Healthy Ambitions Bulletin by elemnopey


									Healthy Ambitions Bulletin
July 2009
Welcome to the Healthy Ambitions
bulletin. It provides a regular update on key
pieces of regional work that are being taken
forward to support the implementation of
recommendations made by local clinicians
and others in Healthy Ambitions.
Delivering Healthy Ambitions explains how
the recommendations in Healthy Ambitions are
being taken forward either locally or regionally.
The majority of work is being taken forward
locally, led by Primary Care Trusts. This update
focuses on regional work.
If you have queries or feedback please
use the contact details on the final page.

Healthy Ambitions Bulletin   02
July 2009
Clinical Leadership
NHS Yorkshire and the          Name                                  Employer       Clinical           Pathway
Humber, on behalf of all                                                            Background         Group
14 PCTs, have concluded        David Dawson                          Ex-Mid-Yorks   Gastroenterology   Acute
a competitive process to       Peter Campbell                        York FT        T&O surgeon        Acute
appoint additional members Kevin Reynard                             LTHT           Emergency          Acute
to the team of senior clinical
                               Ian Lewis                             LTHT           Paed oncology      Children’s
figures to help lead and
                               Eric Kelly                            Doncaster      GP                 Children’s
support reform of the NHS      June Toovey                           YH network     Nursing            EoL
in the region.                 David Levy                            Sheff          Oncology           EoL / cancer
Working with the lead PCT Chief Executive on      Fiona Hicks        LTHT           Palliative         EoL
the appropriate Pathway Delivery Board, as                                          consultant
per the governance arrangements described         Eileen Burns       LTHT           Geriatrics         LTC
in Delivering Healthy Ambitions, the senior
clinical leaders will be tasked with leading      Vicky Pleydell     NYY            GP                 LTC
implementation of the clinical changes            Richard Jenkins    Mid-Yorks      Diabetiologist     LTC
described in Healthy Ambitions across entire      Dotty Watkins      Sheffield      Midwifery          Maternity
pathways. They will lead and support clinicians
and others in delivering the pathway              Sean Duffy         LTHT           Obs and Gynae      Maternity
recommendations across the region.                Nick Morris        Bradford       MH nursing         Mental Health
The new senior clinical leaders will be           Wendy Burn         Leeds PFT      Psychiatrist       Mental health
seconded, initially for one year, to NHS          Ian Jackson        York FT        Anaesthesia        Planned
Yorkshire and Humber for one session (4           Mark Baker         LTHT           PH / oncology      Planned
hours) per week. The following 23 clinicians
form the Yorkshire and Humber Clinical            Wendy Quinn        Harrogate FT   Nursing            Planned
Advisory Group (highlighted names are             Karen Dearden      WY network     Critical care      Planned
new secondees).                                                                     nursing
                                                  Georgina Haslam    Bradford       GP                 Primary care
                                                  Eithne Cummins     Sheffield      GP                 Primary care
                                                  Wendy Richardson   Hull PCT       Public Health      Staying healthy
                                                  Greg Reynolds      LTHT           Cardiologist       Staying healthy

Healthy Ambitions Bulletin                        03
July 2009
Stroke Care
The clinicians working        As we described in the last Healthy Ambitions     Each of the three networks is already starting
                              bulletin the SHA is working with the three        to assess local services against the proposed
on the Healthy Ambitions      cardiac and stroke networks in the region to      standards. A gap analysis should be available
acute care pathway board      develop a stroke assurance framework.             by September. This gap analysis will provide
                                                                                local PCTs with information about where
highlighted the need to       This work is building on the work of the Y&H      services should be improved and allow them to
improve stroke care to save   Acute Episode clinical pathway group (set up
                              as part of the Next Stage Review), the national
                                                                                target investment where it will have the most
                                                                                impact from 2010/11.
lives and reduce disability   stroke strategy and the standards already set
from stroke.                  by both the North Trent and West Yorkshire        Networks will continue to monitor
                              networks in their models of stroke care. It is    improvement against the standards –
                              being undertaken by a sub group of the            potentially by means of peer review. The stroke
                              Healthy Ambitions Acute Pathway Delivery          sub group will meet again in September to
                              Board. The sub group is chaired by David          maintain an overview of progress and to
                              Dawson and includes clinicians and managers       consider shared approaches to monitoring
                              from the cardiac and stroke networks.             data.
                              Since the publication of the last Healthy
                              Ambitions bulletin, the assurance framework
                              (with agreed suggested standards, pathway
                              and levels of care) has now been presented by
                              the networks to the sub group. The sub group
                              has agreed that it should now be
                              recommended to the next meeting of the
                              Acute Pathway Delivery Board and to the
                              Strategic Commissioning Board for their
                              approval, along with a suggested approach to
                              implementation of the standards.

Healthy Ambitions Bulletin    04
July 2009
Pathway Delivery Boards      The precise composition and style of these      Strategic                                       The Strategic Commissioning Board
                             delivery boards varies from pathway to                                                          group will oversee:
                             pathway as appropriate. However all have        Commissioning Board
The pathway delivery         strong clinical representation and managerial                                                    • Region-wide enabling work to support the
boards, set up to advise     support. The composition and terms of           Progress on delivery against the entire Healthy
                                                                             Ambitions programme will be assured by a
                                                                                                                                delivery of Healthy Ambitions (examples
                                                                                                                                include workforce development or the social
the PCTs and SHA on the      reference are bespoke for each board, but
                             there are some core responsibilities common     Strategic Commissioning Board made up of           marketing work, agreed with PCTs and
implementation of the        to each of them, viz:                           the SHA and PCT CEs, with senior clinical, local
                                                                             authority and provider input as appropriate.
                                                                                                                                being undertaken on a Y&H basis)
clinical recommendations     • Assuring themselves of delivery               This group will meet on a quarterly basis with   • Delivery of Healthy Ambitions at
made in Healthy Ambitions      on key issues and priority areas              the first meeting on September 25th and will       the local level – by:
                                                                             provide feedback to the full CE Forum. The
and to have oversight of     • Assuring PCT strategic plans                  SCB will be chaired by the new SHA Chief           - Overseeing the assessment
the regional enabling        • Assuring on progress against Healthy
                                                                             Executive Bill McCarthy.                             of PCT strategic plans
                                                                                                                                - Receiving reports on the Healthy
workstreams, are all now       Ambitions metrics and WCC outcomes                                                                 Ambitions metrics and trajectories
fully constituted and have   • Overseeing regional reviews where
                                                                                                                                - Receiving reports on improvement
                                                                                                                                  against WCC outcome measures
held their first meetings.     appropriate – reporting on these at                                                              - Receiving progress reports from
                               key and agreed intervals to the Strategic                                                          Pathway Delivery Boards
                               Commissioning Board. Pathway Delivery
                               Boards will need to establish workstream                                                      • The regional reviews to be undertaken
                               or task groups to undertake these                                                               as part of Healthy Ambitions (or proposed
                               reviews with access to the right level                                                          from other sources such as SCG) including:
                               of clinical expertise.
                                                                                                                               - Prioritisation, establishment
                             • Identifying developments relevant to                                                              and terms of reference
                               the pathway area and any further work                                                           - Recommendations and their
                               required                                                                                          implementation
                                                                                                                               - Assessment of the cumulative
                                                                                                                                 impact of these reviews
                                                                                                                             All of the above will be underpinned
                                                                                                                             by clinical advice as described on the
                                                                                                                             next page.

Healthy Ambitions Bulletin   05
July 2009
   SHA Board/Senior Management Team

   Strategic Commissioning Board (x 4 per annum)                                                                                  CE Forum

   - SHA and PCT CEs with clinical and LA input
   - Reports from Pathway Delivery Boards                                                                                         - Share and spread good
   - Regional reviews-initiate and conduct                                                                                          practice via SHA quality,
   - Cross system impact of key initiatives                                                                                         innovation & improvement
   - Regional enabling work e.g. social marketing                                                                                   mechanisms
                                                                                                                                  - Performance issues
                                                                                                                                    via SHA performance
                                                                                                                                    management regime

                          Cancer Programme Board

  Pathway Delivery        Primary Care             Mental Health            Planned Care             Long Term Conditions     Staying Healthy          Acute                    Children                 Maternity & Newborn      End of Life
  Boards including lead
  CEs and clinicians

  Regional Review                                                           Workstreams                                                                Workstreams              Workstreams
  areas (all – inc SCG
  initiated reviews)                                                        1.                                                                         1.                       1.
                                                                            Vascular                                                                   Stroke                   Paediatric critical
                                                                            2.                                                                         2.
                                                                            Critical care                                                              Major trauma

                                                                            3.                                                                         3.
                                                                            Urology                                                                    Primary angioplasty

                                                                            Int radiology

                                                                            Upper GI

  Regional enabling       Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams     Enabling workstreams
  workstreams             e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,   e.g. Social Marketing,
                          Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality       Workforce, Quality
                          Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical    Observatory, Clinical
                          Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort        Leadership Cohort

Healthy Ambitions Bulletin                                            06
July 2009
Regional Reviews
Delivering Healthy Ambitions:                     The assessments are primarily concerned with        Finance:                                          Developing an approach
                                                  understanding the potential impact on the
Assessing the impact                              viability and sustainability of organisations in    • What is the financial impact for the relevant   The impact assessments will need to be carried
of regional reviews                               the region.                                           PCTs of commissioning services in line with
                                                                                                        the recommendations, both in absolute
                                                                                                                                                        out across all regional reviews, but the scope
                                                                                                                                                        and work requires is likely to vary considerably.
Healthy Ambitions recommended that a              The assessment will consider the viability of         terms and as a percentage of total budget?
                                                  current services as well as the sustainability of                                                     We propose SHA economic and analytical
small number of service areas to be reviewed
                                                  services in the future as a result of the           • What is the financial impact for the relevant   leads will work will the review teams as they
at a regional level.
                                                  recommendations. The assessment will cover            providers of services being commissioned in     develop recommendations over the summer
The recommendations resulting from these          the following domains:                                line with the recommendations, both in
                                                                                                        absolute terms and as a percentage of total     • Establish the data sources and analysis that
regional reviews will have a range of
                                                                                                        income?                                           will be required to model the impact of the
implications for the way services are delivered
                                                                                                                                                          changes across the three domains set out
across the region, and before taking decisions
                                                  Activity:                                                                                               above.
we need to understand their impact in terms
of activity, finance and workforce on existing    • How will the type of activity change across       Workforce:                                        • Carry out the analysis of the impact of
organisations. It has been agreed that each         relevant providers as a result of the                                                                 emerging recommendations. This will be
regional review will include an impact              recommendations (for example                      • How will the recommendations impact on            done in-house where possible or by
assessment as part of the review process and        management in primary care versus                   the skills required of the workforce?             bringing in additional expertise where
before it makes its recommendations.                emergency admission)?                                                                                 required.
                                                                                                  • How will the recommendations impact on
                                                  • How will the levels of activity change across   the workload of different staff groups              • Develop a generic framework for the impact
                                                    relevant providers as a result of the           across different service settings? What will          assessment of the regional reviews.
                                                    recommendations (for example as a result of     be the additional demand for workforce?
                                                    ceasing to provide services in small                                                                The main purpose of the impact assessments is
                                                                                                  • Are there any knock-on consequences for             to provide advice and assurance to the Chief
                                                                                                    workforce groups and for rotas on the               Executive community that the wider impacts of
                                                  • Are there any knock-on impacts on related       ability to provide related services as a result     the recommendations of regional reviews have
                                                    services of providers that cease to provide a   of the changes in activity flows resulting          been considered and understood.
                                                    given service as a result of the                from the recommendations (for example
                                                    recommendations?                                linkages with critical care)?                       We therefore propose that a small group of six
                                                                                                                                                        PCT and Trust Chief Executives should be
                                                                                                                                                        established to act as a reference group for all
                                                                                                                                                        of the reviews. The primary role of the group
                                                                                                                                                        will be to assure the quality and scope of the
                                                                                                                                                        impact assessments.

Healthy Ambitions Bulletin                        07
July 2009
Short Updates
                             Healthy Ambitions Metrics                         Medium Term                                        The summit also saw the announcement of a
                                                                                                                                  new £100,000 to be spent to radically improve
                             We have been working with PCT and provider        Financial Strategy                                 children’s asthma services in Yorkshire and the
                             trust colleagues to establish robust baselines                                                       Humber thanks to a joint initiative between
                                                                               As part of the Annual Planning Process,            NHS Yorkshire & the Humber and Asthma UK.
                             and trajectories against the metrics identified   spreadsheets detailing Financial Investments
                             in Delivering Healthy Ambitions.                  against initiatives were collected by the SHA      The Yorkshire and Humber Asthma Impact
                             A metrics workshop was well attended by           finance team.                                      Project will support the work NHS Yorkshire
                             colleagues from around the region and                                                                and the Humber is already doing to halve
                                                                               These are intended to provide a read across        emergency childhood asthma admissions over
                             provided useful feedback on how we could          from investment to the various strategic goals     the next 10 years. Asthma hotspots such as
                             refine and improve the metrics to ensure          of each organisation including; Healthy            Hull and Doncaster, where admissions are
                             consistency across the region. A group has        Ambitions, Vital Signs and organisations own       high, will be targeted.
                             been established with representation from         overarching strategic objectives. These will be
                             clinicians, Trusts, PCTs and the SHA to develop   used to ensure that PCT financial strategies are   Rosie Newbigging, Executive Director (Nations,
                             the metrics over coming weeks so that we          linked and informed by overall objectives and      Regions and Services) from Asthma UK said:
                             make maximum advantage of the                     strategic goals.
                             development year and have a robust, clearly                                                          “We are delighted with the commitment NHS
                             understood set of clinically sound PCT
                             trajectories before the metrics are formally      Yorks and Humber                                   Yorkshire and the Humber has shown to really
                                                                                                                                  improving quality of life for children with
                             performance managed from 2010/11.                 Asthma Summit                                      asthma. Sadly, children can still die as a result
                             Any changes to the metrics will be highlighted                                                       of asthma attacks and many thousands more
                                                                               The Healthy Ambitions children’s pathway
                             through this bulletin.                                                                               face emergency admissions to hospital.”
                                                                               suggested numerous improvements to the way
                                                                               in which children with asthma are cared for to Professor Ian Lewis, Chair of Children’s Clinical
                                                                               improve management of the condition in the      Pathway Group at NHS Yorkshire and the
                                                                               community and reduce hospital admissions        Humber said:
                                                                               and readmissions.
                                                                                                                               “We need to improve our services to ensure
                                                                               Last month a regional children’s asthma         that children with asthma receive the very best
                                                                               summit brought together asthma clinical         care and enjoy a normal childhood. We are
                                                                               experts, healthcare professionals and directors thrilled that Asthma UK has recognised our
                                                                               of children’s services from across Yorkshire &  ambition and we will work together to achieve
                                                                               the Humber with representatives from Asthma these goals.”
                                                                               UK to discuss how asthma affects children in
                                                                               the region and plan the action needed to
                                                                               address the problem.

Healthy Ambitions Bulletin   08
July 2009
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