initiative for aspiring clinical managers, and is
              aimed at Band 6 employees.
3.2.3. Knowledge and Skills Framework
      Using the Knowledge and Skills Framework (KSF) we are working to assess the
      competencies required in our commissioning function, and build personal
      development to improve them, through the Individual Performance Review (IPR) and
      Personal Development Planning (PDP) processes. We have recently conducted an
      audit across the whole PCT, which demonstrated that we have not achieved universal
      coverage, particularly among commissioning staff. Given the rapid evolution of their
      roles it is important that we address this, which we have already initiated, with further
      action included in the Action Plan at Appendix 6.
3.2.4. Staff Satisfaction: Key Findings from HCC Report 2007-08
      The key results from the 2007-2008 staff survey are summarized below. We scored
      well or made statistically significant improvement in the following areas:
                    Quality of work life balance;
                    Support from immediate managers;
                    Percentage of staff having health and safety training;
                    Percentage of staff experiencing harassment, bullying or abuse from
                     patients or relatives;
                    Availability of hand washing materials; and
                    Work pressure felt by staff.
      However, we scored poorly or showed statistically significant deterioration in:
                    Percentage of staff having well structured appraisal reviews;
                    Percentage of staff receiving job-relevant training, learning or
                     development; and
                    Percentage of staff experiencing physical violence from staff.
       We recognize that 80% of our current workforce is from the Provider Services area of
       the organisation and these results may not necessarily reflect the workplace issues of
       a commissioning organisation. We intend to try to analyse the current survey to
       distinguish the views of staff in the two areas.
3.2.5. Improving Working Lives (IWL)
      We have been strongly committed to IWL from the outset, and are using it as a key
      vehicle for addressing weaknesses revealed in staff surveys and becoming an
      exemplary employer. We have annual IWL action plans that are monitored by the
      Remuneration and Managing People Committee.




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3.3.   Our Organisational Fitness
       In the Healthcare Commission’s annual health checks we have achieved the following
       ratings:
                      Quality of Services                     Use of Resources
       2005/6         Fair                                    Fair
       2006/7         Fair                                    Good
       2007/8         Fair                                    Good.
       Our ambition is to demonstrate continuous improvement in our services to the
       population of Ealing, and we have strengthened our performance management in
       light of our disappointing failure to achieve “good” on quality of services for 2007/8.
       Our CSP is now the principal vehicle for driving forward our service improvement
       ambitions, incorporating the national and regional goals outlined in the Next Stage
       Review and Healthcare for London.
3.3.2. Fitness for Purpose Development Plan
       In light of its Fitness for Purpose assessment we agreed in 2006 with the SHA, a
       development plan with the following themes:
                     Improving patient experiences;
                     Commissioning for Quality;
                     Improving care pathways;
                     Planning, forecasting, modelling and contracting;
                     Market development, particularly for care outside hospital; and
                     Monitoring and management of performance.
       These themes are all picked up in our CSP and OD Plan for WCC.
3.4.   Our Relationships and Collaborations
3.4.1. Local Acute Providers
       We are the dominant commissioner of Ealing Hospital (EHT) (over 90% of its
       business), but it accounts for less than 50% of our commissioned acute/specialist
       provision, which makes for an unbalanced relationship. We are the hospital’s host
       commissioner and have worked closely on strategic issues (its application for
       Foundation Trust status) and performance issues (A&E, 18 weeks, HCAIs). Our
       relationship with EHT needs to recognise both the interest of local people and
       politicians in their local hospital, and the role it has in serving the most deprived parts
       of the borough.
       Our other major acute provider is Imperial HealthCare Trust (IHCT). We lead a
       commissioning/contracting team on behalf of the outer NWL PCTs that is contributing
       to the collective resource led by the inner NWL PCT alliance (Westminster, H&F,
       K&C). The effective commissioning of this large and powerful provider is one of the
       greatest challenges facing NWL PCTs.
       For the commissioning/contracting of our other significant local acute providers we
       both rely on and support the lead commissioners, NHS Brent for the North West
       London Hospitals Trust and NHS Hillingdon for The Hillingdon Hospital Trust. As a
       group of outer northwest London PCTS we are collaborating to drive more value from
       our local hospitals and develop sustainable strategies for their futures.

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3.4.2. Engagement with the London Borough of Ealing (LBE)
      Relationships with LBE are close and productive. The LBE Leader and the portfolio
      holder for Adult Social Care are associate members of our Board. Our Chief
      Executive is an active member of the LSP, and there is a strong Health and
      Wellbeing Board chaired by the portfolio holder. Joint commissioning arrangements
      have been described in section 2.
      NHS Ealing took part in an evaluation of the partnerships between health and social
      care early in 2008, and has identified key areas of improvement to implement over
      the next year. The evaluation of health and social care partnerships was undertaken
      through a model called the maturity matrix which looked at the alignment of vision
      and values, governance structures alignment of workforce and measurement of
      outcomes. There were clear opportunities to improve partnership working by
      strengthening governance and the measurement of outcomes. An evaluation of the
      next steps in improving joint working with community partners at a borough level was
      undertaken as part of the strengthening commissioning work and detailed
      discussions were undertaken with social care partners on the building on existing
      partnership working.
      To build on these long-standing and effective relationships NHS Ealing and LBE have
      jointly commissioned a consultancy to explore the scope for further joint initiatives,
      particularly to address health inequalities and promote more engagement by the
      public in health improvement. The terms of reference for this consultancy are
      attached at Appendix 4.
3.4.3. West London Mental Health Trust
      Our relationship with the West London Mental Health Trust is generally strong, and
      over the past four years we have decommissioned hospital capacity and increased
      services in the community. As a result we have become an expansion site for the
      national initiative to improve access to psychological therapies (IAPT) through the
      provision of community based CBT services.
3.4.4. Strengthening collaborative commissioning
      We strongly endorse the value of collaborative commissioning for strategic objectives
      that extend beyond our boundaries, and for commissioning/contracting with large
      providers. We are actively engaged with four collaborative groups and are committed
      to getting the best value from these to support its own commissioning work:
      a)     The five outer NWL PCTs (Brent, Ealing, Harrow, Hillingdon, Hounslow) to
             improve the commissioning and contracting of the four local hospitals in the
             area;
      b)     The eight NWL sector PCTs (including Hammersmith & Fulham, Kensington &
             Chelsea, Westminster) to develop and implement a NWL strategy consistent
             with Healthcare for London; the sector has a Joint Committee of PCTs,
             supported by a Collaborative Commissioning Group, Clinical Reference
             Group, a Provider Reference Group, and managed clinical networks for
             Cancer, Cardiovascular Disease, Adult Critical Care and Neonatal/Paediatric
             Critical Care; the sector’s governance and programme are described in detail
             in the NWL Collaborative Commissioning Intentions;
      c)     The mental health commissioning group of three PCTs (Ealing, Hammersmith
             & Fulham, Hounslow) that commission hospital services from WLMHT;
      d)     All 31 London PCTs, to strengthen the commissioning of specialised services
             through the LSCG, and to develop a wide range of commissioning support
             services through the London Commissioning Business Support Agency

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             (LCBSA). This is likely to include existing services (the London
             Commissioning Support Service, the Healthcare for London team and the
             London Health Observatory) and progressively add new ones.
3.4.5. Stakeholder Engagement
      We take an active interest in the views of stakeholders. With regard to the public and
      patients, as well as the national Patient Survey, we have collaborated with LBE in
      adding health-specific questions to their regular household survey.
      We have consistently taken steps to understand informally the views of key
      stakeholders, through frequent top-level contacts with the leaders of local bodies.




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4.     Development Goals/Priorities
4.1.   Strategic Context for our OD Priorities
       Our Organisational Development (OD) Plan is drawn from the World Class
       Commissioning (WCC) Competencies, and builds on the range of spontaneous
       organisational development activities described in section 3. Development needs
       have been identified through early diagnostic exercises, our WCC self-assessment
       and the Board self-certification process.
       The OD plan will be iterative and will be further developed in light of the outcomes of
       the WCC assessment and other initiatives already under way (e.g. the separation of
       commissioning and provision, and the exploration of closer joint working with LBE).
       The OD Plan is a living document, which will be reviewed annually to ensure that
       actions are prioritised in support of the development of WCC outcomes, leadership
       competencies and governance arrangements. Our plan incorporates existing areas
       of development and sets out further development, using an assessment of activities
       we need to sustain, those we need to strengthen, and those we need to initiate,
       underpinned by the build/buy/share methodology. The purpose of our OD Plan is to
       support our achievement of our strategic objectives as described in our CSP.
4.1.2. Strategic Objectives
       As identified in our Commissioning Strategic Plan 2008 – 2012 are:
       a)     Priority 1. To improve the health of the population of Ealing:
                     Improve life expectancy
                     Reduce health inequalities
                     Improve the health and well being
       b)     Priority 2. To improve the quality of health care, including the patient
              experience
       c)     Priority 3. Vascular disease, (coronary heart disease, stroke, hypertension)
       d)     Priority 4. Diabetes
       e)     Priority 5. Dementia
       f)     Priority 6. Infant and child health
4.1.3. Self Assessment
       We conducted our WCC Competency Self-Assessment in three stages:
       a)     In separate sessions two groups of staff rated each criterion and generated
              information and evidence to support their ratings;
       b)     The outcomes of these sessions were collated and presented to an away day
              of the PCT’s top leadership team (NEDs, EDs and Clinical directors) for
              review and revision; and
       c)     The final assessment and evidence was reviewed and validated by the Board.
       The main development needs are in those areas on which we scored level 1 in our
       self-assessment, as set out in the table below:




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Priority areas identified                                                   Competency
Information and intelligence for decision making                            Supporting
                                                                            all 1-11
   Knowledge and information management
   Sophisticated and accurate data gathering to improve quality of
    services
   Systematic use of information to underpin intelligent decision
    making
Public engagement                                                           3
   Clarity on our objectives and proactive planning
   Systematic and varied approaches that inform investment
   Active and visible responses to the information we get from PPI
Priority setting of investment relative to health needs                     6
   Criteria and techniques for wise investment in strategic priorities
   Rigorous evaluation of effectiveness to identify appropriate
    disinvestment/reinvestment
Managing the market                                                         7
   Systematic reviews of supplier market and contracts
   More sophisticated methodologies for modelling demand
Quality                                                                     8
   Evidence-based diagnostics of quality and outcomes from
    contracts
   Systematic and regular reviews of service areas to assure quality
    and effectiveness
Procurement                                                                 9
   Further develop our business acumen to achieve a more informed
    process of using procurements to achieve outcomes
   Understanding and strengthening levers and mechanisms that
    lead to improvement
System management of services                                               10
   Clear methodology and processes for rigorous monitoring of
    contract performance
   Firm application of contract compliance mechanisms
   Increased specificity in contract specification and monitoring
Our improvement aims are, for the next assessment, to move all these areas to at
least level 2 and to consolidate all current level 2 areas at level 3, with an exponential
improvement to level 4 well within the five-year time span of the OD plan.




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4.2.   Our Organisational Development Goals
       Our five OD goals identified below respond to the capability and capacity gaps
       identified through the process above.
       These goals are therefore intrinsically linked to both the WCC competencies and to
       ensuring that our strategic objectives are met.
4.2.2. Goal 1. Leadership
       Exercise leadership built on the trust of our local population, clinicians and
       stakeholders.
4.2.3. Goal 2. Organisational Fitness and Governance
       Ensure organisational fitness through exceptional knowledge management, rigorous
       decision-making, and effective implementation.
4.2.4. Goal 3. Commercial Acumen
       Apply ever improving technical and commercial acumen to achieve increased quality,
       efficiency and responsiveness in services.
4.2.5. Goal 4. Organisational Behaviour
       Embed and continuously improve organisational and personal behaviours that
       promote a culture of continuous improvement of quality in service and patient
       experience.
4.2.6. Goal 5. Relationships and Collaboration
       Develop and extend effective collaborative relationships that ensure delivery of broad
       strategic goals for the wider health and social care communities of which NHS Ealing
       is part.




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5.     Identifying Capability and Capacity Gaps
5.1.   Professional Standards Framework
       We are using the London PCTs Professional Standards Framework for Health and
       Health Commissioning to review skills availability at individual levels within the
       organisation. The Framework links WCC competences with National Occupational
       Standards for Commissioning, Procurement and Contracting and competences in
       Public Health. We will support individuals in accessing learning opportunities relevant
       to their needs, using the London database of relevant courses where appropriate.
5.2.   Identified capability and capacity gaps
       The following section and the table at Annex 6, details the objectives we have set in
       order to meet our development goals.
5.2.2. Goal 1. Leadership
       Exercise leadership built on the trust of our local population, clinicians and
       stakeholders.
       Key gaps:
       a)     Enhancement of clinical leadership and talent management;
       b)     Leadership skills of senior managers to deliver performance improvement;
       c)     Skills and resources for reputation management and strengthened local
              accountability; and
       d)     Better reflection of local cultural diversity in leadership roles.
5.2.3. Goal 2: Organisational Fitness and Governance
       Ensure organisational fitness through exceptional knowledge management, rigorous
       decision-making, and effective implementation.
       Key gaps:
       a)     Capacity and capability for systematic and sophisticated knowledge
              management to inform decision-making;
       b)     Comprehensive framework for strategic and business planning;
       c)     Rigorous framework and processes for performance management of all
              providers, including primary care providers; and
       d)     Accessibility of these skills and systems to Practice Based Commissioning.
5.2.4. Goal 3: Commercial Acumen and Market Management
       Apply ever improving technical and commercial acumen to achieve increased quality,
       efficiency and responsiveness in services.
       Key gaps:
       a)     Professional development in key skills and capacity for strategic planning;
       b)     Better analysis of patients’ needs and experiences, leading to market
              segmentation, more choice and social marketing to diverse local communities;
       c)     Explicit strategies to stimulate innovation, improve quality and improve health
              outcomes through stronger and more diverse providers; and
       d)     Commercial strategy for managing providers and stimulating the market.


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5.2.5. Goal 4: Organisational Behaviour
       Embed and continuously improve organisational and personal behaviours that
       promote a culture of continuous improvement of quality in service and patient
       experience.
       Key gaps:
       a)     An organisational culture that celebrates ambition, creativity and
              accountability;
       b)     Powerful communication programmes for engagement and inspiration of staff
              and contractors;
       c)     A culture of listening to patients, population involvement, and genuine
              responsiveness; and
       d)     An organisation that places mutual value on managerial and clinical
              perspectives.
5.2.6. Goal 5: Relationships and Collaboration
       Develop and extend effective collaborative relationships that ensure delivery of broad
       strategic goals for the wider health and social care communities of which NHS Ealing
       is part.
       Key gaps:
       a)     Deep and extensive engagement by clinicians in Practice Based
              Commissioning;
       b)     Better use of community and voluntary organisations for delivery of community
              strategy;
       c)     Common cause with LBE for health improvement; and
       d)     Effective governance mechanisms for all joint commissioning and
              procurement.




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6.     Addressing the gaps identified
6.1.   Action Plan
       The previous section describes our OD capability and capacity gaps. Our Action Plan,
       which is to be found in detail at Appendix 7, focuses on the initiatives we shall take in
       order to fulfil our objectives. It will be updated and further advanced when the
       recommendations come from the assurance process. Consideration is given whether
       a buy, build or share approach will be used, the allocation of an organisational lead
       and timescales for delivery.
6.1.2. Refer to Appendix 7 for Action Plan
6.2.   NHS London Commissioning Development Programme
       We will also take part in the following initiatives, which are part of the London wide
       development work that is being offered to PCTs as part of the Commissioning
       Development Programme, and that focus on four themes that are aligned with WCC
       competencies. These programmes are referenced to specific goals in Appendix 7,
       and are summarised here to demonstrate their consistency with our identified gaps.
6.2.2. Commissioning Professionals Programme (WCC 1-11)
       The focus of the programme will be to ensure that staff and clinicians who are in key
       commissioning roles in London PCTs are provided with the range of commissioning
       skills, expertise and knowledge to be world class commissioners on behalf of their
       populations. The programme will provide a modular approach so that participants
       have access to a range of development opportunities relevant to their commissioning
       roles, experience and development needs. The Commissioning Professionals
       Programme will design and deliver a framework of competences and criteria for levels
       of competence for individuals that draws on World Class Commissioning
       competencies and links in National Occupational Standards in Commissioning,
       Procurement and Contracting and Public Health competences. It will use the three
       domains of roles in health: practitioner, partner and leader and will link to the
       Knowledge and Skills Framework (KSF).
       It is anticipated that staff will access the Commissioning Professionals Programme
       run on behalf of all London PCTs. The programme is available to all staff members of
       London PCTs involved in commissioning. It provides an independent diagnostic of
       achievements and skills against the Framework and proposed development package.
       Those with appropriate mix of potential and existing experience will be eligible to
       apply for the London PCTs commissioned PG Certificate, Diploma and Masters
       Courses in Strategic Commissioning or for individual modules. The models and
       longer courses will come on stream from spring 2009.
6.2.3. Commercial Development Programme (WCC 7, 8, 9)
       Commercial development is an important area in delivering excellence in
       commissioning and a particular focus for development of capacity and capability. This
       work has been continuing through the Commercial Development Board which will be
       redesigned moving into the delivery stage of the Commercial Development
       Programme.
       One of the ways NHS Ealing is addressing this issue is by sending members of staff
       to the commercial skills development programme, starting in October that will run for
       all London PCTs. This will provide an intensive 12 month accelerated development
       programme that will provide 2 NHS Ealing staff with expert level knowledge on legal
       and regulatory requirements and advance skills on stimulating the market, developing
       procurement skills, making sound financial investments and managing the local
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      health system. The delivery of the our commissioning strategy will require broader
      procurement and market management skills and the development of a high level of
      skills in key staff will enable a spread of knowledge over time to the procurement and
      contracting activities across NHS Ealing.
6.2.4. Developing partnerships and alignment with health and social care (WCC 2)
      In addition to local work that has been taken across health and social care NHS
      Ealing will be involved in a London wide work that will deliver accelerated
      development focussed on delivering and exceeding Local Area Agreement targets.
      NHS Ealing will take part in two development groups that will focus on delivering
      greater outcomes in health and wellbeing through a 9 month programme. PCT’s and
      Local Authorities will work collectively to spread innovation across London, pilot
      approaches and measure outcomes. The work will link quarterly with other key
      agencies and partners to evaluate the success of delivering approaches of improving
      health care. This approach offers a delivery vehicle for key aspects of the Joint
      Strategic Needs Assessment and a forum for innovative commissioning across health
      and social care.
6.2.5. Advancing Quality in Commissioning (WCC 5, 8)
      Ensuring that Commissioning is a key lever to improve quality of services and delivery
      of better health outcomes is a significant area of work. The NHS as a whole along
      with the NHS in London is developing a number of quality metrics to develop the
      ability to commission for quality. As we do this it is important to ensure that PCTs
      have the capacity and capability to undertake the measurement of quality.
      Developing the knowledge and expertise in using quality measures and outcomes is
      an important area that NHS Ealing wishes to strengthen and will be taking part in
      regional workshops and seminars to understand how we can best use these
      measures to respond to patients needs and effectively analyse the quality of service
      providers.




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7.   Commentary
     The gaps we have identified, and the organisational development goals to address
     them, are largely generic to PCTs in London. Hence, we strongly support the
     contributions to these goals that will be made by London-wide collaborations, both
     through the commissioning development programme and the creation of capacity and
     capability in the LCBSA. For this reason many of the resources that we need will be
     externally supplied, and their scale and pace are still being defined. We recognise
     that the investment required will be considerable, and will be able to quantify this
     better in the new year.
     There are also goals that require us to build capacity and capability internally. Given
     the anticipated scale of investment in externally supplied capacity and the importance
     of maintaining a management overhead that is as low as reasonable, we aim to meet
     our internal developments through better application of existing resources, and only
     to consider new investment when we are convinced of the necessity.
     In light of the importance of externally supplied skills and capacity through the
     LCBSA, the main risks are associated with its development and our management of
     our relationship with it. We will mitigate these risks by continuing to contribute
     actively to the specification and implementation of its portfolio, by investing our
     agreed share of costs, and by developing internal skills to be an intelligent client.
     There are also general financial risks. With more intense pressure on NHS funding
     we – and many other London PCTs – may find it hard to identify sufficient funding for
     all the improvements identified in this OD plan. We intend to address this as best we
     can by looking for all possible opportunities to strengthen capability through local
     collaborations, but we may face a difficult tension between the scale of our world
     class commissioning ambitions and the resources we can dedicate to our
     development.
     Finally, one of the greatest risks is around human resources. The pool of skilled
     commissioning staff is constrained, and we plan to identify and grow talent as rapidly
     as we can, but the gap between need and supply appears to be great. We can
     expect much competition for key staff, between PCTs in London, potentially between
     PCTs and the growing LCBSA, and between London and the rest of the country. We
     will all benefit from sound and consistent policies for reward and talent management,
     as consistent as possible across London.




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8.          Timescales
8.1.        OD Plan Timeline Goal 1


     Goal                     Action                  Product/milestone       PCT Lead 2008/09      2009/10     2010/11     2011/12
                                                                                              Q3   Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
 Goal 1       Succession planning for clinical        Rev iew CD            PEC Chair
 Leadership   director positions (PEC members)        roles/establish
                                                      talent pipeline
 Goal 1       Dev elopment programme for CDs          Annual audit of       PEC Chair with
                                                      PDPs; regular         OD support
                                                      biannual rev iews
                                                      of PEC
 Goal 1       Strengthen role of Clinical Adv isory   Ongoing               Director of
              Group                                   monitoring of CAG Clinical
                                                      role                  Leadership
                                                                            and Quality
                                                                            (DCLQ)/PEC
                                                                            Chair
 Goal 1       Sponsor participation in RCGP           One clinician per     PEC Chair
              Leadership Programme                    year
 Goal 1       Rev ise organisational structure for    Confirm new           Chief
              clear focus pf senior roles             structure             Executiv e (CE)


 Goal 1       Sponsor participants on the London      Number and            Executiv e
              Commissioning Professionals             timing to be          Directors (Eds)
              programme                               discussed
 Goal 1       Use Indiv idual performance rev iew     Rev iew ED roles in Human
              process, PDPs and KSF to embed          new structure ;       Resources
              commissioning leadership                audit KSF outlines Director (HRD)
                                                      and PDPs
 Goal 1       Initiate bi-annual senior leadership    Spring and            CE/HRD
              seminars                                Autumn in place
                                                      for 2009; extend to
                                                      council members


 Goal 1       Consolidate resources through new       Clarify new           CE
              organisational structure                structure to link
                                                      PPI/Comms and
                                                      partnership
 Goal 1       Rev iew scope for stronger links with   Interim report of     CE
              Ealing Council (LBE)                    joint rev iew
 Goal 1       Maintain strong participation in        Maintain at least     HRD
              national and local Breaking Through 3 partnerships
              leadership programmes                   participants
 Goal 1       Promote access of local BME leaders Establish rolling         HRD
              to PCT through Ealing Stronger          audit of staff
              Communities Board                       ethnicity




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8.2.        OD Plan Timeline Goal 2


Goal            Action                                 Product/milestone PCT Lead                   2008/09   2009/10    2010/11     2011/12
                                                                                                    Q3   Q4   Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Goal 2          Dev elop the role of Head of           Post holder started         Director of
Organisational Information as intelligent client for   24 Nov ember                Strategic
Fitness and    outsourced serv ices                                                Planning (DSP)
Governance
Goal 2          Commission effectiv e information      Rev iew information         DSP
                management from London                 needs and prov ision
                Commissioning Support Serv ice         and clarify roles of
                                                       LCSS and PCT


Goal 2          Support establishment and              Commit to LCBSA             Director of
                dev elopment of London                 and clarify contract Inv estment
                Commissioning Business Support         for 2009/10; dev elop and
                Agency                                 new lev els of              Procurement
                                                       contract annually           (DIP)



Goal 2          Strengthen planning documentation Rev iew system in                DSP
                and processes                          light of CSP and
                                                       Operating plan;
                                                       consult with PBC
                                                       groups; operate
                                                       and consolidate
                                                       system
Goal 2          Strengthen role of AD Performance      Confirm role and            DSP
                Management in new organisational resources in structure
                structure
Goal 2          Further dev elop role of Boards        Rev iew terms of            DSP
                Performance Committee                  reference of Board
                                                       Performance
                                                       Committee


Goal 2          Institute Balanced Scorecard for       Establish balanced          DCLQ
                primary care prov iders                scorecard;
                                                       ev aluation and roll
                                                       out


Goal 2          Consolidate PBC Support Unit in new Rev ise scope, scale DCLQ
                organisational structure               and operation of
                                                       unit; fill all PBC client
                                                       manager posts




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8.3.      OD Plan Timeline Goal 3


              Action                                   Product/milestone PCT Lead             2008/09   2009/10    2010/11     2011/12
 Goal                                                                                         Q3   Q4   Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
 Goal 3       Sponsor participants in London           Number and timing DIP
 Commercial   Commissioning professionals              of participants to be
 Acumen       Programme                                determined


 Goal 3       Sustain Programme Office for NWL         Commitment               DSP
              strategic planning                       confirmed for
                                                       2009/10; agree
                                                       future plans needs
                                                       with other SWL PCTS


 Goal 3       Dev elop as intelligent client for       Commit to LCBSA          DIP
              LCBSA products                           Dec 2008; clarify
                                                       contract for 2009/10;
                                                       dev elop new lev els
                                                       of contract annually



 Goal 3       Establish new Directorate (jointly with Clarify role and          DE/new
              Council) in new structure                structure with           Director of
                                                       council; appoint         Health and
                                                       director; increment      Clinical
                                                       benefits                 Engagement
                                                                                (DHCE)
 Goal 3       Consult patients and public on adult Launch new                   DCLQ
              serv ices strategy/Health and Well       strategies
              Being Strategy v ia project with Links


 Goal 3       Participate in NHS London on             Include PROMS in         DCLQ
              PROMS for LTC                            09/10 acute quality
                                                       spec
 Goal 3       Strengthen remit of Commissioning for Rev iew                     DCLQ
              Quality Group                            commissioning for
                                                       quality group terms
                                                       of ref.
 Goal 3       Strong participation in London           Dev elop standard        DCLQ
              Adv ancing Quality Programme             quality framework
                                                       based on national
                                                       metrics and HfL
                                                       metrics


 Goal 3       Rolling programme of                     Agree programme of DCLQ
              serv ice/pathway rev iews through        serv ice rev iews
              Partnership Boards (inv olv ing
              patients/public)
 Goal 3       Establish local capacity in new          Specify directorate      DIP
              organisational structure                 of inv estment and
                                                       procurement; carry
                                                       out joint rev iew with
                                                       council



 Goal 3       Application of London Commercial         Access Commercial DIP
              Strategy                                 toolkit and skills
                                                       programme




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8.4.         OD Plan Timeline Goal 4

                 Action                                   Product/milestone PCT Lead        2008/09   2009/10    2010/11     2011/12
Goal                                                                                        Q3   Q4   Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Goal 4           Extend top team dev elopment work Establish Spring and CE/HRD
Organisational for rev iew days to all lev els of         autumn cycle and
Behaviour      management                                 include council
                                                          partners


Goal 4           use IPR/PDP/KSF to embed desired         rev iew roles in new   HRD
                 qualities                                structure; audit KSF
                                                          outlines and PDPs


Goal 4           Strengthen and focus current             Extend ev aluation     DCLQ
                 mechanisms: Team talk, Ealing            and improv ement
                 Matters, annual Celebration Day          of communication
                 and Awards through implementation tools; rev iew comms
                 of Communications Strategy               strategy


Goal 4           Establish new Directorate (Citizen       Clarify role and       CE
                 Engagement?) with Council in new         structure with
                 structure                                council; appoint
                                                          director; increment
                                                          benefits


Goal 4           Implement incrementally and realise Rev iew of function         new DHCE
                 benefits during 2009 and beyond          of new DHCE


Goal 4           Rev iew Partnership Boards to            Joint rev iew with     DSP
                 increase their effectiv eness            council completed;
                                                          dev elop proposals
                                                          for implementation



Goal 4           Use staff engagement on NHS              Establish managers     HRD
                 constitution to dev elop "compact"       forums
                 that reflects contribution of all v ia
                 Forums, PBC and CAG
Goal 4           Use management board and PEC             Improv e staff         HRD
                 jointly to driv e dev elopments          attitude surv eys
                                                          and reduction in
                                                          staff turnov er




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8.5.       OD Plan Timeline Goal 5

                Action                                Product/milestone PCT Lead                 2008/09   2009/10    2010/11     2011/12
Goal                                                                                             Q3   Q4   Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Goal 5          Continuously apply top clinical       Wider engagement DCLQ
Relationships   leadership skills                     of health and social
and                                                   care colleagues
collaboration                                         and participation in
                                                      clinical leadership
                                                      programme;
                                                      dev elop earning
                                                      sets for PBC
                                                      clinicians; rev iew
                                                      progress in
                                                      Nov ember 2009



Goal 5          Strengthen capacity in PBC Support Rev ise scope, scale DCLQ
                Unit                                  and operation of
                                                      unit; fill all PBC client
                                                      manager posts


Goal 5          Strengthen compact with local         Rev iew operation of AD for
                v oluntary sector                     Compact with ECVS Partnerships
                                                      and implement
                                                      outcomes



Goal 5          Strengthen LSP engagement             Secure SCB as Lead DHCE
                mechanisms especially Stronger        LSP 2nd tier Board;
                Communities Board                     through SCB build
                                                      community
                                                      capacity to support
                                                      health agenda



Goal 5          Complete joint rev iew with Council   Joint rev iew               AD for
                and agree actions                     commissioned;               Partnerships
                                                      interim report due
                                                      Jan 2009; pace of
                                                      implementation
                                                      dependent on
                                                      proposals
Goal 5          Gov ernance of joint commissioning    Joint rev iew               AD for
                with LBE including Joint Rev iew      commissioned;               Partnerships
                                                      interim report due
                                                      Jan 2009; pace of
                                                      implementation
                                                      dependent on
                                                      proposals
Goal 5          Take lead in commissioning and        Interim                     CE/DSP
                contracting with OCHT on behalf of    arrangements in
                Outer NWL PCTs                        place for 2009/10
                                                      contracting round;
                                                      future arrangements
                                                      agreed and
                                                      resourced with inner
                                                      NWL PCTs from April
                                                      2009


Goal 5          Consolidate NWL sector                Confirm through             CE/PEC Chair
                arrangement, JCPCT, CCG, CRG,         Strengthening
                PRG                                   Commissioning
                                                      programme




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9.   Summary
     Commissioning is a complex activity demanding sophisticated skills. It needs to work
     at many levels, from the individual (e.g. through personalised care plans) to the scale
     of the whole population (e.g. for interventions promoting health). World Class
     Commissioning requires that we understand our roles and contributions at all levels,
     and manage the intricate interactions and tensions between them.
     Our CSP priorities seek to reflect these levels of commissioning activity. At the
     population level we aim to improve health and wellbeing and reduce inequalities
     (priority 1). At the level of the healthcare system we aim to improve quality, in terms
     of safety, effectiveness and patient experience (priority 2). At the individual level we
     aim to aim to improve specific services for the patients with the highest identified
     needs (priorities 3, 4, 5, 6). Success at all these three levels will be mutually
     reinforcing.
     To realise these ambitions we need to be an organisation that engages better with
     our population, responds more innovatively to local needs, drives improvement more
     rigorously and invests its resources more wisely. This organisational development
     plan is designed to enable us to make the step changes required to be such an
     organisation.




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10.   Appendices
10.1. Annex 1. Structure




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10.2. Annex 2. NHS Ealing Commissioning High Level Structure – Long Term

Directorate                                       Key roles
                                                  Org Culture
Chief Executive
                                                  Vision and Direction
                                                  Strategic performance
                                                  Systems and processes for corporate governance and accountability
Directorate of Corporate Systems and Governance
                                                         CAF, risk register,
                                                         Governance between organisations (LBE, PBC groups)
                                                  Organisational business processes – Board and committees
                                                  Company secretary and legal issues, incl FOI, information governance
                                                  Consultation processes
                                                  Briefings (SHA, DH), ministerial/MPs correspondence
                                                  Securing corporate services – HR, OD, IT, accommodation

Directorate of Clinical Leadership and Quality    Development and support of primary care
                                                                                 practice based commissioning
                                                  Patient engagement and feedback, PALS
                                                  GP intelligence
                                                  Clinicians’ performance – “Medical Director” role
                                                                   responsible officers/accreditation of independent contractors
                                                  Support for clinical directors and PEC
                                                  Clinical workforce redesign


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Directorate                                     Key roles
                                                Clinical education and training
                                                Specification of quality performance in contracts
                                                Monitoring quality performance of providers
                                                Quality assurance processes and certification
                                                Patient safety, complaints and SUIs
                                                HCC/CQC/CNST declarations
                                                Service review and redesign (Managing demand)
                                                Pathways review and development
                                                Vulnerability and safeguarding/Child protection
Directorate of Health and Citizen Engagement,   Public health and health protection
including Directorate of Public Health
                                                Health and well being improvement
                                                Needs assessment
                                                Strategic population intelligence
                                                Analysis and support for priority setting
                                                Individual treatments
                                                Public engagement and strategic involvement
                                                Relationships with OSC and LINks
                                                Communications and marketing
                                                Equality and diversity
                                                LSP and partnerships with statutory partners
                                                               community and voluntary sector
Directorate of Strategy and Performance         Strategy setting and priority determination

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Directorate                                      Key roles
                                                 Demand and capacity modelling/forecasting
                                                 Planning – including alignment between NHS Ealing and PBC
                                                                                        NHS Ealing and LBE (joint commissioning)
                                                 NHS Ealing “prospectus” and market stimulation (looking for new providers)
                                                 Provider relationships management
                                                 Strategic change management (strategic commissioning) for:
                                                         Primary care
                                                         Community services
                                                         Acute services
                                                         Mental health services
                                                 Inter-PCT collaboration
                                                 HfL, NW London strategy
                                                 Networks
                                                 Strategic performance management – outcomes and benefits
                                                                                        delivery of change programmes/projects
                                                 Local performance accountability
                                                 Knowledge management – planning and performance (Performance
                                                 Accelerator)
                                                                          strategic awareness and analysis
                                                 Referrals and choice – systems and processes
Directorate of Investment and Procurement (and   Financial management and control – budget, activity management, tariffs, etc
Shared Services)
                                                         Investment planning and oversight


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Directorate   Key roles
                      Premises development, LIFT
                      Option appraisals and business cases
              Contract negotiation, monitoring and management for:
                      Primary care
                      Community services
                      Acute services
                      Mental health services
              Market testing, management and intervention
              Tendering of contracts
              Monitoring and management of provider project implementation
              PBC business planning and accountability
              [Shared services – PCSS, financial transactions, IT (?), estates management if
              not to providers]




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10.3. Annex 3. NHS Ealing Commissioning High Level Structure – Interim

Directorate                                       Key roles
                                                  Org Culture
Chief Executive
                                                  Vision and Direction
                                                  Strategic performance
                                                  Systems and processes for corporate governance and accountability
Directorate of Corporate Systems and Governance
                                                         CAF, risk register, governance between organisations (LBE, PBC groups)
                                                  Organisational business processes – Board and committees
                                                  Company secretary and legal issues, incl FOI, information governance
                                                  Consultation processes
                                                  Briefings (SHA, DH), ministerial/MPs correspondence
                                                  Communications
                                                  Complaints
Directorate of Clinical Leadership and Quality    Development and support of primary care
                                                                                 practice based commissioning
                                                  Patient engagement and feedback, PALS
                                                  GP intelligence
                                                  Clinicians’ performance – “Medical Director” role
                                                                   responsible officers/accreditation of independent contractors
                                                  Support for clinical directors and PEC
                                                  Clinical workforce redesign
                                                  Clinical education and training
                                                  Specification of quality performance in contracts

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Directorate                                           Key roles
                                                      Monitoring quality performance of providers
                                                      Quality assurance processes and certification
                                                      Patient safety, complaints and SUIs
                                                      HCC/CQC/CNST declarations
                                                      Service review and redesign (Managing demand)
                                                      Pathways review and development
                                                      Vulnerability and safeguarding/Child protection
                                                      Public engagement and strategic involvement
Directorate of Public Health                          Needs assessment
                                                      Strategic population intelligence
                                                      Analysis and support for priority setting
                                                      Individual treatments
                                                      Equality and diversity
                                                      Health and wellbeing improvement
                                                      Public health and health protection
                                                      LSP and partnerships
                                                      Relationships with OSC and LINks
Directorate of Strategy (Planning?) and Performance   Strategy setting and priority determination
                                                      Demand and capacity modelling/forecasting
                                                      Planning – including alignment between NHS Ealing and PBC
                                                                                            NHS Ealing and LBE (joint commissioning)
                                                      NHS Ealing “prospectus” and market stimulation (looking for new providers)

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Directorate                                      Key roles
                                                 Provider relationships management
                                                 Strategic change management (strategic commissioning) for:
                                                         Primary care
                                                         Community services
                                                         Acute services
                                                         Mental health services
                                                 Inter-PCT collaboration
                                                 HfL, NW London strategy
                                                 Networks
                                                 Strategic performance management – outcomes and benefits
                                                                                        delivery of change programmes/projects
                                                 Local performance accountability
                                                 Knowledge management – planning and performance (Performance Accelerator)
                                                                          strategic awareness and analysis
                                                 Referrals and choice – systems and processes
Directorate of Investment and Procurement (and   Financial management and control – budget, activity management, tariffs, etc
Shared Services)
                                                 Investment planning and oversight
                                                 Premises development, LIFT
                                                 Option appraisals and business cases
                                                 Contract negotiation, monitoring and management for:
                                                         Primary care
                                                         Community services

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Directorate   Key roles
                      Acute services
                      Mental health services
              Market testing, management and intervention
              Tendering of contracts
              Monitoring and management of provider project implementation
              PBC business planning and accountability
              Shared services – PCSS, financial transactions, IT, estates management until to
              providers




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10.4. Annex 4. LBE and NHS Ealing Consultancy Role
     National policy, as enunciated for instance in the NHS Next Stage Review, strongly encourages close working between local
     government and PCTs to improve both health status and services for patients/clients. The NSR’s Vision for Primary and Community
     Services describes a wide range of aspirations and actions for local exploration. In London, one of the key conclusions of the recent
     Strengthening Commissioning Capacity and Capability review was the importance of strengthening collaborations between coterminous
     PCTs and boroughs.
     London Borough of Ealing (LBE) and Ealing Primary Care Trust (NHS Ealing) have well established, excellent partnerships, including
     integrated commissioning for health and adult social care, joint commissioning for children’s services and joint medium term
     commissioning strategies. In recent discussions, the leadership of both the LBE and NHS Ealing agreed to explore opportunities to
     build on this current platform, in order to significantly further develop partnership arrangements with 3 objectives in mind
     a)     Improving the health of the whole population and reducing inequalities in health status
     b)     Improving outcomes of all those who use services
     c)     Integrating functions and services where this will prove more effective or more efficient.
     LBE and NHS Ealing wish to engage a consultant, ideally with very senior experience of working in both Health and Local Government,
     to assist in the evaluation of options, and the development of a set of detailed proposals to take forward. This will focus initially on
     a)     Commissioning – already extensive – rapid review to identify if further opportunities exist
     b)     Provision – in conjunction with and contributing to the programme of work initiated by NHS Ealing to prepare its provider
            services for operating in a more open market – review of opportunities for further co-location, joint management or integration in
            specific service lines
     c)     Health and Wellbeing – building on current LSP plans and commitments and initial JSNA – opportunities to effect significantly
            greater impact through greater integration of functions and posts
     d)     Patient and Public engagement, including consideration of public involvement and social marketing – with the twin aims of
            generating both greater understanding of and support for health and social care strategies and greater commitment by
            individuals and communities to appropriate responsibility for their own health
     e)     Co-location
                  Of senior management and leadership teams
                  Of front line staff (see above re provision)
     f)     Shared support functions (e.g. procurement, HR, ICT, communications, and other back office functions).

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g)     Governance – building on existing systems to ensure stronger shared ownership of the agreed partnership goals.
The consultant appointed will work to the steering group established to oversee this work:-
Marion Saunders        NHS Ealing Chair
Robert Creighton       NHS Ealing Chief Executive
Jo Murfitt             Director of Commissioning and Performance
Cllr Jason Stacey      Leader of LBE
Cllr Mark Reen         Lead member for Adult Services
Darra Singh            Chief Executive, LBE
David Archibald        Executive Director Children and Adults, LBE
Timescale
NHS Ealing and LBE wish to make rapid progress on this work. It is hoped to appoint a consultant as soon as possible, and certainly
by early September. The work will be flexible, and is likely to take an average of 2-3 days per week over 3-6 months. A detailed plan
will be agreed on appointment of the consultant, including identification of priority issues for early resolution.
Deliverables
              Review and summary of experiences elsewhere and the learning to be derived from them
              Clear descriptions of desired outcomes for further partnership development, consistent with national policy intentions
              Options for further partnership development
              Critical evaluation of options against agreed criteria
              Proposals for implementation of selected options
1 August 2008




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10.5. Annex 5. Outline Board Improvement Plan 2008
     Item                        Action                               Ownership                       Timing
     1. BOARD PROCESS            1.1 Keep the annual cycle of         Chair and Board Secretary       Continuous
                                 meetings under review to ensure
                                 that they are all synchronised
                                 1.2 Ensure that any governance
                                 changes for the
                                 Provider/Commissioning split
                                 feed down the whole
                                 governance framework
                                 1.3 Ensure that the Board has
                                 clarity on its own performance
                                 objectives
                                 1.4 Check flexibility of Board
                                 procedures
     2. STRATEGY                 Check the common basis of            Chair                           Next strategy seminar
                                 understanding across the Board
                                 on the process for setting,
                                 reviewing and monitoring
                                 strategy is clear to the Board.


     3. RISK                     Ensure that reporting on the risk    Chair, Audit Committee Chair    Immediate
                                 management strategy and              and CEO
                                 system to the Board by the Audit
                                 Committee is clear.
     4. PEER REVIEW              The Board should review the          Board Secretary collating       1 October 2008
                                 current peer group (London           information for EDs for Board
                                 and/or National) to ensure that it   review
                                 has the most comparable profile,
                                 and check that it has assessed

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                         all available benchmarking data
                         to select the most appropriate
                         categories to monitor periodically
                         or by exception
5. STAKEHOLDERS          5.1 Ensure that the Board has        Chair         1 October 2008
                         an overall understanding of the
                         Stakeholder Engagement Plan
                         and communication to the
                         Board.
                         5.2 As suggested by one              Board
                         respondent – consider
                         expanding current practice of
                         holding Board meetings at
                         different venues and use as an
                         opportunity for staff
                         engagement.
6. SUCCESSION PLANNING   6.1 Prepare an outline schedule      HR Director   1 October 2008
                         of succession planning and
                         talent management for executive
                         directors and the management
                         level below – aligned to the
                         agreed strategies and any
                         identified HR risks.
                         6.2 Board to review the plan and
                         agree a basis for periodic           Board
                         monitoring




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    10.6. Annex 6. Capability and capacity gaps

 Developmental      Capability and capacity gaps                           Suitability for collaborative working to        Link to WCC subcategory as
 Goals                                                                     address gap                                     described in Section 4 table

                 1. Enhancement of clinical leadership and talent         1. Build                                          Public engagement – clarity on
Goal 1.             management                                                                                               objectives, systematic and varied
                                                                          2. Build and share through London Clinical
                 2. Leadership skills of senior managers to deliver          Professionals Programme (LCPP)                  approaches, active and visible
Leadership          performance improvement                                                                                  responses (3)
                                                                          3. Build and share with LBE
                 3. Skills and resources for reputation management                                                          Leadership of local NHS (1)
                                                                          4. Build
                    and strengthened local accountability
                                                                                                                            Work collaboratively with
                 4. Better reflection of local cultural diversity in                                                         community partners (2)
                    leadership roles
                                                                                                                            Engagement of clinicians (4)

                 1. Capacity and capability for systematic and            1. Build and share through LCBSA                  Information and intelligence for
Goal 2.             sophisticated knowledge management to inform                                                             decision making (1-11)
                                                                          2. Build and buy in expertise if required
                    decision-making
Organisational                                                            3. Build and buy in expertise if required         Priority setting of investment –
                 2. Comprehensive framework for strategic and                                                                criteria and techniques, rigorous
Fitness and         business planning                                     4. Build
Governance                                                                                                                   evaluation to identify investment
                 3. Rigorous framework and processes for                                                                     or disinvestment (6)
                    performance management of all providers,
                                                                                                                            Quality – Evidence based
                    including primary care providers
                                                                                                                             diagnostics, and systematic
                 4. Accessibility of these skills and systems to                                                             reviews of service areas to assure
                    Practice Based Commissioning                                                                             quality and effectiveness (8)
                                                                                                                            System management of services
                                                                                                                             – rigorous monitoring of contact
                                                                                                                             performance, firm application of
                                                                                                                             contract compliance mechanisms,
                                                                                                                             Increased specificity in contract
                                                                                                                             specification and monitoring (10)
                                                                                                                            Knowledge management (5)



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 Developmental      Capability and capacity gaps                       Suitability for collaborative working to       Link to WCC subcategory as
 Goals                                                                 address gap                                    described in Section 4 table

                 1. Professional development in key skills and        1. Build and share through LCPP and              Priority setting of investment –
Goal 3.             capacity for strategic planning                      NWL strategic programme                        criteria and techniques, rigorous
                 2. Better analysis of patients’ needs and            2. Build and share with LBE and through           evaluation to identify investment
Commercial          experiences, leading to market segmentation,         LCBSA                                          or disinvestment (6)
Acumen
                                                                                                         London 
                    more choice and social marketing to diverse                                                         Managing the market – systematic
                                                                      3. Build and share through
                    local communities                                                                                   reviews of supplier market and
                                                                         advancing Quality Programme
                 3. Explicit strategies to stimulate innovation,                                                        contracts, more sophisticated
                                                                      4. Build and share with LBE and through           methodologies for modelling
                    improve quality and improve health outcomes
                                                                         London Commercial Strategy                     demand (7)
                    through stronger and more diverse providers
                 4. Commercial strategy for managing providers and                                                     Quality – Evidence based
                    stimulating the market                                                                              diagnostics, and systematic
                                                                                                                        reviews of service areas to assure
                                                                                                                        quality and effectiveness (8)
                                                                                                                       Procurement – business acumen
                                                                                                                        to achieve more informed process
                                                                                                                        of procurement to achieve
                                                                                                                        outcomes, understanding and
                                                                                                                        strengthening levers and
                                                                                                                        mechanisms that lead to
                                                                                                                        improvement (9)
                                                                                                                       Knowledge management (5)




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 Developmental      Capability and capacity gaps                         Suitability for collaborative working to       Link to WCC subcategory as
 Goals                                                                   address gap                                    described in Section 4 table

                 1. An organisational culture that celebrates           1. Build                                         Public engagement – clarity on
Goal 4.             ambition, creativity and accountability                                                               objectives, systematic and varied
                                                                        2. Build
                 2. Powerful communication programmes for                                                                 approaches, active and visible
Organisational                                                          3. Build and Share with LBE                       responses (3)
                    engagement and inspiration of staff and
Behaviour           contractors                                         4. Build                                         Priority setting of investment –
                 3. A culture of listening to patients, population                                                        criteria and techniques, rigorous
                    involvement, and genuine responsiveness                                                               evaluation to identify investment
                                                                                                                          or disinvestment (6)
                 4. An organisation that places mutual value on
                    managerial and clinical perspectives                                                                 Quality – Evidence based
                                                                                                                          diagnostics, and systematic
                                                                                                                          reviews of service areas to assure
                                                                                                                          quality and effectiveness (8)
                                                                                                                         Leadership of local NHS (1)
                                                                                                                         Work collaboratively with
                                                                                                                          community partners (2)
                                                                                                                         Engagement of clinicians (4)




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 Developmental         Capability and capacity gaps                        Suitability for collaborative working to       Link to WCC subcategory as
 Goals                                                                     address gap                                    described in Section 4 table

                    1. Deep and extensive engagement by clinicians in     1. Build                                         System management of services
Goal 5.                Practice Based Commissioning                                                                         – rigorous monitoring of contact
                                                                          2. Build and share with LBE and
                    2. Better use of community and voluntary                 Community Partners                             performance, firm application of
Relationships and      organisations for delivery of community strategy                                                     contract compliance mechanisms,
Collaboration                                                             3. Share with LBE                                 Increased specificity in contract
                    3. Common cause with LBE for health improvement                                                         specification and monitoring (10)
                                                                          4. Share with LBE and NWL PCTs
                    4. Effective governance mechanisms for all joint                                                       Procurement – business acumen
                       commissioning and procurement                                                                        to achieve more informed process
                                                                                                                            of procurement to achieve
                                                                                                                            outcomes, understanding and
                                                                                                                            strengthening levers and
                                                                                                                            mechanisms that lead to
                                                                                                                            improvement (9)
                                                                                                                           Public engagement – clarity on
                                                                                                                            objectives, systematic and varied
                                                                                                                            approaches, active and visible
                                                                                                                            responses (3)
                                                                                                                           Leadership of local NHS (1)
                                                                                                                           Work collaboratively with
                                                                                                                            community partners (2)
                                                                                                                           Engagement of clinicians (4)




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    10.7. Annex 7. Addressing the capability gaps

 Developmental               Actions (to address specific and        Products/                                  Link to WCC    Link to       Financial
 objective                   systematic gaps)                        Milestones                                 competency     strategic
                                                                                                                               plan goals

GOAL 1. LEADERSHIP


Enhancement of clinical   1. Succession planning for clinical       1. Review of CD roles Sept 2009;        4                 ALL           1. NIL
leadership and talent        director positions (PEC Members)          establish talent pipeline from CAG
                                                                                                                                            2. NIL
management                                                             members Oct-Dec 2009; Lead:
                          2. Development programme for CDs
                                                                       PEC Chair                                                            3. NIL
                          3. Strengthen role of Clinical Advisory
                                                                    2. Annual audit for PDPs in place for                                   4. £5k p/a
                             Group
                                                                       all CDs; Regular biannual review
                          4. Sponsor participation in RCGP             sessions for PEC; Lead: PEC
                             Leadership Programme                      Chair, with OD support
                                                                    3. Cycle of quarterly meetings
                                                                       established; monitor all CAG
                                                                       members active in service
                                                                       redesign/clinical performance
                                                                       monitoring; Leads: DCLQ/PEC
                                                                       Chair
                                                                    4. One primary care clinician
                                                                       participating each year; Lead: PEC
                                                                       Chair

Leadership skills of senior 1. Revise organisational structure for 1. New structure confirmed Feb 2009 1c, 6, 7, 8, 9, ALL                  1. NIL
managers to deliver            clear focus of senior roles            in light of WCC assessment; Lead: 10
                                                                                                                                            2. Investment to be
performance                                                           CE
                            2. Sponsor participants on the London                                                                              determined
improvement
                               Commissioning Professionals         2. Number and timing to be
                                                                                                                                            3. NIL
                               programme                              determined in light of programme
                                                                      detail; Leads: All Executive                                          4. £5k p/a
                            3. Use individual performance review
                                                                      Directors
                               process, PDPs and KSF to embed
                                                                   3. Review roles in new structure

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  Developmental                 Actions (to address specific and          Products/                                 Link to WCC    Link to       Financial
  objective                     systematic gaps)                          Milestones                                competency     strategic
                                                                                                                                   plan goals

                                 commissioning leadership                    March-April 2009; audit KSF
                                                                             outlines and PDPs May-June 2009;
                             4. Initiate bi-annual managerial forums
                                                                             Lead: HRD
                                                                         4. Spring and autumn cycle in place
                                                                            for 2009; extend participation to
                                                                            Council partners in light of joint
                                                                            review; Leads: CE/HRD

Skills and resources for     1. Consolidate resources through new        1. New structure linking PPI, comms       1a, 1b, 3      ALL           1. NIL
reputation management           organisational structure                    and partnership roles clarified Feb
                                                                                                                                                2. Investment to be
and strengthened local                                                      2009; Lead: CE
                             2. Review scope for stronger links with                                                                               determined
accountability
                                LBE                                  2. Interim Report of Joint Review due
                                                                        Jan 2009; pace of implementation
                                                                        dependent on proposals


Better reflection of local   Maintain strong participation in national   Maintain at least 3 participants each     1, 3           ALL           NIL
cultural diversity in        and local Breaking Through leadership       year; Rolling audit of staff ethnicity;
leadership roles             programmes                                  Lead: HRD




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  Developmental              Actions (to address specific and            Products/                                 Link to WCC      Link to       Financial
  objective                  systematic gaps)                            Milestones                                competency       strategic
                                                                                                                                    plan goals

GOAL 2.
ORGANISATIONAL
FITNESS AND
GOVERNANCE

Capacity and capability   1. Develop the role of Head of                1. Post holder started 24 Nov;            5, 6, 7, 8, 11   ALL           1. NIL
for systematic and           Information as intelligent client for      2. Review information needs and                                          2. NIL
sophisticated knowledge      outsourced services                           provision, and clarify/confirm roles
management to inform                                                                                                                             3. Investment to be
                          2. Commission effective information              of LCSS and PCT, Dec 2008;
decision-making                                                                                                                                     determined
                             management from London                        Lead: DSP/HoI
                                                                                                                                                    (?£250k p/a)
                             Commissioning Support Service              3. Commit to LCBSA Dec 2008;
                          3. Support establishment and                     clarify contract for 2009/10 by end
                             development of London                         March 2009; develop new levels of
                             Commissioning Business Support                contract annually; Lead DIP
                             Agency


Comprehensive             Strengthen planning documentation and Review system in light of CSP and       5, 6,8, 11                 ALL           NIL
framework for strategic   processes                             Operating Plan April 2009; consult with
and business planning                                           PBC groups May 2009; operate
                                                                consolidated system from June 2009;
                                                                Lead: DSP

Rigorous framework and    1. Strengthen role of AD Performance          1. Role and resources confirmed with 10, 11                ALL           1. NIL
processes for                Management in new organisational              new structure Jan 2009; Lead DSP
                                                                                                                                                 2. NIL
performance                  structure
                                                                        2. Review terms of reference of
management of all                                                                                                                                3. NIL
                          2. Further develop role of Board’s               Board Performance Committee by
providers, including
                             Performance Committee                         March 2009; lead DSP
primary care providers
                          3. Institute Balanced Scorecard for           3. Establish balance scorecard for
                             primary care providers                        Primary Care Providers by March
                                                                           09; Phase 1 completed; Phase 2

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 Developmental               Actions (to address specific and       Products/                                  Link to WCC    Link to       Financial
 objective                   systematic gaps)                       Milestones                                 competency     strategic
                                                                                                                              plan goals

                                                                      15 practices recruited November
                                                                      2008; Phase 3 evaluation and roll
                                                                      out if agreed March 2009, ongoing
                                                                      2009; Lead DCLQ




Improve access to these   Consolidate PBC Support Unit in new      Revised scope, scale and operation of   4                 ALL           Investment to be
skills and systems by     organisational structure                 Unit defined Jan 2009; all PBC client                                   determined
Practice Based                                                     manager posts filled Dec 2008; Lead
Commissioners                                                      DCLQ




GOAL 3. COMMERCIAL
ACUMEN

Professional development 1. Sponsor participants in London         1. Number and timing to be              6, 7, 11          ALL           1. Investment to be
in key skills and capacity  Commissioning Professionals               determined in light of programme                                        determined
for strategic planning      Programme                                 detail; Lead: DIP
                                                                                                                                           2. Current budget to
                          2. Sustain Programme Office for NWL 2. Commitment confirmed for                                                     be reviewed
                             strategic planning                   2009/10; agree future sector
                                                                                                                                           3. Investment to be
                                                                  planning needs with other NWL
                          3. Develop as intelligent client for                                                                                determined
                                                                  PCTs during 2009/10; Lead DSP
                             LCBSA products                                                                                                   (?£250k p/a)
                                                               3. Commit to LCBSA Dec 2008;
                                                                  clarify contract for 2009/10 by end
                                                                  March 2009; develop new levels of
                                                                  contract annually; Lead DIP

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  Developmental               Actions (to address specific and       Products/                               Link to WCC    Link to       Financial
  objective                   systematic gaps)                       Milestones                              competency     strategic
                                                                                                                            plan goals

Better analysis of patients’ 1. Establish new Directorate (jointly   1. Clarify roles and resources of new 2, 3, 5, 6      ALL           1. Investment to be
needs and experiences,          with LBE?) in new structure             “Directorate of Health and Citizen                                  determined
leading to market                                                       Engagement” and scope for joint
                             2. Consult patients and public on adult                                                                     2. NIL
segmentation, more                                                      posts with Ealing Council Jan
                                services strategy/Health and Well
choice and social                                                       2009; appoint Director April 2009;                               3. NIL
                                Being Strategy via project with
marketing to diverse local                                              Lead: CE; Implement incrementally
                                LINks
communities                                                             and realise benefits during 2009
                             3. Participate in NHS London on            and beyond; Lead: new “DHCE”
                                PROMS for LTC
                                                                     2. Launch new strategies summer 09
                                                                    3. Include nationally set PROMS (4)
                                                                       in 09/10 Acute Quality Spec;
                                                                       Develop specific PROM integrated
                                                                       into redesigned pathway or service

Strategies to stimulate    1. Strengthen remit of Commissioning     1. Review Commissioning for Quality     7, 8, 9        ALL           1. NIL
innovation, improve           for Quality Group                        Group terms of reference Feb 09;
                                                                                                                                         2. NIL
quality and improve health                                             Lead DCLQ
                           2. Strong participation in London
outcomes through                                                                                                                         3. NIL
                              Advancing Quality Programme           2. Develop Standard Quality
stronger and more
                                                                       Framework based on Safety,
diverse providers          3. Rolling programme of
                                                                       Clinical Engagement, Patient
                              service/pathway reviews through
                                                                       Experience using national
                              Partnership Boards (involving
                                                                       indicators and HfL metrics; Lead
                              patients/public)
                                                                       DCLQ
                                                                    3. Agree programme of service
                                                                       review April 09-March 11; Lead
                                                                       DCLQ

Commercial strategy for    1. Establish local capacity in new       1. Specify Directorate of Investment 7, 9, 11          ALL           1. NIL
managing providers and        organisational structure                 and Procurement Jan 2009; Leads:
                                                                                                                                         2. Investment to be
stimulating the market                                                 CE/DIP; Establish scope for
                           2. Application of London Commercial                                                                              determined
                                                                       outsourcing (some) procurement to

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  Developmental                Actions (to address specific and    Products/                               Link to WCC    Link to       Financial
  objective                    systematic gaps)                    Milestones                              competency     strategic
                                                                                                                          plan goals

                               Strategy                               Council through joint review Jan
                                                                      2009; Lead: DIP
                                                                  2. Access and apply Commercial
                                                                     Toolkit from early 2009; Access
                                                                     Commercial Skills Development
                                                                     Programme during 2009 Lead DIP.

GOAL 4.
ORGANISATIONAL
BEHAVIOUR

An organisational culture   1. Extend top team development work   1. Spring and autumn cycle in place     1, 6, 8, 10    ALL           1. £5k p/a
that celebrates ambition,      for review days to all levels of      for 2009; extend participation to
                                                                                                                                       2. NIL
creativity and                 management                            Council partners in light of joint
accountability                                                       review; Leads: CE/HRD
                            2. Use IPR/PDP/KSF to embed
                               desired qualities                  2. Review roles in new structure
                                                                     March-April 2009; audit KSF
                                                                     outlines and PDPs May-June 2009;
                                                                     Lead: HRD

Powerful communication      1. Strengthen and focus current      1. Extend evaluation of and              1c, 3, 4       ALL           NIL
programmes for                 mechanisms: Teamtalk, Ealing         continuously improve these
engagement and                 Matters, annual Celebration Day      communications tools; Board to
inspiration of staff and       and Awards through implementation    review Comms Strategy in March
contractors                    of Communications Strategy           09




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  Developmental              Actions (to address specific and            Products/                               Link to WCC    Link to       Financial
  objective                  systematic gaps)                            Milestones                              competency     strategic
                                                                                                                                plan goals

A culture of listening to 1. Establish new Directorate Health    1. Clarify roles and resources of new          2,3, 6         ALL           1. Investment to be
patients, population         and Citizen Engagement, with           “Directorate of Health and Citizen                                          determined
involvement, and genuine     LBE(?) in new structure                Engagement” and scope for joint
                                                                                                                                             2. NIL
responsiveness                                                      posts with LBE Jan 2009; appoint
                          2. Implement incrementally and realise
                                                                    Director April 2009; Lead: CE                                            3. NIL
                             benefits during 2009 and beyond
                                                                 2. Review of function of new DHCE
                          3. Review Partnership Boards to
                                                                    Oct 09; Lead; new DHCE
                             increase their effectiveness
                                                                 3. Joint review with LBE completed
                                                                    Dec 2008; proposals implemented
                                                                    Jan-March 2009; Lead DSP




An organisation that      1. Use staff engagement on NHS                1. Establish Managers forums April      1c, 4, 8       ALL           1. £5k p/a
places mutual value on       constitution to develop “compact”             2009
                                                                                                                                             2. NIL
managerial and clinical      that reflects contribution of all via
                                                                        2. Improvement in staff attitude
perspectives                 Forums, PBC and CAG.
                                                                           survey 2009/10, future stakeholder
                          2. Use management board and PEC                  surveys and reduction in staff
                             jointly to drive developments                 turnover.




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  Developmental                 Actions (to address specific and      Products/                                Link to WCC   Link to       Financial
  objective                     systematic gaps)                      Milestones                               competency    strategic
                                                                                                                             plan goals

GOAL 5.
RELATIONSHIPS AND
COLLABORATION

Deep and extensive           1. Continuously apply top clinical    1. Wider engagement of health and   4, 10                              1. £20K p/a
engagement by clinicians        leadership skills                     social care colleagues in PBC
                                                                                                                                          2. Investment to be
in Practice Based                                                     strategic work and specific
                             2. Strengthen capacity in PBC Support                                                                           determined
Commissioning                                                         projects. Ensure “graduates” of
                                Unit
                                                                      PCT provider clinical leadership
                                                                      programme are fully engaged in
                                                                      PBC and CAG. Develop learning
                                                                      sets for PBC clinicians using
                                                                      LNNM Toolkit Nov 09; Lead DCLQ
                                                                     2. Revised scope, scale and
                                                                        operation of Unit defined Jan 2009;
                                                                        all PBC client manager posts filled
                                                                        Dec 2008; Lead DCLQ

Better engagement with       1. Strengthen compact with local        1. Review operation of Compact with      1, 2, 3                     1. NIL
community and voluntary         voluntary sector                        ECVS and implement outcomes
                                                                                                                                          2. NIL
organisations for delivery                                              May-July 2009; Lead: AD for
                             2. Strengthen LSP engagement
of community strategy                                                   Partnerships
                                mechanisms especially Stronger
                                                                                              nd
                                Communities Board                    2. Secure SCB as LSP 2 tier Board
                                                                        Dec 2008; through SCB build
                                                                        community capacity support health
                                                                        agenda - continuous; Lead: DHCE

Common cause with LBE 1. Complete joint review with LBE and          1. Joint review commissioned Nov         1,2, 3                      £20k (one-off)
for health improvement   agree actions                                  2008, Interim Report due Jan
                                                                        2009; pace of implementation
                                                                        dependent on proposals


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  Developmental               Actions (to address specific and         Products/                              Link to WCC   Link to       Financial
  objective                   systematic gaps)                         Milestones                             competency    strategic
                                                                                                                            plan goals

Effective governance       1. Governance of joint commissioning       1. Joint review commissioned Nov       9, 10                       1. £20k (one-off)
mechanisms for all joint      with LBE included in Joint Review          2008, Interim Report due Jan
                                                                                                                                         2. Investment to be
commissioning and                                                        2009; pace of implementation
                           2. Take lead in commissioning and                                                                                determined
procurement                                                              dependent on proposals
                              contracting with ICHT on behalf of
                                                                                                                                         3. Current budget to
                              Outer NWL PCTs                          2. Interim arrangements in place for
                                                                                                                                            be reviewed
                                                                         2009/10 contracting round Nov
                           3. Consolidate NWL sector
                                                                         2008 to March 2009; future
                              arrangement; JCPCT, CCG, CRG,
                                                                         arrangements agreed and
                              PRG
                                                                         resourced (with Inner NWL PCTs)
                                                                         from April 2009; Leads: CE/DSP
                                                                      3. Confirm through Strengthening
                                                                         Commissioning programme Dec
                                                                         2008 onwards; Leads: Chair, CE,
                                                                         PEC Chair




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