Haringey and Islington Wellbeing Partnership Health & Care: working together with the people in Haringey & Islington

Transcription

1 Haringey and Islingtn Wellbeing Partnership Health & Care: wrking tgether with the peple in Haringey & Islingtn Partnership Agreement 1 st June 2017 Final versin h April 2017

2 Signatries The fllwing rganisatins supprt the Haringey and Islingtn Wellbeing Partnership. Organisatin Cuncil Leader / Chairman Chief Executive Haringey GP Federatin Islingtn GP Federatin Haringey and Islingtn Wellbeing Partnership Agreement 2

3 Haringey and Islingtn Wellbeing Partnership Agreement Date effective: 1 June 2017 Signatries: The partners, the CEOs/Accuntable Officers & Chairs f: 1. Lndn Brugh f Haringey 2. Lndn Brugh f Islingtn 3. NHS Haringey Clinical Cmmissining Grup 4. NHS Islingtn Clinical Cmmissining Grup 5. Haringey GP Federatin 6. Islingtn GP Federatin 7. Camden and Islingtn NHS Fundatin Trust 8. Nrth Middlesex Hspital NHS Trust 9. University Cllege Lndn Hspitals NHS Fundatin Trust 10. Whittingtn Health NHS Trust The Partners recgnise that as the wrk f the partnership develps ther rganisatins may wish t jin r becme mre frmally affiliated with the partnership apprach embdied in this agreement. Purpse The Wellbeing Partnership has been established t enable lcal rganisatins t deliver better health and care services, t reduce inequalities and imprve the health and wellbeing utcmes fr the peple f Haringey and Islingtn. It is wrking twards the integratin f health and scial care services in the brughs in rder t deliver these imprvements. As a result, the Partnership will be better able t deliver, at a lcal level, the necessary service transfrmatin t achieve a sustainable health and scial care system. It will d this by building upn lcally delivered initiatives such as the Care Clser t Hme Integrated Netwrks. The need fr change Haringey and Islingtn ppulatins are 263,386 and 215,667 respectively. The ppulatins are expected t grw by abut %% ver the n next 5 years but there will be a much bigger increase in the ver 65 ppulatin f 12% ver the same perid. This is twice the natinal average. This rate f grwth will put enrmus pressure n scial care and health services. Pverty and deprivatin are key determinants f pr health and wellbeing utcmes and majr drivers f health inequalities. Islingtn and Haringey have high levels f deprivatin relative t the natinal picture. Residents are mre likely t spend less f their life healthy cmpared t the England average (apprx. 20 years f their life living in pr health). Haringey and Islingtn Wellbeing Partnership Agreement 3

4 Funding fr scial care and health services will nt increase t meet the grwth in demand n services and the demgraphic pressures. Therefre, we must change the way we deliver services, preventing pr health and supprting individuals, families and cmmunities t achieve healthier, happier and lnger lives. When peple need services we must ensure they are delivered effectively and efficiently, imprving utcmes. The current fcus each rganisatin has t have n its wn gals, structure, regulatrs and finances, with relatinships based upn a cntractual framewrk, cntinues t hinder effective cllabratin, creating inefficiencies and cnstraining ur cllective ability t achieve mre fr the lcal ppulatin. All the rganisatins face ptential financial deficits in future years and s cntinuing t perate independently is nt an ptin. The Wellbeing Partnership members see an pprtunity t achieve this by wrking mre clsely tgether than is pssible as separate rganisatins under the current NHS and lcal gvernment financial and cntracting systems. This prvides a cllective mitigatin f risks faced by individual rganisatins within the system. T help us achieve ur visin fr ur residents we will nw frm a Wellbeing Partnership, a frm f an Accuntable Care Partnership, enabling us t mve twards full cllabratin between rganisatins in a measured way. Objectives The prgramme has set ut a series f bjectives. T take a whle ppulatin apprach t health and care delivery. T supprt all f ur residents t achieve healthier, happier and lnger lives, with a fcus n preventing pr health and imprving utcmes when peple d need care and treatment. T supprt peple, families and cmmunities t stay and be healthy, t reduce the level f ill health within ur ppulatin and reduce health inequalities. T simultaneusly fcus n imprving utcmes and reducing csts fr ppulatin grups wh are currently high cnsumers f health and care. Hw will we d this? The mst imprtant way relates t a new set f behaviurs frm all the Partners, in rder t build lngstanding trusting relatinships that replicate thse f an accuntable care system. By shifting resurces ver the lnger term twards preventin and early interventin t keep peple well and avid preventable ill health e impacting directly n the health and wellbeing f the ppulatin f Haringey and Islingtn By bringing tgether all ur resurces (including budgets), sharing budget infrmatin and taking cllective decisins abut their mst effective use. By wrking tgether t redesign services in a different way using all the skills and experience available t us acrss ur cllective wrkfrce recgnising that these are nt vested in ne rganisatin r prfessinal apprach. By ensuring every rganisatin is seen t succeed thrugh cllective success. Haringey and Islingtn Wellbeing Partnership Agreement 4

5 By develping using ur cllective infrmatin t create insight int hw we can imprve systems as a whle, where investment needs t g and t drive innvative ways f ding things. By imprving service user experience as well as utcmes, efficiency and effectiveness we shuld reduce inequalities. By bringing teams tgether, acting n behalf f each ther, t mre efficiently use ur staff. By wrking tgether with all ur cmmunities and the whle health and scial care wrkfrce we will accelerate the transfrmatin f the health and care system in Haringey and Islingtn. By cllectively taking budget decisins, agreement will be reached n levels f activity and cst, creating jint cmmitment t cllective financial and activity targets. This shuld als reduce transactin csts between rganisatins. Scpe This agreement des nt seek delegated pwers frm its statutry partner rganisatins. It aims t develp cllective decisin making thrugh a partnership frum where the impact f service change can be managed acrss the whle health and care system. Partners are therefre asked t share and align their decisin making recgnising that fr sme partners there are cmmitments utside the Haringey/Islingtn gegraphy. The range f services which might best be cllabratively managed in this way will becme clearer as the partnership develps. Timeframe The expressed aim f the Wellbeing Prgramme s Spnsr Bard members is t achieve full cllabratin between rganisatins. This will take time as rganisatins mve frm partial t full cllabratin. This agreement is a stepping stne t mre frmal future agreement as the cnfidence and level f cllabratin increases. This particular agreement will expire n 31st March 2020 but is expected t be refreshed within a year, by 31st March 2018, t reflect the increasing levels f cllabratin r when it is replaced by a mre frmal partnership agreement. Haringey and Islingtn Wellbeing Partnership Agreement 5

6 Cmmitment 1: One ambitin: T meet the challenge facing the health and care system by wrking tgether as a single team t: Supprt lcal peple, families and cmmunities t take an active and full rle in their wn health and t reduce inequalities Fcus n preventin and early interventin, t keep peple well, realise their ptential, avid preventable ill health and prmte resilience and independence Use the best, evidence-based, means t deliver n utcmes that matter Fcus n what adds value (and stp what desn t) Public expectatins are that health and scial care rganisatins shuld be wrking tgether arund the needs f individuals, s this apprach is in line with that expected f each rganisatin. In practice, the Partners recgnise the pressures caused by current funding, structures and cntracting mechanisms. T manage these cnflicting pressure we cmmit t be hnest, transparent and t prvide mutual supprt f each ther s psitin. Where pssible we will influence the view f regulatrs r external assurance bdies abut the imprtance f the partnership apprach t future lcal system sustainability. Cmmitment 2: One set f behaviurs: All Partners agree explicitly t exhibit the beneficial behaviurs f an accuntable care system. In particular, partner rganisatins cllectively agree t: Peple first: slutins that best meet the needs f tday and tmrrw s lcal residents and health and scial care users must be the guiding principle n which decisins are made. This principle must ver-ride individual r rganisatinal selfinterest. Embedding the vice and views f service users in service imprvement will be key t ensuring this principle is nt frgtten. Cllective decisin-making: Chairs, CEOs, SROs and clinical leads have dedicated time face-t-face t build trusting relatinships, imprve mutual understanding and t take shared strategic decisins tgether. As system leaders, Partners will wrk tgether with integrity and the highest standards f prfessinalism, by: Recgnising mutuality and equality f the partnership Nt undermining each ther Speaking well f and respecting each ther Recgnising we are each trying t ptimise perfrmance in ur wn part f the system Behaving well, especially when things g wrng Keeping ur prmises - small and large Speaking with candur and curage Seeking success as a cllective Sticking t decisins nce made Open bk: finance (cst and spend), activity and staffing data are shared between all parties transparently and in a timely manner. The purpse f this sharing is t supprt cllabrative prblem-slving. Cmmn messaging: there is a cnsistent set f messages we tell ur service users, residents and ur staff abut why we need t wrk tgether, what benefits it Haringey and Islingtn Wellbeing Partnership Agreement 6

7 will bring and hw we are ding it, althugh hw the stry is tld will be tailred t the audience. Each partner rganisatin will take full respnsibility fr making sure their staff are well briefed n system imprvement wrk, drawing frm system messages and materials. Cllective mnitring: if an rganisatin appears nt t be acting fr the cllective gd, Chairs / CEOs will reflect this t the rganisatin and prvide evidence t illustrate their cncern. If there isn t a change in apprach, in extremis, the rganisatin may be asked t leave the partnership. Cmmitment 3: One Plan: Jint Strategic Planning: Recgnising the strng similarities in health prfile f the ppulatin f the tw brughs, Haringey and Islingtn Health and Wellbeing Bards have agreed that they will meet as a jint cmmittee frm April This significant cmmitment t jint wrking immediately prmpts greater integratin f the tw public health teams, ptentially transfrming the way health and inequalities challenges are apprached. All partners have individual crprate r peratinal plans, fr example, recently wrking tgether with ther brughs as part f the Nrth Central Lndn Sustainability and Transfrmatin Plan. Partners cmmit t aligning individual plans where jint wrking can ptimise delivery f imprved services in Haringey and Islingtn. Target: Frm a Haringey-Islingtn Public Health Leadership grup by June 2017 t determine a prcess fr develping a future perating mdel fr integrated wrking. Bring tgether the iterative prcesses underpinning the Jint Strategic Needs Assessment as a precursr t establishing a single Health and Wellbeing Strategy fr the tw brughs. Develp a single Health and Wellbeing Strategy fr the brughs f Haringey and Islingtn by December Review cmmissined services and budgets between bth brughs by September 2017: prviding a deeper understanding f the services cmmissined and supprted by bth Public Health teams. In the future, this wrk will serve as a guide fr i. which services might be jintly recmmissined t ptentially imprve utcmes fr the ppulatins fr bth brughs and ii. which services wuld be better managed lcally r with ther arrangements. Cmmitment 4: One transfrmatin apprach: bringing tgether ur service redesign wrk: Currently each rganisatin has (r is part f) a separate service transfrmatin prgramme linked t the need t meet their financial cmmitments. These include Cst Imprvement Prgrammes within Trusts, Lcal Authrity Transfrmatin Prgrammes t meet their Medium Term Financial Strategies, and CCG and Trust input int the Nrth Central Lndn Sustainability and Transfrmatin Plan. The cmmitment within the Wellbeing Partnership is t bring tgether these ften cmplementary wrk prgrammes t ptimise delivery within Haringey and Islingtn in rder t deliver the best pssible services with the resurces available. Wrk prgrammes prpsed by any rganisatin will first be shared at the Partnership Bard s that the impact n the lcal system can be understd and cllective supprt given t Haringey and Islingtn Wellbeing Partnership Agreement 7

8 the prject. The Partnership Bard will act as a spnsr bard t the prject. Where the prject has limited impact beynd the initiating rganisatin this prcess will ensure understanding f the redesign wrklad in each rganisatin. Target: T share each rganisatin s transfrmatin prgramme with Partners by 30 June 2017 T align lcal authrity scial care transfrmatin prgrammes by 30 July 2017 T bring tgether existing service imprvement prjects undertaken by separate rganisatins where they are addressing similar chrts f the ppulatin, cnditins r diseases s as t ptimise imprvement wrk under the leadership f the Wellbeing Partnership by September 2017 T assess, by July 2017, whether the Wellbeing Partnership needs a particular fcus n wrkfrce develpment, t add t the wrk being undertaken at NCL level. T develp a jint savings / service transfrmatin plan fr 2018/19 between Cuncils, CCGs and Trusts by Octber 2017 s that this can be built int each rganisatin's financial plan fr 2018/19 Cmmitment 5: One delivery team: The Wellbeing Prgramme was established with a 'light tuch' prgramme infrastructure as the majrity f staff resurce cming frm the alignment f rganisatinal and jint prgramme pririties. Partners cmmit t cntinuing this apprach by priritising jint service redesign and supprting this with staff as part f business as usual. All Partners cmmit t using the Wellbeing Partnership as an pprtunity t redefine the reprting relatinships f staff within their wn rganisatins t align with jint service redesign wrk. Target: T establish by 30 June 2017, a single management lead acrss all rganisatins fr specified services e.g. diabetes, with the autnmy t make system wide decisins t imprve services. The rle wuld have accuntability t all rganisatins thrugh the Partnership Bard. T cmplete the alignment f the CCG management teams by September 2017 T establish jint wrk n cuncil transfrmatin prgrammes and peer review pririties by September 2017 T establish tw Care Clser t Hme Netwrks (CHINs) in each brugh as lcal delivery teams by September Cmmitment 6: One apprach t quality imprvement and a shared apprach t perfrmance imprvement: As the Wellbeing Partnership Bard develps as the frum fr cllective management f the health and care system, then partners cmmit t bringing tgether the separate quality imprvement, perfrmance mnitring and assurance prcesses where pssible. Prviding single returns frm the Wellbeing Partnership will establish the rganisatin as a cllabrative venture. Currently, perfrmance and assurance returns t external bdies are required separately frm each partner rganisatin. Organisatins cntinue t have statutry duties t fulfil and these will be maintained. Hwever, whilst separate rganisatin r brugh based data will cntinue t be required, there are als pprtunities t cmpare data returns Haringey and Islingtn Wellbeing Partnership Agreement 8

9 and t bring tgether the prcesses r rganisatins respnsible fr prviding that infrmatin e.g. NHS Cmmissining Supprt Unit. Target: T identify, by 30 September 2017, areas f best practice in quality and quality imprvement and t share these acrss rganisatins. T establish by 30 September 2017, a set f perfrmance indicatrs (ideally frm existing data surces) which will help demnstrate increased cllabrative wrking acrss the Partnership. T investigate jint measurement f service initiatives such as the Better Care Fund and shadw these frm July T cnfirm existing data sharing agreements and ensure cnsistency, establishing new nes where needed by December 2017, s data can be used between rganisatins t imprve and deliver services t users. Cmmitment 7: One financial plan: in line with develping the psitive behaviurs f an accuntable care system, and in recgnitin f the fact that ne rganisatin s decisins abut the level f service may impact anther s csts, the Partners agree they will cllectively fcus n activities that take cst ut, make agreed investments in rder t save elsewhere, and manage financial pressure acrss the system. System csts may be reduced by activity reductins and by unit cst reductins, and we recgnise that all Partners can influence bth. Acting in this way requires: Cmmissining intentins will be based n a clinically led, evidence-based and persn-fcussed appraisal f hw best t meet lcal peple s need and will be based n cprductin with lcal peple. Once develped, Partners will discuss penly within the Wellbeing Partnership Bard any new service develpments, clsures r relcatins prir t public and staff engagement and cnsultatin as required. The Wellbeing Partnership Bard and the wrkstream delivery grups will be the fra fr agreeing cmmissining intentins. Relevant financial and peratinal plans will be aligned acrss health and scial care: the Partners agree t plan finances and peratinal capacity tgether, neutralising any inclinatin t cst shift r nt invest in ne part f the system t save elsewhere. This will invlve wrking frm cmmn assumptins, prducing plans fr regulatrs that are realistic and ding ur best t ensure there are n inyear surprises. Where apprpriate, this will als include greater use f pled budgets between NHS and cuncil cmmissiners, which will be determined n a case by case basis. Cntract negtiatin activity will be minimised during 2017/18 and 18/19 with early cllective CEO engagement t agree key investment pririties and risk sharing parameters at the utset (rather than at the end). Cntract management meetings will be replaced with jint place r care prgramme based financial assurance, perfrmance and planning meetings. It is clear that develping this level f cllabratin will take time t enable partners t develp an understanding f each ther s business, the smetime cnflicting pririties each rganisatin faces and thrugh this t develp trust and mutual supprt. The fllwing milestnes have been suggested t begin this prcess. Haringey and Islingtn Wellbeing Partnership Agreement 9

10 Targets: T establish a regular mnthly sharing f budget (and activity data) at a level f detail that enables each rganisatin t understand hw resurces are being used t deliver health and care services frm June T bring significant investment / disinvestment decisins (eg ver 250k capital r annual revenue) t the Partnership Bard where this investment relates t lcal services fr the ppulatins f Islingtn and Haringey, t enable partners t understand the impact such changes might have. This des nt fetter an rganisatin s independent decisin making autnmy but ensures ne rganisatin des nt make unexpected changes which negatively impact upn anther (frm April 2017). T establish system wide budgets fr specific services e.g. fr diabetes, MSK, t supprt the transfrmatin wrk f the individual wrk streams (by April 2017). T shadw a single system cntrl ttal, taking int accunt the fact that several prviders run services that serve a wider ppulatin (frm September 2017) Cmmitment 8: One set f gvernance arrangements: the fcus f the Wellbeing Partnership is n better delivery f services thrugh clser wrking. The frm f the Partnership (its gvernance arrangements) can supprt staff in that clser wrking arrangement. The Wellbeing Partnership Bard and the grups reprting t it (e.g. Delivery Bard, Finance and Perfrmance Grup, and service wrkstreams), will be the vehicle thrugh which system wide business is cnducted. As much system wide business as pssible will be cnducted thrugh the system gvernance described in the appendix belw, particularly in thse areas where there is a particularly strng system fcus, such as care clser t hme and ut f hspital care t supprt admissin avidance. This prvides the frum fr sharing and aligning verall strategy and decisins. The pwer f the Partnership frum is based n the psitin pwer f the individual members and their cmmitment n behalf f their rganisatins t an agreed curse f actin. It is recgnised that individual Partners Bards r Gverning Bdies have statutry accuntability. Time will be allwed, when planning changes, t enable cllective sharing and discussin. Targets: T establish the verall gvernance arrangements as described belw by 30th June T supprt lcal peple t cprduce the cmmunity reference grup by 30th June T cnsider alternative, strnger gvernance arrangements and rganisatinal frms such as Multispecialty Cmmunity Prviders (MCP) r Primary and Acute Care Systems (PACS) between September 2017 and March T refresh this Partnership Agreement fr April A Gvernance Structure is described n the next page. This cntinues t be develped, in particular: Haringey and Islingtn Wellbeing Partnership Agreement 10

11 reflecting that certain prgrammes f wrk (e.g. CHINs/QISTs) will have systemwide impact and will act as the catalyst acrss a range f ther areas lcal accuntability thrugh input frm cuncillrs and health rganisatin nnexecutive directrs primary care leadership invlvement at all levels c-prductin f the Cmmunity Reference Grup with lcal service user grups. Haringey and Islingtn Wellbeing Partnership Agreement 11

12 Wellbeing Partnership Bard * Sets strategic directin acrss member rganisatins and agrees lcal delivery f STP interventins and jint efficiency plans Hlds accuntability fr delivery f utcmes Jint versight f key financial decisins (funding, spend and savings) Prgramme Delivery Bard * (Clinical, prfessinal & peratinal) Hlds respnsibility fr implementatin f the jint wrk prgramme Reviews and mnitrs prgress acrss all areas and reprts back t Wellbeing and ther rganisatinal Bards Ensures clinical / prfessinal / peratins leadership in place (including husing, vluntary sectr etc.) Cmmunity Reference Cmmittee * Oversee cmmunity engagement & develpment, self care and cmmunicatins thrughut partnership and all wrkstreams Assure and measure cmmunity engagement & develpment, self care, cmmunicatins & equality & diversity thrughut wrkstreams, CHINS and partnership. Preventin & Wider Determinants f Health Ppulatin wide systematic implementatin f preventin and maintaining independence initiatives Supprt all prgramme areas t include fcus n preventin, independence and wider determinants f health (children and adults) Care Clser t Hme (1 Care) Urgent & Emergency Care Mental Health Learning Disabilities Children & Yung Peple Elective Care Wellbeing: CHINs, LTC management (diabetes & CVD) Wellbeing: Frailty, intermediate care Wellbeing: Preventin and Cmmunity Resilience; cmmunity MH Wellbeing: Imprving health, wellbeing & pprtunities and cnslidating csts Wellbeing: Transitin, A&E attendances, LTCs (e.g. asthma) Wellbeing: MSK incl. cmmunity, (gastr. Is an area f need fr bth H&I?) Infrmatin and Analytics Needs assessment, ppulatin and service infrmatin and analytics, utcme mnitring, integrated digital care recrd and e-cmmunicatin Finance and Perfrmance Grup Technical develpment & mnitring f shared savings & perfrmance plans Supprt all prgramme areas t develp finance, activity and impact mdels *under develpment see final paragraph n page 10 Haringey and Islingtn Wellbeing Partnership Agreement 12