System Leadership Briefing
1. Purpose of this paper
The purpose of this paper is to brief CCG Governing Bodies, Acute Trust and Community Partnership Boards and other stakeholder organisations on the approach being taken to develop a new system leadership forum for Bristol, North Somerset and South Gloucestershire.
The intention in providing this briefing is to allow these Boards and Governing Bodies to discuss how they can support their senior officers in effectively participating in these new system leadership arrangements.
2. Background
In July 2014 the healthcare organisations within Bristol, North Somerset and South Gloucestershire (BNSSG) produced five year strategic plans for the development of local health services. These strategic plans highlight the sustainability challenges facing local services from a clinical, workforce and financial perspective. In reviewing the documents the organisations have identified the opportunity to work together in specific areas to improve the coordination and delivery of services for their local population.
This requirement for collaborative working is further supported by the resilience planning guidance for 2014/15 which requires health communities to establish strategic resilience groups. These are proposed to move communities from considering ‘winter pressures’ to sustainable, year-round delivery of all access targets, elective and emergency services, and avoiding any trade-off between finance and performance.
In October 2014 NHS England produced their Five Year Forward View. This document generates further momentum for joint working between healthcare organisations in order to deliver the redesign of services that is required.
3. System Leadership Approach
In the light of the review of the strategic plans and in response to the planning guidance and Five Year Forward View, local organisations have decided to form a new System Leadership Group to provide direction, leadership and support to areas that require joint working across BNSSG.
The first meeting of this new group took place on Thursday 11th September and was attended by Clinical Commissioning Group (CCG) Chairs and Accountable Officers, the Director of Commissioning for the Area Team, and provider Chief Executives. The meeting was chaired by Anthony Farnsworth (Area Team Director).
The proposed Terms of Reference for the Group were approved and the commitment to joint working was strongly supported by all attendees. At this stage membership of the Group (see below) will be from health organisations, with CCGs providing the link to the joint work that is required with local authorities and the respective Better Care Programmes.
Progress reports will be generated to support the exchange of information between the System Leadership Group and other forums and where required, joint work will be undertaken in partnership with other bodies. If appropriate the membership of the System Leadership Group will be expanded to encompass wider involvement on specific issues and to ensure sufficient governance is in place (e.g. the Connecting Care Programme, capacity and demand modelling).
The initial focus of the work will be on four distinct initiatives that will inform and enable further collaborative working between the organisations. These four initiatives are:
· Review and alignment of the strategic plans produced by local healthcare organisations;
· Oversight of the work of the Strategic Resilience Group;
· Sponsorship of the Connecting Care Programme; and
· Delivery of system wide demand and capacity planning.
In addition to these specific initiatives, the organisations present accepted that there was a need to secure whole system financial sustainability, alongside organisations individually pursuing financial balance.To achieve this, the organisations will need to work together to review and change the way resources are deployed across the healthcare system.
A Directors of Finance Group is being established to support the System Leadership Group with this agenda. They will have a specific role in overseeing the alignment of strategic plans, the demand and capacity modelling and the planning for financial sustainability. The Directors of Finance Group will be chaired by Iain Tulley (Chief Executive, Avon & Wiltshire Partnership).
4. Clinical Leadership
The CCG Clinical Chairs are members of the new System Leadership Group and will take a lead in establishing effective links with the existing clinical leadership forums within BNSSG including Bristol Health Partners and the West of England Academic Health Sciences Network. This will help ensure that the views and knowledge of clinicians are integral to addressing the challenges faced by the health and social care system.
5. System Leadership Governance
Governance arrangements for this type of group are complex and need to recognise the tension between the sovereign status held by individual organisations and the confederated working arrangements that are proposed. They also need to take account of and interface with the range of existing forums that operate within the health and care sector, including clinical leadership forums, the Health and Wellbeing Boards and Better Care Programme Boards. A diagram illustrating the governance arrangements is attached below.
The support of organisation Governing Bodies and Boards will be essential in the success of this new forum. We are all familiar with the challenges that we face in maintaining the quality, safety and efficiency of our services on a daily basis and recognise that the solutions lie beyond the control of our individual organisations. In this context we have a collective interest in the success of these new arrangements.
The Group will establish appropriate working relationships with partner organisations in order to support coordinated actions which positively influence the wider determinants of health and wellbeing.
6. System Leadership resourcing
The operation of the System Leadership Group will require programme, project and administrative support. Proposals for the resourcing of these requirements will be discussed with the System Leadership Group.
7. Next steps
As noted above an approach of this nature requires the collective will and effort of the participating organisations. On that basis this paper will be presented for information and to secure the support of the respective CCG Governing Bodies and Provider Boards.
Anthony Farnsworth
Area Team Director
26th November 2014
System Leadership Group - Participating organisationsCommissioners / BNSSSG Area Team
Bristol CCG
North Somerset CCG
South Gloucestershire CCG
Providers / Avon & Wiltshire Mental Health Partnership NHS Trust
Bristol Community Health
North Bristol NHS Trust
North Somerset Community Partnership
Sirona Care and Health
University Hospitals Bristol NHS Foundation Trust
Weston Area Healthcare Trust
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Bristol, North Somerset and South Gloucestershire Healthcare System Leadership
* There are a wide range of clinical forums which exist across Bristol, North Somerset and South Gloucestershire that are redesigning the way services are provided. These groups operate at all levels, e.g. Locality, CCG, individual provider and whole system. Links will be established with these groups to ensure that where appropriate the new System Leadership approach is responsive to and supportive of the work of these clinical forums.
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