Innovation Health and Wealth

Innovation Health and Wealth:

Implementation Plan

10 October 2012

NHS South of England

Innovation Health and Wealth: Implementation Plan

Paper for website publication

Authors Duncan Goodes, Charlotte Moar, John Sadler, Murray Cochrane Responsible Director Richard Gleave

Main aim To set out action in NHS South of England to implement Innovation Health and Wealth (December 2011) Confirm due regard given to the Equality Due and appropriate regard has been Act 2010 and compliance with the three given to the three aims of the equality aims of the Equality Duty as part of the duty: process of decision making  eliminate unlawful discrimination  advance equality of opportunity between people who share a protected characteristic and those who do not  foster good relations between people who share a protected characteristic and those who do not Link to strategic objectives and priorities Takes forward the priority to improve quality, innovation, productivity and prevention Risk associated with the subject matter As set out in the paper of this paper

Resources implications As set out in the paper

Any legal implications or links to All Technology Appraisals published by legislation the National Institute for Health and Clinical Excellence carry a statutory funding implication Freedom of information including Draft until published restrictions

Public involvement history Public involvement takes place in each local health community Previous considerations None

Preface

This document sets out the implementation plan for Innovation Health and Wealth in NHS South of England.

The approach to reducing variation and increasing compliance will ensure that patients have access to cost effective treatments approved through Technology Appraisals published by the National Institute for Health and Clinical Excellence.

Significant progress is expected in 2012/13 to take forward the six high impact innovations. The plan sets out the ambitions and expectations, investments, trajectories and timetable for the high impact innovations, including the position in each Primary Care Trust cluster.

The plan will be updated following the completion of national work to define the specific outcomes and measures for the six high impact innovations and further work on the implementation of Technology Appraisals.

Sir Ian Carruthers OBE Chief Executive 10 October 2012

NHS South of England

Innovation Health and Wealth: Implementation Plan

Table of contents

Page No.

Assessment sheet

Preface

Table of contents

Section 1 Introduction ...... 1 ......

Section 2 Approach ...... 3

Section 3 Implementation plans in NHS South of England ...... 9

Section 4 Next steps ...... 2 7

Appendices

Appendix 1 Compliance with technology appraisals

Appendix 2 Schedule of CQUIN incentives to support high impact innovations

Appendix 3 Approach to setting ambitions and expectations for the six high impact innovations 2012/13 to 2015/16

Appendix 4 Draft Primary Care Trust cluster delivery plans 2012/13

Section 1

Introduction

This section sets out the background to Innovation Health and Wealth (December 2011)

1. Introduction

1.1 The NHS Innovation Review, Innovation Health and Wealth (December 2011), was launched by the Prime Minister alongside the Strategy for UK Life Sciences (December 2011). It is the contribution of the NHS to The Plan for Growth (March 2011).

1.2 The document highlights eight areas where it makes recommendations:

 we should reduce variation in the NHS, and drive greater compliance with guidance from the National Institute for Health and Clinical Excellence;

 working with industry, we should develop and publish better innovation uptake metrics, and more accessible evidence and information about new ideas;

 we should establish a more systematic delivery mechanism for diffusion and collaboration within the NHS by building strong cross- boundary networks;

 we should align organisational, financial and personal incentives and investment to reward and encourage innovation;

 we should improve arrangements for procurement in the NHS to drive up quality and value, and to make the NHS a better place to do business;

 we should bring about a major shift in culture within the NHS, and develop our people by ‘hard wiring’ innovation into training and education for managers and clinicians;

 we should strengthen leadership in innovation at all levels of the NHS, set clearer priorities for innovation, and sharpen local accountability;

 we should identify and mandate the adoption of high impact innovations in the NHS.

1.3 There is a national implementation plan for Innovation Health and Wealth which has 25 workstreams at various stages of progress and staff from across NHS South of England are playing an active part in many of the Task and Finish Groups that are proposing the way forward on the recommendations in Innovation Health and Wealth.

1.4 NHS South of England has developed an Implementation Plan that sets out the way forward in all eight areas. It is also working with the thirteen Primary Care Trust clusters to develop local implementation plans further for handover to new bodies to ensure that there is a clear transition of responsibilities between 2012/13 and 2013/14.

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1.5 In the South of England, the local NHS, universities and industry will be working together on the new architecture for innovation set out in Innovation Health and Wealth. This work is being led nationally by staff from NHS South of England and includes the creation of Academic Health Science Networks that will ‘align education, clinical research, informatics, training and education and healthcare delivery … their goal will be to improve patient and population health outcomes by translating research into practice and developing and implementing integrated healthcare systems’.

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Section 2

Approach

This section sets out the approach to implementation of Innovation Health and Wealth in NHS South of England

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2. Approach

2.1 Innovation activity across the South of England in 2012/13 is focused on three main aims:

 seeking out and applying innovative technology and practice that supports the delivery of demonstrably improved quality and productivity;

 developing the capability of individuals and the system;

 ensuring that in transition the impetus and focus is maintained, such that the health economy as a whole with its partners continues to discover, develop and deliver innovations that support continuous improvement in commissioning and the provision of care.

2.2 NHS South of England is working equally with commissioners (initially Primary Care Trust clusters but increasingly emerging Clinical Commissioning Groups and NHS Commissioning Board Local Area Teams) and providers (NHS Trusts, NHS Foundation Trusts but also the independent and third sectors) to embed Innovation Health and Wealth in local planning and delivery systems. Innovation Health and Wealth local implementation plans will be handed over to new organisations to enable a smooth transition without loss of momentum into the new commissioning architecture in 2013/14.

2.3 Early progress in NHS South of England on innovation over the past two years includes:

 delivering innovations that improve quality and reduce costs and that are strongly aligned to strategic priorities, as set out in Annual Innovation Reports;

 calls for innovation projects and for adoption projects that have resulted in more than 60 innovation projects being delivered each with a focus on quality and productivity;

 progress on all the high impact innovations in different parts of the NHS in the South of England;

 well established partnership work and initiatives to improve dementia care and support the commissioning of the community and voluntary sector;

 productive partnerships with academia and with industry across NHS South of England that have resulted in active participation in bidding for the Delivering Assisted Living Lifestyles at Scale (DALLAS) programme as well as work led by partners such as the Health Innovation and Education Clusters;

 extensive networks in place that support innovation;

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 clinical programmes that can support clinical engagement and that have supported clinical leadership of many innovation projects;

 South East Coast and South Central are two of only three Strategic Health Authorities nationally that have conducted Small Business Research Initiatives (SBRIs) and have innovative products both in development and already commercially available. Those that are commercially available will support the ‘Assistive technologies’ and ‘Digital first’ agendas;

 specific projects reported in the respective Strategic Health Authority Annual Innovation Reports – to be produced as a single NHS South of England document for 2011/12 in June 2012;

 educational and Expo events delivered to wide audiences across the South of England.

Commissioning for Quality and Innovation (CQUIN) in 2012/13

2.4 Commissioners and providers were required to take into account the Innovation Review, Innovation Health and Wealth (December 2011) when developing local CQUIN schemes for 2012/13. This will be used as a pre- qualification criteria for CQUIN in 2013/14 and commissioners and providers must prepare for this during 2012/13.

2.5 It is also considered appropriate for commissioners to confirm that eligibility for CQUIN payments will be determined by passage through the following three local gateways:

 satisfaction of national data collection requirements;

 delivery of all national performance measures with specific focus on:

 accident and emergency four hour wait;

 NHS Constitution requirements;

 cancer waiting time standards;

 MRSA;

 clostridium difficile;

 delivery of the trajectory towards implementing the six high impact innovations (see below).

2.6 From 2013/14, implementation of the high impact innovations set out in Innovation Health and Wealth will be a gateway to accessing CQUIN. 2012/13 will be a transitional year towards this with the expectation that by the end of 2012/13, all relevant providers and commissioners will have the high impact changes published to date in place.

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2.7 Up to 0.5% of CQUIN has been made available to relevant providers in 2012/13 to support delivery of the six high impact innovations. This could be used to provide non recurring funding to support the changes necessary against an agreed trajectory. For those providers which have already implemented the high impact innovations, it should be used for stretch targets to implement further innovation.

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Section 3

Implementation plans in NHS South of England

This section sets out the implementation plans for Innovation Health and Wealth in NHS South of England

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3. Implementation plans in NHS South of England

3.1 The implementation plans for NHS South of England include actions in relation to each of the key themes of Innovation Health and Wealth set out in Section 1:

 reducing variation and increasing compliance;

 metrics and information;

 creating a system for delivery of innovation;

 incentives and investment;

 procurement;

 developing our people;

 leadership for innovation;

 high impact innovations.

Reducing variation and increasing compliance

3.2 Innovation Health and Wealth describes the importance of local adoption of guidance from the National Institute for Health and Clinical Excellence, especially the Technology Appraisals. There is a legal duty on the local NHS to ensure funding is available and a right in the NHS Constitution for patients to have access to treatments that are approved through Technology Appraisals, if their clinician says it is appropriate for them to receive it.

3.3 NHS South of England has asked Primary Care Trusts (on behalf of primary care) and secondary and community care providers to confirm that they have implemented the recommendation of each Technology Appraisal through local formularies and procurement policies where appropriate. Primary Care Trusts have been asked to confirm that there is funding available for each Technology Appraisal.

3.4 The full schedule of Technology Appraisals for which assurance has been sought through a questionnaire is contained in Appendix 1. The key questions that have been asked are:

 has the recommendation in the Technology Appraisal been implemented in the organisation, for example by changes to the local formulary for drugs or procurement of devices? (yes/no/not applicable);

 are agreed clinical protocols in place and being used to ensure that the Technology Appraisal recommendation is used in the treatment of patients? (yes/no/not applicable);

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 Primary Care Trust to confirm that funding has been made available by the local NHS for the Technology Appraisal in line with Directions from the Secretary of State (yes/no).

3.5 A number of Primary Care Trust clusters and providers have not yet responded, but from the data returned the findings include the following:

 most acute hospitals have a small number of Technology Appraisals that they have not yet fully implemented;

 mental health and community providers have either none or one Technology Appraisal that they have not yet implemented, though there are a number of areas where clinical protocols are not yet implemented;

 Primary Care Trust clusters on behalf of primary care report none, one or two Technology Appraisals that they have not yet implemented, though again there are more Technology Appraisals where clinical protocols are not yet in place.

3.6 The interpretation of the findings will need to be confirmed once a number of responses have been clarified, for example in some instances:

 the responses of ‘no’ are in relation to recommendations to end the existing use of a treatment. The answer ‘no’ could mean that the treatment is not used (indicating compliance);

 the three month period for implementation of the Technology Appraisal has not yet been reached. In these cases, some of the responses of ‘no’ indicate that there is an intention to comply once protocols are introduced within the three month period;

 the response of ‘no’ is given because it is understood that the recommendation is under review by the National Institute for Health and Clinical Excellence;

 the response of ‘no’ is given because the recommendation is an option for treatment, not a first line treatment;

 the recommendation or protocol is under discussion with either the Drugs and Therapeutics Committee or the Primary Care Trust cluster. For recommended treatments that are past their three month implementation period, this is clearly not acceptable.

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3.7 A piece of work will be commissioned to define the indicative level of uptake that might be expected in each local health community based on the models produced by the National Institute for Health and Clinical Excellence for each Technology Appraisal. The local NHS will be asked to report the actual current uptake compared to expected, and explain any significant variance. This work will be informed by the work of the NICE Implementation Collaborative as it starts to publish papers on the details of specific Technology Appraisals.

3.8 In summary, the results of the work to date on reducing variation and increasing compliance indicate that:

 most acute hospitals have a small number of Technology Appraisals that they have not yet fully implemented;

 compliance needs to be clarified with certain organisations where there is a recommendation to end an existing treatment, a recommendation under review or a recommendation that is an option for treatment;

 compliance needs to be followed up for a number of recommendations which are beyond the three month period for implementation;

 NHS South of England is to commission work to compare actual uptake of the recommended treatments with expected uptake. This will enable a review any significant variances.

Metrics and information

3.9 NHS South of England will be looking to ensure that there are local innovation scorecards and dashboards in place quickly following the recommendations of the national Task and Finish Group.

Creating a system for delivery of innovation

3.10 In line with the national process to seek designation for a local Academic Health Science Network, five Expressions of Interest have been submitted by the local NHS and Higher Education Institutions across the South of England, with some input from industry. These were reviewed and it has been agreed that all five can proceed to the next stage and put in applications by 30 September 2012.

3.11 The five prospective Academic Health Science Networks are:

 West of England;

 South West Peninsula;

 Oxford;

 Wessex;

 Surrey, Sussex and Kent. Page 13 of 128

3.12 The Sunset Review scoping exercise has identified a number of bodies and funding streams across the South of England that will be part of the Review and so will be part of the recommendations to de-clutter the current innovation landscape.

Incentives and investment

3.13 NHS South of England will swiftly implement the findings of the national Task and Finish Groups on the recommendations in Innovation Health and Wealth in relation to incentives and investment.

3.14 As set out in Section 2 on the approach to Commissioning for Quality and Innovation, NHS South of England has gone further than the national position in 2012/13 on incentives for innovation. In its planning guidance, NHS South of England has required Primary Care Trust clusters to agree with the relevant providers CQUINs in 2012/13 for each of the High Impact Innovations. These are reported each quarter.

3.15 A summary of the CQUIN incentives in 2012/13 to support implementation of Innovation Health and Wealth, amounting to £38 million, is considered below under high impact innovations and shown in Appendix 2.

3.16 Further work is underway to identify the full range of investments by Primary Care Trust clusters in the six high impact innovations. For example, as part of the investments in 2012/13, NHS South of England is running a regional challenge fund for Dementia of £10 million. The focus of the awards will be on adopting and spreading proven good practice through the emerging Clinical Commissioning Groups on topics across the breadth of the Prime Minister’s Dementia Challenge.

Procurement

3.17 Innovation Health and Wealth shows that procurement has the potential to act as a key driver of wealth and can support the implementation of new technologies and interventions that improve health. There is a disparate approach to procurement across the NHS, including NHS South of England.

3.18 The key actions in relation to procurement will follow from the national procurement review, which is being led by Sir Ian Carruthers OBE.

3.19 The national work on the Small Business Research Initiative (SBRI) is being led by NHS Midlands and East. NHS South of England has proposed that it acts as one of the key centres for running future SBRI competitions based on the experience and expertise in NHS South Central and South East Coast.

3.20 As part of the South Dementia Challenge Fund, NHS South of England is exploring options for a Dementia SBRI competition and this work is being shared with NHS Midlands and East.

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3.21 The former Medical Director for the South West Specialised Services is leading the Task and Finish Group on the innovation fund for specialised commissioning.

Developing our people

3.22 Across the South of England there have been a number of pioneering projects to develop skills and expertise in innovation. These include the training programme to create a cadre of Trust Innovation Leads in the South West, which is a fore-runner of the Innovation Health and Wealth recommendation on joint industry and NHS training programmes, and work on developing staff to produce business cases for innovations in South Central.

3.23 NHS South of England will look to incorporate the recommendations of the relevant Task and Finish Groups into its work with the emerging Local Education and Training Boards and the prospective Academic Health Science Networks. Both bodies will play a central role in the development of capacity and capability for staff to identify, adopt and spread innovations.

Leadership for innovation

3.24 NHS South of England has placed innovation high up on the agenda for the current leaders in the NHS and is highlighting this for future leaders in the new commissioning system.

3.25 Each NHS organisation, both commissioner and provider, has been asked to identify a Board level lead for innovation and a webex took place on 19 September 2012 to update all these leads on the implementation of Innovation Health and Wealth.

3.26 Work to support the creation of Clinical Commissioning Groups has highlighted the importance of Innovation Health and Wealth. The decision to focus the Dementia Challenge Fund through the emerging Clinical Commissioning Groups will help put them centre stage for the adoption and spread of innovation.

High impact innovations

3.27 The approach in NHS South of England has required Primary Care Trust clusters and providers to go further than the national position by agreeing Commissioning for Quality and Innovation incentives for 2012/13, in addition to the pre-qualification for 2013/14 CQUINs.

3.28 In addition, NHS South of England has provided advice to the local NHS on measuring progress with implementing the high impact innovations and examples of best practice. This builds on pilots in several of the high impact innovations, some of which were funded by the Regional Innovation Fund in 2011/12.

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Ambitions and expectations

3.29 The summary implementation plan for the high impact innovations is set out in Table 1. The measures of success set out the ambitions and expectations of NHS South of England. These may need to be modified following publication of the national minimum requirements for pre-qualification for CQUIN in 2013/14 to be achieved by 31 March 2013.

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Table 1: Summary implementation plan for the high impact innovations

High Impact Summary Plan for 2012/13 Measures of success* Innovation Growing the Support the identification of solutions. Number of people supported use of Commissioners and providers to agree by assistive technologies assistive trajectories. CQUIN to pump prime (telehealth and telecare) in technologies: delivery. their usual place of ‘3 million lives’ residence with an ambition of 5,500 people per 100,000 population by 2016 Intraoperative Identification of where benefits may lie Number of people goal directed (local basket of cases). Commissioners undergoing surgical fluid therapy and providers to agree trajectories. procedures supported by CQUIN to pump prime delivery. Intra-operative fluid management in theatre: an expectation of initially 150 people per 100,000 population per annum, with a 25% growth in 2013/14 Child in a chair Review of the whole pathway and Waiting time for provision of in a day focused work on shortening it. a wheelchair from time need Baselines to be established and identified with an expectation agreed. Aiming for receipt of order to of all local services chair being available to be as near to delivering 90% of requests one day as is possible. CQUIN to within 6 weeks by 2014 pump prime delivery. Digital first Identify opportunities to substitute Develop a measure of (previously digital transactions where these offer services that have shifted to Digital by an improvement in service. a predominantly digital default) Commissioners and providers to agree provision with milestones for trajectories to increase digital contacts. March 2013, 2014 and 2015. CQUIN to pump prime delivery. Focus on contacts that could be digital and on reducing unnecessary follow-ups. Supporting Identify spend on respite and breaks Proportion of carers who dementia and number of carers in receipt. have received respite care carers Establish baseline and trajectories to and the length of the care improve offer and uptake. provided. International Take forward innovation pipeline Each locality to identify at and through AHSNs. Continue least one innovation that the commercial international benchmarking AHSN will seek to ensure is activity programme. Identify international brought to market in the UK activities in NHS South of England. and overseas. Continue to support NHS International Health Group. * To be updated following completion of national work on pre-qualification requirements for CQUIN

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Incentives and investments for high impact innovations

3.30 The CQUIN incentives in 2012/13 to support implementation of the high impact innovations in each Primary Care Trust cluster are summarised in Table 2.

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Table 2: CQUIN innovation incentives in 2012/13, with allocations to date to the six high impact innovations  (£’000) Primary Care Trust Assistive Fluid Child in a Digital Carers International Total CQUIN - Total cluster technology management chair in a first for and high impact CQUIN - day dementia commercial innovations innovation Berkshire 0 372 193 565 0 0 1130 1991 Southampton, Hampshire, Isle of 0 0 0 0 0 0 0 8198 Wight and Portsmouth Buckinghamshire and 938 734 460 938 0 0 3071 3071 Oxfordshire Kent and Medway 0 0 0 0 0 0 0 4568 Sussex 85 0 0 85 165 0 335 6938 Surrey 0 0 0 0 0 0 0 0 Bristol, North Somerset and South 0 0 0 0 0 0 0 2975 Gloucestershire Gloucestershire and 0 0 0 0 0 0 0 640 Swindon Somerset 326 164 0 326 0 0 816 816 Devon, Plymouth and 0 0 0 0 0 0 0 2731 Torbay Dorset, Bournemouth 0 0 0 0 0 0 0 2816 and Poole Bath and North East Somerset and 0 215 0 622 0 0 837 1525 Wiltshire Cornwall and Isles of 688 0 0 688 0 0 1375 1654 Scilly Total 2037 1485 653 3224 165 0 7564 37923 Overall CQUIN incentives for innovation are being progressively allocated to high impact innovations during 2012/13

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3.31 The incentives through CQUIN schemes for Innovation Health and Wealth amount to £38 million in 2012/13. Overall CQUIN incentives for innovation are being progressively allocated to high impact innovations during 2012/13. Over £7 million has already been allocated to specific high impact innovations.

3.32 The detailed schedule of CQUIN incentives by NHS provider in each Primary Care Trust cluster is shown in Appendix 2.

3.33 Further work is taking place to identify the full extent of investment in each Primary Care Trust cluster in taking forward the six high impact innovations.

Expected trajectories

3.34 Setting trajectories locally for the high impact innovations is a key principle in implementing Innovation Health and Wealth. Innovation Health and Wealth said:

It is not our intention, nor is it appropriate, to make judgements about compliance from the centre, but we will require commissioners to satisfy themselves that all eligible organisations are delivering the high impact innovations set out in this report in order to pre-qualify for CQUIN payments.

3.35 The national position is that there needs to be sufficient progress on implementing the high impact innovations by 31 March 2013 by providers endorsed by local commissioners so that it can be determined that providers will be eligible (i.e. have pre-qualified) for 2013/14 CQUINs. The level of ‘sufficient progress’ and the process of ‘commissioner endorsement’ for each high impact innovation has not yet been defined by the Department of Health but guidance is expected on this for each high impact innovation.

3.36 NHS South of England has gone further than the national position by asking that commissioners agree with providers a CQUIN in 2012/13 covering in-year progress on implementation of the high impact innovations. Thus the NHS South of England expectation is that local CQUINs in 2012/13 set measurable ambitions for each high impact innovation that are in addition to the national requirement for ‘sufficient progress’.

3.37 Table 3 takes the 2015/16 indicative expectation and shows the estimated impact of each high impact innovation for the population of each Primary Care Trust cluster. This ambition will need to be amended for Clinical Commissioning Group populations and revised in the light of the forthcoming national guidance.

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Table 3: Expected impact of each high impact innovation in 2015/16

Fluid * New **Digital first - ***Dementia Assistive management - wheelchairs per digital Carers - number technologies Primary Care Trust Cluster Population number of annum delivered transactions with of carers - people operations per within 6 weeks patients per assessed and supported annum of assessment annum needs met Kent and Medway 1,677,984 92,289 6,712 3,624 16,182,731 15,555 Surrey 1,091,376 60,026 4,366 2,357 10,525,395 10,117 Sussex 1,551,178 85,315 6,205 3,351 14,959,795 14,379 Oxfordshire and Buckinghamshire 1,140,647 62,736 4,563 2,464 11,000,572 10,574 Southampton, Hampshire, Isle of 102,814 7,477 4,038 18,028,168 17,329 Wight and Portsmouth 1,869,337 Berkshire 848,385 46,661 3,394 1,833 8,181,953 7,865 Bath and North East Somerset and 35,535 2,584 1,396 6,231,028 5,989 Wiltshire 646,094 Bournemouth and Poole and Dorset 39,015 2,837 1,532 6,841,165 6,576 709,359 Bristol, North Somerset and South 49,385 3,592 1,939 8,659,560 8,324 Gloucestershire 897,908 Cornwall and Isles of Scilly 543,138 29,873 2,173 1,173 5,238,105 5,035 Devon, Plymouth and Torbay 1,158,382 63,711 4,634 2,502 11,171,611 10,738

Gloucestershire and Swindon 785,800 43,219 3,143 1,697 7,578,374 7,284 Somerset 527,731 29,025 2,111 1,140 5,089,517 4,892 South of England 13,447,319 739,603 53,789 29,046 129,687,974 124,657 Notes * Wheelchair estimates are based on Audit commission estimates of 1 - 1.4% of the population being wheelchair users (<0.2% of under 18yrs) and a need to a replace all every 5 years - delivery at 90% of this figure ** Digital first numbers based on 84.2m hospital appointments per annum in England (2009-10) and an estimated 2 digital opportunities for each + average of 5.3 visits per person to their GP each year - 2 digital opportunities per visit. Delivery at 70% of this total figure *** Alzheimer's society estimates 670,000 carers of people with dementia in the UK - i.e. 1030 per 100,000 population (at a rate of 90% of all carers of people with dementia

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3.38 Table 3 shows that by 2015/16, the expected impact of the six high impact innovations in NHS South of England each year will include:

 over 739,000 people supported with assistive technology;

 over 53,000 operations supported with intra-operative fluid management;

 over 29,000 new wheelchairs delivered within 6 weeks of an assessment;

 over 129 million digital transactions with patients;

 over 124,000 carers of people with dementia supported, with their needs assessed and met.

3.39 For the work on international and commercial activity, Table 4 shows the innovation pipeline currently held by Innovation Hubs in NHS South of England.

Table 4 Innovation pipeline for international and commercial activity

Rating of potential # Title Source Sub-Group financial benefit (1 low – 10 high)* 4 Constraining mitten SE MedTech - direct n/d 25 Biopsy Forceps SE MedTech - direct 5 28 Pulse Oximetry SE MedTech - direct 4 44 Cannulation Device SE MedTech - indirect 6 45 Cannula fixing SE MedTech - indirect 6 46 Webber Privacy Device SE MedTech - indirect 6 47 Tracheostomy Collar SE MedTech - indirect 5 69 Vitalpac SE Software - clinical n/d Minalgo - Bone Disease management 75 SE Software - clinical 1 Algorithm 76 Anti-TNF Therapy Assessment Clinic SE Software - clinical 1 77 Kent Oncology Management System SE Software - non clinical 2 79 Cloud based clinical trials management SE Software - non clinical 6 83 Ladders and Bladders SE Software - E&T n/d 86 COUNT SE Software - E&T 7 94 Dignity Undergarment SE Hardware - clinical 5 97 Simple Music Player SE Hardware - non clinical n/d 99 Mains Isolated Power Socket SE Hardware - non clinical 4 100 Evacuation Mattress SE Hardware - non clinical 3 Portable transfer board for wheelchair 101 SE Hardware - non clinical 3 users A disposable container for food at the 103 SE Hardware - non clinical 3 bedside 104 BEACH - HCA training SE Hardware - E&T n/d

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Rating of potential # Title Source Sub-Group financial benefit (1 low – 10 high)* 106 Emotional First Aid Training Course SE Hardware - E&T 8 107 ALERT SE Hardware - E&T 8 7 Knee Meniscus repair device SW MedTech - direct 10 Cardiac Resynchronisation Therapy 14 SW MedTech - direct 8 Device 19 Cryo-ablative catheter device SW MedTech - direct 7 Raman cancer device oesophageal 20 SW MedTech - direct 7 cancer 29 Epimark / Episcissors SW MedTech - direct 4 32 Finger Traction Device SW MedTech - direct 3 34 Rectus Sheath Catheter SW MedTech - direct 2 54 Vibratip SW Diagnostics n/d 55 Femmeze SW Diagnostics n/d 56 Novel BP monitor device SW Diagnostics 10 80 Doc.Com Solutions SW Software - non clinical n/d 81 Be Smart Cart SW Software - E&T n/d 90 Cardiac Rehabilitation DVD SW Software - E&T 1 Safety clip to prevent needlestick injury 95 SW Hardware - clinical 1 risk 105 The Living Well Handbook SW Hardware - E&T n/d * Savings to the NHS and royalties from commercial sales combined. Scored from 1 (low – under £10,000) to 10 (high - £100 million).

3.40 The analysis of the innovation pipeline for international and commercial activity has been prepared as part of the Sunset Review and will be available to Academic Health Science Networks to take forward.

3.41 Appendix 3 sets out the assumptions that have been made in setting ambitions and expectations for each high impact innovation for 2012/13, 2013/14, 2014/15 and 2015/16. These will need to be revised in the light of the forthcoming national advice. Primary Care Trust clusters will be encouraged to work with Clinical Commissioning Groups to build these into actual CQUINs in these years.

3.42 Appendix 3 also includes a sample delivery framework to support the adoption of the high impact innovations, using the introduction of intra-operative fluid management as an example. The delivery framework is offered as an input to the national programme and includes:

 definitions;

 key performance indicators;

 structure, process and outcome criteria.

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3.43 In 2012/13 expected trajectories will need to take into account the national requirement on pre-qualification when published and the NHS South of England expectations. The baselines and trajectories are being developed as part of the CQUIN programme for 2012/13. The actual levels of improvement for each high impact innovation are being set by Primary Care Trust clusters and providers by the end of Quarter 2 (by 30 September 2012) and will become the basis of the local delivery plans.

3.44 The draft local delivery plans for each high impact change in each Primary Care Trust cluster in 2012/13 are summarised in Appendix 4, based on the CQUIN schemes in each health community.

3.45 Performance reviews with Primary Care Trust clusters will include an assessment of the baselines for each high impact innovation and progress with the agreed actions in each quarter.

Timetable in 2012/13 for the six high impact innovations

3.46 During 2012/13, the overall timetable expected for release of CQUIN incentives related to the six high impact innovations is set out in Table 5.

Table 5: Overall timetable in 2012/13 for six high impact innovations

Quarter Action

Quarter 1: 1 April 2012 to Establish local baselines for each 30 June 2012 high impact innovation

Quarter 2: 1 July 2012 to Develop trajectories. Develop plans 30 September 2012 for delivery of prepared trajectories

Quarter 3: 1 October 2012 to Delivery of the plans. Understand 31 December 2012 any variance by provider for each high impact innovation

Quarter 4: 1 January 2013 to Measure and monitor output to 31 March 2013 confirm delivery of trajectory. Understand any variance by provider for each high impact innovation

3.47 Progress reviews of baselines and the trajectories for improvement will take place in November 2012.

3.48 The specific timetable in each Primary Care Trust cluster related to each CQUIN measure is included in Appendix 4.

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Examples of high impact innovations in NHS South of England

3.49 Figure 1 shows an example of each of the six high impact innovations in action in NHS South of England. The examples illustrate that each innovation can be delivered in practice, usually with financial benefits to the NHS, and that the challenge is to gain further adoption and spread throughout NHS South of England.

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Figure 1: Examples of high impact innovations in NHS South of England

Growing the use of assistive technologies: three million lives - Building telecare in Cornwall – NHS Cornwall and Isles of Scilly and Cornwall County Council  One of three national whole system demonstrator sites, now a pathfinder site looking to support 10,000 people with assistive technology.  Groups supported are those at risk of falls, people with long term conditions, learning disabilities or dementia, and carers. The current referral rate is over 50 patients per month with net growth of over 30 patients per month.  Aims to support earlier discharge, meet previously unmet needs, delay admission to residential or nursing care, reduce care visits, provide reassurance for staff and improved support for family and carers.  The service demonstrated savings after 450 patients and aims to save £500,000 per annum by reducing avoidable admissions to hospital. Digital First – interactive voice response for people with respiratory disease – East Berkshire  A digital system for patients with Chronic Obstructive Pulmonary Disease at Berkshire Healthcare NHS Foundation Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust.  The interactive system calls the 65 patients twice a week and asks five questions about their symptoms. Patients use the telephone keypad to answer.  On average, 25 admissions to hospital are avoided every month, saving 1,800 bed days a year and equating to a financial saving of £900,000 over a year. Intra-operative fluid management – Royal Devon and Exeter NHS Foundation Trust  Use of Oesophageal Doppler monitoring techniques in major and high risk surgery.  Benefits are 2 day reduction in length of stay, 23% decrease in central venous catheter insertions, reduction in complications of over 50% when used in Critical Care and better patient experience.  Cost saving of £1,100 per patient, could save the NHS £400 million annually if used for all applicable patients. Support for carers of people with dementia - Sussex Dementia Partnership  A whole system collaborative approach by all 11 health and social care organisations in Sussex focused on improving dementia services.  Model now being spread out to Oxfordshire and Buckinghamshire, supported by an award from NHS South of England.  Aims to provide the best quality dementia care in England by diagnosing more people more quickly and providing support to them and their carers to keep them independent for as long as possible, improve their quality of life and prevent hospital admissions. International and commercial activity – cannula fixing – East Kent Hospitals University NHS Foundation Trust  Reduces the likelihood of movement or detachment of a cannula. There are no significant cost implications for users in switching to the new design. The only alternative solution is almost 10 times more expensive.  Use of the new cannula-fixing could save the NHS up to £50 million per year.  The innovation was developed by East Kent Hospitals University NHS Foundation Trust with NHS Innovation South East and is now licensed to a British company with established overseas markets. East Kent Hospitals University NHS Foundation Trust will receive royalties. Child in a chair in a day – NHS Plymouth in partnership with Millbrook Healthcare and Whizz-Kidz  NHS Plymouth is working in partnership with Millbrook Healthcare and the charity Whizz-Kidz to to enhance wheelchair service delivery for disabled children and young people.  Aims to aims to eliminate waiting lists, save 60% on previous equipment costs, provide assessment, equipment and support to all service users and families, link users to Whizz-Kidz wheelchair skills and life skills training.  Most young people take home the right equipment on the day of assessment.

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Section 4

Next steps

This section sets out the next steps and timetable in NHS South of England for the implementation of Innovation Health and Wealth.

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Page 28 of 128

4. Next steps

4.1 The next steps and timetable during 2012/13 for the implementation of Innovation Health and Wealth are summarised in Table 6.

Table 6: Next steps and timetable in 2012/13

Action Lead Due by

Conference call with Director of 19 September 2012 named innovation Programmes and directors in Patient Experience commissioners and providers Confirmation of Chief Executives of 21 September 2012 compliance with NHS providers and Technology Appraisals Primary Care Trust clusters Submission of draft Director of 25 September 2012 Implementation Plan to Programmes and Department of Health Patient Experience Academic Health Science Director of 30 September 2012 Network applications Programmes and submitted Patient Experience Review meeting with Programme Director – 2 October 2012 Department of Health Health Policy and Transition/ Deputy Chief Operating Officer Commission analysis of Director of 9 October 2012 actual versus expected Programmes and uptake rates by Primary Patient Experience Care Trust cluster Receive Primary Care Director of 31 October 2012 Trust cluster responses Programmes and on uptake rates Patient Experience Performance reviews of Deputy Chief 30 November 2012 baselines for high impact Operating Officer with innovations and progress Directors of with agreed actions for Performance Quarter 1 Decision on Academic Director of 15 December 2012 Health Science Programmes and applications announced Patient Experience Further conference call Director of 31 December 2012 with named directors Programmes and leading on innovation Patient Experience

Page 29 of 128

Action Lead Due by

Performance review of Deputy Chief 31 January 2013 delivery for Quarter 2 and Operating Officer with progress with agreeing Directors of CQUIN and plan for Performance 2013/14 Resubmission of Director of 28 February 2013 Academic Health Science Programmes and Network applications if Patient Experience required Support Clinical Director of 31 March 2013 Commissioning Groups in Programmes and preparing for their new Patient Experience legal duty on promoting and Director of innovation Commissioning Development Contracts signed for Accountable Officers 31 March 2013 2013/14 which of Clinical demonstrate intended Commissioning compliance with CQUIN Groups gateway for Innovation

Page 30 of 128

Appendices

Appendix 1 Compliance with technology appraisals

Appendix 2 Schedule of CQUIN incentives to support high impact innovations

Appendix 3 Assumptions in setting ambitions and expectations for the six high impact changes 2012/13 to 2015/16

Appendix 4 Primary Care Trust cluster delivery plans 2012/13

Page 31 of 128

Page 32 of 128

Appendix 1

Compliance with technology appraisals

This appendix sets out the questionnaire to obtain assurance of implementation of technology appraisals published by the National Institute for Health and Clinical Excellence

Page 33 of 128

Appendix 1

Page 34 of 128

Appendix 1

Compliance with technology appraisals

National Institute for Health and Clinical Excellence Technology Appraisals - assurance questionnaire

NHS Trust or NHS Foundation Trust Host Primary Care Trust Date Name of person completing this template Person Completing - email address Person Completing - Phone Number

Are agreed clinical Has funding been Outcome of protocols in place and Has the recommendation in the made available by Guidance being used to ensure TA been implemented in the the local NHS for the Green new that the TA intervention TA organisation for example by Technology NOTES TA Subject recommendation is introduced. Number changes to the local formulary Appraisal in line used in the treatment Red end use for drugs or procurement of with Directions from of patients? of existing devices? (yes/no/not applicable) the Secretary of (yes/no/not intervention State (yes/no) applicable)

TA1 Wisdom teeth - removal (TA1) Hip disease - replacement

TA2 prostheses (TA2) Asthma (children under 5) -

TA10 inhaler devices (TA10) Motor neurone disease -

TA20 riluzole (TA20) Brain cancer - temozolomide

TA23 (TA23) TA25 Pancreatic cancer -

Page 35 of 128

Appendix 1

gemcitabine (TA25) Leukaemia (lymphocytic) -

TA29 fludarabine (TA29) Multiple sclerosis - beta interferon and glatiramer TA32 acetate (TA32) Breast cancer - trastuzumab

TA34 (TA34) Arthritis (juvenile idiopathic) -

TA35 etanercept (TA35) Asthma (older children) -

TA38 inhaler devices (TA38) Hip disease - metal on metal

TA44 hip resurfacing (TA44) Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors

(review) (TA47) (partially

TA47 updated by CG94) Renal failure - home versus

TA48 hospital haemodialysis (TA48) Central venous catheters -

TA49 ultrasound locating devices

Page 36 of 128

Appendix 1

(TA49) Myocardial infarction -

TA52 thrombolysis (TA52) Diabetes (types 1 and 2) - long acting insulin analogues

TA53 (TA53) Ovarian cancer - paclitaxel

TA55 (review) (TA55) Electroconvulsive therapy

TA59 (ECT) (TA59) Diabetes (types 1 and 2) - patient education models

TA60 (TA60) Colorectal cancer - capecitabine and tegafur

TA61 uracil (TA61) Growth hormone deficiency (adults) - human growth

TA64 hormone (TA64) Non-Hodgkin's lymphoma -

TA65 rituximab (TA65) TA68 Macular degeneration (age-

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Appendix 1

related) - photodynamic

therapy (TA68) Cervical cancer - cervical

TA69 screening (review) (TA69) Leukaemia (chronic myeloid) - imatinib (TA70) (partially

TA70 updated by TA241 and TA251) Ischaemic heart disease -

TA71 coronary artery stents (TA71) Angina and myocardial infarction - myocardial

TA73 perfusion scintigraphy (TA73) Trauma - fluid replacement

TA74 therapy (TA74) Hepatitis C - pegylated interferons, ribavirin and alfa

TA75 interferon (TA75) Insomnia - newer hypnotic

TA77 drugs (TA77) Menstrual bleeding - fluid- filled thermal balloon and TA78 microwave endometrial

Page 38 of 128

Appendix 1

ablation (TA78)

Atopic dermatitis (eczema) -

TA81 topical steroids (TA81) Atopic dermatitis (eczema) - pimecrolimus and tacrolimus

TA82 (TA82) Hernia - laparoscopic surgery

TA83 (review) (TA83) Renal transplantation - immuno-suppressive regimens

TA85 (adults) (TA85) Gastrointestinal stromal

TA86 tumours - imatinib (TA86) Bradycardia - dual chamber

TA88 pacemakers (TA88) Ovarian cancer (advanced) - paclitaxel, pegylated liposomal

doxorubicin hydrochloride and

TA91 topotecan (review) (TA91) Tooth decay - HealOzone

TA92 (TA92)

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Appendix 1

Cardiovascular disease -

TA94 statins (TA94) Arrhythmia - implantable cardioverter defibrillators

TA95 (ICDs) (review) (TA95) Hepatitis B (chronic) - adefovir dipivoxil and pegylated

TA96 interferon alpha-2a (TA96) Depression and anxiety - computerised cognitive

behavioural therapy (CCBT)

TA97 (TA97) Attention deficit hyperactivity disorder (ADHD) - methylphenidate,

atomoxetine and dexamfetamine (review)

TA98 (TA98) Renal transplantation - immunosuppressive regimens

for children and adolescents

TA99 (TA99)

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Appendix 1

Colon cancer (adjuvant) - capecitabine and oxaliplatin

TA100 (TA100) Prostate cancer (hormone-

TA101 refractory) - docetaxel (TA101) Conduct disorder in children - parent-training/education

TA102 programmes (TA102) Psoriasis - efalizumab and

TA103 etanercept (TA103) Colorectal cancer - laparoscopic surgery (review)

TA105 (TA105) Hepatitis C - peginterferon alfa

TA106 and ribavirin (TA106) Breast cancer (early) -

TA107 trastuzumab (TA107) Breast cancer (early) -

TA108 paclitaxel (TA108) Breast cancer (early) -

TA109 docetaxel (TA109) TA112 Breast cancer (early) -

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Appendix 1

hormonal treatments (TA112) Drug misuse - methadone and

TA114 buprenorphine (TA114) Drug misuse - naltrexone

TA115 (TA115) Breast cancer - gemcitabine

TA116 (TA116) Hyperparathyroidism -

TA117 cinacalcet (TA117) Colorectal cancer (metastatic) - bevacizumab and cetuximab

(TA118) (partially updated by

TA118 TA242) Leukaemia (lymphocytic) -

TA119 fludarabine (TA119) Heart failure - cardiac

TA120 resynchronisation (TA120) Glioma (newly diagnosed and high grade) - carmustine

implants and temozolomide

TA121 (TA121) TA122 Ischaemic stroke (acute) -

Page 42 of 128

Appendix 1

alteplase (TA122) Smoking cessation -

TA123 varenicline (TA123) Lung cancer (non-small-cell) -

TA124 pemetrexed (TA124) Multiple sclerosis -

TA127 natalizumab (TA127) Haemorrhoid - stapled

TA128 haemorroidopexy (TA128) Multiple myeloma -

TA129 bortezomib (TA129) Rheumatoid arthritis - adalimumab, etanercept and

TA130 infliximab (TA130) Asthma (in children) -

TA131 corticosteroids (TA131) Hypercholesterolaemia -

TA132 ezetimibe (TA132) Asthma (uncontrolled) -

TA133 omalizumab (TA133)

TA134 Psoriasis - infliximab (TA134) TA135 Mesothelioma - pemetrexed

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Appendix 1

disodium (TA135) Structural neuroimaging in first-episode psychosis

TA136 (TA136) Lymphoma (follicular non-

TA137 Hodgkin's) - rituximab (TA137) Asthma (in adults) -

TA138 corticosteroids (TA138) Sleep apnoea - continuous positive airway pressure

TA139 (CPAP) (TA139) Ulcerative colitis (subacute manifestations) - infliximab

TA140 (TA140) Anaemia (cancer-treatment induced) - erythropoietin

(alpha and beta) and

TA142 darbepoetin (TA142) Ankylosing spondylitis - adalimumab, etanercept and

TA143 infliximab (TA143) TA145 Head and neck cancer -

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Appendix 1

cetuximab (TA145) Psoriasis - adalimumab

TA146 (TA146) Lung cancer (non-small-cell) - bevacizumab (terminated

TA148 appraisal) (TA148) Glioma (recurrent) - carmustine implants

TA149 (terminated appraisal) (TA149) Diabetes - insulin pump

TA151 therapy (TA151) Coronary artery disease -

TA152 drug-eluting stents (TA152)

TA153 Hepatitis B - entecavir (TA153) Hepatitis B - telbivudine

TA154 (TA154) Macular degeneration (age- related) - ranibizumab and

TA155 pegaptanib (TA155) Pregnancy (rhesus negative women) - routine anti-D

TA156 (review) (TA156)

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Appendix 1

Venous thromboembolism -

TA157 dabigatran (TA157) Influenza (prophylaxis) - amantadine, oseltamivir and

TA158 zanamivir (TA158) Pain (chronic neuropathic or ischaemic) - spinal cord

TA159 stimulation (TA159) Osteoporosis - primary

TA160 prevention (TA160) Osteoporosis - secondary prevention including

TA161 strontium ranelate (TA161) Lung cancer (non-small-cell) -

TA162 erlotinib (TA162) Ulcerative colitis (acute exacerbations) - infliximab

TA163 (TA163) Hyperuricaemia - febuxostat

TA164 (TA164)

Organ preservation (renal) - TA165 machine perfusion and static

Page 46 of 128

Appendix 1

storage (TA165)

Hearing impairment - cochlear

TA166 implants (TA166) Abdominal aortic aneurysm - endovascular stent-grafts

TA167 (TA167) Influenza - zanamivir, amantadine and oseltamivir

TA168 (review) (TA168) Renal cell carcinoma -

TA169 sunitinib (TA169) Venous thromboembolism -

TA170 rivaroxaban (TA170) Multiple myeloma -

TA171 lenalidomide (TA171) Head and neck cancer (squamous cell carcinoma) -

TA172 cetuximab (TA172) Hepatitis B - tenofovir

TA173 disoproxil fumarate (TA173) TA174 Leukaemia (chronic

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Appendix 1

lymphocytic, first line) -

rituximab (TA174) Lung cancer (non-small-cell, second line) - gefitinib

TA175 (terminated appraisal) (TA175) Colorectal cancer (first line) -

TA176 cetuximab (TA176) Eczema (chronic) - alitretinoin

TA177 (TA177)

TA178 Renal cell carcinoma (TA178) Gastrointestinal stromal

TA179 tumours - sunitinib (TA179) Psoriasis - ustekinumab

TA180 (TA180) Lung cancer (non-small-cell, first line treatment) -

TA181 pemetrexed (TA181) Acute coronary syndrome -

TA182 prasugrel (TA182) Cervical cancer (recurrent) -

TA183 topotecan (TA183) TA184 Lung cancer (small-cell) -

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Appendix 1

topotecan (TA184) Soft tissue sarcoma -

TA185 trabectedin (TA185) Rheumatoid arthritis -

TA186 certolizumab pegol (TA186) Crohn's disease - infliximab (review) and adalimumab

TA187 (review of TA40) (TA187) Human growth hormone (somatropin) for the

treatment of growth failure in

TA188 children (review) (TA188) Hepatocellular carcinoma (advanced and metastatic) -

TA189 sorafenib (first line) (TA189) Lung cancer (non-small-cell) - pemetrexed (maintenance)

TA190 (TA190) Gastric cancer (advanced) -

TA191 capecitabine (TA191) Lung cancer (non-small-cell,

TA192 first line) - gefitinib (TA192)

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Appendix 1

Leukaemia (chronic lymphocytic, relapsed) -

TA193 rituximab (TA193) Bone loss (therapy-induced) in non-metastatic prostate

cancer - denosumab

TA194 (terminated appraisal) (TA194) Rheumatoid arthritis - drugs for treatment after failure of a

TA195 TNF inhibitor (TA195) Gastrointestinal stromal tumours - imatinib (adjuvant)

TA196 (TA196) Atrial fibrillation -

TA197 dronedarone (TA197) Psoriatic arthritis - etanercept, infliximab and adalimumab

TA199 (TA199) Hepatitis C - peginterferon alfa

TA200 and ribavirin (TA200) Asthma (in children) -

TA201 omalizumab (TA201)

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Appendix 1

Chronic lymphocytic leukaemia - ofatumumab

TA202 (TA202) Diabetes (type 2) - liraglutide

TA203 (TA203) Osteoporotic fractures -

TA204 denosumab (TA204) Thrombocytopenic purpura -

TA205 eltrombopag (TA205) Lymphoma (non-Hodgkin's) - bendamustine (terminated

TA206 appraisal) (TA206) Mantle cell lymphoma (relapsed) - temsirolimus

TA207 (terminated appraisal) (TA207) Gastric cancer (HER2-positive metastatic) - trastuzumab

TA208 (TA208) Gastrointestinal stromal tumours

(unresectable/metastatic) -

TA209 imatinib (TA209)

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Appendix 1

Vascular disease - clopidogrel

TA210 and dipyridamole (TA210) Constipation (women) -

TA211 prucalopride (TA211) Colorectal cancer (metastatic)

TA212 - bevacizumab (TA212) Schizophrenia - aripiprazole

TA213 (TA213) Breast cancer - bevacizumab (in combination with a taxane)

TA214 (TA214) Renal cell carcinoma (first line metastatic) - pazopanib

TA215 (TA215) Leukaemia (lymphocytic) -

TA216 bendamustine (TA216) Alzheimer's disease - donepezil, galantamine,

rivastigmine and memantine

TA217 (TA217) Myelodysplastic syndromes -

TA218 azacitidine (TA218)

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Appendix 1

Everolimus for the second-line treatment of advanced renal

TA219 cell carcinoma (TA219) Psoriatic arthritis - golimumab

TA220 (TA220) Thrombocytopenic purpura -

TA221 romiplostim (TA221) Ovarian cancer (relapsed) -

TA222 trabectedin (TA222) Peripheral arterial disease - cilostazol, naftidrofyryl

oxalate, pentoxifylline and

TA223 inositol nicotinate (TA223) Rheumatoid arthritis (methotrexate-naïve) -

golimumab (terminated

TA224 appraisal) (TA224) Rheumatoid arthritis (after the failure of previous anti-

rheumatic drugs) - golimumab

TA225 (TA225) TA226 Lymphoma (follicular non-

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Appendix 1

Hodgkin's) - rituximab (TA226) Lung cancer (non-small-cell, advanced or metastatic maintenance treatment) - erlotinib (monotherapy)

TA227 (TA227) Multiple myeloma (first line) - bortezomib and thalidomide

TA228 (TA228) Macular oedema (retinal vein occlusion) - dexamethasone

TA229 (TA229) Myocardial infarction (persistent ST-segment

elevation) - bivalirudin

TA230 (TA230) Depression - agomelatine

TA231 (terminated appraisal) (TA231) Epilepsy (partial) - retigabine

TA232 (adjuvant) (TA232) Ankylosing spondylitis -

TA233 golimumab (TA233)

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Appendix 1

Rheumatoid arthritis -

TA234 abatacept (2nd line) (TA234) Osteosarcoma - mifamurtide

TA235 (TA235) Acute coronary syndromes -

TA236 ticagrelor (TA236) Macular oedema (diabetic) -

TA237 ranibizumab (TA237) Arthritis (juvenile idiopathic, systemic) - tocilizumab

TA238 (TA238) Breast cancer (metastatic) -

TA239 fulvestrant (TA239) Colorectal cancer (metastatic) - panitumumab (terminated

TA240 appraisal) (TA240) Leukaemia (chronic myeloid) - dasatinib, nilotinib, imatinib

TA241 (intolerant, resistant) (TA241) Colorectal cancer (metastatic) 2nd line - cetuximab, TA242 bevacizumab and

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Appendix 1

panitumumab (review)

(TA242) Follicular lymphoma -

TA243 rituximab (review) (TA243) Chronic obstructive pulmonary disease -

TA244 roflumilast (TA244) Venous thromboembolism - apixaban (hip and knee

TA245 surgery) (TA245) Venom anaphylaxis - immunotherapy pharmalgen

TA246 (TA246) Rheumatoid arthritis - tocilizumab (rapid review

TA247 TA198) (TA247) Diabetes (type 2) - exenatide

TA248 (prolonged release) (TA248) Atrial fibrillation - dabigatran

TA249 etexilate (TA249) Breast cancer (advanced) -

TA250 eribulin (TA250)

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Appendix 1

Leukaemia (chronic myeloid, first line) - dasatinib, nilotinib

and standard-dose imatinib

TA251 (TA251) Hepatitis C (genotype 1) -

TA252 telaprevir (TA252) Hepatitis C (genotype 1) -

TA253 boceprevir (TA253) Multiple sclerosis (relapsing- remitting) - fingolimod

TA254 (TA254) Prostate cancer - cabazitaxel

TA255 (TA255) Atrial fibrillation (stroke prevention) - rivaroxaban

TA256 (TA256) Breast cancer (metastatic hormone-receptor) - lapatinib

and trastuzumab (with

TA257 aromatase inhibitor) (TA257)

Lung cancer (non small cell, TA258 EGFR-TK mutation positive) -

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Appendix 1

erlotinib (1st line) (TA258)

Prostate cancer (metastatic, castration resistant) -

abiraterone (following cytoxic

TA259 therapy) (TA259) Migraine (chronic) - botulinum

TA260 toxin type A (TA260) Venous thromboembolism (treatment and long term

secondary prevention) -

TA261 rivaroxaban (TA261) Ulcerative colitis (moderate to severe, second line) -

adalimumab (terminated

TA262 appraisal) (TA262) Bevacizumab in combination with capecitabine for the first-

line treatment of metastatic

TA263 breast cancer (TA263)

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Appendix 2

Schedule of CQUIN incentives to support high impact innovations

This appendix sets out the schedule of CQUIN incentives by provider in each Primary Care Trust cluster to support implementation of the six high impact innovations.

Page 59 of 128

Page 60 of 128

Appendix 2

Appendix 2 Schedule of CQUIN incentives to support high impact innovations

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s South Central Heatherwoo Berkshire East d and and West PCT Acute 0 180 0 0 180 0 359 359 Wexham Cluster Park NHS FT Berkshire Communit  Healthcare y/ Mental  0 0 0   0 861 NHS FT Health Royal  Berkshire Acute 0 193 193 0 386 0 771 771 NHS FT Sub total 0 372 193 0 565 0 1130 1991 NHS Southampton City, NHS University Hampshire, Isle Hospital Acute   0 0  0 0 1770 of Wight PCT Southampton and NHS NHS FT Portsmouth (SHIP Cluster) Portsmouth  Acute    0   0 1571 Hospitals

Page 61 of 128

Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s NHS Trust Hampshire  Hospitals Acute   0 0   0 1162 NHS FT Southern Communit  Health NHS  0 0 0 0 0 0 378 y FT Southern Mental  Health NHS 0 0 0 0 0  0 TBC Health FT Acute/Me ntal Health/Co  Isle of Wight    0   0 365 mmunity/ Ambulanc e South Central Ambulance Ambulanc   0 0 0  0 0 516 Service NHS e Trust Frimley Park  Hospital NHS Acute   0 0   0 1114 FT  Solent NHS Communit  0  0   0 474

Page 62 of 128

Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Trust y Solent NHS Mental  0 0 0 0 0 0 0 848 Trust Health Sub total 0 0 0 0 0 0 0 8198 NHS Buckinghams Buckinghamshir Acute and hire e and NHS Communit 324 324 324 0 324 0 1295 1295 Healthcare Oxfordshire y NHS Trust Cluster Oxford University  Acute 410 410 137 0 410 0 1367 1367 Hospital NHS Trust Oxford Mental  Health NHS 104 0 0 0 104 0 207 207 Health FT Oxford Communit  Health NHS 101 0 0 0 101 0 202 202 y FT Sub total 938 734 460 0 938 0 3071 3071 South Central Total 938 1106 653 0 1503 0 4201 13260

Page 63 of 128

Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s South East Coast Dartford and Kent & Medway Gravesham Acute  0 0 0  0 0 362 PCT Cluster NHST East Kent Hospitals NHS  Acute  0 0 0  0 0 1342 University Foundation Trust Maidstone and  Acute  0 0 0  0 0 681 Tunbridge Wells NHST Medway NHS  Foundation Acute  0 0 0  0 0 584 Trust Kent Communit  Community  0  0  0 0 913 y NHST Medway Communit  Community  0 0 0  0 0 232 y Healthcare

Page 64 of 128

Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Kent and Medway NHS Mental  & Social Care  0 0 0  0 0 156 Health Partnership Trust South East Coast Ambulanc  0 0 0 0  0 0 298 Ambulance e NHST Sub total 0 0 0 0 0 0 0 4568 Brighton and Sussex Sussex PCT University Acute    0   0 1779 Cluster Hospitals NHS Trust Western Sussex  Acute   0 0  0 0 1442 Hospitals NHS Trust East Sussex  Hospitals Integrated    0   0 1584 NHS Trust Queen  Acute   0 0  0 0 230 Victoria

Page 65 of 128

Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Hospital NHS Foundation Trust Sussex Partnership  NHS MH 85 0 0 0 85 165 335 335 Foundation Trust Surrey and Sussex  Acute    0   0 899 Healthcare NHS Trust Sussex Communit  Community    0   0 670 y Trust Sub total 85 0 0 0 85 165 335 6938 Surrey PCT Royal Surrey Acute 0 TBC Cluster County Ashford St  Acute 0 TBC Peters Surrey Numbers are still being confirmed Communit  Community 0 TBC y Health  Surrey & Mental 0 TBC

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Borders Health Partnership Sub total 0 0 0 0 0 0 0 0 South East 85 0 0 0 85 165 335 11506 Coast Total South West NHS Bristol, North Somerset North Bristol Acute   0 0  0 0 1342 and South NHS Trust Gloucestershire University Hospitals  Bristol NHS Acute   0 0  0 0 1212 Foundation Trust Bristol Community Communit   0 0 0   0 126 Health y Services North Somerset Communit  Community  0 0 0   0 TBC y Health Services

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Weston Area  Health NHS Acute   - -  - 0 99 Trust Avon and Wiltshire Mental Mental  0 0 0 0  0 0 196 Health Health Partnership NHS Trust Sub total 0 0 0 0 0 0 0 2975 NHS Gloucestershi Gloucestershire re Hospitals Acute 0  0 0 0 0 0 392 and Swindon NHS FT PCT Cluster 2Gether NHS Mental  0 TBC FT Health Great Western Ambulanc  Ambulance 0 TBC e Numbers are still being confirmed Service NHS Trust Gloucestershi Communit  re Care 0 TBC y Services

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Great  Western Acute   0 0  0 0 248 Hospital Sub total 0 0 0 0 0 0 0 640 Taunton & Somerset NHS Somerset NHS Acute 59 59 0 0 59 0 177 177 PCT Cluster Foundation Trust Yeovil District Hospital NHS  Acute 105 105 0 0 105 0 315 315 Foundation Trust Somerset Mental  Partnership Health/Co 162 0 0 0 162 0 324 324 NHS FT mmunity Sub total 326 164 0 0 326 0 816 816 Royal Devon NHS Devon, and Exeter Plymouth and NHS Acute 0 0 0 0  0 0 631 Torbay Foundation Trust Northern  Acute 0 0 0 0  0 0 215 Devon

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Healthcare NHS Trust South West Ambulanc  Ambulance TBC TBC TBC TBC TBC TBC 0 0 e NHS Trust Devon Mental  Partnership TBC TBC TBC TBC TBC TBC 0 700 Health Trust Plymouth  Hospitals Acute TBC TBC TBC TBC TBC TBC 0 327 NHS Trust Plymouth Community Communit  TBC TBC TBC TBC TBC TBC 0 383 Healthcare y CiC South Devon Healthcare  Acute TBC TBC TBC TBC TBC TBC 0 220 Foundation Trust T(SD)CT Communit  TBC TBC TBC TBC TBC TBC 0 44 Provider y Northern Communit  Devon 0 0 0 0  0 0 211 y Healthcare

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s NHS Trust Community Provider Sub total 0 0 0 0 0 0 0 2731 Dorset NHS Dorset County Bournemouth & Hospital NHS Acute Individual CQUIN categories have not yet been fully determined 0 751 Poole Foundation Trust Dorset HealthCare Communit University  y/Mental  0     0 400 NHS Health Foundation Trust Royal Bournemout h &  Christchurch Acute Individual CQUIN categories have not yet been fully determined 0 883 Hospital NHS Foundation Trust Poole  Acute Individual CQUIN categories have not yet been fully determined 0 782 Hospital NHS

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Appendix 2

4. 1. 3 million 2. 6. Carers 3. Child in Internation Total HI Total IHW lives/ Oesophageal 5. Digital for people PCT Cluster Type of a chair in al and CQUIN CQUIN Provider assistive doppler first - with Commissioner Contract a day - commercial Value Value technologie monitoring - £000s dementia £000s activity - £000s £000s s - £000s £000s - £000s £000s Foundation Trust Sub total 0 0 0 0 0 0 0 2816 NHS Bath and Royal United North East Hospitals Acute 0 215 0 0 622 0 837 837 Somerset and (Bath) Wiltshire  Salisbury FT Acute   0 0  0 0 451 Great Western Communit  Hospital  0 0 0  0 0 237 y Foundation Trust – WCHS Sub total 0 215 0 0 622 0 837 1525 NHS Cornwall Peninsula Communit and Isles of Community  0 0 0 0 0 0 279 y Scilly Health Royal Cornwall  Acute 688 0 0 0 688 0 1375 1375 Hospitals NHS Trust Cornwall Mental  Partnership Health/ TBC TBC TBC TBC TBC TBC 0 TBC NHS Learning

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Appendix 2

Sub total 688 0 0 0 688 0 1375 1654 South West 1014 379 0 0 1636 0 3028 13157 Total NHS South of 2037 1485 653 0 3224 165 7564 37923 England

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Appendix 2

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Appendix 3

Approach to setting ambitions and expectations for the six high impact innovations 2012/13 to 2015/16

This appendix sets out:

 the approach to setting regional expectations and ambitions for implementing the six high impact innovations in the delivery plans of each Primary Care Trust cluster;

 a sample delivery framework to support the adoption of the high impact innovations.

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Appendix 3

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Appendix 3

Approach to setting ambitions and expectations for the six high impact innovations 2012/13 to 2015/16

High impact innovation 2012/13 2013/14 2014/15 2015/16

Assistive technology Local exercise to set 2,500 people 3,500 people 5,500 people baseline performance supported per supported per supported per in Q1 2012/13. 100,000 100,000 population 100,000 population Produce an population (equivalent to 3 improvement plan with million lives for 2015 an expectation of at population estimate) least 2,000 people supported per 100,000 population

Fluid management Local exercise to set 200 cases 250 cases 400 cases baseline performance supported with supported with fluid supported with fluid in Q1 2012/13. fluid management per management per Produce an management per 100,000 population 100,000 population improvement plan with 100,000 per annum per annum an expectation of at population per least 150 cases annum supported per 100,000 population in February and March 2013

Child in a chair in a day Local review using All waits under 18 Maximum 6 weeks Continued delivery national template. weeks and 50% wait achieved in of standard Delivery of current of waits are 6 over 90% of cases target: maximum wait weeks or less of 18 weeks in over 90% of cases

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Appendix 3

High impact innovation 2012/13 2013/14 2014/15 2015/16

Digital first Local review to set a 30% of specified 50% of specified list 70% of specified list baseline using list of interactions of interactions of interactions forthcoming national taking place taking place digitally taking place digitally report plus a local digitally (see list (see list in Appendix (see list in Appendix measurable trajectory in Appendix 3) 3) 3) in this area

Carers for dementia Local exercise to set Year-on-year Year-on-year Year-on-year baseline performance increase of 10% increase of 10% per increase of 10% per in Q1 2012/13. per annum in annum in both annum in both Produce an both respite care respite care respite care improvement plan with available and available and available and an expectation of psychological psychological psychological demonstrable therapy therapy therapy improvement in volume programmes programmes programmes of respite care accessed accessed accessed provided to carers of people with dementia and increased access to psychological therapy programmes

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Appendix 3

High impact innovation 2012/13 2013/14 2014/15 2015/16

International activity Identify current activity Work through Work through Work through in this area. Contribute Academic Health Academic Health Academic Health to the development of Science Science Networks Science Networks the workplan of local Networks to co- to co-ordinate and to co-ordinate and Academic Health ordinate and deliver a deliver a Science Network in this deliver a programme of work programme of work area programme of on commercial on commercial work on benefits benefits commercial benefits

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Appendix 3

Sample delivery framework to support the adoption of the high impact innovations

High Impact Intra-Operative Fluid Management – Provider readiness Innovation Definition Use of various technologies and techniques in the operating theatre by Anaesthetists to optimise the perfusion of the patient’s vital organs during operation. For more information see: http://www.ntac.nhs.uk/Publications/TechnologyAdoptionPacks/Technology_Adoption_Packs.aspx And: http://www.innovation.nhs.uk/pg/dashboard KPIs Local provider to identify which of the OPCS codes on the NTAC list reflect locally undertaken operations and to support a minimum of 80% of such cases with IOFM technology in March 2013 (this is a local aspiration – it may be refined when the National Task and Finish Group reports) Structure Criteria Process Criteria Outcome Criteria  Local List of OPCS Codes derived from  System in place to ensure availability of  Record of number cases supported and the NTAC list that reflects all those on technology in theatres when relevant cases not supported (append please) the NTAC list that are performed locally are to be operated on  Data on impact on ITU usage available  Policies and Procedures in place  Capture of numbers of patient with a (append please)  Adequate volume of Machines relevant OPCS code that have and have  Data on impact on LOS available (append available not had IOFM technology support please)  Consumables available  Trained staff in place on relevant theatre  Delivery plan shared with PCT Cluster  Trained staff available lists  Progress re: Delivery plan (including  CQUIN in place in 2012-13  Recording LOS for cases supported and trajectory and investment ) is reported  Local strategy captured in a delivery not supported by IOFM plan which includes investment  Recording of ITU LOS for cases supported intentions and improvement trajectory and not supported by IOFM (increasing numbers over time)

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Appendix 4

Draft Primary Care Trust cluster delivery plans

This appendix sets out the draft delivery plans in each Primary Care Trust cluster in 2012/13 to support implementation of the six high impact innovations, based on the CQUIN schemes in each health community.

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Appendix 4

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Appendix 4

Appendix 4 Draft Primary Care Trust cluster delivery plans

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Berkshire Primary Care Trust Cluster Heatherwood 2. Oesophageal Full implementation of Intraoperative Provider and Utilise data from Utilise data from and Wexham Doppler Fluid Management Technologies. commissioner to IQUtopia, and IQUtopia, and Park NHS Monitoring Trust to establish criteria for agree a trajectory for undertake retrospective undertake Foundation Trust (ODM) monitoring. implementation of this audit to determine and retrospective audit to technology for record uptake of determine and record appropriate patient IOFMT for each of the uptake of IOFMT for groups. procedures in appendix each of the 3 of the IOMFT procedures in Adoption pack in Q3 & appendix 3 of the Q4. IOMFT Adoption pack Set up a quarterly in Q3 & Q4. Performance Set up a quarterly Dashboard. Performance Dashboard.

Heatherwood 5. Digital first By the end of Q1 the commissioner Jointly agreed action No narrative for Q3 No narrative for Q4 and Wexham and provider will have an plan, setting out Park NHS understanding of the current number increases in levels of Foundation Trust of digital contacts provided and the digital contacts with opportunities to improve on this. milestones and The jointly agreed action plan trajectories for should be targeted at reducing delivery for the follow up appointments in both remainder of the year. secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Berkshire 1. Assistive Assistive Technologies - Q1 and Q2 Outline of pilots to be Case studies and Healthcare NHS Technologies Telecare initiated in 12-13 presentation to Foundation Trust To map those services or patients that would benefit from including scope, PCT/CCGs on some form of Telecare system/intervention as per 3 Million applicable services, progress, results and lives objectives. staff and patients conclusion and BHFT has commenced discussion with all 6 UAs on a project numbers engaged in implementation plans to undertake data mining /tracking and analysis of patients the defined pilots. and timelines. This across health and social care. It is expected that the will also include initial combined data from both health and social care systems will findings from the be able to show current cost and interventions. Transforming By effectively targeting, in partnership with social care, Community Services patients who could benefit from a Telehealth solution and by project. evaluating the appropriate tools and methodology - We would expect to develop a targeted implementation plan on specific cohort of service users/service for 12-13 and implementation for 2013/14. Outline of pilots to be initiated in 12-13 including scope, applicable services, staff and patients numbers engaged in the defined pilots.

Berkshire 5.Digital first Digital first - improving accuracy and A detailed report of • BHFT want to Case studies and Healthcare NHS timeliness of information flow. the findings eliminate NCR presentation to Foundation Trust Baseline in Q1 the number of digital evaluating the discharge papers on PCT/CCGs on contacts within BHFT and in what principles of Baseless the wards and instead progress, results and capacity, and show trends quarter Working Pilot and the use email , which both conclusion and and quarter. BHFT will carry out a tools deployed will be improves depth of implementation plans Baseless working Pilot within a submitted in Q2 communication, and timelines for Community DN team aimed at submission to the legibility and improves 13/14 including increasing the amount of time commissioners. timeliness of investment. available to be with patients and Investigate and pilot information to Primary less returning to base. use of text messaging Care But these NCR for children to contact papers have a dual

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN school nurses. purpose, the second Evaluate being the provision of effectiveness of text drugs on discharge. messages for CAMHS BHFT will be service users and investigating e- their carers, including prescription tools and split between users /or ways to eliminate and carers. BHFT is NCR and allow currently evaluating discharge letters to be the rollout of the produced from RiO SHARON project whilst managing patient (www.sharon.nhs.uk) safety and governance across other services. around the supply of The first of these will drugs. It is only after be around a Young conducting this review Children (Community that BHFT will be able Health and CAMHS) to determine what will version of SHARON. be recommended for BHFT would expect to implementation and be able to roll this out agree timing. Details to in Q3. BHFT may be be submitted in Q3 able to do some returns Jan 2013 elements in Q2, this • BHFT aims to pilot A will become clearer in Transfer of Care Q1. Programme with the Evaluate view to ensuring that effectiveness of text when patients are messages for CAMHS discharged they, their service users and GPs and their their carers, including community pharmacies split between users all know what and carers. medications they are taking.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN BHFT will obtain patient consent, write pharmaceutical care plan for the patient (which contains information such as detailed cross titration? plans, details of how to withdraw sedatives, and any monitoring that is required long term for the medications (such as LFTs and TFTs which need monitoring every 3-6 months with some psychotropic meds) which are all missing from the preliminary discharge letters, and also often lacking in the discharge letters). BHFT will explore options to move away from a paper/fax based process to a digital solution and report the findings in Q3 returns Jan 2013.

Berkshire 6. Carers for Q1 Baseline the number of patients Q2 ,Q3,Q4 a % or Carers of People with Q3 To assess x Healthcare NHS People with with a recorded diagnosis of absolute number will Dementia number or % of carers Foundation Trust Dementia dementia and those that have an be agreed after Q1 Q2 ,Q3,Q4 a % or using the assessment

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN identified carer submission absolute number will be form to be agreed in improvement in those agreed after Q1 Q1 and to report that have both submission finding to the diagnosis and improvement in those commissioners in identified carers. that have both Q4 % of people Q2 Carer support diagnosis and identified defined as in need of assessment form to carers. Respite Care, be defined including Q3 To assess x signposted to by Emotional, number or % of carers locality and to which psychological and using the assessment organisation. Review social needs of carers form to be agreed in Q1 results and in Q4 and signposting tool and to report finding to submission kit to be developed to the commissioners in recommend approach either other services Q4 % of people defined for 13/14. with BHFT and or as in need of Respite other agencies. Care, signposted to by Q2 BHFT will define locality and to which and agree with the organisation. Review commissioners how to results and in Q4 sensitively assess submission recommend respite care need. approach for 13/14. Our aim is to attempt to support those in crisis and not give false hope of respite care in a health and social economy under enormous strain.

Royal Berkshire 2. ODM Intraoperative Fluid Management Q2: Run codes from Q3: Provider and Q4: TBC in October NHS Foundation Technologies Appendix 3 of the commissioner to meet

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Trust Q1: Provider to undertake a scoping Adoption Pack, to agree Q4 targets. clinical audit across previous 3 full financial years and 12/13 to date. Define scope of project including relevant success measures such as length of stay.

Royal Berkshire 3. Child in a Q1: Receipt of full Q1 dataset, and Q2: Collect data and Q3: Meet to agree final Q4: Delivery of NHS Foundation Chair in a Day agreement of trajectory. set-up supply chain Q4 target trajectory. Trust

Royal Berkshire 5. Digital first Young People's Digital Diabetes No milestones No milestones narrative No milestones NHS Foundation Clinic narrative narrative Trust No milestones narrative

Royal Berkshire 5. Digital first Reducing Inappropriate Face To Q2: TBC Q3: TBC Q4: TBC NHS Foundation Face Contacts Trust Q1: Jointly agreed action plan, setting out increases in levels of digital contacts with milestones and trajectories for delivery for the remainder of the year.

Southampton, Hampshire, Isle of Wight and NHS Portsmouth Primary Care Trust Cluster University 1. Assistive Quarter 1: provider and Compliance report Compliance report Full delivery of plan, Hospital Technologies commissioner agreed plan. against agreed against agreed milestones and Southampton milestones and milestones and trajectory as NHS Foundation 2. ODM trajectories. If trajectories. developed in Quarters Trust National Guidance is 1, 2 and 3.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN University 5. Digital first issued, to review Hospital implementation and Southampton agree actions. NHS Foundation Trust Portsmouth 1. Assistive Provider and commissioner agreed Compliance report Compliance report Full delivery of plan, Hospitals NHS Technologies plan. against agreed against agreed milestones and Trust milestones and milestones and trajectory. 2. ODM trajectories. trajectories.

3. Child in a Chair in a Day

5. Digital first

6. Carers for People with Dementia Hampshire 1. Assistive Report and action plan to be The Provider to Progress report to Progress report to Hospitals NHS Technologies submitted to Commissioner undertake a ‘stock Commissioner Commissioner Foundation Trust demonstrating take’ across the demonstrating demonstrating 2. ODM • how the Provider will engage the organisation to compliance with compliance with Board and Senior Management in identify all existing improvement plan and improvement plan and 5. Digital first delivering the 5 high impact and planned performance against performance against innovations innovations relating to trajectories. trajectories. 6. Carers for • how the Provider will develop a the 5 high impact People with culture of innovation within the innovations in this Dementia organisation CQUIN. • the Provider’s process for evaluating and implementing NICE The provider to review Technological Appraisals, to available evidence, improve uptake. including NICE guidance (e.g. MTG3:

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Review baseline information on the ODM 03/11 and numbers of people already CG42 Dementia supported by assistive technology 11/06) (telehealth) – Provider and Commissioner to agree baseline Report of ‘stock take’ figure. and review to be submitted to the Provider to identify current levels of Commissioner digital contacts and agree with Commissioner Provider and Commissioner to Provider inpatient surgical services agree an to participate in SHA regional work improvement plan to develop a regional ‘basket’ of based on the findings procedures that are considered of the ‘stock take’, to most amenable to inter-operative include trajectories fluid management. where appropriate e.g. % reduction in inappropriate face to face contacts; ODM technology for agreed appropriate patient groups.

Business case/s to be developed where required to develop service/s for submission to the Commissioner. Southern Health 1. Assistive To implement and evaluate the pilot Compliance report Compliance report Full delivery of plan, NHS Foundation Technologies use of telehealth as assistive against agreed against agreed milestones and Trust – technologies in the delivery of milestones and milestones and trajectory.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Community community health services providing trajectories. trajectories. a comparison between the effectiveness in Community Care Teams and more specialist areas. In the South East specialist heart failure, COPD and Diabetes staff and patients will form the pilot cohort. Elsewhere the pilots will be within CCTs. Q1: Provider and commissioner agreed plan.

Southern Health 6. Carers for No milestones narrative as yet. No milestones No milestones narrative No milestones NHS Foundation People with narrative as yet. as yet. narrative as yet. Trust – Mental Dementia Health

Isle of Wight 1. Assistive Report and action plan to be The Provider to Progress report to Progress report to Technologies submitted to Commissioner undertake a ‘stock Commissioner Commissioner demonstrating take’ across the demonstrating demonstrating 2. ODM • how the Provider will engage the organisation to compliance with compliance with Board and Senior Management in identify all existing improvement plan and improvement plan and 3. Child in a delivering the 5 high impact and planned performance against performance against Chair in a Day innovations innovations relating to trajectories. By trajectories. By • how the Provider will develop a the 5 high impact 31.12.12 28.02.2013 5. Digital first culture of innovation within the innovations in this organisation CQUIN. 6. Carers for • the Provider’s process for The provider to review People with evaluating and implementing NICE available evidence, Dementia Technological Appraisals, to including NICE improve uptake. guidance (e.g. MTG3: Review baseline information on the ODM 03/11 and

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN numbers of people already CG42 Dementia supported by assistive technology 11/06) (Telehealth) – Provider and Report of ‘stock take’ Commissioner to agree baseline and review to be figure. submitted to the Provider and Commissioner to Commissioner agree current wait times for non- Provider and complex and complex wheelchairs Commissioner to for children agree an • Referral to first contact improvement plan • First contact to order of chair based on the findings • Order to receipt of chair in working of the ‘stock take’, to order by the patient include trajectories Provider to identify current levels of where appropriate digital contacts and agree with e.g. % reduction in Commissioner inappropriate face to Provider inpatient surgical services face contacts; % of to participate in SHA regional work children receiving to develop a regional ‘basket’ of wheelchair equipment procedures that are considered they need on day of most amenable to inter-operative assessment, ODM fluid management. By 30.06.12 technology for agreed appropriate patient groups. Business case/s to be developed where required to develop service/s for submission to the Commissioner. By 30.09.12

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN South Central 1. Assistive No milestones narrative. No milestones No milestones No milestones Ambulance Technologies narrative. narrative. narrative. Service NHS Trust 5. Digital first

Frimley Park 1. Assistive 0.25% payable for developing a plan 0.25% payable for the Progress report to Progress report to Hospital NHS Technologies for innovation agreed by the hospital provider to undertake Commissioner Commissioner Foundation Trust executive board in June which will a ‘stock take’ across demonstrating demonstrating 2. ODM describe: the organisation to compliance with compliance with 1. How an assessment of the identify all existing improvement plan and improvement plan and 5. Digital first baseline of innovation in the 4 and planned performance against performance against CQUIN areas will be carried out. innovations relating to trajectories. By trajectories. By 6. Carers for Assessments to be completed by the relevant high 31.12.12 28.02.13 People with September 2012. impact innovations in Dementia 2. How target for improved use of the CQUIN. technology would be developed and By 30.09.12 agreed for commissioner sign off by October 2012 By 30.06.12

Solent NHS 1. Assistive Provider and commissioner agreed Compliance report Compliance report Full delivery of plan, Trust Technologies plan. against agreed against agreed milestones and (Community) milestones and milestones and trajectory. 3. Child in a trajectories. trajectories. Chair in a Day

5. Digital first

6. Carers for People with Dementia

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Solent NHS Innovations – the Provider to consider options and share proposal with Commissioner in order for Scheme(s) to be agreed by long Trust stop date of 31st May 2012. Should no appropriate scheme(s) be identified, the 0.25% allocation will be split equally between all (Mental Health) local schemes

Buckinghamshire and Oxfordshire Primary Care Trust Cluster Buckinghamshire 1. Assistive Telederm: Increase the number of Delivery of Q2 Delivery of Q3 Delivery of trajectory Healthcare NHS Technologies dermatology outpatient milestones milestones Trust appointments provided through technology outside the hospital setting. Q1 Agree milestones and trajectory for the delivery of the service 31.07.12

Buckinghamshire 2. ODM By end of Q1: Provider and Q2 milestone not Q3 milestone not Q4 milestone not Healthcare NHS commissioner to agree a trajectory specified. specified. specified. Trust for implementation of this technology for appropriate patient groups. Where Trusts have already implemented this technology, agreement needs to be reached around stretch targets around the level of goal directed fluid therapy for cases in the locally agreed basket of procedures. Agreement also needs to be reached to agree targets to reduce length of stay and ITU bed usage for elective surgical cases through the delivery of other complimentary actions.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Buckinghamshire 3. Child in a Improve waiting times for children Q2 milestone not Q3 milestone not Delivery of action Healthcare NHS Chair in a Day requiring wheelchairs. specified. specified. plan, milestones and Trust By end of Q1 Baseline established trajectory. and agreed.

Buckinghamshire 5. Digital first By the end of Q1 the commissioner Deliver Q2 milestone. Deliver Q3 milestone. Deliver Q4 milestone. Healthcare NHS and provider will have an Trust understanding of the current number of digital contacts provided and the opportunities to improve on this. The jointly agreed action plan should be targeted at reducing follow up appointments in both secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient. Jointly agreed action plan, setting out increases in levels of digital contacts with milestones and trajectories for delivery for the remainder of the year.

Oxford University 1. Assistive Electronic track and trigger July 2012 - October 2012 - January 2013 - March Hospitals NHS Technologies – (Expand the use of the electronic September 2012 Meet December 2012 Meet 2013 Meet Q4 targets Trust Electronic Track track and trigger tool.) Q2 targets according Q3 targets according to according to Q1 plan & Trigger April 2012 - June 2012 Agree to Q1 plan 01/10/2012 Q1 plan 01/01/2013 01/04/2013 baseline assessment and trajectory with PCT 01/07/2012

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Oxford University 1. Assistive mHealth (Improved outpatient July 2012 - October 2012 - January 2013 - March Hospitals NHS Technologies – management of women with September 2012 Meet December 2012 Meet 2013 Meet Q4 targets Trust mHealth gestational diabetes mellitus) Q2 targets according Q3 targets according to according to Q1 plan April 2012 - June 2012 Agree to Q1 plan 01/10/2012 Q1 plan 01/01/2013 01/04/2013 baseline assessment and trajectory with PCT 01/07/2012

Oxford University 2. ODM Implement the use of ODM across July 2012 - October 2012 - March October 2012 - March Hospitals NHS all appropriate clinical areas. September 2012 2013 Rollout use of 2013 Rollout use of Trust Participation in a regional working Stocktake/audit what technology if not technology if not group. technologies are already used already used currently being 01/04/2013. 01/04/2013. utilised, current usage levels and for which patient groups 01/10/2012.

Oxford University 3. Child in a Reduce waiting lists for all patients July 2012 - October 2012 - January 2013 - March Hospitals NHS Chair in a Day that require a wheelchair September 2012 Meet December 2012 Meet 2013 Meet Q4 targets Trust April 2012 - June 2012 Agree Q2 targets according Q3 targets according to according to Q1 plan baseline assessment and trajectory to Q1 plan Q1 plan 01/01/2013. 01/04/2013. with PCT 01/07/2012. 01/10/2012.

Oxford University 5. Digital first- Using technology to remotely July 2012 - October 2012 - January 2013 - March Hospitals NHS Digital support diagnose dermatological symptoms. September 2012 Meet December 2012 Meet 2013 Meet Q4 targets Trust in April 2012 - June 2012 Agree Q2 targets according Q3 targets according to according to Q1 plan dermatological baseline assessment and trajectory to Q1 plan Q1 plan 01/01/2013. 01/04/2013. diagnoses with PCT 01/07/2012. 01/10/2012.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Oxford University 5. Digital first- Increase in sending pathology July 2012 - October 2012 - January 2013 - March Hospitals NHS Use of ICE results to GPs via electronic format September 2012 Meet December 2012 Meet 2013 Meet Q4 targets Trust April 2012 - June 2012 Agree Q2 targets according Q3 targets according to according to Q1 plan baseline assessment and trajectory to Q1 plan Q1 plan 01/01/2013. 01/04/2013. with PCT 01/07/2012. 01/10/2012.

Oxford Health 1. Assistive Identify any assistive technologies July 2012 - December July 2012 - December January 2013 - March NHS Foundation Technologies that can be used in Oxford Health 2012 Meet Q2 targets 2012 Meet Q3 targets 2013 Meet Q4 targets Trust - Mental and deliver this across the Trust according to Q1 plan according to Q1 plan according to Q1 plan Health after agreeing targets with the PCT 01/10/2012. 01/01/2013. 01/04/2013. April 2012 - June 2012 Agree baseline assessment and trajectory with PCT 01/07/2012.

Oxford Health 5. Digital first Using technology to reduce the July 2012 - Meet Q2 July 2012 - Meet Q3 January 2013 - Meet NHS Foundation number of unnecessary face to face targets according to targets according to Q1 Q4 targets according Trust - Mental contacts Q1 plan 01/01/2014. plan. 01/01/2013 to Q1 plan 01/04/2014 Health April 2012 - June 2012 Agree baseline assessment and trajectory with PCT 01/07/2012.

Oxford Health 1. Assistive Identify any assistive technologies July 2012 - December July 2012 - December January 2013 - March NHS Foundation Technologies that can be used in Oxford Health 2012 Implement the 2012 Implement the 2013 Review the Trust - and deliver this across the Trust agreed plan agreed plan outcomes of assistive Community after agreeing targets with the PCT 01/01/2013. 01/01/2013. technology April 2012 - June 2012. Establish 01/04/2013. how assistive technology will be implemented and the technical requirements that need to be in place 01/07/2012.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Oxford Health 5. Digital first Using technology to reduce the July 2012 - December July 2012 - December January 2013 - March NHS Foundation number of unnecessary face to face 2012 Implement 2012 Implement digital 2013 Provide a report Trust - contacts. digital first within first within defined detailing progress and Community April 2012 - June 2012 Determine defined remit. remit. 01/01/2013 review of outcomes which services would benefit from 01/01/2013 from the tool digital first tools. 01/07/2012 01/04/2013

Kent and Medway Primary Care Trust Cluster Dartford and 1. Assistive Assistive Technologies and Digital Agreed No narrative for Q3 Delivery of agreed Gravesham NHS Technologies first: Q1. Baseline agreed on current implementation plan milestone. implementation Trust position in relation of the 2 to cover Q3 and Q4 trajectories 5. Digital first innovations and trajectory to end of financial year.

East Kent 1. Assistive Baseline agreed on current position Agreed No narrative for Q3 Delivery of agreed Hospitals NHS Technologies in relation of the 2 innovations and implementation plan milestone. implementation University trajectory to end of financial year. to cover Q3 and Q4. trajectories. Foundation Trust 5. Digital first

Maidstone and 1. Assistive Baseline agreed on current position Agreed No narrative for Q3 Delivery of agreed Tunbridge Wells Technologies in relation of the 2 innovations and implementation plan milestone. implementation NHS Trust trajectory to end of financial year. to cover Q3 and Q4. trajectories. 5. Digital first

Medway NHS 1. Assistive Baseline agreed on current position Agreed No narrative for Q3 Delivery of agreed Foundation Trust Technologies in relation of the 2 innovations and implementation plan milestone. implementation trajectory to end of financial year. to cover Q3 and Q4. trajectories. 5. Digital first

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Kent Community 1. Assistive Baseline agreed on current position Agreed No narrative for Q3 Delivery of agreed NHS Trust Technologies in relation of the innovations and implementation plan milestone. implementation trajectory to end of financial year. to cover Q3 and Q4. trajectories. 3. Child in a Chair in a Day

5. Digital first

Medway 1. Assistive This CQUIN will Incentivise the Presentation of Presentation of agreed Delivery of agreed Community Technologies identification, planning and agreed implementation plan to milestones and Healthcare implementation of a programme to implementation plan cover Q3 and Q4. agreement starting 5. Digital first develop the relevant high impact to cover Q3 and Q4. position for 13/14. innovations ready for the CQUIN gateway in 2013/14.The CQUIN will be divided into 3 parts: Q1. Identification and agreement of the relevant innovations. Q2: Presentation of agreed implementation plan to cover Q3 and Q4 Q4: Delivery of agreed milestones and agreement starting position for 13/14.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Kent and 1. Assistive Delivering threshold level activity on No narrative for Q2 No narrative for Q3 By Q4 the provider Medway NHS & Technologies HIIs to qualify for CQUIN gateways milestone. milestone. will have delivered Social Care in 2013/14. against the trajectory. Partnership Trust 5. Digital first By end of Q1 the provider will have a) identified the initiatives that will contribute to delivery of the HII; b) agreed trajectory (quarterly change) to implement these; c) agreed the intended starting position for 13/14; By end Q1 - agreed initiatives, trajectory, year-end (gateway) position (50%).

South East 5. Digital first Digital first is the most relevant to Agreed Agreed implementation Delivery of agreed Coast ambulance services, and this goal implementation plan plan to cover Q3 and implementation Ambulance NHS will support the electronic transfer of to cover Q3 and Q4. Q4. trajectories. Trust data to GPs and community based providers to minimise manual data entry and re-triage. Q1. Baseline agreed on current position in relation of the 3 innovations and trajectory to end of financial year.

Sussex Primary Care Trust Cluster

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Brighton and 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Sussex technologies IHW implementation plan for the milestone. milestone. milestone. University high impact actions relevant to their Hospitals NHS 2. ODM services. No further elaboration. Trust 3. Child in a Chair in a Day

5. Digital first

6. Carers for people with dementia

Western Sussex 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospitals NHS technologies IHW implementation plan for the milestone. milestone. milestone. Trust high impact actions relevant to their 2. ODM services. No further elaboration.

5. Digital first

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN East Sussex 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospitals NHS Technologies IHW implementation plan for the milestone. milestone. milestone. Trust high impact actions relevant to their 2. ODM services. No further elaboration.

3. Child in a Chair in a Day

5. Digital first

6. Carers for people with dementia

Queen Victoria 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospital NHS Technologies IHW implementation plan for the milestone. milestone. milestone. Foundation Trust high impact actions relevant to their 2. ODM services. No further elaboration.

5. Digital first

Sussex 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Partnership NHS Technologies IHW implementation plan for the milestone. milestone. milestone. Foundation Trust high impact actions relevant to their 5. Digital first services.

6. Carers for people with dementia

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Surrey and 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Sussex Technologies IHW implementation plan for the milestone. milestone. milestone. Healthcare NHS high impact actions relevant to their Trust 2. ODM services.

3. Child in a chair in a day

5. Digital first

6. Carers for people with dementia

Sussex 1. Assistive Providers will develop and deliver a No narrative for Q2 No narrative for Q3 No narrative for Q4 Community Trust Technologies IHW implementation plan for the milestone. milestone. milestone. high impact actions relevant to their 2. ODM services.

3. Child in a chair in a day

5. Digital first

6. Carers for people with dementia

Surrey Primary Care Trust Cluster

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Royal Surrey County

Ashford St Peters

Surrey Current position to be confirmed. Community Health

Surrey & Borders Partnership

Bristol, North Somerset and South Gloucestershire Primary Care Trust Cluster

North Bristol 1. Assistive Assistive technologies: By no later No narrative for Q2 No narrative for Q3 No narrative for Q4 NHS Trust Technologies than the end of Q1 commissioners milestones. milestones. milestones. and providers should be able to report on a quarterly basis the number of people who are being supported by assistive technology and set a trajectory for significantly increasing this by the end of Q3. This excludes patients supported through local authorities (even though nationally this is part of 3m lives). The plan to deliver this should be agreed by no later than the end of Q1. This should set out the schemes to be delivered, the milestones and the trajectory for delivery across the rest of the year. The CQUIN funding can be used to Page 104 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN pump prime initial costs of developing the scheme as well as reward for achievement and the CQUIN funding could be pooled across providers to support delivery if this was appropriate. It should be possible for providers to identify the number of people they provide Telehealth and Telecare services to and this would contribute to 3 million nationally. The local number of people receiving Telehealth and Telecare could be presented as a proportion of population.

North Bristol 2. ODM As well as participating in regional No narrative for Q2 No narrative for Q3 No narrative for Q4 NHS Trust work, providers will be expected to milestones. milestones. milestones. propose a trajectory for implementation of this technology for appropriate patient groups which is to be agreed with commissioners by no later than the end of Q1.

North Bristol 5. Digital first The expectation is that by the end of No narrative for Q2 No narrative for Q3 No narrative for Q4 NHS Trust Q1 the commissioner and provider milestones. milestones. milestones. have an understanding of the current number of digital contacts provided and the opportunities to improve on this. The provider is expected to lead on the work around identifying current levels of digital contacts with the commissioner and

Page 105 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN provider working jointly to agree the action plan. The action plan would be agreed by the end of Q1 and would set out a plan to increase levels of digital contacts with milestones and trajectories for delivery through the remainder of the year. In particular this should be targeted at reducing follow up appointments in both secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient. It is not expected that this trajectory will be delivered by starting to count activity which is currently delivered digitally; the CQUIN will be about improving on the current baseline. The long-term measure for commissioners is the ratio of face- to-face to non-face-to-face (i.e. digital) contacts in the provider with an expectation about improvement annually but commissioners may find it difficult to have complete data on the number of digital contacts from providers initially and therefore other proxy measures should be used.

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN University 1. Assistive Telemedicine No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospitals Bristol Technologies The plan to deliver this should be milestone. milestone. milestone. NHS Foundation agreed by no later than the end of Trust Q1. This should set out the schemes to be delivered, the milestones and the trajectory for delivery across the rest of the year. The CQUIN funding can be used to pump prime initial costs of developing the scheme as well as reward for achievement and the CQUIN funding could be pooled across providers to support delivery if this was appropriate.

University 2. ODM Peri-operative Cardiac Output Hospitals Bristol Optimisation NHS Foundation As well as participating in regional Trust work, providers will be expected to propose a trajectory for implementation of this technology for appropriate patient groups which is to be agreed with commissioners by no later than the end of Q1.

University 5. Digital first Non Face-to-Face contacts - The Hospitals Bristol expectation is that by the end of Q1 NHS Foundation the commissioner and provider have Trust an understanding of the current number of digital contacts provided and the opportunities to improve on this. The provider is expected to lead on the work around identifying

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN current levels of digital contacts with the commissioner and provider working jointly to agree the action plan. The action plan would be agreed by the end of Q1 and would set out a plan to increase levels of digital contacts with milestones and trajectories for delivery through the remainder of the year. In particular this should be targeted at reducing follow up appointments in both secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient.

University 5. Digital first Advice and Guidance - Q1 2012/13 Advice and Guidance Advice and Guidance Advice and Guidance Hospitals Bristol Provider to have participated in Q2 2012/13 • Provider Q3 2012/13 • Provider Q4 2012/13 • Provider NHS Foundation initial service design including: to have met to have met milestones to assist Trust • Providing an identified set of milestones of of implementation plan commissioner with specialities in which Advice and implementation plan agreed at Q1 ( – unless evaluation of services Guidance will be offered agreed at Q1 ( – mitigating • Providing nominated management unless mitigating circumstances agreed • Provider to provide or clinical leads to develop services circumstances agreed by commissioner) minimum dataset as • Working with commissioner to by commissioner) agreed in Q1 develop initial service design • Provider to provide • Working with commissioner to • Provider to provide minimum data set as Achievement of the develop and agree plan for minimum data set as agreed in Q1 above is to be implementation (including agreed in Q1 evidenced by milestones for the rest of the year) Achievement of the - Commissioner • Working with commissioner to Achievement of the above is to be evaluation report develop an evaluation plan and above is to be evidenced by - Provider minimum minimum dataset+N12 evidenced by - Commissioner project dataset

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Achievement of the above is - Commissioner report detailing 31/03/2013 evidenced by the following project report detailing progress against plan documents to which the provider will progress against plan - Provider minimum have contributed: - Provider minimum dataset - Service design dataset 31/12/2012 - Implementation plan 30/09/2012 - Evaluation plan 30/06/2012

Bristol 1. Assistive By no later than the end of Q1 No narrative for Q2 No narrative for Q3 No narrative for Q4 Community Technologies commissioners and providers should milestone. milestone. milestone. Health be able to report on a quarterly basis the number of people who are being supported by assistive technology and set a trajectory for significantly increasing this by the end of Q3. This excludes patients supported through local authorities (even though nationally this is part of 3m lives). The plan to deliver this should be agreed by no later than the end of Q1. This should set out the schemes to be delivered, the milestones and the trajectory for delivery across the rest of the year. The CQUIN funding can be used to pump prime initial costs of developing the scheme as well as reward for achievement and the CQUIN funding could be pooled across providers to support delivery

Page 109 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN if this was appropriate. It should be possible for providers to identify the number of people they provide telehealth and telecare services to and this would contribute to 3 million nationally. The local number of people receiving telehealth and telecare could be presented as a proportion of population.

Bristol 5. Digital first No milestones narrative. No milestones No milestones No milestones Community narrative. narrative. narrative. Health

Bristol 6. Carers for To develop indicator for referral for No narrative for Q2 No narrative for Q3 No narrative for Q4 Community people with careers assessment/carers breaks milestone. milestone. milestone. Health dementia and baseline in Q1, leading to agreement of an improvement trajectory. PCT commissioners should have data about the number of and spend on carers breaks etc. that they fund from providers by the end of Q1. Targets for increasing this by the end of the year should be agreed by the end of Q1 with appropriate measures in place. An appropriate measure might be the proportion of dementia carers who have been assessed as needing breaks and respite care who have had a service within a

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN designated period of time. The local authority should have data on the carers of people with dementia and have undertaken a formal assessment of their needs.

North Somerset 1. Assistive By no later than the end of Q1 No narrative for Q2 No narrative for Q3 No narrative for Q4 Community Technologies commissioners and providers should milestone. milestone. milestone. Health Services be able to report on a quarterly basis the number of people who are being supported by assistive technology and set a trajectory for significantly increasing this by the end of Q3. This excludes patients supported through local authorities (even though nationally this is part of 3m lives). The plan to deliver this should be agreed by no later than the end of Q1. This should set out the schemes to be delivered, the milestones and the trajectory for delivery across the rest of the year. The CQUIN funding can be used to pump prime initial costs of developing the scheme as well as reward for achievement and the CQUIN funding could be pooled across providers to support delivery if this was appropriate. It should be possible for providers to identify the number of people they provide telehealth and telecare

Page 111 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN services to and this would contribute to 3 million nationally. The local number of people receiving telehealth and telecare could be presented as a proportion of population.

North Somerset 5. Digital first e.g. Advice and Guidance No narrative for Q2 No narrative for Q3 No narrative for Q4 Community The expectation is that by the end of milestone. milestone. milestone. Health Services Q1 the commissioner and provider have an understanding of the current number of digital contacts provided and the opportunities to improve on this. The provider is expected to lead on the work around identifying current levels of digital contacts with the commissioner and provider working jointly to agree the action plan. The action plan would be agreed by the end of Q1 and would set out a plan to increase levels of digital contacts with milestones and trajectories for delivery through the remainder of the year. In particular this should be targeted at reducing follow up appointments in both secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient. It is not expected that this trajectory will be delivered by starting to count

Page 112 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN activity which is currently delivered digitally, the CQUIN will be about improving on the current baseline. The long-term measure for commissioners is the ratio of face- to-face to non-face-to-face (i.e. digital) contacts in the provider with an expectation about improvement annually but commissioners may find it difficult to have complete data on the number of digital contacts from providers initially and therefore other proxy measures should be used.

North Somerset 6. Carers for PCT commissioners should have No narrative for Q2 No narrative for Q3 No narrative for Q4 Community people with data about the number of and spend milestone. milestone. milestone. Health Services dementia on carers breaks etc. that they fund from providers by the end of Q1. Targets for increasing this by the end of the year should be agreed by the end of Q1 with appropriate measures in place. An appropriate measure might be the proportion of dementia carers who have been assessed as needing breaks and respite care who have had a service within a designated period of time. The local authority should have data on the carers of people with dementia and

Page 113 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN have undertaken a formal assessment of their needs.

Weston Area 1. Assistive By no later than the end of Q1 No narrative for Q2 No narrative for Q3 No narrative for Q4 Health NHS Technologies commissioners and providers should milestone. milestone. milestone. Trust be able to report on a quarterly basis the number of people who are being supported by assistive technology and set a trajectory for significantly increasing this by the end of Q3. This excludes patients supported through local authorities (even though nationally this is part of 3m lives). The plan to deliver this should be agreed by no later than the end of Q1. This should set out the schemes to be delivered, the milestones and the trajectory for delivery across the rest of the year. The CQUIN funding can be used to pump prime initial costs of developing the scheme as well as reward for achievement and the CQUIN funding could be pooled across providers to support delivery if this was appropriate. It should be possible for providers to identify the number of people they provide Telehealth and Telerate services to and this would contribute to 3 million nationally. The local number of people receiving

Page 114 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Telehealth and Telerate could be presented as a proportion of population.

Weston Area 2. ODM The SHA is proposing to lead a No narrative for Q2 No narrative for Q3 No narrative for Q4 Health NHS piece of work to develop a local milestone. milestone. milestone. Trust basket of procedures that are considered most amenable to goal directed inter-operative fluid management where it would deliver a clinical/patient benefit. The expectation is that all providers of inpatient surgical services would participate as required in this regional piece of work and would agree a local trajectory for delivery. As part of this they would participate in a stocktake/audit of what technologies they are currently utilising, current usage levels (e.g. through a proxy around consumables usage) and for what patient groups. This will provide the baseline position for the region and enable agreement of regional and local improvement plans. As well as participating in regional work, providers will be expected to propose a trajectory for implementation of this technology

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN for appropriate patient groups which … is to be agreed with commissioners by no later than the end of Q1. For those Trusts which have already implemented this technology the expectation would be that they would participate in the regional work and would agree with commissioners stretch targets around the level of adoption of goal directed fluid therapy for cases in the locally agreed basket of procedures and also agree targets to reduce length of stay and ITU bed usage for elective surgical cases through the delivery of other complimentary actions.

Weston Area 5. Digital first Advice and Guidance No narrative for Q2 No narrative for Q3 No narrative for Q4 Health NHS The expectation is that by the end of milestone. milestone. milestone. Trust Q1 the commissioner and provider have an understanding of the current number of digital contacts provided and the opportunities to improve on this. The provider is expected to lead on the work around identifying current levels of digital contacts with the commissioner and provider working jointly to agree the action plan. The action plan would be agreed by the end of Q1 and would set out a plan to increase

Page 116 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN levels of digital contacts with milestones and trajectories for delivery through the remainder of the year. In particular this should be targeted at reducing follow up appointments in both secondary and community care and replacing these with telephone calls, texts or emails either to or from the patient. It is not expected that this trajectory will be delivered by starting to count activity which is currently delivered digitally; the CQUIN will be about improving on the current baseline. The long-term measure for commissioners is the ratio of face- to-face to non-face-to-face (i.e. digital) contacts in the provider with an expectation about improvement annually but commissioners may find it difficult to have complete data on the number of digital contacts from providers initially and therefore other proxy measures should be used.

Avon and 5. Digital first The expectation is that by the end of No narrative for Q2 No narrative for Q3 No narrative for Q4 Wiltshire Mental Q1 the commissioners and AWP milestone. milestone. milestone. Health have an understanding of the

Page 117 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Partnership NHS current number of digital contacts Trust provided and the opportunities to improve on this. The Trust is expected to lead on the work around identifying current levels of digital contacts, with the commissioners and AWP working jointly to agree the action plan. The action plan would be agreed by the end of Q1 and would set out a plan to increase levels of digital contacts with milestones and trajectories for delivery through the remainder of the year if appropriate.

Gloucestershire and Swindon Primary Care Trust Cluster Gloucestershire 2. ODM End Q1 Report to NHSG detailing End Q2 Agree End Q3 Report to End Q4 Achievement Hospitals NHS the following: audit of current inter- trajectory & plan for NHSG detailing update of trajectory for Foundation Trust operative fluid management implementation (or against implementation implementation. technologies & levels of usage. further plan and trajectory. Agree basket of procedures with implementation) of GHT:NHSG. inter-operative fluid management. Establish baseline measures for patient group LOS/ITU bed days.

2Gether NHS 6. Carers for Dementia No narrative for Q2 No narrative for Q3 No narrative for Q4 Foundation Trust people with Improving awareness and access to milestone. milestone. milestone. dementia Telecare and Telehealth support for people with dementia and their

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN carers via the use of information, assessment and referral. (Safety, effectiveness and patient experience )

Great Western Ambulance Service NHS Current position to be confirmed. Trust

Gloucestershire Care Services Current position to be confirmed.

Great Western 1. Assistive More definition required against More definition More definition required More definition Hospital Technologies specific innovations required against against specific required against Foundation Trust specific innovations innovations specific innovations 2. ODM

5. Digital first

Somerset Primary Care Trust Cluster Taunton & 1. Assistive To assist in improving the health No narrative for Q2 No narrative for Q3 No narrative for Q4 Somerset NHS Technologies and quality of life of long term milestone. milestone. milestone. Foundation Trust conditions patients and reducing hospital admissions by increasing the number of patients supported by assistive technologies (Telehealth). The development of an action plan to deliver additional schemes and milestones for implementation to increase access and use of assistive technologies will be used as the

Page 119 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN basis of the CQUIN. CQUIN money will be utilised to pump prime initiatives. Action plan to be submitted by end of Quarter 1 with agreed timeframes for implementation and to inform in-year milestones.

Taunton & 2. ODM In support of the implementation and No narrative for Q2 No narrative for Q3 No narrative for Q4 Somerset NHS increased use of 5 high impact milestone. milestone. milestone. Foundation Trust innovations as outlined in the NHS South of England operating Plan. • Percentage of surgical patients (elective/emergency) receiving ODM peri-operatively as an alternative to invasive monitoring as defined by the Strategic health Authority basket of procedures considered most amenable to goal directed fluid management. To be confirmed based on Quarter 1 analysis.

Taunton & 5. Digital first Reduction in face to face contacts No narrative for Q2 No narrative for Q3 No narrative for Q4 Somerset NHS by use of digital mechanisms milestone. milestone. milestone. Foundation Trust including telephone, text and email. The development of an action plan to deliver additional schemes and milestones for implementation to increase access and use of digital alternatives including telephone, text and email will be used as the basis of the CQUIN. CQIUN money will

Page 120 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN be utilised to pump prime initiatives. Trusts will identify up to three services/areas/specialties for implementation. Action plan for three clinical areas/ specialities to be agreed at the end of Quarter 1 and progress required for Quarters 2, 3 and 4.

Yeovil District 1. Assistive To assist in improving the health No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospital NHS Technologies and quality of life of long term milestone. milestone. milestone. Foundation Trust conditions patients and reducing hospital admissions by increasing the number of patients supported by assistive technologies (Telehealth). The development of an action plan to deliver additional schemes and milestones for implementation to increase access and use of assistive technologies will be used as the basis of the CQUIN. CQUIN money will be utilised to pump prime initiatives. Action plan to be submitted by end of Quarter 1 with agreed timeframes for implementation and to inform in-year milestones. Yeovil District 2. ODM Percentage of surgical patients No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospital NHS (elective/emergency) receiving ODM milestone. milestone. milestone. Foundation Trust peri-operatively as an alternative to invasive monitoring as defined by the Strategic health Authority basket of procedures considered most

Page 121 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN amenable to goal directed fluid management. Q1 including analysis of: Technologies currently in use. Current usage levels using consumables as proxy measure local benefiting group population (patient groups) and respective length of stay. ITU bed usage for elective surgical admissions and respective length of stay.

Yeovil District 5. Digital first Reduction in face to face contacts No narrative for Q2 No narrative for Q3 No narrative for Q4 Hospital NHS by use of digital mechanisms milestone. milestone. milestone. Foundation Trust including telephone, text and email. The development of an action plan to deliver additional schemes and milestones for implementation to increase access and use of digital alternatives including telephone, text and email will be used as the basis of the CQUIN. CQIUN money will be utilised to pump prime initiatives. Trusts will identify up to three services/areas/specialties for implementation. Analysis during Q1 of: Current levels of digital contacts. Development of an action plan. Measurement of current first referrals/follow ups Action plan for three clinical areas/

Page 122 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN specialities to be agreed at the end of Quarter 1 and progress required for Quarters 2, 3 and 4.

Somerset 1. Assistive Quarter 1 Submission of action plan Quarter 2 Quarter 3 Achievement Quarter 4 Partnership NHS Technologies and proposed Achievement of of trajectory Achievement of Foundation Trust milestones/trajectories for trajectory trajectory improvement including identified costs.

5. Digital first Quarter 1 Submission of action plan Quarter 2 Quarter 3 Achievement Quarter 4 and proposed Achievement of of trajectory Achievement of milestones/trajectories for trajectory trajectory improvement including identified costs. Devon, Plymouth and Torbay Primary Care Trust Cluster Royal Devon and 5. Digital first Identification of anticipated benefits Implementation of Delivery of positive Production of plan (to Exeter NHS associated with introduction of this pilot to commence outcomes in line with be confirmed and Foundation Trust innovation, and plan detailing within Q2. benefits realisation refreshed in Q4 in timeframes for implementation of Should Trust decide minimum thresholds. light of further pilot. not to implement pilot, guidance) regarding Trust to inform taking forward the commissioners before high impact end Q2 to enable innovations in 2013- reallocation of 14 remaining CQUIN monies associated with this scheme to remaining CQUIN schemes. Northern Devon 5. Digital first Q1-4 Q1-4 Q3-Q4 Q3-Q4 Healthcare NHS Regular reports to CQRM on Regular reports to Scoping Report (jointly Scoping Report

Page 123 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Trust progress with e-discharge system CQRM on progress with nominated (jointly with nominated rollout. with e-discharge PCT/Primary Care PCT/Primary Care system rollout. Leads) to establish Leads) to establish what further steps need what further steps to be taken to achieve need to be taken to integration of E- achieve integration of discharge system with E-discharge system GP Practice systems. with GP Practice systems.

South West Ambulance Current position to be confirmed. Service Trust

Devon Partnership Trust Current position to be confirmed.

Plymouth Hospitals NHS Trust

Plymouth Community Healthcare CiC

South Devon Healthcare Overall values in contract distribution across six CQUINs to be confirmed. Foundation Trust

T(SD)CT Overall values in contract distribution across six CQUINs to be confirmed. Provider Northern Devon 5. Digital first Implementation of CIDS/ComPAS Regular reports to Regular reports to Regular reports to Healthcare NHS and GP survey e-discharge CQRM on progress CQRM on progress CQRM on progress

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Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Community Regular reports to CQRM on with e-discharge with e-discharge with e-discharge Provider progress with e-discharge system system rollout. system rollout. system rollout. rollout. Scoping Report (jointly Scoping Report with nominated (jointly with nominated PCT/Primary Care PCT/Primary Care Leads) to establish Leads) to establish what further steps need what further steps to be taken to achieve need to be taken to integration of E- achieve integration of discharge system with E-discharge system GP Practice systems. with GP Practice systems.

Dorset, Bournemouth and Poole Primary Care Trust Cluster Dorset County CQUIN scheme does not detail which innovation schemes or allocate funds specifically. Expectation innovation will be included Hospital NHS where relevant to provider. Foundation Trust Dorset 1. Assistive The provider to be able to provide evidence that they are in a state of readiness for full implementation of the 6 HealthCare Technologies high impact innovations by march 31 2013. Evidence to include that the Trust Boards are fully signed up to the University NHS implementation of each high impact innovation, and action plans for each one to be provided. Foundation Trust 3. Child in a • Assistive technologies (CHS) chair in a day • Child in a chair in a day (CHS) • Increased international and commercial activity (CHS) Dorset 4. International • Reduction of face to face contacts (CHS and mental health) HealthCare and commercial • Supporting carers of people with dementia(CHS and mental health) University NHS activity Action plans to be agreed with commissioners in quarter One and evidence of implementation to be evidenced Foundation Trust by Quarter 4, with continued exception reporting in Quarters 2 and 3. 5. Digital first Evidence of Board sign-up and Actions Plan in place to implement each of the High Impact Innovations by March 2013 (where relevant). 6. Carers for 5 relevant High impact Innovations: people with • Use of Assistive Technologies dementia • Implementation of ‘child in a chair in a day’

Page 125 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN • Exploring opportunities to increase national and international healthcare activity • Reduction of inappropriate face to face contacts • Supporting carers of people with dementia

Royal Bournemouth & CQUIN scheme does not detail which innovation schemes or allocate funds specifically. Expectation innovation will be included Christchurch where relevant to provider. The provider to be able to provide evidence that they are in a state of readiness for full implementation Hospital NHS of the 6 high impact innovations by march 31 2013. Foundation Trust

Poole Hospital CQUIN scheme does not detail which innovation schemes or allocate funds specifically. Expectation innovation will be included NHS Foundation where relevant to provider. The provider to be able to submit evidence that they are in a state of readiness for full implementation Trust of the 6 high impact innovations by March 31 2013. Evidence to include that the Trust Boards are fully signed up to the implementation of each high impact. Agreed only relevant innovations to each provider.

Bath and North East Somerset and Wiltshire Primary Care Trust Cluster Royal United 5. Digital first Text Reminders: Text Reminders: End Text Reminders: End Text Reminders: End Hospital Bath Dermatology non-face-to-face of Q2 Implementation of Q3 Update report on of Q4 Report on pilot NHS Trust, & consultations: plan for pilot pilot progress against in Q3 & Q4, including Royal National Electronic Discharge Summaries specialties in Q3 & Q4 KPIs.(31.01.13) KPIs (DNA rate), Hospital for to be shared with Dermatology non-face- confirm full rollout Rheumatic commissioners. to-face consultations: plan for 13/14 (subject Diseases (31.10.12) End of Q3 TBC to outcome of pilot). Foundation Dermatology non- following Dermatology non- Trust, Sirona face-to-face implementation plan at face-to-face CIC consultations: End of end of Q2. 31.01.13 consultations: End of Q2 Implementation Electronic Discharge Q4 TBC following plan for pilot Summaries: Q3 95% of implementation plan specialties to be discharge summaries at end of Q2. agreed with sent electronically (for 30.04.13 commissioners. all practices registered Electronic Discharge

Page 126 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN 31.10.12 with the Trust to Summaries: Q4 95% Electronic Discharge received them) of discharge Summaries: End of 31.01.13 summaries sent Q2 Agree roll out plan electronically (for all for GP practices with practices registered GP Leads and share with the Trust to with Clinical outcomes received them) and Quality 30.04.13 Assurance Group 31.10.12 Salisbury 1. Assistive No milestones narrative. No milestones No milestones No milestones Hospital NHS Technologies narrative. narrative. narrative. Foundation Trust 2. ODM

5. Digital first

Great Western 1. 3 million By the end of Q1 (28 June 2012) No narrative for Q2 By the end of Q3 full By Q4 GWH to Hospital NHS lives/assistive GWH to have agreed priorities via milestone. report to CQRM with publish the high Foundation Trust technologies individual plans with milestone the outcomes impact changes on Community + outcomes for the rest of 12-13 to monitored their website. Maternity 5. Digital first Commissioners to cover all the areas above with a focus on the key outcomes to be achieved in the 2 areas above. By the end of Q3 full report to CQRM with the outcomes monitored By Q4 GWH to publish the high impact changes on their website.

Cornwall and Isles of Scilly Primary Care Trust Cluster Peninsula 1. Assistive Q1 1000 total installs Q2 1500 total installs No narrative for Q3 No narrative for Q4 Page 127 of 128

Appendix 4

Provider Innovation Quarter 1 Quarter 2 Quarter 3 Quarter 4 CQUIN Community Technologies & 500 tele-coaching milestone. milestone. Health Royal Cornwall Hospitals NHS Overall values in contract distribution across six CQUINs to be confirmed. Trust Cornwall Partnership NHS Overall values in contract distribution across six CQUINs to be confirmed. Foundation Trust

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