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  • Bolton Locality Plan

    High Level Implementation Plan

    Version 1

    1 April 2016

  • Contents

    Content Page

    1. Strategic Context 3 - 8

    2. Target outcomes for 2020 9 - 11

    3. Key priorities for delivery by April 2016 12 14

    4. Overview of workstreams and delivery 15 16

    5. Governance framework, including responsibilities for delivery 17

    6. Workstream and detailed activity plan 18 - 30

    7. Enablers of change 31 34

    8. Financial plan 35 36

    9. Timeline for implementation 37 39

    10. Communications and engagement schedule 40


  • 1. Strategic Context

    The Bolton Locality Plan sits within the context of the Greater Manchester Devolution Programme which is aimed at driving the biggest and

    fastest improvement to the overall health and wellbeing of the GM population by the end of 2020.

    For Bolton, this plan sits within the GM context, but focusses on the elements which will be delivered locally, by all partners working

    together to deliver significant transformation change. It makes reference to the elements which will be delivered through the North West

    Acute Sector programme (under Healthier Together) and to the work programmes which are being developed and delivered on a GM


    The Locality Plan sits under the Vision Strategy. The latter being the 20 year strategy for the whole system reform across Bolton, including

    the Economic Strategy and Health and Wellbeing Strategy. The enabling workstreams (of IT, Estates, Workforce, Innovation and

    Engagement/Communication) underpin all of the strategies, including the NW Sector and GM programmes.

    The diagram shown on page 17 illustrates the current Bolton Vision Governance Structure and priorities up to 2016/17 and where the

    Locality Plan currently sits. The strategy and governance arrangements are currently under review and will become Boltons Vision 2020

    and will focus on people and place and growth and reform. The Health and Wellbeing Strategy is also currently under review to ensure it

    is aligned to both the refreshed Vision Strategy and the Locality Plan.

    The Financial Position

    There is an identified gap of 162m across the whole health and care economy in Bolton by 2020. Individual organisation and joint plans for

    cost improvement (through efficiency and effectiveness programmes, focus on improving quality and outcomes and vertical and horizontal

    integration opportunities) can reduce this recurrent gap by 84m (to 78m). With the requested 20m for the protection of social care this

    gap would reduce to 58m. However, the residual gap will require the whole system to reform which will only be possible with transitional

    investment particularly in early intervention and prevention services as well as in the estate and IT infrastructure.

    Population Health Improvement Programmes

    To commission for services to effectively meet the needs of the population of Bolton, we have segmented the locality population (of

    300,000) into four tiers.

    The agreed strategy in the Locality Plan is to pump-prime the new delivery models which will enable the longer term shift in the proportion

    of funding from unplanned hospital admissions and long term care placements (reactive care in Tier 1 predominantly) to proactive and

    preventative care (Tier 2 for the neighbourhood working, Tier 3 for the medium term and specifically Tier 4 for the longer term)


  • 4

    1. Strategic context (cont.)

    Tier 1 (2%): multiple Long Term Conditions, frail elderly individual Multi-disciplinary care plans

    Tier 2 (10%): developing significant risks associated with Long Term Conditions or frailty - need early intervention and tertiary

    prevention to prevent/delay progress of condition and for over 65s: to stay well

    Tier 3 (20%): secondary prevention and early identification: targeted interventions for individuals and communities at risk

    Tier 4 - System-wide interventions to improve health and wellbeing and prevent future ill-health (primary prevention)

    The top tier comprises of 2% of the population (6,000 people) who have two or

    more long term conditions, are the high risk frail elderly or those at the end of

    their life. There has been significant investment already made into services to

    support the individuals within this Tier, including:

    Admissions Avoidance

    Redesigned Intermediate care services (home and bed based)

    Services to support the most vulnerable and complex dependency

    The second tier is the population that has started to become ill or frail, but

    currently not requiring significant health treatment and/or hospital admission

    (and therefore will not necessarily have a risk stratification score) but are

    eligible for social care services. These individuals need preventative

    interventions to stop them moving into the top tier within the next few years

    requiring higher levels of health and social care resources. This is estimated to

    be about 10% of the population (30,000 people).

    The third tier is population wide early identification and prevention with

    targeted interventions for individuals for those at risk of poor health and

    wellbeing (20% of the population: 60.000 people). This tier includes a large

    proportion of the population who are at risk of long term conditions, for example

    due to smoking or being physically inactive, or who may already have long

    term conditions, such as hypertension, but dont yet have social care needs,

    and may not be accessing health services beyond primary care. Future

    demand on health and social care services could be prevented or delayed

    through targeted prevention and early intervention with this population.

    Tiers 2 and 3 are where transformation of existing services together with

    additional funding is required to commission new and enhanced interventions to

    be delivered at individual or on a wider scale. A business case covering all

    elements of the transformation programmes is in development. At high level this

    includes the following:

    Secondary and tertiary prevention, focusing on the specific long term conditions

    (and their risk factors) which are most prevalent across the locality: heart

    disease, respiratory disease and diabetes - delivered through Integrated

    Teams wrapped around general practice (on a neighbourhood basis)

    including Health Improvement Practitioners, ANPs, district nurses, pharmacists,

    mental health practitioners and MSK practitioners. This will include signposting

    people to the right provision of support, including social prescribing with a

    focus on emotional wellbeing and physical activity, to enable individuals to

    develop their health skills and knowledge to build their capacity to manage their

    own health and wellbeing including stopping smoking, reducing alcohol harm,

    eating healthily and becoming physically active. This will include Increasing

    dementia diagnosis and improving care, preventing falls, providing GP

    care to the frail elderly and ensuring people aged over 65 retain their

    independence for as long as possible through physical and mental activity and

    reducing social isolation through participation in activities/groups within the

    community (to be delivered though expansion of the Staying Well programme

    based around GP Practices and full roll out of the Safe, Warm and Dry


    Population Health Improvement Programmes (cont.)

  • Putting in place new service delivery models (with investment 23.75m over 5 years) aimed at reducing demand on the system for those currently in

    Tiers 1 and 2 now will start to pay back within 1 year and has been calculated to deliver savings of 26.545 over 5 years).

    1. Strategic Context (cont.)


  • Key programmes of work targeted at the tier 3

    population include:

    Integrated Team model (also supporting Tier 2 as

    set out above), who will also focus on:

    Increasing uptake of screening, including cancer

    screening programmes, focusing on populations with

    low uptake rates

    Increasing uptake of vaccinations specifically flu

    and childhood immunisation

    Critical to the successful delivery of the new

    neighbourhood models of care is community

    development, capacity building and engagement.

    These are essential to improving the health of the

    population and reducing health inequalities. We will

    work with communities which face the poorest health

    outcomes, using asset based community

    development approaches to build resilience and

    empower communities to play an active role in

    improving their own health and wellbeing. This will

    include a focus on social prescribing, building on the

    strengths of the voluntary, community and social

    enterprise sector in engaging local communities,

    including hard to reach groups, and improving health

    and wellbeing. Additional investment could

    accelerate the development of these social

    prescribing and self-care programmes.

    1. Strategic Context (cont.)


  • The fourth tier is system-wide primary prevention to promote good health and wellbeing across the population. This includes population-wide

    strategies to promote good health and wellbeing and addressing the wider determinants of health. The Early Years New Delivery Model is key

    to this and is a key call on the GM Transformation fund for all localities.

    To secure a financia

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