Re-defining the Strategic Change Programme

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1 Re-defining the Strategic Change Programme i

2 Table of Contents 1. Purpose of Document Overview of the Portfolio Case for Change Where are we now? Priorities - Programme Areas Benefits Governance Arrangements Risks Branding, Communication & Engagement Next Phase Portfolio Plan Recommendations ii

3 1. Purpose of Document The Strategic Change Programme Board (former Transformation Programme Board) has undertaken a high level review of the strategic change programme in line with the with Integrated Medium Term Plan, the new legislation around the Wellbeing and Future Generations Act and the Social Services and Well Being Wales Act, and the agreed case for change to support the integration of services between Powys Teaching Health Board and Powys County Council. This paper is intended to provide a summary at a portfolio level of the redefined strategic change programme and includes an updated case for change to support the continued business justification to invest in the portfolio of change. The paper provides: An updated case for change to promote a shared understanding across the Health Board and with our key stakeholders as to why we need a strategic change programme and what issues the change programme is looking to address. The high level programme scope and intended outcomes to be delivered. An overview of the governance arrangements required to provide assurance to successful delivery. High level intended benefits at this stage. The next phase of work required to take forward the strategic change programme portfolio. The Finance and Performance Committee have considered the detail of the re-alignment of the programmes and this is now recommended for approval at full Board. 3

4 2. Overview of the Portfolio The re-defined portfolio the strategic change programme will seek to develop a long term health and care strategy to provide a future vision and a strategic direction of travel required to meet the future needs of the Powys population. This will ultimately provide sustainable and high quality health and care into the future and will be achieved through discussion with communities, our staff and our key partners. The programme will focus on developing and implementing our longer term plans over the next 5, 10 and possibly 20 year horizon; ensuring a robust plan is in place to meet the population needs in the short term (less than 3 years) and the medium term (5-10 years). The development of new ways of working, new services and new environments is fundamental to improving experiences for people who use and work in these services. We will implement improvements at the earliest opportunity, and will invest in a strong and sustainable infrastructure to ensure developments for our communities, our staff and partners for the longer term. The programme management approach will enable the Health Board to apply a Pan Powys approach to service re-design to spread best practice and reduce duplication. The strategic change programme will address the following questions: What services will we need to provide to meet our population needs in the longer term? How best can we deliver these services within our available resource? The Health Board and Powys County Council will provide develop a long term affordable and sustainable health and care strategy with a clear vision on how we meet the needs of our local population in the future to improve health and well being. A strategic commissioning framework will be developed and implemented to deliver world class commissioning for the population of Powys, working jointly with Powys County Council to commission residential and carers services. What do we need to do now to improve services for our population in the shorter term? Focus will be on modernising and developing alternatives to outpatients and strengthening diagnostics in line with the prudent healthcare guidance. We will invest in ensuring sustainability of primary care services, re-designing hospital pathways and improving patient flow. 4

5 To ensure success in addressing the above strategic questions; the Health Board will focus on: Delivering new technology to support innovation and changes to the way we deliver care. Preparing and developing the organisation for change and ensuring we have robust and appropriate workforce and OD development plans. Providing robust business intelligence to inform and measure our success. Delivering an investment plan to improve our estate. 3. Case for Change There are a number of key challenges the Health Board needs to address as part of the portfolio of the strategic change programme and these are summarised below. Public Health Challenge Increases in our ageing population require future services to support people who are frail and elderly, and who often have multiple long term conditions to continue to live with dignity and independence at home and in the community. This is challenging in Powys due to the rural community, and alternative ways of ensuring elderly people are supported to live independently need to be explored to reduce risk of social isolation and maintain independence and social cohesion. The Health Board, Powys County Council and PAVO have developed an older people commissioning strategy which is currently out for consultation. The implementation of this strategy will aim to meet the needs of our elderly population within the next 5 years, but further work is needed to look at the longer term populations needs to ensure future services meet the needs to our changing population. Changing patterns of illness have resulted in a historical increase in people with long term conditions and it is anticipated this will continue to rise. New ways of working need to be considered to be able to reduce reliance on traditional hospital treatment and to ensure the needs of these individuals are met in a more holistic way to help people manage with multiple chronic conditions and access support tailored to their individual needs. Whilst the Health Board continues to strive to meet the current care needs of our local population, we also need to continue to ensure there is focus on developing services to prevent people from becoming ill. There are opportunities to re-design services in the short to medium term to ensure more focus on earlier intervention and supporting people to self care. 5

6 Quality and Efficiency Challenge It is recognised on a national and local level that health and social care services need to be more co-ordinated around the individual to ensure the right support is offered, at the right time and in the right place. People are currently experiencing fragmented services between health and social care. This is because our population s care needs have changed faster than our health and care systems have been able to respond, resulting in a mis-match between the kind of support that people need and the services that they end up getting. We need to move towards a fully integrated health and social care system which meets the needs of our future generations. In our community hospitals, our current outpatient services are based in buildings which do not support a modern or alternative approach to the way we can deliver our services. We need change our outpatient model to ensure access to specialist advice in primary care settings. This will allow patients to be seen faster and closer to home and free up more time for hospital-based consultants to manage the most clinically complex cases. Diagnostics is crucial to enabling more services to be provided in Powys, currently the Health Board does not have a Powys wide diagnostic strategy to ensure focused investment and development of diagnostic services. A strategy needs to be developed and implemented to improve access to diagnostic services for people and to reduce unnecessary travel out of county. Currently there are inefficient flows between and within our hospitals which often means patients spent time waiting unnecessarily and often are not being cared for in the most appropriate settings. A recent point prevalence study undertaken in our community hospitals, shows a number of patients are waiting in our community hospital beds for social care input and for other reasons and that they could be at home. This study also identified opportunities internally to improve our multidisciplinary approach and discharge processes to reduce the length of time a patient spends in hospital. There are also opportunities to look at how pathways can be re-designed to prevent people from being admitted to hospital and to enable them to receive more care at home and retain their independence. In Primary Care, there are risks with sustainability of primary care services and future resourcing due to national and local shortages in GP s and the ageing workforce profile in Powys. In the short term, the Health Board needs to develop systems and processes to be able to better respond and support practices to ensure future sustainability and look at alternative ways to provide services. 6

7 More broadly, our current configuration of services is fragile and it is often difficult to staff services in multiple locations with low levels of activity. This can often result in services being provided less frequently and reduced productivity, and is due to many reasons at both a local and national level: Sub specialisation has resulted in Consultants undertaking more specialist operations, which has resulted in more services being centralised to ensure critical mass to achieve the best clinical outcomes. There continues to be an increase in service user expectations, people are more able to research into diagnoses and conditions and are increasingly expecting a higher level of customer care. There are difficulties with recruitment in certain staffing groups and attracting staff to work in a rural healthcare settings. There is a need to ensure appropriate governance arrangements or networks in place to ensure staff maintain appropriate professional development. In addition to the current fragility of services; there are also a number of changes happening to services around the border of Powys namely through the future fit programme, mid wales collaborative, and south wales programme. The Health Board will need to ensure a robust short and long term plan is in place to proactively support changes to the way services are configured by continuing to repatriate services in a more economic way. There is a need to review the current configuration of provider services across Powys to build resilience and strengthen our governance arrangements, in the longer term. Economic Challenge Powys has the fastest growing elderly population in Wales and a new approach is required in order to ensure support and services are sustainable and to avoid unaffordable increases in spending. A strategic demand, capacity and financial modelling report indicated a potential cost pressure in Health of between 20-25m (dependent upon inflation) in 2019/20; the report highlighted a number of interventions to mitigate this through efficiency and reconfiguration of services. There is a need to continue to deliver our efficiency savings through service re-design and look at potential opportunities on how to configure services in the longer term. Workforce Challenge Historically the Health Board has struggled with recruiting GP, Consultants and other clinical staff, in part due to the national recruitment issues and as a result of our rurality. There is expectation to provide services 7 days 7

8 a week and to extend some services into the evening. We need to think differently about how we resource and deliver services in future to ensure sustainability and the best services for our local population. We also need to look at how we recruit and market Powys as an attractive place to work and live. The Health Board also needs to ensure it is in a suitable form and is fit to deliver its strategic changes through building on the prudent workforce principles, developing leadership capability and implementing a clinical leadership model. Estate Challenge There are immediate compliance issues across the Estate which need to be addressed to support safe delivery of services which is in part due to our ageing estate which is no longer fit for purpose. There is a longer term requirement to look at how we develop our estate for the future based on a robust health and care strategy to ensure the Health Board invests in buildings which support the future needs of the population. Future buildings will need to be based on alternative approaches to the current traditional style and will look at how technology can support more remote working and people to remain at home. By working together across health and care there is greater potential to realise economies of scale and meet the future needs of our population. New Legislation and Policy Drivers The prudent healthcare paper; Securing Health and Wellbeing for Future Generations sets out a number of particular areas of action that will focus the national implementation of prudent healthcare in a systematic way. The re-defined scope supports the implementation of elements of this plan and further work will be undertaken during the next phase to provide assurance as to how this will be delivered. The Wellbeing and Future Generations Act and Social Services and Well Being Act is predicated on a principle which places well being at the centre of the Act. It links to the role that prevention and early intervention can play in promoting well-being and how people can be empowered by information, advice and assistance. It involves people in the design and operation of the services they use. The code of practice also puts in place a system where people are full partners. A newly formed Joint Partnership Board in Powys has been put in place to oversee joint working and integration. The re-defined portfolio of change takes into account the new legislation and commitment to integrate services, and further work is required during the next phase to fully embed changes required to support joint working and integration. 8

9 The portfolio of change will continue to set out to deliver the requirements of the Welsh Government Consultation Guidance through continuous engagement with our population, staff and stakeholders and will ensure a robust engagement and consultation process supports the portfolio. 4. Where are we now? The former Transformation Programme and programme management office has been predominately focused on three elements; Developing internal programme and project management capability and capacity required to support change. Implementing key projects across Powys such as the Adult Mental Health Project, Strategic Demand and Capacity Modelling Project and Space Utilisation Project. Initiating the change programmes set out in the former Transformation Programme. Following a review of the change programmes in line with recent changes externally and internally to Powys, the following issues were identified: The programme scope for the Strategic Delivery Model programme was focused on health and does not align with future plans to integrate health and social care. The programme scope for the Service Reform Programme was too broad; this was established as an emerging programme based on existing projects underway within the localities to support implementation of the IMTP. It also did not provide sufficient focus on primary care. Upon review of the existing and planned projects, the programme was re-defined and will now focus on delivering six projects. A review of the commissioning services in Powys was undertaken and a report was published in March 15. Further work has been undertaken to strengthen commissioning arrangements at an operational level. This programme will now focus on developing and implementing a commissioning framework to provide assurance around quality of care. The enabling programmes have started to be developed and in some areas, changes have been implemented successfully such as Chat to Change. Further strengthening of these programmes is required to ensure they support the needs of the core key programmes. The outcome of the high level review of the former Transformation Programme demonstrated opportunities to re-define and re-focus the strategic change programme to ensure it addresses the key challenges for the Health Board and supports delivery of the Health Boards strategic objectives. 9

10 5. Priorities - Programme Areas The following programmes remain as priorities under the portfolio of the strategic change programme, however further work has been undertaken to re-scope and re-define the intended outcomes. 1. The SDM programme scope has been extended to incorporate social care and is now referred to as the Health and Care Strategy Development Programme. 2. The Service Reform Programme has been re-scoped to focus on 6 key priority projects shown on page 12. This programme will be pan Powys and will identify financial saving opportunities through implementation of operational changes. This is now referred to as the Primary and Community Care Delivery Programme. 3. The Commissioning programme has been redefined to focus on the development and implementation of a Commissioning Framework to provide assurance around quality of care for the Powys population. This will now be referred to as the Commissioning Development Programme. 4. Further scoping work on the enabling programmes is required, but initial changes are: a. The Workforce and OD programme will focus on 3 priority areas organisation design and deliver; staff engagement; redesign, recruit and retain. b. The ICT programme is now referred to as the Technology Programme, this will remain focused on providing a stable infrastructure but will provide increased focus and co-ordination across the Health Board on how technology can be utilised to support the Health Board in delivering the change agenda. c. The Business Intelligence Programme will focus on the delivering the core business intelligence requirements of the strategic change programmes. d. The Estate Programme will focus on both the short term requirements to deliver the capital programme and address compliance issues, and in the longer term requirements to provide an estate fit for purpose in line with the future health and care strategy. An outline of the revised programmes is provided below. Further work will be undertaken to confirm scope, outcomes and key benefits within the next 3 months. 10

11 Health and Care Strategy Development Programme Executive Lead: Director of Planning and Performance Commissioning Development Programme Executive Lead: CEO and Director of Planning and Performance 11

12 Primary & Community Care Delivery Programme Executive Director: Deputy Chief Executive/Director of Primary and Community Care 12

13 Primary & Community Care Delivery Programme continued. Technology Programme Executive Director: Director of Finance 13

14 Workforce and Organisation Development Programme Executive Director: Director Workforce and OD 14

15 Estate Development Programme Director of Planning and Performance 15

16 Business Intelligence Programme Executive Director: Director of Public Health 16

17 6. Benefits The high level benefits are aligned with our strategic aims and objectives. Further work will be undertaken as part of the next phase to develop a portfolio benefits plan with agreed performance measures and timescales. Improved Patient Experience Reduction in unnecessary hospital visits and time spent in hospital. Improved health and well being of patients. Patients empowered to self manage. Deliver viable and sustainable services Robust strategic plan to develop future services. Reduce unnecessary out of county referrals and admissions. Improve direct access to diagnostics. Reduce variation in referrals. Improved staff experience Sustainable workforce in place to support new models of care. Staff empowered and motivated to change. Programme and project management capacity and capability to deliver change. Fit for Purpose Estate Improved environment for patients and staff and utilisation of existing estate. Move towards compliance of HBN and HTM via potential developments. Reduce backlog maintenance and decommission redundant estate. Improved effectiveness and clinical efficiency Improved clinical outcomes. Reduced length of stay, unnecessary visits to acute hospital, increase use of facilities. Improved patient flow, reduce waste and variation in practice. There is a level of financial saving opportunity identified as part of the strategic demand, capacity and financial modelling work. This work identified a potential financial pressure to the Health Board of 20m - 25m (dependent upon inflation), and also identified interventions that could offset this. There were potential savings identified through focusing on efficiency to delivery 3.037m, which equates to 1.98m when existing efficiency saving schemes are taken into account. There were also potential savings opportunities to release an additional circa 4.6m savings through reconfiguration of services. Both present a level of opportunity at this stage and further work is required to confirm the financial benefits associated with the Strategic Change Programme. 17

18 7. Governance Arrangements The governance arrangements for the strategic change programme are shown in the diagram below. The programmes will continued to be managed through the agreed Executive Sponsors with support from the programme management office. An internal Change Programme Board within the Health Board will continue to manage delivery of the health aspects of the programmes and the terms of reference for this Board will be reviewed to reflect the revised programme scope and outcomes. Further discussion is required to confirm the governance arrangements for the Health and Care Strategy Development Programme and other joint areas of work with Powys County Council. The diagram below shows the current structure of the programme. The reporting arrangements for each programme will be into the Change Programme Board and a bi-monthly progress report will be issued from the Change Programme Board to Finance and Performance Committee and Board. The Health Board will continue to utilise a programme and project management approach to deliver change across Powys. The resourcing across the programmes needs to be further developed to ensure priority areas have sufficient resource. 18

19 A joint methodology and templates have been developed through the joint PMO mechanisms with Powys County Council. The internal project management training programme will be re-launched later this year to improve project management capability across the Health Board and Powys County Council. 8. Risks A full risk assessment as part of the next phase will be undertaken at a portfolio and individual programme level. A portfolio level risk assessment has been completed and will be discussed at the next Change Programme Board on 1 st June 16. All programmes will be reviewing the risk logs in line with the re-defined programmes. 9. Branding, Communication & Engagement As part of the Health and Care strategy work, a branding exercise and an initial engagement and communication plan has been prepared for further discussion. These will support communication and engagement of the strategic change programme and ensure key messages and a strapline are used to support all communication and engagement activities under the strategic change programme. The strategic change programme communication will need to be aligned with the Integrated Medium Term Plan and Annual Plan to raise staff and stakeholder awareness of programmes of work. 10. Next Phase Portfolio Plan The 6 months plan of work at a portfolio is provided below. Following approval to proceed a more detailed plan will be developed and discussed in the June Change Programme Board and monitored at Change Programme Board. A further update on progress will be provided to Board in July 16 and regular bi-monthly progress reporting to Finance and Performance Committee and Board will be established. Portfolio Outcomes Ensure stakeholders are engaged and understand the strategic change programme. Quarter 1 30 th June 16 All engagement activity undertaken as per the plan. Quarter 2 30 th September 16 Feedback report provided beg of August 16 with any further recommendations to be implemented. 19

20 Portfolio Outcomes All Programmes established with measurable outcomes and benefits confirmed. Further strengthen risk management across the programmes to provide assurance on delivery. Further strengthen governance arrangements to provide assurance on delivery. Quarter 1 30 th June 16 Agree approach to branding of the strategic change programme. Confirm scope and outcomes for all core programmes by 31 st May 16. Confirm scope and outcomes for all enabling programmes by 30 th June 16 High level milestone plans for each programme showing key deliverables. EQIA and QIA Impact assessment undertaken. Hold Benefits workshop. Revised Mandates for all programmes approved by CPB. Financial benefits to be confirmed by June 16 All progammes to have identified and be managing risks through a risk register. Immediate changes to governance structures implemented to support re-defined programmes. Quarter 2 30 th September 16 Benefits framework fully embedded. Programmes fully established. Review of risk management across the portfolio. Further opportunities to be explored through joint working with the Council. Review of governance across the programme. 20

21 11. Recommendations The Finance and Performance Committee have considered the detail of the re-alignment of the programme and recommends the Board approve the re-defined strategic change programme and the next phase of work to fully establish the programmes. 21