Enc No 16/03. Healthcare Review Programme Timeline. NHS Milton Keynes CCG Board. Date of Meeting: 12 th January 2016

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1 Subject: Meeting: Healthcare Review Programme Timeline NHS Milton Keynes CCG Board Date of Meeting: 12 th January 2016 Report of: Clare Steward, Programme Director Healthcare Review Is this document: Commercially Sensitive For the Public or Private Agenda To be publically available via the CCG Website Y Public Y

2 Subject: Report of: Healthcare Review Programme Timeline Clare Steward, Programme Director Healthcare Review 1. Purpose This paper sets out the current timeline for the Healthcare Review Programme and the key decision points that will need to be considered by the CCG Governing Body 2. Introduction The Healthcare Review Programme was established in January 2014 across Milton Keynes and Bedfordshire health economies, with the Case for Change published in April The Case for Change set out that the current status quo was not sustainable, both clinically and financially. In response to the Case for Change, both Milton Keynes and Bedfordshire CCG Boards formally accepted the Progress Report on the understanding that further work would need to be undertaken prior to these being taken to public consultation. During the past year, both Bedfordshire and Milton Keynes systems have been working with their local providers to explore the detail required to make further decisions on which proposal(s) should be taken forwards to formal public consultation. This work has now been completed and the Healthcare Review Programme has entered a more formal stage of Testing and Alignment. This brings back together the Milton Keynes and Bedfordshire health systems in order to prepare for the formal Option Development phase. Within the Testing and Alignment phase an Intermediate Model of Care will be developed for each of the short listed options, identifying key features such as workforce and clinical interdependencies but also understanding how the Model will support clinical standards. This will allow Commissioners to make decisions in the next phase of the Programme. 3. Timeline Key Features The timeline of the programme is split into four distinct phases, each phase seeks to further develop the strategic case for the various options considered, and the evidence required to support them as the programme moves forwards towards consultation. 1

3 The areas above are described in a little more detail below: Testing and Alignment Nov 15 Jan 16 Pre Consultation Option Development Feb Mar 16 Development of the Pre Consultation Business Case Apr Jun 16 Intermediate Clinical Models Option(s) Selectionn for Public Consultation Pre Consultation Businesss Case Integrated Impact Assessment Clinical Senate Review / NHS England Assurance Review Alignment of Options Evaluation Criteriaa / Evaluation Scoring Transport Study Clinicall Standards Digest Wider Engagement (Commissioners / Providers) Public Consultation Planning Financial Modelling Pre Consultationn Financial Sensitivity Analysiss / Engagement (Publicc and Capital Clinicians) Engagement Working Group Public Consultation 3.1 Testing and Alignment This phase seeks to consolidate the t work undertaken separately by the Milton Keynes and Bedfordshire health systems, drawing this work into a single narrative. Two key features of this phase are the development of a single clinical c view across both systems andd the establishment of the formal decision making structures whichh will support Commissioners to make sound decisions on behalf of their populations 2

4 3.2 Pre Consultation / Option Development This phase will define the option(s) that will be recommended to Commissioners to take forward to public consultation. In structuring this phase, the Programme will focus upon the Pre Consultation elements of engagement both with the wider public and clinical communities. This is a critical input to the Programme, as whilst Commissioners will need to take decisions, they will need to do so within the context of the wider health economy. A key feature during this phase will be wider engagement and the focus upon developing support for proposals. This phase will conclude with the formal evaluation of the short listed models. The Programme Board will make recommendations to Commissioners on which Option or Options should be taken forwards for development within the Pre Consultation Business Case and for Public Consultation. 3.3 Development of the Pre Consultation Business Case This phase will focus on the detailed work required to develop the Pre Consultation Business Case and the evidence documentation packs. This suite of documents will need to be considered by the NHS England Clinical Senate (for clinical assurance) and will then be approved by an NHS England assurance panel, prior to approval by Commissioners. 3.4 Full Public Consultation Milton Keynes and Bedfordshire health systems will seek to undertake a week public consultation across both Bedfordshire and Milton Keynes, as well as across the relevant surrounding clinical commissioning groups. Once all of these phases have been completed, Bedfordshire and Milton Keynes commissioners will then take a joint decision on the recommendations proposed by the Programme. 4. Key Risks The Programme Board maintains a strategic Risk Log which considers risks across the whole Healthcare Review Programme. The key factor in terms of risk associated with the timeline will be the alignment of clinical agreement, given the variety of perceptions across the two health systems. A key feature of the programme throughout the four phases outlined above will be that there will need to be a credible and constructive engagement by the programme across acute, community and primary care clinicians, in order that agreed models of care can be proposed to the public for delivery. These discussions will over seen by the Joint Clinical Working Group which has been established by the Programme in December 2015, prior to consideration by an external Clinical Senate review in due course. The Clinical Working Group is currently jointly chaired by Dr Kufeji from Milton Keynes CCG and Dr Howard from Bedfordshire CCG. With the recruitment of an independent Clinical Chair from January 2016, The Clinical Working Group will be further supported by the Joint Engagement Working Group which will be responsible for engagement with the wider patient, public and clinical communities. 3

5 Whilst the key risk in terms of the timeline focuses upon clinical agreement, some additional risks are important in terms of the impact upon the timeline s deliverability. The travel analysis supporting the analysis of the current options is being further developed to take into consideration the development of the intermediate clinical model. This will allow a greater understanding of the impact of patient choice on the activity models however, in undertaking this work at a more detailed level, further iterations of the clinical models may be required. As outlined above, there is a need for wider engagement across the health system. This is most visibly seen in the joint work established with Milton Keynes and Bedfordshire Healthwatch groups. In ensuring this engagement is meaningful there is a need for these discussions to help shape the discussions within the Programme a principle the Programme is committed to. This however, does bring risks associated with balancing the need for meaningful engagement with the need to move at pace and speed. Finally, the work to develop the Intermediate Clinical Model is allowing further refinement of the Finance and Capital models which are being developed by the Finance Working Group. Whilst significant progress has been made in this area it is an area which may be impacted by the changes throughout this phase and the Pre Consultation Option Development. At present, the risks associated with the Finance and Capital models are low, but are being closely monitored by the Programme. 5. Conclusions The Programme has a challenging timeline to deliver public consultation by July Significant progress has been made across the health systems during this first phase of Testing and Alignment, with a high level of support and engagement. More difficult discussions will need to be facilitated by the Programme Team over the coming months, but initial discussions have been promising from all parties. 6. Recommendations This paper makes the following recommendations: That the Board notes the current timescale for the Programme and the proposed date of public consultation That the Board notes the key risks associated with the ability of the programme to achieve the proposed date of public consultation. 4

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