Recovery Plan

1
Recovery Plan

• Update August 2006

2
Financial Recovery

• 2005/06
• Deficit - 36.5m
• 2006/07
• Opening deficit - 43.1m Recurrent over
  spending - 25.0m
• Recovery Plan targets
• March 07 expenditure income
• 2007/08 expenditure income
• 2008/09 start to pay back accumulated deficit
  (54.1m)

3
Savings to date- 31 July 2006
4
Financial Recovery- Savings

• Savings Gross 16.0m (full year)
• achieved so far - 5.0 m (full year)
• dependant on demand management - 7.0m (full
  year)
• at risk - 4.0m (full year)
• Update on last month- no new recognised savings
  but-
• Physical Disability review - potential savings
  147k
• Learning Disability review - potential savings
  1.0m
• but we have to discuss with LBH the future of the
  section 31 agreement to realise the savings

5
Financial Recovery-Cost pressures

• Aware to date of
• Over activity at Hillingdon Hospital
• High cost Mental health and other placements
• London SHA intention to create a 70m contingency
  to cover financial risks
• PCT share 0.5m
• Hillingdon Hospital share 2.2m
• CNWL share 1.3m

6
Four legs of the plan

• Making the PCT fit for purpose and capable of
  delivering the turnaround plan.
• Cost savings - cutting expenditure in month
  balance 03/07
• Refocus Provider Services and Primary Care to
  reduce demand
• Engaging stakeholders so that they deliver on
  their parts of the plan

7
Projects 1 -13

• Cost savings
• Project 1 SLAs
• Project 2 Placements
• Project 3 Partnerships
• Project 4 Estates
• Project 8 Prescribing
• Project 11 Shared Services
• Demand Management
• Project 5 24/7 Rapid Response Services Case
  Management of HIUs
• Project 6 Clinical Assessment Service
  Management of Urgent Care
• Project 7 New/Re-engineered Care Pathways
• Infrastructure
• Project 9 New Budget Reports
• Project 10 Data Validation
• Project 12 Communications
• Project 13 Project Office

8
Project 1 - SLAs

• Leadership
• Director - Robin Andrews
• Project managers Terry Kelly
• External consultancy Advice from SHA
• Achievements to date
• SLAs negotiated in line with recovery plan
• Signed all heads of terms bar one
• Achievements planned for next three months
• Validate Quarter1 data
• Sign full contract documentation

9
Project 2 Placements

• Leadership
• Director Robin Andrews
• Project managers Sally Gooch, Sue Maynard and
  Team and Jeanette Hewitt
• External consultancy Care Home Select ,SHA and
  PwC
• Achievements to date
• Review of the most expensive placements yielded
  0.5m savings
• Clinical Review of most current placements (LD
  will take until Sept)
• Achievements planned for next three months
• VFM review of all placements
• Review of Section 31 Learning Disability agreement

10
Project 3 Partnerships

• Leadership
• Director - Hilary Pickles
• Project managers - Heema Shukla
• External consultancy PwC
• Achievements to date
• Review of Voluntary Sector Partnership agreements
  achieved a 10 savings 06/07
• Achievements planned for next three months
• Evaluation and rationalisation of Healthy
  Hillingdon and all agreements with voluntary
  sector 07/08

11
Project 4 Estates

• Leadership
• Director - Barbara Wood
• External consultancy Liftco, Legal Assistance
• Achievements to date
• Proposal submitted to Partnership Board to
  rationalise sites
• Northwood and Pinner Community Hospital,
• Westmead Clinic, Grange Park Clinic, Elers Road
  Clinic, Laurel Lodge Clinic, Yiewsley Health
  Centre, Windsor Street
• Achievements planned for next three months
• Development of the business case incl.
  discussions with stakeholders

12
Project 5a 24/7 Rapid Response Services

• Leadership
• Director - Siobhan Clarke
• Project managers - Joan Veysey
• External consultancy United Health Europe
• Achievements to date
• Service Design agreed and work plan agreed
• Soft launch of service 31 July
• Achievements planned for next three months
• Develop infrastructure for rapid response call
  centre
• Community services referral centre operational

13
Project 5b Case Management of HIUs

• Leadership
• Director - Siobhan Clarke
• Project managers - Joan Veysey
• External consultancy United Health Europe
• Achievements to date
• Service Design agreed and work plan agreed
• Case management started for first cohort patients
  31.7.06
• Achievements planned for next three months
• Training of case managers
• Personalised care plan in place for top 86
  patients

14
Project 6a Clinical Assessment Service

• Leadership
• Practice based Commissioning Board
• Director - Elizabeth Hayes
• Project managers - Esme Young/Sharon
  Willis/Alison Watson
• External consultancy Catchon
• Achievements to date
• Confirm and agree full list of requirements with
  GPs
• Achievements planned for next three month
• Initial roll out of Clinical Assessment Service
  by the autumn

15
Project 6b Management of Urgent Care

• Leadership
• Practice based Commissioning Board
• Director - Elizabeth Hayes
• Project managers - Esme Young/Sharon
  Willis/Alison Watson
• External consultancy Catchon
• Achievements to date
• Agreed full list of requirements with Practice
  based Commissioning Board
• Achievements planned for next three month
• Commence Primary care management of urgent care
  in AE

16
Project 7 New/Re-engineered Care Pathways

• Leadership
• Practice based Commissioning Board
• Director - Elizabeth Hayes
• Project managers - Esme Young/Sharon
  Willis/Alison Watson
• Achievements to date
• Benchmarking used to identify pathways for
  redesign
• AE audit finished and results shared with THH
• Achievements planned for next three months
• Pathways operational for Dermatology, Trauma,
  Musculoskeletal, Cardiology, Optometrist
• Agree new processes and protocols to reduce 0 day
  LoS at THH

17
Project 8 - Prescribing

• Leadership
• Director - Penny Thorpe
• Project managers - Penny Thorpe and PCT
  Prescribing Advisors
• External consultancy Duncan Petty
• Achievements to date
• External review of PCT prescribing finished
• Local Enhanced Service (LES) to incentivise
  reduction in prescribing expenditure agreed with
  GPs
• Achievements planned for next three months
• Introduction of LES

18
Project 9 New Budget Reports

• Leadership
• Director - David Wilson
• Project managers Malcolm London/Stuart
  Castle-Mason
• External consultancy PwC and Interims
• Achievements to date
• New reports designed for budget holders and Board
• Budget instruction pack drafted including draft
  budgets
• Finalisation of new budget reports
• Sign off 2006/07 budgets

19
Project 10 Data Validation

• Leadership
• Director - Robin Andrews
• Project managers Andy Noble
• External consultancy Sarah German (SHA) and
  Ralph Elias (SHA)
• Achievements to date
• New procedures documented and implemented
• Achievements planned for next three months
• Completion of review of Q1 data

20
Project 11 Shared Services

• Leadership
• Director Human Resources - Mel Smith
• Director Estates - Barbara Wood
• Director Family Health Service - Penny Thorpe
• Achievements to date
• Shared HR service set up with Harrow
• Achievements planned for next three months
• Possible expansion may include Finance, IT
  Estates FHS services

21
Project 12 Communications

• Leadership
• Director Ian Ayres
• Project managers - Margie Lindsay
• Achievements to date
• Main stakeholders briefed individually on the
  Recovery Plan
• Staff briefed through Team Briefers and
  Shaping the Future meetings
• Achievements planned for next three months
• Communication of plan to community stakeholders,
  patient and the public

22
Project 13 Project Office

• Leadership
• Director - Tim Morris
• External consultancy PwC
• Achievements to date
• Development of turnaround plan and milestones
• Project management arrangements in place
• Project Office
• Project Reporting
• Communications
• Achievements planned for next three months

23
Recovery Team (25 key members)

• PCT Staff 17)
• Directors (2)
• Siobhan Clarke, Hilary Pickles
• Senior Managers (16)
• Penny Thorpe, Esme Young, Kathleen Sadler, Andy
  Noble, Malcolm London, Joan Veysey, Jan Pearcey,
  Caroline Shermer, Lesley Johnson, Geoff Cross,
  Barbara Wood, Mel Smith, Sue Maynard, Heema
  Shukla, Stuart Castle-Mason, Margie Lindsay
• Interims (6)
• Directors (4)
• Tim Morris, David Wilson, Elizabeth Hayes, Robin
  Andrews
• Senior Managers (2)
• Sharon Willis, Jeanette Hewitt, Sally Gooch
• SHA staff (1)
• Senior Managers
• Alison Watson

24
Actions for the Autumn

• Recruit permanent directors and other staff to
  replace interims and consultancy - process has
  now started
• Deliver demand management initiatives
• GP led referral management and urgent care
• Refocused provider services
• Reduced short Length of stay (LOS) emergency
  admissions at Hillingdon Hospital
• Produce LDP and financial plan for 07/08 to
  achieve in-year balance