INTEGRATED MEDIUM TERM PLAN Director of Planning and Performance. To present the thb s Draft Integrated Medium Term Plan

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1 INTEGRATED MEDIUM TERM PLAN BOARD MEETING 29 JANUARY 2015 AGENDA ITEM 2.1 Report of Director of Planning and Performance Paper prepared by Director of Planning and Performance Purpose of Paper Action/Decision required To present the thb s Draft Integrated Medium Term Plan The Board is asked to: APPROVE the submission of a First Draft of the Integrated Medium Term Plan to Welsh Government NOTE that additional amendments will be made to the Plan prior to submission on 30 January NOTE that the Board will receive its final draft plan for sign-off in March 2015 Link to Doing Well, Doing Better: Standards for Health Services in Wales : This paper supports all Standards for Health Services in Wales. Link to Health Board s Corporate Plan Acronyms and abbreviations IMTP: Integrated Medium Term Plan Integrated Medium Term Plan Page 1 of 6 Board Meeting

2 INTEGRATED MEDIUM TERM PLAN Background The Welsh Government introduced a new NHS Wales Planning Cycle to support the delivery of Together for Health, by Health Boards, that requires the publication of a three year delivery plan on prepared on an annual rolling basis. The delivery of this Integrated Medium Term Plan is mandated through the NHS Finance (Wales) Act The period was the first year of this planning cycle. Welsh Government reviewed the guidance that outlines specific requirements for the plan and issued refreshed guidance on 31 October 2014 to guide health boards and Trusts in Wales in developing plans for the period. The guidance continues to require the Health Board plan to link national, regional and local thb plans, and prepare an integrated plan covering service, finance, workforce, capital and ICT planning in its scope. It includes the new financial duty contained in the Finance Act for Local Health Boards to break even over a rolling 3 financial year period rather than each and every year. The Bill creates a duty for Local Health Boards to adopt a financial regime to flexibly manage resources, expenditure and approved limits over this 3 year period. This is designed to enable Local Health Boards to focus their service planning, workforce and financial decisions over a longer, more manageable, period. The intention of the Bill is to allow for better decision making and implementation of optimal solutions in Local Health Boards and remove a significant challenge, within the previous regime, that encouraged short term decision making around the financial year. The main changes included in the new guidance are as follows: Greater clarity on the overall development, structure and content of the required submission Development, and inclusion, of the underpinning policy framework in respect of the NHS Outcomes Framework, Prudent Healthcare and Innovation Strengthened requirements around Primary Care and the need for reference to Locality Plans prepared by GP clusters A revised set of targets, integrated within the plan and presented within the headings of the Outcomes Framework replacing the Tier 1 Targets The specific requirement to reference all of the Delivery Plans required by Welsh Government. New emphasis on demand and capacity planning Specific templates that demonstrate delivery across the three year period. The thb s IMTP was not approved by Welsh Government for a number of reasons reported to the Board in May The thb was therefore required to submit an annual plan in May This has formed the basis of the thb s activities in the financial year. The Performance and Finance Committee has received a report on progress with the delivery of this Annual Plan from Directors to the end of Quarter 2. A small number of areas within that plan have been deferred for consideration within the IMTP for The Committee will receive a further report to the end of Quarter 3 at its meeting. Integrated Medium Term Plan Page 2 of 6 Board Meeting

3 Diagnostic Phase The diagnostic phase of the planning process takes account of the demands on the organisation from a number of perspectives to create the profile of priorities. These sources include: Current and future performance against Welsh Government targets Performance against the Annual Plan Joint strategic needs assessment priorities Priorities established through the GP cluster plans Director Of Public Health Annual Report Recommendations Risks to delivery of organisational objectives highlighted through Audit Committee External inspections and reviews considered through the Quality and Safety Committee Corporate Risk Register Service Gaps identified in respect of the Welsh Government Delivery Plans These are presented in the Plan in tabular form. Development of the Plan The focus of the development of the Plan for has been to address those areas where the Board and Welsh Government were seeking assurance Director leads have been identified for each of the new Outcomes Framework targets. Directors have been leading on identifying the baseline position against each target, developing performance trajectories against the targets, identifying actions to meet shortfalls in performance and quantifying the resource requirements of delivery including workforce requirements Director leads have been identified for each of the national Delivery Plans to provide a high level summary against each of the plans and identify any resource requirements to support delivery Director leads have been identified to update the narrative sections of the plan that were prepared for In particular this part of the Plan has been strengthened in relation to: o the work undertaken on the Strategic Delivery Model o the approach taken to staff engagement and Organisational Development through Chat to Change o the strategic approach to quality and safety within the organisation o reflect the emerging work of the Programme Director for Commissioning The Director of Finance has led the process of financial planning through the budget setting process with Directors, to deliver the first cut of the revised three year financial plan, taking into account the work outlined above. The Director of Planning completed a first draft of the Plan in time for a Peer Review of IMTPs between Health Boards and Trusts in Wales. The Powys review was undertaken at one of the three events, held on the 19 December This was facilitated by the Good Governance Institute and the report on the Powys Plan is provided at Appendix 1. The report of the process across Wales is provided at Integrated Medium Term Plan Page 3 of 6 Board Meeting

4 Appendix 2. Directors are working through these comments to ensure they are taken into account in further iterations of the Powys Plan. Demand and Capacity A piece of work was commissioned by the Executive Team in 2014 to undertake a strategic Demand and Capacity Study. The project reported to the Transformation Board in December 2014 and takes a further significant step forward in financial and activity modelling of the thb s proposed Strategic Delivery Model. The Demand and Capacity work was underpinned by robust clinical stakeholder engagement on how services in Powys could be modelled in the future to address the demographic, clinical, workforce and estate issues that the thb faces over the next 10 years. This modelling work has supported the review of the thb s financial plans that were set out in the 2014 plan. The IMTP is therefore now based on more robust, benchmarked modelling, building on the previous work commissioned by the Board from by Deloitte. The new modelling is set out in two programmes of work: - A service change programme that is deliverable within the three years of this iteration of the IMTP - The process to engage the public, over the next three years, in discussions around the Strategic Delivery Model for Powys that will enable the delivery of a further programme of change in the medium to long term that are dependent on infrastructure developments Financial Planning The Director of Finance has been leading the financial planning process associated with the Plan. Welsh Government have made public announcements in respect of the additional in-year allocation for to Powys thb and an additional initial uplift for As the Finance team continue to work on the financial modelling of the impact of these changes, and the financial implications of the thb s forward plans, the first draft of these will be presented to the Board at the meeting. The finance chapter in the Plan appended to this report currently therefore outlines a high level position and is subject to change as the financial plan is refined before the final submission IMTP January 2015 Submission The submission to Welsh Government includes a narrative document (Appendix 3) and a supporting Excel workbook of completed templates (Appendix 4) that are derived from the Welsh Government Guidance. Appendix 3 contains the most up to date sections of the Plan that had been drafted at the pointy of issue of papers to the Board. The Board will recognise that the ongoing preparation of the Plan is an iterative process, and refinement of the Plan will continue through the period to submission of the First Draft to Welsh Government on 31 January and the final version at the end of March. The Board will be advised of any significant changes to the issued draft at the Board Meeting. Not all of the templates in Appendix 4 were completed at the time of issue, mainly the technical financial schedules that Welsh Government require. The Board may wish Integrated Medium Term Plan Page 4 of 6 Board Meeting

5 to pay particular attention to the following sheets in the workbook that underpin the plan: C1: current and proposed performance against Outcome Framework Targets. Specifically for waiting times this is supported by Tabs C3, 4 and 5 C6: that will form the basis of the Annual Plan. This document will require further refinement and prioritisation as the Plan develops NEXT STEPS Further work will be required to develop the IMTP in preparation for its final submission by the 30 March 2015 deadline and to meet all of the requirements of the planning Guidance. A key milestone is a meeting with between Welsh Government officials, the Chief Executive of the thb and a Director team on 24 to receive comments on the draft plan. Key milestones to deliver a final plan around this date are outlined below. First week of Desktop internal gap analysis of the Draft Plan, and preparation of action plan to address remaining requirements 6 Feb Further national peer review meeting at exec level through Directors of Planning and Finance Directors planned for 6 th 24 26/27 Feb 2 March 19 th March May Feedback meeting with Welsh Government Internal Review meeting with each executive director led by the Director of Planning and Performance and Director of Finance to focus on C1 (targets); C6 (annual plan), narrative sections and national delivery plans and Finance Discuss and agree specific plans with NHS partner organisations, including a Powys thb hosted provider workshop and participation in a WHSSC workshop around their plan Presentation of the Plan to the Community Health Council, Partnership Forum and Local Service Board Board Workshop and approval of Final Plan for submission Internal Review Workshop to prepare for IMTP cycle CONCLUSION The Welsh Government Planning Framework requires the submission of a Draft Integrated Medium Term Plan to Welsh Government by the end of January Powys thb s draft Plan has been prepared, and it is recognised there is considerable further work to complete prior to submission at the end of March. The Plan will continue to be updated with the latest available information to enable the submission of a rounded Plan in time for the first, January, deadline. Following submission the Integrated Medium Term Plan Page 5 of 6 Board Meeting

6 thb team will continue to work to refine the plan with a particular emphasis on finance and performance in time for the Board to consider the final version at its meeting in March. RECCOMENDATION The Board is asked to APPROVE the submission of a First Draft of the Integrated Medium Term Plan to Welsh Government NOTE that additional amendments will be made to the Plan prior to submission on 30 January NOTE that the Board will receive its final draft plan for sign-off in March 2015 Report prepared by: Bruce Whitear Director of Planning Presented By: Bruce Whitear Director of Planning Integrated Medium Term Plan Page 6 of 6 Board Meeting

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