1. System Changes Update for Partnership Board May 2016

2. STP - Broader System Context

3. Humber Coast and Vale Sustainability &Transformation Plan STP North Lincolnshire North East Lincolnshire Hull East Riding of Yorkshire 3 York Scarborough

4. What are our Collective Challenges & Priorities ? Urgent and Emergency Care Cancer Mental Health Acute & Specialist Care 4 Out of Hospital Care

5. Devolution

6. Key points on devolution for H&SC Agreed and announced at budget Combined authority for greater Lincolnshire Cabinet leadership comprising 10 LA leaders and elected mayor as Chair Early priority –integrated H&SC building upon “pioneering work of NE Lincs” Opportunity to secure national and European investment Opportunity to address wider determinants of health Opportunity to develop consistent innovative local models of integrated physical, mental and social care Opportunity to support small local viable hospitals

7. ACO Progress

8. Case for Change - The current system is unsustainable Budgets tight and getting tighter Increased cost Growing and aging population Access to care and quality of services Inefficiencies through fragmentation of delivery Workforce recruitment and retention Organisation overhead Doesn’t include Social Care and wider determinants Gap is growing Scale and pace of working together through integrated accountable system

9. Future for Health and Care? The NHS Five Year Forward View sets out a vision for the future of the NHS, with the triple aim of: In order to achieve this triple aim, the system will need to: Improving population health outcomes Improving quality and experience of health and care services Reducing per capita costs of health and care provision Align system payment and incentives Join and integrate pathways Reduce complexity and fragmentation Reduce complexity and fragmentation Shift care to alternate settings Personalise care Personalise care Focus on prevention

10. Definition of Accountable Care

11. Accountable Care footprint / size? – 50,000 population – Place footprint – NEL – Footprint 250,000 population – Northern Lincolnshire – Footprint 500,000 plus STP level or bigger Agreed Place based ACO, but with a system Board to ensure that those services that require a bigger popn to be delivered safely, effectively and at best value are.

12. 2016/17 – Putting in place stronger ACS to deliver priorities

13. North East Lincolnshire Shadow ACO Membership Membership NEL ACO NLAG Some NELC functions Primary Care FOCUS NAVIGO Care Plus Health & ASC Commissioning (from CCG)

14. Strategic Commissioners Role (1) The CCGs and Councils have existing joint commissioning arrangements at “place” level which will generate the “place view” of: 1.service outcomes 2.quality standards 3.performance standards 4.efficiency requirements to be delivered 5.capitated budgets and contracting arrangements for the “place” ACO service delivery SCs will meet to share and agree the “Northern Lincolnshire” level commissioning arrangements which will generate the “Northern Lincolnshire” view of: Points 1-4 above Plus capitated budgets and contacting arrangements for “Northern Lincolnshire” service delivery

15. Strategic Commissioners Role (2) These arrangements will be supported by a proposed joint NL and NEL strategic commissioning group/forum (the 4 - NELC, NLC, NELCCG & NLCCG) They will be active participants in the broader than “Northern Lincolnshire” commissioning requirements influencing the wider than “Northern Lincolnshire”(at Scale)commissioning decisions, STP, Devolution etc. They will consider & formally undertake any requirements in relation to scrutiny and public consultation They will set the contracts for services to be delivered by the ACOs at “place” level They will set the contracts for services at “Northern Lincolnshire” level and any contracts that are not included in the ACO contract

16. The ACO Role 2016-17 (1) To be the place based service delivery mechanism for health and care To ensure that there is strong clinical, professional and community involvement, leadership & decision making in service redesign development and delivery Determine how to deliver services to best meet the commissioner outcomes, quality, and performance requirements within its capitated budget at “place” and “Northern Lincolnshire” level To ensure the service(s) meet quality, sustainability and are responsive to wider system decisions and member priorities

17. The ACO Role 2016-17 (2) Delivers best practice and is innovative whilst also ensuring compliance with legislation, regulation & indemnity Delivers diverse and equitable services with special attention to promoting and protecting the interests of vulnerable groups To work collaboratively with other ACOs/providers to deliver services that it cannot safely and effectively deliver in isolation

18. The System Board will support what services can be delivered at: Local ACO (place) level “Northern Lincolnshire” level where the service(s): Cannot be achieved through planned service change within ACO geographies AND Can be met through service change within the ACS boundary Wider than “Northern Lincolnshire” level The System Board will support the ACOs to determine how best to deliver the “Northern Lincolnshire” wide services to ensure the service(s) meet quality, sustainable service requirements and respond to wider system decisions whenever they change Resolution of any material differences in ACO development or pace of change that would significantly compromise service quality and sustainability across the wider system (ACS and beyond) System Board Delivery Role 2016-17 (1)

19. Next steps New arrangements starting to operate Strategic commissioner to set direction & outcomes, decide retained, delegated and shared functions Strategic commissioner to consider resource allocation Strategic commissioner to shape and refine new arrangements

20. Next steps for ACO Considers its offer to strategic commissioner Agrees pooled resources Develops governance, leadership & operating model Agrees arrangements with commissioner & other providers Communicates ambition & changes to workforce & public

21. Timeline for – 2016/17 Q1 System architecture in place Independent System Leader with authority to take improvement action operating under a legally binding agreement Q2 shadow ACO boards for NL and NEL established with agreed terms of reference and programme of work Shadow Strategic Commissioner arrangements established for NL and NEL agreement of new 'At Scale' and 'Place' programmes Q3 legal framework in place for ACO operation of single contracts and subcontracting (may require lead provider) Case for Step 2 considered and being tested through Boards etc. Q4 single contracts in place between Strategic commissioner and ACOs for defined range of services further programme in place across 'At Scale' and ACOs delivering change at pace and scale required to enable financial sustainability