STP Stakeholder Update June 2019

Cambridgeshire and Peterborough Sustainability and Transformation Partnership

What is this document for? Provides an update on the outcomes from the most recent STP Board meeting, as well as on other STP progress and news.

Who is this document for? Written for and distributed to:

 Partner NHS Trust Board members  CCG Governing Body members  Health & Wellbeing Board members  Local Medical Committee  All GP Practices (via CCG Gateway)  Overview & Scrutiny Committee members  Healthwatch  Local MPs

How should this document be used?  Distributed to the above stakeholders  Presented to partner NHS Boards by CEO/Chair  Used as a prompt to brief patient groups and other Fora.

Although written to be publicly available, this update is not designed specifically for a general public audience. We produce a bespoke public Newsletter which can be found on our website here.

Produced by The System Delivery Unit (SDU) Team: [email protected] Contact: [email protected], Head of Communication & Engagement, SDU

1 Fit for the Future is our vision for health and care in Cambridgeshire and Peterborough

STP Board Update The most recent STP Board meeting in public was held on 20 May 2019. The agenda and Board papers can be read on the Fit for the Future website here. This update provides information on the outcomes from the most recent STP Board meeting, as well as other STP progress and news.

A&E Performance – continues to be a challenge, both nationally, and for the system. Trusts are measured by their daily performance on the 4-hour standard. The latest performance metrics are illustrated in the table below:

Recent A&E A&E attendances A&E performance to performance (week (week ending 31 end of March ending 31 March) March)

England Average (type 1 and 3) 88.% England Average (type 1 only) 82.% Total CUH (type 1 and 3) 86.% 85% 3,275 CUH type 1 only 81% 82% 2,428 NWAFT incl. MIU 86% 89% 4,095 Peterborough City Hospital (incl. Stamford) 79.% 87% 2,201 Hinchingbrooke 93% 97% 1,046

Our A&E departments are seeing significant increases in attendances, collectively treating on average 203 more patients each week than the same period last year. A&E attendances have increased in 2018/19 (data to the end of March 2019) compared to previous year by 8% at Peterborough City Hospital and by 7% at Hinchingbrooke Hospital. Recent activity growth is not just a local issue as NHS Improvement data shows that ED attendances across the region have grown significantly.

Further work continues with all system partners to develop a range of projects to reduce A&E attendances and admissions.

Cambridge University Hospitals NHS Foundation Trust (CUHFT) Field Testing new A&E performance standards – CUHFT is one of 14 sites selected by NHS England to test new accident and emergency standards which could replace the four-hour target. The field test, currently scheduled to start at the end of May, will look at measuring: • Time to initial clinical assessment in Emergency Departments and Urgent Treatment Centres (type 1 and 3 A&E departments); • Time to emergency treatment for critically ill and injured patients. Complete a package of treatment in the first hour after arrival for life-threatening conditions; • Time in A&E (all A&E departments and mental health equivalents). Measure the mean waiting time for all patients; and • Utilisation of Same Day Emergency Care. Arrangements for reporting the existing 4-hour standard during the trial period are still being finalised.

Projects on Admission Avoidance and Out of Hospital Urgent Care ‘Roundtable’ – We are working on a range of schemes designed to reduce unplanned activity and cost in 2019/20, which will be a transitional year, as we move towards the following major changes: • Re-structured investment in primary care for 2019/20 to reduce unwarranted variation from Q2 including unplanned acute activity; • Transformation of out of hospital urgent care (‘Roundtable’ programme) which will move to pilot phase from October 2019; and • Development of Integrated Neighbourhoods and Primary Care Networks.

It should be noted that these are subject to further development and change in order to deliver the system control total.

Delayed Transfers of Care (DTOC) – The national standard is that no more than 3.5% of hospital beds should be occupied by people who have been in hospital beyond the point at which they are medically fit to be discharged. The Cambridgeshire and Peterborough System has had particularly high levels of DTOCs compared to other health and care systems.

Since March 2019, our hospitals have made improvements in performance, with Peterborough City Hospital achieving 3.4% in March 2019, whilst CUHFT achieved 3.4% for two consecutive weeks in early April 2019. The challenge is now to ensure that all sites are consistently keeping DTOC at a low level. To support this, the focus continues on the implementation of SAFER on each site. The aim is to improve the experience of patients and staff and help ‘reset’ the hospital by creating internal capacity, restoring flow, and thus relieving pressure. At the next STP Board meeting in July 2019, Jan Thomas will present a focussed report on progress at Hinchingbrooke Hospital.

The five elements of the SAFER are:

S – Senior review. All patients will have a senior review before midday by a clinician able to make

management and discharge decisions.

A – All patients will have an expected discharge date and clinical criteria for discharge. This is set

assuming ideal recovery and assuming no unnecessary waiting.

F – Flow of patients will commence at the earliest opportunity from assessment units to inpatient wards.

Wards that routinely receive patients from assessment units will ensure the first patient arrives on the

ward by 10 am.

E – Early discharge. 33% of patients will be discharged from base inpatient wards before midday.

R – Review. A systematic multi-disciplinary team review of patients with extended lengths of stay (less

than seven days – ‘stranded patients’) with a clear ‘home first’ mindset

Finances – We face a very difficult financial situation across Cambridgeshire and Peterborough. Since 2015/16, we have overspent by at least £100m each year, across all the NHS organisations. The System financial position is an amalgamation of our NHS partners, who each remain accountable to their Boards and regulators for delivering their own individual financial positions.

2018/19 System finances – The System outturn for 2018/19 was a collective overspend of £148m. This represented a £200m overspend which, after receipt of £52m of Provider/Commissioner Sustainability Funding, resulted in the final System overspend of £148m.

2019/20 System plan – Since December, each of our System partners has been developing their financial plans for 2019/20. Our collective System plan, as it currently stands, is an overspend of approximately £112m, inclusive of Sustainability Funding, and £192m overspend without. This plan, which means the System has not met its collective Control Total of £142m overspend, has resulted in on-going discussions at a regional and national level.

Medium-term financial balance – Over the last nine months, our approach has been to, firstly, understand the causes of our financial problems and, secondly, to agree and deliver against a clear set of priorities and plans to address these problems – where we can locally. These plans have been built with renewed engagement, support and leadership from our local councils and primary care. They have been designed to address the root cause of our challenges in line with the direction set out in the NHS Long Term Plan. Our 2019/20 plans will be the starting point of our medium-term financial plan. Over the summer and autumn, these will be developed into a five-year financial plan to ensure that we are working towards a more sustainable financial position in the medium term.

North Alliance – The North Alliance is making progress and gaining momentum, particularly with its key priority – Integrated Neighbourhoods. In September, the ‘Ask and Offer’ exercise (highlighted in a previous edition of this Update) highlighted a gap in intravenous antibiotics service provision for people living within the geography of the North Alliance. This issue was discussed by the STP Board within the context of funding availability, as well as the balance between localised service provision priorities versus perceived inequities of service across the STP area. The Alliance were encouraged to look at local solutions to this issue.

The E-referral process for GPs to refer to District Nursing Teams has received approval and is making progress. There has also been agreement that the Community Geriatrician will attend weekly multidisciplinary team meetings, if required.

Reducing Health Inequalities and Improving Health Outcomes – The North Alliance support the review and option appraisal for the future of the Health Promotion and Prevention Steering Group. Discussions with the District Councils about the transformation of the Living Well Partnerships into Place Based Delivery Boards have been positive and a decision will be made at a future Health and Wellbeing Board meeting.

The ‘Think Communities’ programme have confirmed funding of £1.3 million to fund behaviour change and workforce development. The geographical footprints will align to Primary Care Network geographies, enabling fully joined up Public Service delivery arrangements. The North Alliance recognise and support the pooling of resources where possible to ensure a joined-up approach.

South Alliance – Since the last update to STP Board in March 2019, the South Alliance have been:  Supporting the formation of Primary Care Networks covering 30,000 – 50,000 with a view to identifying the next Integrated Neighbourhoods, where GP colleagues have asked for this;  Working with Granta Medical Practices, Cambridgeshire and Peterborough Foundation Trust, Cambridge University Hospitals and Cambridgeshire County Council to implement the Granta Integrated Neighbourhood;  Engaging with managerial, operational and clinical staff across the South Alliance;  Linking with, and learning from, Cambridgeshire County Council’s ‘Neighbourhood Cares’ teams and ‘Think Communities’ programme; and  Securing a small amount of dedicated resource so the South Alliance can start to scale and accelerate their work.

Phase One Integrated Neighbourhood development: Granta – The South Alliance continues to work closely with Granta Medical Practices on the development of their Integrated Neighbourhood covering a population of 44,000 living in Sawston, Linton and Great Shelford to improve care for patients and outcomes for the population they serve.

The Granta Integrated Delivery Board members hosted a co-designed event for the Granta Integrated Neighbourhood on 8 May 2019. The workshop focused on developing joined up, holistic care for local people.

The Granta Integrated Delivery Board will continue to build on the enthusiasm for this work with staff and have identified eight potential Integrated Neighbourhood projects. Over the coming month, the Granta Integrated Delivery Board will prioritise these projects and work with staff to develop plans for implementation.

Clinical areas for radical transformation – Three new areas of radical clinical transformation were agreed at the STP Board meeting in March 2019, as follows: 1. Cardiovascular Disease (CVD); 2. Respiratory Medicine; and 3. Prevention & Health Inequalities starting with Obesity and Diabetes.

4 Fit for the Future is our vision for health and care in Cambridgeshire and Peterborough

The transformation initiatives are managed within relevant Clinical Communities, which include clinicians, patient representative’s, voluntary organisations/specialty charities as well as commissioning and operational staff. Each clinical area identified for radical transformation will be required to:  Identify a project team: a Senior Responsible Officer and Sponsor; Clinical Lead; project lead; finance lead and health analytics contact (See table below);  Identify representatives from primary, community, secondary care, Public Health and social care, disease or condition specific support groups and societies, voluntary sector, patient representatives;  Identify metrics/outcomes to be addressed by the initiative;  Address draft transformation themes; and  Develop short and medium term priorities.

Diabetes Cardiovascular Respiratory Medicine Disease

STP and CCG Clinical Dr Jessica Carrick- Drs Nick West and Liz TBA Lead Randall Warburton Project leads Lisa Smith, Joanne TBA (CCG to provide) TBA (CCG to provide) Fallon with Laura Cooke CCG SRO Rob Murphy Rob Murphy Rob Murphy HCE Sponsor: Alex Gimson Alex Gimson Alex Gimson

Other news

Workforce Planning Session – a recent workforce session created lively, open, honest and challenging debate with really good quality conversations about workforce priorities across the system. The focus was on the challenges and issues facing the system workforce, particularly in relation to primary care and recruitment and retention. Output from session discussions has been collated, analysed and grouped into themes:  Attraction, recruitment and retention – with strong links to the importance of improving our approach to workforce planning, attraction and recruitment sit together with an emphasis on flexibility of offers, defining clear career pathways, promoting what we can offer;  Workforce Planning – we need to use workforce and other data collaboratively, as System partners, and work proactively together to find solutions;  Focus on temporary workforce – a real drive is required to ensure we were working systematically regarding the use, deployment, booking and cost of our temporary workforce. This included the GP and medical locum market with a focus on reducing costs, providing greater flexibility and supporting retention (particularly of retiring GP population);  Apprenticeships - these offer us the opportunity to build the workforce of the future;  Focus on system leadership - a consistent narrative about helping staff at all levels within organisations to understand system complexity, as a way to promote systems leadership, promote collaboration and problem solving; and  Workforce Flexibility – emphasis on understanding that the needs and work/life choices of our workforce are changing, and we need to keep pace with these generational differences whilst also balancing the system needs. Stroke Early Supported Discharge (ESD) Team shortlisted for the HEAT Awards – The ESD Team have been shortlisted from over 800 nominations for the System Transformation Champion of the Year Award in the 2019 Health Education England HEAT Awards. Charlie Dorer, Clinical Manager for the Integrated Neuro Rehabilitation and Stroke ESD Team, said “I was delighted to receive the news that the Stroke ESD team have been shortlisted. I think that the staff have made an amazing change to stroke survivors and carers outcomes and experiences, in their first year, and we are continuing to develop their pathway.” 5

The award ceremony will take place on 18 July at the Royal College of Physicians in London. NHS England funds £2m to boost system-wide leadership development – NHS England has funded a £2m programme to help 23 areas, including Cambridgeshire and Peterborough, kick-start or boost leadership development activities to support and inspire our workforce from GPs, consultants and therapists to nurses, social workers and managers. Cambridgeshire and Peterborough were awarded £85K of this money Our programme, inspired by Frimley 2020, builds on learning from five successful, national, leadership models and results have shown the importance of equipping individuals with the right skills necessary to drive change and identify new ways of working and collaborating with health, social care and third sector organisations. The funding will support us to develop a locally tailored programme, investing in both newly established and experienced leaders to increase our system leadership capability.

Diabetes Engagement Events – Diabetes UK are hosting a series of engagement events on the future of diabetes care in Cambridge and Peterborough. This is a great opportunity to find out what services are available for people with diabetes in our area; to ask local healthcare professionals and commissioners questions about diabetes care, and to find out what the future holds. To book a place, call Diabetes UK on 01376 501390 or book online at: https://cambridge-engagement-event.eventbrite.co.uk Dates: Date Time Venue Cambridge 11 June 6.30 – 8.30pm Cambridge United Football Club, Abbey Stadium, Newmarket Rd, Cambridge, CB5 8LN Peterborough 18 June 6.30 – 8.30pm Peterborough United Football ABAX Stadium, London Rd, Peterborough, PE2 8AL Wisbech 4 July 6.30 – 8.30pm The Boathouse Business Centre, 1 Harbour Square, Wisbech, PE13 3BH Huntingdon 11 July 6.30 – 8.30pm Hinchingbrooke Country Park, Brampton Rd, Huntingdon, PE29 6DB

Thistlemoor Medical Centre in Peterborough, in the news and hosts NHS England visitors – a BBC film crew spent the day at Thistlemoor Medical Centre in Peterborough recording a news article exploring the effects of different populations from different backgrounds on General Practice. They filmed patients being assigned to GPs or Healthcare Assistants (HCA) according to languages spoken and their health needs. The Practice has HCAs from the same background as the patient population who help with communication and for clinicians to understand cultural issues relating to the population. Dr Neil Modha invited Ian Dodge (National Director of Innovation), Dr Nikita Nanani (National Primary Care Director) and Dr Stephen Powis (National Medical Director) to visit his practice and showcase the open access/workforce-based model which serve a highly deprived population in Peterborough. Ian was impressed by the model and encouraged the mobilisation of our existing assets to develop it further (multi- professional working: social prescribing, digital, voluntary sector).