NHS Birmingham and Solihull Clinical Commissioning Group 2019/20 Operational Plan Contents

Executive summary ...... 2

Section 1 – Context ...... 3

Section 2 - Programme Priorities and Local Delivery Plans ...... 8 Integration – Primary Care and Long Term Conditions (PC & LTC) ...... 8 Integration – Urgent Care ...... 21 Integration – Community Better Care Fund ...... 24 Personalisation and Personal Health Budgets ...... 28 Mental Health ...... 32 Maternity and Newborn ...... 36 Children and Young People ...... 40 Special Education Needs and Disabilities (SEND) ...... 43 Cancer ...... 46 RightCare ...... 57 Continuing Healthcare (CHC) ...... 58 Learning Disabilities and Autism ...... 60 Medicines Management and Optimisation ...... 63 Quality - Improving Quality in Organisations ...... 66 Localities ...... 68

Section 3 – Overarching Corporate Enablers ...... 71 Estates and Infrastructure ...... 71 Digital connectivity ...... 75

Section 4 – Governance and Reporting ...... 77

Abbreviations ...... 79

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Executive summary NHS Birmingham and Solihull Clinical Commissioning Group (BSol CCG) is the largest clinically-led commissioning organisation in England. We commission health services for 1.3 million people in Birmingham and Solihull and our budget is in excess of £1.9 billion – almost 2% of the total NHS resource. Patients are at the heart of everything we do and we actively encourage people living in Birmingham and Solihull to get involved and help us shape our plans. We also work with a network of other NHS organisations, independent providers, GP practices and the third sector including neighbourhood CCGs such NHS Sandwell and West Birmingham CCG for people living in West Birmingham. Our ambition is to ensure the best possible (and world class) healthcare outcomes for everyone in Birmingham and Solihull. Our priorities are to:  Tackle and reduce health inequalities  Rebalance investment in health care from crisis management to prevention and early action  Achieve closer integration between health and social care. We are an active participant and leader of the Birmingham and Solihull Sustainability and Transformation Partnership (STP) and are already taking steps to work collaboratively with partners to develop our Integrated Care System. Operational Plan 2019/20 The CCG has developed an Operational Plan for 2019/20, which is focussed on delivering the national triple aim from the NHS Five Year Forward View of better health, better care, and lower costs. These priorities are aligned and work towards full implementation of the NHS Long Term Plan. Section 1 provides the context to this Operational Plan and how this relates to the STP Plan and the NHS Long Term Plan. It also describes how we intend to deliver strategic and joint commissioning and integration in this context. Section 2 outlines our programme priorities and plans for delivering against the STP Plan and NHS Operational Planning and Contracting Guidance 2019/20. Section 3 describes our overarching corporate enablers, which includes priorities on infrastructure and digital connectivity. Section 4 highlights our governance and reporting framework. This will ensure we oversee the delivery of this Operational Plan with robust governance and accountability.

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Section 1 – Context

CCG Background

NHS Birmingham and Solihull Clinical Commissioning Group (BSol CCG) is the largest clinically-led commissioning organisation in England. It was approved by NHS England on 1 April 2018 following a merger of NHS Birmingham Cross City CCG, NHS Birmingham South Central CCG and NHS Solihull CCG. We are responsible for planning and commissioning health services for 1.3 million people living in Birmingham and Solihull and our budget is over £1.9 billion – almost 2% of the total NHS resource. As a CCG, our population is diverse:  59% of CCG population identify themselves as White compared to 41% of people from a range of different ethnic groups including Black and Asian Minority Ethnic (BAME).  The largest BAME groups are as follows: 22% of people identify themselves as Asian, 7% as Black and 4% as Dual Heritage (previously described as Mixed Race in the 2011 Census) with 8% of people from other parts of the world.  22% of our population are people aged 15 years old and under, 64% are of working age (16-64 years old) and 14% are aged 65 and over.  There is a prosperity gap of 10 years between the most affluent and least affluent people living in Birmingham and Solihull.

CCG Strategic Priorities

Our ambition: To ensure the best possible (and world class) healthcare outcomes for everyone in Birmingham and Solihull. Our priorities:  Tackle and reduce health inequalities  Rebalance investment in health care from crisis management to prevention and early action  Closer integration between health and social care.

Supporting Sustainability and Transformation Partnership (STP) Delivery

As a CCG, we already work closely in partnership with:  Three local authorities in Birmingham, Solihull and Sandwell  Neighbouring CCGs and Specialised Services including NHS Sandwell and West Birmingham (SWB) CCG to ensure consistency and alignment for the West Birmingham footprint. This includes joint working arrangements through the Western Birmingham Joint Committee.  Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT); our main mental health provider.  Several acute hospitals including University Hospitals Birmingham NHS Foundation Trust (UHB), Sandwell and West Birmingham NHS Foundation Trust, Birmingham Women’s and Children’s Hospital NHS Foundation Trust (BWC) and the Royal Orthopaedic Hospital NHS Foundation Trust (ROH).

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 A network of over 177 GP practices.  A network of independent providers and third sector organisations including hospices and care homes. We are also committed to supporting delivery of the STP strategy by “Helping everyone in Birmingham and Solihull to live the healthiest and happiest lives possible.” This will be achieved through an integrated strategic commissioning approach. This will improve outcomes and reduce inequalities through greater service integration, an increased focus on prevention and empowering our citizens through increased personalisation.

Health and Wellbeing

The overall intentions of the STP multi-year strategy are to improve the health and well-being of our population, reduce inequalities, maintain and improve the quality of care we provide, and to live within our means financially. The CCG Operational Plan supports these aspirations. Working through the health and wellbeing strategies our focus across all work programmes is to promote health, well-being and prevention.

West Birmingham

A condition of the Birmingham and Solihull CCG merger was alignment and joint working in relation to the population of West Birmingham. Current arrangements mean that the population is divided between Birmingham and Solihull CCG and Sandwell and West Birmingham CCG.

A joint committee is in place with underpinning terms of reference and a delegation agreement to oversee management arrangements for joint planning and working. During 2018/19 agreement has been achieved to look at ensuring greater alignment for the population of the whole of Birmingham consistently within the strategic and system plan of the BSol STP. This will include the development of a common outcomes framework and provider alliance in response to the publication of the NHS Long Term Plan.

BSol STP, Black Country STP and both CCGs will work collaboratively with key partners in 2019/20 to progress the medium and long strategy for the population of West Birmingham.

Strategic and integrated commissioning in the future – improving outcomes for our neighbourhoods The NHS Long Term Plan has a strong focus on prevention, the wider determinants of health and wellbeing and places a greater emphasis on digital transformation. Those principles are also at the heart of the STP strategy and work plans which means the STP is in a good position with regards to alignment of the current work to the national NHS priorities. As part of our development to become an Integrated Care System (ICS), which is a key feature of the NHS Long Term Plan, we intend to develop an integrated and strategic commissioning approach with our partners that is fully supported by a range of partners across our area. This will be focussed on enabling integrated delivery, prevention, and development and use of community assets to reduce inequalities and improve outcomes for local people. The core areas of work outlined in the STP strategy focus on:  Understanding people’s specific needs in different parts of Birmingham and Solihull. This is a fundamental change as we will focus on what matters to people in the places where they live and work rather than what may appear convenient for public institutions.

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 Marshalling our collective assets e.g. financial investment, public buildings, digital infrastructure, professional time, in those localities to best meet needs in a co-ordinated way. This will include building trust with citizens, patients, organisations and communities.  Working collaboratively as organisations given the significant financial pressures to meet demands for care. This will mean we will have to collectively move resources to where patients and citizens need them most and work together to achieve closer integration of services that people receive. This includes working with Local Authority partners to strengthen existing integrated commissioning arrangements and budgets.  Adopt a population health management approach in the planning and commissioning of services. This will include reviewing public health intelligence and interventions with communities across the region, system, place, localities and neighbourhoods and working with STP partners, Directors of Public Health and Public Health England. Underpinning the above, the CCG is building upon the already formed primary care/GP provider federations and ‘super’ practices to strengthen primary care and to network practices with other key out of hospital services from diagnostics to community and mental health. This is to maximise current data sharing arrangements and ensure working relationships are wrapped around the individual which incorporates frontline staff and local knowledge and intelligence together. In addition to this we are working with councils and the third sector to maximise community assets and maintain people in their communities with support for self-care and place shaping. This will include some targeting and a proactive integrated model approach for defined populations.

Developing our Future Operating Model - Integrated Care Systems

The incremental development towards an ICS has already begun across the BSol STP footprint. The building blocks of a single CCG commissioner co- terminous with the STP are already in place by working with the Birmingham Provider Alliance and collaborative integrated system planning, strategy development and integrated programmes of delivery at system and through place partnerships such as Solihull together and Birmingham Childrens Partnership. Following the ICS development programme last summer, we have developed a collaborative and evolutionary approach with six priority workstreams in readiness for a more confirmed direction of ICS following the wave 1 progress and publication of the NHS Long Term Plan. In 2019/20 we will work collaboratively, as part of the STP governance, an Operating Model Development Group to develop our future ICS operating model at system and place. This will consider the design of the supporting functions for strategic commissioning and integrated care delivery through place alliances, with provider alliance(s) and Primary Care Networks (PCNs) at their heart. As we move in 2019/20 and build on the work from 2018/19 we will look to continue our joint planning, strategy prioritisation and outcomes framework development as a partnership. This will include:  Collaborative development of our future operating model and roadmap.  Development, in partnership and through the STP Portfolio Boards, of a joint strategy, planning and an outcomes framework to support our ICS and strategic commissioning approach. Over time, it is expected this will move into a fully integrated strategic commissioning cycle with a partnership board at its heart, in advance of legislative change which will formalise the ICS structure, legal powers and requirements.  Co-production with Health and Wellbeing boards of place based and STP Outcomes Framework aligned to the outcomes of our STP strategy to reduce inequalities, reduce variation and improve wellbeing.

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 Co-production of the strategic commissioning cycle, place alliance model and business cycle and place alliance integrated care model.  Consideration of options for a new financial framework and financial payment mechanism in a ICS operating model.  Reviewing the collective financial impact across our current partners for implementing the interventions of the Long Term Plan and green paper for adult social care when published.  Development of a System Talent and Organisational Development Programme.  Identification of early adoption phased areas for integrated strategic commissioning and place alliance delivery. We are likely to be piloting this approach with Ageing Well, Maternity, Childrens’ and Young People services.  Development of a system and place level population health management system supporting planning and needs assessment.  Procurement of a single digital care record for BSOL across health and social care. Six priority programmes have been identified to support this:  Leadership and governance  Strategic commissioning and place alliance  System population and health and wellbeing management  Care redesign  Digital  Finance. Strategic commissioning: Evolving from traditional commissioning to strategic commissioning and place alliances We recognise that traditional models of NHS commissioning need to be transformed. In 2017/18 we formed a CCG co-terminous with the STP, which was further supported by the development of our locality development and neighbourhood models. Moving forward, a new paradigm of strategic commissioning is required to successfully deliver outcomes so that as a system we are able to commission services that feel integrated, more personalised and seamless to our patients and citizens. Our strategic integrated commissioning model for the future has three key features:  Commissioning for outcomes  Integrated commissioning and integrated commissioning resources with our Local Authorities; our two ‘places’ Birmingham and Solihull  Commissioning with a single entity e.g. a prime provider/alliance at place. The impact of moving to this approach will mean that some of the functions we currently undertake as commissioners such as the level of contracting, quality assurance, service redesign will be undertaken by the place alliance in future and in a fundamentally different way. In 2019/20, we will explore the development

NHS Birmingham and Solihull Clinical Commissioning Group 2019/20 Operational Plan Page 6 of 79 of a new integrated strategic commissioning cycle and associated competencies (including a system wide organisational development programme), using the traditional framework to evolve from. The table below also outlines our proposed strategic approach to develop integrated commissioning and the shift towards a new way of working. Integrated Commissioning Current state - We will move from Future position - We will move to Focus on organisations and separate areas of spend Focus on place and population health needs Fragmented view of health, social care, education and other public Holistic view of health, social care, education and wider public sector reform services Short term financial planning Long term investment programmes Disconnected services Comprehensive and connected service pathways Inflexible and inefficient commissioning Economies of scale combined with integrated delivery Change initiatives that sit on top of but don’t fundamentally change Creating robust evidence for decommissioning existing models of care the mainstream shown to be of lesser value than new models Single service planning Integrated strategic planning focused on cumulative impact and outcomes

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Section 2 - Programme Priorities and Local Delivery Plans

Integration – Primary Care and Long Term Conditions (PC & LTC) Programme Area Integration (Primary Care - GP Forward View) SRO: Programme Lead Associate Director of Integration (Primary Care and Long Term Conditions) Director Of Integration SUMMARY

KEY ACHIEVEMENTS FROM 2018/19 Primary Care Networks  NHS planning guidance in 2018/19 asked CCGs to encourage every practice to be part of a local Primary Care Network (PCN). This is with the aim of complete PCN coverage at end of 2018/19 serving populations of at least 30,000 to 50,000. These have now been established across BSol. We have worked with our GP Provider Organisations to establish PCNs building on our Extended Access footprints and relationships through 33 PCNs of GP Practices with clear data sharing and governance arrangements.  We are building on our PCNs to support true integration of primary and community care to improve outcomes for patients. There is a clear STP wide mandate to develop the maturity of our networks. A STP wide stakeholder session was held in the Autumn, which has supported further refinement of networks through locality working sessions. This has led to the development of a clear set of principles/vision and an integrated care model for PCNs owned by the STP. Primary Care Access – Delivering Extended Access  The CCG delivered extended access provision to GP services, including at evenings and weekends, for 100% of the BSol population by 1 October 2018. To further support development, we have established a Primary Care Access Transformation Programme which aims to deliver: o An improved and sustainable primary care system, which operates 24 hours per day, 7 days per week. It ensures our population receive safe, high-quality and seamless care from easily accessible, appropriate, integrated and responsive services o A universal general medical service during core practice hours o Digital access to clinical assessment and advice o The development of Urgent Treatment Centres (UTCs) as an alternative to attending an Emergency Department (ED) o The establishment of a 24 hour, 7 days per week BSol clinical hub that incorporates the current GP Out of Hours (OOH) Service - Improved integration 111. Transformational Support  The CCG fully delivered on the NHS General Practice Forward View (GPFV) requirement to set out £3 per head of non-recurrent transformation support funded from CCG allocations starting in 2017/18. This was split over 2017/18 and 2018/19 and used to stimulate development of at scale providers, implementation of ten high impact actions and secure sustainability. BSol CCG specifically negotiated with the NHS England (NHSE) Sustainable Improvement Team to offer a support package and they have commended us for the most systematic approach over the largest area across any STP. General Practice Resilience Programme (GPRP) 2016/20 (£40m over the next 4yrs)  In 2018/19, BSol CCG secured £227k to support 18 practices. Since the start of the Programme we have secured £528k which has helped to support 107 practices. The CCG has supported over 100 practices through CCG General Practice Peer Support and was recognised as an exemplary service nationally by NHSE & Royal College of General Practitioners (RCGP). Recruitment has continued in 2018/19 to meet Practice demand. We have also engaged and collaborated with RCGP for bespoke support for practices.

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Programme Area Integration (Primary Care - GP Forward View) SRO: Programme Lead Associate Director of Integration (Primary Care and Long Term Conditions) Director Of Integration SUMMARY Workforce  In response to NHSE planning requirements a primary care workforce strategy has been developed. The BSol strategy is focused around the “4 Rs” initiative of: Recruitment, Retention, Returners & Role Substitution. We recruited GPs via international recruitment (IR) and now have 2 IGPRs in post. We launched the BSol GP Retention Connect Scheme, which was over-subscribed. This is one of the first STPs to be in delivery phase and there are currently 62 GPs on the scheme.  The CCG implemented the General Practice Nursing 10-Point Action Plan. Expression of Interest for Digital Nurse Champion was approved as one of two STPs in region. BSol CCG’s (General Practice Forward View - GPFV) Online Consultations  BSol CCG online consultation system fund of £1m was refreshed and a Project Initiated Document was approved by NHSE regional team and a Concordant and plan on a page was agreed with all GP providers for single digital front door. BSol Universal Patient Offer  During 2018/19 the CCG has established a programme structure to deliver an evidence based harmonisation of the three legacy CCG enhanced service portfolios into one Universal Offer for BSol General Practices from April 2019.  The Universal Offer will lead to: o Support to urgent care by improved crisis prevention/early intervention o Increased number of people are supported and have their Long Term Condition needs assessed and met in the community o Improved risk stratification and review of high attenders by specialty o Consistent approach at practice and GP at scale level / Improved resources to support more extensive self-care.

Programme Area Integration (Primary Care - GP Forward View)

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning 2019/20 position measure plans mechanism Primary Care STPs/ICSs must Implementation Delivery BSOL STP Q3 Strategy approved STP Not Applicable Strategy include a primary plan Primary Care Strategy through BSOL care strategy as part Governance and of the system assured by NHSE strategy Primary Care Develop mature BSol Established initial Agree baseline position PCNs must 100% of PCNs STP Memorandum of Networks PCNs PCNs building on with NHSE - Develop be in place Directed Ageing Well and Understanding (PCNs) extended access action plan for PCN by Q1 at Enhanced Service Later Life Alliance geographies maturity the latest Contracts signed arrangements by July 1st 2019.

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Programme Area Integration (Primary Care - GP Forward View)

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning 2019/20 position measure plans mechanism Primary Care Primary Care Internal audit Audit programme agreed, Q1–Q4 Full Assurance NHS 2019/20 Not applicable Delegated Delegated function programme in place undertaken, reported to from Internal planning guidance function Internal audit to ensure delegated Primary Care Audits Primary Care Internal audit programme to functions are Commissioning Strategy programme to ensure that BSOL appropriately Committee (PCCC) and ensure that CCG is compliant managed – fully follow up actions BSOL CCG is and effective assured addressed compliant and effective Continue to Improved utilisation Utilisation of Develop data collection Q1 New monitoring Primary Care Not applicable develop and equitable access extended access reporting reports available Access extended to extended access appointments are Contract 111 booking Q2 –Q4 Evidence of Transformation access hubs appointments not monitored at improved Programme as part of an practice level / 111 appointment integrated not able to book utilisation model of Availability of Scoping Q1 Report prepared Contract variation primary care extended access Report approved appointments for Development of delivery/ Q2/Q3/Q4 Booking of patients who have implementation plan appointments from called NHS 111 NHS 111 Ensure the General Practice 2018/19: £227k Refreshed GP peer Q1 No. of practices in BSol CCG GPFV Memorandum of sustainability Resilience secured to support support team appointed receipt of Implementation Understanding of general Programme: 18 practices. for practice support resilience support Plan practice in Responding to Needs assessment of and evaluation of BSol CCG by regional NHSE practices scheme implementing process and Complete & submit Q1 the General timescales to apply business case template to Practice for funding/support local NHSE offices Forward View Memorandum of Q1-Q2 (GPFV) Understanding and funding agreed with practices - support in place Reducing Workload: All practices trained Active signposting spec Q1 Number of BSol CCG Imp Memorandum of on document scoped with GP providers practices in receipt Plan Understanding & training hub. of active

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Programme Area Integration (Primary Care - GP Forward View)

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning 2019/20 position measure plans mechanism Training for clerical & management/workfl Options appraisal Q1 signposting reception staff ow Commission trainer Roll Q1 – Q4 training allocations 2019/20 out training to all practices Ensure the Reducing Workload 2018/19: £23k Needs assessment of Q1 No. of Practice BSol CCG GPFV Memorandum of sustainability Practice Manager secured to support priorities for Practice Managers in Implementation Understanding of general training allocations Practice Manager Managers training- receipt of training Plan practice in 2019/20. Training training Business case completed BSol CCG by rolled out to Practice Commission Trainer and Q2/3/4 implementing Managers rollout the GPFV Online consultation Refreshed Project Refreshed PID 19/20 Q1 Number of BSol CCG GPFV Contract system fund Initiation Document approved by NHSE. practices utilising Implementation allocation 2019/20 (PID) 2018/19 £218k allocation secured BSol Health App Plan approved by NHSE BSol Health app rolled out Q1 Number of BSol CCG Primary £436k allocation to all practices - Online practices utilising Care Access secured consult pilots in place online consultation Digital Concordant & plan on a page 48 International GP 2018/19: 2 IGPRs Refresh IGPR model with Q1 Number of IGPRs BSol GPFV Not applicable Recruits (IGPR) in in training NHSE on performers list Implementation place by 31st March Plan 2020 2018/19 62 GPs on Evaluation of GP Q1 Number of GPs BSol CCG Primary GP Retention retention Connect retained Care Workforce Not applicable Connect Scheme Scheme Plan CCGs are Recruitment to new 5.3 Whole Time Support and facilitate Wave 8 Number of Clinical BSol CCG GPFV Not applicable required to roles in primary care: Equivalent (WTE) Clinical Pharmacists and 9 Q1 Pharmacists, Implementation deliver their Clinical Pharmacists, clinical pharmacists funding waves Physician Plan contribution to Physician 0.6 (WTE) senior Associates, the workforce Associates, Mental clinical pharmacists Workshops benefits of Q1 Mental Health BSol CCG Primary Not applicable commitment to Health Therapists currently recruited new roles plus funding Therapists in post Care Workforce have an extra opportunities Plan 5000 doctors working in primary care by 2020 Universal Offer Successful Final framework in Review and monitoring of Q1 – Q4 Implementation of Aligned with the Local Enhanced Enhanced Implementation and place service delivery a sustainable STP/CCG LTC Service Contract Service ongoing review model strategy. Framework

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Programme Area Integration (Primary Care - GP Forward View)

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning 2019/20 position measure plans mechanism When embedded specific success measures to be reported.

Programme Area Integration (Primary Care and Long Term Conditions) – Diabetes/Respiratory SRO: Programme Lead Associate Director of Integration (Primary Care and Long Term Director Of Integration Conditions) SUMMARY Diabetes/Respiratory

In line with the NHS Long Term Plan we recognise longer term health conditions are making an increasing contribution to the overall burden of disease. Diabetes and Respiratory Our aim is to develop a whole system redesign for both diabetes and respiratory that will develop a robust care pathway that will support BSol CCG patients from prevention, through to diagnosis, planned, urgent and end of life care. There are several key areas of development:  Support the development of a multi-disciplinary approach (MDA) model of care, integrating primary, community and secondary care services and workforce  Increase access to, uptake and completion of structured education/rehabilitation services.  Increase the opportunity to work with third sector providers in an effort to invest greater integration and support into communities. For diabetes additional resource from NHSE will support the transition from current to future model.  Increase working time equivalents Diabetes Inpatient Specialist Nursing to the national patient/nurse ratio  Support the commissioning of Continuous Glucose Monitoring services (CGM). Where are we now?  Appointment of overarching diabetes/respiratory clinical leads  Workforce, skill mix and resource modelling for the multi-disciplinary team through dedicated partnership delivery groups  Contract discussions with providers to understand current structured education programmes and options going forward to increase uptake and completion. Where we want to get to  A fully integrated care pathway that meets the need of patients at risk of or diagnosed with diabetes and respiratory conditions that supports the individual and BSol CCG to develop healthier communities

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Programme Area Integration (Primary Care and Long Term Conditions) – Diabetes/Respiratory SRO: Programme Lead Associate Director of Integration (Primary Care and Long Term Director Of Integration Conditions) SUMMARY Diabetes/Respiratory

 The redesign will also deliver a robust education programme that supports the primary care workforce  A sustainable and cost efficient service that reduces non-elective care, and promotes equitable, quality best practice care.

Programme Area Integration (Primary Care and Long Term Conditions) – Diabetes/Respiratory Priorities for Key Baseline 2019/20 Deadline Success measure Link to other Commissioning 2019/20 deliverables position milestones plans mechanism

Reduce the risk of Identification and Embedded Generate New contract for  Identify and refer 6,900 National NHSE Contract individuals referral of those within the sufficient National patients at risk of Diabetes developing Type 2 at risk of Universal Offer referrals, Diabetes developing Type 2 Prevention Diabetes developing Type subject to Prevention Diabetes into the Programme 2 Diabetes recruitment Programme in National Diabetes place from Prevention Programme August 2018 by Q4 2019/20 (July 2020) Ensure the Multi- MDA model of Pilot sites in Full roll out of Q4  Improved clinical Referral into Service Disciplinary care established place within model, subject outcomes, reduced MDA embedded development/ Approach (MDA) across the BSol areas of BSol to recruitment complications within the redesign model for diabetes footprint and  Improved learning Universal Offer Contract with and respiratory is accessible to all  Reduced referrals BSol STP Service Provider rolled out to all Practices  Improved medication Ageing Well and practices across /cost savings Later Life BSol CCG  100% of eligible patients will be offered access to local pulmonary rehabilitation services within BSol to prevent exacerbations of their respiratory condition and avoid/reduce hospital admissions.

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Programme Area Integration (Primary Care and Long Term Conditions) – Diabetes/Respiratory Priorities for Key Baseline 2019/20 Deadline Success measure Link to other Commissioning 2019/20 deliverables position milestones plans mechanism

Increased access to Delivery of New Pathway / NICE Treatment Q1 80% (1,719) of newly Diabetes Contract variation and uptake of agreed actions in service Targets within diagnosed Type 2 Diabetes Transformation Grant Agreement Diabetes Structured Diabetes Trust specification Universal Offer referred into structured Plan with Diabetes UK Education Services Foundation Plan developed education Improved NICE Treatment Revised plan Shared care Q1 A 3% increase achieved by Diabetes Universal Offer achievement of Targets within with refreshed plan/template Q4 2019/20 and 5% Transformation National Diabetes NICE Treatment the Universal targets subject increase by Q4 2020/21 Plan Audit Targets for Diabetes Offer to recruitment

Improved access to Standardised No of eligible Q1 Q2-4 All eligible patients have National CGM Contract variation Continuous Glucose CCG Policy patients timely access Policy Monitoring (CGM) / 131 against the Flash glucose CGM policy in monitoring 2019/20 802 against the Flash policy in 2019/20

Programme Area: Integration (Primary Care and Long Term Conditions) – End of Life SRO: Programme Lead: Associate Director of Integration (Primary Care and Long Term Conditions) Director of Integration SUMMARY The End of Life Oversight Group has been established as a BSol wide group. The Group will ensure that all decisions and actions are focused on achieving the highest quality of care and services are delivered to its population. The programme scope is based on the six Ambitions for Palliative and End of Life Care: The ambitions are also supported by the recommendations of the:  Integrated Palliative and End of Life Care Commissioning Strategy for Birmingham 2014/15-2017/18  Ambitions for Palliative and End of Life Care for Children and Young People: A Strategy for Birmingham 2016. These aspirations support one of the main priorities under the BSol One Care Partnership Ageing and Later Life Programme of creating a better experience at the end of life. Where are we now?  End of Life Oversight Group has been established and continues to gain momentum  The work programme continues with five task and finish groups set up covering – IT Data Sharing /Estates /Population Based Needs Assessment /Training and Education /Advance Care Planning

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Programme Area: Integration (Primary Care and Long Term Conditions) – End of Life SRO: Programme Lead: Associate Director of Integration (Primary Care and Long Term Conditions) Director of Integration SUMMARY  Planning stakeholder engagement for early 2019  Producing equality analysis  Streamline processes to ensure early identification of those in need of end of life care services – includes primary care, community, secondary care, mental health and third sector  Identifying any overlap with the Birmingham Older People’s Programme  Agreeing model for co-ordination of care  Reviewing potential contracting options available and make recommendations. Where we want to get to?  Early identification of those in need of end of life care services  Reduce inappropriate hospital admissions / Improve early supported discharge  Increase the numbers of patients achieving their preferred place of care/death  Improve care coordination of services

Programme Area: Integration (Primary Care and Long Term Conditions) – End of Life

Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism Education & Education and Scoping current Complete scoping Q3 Resource IT/Data sharing Change to service Technology training task education and and identify host for established and Integrated Palliative and End of specifications and and finish resource central resource for available across all Life Care Commissioning contract where group available across BSol sectors Strategy for Birmingham appropriate. BSol Promotion of 2014/15-2017/18 resources Ambitions for Palliative and End Service Improved advance of Life Care for Children and development / care planning Young People: A Strategy for redesign Birmingham 2016 Advance care Advance care Scoping current Agreed advance Q3 Recommended Anticipatory prescribing Change to service planning planning task advance care care planning Summary Plan for Integrated Palliative and End of specifications and and finish planning across process Emergency Care Life Care Commissioning contract where group BSol and Treatment GP Strategy for Birmingham appropriate education session 2014/15-2017/18 Roll out of Ambitions for Palliative and End Service Recommended of Life Care for Children and development / Summary Plan for redesign

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Programme Area: Integration (Primary Care and Long Term Conditions) – End of Life

Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism Emergency Care Young People: A Strategy for and Treatment form Birmingham 2016 Advance care planning process established Improved advance care planning Population Based Population Undertake Identification of the Q3 A robust population Integrated Palliative and End of Change to service Needs Based Needs population core service based needs Life Care Commissioning specifications and Assessment to Assessment based needs components assessment Strategy for Birmingham contract where understand task and finish assessment for required to meet completed by Public 2014/15-2017/18 appropriate palliative care group palliative care those needs Health. Following Ambitions for Palliative and End service need for BSol Mapping of the the completion of of Life Care for Children and Service services currently the population Young People: A Strategy for development / available to meet based needs Birmingham 2016 redesign those needs assessment, there An assessment of will be identification the priorities for of the success filling the service measure gaps IT/Data sharing IT/Data Scoping of Complete scoping Q3 Able to share data IT/Data sharing Service sharing task current IT/data and identify best for patients at the development / and finish sharing for approach to be end of life to enable Your Care Connected redesign group palliative and taken informed decisions end of life to be made Integrated Palliative and End of available across Life Care Commissioning BSol Strategy for Birmingham 2014/15-2017/18

Ambitions for Palliative and End of Life Care for Children and Young People: A Strategy for Birmingham 2016

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Programme Area Integration (Primary Care and Long Term Conditions) - Dementia SRO: Programme Lead Associate Director of Integration (Primary Care and Long Term Conditions) Director of Integration SUMMARY Dementia is a key priority for the CCG and NHS England (NHSE). In BSol it is estimated that around 12,748 people over the age of 65 years have dementia. NHSE’s aim is that by 2020 we are the best country in the world for dementia care and support. Some of the key aspirations of this vision are; equal access to diagnosis for everyone, GPs ensuring coordination and continuity of care for people with dementia, every person diagnosed with dementia having meaningful care following their diagnosis, all NHS staff having received training on dementia appropriate to their role. One of the 10 priorities identified in the NHS Five Year Forward View was to upgrade the quality of care and access to mental health and dementia services. There is a considerable economic cost associated with the disease estimated at £23bn a year, which is predicted to triple by 2040. This is more than the cost of cancer/heart disease/ stroke. Where are we now?  The CCG currently has a dementia diagnosis rate of 66.4% when the national target is 67%, which is two-thirds of estimated prevalence  The CCG is currently re-procuring a dementia navigator service to cover all of Birmingham. Solihull Metropolitan Borough Council are also procuring a dementia navigator service to cover Solihull  We know we need to Improve access to the service for all communities, in particular Black Asian and Minority Ethnic Groups (BAME) communities who do not appear to be accessing the service  Improve education on the identification of dementia in primary care. Where we want to get to?  Achieve a dementia diagnosis rate of 90% within 3 years, by developing a robust action plan to include targeting care homes and GP education  Everyone with a formal dementia diagnosis will have access to the dementia navigator service at the point of diagnosis  Access to the dementia navigator service improved for all communities, in particular black and minority ethnic communities  CCG education session scheduled for 2019/20 aimed at GPs and Advanced Nurse Practitioners on the identification of dementia. Led by Professor Alistair Burns, National Clinical Director. Summary of achievements/progress of 2018/19  The CCG is currently re-procuring a dementia navigator service to cover all of Birmingham. We have shared the service specification with Solihull Metropolitan Borough Council who are also procuring a dementia navigator service to cover Solihull. This will ensure that the CCG has a consistent service across BSol  We developed a CQUIN (Commissioning for Quality and Innovation) to improve access to the service for all communities.

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Programme Area Integration (Primary Care and Long Term Conditions) - Dementia

Priorities for Key Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 deliverables position plans mechanism

Improve dementia CCG to achieve 66.4% Target practices with low Q1 Practice dementia National dementia Change to service diagnosis rate a dementia October dementia diagnosis rate diagnosis rate reach target is for at least specifications and diagnosis rate 2018 and care homes target of 66.7% in two thirds of contract where of 90% by Education sessions for Q1-4 2019/20 and thereafter people 65+ appropriate. 2022/23 GPs dementia on the increase by 5% each with dementia to identification year in 2020/21 and be diagnosed Service 2021/22. Attendance by (67%) development / Procurement of post Q2 practices at the redesign/ diagnosis support for education session patients and families/ Promotion of Dementia carers Navigator Service and subsequent increase in referrals to the service once patients diagnosed CQUIN to improve Improve access Current Monitoring of the CQUIN 2022/23 Service is more inclusive National dementia Change to service access to the to the service for service via CCG Quality Team of the population CCG target is for at least specifications and Dementia Navigator all communities, performance serves two thirds of contract where Service particularly from people 65+ appropriate. BAME with dementia to Service communities be diagnosed development / (67%) redesign

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Programme Area: Integration (Primary Care and Long Term Conditions) – Prevention SRO: Programme Lead: Associate Director of Integration (Primary Care and Long Term Conditions) Director Of Integration SUMMARY The Prevention work stream forms part of the BSol STP Ageing well and later life portfolio, where all partners and the health and social care system have come together to plan the provision of support and services to people in their local communities. This includes:  Stocktake and mapping of current provision of social prescribing and place based initiatives across Birmingham to highlight opportunities for future provision.  Multi-agency review of risk stratification tools to ensure the appropriate identification of those patients and citizens most vulnerable and at risk.  Promoting the development of intergenerational activities between schools across BSol and local older adult communities. Where are we now? Social prescribing - a general model has been supported via the Better Care Fund. This covers a population of c400k and with two referral routes, primary care referral and self-referral via pop-up clinics in places of worship, supermarkets etc. The model will be integrated within primary care and at a place level through the neighbourhood networks (10 constituencies across Birmingham). Risk stratification - we have collated and acknowledge a number of risk stratification mechanisms across the system as well as soft intelligence of those individuals that are just under the threshold of safeguarding. There is multi-agency working to develop an integrated approach, building on current processes to ensure a system wide solution-focused approach. Intergenerational activities - the aim to build on the successes from Solihull whereby intergenerational activities have demonstrated very positive outcomes for both the older adults and the children involved. The successes have been shared across all Birmingham schools and received positive evaluations. Work has begun to facilitate schools who want to support intergenerational activities with their local care home providers and an event is being planned to achieve this. Where we want to get to? The aim is to demonstrate the value of social prescribing in terms of increased wellbeing to the individual, an increase in the patient’s ability to self-manage their condition as well as a system wide reduction those patients need to access statutory services. This will be achieved by ensuring we utilise existing support networks, services and activities accessible in the community and an effective integration of health, social care and third sector organisations offer of support. We will develop a strategy that is underpinned by a hierarchy of evidence and outcomes framework that ensures any gaps in provision are targeted and evidence based and will support the infrastructure at a place level. Patients will be supported by an integrated approach to intervention and support to build resilience and support network to avoid crisis. Older adults will be seen as valued members of their community, supporting the development of children in schools through intergenerational activities.

Programme Area Integration (Primary Care and Long Term Conditions) – Prevention

Priorities for 2019/20 Key deliverables Baseline position 2019/20 milestones Deadline Success Link to other Commissioning measure plans mechanism Social prescribing Sign off of model Evidence base – Delivery of SP model Q1 Strategy agreed Long Term Plan Service Patient Activation Develop strategy review Strategy draft and signed off STP priority work development / Measures document stream – Ageing redesign Patient Activation and later life Measures rollout

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Programme Area Integration (Primary Care and Long Term Conditions) – Prevention

Priorities for 2019/20 Key deliverables Baseline position 2019/20 milestones Deadline Success Link to other Commissioning measure plans mechanism Risk Stratification & Development of % patient/citizens Incorporate health and Q2 Redesigned STP priority work Service Intervention Supporting Adult discussed at social care into pathway stream – Ageing development / Panel (SAP) Supporting Adult existing Supporting Reduction in use and later life redesign Integration with Panel - % Adult Panel meetings - statutory BSol primary care patient/citizens services networks referred to Safeguarding - % patient/citizens accessing statutory services Prevention: Development of a No. of schools who Development of Q2 No. of toolkits STP priority work Service Intergenerational toolkit which links have links with local network resource for requested stream – Ageing development / Activities schools with their care home with all schools and older No. of schools and later life redesign housing facility intergenerational housing facility linked to STP priority work Peer-support activities taking providers interested in neighbouring stream – mechanism to place currently / intergenerational housing facilities Childhood and support have been given the activities No. of adolescence implementation toolkit in Solihull stakeholders across BSol actively involved in peer networks

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Integration – Urgent Care

Programme Area: Integration – Urgent Care SRO: Programme Lead: Associate Director of Integration (Urgent Care / Community) Director Of Integration SUMMARY

Our ambition is to develop an Integrated Care System providing 24/7 seamless urgent care system which will:  Build care around the patient not the existing services  Simplify an often complicated and fragmented system  Ensure mature urgent primary care system balancing demand across the system  Deliver early intervention and prevention to avoid ‘acute centric’ urgent care  Ensure the urgent care system works together rather than pulling apart - system wide approach  Link to STP and other enablers – digital/workforce/finance. Nationally, the NHS has been significantly affected by urgent care pressures, which we are experiencing locally. We are continuing to work with our partners across BSol to redesign the urgent care system to address these challenges. Our aim is to provide better support for people to self-care to prevent unnecessary admission and help people with urgent care needs to get the right advice in the right place, first time – via NHS 111 and Integrated Urgent Care Clinical Advice Service. In December 2018 the Solihull Urgent Primary Care Centre was designated as an Urgent Treatment Centre (UTC) meeting the new standards and operating as part of an integrated approach to urgent and primary care. In 2019/20 we will develop an urgent treatment centre designated in Birmingham. BSol STP Ageing Well and Later Life priority is focused on delivering the Birmingham Care Quality Commission (CQC) review action plan which correlated with a system wide analysis we undertook which found that some people were admitted to hospital with social care needs that could have been managed more effectively and safely at home and some people stayed in hospital for longer than they needed. At the front door of our hospital sites we have an Older Peoples Assessment and Liaison Service (OPAL) which we are ensuring delivers a ‘quick response’ avoiding unnecessary hospital admissions, including the delivery of traditionally acute clinical interventions for older people that can be safely delivered at home. Optimising this delivery in 2019/20 should reduce demand and improve flow throughout the hospitals.

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Programme Area: Integration – Urgent Care

Priorities for Key deliverables Baseline position 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 plans mechanism High Intensity Deliver a safe Project is live Pathway in place Q1 Reduced 999 calls, Better Care Fund A contract Service Users reduction in the across BSol CCG Emergency Right Care variation has been (BSol) frequent number and there is monthly Revision of service to Q2 attendances and Urgent Care agreed with BCHC of calls and monitoring of its increase efficiencies admissions Multi-Disciplinary for the delivery of ambulance impact and maximise patient Improved quality of Team Model this service. conveyances to numbers whilst care, patient Emergency BCHC currently maintaining a safe experience and health Department (ED) deliver the service and efficient service outcomes through a based on the for patients Reduced preventable coordinated, Blackpool and Fylde causes of ill-health appropriate & Wyre CCG model Reduced health & response to social care demand address the and cost needs to the individual Older People Standardised System in place and Standardisation of Q1 Reduced ED BSol STP – Contract variation Assessment and OPAL service working in Solihull OPAL service across admissions Ageing Well & with Acute Trusts Liaison (OPAL) providing early, BSol Improved quality of Later Life priority (BSol) multi-disciplinary Birmingham review Confirm next steps Q1/Q2 patient care comprehensive part of Quick for OPAL model Less Delayed Transfer geriatric Access element of extension to of Care assessment to the Ageing Well Birmingham elderly, and those Early Intervention with complex work stream Determine if there is Q2 needs referrals a greater need for from frail patients professionals extending beyond working within the current OPAL the BSol with the service –e.g. the aim of reducing Rapid Response unnecessary service

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Programme Area: Integration – Urgent Care

Priorities for Key deliverables Baseline position 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 plans mechanism admissions to Undertake options Q3 hospital appraisal what interventions and services can support these patients, including whether OPAL can be expanded To establish Urgent Designation of Replacement of Develop an action Q1 Formal designation of Primary Care Re-specification of Treatment Centres UTCs by NHSE Walk-in centres plan to meet national the urgent treatment Access existing WiC/ UCC (UTCs) that are (WiC) / Urgent Care core requirements for centres by NHSE Transformation Agreement of integrated into the Centres (UCC) with UTCs Programme contract variations urgent and primary UTCs Urgent and with service care systems Implementation of Q2 & Q3 Emergency Care providers the action plan with Delivery Plan all UTCs designated by Dec 2019. Prepare for UTC procurement in 2020/21. Alternative Reduction in CCG working with Subject to output of Q3/4 Reduction in High Intensity Contract variation Ambulatory Care Ambulance NHSE on 2 REACH and UEC conveyance to ED Service Users Pathways conveyances to programmes of Evaluation Plan ED system evaluation: OPAL Realising Every Asset in the Community (REACH) and an Urgent Emergency Care (UEC evaluation aim to l highlight areas where alternative pathways can reduce ED conveyances

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Integration – Community Better Care Fund Programme Area: Integration – Community Including Better Care Fund SRO: Programme Lead: Associate Director of Integration (Urgent Care / Community) Director Of Integration SUMMARY

In 2018/19, working collaboratively with the two providers of community services in BSol NHS Birmingham Community Healthcare Foundation Trust (BCHC) and University Hospitals Birmingham NHS Foundation Trust (UHB), we developed the BSol CCG Strategic Commissioning Framework for Adult Community Services (the Framework). This sets out our vision for the future of integrated community service and how we will commission this in 2018/19 and beyond. The Framework also supports the aspirations of the BSol STP with particular reference to supporting the ageing population, keeping them at home and preventing unnecessary hospital admissions. We are making progress on reducing delayed transfers of care and improving patient flow through reducing inappropriate length of stay for admissions. Transformation of our community services is needed, making use of all the assets in each local community wherever these are to be found, breaking down silos between services and reducing fragmentation in service delivery. This is alongside the delivery of enabling priorities such as joining up information systems and digital innovation. The Framework also developed an agreed Community Care Model, which will enable us to deliver the care people need efficiently and effectively. The aim of the community care model is to:  Assess need  Focus on Prevention – utilising community assets  Embed a “Home First” ethos  Strengthen integration  Introduce a Multi-Agency approach  Develop a sustainable Care Model delivered on the most appropriate footprint  Deliver Value for Money. In 2019/20 we will develop a strategic Commissioning Framework for children and young people.

Programme Area: Integration – Community Including Better Care Fund

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism Develop the Agree revised model Overall system CCG chairing a multi- Ongoing Reduced hospital Intermediate Commissioning intermediate care and pathway of intermediate agency group to length of stay Care NICE proposal for future offer for intermediate care care pathway is manage flow through Reduction in the Guidance intermediate care Birmingham (home first and unclear short term beds – numbers of delayed model and bedded). This will be Average length identifying opportunities transfers of care National Audit pathway based on the outputs of stay in short for improvement Reduction in length of of Intermediate from system term Enhanced System wide dashboard Ongoing stay in EAB/ interim Care 2017 transformation Assessment in place to monitor flow beds Beds (EAB) and

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Programme Area: Integration – Community Including Better Care Fund

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism working being interim beds is Review learning from Q2 Increase in home first STP Ageing undertaking by 37 days Early Intervention discharges Well and Later a) STP Ageing Well (snapshot of prototype work Reduction in numbers Life priority - Early current patients of people making Programme – Intervention as of 30/11/18) Commission a revised Q3 decisions regarding Early b) Intermediate Care CQC review intermediate care model long term care in Intervention Operational Group findings – over and pathway- based on hospital reliance on bed the prototype model CQC review based care, outcome inconsistent service offer Develop the Clear offer of home Overall system Continue to oversee the Q3 Reduced hospital Intermediate Commissioning Intermediate Care first alternatives intermediate Support U Home Beds length of stay Care NICE proposal for future Offer for Solihull promoted (via care pathway is workstream and in Reduced numbers of Guidance intermediate care engagement in the unclear collaboration delayed transfers of model and Support U Home commission a revised care National Audit pathway Programme) Average length intermediate care model Reduced length of of Intermediate Revised model and of stay for and pathway. stay in bedded Care 2017 pathway of patients exiting intermediate care intermediate care is intermediate Dashboard in place to Q1 Increase in home first STP Ageing developed as part of care beds is 27 monitor flow discharges Well and Later the Support U Home days (October Life Programme 2018) Programme – Early Intervention

Implement the Continue to develop, Strategic Agree priority action Q1 Reduce variation and STP Ageing Commissioning Strategic refine and improve Framework plan improved community Well and Later service redesign Commissioning the delivery of the developed and Engage with localities Life proposal for the Framework - Adult prototype community approved Seek Public and Patient formal delivery of Community care model and test moving to views and continue to the community services against the strategic implementation shape local services care model framework phase. accordingly Agree the community care model service Test, develop and refine Q1/Q2 specification community care model

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Programme Area: Integration – Community Including Better Care Fund

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism Produce and agree the Q3 community care model service specification Commission in 2020/21 Q3/4 Contract negotiation Falls Prevention Develop a pathway NICE guidance Pathways in place. Q3 Reduction in falls Urgent Care, Contract with and Reduction and services that on falls in older Communications related admissions Solihull NHS provider (Solihull) identify, risk assess people not fully evaluated and associate costs Together community for and provide met, approx. Falls dashboard in place Improved confidence Community Falls interventions for £7.5 Million Decision and plans of front line staff Team. older people annually spent regarding Fracture Improved access by Contract with Age identified as at risk of on falls related Liaison Service the public to UK for Postural falling, those who admissions and Community Falls team information and Stability Exercise have had a fall or rising redesign/ improvement advice on falls Instruction falls related injury plan delivered Single prevention. training. Other point of contact for falls Increased numbers of services through referrals agreed people accessing falls partnership, i.e. Plan with West Midlands pathway. non-contractual Falls Prevention Develop a pathway There is no Ambulance Service Q4 Reduction in falls Urgent Care, Community Falls and Reduction and identify or pathway in University NHS related admissions Ageing Well Team (Birmingham) develop services that place, and falls Foundation Trust to and costs Contract with identify, risk assess NICE quality improve response to Improved confidence UHB, Other and provide standards are falls of front line staff services through interventions for not being met. Community exercise Improved access by partnership, i.e. older people who Currently programme in place and the public to non-contractual have been identified spending evaluated information and as being at risk of approximately Key agencies have advice on falls falling, have had a £25m on falls received falls awareness prevention. fall or who have had related training Increased numbers of a falls related injury admissions in Toolkit and training for people accessing falls Birmingham. care homes in place. pathway. Care Homes Business case to £16m spent Case for Change Q4 Increase in number of Urgent Care, Potential contract develop services that annually on developed/ approved people dying in their community with primary care support care homes admissions and Community Pharmacy preferred place strategy, and community to improve quality. A&E pilot evaluated Increase in Support U health providers Processes in place to attendances Solihull Red bag confidence of care Home for enhanced assure quality of from care evaluated home staff to manage (Solihull), support to care Ongoing homes

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Programme Area: Integration – Community Including Better Care Fund

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism homes and homes across Out of hours and crisis the needs of Personalised workforce BSol. support reviewed and residents Support Local Incentive information to all homes Reduction in (Birmingham), Scheme in place NHS mail rolled out to unnecessary national with some GP homes admissions to Enhanced practices to Single Quality hospital from care Health in Care support 29 Assurance Framework homes Homes homes across BSol for Reduction in A&E performance monitoring attendances from reporting significant care homes incidents & dashboard in Reduction in delayed place. transfers of care Identification training Reduction in number gaps and plans in place of ambulance call to address outs from care homes Work with Local Authority to map current care home provision and develop joint market position Statement

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Personalisation and Personal Health Budgets

Programme Area: Personalisation and Personal Health Budgets SRO: Programme Lead: Personalised Care Programme Lead Director of Joint Commissioning SUMMARY

CCGs are expected to deliver Personal Health Budgets (PHBs) to 0.2% of their population by March 2020 which translates to a target of 2020. NHS England (NHSE) published their Vision Paper for Personalised Care and Personal Health Budgets in December 2018. This will guide the CCG in identifying key areas for development during 2019/20. The current focus is on embedding personalised care and support planning within contracts, mapping current self-management activities and rolling out health coaching, patient activation and enabling access to social prescribing. Plans are underway to review the CCG staffing to move to a sustainable infrastructure. Summary of achievement 2018/19 As of January 2019, there are 352 PHBs in place. Due to the slow uptake of PHBs it is unlikely the CCG will achieve their target of 1140 PHBs by April 2019. To address this going forward, the Personalised Care Team are focusing on increasing the number of PHBs delivered and ensuring the sustainability of the PHB offer for 2019/20. Further work streams will focus on:  Personalised care and support planning  Embedding Personalisation and PHBs within contracts  Implementing and embedding resource allocation tools for Continuing Health Care (CHC) and Section 117 (Mental Health and Learning Disabilities)  Co-production  Development of an e-market place.

Programme Area: Personalisation and PHB’s Priorities for Key Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 deliverables position measure mechanism Meet PHB Robust A pilot of PHB E-market place utilised for Q4 PHB Choices CHC Delivery Plan Service level Trajectory infrastructure in Choices has been all PHB Transactions is the default NHSE Personalised Care agreements Target of 2020 place to support agreed for delivery Future Vision Contract the safe and January 2019 mechanism STP Plan variations effective for all PHBs expansion of across the PHBs CCG

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Programme Area: Personalisation and PHB’s Priorities for Key Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 deliverables position measure mechanism Robust Development of A resource allocation tool Q4 Auditable STP Plan Joint finance infrastructure in resource will be developed in line tool for Commissioning Action Plans agreements place to support allocation tools for with requirements of PHB allocating NHS Five Year Forward Service the safe and spend to be cohorts and commissioning budgets View Specifications effective according to responsibilities Fair and Birmingham Special Contract expansion of health and consistent Education Needs and variations may be PHBs wellbeing needs budget Disabilities (SEND) Written required setting Statement of Action Risk Sharing across PHB Solihull SEND Action Plan Agreement holders CCG SEND Operational Plan 2018-19 Meet PHB Resources are Planning to Pilot in place and is Q4 Implementati NHS Five Year Forward Service Trajectory released from develop a evaluated for 30 individuals on of pilot View Development Target of 2020 community business case with education, health and scheme Birmingham SEND Written Possible contracts to and project plan care plans Statement of Action Procurement expand SEND to trial the use of Evaluation Solihull SEND Action Plan Joint finance offer outside PHBs with young proves CCG SEND Operational agreements Continuing Care people with SEND success of Plan 2018-19 Risk Sharing in 2020/21 model Agreement

Embedding PHB project in Continuation of Section 117 Q2 Individuals Mental Health Delivery Plan Joint finance personalised place to embed Mental Health pilot to July eligible for agreements planning and the PHBs for 2019 Section 117 Service delivery of PHBs individuals eligible aftercare Specification to individuals for Section 117 have a Contract variation with Section 117 aftercare personalised where required Aftercare – plan and Mental Health PHB if appropriate Personalised 2017/18 – 44 All appropriate people with Q4 2% of TCP BSol Transforming Care Service planning and the people with a a learning disability are packages Partnership (TCP) Plan Specification delivery of PHBs learning disability offered a PHB delivered via In year contract to all Individuals and/ or Autism. a PHB Model variations with Joint finance Transforming agreements Care Risk Sharing Programme Agreement (TCP) package

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Programme Area: Personalisation and PHB’s Priorities for Key Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 deliverables position measure mechanism PHBs for Funding secured Implementation of the PHB Q1 Continue to Mental Health Vanguard Service Looked after from NHSE to Sustainability Plan that was deliver PHBs Joint Commissioning Specification Children and continue pilot in developed in 2018/19 and at scale in Programme for Children In year contract Care Leavers 2019/21 submitted to NHSE 2020/21 variations accessing Joint finance specialist mental agreements health services depending on evaluation Risk Sharing Agreement Demonstrate the Personalised Personalised care Agree form of words and Q1 Agreed STP Plan Service move to greater care and planning a target numbers across statements NHSE Vision Paper Specification personalisation support planning requirement of each cohort: within cohort Individual workstream plans In year contract written into delivery of PHBs contracts variations contracts At least 1% of Ensure that Some Agree policy and Standard Q4 Agreed STP Plan Agree form of the population validated tools programmes are Operating Procedure statements words and target will have are being used using impact within cohort numbers across personalised to assess assessment tools To be completed across all contracts each cohort care impact of self- –roll this out cohorts management across all programmes e.g. Patient Activation Measures Co-production To develop and Agree co-production plan Q1 Agreed work STP Plan Services group to support support a co- and roles and plan NHSE Vision Paper specification the evolution production group responsibilities Individual workstream plans development of and delivery of these to include personalised patient care engagement People Shared decision Map current To be confirmed Q4 Map of •STP Plan Service accessing self- making shared decision- current •NHSE Long Term Plan Specifications management (including health making activities activities •Universal Personalised support literacy) Care - Comprehensive Contract variation Model where required •Individual workstream plans

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Programme Area: Personalisation and PHB’s Priorities for Key Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 deliverables position measure mechanism At least 1% of Supported self- Map current Health Coaching training Q4 Health •STP Plan Service the population management shared decision- taking place in March/ April Coaching •NHSE Long Term Plan Specifications will have (including making activities. for the diabetes champions programme •Universal Personalised personalised patient Identify and link workers. delivered, Care - Comprehensive Contract variation care activation, opportunities for 2018-19 CQUIN Centred and impact Model where required health coaching, growth. on use of the PAM within measured •Individual workstream plans structured Frailty services – evaluation via usage of education and to support the roll out validated peer support) across LTC more widely Patient Development of a Co- Activation Production group will measures. support and enable access Usage of to peer support models PAM within LTC defined and rolled out Mapping of Implementing the PAM Q4 Access to a •STP Plan Service Social community within BSOL CCG which ‘link worker’ •NHSE Long Term Plan Specifications prescribing and activities and will support social who can link •Universal Personalised community social prescribing prescribing and utilisation to community Care - Comprehensive Contract variation based support across of resources. groups and Model where required Birmingham. Phase 1 will be rolled out activities. •Individual workstream plans Social prescribing within the diabetes Data models are linking champions and ‘provider supporting in with the local organisation’ (health referral and authority Exchange) Link workers. uptake neighbourhood The CCG is working very numbers. constituency closely with the social Development networks to prescribing provider Health of a Social ensure a placed Exchange and Our Health Prescribing based approach. Partnership to get it Strategy. implemented. Work is being The 2nd phase will be the scoped in Solihull practice pilot.

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Mental Health

Programme Area: Mental Health SRO: Programme Lead: Head of Joint Commissioning, Mental Health Director of Joint Commissioning SUMMARY

We all want to prevent poor mental health and provide better help for people who are suffering from, or who are at severe risk of, mental health problems. That means striking the right balance between investment in prevention and early intervention and in services that help people when they become acutely unwell. We will continue to work in partnership across health, social care and the voluntary sector and make personalisation and recovery central to our approach. We believe that every individual can achieve meaningful recovery and greater independence with the right support. The CCG operational plan for 2019/20 focuses on delivering practical changes that make a difference to the experience and outcomes of people who use services, their families and the workforce who support them. We have made good progress in delivering the ambitions of the NHS Five Year Forward View for mental health but there is still work to do in the following areas:  An ambition to reduce out of area placements to zero by 2021 by collaborative agency approach  Increasing access to psychological therapies for people with long term conditions in primary care  Increase the numbers of people with severe mental illness receiving physical health checks in primary care  Ensuring that early intervention in psychosis services deliver care in line with NICE guidance  Working with the Local Authority to ensure a suicide prevention strategy and plan is approved and implemented, which will be supported by the above priorities. In 2018/19 there has been strong local agreement on the most important areas of change and this has laid the foundation for many of the aims set out within the NHS Long Term Plan. In 2019/20 we want to turn our plans into reality through a focus on delivery on the ground by:  Improving the urgent and acute care pathway for adults and children, simplifying access and providing greater choice  Embedding mental health support in local neighbourhoods in partnership with general practice, social care and the voluntary sector  Achieving a step change in access to assessment and diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Autism  Personalising the approach to recovery and rehabilitation, enabling people to lead the life they want to live  Developing a workforce strategy which responds to changing demand.

Programme Area: Mental Health

Priorities for Key deliverables Baseline position 2019/20 Deadline Success measure Link to other Commissioning 2019/20 milestones plans mechanism

Increase access to Physical health 17% of people on Agree service to Q1 60% of people on GP  NHS Five Year Options appraisal services by building checks in primary GP severe mental deliver in severe mental illness Forward View to be undertaken a ‘place-based’ care illness registers had General registers receive for Mental model of mental checks in 2018/19 Practice checks in 2019/20 Health health provision that reduction in referrals to  NHS Long Service better integrates Expand mental 8 clinical mental Publish Q1 secondary care Term Plan Development and peoples mental, health support in health staff working evaluation of Improvement Plan primary care in GP practices (NHS Birmingham

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Programme Area: Mental Health

Priorities for Key deliverables Baseline position 2019/20 Deadline Success measure Link to other Commissioning 2019/20 milestones plans mechanism

physical and social 30% of first 2018/19 early Reduction in Do Not Supports key STP and Solihull Mental needs appointments are adopter sites Attends (DNAs) for principles in relation Health Foundation missed Agree model for first appointment to: Trust (BSMHFT), implementation Increase in discharges  Independence Forward Thinking across localities and resilience Birmingham (FTB) Improve access to 3 voluntary sector Launch tender Q2-4  Integration and voluntary sector mental health Contract award More voluntary/ simplification Procurement services that help recovery workers in Services go live community workers in  Social value leading to award of address the social General Practices primary care  Move from NHS Standard causes of poor institutions to Contract mental health place Procurement Continue to 19% of people with Commission Q1-3  Promotion of leading to award of increase access to depression and activity to More IAPT workers in equity, equality NHS Standard psychological anxiety accessed increase primary care and inclusion. Contract therapies support in 2018/19 capacity across Reduction in A&E  Support people Contract variation Improving attendance and to stay in to increase levels Access to general unplanned employment of activity Psychological admissions for people positively (BSMHFT, FTB, Therapies with mental health impacting Living Well (IAPT) services conditions prosperity. Consortium) in 2019/20 to 20% prevalence Service Oversee Teams scored level All teams have Q1 5/5 BSol Teams Development and improvements in 1 or 2 in Care individual assessed as level 3 in Improvement Plan early intervention Quality improvement CQC self-assessment (FTB, BSMHFT) services Commissioning trajectories (CQC) self- assessment Redesign the Implementation of 421 occupied bed Timelines will be Q2 Reduction in number  NHS Five Year Service pathway for people an Integrated days in out of area set out in of out of area Forward View Development and of all-ages who mental health beds per month at Service admissions for Mental Improvement Plan experience a mental urgent and acute March 2018 Development Reduction in number Health health crisis care pathway for and of people sectioned  NHS Long children and adults Improvement under the Mental Term Plan Plans Health Act by implementing a pathway that identifies and deals with a crisis

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Programme Area: Mental Health

Priorities for Key deliverables Baseline position 2019/20 Deadline Success measure Link to other Commissioning 2019/20 milestones plans mechanism

at the earliest point possible. Transform the mental Safely discharge, 44 people in out of 44 out of area Q1-2 All patients in out of STP Plan is in Service health re-ablement individuals area rehabilitation patients to be area rehabilitation relation to: Development and and recovery currently in long placements at Dec reviewed and placements have  Personalising Improvement Plan pathway for people stay out of area 2018 have person-centred provision following discharge rehabilitation or personalised discharge plan  Increasing Market from hospital treatment support plan independence development placements Target of 350 PHBs in and resilience activity with Introduce Personal Target of 250 PHB Widen scope of place in 2019/20  Integration and particular focus on Health Budgets in place in 2018/19 early adopter to simplification small supports (PHBs) for all include  Increase patients eligible for additional hub prosperity Section 117 aftercare Become one system Work with Local Age standardised Birmingham Q1 Reduction of 10% by  NHS Five Year Partnership of multiple partners Authorities to mortality rate from strategy and 2020/21 Forward View working and working in true ensure a suicide suicide and injury of multi-agency for Mental system leadership collaboration prevention strategy undetermined intent action plan Health and plan is per 100,000 agreed by CCG  NHS Long approved and population and Birmingham Term Plan implemented. 2014/16 baseline City Council Supports key STP 10% (Birmingham) Reduce staff attrition principles in relation Produce a whole 10% Solihull) Completed plan Q2 Reduce vacancies and to: BSol STP system mental agency usage in key  Work place Workforce Delivery health workforce areas wellbeing Plan strategy for BSol 4332 children Detailed Q4  Development of waiting for implementation sustainable Establish an neurodevelopmental plan for 2019/20 Reduction in waiting workforce integrated all-age assessment at is being time in line with agreed model to assessment and October 2018 developed trajectory positively diagnostic pathway Capacity for 550 Launch tender Q1 Increase in number of impact Contract variation for people with mental health carers Contract award Q1 mental health carers prosperity to NHS Standard neurodevelopment to be referred for Service Q2 supported  Support Contract (BCHC, al needs support mobilised children to FTB, BSMHFT) Work with have a healthy Birmingham City Increase access to FTB partners Q1 By March 2020 34% of start to life Council to re- Children and Young flowing activity children aged under 18 Contract variation

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Programme Area: Mental Health

Priorities for Key deliverables Baseline position 2019/20 Deadline Success measure Link to other Commissioning 2019/20 milestones plans mechanism

procure support for People with data via mental with a diagnosable  Supporting Data Quality mental health diagnosable mental health service mental health people with Improvement Plan carers as part of a health conditions data set condition will access caring (2018/19) single carers offer 32% of children NHS funded mental responsibilities. aged under 18 with Confirm 2018/19 Q1 health services in year.  Future in Mind Service Deliver the a diagnosable baseline Progress to this target Development and ambition of the mental health to be achieved in Improvement Plan Local condition access 2019/20 (FTB and Solar – Transformation NHS funded mental Brightening Young Plans for Children health services in Futures Service) and Young 2018/19 People’s Mental Health in BSol

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Maternity and Newborn

Programme Area: Maternity and Newborn SRO: Programme Lead: Head of Children & Maternity Director Joint Commissioning SUMMARY

BSol Local Maternity System Birmingham and Solihull United Maternity and Newborn Partnership (BUMP) is the STP programme delivering transformation across the Local Maternity System (LMS). BUMP brings together maternity partners to realise the vision and drivers set out in the national case for change ‘Better Births’: “Every woman will be empowered to access consistent, world-class and holistic care right for them, their baby and their family.” Some of the key themes include:  Implementing an enhanced and targeted continuity of carer model to improve outcomes for the most vulnerable mothers and babies  Delivering care closer to home  Enabling a choice of birth setting  Increased personalisation including access to maternity personal health budgets  Reducing stillbirth, maternal mortality, neonatal mortality and serious brain injury  Reducing smoking in pregnancy and increasing rates of breastfeeding  Ensuring the service user has a voice and any developments co-produced. Summary of BUMP 2018/19 achievements:  Delivering a number of continuity of care pilots to inform future roll out and achieving the NHSE target: 20% of all women must be booked onto a continuity of care pathway by March 2019  The only team nationally to have achieved a single IT/data collection system across multiple providers  Commissioning third sector organisations that ensure the voices of women inform service developments and additional provision for the most vulnerable women  Piloting a single point of access model to improve access and reduce the referral process  Women accessing a choice of birth settings e.g. an obstetric unit, alongside midwifery unit, freestanding midwifery led unit and homebirth  Exploring opportunities for women to have access to personal budgets as an early implanter site.

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Programme Area: Maternity and Newborn

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism Full Risk assessment and NHSE assured Audits will be Q2 Working towards the Provider plans Service Development implementation surveillance for foetal against progress undertaken regularly to national target of a 50% and Improvement of Saving growth in January 2019, assess the impact. reduction in stillbirth, Clinical Plan Babies Lives restriction progress was Current approach to maternal mortality, Network Plans Care Bundle rated ‘Green’ i.e. detecting Small neonatal mortality and New national everything is Gestational Age babies serious brain injury. All maternity service going well delivers a high staff are competent in the specification detection rate. use of estimated foetal BUMP/BSol LMS weight charts, and implementation plan audited within Trusts Raising awareness NHSE assured Development of an Q2 Increase in the Provider plans of reduced foetal against progress information and advice percentage of women movement (RFM) in January 2019, leaflet on RFM to raise reporting RFM who have Clinical progress was awareness received the leaflet Network Plans rated ‘Green’ i.e. Increase in the everything is percentage of women going well reporting RFM who understood the message Reducing smoking in 11.5% On-going By 2023/24, all people Saving Babies’ All providers will carry pregnancy work admitted to hospital who Lives out Carbon Monoxide during smoke will be offered (CO) test at antenatal 2019 - NHS-funded tobacco booking appointment 2024 treatment services; this and refer to the stop Quality schedule model will be adapted for smoking requirement in the expectant mothers, and service/specialist as contract their partners, with a new appropriate. smoke-free pregnancy pathway including focused sessions and treatments

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Programme Area: Maternity and Newborn

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism All maternity UNICEF UK Accredited Ensuring accreditation Ongoing Maternity and neonatal NHS Long Service specification services that do accreditation is maintained units are accredited and Term Plan not deliver an accreditation is accredited, maintained. evidence- based infant feeding programme, such as the UNICEF UK Baby Friendly Initiative, will begin the accreditation process in 2019/20. Embedding the Ensure that a Current national Awaiting confirmation Q1 BSol Maternity LMS (all Legal Service Specification new national comprehensive service of release of the new service providers) will requirement Contract variations maternity single service specification in maternity specification adopt a single National Service specification is part contracts Maternity Service Specification of the Maternity Specification, with agreed contract for 2019/20 quality standards across for all BSol providers all areas Continuity of Provide consistency The baseline will Review the outcome of Q4 An increased number of STP plan Service specification care of the midwife and/or be determined the 2018/19 pilots and women will be booked Operating Plan Contract variations to obstetrician, from the pilots agree the model to be onto a continuity of carer BUMP/LMS include specific throughout the adopted across the pathway (20%) plan targets antenatal, LMS. NHSE expect that units Better Births intrapartum and Complete finance will achieve between 10- implementation postnatal periods modelling, to assess 16%by 2019 requirement affordability 5% of births Combine current Will be derived Monitor the increase in Q4 Increased numbers of STP plan Contract variation to within BSol to Wave 1 and Wave 2 from Wave 1 and activity every 3-months women accessing Operating Plan include specific receive a Perinatal Mental 2 activity specialist Perinatal BUMP/LMS targets comprehensive Health services, to Mental Health plan NICE ensure a single compliant

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Programme Area: Maternity and Newborn

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism Perinatal service is on target to Better Births Mental Health deliver in 2019/20 implementation Service requirement

Fully Create a single Equitable access Women at UHB will Q4 All women who book STP plan Service development Implement a electronic patient across BSol of have access to within the BSol LMS will Operating Plan and improvement single record electronic record electronic patient be able to access an Bump/LMS plan electronic irrespective of record electronic patient record plan patient record Maternity Information provider Better Births and Maternity System (BadgerNet) The Maternity The Maternity The Maternity Information implementation Information to be utilised across Information Information System will System will be available requirement System across all Maternity System has been be rolled out across all across the LMS, and the LMS Pathways implemented for maternity pathways across all maternity Patient portal to be the antenatal Primary care access pathways made available pathway, not will be completed Primary care to have currently available Patient access to the access to the system for intrapartum or system will commence post-natal care pathways Ensure full Single point of Single point of Pilot sites within Q4 The BSol LMS has a STP plan This requirement is implementation access for all access pilot to primary care to be single point of access in Operating Plan already included in of a single point maternity referrals commence April approved for use for operation BUMP/LMS the existing delivery of access 2019 the single point of plan plan (SPA) across access Better Births the BSol LMS Pilot in full alongside implementation traditional referral requirement routes Scope the implementation of virtual clinics, including access to an obstetrician Ensure Community hubs are Pilot hubs A robust evaluation of Q4 Community hubs are fully STP plan This requirement is maternity available locally to established in 3 pilots to be undertaken operationalised. Operating Plan already included in community ensure care is locations to inform on full Improvements in the BUMP/LMS the existing delivery hubs are delivered closer to implementation quality of care are plan. plan home undertaken in community

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Programme Area: Maternity and Newborn

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism operationalised settings, and an increase Better Births across the LMS in the proportion of implementation antenatal care delivered requirement in the community Children and Young People Programme Area: Children and Young People SRO: Programme Lead: Head of Children & Maternity Director Joint Commissioning SUMMARY

Maternity, childhood and adolescence is a fundamental priority within the STP strategy led by a portfolio board. The multi-agency BSol Child Health Improvement Programme (CHIP) has been developed to contribute to elements of this portfolio of work. CHIP aligns to the emerging strategic priorities developed by the STP and focuses on prevention, keeping children safe from harm, promoting greater independence and ensuring excellence in terms of quality, experience and outcomes when services are required. CHIP has three work streams (the CCG contributes to them all by working collaboratively with partners):  Transforming inter-agency working: healthy children, vulnerable children with social need and children with education, health and care needs (SEND). (See the SEND section of the Operational Plan for more detail in relation to this programme of work)  Transforming inpatient care for children; the acutely unwell child  Transforming primary care for children; the mild to moderately unwell child with long term conditions. To secure the best outcomes for all children and young people across BSol, a number of developments will be explored and driven as part of collaborative working arrangements with our partners:  Shift to integrated commissioning across health and care by developing a shared approach with social care  Shift towards commissioning based on local needs and local services  Review and development of a model of healthcare for Children and Young People across acute, community services and complex needs  Embed patient engagement at the heart of all service developments and commissioning so that services are responsive to need and co-produced  Exploring the role of personalisation in care planning and expanding the use of PHBs, promoting choice for families. Summary of achievements/progress (2018/19):  Ensuring children and young people are a priority and considered as part of a wider systems approach at the STP level and beyond. New ways of working with partners are being developed alongside an agenda focussed on improvement  60 GP practices have received face to face training on managing the Big 6 (reasons for attending A&E) and Top 20 conditions (requiring a hospital outpatient appointment) in an attempt to prevent unnecessary hospital demand  Implementation of a rapid response nurse service to help children and young people with complex health needs avoid the need to attend hospital when care could be provided by alternative means

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Programme Area: Children and Young People SRO: Programme Lead: Head of Children & Maternity Director Joint Commissioning SUMMARY  Development and delivery of SEND plans (please refer to SEND Section).

Programme Area: Children and Young People Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism

Roll out of the Big Continue to 60 GP practices Share clinical Q1 Health professionals feel Children’s and A future Universal 6/Top 20 GP deliver the GP trained to date guidelines with GPs confident to provide Young Offer Education Education and other healthcare advice and guidance to People’s STP recommendation programme including programme professionals parents and carers Plan transferring the supported by clinical methodology (of Ensure clinical Identification of Q2-3 guidelines stemming demand guidance is practices who have A reduction in avoidable for costly services) available to GPs high attendances or attendance and referral to with colleagues in and other referrals to secondary outpatient services social care and healthcare care and undertake a education providers joint review

Roll out of Q1 methodology Harmonising the Scope and Three different Review the current Q1 An equitable and Children’s and Service Consultant Paediatric implement service models service models accessible service is Young Development Advice and Guidance sustainable, across BSol at available to all GPs People’s STP Improvement Services across BSol equitable, present Develop a proposal for across BSol Plan Plans or contract paediatric advice sustainable services Q2 Improved patient and variations. and guidance carer experience services across BSol The review of the A sustainable Baseline costs Review the current Q1 A deliverable new Children’s and Service Children’s rapid response of A&E service against the proposal which supports a Young Development Community Rapid service is in place attendances and anticipated reduction reduction in A&E activity People’s STP Improvement Plan Response Service which supports inpatient in A&E activity and Plan or contract the reduction in admissions prior actual clinical pathway variation cases

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admissions to to service Develop a proposal Q1 A reduction in the average A&E commencement integrated with the cost of A&E attendances urgent care system and inpatient admissions designed to reduce A&E admissions Improved patient and carer experience Development of A new model of Non at present, Agree the service Q1 Improved patient Children’s and Service integrated care healthcare baseline to be outcomes and experience Young Development teams provision across established milestones with key Reduced avoidable People’s STP Improvement Plan primary, partners across health admissions and referrals Plan or contract community and and social care to secondary care and variation secondary care to outpatient services reduce the demand on acute and social care by bringing services closer to home The review of Neuro- Re-specification 186 occupied Review of the current Q1 Acute inpatient and Children’s and Service rehabilitation of a new neuro- bed days where service and patient community services are Young Development pathways rehabilitation care could have need tailored to meet the needs People’s STP Improvement Plan pathway been provided in of children and young Plan or procurement the community. * people with Acquired *This Brain Injury information is Reduced length of stay in based upon data hospital for those with from Acquired Brain Injury Birmingham Women’s and Improved access to Children’s community therapies such Hospital, a as, Occupational Therapy, sample audit Physiotherapy, Speech over 4-weeks for and Language Therapy a small number and Psychology of patients Explore the use of Developing PHBs 0 PHBs in place Plans to set up a Q1 Children and young Children’s and Service PHBs promoting for children and for children and working group to people are offered PHBs Young Development choice for families young people who young people explore the options. as part of their routine People’s STP Improvement Plan receive joint Develop a set of care package Plan or procurement funded packages proposals and of care implement PHBs.

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Harmonise the Ensuring the Currently at Review the current Q1-2 A reduction in clinical Children’s and Service service offer for service offer and scoping phase work undertaken to variation across BSol Young Development children and young outcomes are the date People’s STP Improvement Plan people across BSol same across Develop a proposal Q2-3 Equity of access and Plan and contract acute/community setting out the harmonisation of variation care for children changes to services pathways across BSol and young people and pathways as a result of the review

Special Education Needs and Disabilities (SEND)

Programme Area: Special Education Needs and Disabilities (SEND) SRO: Programme Lead: Head of Children & Maternity Director Joint Commissioning SUMMARY

SEND improvements and focused work are a priority for the CCG and its partners across both BSol. Birmingham was inspected by Office for Standards in Education (OFSTEAD) and Care Quality Commission (CQC) in June 2018 to judge the effectiveness of the area in implementing necessary reforms as set out in the Children and Families Act 2014. The Chief Inspector determined that Birmingham City Council and BSol CCG were required to jointly submit a Written Statement of Action due to significant areas of weakness in the local area practice. Whilst there were some examples of good practice, overall services and the SEND system across the city was failing children and families and not delivering good outcomes for individuals with SEND. Solihull have clear plans to improve outcomes for children and young people. The several and consistent inspections by statutory organisations including CQC and OFSTED have demonstrated that the overall provision of services to children, with SEND in particular, are below that which is acceptable. As a result, all stakeholder organisations across BSol have committed to delivering a comprehensive SEND improvement programme. The overall SEND system for Birmingham is rated as ‘Requires Improvement’ by CQC/OFSTED and for Solihull the system was rated as adequate in 2018 but still requires significant improvement. In year (2018/19) progress has been made across the following areas:  Establishment of multi-agency improvement system including governance and senior level leadership to deliver SEND improvement  Development of comprehensive SEND action plan backing the written statement of action  Increase in Designated Medical Officer (DMO) and Designated Clinical Officer (DCO) posts  Immediate action to address waiting times for speech and language assessments  Business cases in development for Autistic Spectrum Disorder (ASD) and longer term response to community therapies provision. A community healthcare commissioning deep dive and development of a commissioning framework will be developed in 2019/20.

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Programme Area: Special Education Needs and Disabilities (SEND) Priorities for Key deliverables Baseline 2019/20 Deadline Success measure Link to other Commissioning 2019/20 position milestones plans mechanism Deliver integrated Agree mandate and road SEND services Proposal for joint Q1-3 Joint commissioning In line with Memorandum of commissioning map to develop integrated commissioned by commissioning process established acknowledged Understanding process for SEND joint commissioning agreed a number of process agreed and embedded benefits of closer Possible shared by Children’s Strategic organisations by Children’s working across budgets Partnership Executive including CCG, Executive organisations local authority, Partnership Aligns health and education and Joint social care children’s trust commissioning commissioning embedded within STP system Improved health CCG Approval of 4 DMO sessions Health input into Q1 education health and Delivers Service input into increased Designated and no DCO in education health care plans quality outcomes of development education health Clinical Officer (DCO) and BSol and care plans improved SEND written and care plans Designated Medical Officer increased statement of (DMO) whole time Education action equivalent (wte) – Education programme for recruitment commenced. programme for health staff, including Recruitment completed health care staff primary care, DCO and DMO in post on SEND delivered Improved access CCG approval of business 2,212* patients Revised service Q2 Reduction in waiting NHS Five Year Contracting, to speech and case to re-provide SLT waiting for a 1st specification and times for SLT Forward View procurement language therapy services appointment pathway Birmingham (SLT) for children *These are the SEND Written with SEND total number of Improved access Q3 Greater parent/carer Statement of patients waiting, and reduction in satisfaction Action patient with SEND waiting times CCG Operational will be a sub-set Plan 2018/19 of this number Improved access CCG approval of business 1,048 patients Revised service Q2 Reduction in waiting NHS Five Year Contracting, to Occupational case to re-provide OT waiting for a 1st specification and times for OT Forward View procurement Therapy (OT) for services appointment pathway Birmingham children with Improved access Q3 Greater parent/carer SEND Written SEND and reduction in satisfaction Statement of waiting times Action Improved access CCG approval of business 385 patients Revised service Q2 Reduction in waiting NHS Five Year Contracting, to physiotherapy case to re-provide physio waiting for a 1st specification and times for physio Forward View / procurement for children with services appointment pathway Birmingham SEND Q3 Greater parent/carer SEND Written satisfaction

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Programme Area: Special Education Needs and Disabilities (SEND) Priorities for Key deliverables Baseline 2019/20 Deadline Success measure Link to other Commissioning 2019/20 position milestones plans mechanism Improved access Statement of and reduction in Action waiting times CCG Operational Plan 2018/19 Implement To develop and embed in Current Review of current Q1 Inclusion of new NHS Five Year Service Standard practice SOPs that support procedures are specifications SOPs in contracts for Forward View Specification Operating the transition of young unclear and can across existing 2020/21 onwards Review and Re- Procedures people from children to be confusing for providers and Increased Birmingham design (SOPs) for the adult services, across a children and consultation, satisfaction with SEND Written transition of range of providers at a young people and Discussion and Q1 transition pathways Statement of children to adult range of different ages families agreement of best shown by children Action Contract services in all practice in BSol and young people Variations provider contracts SOPs need to ensure that Re-write of and families and Solihull SEND transition is seamless and service Q2 professionals Action Plan people involved feel specifications supported Implementation CCG Operational within contracts Q4 Plan 2018/19 and service The CCG intends The initial aim is for CCG No current Full business Q1 Agreement of to work in agreement to fund a pilot specific PHB case produced proposal Service collaboration with scheme to offer PHBs to provision for and agreed by Sign off for business Development providers to SEND children and young SEND children CCG case in full deliver personal people as a specific cohort and young people Implementation of Possible health using the Evaluation of this scheme Implementation of Q1 pilot scheme Procurement national CQUIN should support pilot scheme Evaluation proves scheme as development of recurring success of model appropriate to funded SEND PHB Evaluation of pilot Q3 including feedback support the scheme from children and improvement young people and families

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Cancer

Programme Area: Cancer SRO: Programme Lead: Director of Planning and Delivery Chief Finance Officer / Director of Planning and Delivery SUMMARY

SUMMARY OF ACHIEVEMENTS IN 2018/19 National Cancer Targets  Implemented first phase of NICE compliant 2 week wait referrals forms  Audited use of NICE compliant 2 week wait referrals forms  Co-produced with West Midlands Cancer Alliance, NHS England (NHSE), NHS Improvement (NHSI), local providers action plans to deliver national cancer standard (including work to improve timeliness of tertiary referrals)  Established Primary Care Cancer Education and Development Group to improve GP awareness of signs and symptoms and cancer to ensure early onward referral. This will improve the number of cancers that are detected early, thus improving survival rates. Screening  Established Screening Task and Finish Group, which seeks to improve cancer screening uptake across BSol for all national screening programmes (i.e. breast, bowel and cervical)  Development of a Universal Offer for screening which includes opportunistic intervention in primary care that will be incentivised to encourage patients to take up their offer of screening  Working with NHSE to prepare for the introduction of the new FIT (Faecal Immunochemical Test) for bowel screening. Health Inequalities  The CCG has a health inequalities strategy to improve access and reduce health inequalities. We have been collaborating with Birmingham Race Action Partnership and NHSE on the "Experience of Black, Asian and Minority Ethnic (BAME) Groups in Cancer Care" to develop better understanding of the issues affecting access and outcomes in cancer care for these groups Living with and Beyond Cancer (LWBC)  The CCG has been working closely with the West Midlands Cancer Alliance and other partners to develop a new Stratified Pathway (Person Centred Follow Up) for breast cancer. Challenges  Challenges around prevention of cancer, including reducing alcohol consumption, cigarette smoking and obesity  Public awareness of the early signs of cancer and symptoms  Late diagnosis (patients diagnosed late at stages 3 & 4)  Diagnostic capacity  Workforce resilience.

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Programme Area Cancer Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to Commissioning 2019/20 milestones measure other plans mechanism Deliver the 2 National Standards January 2019 Achievement As Soon Achieve and Achieving NHS Contract week wait 31 & TARGET BWCH ROH UHB of national 2 As Possible maintain World Class 62 day cancer week wait, 31 delivery of key Cancer targets (key 2 week wait (93%) 84.65% 99.33% 91.93% & 62 day targets Outcomes – deliverables) 2 week wait breast cancer targets A Five Year (93%) 86.40% Strategy 31 day first def 2015-2020 treatment (96%) 100% 100% 96.88% NHS 31 day sub drugs Operational (98%) 100% 99.26% Plan & 31 day sub surgery (94%) 100% 97.53% 97.01% Contracting 31 day radiotherapy Guidance (94%) 100% 98.12% 2019/10 NHS Long 62 day (85%) 81.36% 74.65% 81.41% Term Plan 62 day screening BSol Cancer (90%) 100% 92.44% Plan

Deliver the Measure Trust baseline data currently being National Increase in As above NHS Contract Faster percentage of collected Standards: percentage of Diagnosis patients who Data collection Q1 patients Standard receive their to commence receiving a definitive diagnosis Full monitoring Q4 definitive within 28 days of against Faster diagnosis referral Diagnosis within 28 days Standard of referral Improve Measure Data Source – Public Health England Introduction of Q1 Increase bowel Achieving Programmes screening improvement in (PHE) Fingertips FIT Test screening World Class commissioned uptake for screening uptake Region/CCG 2017/18 uptake rate Cancer by PHE breast, bowel across all Data (%) across BSol Outcomes – and cervical screening A Five Year Females 50- Bham 64.8 cancer programmes 70 CrossCity Increase the Q4 Increase in Strategy uptake of all uptake rate for 2015-2020 screening Bham South 64.7 for breast Central national all national NHS cancer Solihull 69 screening screening Operational within 6 programmes programmes. Plan & months of Contracting invitation Guidance 2019/10

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Programme Area Cancer Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to Commissioning 2019/20 milestones measure other plans mechanism Persons 60- Bham Cross 49.1 NHS Long 74 screened City Term Plan for bowel BSol Cancer cancer Bham South 43.6 Plan within 6 Central months of Solihull 58.3 invitation (uptake) Females 25- Bham Cross 67.6 64 attending City cervical screening Bham South 65.7 within target Central period (3.5 Solihull 73.3 or 5.5 year coverage%)

Increase Measure Baseline data to be obtained Short life Q1 Increase in As above Screening screening improvement in primary care uptake rate delivered uptake for screening uptake Task and through BAME Groups, across all Finish Group National those living in screening and Work Plan Screening areas of high programmes developed Programmes deprivation commissioned and vulnerable Improve data Q4 by PHE adults – collection on including those ethnicity with a learning disability Human Introduction of new Awaiting guidance from Public Health Introduce new Q4 Target to be NHS Long Screening Papilloma test for Human England (PHE) on the implications for test across confirmed Term Plan Programmes Virus testing Papilloma Virus CCGs BSol practices once more 2019 commissioned for cervical details are by PHE cancer. The available new test will regarding roll help identify out from PHE. who is at a higher risk of developing cervical cancer. Those

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Programme Area Cancer Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to Commissioning 2019/20 milestones measure other plans mechanism who test positive for HPV will have further tests more quickly and those who are low risk can be reassured. Implement Sign off and Guidelines in development. Implement Q1 All patients on As above NHS Contract – Personalised implement the Trust to submit baseline data on: breast stratified follow data and Cancer Care stratified guidance  Patients on Stratified Pathway pathway & up will receive information (stratified and collect data on  Health Needs Assessments undertaken commence information on requirements pathways) for number of patients Patients re-engaging with service after data collection. their diagnosis, Reporting breast, agreed to join discharge onto stratified pathways Implement Q4 treatment requirements colorectal and personalised colorectal & options and for delivery of prostate pathway Health prostate subsequent Accountability cancer Needs pathways & follow up Framework Assessments commence arrangements undertaken data collection Fully Implement 2 week Phase 1 forms rolled out Phase 1 – Q1 Forms As above NHS Contract implement 2 wait referral forms Currently 33% referrals on correct audits of use embedded in week wait for all cancers form/correctly completed forms GP referral forms Co-produce common forms for all cancers Phases 2 & 3 Q4 All referrals (Phases 1, 2 & and ensure that they are embedded in Forms fully made on 3) to support primary care systems implemented correct forms timely recognition of potential cancer symptoms and facilitate early onward referral. Earlier Measure Current National Target (Long Term Plan See increase Q4 Increase in the As above NHS Contract diagnosis improvement in the 2019: 75% by 2028 in the % of number of (Stages 1 & 2) % of cancers 2017/18 Data: cancers cancers diagnosed early Birmingham Cross City 55.7%

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Programme Area Cancer Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to Commissioning 2019/20 milestones measure other plans mechanism to improve Measure reduction Birmingham South Central 51.7% diagnosed at diagnosed at survival rates in % of emergency Solihull 57.3% Stage 1 & 2 stage 1 & 2 admissions for cancer 2017/18 1.18% emergency admissions for cancer See decrease Reduction in across BSol in the % of the number of emergency cancers admissions for presenting as cancer emergencies Improve Develop better Report and Action Plan produced with Action Plan Q1 Deliver key As above NHS Contract access to understanding of NHSE and Birmingham Race Action produced actions cancer the issues affecting Partnership with CCG specific actions services for access and identified and CCG Action Plan Delivered BAME groups outcomes in cancer and all those care for these who share a groups protected characteristic Promote key Promote key Coverage ad hoc at present. Plan of Q1 Key messages Birmingham None cancer messages on awareness and Cancer City Council prevention cancer prevention days and Awareness Public Health messages to and cancer events Days receive Green Paper the general awareness to tie in produced coverage and 2019 public aligned with national promotion on to national cancer awareness All awareness Q1-Q4 social media Public Health days. days are and CCG Strategy and promoted website messages throughout relating to 2019/20 by the reducing CCG smoking, alcohol consumption and obesity

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Elective Care

Programme Area: Elective Care SRO: Programme Lead: Associate Director of Right Care and Planned Care Chief Finance Officer / Director of Planning and Delivery SUMMARY The Need for Elective Care Transformation

Nationally, demand for elective care services is continuing to grow and more patients are being referred to secondary care for treatment than services are able to accommodate. Since 2005/6 total outpatient appointments have risen from 61 million to 119 million. 501,000 patients were waiting longer than the 18-week standard for hospital treatment in June 2018 compared to 373,000 in June 2017 – which is a 26% increase on the previous year. The steady rise in referrals has contributed to that increase.

National data shows that there has been a sustained growth in non-GP referrals generated mostly from within hospitals. Therefore, more services are being made available for patients in community settings and patients being given the opportunity to make use of them. This means that we need high quality referral assessment by clinicians in both primary care and secondary to ensure the most clinically appropriate cases are referred for face-to-face consultation. Where possible we will adopt digital alternatives to ensure that patients and clinicians can more easily access best clinical practice guidance plus lifestyle support.

Where appropriate, in certain specialties clinically safe and effective assessment and triage and treat services can be delivered by clinicians with appropriate qualifications and experience outside of hospital settings and closer to the patient’s home. In addition, we will seek to reduce outpatient appointments that do not lead to further treatment while retaining the right of GPs to refer in cases of diagnostic uncertainty. The CCG and national Get It Right First Time (GIRFT) and Right Care teams are also working with local providers to promote national evidenced based clinical practice unwarranted clinical variation.

Through the Elective Care Transformation Programme, BSol is aiming to deliver the following:  More hospital consultant capacity for virtual clinics and telephone appointments  More patient consultations closer to home such as optometrists, audiology technicians, dieticians, physiotherapists and community nurse specialists  Better and increased information for patients to help them to be more part of clinical decision about their treatment or support; e.g. hip and knee surgery  Increased use of pre-surgery consultant and multi-disciplinary team assessments  Innovation in providers’ offers of advice and guidance to GPs in line with planned national development of the e-referral tool to support reduction in outpatient referrals discharged at first appointment  Improved physical and psycho-social support options for patients with chronic pain as an alternative to medication or surgery.

SUMMARY OF ACHIEVEMENTS IN 2018/19 National Referral to Treatment (RTT) Targets  The CCG and its providers consistently achieve the 6 week from referrals diagnostic waiting time target.  52-week breaches are Referral to Treatment (RTT) and relate largely to few – mostly NHSE specialised paediatric spinal deformity cases where specialist capacity locally and nationally is at a premium.  RTT incomplete (open) pathways leading to outpatient discharge or surgery is just below the 92% of patients waiting less than 18 weeks.  The CCG is commissioning more referral support and assessment capacity in and out of hospital in a number of specialties.  BSol GP referred outpatients at Month 10 (January 2019) are slightly less than in 2017/18. However, hospital initiated referrals are continuing to grow in a number of specialties.

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Programme Area: Elective Care SRO: Programme Lead: Associate Director of Right Care and Planned Care Chief Finance Officer / Director of Planning and Delivery SUMMARY Progress against NHS England Elective Transformation requirements Elective Transformational pathway re-design a. Musculo-skeletal (MSK) Harmonised Triage Model and First Contact Practitioner Pilot proof of concept pilots commenced b. Working to enhance the consultant and other clinician Advice and Guidance (A&G) offer to GPs the highest volume specialties. c. Ophthalmology high impact interventions including: i. Audit of patient follow up processes and reducing waiting times for follow up appointments for eye patients to avoid risk of harm. A full BSol eye health needs assessment (https://www.birminghamandsolihullccg.nhs.uk/about-us/publications/strategic/2308-birmingham-and- solihull-eye-health-sight-loss-evidence-base/file) ii. A related initial eye provider’s capacity reviews has been completed that looks at the next 5 years to 2023. d. Specialty specific pathway transformation has begun in areas such as: Gastroenterology; Bariatric Surgery; Dermatology; adult non-complex Audiology and ear wax management; and Gynaecology Elective System Capacity priorities are detailed below. During 2018/19 challenges remained and hospital initiated referrals are continuing to grow in a number of specialties.

Programme Area: Elective Care Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism Deliver the RTT National RTT 92% Achievement of Q2 – note: Achievement of 2019/20 NHS national National targets targets: Standards: performance M9: national RTT and UHB national RTT and planning guidance part of NHS  Incomplete  92% of diagnostic wait currently not Diagnostic wait Contract and NHS Pathways patients CCG – 88.2% targets planning to targets. Enablers: Constitution waiting 0-17 UHB – 86.9% achieve  NHS/Private weeks BWC – 92.0% national provider  52 week  No cases ROH – 87.1% target in additional breaches 19/20 capacity  Diagnostic  99% within 6 52 week waits M10:  GP Advice and reports weeks CCG: 5 (all with Zero Guidance  Overall  NHS 2019/20 treatment dates) tolerance of  Capacity alert waiting list No more Diagnostics M10: breaches pilot (UHB) size patients CCG and all that were not  Eye Regular waiting than providers meeting patient’s own engagement with March 2018 target choice local providers

MSK MSK Triage Right Care National MSK Triage and Q1- 2019/20 The new service will BSol CCG Contract Variation Transformation First Contact Spinal/Back Pain First Contact Q4 – be a single BSOL Elective Care with revised/new including: Physio Pilot Baseline Services Physio Proof of 2020/21 pathway to cover all Transformation Plan – specifications, and Orthopaedics, National Spinal / and pathways exist concepts of the BSOL patients August 2018 (NHSE Price Activity Pain Back Pain across BSOL but Full Case for with at least 20% - approved) Matrix schedules Management, Pathway not harmonised. Change 40% deflection of during 2019/20 for

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Programme Area: Elective Care Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism Spinal/Back and 2 Year cases away from the respective Rheumatology Some Back Pain Demonstrator hospital services with affected providers MSK Triage and Roadmap necessary patient First Contact advice and support Practitioner primary care proof of Improved waiting concepts to shape times and hospital final service capacity for all MSK specifications. conditions across local providers NHSE baseline Harmonisation of assessments local providers clinical completed for key practice for all MSK deliverables. conditions with assessment sent Patients will have an to NHSE 31/10/18 Improved pathway organised by Primary Care MSK Team including shared decision about care. MSK triage to inform Patients and referring GP of the referral outcome within 2 working days Improving Eye Ophthalmology BSol CCG Eye Priorities for Q1-4 A capacity plan to BSol CCG Elective Contract Variation Health and High Impact Health Sight Loss review/re-design: understand the Care Transformation with revised/new Reducing Sight Interventions # 1- Needs Assessment 1. Eye Care drivers for future Plan – August 2018 specifications, and Loss for all main 3 published October Liaison Officer demand that the (NHSE approved) Price Activity eye conditions 2018: sign posting impact on services Matrix schedules BSolhttps://www.bir service for across the system. during 2019/20 for minghamandsolihull visually impaired the respective ccg.nhs.uk/about- 2. Rehabilitation Eye health (SAFE) affected providers us/publications/strat needs due to low recommendations for egic/2308- vison or loss or cataracts, glaucoma birmingham-and- sight and wet AMD solihull-eye-health- 3. Community Best practice through sight-loss- cataract and pathway redesign evidence-base/file including virtual

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Programme Area: Elective Care Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism glaucoma referral clinics - additional refinement success measures to 4. Cataract be identified during outpatient follow pathway redesign up out of hospital 5. Stable With providers glaucoma follow- manage key issues up capacity in e.g. work force, new community training opportunities medical particularly with the ophthalmology increase of private service providers, estates, pressure on A&E or future drug innovations that alter the patient treatment and experience Implement IT connectivity and infrastructure which improves system pathways and patient choice. Transforming A GP digital BSol CCG Elective Design and initial Q2  Reduction in BSol CCG Elective Contract variation Outpatients referral support Care market inappropriate Care Transformation with revised/new tool in place that Transformation engagement and outpatient Plan – August 2018 specifications, and  Enhanced enables patients Plan – August 2018 solution pilot appointments (NHSE approved) Price Activity Advice and to have virtual (NHSE approved). testing. across all Matrix schedules Guidance follow-up Per BSol CCG Contract Variation Q2 specialties Royal College of during 2019/20 for appointments or Strategic and / or good and  Increase in the Physicians - the respective  Digital self-initiate a Programme Board services uptake of virtual Outpatients: affected providers Solutions – follow-up papers June and procurement. follow-ups The future Referral appointment September 2018  GP learning from Adding value through Support / (through pathway . Solutions Q3-4 e-referral Service Sustainability, Pathway review) which implementation. responses November 2018 Advice supports  Increased uptake GP education on of patient-initiated Nuffield Trust -  Virtual pathways and follow-up Rethinking Outpatient Clinics referral criteria.

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Programme Area: Elective Care Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism A single system  General reduction Services, August for Advice and in referrals 2018 Guidance that  Reduced waiting incorporates times for first direct/instant outpatients access to consultant advice and which integrates with GP IT systems. National  Gastroenterol Per:https://www.en Progressive Wave 1 and 3 themes BSol CCG Elective Contract Variation Specialty-Based ogy and MSK gland.nhs.uk/electiv publication of 2 - 1. Re-thinking Care Transformation with revised/new Transformation Orthopaedics e-care- NHSE specialty implementati referrals Plan – August 2018 specifications, and  Diabetes, transformation/han guides and on – Q1-Q4 2. Shared (NHSE approved) Price Activity Dermatology, dbooks-and-case- related specialty Wave 3 – 5 decision Matrix schedules Eyes studies/ and road shows publication making during 2019/20 for  Cardiology, https://future.nhs.uk expected 3. Transforming the respective ENT, Urology /connect.ti/ECDC/gr Local during Outpatients affected providers  General ouphome and consideration and 2019/20 with  Reduction in Surgery, BSol CCG Elective CCG / providers roll out post- inappropriate Respiratory, Care dialogue re: publication outpatient Gynaecology Transformation baseline referrals from any  General Plan – August 2018 assessment and source Medicine, (NHSE approved) pathway  More virtual Neurology, transformation follow-ups Radiology / opportunities  GP learning from Pathology Case for change Advice & governance Guidance process  More patient self- management support and patient-initiated follow-up  Reduced waiting times for first outpatients

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Programme Area: Elective Care Priorities for Key Baseline 2019/20 Deadline Success measure Link to other plans Commissioning 2019/20 deliverables position milestones mechanism Elective Clinical Treatment See:https://www.bir Phase 2 Effective Reduction in acute BSol CCG Elective Notice letter to Transformation Policies Phases minghamandsolihull Phase 2 – activity against the Care Transformation BSol NHS/ Enablers 2-3a/3b ccg.nhs.uk/your- Phase 3a and 3b Feb 19 procedures within the Plan – August 2018 Independent health/treatment- policies. (NHSE approved) Sector acute policies Phase 3 – providers w/e Feb 20 Links to NHSE 21/12/18 Evidence Based Interventions Programme Elective Elective Care Final protocol Via contract Q1 Improved transfer of NHSE/I and Royal Contract Variation Transformation Transfer of Care between BSol variation - to care and discharge College of Physicians December 2018 / Enablers and Discharge CCG, Local NHS finalise and sign interface between - Consultant to January 2019; then Protocol acute trusts and off in above acute and primary Consultant Referrals implementation primary care contracts care clinicians Guide NHSE, and impact November 2018 Information NHSE/I 2017/19 NHS Requirement Contract requested for Toolkit, October 2018 2019/20 UHB, ROH, BCHC and BWC Contracts Elective Capacity alerts Capacity alerts set See baseline text Q1 onwards Supporting and BSol CCG Elective BSol CCG Elective Transformation on specific clinics – 2019 alleviating elective Care Transformation Care Enablers (not overall milestones tbc system capacity Plan – August 2018 Transformation specialties) within pressure and RTT (NHSE approved) Plan – August e-referral Service, performance 2018 (NHSE giving GPs and approved) Contract patients an idea of variation capacity availability and constraints for services in a radius of up to 50 miles

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RightCare Programme Area: RightCare SRO: Programme Lead: Associate Director of Planned Care Chief Medical Officer SUMMARY RightCare is an approach to reviewing where the CCG spends more on healthcare compared to other CCGs with similar populations. The variation is split into warranted and unwarranted variation. Warranted variation means that the variation is due to known differences in pricing arrangements or how patient activity is recorded against a particular care pathway. Unwarranted variation is where there is no known pricing or activity/pathway differences and the CCGs’ patients are seen more often in acute hospital settings compared to other similar CCGs. Where unwarranted variation is identified then clinical experts for a particular specialty or service are brought together to agree a revised service and/or care pathway to provide alternatives to hospital admissions and outpatient appointments. This new service or care pathway is co- developed by all key system stakeholders to ensure the best quality outcomes are achieved for patients across general practice, community and acute hospital settings whilst releasing financial efficiencies.

Programme Area: RightCare Priorities for 2019/20 Key deliverables Baseline 2019/20 Deadli Success Link to Commissioning position milestones ne measure other mechanism plans Review all RightCare To analyse all variation RightCare To analyse all Q1 Commissioning QIPP System engagement in opportunities into warranted and Commissioning variation into proposals to Optimal Design unwarranted for Value pack warranted and improve patient Workshops. Programme To develop a delivery opportunities unwarranted quality outcomes management of programme for right care To develop a Q1 and release opportunities and routine. unwarranted variation delivery programme financial Business Intelligence To embed the Right Care for right care efficiencies reporting against QIPP Methodology into CCG unwarranted submitted through scheme Delivery Programmes variation CCG Governance Right Care Standard Processes Operating Procedures Align opportunities across Single schedule RightCare Single schedule Q1 Single schedule QIPP RightCare standard RightCare, GIRFT, Model confirming overlap of Commissioning confirming overlap confirming operating procedure Hospital and High Impact RightCare, GIRFT and for Value pack, of RightCare, overlap of process Interventions best Model Hospital GIRFT, Model GIRFT and Model RightCare, GIRFT practice guides Hospital Hospital and Model opportunities Hospital To agree data sharing, Agree contractual GIRFT data 2019/20 contracts Q1 2019/20 contracts QIPP Contract Information regular reporting and information requirements pack, GIRFT to include to include Requirements and KPIs action plan updates from and Key Performance action plan and information information providers in relation to indicators (KPIs) for Model Hospital requirements and requirements and provider efficiency GIRFT and Model data KPIs for GIRFT and KPIs for GIRFT programmes (Get it Right Hospital Model Hospital and Model First Time (GIRFT) and Hospital Model Hospital)

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Continuing Healthcare (CHC)

Programme Area: Continuing Health Care and Children and Young Peoples Continuing Care SRO: Programme Lead: Head of Quality & Transformation (Continuing Healthcare) Chief Nurse SUMMARY: The current local CHC process is fragmented and further complicated by responsibilities crossing organisational boundaries. Partner agencies remain confused as to where their individual responsibilities lie, and where the transfer of information and accountability occurs. The current process is made unnecessarily complex by the number of hand offs within the system, which disempowers professionals trying to work on an individual case, and expressly disenables one individual professional, from anywhere within the system, being able to assist the patient concerning how the process works, and where their individual application may be within the system.

In 2018/19 the CCG established robust governance and programme management around the delivery of Continuing Healthcare to improve the quality of services to patients and their families. This was through a new CHC service provider (Midlands and Lancashire Commissioning Support Unit) in a step in capacity resulting in achievement of the 28-day assessment standard. From 1 January 2019 all CHC patients receiving domiciliary care have their packages delivered as a Personal Health Budget (PHB) promoting self-management and control over care.

For 2019/20 the CCG plans to procure an End to End CHC service where one provider will undertake the assessment; case management and review function from start to finish. A business case has been agreed and the procurement will take place during 2019. The CCG will re-house some back office functions and will have contractual discussions through the Section 75 agreements regarding the brokerage of care packages in conjunction with the local authorities. The new model of provision will ensure the CCG meets its requirements in respect to the national CHC framework for timely assessment and to achieve the quality standards required as well as support local collaborative working across the STP.

Programme Area: Continuing Health Care (CHC) and Children and Young Peoples Continuing Care (CYPCC) Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to other Commissioning 2019/20 milestones measure plans mechanism Ensure equity of A new single 83% patients New end to end Q3 Framework NHSE CHC Single provider service and provider for an assessed in 28 provider in place compliant services Strategic contract through reduce variation end to end service days as assured Improvement contract and compliance across the CCG 25% of patients through the Programme management with the National covering the assessed in acute Continuing STP Ageing Well Framework for assessment, case settings HealthCare Programme Sections 75 CHC/Funded management and Assurance Tool QIPP agreements with Nursing Care/CCC review function >80% 28 days Local Authorities from start to finish. <15% acute assessments Work through the Patients are Integration of work STP CHC Q2 Strategy in place STP Ageing Well Intermediate Care STP to ensure that supported at home stream across the strategy Programme and Discharge to patients are wherever possible STP Assess contract supported home in a timely manner first in and there are

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Programme Area: Continuing Health Care (CHC) and Children and Young Peoples Continuing Care (CYPCC) Priorities for Key deliverables Baseline position 2019/20 Deadline Success Link to other Commissioning 2019/20 milestones measure plans mechanism collaboration with reduced delays in local authority transfers of care partners

Personalisation All individuals in All new domiciliary All patients Q3 Increased National Contract and support receipt of packages receiving numbers of personalisation management via through personal domiciliary CHC/ delivered through domiciliary patients with programme CHC service health budgets for CYPCC packages PHB packages will PHBs provider individuals will hold a PHB have packages receiving CHC / converted to PHB CYPCC at review

All children and young people will have packages as PHBs

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Learning Disabilities and Autism

Programme Area: Learning Disabilities and Autism SRO: Programme Lead: Transforming Care Programme Manager Chief Nurse SUMMARY: The CCG has made significant progress in 2018/19 to transform the care of clients who have a learning disability and/ or autism with behaviours that challenge through the BSol Transforming Care Partnership (TCP). The Partnership has increased access to community based provision to allow clients to live meaningful lives within the community in line with the ‘Building the Right Support’ principles. The availability of high quality care and support providers in BSol has been increased along with an improved housing offer which has enabled the partnership to achieve successful transition of clients into the community, resulting in a reduction on the reliance of inpatient provision.

Steady progress has been made with the delivery of NHS Health Checks pledge for patients with learning disabilities alongside raising and increased awareness across the health and social care system to Stop The Over Medication of Patients (STOMP) which have all contributed to tackling health inequalities within the TCP along with embedding the Learning Disability Mortality Reviews (LeDeR) into every day practice. The Partnership has worked closely with partners to deliver the requirements of the national policy for care and treatment reviews/ care and education treatment reviews which has reduced the number of admissions into hospital, reduced the length of inpatient stays, improved the quality of care people receive in hospital as well as improving the planning of current and future care and increased families and carers’ engagement in the care planning process for leaving hospital.

In 2019/20 the CCG will continue the work of the Partnership, expanding the support to the wider learning disability and autism population. This will be achieved through ensuring clients have access to treatment, care and support enabling people to lead longer, happier, healthier lives in the community. Where care in a hospital setting is required we will aim to ensure the length of stay is as short as possible in the least restrictive environment with improved quality of care. The TCP has a clear focus on personalisation of services to meet our populations needs and the work to stimulate the market to support wider service transformation will continue.

Where possible the CCG will work with the other TCPs across the West Midlands to develop and commission some aspects of service provision where collaboration is required on a greater footprint to maximise quality, innovation and efficiency whilst maintaining a focus on place based service provision. The CCG will improve its understanding of the needs of people with a learning disability and autism and work with partners including service users and carers to improve this client groups health and well-being which will underpin the delivery of the ambition within the NHS Long Term Plan.

Programme Area: Learning Disabilities and Autism Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to Commissioning 2019/20 position measure other plans mechanism Reduction in 18.5 inpatients per As of the Sufficient community capacity Q4 Delivery of set 2019/20 NHS NHS Contractual reliance on million adult January 2019, commissioned from health providers to trajectory planning mechanism inpatient care for population by the TCP has support discharges from inpatient guidance people with a March 2020 69 inpatients provision into the community learning disability (all age) Stimulation of the care and support market NHS Long and/or autism to allow for sustainable transition. Term Plan Housing plan in place which will outline needs and vision for BSol, supporting

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Programme Area: Learning Disabilities and Autism Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to Commissioning 2019/20 position measure other plans mechanism increase engagement with housing providers Workforce plan will be developed with an action plan to address the workforce challenge A strategy for Learning Disabilities and Autism will be developed which will outline how the needs and how key partners will support this patient population and deliver the NHS Long Term Plan Improve access to Increased number 53% as of Practices will need to offer annual health Q4 That the CCG 2019/20 NHS England healthcare for of people with a 1/4/18 check to patients with a learning disability will achieve Planning Local people with a learning disability as an entry requirement to access the 75% or above Guidance Improvement learning disability receiving an primary care universal offer for 2019/20 of patients with Scheme (LIS) so that by March annual health a learning NHS Long 2019 75% of check from their disability on a Term Plan people on a GP GP GP register register are receiving an receiving an annual health annual health check check Reduce LeDeR plan in The LeDeR There is a robust CCG plan in place to Q4 That all 2019/20 NHS Contractual premature place to support programme ensure that LeDeR reviews are undertaken learning planning mechanism mortality by the review of all was within 6 months of the notification of death disability guidance improving access deaths of patients implemented to the local area patient deaths to health services, with a learning within the CCG CCGs have systems in place to analyse that are NHS Long education and disability and to in October and address the themes and notified Term Plan training of staff, share learning and 2017 which set recommendations from completed LeDeR through the and by making finds support out the process reviews review system necessary service for the An annual report is submitted to the are reviewed reasonable improvements reporting and appropriate board/committee for all and finds/ adjustments for review of statutory partners, demonstrating action learning is people with a deaths taken and outcomes from LeDeR reviews presented to learning disability Steering key partners and/or autism Group in place Local Area Contact in place

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Programme Area: Learning Disabilities and Autism Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to Commissioning 2019/20 position measure other plans mechanism Increase the That a mechanism 2017/18 – 44 That all appropriate people with a learning Q4 2% of TCP 2019/20 NHS Contractual uptake of will be in place to people with a disability are offered a PHB packages planning mechanisms with Personal Health ensure all learning delivered via a guidance providers may be Budgets (PHBs) appropriate clients disability and/ PHB Model required and to allow patients are offered a PHB or Autism had 72 PHBs as a NHS Long service more flexibility on a PHB minimum to be Term Plan specifications how their care delivered needs are met BSol TCP Plan Reduction in 18.5 inpatients per As of the Sufficient community capacity Q4 That the CCG 2019/20 NHS Contractual reliance on million adult January 2019, commissioned from health providers to will have planning mechanism inpatient care for population by the TCP has support discharges from inpatient delivered the guidance people with a March 2020. 69 inpatients provision into the community set trajectory learning disability (all age) Stimulation of the care and support market NHS Long and/or autism to allow for sustainable transition. Term Plan Housing plan in place which will outline needs and vision for BSol, supporting increase engagement with housing providers Workforce plan will be developed with an action plan to address the workforce challenge A strategy for Learning Disabilities and Autism will be developed which will outline how the needs and how key partners will support this patient population and deliver the NHS Long Term Plan

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Medicines Management and Optimisation

Programme Area: Medicines Management and Optimisation (MMO) SRO: Programme Lead: Clinical Director, Medicines Management and Optimisation Chief Medical Officer SUMMARY

The Medicines Management and Optimisation (MMO) programme consists of a number of business as usual projects which have a quantifiable effect on the CCG’s financial position. Where there is an effect on the CCG finances, the project is listed in this operational plan. Projects relating to clinical quality are covered in the Medicines Management element of the Universal Patient Offer. The entire medicines work plan is described within the Universal Patient Offer.

Programme Area: Medicines Management and Optimisation Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism

Delivery of the Improve the cost 2018/19 Budget 2019/20 Budget Q4 12 month savings Achievement of Internal delivery CCG MMO Cost effectiveness of £1.16M proposal accumulation to financial balance through MMO Improvement Plan prescribing in £1.36 to £1.58M exceed target team primary care through Included in a set of targeted Universal Patient interventions Offer Delivery of NHS Reduce primary care 2018/19 2019/20 Budget Q4 12-month savings Achievement of Internal delivery England expenditure in key Budgets proposal accumulation to financial balance through MMO Medicines Value areas: exceed target team Programme as Drugs of Limited £330k 450k Overall reduction in Included in relevant to primary Clinical Value proportions of Universal Patient care Over the Counter medicines prescribed Offer Medicines £337k £500k to £575k as Over the Counter Medicines General reduction in the use of medicines designated of lower clinical value

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Programme Area: Medicines Management and Optimisation Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism

Polypharmacy Undertake patient 2018/19 2019/20 Budget Q4 Key measures: Achievement of Internal delivery reviews specific medication Budgets proposal Number of medication financial balance through MMO reviews utilising reviews team specialist medication £450k review pharmacists £866k Cost reduction per Included in Budget reduced for intervention Universal Patient Full Outturn: 2019/20 as team will Offer £687k need to be re-recruited Overall cost reduction for 2019/20 Reduction in harms associated with polypharmacy

Improved patient outcomes associated with ‘right medicine, right dose, right time’ Medicines Waste System level review 2018/19 2019/20 Budget Q4 Key measures: Achievement of Internal delivery Reduction of medicines Budgets proposal financial balance through MMO ordering schemes Number of quantity team and reduction in use reviews undertaken of third party £800k £800k Included in ordering Cost reduction per Universal Patient Patient level quantity intervention Offer reviews to ensure patients receive the Overall cost reduction correct amount of £230k medication £269k Support for the Support for the Referenced in Referenced in Q4 Key measures: Achievement of Internal delivery Universal Patient delivery of the Integration - Integration - Primary MMO universal through MMO Offer practice Universal Patient Primary Care Care Number of practices offer objectives team Local Offer for schemes achieving all MMO Improvement not associated with objectives Reduction in harm Included in Scheme financial balance General improvement associated with Universal Patient Antimicrobial in metrics associated medications Offer resistance with Antimicrobial Medication reviews resistance in care homes

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Programme Area: Medicines Management and Optimisation Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 position plans mechanism

Clinical audit (one Achievement of target per practice) numbers of medication Patient medication reviews safety audit Practice level actions plans to deliver change identified by clinical audit

General improvement in the awareness of medication safety issues in general practice and evidence of implementation of medication safety audits

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Quality - Improving Quality in Organisations

Programme Area: Quality – Improving Quality in the Organisation SRO: Programme Lead: Associate Director of Quality Chief Nurse SUMMARY Our focus will be to ensure that a robust quality strategy is in place which will be supported by plans that will to seek to continually improve the quality of care delivered across all providers. We want to strengthened our approach to quality surveillance and quality improvement.

We will do this by building upon our current systems for gathering data, analysing and benchmarking hard and soft intelligence, monitoring Serious Incidents (SI’s) and complaints, to ensure that we maintain effective oversight of clinical quality, patient safety and patient experience. We remain committed to working closely with the Care Quality Commission (CQC) and NHS Improvement (NHSI) to achieve these goals.

The notion of unwarranted variation is a helpful way to focus on quality improvements by delivering the right care in the right place at the right time. Unwarranted variations are those which we could change they can be a sign of poor quality care, missed opportunities and waste and can result in poorer outcomes, poorer experience and increased expense.

We will work closely and continue to develop our relationships with provider organisations in order to support them to achieve our shared quality goals improved patient experience and improved patient outcomes. This will require us to focus on activities that create ’high value’ whilst having the courage to phase out activities that contribute ’low value’ that deliver poor quality and poor patient outcomes.

We will focus on the three aims to arrive at a shared understanding of the resources available and a commitment to use them for high value care, driven by local health needs and the choices of local people and users of services. 1. Health and wellbeing: Without a greater focus on prevention, health inequalities will widen and our capacity to pay for new treatments will be compromised by the need to spend billions of pounds on avoidable illness 2. Care and quality: Health needs will go unmet unless we reshape care, harness technology and address variations in quality and safety 3. Funding and efficiency: Without efficiencies, a shortage of resources will hinder care services and progress.

Programme Area: Quality Priorities for Key deliverables Baseline position 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 plans mechanism

Develop a quality Patients will be Not Applicable STP wide Quality Q1 Strategy in place All STP No required strategy which will supported to get monitoring approach in programmes underpin our the best possible place approach to quality outcomes improvement and monitoring

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Programme Area: Quality Priorities for Key deliverables Baseline position 2019/20 milestones Deadline Success measure Link to other Commissioning 2019/20 plans mechanism

Improve outcomes Increased Friends and Family Improved Friends and Q4 CCG will see a year on NHS 2019/20 Service for patients numbers of people Test scores in Family Test score year percentage planning guidance developing accessing demonstrating NHS providers improvement against initiatives healthcare in BSol improved patient Greater compliance all core NHS NHS Long Term Commissioning for reported outcomes Current towards achieving all constitutional Plan Quality and performance core NHS targets standards Innovation against NHS (CQUIN) constitutional NHS England standards Local Improvement Scheme. Ensuring patient Compliance with Number of safe BSol is seen as key Q4 Reduction in the All STP Delivered through safety is a top all national and guarding alerts delivery partner in numbers of programmes the safeguarding priority for all local safeguarding system wide safeguarding alerts boards work providers requirements safeguarding programmes partnership boards for Learning from both adult and Safeguarding Adult children’s services Reviews and Serious Case Reviews is embedded into our safety culture Implementing The system is able Number of serious Demonstrating a net Q4 Reduction in the All STP Serious incident system wide to clearly incidents across reduction in recurrent numbers serious programmes action plans learning from demonstrate a all specialists themed serious incidents CQUIN serious incidents safety culture areas: Acute, incidents NHS England and never events where leaning Community, Learning for serious Local in both secondary from incidents is primary care incidents and never Improvement and primary care embedded in our Mental Health & events is embedded Scheme core approach to Learning into culture and patient safety Disabilities practice

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Localities

Programme Area: Development of Locality Working SRO: Programme Lead: Locality Directors Director of Organisational Development and Partnerships SUMMARY

Birmingham and Solihull is an area of significant diversity, containing some of the country’s more affluent neighbourhoods alongside some of the most deprived. As a consequence, considerable inequity exists within our health outcomes. Sitting at the interface between strategic commissioning plans and local service delivery networks, locality working is the way in which we will ensure that services are delivered in a way which responds to the distinct needs of our local communities. Within our locality working health and care model, developed in conjunction with our STP partners, we have created a number of sub-levels within our overall footprint to enable us to plan, commission and deliver services effectively. Importantly six localities have been created within our overall population of 1.3 million, one for Solihull and five for Birmingham. Each locality has a population of c250,000 and has been formed to be co-terminus with recognised civil governance boundaries to create an alignment to other statutory and partner agencies. The creation of these localities has enabled us to create strong partnerships with Solihull Metropolitan Borough Council and Birmingham City Council respectively and are an important level for the planning and commissioning of health and care services. Within each locality a number of local networks are being created to serve population of 30,000 – 50,000. These networks will be the delivery units for primary care and community services. Partnership working is a key element of the locality model, not just in relation to health and social care, but also in relation to crime, employment, education and housing, all of which have a significant impact on the wellbeing of local communities. Locality working provides us with a common unit of planning shared by our strategic partners in the local authority and the police to come together and work collectively for the wellbeing of local people. What have we achieved in 2018/19 2018/19 has been a start-up year for locality working. We have developed and agreed our locality health and care model as set out above and have confirmed the role of localities in enabling local partnerships and service delivery. GP Locality Leads have been appointed to embed locality working and deliver the localities vision. Our priorities for 2019/20. In the coming year we will:  Finalise our neighbourhoods and work with the newly established primary care networks to secure delivery of the new enhanced model of primary care.  In conjunction with CCG commissioning colleagues establish a road map to support ongoing development of PCNs, including resources to ensure operational delivery.  Work with our partners in the local authority, community services and the voluntary and community sector to develop and implement integrated delivery models for health and social care at the neighbourhood level.  Create new ways of working with local communities which promote independence, health and wellbeing and ensure that there is a strong prevention offer available to all our communities through activities like social prescribing.  Support and inform the CCG in its role as strategic commissioner of health services for children, adults and older people by enabling the delivery of strategic priorities and outcomes at the locality level.  Work with our partners in the local authority and the police to tackle the wider determinants of health through effective public sector reform initiatives such as for example the delivery of the East Birmingham North Solihull Regeneration Corridor.

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Programme Area: Development of Locality Working SRO: Programme Lead: Locality Directors Director of Organisational Development and Partnerships SUMMARY  Collect and collate information on the needs of local people to secure a clear understanding of the health inequalities that exist across Birmingham and Solihull to act as a baseline for the planning and delivery of health services.  Maintain and strengthen our leadership role within key Place based partnerships such as Solihull Together and the East Birmingham Board to help shape the agenda and ensure that health issues are reflected and addressed appropriately.

Programme Area: Development of Locality Working Priorities for 2019/20 Key deliverables Baseline 2019/20 Deadline Success measure Link to other plans Commissioning position milestones mechanism

Work with partners to Establishment of Not July 2019 TBC Increase in joint STP Not applicable develop and implement integrated applicable commence new working and Delivery through integrated delivery neighbourhood delivery integrated practice partnership models for health and based delivery partnership working social care at the groups neighbourhood level Confirmation of local integrated delivery model

Confirmation of local delivery priorities Create new ways of Confirmed map of Not Developed new Q3 Increased referral STP and CCG Not applicable working with local neighbourhood applicable ways of working levels from general Commissioning priorities Delivery through communities via a assets practice to social partnership strong local prevention support and working offer Development of Developed a prescribing options local prevention strong local offer prevention offer Support and inform Effective joint Not Confirm locality From Q1 Integration of CCG Commissioning Not applicable strategic working between applicable representation at locality perspective priorities commissioning by strategic strategic into strategic enabling the delivery commissioning commissioning commissioning of strategic priorities teams and locality boards plans and outcomes at the team. Attend meetings locality level

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Programme Area: Development of Locality Working Work with our partners Membership of Not Commence From Q1 Increased clarity in STP Not applicable to tackle the wider relevant public applicable partnership relation to common delivery through determinants of health sector conversations and shared partnerships and through effective public partnerships strategic objectives. alignment of sector reform initiatives Agree priorities Enhanced definition commissioning of role and function. priorities and Establish relevant delivery plans task and finish groups Collect and collate Locality and N/A Work with PH Q1 Clear and shared STP, LA and CCG Not applicable health inequality neighbourhood teams to define understanding of commissioning plans delivery through information level needs requirements local priorities and joint working with assessments need Birmingham and Secure and Solihull Public interpret Increased use of Health Teams information baseline data in received strategic commissioning plans to inform targeting and phasing Maintain and Leadership role in N/A Maintain From Q1 Clear and accurate STP, LA and CCG Not applicable strengthen our Solihull Together attendance at representation of commissioning plans delivery through leadership role within Boards health issues within partnerships key place based partnership partnerships Leadership role in Identify and discussions East Birmingham participate in Programme newly forming Board boards as appropriate

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Section 3 – Overarching Corporate Enablers

Estates and Infrastructure

Programme Area: Estates and Infrastructure SRO: Programme Lead: Head of Estates (Primary Care) Director of Organisational Development and Partnerships SUMMARY

Development of CCG Estates Strategy Investing in improving the primary care estate, maximising the use of existing NHS estate, delivering the CCG accommodation programme and developing a system wide response to clinical strategies are the key aims of the estate workstream over the next 12 months. To support this, the CCG will produce a CCG Estate Strategy and continue to engage with partners to revise and improve the STP Strategic Estate Plan. This will meet the needs of the organisation in terms of:  quality and safety of the environment  suitability to support the service delivery model  capacity to meet the volume of work anticipated  financial sustainability – the Estates Strategy will take into account the financial implications of investing in a new estate. The CCG estate strategy will focus on primary care estate and recognise the estate requirements of developing clinical strategies, particularly with regard to community and urgent care. Estates and Technology Transformation Fund Opportunity 2019/20  CCG Estates Technology and Transformation Funds allocation c£3.7m (to cover technology and estate transformation)  Primary Care Estate Strategy to include the prioritisation methodology, principles and to identify priority projects. 2020/21  CCG Estates Technology and Transformation Funds allocation c£2.5m, allocated to support the development of the Bournville Health and Wellbeing Centre. The scheme approved by the CCG Primary Care Commissioning and Contracting Committee. Feasibility and Business Case Development Perfect Circle Consulting have been appointed as part of NHS procurement framework to complete analysis, feasibility and Strategic Business Case for:  Solihull Town Centre Enhanced Access Hub/Urgent Treatment Centre  South Birmingham Enhanced Access Hub/Urgent Treatment Centre  North Birmingham Enhanced Access Hub/Urgent Treatment Centre

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Programme Area: Estates and Infrastructure SRO: Programme Lead: Head of Estates (Primary Care) Director of Organisational Development and Partnerships SUMMARY Feasibility studies will be completed in March 2019. Next steps to be agreed in April 2019. Void Reduction Programme There is a need to reduce the significant expenditure on void space across the CCG’s footprint. The void reduction programme works with providers and building operators to improve utilisation of the buildings and support the move of services into the community. CCG HQ Relocation The CCG’s office accommodation strategy will be executed during the first quarter of 2019/20. There will be three CCG bases:  Wesleyan building, Birmingham – CCG Headquarters  Friars Gate, Solihull – to deliver our commitment to maintain a Solihull base to support integrated commissioning with Solihull Metropolitan Borough Council  Woodcock Street – co-location with Birmingham City Council to support integrated commissioning

Programme Area: Estates and Infrastructure Priorities Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning position measure plans mechanism

Estates and Improved primary care C£3.7m Estates Project feasibility analysis Q1 Completion of Primary Care Improvement Technology estates Technology and CCG approval of Estates projects to time Strategy and grants Transformation Transformation Technology and Q1 and budget GP Forward Fund Funds allocation Transformation Funds View (£2.7m for plan estates) Bournville Health and December 2018 – Implementation of plan Q1 – Q4 New building General Medical Wellbeing Centre the CCG’s (subject to NHS England operational and Servicer contract Primary Care approval) serving patients of The new facility will Commissioning Bournville enable greater at scale Committee NHSE final approval of Q1 working and a wider approved the final the Full Business Case range of quality revenue services to the patient consequences of Appointment of main Q1 population the development contractor and October 2018 - mobilisation the revised Outline Business Construction period Q1 – Q4 Case was

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Programme Area: Estates and Infrastructure Priorities Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning position measure plans mechanism

approved by the Practical completion, Q4 CCG’s Primary handover, commissioning Care and occupation by GP Commissioning practices Committee and submitted to NHSE for final approval Estates Strategy Approved Primary Care 3 legacy CCG Appoint Strategy writer Q1 Approved strategy Primary Care Not applicable Estate Strategy primary care Locality workshops and Q2 Strategy estate strategies reviews BSol CCG Agreed Primary Care Q3 primary care Estate Strategy estate strategy

Void Reduction 1. Washwood Heath Feasibility study i)Detailed design and Q2 Ophthalmology CCG Estates N/A Programme Primary Care Centre: prepared by business case approvals service operating Strategy a) Heartlands Hospital Birmingham and ii) Construction works and Q2 – Q4 at Washwood Improved building Ophthalmology Solihull BaS service commissioning Heath Primary utilisation Outpatients Department LIFTCo and i) Detailed design and Q2 Care Centre Reduced CCG relocation Strategic Outline business case approvals spend on void Case approval by ii) Construction works and Q2 – Q4 Practice relocated space b) Ammaanah Practice UHB and CCG service commissioning Increased range of relocation from Saltley FTB service services provided Health Centre i) Short term solution Q2 operating from in ii) Interim solution TBC Washwood Heath community c) Forward Thinking iii) Full solution to be Q3 Medical Centre facilities Birmingham relocation worked up and planned 2) Queen Elizabeth Feasibility study i) Detailed design and Q1 All bases CCG Estates TBC Hospital Ophthalmology prepared by BaS business case approvals operational Strategy Outpatients Department LIFTCo and iii) Construction works Q3 extension to Strategic Outline and service Sparkbrook Primary Case approval by commissioning Care Centre CCG

3) Chest Clinic i) Detailed design and Q2 All bases CCG Estates TBC relocation to Attwood business case approvals operational Strategy Green

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Programme Area: Estates and Infrastructure Priorities Key deliverables Baseline 2019/20 milestones Deadline Success Link to other Commissioning position measure plans mechanism

iii) Construction works Q2 – Q4 and service commissioning 4) Sexual Assault i) Detailed design and Q1 All bases CCG Estates TBC Referral Centres business case approvals operational Strategy relocation to Hodge Hill ii) Construction works and Q1 – Q4 service commissioning CCG CCG staff in high Staff based at Consolidation of space at Q1 All new bases Supports the Leases Accommodation quality office bases Attwood Green Friars Gate operational Organisation Health Centre and Move to Woodcock Street Development 1st and 3rd floor of Move to central Strategy and Friars Gate Birmingham office establishing an effective and high performing organisation

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Digital connectivity

Programme Area: Digital SRO: Programme Lead: Deputy Chief Information Officer Chief Information Officer SUMMARY

The digital function through the 2018/19 year delivered a number of key achievements.  The design, mobilisation and implementation of the digital services to enable extended access  Implementation of public and private Wi-Fi across the CCG estate, with plan being implemented to include govroam  Deployment of Voice over Internet Protocol telephone system to 60 GP practices  Completion of the economy wide back-office infrastructure consolidation, consolidating the network infrastructure at all 222 sites  Deployment of Docman 10 to the whole health economy  Deployment of Your Care Connected providing healthcare access to a summary GP record  Deployment of a local app to provide the public access to their GP record and GP service. The outline plans for 2019/20 include:  Refresh of the CCG Digital Strategy, including a 1-3-5 Year Technical Plan, based on the forthcoming new national GP IT Strategy  Deployment of the new NHS network (known as Health and Social Care Network  Deployment of Microsoft Windows 10 to ensure the latest NHS digital security standards are met  Working with the STP to develop and deliver the STP Digital Roadmap in particular the further development of the Local Health Care Record  Deployment and expansion of use of local and national patient apps.

Programme Area: Digital

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 position measure mechanism

Migration from N3 Confirmed technical Baseline is 0% New connectivity to all Q4 All sites Aligns with STP and Alignment with to Health and architecture, adoption as of sites. Improving deployed by CCG digital national Social Care overarching December 2018 connectivity for digital March 2020 strategy. Supported programme Network deployment plan and access requirements and by national mandate connectivity at all project resources. reducing N3 transition sites cost pressures Windows 10 Confirm technical Baseline Development of the Q4 All sites Aligns with CCG Alignment with migration deployment plan position is <5% detailed project plan deployed by and STP digital national Confirm funding to as of December Convergence with current March 2020 strategy requirements undertake work 2018 Virtual Desktop Compliance with Improve cyber security Infrastructure project to National Cyber cover estate. Security Centre and

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Programme Area: Digital

Priorities for Key deliverables Baseline 2019/20 milestones Deadline Success Link to other plans Commissioning 2019/20 position measure mechanism

and sustainability of Data Security and the estate Protection Toolkit requirements Digital and Local Confirmation of funds Baseline Development of the Q3 Three shared Supports STP Alignment with Health Care from treasury. position is detailed project plan records record sharing STP mandate Records including Confirmation of project inception Delivery of the systems converged into a mandate and Health System business case from Requires integration single care alignment with Led Investment individual ‘host’ comprehensive record national organisations. Link of project plan to accessible by all requirements Your Care Connected, be finalised care providing maternity record and statutory bodies Mental health records to form a person centred care record Urgent Care Supporting the Urgent Different Complete review of Q3 Systems in Supports STP Alignment with Centre (UCC) IT Care Team, procure systems current system place record sharing STP mandate System and implement a new currently in Develop specification Provision of mandate and standard IT system place with Tender and implement A&E Minimum alignment with supporting the UCCs limited reporting new system Data Set national including provision of in place and no requirements the A&E Minimum local links Data Set and links to the Local Health Care Records NHS patient apps Expand the technical Local app Monthly deployment and Q1 Increasing use Support STP Digital Alignment with capability of the new deployed across usage figures for the local priorities and STP mandate local Birmingham & all STP app Full deployment alignment with Solihull Patient app practices by the Deployment of NHS app Q4 national priorities end of March across all practices Deployment of the new 2019 NHS patient app in line NHS app rollout with Primary Care due to start from Strategy and new GP spring 2019 Contract

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Section 4 – Governance and Reporting CCG Governance The CCG Constitution and Governance Handbook were reviewed during 2018/19 to establish the governance framework within which the CCG operates. The high level CCG governance architecture is shown below:

NHS England Governing Body BCC & SMBC

Executive Team

OSC HWBB

Primary Care Finance & Clinical Investment & Joint Committee Joint Committees Audit & Risk Remuneration Quality & Safety Commissioning Performance Disinvestment with Western under Section 75 Committee Committee Committee Committee Committee Committee Birmingham arrangements

The governance of an integrated system is complex and the CCG has clear lines of authority and accountability to ensure our decision making processes are robust and stand up to scrutiny. Internal Assurance, Monitoring and Reporting of this Plan The CCG will take internal assurance of the delivery of this plan in a number of ways. This will be via the development of projects and programmes falling from this plan which are managed operationally through the Programme Boards, Programme Review Group and the Executive Team. The Clinical Investment and Disinvestment Group, comprising of GPs and independent members will make decisions and recommendations with the business case outputs relating to the programmes of work. Governing Body will receive reports three times a year on the CCG’s progress in respect of the achievement of delivery of this plan and thus in turn, its strategic objectives as these are realised through the plan’s delivery. Programme Governance The principles applied to each programme to support the delivery of the operational and strategic plans follow.

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Each programme will:

 be led by a senior executive and clinician  have a work plan setting out how it will support delivery  set clear milestones and actions required to achieve delivery.  have measureable KPIs which will be reviewed and monitored on a risk basis.  provide assurance reports detailing progress made, barriers to delivery or risks. The CCG uses its risk management and assurance framework strategy to undertake a risk assessment of this plan and its supporting programmes. This will inform a risk based approach to prioritisation and enable us to understand and identify where resources need to be focused to support delivery. System Assurance STP governance continues to evolve and a Memorandum of Understanding underpins the system. The CCG’s decision making structures are reflective of the STP programmes, but have appropriate checks and balances to manage potential conflicts of interest in accordance with statutory guidance. The CCG will, as far as is possible, ensure its decisions are made openly and transparently, with appropriate clinical and patient input. Risk Management Strategy and Board Assurance Framework The Risk Management Strategy and Board Assurance Framework underpin the CCG’s risk management framework, enabling the Governing Body to remain sighted on the CCG’s strategic and high level corporate risks, assuring itself that appropriate mechanisms of control are in place. The Governing Body is responsible for ensuring the CCG applies the principles of good governance through its Board Assurance Framework and other processes and reviews the Board Assurance Framework on a quarterly basis. This includes systems of internal control, clinical and information governance and risk management.

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Abbreviations ADHD Attention deficit hyperactivity disorder MDA Multi-Disciplinary Approach A&E Accident and Emergency MDT Multi-Disciplinary Team ASD Autism Spectrum Disorders MMO Medicines Management and Optimisation Aspyre A software used to report progress of projects against milestones MSK Musculoskeletal set by the CCG Programme Management Office. NHS National Health Service BCHC Birmingham Community Healthcare NHS Foundation Trust NHSE National Health Service England BCC Birmingham City Council NHSI National Health Service Improvement BAME Black Asian and Minority Ethnic NICE National Institute for Health and Care Excellence BSol Birmingham and Solihull OD Organisational Development BSMHFT Birmingham and Solihull Mental Health NHS Foundation Trust OFSTED Office for Standards in Education BUMP Birmingham and Solihull Maternity and Newborn Partnership OOH Out of Hours BWC Birmingham Woman’s and Children Hospital NHS Foundation OPAL Older Peoples Assessment and Liaison Service Trust OSC Overview and Scrutiny Committee CCG Clinical Commissioning Group OT Occupational Therapy CGM Continuous Glucose Monitoring PCCC Primary Care Commissioning Committee CHC Continuing Health Care PCN Primary Care Networks CHIP Child Health Investment Programme PHB Personal Health Budgets CQC Care Quality Commission PHE Public Health England CQUIN Commissioning for Quality and Innovation PID Project Initiation Document CYPCC Children and Young Peoples Continuing Care QIPP Quality Innovation Productivity and Prevention DCO Designated Clinical Officer REACH Realising Every Asset in the Community DMO Designated Medical Officer RCGP Royal College of General Practitioners EAB Enhanced Assessment Beds RFM Reduced Foetal Movement ED Emergency Department ROH The Royal Orthopaedics Hospital NHS Foundation Trust FIT Faecal Immunochemical Test RTT Referral to Treatment FTB Forward Thinking Birmingham SEND Special Education Needs and Disabilities FYFV NHS Five Year Forward View SLT Speech and Language Therapy GIRFT Get It Right First Time SMBC Solihull Metropolitan Borough Council GP General Practitioner STOMP Stop The Over Medication of Patients GPFV General Practice Forward View STP Sustainability and Transformation Partnership HWBB Health and Well Being Board SRO Senior Responsible Officer HGS Heartlands, Good Hope and Solihull Hospitals SWB Sandwell and West Birmingham IAPT Improving Access to Psychological Therapies TCP Transforming Care Partnership ICS Integrated Care System UCC Urgent Care Centres IGPR International GP Recruitment UEC Urgent Emergency Care IT Information Technology UHB University Hospitals Birmingham NHS Foundation Trust KPI Key Performance Indicator UHB HGS University Hospitals Birmingham NHS Foundation Trust, LeDeR Learning Disability Mortality Review Heartlands, Good Hope and Solihull Hospitals LMS Local Maternity Scheme UTC Urgent Treatment Centre LTC Long Term Conditions WTE Whole Time Equivalent

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