Oxfordshire Clinical Commissioning Group Board Meeting. Date of Meeting: 26 May 2016 Paper No: 16/37

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1 Oxfordshire Clinical Commissioning Group Board Meeting Oxfordshire Clinical Commissioning Group Date of Meeting: 26 May 2016 Paper No: 16/37 Title of Presentation: Oxfordshire CCG s RightCare Approach Is this paper for (delete as appropriate) Discussion Decision Information Purpose and Executive Summary (if paper longer than 3 pages): This paper is to update the Board on how the RightCare approach will be implemented in the CCG. Background The NHS RightCare approach has been tested and proven successful in recent years in a number of different health economies. It is a programme that focusses on value, increasing quality and releasing funds for further innovation. The steps in the approach are: Where to look supported by the Commissioning for Value packs and benchmarking tools. This involves triangulation of data to identify which programmes offer the best value opportunities. What to change an approach to using service reviews to identify what needs changing and building the case for change. How to change driving through changes with clinical leadership and business process re-engineering techniques. NHS England has committed to rolling out the RightCare approach to all CCGs over the next two years. OCCG are part of the Wave 1 roll-out. The Impact of Value RightCare, together with the New Care Models, support the vision set out in the Five Year Forward View with its focus on the transformation of healthcare services to drive improvements in quality and efficiency. The rollout and implementation of the RightCare approach is expected to inform and contribute to the delivery of c7% of the 22bn national financial challenge articulated in the 5YFV. Paper 16/37 26 May 2016 Page 1 of 3

2 If this is modelled pro-rata to Oxfordshire then c 20m of value improvements might be expected to be delivered locally over the 5 years of the plan. Commissioning for Value Opportunities The initial benchmarking opportunity pack for Oxfordshire identified opportunities totalling 6.3m when compared to the best 5 of our comparator CCG s. Highest value opportunity areas are: Cancer pathways, 1.4m in planned care and 0.4m in urgent care. MSK, 1.3m. Trauma, 0.8m. Given the comparatively low value of opportunity identified for Oxfordshire we are seeking to develop the benchmarking information to show the opportunity against the top quintile and top decile performing CCG s in England. Approach The implementation of the RightCare approach locally will be used alongside and to inform the work of the Oxfordshire Transformation Programme work-streams and the Sustainability and Transformation Plan (STP). The attached document identified the key roles involved in the approach, focussing on the importance of clinical leadership and engagement. The document sets out a standard structure approach in stages over 2016/17 and beyond. The next step is to agree the priority area(s) for the launch of the approach. Financial Implications of Paper: Deep-dive analysis work packages will need to be commissioned/procured from commissioning support services providers. The cost of this per dive has not yet been quantified but at this stage is expected to be managed within the CCG running cost budgets and resources to support transformation. Action Required: The Board are asked to note the proposed approach. NHS Outcomes Framework Domains Supported (please delete tick as appropriate) Preventing People from Dying Prematurely Enhancing Quality of Life for People with Long Term Conditions Helping People to Recover from Episodes of Ill Health or Following Injury Ensuring that People have a Positive Experience of Care Treating and Caring for People in a Safe Environment and Protecting them Paper 16/37 26 May 2016 Page 2 of 3

3 from Avoidable harm Equality Analysis completed (please delete tick and attach as appropriate) Outcome of Equality Analysis Yes No Not applicable Author: Gareth Kenworthy Director of Finance Clinical Lead: Dr Joe McManners Clinical Chair Paper 16/37 26 May 2016 Page 3 of 3

4 Oxfordshire CCG s RightCare approach DRAFT for discussion v0.5

5 Oxfordshire CCG RightCare approach Level BOB-level CCG-Level How RightCare can be applied Identify Care and Quality Gap and means of closing it (STP) Identify Finance Gap and means of closing it (STP) Understand and evaluate the relationship between spend and outcomes (STP) Strategically realign resources (STP)/strategic contract negotiations Service-level Service redesign Locality-/ Practice-level Identify and understand variation Performance management and support to practices

6 Oxfordshire CCG RightCare approach to service redesign Right Care Phase Where to look Stage in OCCG approach Identify & Initially Understand Prioritise High-level stage description Using existing sources (Commissioning for Value pathway and focus packs; SPOT tool; Programme Budgeting; Atlas of Variation etc.) identify and long-list potential opportunities (NB in future years, this should be part of an annual planning cycle). Build an initial understanding of as is Develop a decision tree. Prioritise opportunities according to the agreed criteria (e.g. size of the opportunity, deliverability, ROI, payback period) Stakeholder Analysis What to change How to change Analyse & Fully Understand As Is (Re-)design to be Mobilise Implement Undertake a deep dive analysis using CfV focus packs + locally commissioned analysis to understand variation (at a granular level); understand cause of variation and opportunities to deliver change. Understand current state( as is ) Understand best practice and/or Design to be : design optimal pathways; new clinical models Understand the gap between the as is and best practice; Agree means of closing the gap Define benefits; establish baseline and define means of measuring the benefits Draft service specification, business case and PID Develop action (mobilisation) plan(s) Enact actual changes to the pathway, revised/new supporting policies, contracts/contract variations etc. Stakeholder engagement Deliver Benefits & Learn Deliver financial and quality benefits as per the agreed business case and benefits realisation plan. Evaluate and learn

7 Oxfordshire CCG RightCare approach to service redesign: stages, duration, decision points and supporting project documents Identify & Initially Understand Prioritise Analyse & Fully Understand As Is (Re)-design to be Mobilise Implement Deliver Benefits & Learn 3-4 weeks 3-4 weeks 4-6 weeks 2 weeks weeks weeks weeks 4 weeks+ Project documents Decision point Mandate (Idea) Problem Statement (Revised Project Brief) Simplified Business case & PID Stakeholder Analysis Stakeholder engagement

8 Oxfordshire CCG RightCare Approach to service redesign: Implementation Roadmap 2015/ / /18 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Initiation Wave 1 of reviews Wave 2 of reviews Wave 3 of reviews Identify & Initially Understand Prioritise Analyse & Fully Understand As Is (Re)-design to be Mobilise Implement Deliver Benefits & Learn

9 Stage 1: Identify and initially understand Using existing sources (Commissioning for Value pathway and focus packs; SPOT tool; Programme Budgeting; Atlas of Variation etc.) identify and long-list potential opportunities. Build an initial understanding of as is Inputs Commissioning for Value packs; SPOT tool; Programme Budgeting; Atlas of Variation; local benchmarking and soft intelligence Process CCG (PMO Analyst and PMO Manager, with substantialinput from Clinical Lead(s), Public Health, Quality, Finance and Business Intelligence) undertake initial analysis PMO seek input/comments from Commissioning Teams and Clinical Leads PMO finalise the long list of opportunities Outputs Evidence-based long list of opportunities R -responsible A -accountable C -consulted I -informed R PMO Analyst and PMO Manager (RightCare Programme Manager) C Public Health, Quality, Head of BI, Finance, Commissioning (Senior) Managers A RightCare Programme Director (Head of PMO) I CCG Executive, Senior Management Group Considerations NB in future years, this should be part of an annual planning cycle). Priority list to be refreshed on release of new CfV packs/releases and updates to other tools

10 Stage 2: Prioritise Develop a decision tree. Prioritise opportunities according to the agreed criteria (e.g. size of the opportunity, deliverability, ROI, payback period) Inputs Evidence-based long list of opportunities (from Stage 1) Agreed prioritisation criteria and a decision tree Process CCG (PMO) hold conversation with relevant stakeholders (Commissioning (Senior) Managers; Clinical Leads; Executives CCG (PMO) organise stakeholder workshop Clinical Lead, supported by PMO, run a facilitated discussion and prioritisation of opportunities PMO update the list with the results of the prioritisation PMO develop a reviews rollout plan PMB and/or Joint QIPP SG, acting as RightCare Steering Group, sign off the rollout plan Outputs Evidence-based, prioritised list of areas for further analysis Reviews rollout plan R -responsible A -accountable C -consulted I -informed R PMO Manager and Head of PMO C Commissioning Senior Managers, Clinical Leads, Executives A RightCare Programme Director I CCG Executive, Senior Management Group Considerations System-wide/STP mechanisms and fora to be used in 2016/17 e.g. service redesign groups; service redesign checkpoint workshops; Joint QiPP Steering Group

11 Stage 3: Analyse & Fully Understand As Is Undertake a deep dive analysis using CfV focus packs + locally commissioned analysis to understand variation (at a granular level); understand cause of variation and opportunities to deliver change. Understand current state ( as is ) Inputs Process Outputs Evidence-based, prioritised list of areas for further analysis Existing reports, process maps, Datix and other feedback etc. describing current state CCG (PMO Manager, with input from Commissioning (Senior) Managers, Clinical Leads, Locality Co- Ordinators? and (Head of) BI draft data queries/lines of enquiry Clinical Lead agrees data queries/line of enquiry CCG (PMO Manager) commissions analysis from CSU; CSU produce analysis PMO, with input from clinical and managerial leads, identify and analyse review-specific stakeholders CSU and PMO facilitate deep dive workshop, fronted by the Review Clinical Lead, with clinicians and managers from across the system to understand variation at a granular level, understand causes of variation and opportunities to deliver change Review specific stakeholder analysis Understanding of variation at a granular level; understanding of causes of variation; understanding of opportunities to affect change, combining hard and soft intelligence (i.e. workshop discussion) captured in writing a joint problem statement R -responsible A -accountable C -consulted I -informed R Review Clinical Lead; PMO Manager; CSU BI team; workshop participants C Head of BI, Finance, Commissioning Senior Managers, Clinical Leads, Locality Co- Ordinators? A RightCare Programme Director I CCG Executive, Senior Management Group Considerations The Analyse and Fully Understand and Redesign stages will likely be completed in two separate workshops, a couple of weeks apart: Workshop 1 (1/2 day) will consider the results of the completed analysis and agree a picture of as is. Further analysis/research may be required and will be commissioned as a result of this workshop e.g. process mapping; best practice research. This may be tasked to a task and finish subgroup.

12 Stage 4: (Re-)design to be Quick stock take of we know about the as is Understand best practice AND/OR (Re-)design to be : design optimal pathways; new clinical models Understand the gap between the as is and best practice Agree means of closing the gap Inputs Process Outputs Understanding of As Is from the previous workshop (pathways; variation; causes of variation; opportunities to deliver change, combining hard and soft intelligence) Understanding of best practice Review Lead and Review Clinical Lead, with input and support from PMO, presents evidence describe as is and best practice Review Lead and Review Clinical Lead, with input and support from PMO, designs and facilitates workshop to define to be (based on best practice); workshop confirms/defines as is and to be NB where no best practice exists, the review will design to be acceptable to OCCG; relevant stakeholders and approaches e.g. experience-based co-design - will be used To Be clinical models described (e.g. process maps; process step descriptions, including RACI) Gap described and means of closing the gap identified R -responsible A -accountable C -consulted I -informed R Review Lead; Review Clinical Lead; Clinical Directors; invited stakeholders C PMO; Head of BI, Finance, Commissioning Senior Managers, Clinical Leads, Locality Co- Ordinators? A Director of Delivery & Localities I CCG Executive, Senior Management Group Considerations The Analyse and Fully Understand and Redesign stages will likely be completed in two separate workshops, a couple of weeks apart: Workshop 2 (1 day) will take stock of what we have learned about the as is ; design to be: (optimum pathways, new clinical models); identify the biggest gap between the as is and to be and agree means of bridging the gap

13 Stage 5: Mobilise Define benefits; establish baseline and define means of measuring the benefits Draft service specification, business case and PID Develop action (mobilisation) plan(s) Inputs Agreed As Is and To Be clinical models Agreed means of closing the gap Process Outputs Review Lead and Review Clinical Lead, with input and support from the review team, Quality, PMO and BI, defines benefits, ways of measuring benefits, and the baseline BI commissions benefits realisation report from CSU Review Team develops business case, service specification and PID Provider(s) develop implementation plans Joint QIPP signs off and PMB approves business case and PID Agreed business case, service specification, and PID Action (mobilisation) plan(s) / provider implementation plans Benefits realisation monitoring report R -responsible A -accountable C -consulted I -informed R Review Lead, with input and support from review team and PMO and BI; CSU BI; Joint QIPP SG; PMB C PMO; Head of BI, Finance, Quality, Commissioning Senior Managers, Clinical Leads? A Director of Delivery & Localities I CCG Executive, Senior Management Group Considerations Depending on the value of the contract/variation, approval by the Finance Committee and/or Governing Body may be required, as per the OCCG Scheme of Delegation

14 Stage 6: Implement Enact actual changes to the pathway, new supporting policies, contracts/contract variations etc. Inputs Agreed business case, service specification, and PID Benefits realisation monitoring report Process Implementation Project Lead to enact changes as per the action (mobilisation) plan Deliver quick wins Relevant Programme Board and PMO to track progress of implementation and benefits realisation Outputs Actual changes to the pathway, revised/new supporting policies, contracts/contract variations etc. enacted as per the plans Benefits realisation plans R -responsible A -accountable C -consulted I -informed R Implementation Lead; PMO C relevant Programme Boards; PMO A Director of Delivery & Localities and/or Provider I CCG Executive, Senior Management Group; Locality Co-ordinators Considerations Successful implementation is dependent on the effective engagement of relevant stakeholders throughout the process

15 Stage 7: Deliver Benefits & Learn Deliver financial and quality benefits as per the agreed business case and benefits realisation plan Inputs Implemented changes to the pathway, revised/new supporting policies, contracts/contract variations etc. Benefits realisation plan Process Enact benefits realisation plans, taking corrective action as necessary Hold lessons learnt workshop to capture learning Make changes to the approach, if required Outputs Accrued benefits Learning captured; changes to the approach made, if required R -responsible A -accountable C -consulted I -informed R Implementation Lead; relevant Programme Boards C PMO; Head of BI, Finance, Commissioning Senior Managers,, Clinical Leads, Locality Co-Ordinators? A Director of Delivery & Localities and/or Provider I CCG Executive, Senior Management Group Considerations As some benefits will likely accrue after the project has finished, a handover to the relevant programme, with responsibility for benefits realisation explicitly assigned, will be required

16 Oxfordshire CCG RightCare Approach: Clinicians role is vital to success Level Lead Role & responsibilities CCG RightCare Programme Clinical Chair Clinical face and champion of the Right Care programme Provide clinical advice, input and leadership (Help) build support amongst the CCG and clinicians for the approach and agreed priority areas Nominate/confirm clinical leads for individual projects Liaise with secondary care Clinical Directors/consultants for relevant areas Individual service reviews Named Clinical Lead NB might be existing clinical lead for the relevant area/specialty Clinical face and champion for the review. Build support amongst the CCG and clinicians for the approach and agreed priority areas Liaise with relevant secondary care Clinical Directors/consultants Bring in clinical and patient perspective to the project at all stage of its lifecycle (identifying a need for the project; scoping the project; delivering the project) Advise on relevant notable practice and clinical/policy developments impacting the project Localities- /Practice-level Locality Clinical Director With support from Locality Co-ordinators, identify and understand variation Performance management and support to practices (e.g. through Practice Commissioning Pack (PCP) meeting)

17 with managers providing appropriate coordination, input and support Level CCG RightCare Programme Lead SRO/Programme Director Programme Manager Role & responsibilities Lead the Right Care programme Provide advice and liaison with the national programme, system transformation, STP and corporate functions Targeted support to individual reviews Programme manage the Right Care programme Commission analysis to enable prioritisation and inform reviews Targeted service improvement support to individual reviews Individual service reviews Review Lead NB might be existing senior managerial lead for the relevant area Support the Clinical Lead in undertaking the review Resource the review and ensure it is delivered within the agreed timescales, plan etc. Ensure benefits are identified and realised (during and post the review) Ensure learning is applied to future reviews Localities- /Practice-level Locality Sponsors and Locality Co- Ordinators Support Locality Clinical Directors in identifying and understanding variation Support Locality Clinical Directors with performance management and support to practices (e.g. through Practice Commissioning Pack (PCP) meeting)

18 RightCare is not an add-on: it is our underpinning approach to commissioning/service redesign. It needs to become everyone s responsibility