Shaping our Future Assurance report to Transformation Board

1 Shaping our Future Assurance report to Transformation Board Progress update for the October meeting Contents Shaping our Future in 18/19 Current status SoF projects summary overview Headline messages Exception report : Amber and Red Projects Key SoF Risks Significant Actions in Next Reporting Period Conclusions Appendix 1 - Quantifying Benefits 2 - System financial and operational performance Shaping our Future in 2018/19 2016/17 2017/18 2018/19 Year 3 2019/20 2020/21 Phase 1: Clinical and financial sustainability plan Design and engage on a strategic sustainability plan for Cornwall & the Isles of Scilly (Outline Business Case) Integration of community and mental health services into a single provider Phase 2.

2 Start planning and implementing the longer term clinically and financially sustainable models of care Co-production of new service model of care shaped around integrating primary and community services, creating a strong and resilient community-based system of planned and urgent care that better meets local needs Partner commitment to work towards the development of an integrated care system Establish new integrated 111 and Out of Hours service Agree 3 year financial framework for achieving financial sustainability across NHS and move to single local NHS control total .. Phase 3: Take major steps towards joining up how care is provided through the development of an integrated health and care system Develop, subject to gateways, the model for strategic, outcome based, health and social care commissioning Establish an integrated care partnership, subject to gateways, with a strong locality focus, using 2018/19 to design and refine the model.

3 Ensuring that it facilitates providers being able to respond more flexibly to local need and improves how we function as a system Agree a set of system priorities to be delivered at pace in 2018/19 to support our system sustainability and demonstrate early success Establishing local integrated care teams to increase the capacity, capability and resilience of community-based care Support the development of primary care networks and GP Practices to deliver primary care at scale Components of new care model to be assessed through test and learn approach to bolster capacity ahead of winter 2018 and build local evidence for reconfigured service model Further develop three year financial recovery plan, in line with agreed financial framework, and Implement year 1.

4 Meeting regulator control totals and better aligning with local authority finances Production of system workforce Transformation plan to support care model delivery and development of other enabling strategies including estates and digital Phase 4: Secure the benefits of reduced variations in care with efficient pathways of care for people, improving quality and performance and continue transition to new out of hospital service model Deliver system wide efficiencies and remove unwarranted variation, starting with making care more effective and efficient for people who have musculoskeletal problems; cardiovascular problems; people with complex needs or have fallen or are at risk of falling.

5 Consult (if necessary) on reconfigured service model for community services Implement new governance and leadership arrangements for the Integrated Care System Implement agreed approach to transforming our enabling (back office) services to support our operation as an integrated care partnership Phase 5: Clinical and financial sustainability secured Deliver 3 year financial recovery plan One plan, one system, aligned budgets Realisation of new out of hospital service model 3 Current status SoF projects summary overview Programme Project System Lead SRO RAG Jun Jul Aug Integrated Community Services (Model of Care) Urgent & Emergency Care Jackie Pendleton & Helen Charlesworth-May Tryphaena Doyle Improving Access to General Practice Rehab, Reablement & Recovery Multi-agency Multi-disciplinary-team meetings Integrated Care Teams Proposal and timelines to be shared at Future ICP Mobilisation Board .

6 Personalised Care Planning Single Point of Access Rapid Frailty Response Self-management Healthy Weight Social Prescribing Isles of Scilly Health and Social Care Integration Community Hospitals Integrated Care Area Plans Suicide Prevention Pathways MSK (Hip & Knee implementation) Phil Confue Ethna McCarthy Coronary Heart Disease Falls Outpatients Complex patients Jackie Pendleton Adrian Flynn Reporting to commence September Integrated Care System ISC Mobilisation Kate Kennally Helen Childs ICP Mobilisation Phil Confue (interim) Tracey Lee Enabling Services review Phil Confue Karl Simkins Workforce Phil Confue Adrienne Murphy Estates Jackie Pendleton Karl Simkins Digital Kate Kennally Dave Thompson Current status Headline messages Integrated Community Services/Model of Care A process and timeline for decision making about the Future of the temporarily closed inpatient and other services at Fowey, Saltash and St.

7 Ives community hospital sites has been proposed. This will be described in more detail at the October Transformation Board meeting. A high level strategic model for Future urgent care services has been set out. This will also be described in more detail at the October Transformation Board meeting. Cornwall Council have commissioned Newton Europe Ltd to support work on improving community-based reablement services. An optimum model is being tested initially in St. Austell ahead of countywide roll-out. A pilot to test a rapid access frailty clinic at West Cornwall Hospital Urgent Care Centre, with access to short stay assessment beds, continues. To date, demand has been lower than expected and work has started to review and refine the model ahead of Winter 18.

8 A pilot to test a rapid frailty response service has started in St. Ives and Hayle. The new domiciliary care contract for the Cornwall health and social care system went live on 9th June 2018, using the Dynamic Purchasing System (DPS) framework. This will support the Shaping our Future strategic aim of building additional capacity in communities. Frailty - work is underway across a number of interventions ( rapid response service, integrated care teams, personalised care plans, and frailty assessment clinics) that will contribute to the frailty model of care. An initial Gateway 1 review has been held but further work is required to outline service model and approach to delivery.

9 A system wide clinical strategy is being developed. Pathways The Programme Board overseeing the Pathways work stream has confirmed that the immediate priorities are improving care and support for people with joint problems, people at risk of having coronary heart disease, and people at risk of falling, who have fallen or who have fragility fractures. Consideration is needed of what resources are required to enable changes in detection and management of conditions that lead to coronary heart disease. Plans for taking forward the work have been agreed in principle and set out the key actions. Work is underway to determine whether there is potential for improving care and support for people with respiratory problems and how improvements might be made to care and support for people with mental health issues related to their long terms conditions or medically unexplained symptoms.

10 This work is to be discussed with the Clinical Practitioner Cabinet. Test & Learns underway Rapid Frailty Assessment Service West Cornwall Hospital Improving Access to General Practice St. Austell & 3 Harbours MDT framework St. Austell NB: Further test & learns being mobilised 5 Current status Headline messages Outpatients A multi-agency Outpatient Transformation Board is now A formal Outpatients Strategy has been developed which holds at its core the theme of Valuing Patients time , and sits in line with the national remit of transforming service delivery, appropriate referral Assurance , and supporting patients to self-manage conditions.