CCG Organisation Improvement Plan November 2017 Exceptions Report

Transcription

1 CC Organisation Improvement Plan November 2017 Exceptions Report Sheila Bremner Chief Officer November 2017

2 Improvement Plan QIPP Delivery Key: Blue rating = change complete and embedded Pg 2 The CC needs to ensure adequate resource and experience to manage the financial improvement Assess internal capability to deliver financial improvement On review it is clear that CC staff do not have the capability in project delivery to provide assurance that QIPP will be delivered. overning Body agreed to seek approval from NHS England to commission external expert team to secure delivery Part of specification is to develop capability in CC staff CFO Sept LC Staff realigned to financial recovery and QIPP week ending Approval received from NHS England overning Body approved preferred bidder McKinsey & Co commenced on Diagnostic Phase and Phase 2 completed. Capacity increased in new structure and McKinsey methodology to be embedded into processes. Increased PMO resources as part of organisational realignment. Year to Date QIPP Performance currently 3.86m behind plan due to slippage in a number of schemes Regular QIPP Reports to Finance Committee including monthly deep-dive presentation from a QIPP Workstream to review progress and learn about any related challenges or concerns. Financial Workshop planned to consider the position. Reprioritisation of projects and shift of resource to deliver Will be Blue when clear that QIPP Delivery Plan is achieving against its targets.

3 Improvement Plan QIPP Delivery Pg 3 The CC needs to establish rigorous programme management and drive at pace PMO interim has established a project management approach External team to provide a cloud based programme management tool Weekly executive oversight of progress and escalation where necessary CFO Sept Weekly review through executive Turnaround oversight weekly meeting Monthly review with NHS England Regional Director Wave project management approach implemented across the CC New Project Management Tool in place to replace Wave during 18/19 Planning Round. Regular Deep Dives at Finance Committee Will be Blue when all projects more than 2 months old past L3 approval stage (ie with full IAs in place) Control of overspend in other contractual areas Review all MH placements and ensure only pay for those CC should pay for CHC review process in progress interim lead in post Medicines use / prescribing PMO interim lead in post Need to establish improved business management in new substantive structure DCP DNQ CFO DNQ July July July Nov MH placement reviews under escalated resolution Meds plan to get back to budget interim in post to secure QIPP retained to March 16 Backlog of reviews CHC being accelerated CHC Business Plan approved by overning Body on Now being implemented. New structure implemented MH Placements dispute work in progress Will be Blue when MH placements dispute resolved

4 Improvement Plan Organisational Structure - LCs Pg 4 Consider whether the objectives of the CC can be delivered with the current LC structure; consider reducing number of LCs, centralising commissioning functions, modifying the LC structure whilst maintaining P clinical leads for localities ensure lines of accountability are clear Discussion with overning Body to consider future of LCs Discussion with LC Chairs and B Ps Contracts, Finance and Business Intelligence functions to be centralised Review locality working in view of STP priorities and PFV Revise means of engaging clinical commissioners so on payroll As a result all Clinical Leads have objectives and clear accountability to Chief Clinical Officer Describe alternative structure and means of locality working AO / Chair Sept Agreed that CC objectives cannot be achieved with current LC structure Finance team and contracts teams and BI teams centralised (Aug / Sept 2016) Chief Clinical Officer and Chief Officer engaged with member practices on future locality arrangements and role of Ps in commissioning ( ) Discussed with LMC and Member Practice support for new arrangements and changes to Constitution from B approved changes and request made to NHSE to vary Constitution. Awaiting formal response. Locality Partnership Boards established as part of part of STP delivery structure from Sept NHSE Approval to Constitution changes received Clinical Leadership posts agreed and recruited to in most instances. Will be Blue when new arrangements for clinical leadership in place Move to B Mandate that local clinical leaders are overning Body members overning Body Ps to sit on Clinical Executive and on overning Body Revise terms of engagement of B Ps so contracted to attend B and Clinical Executive B Ps to Chair new Area Executive Partnership Boards (AEPBs) AO AO/ Chair Sept Feb Maintain P B members to 8. B Ps required as part of role to sit on CEC meetings established from Nov TORs for AEPBs agreed. Election process for B in place Jan 2017 (new appointments from April 2017). One P Member vacancy remains following nomination process. Discussions with B to take place. Will be Blue when all 8 members in place

5 Improvement Plan Organisational Design Pg 5 Undertake an organisational design review to ensure adequate and appropriate resources with clear roles, responsibilities and accountabilities Review current and next three year priorities Assess existing capacity and capability to deliver Design organisational structure to enable delivery of these priorities with pace and in sustainable ways Re-establish staff roles, responsibilities and objectives Ensure clear route for decision making AO Mid Sept end Nov Draft structure defined one CC with Directorate structure Additional capacity added to work with primary care, LD, childrens commissioning and PMO Established new Directorate structure Consultation with staff complete Implemented December and fully launched January 2017 All teams and staff have clear objectives by end of January. Corporate Objectives approved by the B Organisational Realignment completed and implemented Corporate Objectives aligned to Appraisal and PDP process for Personal Objective setting undertaken as part of Annual Appraisal Process. Will be Blue when all staff have personal objectives in place for new roles Move to B

6 Improvement Plan overning Body and Committees Pg 6 Reflect on how quality feeds into the F&P meeting; how this links to patient safety and quality and identify Ps with quality leadership and mandate attendance overning Body, F&P Committee and patient safety and quality committees to consider recommendation and make a proposal on way forwards. B to approve proposed changes Date of commencement to be confirmed Reflect in Constitution changes Seek approval from NHS England ovn Lead Sept Reviewed and propose that performance moves to patient safety and quality committee and finance committee concentrates on finance, activity and FRP delivery Changes to Constitution approved by B on and submitted to NHSE w/c 8/ QOP Business Cycle and Finance Business Cycle agreed. Meetings established from October. P members to be employed to attend Quality, Performance and Outcomes Committee new P Member nominated. Regular overview reports to B in public now established. Quality, Outcomes and Performance Report reviewed to provide clarity on SRO, and reporting timeframes. Detailed scrutiny on QOP Report and feedback to overning Body Agreement on areas of focus for QOP Committee and Finance Committee. Regular Deep Dives on Exceptional Issues and clear programme of business agreed. Will be Blue once QOP reporting clearly demonstrates sufficient scrutiny in place through QOP Committee Move to B

7 Improvement Plan Organisational Development Pg 7 Establish a overning Body effectiveness programme and once the executive team is established, a programme to ensure this functions as a highly performing team Commission a B effectiveness programme Once clinical executive in place, commission support to develop this as a highly performing team Ensure development sessions for both B and Clinical Exec have protected time Ensure actions agreed at development sessions are implemented - including critical review of meeting organisation, scrutiny by Board, agenda setting, time management AO Sept - Dec B agreed need to undertake this development Head of HR and OD sourced support for B and Clinical Executive NHSE to approve as discretionary expenditure Sessions commenced with B Away Day and CEC Development Day Actions agreed and further Development Planned. Scrutiny session Personal Feedback sessions held for B members on Myers Briggs and PDP approach proposed with individual members. B Away Day held in June Annual overning Body Effectiveness Survey completed and reviewed. OD Plan direction provided. 360s to be scheduled to support further development in Consider Lay Member development Chair to agree PDP with each Lay member Lay Members to be offered PWC support programme Head of OD to support Lay Member development plans Chair Sept - Dec PWC opportunity offered to Lay Members PDPs to be agreed with new Clinical Chair Bespoke plans for each Lay Member plus B development meetings to be arranged in January 2017 with Head of OD & HR and the Clinical Chair. Lay Members meeting held on 31 January 2017 and new roles and responsibilities agreed PDP sessions held overning Body Development Session in February focussed on the scrutiny role. Regular Lay Member meetings scheduled 360s to be scheduled to support further development in Move to B

8 Improvement Plan NAO Report and other UnitingCare reviews Pg 8 Revise procurement policy and strategy to ensure learning Establish procurement Checklist Ensure revised COI policy Recruit head of procurement DCP to revise procurement strategy and policy DCP to develop procurement checklist overning Body to assess each procurement to ensure UC errors not repeated CMET to approve overning Body to approve Staff involved in procurement to be advised of policy and how to apply CC to consider employing or sourcing procurement expertise in new structure COI Policy to be revised DCP Sept Strategy and Policy revised and approved by B COI Policy revised Associate Director of Contracting and Procurement in new structure Agreed to outsource specific procurement expertise Conflicts of Interest Implementation received Substantial Assurance. Revised COI Policy to reflect revised Mandatory uidance issued by NHSE in June Approved by B COI Mandatory Training to be rolled out by NHSE in November complete by March Procurement Strategy and Policy now reviewed October/November to be presented to CEC for review in November and to be presented to B in January for formal ratification. Will be Blue once new policy tested with substantial procurement

9 Improvement Plan Directions Letter Pg 9 Develop full recovery plans for A&E DTOCS RTT Cancer Ensure recovery plans for each standard at each provider where required developed Ensure each has agreed trajectory for improvement that matches back to actions in plan Report progress to Clinical Executive in performance report Apply contractual clauses where necessary Report to overning Body monthly DCP Aug A&E and DTOC improvement plans re drafted with new A&E Delivery Board advice and feedback from NHS England RTT plan agreed for CUH by end March 2017 Cancer plan for PSHFT agreed and implemented Plans, monthly update and escalation status to be reported to Clinical Executive and overning Body Performance deteriorated in A&E delivery, RTT, Ambulance Response times as per QOP Report November 17. Will only be reen when standards being delivered Will be Blue when standards all maintained Reduce from A/ to A/R Develop recovery plan for CHC Receive NHS E Review Receive Arden em review Develop comprehensive improvement plan Clinical executive to approve plan NHS E to be sent plan Clinical Executive to receive a monthly progress report overning Body to receive report on improvement plan DQN DQN Sept Nov Both reviews now received Reported to NHS E as part of Monthly Assurance Meeting during Improvement plan developed and submitted to CMET and approved by B as part of Chief Officer s report November Improvement Plan to be presented to B and updated. Business case for increased staffing approved and being implemented. 52.1% of patients had their CHC assessment completed by the CC within 28 days in September against the target of 80% and substantial backlog. See QOP Report. Will be Blue once backlogs addressed and new processes fully embedded Reduce from to A/R