NHS Improvement Board27 April 2017

Greater Manchester devolution – progress, challenges and next steps

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Greater Manchester: a snapshot picture

Our Governance

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Strategic Partnership Executive

Quality Surveillance

Group

Finance Executive Group

Performance & Delivery Board

Transformation Portfolio Board

Transformation Fund Oversight

Group

Joint Commissioning

Board

Strategic Partnership Board

GM Reform Board

GMCA

Assurance & DeliveryDeveloping a full Assurance & Delivery Framework across:• Quality• Finance• Performance and Delivery• Strategic Plan Implementation• Transformation Fund

Management

Health Innovation Manchester

Board

Retained and strengthened to maintain a national networks of QSGs. Increased focus on co-ordinated approach to improvement, working in conjunction with Finance, and Performance and Delivery arms.

Connecting finance leadership; supporting transformation and day to day financial management; working with the Performance & Delivery Board to co-ordinate planning round activity; developing the principles of system control totals.

Providing oversight to Constitution & Mandate requirements; initiating and directing performance Taskforces to support recovery and improvement.Replaces the Operational Management Team.

Oversee and direct delivery of the Strategic plan; aligning activities across the themes; developing a clear programme management approach to implementation of the Plan.Replaces the Implementation Working Group.

Overseeing the pipeline of Fund Applications; ensuring proper process for Independent Evaluation

Implementing the Commissioning for Reform Strategy; discharging delegated joint commissioning arrangements. Commissioner only membership, but is supported by JCB Exec. Group which includes provider representation.

WorkforceBoard

IM&TBoard

EstatesBoard

Other thematic Boards

Accelerating the discovery, development and implementation of new treatments and approaches, with focus on improving health outcomes and generating economic growth. Includes GM Accelerating Innovation into Practice Group.

STANDARDISING

ACUTE

HOSPITAL CARE

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2 TRANSFORMING

COMMUNITY

BASED CARE &

SUPPORT

RADICAL

UPGRADE IN

POPULATION

HEALTH

PREVENTION

STANDARDISING

CLINICAL

SUPPORT AND

BACK OFFICE

SERVICES

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5ENABLING BETTER CARE

A comprehensive framework for transformation

underpins GM’s Strategic Plan

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Taking Charge – the first 5 years

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The bridge has now been updated to reflect changes to assumptions, and recut to show the transformation themes

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5Radical upgrade in population health

Transforming care in localities

Standardising acute hospital care

Standardising back office

Enablers

(1,786)

(1,162)

-

100

269

(664)

(817)

(305)(444)

(180)(88)

(239)

(207)

(140)(100)

736

21

(2,000)

(1,500)

(1,000)

(500)

-

500

This is the GM financial gap

Opportunities still return GM to financial balance, with significant contingency e.g. baseline expected to be updated further to reflect 15/16 actual outturn, additional pension pressures announced in 2016 budget, etc.

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The outcomes we seek cannot be delivered by health and social care alone

• Thinking about cumulative

impact rather than single

service planning

• Identifying and addressing

demand before it escalates

• Supporting individuals and

families collaboratively,

working across organisational

boundaries

• Reducing demand on

expensive, reactive servicesHousing

Fire & Rescue

Police

Health services

Local Government

Working in collaboration to support GM residents and improve outcomes

We’re Shifting the Balance of Spending, Focusing

Resources on Early Intervention and Prevention

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(1) Transformation Fund pipeline – full applications

Proposal

Locality

, Theme

or

Prog.

Funding

ask £m

(awarded

in bold)

Proposal Development Proposal Assessment and Award

Advisory

session

Proposal

development

Proposal

submission

Proposal

evaluation

Independent

Assurance

TFOG and

SPBE

Finalise IA and

metrics

Exec- Exec

session

Investment

Agreement

finalised

Funding

released

Integrated

CareSalford 18.2 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

ICO Stockport 15.9 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Care Together T&G 23.2 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Phase 1 - ICO Wigan 15.5 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Delivery of

Locality PlanBolton 28.8 ✓ ✓ ✓ ✓ ✓ ✓

Being

updated ✓

LCO & SCF Mcr 12.0 ✓ ✓ ✓ ✓ ✓ ✓Being

updated

SHS Mcr 56.3 ✓ ✓ ✓ ✓To start

w/c 3 April

TFOG 29

March

Dementia

UnitedTheme 2 2.29 n/a ✓ ✓ ✓

To start

w/c 3 April

TFOG 29

March

Healthier

TogetherTheme 3 TBD n/a ✓

Being re-

worked

Tranche 1

ProjectsTheme 1 TBD ✓

Being

developed

Locality Plan Rochdale TBD ✓Being

developed

Locality Plan Bury TBD ✓Being

developed

Locality Plan Oldham TBD ✓Being

developed

Population Health Transformation

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Making a difference

Creating dementia-friendly pharmacies

Ambitious new partnerships with Sport England, the GM VCSE sector & the

pharmaceutical industry

Transforming community based care and

support

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Increasing health and social care needs

Integrated Record & Care Plan for health & care

needs

Equally involved Carers & Family

Involved in decisions on care & support

Assets & strengths of people & communities

Mostly HealthyWell managed needs 2 or more health/complex

needs3 or more health/complex

needs

People & carers empowered to self care

Home

Tailored increase in resources for self-care, carer involvement & primary & social care e.g. longer appointments, same day access, social prescribing, 24/7 cover

Advice & support

GP

Care & support co-ordination Integrated team

pharmacy GP Practice Cluster/Group

Voluntary & Community Sector

Wider Public services (housing,

fire etc)

Diagnostics Community Pharmacy

Primary & social care care at

Scale999,111, OOH

Acute & urgent care

VCSESocial

worker

Pharmacist

Mental Health Physio

OT

Diagnostics

Existing services

Specialists Care Co-ordination

Case manageme

nt Clinical lead

Key Assumptions &

principles

Use of risk stratification &

population segmentation

Resources & approach

reflective of intensity of

support required

Better connections of existing teams

alongside development of

new roles

Connecting all who contribute

to health benefit

Behaviouralhealth

Intermediate Care

New/emergent

roles

Nurse practitioner Physician

associate

Extra Care Housing

Network enablers

• Cultural & people integration: Human to human, individual to team, team to team - local staff moving towards a single organisation• Financial Integration: Capitated budgets for a defined population with aligned incentives developed within longer term contracts• Systems and operational integration: shared IT & systems supported with robust governance arrangements

Recognisingorganisational

& cultural development

JCP

LCOs - core characteristics

Acute Strategy

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•Long term, sustainable savings and business case at SOC stage.

•£23.1 million of savings opportunity identified (12.8%

•Includes Finance, Payroll, HR, IM&T, Procurement, Governance & Risk, Communications.

Corporate Functions

•Strategic Case in final stages of production identifying circa. £20 million of recurrent savings, 14% of baseline cost.

•Discussions underway with NHSI Pathfinder Status secured.

•GM consideration of future direction of pathology

Pathology

•Emerging GM Radiology Strategy.

•GM Collaborative Image Sharing project at OBC stage, (centralised) Vendor Neutral Archive and Common PACS delivering significant improvements in service provision and benefits totaling £3 million per annum.

Radiology

•Reviewing store/distribution and procurement across the region

•Reviewing aseptic production

•Assessing out-patients dispensing and

•Reviewing homecare provision

•Developing an informatics strategy

Hospital Pharmacy

•Baseline and potential savings in final stages of calculation

•Strategic Outline Case in early stages of development

•GM procurement board established

•Collaborative savings projects ongoing across GM within appropriate Trusts.

Procurement

Standardising Clinical Support Services and

Corporate Functions – the Carter Review in GM

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Enabling Better Public Services

Making it Real

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Cancer Mental health

Disabilities

Listening to our communities

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The GM Commissioning Review is informing significant changes across our commissioning landscape as Single Commissioning Functions emerge in localities and tactical commissioning transfers to providers

Looking forward

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