Pee Our task has been to ‘undertake a rapid assossmont ofthe issues and to proffer solutions that vill improve quality and Jong term affordability of the LHE. We have acted as a catalyst for organisations and leaders to tackle some fong standing Issues. ‘Momentum is building and there now exists a better ‘opportunity for success. ‘The silo way of working is ‘gradually being eroded but there is more to do. Our transparent approach, ‘means that we have shared data packs and financial bridges with each ‘organisation to create ‘one vorsion of the truth’ = We have excluded any analysis of maternity services given the SofS Overview of project delivery Objectives and approach Objectives and key features of the work = We have worked intensely with the whole Local Health Economy (LHE) to understand the root cause of the big financial and cli ies on the patch. This approach has led us to focus on the following areas: Streamiining the frail elderly pathway as it impacts on every organisation; 2. The use of community hospital beds; ‘The productivity gains that can be made in non-elective secondary care beds; The potential ‘repatriation’ or local opportunity’ for elective services that are currently provided out of County for Staffordshire residents; 5. How primary care and community services can be more effectively organised; ©. Existing plans for Cost Improvement Plans jated review. The TSA decisions following Mid Staffs 31 re-organisation of mental health services fc have also been out of scope, We have also not examined the pote discussion with the local sponsor. Our approach = We have taken an approach of‘ ionally agnostic’ when consider tempted to take the whole LHE wi a data pack that can be seen as the ‘one version the many myths that persist in the County. This approach means we have: Built solutions around the three pillars of quality of care, reasonable access and long term affordabilty, We have used a mix of quantitative and qu: Built individual financial bridges for every NHS organisation in the LHE: Created data packs for each organisation that show a clear audit trall of our evidence — each pack has been through an iteration with the relevant organisation; Run a series of LHE workshops and smaller groups fo engage and involve stakeholders including the Local Authorities and patient representatives; We have held a mirror up to the LHE to discuss the relatively poor behaviours and insular culture we have found. tive evidence,9 on WHO D “va ‘sdas pxou Jo wed oup wed se uayeLepUn aq jim SI “UONN}OS Ino Jo ‘ou ujJm Uo|ssnasip pure ied se papuowivoces sebueyp 4) 0 Sui0s anaj\yoe 0} papaou JUSLIISAAL 94} 1500 OU aera ney an ar wos Uy SBTaR eines aie ‘uel Jo jes au yBnoiy s3s09 yeudeo paonpas : : wos) Bunyeued Ayenuayod ysylyn “Aywonpoud asee10U! pUe eVBIS@ UNO sTe\Y @sEUONeS O} WIN MoO[e 0} S18pINOUM JO JoqUIN SIUL “SUS PHONEIS 24) 105 idjoo) aye)se Jayfeuus & \jIM asjueo uoHeyEqeyas pUe anpodja Ue BuIWoDaq [edSOH suonduinsse ys ely uo (2 at uo yng Yoru suaRaO il 03 2] yoiy Jo 8u0 jepuauiwoses auy awed eae “suonse (e21pe |euOIPPe ‘aaynbea pinom youap ay) 40 vopeujuyye ayaydusog Je 10% ¥S.L @tN WHOM UOHEjOs! UI parepIsuOD oq yoUUED Siu) Ing ‘seweUDS SBuIneS Jo\IN) a1oKdxe 0} unBaq auojoL6Kp eneY OM ‘voI|wg'g93 Jo deB e senee| INS Sip Inq LONI Z'apL-3 AINquiUCO sBUINeS Jo sdnosb GouKA YAY OY YEU 9H2HO9 OAK “abo angooja Jo} jopow Mou y Fea pen eae 2/893 013}2N9p aup oonpar ay yesueB.0 feuonippy - picea does upuom angaaya aION - unove paseq axe 28041 ‘pi = a Hoq ome J 2 sous (Q}, a0 39401) eBpuq uod|os sno peers BUEN Fe ajqenanyae st axa you Op am Lyoiym ‘sieak af s20K Yow %p AleyELUIK fefoueuy peysebGns sng: .Suiyjou op, © ‘pig e paonpoid ancy an» feat on uopised yeroueutg mucesaine 1900 01g eyduvexs Jo} ~ 3} ey} Jo Sued u! So;UBDEN YBLY aX pUE UOREINdod ay JO} SH Jo SIBGUT jeroueuy ueoyiubis ayado ey! 40mo} ou) Kq popunodwiod s1siq1 “WUaIsISUOD jou sraxes AleWHd SsOIOe a1eD jo Ayenb om ey sisebBns coup = ‘aug apnjout aye ‘ssoufoid ayEUI 0} Se retads pey mou aney say's yBooy, || jeuiGu0 oy) Jo 1aquinu e yelp UaAlg ps uoung yey) s}s966ns siuj sexowes seunseow! y0U Soop S141 “6L/8L0z J0pun UIeWOs jj LOUNg YEU) poUAyUCO Sey senso} Jo J0,oOK ‘Aq uous 99123 3037 2, oes 0} ued uoyoe payeyep e pue maya Sosy 64) Aq PayueUinoop ua9q BABY | JeIESOH| UON ye SUIDOUON-ANEr ou, = oughlfcaeupeeteitics ‘anSSy WWEUTTTTRSI Aq payooye pue siapisoid SHN oun ‘a1 sterisoy Ajunuuwoo au sequunu @ u Ba/u0s ou Jo spoodse ews “swershs ofgereduioo VEY) Bouapisa jo oped fens side jae ieeuni cd pue yo0dxe pinom om ueWy Saibop 19}e0i6'e 0} Pap 4 JO waUIaBEUEU! a4) Ul a120 WUetJed UO Buyoeduu! exe yeM) sons! . ene ie ___sonssy yen —_ ur synsoz Buywnou Bujog épuno} am aaey JeUM CIEE Alanijap yoaloud Jo MaIAI@AD tiledKPMG ur recommendations start “with the largest cohort of patients who can benefit from a transformational solution — frail older pe ‘The service offered to this, group can be improved in a way that also reduces costs. ‘Community Hospitals are know that the LHE has a greater number of beds than would be expected for this population. We beds could be reduced, ‘Akey theme of our recommendations are that organisations need to work in amore open and collaborative way to bring benefits to the population. Overview of project delivery What are our recommendations? ‘The solutions bridge (refer page 18) shows the key groups of savings. The recommendations below are based on the 13 weeks work with the LHE. Our recommendations are based on a mix of qualitative and qualitative information. We have detail behind all the recommendations with a full data book issued to the sponsors and bespoke data books issued to local stakeholders, The key recommendations to note are: ‘i gle frail eKerly pathway across the LHE to replace the two pathways that curr {UFCes and improve the quality for patients. ily exist. This 2. More services will be provided ina community, primary care or home setting, This wil mean, overtime, a reduced reliance on hospital buildings for certain types of care. Commissioners should engage and con local population about the future use of Community Hospitals in Longton and Cheadle, including the possibly of providing continuing health care 3. Beds at Tamworth CH can be reduced as the pathway management with integrated primary care and community care services. are improved. Commissioners should start this dialogue with the local population. 4. Management ofthe community hospital stock should be aligned with the accountabily for fulure care pathways — particularly those linked to long term conditions of co-morbidities of trail older people. Our recemmendation is that community hospitals need tobe providing services that dovetail effectively into the integrated primary and community service teams work. This may mean redesigning elements oftheir function. We should also consider the community hospital services in three groups: ‘Step up facilties to help avoid hospital admissions ‘Step down facilties organised around pathways such as stroke services Other sub acute services ‘At this point we then believe the appropriate management ofthe community hospital services can be determined. We believe that an exercise to align community hospital services tothe nevr integrated models and single frail elderly pathway c ‘completed in 12 weeks to allow the new way of working to go live in December 2014, 6. Beds and resources can be saved at UHNS and Burton by improving the non-elective met reducing both A&E attendances and admissions. 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(continued) provider and comi sioner plans but we have seen some progress over th ‘The lack of one strategic -eds to be resolved if the LI qress. The same issue has been a ch plan that all providers and the BCF coordination. We expect that the LHE should work together to creata a single high level plan by September 2014, commissioners ‘own’ is 414, The lack ofa single strategic plan across the LHE has reinforced the ‘silo working’ culture we have witnessed. This is stil in evidence with NHS commissioners pursuing market tenders for services that do not always appear to have the full support of all commissioners or to be linked to a clear long term strateay for the whole LHE. Whilst we support the view that ‘commissioners should be allowed to commission we think that the tenders should pass some simple tests: impeding change, ‘The potential change of service has been flagged in the commissioner five year plan That strategie decisions have the support ofall six commissioners inthe spit of doit once where possible! for the ownership and * The beneficial impact across the LHE has been considered delivery of the solutions. * The extent to which the public, GPs and effected providers have been involved We are proposing that the ‘That unintended consequences for the LHE have been considered ‘two Health and Well 15. The impact of specialised commissioning has been factored into the work. We have taken advice from NHS England on Suing boars = assumptions we can make fc income changes. We know that UHNS are making assumptions about additonal income 16. TDA should work with local commissioners to determine a sustainable model for mental he h GPs and collaborate with local providers to help support the return of some care ture years but ths has nol yet been validated reconfigured to include a _ providers —form a gle over arching ‘executive group fo ‘overseo implementation of the recommendations. ith services in North Staffordshire. 17. Commissioners should work closely ot 18. We believe that greater cooperation across the LHE should provide opportunities for savings to be made in ‘back office’ functions, Details are given on page 27. n of plans is not strong across the LHE. We have proposed a governance approach to hold 9 delivery. The two Health and Well Being Boards should create a single executive approach has the 19. The track record of execu ed mara tet PANG ao fect none ne td wh XPD nents Carpet, St ey, 5a te su gu puro None SH Pe toe eon A Hap ‘poredaid oq uous pino> 8102 0} 3800105 1804 ony BHT peresBouuy uy ‘sued 4aB0K ony 10p|noie PUE 1990 Se [19M Se suoHnjos posodaid sno yj ous ‘uruspuoyseis IW etn 40} suondwnsse SNHNIVSL ‘up areinBuet siosuods yey) puowUsOD94 on “9visboz pue ‘GL/BLOZ 0} ISED@I0} jeIOUeUY 3H] peyesBaruy Se eee ee ue azedeid 0} pue suondwnsse Aey ejeInGuew oj siosuods oy) Aq UayeLepun SI yJ0M jo dootd ojeedos e yew puowwoodd /pajeBnsonuy oq 0} speeu 910j010\) 9M "61/8102 0} Suefa 120K ony J9PIAo1g PUE OO ay OU PJEHEAO OG O} YS Bre SUORTIOS sno 'uORIPPe UI “SNHN ‘ypqum anuonas yoequoa ‘ju ais aulyspioyers ply ou) Jo UoNeAGajut oy 10} suoRduNSsE SNHN PUE yS.L eu) BUMaIned pepnyoxe sey yiOM Jo Bdoos IN “eZ ppollness hein pu ‘Se0UeUuoD puno1 BulibeauoD 91/50z et e1ojeq '(sse00ud pueds yoequos pouueld {yo uBis W417 244 Jo ued se Ya. 94) 0 eouepI 249 JopUN) SHIN UN 990 Uy Ag YBNOAA PO.OA. pue PayRWEp) Ave—}p cease anes aie sionup ey) yey puauiuooe! en. ueUUByeSIU 6 Jo AjfeURIEW oY UeAID “O90 SpunoUnS ¥ proyeIS eM Aq pesteUY a4 ead 's] UoIUM Uo\dWNEYeNJON PUE SNHM O} Pueds Ld SHN ealyspioyers pi] e10jeq SI SIY) Jz PUL SL/PLOZ jo uowuByesjw jeyayew JOYEIS YUON WOY puads 990 payeba161i 30 Bur ‘8909 Spunouns * PIOWEIS PUE WE] UO-2y0IS ‘2 ‘sod se uoos se su sso1ppe plows sp1eog SueR eM PLE YESH Wo YeN GupUEWILCOSH om OM “3H OU J0} BHT oun u ss000n5 peunba: yoeoidde anyesoge}0o 24 19/304 djey jou Seo spueog Buled jem PUe LOY OM o4N Woy Siepinoud jo UOISNOKe OY “}Z ‘aunjny 04 jerons9 9q, yun exmyno onesteB10 nun eunyina jeuonestue6io o} fexyou9g 24 pynOM ee anon ‘uoeindod ey) 0} sowoojno panoidus sonyjop 0} diystopeo| au Jo Ayyqedeo oy; enoudus ‘Ayunyoddo ue aq pue auoks "LOSS pUe SNHN UeeMa JeINoILEd wy puE “diusiepee] 3H OM SSOIDe SdiysuONejes pancidwy ’siuy encidus ‘aucreniee) 2} seBed uo suojepusuuiooai pue suonensasqo Jno yno 188 aney BAA IH OY) Ut (panuguoos) gsuoyepuswwodei Jno ale yey OEP A Aiaayap yoaloud yo MaIAaAQ, i} |Behaviours and culturea su omen EO OE MBE NI OLN OAC FET eI OMAR eH passaujun oney an oodse quajenaxd ‘oy 18 sanyeBau ayy ‘Apes yng syj9U9q paygnopun Bulg Leo sy “AUN LIOS Jo) @NYSPIOYEIS UI U8aq AneY di4sIepe=| JoIUeS SHT BW jo AofeW seh oy, ‘eBuajeyo awes oy Ayequesse uy Bujeep spreog ewutesBord e1e0 eb oeiy) ejd\Nexe Jo} 218 @10y)~ Wa}Shs ojBuIs e Se >0M 1098 JOU SEP 3HTAUL * '3H11 e1n ssosce sdiysuonetas ain ping choy veo eu) suoyessanuco ayy Jo Bupjuy 10) auuy ou S@Nee| sj “wud O} WER Wow Y9eq 0} ¥9eq, UEYO siepeD) YAM SIN|IOWUeles BUSOU AIBuIpIOeINS ve sey WO}Shs OU :sorqedeo pue seainosa1 asiuxew sdjay yorum yoeoudde dn paupf fuen 8 eney semonsed ur s909 axo1g pue syeIg yHON “sdnovb Loews Ul JeH!q Y1OM yng eo}OK 1OUOISSILULUOD ejBuIs © AesuOd 0} seUIOBO AlanRIeYO B}e4OqE}OD OU Op SOOO ¥!8 IV ‘uoyestueBs0 uno 2104} Jaye 09, efdoad se snowneysq sy BuyenjueDde AjenUEIOE ‘51 pue yuased jgs s1 Aunbuy syeys PW 24} yo YoedU OU “GUNHIOM OFS Jo SeyduMeKe AUEW YUN 3H Au sjeuowssed, es! 2104, ‘slope eau yo KINGS Jou] Yonw IA POSENo0}ABUSCEURLL fan 990 sreedde 3H AL ‘jeuoroesuey AjueuWopeid aq 0} szeedde siouOIssIUIWOD Pue siepinaud ainoe UeaMeq diysuONE|eN YL ‘se0|ios anosdus 0} aBuayeys anjonsysto9 Jo sejdLueX® Maj MES OM ‘suopesiuetio Jojo sjedua uay) YoIynyJans7 ye AyEINBa1 Bulag axe9 Arepucoes au) wos ved Ui BuwuLHe|s — POU! SISU JeryadsBd w aq 0} syeodde woyshs Ou, C9 Buppiom anjes0qey09 J0 992] y, ANN ‘sBujoow ojBeyens fo» ye Ayes Buinea| pue eye} dn Buuury etdoog ‘Jou op vow) pu suorie uIeH29 ye) 11M fay) Aes edad :suojsipap oj sanBieayoo 6urounoa, 9 3H au Jo swos Aq uoes 51 yoy suotsioep BuipUnoUuUe-o1d sjenpinpul yo Sefdwexe Gurpnjou — eoueyod Jerynus Jo SoNSs1 @wWOS UO WELUOBEBUD OG = ‘peasdsopm 19 enaeq 0} suoIsecoo iuerayns uo AjeiopOaUE Sup ploy ont ~ Bujoaw 214 apis! Auosoylp Bureyoq usy} pUE BuZOUL e u Bury euO BuKEs erdoag !anssi euleyu 40 o}e[2089 0} PLB} Yow syeWe papuoM AjBuONS AGA, = suno\aeyog {Sumo} 24) $490M ENO w puro} oneY BM, ue jdoad fuew wo ssouuado fees puno} ose @nzy am yo9 9 ‘Sinoin2yeq UELE0 Sup io Ayesaua e paniosgo ane 2M sejnaqued ut siapinosd yyeay [equeW OM ey) seaqu09 uy ‘poqe9s dé jou ayy uOWIOnoIduN) eoy\9s Jo} WSEIENYTUS Ye épunoy am aaey }eUM aimjn9 pue sunoeyagBehaviours and Culture ees What do we recommend? We believe that these issues of behaviour and culture can be sucessfully addressed. Indeed we are slrongy ofthe view thatthe recommendations set out on pages 7 re owt gveczed unless behaviour and culture mproves. We are unclear whether all the leaders wil be able 1 modify their behaviour sufienty and therefore there may need to be movement of individual(s) out of the LHE to allow themselves space to recover ‘We recommend the following actions be taken: «Arapid organisational culture survey be undertaken to pinpoint areas of commonaity that the LHE can address collectively. (One-to-one ‘honest conversations’ to continue to address the key tensions, leral sessions with individuals or teams to tackle practical challenges they jointly face — for example the delivery of care pathways ‘Aseries of bilateral an between SSOTP and UHNS. ALHE senior leadership session on behaviours and ways of working, ‘Assigned MOU between al the LHE leadership publically setting out how they work together from tis point on. Joint solutions workshops for organisations to work together on strategic issues. TDA, Monitor and NHS England should take a lead role to reinforce the need for appro ‘All inclusive communications need to be the norm ~ the progress on the LHE solution should be put ‘We can see powerful merit in having ics and objectives to te the success of individuals together ~for example, the CCG Chairs could have @ shared objective relating fo the commissioning ofa new single care pathway andthe acute and community providers could have a shared strategic objecive re cohort be reated in the Nye Bevan Programme at the NHS Leadership Academy. This would be for 3-4 people, who a Yion vithin the LHE. The nine month programme would ellow the LHE cohort to work together and begin to break the slo mentalty that prevails as well across Staffordshire introduce clinical and managerial leaders to new ways of thinking and solutions to local challenges that have been successful elsewhere. ie behaviours by leaders across the system. hed to all the LHE on a regular basis. ALLHE wide programme Clear pubic accountability, through each Board and the overarching HWB Execuve Group to demonstrate that ll leaders are working together to tackle common issues, “The LHE should have three set piece events a year when the entire leadership meets to work together on solving 0 Facp LLP and amen rn XPG pea ined nb re aa HG rato Congr, 8S oy, a