Business Plan for 2013/14

NHS Lambeth CCG

Business plan for 2013/14

Contents

1. / INTRODUCTION / 4
2. / Our Mission, Vision, Values and Objectives / 5
2.1 / Mission / 5
2.2 / Vision / 5
2.3 / Values / 5
2.4 / Strategic Objectives / 6
2.5 / Strategic Health Priorities / 7
2.6 / Mapping our objectives and priorities / 8
2.7 / Working in partnership with others / 10
2.8 / 2013/14 – ‘Plan on a Page’ / 11
3. / GOVERNANCE & PERFORMANCE / 12
3.1 / Committee Structure / 13
3.2 / Oversight of delivery / 15
3.2.1 / Operations Group / 15
3.2.2 / Management Team / 15
3.2.3 / Finance & QIPP Group / 15
3.2.4 / The PMO / 16
3.3 / Equalities / 17
4. / OPERATIONAL DELIVERY / 20
4.1 / Planned care programme / 21
4.1.1 / Long term conditions / 21
4.1.2 / Elective / 22
4.1.3 / Sexual Health / 23
4.1.4 / Contract management & monitoring of acute services / 25
4.1.5 / Contract Management GST / 26
4.1.6 / South East London Community Based Care / 27
4.1.7 / Lambeth & Southwark Integrated Care Programme / 27
4.2 / Unplanned Care Programme / 29
4.2.1 / Frail Elderly (admissions avoidance) / 30
4.2.2 / Urgent Care / 30
4.3 / Mental health improvement programme / 31
4.3.1 / Continuing Care / 34
4.4 / Children & maternity improvement programme / 34
4.5 / Medicines optimisation / 36
4.6 / Staying Healthy / 37
4.7 / Cardiac & Stroke / 38
4.8 / Cancer services / 38
4.9 / Specialised Commissioning / 39
4.10 / Estates / 40
5. / ORGANISATIONAL DEVELOPMENT / 41
5.1 / Organisational development / 41
5.2 / Engagement and Communications / 42
5.3 / Human Resources / 43
6. / GOVERNANCE AND ASSURANCE / 43
6.1 / Quality and safety / 43
6.2 / Finance / 45
6.3 / Information governance / 46
7. / ENABLERS / 46
7.1 / Primary Care development / 46
7.2 / Business Intelligence ICT / 48

1. Introduction

This Business Plan sets out how the key objectives for 2013/14 will be delivered under the leadership of the Governing Body. These key objectives are described in the Clinical Commissioning Group’s Prospectus; and, based on both the local NHS Lambeth Commissioning Strategy for 2012-15; and, national mandatory requirements described in ‘Every patient counts: planning for patients 2013/14’.

The business plan is divided into threekey areas:

Operational Delivery
Organisational Development
Governance and Assurance

This plan is written for the CCG to provide clarity on the work of NHS Lambeth Clinical Commissioning Group for the year 2013/14. Lambeth CCG will refresh and update this plan for 2014/125. The Business Plan forms the basis for individual objective setting for every member of staff and performance review. Each programme within the Business Plan has designated Clinical and Director / Executive leadsand sets out the key areas of business for 2013/14. Within each programme key objectives areassigned to Assistant Directors through the individual objective setting as part of establishing work plans, and personal developments plans.

2. Our mission, vision, values and objectives

2.1 Our Mission

To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

2.2 Our Vision

/ Health improvement is at the heart of all we do. We will increase life expectancy for all and reduce the difference in life expectancy between the most and least deprived in our diverse communities.
/ We will maintain a thriving, financially viable, health economy delivering safe and effective
high quality care.
/ We will commission comprehensive integrated care that meets the needs of local people. We will value diversity amongst providers, but will expect excellent outcomes.

2.3 Our values

We will always tell the truth
We are fair
We are open
We recognise our responsibilities to service users and the wider public
We act responsibly as a public sector organisation

2.4 Our Strategic Objectives

/ Develop and deliver planned care which reduces premature mortality and improves quality of life, reducing reliance on hospital services and improving the quality of primary care.
/ Improve the integration and quality of care for older people and reduce the number of avoidable hospital admissions and readmissions.
/ Deliver good quality mental health services and improve patient outcomes.
/ Implement the Secretary of State Trust Special Administrator (TSA) recommendations.
/ To support the new Health and Wellbeing arrangements and commission Health and Wellbeing services on behalf of London Borough Lambeth
/ To deliver our annual operating and medium term financial plans to ensure an ongoing sustainable financial position that delivers our strategic health goals for the Lambeth population.
/ To ensure systems and processes are in place to support individual, team and corporate accountability for delivering patient centred, safe and high quality care.

2.5 Strategic Health Priorities

2.6 Mapping our objectives and priorities

2.7 Working in partnership with others

NHS Lambeth CCG is the new clinical commissioning organisation made up of the 49 general practices that deliver primary health care services to the population of Lambeth. As a new CCG commissioning health services for Lambeth we build on a long history of partnership and multi agency working. This includes a working with local clinician teams and patients to develop innovative approaches to service redesign seeking to promote excellence in service quality, patient access and productivity through more integrated services operating at scale. The way of working for the CCG strengthens this partnership approach, and the establishment of the Clinical Network and locality forums provides the architecture to continue to do this in the new commissioning landscape.

Existing partnerships and relationships continue to be built on and strengthened, including those with London Borough of Lambeth, Guy’s and St Thomas’ Hospital (GST), Kings College Hospital (KCH), St George’s and South London and Maudsley. New relationships and partnerships will need to be formed with other new commissioning bodies such as NHS England who have taken on the role of commissioning services from GPs, pharmacists, opticians, dentists and 0-5 community services for including health visiting, immunisations, screening services and specialisedservices for Lambeth. Existing partnerships that have served us well will now include new areas of joint working and a different role for the CCG. London Borough of Lambeth, with whom we have worked in partnership for many years jointly commissioning services including those for older people, people with learning disabilities, physical disabilities and some mental health services will now also cover sexual health, school nursing, drug and alcohol, and health promotion. A key new partnership for Lambeth is the Health and Well Being partnership with the strategic objective of improving health and social care services through joint commissioning arrangements and joint monitoring or outcomes and performance.

We also recognise the importance of the partnership we have with local people, patients, and other organisations (Lambeth HealthWatch and community groups). These partnerships are key to us being able to improve the health and wellbeing of Lambeth citizens reduce health inequalities in the borough.

Achieving the Lambeth mission of improving health outcomes will also require Lambeth CCG to continue its work with other CCGs. The partnership approach with Southwark CCG on both planned and urgent care will continue through the Planned Care and Urgent Care Programme Boards and includes the Integrated Care Pilot across Lambeth and Southwark CCGs in partnership with Kings Health Partners (KHP). Work across south east London (SEL) on the community based care strategy involves a partnership of all six south east London CCGs through the SEL Clinical Strategy Group supported by a shared Programme Management Office. Lambeth CCG also has a new partnership with the South London Commissioning Support Unit who host a shared multi-disciplinary contracting team for the acute contract covering GST.

2.7 2013/14 Plan on a Page

3. Governance and Performance

NHS Lambeth CCG comprises 49 Member Practices across three localities.

The Governing Body of NHS Lambeth CCG, (the Lambeth Clinical Commissioning Governing BodyLCCGB) is responsible for ensuring that the CCG has appropriate arrangements in place toexercise its functions effectively, efficiently and economically and in accordance with the CCG Constitution and our principlesof good governance. Membership of the Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and nominees from our key Lambeth partners.

The Lambeth Clinical Commissioning Governing Body is supported by the NHS Lambeth CCG Collaborative Forum made up of all Lambeth member practices. The Collaborative Forum held its first meeting in April 2013. This built upon a range of events with Member Practices over the past two years. Under the CCGs agreed Constitution the Collaborative Forum has a number of specified responsibilities, including agreeing the election process for elected members of the Governing Body and changes to the NHS Lambeth CCG Constitution.

The Governing Body is also supported by the Clinical Network of clinical leads for each area of work being taken forward. The purpose of the Clinical Network is to provide the CCG Board members with sound clinical advice on commissioning care services, care/clinical pathways and best practice. The Clinical network consists of care and clinical “subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists, opticians and social care colleagues.

3.1Committee structure

3.2 Oversight of Delivery

The Governing Body is ultimately responsibility for the delivery of the 2013/14 Business Plan and overseesdelivery through a comprehensive Integrated Performance and Governance report at each Board meeting addressing:

The Board Assurance Framework,
Key risks to delivery, including zero tolerance risks, and
Performance against our Business Plan objectives.

In order to support the delivery of the business plan three management groups have been set up supported by a Programme Management Office (PMO):

3.2.1 Operations Group

The Operations Group is chaired by the Chief Officer, with membership comprising of all NHS Lambeth Directors and Assistant Directors. This group meets twice a month with the role sharing information and best practice, providing peer support and review and challengeboth within and across health programmesincluding equalities action plans and QIPP delivery.

3.2.2 Management Development Team

The Management Development Group is chaired by the Chief Officer, with membership comprising all NHS Lambeth Director’s. This group meets weekly with the role of enabling ongoingorganisational development and oversight of key issues of assurance and governance. This meeting reviews and quality assuresthe governance of and reporting to the governing body and its committees.

3.2.3 Finance & QIPP Working Group

The Finance and QIPP Working Group is a working group of the Integrated Governance Committee for the Lambeth CCG Governing Body. It is accountable for overseeing a robust organisation-wide system of financial management that enables the CCG to deliver its statutory financial targets at the same time as securing Value ForMoney (VFM). This includes monitoring of the CCG’s QIPP programme which is an integral part of the annual business plan. The successful delivery of the 2013/14 QIPP has an impact on our ongoing financial sustainability.

The Group ensures that the finances of the CCG are scrutinised to ensure budgets are set and managed in an appropriate and timely manner. It ensures that the Governing Body is fully aware of any financial risks which may materialise throughout the year. The Group will also be responsible for reviewing the Medium Term Financial Strategy (MTFS) of the Governing Body.

It reports to the Integrated Governance Committee to ensure financial probity within the organisation.

The Group has, on behalf of the Governing Body, an overview of all aspects of finances (including capital spend and cash management), which involves work relating to commissioning of health services, including detailed review of the CCG’s contractual position.

3.2.4 The Programme Management Office

Clinical lead: DrAdrian McLachlan

Executive lead: Andrew Parker, Director Governance & Development

Programme lead:Kathryn MacDermott, AD PMO, Transformation & QIPP

The PMO has been established to enable Lambeth CCG to take a consistent and rigours approach to monitoring the implementation of the key priorities, strategic goals and objectives. To provide expertise and support across the CCG as required toenable delivery.

Development and agreement of the five year commissioning strategy plan for Lambeth CCG
Development and agreement of the annual Business Plans
Development and monitoring of the Lambeth QIPP plans
Development and implementation of a PMO approach to Lambeth CCG business
Support to the Clinical Leads
Performance monitoring and reporting on all QIPP plans
Working with Finance ensure monitoring of all QIPP savings

The Programme Management Office (PMO) will have responsibility for monitoring and reporting on the performance of the CCG against its corporate objectives and programmes of work as set out in the business plan. Reporting on performance will be collated through the PMO on a monthly basis with exceptions, risks, slippage and/or action plans highlighted to the Governing Body through the Integrated Performance and Governance report.

The business plan is structured to reflect the programmes of work. Whilst each programme has a named clinical and director lead many programmes will not be delivered unless there is significant working across teams. These interdependencies will be listed in the PMO documentation.

3.3Equalities

NHS Lambeth CCG has adopted an equality objective for each of its seven health priorities which are the responsibility of the respective programme boards to drive, monitor and report on. The objectives are set out over the page:

7 Equalities Objectives / Serious mental illness / To improve the physical health of people known to have mental health problems especially people with severe mental illness (SMI) as measured by:

Reducing the numbers who smoke and narrow the gap between people with SMI (44.2% known to be smokers according to GP records) and thegeneral adult population of Lambeth (23% smokers)
Improving diabetic control fromthe beyond the Lambeth average (66% achieving good control as measured byHbA1C) towards that of the highest performing practices in Lambeth of80% or above for people with SMI and diabetes
Increase access to talking therapy services to those people over 55 and who have long term conditions
Increase access to the memory service for peoplefrom ethnic minority communities

Cardio Vascular
Disease / To improve control of high blood pressure (defined as less than 150/90) in Lambeth, specifically to reduce the between practice variation by achieving measurable change in the poorest performing practices towards the Lambeth average of blood pressure controlled in at least 75% of people known to have hypertension, and to improve the quality of care for all.
Diabetes / To improve the detection and control of diabetes in Lambeth (as defined by achieving HbA1c of less than 8), specifically to reduce the between practice variation in control achieving measurable change in the poorest performing practices towards the Lambeth average of 66% of people known to have diabetes achieving good control and between different population groups focusing on some ethnic minority populations andpeople with mental health problems known to have increased prevalence, earlier onset and higherrates of complications.
HIV / To ensure the revised HIV treatment and support services are informed both by detailed evidence on which populations are experiencing the highest prevalence, the highest transmission rates and the highest social needs profile,and by a diverse Service User Reference Group (SURG) indicative of the different communities affected inLambeth
Smoking / To enable all smokers to have equal opportunity to quit through the Lambeth stop smoking service focusing particularly on particularly on lower socio economic groups who are more likely to smoke
Childhood Obesity / To reduce any inequality experienced by different population groups in their ability to benefit from the Childhood Obesity Programme and to promote equality and equity as a key element to successful delivery of the Programme overall
Alcohol / To promote equity of access to information on alcohol and safe drinking, and to alcohol misuse services for population groups at higher risk of alcohol related harm.
In partnership with and the active support of the local Public Health service the CCG undertakes to:

Be more transparent about equality in health services commissioning
Ask more specific questions about equality and human rights in engagement activity
Advocate on behalf of populations that are historically marginalised and/or discriminated against
Promote more comprehensive equality monitoring; patients asked (with explanations and assurances about confidentiality) to give more information that assists services to demonstrate whether they are providing an equitable service
Commission primary and secondary care services that are competent and considerate on equality and human rights e.g. staff do not make assumptions and address their own prejudices

MILESTONES / KEY ACTIONS / DATE DUE
Publish an updated review of the evidence the CCG has on equality and the CCG’s impact on equality including progress against equality objectives / 31st January 2014
Stakeholder (particularly equality groups) engagement on progress against equality objectives and agreement of ‘grading’ of progress / 31st March 2014
Publication of the stakeholder grading and updates to equality objectives.
NB: This will be the 3rd annual update of a 4 year cycle. / 4th April 2014