Operational Resilience and
Capacity Planning 2014/15
Date: October 2014
Draft: 0.4 for review by NHSE
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1.0 INTRODUCTION
This resilience plan summarises the current progress in establishing whole system, on-going capacity
planning for the York and Scarborough localities in order to achieve operational and system
resilience.
This plan supports and aligns with the operational delivery of the constituent CCGs’ and providers’
Five Year Strategic Plans and the requirement to deliver all patient rights included in the NHS
Constitution.
It has been prepared by the key stakeholders included in the System Resilience Group (SRG) and has
been agreed and approved for submission to the national tripartite body including NHS England,
NHS TDA, Monitor and Adaas.
The SRG members are outlined below and represent all the key stakeholder organisations who have
committed to work together to achieve system resilience. These include:
NHS Vale of York CCG
NHS Scarborough and Ryedale CCG
NHS East of Riding CCG
York Teaching Hospitals Foundation Trust
Yorkshire Ambulance Service
The SRG is supported by unplanned and planned care working groups which include representatives
from the following stakeholder organisations:
City of York Council
North Yorkshire County Council
East of Riding County Council
Leeds & Yorkshire Partnership Foundation Trust
NHS England Direct Commissioners
Voluntary and Third Sector Partners
Healthwatch and patients/ public representatives
2.0 SYSTEM RESILIENCE OBJECTIVES
The SRG will work together to plan and deliver more integrated services across the health and social
care system to increase resilience in the system and deliver smooth patient flow across primary care,
community and acute hospital settings.
The operational resilience and capacity planning process considers how resilience can be assured
throughout the year based on robust analysis and review of the current service delivery and
performance position, a joint approach across all commissioners and providers locally, and with
consideration of the impact that planned care has on unplanned care, and vice versa.
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When considering this plan the following core objectives for resilience are central:
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Delivery of safe, effective and prompt care
Delivery of overarching system sustainability
Minimising emergency department attendances
Minimising hospital admissions
Minimising inpatient bed days and avoiding delayed discharges (LOS)
Optimising system flow
3.0 SYSTEM CONTEXT
The Operational Resilience and Capacity Planning Guidance (13th June 2014) provides a detailed and
specific framework for SRGs to undertake whole system planning for unplanned (urgent and
emergency) and planned care.
This resilience plan identifies the key drivers for current performance and issues in the system and
identifies a range of proposals from across health and social care partners to deliver additional
capacity in order to better manage more patients outside of hospital and increase the flow of
patients through hospital and back home.
Principles of good practice have been clearly identified throughout both the unplanned and planned
care system and the plan also reflects on which schemes from the winter planning pressures money
schemes in 2013/14 had the greatest benefits and impact on outcomes, and have (or can be) funded
as a priority in 2014/15.
Voluntary and third sector stakeholder proposals for contributing towards the resilience plan have
or are currently being considered, and this builds upon the now well established partnership working
in place between the CCGs and this sector, facilitated by Healthwatch and embedded within the
Urgent Care Working Group.
Links to the Better Care Fund are clear throughout the resilience plan with a number of schemes
being programmed managed through the BCF contributing towards avoiding admissions, and now
considered to be integral to integrated working and service development. The refreshed BCF plans
due for submission in September 2014 will be closely linked to the resilience plan and SRG.
4.0 SYSTEMS RESILIENCE GROUP
4.1 Establishment and Governance
The existing Collaborative Improvement Board (CIB) will take on the SRG function. The Urgent Care
Working Group (UCWG) will form one of the working groups supporting the SRG [the unplanned
care working group], alongside a newly established planned care working group. Organisational
leads from each local stakeholder organisation will be represented on these working groups in order
ensure all resilience plans are aligned with local organisational plans and improvement initiatives.
4.2 Terms of Reference & Process Map
The terms of reference for the SRG and the process map summarising the partnership working and
alignment of partners and plans are attached as Annex 1
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4.3 Partnership working
All members of the SRG represent all parts of the local health community and have agreed to the
TORs for the SRG and its constituent working groups. They all attend each group in order to align
themselves to one framework and one resilience plan, supporting each other and each element of
the system.
The SRG has now reviewed all Surge & Escalation Plans and confirmed alignment and fitness for
purpose for use from September 2014. Scorecards are currently being developed to support
utilisation of the plans by all stakeholder organisations.
The unplanned care and planned care working groups of the SRG have worked to finalise the
schemes and Action Plans which they believe will have an impact on improving resilience across the
whole system. These are captured in the finalised Operational Resilience Planning template which is
submitted to NHSE on 18th September 2014.
4.4 Programme Management
Responsibility for operational delivery of each scheme contributing to the resilience plan is currently
being agreed and the processes for monitoring and reporting delivery to the working groups and in
turn the SRG will be clarified.
The existing programme management system Covalent is available via VoY CCG as required to
support SRG programme management, reporting and monitoring of SRG Plans.
A SRG Scorecard/Dashboard for both planned care and unplanned care will be developed which
effectively captures all the metrics required for monitoring and reporting of KPIs, benefits and
outcomes across the system for delivery of the resilience plan, including escalation plans for winter
2014/15. For unplanned care there is a clear aim will be to have a predictive modelling which clearly
identifies pressures on the system and gives early warning. Additionally this should have
functionality to model and apply specific changes to the Urgent Care System to understand and map
the outcomes. This modelling will therefore add a proactive element and the capability to estimate
the risk to service provision.
Any SRG scorecards will align to NHSE tracking tools and assurance requirements. The tracker tool
has yet to be released for implementation.
4.5 Monitoring and Communication
There are named executive leads for each member organisation of the SRG and working groups,
including Chairs for all groups. These leads can escalate issues within their own organisations and
share information and intelligence across the member organisations. Similarly communication across
the various programme delivery groups who may be co-ordinating delivery of plans (e.g. Better Care
Fund Joint Delivery Group) will also be aligned with the SRG.
5.0 LESSONS LEARNED FROM WINTER PLANNING 2013/14
The UCWG undertook a full review of the impact of 13/14 winter pressures schemes. The outcomes
and performance review was undertaken in March 2014 and several schemes appeared to have
clear benefits to improved flow and helped to achieve the 4-Hour Target. Most of these schemes
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have been identified to have a positive impact and, as such, have been incorporated into the
2014/15 resilience plan. The projects are summarised below:
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Single Point of Access (Effective Referral Management) – This SPA has been developed with
YAS NHS111 and is intended to be funded for at least 6 months during which and evaluation
process will look at the impact. The SPA linked Community Services and is a single point of
access for health and social care professionals.
Emergency Care Practitioners: An additional three ECP’s were employed to augment the
regular ambulance crews. These roles have helped to reduce conveyance rates to A&E and
have improved the quality of care for some patients in the urgent care scenario.
End of Life Care and Hospice@Home: This programme provided additional weekend and
evening support to individuals on an EOLC Pathway. It helped to provide a better option
than admission to hospital and increased the opportunity of patients to die in their Place of
Choice.
Rapid Access and Treatment Service – The joint hospital and social care team increased
their hours of support until 8pm. The impact has been to allow for quicker therapy
assessments and packages of care to prevent unnecessary admissions to health and/or social
care beds.
Frailty Unit and Social Worker Support: A social worker worked along sided the frailty unit
with links to the RATS scheme to facilitate a safer discharge component of the patients’
admission cycle
Emergency Department Staffing – This scheme provided additional Registrars and senior
Nurses to work in ED. It included a clinical educator role to provide specific training for staff
to aid their work.
Elderly Care – Slow v Quick Pathway – Discharge nurses – Patients to have adequate social
care on discharge.
Delayed Transfer of Care – This is an area of significant work that was principally reactive
during the winter period and led to an RPIW event that identified several areas of enquiry.
The delays in the system have identified the need for increased step-down beds locally. The
integrated hospital/community team were provided with additional funding to support
individuals outside of the hospital setting.
Additional Community Beds- Additional beds for step-up and step-down were purchased.
These provided an additional 1000 bed days to help improve flow and discharge in the
system. This project will go forward to support a similar scheme in 2014/15.
Homeless Support Worker – This was funding for a support worker and two beds in
ARCLight for the three busiest evenings of the week within the Emergency Department. It
received excellent staff and patient feedback and resulted in small numbers of avoided
admissions.
Care Homes Support Project – It has used protocols for Nursing and Residential Homes to
support vulnerable patients to prevent admission and also to facilitate earlier discharge. It is
a scheme that was initially funded with winter pressures money and will be taken forward
under the Better care Funding structure.
Equipment Provision – This scheme provided additional equipment to improve discharge
flow. It included beds, mattresses and hoists.
Care Home Working Group – This membership group includes all providers and stakeholders
in the Care Home Sector. It provided a link to the UCWG and the winter plans for the Care
Homes in the locality.
Frequent attenders – YAS identified high users of the emergency services and worked with
them to identify alternative options.
Age UK – Funds were allocated for additional discharge support for elderly patients into
their homes in a timely way and additionally when other provided transport was not
available. This scheme added value and facilitated discharges. It will be considered for longer
term funding in the current year.
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5.2 Modelling
There is a clear need for predictive modelling and scenario planning in order to be able to both plan
proactively for year-long resilience, and identify the mitigation plans required to minimise impact in
the system. Any modelling and trend analysis undertaken in 2014/15 would inform future years’
resilience planning and risk mitigation. This has therefore been identified as a key development from
September 2014. The identification of current baselines will be critical in order to understand the
impact of proposed schemes in the resilience plan, and allow the SRG to monitor the use and impact
of non-recurrent resilience funding on a monthly basis. Likewise sharing of live data with providers
that supports planning and dashboard development will need agreement through the SRG and its
working groups.
6.0 ANALYSIS OF CURRENT RESILIENCE AND DEMAND & CAPACITY
York Teaching Hospitals Foundation Trust has recently been subject to two ECIST reviews to report
on the current urgent care and Referral to treatment (RTT) pathways and position. These have
provided a detailed analysis and set of recommendations for improvements which are now being
addressed through the SRGs and their working groups.
6.1 ECIST Urgent Care
The ECIST reports on all elements of the Urgent care System and made recommendations to
improve the System performance whilst maintaining safety and quality. It recognised that the
Hospital had embarked on an Improvement Plan. The main recommendations provide the basis of
service improvement. The YTHFT Team have accepted the report and are planning to work with the
UCWG to establish a plan of agreed actions. Several of the adjustments to the system are already
addressed in the UGWG plans following the winter schemes. Annex 2 outlines the summary Action
Plan in response to ECIST recommendations.
In order to improve the discharge processes, YTHFT will have to left-shift discharge to an earlier
point in the day. The workforce capacity is confronted in ED, particularly with a reduced
complement of senior decision. This problem is compounded by a national challenge to Emergency
Department recruitment. Mental Health provision is inadequate and erodes 4-hour performance
and patient experience. Community nursing and the integration of social care is variable across the
local system and it is compounded by having different Local Authorities and historical service
provision that needs to be aligned to the current service provision. It is recommended that this is
reviewed and addressed. Complex discharge services are not helped by variable community hospital
referral criteria and operation. ECIST have offered to provide a review of this area as it appears to
offer opportunities for improvements. The report advises attention to a frail elderly pathway as an
integrated service. ECIST recommended a ‘Discharge to Assess’ model which supports earlier
discharge with the aim of reducing rapid decompensation of patients whilst in-patients.
The report discusses a specific area for improvements in the application of best practice when
treating children in ED. The treatment of the under-fives is an area of attention in the current plans.
Ambulatory care was highlighted and it was recognised in the report that the Trust are in the process
of dealing with this.
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Discharge planning has a prominence in the report with recognition that the Length of Stay profiles
are not ideal. The activities promoted in the report are use of discharge toolkits, such as the ‘SAFER’
bundle, daily senior review and the use of take home medications to be provided by midday and that
this is used as a KPI. Discharges are adversely affected re-ablement waits and a higher volume of
contact episodes in the district nursing team versus the current block contract. Work on a single
point of contact is underway
Finally, ECIST recommends that the three CCGs a single standard output driven specification for the
Urgent Care System, principally agreed through the UCWG structure. There has been progress on
this, although the new SRG structure has provided for an Unplanned Care subgroup each for
Scarborough General Hospital and York Trust.
6.2 ECIST IMAS non-elective care RTT
This report by the Intensive Support Team addressed the RTT management and performance
processes, policies and the planning for recovery and capacity at York Teaching Hospital Foundation
Trust. It also reviewed some of the cancer pathways. The report highlighted a consistent delivery of
all three RTT standards over the preceding 12 months. The backlog remains a problem for the Trust
and focus has been on the 36 week cohort. The sustainability of the backlog has not been achieved
and some of the outpatient waits have affected the pathway management. The report advocated
high level oversight and consistency at speciality level and the need to resolve contractual issues.
The vision is to achieve sustainability of waiting list sizes with contingency built in. The IST were
impressed with the hospital CPD system and considered whether Board reports should include RTT
indicators. This issue could be addressed by the proposed Planned Care Dashboard which, via the
SRG, could use a cross-economy influence to improve the flow. Annex 3 includes the IMAS Recovery
Plan for reference.
7.0 KEY RISKS FOR WINTER 2014/15
The SRG is currently undertaking a risk assessment for winter 2014/15 and will work to refine this
during August 2014. Initial risks are principally capacity and demand related and are as follows:
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Serious risk of flu epidemic as none in 13/14
Adverse weather restricting access to health care
Overwhelming Demand as a result of elderly frailty
Staff sickness
Local and regional supply of staff
Diarrhoeal and vomiting outbreaks in the hospital and the community.
8.0 PLAN ON A PAGE (What Good Looks Like)
A summary of the current approach for whole system resilience is summarised below:
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System Vision: Delivering integrated care across primary care, community and acute hospitals
Timescale: In line with 5 year Strategic Plans – Year 1
Drivers:
Requirement to apply principles of good practice including assessments of efficiency, sustainability
and implementation
Patient expectation and increasing demand
System Resilience Group
Key Objectives:
 Overarching system sustainability and associated financial sustainability/affordability based
on prioritised decision-making
 Delivery of safe, effective and prompt care in appropriate settings that fit patients’
requirements
 Minimising inappropriate ED attendances
 Minimising inappropriate hospital admissions
 Whole health and social care “System Flow”
 Avoiding delayed discharges and minimising inpatient bed days (LOS)
 Embedding principles of good practice throughout all pathways and systems
 Exploring additional flexible health and social care capacity to meet fluctuations in demand
 Exploring additional flexible capacity to meet fluctuations in demand
Unplanned Care Working Group
Expected outcomes:
 Achieve NHS Constitutional targets and 4 hour
A&E standard
 Achieve care quality standards for urgent care
 Optimise whole system flow and resilience
 Minimum of 3.5% reduction in emergency
hospital admissions
 Reduction in patient reported poor experience
of in and out of hospital care
 Integrated urgent and ambulatory care
pathways
 7 day working in priority areas
 Effective discharge planning and achievement
of smooth discharge
 Effective signposting and communications
 Expansion of choice – independent and
voluntary sector
 Timely and accurate urgent care information
 Refreshed and aligned Surge and Escalation
Plans
Planned Care Working Group
Expected Outcomes:
 Achieve NHS Constitutional
targets and RTT waiting time
targets
 Reduction in length of stay and
delayed discharges
 Reduction in patient reported
poor experience in hospital
 Timely and accurate planned
care dashboard
Enablers:
 Intensive Care Support Team recommendations and YFT Action Plans
 Demand and capacity planning modelling
 Operational plans for delivery of additional activity to reduce backlog
 Implementation of Referral Support Service (RSS) to improve quality of referrals and improve information
 Additional national funding to support RTT and A&E standards
 Lessons learnt from 2012/13 and 2013/14 winter planning
 Strong partnership working through SRG
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8.1 Unplanned Care
The SRG has prepared detailed plans for implementation in order to improve unplanned care
resilience. These interventions are outlined in the submitted template for Operational Resilience
Plan.
Local objectives for unplanned care are aligned to the recommendations in the ECIST report, the
extension of the winter projects which appear to have impact and those programmes that form part
of the BCF that are intended to reduce the level of non-elective activity. An essential and pressing
need is the acquisition of an effective Urgent Care Dashboard.
Local standards: the UCWG currently works to achieve the 4-hour target and to improve flow in the
system. Once the Dashboard is established the UCWG will be in a position to work to more specific
KPI’s, such as: 10-minute admission rates, admission profiles, discharge metrics and LOS. The UCWG
has entered into discussion with the Academic Health Science Network to develop these metrics
further.
Benefits to each patient cohort: the areas of activity relate to the under-fives, young adults who
access A&E frequently, frail elderly
Target Outcomes: the aims of the Projects are to maintain patients in the appropriate setting for
safe care to be provided whilst reducing the numbers of non-elective admissions. There are specific
targets including the 4-hour wait, ambulance handover times, GP OOH NQR’s and NHS111 NQR’s,
Ambulance Service NQR’s.
The KPIs that are currently monitored are the 4-hour wait, ambulance handover metrics, OOH KPI’s,
discharge metrics, NEL’s and NHS111 metrics. In addition to these we are looking at some quality
indicators to populate the UCWG Dashboard.
Overarching Plans/Proposals
System UCWG Dashboard – this requirement is a crucial piece of the overall strategy to
improving Urgent Care Provision. The VOYCCG is currently working with the CSU to develop
this as a priority.
2. Escalation planning* - This was done last winter and agreed with all Organisations as a
regional assurance process. There has been some alignment and sharing of policies. It will
require a quick review for the coming winter to align these further. The system flash reports
worked well.
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Pre-hospital plans
Single point of access*
Frequent callers* – This was based in Primary Care and is a project aimed at managing
patients who call nhs111 and attend AE frequently.
3. Frequent callers for YAS* – A YAS project regarding patients calling nhs111 and calling 999.
4. Urgent Care Practitioners – An on-going project with YAS funding agreed and forming one of
the BCF Projects. The training of UCP’s is underway.
5. GP call-back scheme* - This has been successful and is embedded now and has reduced 999
conveyance.
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2.
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Community IV – A project already started for one cohort (Bronchiectasis) and is planned to
expand to cellulitis.
7. Alcohol Agenda – The CCG is already scoping this with CYC and Public Health. There will be
some work aimed at binge drinking and its relationship to AE attendance
8. Hospice@Home – This is aimed at providing the Hospice service at home. There are some
funding issues are being solved.
6.
In Hospital Plans
10. Paediatrics zero bed stay – This is currently being scoped.
11. Front Door Geriatrician – This is being scoped and is under review.
12. GP in AE (2pm to 10pm 7/7) - to manage waiting room queues and keep flow moving
irrespective of hospital bed state. – There is a commitment to work this through and is
currently at scoping stage.
13. Additional Staffing* - This was stopped when the funding ended after having shown a
successful winter impact. It amounted to additional middle grade time and some senior
nurse practitioner time during extended hours. There will be recruiting issues for the trust if
they agree to this and it could be considered as part of their core contract going forward.
The current plans are in negotiation.
14. Senior Clinical assessment at the front door of ED (consultant plus senior Nurse)
15. Extend RATS Team* from ED to 8pm including Saturdays, this worked well in winter and is
considered for extension. This project has some implications for the Rapid access teams and
system downstream. The impact of this is being assessed currently and potentially could link
to the step down beds scheme.
16. Additional ACP - This is additional cover on AMU to facilitate faster flow.
17. Extended opening of the Frailty Unit – This is in the hospital and aims to enable faster
admission from ED.
18. Transitional waiting area- This is for mental health patients waiting for transfer to a Mental
Health Hospital. It will require a band 3 health care worker 24/7.
19. ARClight homeless support worker* – This project was well received and popular with ED in
the winter plans and is a proposal for extension to the coming winter period.
Post Hospital Plans
DTOC activities* – There is a current proposal to commission 6 to 10 step down beds with
intensive re-ablement activities linked to care home provision should the patient not be fit
to discharge home. It may be linked to a discharge to assess model.
12. Patient Transport* - Provided by AGE UK, this project helped flow through the system by
providing an enhanced ability to discharge patients to their home. It was extended to cover
the Tour de France recently as part of the hospital enhancements. There is a current bid to
commission this long term.
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*Note that the projects with an asterix are those that were part of 2013/14 winter plans.
8.2 Planned Care
The SRG has prepared and is considering plans for implementation in order to improve planned care
resilience. These interventions are outlined in the submitted template for Operational Resilience
Plan.
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Local objectives for unplanned care are aligned to the recommendations in the ECIST report for
improving RTT recovery as captured in the IMAS Action Plan.
9.0 ESCALATION AND DE-ESCALATION
Refreshed Surge and Escalation Plans have been finalised and approved at the Urgent Care Working
group in September 2014. The development of modelling for capacity planning and scenario
planning would inform and support risk assessment and mitigation plans around escalation. The
system-wide alerts and triggers for escalation currently incorporated into the escalation plan will be
revisited and adjusted as required for 2014/15. Similarly processes for de-escalation have been
reviewed and refreshed in relation to SRG plans approved.
The Surge & Escalation Plans will form part of the cohort of plans monitored by the SRG but will be
managed by the individuals from each contributing organisation responsible for overseeing the
operational response to winter pressures.
10.0 RISK MITIGATION
Each scheme has, or will have, a rigorous programme management approach with IVAs, project
plans and risk plans. It is possible to use the PMO tool Covalent to support SRG monitoring.
SRG Governance including agreed process for funding allocation, risk sharing and performance
management (see below)
The SRG will apply a Risk Mitigation framework which focuses on early identification of risks and
development of risk mitigation plans which ensure system resilience planning remains on track.
11.0 FUNDING ALLOCATION & MONITORING
The allocation of non-recurrent funding for RTT plans has been agreed for allocation. All other nonrecurrent funding will be agreed after a period of evaluation and assessment of all resilience plans
during August. The process for allocation and reinvestment of 70% marginal rate funding will also be
agreed by the SRG during August. Requirements for data reporting and exception reporting linked
to both will also be agreed.
11.1 Contingency arrangement (incase activity exceeds capacity)
In the case of activity exceeding capacity despite the implementation of operational delivery plans to
deliver system resilience the SRG will agree during August and September how to prepare
contingency plans. Risk sharing arrangements in relation to resilience funding and delivery of
outcomes will also be agreed by the SRG.
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12.0 MONITORING AND REPORTING
The SRG have identified the need for dashboards for both urgent care & planned care and have
included in the operational resilience plan submission a request for funding to support this
development.
13.0 TESTING & ASSURANCE of PLANS
Some individual plans and schemes have already been piloted and tested. Other schemes are still
currently being scoped. The SRG will agree how to test and exercise the full approved resilience plan
approved by the national tripartite body from September onwards. Plans will be regularly assessed
and refreshed as required depending on impact on outcomes and achievement of KPIs.
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Annex 1 Terms of Reference System Resilience Group
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SYSTEM RESILIENCE GROUP
DRAFT TERMS OF REFERENCE
VALE OF YORK, EAST RIDING, SCARBOROUGH AND RYEDALE CCGS
PURPOSE
The System Resilience Group (SRG) provides the strategic and operational leadership across the
health and social care system of Vale of York, East Riding and Scarborough and Ryedale CCGs for
both unplanned (non-elective) and planned (elective) care for the populations it serves. All partners
across the system jointly shape and co-ordinate the planning, integration and delivery of care in
order to support the delivery of safe, responsive, effective, high quality accessible services which are
good value for taxpayers by local providers. The SRG role and function will be taken by the existing
Collaborative Improvement Board (CIB) which represents the joint VoY CCG, Scarborough & Ryedale
CCG and East of Riding CCG and York Teaching Hospitals Foundation Trust stakeholder group.
The SRG will be supported by two working groups for:
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Unplanned care (this will be delivered through the existing Urgent Care Working Group with
a new additional local subgroup for the Scarborough community)1
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Planned care
The relevant stakeholders representing all the required local commissioners and providers of
unplanned care and planned care will be represented on these two working groups and will report
to the SRG (CIB) as required. The membership of the CIB will not change to take on the SRG role.
The key focus of the SRG will be on:
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Determining service needs on a geographical footprint
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Initiating the local changes needed, and
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Addressing the issues that have previously hindered whole system improvements
OVERARCHING GOALS
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To come together and work across boundaries to ensure operational resilience, matching
resources with demand, to improve patient experience and clinical outcomes in both urgent
and planned care
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To enable systems to deliver high quality, safe services and optimise all parts of the health
and social care system to eliminate waste of resource
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To understand the impact and align the planning and delivery of planned care with
unplanned care across the whole system
These group will evolve from the existing Emergency Care Network in Scarborough
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KEY PERFORMANCE TARGETS
1.
To ensure capacity planning is resilient and sustainable year-round in order to ensure all NHS
Constitution rights and pledges are met, and exceeded where possible – including 18 week RTT;
cancer waiting targets, diagnostics waiting targets and A&E waiting targets
2.
To demonstrate efficient and smooth patient ‘flow’ throughout the whole system from patient
referral/ contact to discharge/ handover
3.
To consistently achieve a high measure of patient satisfaction within all elements of the
unplanned and planned care systems
4.
To maintain financial balance and sustainability across the whole system
KEY FUNCTIONS
The SRG will have a number of key functions:
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To ensure that capacity planning is undertaken and agreed jointly across the whole system
simultaneously and on an on-going basis, based on local needs and a robust understanding
of the pressures and drivers in the local system
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To co-ordinate and pro-actively drive operational delivery across the whole system,
reviewing and revising regularly as required, providing oversight and holding leads for work
programmes to account (NB. it is acknowledged that programmes of work which contribute
towards system resilience will be developed, mobilised, delivered and programme managed
through a multitude of different groups and mechanisms. The processes and documentation
for providing engagement, involvement, assurance and monitoring from each of these
programmes of work through to the planned and unplanned working groups, and
subsequently to the SRG, will need be clarified)
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To drive opportunities to extend work across health and social care further in order to
achieve truly integrated service delivery
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To approve and allocate non-recurrent funding and use of marginal tariff to support delivery
and programmes of improvement
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To monitor delivery against plans, outcomes, KPIs and funding allocations
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To access, share and undertake detailed analysis of the full range of appropriate data to
support evidenced based decision making
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To use local, national and international best practice to shape and model services that are fit
for the local population (initially this will reference the ‘Principles of Good Practice’ as
outlined in ‘Operational resilience and capacity planning for 2014/15’ [Monitor, NHSETDA,
NHSE & Adass June 2014])
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To use local innovative schemes and pilots as required to drive integration and
transformation and focus on specific patients/ patient groups with particular needs/ acuity/
dependency/ vulnerability
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To clearly identify interdependencies between services and plans across unplanned and
planned care
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To benchmark against local and national peers
ACCOUNTABILITY and DECISION MAKING
• The SRG is not a statutory body and does not have delegated authority. The individual SRG
representatives have delegated authority from their member organisations by virtue of the
roles they hold in those member organisations, and as such are accountable to their individual
organisational Boards. Therefore the SRG will make decisions as required in relation to
delivery of agreed plans and to support further development of unplanned and planned care
as developed and approved by their supporting working groups (NB. this does not infer that
the SRG will need to approve all programmes of work across the whole system which could
contribute to system resilience on an on-going basis)
• SRG decisions are not formally binding but should seek to represent all the links with
delegated authority arrangements from relevant statutory bodies and their member
organisations in order to drive consensus, alignment of plans and delivery at pace
• The SRG will be accountable for the delivery of the overarching system resilience plan (to be
submitted and approved during July and August 2014)
• The SRG will be accountable to the tripartite Monitor, NHSE, NHSTDA & Adass bodies and all
SRG approved plans must be assured and approved by this body before funding is authorised
for release and allocation
• Members of the SRG will report to their own member organisation through their agreed
governance and committee structures, including the Health & Well-Being Boards
• There are also a number of Boards and committees including local Better Care Fund
Integrated Care Delivery Board, Joint Delivery Groups and Contract Monitoring Boards which
will require regular updates on progress and agreed changes to operational delivery, activity
plans and funding allocations
• SRG will be responsible for the decision-making process around the allocation of the nonrecurrent funding which is released to the member CCGs based on tripartite approval of the
resilience plans, as well as any risk sharing arrangements which support delivery of required
outcomes
DUTIES
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• Member CCGs are expected to support and manage the performance of the SRG and assure
planning and delivery as required
• Member organisations are expected to support the SRG by providing clinical representatives
for expert advice and guidance when developing plans and support for implementation
• The two working groups will be responsible for ensuring the co-ordination and delivery of the
programmes of work and reporting back to SRG
• Specifically the SRG and working group responsibilities are to:
a) Develop key overarching performance targets for operational resilience in capacity
planning
b) Develop the capacity plans and contributing programmes of work for planned and
unplanned care to support implementation
c) Develop the key outcome indicators, the benefits and KPIs against which impact and
progress of programmes of work and monitor delivery of programmes against these
d) Actively oversee the development and delivery of plans and ensure the changes to
urgent care are delivered as planned and on schedule
e) Identify interdependencies across planned and unplanned care programmes of work
and ensure effective co-ordination.
f)
Understand the financial resources required for investment for delivering capacity
plans and any implications for re-investment and dis-investment
g) Provide the clinical, organisational, managerial and patient views in relation to both
planned and unplanned care
h) Foster widespread involvement, seeking views of stakeholders including patients
and the public
i)
Ensure appropriate communications are maintained with all public, patient and
other stakeholders
j)
Throughout the transformation to any new service models or care pathways, receive
reports on the organisational and managerial arrangements necessary to ensure all
required changes are undertaken in a timely manner with the safety of patients
being paramount
k) Ensure that risks and issues are identified, managed, and escalated to the
appropriate committees within each organisation
l)
Respond to directions, national, regional and local and take action accordingly.
AREAS OF CARE
The SRG will potentially focus on the following areas of health and social care:
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UNPLANNED CARE
PLANNED CARE
A&E and urgent care
Planned care pathways identified as priorities by
the SRG and planned care working group
Ambulance services
Diagnostics services
Out of hours services
Cancer services
Crisis and liaison services for patients with
mental health needs
Prescribing – Joint Formulary & Access to
medicines
Children’s and young peoples’ urgent care
services
Mental health services
Frail & elderly people care and services
Primary care services
Primary care services
Community Services
Community Services
Care home services
Social care-enabled or focused multi-agency
services (e.g. re-ablement or support for
discharge planning)
Patient transport services
Public health (including vaccination
programmes)
MEMBERSHIP
The SRG is represented by the existing Collaborative Improvement Board. Additional representative
for operational resilience planning are sought from all key planning and delivery stakeholders
including providers in the independent and voluntary sectors, local authority, patient engagement
forums/ representatives, public health, police services, NHS England Area Team. These will be
represented on the two working groups.
As such, the SRGs and working groups shall comprise the following organisations, represented
wherever relevant and feasible to as required to deliver the duties of the SRG2:
SRG
Unplanned care
working group
Scarborough and
Ryedale CCG
Chief Officer;
Clinical Chair;
Chief Finance
Officer
Clinical and
Management
Leads Urgent
Care
Vale of York CCG
Chief Clinical
Clinical and
2
Unplanned care
working group
(Scarborough
subgroup)
Clinical and
Management
Leads Urgent
Care
Planned care
working group
Clinical and
Management
Leads Planned
Care
Clinical and
Acknowledging that there may be significant pressure on the capacity of some organisations to be able to
attend multiple working groups
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East Riding CCG
York Teaching
Hospital NHS
Foundation Trust
Leeds and York
Partnership NHS
Foundation Trust
SRG
Unplanned care
working group
Officer; Chief
Operating
Officer; Chief
Finance Officer
CCG Chair;
Chief Officer;
Chief Finance
Officer
Chief Executive
Office or
Deputy CEO;
Director of
Nursing
Management
Leads Urgent
Care
City of York Council
Management
Leads Planned
Care
Clinical and
Management
Leads Urgent
Care
Clinical and
Management
Leads Planned
Care
Clinical and
Management
Leads Urgent
Care; Clinical
Lead OOHs
Clinical and
Management
Leads Urgent
Care; Clinical
Lead OOHs
Clinical and
Management
Leads Planned
Care; Children’s
leads;
community
services leads.
Clinical and
Management
leads
Clinical and
Management
leads
Representative
Clinical and
Management
leads (including
crisis and rapid
response teams)
Representative
Representative
Representative
Representative
Clinical and
Management
leads
Public health &
well-being lead;
Head of Adult
Services; Head of
Children’s
Services
Clinical and
Management
leads
Clinical and
Management
leads
Public health &
well-being lead;
Head of Adult
Services; Head of
Children’s
Services
Public health &
well-being lead;
Head of Adult
Services; Head of
Children’s
Services
Public health &
well-being lead;
Head of Adult
Services; Head of
Children’s
Services
Representative
Clinical and
Management
leads (including
crisis and rapid
response teams)
Scarborough and
Ryedale of Yorkshire
Council
East Riding of
Planned care
working group
Clinical and
Management
Leads Urgent
Care
Tees and Esk Valley
Voluntary Sector
Providers
Independent Sector
Providers
Yorkshire Ambulance
Service
Unplanned care
working group
(Scarborough
subgroup)
Representative
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Representative
SRG
Yorkshire Council
Selby District Council
Healthwatch North
Yorkshire and other
Patient and Public
Voice/ Engagement
Groups
North Yorkshire
Police
Area Team – North
Yorkshire and
Humber NHS England
Harrogate Hospital
NHS Foundation Trust
Humber Foundation
Trust
Primecare Ltd
Representative
or patient/
carer
Unplanned care
working group
Representative
Representative
or patient/ carer
Commissioner or
delegated
Direct
commissioning
of primary care,
dental,
ophthalmic and
community
pharmacy leads
as required
Unplanned care
working group
(Scarborough
subgroup)
Planned care
working group
Representative
or patient/ carer
Representative
Representative
or patient/ carer
Direct
commissioning
of primary care,
dental,
ophthalmic and
community
pharmacy leads
as required
Commissioner or
delegated
Direct
commissioning
of primary care,
dental,
ophthalmic and
community
pharmacy leads
as required
Representative
Representative
Clinical and
Management
Lead
Representative
Clinical and
Management
Lead
The SRG will be chaired by a senior leader of one of the member CCGs. The option to rotate the
Chair can be offered 6 monthly between members CCGs.
The process for establishment and on-going operation of the SRG within this wider context is
outlined below:
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REPORTING ARRANGEMENTS
The SRG will have the following reporting responsibilities:
a. Develop a final resilience and capacity plan for the use of resilience funding,
including agreed outcome indicators, KPIs, supporting workplans for each work
scheme
b. Agreed use of the 70% marginal tariff funding to support system resilience
c. Provide a monthly formal update on progress, including delivery status on action
plans, risk status and changes to approved work.
d. Formal updates will be recorded and shared with member organisations.
e. The minutes of the SRG shall be formally recorded although there is no formal
requirement to present to the individual organisations, the SRG will by exception
escalate matters it considers should be brought to the attention of member
organisations
f.
Risk assessment and mitigation plans of the resilience and capacity plan
g. Publication of final plans on CCG websites.
FREQUENCY AND FORMAT OF MEETINGS
•
The SRG will meet monthly.
•
The group may meet at more frequent intervals, as required by the status of the capacity
plans and contributing programmes of work, or in response to acute pressures in the health
and social urgent care system.
QUORACY
•
The SRG is to monitor delivery of unplanned and planned care capacity plans, and agree and
review the progress against outcomes and KPIs included in contributing programmes of
work. It is therefore essential that members (or their deputies) attend every meeting as it is
expected that decisions will be required to be made at each meeting.
REVIEW OF TERMS OF REFERENCE

The SRG Terms of Reference will be formally reviewed in December 2014.
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Annex 2 ECIST Action Plan for A&E 4 hour target recovery – York Teaching Hospitals NHS
Foundation Trust September 2014
Annex 3 IMAS Final Review Recommendations RTT Delivery recovery – York Teaching Hospitals
NHS Foundation Trust September 2014
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