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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