BOARD 9 DECEMBER 2015 AGENDA ITEM 3.3 STRATEGIC PLANNING AND STRATEGIC CHANGE REPORT of Director of Planning and Performance Paper prepared by Director of Planning and Performance Purpose of Paper Action/Decision required The purpose of this paper is to provide an overview of the Health Board s key strategic planning activities and an overview of progress against the strategic change programmes around the border of Powys. The paper describes the approach to develop the Integrated Medium Term Plan (IMTP) for 2016-19. The paper provides an overview of work that will be undertaken to meet the requirements set for national delivery plans by the end of the financial year. Progress to manage the strategic change agenda programme and a summary of overall high level risks is highlighted. The Board is asked to NOTE and DISCUSS the paper. Link to Health and Care Standards This paper supports: Governance, ership and Accountability Theme 1: Staying Healthy Theme 2: Safe Care Theme 3: Effective Care Theme 4: Dignified Care Theme 5: Timely Care Theme 6: Individual Care Theme 7: Staff and Resources Page 1 of 10
Link to Health Board s Annual Plan Acronyms and abbreviations Improving Health & Well-Being Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count Always with our Staff SDM Strategic Delivery Model SWP South Wales Programme ACA Acute Care Alliance CCG Commissioning Group SATH Shrewsbury and Telford Hospital NHS Trust SOC Strategic outline case OBC Outline business case FBC full business case WAST Welsh Ambulance Service NHS Trust MWHC Mid Wales Healthcare Collaborative Page 2 of 10
PURPOSE OF THE PAPER STRATEGIC PLANNING REPORT The purpose of this paper is to provide an overview of the Health Board s key strategic planning activities and an overview of progress against the strategic change programmes around the border of Powys. The paper describes the approach to develop the Integrated Medium Term Plan (IMTP) for 2016-19. The paper provides an overview of work that will be undertaken to meet the requirements set for national delivery plans by the end of the financial year. Progress to manage the strategic change agenda programme and a summary of overall high level risks is highlighted. IMTP 2016-19 DEVELOPMENT PROCESS In response to the internal audit review recommendations on the process undertaken to develop the IMTP for 2014-17, a project management approach is being taken to develop the IMTP for 2016-19 that provides a formal framework with clear roles and responsibilities to the development of the plan as well as to address concerns and feedback of staff on the process undertaken in 2014. A project team has been established and will lead and direct the production of the health board s IMTP, ensuring coordination and alignment of the multiple elements of the plan so that the final product is integrated and coherent and developed through engagement with stakeholders. The project team consist of senior staff from within the health board who hold responsibility for the development of key areas of the IMTP. These area have been identified as being the essential foundations which support and must be reflected across all elements of the Plan. The project team membership is as follows: Interim Director of Planning and Performance Planning and Project Manager Assistant Director of Quality and Safety Assistant Director of Workforce and OD Locality Planning Managers Interim Head of Commissioning Finance Deputy Director of Public Health Prudent healthcare lead An IMTP toolkit has been developed to help inform the process that the key leads are undertaking in refreshing the content, helping to distil and localise the information of the NHS Planning Framework. This toolkit provided context to the refresh and clear guidelines on expectations, requirements and timescales. Also included is information and key points to be considered in all sections of the plan in related to: Prevention & Health Improvement Business Intelligence Quality & Safety Commissioning Page 3 of 10
Workforce & OD Finance Prudent Healthcare Engagement The revised NHS Planning Framework issued in October 15, remains consistent with the approach and requirements of last year with an increased emphasis on articulating outcomes and mechanisms of delivery as opposed to descriptive narrative of our services. Timeline The timeline above shows the key milestone dates against which we are progressing, with Board approval of the final draft taking place on January 21st 16. Work is currently underway to bring together the refreshed sections of the plan, with the project team undertaking a challenge and scrutiny role. Independent members, Executive directors and key project team members will meet on Dec 16 to review the plan; challenging and assessing the various elements of the plans and their implications. In addition to our internal scrutiny process we will be participating in an all wales peer review process in December. In addition to the scrutiny process a clear engagement plan is in place to develop the level of engagement around the plan with stakeholders. This process of engagement will continue after the plan is submitted to further embed the IMTP and planning processes across the organisation. A key engagement activity taking place on December 7 will be the Commissioner Workshop event which has been set up to discuss the implication of our plan and commissioning intentions with our secondary care providers. NATIONAL DELIVERY PLANS The THB is not currently fully meeting the planning and reporting requirements consistently across all of Welsh Government published planning requirements for national delivery plans, and progress to recover the Health Board s position is monitored by the Finance and Performance Committee. There are examples of good progress against some national delivery plans, for example with regard to heart disease, stroke, neurological conditions and mental health. The THB is fully committed to fulfilling the requirements set out for the service improvement areas and to address the backlog of outstanding plans and reports by the end of 2015/16 financial year. It should be noted that there are a number of matters to consider. Page 4 of 10
Each of the plans generally, though not universally, have the following expectations attached: The production of a plan following a national template, to be approved by the THB s Board, against a series of action areas outlined in the national plan Annual review and refresh of the plan Inclusion of a summary in the IMTP (although the timetables are not aligned with some individual plans having a mid-year refresh requirement) Production of an annual report presented and approved by the Board and published on the THB s website Engagement in regional/national delivery mechanisms including clinical networks, events, peer review exercises etc. Delivery and performance management of actions committed to within each plan Stakeholder and public engagement mechanisms in both planning and delivery. To enable the basic delivery of plans and associated work, each planning area has been allocated an Executive Director lead to provide assurance to the Board of development and delivery of an approved plan. A process is required that enables the THB to fully establish the scale of work required to provide assurance on compliance with the plans and secure an overall approach to priorities. Further work will be undertaken by the Executive Team to review the mechanism by which the executive team manages relative priorities across multiple plans in respect of organisational capacity for delivery and potential new investment: The plans will be collectively assessed and prioritised by the Executive Team as part of the IMTP process for 2016-19. There are a number of steps required to enable this to happen: Review Director level leadership, clinical leadership and officer support for each plan through the executive team, and address resource gaps to supporting the plans. Different models of supporting development and delivery of plans will need to be considered including the role of GP clusters. Undertake an assessment of overall performance against the plans, key risks of non-delivery, financial implications and priorities for delivery across the Plans. It is proposed to initiate this work to enable a comparative assessment of priorities to be undertaken which is now planned during December/January 2015. Establish the performance arrangements that demonstrates delivery against the actions within the Plans. This will need to take account of the THB s Performance Framework, and the role of the THB s Commissioning Development Programme and Service Reform Programme Boards as this work is taken forward. Page 5 of 10
The completion of outstanding work on the document requirements of the Plans to bring the Board fully up to date with the planning and reporting requirements by the end of March 2016. In the short term, a Delivery Plan steering team will be established by the Director of Planning and Performance to provide high level direction, oversight and review to the process, developing a work plan and guidance, ensuring all plans are up to date, published and approved by the Board. The first meeting of the Delivery Plan Steering Team has been scheduled for early January 2016 to consider the priorities for the IMTP and to review progress with outstanding plans. The proposed process for managing the development of plans is outlined below: Welsh Government Planning National Delivery Plans PTHB Delivery Plan Steering Group Providing oversight of local delivery plan development, ensuring plans are in place, up to date and meet WG and HB guidelines and specifications e.g: Quality & Safety Priorities Whole Pathway Commissioning led HB Priorities and Objectives Co Production/ Partnership Guidance and Review Board For Approval STRATEGIC CHANGE PROGRAMMES Large scale strategic change programmes are underway in all organisations surrounding Powys teaching Health Board. Each of the external strategic change programmes: involve multi agency/partnership working to achieve whole system change have interdependencies with other local change programmes or improvement initiatives have a number of high risks which may impact on programme delivery and completion. To deliver the HB s Strategic Delivery Model Programme which will agree the best models of care and configuration of services to deliver clinically viable and Page 6 of 10
economically sustainable services to meet local needs in Powys, it is important to plan and align our future health and care services across the whole system of care and this work is interdependent with the neighbouring Health Boards and Trusts service plans A visual representation of the change programmes across our borders is attached below Mid-Wales Collaborative MWWHSC ARCH SW ACA South Wales Programme ACA s Velindre The scale and complexity of the strategic change agenda that the HB is engaging with is challenging and it is critical that Powys teaching Health Board is able to demonstrate a robust approach to managing involvement in and engagement with these external strategic change programmes in order to: suitably discharge the organisation s statutory duties whilst ensuring the needs of the Powys population are considered; manage the interdependencies between the programmes and to ensure alignment wherever possible; Page 7 of 10
design and implement a future health and care strategy for Powys that considers the impact of the proposed changes around the border of Powys. The following strategic change programmes are in place: Future Fit and Community Fit SATH and Shropshire Health Economy Herefordshire Transformation Programme South Wales Programme including Acute Care Alliances Mid Wales Health Collaborative Transforming Cancer Services in South East Wales Betsi Cadwaladr University Health Board Mid and West Wales Health and Social Care Collaborative Futures Programme, Aneurin Bevan Health Board Welsh Ambulance Services NHS Trust reform ARCH. PROGRESS It is essential that the Board are confident in the systems that are in place within PTHB to engage with, contribute to and feedback regarding these programmes. In managing the organisation s own transformation programme, PTHB will need to consider and respond to the outputs from external programmes which will impact on the Health Board s strategy and commissioning plans. During quarter 2 and 3, further work has been undertaken to consolidate our input into and knowledge of external strategic change programmes. Further work is required to determine the Health Board s input to the ARCH programme, and Herefordshire Transformation Programme. The Health Board s current approach to engagement with strategic change programmes across our borders has been reviewed and legal advice sought to clarify the role of the Health Board in relation to its involvement as a Partner in change programmes across the border in England. Work has been led by Powys Community Health Council with the input of the interim Director of Planning and Performance to set out clear desk top guidance on consultation requirements in line with national guidance. The establishment of the CHC s Services Planning Committee will play a pivotal role and the interim Director of Planning and Performance will use this mechanism to discuss engagement and consultation requirements. How the HB is involved and represented in external strategic change programmes has been reviewed and arrangements have been strengthened for example with regard to Future Fit. A continuous process of review has been established to prioritise the HB s input and involvement in programmes led by the Director of Planning and Performance. The scale of this challenge should not be underestimated, for example during the desk top review undertaken in July 2015 of strategic change programmes, PTHB were asked to participate in over 100 formal meetings (excluding clinical design/work stream meetings). Progress reporting (including centralised documentation management) will Page 8 of 10
be fully established once planning capacity is secured through the revised Planning and Performance directorate structure. Further work will be initiated during quarter 4 with the Board Secretary to review the effectiveness of governance and decision making in relation to strategic change programmes. PROGRESS REPORTING BY EXCEPTION Since November 2015, each strategic change programme is assessed on a bi-monthly basis against the HBs performance management framework. This assessment will be undertaken from a PTHB perspective and may differ from overall Programme performance assessments. By exception, any programmes assessed as red will be escalated to Finance and Performance Committee and details will be included in this Board report. The Board received a detailed briefing at its October 2015 meeting regarding the changes to the scope of the Future Fit Programme which delayed the planned public consultation process scheduled for December 2015. PTHB s assessment of progress in November 2015 is red against the Health Board s performance management framework because there is further assurance and detail required to fully understand the impact of the underlying financial issues of the health economy on the scope and deliverability of the clinical model developed as part of the Future Fit Programme. The current fragility of emergency care services across both Shrewsbury and Telford hospital sites has been highlighted by SATH as a risk that requires urgent resolution. KEY RISKS FOR PTHB There are a number of high level risks that are associated with the strategic change programmes and include: Engagement/Consultation Requirements PTHB s responsibility to engage with the population of Powys is an area of particular risk in relation to delivering the strategic change agenda. PTHB will need to ensure engagement activity reflects the varying levels of understanding and reassures people who use services that whilst programmes are separate entities, PTHB will diligently discharge its statutory duties with regard to engagement and consultation with the Powys population. Affordability Each of the external strategic change programmes involve multi agency/partnership working to achieve whole system change. There are potential cost implications of the new models of care developed under each programme and risk around assumptions made around PTHB s future response to proposed changes. Page 9 of 10
Demand and Activity Assumptions Some external strategic change programmes have made assumptions around future activity and demand to support the new models of care. There is a level of risk around these assumptions with regard to ensuring those assumptions align with PTHB s future strategy which will be developed as part of the Strategic Delivery Model Programme. Commissioning A comprehensive understanding of the impact of external strategic change programmes on Powys provider and commissioning plans will be worked through in discussion with the relevant Programmes. It will be important for this work to proceed at pace to ensure that current and future repatriation plans to bring care closer to Powys residents is realised. RECOMMENDATIONS The Board is asked to RECEIVE AND DISCUSS the update regarding strategic planning and strategic change programmes across our border. prepared by: Hayley Thomas Director of Planning and Performance Presented By: Hayley Thomas Director of Planning and Performance Page 10 of 10