Appendix Central Sussex Integrated Musculoskeletal (MSK ... · • Travel (reducing carbon footprint) • Procurement (Food- locally produced) • Waste (reduce, reuse and recycle)

Agenda Item No. 9b Appendix 1

Sustainability – MSK Service (Brighton & Hove, Crawley, Horsham & Mid Sussex CCGs only) Page 1 of 12 Contact: Kate Parkin, Associate Director Sussex Collaborative Delivery Team ([email protected])

Sustainability and Social Value Needs

Integrated Musculoskeletal (MSK) Service

Brighton and Hove CCG

Crawley CCG, Horsham and Mid Sussex CCG

August 2013 updated March 2014

Version Author Distribution Amendments Date 0.1 K Parkin Steering Group Creation of document 22/07/13 0.2 K Parkin Steering Group Incorporated Lisa Forward Comments 04/09/13 0.3 K Parkin Steering Group

and MSK programme Board

Incorporating new national strategy 10/03/14

mailto:[email protected]



Contents

1. Introduction ............................................................................................................................................... 3

2. Sustainability ............................................................................................................................................. 3

2.1 Commissioning for Sustainable Development: ................................................................................. 3

2.2 Social Value ........................................................................................................................................ 4

2.3 Legal Requirement ............................................................................................................................. 4

2.4 Environment ...................................................................................................................................... 5

2.5 The key areas which must be covered are: ....................................................................................... 5

2.6 A sustainable Development Strategy for the NHS, Public Health and Social Care System .............. 5

3. Sustainable model of care ......................................................................................................................... 5

3.1 Healthcare for the future .................................................................................................................. 6

3.2 MSK service........................................................................................................................................ 6

4. Sustainability Indicators ............................................................................................................................ 7

4.1 Good Corporate Citizenship .............................................................................................................. 8

4.2 Steps the tender would need to show compliance by ...................................................................... 8

4.3 MSK Assessment ................................................................................................................................ 8

5. Tender process .......................................................................................................................................... 9




1. Introduction The aim of the document is to identify what is the sustainability and social needs of the Musculoskeletal (MSK) population in Brighton and Hove, Crawley and Horsham and Mid Sussex through the procurement of an Integrated MSK service; how this procurement will address those needs and what will be expected from any tender. The Clinical Commissioning Groups (CCGs) have responsibility to manage the budgetary constraints in the public sector and the challenges of an ever increasing demand on health services fuelled by a less healthy, aging population with numerous co-morbidities. Increasing expectation around quality of clinical outcomes and experience whilst managing constrains on global resources and changing climate. The CCGs are expected to manage these challenges by being innovative with new approaches that encourage the seamless integration of services, managing demand by providing appropriate service in the community rather than incentivising secondary care activity. Things have to be different and delivered in a sustainable whole system which requires lateral thinking.

2. Sustainability “‘Sustainability’ can be defined as meeting the needs of today without compromising the needs of tomorrow.” NHS Sustainable Development Unit- Sustainable development for Clinical commissioning Groups The guiding principles for sustainable development are from Sustainable Development in Government: • Ensuring a strong, healthy and just society • Living within environmental limits • Achieving a sustainable economy • Promoting good governance • Using sound science responsibly 2.1 Commissioning for Sustainable Development:

• Saves Money • Saves resources • Benefits staff and patients (both short and long term) • Provides leadership for the community as NHS are large organisations • Legal duty to undertake 2008 Climate change Act.

The process can provide a sustainable organisation which through the right interactions with the people in the community balances the elements.




The Venn diagram of sustainable development at the confluence of three constituent parts GNU Free Documentation License from Wikipedia Sustainability; Adams, W.M. (2006). "The Future of Sustainability: Re-thinking Environment and Development in the Twenty-first Century." Report of the IUCN Renowned Thinkers Meeting, 29–31 January 2006. Retrieved on: 2009-02-16. 2.2 Social Value Social value describes the wider social benefits achieved from high quality public services. It aims to generate wider benefits from investment in health services. It promotes the wellbeing, health inclusion and employment of local people and communities. Adopting an approached based on social value principles requires a change to the traditional mind-set of the care system from one which sees communities and people having needs, to one which understands and empowers them as having assets that contribute to our health and wellbeing. Social value can also add specific environmental value e.g. community food gardens in care grounds improve mental wellbeing, nutrition and benefits the environment. The health and care system could aspire to add social value by:

• Considering social value as part of the delivery of everyday business, for example buying goods and services locally

• Creating an organisational culture that raises awareness of the importance and benefits for the community of adding social value.

• By being a really good employer, an organisation can directly invest in a significant number of people, families and organisations locally

• Realising and reinforcing social value and social capital that already exists in the community for example, via local sports team helping to communicate the message of active, participative and fulfilling health lives.

2.3 Legal Requirement The Public Services (Social Value) Act 2012 requires the procurement of the services to consider how the proposed procurement might improve the economic, social and environmental wellbeing of the relevant area. How in conducting the process of procurement, it might act with a view to securing that improvement.


http://cmsdata.iucn.org/downloads/iucn_future_of_sustanability.pdf

http://cmsdata.iucn.org/downloads/iucn_future_of_sustanability.pdf



2.4 Environment The NHS has pledged to reduce carbon emission in line with UK climate Change Act (2008). There are legal and policies which all organisations providing care to NHS patients must adhere to. The NHS Carbon Reduction strategy was developed in 2009. To date NHS1.9% reduction in building energy whilst coping with an 11.4% increase in activity. The aim is for individuals, groups and organisation across all health and care sectors to take responsibility for sustainable delivery. It includes patients, service users, community’s health and care partners in local authorities and 3rd Sector. 2.5 The key areas which must be covered are:

• Measuring the carbon footprint (Energy- total consumption) • Governance • Interventions • Building energy • Travel (reducing carbon footprint) • Procurement (Food- locally produced) • Waste (reduce, reuse and recycle) Use of pharmaceuticals – minimise waste • Commissioning (services – sustaining the local community

Align, integrate and embed approach to sustainability. Staff and leaders at all levels are empowered to behave sustainably at work. Structure/leadership and delivery meet sustainable objectives. Produce in-line with national requirements publishable and quantifiable performance reports on sustainability. 2.6 A sustainable Development Strategy for the NHS, Public Health and Social

Care System As the above title suggests an integrated system for sustainability has been developed and published in January 2014. It supports all of the areas already identified above. It will cover the whole integrated care model linking with social care and public health. There are three Goals that it aims to achieve: • A healthier environment, • Communities and services are ready and resilient for changing times and climate, • Every opportunity contributes to health lives, healthy communities and healthy environments.

3. Sustainable model of care Transformational change in how delivery services model of care enhance outcomes and improve suitability. Clinical led models of care need to consider:

• Impacts • Outcomes • New technology • Integrated experience for patients and service users




A sustainable model supports innovation and by involving the transformation of the entire model (financially, environmentally and social sustainably) it is more than just an efficient pathway. 3.1 Healthcare for the future

1. Supporting people in taking responsibility for their own health a. Behaviour

i. Society; engage and influence outcome, ii. Individuals – what they can do, act and make a difference.

2. Build greater acceptance of Information communication technology in health care provision.

a. Better use of technology. How the health and care systems interacts with patients, services users and community

b. Sustainable technology can save money, reduce pollution and improve the patients environment i.e. LED lighting

c. technical building solutions i.e. solar panels and energy management software

d. Telehealth and IT. I.e. Telephone, Web access, other telehealth options as they become available.

3. Low carbon/high quality of life sweet spot (balance). Service transformation/work in partnership with Local Authority etc.

a. Reduce waste b. Reduce carbon foot print

4. Promote Health rather than treat illness There is a requirement that Health and Care work together to deliver the changes. The Public Health Outcomes Framework 2013-16 requires the systems to focus on positive health outcomes for the population and reducing inequalities. The relevant Domains are Domain 1: Improving wider determinates of health; improvements against wider factors that affect health and wellbeing and health inequalities Domain 2: Health improvement; lifestyle, health choices and decrease healthy inequalities. Domain 4: Healthcare public health and preventing premature mortality; reducing gap between communities and preventable illness.

5. Leadership role in carbon reduction and climate resilience. Standards – agree responsibility, mechanisms, measures, incentives, legislations etc. System governance

3.2 MSK service • Provide access to the right care in the right place by the right person. • Establish standards for quality of care within an effective and integrated

service/network. • Intends to improve patient care and outcomes from MSK service through:

o Access Local integrated community services (Geographically spread Hubs

and spokes)




Wider and appropriate opening times (1 stop clinics where appropriate)

o Quality of Outcomes Integrated MDT (consultant delivered service) Clinical outcomes

o Equality: Standardisation Shared care plans Single overall provision Increase equality and reduction of inequalities.

o Experience: Shared Decision Making Supported Self-Management

The service pathway

• Maximises prevention, either as part of the service or another closely related service

• Reduces supply induced demand, by ensuring that need has been demonstrated • Uses best available evidence of effectiveness in deciding details of service design

and local population need.

The new national strategy supports the model and direction the MSK services are going as shown in the diagram below where many of the aims of the MSK shown in it.

4. Sustainability Indicators The new service will be required to show how they will deliver a sustainable service and the following are some indicative/possible indicator which will be monitored.




4.1 Good Corporate Citizenship The Good Corporate Citizenship is a NHS tool to help you think about how you and your organisation can contribute to a sustainable development. http://www.corporatecitizen.nhs.uk/

There are 5 principles which need to be taken account: 1. Living within environmental limits 2. Ensuring a strong, healthy and just society 3. Achieving a sustainable economy 4. Using Sound science responsibly 5. Promoting good governance

There is new ‘model of care’ section in Good Corporate Citizenship tool.

4.2 Steps the tender would need to show compliance by Nominate sustainable development champion Board level management plan with carbon management plan Raise awareness and change behaviour 4.3 MSK Assessment The following table shows indicative drivers and indicators where sustainability can be achieved in the Integrated MSK Service procurement. The table below is not exhaustive but illustrates some areas which the procurement commissioners and bidders need to take account of. Based on NHS Sustainable Development Unit Sustainability Indicators www.sdu.nhs.uk Aim: Improve Sustainability in the integrated MSK Service Procurement. Through:

• Care close to home • Right person, right place, first time • Manage own condition • Use of technology • Decrease emergency admissions

Primary Drivers Secondary Drivers Indicators

Governance

Sustainable Development Board level sign off of plans Management Plans Plans Good Corporate Citizen GCC Score Structure Benchmarking, performance reviews

Use of Resources

Carbon Reduction Monitoring Waste/Water Monitoring Procurement Assessment of Procurement

Decrease environmental impact Assessment P4CR Sustainable input on service reconfiguration

Models of Care

Effective Treatment Effective Treatment, Shared Decision Making Reduction in treatment, 1 stop clinics

Effective Delivery Decrease in wastage, Supported Self-Management

Prevention Prevention of falls, Healthy expectations, Exercise, weight management

Adaptation Facilities Adaptions of facilities to improve sustainability i.e. lighting, energy


http://www.corporatecitizen.nhs.uk/

http://www.sdu.nhs.uk/



Aim: Improve Sustainability in the integrated MSK Service Procurement. Through: • Care close to home • Right person, right place, first time • Manage own condition • Use of technology • Decrease emergency admissions

Primary Drivers Secondary Drivers Indicators management

Business culture

Use of technology for communications, bookings, letters, web information, translations. Use of technology for treatments, telephone clinics, assessments tools, innovation

Behaviour

Society Legislation compliance Health and Social care framework

Individuals Workplace encouraged to implement ideas i.e. work from home Job descriptions

5. Tender process Tender process supported by Policy and standards framework must ensure:

• Equal treatment • Non discrimination • Mutual recognition • Proportionally • Transparency

Sustainability is a requirement of the CCGs. There is an expectation that commissioners will require providers to demonstrate improvement in sustainability performance. Currently there is a national review and consultation of the Sustainable development strategy. This is expected to be published in January 2014. The expectations are that this strategy will be developmental from the current carbon reduction strategy and therefore the tender will need to strive to meet the intentions of the strategy.

Indicative direction from the consultation paper on sustainability.

The direction of the this orginal document and consultation paper have not significantly changed with the new Strategy which was published in January 2014.




5.1 The provider organisation must: • Have a board-approved sustainable development management plan • Signed up to the Good Corporate Citizenship Assessment Model • Have in place measure monitors and is trying to reduce carbon where possible in

the organisation • Organisation which is awareness of sustainability at every level of the

organisation/change of behaviour • Nominated Sustainable development champion

The following information is to aid tender




E.g. National P4CR

The Procurement decision will in part use the ‘The Procurement for Carbon Reduction’ P4CR) tool. See print out from the Sustainable Development unit website.




AreaLevel 1

Task 1.1.1

You might f ind it useful to insert comments against tasks or scores to make notes on your progress - go to INSERT, on the Excel tool bar at the top of the screen, and select COMMENT from the drop dow n menu.

The P4CR is supported by a Guidance document w hich consists of 25 tw o-page summaries that corespond to the boxes in the f lexible framew ork

The P4CR consists of a matrix of f ive Levels (Foundation, Embed, Practice, Enhance and Lead) and f ive Areas (Policy and Communications, People, Procurement Process, Engaging Suppliers and Measurement and Results).

Foundation

Business Case Developed

ExamplesLevels, Area & Key ComponentThe P4CR is broken dow n into f ive AreasFive levels are described under each Area

An example of an inserted comment can be seen by f loating your mouse over this cell. Note the red triangle in the top right hand corner indicates an inserted comment.

Cell colours automatically change to match the Key component Scores, as show n in the key on the index page, to enhance the visual impact and usefulness of the charts.

The Procuring for Carbon Reduction (P4CR) f lexible framew ork is designed to support procurers in the NHS and w ider health and social care sector to integrate carbon emissions into their procurement activities.

Procuring for Carbon Reduction - Flexible Framework Self-Assessment tool

How to use this spreadsheet

Overall Level scores are show n as percentage completed, and are plotted on the summary chart (sheet 3)

Scores should be entered for each Key component on a regular basis (e.g. monthly) to monitor progress. The scores for the Areas and Levels are calculations based on scores enetered against Key Component in RED text.

Using the key on the index page , each Key component can be rated to reflect progress based on a simple scoring mechanism using a scale from 0 (no action taken) to 3 (completion).

P4CR Progress - Self-AssessmentTo monitor the progress of P4CR implementation, you w ill need to enter a progress rating against each Key Component.

Policy and Communications

Under each Area a number of Key Components are described

Procuring for Carbon Reduction (P4CR) Flexible Framework - Self Assessment Tool


Documents

Appendix Central Sussex Integrated Musculoskeletal (MSK ... · • Travel (reducing carbon footprint) • Procurement (Food- locally produced) • Waste (reduce, reuse and recycle)