Peterborough Turnaround Plan 11 Draft for Board approval 19 May 2010 Main document
DRAFT FOR BOARD APPROVAL Sections � Looking backwards – How we got here 12 � Looking forwards – Turnaround Plan 1
DRAFT FOR BOARD APPROVAL Where we are now � Understanding of the size of challenge � Understanding of the underlying factors 13 � Turnaround plan � System Transformation Board � Public and stakeholder engagement 2
DRAFT FOR BOARD APPROVAL What was NHS Peterborough deficit in 2009/10 Spend vs. revenue resource limit , £m PCTs must ensure system spending matches resources as: 3.4 2.9 2.9 � This is a statutory legal requirement 0 � Other communities and counties in East of This debt is borrowed from England will not bankroll other communities and 14 Peterborough counties in East of England via the Strategic Health � With 95% of PCT Authority and must be repaid spend passed to providers, PCT debt is a system issue -12.8 2005/06 2006/07 2007/08 2008/09 2009/10 3
DRAFT FOR BOARD APPROVAL What is the size of the management action required 1 2 3 4 5 In total, the PCT receives PCT also needs The recurrent impact before In 2009/10, the deficit growth money to fund rising value of the 09/10 interventions is was £12.8m due to that is offset by population and over-spend is £33m which multiple overspends pre-committed “non recurrent £17.2m in 10/11 reconciles to costs change” £27m in March 33.0 6.2 15 13.9 10.7 17.2 12.8 Change from March to April largely due to £4.4m in population uplift netted off in March and now shown on a gross basis Debt owed to Recurrent Change in income Pre-committed Activity growth Total 10/11 SHA from 09/10 deficit in 10/11 costs and change costs challenge overspend 4 SOURCE: NHS Peterborough Financial plan 2010, PCT Finance team, team analysis
DRAFT FOR BOARD APPROVAL Which are the contributing factors to the financial challenge � Costs exceed income in many areas – 12% growth in 09/10 in acute – 8% spend growth in 09/10 in community services � Extensive NHS infrastructure and broad range of services in 16 Peterborough � Rising usage of healthcare services � Variation in care provided to local people and high non elective (emergency hospital) activity 5
DRAFT FOR BOARD APPROVAL How is our Organization Health % of respondents agreeing or strongly agreeing Distinctive, 85% + Superior 70–84% 0 10 20 30 40 50 60 70 80 90 100 Common, 50–69% Not effective, <50% Direction 37 48 63 Average score Peterborough PCT (n = 143) Alignment Leadership 65 74 50 Average PCT score (10 PCTs) NHS Peterborough’s Envt & Values 56 67 Maximum PCT 39 coordination & control score (10 PCTs) 17 is perceived as Accountability significantly below 44 55 66 Comparison average against other Coord & PCTs need to 67 58 30 Control consider that other Execution PCTs may not Capabilities have been in 47 34 63 similar financial NHS distress as NHS Peterborough’s Motivation 63 77 Peterborough 55 motivation is perceived as at the average Innovation 50 67 37 Renewal External 59 77 50 Orientation 6 SOURCE: NHS Peterborough PCT, Opportunity For Improvement Survey, 12th-16th April’10, survey received by 168 people response rate of 85%
DRAFT FOR BOARD APPROVAL Sections � Looking backwards – How we got here � Looking forwards – Turnaround Plan – Process 18 – Overview of the plan and implementation – Detailing the plan 7
DRAFT FOR BOARD APPROVAL How did we approach it May 14- Validate existing initiatives today and develop new Develop options; Derive Produce high- Initiate Baseline Identify assess impact on implication on level turnaround mobilization validation potential providers existing plans plan Agree Kick off � Close 2009/10 � Benchmark � Validate existing initiatives � Draft plan and refine savings � Set up accounts and Peterborough against opportunity with Executive plan � Prioritize and develop big ticket � Review plans with workstreams firm up against peers � Align approach baseline (ONS, national, initiatives to close gap Board for sign off 19 � Understand � Develop options for � Discuss SHA with Directors, SHA) ADs, Chair, 2010/11 � Review Peterborough to close gap, proposed plan and PEC chair growth “earmarked” including debt repayment and link to QIPP � Launch specific spending assess implications on providers � Determine changes to PCT projects e.g., referral strategy promises, if any management � Understand Develop � Set up one- on- � Interpret � Develop options for organisational � Design proposed – Organisational ability to ones with findings structure, and governance organisational structure deliver leadership and arrangements and governance – Governance � Set up delivery mechanisms clinicians changes – Organisational � Formal and � Create rapid (PMO process, including director health (inter- informal briefing responsibilities, tools and delivery pace views, focus meetings with resource work streams) supported by group, survey) � Set up series of System providers and System Board local partners Transformation Board meetings and PMO Communication 8
DRAFT FOR BOARD APPROVAL How we mobilize the organization Membership 1 Working group � � Exec - Sarah Shuttlewood Finance: Caroline Hall Planned care & � � AD - Jacqui Collins Contract: Jacqui/Chris Daff 1 acute � � Clin/Pro - Dr Sanath Yogasundran Performance: Mathew contracting � � ACM - Dr Mark Kroese, Dr Andy Liggins, HR: Christine Pattissan � Andrea Patman, Dr Malcolm Bishop, & Consultancy support Matthew O’Grady Marshall � Exec - Peter Wightman & Paul Whiteside � Finance: Caroline Hall � � AD - Richard Mills Unplanned Care: Kyle Cliff Unplanned care/ 2 � � Clin/Pro - Dr H Mistry, Dr.Mike Caskey Performance: Noor/ Chris Gillings urgent care � � ACM - Sue Oakman, Andrea Patman, Dr HR: Christine Pattisson Richard Withers, Tim Bishop or Denise � Consultancy support Time commitment Radley, Alison Reid, Jacqui or Sarah � 2 weekly meetings � � Exec - Denise Radley Finance: Cheryl Osborn � Daily catch up � � AD - Ray Legge Contract: Paul Raymond/ Jacqui Collins Mental health with key members 3 � � Clin/Pro - Sue Clarkson Performance: Alison North & LD 20 � Core members 30- � ACM - Kathryn Woods, Ralph � HR: Christine Pattisson � Middlebrook Consultancy support 40% of time � Clinical leads � � Finance: Sue Cuthbert/ Cheryln Osborn 2 Exec - Dr Andy Liggins invited to Community � AD - Richard Mills/ Jessica Slater 2 � Contract: Tony Lacey meetings/ 4 services. CC � Clin/Pro - Dr Van Den Bent, Paul Kitney 2 � HR: Christine Pattissonn care, LTC briefed weekly � � ACM - Sue Mitchell, Tim Bishop, Paul Consultancy support Kitney 2 � � Exec - Dr Richard Spiers Finance: Sue Cuthbert � AD - Andrea Patman � Contract: Diane Siddle/ Jacqui Collins Primary care 5 � � Clin/Pro - Dr Kevin Brinkhurst Performance: Chris Gillings & prescribing � � ACM - Dr Mike Caskey, Ron Smith, HR: Christine Pattissan � Diane Siddle, Sarah Shuttlewood Consultancy support � � Exec - Rob Yeomans Finance: Donna Shade/ Hazel Allerton � � AD - John Bain Contract: Jacqui Collins 6 Corporate � � Clin/Pro - Dr Neil Modha Performance: Chris Gillings � � ACM - Chris Palmer HR: Angela Hartley � Consultancy support 1 ‘Exec’ = Executive Lead, ‘Clin’ = Clinical Lead, ‘Pro’ = Professional Lead, ‘ACM’ = Additional critical members 9 2 Continuing care sub-group
DRAFT FOR BOARD APPROVAL How we ensure the robustness of the plan � Clear accountability and governance from the beginning – Each work stream has met a minimum of twice per week led by an executive lead working alongside a clinical lead – Tight turnaround discipline has been in place with daily conference calls to clear any blockages to progress – Weekly turnaround oversight meetings – Range of meetings with partners, staff and stakeholders. 21 � External expertise has been deployed to assist in developing a robust Turnaround Plan and challenge assumptions � Plan reviewed against the PCT Strategic Plan to ensure that major priorities in lifestyle, inequalities, vulnerable people and access are supported within a lower spending envelope � Opportunities in the Plan have been validated using a benchmarking exercise to compare Peterborough spending with best practices � Equality impact assessment undertaken by each of the Delivery Boards shows that while plans have the potential to impact vulnerable groups, plans have been established in all of the groups to manage this transition 10
DRAFT FOR BOARD APPROVAL Sections � Looking backwards – How we got here � Looking forwards – Turnaround Plan – Process 22 – Overview of the plan and implementation – Detailing the plan 11
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