Agenda Item 16b Enclosure CKWCB/12/91
Title of Report:
NHS Calderdale, Kirklees and Wakefield District Cluster Board
Transformation Programmesâ€™ reports: Mid Yorkshire Hospitals NHS Trust
FOI Exemption Category: Open
Chris Dowse, Director for Transition, Calderdale & Mid Yorkshire Health and Social Care Partnership Programme
Report Author and Job Title:
Martin Land, Programme Manager, Mid Yorkshire Health and Social Care Partnership Programme
Governance arrangements and structures for the Mid Yorkshire Programme are being revised to better meet the requirements for both recovery and transformation across the Mid Yorkshire health and social care economy The revised programme structure consists of three interconnecting programmes: Financial and Recovery Programme; Transformation Programme and the Foundation Trust Application Programme The Trust has formally declared to the Strategic Health Authority, a deficit financial position for 2011/12 and continues to face significant performance challenges. The Directors of Finance at the Cluster and MYHT with their teams are working closely to develop a detailed financial plan for 2012/13 alongside a longer term financial recovery strategy The scope of the CSS has been widened, to include: the impact of specialised commissioning; making best use of all hospital capacity and estates rationalisation. The key drivers of the CSS have also been extended from safety and quality to explicitly include supporting financial recovery and delivering efficiencies.
The financial/resource implications are set out in the paper and are monitored/managed through the Financial Recovery and Performance Improvement Programme.
A risk register has been developed for the programme
Legal Implications: Health Benefits:
The aim of the programme is to improve health and well being of local people working within the financial resources available.
The programme contains a cross cutting workstream which will be reviewing any impact on workforce and organisational development requirements.
Outcome of Equality Impact Assessment:
An EqIA assessment will be undertaken as part of the transformation programme and in particular as part of the Clinical services strategy.
Mid Yorkshire Health and Social Care Partnership Programme
The Board is recommended to note the update and next steps.
Purpose of Report 1.1
Provide the Board with an update on the development of the revised governance and structures to support the Mid Yorkshire Health and Social Care Partnership Programme. Provide the Board with a report on progress in each of the programme areas.
Governance arrangements and structures for the Mid Yorkshire Programme are being revised to better meet the requirements for both recovery and transformation across the Mid Yorkshire health and social care economy. The Programme has been renamed the Mid Yorkshire Health and Social Care Partnership (MYH&SCP) Programme. The proposed new arrangements and Terms of Reference were approved by the Partnership Board meeting on 15 March and the revised structure is set out in the schematic below. The key change is the clearer distinction between the recovery and transformation elements and development of new workstreams, each of which will be monitored within new programme management arrangements.
MY Hospitals Trust Board
CKW Cluster Board/ CCGs Wakefield, North Kirklees
Partners: Wakefield Council
Partners: Kirklees Council
Mid Yorkshire Health and Social Care Partnership Programme
• • • •
Care outside hospital Urgent care Clinical services strategy Primary care Transformation scheme
Foundation Trust Application Transactional processes
Financial Recovery & Performance Improvement Programme Part two:
Longer term development & Recovery Plan
Monitoring In- year performance on current operational plan
Partners SWYPFT, Locala, NHS Leeds CCGs
Cross Cutting workstreams: Communications and Engagement; Clinical Leadership; Quality and Safety; Workforce, IM&T, Estates
Version 7, 9th March 12
Since the previous report (January) significant changes have taken place at Mid Yorkshire Hospitals NHS Trust (MYHT) including the appointment of two new senior leaders: David Stone, Chairman (interim six month appointment) and
Stephen Eames, Chief Executive (interim two year appointment). The Trust has formally declared to the Strategic Health Authority, a deficit financial position for 2011/12 and continues to face significant performance challenges. Alongside these changes, the scope and scale of transformation workstreams in the Programme have been revised, as explained briefly below. It is noted that the Cluster Board routinely receives minutes from the MYH&SCP Board (previously MYHEFT – Health Economy Foundation Trust Programme Board). 3.2
The Mid Yorkshire Foundation Trust application programme remains in place, focusing on transactional processes such as the recruitment of members. The overall timetable and milestones remain as set out in the Tripartite Formal Agreement (TFA) signed in September 2010, and may be subject to further revision in discussion with the Strategic Health Authority.
Recovery and Improvement Programme Following an extensive review of its financial position, MYHT declared a deficit of £19.7m for 2011/12. The deficit includes the cost of the Employment Tribunal, but is net of transitional support of £14m provided by the Cluster and the reinvestment of readmission penalties of £5m.
The Directors of Finance at the Cluster and MYHT with their teams are working closely to develop a detailed financial plan for 2012/13 alongside a longer term financial recovery strategy. It is anticipated that the Trust will set a planned deficit for 2012/13 and negotiations are ongoing concerning the impact of this position on the Trust (in terms of Cost Improvement Plans) and the Cluster (in terms of Quality, Innovation, Productivity, Prevention (QIPP) plans and transitional support) and closely involving the Strategic Health Authority.
In terms of performance, the Trust is failing to meet consistently key access targets including 95% A&E and 18 week Referral To Treatment (RTT). The main area of concern relates to urgent care capacity and patient flows at Pinderfields Hospital. The Trust has applied for Department of Health Access Funds which provide for additional investment in both these areas, but are predicated on delivery of the targets which remains a significant challenge in Mid Yorkshire.
As part of the new governance arrangements, a Financial Recovery and Performance Improvement Programme will monitor and support both of these areas and discussions are ongoing to firm up the targets, improvement trajectories and reporting arrangements.
Transformation Programme The Cluster approach to Transformation and the development and delivery of QIPP plans are integral to delivery of the Programme. Action taken over the last six months includes the following.
Stocktake of QIPP Plans (11/12) – to capture QIPP plans within CKW Cluster and provide a high-level estimate of the direct impact on finance and activity in Mid Yorkshire. Alignment to CIP Plans (11/12) – work to test consistency between Cluster QIPP and MYHT CIP plans, highlighting areas to be resolved (e.g. CIPs based on assumed activity growth). Detailed Review of QIPP Plans – conducting a ‘confirm and challenge’ process to assess the deliverability of QIPP plans which captured progress to date and estimated impact for 12/13. 3.8
The three largest QIPP schemes affecting MY are as follows: Primary Care Transformation (Wakefield) – recently agreed initiative to increase primary care capacity and reduce A&E admissions and LTC admissions (8% and 5% respectively). Planned Care Schemes (Wakefield) – pathway redesign to shift activity out of hospital and improve cost-effectiveness, such as for ophthalmology and dermatology. In part these schemes address current imbalances in demand and capacity in MY. Wellbeing and Integration Programme (Kirklees) – comprising nine schemes directly targeting disease areas and client groups, from rapid response urgent care in the community, to diagnostic, diabetes, rehab and chest pain pathways.
To support the continued roll out of these schemes and development of whole system Transformation across the health and social care economy, an event was held at the beginning of November, the outcome of which includes: A set of principles and agreements on ways of working together. An overall vision with shared ambitions for improving health and health care in Mid Yorkshire. A set of inter-dependent priorities to be delivered collaboratively.
Building on these actions and discussions, the revised Transformation Programme incorporates four key workstreams, on which MYHT, Cluster, Clinical Commissioning Groups are working collaboratively: Developing care outside hospital – including the intermediate tier and redesign of pathways for key areas including frail elderly / dementia and end of life care. A whole health economy event was held on 26 January to capture current activity and develop shared strategic objectives. Improving urgent and emergency care – to maximise use of current facilities, including developing a new clinical model for urgent care in Pontefract, and tackling high levels of access. MY Clinical Services Strategy (explained below). Primary Care Transformation Scheme
The scope of the CSS has been widened, such as by including: the impact of specialised commissioning and related reviews; making best use of all hospital capacity (including the Pontefract Optimisation Project); and estates rationalisation. The key drivers of the CSS have also been extended from safety
and quality to explicitly include supporting financial recovery and delivering efficiencies. Consequently the range of specialties included in the CSS now includes all key areas, including the medical specialties. A revised timetable for the CSS was considered by the Programme Board at its meeting on 15 March which included extensive engagement with CCGs and other partners. Work to be completed over the coming weeks is expected to clarify that some specialties will not be subject to major service change, whilst others may require reconfiguration in advance of the whole health economy changes. The Programme Board, chaired by the new Chair of MYHT and including the new Chief Executive, provided further steers to the CSS process and recognised the significant challenge of completing all necessary planning and engagement work to enable a consultation to commence in December 2012. 3.12
In addition to the two core components outlined above, there is a Programme which covers the mechanics of the Foundation Trust application process itself (including membership recruitment) and a number of cross-cutting areas including communications, clinical engagement, quality and safety.
The Programme Board at its meeting on 15 March agreed a number of key messages from discussions amongst partners, which included the following. Recognition of the importance of finance as a key driver of the Mid Yorkshire Clinical Services Strategy â€“ alongside quality and safety. The need for further work to review progress and clarify the forward plan to develop the CSS and particularly to prepare for public consultation. The shift in the role of the Partnership Programme Board to focus primarily on Transformation. The Recovery and Improvement elements will be managed through existing mechanisms and the Programme Board will seek assurance on their delivery. A joint approach will be critical to deliver the major strategic shifts required to make health and social care in Mid Yorkshire clinically sustainable and financially viable. The approach captured in the Programmeâ€™s workstreams include making better use of hospital and other service capacity, creating new models of urgent, out-of-hours care and developing pathways to enable more care to be delivered closer to home.
Next Steps 4.1
To develop a detailed financial plan for 2012/13 alongside a longer term financial recovery strategy.
To continue to work with the Clinical Commissioning Groups and key partners to develop the detailed Transformation priorities including QIPP plans
Review the specialties within the Clinical Services Strategy, identifying those which may no longer be subject to major service change.
To continue to develop the governance, structures and detailed project plans sitting underneath each of the programmes.
Recommendations It is recommended the Board: i) ii)
Notes the content of this report Supports the next steps