1. Operational Plan 2009/10 Health Overview and Scrutiny Panel February 2009

2. Context including JSNA, national targets, operating framework Programmes of work and implementation plans for Improvements in the quality of care for patients Progress on ambitions in our Strategic Framework Plans for the use of system reforms such as patient choice, PBC, contestability, WCC Supporting strategies such as workforce and OD, IM&T, estates development Financial framework and our investment plans Risk assessment and management plans What does it include?

3. The Operational Plan in Context Operational Plans (LDP) 1 year plan, detailed actions Operational Plans (LDP) 1 year plan, detailed actions Strategic Framework 3-5 year plan, long term ambitions, big strategic issues Strategic Framework 3-5 year plan, long term ambitions, big strategic issues Operational Plans (LDP) 1 year plan, detailed actions Operational Plans (LDP) 1 year plan, detailed actions Operational Plan (LDP) 1 year plan Operational Plan (LDP) 1 year plan Commissioning Strategy How we commission Commissioning Strategy How we commission Medium term financial plan 3-5 year plan Medium term financial plan 3-5 year plan Organisational development plan 3-5 year plan Organisational development plan 3-5 year plan Practice based commissioning plans Plans to meet health needs of local communities Practice based commissioning plans Plans to meet health needs of local communities Practice based commissioning plans Plans to meet health needs of local communities Practice based commissioning plans Plans to meet health needs of local communities Practice based commissioning plans Plans to meet health needs of local communities Practice based commissioning plans Plans to meet health needs of local communities Strategic Objectives 2008-2011, organisational goals for PCT Strategic Objectives 2008-2011, organisational goals for PCT

4. Statutory Requirement e.g. NICE, Health & Safety Highest Lowest Priority National Target Improving Efficiency and Cash Releasing Saving (Resource Utilisation Management Schemes) Reduces demand for acute services and is cost saving or cost neutral Local Priority Local Ambition National Service Framework Gap or other National Target Prioritisation

5. National Operating Framework 2009/10 High quality care for all remains as guiding principle for the Operating Framework and underpinning every stage of development and reform are: safety of patients and staff effectiveness of care experience of patients

6. National Operating Framework 2009/10 Opens with confident assessment that: “we have never been in a better place to deliver these ambitions” Focus continues to shift from better health care to better health

7. National Operating Framework 2009/10 Priorities improving cleanliness and reducing HCAIs 18 weeks Referral to Treatment (RTT) target improving health and reducing health inequalities improving patient experience and satisfaction preparing to respond in a state of emergency such as pandemic flu outbreak National priorities essentially the same as 2008/09:

8. National Operating Framework 2009/10 Setting standards Continued focus on ‘Vital Signs’ framework: Tier one:Tier one: “must do” indicators, apply to all Primary Care Trusts Tier two:Tier two: national priorities for local delivery Tier three:Tier three: Primary Care Trusts can use with Partners and local communities

9. Our Primary Goals Reduce health inequalities in all areas of our work by targeting effort in the areas with greatest deprivation Address the inter-related issues of care for older people, long term conditions and increasing independent living at home Work across boundaries to improve joint working……in order to find new and radical solutions to systemic problems Get it right first time – deliver safe, effective care, by ensuring that systems and processes are efficient and reflect best practice

10. Our Strategic Objectives To improve quality and earn autonomy by meeting necessary targets To meet our challenges through innovative service redesign – to meet identified needs. To reduce health inequalities and promote health and wellbeing based on an understanding of health needs To be a competent commissioner and ensure the development of a fit for purpose provider service To be a good partner to work with – building public, stakeholder and staff confidence

11. Work to reduce childhood obesity Targeted cardiovascular screening Increase help for people who want to stop smoking Additional health trainers Promoting physical activity Brief interventions for alcohol in A&E services Intensive support for vulnerable families in deprived areas Healthy Living and Health Improvement

12. Long Term Conditions Single point of access to community services Develop and progress North Somerset Self-Care Policy Implementation of the North Somerset Carers Strategy Implementation of a new Rehabilitation Care Pathway Meeting target for diabetic retinopathy screening Development of best practice care pathways for a range of neurological conditions Implementation of the national stroke strategy Continue the development of Dignity in Care Challenge

13. Cancer Services Continue the implementation of Improving Outcomes Guidance specifically: –Expansion of bowel screening –Expansion of breast screening –Further reduction of wait times –Implementation of an intermediate level skin care service –Improved access to diagnostics

14. Mental Health Further develop the primary mental health services by taking forward improvements in access to psychological therapies Implement the Joint Commissioning Strategy for people with dementia Developing psychiatric liaison services both in adult and older people services Review acute care pathways with providers to create a focus on recovery Develop training on understanding eating disorders and a range of educational leaflets for primary care

15. Learning Disabilities Develop and implement plans in response to ‘Valuing People Now’ Deliver recommendations contained within ‘Healthcare for All’ Continue pilot of health checks with GP practices Improve Speech and Language therapy services Support the joint action plan to respond to the needs of people with Autism and Aspergers Continue to improve access to services by ensuring information is produced in an accessible format

16. Planned Care Reduce waiting times to 13 weeks from referral to treatment across all specialties Extend opening hours in all GP practices Deliver a year on year increase in patients accessing dentistry Implement the new GP practice in Worle Implement the new GP Led Health Centre and satellite unit in central Weston Open the new Marina Healthcare Centre in May 2009

17. Urgent and Emergency Care Work with GWAS to implement service redesign to improve ambulance response times Implement a recruitment drive for Community First Responders Implement GP in urgent care model through the GP Led Health Centre Work with WAHT to maximise the potential of the Assessment and Treatment Centre Reduce waiting times in A&E and make progress against the 2 hour target

18. End of Life Care Deliver the Marie Curie Delivering Choices Programme and implement plans agreed with the North Somerset End of Life Strategy Group Introduce and implement Advanced Care Planning Introduce and deliver the use of the Gold Standards Framework module for Care Homes

19. Improving Quality Project working with Nursing Homes to reduce MRSA and targeted improvement events e.g. diabetic foot ulcer patients Continued focus on reducing C-diff in hospitals Supporting ‘Safety First’ initiative around avoidable deaths CQUINs included in contracts with acute providers Implement Patient Safety Report ‘Safety in Doses’

20. Supporting Strategies Action Plans also included to improve: Patient satisfaction Involvement and engagement Information management and Technology Workforce development Estates and capital development Organisational performance and development Leadership capacity and capability

21. Challenging Financial Context Funding position relative to neighbouring PCTs Significant savings over last two years – further savings less easy to deliver Need to be in the top 10% of the country for efficiency and productivity

22. Next Steps Equality Impact Assessment (ongoing) Consultation and Engagement (ongoing) Continued risk assessment Amend plan to take account of engagement and consultation Draft plan to Board 25 February 2009 Submitted to NHS South West for comment Final plan published by 31 March 2009

23. Let us know what you think We are keen to know what you think of our plans. Please let us have your comments. E-mail: operationalplan@nsomerset-pct.nhs.ukoperationalplan@nsomerset-pct.nhs.uk Write to: North Somerset PCT, Waverley House, Old Church Road, Clevedon BS21 6NN Telephone on 01275 546678