bolton locality plan - bolton community and · pdf filethe bolton locality plan sits ... can...

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

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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

footprint.

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)

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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

initiative).

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.)

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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.)

6

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