Subject: 2016-17 Operational Plan Meeting: NHS Milton Keynes

Transcription

Enc No 16/22
Subject:
2016-17 Operational Plan
Meeting:
NHS Milton Keynes CCG Board
Date of Meeting:
24th May 2016
Report of:
Donna Derby, Director of Transformation & Delivery
Alison Joyner, Head of Strategic Planning
Is this document:
Commercially Sensitive
For the Public or Private Agenda
To be publically available via the CCG Website
N
Public
Y
1. INTRODUCTION
1.1.1 In order to respond to the significant challenges that the NHS is facing, CCGs
must take a leading role in developing and implementing transformative long
term strategies and plans for their commissioning of services. Delivering the
Forward View: NHS planning guidance 2016/17/ - 2020/211 describes the
requirement for CCGs to now consider their planning and delivery across a
wider geographical footprint through the development of a 5 Year
Sustainability and Transformation Plan [STP] and for the 2016/2017
Operational Plan to effectively form Year 1.
1.1.2 An overview of the emerging plan was presented to the Board at its meeting
on 22nd March and following draft submissions to NHS England in March and
April changes have now been made to finalise this annual plan.
1.1.3 The CCG Operational Plan was submitted to the Area Team on 18th April
2016. This sets out the key health issues and commissioning priorities which
will be addressed to improve the health and wellbeing of the population of
Milton Keynes. It summarise the key commissioning intentions for 2016/17 as
developed by the clinical Programme Boards and how these (where
appropriate) will contribute to driving forward the emerging Sustainability &
Transformation Plan2 (which will be developed in conjunction with
Bedfordshire & Luton health and care systems). Finally it outlines how the
CCG will deliver the national ‘must do’ requirements.
1
2
NHS England: Delivering the Forward View: NHS planning guidance 2016/17/ - 2020/21, December 2015
To be developed by end of June 2016
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1.1.4 The plan, which is currently with NHS England for review, outlines six key
areas (in line with the NHS 5 Year Forward View3) in which the CCG needs to
continue to explore, agree and build new models of care delivery during the
next 5 years. Namely:





Citizen & participation empowerment
Wider primary care, provided at scale
A modern model of integrated care
Access to the highest quality urgent and emergency care
A step change in productivity of elective care.
Sustainable hospital services
1.1.5 It draws upon the Joint Strategic Needs Assessment 2014-15, the Health and
Wellbeing Strategy 2015-18, reflects the proposed CCG financial plan for 201617, provides an update on the development of QIPP saving plans to address
the gap in planned funding requirements and identifies any remaining risks
associated with these plans. Finally, it includes the specific performance
measures and outcomes that the CCG will deliver during 2016-17.
2. KEY ELEMENTS
2.1.1 The plan has been built up based on planning guidance issued by NHS
England in December 2015 and continues to be refined as further guidance is
released.
2.1.2 The plan is fully reflective of the 2016/2017 CCG Financial Plan, including the
Quality, Innovation, Productivity & Prevention (QIPP) target which is being
addressed by the development of QIPP saving plans across each of the
Programme Boards and other identified areas.
2.1.3 Delivery of Year 2 of the Better Care Fund Plan4 (BCF) is broadly reflected
within the plan, although a final submission of this is due on 29th April.
2.1.4 It reflects and addresses the national ‘must do’ requirements including NHS
Constitution targets, care for people with Learning Disabilities, national
CQUINs and the agreed Quality Premium measures.
2.1.5 An overview of the plan is shown on the following page, with links to the wider
strategic context indicated.
3
4
NHS England: The Five year Forward View, October 2014
MKC & MKCCG, Better Care Fund Plan: 2014-2018: September 2014 (Final)
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3.0 NEXT STEPS
3.1.1 Following earlier submissions, a final draft of the plan has been submitted
to the Local Area Team of NHS England for their review.
3.1.2 As the work across the wider BLMK ‘footprint’ continues to develop, there
will be a requirement on the CCG to consider how best to entwine internal
work streams & clinical programmes with the emerging themes of the STP
shown in the diagram below. This will be of particular importance once
transformational funding becomes dependent on identification and
agreement of key priorities across the STP.
Emerging STP priorities across Bedfordshire, Luton &
Milton Keynes (1)
•
The STP does not substitute for local leadership or responsibility of the health and social care agenda
•
STP emerging priorities reflect those where significant benefits are expected through collective action by bodies
operating across Bedfordshire, Luton & Milton Keynes
•
Other local priorities exist and will remain firmly gripped by individual bodies
•
STP priorities break down into four themes within which nine workstreams have been identified

Theme 1 – public-facing initiatives

Theme 2 – service user-facing initiatives



Prevention

Primary, Community & Social Care

Urgent & Emergency Care
Theme 3 – Enabling Initiatives

Workforce

Shared patient care record, digitisation and communications

New models of care
Theme 4 – initiatives to reduce system overheads

Clinical support services

Back-office support services

Estates and estates management
3
4.0 RECOMMENDATION
The Board is asked to approve this final version of the 2016/2017 Operational
Plan and note its relationship with the wider STP in due course.
Enc No 16/22
Strategic Summary Year 1 (2016-2017) Operational Plan v6 - FINAL 24th May 2016
Strategic Summary &
Year 1 Operational Plan
2016-2017
Final Draft v. 5
Delivering the NHS Forward View:
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Reader Information
Version control
v.6
Publication Date
24 April 2016
Sign Off Date
CDG – 3 May 2016
Lead Author
Donna Derby
Key Contributors
th
rd
th
Governing Body/Board – 24 May 2016
Director of Transformation & Delivery
[email protected]
Alison Joyner
Head of Strategic Planning
[email protected]
Wendy Rowlands
Deputy Chief Financial Officer
[email protected]
“Delivering the Forward View: NHS Planning Guidance 2016/17 - 2020/21” sets out the priorities for the NHS in
meeting the commitments and vision set out in the NHS Five Year Forward View, including the planning requirements
to be fulfilled by CCGs in England. This plan fulfils the requirements for each organisation to produce a 1 Year
Operational Plan for 2016/17. It covers the operational period April 2016 - March 2017, and sets the scene for the
wider, emerging Sustainability & Transformation Plan. It incorporates the existing priorities of the CCG’s 5 Year
Strategic Plan and also reflects the current work associated with the Bedfordshire/MK Healthcare Review.
Description
Contact Details
[email protected]
Equality Impact
Analysis
We understand our responsibilities in relation to equality impact analysis; the reviews and projects that will arise as a
result of this plan will each undertake their own equality analysis (as per MKCCG’s Planning & Delivery process), and
address any potential inequalities appropriately.
Glossary
AT
NHS England Area Team
MKUHFT
Milton Keynes University Hospital Foundation Trust
A&E
Accident & Emergency
LETB
Local Education & Training Board
BCF
Better Care Fund
QIPP
Quality, Innovation, Productivity & Prevention Plan
CCG
Clinical Commissioning Group
PCOCs
Primary Care Outpatient Clinics
CIPs
Cost Improvement Plans
PAF
Patient Advisory Forum
CNWL:MK
Central North West London Foundation Trust
PBR
Payment by Results
CQC
Care Quality Commission
PPG
Patient Participation Groups
CQUIN
Commissioning for Quality and Innovation
RMS
Referral Management Service
DoH
Department of Health
TDA
Trust Development Agency
EIA
Equality Impact Assessment
RTT
Referral to Treatment
LIT
Local Implementation Team
SCAS
South Central Ambulance Service
MKi
Milton Keynes Intelligence Observatory
SRO
Senior Responsible Owners
MKUCS
Milton Keynes Urgent Care Services
JSNA
Joint Strategic Needs Assessment
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Table of Contents
Reader Information & Glossary
Executive Summary
2016/2017 Plan on a Page
2
4
6
1.
2.
3.
4.
5.
6.
7
7
8
10
13
16
Purpose
Introduction
Strategic Context
National Context
Health & Wellbeing in Milton Keynes
System Vision
1.1
1.2
1.3
1.4
1.5
1.6
7.
17
19
23
26
29
31
Transformation & Delivery
7.1
7.2
7.3
7.4
7.5
8.
9.
10.
11.
12.
Citizen Participation & Empowerment
Wider Primary Care at Scale
Modern Model of Integrated Care
Access to High Quality Urgent & Emergency Care
Increase in Productivity of Elective Care
Sustainable Hospital Services
Urgent Care (SRG)
Care Pathways & Primary Care
Integration & Better Care Fund
Mental Health & Learning Disabilities
Maternity, Children & Young People
Integration & Partnership
Governance
Improving Quality & Outcomes
Commissioned Activity Plan
Sustainability & Finance
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
5 Year Outcome Ambitions
2016/17 NHS Constitution Trajectories
5 Year Financial Plan & QiPP
Health Care Review Timeline
Better Care Fund Plan
36
36
38
39
40
42
46
48
50
61
63
71
78
80
83
84
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Executive Summary
This Operational Plan sets out the focus of MKCCG’s activities in 2016-17, and summarises the overall direction we
will take in Year 1 of our emerging 5 Year Sustainability & Transformation Plan, which we are developing in
conjunction with neighbouring systems, Luton & Bedfordshire. It describes the specific programmes of work we
intend to prioritise to drive better care delivery and health outcomes for our local population, whilst at the same
making significant progress in ensuring a sustainable financial position going forwards.
Improving Local Health & Wellbeing
The health of people in Milton Keynes is varied compared with the England average. Data from the 2015 Health
Profile1 indicates that deprivation is lower than average, however about 19.0% (10,500) children live in poverty. Life
expectancy for women is lower than the England average and life expectancy for men is 6.6 years lower in the most
deprived areas of Milton Keynes than in the least deprived areas. The main causes of life expectancy gaps are
cardiovascular diseases, cancers and respiratory disease. Obesity is a significant issue with 18.6% (547) of Year 6
children classified as obese and 23.4% of adults are classified as obese. Recorded diabetes prevalence is rising. The
rate of smoking related deaths was 304*, which represents 289 deaths per year. The percentage of hospital
admissions that are emergencies is higher in MK than the national average; with the percentage being higher among
people from a Black or Asian ethnic group. Priorities for tackling this therefore need to focus on reducing early
deaths (particularly from cancer and lung disease), to reduce physical inactivity, and to reduce emergency hospital
admissions. There have been tangible improvements in health in MK since the 2014 health profile; namely a small
improvement in the life expectancy for men, however MK CCG recognises that there has been no real change in the
very real health inequalities experienced by certain communities in the borough and will continue to work closely
with our Public Health colleagues to drive a reduction in those inequalities. Improving healthy life expectancy
through primary prevention will be key to reducing the burden of an ageing population.
Delivering Better Care & Higher Quality
The NHS has been subject to a number of high profile reviews relating to patient safety in recent years. MK CCG will
continue to make progress in ensuring that all recommendations of Francis, Berwick and Winterbourne View are
fully implemented and assure our population that will continue our relentless drive for better quality and safe
services from all of our providers. This includes establishing a Transforming Care Partnership with Luton &
Bedfordshire. We will also continue to drive progress on the delivery of appropriate seven day services, ensure a
common core offer of high quality, patient centred primary care and put in place mechanisms to ensure that patient
and staff experience continues to improve, including specifically responding to the recently published National
Maternity Review. Services will be commissioned as locally as possible and practices will be encouraged to respond
and provide services.
Delivering Better Outcomes – A Transformed System
MK CCG needs to find ways within its commissioning to ensure that it can play its part in delivering improvements in
patient health outcomes, reducing inequalities and improving access to services. Through the Quality Premium,
commissioners are incentivised to support the national outcome priorities as set out in the Five Year Forward View
and the NHS Mandate, but also through the selection of local indicators which allows the CCG to engage and drive
improvements in areas agreed with its partners. The CCG Improvement and Assessment Framework is the
mechanism by which progress will be monitored.
The Operational Plan sets out the progress against the delivery of those outcomes that will be achieved by the end of
2016/2017. The CCG has agreed, with system partners, to focus on the following local indicators:



1
% of patient returning to their usual place of residence following hospital treatment for a stroke
% of mothers who give their babies breast milk in the first 48 hours after delivery
Reported prevalence of hypertension on GP registers as % of estimated prevalence
http://www.healthprofiles.info
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Access
The CCG has delivered strongly against the NHS Constitution Standards, such as 18 week waits and urgent referrals
for cancer in 2015/16, though there are areas that need improvement and more importantly sustainability moving
into 2016/17. This is particularly with cancer where too many people are diagnosed too late and A&E access where
there has been a growth in attendances. Access to primary care remains an issue for the CCG with primary care
experiencing significant and increasing pressure in patient activity, increasing complexity and challenges in being
able to recruit and retain key practice staff. In order to meet future demands and make primary care an attractive
career choice we need to do things differently. With increasing workloads across GP practices, challenges to access
and patient demand means that this work needs to start urgently and involve close working with NHS England, our
practices and neighbourhoods. The CCG Joint Commissioning colleagues continue to improve access to mental
health services in collaboration with providers, to implement the locally agreed Mental Health Strategy 2014-17. This
includes meeting the new mental health standards relating to people with the first episode of psychosis commencing
treatment within 2 weeks, and ensuring people with common mental health conditions referred to Improved Access
to Psychological Therapies (IAPT) programme within six weeks of referral and treatment within 18 weeks.
Parity of Provision
MK CCG strongly supports the national focus on putting mental health on an equal footing with physical health and is
committed to the parity of esteem for mental health investment. It will ensure parity of esteem for mental health
services in terms of % funding growth and through Joint Commissioning good progress has been made in the last
year to deliver better outcomes for people with mental illness through sustained delivery against the IAPT & EIP
indicators, and ensuring that those with mild to moderate illness are able to access high performing services within
the new waiting times standards. The CCG has also made significant progress in ensuring that a bigger proportion of
people with dementia are diagnosed and treated, and are confident that the Prime Ministers challenge of a 66.7%
diagnosis rate for people with dementia will be achieved and maintained during 2016/17. In addition an
implementation plan will be agreed to improve post diagnostic support for people and their carers.
Finance & Efficiency Gap
The NHS continues to face a period of unprecedented change and financial challenge, increasing the need for both
commissioner and providers to deliver both improved productivity and quality. The updated planning guidance for
CCGs was issued in December 2015, along with refreshed financial allocations to CCGs for the next five years. Milton
Keynes has again benefited from a high level of growth in 2016-17 of £16.8m; however the % increase drops
significantly during the next three years so it is important that this first year of the five year plan is a year of stability
bringing the system back into financial balance. The high level of growth in allocation funding has been more than
offset by the underlying pressure from the previous year. There is a continued requirement to contribute part of the
CCG funding allocation to the system wide Better Care Fund. The minimum contribution for Milton Keynes is £14m.
In its planning, MK CCG anticipates a net QIPP target of £7.3m in its Programme Budgets for the forthcoming year. A
number of the QIPP schemes already have well developed business cases and closely relate to the BCF and new
community based services, which were implemented during 2015. It is anticipated that they will result in a
reduction of acute emergency admissions. The CCG has just agreed an 18 month pilot managed care pathway for
ophthalmology with Milton Keynes hospital. The service went live in February 2016. Joint work is also well
progressed to transform urgent care services and the hospital has completed estate works in A&E to facilitate an
integrated urgent care service. A further £1m will be saved through prescribing initiatives in 2016-17.
Where possible, the CCG will aim to take a collaborative approach with all partners – using the same language,
having the same vision and aims for our population and bearing in mind the priorities outlined in the Sustainability &
Transformation Plan (STP). The diagram on the next page outlines our summary ‘plan on a page’ for 16/17 of key
initiatives, transformation & actions we will take to deliver the plan, with links to the wider strategic context.
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Strategic Summary & Year 1 Operational Plan (v5) – 18th April 2016
1. Purpose
This document sets out the key health issues and commissioning priorities which will be addressed to improve the
health and wellbeing of the population of Milton Keynes and to meet the objectives set out in the local Health &
Wellbeing Strategy2. At this point in time it summarises the key operational commissioning intentions for 2016/17
and how these (where appropriate) will contribute to driving forward the emerging Sustainability & Transformation
Plan3 at a wider geographical level and how the CCG will deliver the national ‘must do’ requirements. This plan
effectively forms Year 1 of that 5 Year Transformation journey. The plan describes the monitoring of quality and
safety assurance process; how financial resources will be used and how the CCG will deliver its key priorities.
2. Introduction
NHS Milton Keynes Clinical Commissioning Group (MK CCG) has delegated responsibility in 2016-2017 for
commissioning services estimated at around £295 million. It has a geographic area of responsibility that covers all
the wards in Milton Keynes Local Authority plus the wards of Great Brickhill and Newton Longville which are in
Aylesbury Vale. Its members are 27 general practices organised into 4 neighbourhood groupings, geographically
based in the north, south, east and west of Milton Keynes. Milton Keynes CCG is largely (98%) co-terminous with
Milton Keynes Council and has a registered population of around 286,0004. The CCGs main acute provider is Milton
Keynes University Hospital NHS Foundation Trust (MKUFTH), accounting for approximately 45,000 admissions p.a.
(85% of the total for that hospital) while Mental Health & Community Services are provided locally by Central
Northwest London NHS Foundation Trust.
As the primary organisation within Milton Keynes for commissioning health services to meet all the requirements of
patients, the CCG will work collaboratively to ensure that it can meet the needs of the local population whilst living
within its delegated resource limit. Improving the health of the local population is key to this aim, and is being
delivered through the implementation of a number of locally agreed individual commissioning strategies for Urgent
Care5, Mental Health6, Older People7, Dementia8, and Children & Young People9. A Care Closer to Home strategy10
has also been developed, which lays out the ambition to commission a greater proportion of activity in community
and home settings in order to rebalance the health economy and a Primary Care Development Strategy11 which
underpins how the CCG can support NHS England in the delivery of high quality of services in primary care. MK CCG
is likely to oversee significant changes in acute care configuration within the next few years, with greater
centralisation of specialist care, to achieve better patient outcomes. The local provider landscape is evolving and will
experience significant shifts over the next 2-5 years. The CCG will need to improve the efficiency and value of the
funding currently invested in the secondary care sector if it is to be able to commission the necessary resulting
increases in breadth and volume of care required to be provided in communities and primary care. Joint work in this
area is currently underway across Milton Keynes & Bedfordshire via the review of acute hospital services, supported
2
H&WB Board, Milton Keynes Joint Health & Wellbeing Strategy: 2015-2018: June 2015
To be developed by end of June 2016
4
Taken from Research & Intelligence Team at Milton Keynes Council using Population Bulletin 2013/14 data
5
MK CCG, Urgent & Emergency Care Strategy: 2013-2016: October 2013
6
H&WB Board: Mental Health Strategy: 2014-2017: December 2013
7
H&WB Board: Older People’s Strategy: 2014-2017: August 2013
8
H&WB Board: Dementia Strategy: 2014-2017: September 2013
9
MK CCG: Children & Young People’s Strategy (in development)
10
MK CCG, Care Closer to Home Strategy: 2013-2015 (Working Draft), September 2014
11
MK CCG Primary Care Development Strategy, 2013-2015, June 2013
3
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by Monitor, TDA & NHS England. The outcomes of the October 2014 Progress Report has already influenced the
CCGs 5 Year Strategic Plan12 and immediate priorities for 2015/2016 are included in this plan.
3. Strategic Context
MK CCG is committed to improving health, reducing health inequalities and ensuring that the public have access to
safe, high quality services. As a commissioner, the CCG’s intentions are to shift care from hospital to community
settings where truly integrated care across a range of partners will be the norm, whilst maintaining sustainable
hospital services for care that cannot be delivered elsewhere. There remains a compelling case to modernise services
and to improve the degree of co-ordination with other partners, particularly in primary and social care. The MKCCG
approach to creating a system which delivers high quality safe services for its population is illustrated below.
Deliver more
Care Closer to
Home
Ensure
Sustainable
Hospital
Services
Make a
Positive
Impact
The CCG has organised delivery of its strategic approach and commissioning priorities through four interdependent
Clinical Programme Boards, plus the Clinical Executive. Additionally, a Programme Board is in place for both delivery
of the Better Care Fund Plan and the Healthcare Review. The detailed focus for each board for 2016/17 is
summarised later in this document, but the overall approach is summarised in the Plan on a Page shown on page 2.
However, Delivering the Forward View: NHS planning guidance 2016/17/ - 2020/2113 describes the requirement for
CCGs to consider their planning and delivery across a wider geographical footprint through the development of a
Sustainability and Transformation Plan [STP]. Covering the period between October 2016 and March 2021, STPs will
become the local blueprint for accelerating the implementation of the Forward View, to deliver the triple aim of
better health; transformed quality of care delivery; and sustainable finances. The diagram below illustrates how the
development of the STP might fit with existing plans and local strategies and demonstrates how this plan effectively
forms Year 1 of that 5 Year transformation journey.
12
13
MKCCG, 5 Year Strategic Plan: 2014-2019, January 2015
NHS England: Delivering the Forward View: NHS planning guidance 2016/17/ - 2020/21, December 2015
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Strategic Planning Landscape (2016-2020)
MK Health & Wellbeing Strategy
2015-2018
MK Joint
Strategic
Needs
Assessment
Sustainability & Transformation Plan(s)
Yr 1
[2016-2020]
Strategic
Estates Plan
2016-2018
MKC
Corporate
Plan &
Service
Plans
Operational
CCG Plan
Yr 2
HCR Options
Agreed
Yr 2-3
Transf £
Dependent
Better Integration Plan
2017-2020
Primary
Care
Strategy
BCF Delivery Plan
2016-17
System Wide DTOC
Plan 2016-17
Digital Roadmap & IT Strategy
Transformation footprints for STPs should be locally defined, based on existing working relationships, patient flows
and other footprints such as learning disability units. They must also take into account where geographies are
already involved in success regime or other programmes of work and so MK CCG is currently in discussion with its
neighbouring CCGs regarding a possible footprint that would encompass Bedfordshire, Luton and Milton Keynes.
Placed-based planning on this scale accounts for the work being undertaken within the healthcare review of services
in Bedfordshire and Milton Keynes, acknowledges wider patient flows for more specialist services to both Bedford
Hospital and the Luton and Dunstable Hospital and reflects the existing planning footprint for the development of
our Learning Disability Transforming Care programme. As NHS planning guidance suggests, however, the STP will be
an umbrella plan, with differing levels of shared planning. Transformational change for care pathways such as
urgent emergency care will be mapped across this broad footprint, whereas locality specific plans for Primary Care
will be described on CCG organisation-based levels. The diagram below illustrates how this might work for MK CCG
in practical terms.
Layers of Strategic Planning Footprints
MK NHS Only
Footprint
Electiv e Care
Productiv ity &
Efficiency
Wider
Primary
Care
at Scale
Modern Model
Of Integrated Care
MK NHS/MKC
Footprint
MK &
Bedfordshire
Footprint (HCR
Sustainable Hospital
Services)
MK, Beds & Luton
Footprint (LD Services
only)
High Quality Urgent
& Emergency Care
Specialised Services,
centres of excellence
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4. National Context
4.1 NHS Mandate
The NHS Mandate14 between the Government and NHS England sets out the ambitions for the health service for
2016-17 and a series of objectives for delivery by 2020. Effectively it is a multi-year mandate to enable local
commissioners to plan more effectively and over a longer term. Objectives for 2016/17 are:NHS Mandate
1. To improve local and national health outcomes, particularly by addressing poor outcomes and inequalities;
2. To help create the safest, highest quality health and care services;
3. To balance the NHS budget and improve efficiency and productivity;
4. To prevent ill health and support people to live healthier lives;
5. To maintain and improve performance against core standards;
6. To improve out of hospital care;
7. To support research, innovation and growth;
Measurable Goals
The table below indicates clear priority deliverables for CCGs during 2016/17 along with how they will be measured.
Goal
2016/17 Deliverable

Performance/
Improving Outcomes
7 Day Services
Patient Experience



Maternity
EOL

PHB
Consistent improvement against new National CCG
Assessment Framework






Achieve significant reduction year on year.
7 day services to 100% population in 4 clinical
priority area (& progress on other 6 standards)
Reduce avoidable deaths
Reduce rate of stillbirths/neonatal and maternity
deaths and brain injuries
Measureable improvement of antimicrobial
prescribing
Maintain and increase the number of people
recommending FFT (88 – 96% current)

50-100,000 people to have PHB or IPB (increase)
Building on F&F Test results, enhance proposals

Improve patient choice







-MAT / EOL / LTC / CANCER
Deliver Independent Cancer Taskforce
Improve 1 year survival to achieve 75%
28 day diagnosis or clear from

14

Prevention
Publish Avoidable Deaths data (MKUHFT)
And improvement plan from Mar 2016 Baseline.

Achieve 7 Day Services in 4 clinical priority standards,
delivered to 25% of population

National Maternity Review Recommendations

Progress on Sign Up to Safety
 Set baseline for antimicrobial prescribing and
resistance rates
Plan for improving patient choice in

Avoidable Deaths/
Cancer
Publish CCG assessment framework performance data
for 2015/16 (June)

Cancer

Dementia

Maternity

MH & LD

Diabetes
2020 Ambition
62 day cancer wait
Progress to achieve diagnosis standard (6 wks)
Increase diagnostic capacity (Yr 1 figure)
£ Investment in cancer treatments not through
Cancer Drugs Fund
Recommends from Cancer Taskforce delivered
https://www.gov.uk/government/publications/nhs-mandate-2016-to-2017
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Child obesity improvement plan and improved
trajectories in % terms year on year.
10,000 people (nationally) referred to prevention
programme



Maintain 2/3 diagnosis rate
A&E, Ambulances




& RTT

Improvement trajectory and deliver plan for year 1 of
ambulance response and Red 1 pilots

18ww RTT achieved





New models of care covering 20% population
Enhanced GP services evenings and weekends
Same day appointments for over 75s
Publish practice level metrics on quality
Develop MCP contract for 17/18 implementation


Year 2 BCF implemented
Agreed plan for wider H&SC Integration by March
2017
Agree and support improvements local development
deals
Obesity & Diabetes


Dementia
New Modes of Care/
General Practice
H&SC Integration

MH & LD/Autism
Agree implementation plan for PM challenges
Achieve A&E target
Urgent & Emergency Care Networks in 20% country

System wide plan for DTOCs with overall goal and
trajectory improvement;

Implement Year 1
Increase people with LD/autism in cared for
community settings
50% access within 2 weeks (psychosis)
Implement actions of MH taskforce.
75% access to talking therapies in 6 weeks, 95% in 18
weeks
Improve crisis care for all ages
Locally transformation plan for YP’s MH
















Measurable reduction in line with national child
obesity strategy
Reduce risk of Diabetes (DPP)
Measurable reduction in variation of management
of diabetes
Same
Improvement on all areas of PM challenges
96% achieved
Roll out to 100%
U&EC networks covering 100%
75% CAT A achieved
92% 18ww RTT
0/52 weeks achieved
100% access to weekend / evening routine GP
appointments
Reduction in age/std. emergency admissions rates,
emergency IP bed days

H&SC integration, urgent and emergency care
(SPOC & EHRS)

5000 extra doctors in P Care.
Better integration
Improvements in performance against CCG metrics
Significantly reduce DTOC’s
Longer term implementation
Years 2-4 implementation









Close health gap
Access and waiting times embedded including;
st
50% people experience 1 episode of psychosis –
access 2 weeks
75% people access to talking therapies in 6 weeks,
95% 18 weeks
4.2 NHS CCG Assessment Framework
NHS England is introducing a new Improvement and Assessment Framework (IAF) for CCGs from 2016/17 onwards 15.
It has been designed to work in conjunction with the Five Year Forward View, NHS planning guidance and the
Sustainability and Transformation plans with the “triple aim” of improving the health and wellbeing of the whole
population; better quality for all patients, through care redesign; and better value for taxpayers in a financially
sustainable system. The framework should be used as a dynamic learning tool to measure performance and
improvement and support CCGs in delivering the “triple aim”. The IAF will cover four domains:
1. Better Health: this section looks at how the CCG is contributing towards improving the health and wellbeing of
its population, and bending the demand curve;
2. Better Care: this principally focuses on care redesign, performance of constitutional standards, and outcomes,
including in important clinical areas;
3. Sustainability: this section looks at how the CCG is remaining in financial balance, and is securing good value for
patients and the public from the money it spends;
15
NHS England: CCG Improvement & Assessment Framework, March 2016
11
Enc No 16/22
4. Leadership: this domain assesses the quality of the CCG’s leadership, the quality of its plans, how the CCG works
with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity for
example in managing conflicts of interest.
The Forward View and the planning guidance sets out national ambitions for transformation in a number of vital
clinical priorities such as mental health, dementia, learning disabilities, cancer, maternity and diabetes. The first
assessment for each of these six areas will be published as soon as possible, derived solely from the metrics in the
new framework looking at current baseline performance. This initial assessment will offer a useful starting point for
all CCGs.
4.3 NHS 5 Year Forward View
The NHS Forward View sets out three interdependent and essential tasks: first, to implement the following principles
6 Principles of 5 Year Forward View
1
Citizen Participation & Empowerment in Service Design & Change
Wider Primary Care, provided at Scale
2
5
6
3
A modern model of Integrated Care
4
Access to the highest quality urgent & emergency care
Step-change in the Productivity of Elective Care
Specialised services, concentrated in centres of excellence
Secondly to restore and maintain financial balance; and third to deliver core access and quality standards for
patients. Whilst developing long-term plans for 2020/21, the NHS has a clear set of plans and priorities for 2016/17
that reflect the Mandate to the NHS and the next steps on Forward View implementation. Some of the CCGs most
important delivery for 2016/17 involves partial roll-out rather than full national coverage as outlined above.
Nationally, the ambition is that by March 2017, 25% of the population will have access to acute hospital services that
comply with four priority clinical standards on every day of the week, and 20 percent of the population will have
enhanced access to primary care. There are three areas where good progress will need to be made under the
banner of seven day services. These are:
 reducing excess deaths by increasing the level of consultant cover and diagnostic services available in
hospitals at weekends. During 16/17, a quarter of the country must be offering four of the ten standards,
rising to half of the country by 2018 and complete coverage by 2020;
 improving access to out of hours care by achieving better integration and redesign of 111, minor injuries
units, urgent care centres and GP out of hours services to enhance the patient offer and flows into hospital;
 improving access to primary care at weekends and evenings where patients need it by increasing the
capacity and resilience of primary care over the next few years.
Both this and the development of new care models will feature prominently within the CCGs wider STP, which will be
developed and agreed by end of June. However, first steps towards this (within the framework of the 6 Forward
View areas shown above) are reflected within this 2016/17 Operational Plans.
12
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5. Health & Wellbeing in Milton Keynes
The Health and Wellbeing Board is a partnership designed to ensure an integrated and coordinated approach across
the NHS, social care and public health services in Milton Keynes. In 2015/16, MK CCG alongside its health and social
care partners published its refreshed Health & Wellbeing Strategy covering the period 2015 – 2018. This builds on
the achievements of the first strategy as well as recognising some of the more challenging areas being faced, but
maintains the commitment to place our community at the heart of our commissioning to improve health and
wellbeing, whilst reducing inequalities. By working together the partners aim to improve the opportunities for adults
and children to enjoy a healthy, safe and fulfilling life. The Joint Strategic Needs Assessment (JSNA) provides a
comprehensive picture bringing together what we know about the health and wellbeing of the people living in
Milton Keynes. Drawing from the Joint Strategic Needs Assessment 2014/1516, the Social Atlas 2013 and the latest
Director of Public Health Annual report17 the strategy focuses on four new priorities that the system needs to jointly
focus on over the next three years, illustrated below.
Starting Well
Giving every child the
best chance in life
Living Well
Working with communities to
live longer & healthier lives
Ageing Well
Improving outcomes
for older people
Mental Health
Good mental health is essential for people of all ages
The Place
Making Milton Keynes a healthy city
improving outcomes for older people
Each priority will have key objectives which describe the short, medium or longer term actions that are required to
deliver against the priorities. The CCG has a key partnership role in supporting their delivery and in particular in
targeting appropriate services to help reduce health and healthcare inequalities, as well as developing a more
preventative approach to how we commission services. The Health & Wellbeing priorities outlined in the strategy
form the framework for NHS commissioning plans which the CCG needs to take forward, as its part, towards shaping
how the health and care system will look in 5 years’ time. There are a number of factors which will impact upon an
individual’s health and wellbeing such as their income, employment, education and the place in which they live.
Therefore understanding the local position and what needs to be done is crucial to improving health and wellbeing in
Milton Keynes. This is particularly important for those areas and populations that are more deprived.
5.1
Population & Health in Milton Keynes
Milton Keynes is a mainly urban location with relative low levels of deprivation and is considered to be a desirable
place to live and work. Nationally, Milton Keynes ranks 211 out of 326 local authorities in England for deprivation.
However, this average rating masks pockets of significant deprivation that fall into the 10% most deprived areas
16
17
MKCCG & MK Council: JSNA 2014-2015, March 2015
Milton Keynes PCT: DPH Annual Report 2011, September 2012
13
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nationally and 19% of children live in poverty. Two key aspects of the local population stand out in relation to what
and how the CCGs must commission services now and into the future. They are:-
A GROWING
AN AGEING BUT
POPULATION
STILL YOUNG POPULATION
In 2015 Milton Keynes Borough was home to approximately 256,000 people, which is an increase of 38,100 (17.3%)
since 2003. The population is expected to continue to grow, rising by a further estimated 49,700 (another 19.7%)
between 2012 and 2026. The population is growing due to increasing life expectancy, a rising birth rate and net
inward migration; both from other national locations and internationally. Since 2004, Milton Keynes Borough has
experienced major inward migration from the European Union Accession countries, particularly Poland and
Lithuania. Numbers entering the Borough peaked in 2005/06, and subsequent years have fluctuated. The number of
people registered with the 27 Milton Keynes General Practices was 278,383 in November 2014. The number of
births has increased steadily by an average 2.7% annually between 2001 and 2013 from 2,830 to 3,901.
The number of people in each group is growing at a different rate but overall the average age of the population of
Milton Keynes is increasing more than the England average. Most significantly, the population over 85 years of age is
forecast to increase by 95% from 3,635 in 2010 to 7,060 in 2026. In 2012 there were 29,500 people aged 65 and over
in the borough, and this number is expected to increase by 82.8% to 53,900 by 2026. The corresponding increase
nationally is 33.3%. However, the Milton Keynes population age profile is younger than that for England as a whole
and is set to remain so. 22.4% of the Milton Keynes population are currently aged under 16, compared with 18.9% in
England.
Life expectancy at birth is a good overall indicator of health and wellbeing. In Milton Keynes the average life
expectancy at birth (2010-12) has increased steadily over the past decade and is currently 78.7 years for men (78.4 in
2009-11) and 82.5 years for women (82.6 in 2009-11). This is 0.5 year below the national average of England for
both males and females. Life expectancy over the period 2002-12 increased 2.5 years for men and 2.2 years for
women compared to England average of 3.2 and 2.3 years respectively. However, life expectancy is 6.6 years lower
for men in the most deprived areas than those in the least deprived. In summary then:-

Milton Keynes population is growing in size and diversity.

Too many children have a poor start to life and suffer health problems.

Premature deaths contribute to life expectancy at birth, which is 6
months less than the national average.

Significant health inequalities persist between the more affluent and
more deprived areas but the gap in life expectancy is slowly narrowing.

Mental health problems affect people of all ages.

Partners need to ensure that services that are provided or commissioned
to meet the above needs provide the best possible value for money.

The city’s environment could contribute more to healthy outcomes.
14
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5.2
Reducing Inequalities
Life expectancy is now 7.1 years lower for men (8.0 years in 2009-11) and 5.3 years lower for women (6.4
years in 2009-11) in the most deprived areas of Milton Keynes compared to the least deprived areas. This
compares to 9.2 years for men and 6.8 years for women for the England average. Wards with the lowest life
expectancy (2008-12) for both men and women are Woughton and Eaton Manor, followed by Wolverton for
men and Walton Park for women. The main diseases that are causing the differences in life expectancy within
Milton Keynes are for males’ coronary heart disease and COPD, followed by lung cancer. For females the main
causes are all main cancers (breast, lung, and bowel) and COPD. This gap is slowly narrowing for both men and
women, but more can be done to contribute to this. Long term conditions are more common in more
disadvantaged communities and happen earlier in life. They live therefore not only shorter, but also many
more years in ill health. Having two or more long term conditions is linked to higher death rates, more hospital
admissions, reduced quality of life, and higher levels of depression. Certain ethnic groups are at increased risk
of some long term conditions. People from South Asian backgrounds for example are at higher risk of heart
disease, strokes and diabetes. Many long term conditions are preventable – lifestyle changes could prevent
half of all cancers and more than half of new cases of cardiovascular disease. Mental health and wellbeing is
important. Good mental health and resilience are fundamental to our physical health, relationships, education,
training, work and to achieving our potential. There is a strong association between mental illness and
deprivation and also between mental ill health and reduced life expectancy.
5.3
Focus for 2016/17
Ensuring a focus on prevention and early identification of ill health, in order to manage increasing demand is will be
a key factor in how the CCG will work with partners (especially local Public Health) to commission services with a
focus on reducing health inequalities and allocating resources in relation to identified need across the whole
population. Key areas of particular focus will include:•
To reduce smoking prevalence by promoting uptake of stop smoking services.
•
To invest further in:
•
prevention of obesity by promoting physical activity and healthy diet to reduce existing health
inequalities, and prevent future ill health, especially in children
•
better obesity treatment at tiers 1-3 as outlined in Healthy Weight Strategy 2014-19.
•
Increase opportunities to prompt healthier lifestyles e.g. through Every Contact Counts, Health Checks
programme, and utilising social marketing techniques.
•
Increase the capacity of the ‘identification and brief advice’ alcohol services across primary and secondary
health care.
•
Deliver good quality universal drugs and alcohol education through the Personal, Social and Health
Education (PSHE) curriculum, and ensure that children affected by parental alcohol and drug misuse are
identified early and high quality support is available to meet their needs.
•
To implement the recommendations of the Milton Keynes HIV Needs Assessment: increasing early
identification and treatment, particularly through continued and improved routine HIV testing for hospital
admissions and new GP registrants.
15
Enc No 16/22
•
To intervene to reduce the predicted high rise in the level of long term conditions in our population through
investing in prevention by supporting healthy lifestyles across all age groups and improve health outcomes in
people in the early stage of disease by promoting self-care.
•
To ensure our population receives the maximum benefit from a higher uptake of immunisation and
screening programmes.
6. System Vision
The NHS is founded on a set of fundamental and enduring values: that the NHS should be a universal, tax-funded
service, with equal access for all, free at the point of use and provided according to clinical need rather than the
ability to pay. Naturally these values underpin all of the work of MK CCG, as we strive to ensure equity of access to
appropriate high quality healthcare across our local population – whether that healthcare be provided by an NHS
body or another organisation. The challenge we face however is to ensure adequate provision of such care to meet
all existing and future clinical need, within an extremely tight funding mechanism that has not always reflected the
continuing growth of the Milton Keynes population. MK CCG wishes to plan and buy services that are high quality
and provide the best outcomes, whilst achieving value for money for the local community. Its 4 Strategic Aims, as
set out below, will underpin its approach to achieving the vision set out above:-
1. Commission Services Which Are Value For Money
2. Involve Clinical Leadership To Make A Real Difference
3. Improve Quality And Safety To Positively Impact On Clinical Outcomes And
Patient Experience
4. Develop A High Performing Organisation
The overall vision for Milton Keynes is for a system that is as simple and straightforward as possible, with patients
aware of and able to access appropriate high quality clinical care and support at the right time and in the right place,
such that inequalities in access to this care are eliminated. The CCG is committed to commissioning a greater
proportion of activity in community and home settings to support the required rebalancing of the health economy
away from local acute services, with a real emphasis on ‘care closer to home’. This is necessary to support acute
provider sustainability and to ensure that services are delivered in the best location. Far too many people currently
access care in an acute hospital setting when they could be treated just as well within the community, often with
less delay. Overuse of the acute sector is not sustainable because that specialist care is very expensive – and as the
population grows and demand rises with people living with one or more long term conditions18 it will increasingly
become unaffordable. The current healthcare review across Bedfordshire and Milton Keynes indicates that current
service provision is fragmented, difficult to navigate through and delivered through traditional models of care,
emphasising the need for consideration of new ways to deliver NHS care that can deliver improved patient outcomes
but within a tight financial environment.
The CCG is also looking to understand where other care providers can offer support to the population at least as
effectively as statutory providers. Greater emphasis on prevention and self-care are important long term strategies
for the CCG. Helping those with long term conditions to take more responsibility for managing their care and using
support networks outside of the NHS are important future options, and are reflected in the joint Better Care Fund
18
th
MK & Bedfordshire CCGs: Bedfordshire & Milton Keynes Healthcare Review: A Case for Change; 9 April 2014
16
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Plan submission that sits alongside this plan and within the Urgent & Emergency Care 8 High Impact Interventions
Delivery Plan which has been developed. For those requiring on-going health and social care it will be important to
further strengthen links between the statutory commissioners – working closely through the Joint Commissioning
arrangements. Our vision for how the whole health system should look and be working by the end of 2020,
including how we will deliver the ambitions of the 5 Year Forward View is summarised below and fully outlined in
sections 6.1-6.6.
CURRENT STRATEGIC AMBITION
From
To
Variations in performance and
quality
Challenges in accessing
primary care

1. Transform
primary care
& elective
care closer to
home


•
•
Fragmented Care Pathways
From

•
•
•
•
From
•







Managed Networks of Care





Mat, C & YP
BCF/ MH & LD
Mat, C & YP
Integration around Patient
Streamlined care pathways and referral
routes into services.
Increasing no. of elective services
delivered in primary care settings
New models of Care
New models of Care
Mat, C & YP
CPPC
Mat, C & YP
B & MK HCR
To
Fragmented, inequitable
service provision
Variable quality of care
Clinical workforce shortages
Financial challenges
CPPC
BCF/SRG
Single point of access for urgent
care services
•
Access to a range of health and
social
care professionals depending on
To need
Fragmented pathways of care
Inconsistent referral processes
Overlapping service provision
From
5. Sustainable
local Hospital
Services for the
future
Pro-active support/focus on self-care
Fully integrated health, social and
mental health teams to provide services
Earlier discharge planning at admission
Range of home-based care & support
services
•
From
4. Efficient
Planned Care
which is provided
closer to patient’s
homes
New models of Care
To
Multiple overlapping services
leading to confusion in access
Limited access to non-acute
services out of hours
•
3. Rapid
Response to
Urgent Health
Needs
To
Fragmented services leading to
duplication of effort
People kept longer in hospital
because appropriate services
are not in place

2. Integrated
Care for
complex
health &
social care
needs
Consistent quality of where/how to
access
Access to primary care services 7
days, 12 hrs
Pro-active care and support within
the community/focus on self-care
•
GP Coordinated Care, increasingly
supported by community level services
Patients admitted to hospital only for acute
specialist interventions & more care
delivered ‘closer to home’
Financially and clinically viable services
New models of Care
CPPC
Mat, C & YP
SRG
5
6.1
Citizen Participation & Empowerment
Since its formation in April 2013, Milton Keynes Clinical Commissioning Group (MK CCG) has worked to develop a
strong framework for engaging with patients, the public and key stakeholders. This has led the CCG into a regular
pattern of engagement, and to effective partnership working with the local Healthwatch. Engagement is at the heart
of the CCG’s vision and principles since Milton Keynes CCG is a membership organisation comprising the 27 GP
practices that serve the population of Milton Keynes. Together, Board members, members of staff and patient
representatives work to develop the strategic direction and to deliver the Group’s commissioning plans and
intentions. Being co-terminus with Milton Keynes Council supports close working with our Local Authority
commissioners – this includes some joint commissioning arrangements and also public health advisers.
The CCG recognizes that its relationships with all our partners are evolving. The avenues of engagement currently
used by the CCG include Healthwatch and a number of other forums. Healthwatch provides patient representatives
at all the CCG’s programme boards, which help to advise the boards on engagement and consultation. The
engagement, communications and marketing team have worked to develop comprehensive means of
communicating and engaging with local stakeholders through existing databases held by the local authority,
Healthwatch and the voluntary sector.
17
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Additionally, work with member practices has developed ways in which to ensure they are informed and involved
with the CCG work, including a Clinical Forum Group and Neighbourhood Group meetings. The CCG has continually
strived to embed further co-operation with multi-agency partnerships where health commissioning makes a key
contribution, such as the Safer MK Board which meets to assess and review joint programmes of work to reduce
crime and make our city safe, and the Safeguarding Boards. The CCG has established strong relationships and close
working with the Local Authority with arrangements in place for joint commissioning through the Joint
commissioning Board and the Health and Wellbeing Board.
The Bedfordshire and Milton Keynes Review continues to explore ways to improve future local healthcare for the
populations of Bedford Borough, Central Bedfordshire and Milton Keynes (including North Buckinghamshire).
Following a period of extensive engagement where individuals and representatives from many different
communities had the opportunity to get involved to help shape thinking around future service needs, a joint
programme by Milton Keynes CCG and Bedfordshire CCG has now been established. This recognises the importance
of primary and community services in relation to future hospital provision across both health economies, drawing on
the insights already gained and the wider national context. Further work, including an integrated impact assessment
and the collection of local HES data to support activity modelling, will provide more detailed, valuable information
on local populations and how they use and access local healthcare services, highlighting potential issues and
opportunities that can be considered and developed by the CCGs. Clinicians, public and patient views will continue to
be at the heart of this process, both in developing recommendations and during formal public consultation which is
due to take place in July 2016. More details are available on the Review website - www.bedsandmkhealth.org
5 Year Vision
Through our approach to public engagement we will ensure that Milton Keynes CCG develops quality services, based
around people’s individual needs and aspirations and values the contributions they can make. The recently
published Patient & Public Engagement Strategy19 contains the following objectives which will guide future
engagement approaches:-
1) Ensure that engagement is part of the everyday work of the CCG, at each level
2) Equip key leaders in the CCG with the knowledge and expertise to carry out effective
engagement and consultation
3) Create and maintain effective avenues of engagement
4) Strengthen key relevant partnerships e.g. with Healthwatch, local authority, voluntary sector,
neighbouring NHS bodies
5) Obtain assurance that there is an appropriate programme of engagement for each Programme
Board
2016/2017 Actions
Overall, the CCG aspires, when planning and commissioning services, to take account of the complete ‘engagement
cycle’, which shows how engagement and consultation can feed ceaselessly into commissioning decisions as shown
below.
19
MK CCG: Patient & Public Engagement Strategy
18
Enc No 16/22
Specifically, during 2016/17 the CCG will:

Establish a set of guiding principles for future engagement
Streamline the current structures and embed engagement more firmly into the CCG’s governance structures by
creating a Patient and Public Engagement Steering Group
Set a strategy and objectives for the next year and beyond

6.2
Wider Primary Care at Scale
Primary care, and in particular care delivered by general practice has been a cornerstone of the NHS since its
inception. Whilst GP services are likely to see changes to who and how they are commissioned in the future, it will
be imperative that Clinical Commissioning Groups continue to support and encourage the development of primary
care services and work jointly with NHS England to ensure the way primary care is transformed fits alongside the
wider aims of the overall strategic plan. MK CCG has been co-commissioning GP services from October 2015 at Level
2, giving it an expanded role in primary care commissioning so that it can to drive up the quality of care, cut health
inequalities in primary care, and help put their local NHS on a sustainable path for the next five years and beyond.
Having high quality and equitable primary care chosen by patients and local residents is central to our vision. We
recognise the need to be linked with the community, acute and mental health strategies so that patient pathways
are seamless and the health economy works well. Improving health outcomes and significantly reducing inequalities
remain a key focus. Access, clinical effectiveness and patient experience are key components of our direction of
travel. The strategy promotes a patient-centred integrated care service. As set out in its existing Primary Care
Development Strategy20 and the draft Care Closer to Home Strategy21 MK CCG will focus on transformation which:-
20
21

Has a clear focus for improving overall quality.

Establishes primary care at the heart of integrated care networks with other health and social care providers.

Acts as the catalyst for encouraging practices to work together with a focus on enablement and
empowerment, so that delivery at greater scale can be achieved.
MK CCG: Primary Care Development Strategy: Achieving Excellence in Primary Care. 2013-2015; October 2013
MK CCG: Care Closer to Home Strategy, 2014-2018 (draft); September 2014
19
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
Maximises the role of information management technology to ensure practices are able to access high
quality information in order to improve quality and value for money.

Recognises the recommendations for the future of primary care outlined in A Call to Action22 and the work
needed to develop the necessary clinical and organisational models.
It is recognized nationally that general practice in its current physical form may not be suited to take on a new role
delivering a wider range of care or providing that care closer to the patient’s home. There have been a number of
reports including the Royal College of General Practitioners “A Plan for Primary Care in the 21st Century”23, The King’s
Fund report “Improving Quality of Care in General Practice”24 and the Nuffield Report “Primary Care in the 21st
Century”25. All three reports suggest there are benefits in closer collaboration between practices and the provision of
a wider range of services under one roof that are integrated with social care. This theme continues in the NHS
document “Five Year Forward View” which sets out a range of new models of care including Multispecialty
Community Providers (MCP) which would become the focal point for a wider range of health and social care needed
by their registered population and primary and acute care systems with vertical integration.
5 Year System Vision
Our vision is to create a sustainable primary care service operating on a single clinical system with collaborative
working between practices. If we are to meet our overall strategic direction of delivering care closer to home then
this will require a substantial shift of care from hospital to community settings. Evidence shows us that many people
could be treated more locally;26 hospital based care is not necessarily the best way to care for people but with 90%
of patients/users already using primary care services as their first point of contact with healthcare – increased use of
primary care and plans to develop 7 day working will require both additional capacity and capability, and funding.
The CCG will therefore need to develop and reward innovation and quality improvement in primary care and
promote and support mechanisms for improved integrated working.
The NHS reforms put General Practice in a unique position as both provider and commissioner of healthcare
services, but unlike many other areas, the high rate of population growth and creation of new communities provides
Milton Keynes with both challenges and opportunities for the provision of modern, efficient high quality primary
healthcare. It is therefore important that the CCG is able to articulate clearly to NHS England and Milton Keynes
Council its aspirations for healthcare estates that are fit for purpose. Services need to be delivered from wellpositioned, functional estate that provides value for money and it is recognised that individual small practices may
lack the capacity and capability to provide an extended range of services. The table below illustrates desirable
attributes for the healthcare estate in order that MK CCG can deliver its strategic objectives and clinical priorities.
Premises Attribute
Location
Physical condition
Explanation
Premises should be accessible by sustainable public transport, on foot and have sufficient
parking for patients either on site or nearby.
Premises should be safe, clean and in a good state of repair. They should provide a positive
experience for the patient and have good accessibility. All practices must meet the
requirements for CQC registration.
22
NHS England: A Call to Action, July 2013
st
RCGPs: Patient Centred Care for the 21 Century, November 2014
24
Kings Fund: Improving Quality of Care in General Practice, March 2011
25
st
Nuffield Trust: Primary Care in the 21 Century, September 2012
26
MK Public Health Team (S Godward); Urgent Care Needs Assessment; August 2013
23
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Enc No 16/22
Functional suitability
Fit for future
developments
Space should be multipurpose where possible.
In order to deliver the breadth of services in primary care, GP practices will need to work
together within and across the physical constraints of buildings. A number of practices will
be identified as expansionist practices to facilitate delivery of a wide range of services to
patients within a local area.
There is a fine balance between these two and in Milton Keynes it is envisaged that primary care will increasingly
both work collaboratively as providers of services, but also work within geographic neighbourhoods to commission
an appropriate range of care. Member practices are encouraged to actively engage in the commissioning work of the
CCG, by contributing to clinical pathway and service redesign, engaging with local communities and understanding
local health needs. Services beyond core GMS will be delivered through a collaborative working approach. Like
minded practices will federate to deliver an enhanced range services that move care close to home. Primary care at
scale (to deliver 7 days a week, 8am to 8pm) will be delivered through an integrated approach. The vision for
developing excellence in primary care, delivered through the establishment of federated working across Primary
Care is illustrated below.
All this means we need to commission a greater proportion of activity in community and home settings to support
the required rebalancing of the health economy away from local acute services. This is necessary to support acute
provider sustainability and to ensure that services are delivered in the best location. An illustration of how this can
be achieved is shown below.
21
Enc No 16/22
What will it look like?
From
Transformed
primary care
& elective
care closer to
home




Variations in performance and quality
across practices
Challenges in accessing primary care at
times & location convenient to patients
Fragmented Care Pathways and
multiple patient hand-offs
Fragmented approach to responding to
population increases
To




Consistent quality regardless of where
and how people access services
Access to primary care services 7 days
a week, 12 hours a day
Pro-active care and support within the
community and a focus on self-care
Federated working to provide greater range of
services within primary care setting
The model will ensure delivery of ‘beyond core’ GMS services, in a collaborative or ‘federated’ arrangement.
Enhanced services delivered through this model would include:




Access to diagnostics
Vertical integration across a continuum of care with Community nurses attached to practices; delivering
same range and quality of acre
Integrated health and social care teams comprised of health and social care professionals from primary and
community care based around GP localities supporting patients with complex needs.
Neighbourhood mechanisms for monitoring information, performance and quality developments.
Seek to broaden training opportunities for nurse development and AHPs.
2015/2016 Delivery & Achievements
1. Implementing a
Referrals Mgt Service
Evaluation of Stage 1 specialities and Stage 2 roll out of next 4
specialities completed
First outpatients/follow-up
2. Development &
Improvement of MSK
Pathways (including
Pain Mgt & PLCV)
3. Development of
Managed Care for
Ophthalmology
Established Integrated Musculo-skeletal services in the
community to allow for more patients to be managed in the
community, reduce congestion (waiting lists) in secondary care,
and reducing costs.
Procurement and introduction of Ophthalmology Managed
Care Service
First out-patients for Pain Mgt;
Orthopaedics and
Rheumatology. MSK Inpatient
Procedures
First Outpatients, Follow Up,
O/P Procedures, daycases and
inpatients
4. Implement Practice
Based Budgets
Continued to promote practice based budgets to educate
primary care to take some responsibility for the consumption of
secondary care resources. 2015/2016 six audits have been
completed, 2 of which have been escalated so that changes to
clinical behaviour can be encouraged.
Elective day-cases, first
outpatients, In hours A/E and
UCC attendances.
5. Introduce Primary
Care Outpatient Clinics
Pilot PCOCs have been evaluated and developed in x
specialities. PCOCs provide additional services in primary care
setting, allowing secondary care waiting time reduction and
delivering CCG strategy of more elective care closer to home.
Delivered a number of pilot projects that will prevent
unnecessary emergency admissions/attendances in Secondary
Care.
Focus on general stroke pathway to ensure effectiveness of
First Outpatients, Follow Up
Outpatients, basis diagnostics
6. Primary Care
Transformation Funding
Pilots - Over 75’s Care
7. Improve Stroke
Emergency Admissions, Non
Elective cases
n/a
22
Enc No 16/22
Pathway & Quality of
Care
current stroke unit pathway by working with the Quality and
Performance teams.
2016/2017 Actions









6.3
Continue to support the development of federated primary care working to drive up quality and access
standards
On a federated basis, to commission and provide a greater range of diagnostics within primary care
Provide new 20,000 patient health facility on Eastern Flank, with extended range of services
Deliver an ‘End to End’ Trial of Ophthalmology Managed Care Pathway
Implement a ‘whole-system’ approach to reducing prescribing waste
Commission a new Primary Care Outpatient Clinic (PCOC) in Gastroenterology
Ensure more hospital based elective activity takes place within an outpatient setting
Increase the number of outpatient procedures taking place in Primary Care Outpatient Clinics (PCOCs)
Ensure all NHS Constitution, Quality Premium and CCG performance targets are delivered in year.
Modern Model of Integrated Care
For the 5% of patients with multiple, often complex mental or physical long-term conditions, frequently
compounded by being elderly and vulnerable, there needs to be a modern model of integrated care. Milton Keynes
has a long history of joint working, and has a number of integrated services: Intermediate Care; Mental Health;
Learning Disabilities; Integrated Community Equipment services and a Joint Commissioning team. Work is ongoing to
further develop integrated services to better meet the needs of older people and those with long term conditions
and/or physical disabilities. The whole system has agreed to support a specific programme focussing on services for
this group. Implicit in the Joint Health and Wellbeing Strategy is the empowerment of Milton Keynes residents to be
supported to help manage their own health and wellbeing through the commissioning and delivery of integrated,
person centred services, which place the individual at the heart of service delivery. The Better Care Fund (BCF) is an
opportunity for the CCG and Council, working in partnership, to transform local services so that people are provided
with better integrated care and support. It encompasses a substantial level of funding to help local areas manage
pressures and improve long term sustainability. A Milton Keynes 2 Year BCF Plan27, outlining how locally we will use
this initiative to deliver improved integrated care for the population was submitted and approved during 2014 and
further detail is outlined in Section 10.
Our vision for integrated care in Milton Keynes is to improve the experience of, and access to, health and social care
services for citizens. More citizens will report that their quality of life has improved as a result of integrated health
and care services. The number of citizens remaining independent in the community, including after hospital
admission will increase with improved and seamless transfers of care. To deliver this vision we will undertake an
extensive system wide programme of change that will see local services reshaped to deliver joined up care. The
emphasis on integration will be focused on:
27
Services that are configured to support people to live independently in their own home, within their local
communities, wherever possible. This will be our default option for service delivery.
th
MK CCG/MKC: Better Care Fund Plan 2014-2018: Final Submission; 30 September 2014
23
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
Acute care as an inpatient will be as short as clinically appropriate for that individual.

Capacity will be developed in community health and social care services to meet the delivery of this
objective and will be provided by a full range of statutory and voluntary and community organisations.

More effective partnerships will be developed with housing providers, employment services, transport and
leisure services to enable people to improve their quality of life and improve wellbeing.

GPs will be central to organising the co-ordination of people’s care and will work in a seamless integrated
way with health and social care providers to better manage care and treatment of patients. This will be
achieved through implementation of the national Enhanced service and the additional case management
role that will be developed for the over 75s.

Self-care and self-management of an individual’s health will be encouraged and people will be supported to
develop strategies for managing their health and independence, including access to a range of preventative,
early intervention services to support people to pro-actively manage their health.

Supporting services such as telehealth, telecare and community equipment will be strengthened to support
independence.

Rehabilitation, re-ablement and recuperation will be offered to everyone. We are clear that everyone has
the potential for restoring some level of physical and mental functioning.
There will be more integrated commissioning of services through a single pooled budget (facilitated through the
Better Care Fund) and delivered through integrated health and social care teams. These teams will be configured so
that they can support people, within an overall integrated care pathway model:-
24
Enc No 16/22
In the next five years it is expected that the demand for high cost secondary care (acute hospital) services will reduce
as the service offer delivered in primary care, community care and social care settings will increase, as shown in the
diagram above. Through the development of self-management and preventative services, ill health can be better
managed at an earlier stage, and linked in to community based rehabilitation and re-ablement services to provide
intensive support over the short term with a view to restoring people to independence. Delivering a new model of
integrated care will require a significant shift in the make-up of the entire community workforce. Increasingly
individuals and organisations providing care will need to work in cross-organisational teams, with a workforce
equipped with skills to span traditional professional boundaries. Increases in nursing capacity across both primary
and community care will be required to deliver the models of care outlined, along with a more diverse range of
support staff. Regardless of which organisation or provider staff members will be employed by, all will need to
deliver care in the setting where it is needed and manage risk within a devolved structure.
From
Integrated
Care for health
& social care
needs


To
Fragmented services leading to duplication
of effort and allowing people to fall
through the cracks
People kept longer in hospital because
appropriate services are not in place for
them to return home

Pro-active support and a focus on self-care

Fully integrated health, social and mental
health teams to provide a seamless service to
patients tailored to their needs


Discharge planning commences at admission
Range of home-based care & support services
The model will help the system initially to move from fragmented services and delivery for people with long term
conditions and vulnerable older people, to a system of integrated care providing ‘seamless’ care that can be tailored
to the needs of patients, and which supports significant admission avoidance and a proactive focus on self-care.
Initial delivery will be implemented under the auspices of the Better Care Fund Programme Board & Delivery Group
which will comprise of commissioners, service providers and key stakeholders. This working group will be
responsible for the day-to-day management of the implementation of the proposals within the BCF and will report
on progress to the Joint Commissioning Board, using established Programme and Project Management tools and
techniques. It is also proposed to establish individual work streams for each of the proposals to ensure focused
dedicated effort to implementation. The diagram below outlines the governance framework.
Health and Well Being
Board
System leaders
Group
(Whole system)
Joint Commissioning Board
(Chief Executives/lead
Officers)
Better Care Fund Delivery
Group
Commissioners BCF
Working Group
Scheme
project
Group
Scheme
Project Group
Performance management,
finance and contracting
Clinical
Pathways
Workforce and
engagement
Scheme Project
group
Information
sharing and
logistics
25
Enc No 16/22
1. Integrated Health & Social
Care Teams (MDTs & Rapid
Response Service)
BCF1: Implemented jointly with BCF6. MDTs and 24/7 Rapid
Response.
2. Recuperation Pathway
BCF2: Improved pathways of care for people with complex health
and social care needs and co-morbidities. Provision of intensive
domiciliary support and therapy, step down beds, social care and
nursing interventions through this new pathway. Well utilised with
good home care
BCF3: Additional Investment within existing service
3. Improved Community
Equipment Service
4. Alcohol Liaison
5. 7 Day Working for
Intermediate Care
6. High Impact Team for Care
Homes
7. Dementia Services
8. Community Geriatrician
BCF4: Additional Investment within existing service
BCF6: Implemented jointly with BCF1 & 2. Weekend working for
specific elements Intermediate Care Service, particularly ESD Team.
Implemented new team to support Care Homes in managing
people and avoiding admissions. Positive evaluation.
BCF 14. Expansion of Diagnosis Support pilot.
Implemented Community Geriatrician Posts to assist integration
between acute and community care services.
Non Elective Spells
Non Elective Spells
Non Elective Spells
2016/2017 Actions
Actions for next year build on those implemented during 2015/16 and are very much a consolidation of the whole
BCF Plan drawn up and agreed across the system in March 2015.
•
Increase the number of people who can be cared for at home by providing care close to home
•
Evaluation and further development of a 24/7 clinically led rapid service to provide realistic alternative to
admission
•
Development of locality based Multi-Disciplinary/multi agency Teams to identify and appropriately care plan
for people with complex health and social care needs

Consolidation of a recuperation pathway to provide rapid and intensive packages of care to individuals not
immediately appropriate for reablement support

Development of social care step down alternative

Better co-ordination of new and existing services to maximise efficiency and reduce system gaps.

Consolidation & Procurement of High Impact teams for Care Homes

Development of joint local integrated plan for reducing Delayed Transfers of Care.

Ensure all NHS Constitution, Quality Premium, BCF and CCG performance targets are delivered in year
6.4
Access to Highest Quality Urgent & Emergency Care
Urgent and emergency care is the range of healthcare services available to people who need medical advice,
diagnosis and/or treatment quickly and unexpectedly. Everyone in Milton Keynes deserves access to the highest
26
Enc No 16/22
quality urgent and emergency care. The report on the first phase Urgent & Emergency Care Review28 sets out an
exciting vision for how we deliver NHS Services in a way that can complement current and future demand for and
usage of these services. In line with that national vision, Milton Keynes CCG is developing a local approach that
treats an increasing proportion of people as close to home as possible, whilst recognising that greater specialism will
mean significant changes to how current hospital based emergency care may be delivered.
The overall vision for urgent and emergency care in Milton Keynes is for a system that is as simple and
straightforward as possible, with patients aware of and able to access appropriate high quality clinical care and
support at the right time and in the right place, such that inequalities in access to this care are eliminated. Urgent
and emergency care commissioning within Milton Keynes is currently implemented through a well-established
System Resilience Group, and in line with its Urgent Care Strategy29, informed by ongoing national guidance (Urgent
and Emergency Care Review, etc.) and examples of good care from across the country.
The vision for urgent and emergency care provision going forward must incorporate economies of scale and
improved integration to decrease the number of entry points into the system, whilst recognising and progressing the
recommendations from the first phase of the national “Urgent and Emergency Care review”.30 Firstly, for those
people with urgent care needs we should provide locally a highly responsive service that delivers care as close to
home as possible, minimizing disruption and inconvenience for patients and their families. For those people with
more serious or life threatening emergency care needs, we should ensure they are treated in centres with the very
best expertise and facilities in order to maximise the chances of survival and a good recovery.
Local transformation of urgent care services within Milton Keynes during the next 5 years will focus on how
organisations can translate local needs and national policy/guidance into local action to improve the value and
quality of urgent and emergency care in Milton Keynes, specifically to:
28
NHS England, Urgent & Emergency Care Review: November 2013
MK CCG: Urgent & Emergency Care Strategy 2013-2016, October 2013
30
NHS England: Urgent and Emergency Care Review, August 2013
29
27
Enc No 16/22

Increase the number of people who can be cared for in an ’out of hospital setting’, by providing
care closer to home

Deliver further integration of health & social care provision

Reduce the growing demand for urgent and emergency care presenting at hospital site.

Reduce the variation in response to urgent & emergency care between ‘in hours’ & ‘out of hours’.

Improve quality and responsiveness of GP access across Milton Keynes primary care.
From
Appropriate &
Timely Access to
Urgent Health
Needs
•
•
Multiple overlapping services leading to
confusion over how to access care
Limited access to non-acute services out
of hours
To


Single point of access for urgent
care services
Access to a range of health and social
care professionals depending on need
1. Define & Implement
Integrated Urgent Care
Service
Service specification for Integrated Urgent Care service developed.
New integrated service will be mobilized over April-July 2016
Reduced A&E attendances,
emergency admissions
2. Additional Support to
Nursing & Care Homes
(HIT)
High Impact Teams successfully recommissioned with revised
service specification from October 2015.
Reduced A&E attendances,
emergency admissions,
ambulance conveyances
3. Getting People
Home/Discharge to
Assess
Implementation of a 'Discharge to Assess' service model. This is
intended to ensure that people only spend time in hospital whilst
they are acutely unwell and as soon as this phase is over they
move into the community. Capacity for 2 patients per weekday has
been made available.
Reduced acute hospital lengthof-stay, excess bed-days, long
term placements and Delayed
Transfers of Care
4. Reduction in
ambulance
spend/contract value
Increased “Hear and Treat” (H&T) referrals.
Hear & treat; Hear See & Treat;
Conveyance
5. Social Marketing
Campaigns (included
Structured Promotion of
111 & Self Care)
Communications and social marketing activity (including on-line,
face-to-face engagement with patients and the public, distribution
of printed materials and branded item) aimed at informing the
public about the range of available healthcare services (particularly
Pharmacy First and NHS 111) so as to reduce the demand for A&E
and Urgent Care.
A&E attendances
28
Enc No 16/22
2016/2017 Actions

Increase the number of people who can be cared for in an non-hospital setting, by providing care closer to
home

Deliver further integration of health & social care provision

Reduce the growing demand for urgent and emergency care presenting at hospital site.

Provide integrated urgent care on the hospital site. Patients will be streamed to the most appropriate
clinician for their presenting condition. One of the options available will be a primary urgent care stream.

Commission an ambulance service which pro-actively utilises its Clinical Support Desk to review patients and
direct them to the most appropriate services rather than defaulting to ambulance dispatch or conveyance to
hospital. Paramedics and Emergency Care Practitioners (ECPs) are in a prime position to clinically triage
patients and bring in other health and social care professionals as required, rather than taking all patients to
an acute hospital.

Reduce the variation in response to urgent and emergency care between ‘in hours’ and ‘out of hours’.

Improve quality and responsiveness of GP access across Milton Keynes primary care.

Ensure all NHS Constitution, Quality Premium and CCG performance targets are delivered in year
6.5
Increase Productivity in Elective Care
For people who need episodic, elective care, access to those services must be designed and managed from start to
finish removing error and maximising quality. For many existing patient pathways and referral routes into services,
providers are not necessarily delivering them to extract maximum productivity and if we are going to transform
hospital care, look to concentrate specialist services on fewer sites, and deliver more care ‘closer to home’ then the
CCG needs to review how to deliver routine elective care. The provider landscape in Milton Keynes is evolving and
will experience significant shifts over the next 2-3 years. For example the outcomes of the Bedfordshire & Milton
Keynes healthcare services review of acute services reconfiguration will undoubtedly mean future changes in locally
provided acute services. Milton Keynes Hospital became a foundation trust in 2007 but is increasingly competing
with four other main hospitals within 30 minutes’ drive of Milton Keynes, and with the national drive to concentrate
services for less common disorders e.g. stroke, cardiac surgery, rare cancers in fewer centres of excellence, the
traditional role of the District General Hospital is likely to be required to change.
Our vision for planned care is to have a safer, more predictable and reliable planned health care system, providing a
consistent quality of service that will support the delivery of more services close to patient’s homes, and ensure that
they are getting the right treatment for their condition. This will mean a focus on a range of methodologies that:
Provide more efficient pathways for patients and ensure that they are seen in the most appropriate setting
for their condition

Build on the Practice Based Budgets system that was introduced in 2013/14

Ensuring the right referrals – putting in place systems to improve referral quality via active Referral
Management System (RMS)
29
Enc No 16/22

Implementing systems that manage the whole elective care pathway. Upholding the principles of
prevention, health education, self-management and informed decision making throughout.

Developing and improving locally agreed guidelines and thresholds for treatments and interventions.

Ensuring a much wider range of outpatient appointments is available within the community through the
establishment of Primary Care Outpatient Clinics (PCOS).

Encourage ‘one stop shops’ which reduce significantly follow ups.

Reduce cost of the pathways for the CCG and re-organise the clinical resource across different care settings
All this means we need to commission a greater proportion of activity in community and home settings to support
the required rebalancing of the health economy away from local acute services. This is necessary to support acute
provider sustainability and to ensure that services are delivered in the best location. However, this is not simply a
strategy to support a rebalancing of resources within the NHS – the CCG is also looking to understand where other
care providers can offer support to the population at least as effectively as statutory providers. MKCCG needs to
find efficiency gains from diverting secondary care activity to Primary care and by developing pathways that offer
an alternative to traditional hospital care.Where planned hospital care is required, the best healthcare systems provide access to highly trained clinicians who
are exposed to the numbers and range of patients required to develop and maintain their skills. An increasing trend
in how hospital based care is delivered will mean a reduction of general clinicians, and increasing numbers of
specialist or sub-specialist staff concentrated in specific locations, allowing them to see sufficiently high number of
patients and effectively utilise expensive equipment. The type and nature of workforce for planned interventions
will therefore be heavily dependent on the patient pathway across the spectrum of elective care.
From
Efficient Planned
Care which is
delivered through
fully integrated
Patient Pathways
•
•
•
To
Fragmented pathways of care,
with duplication of effort
Inconsistent referral processes
from primary into secondary care
Overlapping service provision
•
•
Streamlined care pathways and referral
routes into services, with reduced patient
hand offs.
Increasing no. of elective services
delivered in primary care settings
1. Implementing a
Referrals Mgt Service
Gateway
Evaluation of Stage 1 specialities and Stage 2 roll out of next 4
specialities completed
First outpatients/follow-up
2. Development &
Improvement of MSK
Pathways (including
Pain Mgt & PLCV)
3. Development of
Managed Care for
Established Integrated Musculo-skeletal services in the
community to allow for more patients to be managed in the
community, reduce congestion (waiting lists) in secondary
care, and reducing costs.
Procurement and introduction of Ophthalmology Managed
Care Service
First out-patients for Pain Mgt;
Orthopaedics and
Rheumatology. MSK Inpatient
Procedures
First Outpatients, Follow Up, O/P
Procedures, daycases and
30
Enc No 16/22
Ophthalmology
inpatients
4. Implement Practice
Based Budgets
Continued to promote practice based budgets to educate
primary care to take some responsibility for the consumption
of secondary care resources. 2015/2016 six audits have been
completed, 2 of which have been escalated so that changes to
clinical behaviour can be encouraged.
Elective day-cases, first
outpatients, In hours A/E and
UCC attendances.
5. Introduce Primary
Care Outpatient Clinics
First Outpatients, Follow Up
Outpatients, basis diagnostics
6. Improve Stroke
Pathway & Quality of
Care
Pilot PCOCs have been evaluated and developed in x
specialities. PCOCs provide additional services in primary care
setting, allowing secondary care waiting time reduction and
delivering CCG strategy of more elective care closer to home.
Focus on general stroke pathway to ensure effectiveness of
current stroke unit pathway by working with the Quality and
Performance teams.
7. Diabetes Single Point
of Access
Continued to develop and establish a single point of access
and enhanced community and primary care provision
8. Enhanced
Community Cardiology
services
Developing a single point of access for cardiology, and
establishing a structure of tiered community/primary care
services (including PCOC)
Reduction in acute hospital
outpatients and follow-up
activity
Reduction in acute hospital
outpatients and follow-up
activity
n/a
2016/2017 Actions






Deliver an ‘End to End’ Trial of Ophthalmology Managed Care Pathway
Implement a ‘whole-system’ approach to reducing prescribing waste
Commission a new Primary Care Outpatient Clinic (PCOC) in Gastroenterology
Ensure more hospital based elective activity takes place within an outpatient setting
Increase the number of outpatient procedures taking place in Primary Care Outpatient Clinics (PCOCs)
Ensure all NHS Constitution, Quality Premium and CCG performance targets are delivered in year.



Increase the number of people who receive elective care in an non-hospital setting
Review and re-procure Referral Management System if evaluation of current service is positive
Further develop a suite of Primary Care Outpatient Clinics to include paediatrics, headache pathway,
community based atrial fibrillation clinic
Investigate potential models for intermediate diabetes services
Ensure all NHS Constitution, Quality Premium and CCG performance targets are delivered in year


6.6
Sustainable Hospital Services
The key focus for developing safe and sustainable hospital services across Milton Keynes and Bedfordshire is the
continued development of the Healthcare Review. MK CCG is working with Bedfordshire CCG to develop a
comprehensive review of hospital and community health services across Bedfordshire and Milton Keynes, with the
aim of developing stronger, more resilient local healthcare and a series of options that can be taken forward to
formal public consultation.
Both local health systems remain under significant pressure from an ageing and expanding population – whilst there
is a need to improve outcomes from existing resources. This year has seen both local health systems under financial
31
Enc No 16/22
pressure to ensure they can deliver a surplus, at the same time as delivering exciting new initiatives focused upon
the integration of services, and delivering care closer to patient’s homes.
However a key element of the Review has been a renewed focus upon engaging the local community in the debate
about the way in which their clinical services might change. The support this the Healthcare Review Programme
(HCR Programme), has run a series of events across Bedfordshire and Milton Keynes, but also across a wider
geography to ensure there is a real understanding of how potential change, might impact the populations that use
the hospitals in Milton Keynes and Bedfordshire that form part of the review.
Finally a focus over the last year has been the reflection within Milton Keynes on the proposed clinical models. The
CCG has considered the models and how their commissioning intentions are aligned with developing clinical
standards, to ensure its population has safe, sustainable, high quality care for local people now and in the future.
The objectives of the Healthcare Review are to:



Address concerns around the challenges faced by the local health system, specifically the clinical and financial
sustainability of hospital services; and
Generate options for delivering high quality, sustainable health services for our residents.
Ensure that our residents get the right care at the right time, and that we are able to make decisions on the best
use of public spending on healthcare to meet our population’s needs, informed by our residents’ views.
The first three phases of the review have now been completed:
-
Demonstrating the Case for Change (published April 2014) – which highlights pressures that the local health
system is currently experiencing and sets out the case for transforming local healthcare services in
Bedfordshire and Milton Keynes
-
Publishing a Progress Report31 (published late October 2014) – which describes ways in which the CCGs can
and should deliver more robust care closer to home and potential solutions to ensure the future provision of
high quality, sustainable hospital services.
-
Testing and alignment (completed in January 2016) – in which both health systems testing the proposed
clinical models with their clinical communities and the wider population.
The conclusion of this phase has been that both MK CCG and Bedfordshire CCG have agreed to establish a Joint
Committee, which will take decisions on behalf of both sets of Commissioners in relation to the Programme.
To provide assurance to this Joint Committee, the Programme will be undertaking a Strategic Sense Check with NHS
England as part of the assurance framework required to support the development of the proposals. Further
development would then be required in the development of the Pre-Consultation Business Case, review by NHS
England’s Investment Committee and then formal public consultation on the proposals.
Local NHS hospital services have been built up incrementally in Milton Keynes, evolving gradually to deal with
changing health needs, clinical standards and public expectations. This has produced some services and pathways
31
Bedford CCG/MK CCG/McKinsey: Bedfordshire & Milton Keynes Healthcare Review: Progress Report, October 2014
32
Enc No 16/22
that may now not be right for delivering the care patients need today or may need in the future. The Healthcare
Review32 being conducted across Milton Keynes & Bedfordshire is currently concluding and aims to produce a range
of options for delivering affordable high quality healthcare, now and into the future, for the population. At its heart
is the aim to transform and redesign services so that:
People can be supported to take better care of themselves, lead a healthier lifestyle, understand where and
when they can get treatment if they have a problem, understand different treatment options, and better
manage their own conditions with the support of healthcare professionals if they wish

Older, frailer people are supported on a 24 hours a day, seven days a week basis to maintain their health,
dignity and independence at home

When someone has an urgent healthcare need, they can easily access a primary care clinician 24 hours a
day, seven days a week by telephone, email and face to face consultations in local, easily accessible facilities
as close to home as possible

If they need to see a specialist or receive support from community or social care services, this will be
organised in a timely way and GPs will be responsible for co-coordinating the delivery of their health care

If they need to be admitted to hospital, it will be only when they require acute specialist interventions that
cannot be delivered in community settings, and then it will be to a properly maintained and up-to-date
facility where they receive care delivered by highly trained specialists available seven days a week with the
specific skills needed to treat them.
The review team have gathered an evidence base which builds on national guidelines, examples of service delivery
models elsewhere and academic research. The Clinical Advisory Group reviewed the clinical evidence base and,
building on the Keogh33 report into emergency and urgent care, identified six clinically sustainable archetypes for the
delivery of acute care. These six models take into account the complex interdependencies between different
hospital services such that there was confidence that they could deliver services to a high standard. The theoretical
hospital models are depicted below:
32
33
Bedford CCG/MK CCG/McKinsey: Bedfordshire & Milton Keynes Healthcare Review: A Case for Change, April 2014
NHS England, Urgent & Emergency Care Review: November 2013
33
Enc No 16/22
Six high level archetypes of hospitals
What
1
Major trauma
centre - MTC
Services offered
• Specialised centres co-locating tertiary/complex services on • Neurosurgery, Cardiothoracic surgery
a 24x7 basis
• Full range of emergency surgery and acute medicine
• Serving population of at least 2 -3million
• Full range of support services, ITU etc
• Larger units, capable of assessing and initiating treatment
Major
Emergency
2a
Centre - MEC
(a)
2b
Major
emergency
centre - MEC
(b)
3
Emergency
Centre - EC
4
5
Integrated
care hub with
emergency
care - IC hub
Urgent care
centre - UCC
•
for all patients and providing a range of specialist hyperacute services
Serving population of ~ 1-1.5m
•
•
•
•
•
• Larger units, capable of assessing and initiating treatment
•
for the overwhelming majority of patients but without all
hyper-acute services
Serving population of ~ 500-700K
• Assessing and initiating treatment for majority of patients
• Acute medical inpatient care with intensive care/HDU back
Hyperacute cardiac, stroke , vascular services
Trauma centre
Level 3 ICU
24x7 consultant delivered A&E, emergency surgery, acute
medicine, inpatient paeds
Full obstetrics and level 3 NICU
• 24x7 consultant delivered A&E, emergency surgery, acute
medicine
• Level 3 ICU
• Inpatient Paeds
• Obstetrics with level 2/3 NICU
• Serving population of ~ 250-300K
•
•
•
•
• Assessing and initiating treatment for large proportion of
• GP and A&E consultant led urgent care incorporating out of
up
•
•
patients
Integrated outpatient, primary, community and social care
hub
• Immediate urgent care
• Integrated outpatient, primary, community and social care
•
Consultant led A&E
Acute medicine and critical care/HDU
Access to surgical opinion via network
Paeds assessment unit and obstetrics
hours GP services
• Step up/step down beds possibly with 48 hour assessment
unit
• Outpatients and diagnostics
• As above but no beds
hub
PRELIMINARY DRAFT
2
A steady process of evaluation and elimination which drew on clinical expertise and public/patient feedback enabled
the review team to narrow the list of possible options for reconfiguring both hospitals. In doing so, the option
resulting in either Bedford or Milton Keynes hospital becoming a hospital without inpatient beds – an ‘urgent care
centre’ – has been ruled out as this could leave local people with insufficient access to inpatient and rehabilitation
beds. In addition, the scale of change, impact on neighbouring health systems and lack of stakeholder support could
make it undeliverable. The evaluation undertaken proposes the two options in the table below. Under these
options, either hospital could become a major emergency centre or an integrated care centre. These options
recommended by the review team retain a district general hospital with A&E, paediatric, maternity and inpatient
services in both Bedford and Milton Keynes.
Bedford Hospital
Milton Keynes Hospital
4. Integrated care centre
2b. Major emergency centre
During the Testing and Alignment phase of the Programme, the Bedfordshire Local Health System (via the North
Beds Primary / Acute Care Programme) developed the Integrated Acute and Community Service (IACS) clinical
model. This clinical model was fully supported by Bedford Hospital Trust and Bedfordshire CCG, however Milton
Keynes CCG reflecting upon the needs of the local population agreed that the clinical model was not suitable for its
population. As a result there are currently three clinical models proposed for the Review to consider
Bedford Hospital
Milton Keynes Hospital
34
Enc No 16/22
Integrated Acute and Community
Service (IACS)
The next step for the Programme will be to establish a Strategic Sense Check with NHS England, to review the
Options set out above.
From
Sustainable &
Accessible
Hospital
Services for
the future
a) Fragmented, inequitable service
provision
b) Variable quality of care and safety
c) Clinical workforce shortages
d) Financial challenges across system
To




GP Coordinated Care, increasingly supported by
community level services
Patients admitted to hospital only for acute specialist
interventions & more care delivered ‘closer to home’
Hospital care delivered by highly trained staff
Financially and clinically viable services in place locally
2016/2017 Actions
•
Undertake a Strategic Sense Check with NHS England to allow an assessment of the areas of focus required
by the Programme.
•
For the Joint Committee to complete the Option Selection process to allow a decision on which option is
developed in detail for public consultation.
•
Undertake a Clinical Senate Review. This will provide assurance to the local system that the Clinical Model is
safe and sustainable.

Complete NHS England assurance review with the Investment Committee, as the body which can assurance
the reconfiguration proposals developed by the local system

Undertake a Public Consultation on the proposals that have been approved by the Joint Committee.
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7. Transformation & Delivery
MK CCG’s commissioning, transformation and overall delivery is currently overseen and implemented through four
clinical programme boards: Urgent Care Board (SRG); Care Pathways & Primary Care Board; Mental Health &
Learning Disabilities Health Board (jointly with MKC;) Maternity, Children & Young People’s Board; and also the
Clinical Executive. Each programme area is responsible for ensuring that both local and national focus is considered
and acted upon, and that contributions to QIPP development are clinically assured. Additionally, programme boards
are also currently operating for overseeing the Healthcare Review and implementation of the Better Care Fund. The
CCG has established itself as a clinically led, innovative, forward thinking CCG with a culture committed to delivering
high quality care to the communities it serves. However, fulfilling the long term ambitions of the NHS, as outlined in
the latest planning guidance will mean that CCGs must drive forward a change in the way that health services are
delivered. Therefore, given the local needs, system vision, strategic priorities and wider context set out above, the
local focus for commissioning, transformation and driving continuous improvement by each programme board will
be driven by:

Avoiding time spent in/referrals to hospital, if it is not necessary

Improving patient flows within and through secondary care settings

Promoting independent living, with better, more integrated care outside of hospital
Steps we take in transforming and developing services in the next couple of years must ultimately ensure that we
have local models of care that will apply to the needs of the population in 5-10 years’ time. Our programme boards’
transformation and improvement intentions for 2016/2017 are summarised below, along with their commissioning
impact in terms of QIPP initiatives & activity changes.
7.1
Urgent Care (System Resilience Group SRG)
Strategic Direction:
MK CCG Urgent & Emergency Care Strategy 2013/2016
Principles for Change
 Ensure patients receive the ‘right care, first time’
 Improve the flow out of the hospital
 Reduce variation in response to care needs between ‘in-hours’ and ‘out of hours’
Aims of the Programme Board:
1. To improve the experience and outcomes for people who use urgent care services
2. To provide whole system leadership, assurance and ownership to ensure achievement of the 4 hour
standard for A&E
3. To eliminate waste and improve overall quality
4. To increase integration
5. To review and redesign services
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Enc No 16/22
Year 1 Transformation Initiatives - 2016-2017:
Commissioning Intervent
ion/Intention
Actions
Net Risk
Assessed
Savings
Activity Impact
Area
Lead
1. Define & Implement
Service
UC4: Define clinical model and
develop service specification for
Integrated Urgent Care service and
develop plan for procurement.
£354,000
A&E attendances,
emergency
admissions
Mark Cox
Delayed Transfers
of Care, Excess
bed-days
Mark Cox
A&E attendances,
emergency
admissions,
ambulance
conveyances to
A&E
Mark Cox
Hear & treat; Hear
See & Treat;
Conveyance
Steve
Gutteridge
Urgent Care
Programme
Manager
Change
Deliver
ed from
July
2016
New integrated service will be
mobilized over April-July 2016
2. Improve hospital
discharges
UC10: Implement the ‘Getting
People Home’ programme, firstly
by extending the ‘Discharge to
Assess’ scheme, and subsequently
by reviewing recuperation,
rehabilitation and non-weight
bearing pathways
£0
3. Further integration of
NHS 111 with the Urgent
Care system
UC12: Further integration of Outof-Hours GP and 999 services with
NHS 111, increased clinical input
into NHS 111, and increasing
utilization of NHS 111 by building
on national communications
£44,000
4. Ambulance demand
growth management
UC13: Promotion of the use of
mobile Directory of Services for
ambulance crews to further
increase non-conveyance, and
ensuring that contractual activity
plans reflect MKCCG demand
management schemes.
£375,000
5. Procurement of NHS
111 service
6.Budget Flexibilities
Re-procurement of NHS 111
service, informed by emerging
national guidance and local
integration efforts, to start in April
2017
Flexibility within existing budgets
Urgent Care
Programme
Manager
Urgent Care
Programme
Manager
July
2016
April
2016
April
2015
Urgent Care
Commissioner
Steve
Gutteridge
April
2017
Urgent Care
Commissioner
£387,000
Mark Cox
Urgent Care
Programme
Manager
April
2016
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7.2
Care Pathways & Primary Care
MK CCG Care Closer to Home Strategy (currently in draft and under further development)
MK CCG Primary Care Development Strategy, 2013-2015
MK Healthcare Review 2014-2015
MK End of Life Strategy 2016-2020 (localising of national ambitions for EoL Care)
 Ensure patients receive high quality consistent care


Ensure patients receive the ‘right care, first time’
Bringing care closer to home
Aims of the Programme Boards are:
1.
2.
3.
4.
To improve the experience and outcomes of people who use planned care services
To eliminate waste and improve overall quality
To increase integration
To review and re-design services
Commissioning
Intervention/Intention
Actions
Net Risk
Assessed
Savings
1. Ophthalmology
Managed Care
PC15: End-to-end trial of
Ophthalmology Managed Care
pathway
£388,000
2. Prescribing
Whole system approach to
reducing prescribing waste,
including care home initiatives,
practice based script-switch
system, prescribing team
checks, dietician initiatives,
repeat prescribing management
and reducing waste.
Renegotiation of non-acute
contracts
£1,000,000
PC10: Primary Care Outpatient
Clinics (PCOCs) have been
developed to divert a
proportion of outpatient
appointments that would
otherwise have gone into
secondary care to be seen in the
Community using GPwSIs, Nurse
Specialists or Consultants as
clinical leads. MKCCG will be
commissioning new PCOCs in
£24,000
3. Non-acute contracts
4. Direct to test
‘oscopies’
Activity Reduction
Area
Primary care
prescribing
£473,000
Acute hospital
diagnostics
Lead
Delivered
from
Asma Ali
Programme
Manager
December
2016
Janet Corbett
Head of
Prescribing
and
Medicines
Management
April 2016
Asma Ali
Programme
Manager
April 2016
Asma Ali
Programme
Manager
July 2016
38
Enc No 16/22
Gastroenterology.
5. Day case to out-patient
shift
PC30: Shifting activity in line
with BADS guidance.
£25,000
Acute hospital
day-cases
6. Moving care into the
community
PC34: Transferring outpatient
procedures to Primary Care
Outpatient Clinics (in addition to
first and follow-ups).
LTC13: Implementation of a
managed care model for
Diabetes services.
LTC3a: Community DVT
pathway – phase two PCOC
hubs to be made available to all
GP practices.
LTC3: Streamline activity
between primary and secondary
care and bring in an integrated
transformational value-based
commissioning model providing appropriate activity in
low cost settings.
PC31: Audit of MKUHFT
respiratory medicine case mix
and procurement of a
substantive service following
evaluation of a pilot.
Implement a managed care
integrated service
£24,000
Acute hospital
outpatient
procedures
£1,000,000
12.Rationalise Primary
Care initiatives
Joint work commenced in 201516 to identify initiatives to
manage the increase in demand
and reduce the activity flow
through the hospital
Rationalise primary care
initiatives started in 2015-16
13. Funded Nursing Care
Efficiencies within services
£150,000
14. Translation Services
Contract negotiation for
reduction in price
£15,000
7. Community DVT
pathway
8. Cardiology Single Point
of Access
9. COPD services
development
10.Diabetes Pathway
11. MKUHFT Deep Dive Joint Activity
Management Action Plan
Asma Ali
Programme
Manager
Asma Ali
Programme
Manager
April 2016
Asma Ali
Programme
Manager
Asma Ali
Programme
Manager
September
2016
Asma Ali
Programme
Manager
January
2017
£150,000
Asma Ali
Programme
Manager
April 2016
£53,000
Asma Ali
Programme
Manager
Maria Wogan
Project
Manager
January
2017
Alexia
Stenning
Asst. Director
– Primary &
Community
Services
Michael
Ramsden
Quality
Standards
Manager
April 2016
£6,000
£549,000
Acute hospital
April 2016
April 2016
April 2016
April 2016
Alexia
Stenning
Asst. Director
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15. Out of Area Acute
Services
Activity Management
£123,000
16. Improve the quality
and care for End of Life
patients
Improve End of Life service
provision, particularly in: 24/7 access to advice and
support and admission
avoidance
 Access to palliative rehab
 Community Ascites
Diagnostics Project
£0
7.3
– Primary &
Community
Services
Jim Arnold
Head of
Contracts
Tracey
Doherty
End of Life
Care
Commissioner
Integration & Better Care Fund
MKC & MK CCG Better Care Fund Plan, 2014-2018
MKC & MK CCG Older People’s Strategy, 2013-2016
MKC & MK CCG Dementia Strategy
MK CCG Out of Hospital Strategy (currently in development)
 Driving integration at scale and pace.
 Standardise and communicate what primary care should provide for patients with long term conditions.
 Commission pathways that are in line with NICE Guidance or for the best outcomes available.

Commission a ‘One Stop Shop’ approach wherever possible.
Aims of the Programme Board are:
1.
2.
3.
4.
5.
6.
To improve the experience and outcomes for people who use our services
Preventing people from dying prematurely
Enhancing quality of life for people with long term conditions
Empower patients to manage their own conditions
Supporting people to recover from episodes of ill-health or following injury
Enabling and supporting people in Milton Keynes to die in their place of choice
Commissioning
Reduce the number of non-elective
admissions going into MKUHFT, and
prevent readmissions by improving
services and pathways to support
patients in the community
Action
A Rapid Response Team
Recuperation Pathway
High Impact Team
Falls Prevention service
Autism Diagnosis service
Dementia Pathway review
Net Risk
Assessed
Savings
£1,050,000
Activity
Reduction
Area
Lead
Joint
Commissioning
Team
Delivered
from
Ongoing
Consolidation & further development
of schemes initiated under Year 1 of
BCF Plan.
40
Enc No 16/22
7.4
Mental Health & Learning Disabilities
MKC & MK CCG Mental Health Strategy,
MKC & MK CCG Dementia Strategy




To ensure parity of esteem for mental health services in terms of % funding growth
Commission a shift of care from acute inpatient care to preventative and recovery based wellbeing services
in the community
Commission pathways that are in line with NICE Guidance or for the best outcomes available
Commission services that are increasingly focussed on individual packages of treatment and care
1. To improve the experience and outcomes for people who use services
2. To ensure that people can stay well
3. To ensure that when people become unwell, they receive the right care in the right place, getting better,
quicker, effective and appropriate interventions delivered in a timely and personalised way.
4. To increase integration
Commissioning
Action
Net Risk
Assessed
Savings
1. Home
Treatment/Crisis
response
MH4: Commission a 24/7 Home Treatment / Crisis
Response team on a permanent basis
£0
2. Primary Care Mental
Health service
development
MH3: Develop primary care mental health service model
that best meets the needs of people accessing general
practice teams (may include PCOC and SMI LES
approaches).
3. Recovery and Primary
Care mental health
pathway development
MH9: Commission/ procure supported accommodation,
community support and employment support from
independent and voluntary sector with the active
involvement of service users and carers to facilitate
transition to primary care MH service.
4. Supporting patients
with complex needs
MH10: Commissioning step 4 psychological therapy that
will deliver an evidenced based service to people with
Complex Needs. Two key strands are Psychological step 4
services and Voluntary Sector services. Will involve
mapping, and evidence for good practice.
5. Reducing Out-of-Area
placements
MH11: Reduction in number and duration of out of area
placements focusing on patients with the following needs:
1. Complex needs - reliant on investment in community
and crisis services by developing local care options.
2. Learning Disability and/or Autism - by developing local
care options.
3. Dementia with Challenging Behaviour by developing
Lead
Delivered
from
Wayland
Lousley /
Tracey
Chapmen
41
Enc No 16/22
local care options.
6. Specialist Memory
Service
MH13: Development of Specialist Memory Service.
Earlier identification of dementia and a growing elderly
population in Milton Keynes requires increased capacity
within our Specialist Memory Service to meet the growing
demand for:
• Ongoing screening (subject to Pilot evaluation)
• To provide full dementia diagnosis
• To complete ECG’s
• To provide intensive clinical care for complex cases in
the community
• Post diagnosis support (Better Care Fund resourced)
7. Autism service
development
MH16: Development of Autism diagnosis, follow up and
support service as part of a wider lifespan approach to
pathway development.
Will provide a base to further develop a complex needs,
ADHD, Personality Disorder, Conduct/Behavioural
disorders service.
8. Street Triage
MH17: Mental Health Street Triage to enhance availability
by 3hrs per day (3pm - 6pm). Working from 3pm - 2am in
total = 93% of incidents vs current 70% incidents
9. Hospital Liaison Team
Implementation of effective, sustainable service model.
People experiencing mental illness or dementia will be
assessed promptly and directed towards the appropriate
treatment and care reducing inappropriate hospital
admissions, delayed discharges, waiting time in A&E.
10. Service redesign
based on evidencebased care packages
and improved care
pathways
Clear urgent and planned care pathways will be put in
place. Access target achievement will be improved within
this.
11. Learning Disability
Service development
Develop a service model with the Transforming Care
Partnership to meet the needs of CCG Learning Disability
placements for Transforming Care cohort.
12. Wellbeing Service
development
Develop an MK Wellbeing Service, in order to prevent
entry into secondary mental health and statutory social
care services and prevent poor health outcomes
associated with mental ill health.
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Enc No 16/22
7.5
Maternity, Children & Young People
Milton Keynes Joint Health and Wellbeing Strategy 2015-18 – Starting Well
MK CCG Care Closer to Home 2014 - 18
Future in Mind 2015
Children and Families Act 2014
Better Births 2016
Working Together to Safeguard Children 2015



Promote integration and collaborative working
Commission pathways that are in line with NICE Guidance or for the best outcomes available
Strengthen prevention to avoid the need for acute health and social care
1.
2.
3.
4.
To improve the experience and outcomes for people who use services
To deliver quality service that provide demonstrable value for money
To benchmark services with best practice in comparable areas
To commission care pathways that reflect the intent to avoid admissions to hospital and advice to allow
children to be cared for in the community or close to home.
5. To focus on prevention and providing universal, accessible services with targeted care
Commissioning
1. Improve Children’s
Mental Health and
Wellbeing
Action
CM24: Re-commission and/or
redesign services as part of multiagency 5-year programme to
transform the children and young
people’s mental health and
emotional well-being pathway in
MK. Local Priorities include:
Net Risk
Assessed
Savings
Investment
required
Activity
Reduction Area
Lead
Hannah
Pugliese
Children’s
Service
Commissioner
Delivered
from
Ongoing
 Enhanced Eating Disorder Service
 Integrated care pathway for C&YP
with complex and challenging
behaviour including CYP with
learning disabilities and autism
 Urgent Care Pathway for 24/7
crisis care - Hospital Liaison and
Home Support
 Psychological support for CYP with
specialist needs
 Improved confidence and capacity
in Universal Services.
 Access to specialist C&YP Mental
Health Care Pathway including
implementation of CYP IAPT
 Perinatal Mental Health Integrated
Care Pathway (Investment from
parity of esteem allocation)
 Out Of Area Discharge and
Transition Pathway
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Enc No 16/22
 Early Intervention in Psychosis
(Investment from parity of esteem
allocation)
 CYP IAPT Reading Collaborative
2. Caring for Children
Closer to Home
CM25: A set of workstreams
aimed at insuring that children
are cared for in the community
and close to their home:
- Supporting children and families
with common health conditions
- Paediatric Community Nursing
Team
- Enhanced Continuing Care
packages
- A review of Long Term
Conditions pathways
- Explore opportunities to
undertake more procedures in
the community
£287,000
3. Improve outcomes
for children with
Special Educational
Needs and Disabilities
CM26: Ensuring the embedding
of reforms to meet the needs of
children with special educational
needs and disabilities
Investment
required
4. Improve Maternity
care
CM27: Respond to national
maternity review aimed at
improving maternity care and
implement measures to support
reduction of stillbirths and low
birth weight babies.
5. Safeguarding
CM28: Commission a dedicated
service for females who have
been subject to female genital
mutilation
6. Perinatal Mental
Health
To strengthen the Perinatal
Mental Health pathway and
Services.
A&E
Attendances
Emergency
Admissions
Hannah
Pugliese
Children’s
Service
Commissioner
October
2015
Fiona West
Programme
Manager
Ongoing
Fiona West
Programme
Manager
Tbc
Investment
required
Fiona West
Programme
Manager
Ongoing
Investment
agreed
Fiona West
Programme
Manager
Ongoing
 A joint initiative has been
undertaken between the C YP & M
commissioners and the adult metal
health commissioners to include
the formation of a Milton Keynes
Perinatal Collaborative.
 Developed a programme of work
designed to improve outcomes for
women and families experiencing
mental ill health in the perinatal
period.
 The work programme includes the
development of a Perinatal
Integrated Care Pathway for
Milton Keynes and a multiagency
training programme.
44
Enc No 16/22
 The CCG also committed funds to
enhance the local specialist
perinatal services which have
created an additional 3 posts in
community mental health services.
7. Continuing Care
Efficiencies within service
£90,000
Fiona West
Programme
Manager
April 2016
8.Local Authority
Medical Certificates
Cease re-imbursement to Local
Authorities
£10,000
Fiona West
Programme
Manager
April 2016
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8. Integration & Partnership
Milton Keynes has a long history of joint working, and has a number of integrated services: Intermediate Care; Mental
health; Learning Disabilities; Integrated Community Equipment services and a Joint Commissioning Team. Work has
been underway for some time to further develop integrated serves to better meet the needs of older people and
those with long term conditions and/or physical disabilities. As part of this process, a number of workshops have been
held with service providers and members of the public to discuss the development of integrated services.
8.1 Approach
Implicit in the Joint Health and Wellbeing Strategy is the empowerment of Milton Keynes residents to be supported to
help manage their own health and wellbeing through the commissioning and delivery of person centred services,
which place the individual at the heart of service delivery. Through local health and social care teams we will work
with local people in Milton Keynes to further develop our plans for integrated care and support to enable people to
maintain their independence. Our vision for health and social care services in Milton Keynes is for services that are
configured to support people to live independently in their own home, within their local communities, wherever
possible, including those at the end of their life. This will be our default option for service delivery. The aim of any
intervention, especially acute care, will be to support people to realise this objective. Through effective utilisation of
the Better Care Fund, capacity will be developed in community health and social care services to meet the delivery of
this objective and will be provided by a full range of statutory and voluntary and community organisations.
By working together in this way, then the objectives of the MK Older People’s Strategy and the Better Care Fund
proposals will be delivered. GPs will be central to organising the co-ordination of people’s care and will work in a
seamless integrated way with health and social care providers to better manage care and treatment of patients. Selfcare and self-management of an individual’s health will be encouraged and people will be supported to develop
strategies for managing their health and independence, including access to a range of preventative, early intervention
services to support people to pro-actively manage their health. Supporting services such as telehealth, telecare and
community equipment will be strengthened to support independence. Rehabilitation and re-ablement will be offered
to everyone. We are clear that everyone has the potential for restoring some level of physical and mental functioning.
8.2 Vision
MK vision for the future model of integrated care is outlined below.
“We aim to configure services that support people in their own homes and local communities
wherever possible, delivered on a 7 day a week basis. The use of services in the secondary care
(acute) sector is essential for those people that need them where community, primary and social
care services cannot meet the (acute) healthcare need.”
We aim to deliver services with the following objectives:
a)
b)
c)
d)
Focused on improved outcomes not solely on activity
Promote individual independence for all
Improving the experience of patients/service users and carers
Reduce delayed transfers of care by the development of a range of community based services that can
meet a range of needs for post-hospital support.
e) The extension of rehabilitation and reablement to people with dementia
46
Enc No 16/22
f)
The links between physical health and mental health are well known, although our services continue to
work in silos. Services (Relationships) will be strengthened to deliver the objective of “no health without
mental health”
g) A reduction in the rate of emergency admission to hospital and the number of permanent placements to
residential and nursing care
h) Support early intervention, identifying people who may need support before a crisis
i) Case management and co-ordinating care to ensure people are cared for in the most appropriate
environment by the most appropriate professional
8.3 Better Care Fund
The Better Care Fund (BCF) will be deployed during 2016/17 in line with the Year 2 plan that was developed in March
2015. The plan provides a four year vision for delivery and enhancement of integrated care across the Milton Keynes
health and social care economy. From April 2016 the CCG will transfer £14.085m into a pooled fund totalling
£14.956m with the Milton Keynes Council as a means of driving further integration between health and social care.
The CCG will also pool £0.307m with Buckinghamshire County Council.
Locally the BCF provides an opportunity to transform local services so that people are provided with better integrated
care and support and is an important enabler to take the integration agenda forward at scale and pace, acting as a
significant catalyst for change. The BCF Plan34 will support integrated commissioning of services through a single
pooled budget and delivered through integrated health and social care teams. These teams will be configured so that
they support people either on
a) a short term basis i.e. to deliver rehabilitation and reablement to help people regain confidence and
previous levels of functioning or to provide support for physical health at home until reablement can be
commenced.
b) or on a longer term basis for people with more complex health and social care needs that may require
more intensive support over a longer timeframe especially when they have an exacerbation of their
condition.
During 2015-16 progress with the plan has been reviewed by the BCF Programme Board on a regular basis. The BCF
Programme Board recommended to the Joint Commissioning Board that these schemes continue into 2016-17. The
impact of these schemes on making the shift from acute care to community based services has begun, but the
schemes will take longer to bed in. The Year 2 plan delivery will consolidate transformation initiatives based on the
evaluation of implementation achieved during 2015/2016. More details are shown in Appendix E. The focus will
continue to be on reducing the impact on acute care, increasing the number of people who can be successfully
supported to remain at home, reducing the number of people who are admitted to residential and nursing home care
and named professionals for people at risk through delivery of:






34
Community MDTs
Rapid Response Service
Recuperation Pathway
High Impact Team
Falls Prevention
Dementia Pathway Review
Autism Diagnosis Review
MKC & MKCCG, Better Care Fund Plan: 2014-2018: September 2014 (Final)
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In 2016/2017 dependant on the evaluation of 2015-16 schemes a decision will be made in year on whether to invest
an additional £1m which will come out of acute care to be re-invested through the BCF. This will make the total
amount £8m out of £15m invested in out of hospital services. The CCG commissioning plans and local authority plans
for social care have also been developed in the context of the JSNA and the Joint Health and Wellbeing Strategy, so
there is a “golden thread” linking the health and social care high level strategic documents with the BCF service
proposals.
9. Governance
MK CCG’s commissioning changes are implemented through its 4 clinical programme boards and through work in the
four neighbourhood quality & performance groups. In addition, programme boards for the delivery of the Better Care
Fund and the Health Care Review have been established. These boards work alongside the current programme board
structure and will eventually be integrated into the existing governance structure as the work progresses. All
programme board work stream delivery is overseen by the CCG’s Programme Management Office function (PMO) and
each clinical board includes clinicians and patients in its membership and has a CCG GP as the Senior Responsible
Owner (SRO), who is supported by a dedicated programme manager. All programme SROs are accountable to the
Commissioning Decisions Group (CDG) and through this to the MK CCG Board. Included within the remit of the
programme boards is responsibility for the development and delivery of the annual QIPP plans, monitoring of delivery
against plans, the management of risk and provision of programme and project management advice to the clinicians
and staff involved. The governance structure for delivery is shown below:-
Clinical
Federation of
Member
Practices
NHS MK CCG
Board
NHS MK CCG
Leadership Team
EXTERNAL RESOURCES
NHS MK
Commissioning
Delivery Group
Commissioning Support Hub
Joint Commissioning Team
Advisory
Stakeholders
Service Providers
Health & Wellbeing Board
Clinical Networks
Partner Organisations
Patient Congress
Practice Participation Groups
Programme
Management
Office
Mental
Healthcare
Learning &
Disabilities
Programme
Board
Care
Pathways &
Primary
Care
Programme
Board
Healthwatch
Urgent
Care
Working
Group
Children
Young
People &
Maternity
Programme
Board
Better Care
Fund
Delivery
Group
Health Care
Review
Programme
Board
NHS Milton Keynes CCG Management Framework
Internal Decision Making Structure
Each Programme Board has an agreed/approved Annual Work Plan which it will use to focus and drive forward its
work, thus ensuring that the CCG can deliver stepped changes and transformation that will support the
implementation of its overall Strategic Plan.
The Programme Management Office (PMO) to support the organisation in turning its’ strategy and plans into delivery
by:48
Enc No 16/22



Working with strategic leads, programme boards and finance to develop commissioning intentions (CI) that
are value adding, evidence based and fit with strategic direction
Turning the commissioning intentions/initiatives in the plan into realistic programmes of change/work plans
through opportunity appraisal and robust business case development
Monitoring, evaluating and reporting on progress towards benefit delivery and strategic objectives
The PMO seeks to operate best practice public sector methodology in portfolio, programme and project management
to support delivery of the CCGs’ strategic plans. Working across the organisation, the PMO drives and supports
project delivery by ensuring that all key projects are managed in a controlled way by establishing real rigour, careful
planning and sound processes in the management of projects including:

The provision of consistent documentation whilst avoiding unnecessary bureaucracy.

The development of a clear authorization process with programme and project lifecycle & governance
guidance that is understood by everyone. This includes robust evaluation & post implementation process for
pilots and projects

The prioritisation of projects that are value-adding, realistic, strategically aligned, properly scoped and with
robust business cases proving the case for change

The introduction of benefit mapping and management, ensuring the anticipated benefits of programmes and
projects are clearly articulated and fit with organisational strategy

Robust monitoring and evaluation of progress against the plans

Effective risk management
This approach ensures a focus on delivery with underpinning sound governance and approval processes.
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10. Improving Quality & Outcomes
10.1 OUTCOMES AMBITIONS
Within the five domains in the NHS Outcomes Framework, NHS England has identified the measures best placed to
provide assurance in planning and delivery, where CCG data exists and a baseline could be determined. Everyone
Counts: Planning for Patients 2014/15 to 2018/19 translates these outcomes into specific measurable ambitions which
are critical indicators of success and against which progress can be tracked. Milton Keynes CCG is required to ensure
delivery of the following seven outcomes ambitions, which are set out below. Performance against the following
standards is reported to the Commissioning Delivery Group (CDG) every month and the CCG Board bi-monthly. 5 year
trajectories for improvement as set in April 2014 are shown in Appendix A.
Outcome 1
Securing additional years of life for the local population, with
treatable mental & physical conditions measured by
Potential Years of Life Lost (PYLL)
from conditions amenable to
healthcare
Outcome 2
Improving the health related quality of life of people with one or
more long-term conditions measured by:-
Health related quality of life for
people with long-term conditions
(EQ5D tool GP Survey)
Outcome 3
Reducing the amount of time people spend avoidably in Reduction in Emergency Admissions
hospital through better, more integrated care measured by:(composite rate)
Outcome 4
Increasing the proportion of older people living independently No indicator currently available at
at home following discharge from hospital, measured by:CCG Level
Outcome 5
Increasing the number of people having a positive experience Patient Experience of Hospital Care
of hospital care, measured by:Survey
Outcome 6
Increasing the number of people having a positive experience Patient Experience of Primary Care
of care outside hospital in general practice and the (composite rate)
community, measured by:-
Outcome 7
Making significant progress towards eliminating avoidable Indicator in development
deaths in our hospital caused by problems in care, measured
by:-
The current position with regards to delivery against these ambitions is shown below, measured up to the end of
Month 9 (December 2015). Supporting measures are also indicated in the table, and denoted by the pre-fix EAS.
Performance against the following standards will be reported to the Commissioning Delivery Group (CDG) every
month and CCG Board bi-monthly.
50
Enc No 16/22
Description
E.A.1
PYLL from Causes
Amenable to Health
E.A.2
Health-Related Quality
People w ith LTCs
E.A.3
Improved Access to Psychological
Services (IAPT) Roll-Out
E.A.4
Emergency
Measure
Admissions
Considered
of
Life for
Composite
Plann
ed
Metric
Aspir
ation
“Annex A” - Outcomes Measures Dashboard

Below
2,083.7



Above
74.70
2 0 11.12
b aseline
Dec-15
Jan-16
Feb-16
1,886.9
1,886.9
1,886.9
(2014)
(2014)
(2014)
Next update Next update Next update
09/2016
09/2016
09/2016
2015
Ambition
1,847
75.70%
2014.15
next update
08/16
2015.16
Ambition
75.80
75.1%
2014.15
75.1%
2014.15
1.25% p/m
or above
1.20%
1.30%
1.80%
15% p/a
Below
Next update Next update Next update
1950
March 2016 March 2016 Sept 2016
2 0 11.12
b aseline
E.A.4.i
E.A.4.ii
E.A.4.iii
E.A.4.iv
Unplanned Hospitalisation for Chronic
ACS Conditions
Unplanned Hospitalisation for Asthma,
Diabetes and Epilepsy
Avoidable Emergency Admissions for
Acute Conditions
Emergency Admissions for Children
w ith LRT Infections

2 0 11.12
b aseline



Below
481.40
(DSR)
2 0 11.12
b aseline

E.A.7
Patient Experience of Primary Care Negative Responses Per 100

E.A.8
Hospital Deaths Attributed to Problems
in Care

E.A.10
One Year Survival from All Cancers

E.A.S.1
Estimated Diagnosis Rate for People
w ith Dementia

E.A.S.2
Improved Access to Psychological
Services (IAPT) Recovery Rate
E.A.S.5
Below
1,082.60
(DSR)
2 0 11.12
b aseline
Patient Experience of Hospital Care Negative Responses Per 100
Healthcare Acquired Infection Measure
(MRSA)
Healthcare Acquired Infection Measure
(Clostridium Difficile)
Below
272.60
(DSR)
2 0 11.12
b aseline
E.A.5
E.A.S.4
Below
668.80
(DSR)
Below
145.80
2 0 12
b aseline
9.6
2 0 11.12
b aseline
YTD
13.90%
2015.16
Ambition
1,921
665.1
July 14June 15 Provisional
data
407.2
data
1,193.0
data
523.8
data
735.6
Oct 2014 to
Sept 2015 Provisional
data
467.7
Oct 2014 to
data
1,195.4
Oct 2014 to
data
549.5
Oct 2014 to
data
144.2
2014
2015 data
due July
2016
2015 data
due July
2016
2015
Ambition
132.0
10.9
2013.14
11.0
2014.15
Next update
TBC 2016
2015.16
Ambition
8.9
661.7
2014/15
443.3
2014/15
1,191.2
2014/15
478.7
2014/15
Indicator in development. Should be published
Autumn 2015 - Not yet out.
NA
NA
NA
NA
NA
67.4%
(2011/12)
68.7%
(2012/13)
70.0%
(2013/14)
NA
66.5% or
above
66.04%
65.13%
64.12%
66.32%

50% or
above
54.70%
66.70%
66.70%
50.90%

0.00%
1
0
1
2

Below 81
PA
3
5
5
59
Above
68.73%
N at io nal
A ver ag e
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10.2 NHS CONSTITUTION MEASURES
Milton Keynes CCG plans to ensure that the requirements of the NHS Constitution are delivered to the local
population. The CCG has put in place robust governance arrangements to ensure that all performance measures
required by the NHS Constitution are delivered and any performance issues addressed with providers in a timely
fashion. This is done through robust monitoring by the relevant Programme Board, with remedial action plans worked
up between providers and each Programme/Lead Manager – overseen through the monthly contracting review
meetings. PMO will oversee the delivery of any remedial action plans that are agreed. Current CCG performance
against these measures is shown below. Performance against the following standards will be reported to the
Commissioning Delivery Group (CDG) every month and CCG Board bi-monthly. The current position with regards to
delivery against these indicators is shown below, measured up to the end of Month 11 (February 2016). Trajectories &
ambitions for 2016/2017 are outlined in Appendix B.
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Enc No 16/22
“Annex B” - NHS Constitution Dashboard
E.B.2
E.B.3
E.B.4
E.B.5
E.B.6
E.B.7
E.B.8
E.B.9
E.B.10
E.B.11
E.B.12
18 Week RTT Admitted Pathw ays
<18 Weeks
18
Week
RTT
Non-Admitted
Pathw ays <18 Weeks
18 Week RTT Incomplete Pathw ays
<18 Weeks
Diagnostic Waits >6 Weeks
A&E Waits Seen Within 4 Hours
(MKUHFT)
Cancer 2 Week Waits -Suspected
Cancer Ref errals (CCG level)
Cancer 2 Week Waits -Breast
Symptomatic Ref errals (CCG level)
Cancer 31 Day Waits -First Def initive
Treatment (CCG level)
Cancer 31 Day Waits -Subsequent
Treatment -Surgery (CCG level)
Treatment
-Chemotherapy/drug
(CCG level)
Treatment
-Radiotherapy
(CCG
level)
Cancer 62 Day Waits - First
Def initive Treatment -GP Ref erral
(CCG level)
Jan-16
YTD
Standard
E.B.1
Description
Aspiration
Metric

90%
80.73%
87.06%

95%
94.35%
95.15%

92%
89.12%
91.20%

99%
98.51%
99.10%

95%
92.6%
94.50%

93%
93.06%
95.34%

93%
100%
93.95%

96%
97.18%
98.23%

94%
94.74%
95.86%

98%
100.00%
98.99%

94%
87.50%
96.78%

85%
70.45%
82.22%
E.B.13
Cancer 62 Day Waits -Treatment
f rom Screening Ref erral (CCG level)

90%
100%
94.12%
E.B.15.i
Ambulance Clinical Quality -Category
A (Red 1) 8 Minute - SCAS Level

75%
71.9%
72.20%
E.B.15.ii

75%
71.1%
72.90%
E.B.16

95%
93.80%
94.40%
EIP pathw ays completed (treatment
w ithin 2 w eeks of ref erral)

50%
87.50%
84.73%
EIP pathw ays incomplete

50%
0%
50%

0
0
1

0%
8
63

95%
TBC
(Q4)
98.59%

0
1
4

0
0
0

0
0
0

411
17
432

60
6
41
E.B.S.1
E.B.S.2
E.B.S.3
E.B.S.4
E.B.S.5
E.B.S.6
E.B.S.7
E.B.S.8
Mixed Sex Accommodation (MSA)
Breaches
Cancelled Operations -Not Seen <28
Days (MKUHFT)
Mental
Health
Measure
-Care
Programme Approach (CPA)
Number of 52 Week Ref erral to
Treatment Incomplete Pathw ays
Trolley Waits in A&E >12 hours
Urgent Operations Cancelled f or a
Second Time (MKUHFT)
Ambulance Handover Delays > 60
minutes
Crew Clear > 60 minutes
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10.3 QUALITY PREMIUM
The quality premium (QP) was introduced in 2013/14 to reward CCGs for improved outcomes from the services they
commission. The maximum payment for a CCG is expressed as £5 per head of population. Quality premiums must be
used to improve quality of care or health outcomes and/or reduce health inequalities. The Quality premium for
2016/17 will consist of 7 measures in total. These will be made up of four national and three local measures reflecting
the quality of health services commissioned by MK CCG in 2016/17. Payment for the 2016/17 QP will be made to
CCG’s in 2017/18. National measures that fall into the Quality Premium this year and account for 70% are shown in
the table below.
National Measure
Description
Cancer
Cancer diagnosed at an early stage (stages 1 and 2)
GP Patient Survey
Overall experience of making a GP appointment
E-Referrals
Increase the proportion of GP referrals made by E-referrals
Improved antibiotic
prescribing in primary care
Antimicrobial resistance (AMR) Improving antibiotic
prescribing in primary care
Part a) reduction in the number of antibiotics prescribed in
primary care
Part b) reduction in the proportion of broad spectrum
antibiotics prescribed in primary care
Milton Keynes CCG takes a whole system approach to delivering the Quality Premium trajectories utilising financial
incentives, contract levers and links with social care to maximised delivery. In 2016/17 it has chosen the following 3
Local Measures which account for 30% of the total:


% of patient returning to their usual place of residence following hospital treatment for a stroke
% of mothers who give their babies breast milk in the first 48 hours after delivery
Reported prevalence of hypertension on GP registers as % of estimated prevalence
Improvement trajectories for each local indicator have been agreed with NHS England and further details are shown in
Appendix A.
10.4 QUALITY & CQUINs
Milton Keynes Clinical Commissioning Group (MKCCG) seeks to commission the best possible healthcare within
available resources, with a focus on reducing health inequalities and improving outcomes within the local population.
The CCG is committed to continuously improving the quality of care provided to people regardless of setting through a
range of activities and interventions. The three elements of quality; patient safety, clinical effectiveness and patient
experience, form the basis of all commissioning decisions, in order to ensure that services deliver the best outcomes
for our community. The CCG uses a range of data to ensure the approach to quality is comprehensive. Independent
sources of assurance include:
National and statutory guidance
Links with regulators including Care Quality
Commission and Monitor Reports
Recommendations as a result of national reports and Internal Audit annual review of clinical quality
enquiries
processes
National benchmarking data
Safeguarding Children and Adult Boards
Clinical network intelligence
NHS England assurance processes
Royal College audits and peer reviews
Social Care
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Enc No 16/22
The following activities have been identified to improve the quality of commissioned services for the population of
Milton Keynes.
Transforming Care for People with Learning Disability and Autism
Following the publication of the Department of Health’s report ‘Transforming Care: A national response to
Winterbourne View Hospital’ in December 2012, a significant amount of work has been undertaken to make
improvements in the care and services available for people with learning disabilities and/or autism spectrum
disorders. In Milton Keynes the CCG has been working in partnership with NHS England, Local Authority, people with
learning disability and autism, their carer’s and providers to reduce the numbers of people who are cared for within
hospital environments. This has delivered significant progress in responding to learning from Winterbourne View.
For individuals, Care and Treatment Reviews (CTRs), as set out in ‘Care and Treatment Review: Policy and Guidance’
October 2015 have been carried out with all people who are inpatient. A Milton Keynes operational ‘Winterbourne
View Assurance Meeting’ has been in place since 2014, to track progress of individuals’ care and their discharge plans.
In 2015, this group extended the brief to include review of those people at risk of admission, introducing a process of
pre-admission CTR’s.
Following the publication of the national plan ‘Building the Right Support’ Oct 2015 MKCCG has established with Luton
and Bedfordshire, a Transforming Care Partnership. Local Authorities, Clinical Commissioning Groups (CCGs) and NHS
England specialised commissioners from this geographic footprint are working together to build up community
services and close unnecessary inpatient provisions over the next 3 years and by March 2019. This strategic
partnership brings together expertise and resources to develop a service model to meet the complex needs of this
group of children and adults.
Milton Keynes CCG has established a local Transforming Care steering group to drive the Milton Keynes elements of
this work. This feeds up to the Transforming Care Partnership Board and reports to the MKCCG Mental Health and
Learning Disability programme Board. Both the Milton Keynes Transforming Care steering group and the Transforming
Care Partnership benefit from inclusion of services users and carers with lived experience.
Improving access to mental health services
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Significant progress had been made at CCG level in terms of dementia diagnosis rates and we will continue to improve
performance associated with the Prime Ministers challenge of a 66.7% diagnosis rate for people with dementia during
2016/17. In addition an implementation plan will be agreed to improve post diagnostic support for people and their
carers. This is currently included in the list of commissioning intentions for 2016/17 subject to the outcome of the pilot
evaluation.
The CCG Joint Commissioning colleagues continue to improve access to mental health services in collaboration with
providers, to implement the locally agreed Mental Health Strategy 2014-17. This includes meeting the new mental
health standards relating to people with the first episode of psychosis commencing treatment within 2 weeks, and
ensuring people with common mental health conditions referred to Improved Access to Psychological Therapies (IAPT)
programme within six weeks of referral and treatment within 18 weeks. This will be achieved through the existing
Mental Health Programme Board.
Safeguarding vulnerable people
Our population has a right to live free from harm and abuse. Safeguarding must be at the core of Health service
provision and reflected throughout our vision, priorities, values, aims and the delivery of healthcare. MKCCG’s
approach to safeguarding is to make it integral to all aspects of commissioning through:
 Working in partnerships
 Seeking assurance that all our providers are delivering safeguarding responsibilities
 Supporting all our providers to continually improve their safeguarding.
Specific areas of work to align with the CCG and safeguarding partnerships priorities are:
 Development of care homes and domiciliary care – prevention of safeguarding concerns and enabling care
closer to home
 Involving people – hearing voices from those with lived experience of safeguarding
 Developing safeguarding practice within Primary Care
 Development work on the Local Safeguarding Board priorities
Person centred care and support, which is personalised, co-ordinated and empowering
Personal health budgets (PHB) are a new tool to increase individual choice and control within the NHS as part of the
mandate to increase the role of patients as partners in the management of long-term conditions. During 2016/17
Milton Keynes Clinical Commissioning Group will develop personal health budgets for children with special educational
needs and disabilities, adults and children with learning disabilities. During 2016/17, Personal Health Budgets will be
included as part of the Joint Transformation Plan developed through the Transforming Care Partnership between
Bedfordshire, Luton and Milton Keynes (BLMK).
Focus on equality and narrowing inequalities
We will ensure our quality priorities are aligned to the current and future health needs identified within the Joint
Strategic Needs Assessment and are consistent with the Health and Wellbeing Board strategic priorities. All contract
negotiations to improve quality take place in collaboration with other partner commissioners, social care partners,
public health and clinical networks, to ensure a whole system approach to delivering improvements is in place.
Contracts with providers ensure the delivery of improved local outcomes for patients and reduce inequitable access to
healthcare.
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Actions to address unwarranted variation in health care are incorporated into the clinical commissioning process. The
primary care web-tool is used to review GP practice outcome indicators and to identify where there may be variations
in for example, cancer survival or A&E attendances, and reasons behind variation is explored and progressed within
the GP locality teams. All CCG plans and commissioning decisions are quality and equality impact assessed to ensure
that equality and health inequality issues are addressed in the local population. Community engagement relating to
proposed service changes takes into account the needs of disadvantaged groups.
The CCG will continue to undertake pathway redesign to address unwarranted variations locally relating to diabetes,
cancer and mental health specialties, whereby ensuring that what is known to be clinically effective happens in
practice. The CCG will progress the implementation of the Equality Delivery System (EDS2) within commissioning and
provider settings to improve the services provided for our local community and offer better working environments
free from discrimination for both staff and users.
Services are created in partnership with citizens and communities
The CCG has a regular programme of engagement in place with Healthwatch and a number of other forums and user
groups. The CCG Patient and Public Engagement strategy provide a framework for engaging with patients, the public
and key stakeholders. To support the delivery of this strategy the CCG will establish a set of principles for future
engagement, streamline the current structures and embed engagement more firmly into the CCG’s governance
structures. A Public and Patient Engagement Steering group has been established which will set objectives to improve
engagement over the next year.
Improving Patient safety
The CCG is committed to supporting providers to reduce avoidable adverse events, ensuring learning is maximised
when adverse events occur, and that learning is embedded to ensure that risk of harm to patients is minimised. CCG
Governance processes have been reviewed in relation to patient safety incidents in line with new national guidance.
The CCG provides leadership in reducing avoidable harm to patients and has established risk management and patient
safety process with providers. All serious incidents are reported and analysed, and action plans associated with the
root causes of the incident are agreed. Monitoring of implementation of actions plans takes place to ensure that
lessons are learnt and embedded within organisations to deliver sustainable improvements in patient safety. A clear
focus on patient and carer involvement, and full integration of learning across provider settings has strengthened the
ability of the CCG to oversee the development of sustainable, patient focused and whole system improvements.
Mechanisms are embedded within provider contracts linked to Commissioning for Quality and Innovation (CQUIN) and
Quality Schedules to further reduce patient harm, for example linked to sepsis and the management of acute kidney
injury and implementation of the catheter care bundle. Zero tolerance of never events is established. The CCG
reviews processes design with providers during quality visits to ensure that safer design of systems, such as use of the
WHO checklist, mitigate against the risk of human factors impacting on patient safety. The CCG and the two main
providers have signed up to the Sign up for Safety campaign, and have aligned patient safety objectives to deliver
whole system safety improvements.
The CCG will work collaboratively with all providers to develop a clearer understanding of how system failures and
culture and behaviour influence patient safety incidents through an open examination of human factors in relation to
patient safety. Providers are supported to develop a positive safety culture by being open when incidents occur,
ensuring staff are comfortable with the reporting system, treating staff fairly, maximising learning, and identifying and
mitigate future incidents. The CCG will further develop this culture of learning by working collaboratively to providers
through an open and engaging process to maximise learning across the wider health and social care setting in order to
improve care for all service users.
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Reducing health care acquired infections
The CCG has strengthened systems to reduce health care associated infections through the investment in further
Infection, Prevention and Control expertise. Route Cause analysis of Clostridium difficile Infections is fully embedded
within the acute trust, this includes processes for identifying and sharing key learning. A similar process has been
rolled out in primary care settings. This will enable the CCG to identify themes and key learning from any identified
lapses in care. The CCG will maintain a focus on prudent antibiotic prescribing is a key focus for reducing C Difficile
infections and antibiotic resistance across all care settings. Antimicrobial prescribing and resistance rates will continue
to be monitored to ensure that measurable improvements are in place. A whole health economy infection control
committee will continue to meet regularly and works closely with Public Health teams to ensure key mechanisms are
in place to identify, monitor and achieve health economy wide objectives linked with national priorities.
Reducing avoidable deaths
The CCG has established mortality governance processes and worked closely with Public Health and MKUHFT since
April 2014 to understand Hospital Standardised Mortality Ratios (HSMR) and Summary Hospital Level Indicators
(SHMI). In doing so a morality rates have reduced and whole system risks in terms of increase mortality rates are
understood and mitigated through commissioning processes. Going forward the CCG will support MKUHT in the
review of avoidable deaths using the standardised national tool to ensure action is taken to prevent future deaths. In
addition specific measures for quality such as adherence to good practice guidance, disease specific outcomes, patient
and staff surveys and infection rates will be used to inform improvements actions. The CCG now hosts the CDOP coordinator and has reviewed the child death overview processes. This will strengthen the identification of modification
factors in child deaths and support the continued reduction in avoidable child deaths in Milton Keynes
Improving maternity services
The Morecambe Bay Investigation was established following concerns over serious incidents in the maternity
department at Furness General Hospital (FGH). The report concluded that cultural issues and serious failures of clinical
care led to unnecessary deaths of mothers and babies. Existing governance arrangements are in place to oversee the
quality of the maternity services at MKUHT, in the form of an executive led Maternity Improvement Board with CCG,
CQC and Monitor representation. This Board will continue to oversee the implementation of the agreed
recommendations of the National Maternity Review in relation to safety, outcomes and experience within maternity
units and progress will be reported the CCG Quality Board.
Ensuring sustainable staffing models within provider settings
The CCG works closely with all providers to gain assurance that safe staffing levels are in place and that plans to
reduce agency spend are being rolled out. The CCG will work with providers to implement the refresh of the national
sustainable staffing guidance for midwifery, nursing and care staff across all provider settings. This will enable the CCG
to actively seek assurance about the level of safety linked to staffing capacity and capability. The CCG adopts a
triangulated approach to determining risks to patients in relation to staffing levels, including incident reporting,
incidence of pressure ulcers and falls, complaints and staff feedback. Further assurance in relation to patient safety
linked to staffing levels is a component of quality assurance visits.
Developing 7 Day services
A key element of providing clinically effective and safe services is to ensure that providers work towards delivering
seven day services. In line with national guidance the CCG is working with providers to focus on the four key elements
of 7 day services including, time of clinical review, and access to diagnostics, access to consultant directed
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Enc No 16/22
interventions and access to ongoing reviews. The CCG is initially focusing on urgent and emergency care by
redesigning pathways, and on relevant specialties to ensure that access to services is improved for the local
population. Included within this is 7 day service access for End of Life care.
Improving patient and carer experience
The CCG sees the patient experience data as central to determining the quality of care provided to the local
population, and is committed to using systems and processes for capturing, understanding and improving patient and
carer experience, to create and improve care for individuals, families and carers. The CCG’s works with providers,
patients, carers and community stakeholders to strengthen the collection of a range of patient experience
information. The reporting and triangulation of this information is used to influence commissioning decisions and
inform improvements in care which deliver patient centred outcomes with an emphasis on vulnerable and
disadvantaged groups.
Patient and carer experience is a central component of all quality visits. We will build upon the CCG use of Experts by
Experience in our Winterbourne View monitoring visits by investing in a Patient Leadership programme and regular
mystery visit programmes. A further priority will be working with local GP surgeries and Patient Participation Groups
(PPG’s) to improve patient experience in primary care recognising that the quality of primary care services impacts on
care pathways for both acute and long term conditions.
Young carers are identified as a group with specific needs within the Children and Young People’s Mental Health and
wellbeing Local Transformation Plan (CAMHS LTP). The CAMHS LTP 5 year programme in place seeks to improve
outcomes for children, young people and families with mental health and emotional needs through transformation of
the pathway. Young carers will benefit from the overall improvement to the pathway but also from some targeted
work looking at the needs of a number of specific groups of vulnerable children and young people who are hard to
reach.
2016/17 a plan will be developed for improving patient choice relating to maternity services. The End of Life Steering
Group will be rolling out the implementation plan for the MK End of Life Care strategy linked to improving choice
relating to end of life care and place of death, and achieving the preferred place of death. This will include increasing
EOL training and education and access to 24/7 care, development of existing 24/7 advice and support, a reduction in
inequalities of service provision and improved coordination between care providers. Building on the Friends and
Family Test the CCG will work with providers to ascertain how feedback drives improvements in services at ward level.
Improving patient outcomes
The CCG membership ensures that clinical effectiveness and continuous quality improvement is at the heart of the
CCG quality and commissioning plan. GP programme board chairs and clinical representation at programme boards
ensure that the transformation agenda is clinically led, reflects evidence based practice and is outcome focused.
We want to ensure that the local community is provided with the most up to date clinical models of care associated
with the very best outcomes. This is achieved through the search for and application of innovative models of care
based on the NHS Outcomes Framework, and guidance from NICE and other clinical bodies. In order to support this,
the CCG is an active member of relevant strategic clinical networks and has developed links with Academic Health
Science Network to enhance and progress the application of evidence-based research into local practice. During
2016/17 the CCG will work with the Thames Valley Stroke Strategic clinical network to review how standards of stroke
services can be improved across a larger population footprint.
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Supporting people to live healthier lives
The CCG works closely with Public Health to improve the overall health of the population through the establishment of
an equalities and health inequalities working group. Within provider contracts there will be a requirement to embed
the principles of Making Every Contact Count (MECC) within care settings particularly in relation to lifestyle
improvements linked to obesity, smoking and alcohol.
Workforce development
The CCG has considered the Health Education England Mandate, the Five Year Forward Plan, and local commissioning
intentions in terms of identifying the future workforce needs.
We are working with the local LETB and providers to ensure that a whole system strategic workforce plan is developed
for Milton Keynes, to ensure clinicians have the skills necessary to practice in different settings, and reflect values of
behaviours to deliver compassionate patient centred care. The CCG will work with providers to determine how more
productive use of existing staff can improve care, and how the skills of the existing workforce skills can be exploited
for the benefit of service users.
Developing leadership for Quality
We have a duty to lead, drive and secure continuous improvement through the services we commission ensuring that
high quality care is central to all commissioning decisions. In order to achieve this we will ensure that the potential of
all staff is maximised through the appraisal and personal development plan process. Individuals are supported to
undertake leadership programmes to work effectively across the health and social care system. The CCG will continue
to lead whole system change including the development of joint outcome measures delivered across organisational
boundaries. This is achieved through the CCG leadership of a number of health economy wide groups focusing on
mortality, tissue viability, health care acquired infections and learning from incidents. The CCG will work
collaboratively with a number of partner agencies including the Local Authority, neighbouring CCG’s, NHS England
Regional teams, Monitor the Trust Development Authority and the CQC, and be active members of the Health and
Wellbeing and Safeguarding Adults and Safeguarding Children’s Boards.
Achieving cultural change
A collaborative approach is taken with providers to support a culture of learning and patient focused care and
compassion, with patients at the heart of decision-making. This values based approach we believe will embed
sustainable quality improvements and support innovation. A proportionate approach is adopted when areas for
improvement are identified including the use of contractual levers when formal recovery plans are required.
Improving Staff Satisfaction
The CCG is aware of the links between staff satisfaction and patient care and will continue to work with providers to
drive improvements in staff satisfaction. Staff satisfaction is a critical element of all quality visits. National staff survey
results will continue to be monitored and benchmarked against other similar providers and used within the
triangulation of evidence to inform commissioning decisions. Performance against implementation of the staff friends
and family test across all services are monitored, and providers supported to implement improvements as required.
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Proportionate use of contractual levers to support quality improvements
The national contract is used to support local quality improvements. The CCG emphasises innovation and critical
interventions which improve outcomes for patients through the CQUIN schemes. MK CCG incentivises providers to
deliver the national CQUINs and negotiates the agreement of local CQUINs to support improved outcomes based on
local needs. Local CQUINs are linked to mental health support for people following a stroke and those with COPD;
breastfeeding initiation, supporting earlier discharge from hospital; child friendly services and improved patient safety.
CQUIN payments are profiled to incentivise initiatives that reduce overall risk to patient safety and support innovation.
Locally agreed quality schedules are linked to the outcome goals and indicators in the NHS Outcomes Framework
domains. They have a strong emphasis on measuring and improving patient safety, experience and outcomes. Should
the required outcomes fail to be delivered we will work collaboratively with providers to make improvements and
use contractual levers if required in the form of joint reviews, the development of recovery action plans or the
application of appropriate penalties. The Quality & Outcomes Framework is implemented in primary care based on
the nationally set portfolio of indicators. Performance is monitored through locality teams and reported to the quality
committee. Payments are made to GP practices based on points achieved and performance is published on line.
Governance arrangements
All providers are held to account for the delivery of quality improvements. For the two main providers the CCG
governance arrangements have reporting to the Quality Committee and provider Clinical Quality Review Meetings
(CQRM). The CQRM meets monthly as an operational group and quarterly as a strategic group. The strategic meetings
are to gain assurance and hold providers to account, while the operational meetings are to provide an opportunity for
the CCG Quality team to support providers to deliver the required improvements. Quality contract monitoring, and
reviews of CQC Quality and risk profiles takes place at the strategic CQRM. The CCG will continually develop reporting
to the CQRM to ensure that all provider quality issues are robustly monitored. This will in turn refine reporting to the
quality committee and subsequently to the CCG Board and the Quality Surveillance Groups. The delivery of CQUINs
will be closely monitored to drive up quality of care through the achievement of challenging but realistic outcomes.
Assurance mechanisms
The CCG receives regular assurance that existing services meet acceptable standards, through the triangulation of a
range of information including both hard and soft data from a number of sources. These include independent
information sources, provider visits, evidence of historic progress, monitoring of outcomes, interactions with patents’
and carers, and provider dashboard reporting. A range of nationally published information is also scrutinised and
monitored at provider and CCG level against the NHS Outcomes Framework, NHS Constitution, Local Priority
indicators, patient safety, quality and experience measures, the Quality Premium and the CCG assurance framework.
We will continue to utilise relationships and interactions with other regulators or agencies to be alert to concerns and
drive improvements. The CCG will continue to have active clinical participation in Quality Surveillance Groups.
Concerns about the quality of care provided are raised either through the CCG governance arrangements or directly
with providers using a transparent supportive approach to achieving improvements.
Measuring and publishing quality
Continuous improvement is aided through effective measurement. The CCG, based on transparent relationships with
providers, requires providers to share robust, relevant and timely information. Information published nationally is
reported monthly. This information will be shared and published by the CCG to ensure accountability and support
patient choice.
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11. Commissioned Activity Plan
In line with national guidance, the CCG has ensured that its activity planning has been undertaken using an ‘openbook’ methodology, taking account of 15/16 demand, available capacity, overall financial sustainability and the
implications on activity of commissioning intentions and transformation initiatives planned by each Programme Board.
An overall summary of these plans are outlined below, and later within Section 12. Detailed activity plans have been
submitted via the nationally mandated UNIFY returns.35
11.1 PLANNING ASSUMPTIONS
The following planning assumptions have been taken into account when preparing the CCGs Activity Plan for
2016/2017:






2016-17 Baseline is based on Month 10 data multiplied by 12/10ths
Whilst it was not available at the time of developing our activity plans the IHAM (Indicative Hospital Activity
Model) has been utilised as a guide to help sense check the plans. It would be the aim to use this more fully as
a planning tool in the future to support our internal Programme Boards as they develop future initiatives
The Demand & Capacity Planning tool has been used in a similar way
Population growth modelling has been applied at age specific rates to patient level data, averaging at 1.98%.
The data used is from the Mk Observatory, a Council led data source which provides a more up to date
forecast of the population growth rates.
Further demand growth averaging at 1.5% has been applied. This aligns with the Bedfordshire / Milton Keynes
Healthcare Review planning assumptions. Aligned with this the CCG has increased activity to meet the backlog
for delivery of RTT in 2016-17
QIPP reductions reflect current plans listed in Section 7 above and include:
o Outpatients reductions predominantly Ophthalmology project
o Non Elective admissions predominantly BCF
o A&E reductions predominantly Integrated Urgent Care
o Non Elective excess bed days predominantly Getting People Home programme
There is alignment between the CCG Activity Planning and the contract offers submitted to providers. The
CCG has agreed and signed contracts with our main acute Provider MKUHFT and the other independent
sector contracts that the CCG leads on.
11.2 ACTIVITY PLAN
The table below shows projected activity changes for MK CCG between 2015/16 and 2016/17.
35
MK CCG UNIFY Returns: CCG Monthly Activity & Other Requirements: Annual Activity ProvComm; Financial Plan; Operational
nd
Resilience Template, 2 March 2016.
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Non-recurrent activity
changes
Underlying trend and
demographic growth
Transformational change
Policy changes
E.M.2
E.M.3
E.M.4
E.M.5
E.M.6
Apply the impact of
transformation / allocative To capture the impact of
CCG 15/16 Forecast To capture the effect of for To capture any additional
efficiency. To include for
new policies, for example 16/17 Annual Plan
outturn
example, changing
activity as a result of
example: NCMs, UEC,
hospital 7 day services;
definitions, boundaries,
changes in population and
RightCare, Prevention, Self primary care access, Cancer,
reporting standards.
underlying changes in trend
care and procedures of
Mental Health.
limited clinical value.
0
Consultant Led First Outpatient Attendances (Total Activity)
97,603
0
3672
-5112
0
96,163
Consultant Led Follow-Up Outpatient Attendances (Total Activity)
113,283
0
4522
-5226
0
112,579
Total Elective Admissions (Spells) (Total Activity) [Ordinary Electives + Daycases ]
27,816
0
1044
-54
-157
28,649
Total Non-Elective Admissions (Spells) (Total Activity)
30,880
0
1065
-1362
297
30,880
Total A&E Attendances
70,958
0
2433
-7896
0
65,495
E.M.8
E.M.9
E.M.10
E.M.11
E.M.12
Consultant Led First Outpatient Attendances (Specific Acute)
Consultant Led Follow-Up Outpatient Attendances (Specific Acute)
Total Elective Admissions (Spells) (Specific Acute) [Ordinary Electives + Daycases ]
Total Non-Elective Admissions (Spells) (Specific Acute)
Total A&E Attendances excluding planned follow ups
93,166
104,832
27,768
24,747
70,544
0
0
0
0
0
3510
4193
1125
928
2418
-5112
-5226
-54
-1362
-7817
91,564
103,799
28,601
24,747
65,145
0
0
-238
434
0
Activity changes relating to individual QIPP schemes are shown below in more detail. Financial implications of each
are also recorded against each individual commissioning intervention shown within the tables in Section 7 –
Transformation & Delivery above.
Activity reductions for QIPP schemes
Scheme
CCG Ref
No.
Workstream
Scheme Name
TOP 5 SCHEME: DATA COMES FROM WORKSHEETS
1
PC15
Care Pathway & Ophthal mol ogy Managed Care
Pri mary Care
End to End Pathway of care Tri al
2
UC4
Urgent Care
3
UC10a
4
CM25
5
BCF
10
PC10
11
PC30
12
PC34
14
LTC3a
15
PC31
16
UC13a &
UC12b
Day Case
Elective Spells
Non Elective
Spells
Ordinary
Elective Spells
2016/17 Activity
Consultant
Consultant
Led First
Led Follow up
outpatients
outpatients
A&E
Attendances
0
0
0
-4,501
-5,080
0
Other Acute
Community
Based
-5,514
13,993
3,934
0
0
0
0
0
-6,664
0
Getti ng Peopl e Home Discharge to Assess
Chi l dren, Young Cari ng for Chi l dren Cl oser to
Peopl e &
Home
Better Care Fund Better Care Fund
0
0
0
0
0
0
-5,010
0
0
-468
0
0
0
-816
0
816
0
-884
0
0
0
0
0
0
Care Pathway
Pri mary Care
Care Pathway
Pri mary Care
Care Pathway
Pri mary Care
Care Pathway
Pri mary Care
Care Pathway
Pri mary Care
Urgent Care
0
0
0
-215
-146
0
0
361
Urgent Care
&
&
Direct to Test Oscopi es- Gastro
PCOC
Day Case to OP Shi ft
-54
0
0
54
0
0
0
0
0
0
0
-165
0
0
0
165
&
Outpati ent Procedures transfer
to PCOCs
Communi ty DVT pathway
0
0
0
-112
0
0
-112
224
&
COPD
0
-10
0
-173
0
0
0
0
Managi ng ED Demand
0
0
0
0
0
-416
0
0
-54
-1,362
0
-5,112
-5,226
-7,896
-10,636
19,493
&
Further work is underway to refine activity plans to reflect the further QIPP stretch agreed within the financial plan.
11.3 RISKS AND MITIGATION
This plan incorporates a number of risks which could impact on the delivery of the proposed activity plan shown
above. These include:



Managing demand from primary care
Delivery of QIPP schemes and transformation projects
Further development and expansion of hospital services by the Provider
Rate of population growth within Milton Keynes
To mitigate, the CCG has



Embedded QIPP schemes in Provider contract activity plans
Included assumptions for population and demand growth within contract activity plans
created a Demand Growth reserve
In addition the CCG will be closely monitoring on a monthly basis against the plan and will use contractual levers to
implement activity management plans in-year with providers were appropriate.
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12. Sustainability & Finance
The NHS continues to face a period of unprecedented change and financial challenge, thereby increasing the need for
both commissioners and providers to deliver both improved productivity and quality, but also to ensure that resources
are targeted as effectively as possible to maximise patient treatment and care. Milton Keynes Hospital Foundation
Trust, the main acute provider, is seriously financially challenged and the main community & mental health provider is
also under financial pressure. The CCG also incurred significant financial pressure during 2015-16 and whilst the draft
accounts report delivery of the planned surplus for the year, this has required a number of measures including nonrecurrent interventions to achieve this position. Given the level of financial challenge across the whole system the
financial strategy requires a whole system approach which aligns with the latest planning guidance from NHS England
regarding STPs, to ensure sustainability and continuity of services for Milton Keynes residents.
The updated planning guidance for CCGs was issued in December 2015, along with refreshed financial allocations to
CCGs for the next five years. Milton Keynes has again benefited from a high level of growth in 2016-17 of £16.8m,
however the % increase drops significantly during the next three years so it is important that this first year of the five
year plan is a year of stability bringing the system back into financial balance. We have used the planning guidance to
refresh the 5 Year Financial Plan. The strategic implications for the CCG of this are outlined below.

The CCG has received a programme allocation of £295.6m in 2016-17 which includes £16.8m growth funding
(6.01% uplift). The national average growth is 3.74%. Allocations for the next four years have also been
announced (last two years indicative) although the uplift reduces significantly in future years.

All CCGs have been brought within 5% of their target allocations. MK CCG is now within 3.93% away from its
target allocation after growth in 2016-17.

The running cost allocation remains at £5.9m, the same as 2015-16.

There is a continued requirement to contribute part of this funding allocation to the system wide Better Care
Fund (BCF). The total minimum contribution for 2016-17 is £14.392m

After modelling the planning assumptions released in December the CCG anticipates a net QIPP target of
£7.3m (2.5%) in its Programme Budgets in 2016-17 and the target over the next five years is £37m. The high
level of growth in allocation funding has been more than offset by the underlying pressure brought forward
from the previous year and additional planning requirements. There is a further £0.3m pressure in running
costs.
12.1 PLANNING ASSUMPTIONS
The following planning assumptions have been notified by NHS England and factored into the CCG plan:




The CCG plans to deliver a 1% surplus on its budget
1% of the allocation has been set aside for non-recurrent reserves and 0.5% for general contingency
Sufficient funding has been earmarked to ensure parity of esteem for mental health services at 6.01% growth.
The actual growth over 2015-16 appears higher due to the slippage on in 2015-16 on parity of esteem
investments.
Funds have been re-instated for GP IT, Camhs national initiatives and PbR tariff uplift which were all funded
through separate NHSE allocations in 2015-16
Total funding of £15m including social care grants will be pooled with the Local Authority in the Better Care
Fund.
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





The national tariff assumptions are based on draft PbR guidance. These currently assume a general net 1.1%
uplift in Provider tariffs and circa 1.8% uplift on average in the acute PbR tariffs.
MRET for emergency admissions to continue at 70% rate, but budgeted for re-investment of any rebate.
Plans also assume that the Re-admissions penalty will continue, although no other penalties have been
planned for.
Current arrangements for CQUIN to continue
The activity plans include investment of £1.4m to meet the constitutional standards
The running cost allocation has been maintained
Local assumptions have also been built into the draft plans as follows:-







CCG surplus from previous years will be made available to re-invest non-recurrently in the following year plan
Population and demand growth has been estimated at on average 3.48% in the plan. The CCG has used local
Council held population figures in line with the JSNA. These reflect a more accurate picture on the population
growth for Milton Keynes. The population percentages have been modelled at patient level on hospital activity
reflecting the differing growth levels for each specialty. Demand growth has been built into the activity plans
for the main CCG providers, partly to meet backlog RTT targets. For other providers this is currently held in a
demand reserve.
No additional funds have been set aside for investments other than the national requirements identified
above and the non recurrent Bedfordshire / Milton Keynes healthcare review.
Prescribing growth assumed at 5% per annum plus 2.55% population growth
Continuing Care growth is assumed at 8.37%
Running cost pressures assumed at 2% mainly increases in staff NI costs.
NHS Property service rent increases assumed to be cost neutral
The net impact of the planning assumptions can be seen in the table below
Key Planning Assumptions
Notified Allocation Change (£'000)
Notified Allocation Change (%)
Tariff Change - Acute (%)
Tariff Change - Non Acute (%)
Demographic Growth (%)
Non Demographic Growth - Acute (%)
Non Demographic Growth - Cont.Care(%)
Non Demographic Growth - Prescribing (%)
Non Demographic Growth - Other Non Acute (%)
Mental Health Parity of Esteem
2016/17
16,757
5.9%
1.7%
2.0%
1.8%
1.3%
1.5%
1.5%
1.1%
7.7%
2017/18
7,328
2.4%
0.9%
1.9%
2.3%
1.5%
1.5%
1.6%
1.4%
2018/19
8,519
2.8%
1.0%
2.1%
2.4%
1.5%
1.5%
1.5%
1.4%
2019/20
9,386
3.0%
1.1%
2.3%
2.2%
1.5%
1.5%
1.5%
1.5%
2020/21
15,291
4.7%
1.1%
2.5%
1.6%
1.5%
1.5%
1.5%
1.5%
12.2 FINANCIAL PLAN
Based on the above planning assumptions the table below identifies the anticipated income and expenditure over the
next five years and the more detailed schedule at Appendix C shows the changes year on year.
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Enc No 16/22
Revenue Resource Limit
£ 000
Recurrent
Non-Recurrent
Total
Income and Expenditure
Programme Costs
Running Costs
Contingency
Total Costs
£ 000
Surplus/(Deficit) In-Year Movement
Surplus/(Deficit) Cumulative
Surplus/(Deficit) %
Surplus (RAG)
2015/16 blank1
2016/17
284,810
301,567
4,569
2,880
288,879
304,447
280,695
5,804
286,499
293,950
5,929
1,523
301,402
2015/16
1,867
2,880
1.0%
AMBER
2016/17
165
3,045
1.0%
GREEN
2017/18
308,895
3,045
311,940
2018/19
317,414
3,120
320,534
2019/20
326,800
3,206
330,006
2020/21
342,091
3,301
345,392
301,296
5,964
1,560
308,820
309,727
5,998
1,603
317,328
319,023
6,031
1,651
326,705
334,147
6,063
1,727
341,937
2017/18
2018/19
2019/20
75
3,120
1.0%
GREEN
86
3,206
1.0%
GREEN
95
3,301
1.0%
GREEN
2020/21
154
3,455
1.0%
GREEN
The CCG forecasts delivery of the business rules in each year, although in order to achieve this there is a
requirement for a significant QIPP target. This is despite the higher than average allocation growth. The CCG is
still required to close a QIPP gap which equates to £7.3m in 2016-17 and £37m over the five year planning
period. This is in part due to the underlying pressures brought forward from 2015-16 and also additional
planning requirements for five years which include the following:



Population and demand growth
Requirement to deliver a 1% surplus
Parity of esteem for mental health investment
Requirement to hold aside funds for primary care IT & CAMHS previously funded separately
The table below shows the source and application of the growth funds demonstrating that 6.4% of the total
6.01% growth is required to meet ‘must do’ policy pressures and tariff and demographic growth. In addition
the local requirements to re-instate slippage on investments and reserves used in 2015-16 to support the
bottom line create the QIPP requirement identified above. The CCG has incorporated no new recurrent
investments in 2016/17 into its budget plans other than those required as part of QIPP or those nationally
mandated.
£m
£m
Source of Funds
Programme & Running Cost Allocation Growth
Application of Funds
Camhs Investments
GP IT
Top up for 15/16 tariff
Sub Total Mandated Investments
16/17 Tariff & Other Inflation
Population & Demand Growth
Top up surplus
Sub Total Must Do Pressures
Additional MH top up for Parity of Esteem
Increase in Cquin on contracts
Other Investments (mainly NR Beds / MK HCR)
Reduce Reserves by 1% for 2016-17
Reverse Non Recurrent Benefits from Slippage / Use of Reserves in 15/16
Adjustment for Other Non Recurrent Allocations
Gross QIPP Saving
QIPP Investment
Total Application of Funds
16.9
6.01%
2.0
0.71%
15.8
17.8
6.33%
-0.9
16.9
6.01%
0.5
0.7
0.8
5.4
10.2
0.2
0.3
0.3
1.0
-2.7
7.4
0.3
-10.2
2.7
The bridge chart below further explains the movement between the 2015-16 outturn and the 2016-17 plan.
This is also supported by a table reflecting the actual numbers in Appendix A
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Summary Financial Movements 2016/17
320
£ M's
310
8.6 4.6 1.4 0.3
300
290
280
10.2
0.3 1.5 2.7 0.2
7.2
0.3
7.4
304.5
289.4
2015/16
Plus
Minus
2016/17
Category
Within the above bridge the non recurrent adjustments relating to the prior year reflect the use of reserves,
slippage on investments and non recurrent benefits against contracts that supported delivery of the bottom
line surplus in 2015-16. The budgets affected can be seen more clearly in the bridge table at appendix C. Other
than population and demand growth the investments planned in 2016-17 include:



Camhs National Strategy
NR Beds / MK Healthcare Review Project
Running Cost growth
Other
£0.5m
£0.8m
£0.1m
£0.1m
The underlying surplus can also be seen in the 5 year plan table at Appendix C. This shows a 2.5% surplus for
2016-17 after accounting for the non recurrent reserves, this reduces to 1.9% for the remainder of the 5 years
following the cessation of non recurrent investments for the Bedford/MK Healthcare review project and the
CHC retrospective topslice. These benefits offset the recurrent pressures arising with the reduction in CCG
allocations over these later years.
12.3 FINANCIAL RISKS AND MITIGATION
This plan incorporates a number of risks which could impact on the financial position as follows:





The plan assumes that the CCG will deliver its planned forecast outturn for 2015-16 based on the month
11 reports. If further non recurrent measures are required then this will impact on the underlying financial
position rolling into 2016-17.
The plan assumes that the CCG will deliver its surplus each year going forward and that this funding will be
available non-recurrently in the following year.
The plan assumes that the CCG will deliver its QIPP targets each year and that the further stretch targets
to close the QIPP shortfall in 2016-17 can be mobilised into actions during the year.
If activity and population growth vary from current assumptions then this could impact on the plan. A 10%
variation in the assumptions equates to £970k.
No allowance has been made for support to the financial pressures within the two main providers.
It is assumed that a continued topslice will apply for the CHC provision in 2016-17 and that no further
pressures will arise for retrospective reviews in year.
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





The plan assumes that the Better Care Fund plans will deliver the required shift in expenditure from Acute
settings.
The plan assumes that any changes as a result of co-commissioning will be cost neutral
No allowance has been made to fund the continuation of the PMCF apart from the Paediatric nursing
service.
The plan assumes that the continued expansion of personal health budgets will be cost neutral as a
minimum.
Additional investments will need to be funded from funds set aside for activity and population growth or
dis-investments elsewhere.
It is assumed that the running cost pressures can be managed
The mitigations against these risks include the following:




The financial plan has been set based on outturn from the previous year, assuming existing pressures will
continue and include assumptions for population and demand growth which will not be released in full at
the start of the year
The CCG has reached agreement of contracts with its two main providers for 2016-17 which include
realistic activity plans and embed QIPP plans into those agreements. These are factored into the financial
plan.
For 2016-17 development of a number of the QIPP plans is well progressed and several pathway changes
are in the latter stages of negotiation with providers. The overall QIPP target is just a 25% stretch on
average delivery levels for previous years.
The budgets for prescribing and continuing health care are based on outturn plus realistic growth levels at
7.55% and 8.37% respectively. A 2% QIPP saving have then been applied for prescribing.
12.4 FINANCIAL STRATEGY
The financial plan during this year will focus on:

Delivery of the financial requirements of the NHS planning guidance “Delivering the forward view” to
ensure that there is a sustainable platform from which to move forward

Develop local system medium term financial plans as part of the STP planning process

Ensure real shift within year of resources from Secondary Care to Primary Care and Community Services

Ensure parity of esteem for mental health expenditure is maintained

Appropriate use of financial incentives within contracts in order to drive up quality of services (penalties
will not be applied in line with new guidance).

Aligning CQUINs to the CCG’s key priorities and programme objectives

Development of new mental health funding mechanisms with the Provider in shadow form

Agreeing an appropriate strategy for the commitment of and use of any Transformation Funds in a way
that truly incentivises strategic change and improvement in the quality of services delivered

Ensure that all providers have a demand management commitment i.e. that capacity is taken out as
demand for services is reduced
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Enc No 16/22

Ensure value for money from jointly commissioned funds and resources, particularly the BCF
12.5 QIPP PLAN 2015-2016
The financial plan indicates that the total difference between programme resources available and anticipated
expenditure is £7.3m. This gap has been closed through the development of the CCGs QIPP Plan which includes a
range of schemes across programme areas. In addition the CCG has a running cost pressure of £0.3m, so the total
savings requirements are £7.5m (rounded).
Based on the above financial planning assumptions the table below identifies a summary of the CCGs proposed
QIPP Plan for the year.
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Enc No 16/22
CCG Ref Workstream
No.
Scheme Name
Scheme Type
UC4
Urgent Care
Transformational
Jul-16
548
194
354
UC10a
Urgent Care
Getting People Home - Discharge to
Assess
Transformational
Jul-16
727
727
0
UC13a
&
UC12b
UC13b
Urgent Care
Managing ED Demand
Transformational
Apr-16
44
0
44
Urgent Care
SCAS contractual activity planning
Transactional
Apr-16
375
0
375
NEW
QIPP
Urgent Care
Budget Fl exibilities - Resilience
Transactional
Apr-16
387
0
387
PC15
Care Pathway &
Primary Care
Ophthalmology Managed Care End to
End Pathway of care - Trial
Transformational
Feb-16
1,671
1,283
388
Prescribing
Transformational
Apr-16
1,049
49
1,000
Apr-16
473
0
473
0 Care Pathway &
Primary Care
Start Date
Gross Saving
£000
Investment
£000
Net Saving
£000
NEW
QIPP
Care Pathway &
Primary Care
Non-acute Contracts
Transactional
PC10
Care Pathway &
Primary Care
Direct to Test Oscopies- Gastro PCOC
Transformational
Jul-16
55
31
24
PC30
Care Pathway &
Primary Care
Day Case to OP Shift
Transformational
Apr-16
33
8
25
PC34
Care Pathway &
Primary Care
Outpatient Procedures transfer to PCOCs Transformational
Apr-16
47
23
24
LTC3a
Care Pathway &
Primary Care
Community DVT pathway
Transformational
Aug-15
28
22
6
PC31
Care Pathway &
Primary Care
Respiratory - COPD including home
oxygen
Transformational
Oct-16
188
38
150
NEW
QIPP
Care Pathway &
Primary Care
Diabetes Managed Care Pathway
Transformational
Oct-16
259
206
53
NEW
QIPP
Care Pathway &
Primary Care
Acute Deep Dive Plans
Transformational
Oct-16
1,000
0
1,000
NEW
QIPP
Care Pathway &
Primary Care
Rationalise Primary Care Initiatives
Transactional
Apr-16
549
0
549
NEW
QIPP
Care Pathway &
Primary Care
Funded Nursing care
Transactional
Apr-16
150
0
150
NEW
QIPP
Care Pathway &
Primary Care
Translation Contract
Transactional
Jul-16
15
0
15
NEW
QIPP
Care Pathway &
Primary Care
Out of Area Acute Contracts
Transactional
Apr-16
123
0
123
BCF
Better Care Fund Better Care Fund
Transformational
Nov-15
1,050
0
1,050
CM25
Children, Young
People &
Maternity
Children, Young
People and
Maternity
Children, Young
People &
Maternity
Children, Young
People &
Maternity
Health Care
Review
Caring for Children Closer to Home
Transformational
Nov-15
403
116
287
PAU Tariff
Transactional
Apr-17
Childrens CHC
Transactional
Apr-16
90
0
90
LA Medical Certifi cates
Transactional
Apr-16
10
0
10
HCR Costs moved to capitation share
Transactional
Apr-16
222
0
222
ALL
Baseline Budget Review
Transactional
Apr-16
470
Running Costs
Transactional
Apr-16
260
0
260
10,226
3,124
7,102
2,697
0
2,697
7,529
3,124
4,405
FRP03
NEW
QIPP
NEW
QIPP
NEW
QIPP
NEW
QIPP
0 Corporate
Total QIPP Target
Transactional
Transformational
0
470
41%
59%
Each programme of work is overseen by a CCG Programme Board which includes a range of representatives from
across the local health & social care economy in addition to CCG staff. These Boards will oversee projects from
business case development, through monitoring and up to final evaluation. There are also lots of informal links with
the consultants at MKFT. The QIPP is monitored on a monthly basis through the CDG which includes clinical
representation and reports in to the CCG Board. The Directors also undertook several QIPP challenge events during
2015-16 and plan to do the same for 2016-17. Delivery of the QIPP schemes will be closely monitored on a monthly
basis during 16/17 through the PMO.
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Enc No 16/22
A number of the QIPP schemes have well developed business cases so a full year of savings are anticipated. The
greatest savings relate to the BCF and new community based services went live at the end of 2015 so it is anticipated
that this will result in a reduction of acute emergency admissions. The CCG has just agreed an 18 month pilot managed
care pathway for ophthalmology with Milton Keynes hospital. The service went live in February 2016. Joint work is
also well progressed to transform urgent care services and the hospital has completed estate works in A&E to facilitate
an integrated urgent care service. Negotiations are ongoing regarding the contractual terms for this service change. A
further £1m will be saved through prescribing initiatives in 2016-17.
A detailed phasing of how the QIPP is to be achieved across the schemes is shown in Appendix C.
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Enc No 16/22
Appendix A
Milton Keynes CCG – 5 Year Outcome Ambitions
Ambition 1 (E.A.1): Potential years of life lost from causes considered amenable to healthcare.
Definition:
Rate of potential years of life lost from causes considered amenable to healthcare.
Numerator:
Annual ONS avoidable mortality for England.
Denominator: ONS mid-year population estimates of the relevant age group and gender.
Baseline year: 2012
(Note that this is a Quality Premium indicator in 2015/16).
E.A.1: Potential Years of Life Lost (PYLL) through Causes Considered Am enable to Healthcare
PYLL from causes considered amenable to healthcare - persons (all ages) (OF 1a) (directly standardised)
Indicator
2
3
4
5
6
7
8
9
10
11
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
1,865
1,847
1,828
1,810
1,792
2,964
2,984
2,805
2,441
2,669
Persons Females
Males
Planned Rate
Years of life lost
GP registered population
134,408 134,408 134,408 134,408 136,019 276,088
Rate
2,401
2,432
2,255
2,048
2,103
Years of life lost
2,232
2,253
2,416
2,137
2,114
1,782
1,837
1,933
1,805
1,675
Years of life lost
5,197
5,237
5,221
4,578
4,783
Rate
National average
CCG rank
2,400
133,566 133,566 133,566 133,566 135,309 137,834
Rate
4,672
2,271
267,974 267,974 267,974 267,974 271,328 138,254
2,077
2,135
2,097
1,927
1,886
2,262
2,182
2,079
2,001
2,303
100
101
105
73
74
Comments: To achieve this element of the 2015/16 Quality Premium, the CCG must achieve a reduction of no less than
1.2% in the rate of potential years of life lost from amenable mortality between 2012 and 2015.
72
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Ambition 2 (E.A.2): Health-related quality of life for people with long-term conditions.
Definition:
Average health status (EQ-5D) score for individuals who identify themselves as having a long-term
condition.
Numerator:
The sum of weighted EQ-5D values for all responses from people identified as having a long term
condition.
Denominator: The weighted count from all people identified as having a long term condition.
Baseline year: 2012
Indicator
2011/12
2012/13
2013/14
Planned Rate
2014/15
2015/16
2016/17
2017/18
2018/19
75.5
75.8
76.1
76.4
76.7
Weighted EQ-5D values
1,592
1,576
1,463
1,396
Weighted responses
2,133
2,096
1,941
1,856
Total EQ-5D per 100 LTC patients
74.65
75.19
75.37
75.70
72.89
73.12
73.00
74.30
National average
Comments: The data source for this indicator is the HSCIC website.
73
Enc No 16/22
Ambition 3 (E.A.4): Composite measure on emergency admissions.
Definition:




This is a composite measure of:
Unplanned hospitalisation for chronic ambulatory care sensitive conditions.
Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s.
Emergency admissions for acute conditions that should not usually require hospital admission.
Emergency admissions for children with lower respiratory tract infections.
Numerator:
Includes any admission matching the criteria in any of the 4 individual indicators published by the
HSCIC.
Denominator: The sum of population registered with each CCG’s practices, October 2013.
Baseline year: 2012/13
Time period
Actual
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
Ambition
1,879
1,927
1,950
1,926
2,119
1,980
1,924
% Difference
2.9%
The chart above plots the proposed trajectory to reduce the growth in emergency admissions. Data source: Levels of
ambition tracker
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Enc No 16/22
Ambition 4 (E.A.5): Patient experience of hospital care.
Definition:
Patient experience of hospital care, as reported by patients to the CQC inpatient survey.
Numerator:
Total number of ‘poor’ responses.
Denominator: Total number of respondents to the survey questions.
Baseline year: 2012
Time period
Actual
2012
2013
2014
Ambition
145.8
130.0
144.2
138.6
% Difference
4.0%
Comments: The latest available data places MKHFT in the top decile of providers based on ‘poor’ hospital experience.
The planned rate will improve patient experience to the current national average by the end of 2018/19. Data source:
Levels of ambition tracker
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Ambition 5 (E.A.7): Composite indicator comprised of i) GP Services ii) GP Out of Hours
Definition:
Rate of responses of either ‘fairly poor’ or ‘very poor’ experience across General Practice and Out of
Hours services per 100 patients.
Numerator:
Total number of responses of either ‘fairly poor; or ‘very poor’ experience.
Denominator: Total number of respondents to the survey questions.
Baseline year: 2012
Time period
Actual
2012/13
2013/14
2014/15
Ambition
9.8
10.9
11.0
% Difference
9.3
18.6%
Data source: Levels of ambition tracker
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Enc No 16/22
National Target 1 (E.A.3): IAPT Roll-Out
Definition:
The proportion of people that enter treatment against the level of need in the general population i.e.
the proportion of people who have depression and/or anxiety disorders who receive psychological
therapies.
Numerator:
Total number of people who receive psychological therapies.
Denominator: The number of people who have depression and/or anxiety disorders.
77
Enc No 16/22
Local Quality Premium Target:
Quality Premium Local Measure 1
Please select a measure from the drop down below
12 - Circulation - % of patients returning to usual place of residence following hospital treatment for stroke
Please describe the 'Other' measure - 1000 characters remaining.
TRUE
TRUE
FALSE
TRUE
QP Local Measure 1 - Locally agreed target
Please provide the agreed level of improvement - 422 characters remaining.
TRUE Suggested target - 75%
The available historical data shows that over the last 4 years the % value fluctuates. The last reported MK figure was 74.12%. The figure in 2012/13 appears to be an outlier; therefore the target of 75% is
suggested due to the fact that the number of people related to this measure are very small (approximately 13 per month) and Milton Keynes are currently carrying out an end to end pathway review of Stroke
services which will impact achievement.
Historical data -
24 - Maternity - % of mothers who give their babies breast milk in the first 48 hours after delivery
TRUE
TRUE
FALSE
TRUE
TRUE Suggested target - 75%
The Average across 2014/15 for MK was 73% in MK. The England average in Q1 is 73%. England average for 2014/15 was 74% however, due to Q1 drop, 75% for MK is a stretch target as it is unclear if this was
an anomaly or if this is a downward trend for 2016/17.
Breastfeeding initiation has also been selected as a 2016/17 CQUINN measure to drive improvement amongst MK Providers. It is considered an important and relevant measure for the “young” population of
Milton Keynes. Breastfeeding has a number of health related benefits for both mother and child and longer term health related conditions.
9 - Circulation - Circulation - Reported prevalence of hypertension on GP registers as % of estimated prevalence
TRUE
TRUE
FALSE
TRUE
TRUE Suggested target - 12.5%
Based on previous 5 years data the target for 16/17 is suggested as 12.5% - this is an ambitious target especially when the 15/16 figure is unknown at this time. The last 5 years for MK and England sees a
minimal 0.2% for MK and 0.1% for England increase year on year.
Historical Data:
2009/10 - 11.3%
78
Enc No 16/22
Appendix B
Milton Keynes CCG – 2016/2017 NHS Constitution Trajectories
E.B.3
National Standard
92%
Monthly Diff Tolerance >>
10%
Incomplete Pathways < 18 weeks
APRIL
8,881
MAY
8,731
JUNE
8,915
JULY
10,275
AUGUST
9,276
SEPTEMBER
9,048
OCTOBER
8,708
NOVEMBER
8,769
DECEMBER
8,706
JANUARY
8,367
FEBRUARY
8,327
MARCH
8,609
Total Incomplete Pathways
%
%
9,516
93.3%
8,760
9,433
92.9%
9,318
93.7%
9,117
9,773
93.3%
9,452
94.3%
9,012
9,684
93.1%
10,831
94.9%
9,370
10,154
92.3%
9,779
94.9%
9,473
10,278
92.2%
9,475
95.5%
9,904
10,737
92.2%
9,135
95.3%
10,175
11,156
91.2%
9,142
95.9%
9,224
94.4%
8,904
94.0%
8,938
93.2%
9,275
92.8%
10,665
10665
10665
10665
10665
10665
10720
10720
10720
10780
10780
10780
11,587
11587
11587
11587
11587
11587
11587
11587
11587
11587
11587
11587
92.0%
92.0%
92.0%
92.0%
92.0%
92.0%
92.5%
92.5%
92.5%
93.0%
93.0%
93.0%
2014-15
RTT - The percentage of incomplete pathways
within 18 weeks for patients on incomplete
pathways at the end of the period.
2015-16
2016/17 Plan
%
E.B.4
National Standard
1%
10%
Number waiting > 6 weeks
APRIL
31
MAY
42
JUNE
49
JULY
24
AUGUST
12
SEPTEMBER
19
OCTOBER
16
NOVEMBER
16
DECEMBER
29
JANUARY
41
FEBRUARY
28
MARCH
36
Total Number waiting
%
%
3,762
0.8%
27
3,491
0.8%
3,768
1.1%
30
3,896
0.8%
3,884
1.3%
23
3,797
0.6%
3,752
0.6%
28
3,721
0.8%
3,420
0.4%
21
3,059
0.7%
3,635
0.5%
19
3,262
0.6%
4,047
0.4%
22
3,523
0.6%
4,021
0.4%
3,663
0.8%
3,633
1.1%
4,001
0.7%
4,099
0.9%
2014-15
2015-16
Diagnostics Test Waiting Times
2016/17 Plan
%
E.B.6
National Standard
93%
10%
2014-15
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
444
463
521
510
567
445
502
556
475
490
546
531
588
476
525
633
93.9%
94.6%
95.6%
93.7%
93.5%
94.5%
95.4%
96.0%
96.4%
93.5%
95.6%
95.6%
571
517
585
645
650
578
571
Total number waiting
National Standard
96%
10%
Number waiting < 31 days
%
%
%
E.B.9
National Standard
94%
10%
%
%
2014-15
Cancer - 31 Day standard for subsequent cancer
treatments -surgery
2015-16
2016/17 Plan
%
E.B.10
National Standard
98%
10%
%
%
2014-15
treatments -anti cancer drug regimens
2015-16
2016/17 Plan
%
E.B.11
National Standard
94%
10%
%
%
2014-15
treatments - radiotherapy
2015-16
2016/17 Plan
%
E.B.12
National Standard
85%
10%
%
%
2014-15
Cancer - All cancer 62 day urgent referral to first
treatment wait
2015-16
2016/17 Plan
%
E.B.13
National Standard
90%
10%
%
%
2014-15
Cancer - 62 day wait for first treatment
following referral from an NHS cancer screening
service
2015-16
2016/17 Plan
%
E.B.14
602
541
604
677
694
604
597
94.9%
95.6%
96.9%
95.3%
93.7%
95.7%
95.6%
670
577
577
625
585
577
577
670
670
625
620
641
640
700
620
620
720
93.3%
93.6%
93.1%
93.6%
93.8%
93.6%
93.1%
93.1%
93.1%
APRIL
97
112
86.6%
MAY
73
77
94.8%
JUNE
83
86
96.5%
JULY
90
93
96.8%
AUGUST
88
92
95.7%
SEPTEMBER
100
101
99.0%
OCTOBER
139
142
97.9%
NOVEMBER
104
107
97.2%
DECEMBER
99
105
94.3%
JANUARY
92
93
98.9%
FEBRUARY
84
85
98.8%
MARCH
87
89
97.8%
87
54
41
39
52
69
59
92
67
46
42
57
74
59
94.6%
80.6%
89.1%
92.9%
91.2%
93.2%
100.0%
70
70
70
61
56
67
57
57
50
59
57
52
75
75
75
65
60
70
60
60
53
63
60
55
93.3%
93.3%
93.3%
93.8%
93.3%
95.7%
95.0%
95.0%
94.3%
93.7%
95.0%
94.5%
APRIL
94
98
95.9%
66
67
98.5%
MAY
62
66
93.9%
58
58
100.0%
JUNE
62
69
89.9%
68
69
98.6%
JULY
69
71
97.2%
79
80
98.8%
AUGUST
56
57
98.2%
70
70
100.0%
SEPTEMBER
87
92
94.6%
91
92
98.9%
OCTOBER
67
70
95.7%
76
77
98.7%
NOVEMBER
72
72
100.0%
DECEMBER
69
69
100.0%
JANUARY
64
64
100.0%
FEBRUARY
78
80
97.5%
MARCH
68
70
97.1%
64
60
64
80
70
84
74
70
69
64
79
70
65
60
65
80
70
85
75
70
70
65
80
70
98.5%
100.0%
98.5%
100.0%
100.0%
98.8%
98.7%
100.0%
98.6%
98.5%
98.8%
100.0%
APRIL
14
15
93.3%
6
6
100.0%
MAY
10
10
100.0%
17
17
100.0%
JUNE
11
12
91.7%
20
22
90.9%
JULY
9
10
90.0%
18
18
100.0%
AUGUST
14
14
100.0%
7
7
100.0%
SEPTEMBER
12
13
92.3%
14
15
93.3%
OCTOBER
8
8
100.0%
10
10
100.0%
NOVEMBER
9
9
100.0%
DECEMBER
11
11
100.0%
JANUARY
10
10
100.0%
FEBRUARY
17
17
100.0%
MARCH
14
14
100.0%
8
19
24
18
8
16
10
15
10
12
15
15
8
20
25
18
8
16
10
15
10
12
15
15
100.0%
95.0%
96.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
APRIL
44
44
100.0%
26
26
100.0%
MAY
20
20
100.0%
38
38
100.0%
JUNE
18
18
100.0%
9
10
90.0%
JULY
23
23
100.0%
24
24
100.0%
AUGUST
41
41
100.0%
26
26
100.0%
SEPTEMBER
6
6
100.0%
29
29
100.0%
OCTOBER
31
31
100.0%
32
32
100.0%
NOVEMBER
20
20
100.0%
DECEMBER
8
8
100.0%
JANUARY
32
32
100.0%
FEBRUARY
35
35
100.0%
MARCH
21
21
100.0%
25
35
40
35
35
30
35
35
25
25
30
20
25
35
40
35
35
30
35
35
25
25
30
20
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
APRIL
30
36
83.3%
23
23
100.0%
MAY
28
28
100.0%
16
18
88.9%
JUNE
41
41
100.0%
14
14
100.0%
JULY
13
20
65.0%
29
30
96.7%
AUGUST
24
24
100.0%
27
28
96.4%
SEPTEMBER
11
12
91.7%
25
26
96.2%
OCTOBER
18
18
100.0%
21
21
100.0%
NOVEMBER
13
13
100.0%
DECEMBER
20
20
100.0%
JANUARY
11
12
91.7%
FEBRUARY
17
17
100.0%
MARCH
18
18
100.0%
24
19
15
29
28
24
20
19
19
15
19
19
25
20
15
30
28
25
20
20
20
15
20
20
96.0%
95.0%
100.0%
96.7%
100.0%
96.0%
100.0%
95.0%
95.0%
100.0%
95.0%
95.0%
APRIL
42
51
82.4%
33
39
84.6%
MAY
27
32
84.4%
23
33
69.7%
JUNE
29
37
78.4%
32
39
82.1%
JULY
28
34
82.4%
32
39
82.1%
AUGUST
22
32
68.8%
36
45
80.0%
SEPTEMBER
40
45
88.9%
53
56
94.6%
OCTOBER
29
35
82.9%
31
37
83.8%
NOVEMBER
39
45
86.7%
DECEMBER
28
31
90.3%
JANUARY
26
37
70.3%
FEBRUARY
38
43
88.4%
MARCH
36
40
90.0%
40
32
41
40
41
47
29
39
29
37
36
41
46
37
48
47
47
55
33
45
33
43
42
47
87.0%
86.5%
85.4%
85.1%
87.2%
85.5%
87.9%
86.7%
87.9%
86.0%
85.7%
87.2%
APRIL
12
13
92.3%
2
2
100.0%
MAY
10
11
90.9%
4
5
80.0%
JUNE
6
7
85.7%
2
2
100.0%
JULY
7
7
100.0%
8
8
100.0%
AUGUST
5
5
100.0%
5
6
83.3%
SEPTEMBER
6
7
85.7%
10
10
100.0%
OCTOBER
4
4
100.0%
6
6
100.0%
NOVEMBER
3
3
100.0%
DECEMBER
10
11
90.9%
JANUARY
5
5
100.0%
FEBRUARY
5
5
100.0%
MARCH
2
2
100.0%
7
8
7
7
6
8
6
5
10
7
7
5
7
8
7
7
6
8
6
5
10
7
7
5
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
JUNE
AUGUST
SEPTEMBER
1
1
100.0%
OCTOBER
NOVEMBER
0
1
0.0%
DECEMBER
1
2
50.0%
JANUARY
1
1
100.0%
FEBRUARY
1
1
100.0%
MARCH
1
1
100.0%
1
1
100.0%
JULY
1
1
100.0%
1
1
100.0%
1
1
1
1
APRIL
2
2
100.0%
MAY
1
1
%
577
620
93.1%
10%
%
%
655
620
93.1%
None
2016/17 Plan
600
720
2015-16
600
605
93.1%
National Standard
2014-15
Cancer - 62 day wait for first treatment for
cancer following a consultant's decision to
upgrade the patients priority
MARCH
AUGUST
521
%
2016/17 Plan
1.0%
JULY
10%
Number waiting < 2 weeks
%
2015-16
37
3757
1.0%
502
%
Cancer - Percentage of patients receiving first
definitive treatment within 31 days of a cancer
diagnosis.
36
3667
1.0%
480
93%
2014-15
33
3330
1.0%
JUNE
E.B.8
33
3357
1.0%
480
2016/17 Plan
36
3686
1.0%
454
National Standard
2015-16
34
3424
1.0%
MAY
Cancer - Two week wait for breast symptoms
(where cancer not initially suspected)
31
3171
1.0%
526
%
2014-15
29
2973
1.0%
494
E.B.7
36
3617
1.0%
APRIL
%
2016/17 Plan
36
3691
1.0%
2015-16
36
3787
1.0%
%
Cancer- All Cancer two week wait
33
3393
2
2
100.0%
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
79
Enc No 16/22
Milton Keynes CCG – 2016/2017 NHS Other Requirements Trajectories
E.A.S.1
Dementia - Estimated diagnosis
rate
National Standard
66.7%
10%
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
Number of People diagnosed (65+)
1447
1447
1447
1450
1450
1450
1453
1453
1453
1456
1456
1456
2,168
66.74%
2,168
66.74%
2,168
66.74%
2,168
66.88%
2,168
66.88%
2,168
66.88%
2,168
67.02%
2,168
67.02%
2,168
67.02%
2,168
67.16%
2,168
67.16%
2,168
67.16%
2016-17 Plan
Estimated dementia prevalence (65+ Only
(CFAS II))
%
E.A.3
National Standard
3.75%
Quarterly Diff Tolerance >>
5%
The number of people who receive
psychological therapies
The number of people who have depression
and/or anxiety disorders (local estimate
based on Adult Psychiatric Morbidity Survey
2000).
Quarter 1
Quarter 2
Quarter 3
825
775
885
1,250
26,724
26,724
26,724
26,724
% per quarter (e.g. 3.75%)
psychological therapies
The number of people who have depression
2000).
3.09%
2.90%
3.31%
4.68%
890
1,050
-
-
26,724
26,724
3.33%
3.93%
2014-15
IAPT Access - Roll Out
2015-16
2016-17 Plan
E.A.S.2
Quarter 4
psychological
The
number oftherapies
people who have depression
1003
1003
1003
1003
26724
26724
26724
26724
3.75%
3.75%
3.75%
3.75%
Quarter 1
Quarter 2
Quarter 3
Quarter 4
160
195
145
140
National Standard
50%
20%
The number of people who have completed
treatement having attended at least two
treatment contacts and are moving to
recovery (those who at initial assessment
achieved 'caseness' and at final session did
not)
2014-15
The number of people who finish treatement
having attended at least two treatment
contacts and coded as discharged) minus
(The number of people who finish treatment
not at clinical caseness at initial assessment)
%
The number of people who have completed
treatement having attended at least two
treatment contacts and are moving to
recovery (those who at initial assessment
achieved 'caseness' and at final session did
not)
435
485
480
405
36.78%
40.21%
30.21%
34.57%
190
175
2015-16
IAPT Recovery Rate
%
contacts and are moving to recovery (those
who at initial assessment achieved 'caseness'
and at final session did not)
445
385
42.7%
45.5%
-
-
94
94
94
94
2016-17 Plan
%
187
187
187
187
50.3%
50.3%
50.3%
50.3%
Mental Health Access
E.H.1 - A1
The proportion of people that
wait 6 weeks or less from
referral to entering a course of
IAPT treatment against the
number of people who finish a
course of treatment in the
reporting period.
National Standard
75%
10%
2016-17 Plan
Quarter 1
Quarter 2
Quarter 3
Quarter 4
The number of ended referrals that finish a
course of treatment in the reporting period
who received their first treatment
appointment within 6 weeks of referral
141
141
141
141
course of treatment in the reporting period. 1
187
187
187
187
75.4%
75.4%
75.4%
75.4%
%
E.H.2 - A2
The proportion of people that
wait 18 weeks or less from
referral to entering a course of
IAPT treatment against the
number of people who finish a
course of treatment in the
reporting period.
National Standard
95%
10%
2016-17 Plan
Quarter 1
Quarter 2
Quarter 3
Quarter 4
course of treatment in the reporting period
who received their first treatment
appointment within 18 weeks of referral
178
178
178
178
The number of ended referrals who finish a
course of treatment in the reporting period. 1
187
187
187
187
95.2%
95.2%
95.2%
95.2%
%
National Standard
E.A.S.5
HCAI measure (C.Difficile
infections)
None
10
2014-15
2015-16
2016-17 Plan
APRIL
7
8
5
MAY
11
7
5
JUNE
4
5
5
JULY
2
4
5
AUGUST
9
3
5
SEPTEMBER
5
6
5
OCTOBER
11
5
5
NOVEMBER
8
8
5
DECEMBER
8
JANUARY
5
FEBRUARY
6
MARCH
7
5
5
5
5
Total
83
46
60
80
Enc No 16/22
Appendix C
Milton Keynes CCG – 5 Year Financial Plan
Revenue Resource Limit
£ 000
Recurrent
Non-Recurrent
Total
Income and Expenditure
Acute
Mental Health
Community
Continuing Care
Primary Care
Other Programme
Primary Care Co-Commissioning
Total Programme Costs
Running Costs
Contingency
Total Costs
£ 000
Surplus/(Deficit) In-Year Movement
Surplus/(Deficit) Cumulative
Surplus/(Deficit) %
Surplus (RAG)
2015/16 blank1
2016/17
284,810
301,567
4,569
2,880
289,379
304,447
Contingency
Contingency %
Contingency (RAG)
Notified Running Cost Allocation + Quality Premium
Running Cost
Under / (Overspend)
Running Costs (RAG)
Population Size (000)
Spend per head (£)
2018/19
317,414
3,120
320,534
2019/20
326,800
3,206
330,006
2020/21
342,091
3,301
345,392
160,243
26,979
20,438
15,104
41,426
16,505
280,695
165,831
29,176
23,017
17,058
43,093
15,775
293,950
170,429
31,611
25,284
18,444
45,603
9,925
301,296
178,663
34,191
26,322
19,961
48,989
1,601
309,727
186,945
36,833
27,366
21,674
52,524
(6,319)
319,023
194,472
39,381
28,320
23,386
55,883
(7,295)
334,147
5,804
5,929
5,964
5,998
6,031
6,063
-
1,523
1,560
1,603
1,651
1,727
286,499
301,402
308,820
317,328
326,705
341,937
2015/16
1,867
2,880
1.0%
AMBER
2016/17
165
3,045
1.0%
GREEN
Net Risk/Headroom
Risk Adjusted Surplus/(Deficit) Cumulative
Risk Adjusted Surplus/(Deficit) %
Risk Adjusted Surplus/(Deficit) (RAG)
Underlying position - Surplus/ (Deficit) Cumulative
Underlying position - Surplus/ (Deficit) %
2017/18
308,895
3,045
311,940
2017/18
2018/19
2019/20
75
3,120
1.0%
GREEN
86
3,206
1.0%
GREEN
95
3,301
1.0%
GREEN
2020/21
154
3,455
1.0%
GREEN
3,045
1.0%
GREEN
(940)
-0.3%
7,558
2.5%
6,025
2.0%
6,164
1.9%
6,315
1.9%
6,602
1.9%
0.0%
1,523
0.5%
GREEN
1,560
0.5%
GREEN
1,603
0.5%
GREEN
1,651
0.5%
GREEN
1,727
0.5%
GREEN
6,474
5,804
670
GREEN
266
21.82
5,929
5,929
GREEN
269
22.07
5,964
5,964
GREEN
272
21.91
5,998
5,998
GREEN
276
21.75
6,031
6,031
GREEN
279
21.60
6,063
6,063
GREEN
283
21.46
81
Enc No 16/22
Appendix C
2015-16 to 2016-17 Bridge
Description
MKUHFT
OTHER ACUTE
SCAS
2015-16
Recurrent FOT
before CQUIN
121,855
29,794
8,594
2015-16
2015-16
Recurrent
Recurrent FOT
FOT before
before CQUIN
CQUIN
1,283
123,137
-17
29,777
-189
8,405
-2,425
-584
-166
4,547
1,087
257
0
400
0
1,819
228
124
Mental Health
Investment
top up
£000
2,401
0
301
0
164
0
Efficiency
Savings
£000
Provider Infl
£000
Other
Changes
£000
Activity
Growth
£000
Population
growth
£000
Total Before
CQUIN
£000
Contract top
up
QIPP
CQUIN
£000
Total Budget
£000
-4,155
-178
-375
617
0
0
125,941
31,032
8,410
236
54
8
126,176
31,086
8,418
160,243
1,077
161,319
-3,175
5,891
400
2,171
2,866
0
-4,708
617
165,383
298
165,680
CNWL CONTRACT
OTHER MH
PARITY OF ESTEEM RESERVE
CAMHS INCL CNWL
LEARNING DISABILITY
19,744
206
171
2,448
3,903
-64
5
317
-56
-59
19,680
211
488
2,392
3,843
-384
-4
-10
-47
-29
595
7
15
72
119
0
0
0
456
0
281
0
0
35
36
370
0
0
46
91
0
0
354
0
0
0
0
0
0
0
200
0
-200
0
0
20,742
213
648
2,954
4,061
12
0
0
11
0
20,754
213
648
2,965
4,061
TOTAL MENTAL HEALTH
26,473
142
26,615
-473
808
456
351
507
354
0
0
28,619
23
28,642
CNWL CONTRACT
OTHER CHILDRENS SERVICES
OTHER COMMUNITY (INCL BCF)
TOTAL COMMUNITY
13,485
216
10,159
23,860
273
33
445
751
13,758
249
10,604
24,611
-269
-5
-360
-634
417
8
575
999
0
3
0
3
194
0
187
381
256
0
284
540
0
0
0
0
0
106
727
833
319
0
0
319
14,675
360
12,017
27,052
17
0
2
19
14,691
360
12,019
27,071
ADULT CHC
CHILDRENS CHC
FUNDED NURSING CARE (FNC)
TOTAL CHC
12,421
675
2,008
15,104
649
222
0
871
13,070
897
2,008
15,975
0
-2
-6
-7
405
28
62
495
0
-3
0
-3
196
12
30
238
493
31
76
599
0
0
0
0
0
-90
-150
-240
0
0
0
0
14,164
873
2,020
17,057
0
0
0
0
14,164
873
2,020
17,057
6,011
35,415
487
-108
6,499
35,307
-116
0
179
1,235
0
0
0
530
0
900
0
0
-347
-1,094
0
0
6,215
36,878
0
0
6,215
36,878
TOTAL PRIMARY CARE
41,426
379
41,805
-116
1,415
0
530
900
0
-1,441
0
43,093
0
43,093
OTHER COMMISSIONING
OTHER
CLINICAL RUNNING COSTS
RESERVES
NON RECURRENT PROGRAMMES
QIPP GAP
1% SURPLUS
TOTAL OTHER PROGRAMMES
5,332
3,033
1,424
3,799
0
0
2,880
16,469
224
-200
216
3,825
0
0
0
4,066
5,556
2,834
1,641
7,624
0
0
2,880
20,535
-111
-6
-12
0
0
0
0
-128
172
21
39
0
0
0
0
232
0
-1,000
0
-2,699
1,375
0
165
-2,159
0
0
0
498
0
0
0
498
0
0
0
658
0
0
0
658
0
0
0
0
0
0
0
0
-681
-387
49
0
-222
-470
0
-1,712
0
0
0
-950
0
0
0
-950
4,936
1,462
1,717
5,131
1,153
-470
3,045
16,974
0
0
0
0
0
0
0
0
4,936
1,462
1,717
5,131
1,153
-470
3,045
16,974
283,575
7,285
290,860
-4,533
9,841
-1,303
4,171
6,070
354
-7,269
-14
298,178
340
298,518
5,804
124
5,928
-71
101
231
0
0
0
-260
0
5,929
0
5,929
289,379
7,409
296,788
-4,604
9,942
-1,072
4,171
6,070
354
-7,529
-14
304,107
340
304,447
TOTAL ACUTE
PRIMARY CARE
PRESCRIBING
TOTAL PROGRAMME BUDGETS
RUNNING COSTS
TOTAL ALLOCATION
82
Enc No 16/22
Appendix C
Milton Keynes CCG –QIPP Plan
QIPP 2016/17
Local Scheme Name (over £0.5m)
April
May
June
July
August
Saving Profile (£000)
Sept.
Oct.
Nov.
Dec.
Jan.
Feb.
March
Total
Transactional Productivity and
Contractual Efficiency Savings
Reduction in agency costs
Contract Management
Cease Primary Care Investments
Sub Total
Balance of Schemes under (£0.5m)
(39)
(43)
(82)
(39)
(46)
(85)
(39)
(46)
(85)
(28)
(39)
(46)
(113)
(29)
(39)
(46)
(114)
(29)
(39)
(46)
(114)
(29)
(39)
(46)
(114)
(29)
(40)
(46)
(115)
(29)
(40)
(46)
(115)
(29)
(40)
(46)
(115)
(29)
(40)
(46)
(115)
(29)
(40)
(46)
(115)
Balance of Schemes under (£0.5m) Total
(71)
(7)
(12)
(32)
(18)
(9)
(149)
(71)
(7)
(12)
(32)
(18)
(9)
(149)
(71)
(7)
(12)
(32)
(18)
(9)
(1)
(150)
(1)
(71)
(7)
(12)
(32)
(18)
(9)
(1)
(151)
(1)
(71)
(7)
(12)
(32)
(18)
(9)
(1)
(151)
(1)
(71)
(7)
(12)
(32)
(18)
(9)
(1)
(151)
(2)
(71)
(8)
(13)
(32)
(19)
(9)
(1)
(155)
(2)
(72)
(8)
(13)
(32)
(19)
(9)
(1)
(156)
(2)
(72)
(8)
(13)
(32)
(19)
(10)
(1)
(157)
(2)
(72)
(8)
(13)
(32)
(19)
(10)
(1)
(157)
(2)
(72)
(8)
(13)
(32)
(19)
(10)
(1)
(157)
(2)
(72)
(8)
(13)
(34)
(19)
(10)
(1)
(159)
(260)
(473)
(549)
(1,282)
(15)
(857)
(90)
(150)
(386)
(222)
(112)
(10)
(1,842)
Transactional Productivity and
Contractual Efficiency Savings
(231)
(234)
(235)
(264)
(265)
(265)
(269)
(271)
(272)
(272)
(272)
(274)
(3,124)
(61)
20
(81)
81
(34)
10
(7)
(25)
(88)
(61)
22
(81)
81
(34)
10
(7)
(25)
(88)
(61)
22
(81)
81
(34)
10
(7)
(25)
(88)
(167)
(9)
(87)
4
(442)
(33)
5
2
(4)
(30)
(61)
22
(81)
81
(34)
10
(7)
(25)
(88)
(167)
(9)
(87)
4
(442)
(33)
5
2
(4)
(30)
(61)
22
(81)
81
(34)
10
(7)
(25)
(88)
(167)
(9)
(87)
4
(442)
(34)
(1)
6
2
(4)
(31)
(61)
22
(81)
81
(34)
10
(9)
(25)
(88)
(167)
(9)
(87)
4
(444)
(34)
6
2
(4)
(30)
(61)
22
(81)
81
(34)
10
(9)
(25)
(88)
(167)
(9)
(92)
5
(448)
(34)
(1)
6
2
(4)
(31)
(548)
194
(727)
727
(403)
116
(88)
(300)
(1,050)
(1,000)
(53)
(1,049)
49
(4,132)
(337)
(5)
92
22
(45)
(273)
(4,405)
(7,529)
Transformational Service Re-design and Pathway Changes
Integrated Urgent Care Service
Integrated Urgent Care Service
Getting People Home - Discharge to assess
Getting People Home - Discharge to assess
Paediatric Community Nursing Team
Paediatric Community Nursing Team
Opthalmology Managed Care Pilot
Opthalmology Managed Care Pilot
Better Care Fund
Acute Deep Dive Variations
Diabetes Managed Care Pathway
Prescribing Initiatives
Prescribing Initiatives
Sub Total
Balance of Schemes under (£0.5m)
(29)
8
(7)
(25)
(82)
(34)
8
(7)
(25)
(88)
(34)
10
(7)
(25)
(88)
(60)
20
(79)
79
(34)
10
(7)
(25)
(88)
Balance of Schemes under (£0.5m) Total
(87)
4
(218)
(19)
(1)
9
1
(3)
(13)
(87)
4
(229)
(22)
9
1
(3)
(15)
(87)
4
(227)
(24)
(1)
9
2
(3)
(17)
(87)
4
(267)
(28)
11
2
(4)
(19)
(87)
4
(268)
(21)
11
2
(4)
(12)
(87)
4
(266)
(22)
(1)
11
2
(4)
(14)
(61)
22
(81)
81
(34)
10
(7)
(25)
(88)
(165)
(8)
(87)
4
(439)
(33)
4
2
(4)
(31)
Transformational Service Re-design and
Pathway Changes
(231)
(244)
(244)
(286)
(280)
(280)
(470)
(472)
(472)
(473)
(474)
(479)
(462)
(478)
(479)
(550)
(545)
(545)
(739)
(743)
(744)
(745)
(746)
(753)
Unidentified QIPP
Total Unidentified QIPP
Total QIPP Schemes
83
Enc No 16/22
Appendix D
Year
2015
Workstreams:
Phase 1
Dec
Jan
Feb
InternalProgramme Review (1)
Scope, governance, ToR, structure,
workstreams and resources for
Acute Services confirmed
Agree PID with
all providers and inform
Health Watch / HOSCs
/HASSC
Undergo strategic
Sense Check with NHS
England
Agree
SRO,
Clinical
Lead
Mar
Apr
May
Finalise outstanding
tripartite reqm’ts
Internal Programme Review (4)
Checking PCBC progress; 3-month
Benefits Check Point
Joint Committee
Milestone
Gear up for
Assurance
Programme plan
with Programme
Board
Deadline for
papers
Jul
Alignment of MK CCH and Acute
Services strategies and plans in
advance of PCBC; ready to
implement short-term delivery
Baseline information confirmed;
working grous established for CCH
and Acute Services
Revised
Governance
structure Go live
Implement ToR
and Committee
membership
Jun
Joint MK/B CCG Progress Review
Alignment of MK and Bedford Acute
Services strategies and plans in
advance of PCBC
Phase 2
Joint MK/BCCG Programme Board
Review
Sign off Programme
Next Steps, Joint
Governance and
Resource Plan
Programme
Governance
2016
Nov
Present outcomes of
Strategic Sense Check /
Option Evaluation
Soft launch of Programme Next Steps
Tri-partite / NHSECheck Point meetings
Joint MK/Beds Programme Board
Meeting (monthly)
H&WB Board(s)
Deadline for papers
Joint Executive Operational Meeting
(monthly meetings)
HASCC/JHOSC
Deadline for papers
Internal Programme Review at
Programme Board
(bi-monthly)
Commissioning Delivery Group (strategic)
MK CCG Board
(bi-monthly)
Deadline for papers
Milton Keynes Hospital Board
of Directors (bi-monthly)
Deadline for papers
Bedford Hospital Trust Board
s (monthly)
Bedford CCG
Board (monthly)
Deadline
for papers
Deadline for
papers
OGC Review – Gateway 3
OGC Review – Gateway 0
Legal Review
Procurement of supporting work
required
To discuss scope,
•
Integrated
Impact
governance,
ToR, Assessment
•structure,
Health
data analysis
worksteams
•
Scenario
Modelling
and resources
•
Capital review
•
Transport study (refresh)
Interim Report
Under take Health data and activity analysis
Patient Flows - Agreed
Clinical
Standards
Clinical Model
development
Pre-consultation Report Duties
Integrated Impact Assessment
Sign off – Clinical Models
1. Intermediate Clinical Models \
Pathways / Choice / Personalisation
2. Detailed Clinical Model(s)
Emergency Care -Task and Finish (tbc)
Planned Care -Task and Finish (tbc)
LTC -Task and Finish (tbc)
Women and Children's -Task and Finish (tbc)
Six Week Lead Time for Clinical Engagement*
Specialised Services Surrounding
Commissioner Decision-Making
1.
2.
3.
4.
5.
6.
Specialised Services
Clinical Sensitivity Analysis
Outcomes / Benefits
Training & Research
Commissioner Duties
Standards
Clinical Senate
Report
Transport Study
PTS & Ambulance
Senate Council
Recommendations
Review
Revised Protocols & Costs
Confirm and Challenge
Surrounding Provider
Support - Letters
Sustainability Narrative
Financial Sensitivity Review
Commissioner/Provider Boards
Financial
Capital Review
Draft PCBC
PCBC Preparation /
Decision Making /
Formal
Consultation
Report
Strategic Context - Chapters
Evaluation Criteria
Transitional Costs
Provider Boards
Detailed Implementation Plan / Capacity Model / Costs
Provider Boards
Option Development - Chapters
Regulator(s) / HMT
Capital Letter of
Comfort
Option - Chapters
Draft Submission
Commissioner
Decision on Option(s)
Option Evaluation (Commissioner)
Commissioner Boards
HASCC/JHOSC
Undergo strategic
Sense Check with NHS
England
Joint Committee
Approval
Public
Consultation
Draft Detailed Consultation Plan
Review identity/channels/messaging update to reflect joint programme
Refresh C&E strategy
Formal External Provider
Engagement
Commissioner Boards
Strategy
Communications &
Engagement
Update events
IIA Support
Pre-consultation engagement ‘relaunch’ – public events
Ramp Up for Public Consultation
Ongoing Comms & Engagement
09
84
Enc No 16/22
Appendix E
Scheme Name
Objective
BCF allocation
16-17
24/7 Rapid Response team
To prevent hospital admission
£327,000
Appointment of two Consultant Geriatricians
To support more complex patients in the community
£157,000
Multi-Disciplinary Case Reviews
To support more complex patients in the community
£60,000
Extension of the Recuperation Pathway
To ensure timely discharge from acute hospital care for patients not ready for £480,000
reablement
Community Equipment
To enable people to be more independent at home
Alcohol Liaison Service
To minimise hospital admission for people with alcohol problems by diverting to £50,000
community based services
High Impact Team for Care Homes
A specialist team to support care homes to manage more complex patients in
the home rather than acute care
£254,000
Community Dementia Service
Funding for a scheme supporting GPs to diagnose dementia in primary care;
improving post-diagnostic services e.g. carer support, community dementia
£63,000
Community based falls prevention
To reduce the incidence of falls in the older population, reducing hospital £98,000
admissions for people who have fallen and preventing re-admission
Schemes previously funded through S256
Various schemes supporting protection of community and social care
£3,130,000
Social Care Grants
Disabled Facilities Grant and Other Social care Capital grants
£871,000
Care Act
Funding to support the implementation of the Care Act
£528,000
£385,000
85
Enc No 16/22
Phased reduction in acute sector activity
To support the acute care sector and the CCG whilst the new community £8,000,000
services above bed in.
Inflation Reserve/ Contingency
Funds set aside to cover inflationary increases / in year contingency
Total 2016/17
£553,000
£14,956,000
86

Subject: 2016-17 Operational Plan Meeting: NHS Milton Keynes

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