Northamptonshire Sustainability and Transformation Plan How We Will

1. Northamptonshire Sustainability and Transformation Plan How We Will Support Local People To Flourish

2. Northamptonshire STP The STP is • The local plan to deliver the ambitions set out in the Five Year Forward View • A national approach to ensuring Health, Social Care and Voluntary Care Services are built around the needs of local people and deliver better outcomes for patients and the public. Our plan was published in mid December 2016 and will achieve • Better lives and the best outcomes for the people of Northamptonshire including a focus on prevention and self care • Reduced health inequalities and better quality of life for people living with long term conditions • Ensuring parity of esteem between mental and physical health need • Ensuring that that the local population can access ‘right care, in the right place, at the right time’ by building on the good work and practices that are already happening in the county. • Sustainable, integrated care that is cost effective and the best value for money.

3. What does this mean for local priorities – Sustainability and Transformation Plan (STP) • What is a Sustainability and Transformation Plan (STP)? • The local plan to deliver the ambitions set out in the Five Year Forward View and the General Practice Forward View and is the new national approach to ensuring Health, Social Care and Voluntary Care systems are built around the needs of local people. • High quality, robust and sustainable primary care service are a key part of the Northamptonshire STP. • Who is involved in the Northamptonshire STP? • The STP planning partners include: • Nene CCG • Corby CCG • Local Acute Providers • Mental Health • Community Trusts • Local Authority • NHS England • 4 Primary Care Federations

4. Why do we need this plan? • Population change. • Health and wellbeing • Access. • Mental health. • Standards • Staff shortages. • Integration. • Money.

5. Northamptonshire’s Sustainability and Transformation ‘plan on a page’Our vision is to improve the health and wellbeing of all people in Northamptonshire and reduce health inequalities by enabling people to help themselves (Supporting Northamptonshire to Flourish: Health & Wellbeing Strategy 2016-2020) 1 2 3 • Urgent Care Pathway • Rapid access to primary and community care • Enhanced routine care & discharge support in the community • Rapid & coordinated urgent care & crisis response • Emergency and acute care To increase the ability for patients and users to self-care i Integrating primary health and care services to create Multispecialty Community Provider (MCP) models To increase the amount of Integrated Care delivered Closer to Home • Complex Patient Care • Proactive care • Intermediate care • Specialist care • Cross-Cutting Patient Cohorts and Pathways Respiratory services; Cardiovascular services; Cancer services; Maternity services Children & Young People; Mental Health; Learning Disabilities To appropriately manage the patient flow through Urgent Care Scheduled Care Delivered through transformation initiatives ‘Big ticket’ Plan Actions • Prevention, Community Engagement & Patient Activation • Building resilient communities through volunteering and social action • Improved population mental health and wellbeing through social prescribing • Systematic, personalised and proactive prevention at scale • Clinical preventative services Acute services transformation Designing Urgent Care around the patient To increase provider collaboration ii iii To deliver clinical and financial sustainability Provider Development 4 We will maintain transparency and openness in relation to the challenges we face and the decisions we have to make and facilitate better and more appropriate use by the public of prevailing services 5 • Better lives for the people of Northamptonshire with improved health outcomes and experience of care and a focus on prevention and self-care • Reduced health inequalities and an enhanced quality of life for people living with long term conditions • Parity of esteem between mental and physical health • Providing care in the most appropriate setting and in line with best practice • Sustainable, integrated and self-improving system of care that is accessible, cost effective and best value for money iv We will engage, involve and consult with our stakeholders, including the public, in our planning for improvement and radical changes to the system of health and care provided v vi We will work across sectors and across regional boundaries to ensure the best range of integrated services is available to our population vii Success Criteria Vision Commitments We will ensure improved and equitable access to high quality health and social care services We will ensure that a key measure of success going forward will be the elimination of unacceptable health inequalities across Northamptonshire viii ix We will provide safe care in the most appropriate setting and in line with best practice We will deliver fundamentally different new models and pathways of care and ways of working that seek to enhance staff satisfaction throughout our health and care services x

6. Our Integrated model of care will be deliver through 5 key areas outlined below and underpinned by a number of enablers Key Enablers Acute and hyper- acute services We will ensure we have appropriate Information Technology links across the county Integrated Acute service lines • Prevention • Scheduled Care Out of hospitalhealth and social care services Prevention at scale We will deliver care in the appropriate care setting Community capital and VCS Integrated outpatient services IM&T Estates Social prescribing Volunteering & comm. engag. We will develop our workforce to support the new delivery models of care People Workforce Emergency and acute care Same day UC Patient activation s There will be a number of other enablers to support the delivery Collaborative care Contracting and commissioning Accountable Care Networks Organisational development Governance • Complex Care In-reach and discharge Extensivist care Rapid response • Urgent Care SPA • Cross-Cutting Patient Pathways Mental Health; Children and young people services Respiratory services; Cardiovascular services Cancer services

7. Local Priorities – Sustainability and Transformation Plan (STP) • Who are the people leading the STP for Northamptonshire? • John Wardell (Nene CCG) is the Northamptonshire STP Footprint Lead • Responsibilities for the STP are shared and CEO Sponsors and SRO Leads have been established for each programme: Supporting enabling groups have also been established and equally have a Director Lead and SRO support.

8. 6.0 STP Priorities STP YEAR 2 16/17 STP YEARS 3 - 5 Agree the revised model for both Trusts Jan 17 Agree the contractual framework to transact the new pathway Feb 17 Mobilise staff to deliver new model of care Mar 17 Go Live with Service Apr 17 Urgent care IMPACT Reduction in A&E attendances and Admissions Reduction in Delayed Transfers of Care Primary Care Streaming at NGH/KGH Agree Model for Delivery OOH services Jan 17 CCGs to approve OOH model Mar 17 Procurement to commence from OOH service April 17 Award contract mobilisation for OOH Nov 17 Go Live with OOH April 18 Out of Hours Urgent Care Evaluate the current DTA Schemes and services and conclude by Mar 17 Agree Model for integrated H&SC for DTA Mar 17 Agree the revised contractual framework to transact the new pathway Apr 17 Right sizing DTA at home Development of Projects in Prevention, Community Engagement and Patient Activation Incorporate the individual Care Home projects into CCTs specification Dec 16 GP Federation proposal to be sent to CCGs on delivery care homes Dec 16 Model the impact of GP federations solutions on Care Homes Jan 17 Develop new Care Home Delivery in CCTs contracts Mar 17 MCP to deliver phased Cares homes/CCT model from Apr 17 Primary Care Same Day Access will be phased from Apr 17 Urgent / Complex Care Primary Care Same Day Access IMPACT Reduction in A&E attendances and Admissions Redesign Scheduled Care across 10 specialties Care Homes Implementation of the Local Digital Road Map, implementation of Workforce strategy, and Estates strategyiesandfurther development of New Models of Care Agree Delivery model for planning and pre-engagement activities Jan 17 Consultation to commence May 17 Analysis , insight and decision making based on consultation Aug 17 Implementation to commence Sept 17 Complex Care Keeping you well at Home IMPACT Reduction in A&E attendances and Admissions Released Acute Bed days Reduced Length of stay in a community setting Closure of community beds and released community estates Collaborative Care Teams CCT specifications are currently with the Federations and Super Practices with a submission date of Dec 16 Review the data and financials as a part of our Gateway 2 process Jan 17 Review the submissions and work with the 4 submissions to share learning and co-produce solutions Jan 17 Community CCT contracts to be finalised Feb 17 Go live Apr 17 Learning Disabilities Mental Health Long Term Care Packages Diabetes specification released through new care models gateway –Dec 16 GP Federation/MCP diabetes delivery plan – Dec 16 CCG assessment of service delivery plan – Jan 17 Formal Decommissioning Letter to NHFT – Jan 17 Diabetes Care packages go live Apr 17 Children's and Paediatrics COPD /CHD will follow a similar process to Diabetes

9. What care will look like

10. We will achieve • A focus on prevention first • A “whole person” approach • The right care, in the right place and at the right time • Reduced reliance on hospitals • Integration • Voluntary support • Viable hospitals • Sustainability in general practice • Working differently

11. Where do we go from here? We need to: • Secure additional transformation resource to pump-prime change (particularly to support the transformation programmes, IM&T and organisational development) • Support providers through change to sustain services financially and operationally • Develop a sustainable and flexible workforce empowered to work across organisational boundaries • Implement a delivery and governance structure, supported by regulators that enables the system to manage and deliver the change process to a successful conclusion. Next Steps • A comprehensive engagement strategy to ensure we take all our stakeholders and the Northamptonshire public with us • Phasing and sequencing of the delivery programme and highlighting time critical events within our plan • A refocusing of our leadership and boards to drive the transformational change process and ensure the commitment of all staff to the changes • Aligned and streamlined commissioner and provider operational plans designed to support and drive the change agenda within a transparent commissioning framework.