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  1. Context • Developing our Five Year Strategic Plan jointly since Summer 2013 – ‘Joining up Your Care’ … final version for submission by 20 June 2014 • Key phase of this was an 8 week public and partner (including staff) engagement exercise – embedded throughout our Five Year Strategic Plan • Two Year Plan being produced focusing on what will be delivered in the first two years of the Five Year Plan • Undertaken a prioritisation process to determine what will be included • Equality Impact Assessments undertaken

  2. Our Shared Vision for the next 5 years: To improve health and wellbeing, we believe that by all* working better together - in a more joined up way - and using the strengths of individuals, carers and local communities, we will transform the quality of care and support we provide to all local people.

  3. * The health and care community in Gloucestershire consists of … … the Clinical Commissioning Group and main NHS service providers in the county, the County Council and District Councils, and colleagues representing the public and those representing the voluntary sector

  4. Our Ambitions • People are provided with support to enable them to take more control of their own health and wellbeing; • People are provided with more support in their homes and local communities; • When people need care that can only be provided in a hospital setting, it is delivered in a timely and effective way.

  5. How are we going to work together to make all this happen?

  6. We have agreed a set of principles as the foundation of our collaborative working: • A person-centred approach; • Drawing uponthe diverse range of assets within each local community; • We will adopt a “one system, one budget” approach implemented through: • Utilising a clinical programme approach; • Exploring and testing the use of innovative forms of contracting; • Commissioning services jointly. • We will design the most efficient and effective services possible: • Agreeing the best route people take through their care. Care pathways - will be a key mechanism for change;  • We will create a systematic approach to delivering transformational change.

  7. Two Year Plan

  8. Transforming our health and care system • Integration – supported by BCF, and integrated commissioning • Care Pathways – accessible, easy to up-date, adherence ensured • Common approach to change management/service redesign – giving people the tools to improve care • Effective utilisation of sites and services (including 7 day services) • Technology – crucial role of developing IM&T as an enabler (e.g. shared records) • CPG approach –to drive transformation

  9. Prevention and Self Care • Development of clear strategy • Use of ‘Social Prescribing’ approach • Shared Decision-Making • Personalised Care Planning • Support for carers • Personal Health Budgets

  10. Enhanced Services Primary Care • Clinical Programme Groups • New ways of working • Primary Care Offer • New Enhanced Services to support practices in transforming the care of elderly and high risk people, as well as reducing avoidable admissions: £5 per head - • Unplanned Care (incl. lead clinician for over 75s) • DVT • Diabetes Phase 2 • Care Homes • Reducing variation • Improved quality and urgent care • Developing innovative approaches to new ways of working - • Technology and practices working together • Diabetes, Frail Elderly

  11. Commissioning Plan • Integrated Community Teams • Clinical Programme Groups Community Care • Producing Community Services Commissioning Plan • Diagnostics, Minor Injury, LTC Management, Rehabilitation and Reablement, Surgery • Roll out and further development of Integrated Community Teams • Mental Health, ABCD • Respiratory, Cardiovascular – Leg Ulcers, Mental Health, Learning Disabilities, Frail Elderly

  12. Streamlining Urgent Care • Front Door • Pathways • Clinical Programme Groups Urgent Care • Self Care • Sign posting • Acute Care (Optimal Pathways) • Discharge • SWAST Right Care • AEC and OPAL Development • Risk Stratification • IDT • Cardiovascular, Mental Health, Respiratory, Paediatrics

  13. Medicines Optimisation • Specialised Services • Best practice prescribing, safe medicines usage, reducing wastage • Focus on collaborative working with NHS England Area Team • Alignment to our clinical programme approach • Responding to national service specification process

  14. Demand Management • Pathways • Clinical Programme Groups Planned Care • Focus on Demand Management • Advice & Guidance Services • Develop clear Follow-up Pathways • Evidence based pathways offering appropriate thresholds • Promoting patient choice e.g. diagnostics through AQP • Musculoskeletal, Ophthalmology, Cancer, Respiratory

  15. Transformation of the System • Ways of Working • Care Pathways • Innovative System-wide Thinking • Effective Utilisation of Sites & Services with a focus on 7 Day Services • Technology • Service Change Priorities • Prevention and Self Care • Primary Care • Integrated Community • Care • Urgent Care • Planned Care • Medicines Optimisation • Clinical Programme Groups • Respiratory • Cardiovascular • Cancer • Mental Health • MSK • Ophthalmology • Paediatrics • Women’s Health • Learning Disabilities • Diabetes • Frail Older People

  16. How we will ensure delivery? • Clear alignment to the 5 yr strategic plan, supported by health and care community partners • Range of community-wide groups variously focused on ongoing strategic development and ensuring delivery … both of individual organisations workstreams and community-wide transformation workstreams • Underpinned by strong programme management – with closer alignment between commissioner and provider PMOs

  17. Two Year Financial Plan

  18. Key Investments to Deliver the Plan • Rapid response & ICTs • Funding for demand & Demographic growth • New NICE TAs • Staffing for community hospitals • Mental health services; liaison, IAPT, CAMHs • Primary Care Offer, and £5 per head • Multi agency safeguarding hub • Urgent care pilots

  19. Use of Headroom to Deliver the Plan • Urgent care initiatives & pilots • Out of hospital care • Pump priming for county wide IM&T initiatives • Planned care initiatives • Continuing health care – contribution to national risk pool for retrospective claims • Headroom investment held back to offset slippage on QIPP

  20. Activity Assumptions to Deliver the PlanEmergency

  21. Activity Assumptions to Deliver the Plan Elective

  22. Activity Assumptions to Deliver the PlanOther Key Assumptions • A&E – Approximate yr on yr growth across 5 years = 7.6%, QIPP impact = 6.5% • Outpatients - Approximate yr on yr growth across 5 years = 9.9%, QIPP impact = 8.4%

  23. Performance • Commitment to improving outcomes for our population • Plan highlights aim to achieve for 7 key outcome measures, Quality Premium ambitions and Better Care Fund indicators • Improved outcomes through the CPG approach • Delivery NHS Constitution, reflecting actions required to ensure delivery.