greater manchester health and social care … · 2020. 2. 20. · collective commitment against the...

GREATER MANCHESTER

HEALTH AND SOCIAL CARE PARTNERSHIP

Strategic Partnership Board

Date: Friday 28 July 2017

Time: 10.00am – 11.30am

Venue: The Council Chamber, Manchester Town Hall, Albert Square, Manchester, M2 5DB

AGENDA

1. WELCOME AND APOLOGIES

2. CHAIR’S ANNOUNCEMENT AND URGENT BUSINESS

3. MINUTES

To consider the approval of the minutes of the meeting held 30 June 2017

4. CHIEF OFFICER’S UPDATE

Report of Jon Rouse

5. TRANSFORMATION FUND UPDATE

Report of Steve Wilson

6. GM HEALTH AND SOCIAL CARE COMMISSIONING REVIEW

Report of Jay Bevington and Sara Segal (Deloitte), presented by Sarah Price

7. MENTAL HEALTH TRANSFORMATION – NEXT STEPS

Report of Dr Tom Tasker, Bev Humphrey and Warren Heppolette

8. GM TOBACCO STRATEGY

Report of Carolyn Wilkins and Sarah Price

9. THEME 1 – POPULATION HEALTH – GM MOVING

Report of Steve Pleasant

10. HOSPITAL DISCHARGE POLICIES

Report of Colin Kelsey and Cara Purcell

11. TRANSFORMATION THEME 3 – APROACH TO THE HOSPITAL BASED SERVICES STRATEGY

Report of Diane Whittingham

12. TRANSFORMATION THEME 3 – REVISED GOVERNANCE TO DELIVER THE STRATEGY FOR HOSPITAL BASED SERVICES

Report of Diane Whittingham

13. WORKFORCE STRATEGY AND IMPLEMENTATION PLAN

Report of Nicky O’Connor and Stephen Welfare

14. GMHSC PARTNERSHIP ANNUAL REPORT AND ACCOUNTS 2016/17

Report of Warren Heppolette and Steve Wilson

15. BUSINESS PLAN 2017/18

Report of Warren Heppolette and Steve Wilson

16. DATES OF FUTURE MEETINGS

To be confirmed

Strategic Partnership Board – 28 July 2017, Summary and Key Messages

1

Name of board report Summary of report Key messages

1. Welcome and Apologies N/A N/A

2. Chair’s Announcement and Urgent Business

N/A N/A

3. Minutes N/A N/A

4. Chief Officer’s Update N/A N/A

5. Transformation Fund Update Report of Steve Wilson

The report contains an update on recent developments with the Transformation Fund This month has an expanded section on the findings and recommendations from the assessment team in their evaluation of the proposals from Healthier Together and Oldham.

This report reports on wider updates within the Transformation Fund and contains in detail the findings of the Transformation Fund Oversight Group (TFOG) on 28 June 2017 and the decisions of the Strategic Partnership Board Executive on 12 July 2017, where the Healthier Together and Oldham submissions were considered.

Healthier Together is a clinically led Greater Manchester quality improvement programme. The scope of the wider programme stretches across primary care, integrated care and acute care. The acute element, for which transition funding is being sought, tackles variation in quality in GM A&E, Acute Medicine and General Surgery services.

Oldham’s proposal is a central part of their plans to increase the pace and scale of delivery of their Locality Plan which will close the forecasted financial gap of £70.8m by 2020/21 by supporting people to be more in control of their lives; having a health and social care system that is geared towards wellbeing and the prevention of ill health; providing access to health services at home and


2

Name of board report Summary of report Key messages

in the community; and by providing social care that works with health and voluntary services to support people to look after themselves and each other.

TFOG recommended a substantive investment of £17.2m over five years for Healthier Together, and a substantive investment of £21.3m over four years for Oldham. These funding recommendations were accompanied with material conditions for the funding. Funding for both schemes was approved by SPBE on 12 July 2017.

6. GM Health and Care Commissioning Review Introduced by Sarah Price, presented by Jay Bevington and Sara Segal (Deloitte)

Deloitte have undertaken a review of health and social care commissioning across Greater Manchester (GM) on behalf of the Partnership and engaging closely with all partners including CCGs, Local Authorities and Providers. The report sets out a range of approaches the Partnership could take in relation to the level at which services should be commissioned and set alongside the emergence of the new organisational landscapes across GM.

Deloitte were commissioned by the Greater Manchester Health and Social Care Partnership to undertake a review of health and social care commissioning across Greater Manchester (GM), building on the work of Commissioning for Reform publication. The scope includes:

1. Designing a truly place-based approach to public service reform, with investment led commissioning at its heart.

2. Defining the support provided by the services commissioned at the GM spatial level; and

3. Designing a framework for responsive and effective commissioning support services in the context of the new commissioning landscape


3

7. Mental Health Transformation – Next Steps Report of Warren Heppolette

The paper outlines the approach to ensure the full implementation of the GM Mental Health Strategy. It recognises progress against the objectives of the strategy to date and the significant work still to take place. The paper outlines a broad investment framework for the implementation of the strategy. This framework blends locality level resources as part of GM’s collective commitment against the Mental Health Investment Standard and a financial envelope proposed to be secured from the Transformation Fund.

The paper recognises the challenges facing mental health service access currently for GM residents and outlines our key performance deficits. It also considers the implications for commissioning mental health following the GM Commissioning Review and the opportunity of the new care models developing in localities and across GM.

This represents a historic statement of intent, backed by investment, to radically improve the mental health and wellbeing of GM residents.

Our aims are that:

We will better connect public services, communities and individuals to improve mental wellbeing and life chances.

We will secure key gains in access to a good range of mental health services.

We will eliminate the current fragmentation of services and improve the experience of service users through the system.

We will use our Partnership to agree the standards which underpin the quality of care provision and have agreed measurable and defined outcomes.

We will seek to improve public attitudes and behaviour towards people with mental health problems and reduce the amount of stigma and discrimination that people with mental health problems report in their personal relationships, their social lives, at work and also in their treatment within the services.

There has been no part of the GM system from health and care commissioners, NHS providers, service users and carers, VCSE partners and wider public services which has not been involved in the production of the strategy, the work to date and the development of the proposed next steps.


4

8. GM Tobacco Strategy Report of Sarah Price

The Tobacco Free Greater Manchester Strategy sets out our ambition to reduce smoking in our population by one third by 2021. This will result in 115,000 fewer smokers, supporting a tobacco free generation and ultimately helping to make smoking history.

Ambitions within the strategy take account of targets within the newly published Towards a smoke-free generation: tobacco control plan for England. This will allow us to close the gap with smoking prevalence in England, reducing inequalities and saving thousands of lives and millions of pounds.

We are learning from best practice in tobacco control locally in Greater Manchester, the UK and globally to bring the very best evidence and innovation to our delivery. Stakeholder engagement will continue through to September, with plans to launch a public conversation to engage communities later in the summer.

Localities will continue to deliver local tobacco control and local stop smoking support which is reducing smoking prevalence year on year. The aim of the tobacco control strategy is to significantly accelerate the current rate of decline. Implementation planning is underway involving a wide range of existing stakeholder groups and forums and specific task groups with governance provided through the GM Population Health Programme Board. The VCSE sector is a key partner due to their reach into the communities and priority groups outlined in the strategy. Empowering individuals, families and communities to make smoking history together across our conurbations in Greater Manchester can break an intergenerational cycle of smoking in our poorest communities.

Detailed delivery planning will run through to September. A range of initiatives is planned for implementation from September 2017. For example, this will include new and better help for smokers who want to quit through a GM wide digital support offer. Piloting and evaluation of an initiative with social housing providers and their tenants is also planned for Stoptober.

A business case for transformation funding


5

alongside external funding cases will be part of the population health strategic investment case which will be reviewed in September. An evaluation and performance monitoring framework is in development for the strategy with PHE and CRUK with outcome metrics/ interim milestones - both locality and GM.

9. GM Moving Report of Steve Pleasant

To share the final version of the Greater Manchester Moving Plan (2017-21), before a shared launch event with GMCA, Sport England, wider stakeholders and the public.

‘Greater Manchester Moving: The Plan for Physical Activity and Sport’ 2017-21 (appended to this paper) is the comprehensive plan to reduce inactivity and increase engagement in physical activity and sport. It is aligned to the Greater Manchester Population Health Plan priority themes and the wider reform agenda.

A refresh of GM Moving has been taking place since April 2017, in the context of the Sport England/GMCA/NHS MOU, The Population Health Plan, GM Mayoral Manifesto and a range of other recent developments, bringing them into one place with the following ambition:

Everyone in Greater Manchester more active, to secure the fastest and greatest

improvement to the health, wealth and wellbeing of the 2.8 million people of Greater

Manchester.

An ambitious target to double the rate of past improvements, reaching the target of 75% of people active, or fairly active by 2025. GM Moving 2017-21 and the implementation plan outlines the journey we need to go on, to realise that ambition.

Greater Manchester Moving 2017-21 has been


6

developed following an extensive engagement process with cross sector partners across Greater Manchester and in localities. Its development has been supported by the GM Moving Leadership group and other key system leaders.

The final draft document has been signed off by the MOU Programme Board and GMHSC Executive.

The Plan is also being approved by GMCA at their 28 July meeting, prior to a joint launch event following both meetings.

GM Moving outlines a whole system approach to tackling inactivity and increasing active lives across the city-region. It presents an approach to transformational change, with people at the heart, led by insight, to support positive behaviour change. It starts by celebrating progress to date, whilst acknowledging the challenge that lies ahead.

The Plan outlines twelve priority areas, with priority actions identified to begin this work, at scale and with pace.

A full detailed implementation plan is being developed, including leadership and investment considerations. This is a working document, which will enable implementation to begin at the end of July.

Outline governance arrangements for GM Moving have also been developed to refresh the current Programme Board/Steering Group/Leadership Group arrangements. These will be published online, once agreed.


7

10. Hospital Discharge Policies Report of Colin Kelsey and Cara Purcell

This paper introduces three standards which have been produced in partnership with stakeholders from the wider health and social care community which are designed to reduce the number of patients who wait in hospital unnecessarily and to improve patient flow, improving patient experience and maximising the optimal use of health and social care resources. These are Discharge to Assess, Trusted Assessment and Patient Choice.

In the previously agreed UEC Reform paper we agreed to establish GM Standards that would reduce variation and enhance the ability of the Partnership to deliver effective and timely care to our population. This paper introduces the first of the three standards for urgent and emergency care which respond to variation in the discharge process and the national drive to reduce delayed transferred of care through the implementation of best practice.

These documents have been developed using research in local and national best practice and through discussion with stakeholders from Providers, CCGs, Local Authority and Continuing Health Care (CHC).

It is anticipated that the Standards will be formally launched in July 2017 with plans to be agreed by partners through the locality Urgent and Emergency Care Delivery Boards by September 2017.

A number of performance indicators have been defined in order to monitor progress and success of the standards and collection is planned to commence by Greater Manchester Health and Social Care Partnership in September 2017.

11. Transformation Theme 3 – Approach to the Hospital Based Services Strategy Report of Diane Whittingham

This paper is an update and follow up to the paper presented to the Strategic Partnership Board on 28 October 2016, and sets out the proposed approach to developing a GM strategy for hospital based services under Theme 3, Standardising Acute and Specialised Care.

This paper describes an approach and framework for developing a strategy for hospital based services, and describes how this will be achieved such that all the work under Theme 3 is brought together and delivers under a single process.

The development of this paper marks the start of working and engaging differently with our


8

This paper is the first step in a series of papers which will build the strategy for hospital based services. This paper is complementary to and should be read in conjunction with the governance paper (Theme 3 – Revised Governance to deliver the Theme 3 Strategy for Hospital Based Services), which outlines what governance arrangements are needed to support the strategy work and the inputs to it.

stakeholders across the GM Health and Social Care system. We have widely shared our thinking within the health and social care system as the basis for discussion and feedback in preparing this paper.

This paper has been discussed and supported by the Strategic Partnership Board Executive on the 12th April 2017 and the Joint Commissioning Board on the 18th April 2017.

12. Transformation Theme 3 – Revised Governance to deliver the Strategy for Hospital Based Services Report of Diane Whittingham

This paper is the second step in a series of papers which will build the strategy for hospital based services. This paper is complementary to and should be read in conjunction with the strategy approach paper (Transformation Theme 3 – A Strategy for Hospital Based Services), which sets out the proposed approach to developing a GM strategy for hospital based services under Theme 3, Standardising Acute and Specialised Care.

This paper details the results of a review of the Theme 3 governance required to support the delivery of the strategy. In doing so it also describes the integrated governance of Theme 3 with the reconfiguration of A&E, Acute Medicine, and General Surgery (Healthier Together).

Following communication to all key stakeholder groups about the strategy approach paper, system stakeholders have been engaged about how the governance and decision making needs to change to deliver the strategy. A series of governance working groups as well as 1:1 engagement and further feedback have informed the development of this paper.

The paper details the results of this review, and makes proposals for governance changes to support the delivery of the strategy. This includes a proposed revised governance structure and suggests roles and responsibilities of key groups, both within Theme 3 governance, and wider Partnership governance. A summary of proposals is provided in the Executive Summary (p4).

This paper has been discussed and supported by the Strategic Partnership Board Executive on the 12th May 2017.


9

13. Workforce Strategy and Implementation Plan Report of Nicky O’Connor

The report presents the Greater Manchester Health & Social Care (GM HSC) workforce strategy and outlines the implementation plan for 2017/18.

The Strategic Partnership Board Executive, Strategic Workforce Board and wider groups have been consulted on the workforce strategy and implementation plan. Four strategic workforce priorities and eleven related action areas have been identified within the 2017/18 implementation plan. The current and projected future workforce is outlined, informed by 3 scenarios or ranges across GM and for each locality. Key feedback points from the May SPBE have been addressed in the Strategy and are summarised in section 3 of this paper. Overall feedback is also summarised in the main strategy documentation, slides 18 and 19.

14. GMHSC Partnership Annual Report and Accounts Report of Warren Heppolette and Steve Wilson

The Annual Report 2016/17 describes the work of the GM Partnership. The SPB is asked to endorse the enclosed report.

The Annual Report describes the Partnership’s work in 2016/17 – the first year of its operation.

15. Business Plan 2017/18 Report of Warren Heppolette and Steve Wilson

This report is the final version of the GM HSCP Business Plan for 2017/18 for consideration and endorsement by the Strategic Partnership Board.

It has been developed in conjunction with key leads and stakeholders from across the GM Health and Social Care Partnership and has been subject to extensive review and comment by the key GM leadership groups during May.

It outlines the key strategic activities that will take place during 2017/18, as Greater Manchester moves into the second year of operation of the GM HSC Partnership and the

The GMHSC Partnership Business plan has been compiled using detail provided from across the Partnership and key programmes at a GM and locality level, which have been considered through the Partnership governance.

It has been reviewed by a range of stakeholders and all of the key GM leadership groups during May and has been amended as a result of those discussions. Therefore the final version is presented to the Strategic Partnership Board for consideration and approval.

The Plan outlines the key strategic activities that will take place during 2017/18, as Greater


10

implementation of Taking Charge.

It is presented to the Strategic Partnership Board for consideration and approval prior to publication.

Manchester moves into the implementation of Taking Charge.

The 10 GM localities have also been asked to complete a template, which provides specific detail relating to implementation within each locality. These form the appendix of the Business Plan.

16. Dates of Future Meetings N/A N/A

1

3

GM HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD

MINUTES OF THE MEETING HELD ON 30 June 2017 Bridgewater Community Healthcare NHS Dorothy Whitaker Trust Colin Scales Bolton CCG Wirin Bhatiani Bolton Council Councillor Cliff Morris Sue Johnson Bury CCG Stuart North Bury Council Councillor Rishi Shori Pat Jones-Greenhalgh Central Manchester FT Kathy Cowell Christie NHS FT Christine Outram GMCA Eamonn Boylan Julie Connor Andrew Lightfoot Liz Treacy Adam Allen Paul Harris Emma Stonier GM CCGs Rob Bellingham

Chris Duffy GM H&SC Partnership Team Jon Rouse

Warren Heppolette Nicky O’Connor

Claire Norman Steve Wilson Stephen Dobson Laura Browse GM Mayor Andy Burnham GM Deputy Mayor Police & Crime Beverley Hughes Healthwatch Jack Firth

2

Manchester CC Councillor Richard Leese Geoff Little North West Ambulance Service NHS Trust Salman Desai Oldham Council Councillor Jean Stretton Carolyn Wilkins Oldham CCG Majid Hussain Pennine Acute NHS Trust Jim Potter Primary Care Advisory Group (Dental) Mohsan Ahmad Primary Care Advisory Group (GP) Tracey Vell Primary Care Advisory Group (Optometry) Dharmesh Patel Primary Care Advisory Group (Pharmacy) Adam Irvine Royal College General Practitioners (RCGP) Martin Marshall Simon Ashmore Rebecca Hughes Jayne Dewhurst Alison Lea Bikesh Dangol Rochdale BC Councillor Allan Brett Steve Rumbelow Salford CC Mayor Paul Dennett Ben Dolan Salford CCG Tom Tasker Salford Royal NHS FT Jim Potter Stockport MBC Councillor Wendy Wild Laureen Donnan Tameside and Glossop CCG David Swift Tameside MBC Councillor John Taylor Councillor Brenda Warrington Steven Pleasant Tameside NHS Foundation Trust Karen James

3

Trafford Council Councillor Sean Anstee Theresa Grant

UHSM Barry Clare Jane McCall Wigan CCG Tim Dalton Wigan Council Councillor Peter Smith (in the Chair) Alison McKenzie Folan Wigan, Wrightington & Leigh NHS FT Carole Hudson Neil Turner SPB 56/17 WELCOME AND APOLOGIES Apologies were received from; Trish Anderson, Margaret Asquith, Helen Bellairs, Derek Cartwright, Katy Calvin-Thomas, Matt Colledge, Steve Dixon, Alan Dow, Cllr Richard Farnell, Cllr Alex Ganotis, Denis Gizzi, Donna Hall, Anthony Hassall, Harry Holden, Su Long, Michael McCourt, Cllr Kieran Quinn, Joanne Roney, Roger Spencer, Jim Taylor, Cllr Linda Thomas, Alex Whinnom and Ian Wilkinson. SPB 57/17 CHAIR’S ANNOUNCEMENTS AND URGENT BUSINESS The Chair notified Board Members that he will remain the Lead Portfolio Member for health and Social Care and will be continuing in his role as Chair of the Board. SPB 58/17 MINUTES OF THE MEETING HELD 28 APRIL 2017 The minutes of the meeting held on 28 April 2017 were submitted for consideration. It was noted that in Item 49/17, paragraph 6, page 5 the following sentence should read; ‘Colleagues from CCGs acknowledged and have recognised the requirement for 136 provision in the city and are committed to providing this’. RESOLVED/- To approve the minutes of the meeting held on 28 April 2017 as a correct record subject to the amends being made to Item 49/17, paragraph 6, page 5.

SPB 59/17 CHIEF OFFICER’S UPDATE

Jon Rouse, Chief Officer, Greater Manchester Health and Social Care Partnership, provided an update on key items of interest both within the Partnership and partner organisations. Sincere condolences were extended to all victims of the terror attack at the Manchester Arena. Gratitude to the response of staff across the health and social care system, and to public and voluntary sector partners, from first response, through to treatment and aftercare was expressed. A full debrief, lessons learned and updated plans and protocols will be undertaken. A Health and Welfare Group that reports to the Recovery Co-ordination Group

4

has been created to provide post discharge support to those injured in the incident. GM Health and Social Care Partnership will play a full role on the group and various specialist sub boards. Mental Health support plans are being implemented which will have multiple phases. A coordinated screening programme will take place to ensure support is offered to those most vulnerable, and the offer of support will be available to anyone who needs it. The following items were also highlighted;

The achievements of the Health and Care sector in the context of an extremely difficult month following the Manchester Arena attack, which included; the launch of a Bio-Medical Research Centre, launch of Gateway C and the arrival of the Cyclotron machine for proton beam therapy at the Christie; and;

The first meeting of the Children’s Health and Wellbeing Board had taken place. Ways to engage with children and young people were being considered and expressions of interest were currently being received from organisations to coordinate this approach. A ‘deep dive’ was carried out into how to prevent avoidable hospital admissions for children with common conditions and a task and finish group has been established to drive work streams forward.

RESOLVED/-

1. To note the content of the report. SPB 60/17 TRANSFORMATION THEME 2 – GENERAL PRACTICE SUPPORT AND

RESILIENCE APPENDIX – MEMORANDUM OF UNDERSTANDING BETWEEN THE

GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP AND THE ROYAL COLLEGE OF GENERAL PRACTITIONERS

Dr. Tracey Vell, Associate (Clinical) Lead Primary Care, GM Health and Social Care Partnership, presented a report which provided an overview of the GP Excellence model which will be implemented across Greater Manchester. The report also highlighted progress made to date and identified the next steps.

The Memorandum of Understanding (MOU) between the Royal College of General Practitioners (RCGP) and the Partnership is the first time in the country this has happened and will bring a wealth of experience into the GM health system.

Dr. Tracey Vell introduced Professor Martin Marshall, Vice Chair at the Royal College of General Practitioners. Professor Marshall highlighted the unique opportunity the MOU presented to bring together the RCGP and the Greater Manchester Health and Social Care Partnership. GPs were noted as essential to the success of the NHS, and in a time of increasing demand on services the MOU will support the development of this sector within Greater Manchester, providing development of trust, educational tools, identification of future leaders and innovation.

Members expressed their full support for the work programme and the signing of the Memorandum of Understanding (MOU); in particular the proactive approach was welcomed as being especially relevant for GPs and the partnership.

5

RESOLVED/-

1. To support the signing of the MOU between the RCGP and GM Health and Social Care partnership; and

2. To support the implementation of the GP Excellence Programme within the localities of GM.

SPB 61/17 TRANSFORMATION THEME 2 – LOCAL PROFESSIONAL NETWORK

TRANSFORMATION PLANS FOR PHARMACY, DENTAL AND EYE HEALTH Dr.Tracey Vell, introduced a report which presented the Greater Manchester Local Professional Networks (LPN) transformation plans for Dental, Eye Health and Pharmacy; each of the plans are aligned to the GM Strategic plan and include the contribution of the wider primary care professional groups to the GM Strategic Plan ambitions. Mohsan Ahmed, Primary Care Advisory Group (Dental) provided an overview of the Dental Local Professional Network. In GM almost £200m per year is spent on the treatment of the largely preventable diseases of decay and periodontal disease; oral health was also described as being a barometer of other health measures. It was highlighted that in GM 40% of young children are affected by decay by the time they are school age and over a fifth of adults have dental decay, urgent dental conditions and/or infection. The challenges facing GM were outlined, including the need to engage communities to value good oral health. Dental practitioners will visit early year’s settings and nurseries to identify high risk children and to provide advice and care at the earliest stage possible. Work will take place with primary care colleagues and other stakeholders to ensure that dental services are not considered in isolation but integrated with the wider primary care offer. Dharmesh Patel, Primary Care Advisory Group (Optometry) provided an overview of the approach to transforming the eye health of the population of GM. Eyes and ophthalmology were highlighted as being the second highest cause of attendance at hospital in GM, and with an ageing population at greater risk of eye health problems demand has continued to rise. GM is leading nationally on the transformation of eye health and the GM approach is aligned to the transformation themes in Taking Charge; some of the work outlined was; preventing visual loss by encouraging attendance at regular eye examinations, recognising the role primary care optometry has in the delivery of standardised community based care, collaborative working across acute hospitals to standardise ophthalmology services and providing support for those with unavoidable vision loss by developing a GM sight loss strategy. Adam Irvine, Primary Care Advisory Group (Pharmacy), provided an overview of the work the Pharmacy Local Professional Network was undertaking, to ensure that the contribution of pharmacy teams were maximised in the improvement of medicines outcomes and reductions in inequalities across the system. In GM over £900m is spent on medicines per year within across primary and secondary/tertiary care and ensuring the use of medicines is optimised across the health system is crucial. Some of the work underway highlighted was; improving patient safety through sharing and implementing learning from controlled drug incidents, reducing variation in service specifications across GM and the pharmacy workforce working

6

together to ensure the best use of skill mix within teams with the relevant skills put in place to deliver future services for patients and the public. Members welcomed the report and the work underway to transform primary care services. The importance of reducing medicines wastage was highlighted as being a key component of this. The Bolton Campaigns’ effect on reducing prescribing costs was re-iterated and the role pharmacy colleagues had in contributing to this was noted as being extremely important. The Board were informed that a priority within the new medicines strategy was to reduce medicines wastage and optimise their usage throughout the healthcare system. Members also noted the use of social prescribing and that alternatives to the prescribing of medicines should be considered. RESOLVED/-

1. To support the Local Professional Networks Programmes of transformation; and 2. To support the requirement for localities to demonstrate how they will embed these

initiatives into the emerging models of care to the benefit of patients. SPB 62/17 END OF YEAR FINANCIAL POSITION 16/17 Steve Wilson, Executive Lead: Finance and Investment, Greater Manchester Health and Social Care Partnership, introduced a report which provided an analysis of the financial performance of the Partnership for the year 2016/17. The Board were informed that Greater Manchester had delivered a strong financial performance in 2016/17 despite significant challenges for the NHS and local government nationally and locally. Overall GM health and social care budgets have delivered a surplus of £237m, which was £157m more than planned; this has been achieved through strong financial performance in all sectors, and has enabled the Partnership to deliver the transformation and improvements to patient care. The NHS Provider position has been boosted by additional, national, non-recurrent sustainability and transformation funding including £60m provided as a reward for individual trust performance. CCGs financial positions have benefited from the release of a risk reserve of £42m. The additional surplus funding will remain in Greater Manchester and will be available for organisations to invest in capital and other programmes in the coming years. The Board were informed that the 2017/18 financial year would remain a challenge and that it was crucial that the level of financial control and management was maintained. Monthly updates regarding financial performance will continue to be provided and the Board will be notified of any identified risks. Members asked whether analysis of outcomes and performance relating to the Transformation Funding organisations had been awarded would be coming to the Board at any stage. The Board were notified that an update on current positions, which will include reflections on the move from the award stage to the monitoring stage, would be provided at the next Strategic Partnership Board meeting. RESOLVED/-

7

1. To note the 16/17 outturn position which shows that GM delivered a total surplus of

£237m representing an additional surplus of £157m above the planned surplus of

£80m;

2. To note that the additional surplus of £157m includes a combination of (i) the release of

1% reserve held by CCGs (£42m) to ‘bottom line’, (ii) additional income received by

Acute Providers via STF (£60m) and (iii) improvement in performance (£55m); and

3. To note that this demonstrates strong financial management and partnership working despite the significant challenges faced across GM and that this has been well received colleagues at NHSE.

SPB 63/17 IM&T STRATEGY AND ARCHITECTURE Nicky O’Connor, Chief Operating Officer, GM Health and Social Care Partnership introduced a report which updated the Board on the development of the implementation phase of the GM IM&T Strategy. The next step priorities for action were identified and the key enabler role IM&T has to play in transformation of the health and social care system was highlighted. Stephen Dobson, Chief Digital Officer, GM IM&T Program, GM Health and Social Care Partnership provided the Board with a presentation. The key items highlighted were;

The GM IM&T Framework developed which will be used to help guide localities through applications to the Digital Fund;

Encouraging GM prioritised and implemented projects which directly or indirectly supported localities and where GM implementation makes sense, for example encourages consolidation or fills gaps between organisations;

Creating a GM cloud environment/platform to prevent fragmentation of cloud solutions;

Using the Framework to get the most out of programmes taking place within GM, for example the Trafford Care Contact Centre and Bolton Foundation Trust, by sharing knowledge, experience and innovation;

Process of prioritisation in place to identify programmes to work on; currently there are 40 being worked on across Greater Manchester, including GM Business Intelligence Hub- Population Health, GM patient Wi-Fi, GM staff Wi-Fi and GM Electronic Document Sharing within and across localities;

The governance arrangements; the GM Digital Collaborative Board will feed into the GM Transformation Portfolio Board; and

A mapping of assets will take place across GM health and social care organisations to ensure the current position is understood and identify what systems could migrate to a shared GM cloud.

Members welcomed the strategy and implementation plan and engagement with the programme. The Partnership were asked to consider the numerous points of contact and entry into the Primary Care system when planning programmes. The Board were also informed that a joint letter between GPs, Providers, CCGs and the GMCA had been sent to the Secretary of State for Health regarding the release of resources for the IM&T programme transformation.

RESOLVED/-

1. To note the presentation; 2. To note the progress to develop the function of the Digital Collaborative;

8

3. To approve the approach and prioritisation and implementation; and 4. To support the resulting programme of work.

SPB 64/17 TRANSFORMING CARE FOR PEOPLE WITH LEARNING DISABILITIES

AND/OR AUTISM UPDATE Warren Heppolette, Executive Lead, Strategy and System Leadership, Greater Manchester Health and Social Care Partnership presented a report which provided an update on the progress to date to deliver the Transforming Care programme. The Board were informed of the following;

Long term hospital stays have been reduced, with more opportunities for people to be supported within their communities;

Learning Disability teams are being provided with further training to ensure they have the right skills to support clients in challenging circumstances; this included the roll out of Positive Behaviour Support (PBS) training to key community teams and providers in Greater Manchester;

New services for people with learning disabilities and/or autism including a specialist support service and crisis beds are in development in line with the national service model; and

That activity and finance modelling were underway to ensure the impact of Transforming Care and the new community model across Greater Manchester, was fully understood. The Board will receive a further report for discussion on the finance model in September.

RESOLVED/-

1. To note the content of this update report; and 2. To receive a further report for discussion on the finance model in September.

SPB 65/17 HEALTH AND EMPLOYMENT Cllr Sean Anstee, GMCA Portfolio Lead Skills and Employment, introduced a report which set out a joint proposal across the GM Health and Social Care Partnership and the GMCA to develop a whole population approach to work and health. Cllr Anstee informed the Board that he was pleased to be continuing as the Portfolio Lead for Skills and Employment. Devolution has given GM opportunities to transform the support of the GM population and build on the ambitions set out in the Skills Strategy and the GM Population Health Plan, and to integrate the approaches to work and health. The Working Well programme has had positive outcomes with regards to supporting people with health conditions who have been out of work for some time to move towards employment; the aim is now to focus on the following areas;

Continuation of the Working Well (work & health) programme;

Building an early help offer to support workers to retain employment when suffering from poor health or disability;

9

Creating healthy GM workplaces which support workers to thrive, reduce sickness absence and increase productivity; and

Creating pathways to employment for those with more complex or enduring health conditions.

It is intended to align the four areas of focus with a number of strategic initiatives which included; Employer Engagement and Public Service Leadership, with a GM Employment Charter supporting the development of this theme, and Apprenticeships. The Early Help Model was highlighted as being an innovative approach, supporting those in work and at risk of being unemployed or newly unemployed. It is also intended to assist Small, Medium Enterprises (SMEs) to support employees and to get people into higher paid, sustained employment. Members endorsed the integration of support which incorporated work and health, highlighting that it helped provide focus to the effect of work on health. Members also highlighted that it was positive to see reference to employment in the over 50s, which could help capitalise on work already undertaken in Greater Manchester through the Centre for Aging Better. A Member also noted the importance of making sure that this programme of work aligned with the GM Strategy. RESOLVED/-

1. To note that the GM Working Well brand is expanding to encompass a whole population approach to work and health;

2. To agree the priorities proposed for the development of a GM Working Well (Early Help) programme;

3. To support the proposal for four key areas of focus for the working age population; 4. To agree the proposed stages of delivery; and 5. To note and support the progress to date on Working Well (Work & Health

Programme). SPB 66/17 PROPOSED EVALUATION FRAMEWORK FOR THE GMHSC

PARTNERSHIP AND THE IMPLEMENTATION OF TAKING CHARGE Warren Heppolette presented a report which described the proposed evaluation of the GM Strategic Plan and the latest position on putting this into place. A timetable of engagement with the localities and strategic themes had been produced following discussion at the Strategic Partnership Board Executive. Evaluation at three levels has been agreed;

Locality evaluation to evaluate the transformation programmes of the ten localities, ensuring a consistent approach to allow the same key features of each transformational change to be analysed;

Evaluation of the GM Strategic plan including at a programme and project level within the five programme themes and looking at qualitative and quantitative evaluation; and

Evaluation of GM Devolution; this work will be carried out by the University of Manchester and as funded by the Health Foundation and the National Institute for Health Research.

10

The Board were informed that a GM Evaluation Working Group has been established under the Transformation Portfolio Board. This will compose the detail of the evaluation to allow all findings to be aggregated and will secure an independent/academic partner to pursue the longitudinal study. RESOLVED\-

1. To note the report. SPB 67/17 ROCHDALE PRESENTATION Dr. Alan Dow, Chair, Heywood, Middleton and Rochdale CCG, introduced a presentation which gave the Board an overview of work taking place in Rochdale to improve outcomes for people and the health and social care system. The presentation highlighted;

Commissioners and providers working together to make a difference;

The ambitions of transforming care were; improving independence and outcomes for people, to manage the whole system capacity better, to avoid unnecessary hospital care and to achieve whole system ownership of the system;

Changing the conversation with people from ‘What’s the matter with you?’ to ‘What matters to you?’, for example keeping people informed, listening to what’s important and helping people to make own decisions;

Some of the early outcomes of the programme were a 6.7% reduction in non-elective admissions to hospital, delayed transfers of care in the lowest quartile in GM and had moved to the 7th best nationally and reductions in A&E attendances;

New developments including the Discharge 2 Assess (D2A) Pilot which has 3 simple pathways out of hospital with 80% of supported discharges taking place through D2A and assessments taking place at home or in a community setting;

The outcomes for people included people spending less time in hospital, increased service user satisfaction rates and fewer people in residential care; and

The next steps, which included plans to extend the Intermediate tier and other home based treatment and care and the significant development and investment planned across personal social care services to achieve planned reduction in hospital services and increase in caring for people at home.

RESOLVED\-

1. To note the presentation. SPB 68/17 DATES OF FUTURE MEETINGS The Chair informed Board members that the dates of future meetings would be changing. The meeting on 28th July was due to take place as scheduled, the meeting on 25th August was cancelled and dates after these dates would be confirmed with Members as soon as possible. Friday 28 July 2017 10:00-11:30am Manchester

11

Future dates post July TBC

1

Greater Manchester Health and Social Care Strategic Partnership Board

Date: 28 July 2017

Subject: Chief Officer’s Update

Report of: Jon Rouse, Chief Officer, GMHSC Partnership

SUMMARY OF REPORT:

The purpose of the report is to update the Strategic Partnership Board on key items of

interest both within the GMHSC Partnership and also within its partner organisations.

RECOMMENDATIONS:

The Strategic Partnership Board is asked to note the content of the brief.

CONTACT OFFICERS:

Karishma Chandaria, Executive Officer, GMHSC Partnership

[email protected]

4

2

1.0 GENERAL

1.1. I’m pleased to announce that Kim Curry has joined the partnership as Associate

Lead for Adult Social Care. Kim has had a number of senior roles in health and

social care including as a DASS. Steve Barnard has been jointly appointed with

NHS I as the head of the Urgent and Emergency Care Service Improvement Team.

2.0 OPERATION NEWTOWN UPDATE

2.1. There are two key strands of recovery work. The first is the aftercare for those

seriously physically injured. A dedicated team continues to oversee the case

management for these individuals including support with transition through a lead

worker arrangement where this is wanted by the individual and/or family. The

second strand is the mental health offer. This has now moved into a new phase as

a dedicated Mental Health Hub has come on stream providing a proactive offer of

screening and where necessary, managed referral for treatment.

3.0 SUSTAINABILITY AND TRANSFORMATION PLAN DASHBOARD

3.1 On 21 July the Department of Health and NHS England published a baseline position

for all 44 STPs against nine domains. The performance was then aggregated to

place all STPs in four bands. Greater Manchester was placed in the second highest

band, ‘Advanced’. We scored well in most categories but fall down on our non-

elective performance. There are five STPs rated as ‘outstanding’ including South

Yorkshire and Bassetlaw and we will look very closely at these systems to see what

we can learn and adopt.

4.0 CAPITAL FINANCE

4.1 The Government has announced capital allocations from the initial £325m Fund

announced before the Election. The Department of Health and NHS England have

chosen to prioritise bids from higher performing STP areas. To this end, Greater

Manchester has received one of the largest allocations of up to £80m in the first three

years and up to £93m overall, to support the delivery of Healthier Together in the

context of the wider acute services programme, and to enable Salford Royal to build

its new major trauma facility.

5.0 BETTER CARE FUND

5.1 NHS England has published the guidance for the Better Care Fund (BCF) this year.

Their approach has been to place an intensive focus on reducing Delayed Transfers

of Care, setting individual local authorities specific targets to meet commensurate

with the overall national target of reducing DTOCs below 3.5% of bed days. Failure to

meet the target could lead to loss of resources in 2018/19.

3

5.2 The BCF requirements are a legal obligation and each of our localities will have to

follow the required methodology. However it is difficult to reconcile the NHS England

approach of the NHS commissioners being directed to hold local government to

account for performance with the devolved partnership model that we operate - our

commitment to single commissioning functions, mutual assurance and to fully pooled

budgets. It underlines the need to secure graduation from the Better Care Fund

system as soon as possible as its continued application acts as an increasing drag

on our progress.

6.0 CCG ASSURANCE 16/17

6.1 On 21 July the end of year ratings for CCGs across the country were published,

based on a range of indicators, financial performance, plus assessment of leadership

and governance. We have one ‘outstanding’ CCG Salford, eight ‘good’ CCGs and

one, Trafford, rated as ‘requires improvement’. Overall, this is a strong level of

performance.

7.0 PENNINE CARE

7.1. Pennine Care and its commissioners have committed to a focused process to

secure agreement on a medium term financial strategy for the Trust to aid both

financial recovery and quality improvement. To that end at a recent Pennine Care

summit in June four key work streams were identified to facilitate the recovery plan

for Pennine Care:

Finance –– fast track to agree the size of the gap and the proposed

agreement for 2017/18 and 2018/19. NHSI and GMHSCP to support this work

jointly with the Trust and its commissioners.

Quality – progress work with the existing Improvement Board which is chaired

by NHS Improvement

Digital – –a digital plan is needed to address fundamental problems with

Pennine Care’s digital infrastructure which impacts records keeping and

information sharing..

Estates – –pursuing opportunities for rationalisation and redesign linked into

the Improvement Board and wider GM configuration

7.2. I will continue to chair monthly meetings to support pace and grip of the recovery

plan. That work will run alongside the Improvement Board responding to the

recommendations of the CQC report. The whole process will be supported by a

team comprising of both GMHSCP & Pennine Care staff.

4

8.0 CARE QUALITY COMMISSION SECTION 48 REVIEWS

8.1. The CQC has been asked by the Secretaries of State for Health and for

Communities and Local Government to undertake a programme of local system

reviews of the interface of health and social care in 12 local authority areas.

8.2. These reviews, exercised under the Secretaries of State for Health's Section 48

powers, will include a review of commissioning across the interface of health and

social care and an assessment of the governance in place for the management of

resources.

8.3. They will look specifically at how people move between health and social care,

including delayed transfers of care, with a particular focus on people over 65 years

old. The review will not include mental health services or specialist commissioning

but, through case tracking, will look at the experiences of people living with

dementia as they move through the system. Two areas in Greater Manchester,

Trafford and Manchester have been chosen as two of the 12 areas that are being

reviewed, based on a statistical performance assessment of a basket of indicators

(which DH plan to publish on a quarterly basis going forwards.). While we do not

necessarily agree with the process for selection we will work with CQC to ensure

that the process adds as much value as possible to existing reform plans

9.0 ADULT CONGENITAL HEART DISEASE

9.1. NHS England is currently conducting a national public consultation on how it will

ensure adherence to new standards for hospitals providing congenital heart disease

services in England and the implications for service configuration. It follows the

publication in 2015, of a new set of quality standards for all hospitals providing

congenital heart disease services covering both adults and children. The

consultation will end in July but a final decision is not expected until early 2018.

9.2. As part of that process, NHS England published a plan in June 2016 that they were

minded to remove the Adult Congenital Cardiac Surgery services from Manchester

Royal Infirmary and transfer them to Liverpool. In a subsequent document the

transfer of services also included interventional ACHD cardiology procedures (level

1).

9.3. As a result of the publication of the consultation paper and the way in which the

process has been handled by the national specialised commissioning team, CMFT

have lost key staff leading to a point where they have had no choice but to suspend

the provision of the relevant services. As Liverpool is unable to recruit to these

services pending a decision there is therefore no longer any service in the North

West. CMFT has therefore worked at speed to put in place alternative

arrangements, working closely with the relevant centres in Leeds and Newcastle.

Nevertheless, many of the patients and their families are very upset at the loss of

the service and how this has been handled, and these feelings were expressed at a

meeting on 1 July.

5

9.4. I have responded as Chief Officer to the consultation jointly with the CCGs,

expressing concerns about the process to date and seeking rapid development of a

pan-North West clinical model and an accelerated final decision to allow restoration

of a NW service as soon as possible.

10.0 GM FRAILTY PATHWAY

10.1. Any analysis of our core data shows that unless we manage frailty well, from

prevention through to crisis care, we cannot succeed in terms of our core aim to

reduce acute activity levels. This includes our work on falls prevention. As we come

towards the end of the process of allocating TF resources to localities and signing

off investment agreements, we need to do more to equip our localities to

implement successful programmes that help them deliver on the commitments that

they have made. To this end we will be creating a task and finish group to develop a

single plan for improving care pathways for managing frailty, drawing on best

practice from across the world. This will incorporate work on informatics, science,

standards, service design etc. Jackie Bene, Chief Executive of Bolton Royal

Infirmary and a qualified geriatrician has agreed to chair the group with clinical

leadership being provided by Dr Sarah Briggs from UHSM. We will also be drawing

on the work of Dr Martin Vernon (National Clinical Director and CMFT.) The work

will also facilitate the opportunity identified in the emerging clinical strategy for North

Manchester Hospital to incorporate some form of Centre of Excellence for Frailty in

partnership with our universities. The group will be supported by our Strategic

Clinical Network.

11.0 ELECTIVE CARE PROGRAMME

11.1. In relative terms we have placed less emphasis to date on improving demand

management for elective care. Last year we saw a 2% growth in elective

admissions. There is already some excellent practice in some of our localities,

notably Stockport, that we can build upon. Our plan is to work with the national

elective care programme to develop a prioritised GM plan focused on improving the

interface between primary and secondary care. We have been allocated £370,000

to support the development and delivery of the plan and will create an elective care

improvement hub to work with localities to develop standards and models of care.

We will use proven methodologies and tools such as alternative MSK referral

pathways and use of peer review.

12.0 STAKEHOLDER ENGAGEMENT

12.1. We were delighted to welcome Caroline Gulleray from Canterbury Health Systems

in New Zealand who gave a masterclass for the senior leadership team on health

systems development. Canterbury Health Systems is one of the most advanced

health systems in the world and has been internationally recognised for its levels of

collaboration and integration leading to real reductions in acute level activity, better

patient outcomes and excellent financial performance. We will maintain the

6

relationship with Canterbury as one of an emerging network of key external

relationships that also include New York State, Scotland and Northern Ireland.

12.2. Colleagues from the GM universities, health and care, local third sector and

Universities UK came together this month to identify how we can improve the

support for students’ mental wellbeing. The summit was opened by the Mayor and

considered:

The national strategy on student mental health

Supporting students: via primary and community mental health pathways

Supporting students through the community and voluntary sector

Examples of how GM universities are currently supporting students

We are producing a report of the summit including some practical proposals and

recommendations which can be adopted for the whole GM student population

13.0 GM HEALTH AND SOCIAL CARE BIG EVENT 11 OCTOBER 2017

13.1. On 11 October we will be holding the first leadership summit showcasing the

excellent health and care programmes across Greater Manchester and exploring

how we continue to develop best practice, service transformation and collaboration

in the future. It will be an opportunity to share your experiences, lessons learnt and

how we use devolution principles and local priorities to shape our services. Please

hold the date in your diaries.

14.0 FORWARD LOOK

14.1. We will be bringing forward report on our work on carers, progress on adult social

care transformation and medicines management in September. We will also focus

on Q1 performance including first exposure to some of our new thematic

dashboards such as mental health and social care. And we will also be bringing

forward proposals for some changes in our governance structure to support the

next phase of the Partnership’s work.

1


Date: 28 July 2017

Subject: Transformation Fund Update

Report of: Steve Wilson, Executive Lead: Finance & Investment, GMHSC Partnership

SUMMARY OF REPORT:

The report contains an update on recent developments with the Transformation Fund This

month has an expanded section on the findings and recommendations from the assessment

team in their evaluation of the proposals from Healthier Together and Oldham.

KEY MESSAGES:

This report reports on wider updates within the Transformation Fund and contains in detail

the findings of the Transformation Fund Oversight Group (TFOG) on 28 June 2017 and the

decisions of the Strategic Partnership Board Executive on 12 July 2017, where the Healthier

Together and Oldham submissions were considered.

Healthier Together is a clinically led Greater Manchester quality improvement programme.

The scope of the wider programme stretches across primary care, integrated care and acute

care. The acute element, for which transition funding is being sought, tackles variation in

quality in GM A&E, Acute Medicine and General Surgery services.

Oldham’s proposal is a central part of their plans to increase the pace and scale of delivery

of their Locality Plan which will close the forecasted financial gap of £70.8m by 2020/21 by

supporting people to be more in control of their lives; having a health and social care system

that is geared towards wellbeing and the prevention of ill health; providing access to health

services at home and in the community; and by providing social care that works with health

and voluntary services to support people to look after themselves and each other.

TFOG recommended a substantive investment of £17.2m over five years for Healthier

Together, and a substantive investment of £21.3m over four years for Oldham. These

funding recommendations were accompanied with material conditions for the funding.

Funding for both schemes was approved by SPBE on 12 July 2017.

5

2

PURPOSE OF REPORT:

The purpose of the report is to update the Strategic Partnership Board on investment

decisions made by the Strategic Partnership Board Executive in relation to the Healthier

Together programme and Oldham’s locality proposal. It is also to update the Board on other

developments with the Transformation Fund.

RECOMMENDATIONS:

The Strategic Partnership Board is asked to:

Note the progress update reported on the Transformation Fund:

Note the Executive’s decision to:

o Approve a substantive investment of up to £17.2m over five years for

Healthier Together:

Manchester & Trafford sector: £3.19m

North East sector: £1.86m

North West sector: £5.26m

South East sector: £1.19m

NWAS PMO: £250k

Potential funding for unmitigated stranded costs of up to £5.5m

Noting that there are material conditions to funding, only to be

released upon their satisfactory completion. These are set out at

2.3.2.

o Approve a substantive investment of up to £21.3m for four years for Oldham,

phased as follows:

2017/18: £4.65m

2018/19: £10.56m

2019/20: £5.26m

2020/21: £0.85m



3.3.2.

3

CONTACT OFFICERS:

Sally Parkinson, Associate Chief Finance Officer, GMHSC Partnership

[email protected]

Thomas Daines, Transformation Fund Project Manager, GMHSC Partnership

[email protected]

4

1.0 INTRODUCTION

1.1. The GM Transformation Fund (TF) became operational in April 2016 following the

successful delegation of transformation responsibilities to the GM Health & Social

Care Partnership.

1.2. This paper is written to provide the Strategic Partnership Board (SPB) with an

update on recent developments and seek key decisions on the Transformation

Fund.

2.0 LOCALITY UPDATE: HEALTHIER TOGETHER

2.1. Background and Context

2.1.1. Healthier Together’s submission to the Transformation Fund has been assessed by

a team within the GMHSC Partnership and a Transformation Fund Oversight Group

meeting was held on 28 June 2017 to make recommendations to the Strategic

Partnership Board Executive.

2.1.2. Healthier Together is a clinically led Greater Manchester quality improvement

programme:

2.1.3. The scope of the wider programme stretches across primary care, integrated care

and acute care. The acute element, for which transition funding is being sought,

tackles variation in quality in GM A&E, Acute Medicine and General Surgery

services.

2.1.4. The programme will improve quality in all GM Trusts and for all patients that use

GM services (the 2.8m population of GM and patients from surrounding areas).

2.1.5. Following a unanimous decision by GM CCGs to support the implementation of the

programme in the autumn of 2014, a judicial review was then successfully

defended. Healthier Together initiated implementation in January of this year and is

now seeking transition (as well as revenue and capital funding) to support go-lives

from October 2017.

2.1.6. In line with the revised assessment approach as agreed at September 2016 SPBE,

Healthier Together’s proposal was assessed by a team from the GMHSC

Partnership between April and June 2017.

5

2.2. Findings from the Assessment Team

2.2.1. The proposal asks for a £44.5m investment over 5 years. The breakdown of funding

requested can be seen below:

2.2.2. The overall view from the assessment team is summarised as follows:

The programme has undergone considerable scrutiny to date, with extensive

consultation and refinement of plans over the last few years. As such the plans

are mature with good evidence and detail underpinning the proposition.

There has and continues to be good engagement with the sectors, with the

central programme team driving progress, challenging plans - specifically the

financials to ensure consistency and economies of scale where appropriate.

Alignment of HT to the emerging Theme 3 strategy and Single Hospital Service

present an opportunity to mitigate a large proportion of stranded costs.

Delivering HT is a key enabler for the delivery of the hospital based service

strategy under Theme 3.

Whilst there has been good engagement to date with sectors, we await final

commitment from all four sectors to meeting the recurrent costs required to

deliver the programme.

The programme is contingent on other sources of funding being secured, in

particular capital and digital funding. GM has been successful in bidding for up

to £63m of capital funding from the recent National allocation of £325m STP

capital to the DH. However this is dependent on approval of the final HT

business case.

Whilst the longer term benefits of the programme outweigh the costs resulting

in a positive NPV overall, there is no demonstrable return on investment within

the transformation fund timeframe.

Securing the workforce remains a significant risk to the programme; failure to

recruit to the required numbers will impact on the sector’s ability to deliver the

standards. This in turn drives the dependency on agency staffing which needs

to be mitigated.

7

2.2.3. The key points from the discussion at TFOG were as follows:

A standard approach towards stranded costs has been agreed with the

Finance Executive Group to ensure consistency across GM. This is still to be

agreed by one of the four GM sectors. There was a question, however, as to

whether paying for 75% of the stranded costs was the right thing to do, or

whether that was likely to remove incentives.

There was discussion on recurrent ambulance costs and whether their future

consideration needed to be a formal material condition to the funding. It was

agreed that the need to revisit the ambulance costs after engaging further with

NWAS and commissioners to secure this funding.

It was emphasised how much of this programme is enabling benefits to be

realised from other programmes of work, specifically Theme 3. It was agreed

therefore that the programme could not be judged on an ROI figure and

needed to be seen in terms of its enabling capabilities.

There was a challenge on the deliverability of some of the stated outcomes,

and it was reported that providers do not see a reduction of admissions as

realistic to expect. It was confirmed that the outcomes were taken from the full

business case that would be subject to further scrutiny before the final go

ahead is given for implementation.

It was raised whether it was realistic to expect all sectors to have signed up to

meeting the recurrent funding by the end of July 2017. It was clarified that it

was not the case of going back to the drawing board if sign up was not

achieved, but things may commence in the interim on a phased basis whilst

agreement was obtained.

There was discussion of what it would mean if all sectors did not sign up to

Healthier Together. It was therefore advocated that the TF proposal would also

be split sector by sector going forward to better understand the costs and

benefits on a segmented level.

2.3. TFOG Recommendation

2.3.1. Approve a substantive investment of up to £17.2m over 5 years in Healthier

Together:





8

NWAS PMO: £250k

Unmitigated stranded costs of £5.5m

Additional funding of £5.5m to be provided from GM CCG risk share to support

other unmitigated risks.

Noting that there are material conditions to funding, only to be released upon

their satisfactory completion. These are set out at 2.3.2.

2.3.2. There are a number of material conditions attached to the recommendation:

The proposal needs to be broken down sector by sector and should be

presented in this manner going forward.

Each sector must commit to meeting the recurrent costs of the programme by

end July, including ambulance costs, before TF will be released to that sector.

The programme team shall continue to work with the Theme 3 Lead to develop

plans to mitigate all stranded costs.

Funding from Q3 17/18 onwards shall be predicated on the final decision to

award capital funding following the successful bid to the national STP capital

fund.

Further review and benchmarking of Implementation and PMO costs – open

book approach to monitoring.

Review of revenue costs of capital following final business case.

A review of phasing of commitments given slippage in overall timeline.

The GM workforce strategy urgently seeks to address the risk associated with

recruitment in particular in the NE sector, in addition to a stronger statement of

risks overall.

The need to revisit the ambulance costs following negotiations with

commissioners and NWAS.

3.0 LOCALITY UPDATE: OLDHAM

3.1. Background and Context

3.1.1. Oldham’s submission to the Transformation Fund has been assessed by a team

within the GMHSC Partnership and a Transformation Fund Oversight Group

meeting was held on 28 June 2017 to make recommendations to the Strategic

Partnership Board Executive.

9

3.1.2. Oldham’s proposal is a central part of their plans to increase the pace and scale of

delivery of their Locality Plan which will close the forecasted financial gap of £70.8m

by 2020/21 through:

Supporting people to be more in control of their lives

Having a health and social care system that is geared towards wellbeing and

the prevention of ill health.

Providing access to health services at home and in the community

Providing social care that works with health and voluntary services to support

people to look after themselves and each other

3.1.3. The proposal to the Transformation Fund builds on the work undertaken in the

locality over the last 4 years to progress their vision around integrated care.

Specifically funding is requested for the following schemes:

Establishing the primary care cluster system across the locality, completing the

establishment of integrated health and care teams and creation of single

structures at a GP cluster level

Creating and implementing a more effective urgent and emergency care offer

on the Royal Oldham Hospital site

Oldham’s community re-ablement, rehabilitation and community bed services

(including a rapid response facility)

Oldham’s approach to community resilience, branded as ‘Thriving

Communities’

3.1.4. In line with the revised assessment approach as agreed at September 2016 SPBE,

Oldham’s proposal was assessed by a team from the GMHSC Partnership between

April and June 2017.

3.1.5. An independent assurance is being undertaken by BDO to provide assurance that a

transparent process for application and assessment was followed and the findings

and recommendations fair, robust and reflective of criteria to access the fund.

3.2. Findings from the Assessment Team

3.2.1. The proposal asks for a £23.2m investment over 5 years which will deliver net

cashable savings benefit of £12.9m over the period 2016/17 to 2010/21, and

produce recurrent revenue savings of £11m as a contribution to closing the locality

gap (100% of the overall 2020/21 gap of £70.8m), leaving a sustainable recurrent

financial surplus of £3.3m by 2020/21.

3.2.2. The breakdown of funding requested can be seen below:

10

3.2.3. The overall view from the assessment team is summarised as follows:

It is strongly aligned to the GM Strategy, in particular themes 1 and 2 with a

strong focus on Primary Care and prevention strategies.

There is a good level of detail underpinning each of the schemes, reflecting the

maturity of the locality in developing their integrated care model.

The locality has undertaken a significant amount of engagement in developing

their integrated care model, particularly with target patient groups.

The finance information underpinning the costs of each scheme is well defined

and supported by clear assumptions. A comprehensive set of benefits have

been identified and translated into metrics in a draft investment agreement.

As schemes have commenced, the locality’s focus has turned to the

organisational form and there is a strong concern that this may detract from

delivery of the model of care and impede progress.

There is limited detail in the proposal in respect of workforce development and

engagement. Additionally further engagement is required with wider Primary

Care providers.

The locality’s approach to risk management could be strengthened, particularly

when considering the implications of organisational form on delivery of the

schemes.

Whilst assumptions on cashability have been agreed with the main providers,

the overall financial model for the NES does not yet translate the expected

demand reductions into a detailed benefits realisation plan.

Whilst significant learning and sharing has been undertaken at a NES level,

this learning should be extended to other localities, particularly in respect of

exploring options for organisational form.

11

Plans for evaluation are not yet developed.

3.2.4. The key points from the discussion at TFOG were as follows:

Oldham’s engagement with Pennine Acute as part of Oldham’s bid was

highlighted and the fact that the assumptions around cashability were agreed

across all parties

The issue of double counting benefits was raised and how the GMHSC

Partnership is mitigating against it. There was discussion on it being an

ongoing difficult issue and that the benefits of cross-cutting programmes and

enablers would need to be carefully considered for this reason.

There was question of how the locality plans incorporated plans around adult

social care. It was noted that the links with adult social care were embedded in

each of the schemes but this could have been strengthened in Oldham’s bid.

It was stated that the investment agreement for Oldham must include the

locality’s plans in relation to Mental Health transformation

Concerns were raised over Oldham being overly focussed on their future

organisational form. It was then revealed that Oldham are to pursue a more

straight-forward alliance model for the next two years, which should reassure

against this.

There was a reminder of the need to be conscious of the future of Pennine

Acute and how this would impact upon the benefits realisation plans for the NE

sector localities.

3.3. TFOG Recommendation

3.3.1. A recommendation for a substantive investment of £21.3m over four years, with

phasing to be set out in the Investment Agreement and paid quarterly in advance.

2017/18: £4.65m

2018/19: £10.56m

2019/20: £5.26m

2020/21: £0.85m

Noting that there are material conditions to funding, only to be released upon

their satisfactory completion. These are set out at 3.3.2.

3.3.2. There are a number of material conditions attached to the recommendation which

should be satisfied prior to signing an investment agreement:

12

The locality shall work with PAHT to develop detailed plans to translate the

anticipated activity savings into detailed benefits realisation plans, working

alongside Bury and Rochdale to ensure consistency in approach .

There shall be an exchange of letters to confirm that Oldham are to pursue a

simpler alliance model for the next two years, before potentially later

committing to a preferred option, thereby providing assurance that delivery of

schemes in the short term will not be adversely impacted.

The locality shall liaise with Bury and Rochdale to identify opportunities for

economies of scale in relation to programme infrastructure such as OD, comms

and PMO staffing.

The locality’s investment agreement shall include the locality’s plans for mental

health transformation.

4.0 LOCALITY UPDATE: BURY

4.1. Bury’s submission to the Transformation Fund has been assessed by a team within

the GMHSC Partnership and a Transformation Fund Oversight Group meeting was

held on 28 June 2017 to make recommendations to the Strategic Partnership Board

Executive.

4.2. The recommendation on Bury’s submission has now been deferred until the

Transformation Fund Oversight Group on 24 July 2017, in order to allow further

analysis of Bury’s submission. An exec-to-exec meeting was held on 14 July 2017.

5.0 LOCALITY UPDATE: ROCHDALE

5.1. The proposal from Rochdale was received on 31 March 2017 and is currently under

assessment from a team from within the GMHSC Partnership.

5.2. To allow more time for the assessment team to complete their evaluation, a

Transformation Fund Oversight Group (TFOG) has been scheduled for 24 July

2017 to consider their findings. An exec-to-exec meeting took place on 4 July 2017.

6.0 LOCALITY UPDATE: TRAFFORD

6.1. The proposal from Trafford was received on 30 June 2017 and will be under

assessment from a team from within the GMHSC Partnership during July and

August 2017.

6.2. A Transformation Fund Oversight Group (TFOG) has been scheduled for 1

September 2017 to consider their findings.

13

7.0 RECOMMENDATIONS

7.1. The Strategic Partnership Board is asked to:

Note the progress update reported on the Transformation Fund:

Note the Executive’s decision to:

o Approve a substantive investment of £17.2m over five years for

Healthier Together:





NWAS PMO: £250k

Potential funding for unmitigated stranded costs of up to £5.5m



2.3.2.

o Approve a substantive investment of up to £21.3m for four years for

Oldham, phased as follows:

2017/18: £4.65m

2018/19: £10.56m

2019/20: £5.26m

2020/21: £0.85m



3.3.2.

1


Date: 28 July 2017

Subject: Greater Manchester Commissioning Review

Report of: Report of Jay Bevington and Sara Segal (Deloitte), Lead Sarah Price

SUMMARY OF REPORT:

Deloitte have undertaken a review of health and social care commissioning across Greater

Manchester (GM) on behalf of the Partnership and engaging closely with all partners

including CCGs, Local Authorities and Providers. The report sets out a range of approaches

the Partnership could take in relation to the level at which services should be commissioned

and set alongside the emergence of the new organisational landscapes across GM.

KEY MESSAGES:

Deloitte were commissioned by the Greater Manchester Health and Social Care Partnership

to undertake a review of health and social care commissioning across Greater Manchester

(GM), building on the work of Commissioning for Reform publication. The scope includes:

1. Designing a truly place-based approach to public service reform, with investment led

commissioning at its heart.

2. Defining the support provided by the services commissioned at the GM spatial level;

and

3. Designing a framework for responsive and effective commissioning support services

in the context of the new commissioning landscape

PURPOSE OF REPORT:

Building on the ‘Commissioning for Reform’ publication of 2016, the report sets out the

findings of the review undertaken by Deloitte between February and April and sets out a

number of recommendations for strengthening commissioning in light of the development of

place based public service reform within a Locality, a consistent and standardised approach

to commissioning and provision of health and social care across GM.

6

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0386265e63d1d491e8bf67c999a266239&authkey=AQL3h8pN9XJ2EiDEVDgWPRg&expiration=2018-08-31T23%3a00%3a00.000Z

2

RECOMMENDATIONS:


Approve the recommendations set out on slide 4 of the pack grouped into; place

based recommendations, scale recommendations and support services

recommendations.

CONTACT OFFICERS:

Sarah Price, Director Population Health & Commissioning, GMHSC Partnership

[email protected]

1


Date: 28 July 2017

Subject: Mental Health Transformation – Next Steps

Report of: Warren Heppolette, Executive Lead, Strategy and System Development,

GMHSC Partnership

SUMMARY OF REPORT:

The paper outlines the approach to ensure the full implementation of the GM Mental Health

Strategy. It recognises progress against the objectives of the strategy to date and the

significant work still to take place. The paper outlines a broad investment framework for the

implementation of the strategy. This framework blends locality level resources as part of

GM’s collective commitment against the Mental Health Investment Standard and a financial

envelope proposed to be secured from the Transformation Fund.

The paper recognises the challenges facing mental health service access currently for GM

residents and outlines our key performance deficits. It also considers the implications for

commissioning mental health following the GM Commissioning Review and the opportunity

of the new care models developing in localities and across GM.

KEY MESSAGES:

This represents a historic statement of intent, backed by investment, to radically improve the

mental health and wellbeing of GM residents.

Our aims are that:

We will better connect public services, communities and individuals to improve

mental wellbeing and life chances.

We will secure key gains in access to a good range of mental health services.

We will eliminate the current fragmentation of services and improve the experience of

service users through the system.

We will use our Partnership to agree the standards which underpin the quality of care

provision and have agreed, measurable and defined outcomes.

7

2

We will seek to improve public attitudes and behaviour towards people with mental

health problems and reduce the amount of stigma and discrimination that people with

mental health problems report in their personal relationships, their social lives, at

work and also in their treatment within the services.

There has been no part of the GM system from health and care commissioners, NHS

providers, service users and carers, VCSE partners and wider public services which has not

been involved in the production of the strategy, the work to date and the development of the

proposed next steps.

PURPOSE OF REPORT:

This paper outlines the approach to ensure the full implementation of the GM Mental Health

Strategy. It proposes the investment framework to underpin the implementation of the plan

for the next 4 years.

RECOMMENDATIONS:


Note the progress which has been made against the GM mental health strategy over

the past year;

Agree the proposed mental health transformation areas and the investment

framework providing an overall envelope of £133.9m;

Support the onward process to work with localities to support their local investment

and transformation plans for mental health;

Support the onward process to develop business cases against which transformation

funding for the GM mental health programmes can be allocated; and

Support the further work to apply the findings of the GM Commissioning Review to

the future commissioning of mental health in localities and across GM.

CONTACT OFFICERS:

Warren Heppolette, Executive Lead, Strategy and System Development,

GMHSC Partnership

[email protected]

3

1.0 INTRODUCTION

1.1. This report outlines the investment and implementation framework, including the

proposal to the transformation fund, to deliver the Greater Manchester (GM) Mental

Health (MH) and Wellbeing Strategy and GM commitments aligned to the NHS

England’s Five Year Forward View for Mental Health (5YFVMH). Agreement and

endorsement of the proposal is sought from the Strategic Partnership Board

Executive.

1.2. The report will cover the following areas:

Mental health (MH) in GM, the background to the HM MH & Wellbeing strategy

Progress that has made against the GM MH & Wellbeing strategy since it was

published in February 2016

An outline of the proposed GM MH transformation work areas and an indication

of the overall investment required

The investment framework for MH

The implications of the GM Commissioning Review for MH commissioning

Next steps to maximise digital capabilities to improve MH in GM

The approach towards implementation of the GM MH strategy and next steps

to develop further understanding of the investments in MH and support required

at locality level.

Performance on mental health across GM

2.0 OVERVIEW

2.1. The GM devolution agreement has provided an unprecedented opportunity to

address challenges to improved MH and wellbeing in GM. GM has a strong track

record of collaboration with all key stakeholders, in particular between NHS

commissioners, local authorities and business. By building on these partnerships

and working more closely with the third sector, service-users and carers, it will be

possible to draw on the many resources and insights that already exist to promote

and improve MH. By working together, breaking down artificial and bureaucratic

barriers, organisations will be able to provide integrated care to support mental,

social and physical wellbeing and improve the lives of those who need most help.

2.2. We are clear that the transformation in mental health care and support, and

outcomes, is a key contributor to the long term sustainability of the health and care

system and the success of GM as a place. Economic benefits are associated with

early intervention; e.g. early intervention services that provide intensive support for

4

young people experiencing a first psychotic episode can help avoid substantial

health and social care costs: over 10 years perhaps £15 in costs can be avoided for

every £1 invested.

2.3. Mental illness can seriously affect the lives of individuals and families. People with

mental health problems are far more likely to experience physical ill health and

those with serious mental illness are likely to die 15-20 years earlier than those

without. Health costs for people with long-term conditions are at least 45% higher if

they also have a mental health problem. Employment rates in GM for people with

severe mental illness (SMI) are below the national average and sickness absence

across the workforce is high. Common mental health problems (for example,

anxiety, stress and depression) are now the most frequent reason for people

needing time off work.

2.4. This package starts to rebalance the levels of investment in mental and physical

health and seeks specifically to tackle those areas in most urgent need of support –

the provision of reliable crisis care for children and young people, support to new

mothers and the delivery of physical health checks and health improvement support

for people with serious mental illness.

2.5. The quality of mental health care across GM has seen improvements in recent

years. Skilled and committed front-line staff and the development of community-

based services and widespread integration of health and social care has meant that

fewer people need access to inpatient care and the number of inpatients dying by

suicide has reduced. However, much still needs to change to meet the needs of

individuals and communities.

2.6. Unless action is taken to address poor mental health in GM, it will not be possible to

build a future where there are increased opportunities, economic prosperity and

sustainability of the health and care economy in GM. Addressing MH and wellbeing

and building resilience are crucial to unlocking the power and potential of individuals

and communities.

2.7. Within GM, MH and wellbeing is seen as a whole system issue requiring a whole

system response. To address this, the GM Health and Social Care Partnership

(GMHSCP) agreed a single GM wide MH and Wellbeing Strategy in January 2016,

for launch in February 2016. The strategy set out our collective ambition and

focused on shifting the balance towards early intervention and prevention,

improving access and providing integrated, sustainable services that support the

whole needs of the individual. The strategy highlights 32 strategic initiatives which

incorporate the national priorities set out in the 5YFVMH. However, it does go

further to address key challenges to GM, particularly around employment, suicide

prevention and the resilience of communities.

2.8. Significant progress has been made against the year 1 priorities of the GM MH and

Wellbeing strategy. Despite the progress to date, further work is needed if we want

to make sustainable, system wide change and address historic underinvestment

and areas of poor performance in MH.

5

2.9. Funding for transforming MH services comes through 2 routes. The first, totalling

£77.6m is through additional monies that have gone directly into CCG baselines to

support their commitments to deliver the 5YFVMH. A detailed process is underway

to look at how we can support realignment of existing funding streams (in CCG and

LA baselines) to the agreed priorities of the GM MH and Wellbeing strategy and

locality plan objectives. The second route of funding to transform MH services,

totalling £56.2m, is through GM Transformation Fund, which will support the

commitments already made at locality level to invest in MH. Together these two

funding streams will generate a single investment framework for transforming MH

and wellbeing in GM.

2.10. In developing the investment framework a significant amount of engagement across

the GM system has taken place. There have been individual discussions with all

localities and a specific engagement session with stakeholders from health and

social care organisations across GM. This has shaped the content and

understanding of investment requirements and the impact this will have on

transforming services.

2.11. Key priorities for investment have been identified for a number of reasons. These

are because they may be an area of historic underinvestment, poor performance,

central to achieving sustainability of the health and social care economy and they

have been highlighted by the wider system and service users as the right areas to

invest financial resource.

2.12. Each key priority for investment that has been proposed also sets out whether this

should be commissioned and coordinated at a GM or locality level. The

commissioning level attributed to each investment has been selected because

geographically this appears to be the most suitable mechanism for delivery. The

decision has also been informed by the level of existing provision and variation in

service outcomes.

2.13. We have also recognised that related investment in MH and wellbeing will also be

through other connected areas of work such as through locality plans, elements of

the GM Population Health strategy and the transformation funding awarded for the

delivery of the GM Dementia United strategy.

2.14. Any new proposals to commission MH services either at a GM or locality level will

need to be cognisant of the GM commissioning review and take its

recommendations into account. There is also the requirement to focus on the

enablers of care, in particular the use of digital technology and capabilities to

improve service delivery and service user and carer experience.

2.15. Further information will be brought forward for approval at a later date that set out

the detailed business cases for the proposed pan-GM activities and investment

plans on MH at locality level.

2.16. An overview of the proposed workstreams and attached funding is given in the table

below:

6

Ref Investment Priorities

Overview Key Projects Budget

Mainstream, Locality Funding

1 GM CCG and Locality Baselines Funded Programmes

MH must do’s: mandated programmes of work set out in the 5YFVMH that Localities are committed to deliver FYFV national programme outcomes

Treatment Access - Additional psychological therapies

High quality MH services - CYP IAPT

Expand Capacity – Psychosis treatment

Individual Placement Support into Secondary Care – Severe mental illness

Referral to Treatment - Community Eating disorder teams

Eliminate Out of Area Placements for non-secure for non-specialist acute care

Reduce suicide rates

Increase baseline spend on MH to deliver MH Investment standard

Dementia diagnosis rate/post diagnostic care & support

MH Access & Quality standards – 24/7 access to community, home & liaison teams

Up to £77.683m

Transformation Funding

2.1 CCG Locality Plan Support

Will support the delivery of the 5YFVMH and GM MH Strategy through locally sensitive additional resource

Enhanced Adult Crisis & Urgent Care programme options -

Integrated IAPT/Primary Care RAID programme

Up to £10.800m excluding MMH £4.0m + and slippage in 2.2 & 2.3

2.2 GM Coordinated Programmes: Other transformation programmes

Delivered through the Theme 1 Population Health Work Stream of the GM ‘Taking Charge’ Strategy and other Transformation Boards

Suicide prevention, overcoming MH stigma and Supporting Communities of Identity

Work & Health across the life course

Dementia United

Health & Justice

Up to £6.800m

7

2.3 GM Coordinated Programmes: Mental Health

Projects to deliver 5YFVMH and GM MH Strategy

24/7 Community-based access and Crisis Care (children and young people)

GM iThrive Network and CYP MH Workforce development (NHS, LA and VCSE

Improving mental wellbeing, building capacity and resilience of communities (including schools)

GM Perinatal and Parent-Infant mental health

Liaison Mental Health – Core 24 access GM

Up to £34.625m

3.0 PROGRESS AGAINST THE GM MH & WELLBEING STRATEGY TO DATE

3.1. The GM MH and Wellbeing strategy was supported by the GMHSCP Board and has

received strong commitment from colleagues working across localities and at a GM

level since it was launched in February 2016.

3.2. The strategy prioritised the following activities for years 1 and 2:

Suicide prevention

Work, health and employment

24/7 mental health and 7 day community provision for children and young

people

24/7 mental health and 7 day community provision for adults including

embedding the Crisis Care Concordat

Integrated place based commissioning and contracting aligned to place based

reform

Integrated monitoring, standards and key performance indicators across mental

health services

Redesign of the provider landscape

In addition to the points listed above, Dementia United, improvements to Attention

Deficit Hyperactivity Disorder (ADHD) services for all age groups and Eating

Disorder services for children and young people were also prioritised.

3.3. Since June 2016, a MH Implementation Executive has been in place which has

been independently chaired by Steven Michael (formerly Chair of the National

Mental Health Network and Foundation Trust Chief Executive). This independent

chairing has been essential for bringing commissioners, providers (including VCSE)

8

and GM Healthwatch from across the system together, developing relationships and

creating an environment which facilitates collaborative working.

3.4. The MH Implementation Executive has been fundamental in turning the priorities

set out in the GM MH strategy into an initial set of key workstreams, providing

leadership and identifying Senior Responsible Owners and key individuals within

the system to deliver the strategy. It has also been providing expertise, guidance

and sense-checking on proposals for the development of a dashboard for

measurement of MH performance across GM and this proposal to the

transformation fund. The workstreams currently under the MH programme are at

different stages of development.

3.5. To date under the Children and Young Peoples (CYP) MH working group, a single

GM specification for ADHD and Eating Disorder services has been developed and

put in place. A model for CYP community-based crisis care response and support

has been drafted too. In addition, a collaborative Tier 4 Children and Adolescent

Mental Health (CAMHS) provider alliance has been established and work to

introduce the iTHRIVE model (a framework for supporting children and young

peoples’ mental wellbeing) across localities has already been initiated.

3.6. The Strategic Clinical Network (SCN) have also set up a GM network for Perinatal

and Parent-Infant MH and drafted a model for greater provision of this across GM.

3.7. Under governance of the Crisis Care working group, the principles set out in the

Crisis Care Concordat have been embedded across GM with the development of a

Crisis Care Concordat performance dashboard completed. A cost-benefit analysis

has been undertaken on The Sanctuary service (a place that provides adults

experiencing MH crisis a space to find support) has been undertaken. This has

demonstrated that the current Sanctuary model will need revising to increase its

effectiveness and sustainability. Funding for a police control room triage service

which employs mental health nurses to support frontline police offices has been

agreed between Clinical Commissioning Groups (CCGs) and the Greater

Manchester Police and Crime Commissioners office (GMPCC). Reducing the

numbers of people in police custody needing a place of safety during a mental

health crisis (section 136) has been a continuing priority and at 1%, the rate is 5

times lower than the rest of England & Wales.

3.8. Under the Suicide Prevention working group, a GM strategy has been launched

with leadership provided by Rochdale’s Director of Public Health. An audit of

completed suicides from 2015 has been undertaken and the draft findings reported,

to support improved data collection and formulating action plans to reduce suicide

across GM.

3.9. For Work and Health, an effective Working Well programme is in place across GM,

which includes a talking therapies service and caseworkers. Plans are in place to

extend this programme using a 5 category population model which identifies gaps in

support for people

http://www.crisiscareconcordat.org.uk/

9

3.10. GMHSCP colleagues provided strong support to the merger between Greater

Manchester West (GMW) and the Manchester Mental Health and Social Care NHS

Trust (MMHSCT). This transaction was completed in 2016 and the new Trust was

formally established on 1 January 2017. Service improvement programmes in line

with MH priorities are in place across the new Trust to transform the city’s services.

4.0 MENTAL HEALTH INVESTMENT FRAMEWORK

4.1. The outcomes we are committing to deliver

4.1.1. The GM MH and Wellbeing strategy was developed at the same time as NHS

England’s 5YFVMH was being developed and incorporated the ‘must do’ priorities

set out in the national strategy. GM worked closely with national colleagues to

ensure alignment and fidelity to national objectives. However, we recognised and

pursued the opportunities to go further and think radically about prevention, early

intervention and social prescribing to improve the mental wellbeing of the GM

population.

4.1.2. The 5YFVMH gives a clear indication to the public and people who use services of

what they should expect from mental health services, and when. This includes

commitments to improve access to, and availability of, MH services across the age

range. It focusses on the development of community services to reduce pressure on

inpatient settings, and provide people with holistic care that recognises their mental

and physical health needs.

4.1.3. We will remain focussed on the impact this has for GM residents and the reliability

with which they receive support for their mental health needs. We are making new

commitments to residents of GM with this package:

Making sure everyone in a mental health crisis is able to get immediate support

(and that no one ends up in a police cell when they are in mental health crisis)

Helping new mums who experience significant mental health problems –

babies and children whose mum’s suffer poor mental health can be affected

through their whole life.

Making sure people with serious mental illness have their physical health better

looked after – at the moment those people die on average 15-20 years earlier.

4.1.4. The changes which this package will secure will mean that over the next 4 years we

will ensure that:

10

4.2. Confirmation of strategic priorities

4.2.1. We have aligned local, GM and national objectives to inform the proposed priorities

of this package. The objectives are organised according to:

Improving Mental Wellbeing & the Resilience of Communities

Integrating physical and mental health programmes

Children and Young People’s Mental Health

Perinatal Mental Health

Adult Mental Health: IAPT

Adult Mental Health: Community, Acute and Crisis Care

Suicide Prevention

Work & Health

11

Health & Justice

Older People and Dementia

4.2.2. Delivery of these objectives will create a step change in mental health provision

across GM. The impact of this delivery will principally be seen in new models of

community-based care in localities.

4.2.3. Within Local Care Organisations, mental health provision will integrate with services

for both physical health and the social needs of individuals, breaking down

traditional care silos and making a significant contribution to realising parity of

esteem for mental health. Primary care (including Out of Hours services) should

form a part of each of the relevant pathways within this programme. There will also

be a new focus in primary care on the physical health care of people with severe

mental health problems, including psychosis, bipolar disorder and personality

disorder. Specifically, new models of enhanced primary care and collaborative

specialist care that meets the physical and mental health needs of people with

severe mental illness will have been fully trialled.

4.2.4. The new care models will also recognise those wider factors impacting on mental

health and well-being. Taking a place-based approach, they will align with reformed

public services and with the offer from the VCSE sector. The new single

commissioning functions will further enable this integration within the 10 localities.

4.2.5. Further information on each of the strategic priorities is given below.

4.2.6. Improving mental wellbeing and the resilience of communities: By improving

the capacity of children, young people, adults and communities to deal with difficult

emotions and experiences and reducing social isolation people will develop greater

confidence and live happier lives.

Resilience and mental wellbeing are developed through activities that promote

wellbeing, building social capital and developing psychological coping strategies

(MIND & Mental Health Foundation [MHF], 2013). Using the 5 ways to wellbeing

model and working across the health and social care, private and in particular the

voluntary sector, we will work with GM residents to improve connectedness, levels

of activity, encourage learning and opportunities to people to volunteer.

We will progress evidence-based approaches to increase knowledge and

understanding of mental health for GM residents. In addition, we will support to

public campaigns to tackle MH stigma and promote positive MH and wellbeing.

While improving the mental wellbeing of all GM residents is imperative, to reduce

the social gradient in health, we will consider targeted interventions with people at

increased risk of poor mental wellbeing such as those from socio-economically

deprived backgrounds. We will also consider evidence-based approaches to

improve mental wellbeing in people with severe and enduring MH problems.

12

When setting out detailed plans to deliver this priority it will be essential to engage

stakeholders from across the wider system and encourage co-production

approaches with localities and communities.

4.2.7. Integrating physical and mental health: We will start to turn around the appalling

truth that people with serious mental illness die 15-20 years earlier than the general

problem. So much of this gap relates to the support they receive to improve their

physical health. In GM by 2020/21, the ambition is for 15,000 people with SMI to

have access to physical health checks which are integrated as part of the care they

receive for their mental health. Levels of obesity and in particular smoking, alcohol

and substance misuse are much higher in people with SMI. People with SMI are

also much more likely to have a long-term chronic condition. This will require the

review of services to promote easier access, better continuity of services for people

with SMI and to ensure that health and social care professionals have the

knowledge and skills to facilitate a better journey for the service-user.

Integrating delivery of physical and mental health care and ensuring people with

SMI receive a full annual physical health check will help to address barriers to

recovery and aim to reduce demand on acute treatment by addressing physical

health problems earlier.

Providing better integration of physical and mental health care for people with SMI

can support:

Reductions in health inequalities (by providing better access to smoking

cessation, alcohol and substance misuse programmes and lifestyle support)

Enable the development of common shared care protocols for prescribing and

physical health checks

Holistic assessment, treatment and ongoing support for people with multiple co-

morbidities

Better end of fife experiences

4.2.8. Children and Young People’s (CYP) mental health: In GM we will ensure that by

2020/21 at least 3,920 additional children and young people each year will receive

evidence-based treatment, representing an increase in access to NHS-funded

community services to meet the needs of at least 35% of those with diagnosable

MH conditions.

We will implement delivery of the evidence-based iTHRIVE model throughout GM to

support effective delivery of children and young people’s (CYP) services. Work will

be done to provide further training of the CYP workforce to enable them to embed

iTHRIVE into professional practice. There will also be a focus on improving the

mental health pathway for CYP and promoting shared learning and system-wide

effective responses to adverse childhood experiences. We would include in this

support a school, college and university leadership programme which equips senior

educational leaders, in small clusters/learning sets, to review their approach to

13

meeting the MH needs of their school/college and to work through their

commissioning plans and training strategies.

The iTHRIVE model will be used as a basis for ensuring CYP support and access is

suited to the need of the child or young person and their parents or carers in their

particular circumstance. This may mean self-help and library resources for those

who require minimal support through to home treatment teams, RAID services, CYP

safe spaces and suitable inpatient access.

Currently there is little to no provision for children and young people (CYP) who

experience mental health crisis or need more intensive support in the community.

Establishing 24/7 crisis care and community provision for CYP will be essential to

deliver on the pledges set out in the GM MH strategy and also to deliver the

5YFVMH.

4.2.9. Perinatal mental health: By 2020/21, there will be increased access to specialist

perinatal MH support in Greater Manchester, in the community or in-patient mother

and baby units, allowing at least an additional 1,680 women each year to receive

evidence-based treatment, closer to home, when they need it. This will support:

Community Parent-Infant MH Early Help Hub Programmes

Developing and Sustaining GM Perinatal Infant MH Model

GM Integrated Mother Baby Unit - GM Specialist Perinatal MH Teams

Specialist in-patient/outreach

Local Parent-Infant MH Early Help/Attachment Programmes

Extended Fast-Track IAPT Access

4.2.10. Adult Mental Health: IAPT: By 2020/21, there will be increased access to

psychological therapies, so that at least 25% of people (or 84,000 in GM) with

common MH conditions access services each year. The majority of new services

will be integrated with physical healthcare and it is intended that 168 new MH

therapists are co-located in primary care to maintain quality in services, access and

recovery standards across the adult age group. Through this we will build a robust

invest to save model for integrating psychological therapies into primary care

through GP collaboratives. We also want to increase the number of employment

advisors based in IAPT services to support more people with staying in work and

getting back into work. IAPT services will cover:

Core MH IAPT – low and high Intensity (incorporating services for medically

unexplained symptoms, co-morbid depression, anxiety disorders and physical

long-term conditions)

Primary Care Rapid Access, Interface and Discharge (RAID)

14

Reconfigured secondary care Health Psychology Services

Targeted action to address lower rates of access and recovery for key groups,

including BME populations.

4.2.11. Adult Mental Health: Community, Acute and Crisis Care: By 2020/21, adult

community MH services in GM will provide timely access to evidence-based,

person-centred care, which is focused on recovery and integrated with primary

care, social care and other sectors. Our ambitions are to achieve:

At least 60% of people experiencing a first episode of psychosis to be referred

and treated with a NICE approved package of care within 2 weeks

Well established and effective crisis and acute care that includes Crisis

Resolution and Home Treatment Teams (CRHTT)

Significantly reduced Out-of-Area Hospital Placements

Embedded Crisis Care Concordat principles in all emergency response service

across GM

An established and effective Control Room & Street Triage to support police

officers who respond to people in crisis and to provide more suitable

alternatives to the use of section 136.

Better MH support for people who work in the armed forces and military

veterans

Liaison mental health will ensure all-age Core-24 compliant support for acute

hospitals with 24/7 A&Es and a modified Core-24 service in hospitals with Urgent

Care Centres. Implementation and roll out will begin with specialist hospitals to

improve early detection and treatment of mental health problems in people with

existing physical health problems/ medically unexplained symptoms and people

attending acute hospitals in a mental health crisis. The benefits of this are reduced

inappropriate inpatient admissions, shorter lengths of stay, fewer delayed

discharges and reduced re-admissions.

4.2.12. Suicide prevention: We launched our Suicide Prevention Strategy in February

2017. The strategy outlines the actions we will take to reduce the number of people

who die by suicide by 10% by 2020/21.

Implementation is underway and will ensure:

All 10 boroughs (and GM as a whole) will achieve Suicide Safer Communities

Accreditation (the ‘nine pillars of suicide prevention’) by 2018

Mental Health Service Providers will collaborate to work toward the elimination

of suicides for inpatient and community mental health care settings by

15

continuous quality improvement in relation to 10 key ways for improving patient

safety

We will strengthen the impact and contribution of wider services

We will offer effective support to those who are affected

We will develop, train and support our workforce to better assess and support

those who may be at risk of suicide

We will use the learning from evidence, data and intelligence to improve our

plan and our services.

4.2.13. Work and Health: The GM Employment & Health Programme will support the

integration of health, skills and employment systems to enable delivery of improved

health outcomes and economic growth as set out in the Greater Manchester

Strategy and the GM Health and Social Care Strategy.

The programme objectives will create a system response to ensure:

An effective early intervention system available to all GM residents in work who

become ill and risk falling out of the labour market

Early intervention for those newly out of work who need an enhanced health

support offer

Better support for the diverse range of people who are long-term economically

inactive

Development to enable GM employers to provide ‘good work’, and for people to

stay healthy and productive in work

4.2.14. Health and justice: GMHSCP and the GM Mayor have undertaken a first joint

procurement for two key services: an integrated Policy Custody Healthcare Service

and a Liaison and Diversion Service for Greater Manchester.

People of all ages who commit, or are suspected of a crime, will have a health

assessment while in custody and those with mental health, learning disabilities,

substance misuse or other vulnerabilities will be identified as soon as possible and

then supported to access appropriate services.

These two services have historically been commissioned separately, but by bringing

them together, service users will be supported faster, streamlining the way they are

assessed. The information gained will be shared with relevant Youth and Criminal

Justice agencies to enable more informed decisions on how to improve their

physical and mental health, with the aim to reduce reoffending.

4.2.15. Older people and Dementia: At least two-thirds of those with dementia will have a

formal diagnosis and access to appropriate post-diagnostic support. Unwarranted

variation in diagnosis rates and post-diagnostic support between localities in GM

16

will be reduced. By March 2020/21 people with suspected dementia can expect to

receive a diagnosis within 6 weeks from referral. By March 2020/21 people who are

newly diagnosed with dementia can expect to have a named coordinator of care, a

care plan, and at least one annual review of that care plan. Our objective is to make

GM the best place to live in the UK for dementia care.

Dementia United is the five-year, GM-wide dementia strategy and support

programme aligned to the Living Well with Dementia pathway. The direction and

support it offers will enable GM to meet the Dementia United standards, build on

work that is already taking place and develop a campaign and platform for

improvement. It will be delivered through key partnerships, listening to the voice of

people with dementia and those who care for them, and offering the opportunity to

have a ‘big conversation’ across GM.

Dementia United is made up of 4 work priorities designed to help localities improve

their dementia care.

Priority 1: Locality delivery – describes the delivery system within localities

Priority 2: Regional support – describes the regional support architecture

Priority 3: Intelligence – describes the infrastructure for intelligence

Priority 4: Innovation, research and evaluation

This structure gives GM a clear roadmap for what it wishes to achieve and marks a

move from focusing on diagnosis to focusing more broadly on the experience of

care, post-diagnostic support and health and social care utilisation.

Over the course of the five-year programme we expect to achieve 222,000 fewer

hospital bed days and 72,000 fewer permanent admissions to residential care as

people are supported to stay well and at home. We also want to see clear

reductions in the inappropriate prescribing of antipsychotic medication and fewer

demands on the police because people with dementia have gone missing.

5.0 THE APPROACH TO INVESTMENT

5.1. New models of care, health and social care integration and devolution all present

opportunities to improve how mental health services are commissioned and funded,

such as moving towards population-based commissioning and personal budgets.

However, the risks associated with ambitious new systems must be carefully

managed. A focus on mental health, and keeping up levels of spending, must be

maintained, despite the challenging financial circumstances.

5.2. The implementation of the GM MH strategy and the commitment to GM residents is

underpinned by significant additional transformation funding but this is not the only

investment in mental health services. GM transformation funding builds on both the

foundation of existing local investment in MH services and the ongoing requirement

– repeated in the 2016/17 NHS England planning guidance – for CCGs to increase

17

baseline investment by at least the overall growth in CCG allocations – and improve

Right Care outcomes. We should emphasise that this investment capability rests on

our having secured transformation funding and the strong financial management of

the GM system in ensuring that funds can genuinely be protected for

transformation. The reversal of that investment capability remains a constant threat.

5.3. Additionally, the implementation of locality plans will support the implementation of

new models of integrated care through Local Care Organisations (LCOs), and

locality ambitions to extend approaches to prevention, early help and asset and

community based approaches to improving health. In each case locality plan

investments will support our comprehensive mental health & wellbeing ambitions.

5.4. This blending of mainstream and GM Transformation Fund investment is essential

to maximise the shift in resources to improve MH. Through the commissioning

review we have also identified specific programmes where there is a clear rationale

for GM level co-ordination and delivery

The Mental Health Investment Standard and Delivery Priorities

5.5. The government has provided new monies into CCG baselines to support delivery

of the 5YFVMH. This new CCG investment is not seen in isolation and should not

be used to supplant existing spend or balance reductions required elsewhere but

will focus on delivering 10 local delivery priorities:

Expanded service capacity – with full implementation of new access and

waiting time standards for adult psychological therapy and Early Intervention in

Psychosis, with further standards for other mental health services over the next

five years

Extended access to psychological therapy services, especially for people with

long-term physical conditions (e.g. asthma and diabetes)

Expanded high quality all-age MH services – with a priority on CYP IAPT,

Community Eating disorder teams and eliminating Out-of-Area admissions and

placements for non-secure or non-specialist acute care

Delivery of key MH access and quality standards – Improved crisis care,

including the provision of 24/7 Crisis Resolution and Home Treatment (CRHT)

services in all local areas and liaison mental health services in community,

home & all general hospitals

Improved support for new mothers and fathers with mental health problems,

during pregnancy and in the year after giving birth

Better help for the physical health of people with a severe mental illness, for

example improved access to smoking cessation services

Doubling the provision of Individual Placement and Support for people using

mental health services who want help with employment

18

Reducing suicide rates

High rates of dementia diagnosis with adequate post diagnostic care and

support

Increased baseline-spend on MH and a ‘data and transparency revolution’ to

ensure better information is available about spending on mental health care in

local areas.

5.6. As the national planning guidance makes clear in a number of areas, successful

implementation of the 5YFVMH is dependent upon establishing services which are

sustainable for the long-term. That sustainability is predicated on evidence which

shows the savings realised across the health and care system outweigh the

investment needed to deliver services. In order to ensure that this fundamental

economic case is met, it will be critical for local organisations across GM to agree

how they will share both the costs of investment and the proceeds of savings and

efficiencies. This will include how savings will be identified, especially where they

accrue in other areas of the health system, and require reinvesting into mental

health services.

5.7. The majority of new funding over the period is included in CCG baselines to support

delivery of Local Transformation Plans and achievement of the 5YFVMH objectives.

Work to understand current GM locality investments in MH was carried out in line

with the national 5YFV planning guidance. All GM CCGs have confirmed planned

increases in MH funding 2017/18 at least in line with the required minimum

requirement of the Investment Standard – that is 2.8% average. This means that

they have committed to at least ensure a rise in MH investment in line with the

relative increase in CCG funding allocations. This represents the largest proportion

of investment in the standards and objectives outlined in this paper.

5.8. The specific required additional 5YFVMH funding has been profiled to increase

CCG allocations over time to support transformation and plan for recruitment of the

additional workforce required, as set out in the indicative table below.

Locality Committed Additional Baseline CCG Net Investment

(£ to support local ‘must do’ MH FYFV delivery options)

Investment Area 2017/18 2018/19 2019/2020 2020/21 Total

Bolton (10.1%) £1.516m £2.036m £1.952m £2.342m £7.846m

Bury (6.5%) £0.976m £1.311m £1.256m £1.507m £5.049m

HMR (8.0%) £1.201m £1.613m £1.546m £1.855m £6.214m

19

Manchester (21.1%) £3.167m £4.254m £4.077m £4.892m £16.391m

Oldham (8.1%) £1.216m £1.633m £1.565m £1.878m £6.292m

Salford (9.5%) £1.426k £1.915m £1.836m £2.203m £7.380m

Stockport (10.0%) £1.501m £2.016m £1.932m £2.319m £7.768m

Tameside & Glossop

(8.3%)

£1.246m £1.674m £1.604m £1.924m £6.448m

Trafford (7.4%) £1.111m £1.492m £1.430m £1.716m £5.748m

Wigan (11.0%) £1.651m £2.218m £2.126m £2.551m £8.545m

Total Planned and

Committed

Investment

£15.011m £20.163m £19.323m £23.187m £77.683m

5.9. To support implementation of the National Operating Model related to this additional

CCG baseline investment, NHS England has now developed a MH delivery plan.

This aims to provide a comprehensive overview of delivery activities for 2017/18, to

clarify key responsibilities across the system, and to provide a clear timeline for

implementation. Please see Appendix 4 for further information on this.

5.10. If we are to secure and maintain the benefits of this additional investment, each

locality much establish an aligned commissioning plan for mental health as part of

their locality plan and delivered through their Single Commissioning Function. Local

council services have a vital role in improving mental health support. Social care is

a key component of mental health care in all local areas, including in the operation

of the Mental Health Act. Public health and early-years services help to prevent

mental ill health and ensure children have the best start in life, for example through

commissioning evidence-based parenting programmes. Drug and alcohol services

are also crucial because a large proportion of people with substance misuse

problems also have poor mental health.

5.11. However, local government pressures are seen as a key risk to meeting the

aspirations in this report. There is a currently a lack of detailed information on the

investment and disinvestment decisions taken in relation to mental health over

recent years. This is a feature of fragmented commissioning which the

establishment of the Single Commissioning Functions being established in each

locality are clearly intended to avoid in future. However, in order to move forward

we must understand and progress from the recent past.

20

5.12. As a result, work has been initiated to understand the recent change in GM local

authority investments in mental health over recent years. It is acknowledged that

overall the pressure on social care funding budgets has been very challenging.

While this work requires further analysis, it is clear from a provisional analysis that

across GM Councils returns on average since 2014/15, there has been:

Significant reduced net expenditure in CYP MH services – approximately 30%

Increased net expenditure in Adult MH short and long term services –

approximately 15% - and at least one council reporting reduced expenditure

5.13. However, it is important to recognise that pressures on more generic budgets often

have a disproportionate effect on those suffering mental ill health. For example,

reductions in available supported accommodation, residential care and help at

home services. As LAs have had to restrict eligibility criteria for care and support

due to affordability, MH Providers are also reporting increasing pressures on NHS

services. This represents significant risks to achieving improved mental health and

wellbeing in GM. We will support more joined up and transparent commissioning to

minimise unexpected consequences of individual organisational decisions across

the health and social care system.

5.14. The development of GM Locality Plans provides the opportunity to agree an

approach between partners to achieve the ambition of the GM MH and Wellbeing

Strategy. As such, the journey to fully transform mental health services – as the

5YFVMH states – should be thought of as longer than a five-year programme. This

roadmap prioritises objectives for delivery by 2020/21 and therefore describes the

next stages in that journey whereby locality matched commitments for additional

investment in MH enables access to GM Transformation Funds.

GM Transformation Funding

Locality TF Envelope to deliver 5YFVMH and locality objectives

5.15. A financial contribution within the Transformation Fund envelope exists to be

distributed to localities to support their local mental health objectives. This element

recognises the differential starting positions across localities and introduces an

opportunity for a degree of flexibility and, potentially, innovation. It has been

identified that activities related to 24/7 Community-based Access & Crisis Care

(Adults) and Integrated IAPT are most suitable to be considered for delivery at a

locality level first. If it is later considered that these are delivered at GM cluster-

level, MH Trust provider or GM-wide level, these can be reviewed.

5.16. Further engagement with localities will be to identify mental health investment

baselines for locality-led activities, planned increases in investment and

commitment to delivering the GM MH strategy and 5YFVMH. This process will also

highlight locality variations in planned and matched increases in mental health

investments over time and support localities with refreshing their locality plans and

programme budgeting over the coming years.

21

5.17. Within the available envelope for additional TF investment for locality-led activities,

each locality will receive a fair, population based, share of the TF monies

attributed to this element of the programme. This resource will be released on

submission of an agreed locality mental health plan which details the

objectives, the application of the new delivery model within the LCO and a

confirmed Single Commissioning Plan between the CCG and Local Authority.

For more information on the approach to implementation, please see section 8.

GM Coordinated Programmes of Work to be delivered through other Transformation

Fund Work Streams

5.18. In the first instance we must recognise that Transformation Funding which supports

a number of the objectives in the GM MH and Wellbeing Strategy has already been

committed. These often speak to our Public Service Reform and Population Health

ambitions and include:

Suicide Prevention

Work & Health

Dementia United

Health & Justice

5.19. The summary investment associated with each programme is presented below. It is

intended that they will be delivered through other programmes within the Health and

Social Care Partnership with links to MH Programme governance.

22

GM Coordinated Programmes of Work to Deliver 5YFVMH and GM MH Strategy

5.20. The specific mental health Transformation Fund proposition proposes TF

investment to accelerate GM MH performance and outcomes across localities

through GM Wide Co-ordinated programmes where there is a clear rationale for

joint action and GM level application (for example where limited or variable or where

there is an economy of scale which can be achieved).

23

6.0 GM COMMISSIONING REVIEW: IMPLICATIONS FOR MENTAL HEALTH

6.1. Deloitte were commissioned by the GMHSCP to undertake a review of health and

social care commissioning across GM building on the work of Commissioning for

Reform publication. The scope of the Deloitte commissioning review included:

Designing a truly place-based approach to public service reform, with

investment led commissioning at its heart;

Defining the support provided by the services commissioned at the GM spatial

level;

Designing a framework for responsive and effective commissioning support

services in the context of the new commissioning landscape.

6.2. The outcome of the review described a streamlined landscape of 2 main

commissioning levels. These are:

Locality level: LAs and CCGs come together to form a single, small and strong

Strategic Commissioning Function (SCF) with a broad set of responsibilities

across public services (including mental health). The SCF is seen as

responsible for setting the commissioning and place-based strategy and

leading on local growth and economic reform policies.

http://www.gmhsc.org.uk/assets/GM-Partnership-Commissioning-Strategy-FINAL-web.pdf

http://www.gmhsc.org.uk/assets/GM-Partnership-Commissioning-Strategy-FINAL-web.pdf

24

GM level: The Joint Commissioning Board (JCB) taking on a formal role in the

commissioning and contracting of services, including those previously

commissioned by NHS England regional commissioners such as specialised

mental health services. The JCB would also then develop common standards,

model specifications, and outcome frameworks for all key services; so that

SCFs can commission services in a more uniform way across GM and through

the support of a GM Commissioning Hub, discharging agreed specialist

commissioning functions on behalf of CCGs, LAs and NHS England.

6.3. For a diagram of the proposed MH commissioning framework, please see Appendix

2.

6.4. Impact on commissioning of MH services in GM

6.4.1. For GM MH commissioning, the locality level will remain the core building block,

with locality-integration happening around coterminous LA and CCG boundaries to

incentivise public service mental health reform on a locality basis. It will be at this

level that the single Health and Social Care Operational Commissioning function will

be actioned to hold the new provider models to account for the outcomes localities

seek. MH commissioning decisions will predominantly be taken at locality level by a

single Strategic Commissioning Function (SCF).

6.4.2. The proposed GM Commissioning Hub has a key opportunity to support mental

health commissioning in relation to an agreed set of collaborative commissioning

priorities for mental health. We envisage a small and strategic unit, with the

transactional costs of commissioning reduced through formally releasing agreed

sessions of locality commissioner resource to act as GM strategic leads for

particular work areas. It is also intended that there will be Operational Leads to

support Strategic Commissioning Leads. This is to ensure co-production with

providers using resource from the current MH workforce. This approach maximises

the expertise and resources available and drives efficiency, with reduced need to

recruit additional staff.

6.4.3. MH commissioners across GM will have the opportunity to formalise their existing

commitment to joint working as part of the new framework of collaborative

commissioner and provider network meetings.

6.5. Changing the approach to contracting for MH

6.5.1. We will seek to ensure the best spend of the GM funding through improving

financial and clinical sustainability by changing contracts, incentives, integrating and

improving IT & investing in new workforce roles. By shifting away from simplistic

block contracts, it would significantly improve our intelligence on spend, activity and

outcomes.

6.5.2. A key stage on this journey is the move to Service Line Reporting (SLR) for mental

health. SLR provides data on financial performance, activity, quality, and staffing. It

enables us to plan service activities, set objectives and targets, monitor a service’s

financial and operational activity, and manage performance.

25

6.5.3. SLR is a critical first step to more comprehensive approaches to support outcomes

or value-based commissioning and provide the insight to inform new incentives to

drive change. We will ensure the specific MH payment and contracting changes are

considered through the GM Incentivising Reform work to support this objective.

7.0 MAXIMISING DIGITAL CAPABILITIES TO IMPROVE GM MENTAL HEALTH

7.1. Transforming our use of digital is a key enabler to the delivery of the GM ambition

for improving health and social care. The GM H&SC Partnership adopted an

information management and technology strategy in June 2016. To support the

delivery of the strategy a Digital Collaborative has been established and priority

areas of work identified. The priorities laid out in the strategy are based on ensuring

that as a whole system we have the right information available to the right people at

the right time, supporting the delivery of care.

7.2. GM is currently negotiating a Digital Transformation fund with NHS England and the

Department of Health. This will sit alongside our wider GM Transformation Fund to

ensure we are optimising the use of digital technology in improving services. This

fund will support the delivery of locality plans as well as GM wide priorities such as

the implementation of an information exchange (secure online system providing a

single place for the exchange of information) and information governance.

7.3. Mental health, as with other service areas, will be a key area of focus for the Digital

Strategy and related Transformation Fund. In order to optimise the use of

technology in mental health we need a clear understanding of our current position

across our main providers with a view to optimising our existing systems across

pathways of care. Some of this information already exists through a national digital

roadmap exercise that has been undertaken. However, this is now out of date and

focused primarily on the acute environment rather than a whole system of care. We

are looking to build on this initial work to gain a fuller understanding of how we can

optimise the use of digital in the delivery of mental health and wellbeing services.

This will include a number of steps:

Clarifying our goals in relation to digital for mental health;

Assessment of our current state;

Identifying existing common technology and good practice;

Identify target improvements;

Clarify investment requirements and priorities for bridging the gap.

8.0 APPROACH TO IMPLEMENTATION

8.1. The programme will transition into implementation phase at pace once the overall

financial investment against the GM MH & Wellbeing strategy has been formally

26

ratified. The initial objectives will be to develop the locality mental health plans,

single commissioning intentions and business cases for the pan-GM projects.

Locality-led activities and transformation funding

8.2. Within the available envelope for additional TF investment for locality-led activities,

each locality will receive a fair, population based share of the TF monies

attributed to this element of the programme. Further engagement is planned

with each locality to fully understand their current financial investment in MH and

the maturity of planning for or current service provision for adult urgent and crisis

care, integrated IAPT and primary care RAID. This resource will be released on

submission of an agreed locality mental health plan which details the

objectives, the application of the new delivery model within the LCO and a

confirmed Single Commissioning Plan between the CCG and Local Authority.

The agreement underpinning this aspect of the Locality Plan will be an

addendum to each locality Investment Agreement and progressed and

monitored as part of the wider transformation.

8.3. The intention is to undertake this piece of work over a three month period, with the

ultimate objective of having a clear view of what is their current position in terms of

service provision across these key elements of MH. Subsequent funding allocation

to the localities will support them in delivering the key themes and allow them to

operate from a sound position by which they are able to deliver their 5YFVMH and

GM MH strategy aspirations.

8.4. The MH programme team will ensure that across the three workstreams there will

be appropriate scrutiny and delivery assurance to ensure the realisation of benefits

remains firmly on track across the programme life cycle. The assurance process will

have rigour via both the MH Programme Board (balance scorecard, benefits

realisation review etc.) and quarterly locality assurance meetings. There is also an

expectation that regular updates on the progress of the MH programme are brought

to SPB level.

GM-wide coordinated activities and transformation funding

8.5. Once the business cases for the pan-GM projects are developed (which will include

financial, resource and benefits profiles), they will be assessed to ensure their

potential to successfully deliver. This will be undertaken via the existing TFOG

(Transformational Fund Oversight Group) process which will apply the necessary

scrutiny to the individual business cases.

8.6. The consensus within the senior MH programme team is that the Partnership will be

in a position to instigate the transformational fund process for each one of the pan-

GM projects in September/ October 2017.

8.7. The timelines for implementation for the other two key workstreams are not defined

at present. We anticipate that significant additional work is required before we will

be in a position to move into implementation for both of these workstreams. Further

27

discussion is required with the Population Health programme to agree the scope

and delivery of the work on suicide prevention.

Risk framework

8.8. There are a number of potential risks and barriers by way of which the delivery of all

the core workstreams could be fundamentally undermined, the following are some

of the key ones that need to be reviewed and subsequently managed as part of

programme delivery to ensure they are fully mitigated against:

Control of specialised commissioning; by delaying the delegation of

responsibility for specialised commissioning to GM this creates unnecessary

risk on projects such as ithrive, where the scope for efficiencies are significantly

reduced. The integration of care pathways around the individual and not

fragmented by commissioner provides the rationale for that delegation. More

significantly it invites us to rebalance investment across that pathway to support

prevention and early help and avoid the development of crisis. We believe this

is an essential means of controlling spend in expensive specialist services

through better co-ordination and greater investment in preventative and early

intervening services.

The financial pressures in the system that we currently face are unprecedented

and this could potentially result in further investment reductions by localities in

MH as pressures to realise efficiencies drive out service transformation

investment. In GM, due to our financial performance to date, we have been

able to avoid such a scenario; however, if not effectively managed, this may

well be a key risk we face system wide in GM.

Digital: we need to acknowledge that some parts of GM are starting from very

low base in terms of the maturity of their systems infrastructure, which

undermines the core process which we are aiming to instil. To mitigate this risk

there is an urgent need for access to the national TF digital funding, which will

allow for the required systems development to take place.

Mental health programme governance

8.9. To facilitate the delivery of the three work streams, an updated programme and

governance structure has been developed. It has been structured to ensure that the

all the key stakeholders are suitably engaged within the appropriate forums. The

proposed governance framework will allow for efficient reporting flows between the

various forums and what we anticipate will be a streamline and effective decision

making model. However, the governance structure will be monitored to ensure it is

working efficiently and facilitating programme delivery.

8.10. The design of the governance model has been established to allow for the many

stakeholders involved in the MH programme to have a voice that will be both heard

and acted upon. For example, in the structure the patient, carer and public group

underpin all the work that is being undertaken within the programme, so they have a

real influence across the portfolio of work.

28

8.11. Projects within the MH programme will be designated into four key themes with a

Projects Oversight Board attached to each one. They are:

Children and Young People’s Mental Health (CYP MH)

Adult Mental Health

Population Health

Dementia

This approach will allow for Project leads and subject matter experts working on

related projects (for distinct populations groups) to come together in one place. It is

recognised that there will also need to be strong links between each of these

Projects Oversight Boards via the MH programme so that interdependencies of the

different works areas are well managed. For example, it is proposed that perinatal

mental health work will report into the CYP MH Board but this will need to be

brought into the Adult MH Board also.

8.12. The delivery of each of the four themes and the Projects Oversight Boards will be

chaired by senior leads from within the system. The assumption is that these chairs

will be able to impart their experience and knowledge to successfully steer the

projects within the remit of their individual Boards. These Boards will be facilitated

by a GM wide improvement collaborative that will provide insight and

recommendations in relation to the various projects across the four themes.

8.13. Assurance of benefits realisation will be provided by a series of senior Boards,

namely the MH Programme Delivery Board. This Board will include system leaders

that will monitor delivery and provide invaluable feedback to project leads to ensure

delivery of benefits remains on track. Reporting will also be undertaken at Boards

across the wider system, including:

Provider Federation Board

GMCA

Association of GM CCG’s

8.14. To support the delivery of the MH programme, it is also proposed that a senior level

programme team meeting is established (led by the MH Senior Responsible Owner

and involving senior managers from the Strategic Clinical Network). In addition, an

operational delivery team meeting will be set up which will include individual project

leads and any co-opted functional leads (for example finance and workforce

colleagues). Both of these meeting groups will be linked by the core MH programme

team (the MH Programme Manager and Head of Cross-Cutting Programmes) who

will attend both meetings.

29

8.15. Please see Appendix 3 which provides a diagram of the proposed governance

architecture to ensure the successful implementation and delivery of the delivery of

the MH Programme.

9.0 RECOMMENDATIONS


Note the progress which has been made against the GM mental health strategy

over the past year;

Agree the proposed mental health transformation areas and the investment

framework providing an overall envelope of £133.9m;

Support the onward process to work with localities to support their local

investment and transformation plans for mental health;

Support the onward process to develop business cases against which

transformation funding for the GM mental health programmes can be allocated;

and

Support the further work to apply the findings of the GM Commissioning

Review to the future commissioning of mental health in localities and across

GM.

30

APPENDIX 1:

MENTAL HEALTH PERFORMANCE IN GM

a. Nationally monitored performance metrics for mental health related to delivery of the 5YFVMH do not tell the whole story of how

we could and should measure progress on our mental health ambitions. However, they provide useful indicators around service

access for GM residents. Nationally measured performance metrics include:

waiting times and recovery for Increasing Access to Psychological Therapies (IAPT);

patients with suspected psychosis starting treatment within 2 weeks of referral to support Early Intervention in Psychosis

(EIP);

waiting times for Children and Young People (CYP) accessing treatment for Eating Disorders (ED);

diagnosis rates for Dementia.

b. As an area, GM exceeds the national access target to IAPT services (1.25%), achieving 1.40% access levels on aggregate

across the area (based on national data for Q3 2016/17, published February 2017). However, achievement of the recovery rate

of 50% across GM is variable but improving. For EIP, GM has succeeded in achieving above the national performance target for

early access to treatment, although there are concerns around whether treatment always meets the NICE recommendations for

care. There are also particular pressures sustaining current levels of performance, with EIP teams under growing pressure as

referrals continue to increase. In terms of CYP accessing treatment for ED, average waiting times across GM are reducing

although there has been variation in achieving the 1 week and 4 week waiting time targets. Dementia diagnosis rates have been

consistent across GM for the last 2 years at 67%. This is above the national target of 50%.

31

c. Urgent and emergency mental health care across GM has improved as a result of ongoing work to implement the principles set

out in the Crisis Care Concordat. Plans to establish a health based Place of Safety for the city of Manchester and appropriate

facilities for children and young people across GM who experience mental health crisis are in development. In addition, there is a

need to significantly reduce inappropriate Out of Area Placements/ Treatment (OAP/ OATs). This problem largely affects

residents from the City of Manchester area. OAP/ OATs have a significant impact on outcomes for people experiencing severe

mental health problems and are also of high cost to the health and social care system. It is also imperative that psychiatric

intensive care unit (PICU) facilities for women are reviewed to ensure there is sufficient provision.

d. Historically Mental Health services across GM have been commissioned on a block contract basis across several CCG’s, Local

Authorities, and a range of NHS England contracts and associated contracts. A number of these contracts include indicative

activity targets against which performance is monitored. Currently the focus is on activity based targets meaning reliable MH

outcome data has been difficult to obtain. A number of commissioner led initiates are taking place across GM to shift towards an

outcomes-based commissioning approach for MH.

e. Data quality continues to be a priority area for improvement with continuing discrepancies between the data submitted via Unify

and the data published by NHS Digital from the Mental Health Services Dataset (MHSD). Where required Provider Trusts are

reviewing how the MHSD is populated and have robust action plans to address any gaps during 17/18. The issue of discrepancy

between the two datasets is not limited to GM: there are a significant number of trusts across the country where there is a similar

or even greater discrepancy between Unify and the MHSD; historic low levels of investment in electronic patient records systems

has also played a contributory factor in terms of the ability to collect large amounts of data accurately.

f. There are also issues with the completeness of our understanding on mental health provision in GM because of the limited data

that is available from across the wider system (for example, in the Third Sector), which have limited digital capability to support

systematic data collection. However, this challenge is a national one and not unique to GM.

g. NHS England are expecting all areas (through Sustainability & Transformation Plans) to address these data issues over the

coming years and further develop their own quality and outcome frameworks to measure performance across a range of health

issues, including MH. This process of measuring MH system performance will be facilitated by CCG initiatives to unpick MH

multilateral block contracts currently based on activity rather that outcomes. Importantly, a quality and outcomes framework will

http://16878-presscdn-0-18.pagely.netdna-cdn.com/wp-content/uploads/2014/04/36353_Mental_Health_Crisis_accessible.pdf

32

need to bring in data from the wider health and social care system and link with broader outcomes, for example employment,

increased wealth and housing. This will provide a more complete picture of how mental health improvements and transformation

in GM are contributing to improved population outcomes for its residents.

h. The GMHSCP has been developing an early version of a MH performance dashboard. It seeks to extend beyond access and

waiting time KPIs to better reflect people’s experience of care and the wider drivers of underperformance. It includes a wide

range of performance and outcome metrics. It covers IAPT, EIP, ED, Memory Assessment Services and Dementia Diagnoses,

MH service users family and friends test recommendations, numbers of Out of Area Placements (OAPs), waiting times for

Healthy Young Minds assessment and treatment, use of section 136 and a number of additional performance metrics related to

people receiving MH inpatient care. It is populated with validated local data from the 3 MH provider Trusts in GM (NW Boroughs,

GM Mental Health and Pennine Care).

i. An advantage of using local data returns to assess MH performance across GM is that data is available much more quickly

compared to nationally collected performance data, which can take between 3-9 months to be released. Using this local data has

enabled identification of early performance trends ahead of the release of nationally validated data. However, national data does

have the advantage of having greater completeness and being subject to more robust validation.

j. Next steps to further develop the MH performance dashboard will be to link in with system performance dashboard development

work being undertaken by the GMHSCP Performance and Assurance team. It will also need to link into the development of a

wider system performance dashboard being developed by the GMCA and ongoing work to look at how devolution of health and

social care in GM is effectively evaluated. The MH performance dashboard must continue to evolve in alignment with national

performance measurement for mental health.

k. Please see below for illustration of the mental health performance metrics framework developed so far.

33

MENTAL HEALTH PERFORMANCE METRICS FRAMEWORK

SERVICE KPI Target Reported asIn month

actual

In month

Target

3.75%Cumulative

Qtr. Jan, Feb,

Mar) 3.81% 5.06% 3.33%

1.95%

target 4.13% 7.66% 3.58%

158/733 201/348 120/276 265/436 102/181 100/193 67/124 102/202 116/193 534/954

21.56% 57.76% 43.48% 60.78% 56.35% 51.81% 54.03% 50.50% 60.10% 56.00%

204/749 310/364 246/303 419/475 166/185 166/197 111/138 174/209 192/205 997/997

27.24% 85.16% 81.19% 88.21% 89.73% 84.26% 80.43% 83.25% 93.66% 100.00%

582/749 364/364 300/303 466/475 184/185 196/197 135/138 207/209 205/205 997/997

77.70% 100.00% 99.01% 98.11% 99.46% 99.49% 97.83% 99.04% 100.00% 100.00%

93/96 80/104 78/104 89/89 49/49 158/158 85/90 65/70

41.50% 96.88% 76.92% 75.00% 100.00% 100.00% 100.00% 94.44% 92.86%

33/37 31/41 16/21 10/17 15/18 9/10 8/15 12/28 18/24

89.19% 75.61% 76.19% 52.82% 83.33% 90.00% 53.33% 71.43% 75.00%

0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

59/60 38/46 84/99 122/129

98.33% 82.61% 84.85% 73.00% 96.00% 96.00% 97.00% 88.00% 95%

261/267 110/110 136/138 82/83 70/70 41/43 49/50 52/56 60/61 153/161

97.75% 100.00% 98.55% 98.80% 100.00% 95.35% 98.00% 92.86% 98.36% 95%

1 2 1 0 9

126 4 18 4 0

12630/12420 3907/3780 4242/4242 3993/3870 3563/3737

101.69% 103.36% 100.00% 103.18% 95.00%

3301/3600 1123/1350 1414/1350 913/900 1967/2093

91.69% 83.19% 104.74% 101.44% 94.00%

1664/1620 580/540 730/720 539/540 653/681

102.72% 107.41% 101.39% 99.81% 96.00%

Average Length of Stay by:

Adult 114 45 40 59 15 20 17 16.6 31.4 21

Older Adult 107 66 47 55 70.70 32.5 45 36.70 31 78

Organic 0 52 94 87

PICU 75

Greater Manchester Mental Health (NHS Provider) Performance : Q4/March 2017 Stockport ( PCFT) WiganManchester Bolton Salford Trafford Oldham T&GHMR BURY

CCG Target CCG Target CCG Target

CCG Target CCG Target

6 weeks - Completed Treatment 75% Quarterly

IAP

T

Prevalence

CCG Target

CCG TargetCumulative

Qtr. (Jan, Feb,

Mar)

Recovery50% per

MonthQuarter

CCG Target

MA

S

Referral to Diagnosis 12 weeks 80% per

Quarter

Cumulative

Qtr.

(Jan,Feb,Mar)

18 weeks - Completed Treatment 95% Quarterly

EIP Patients with suspected psychosis must been

seen within 2 weeks of referral

50%per

QuarterCumulative

(Jan,Feb,Mar) N/A

N/A

GA

TE-

KEE

PIN

G Admissions to adult facilities of patients who

are under 16 years old 0 In month

% of discharges from inpatient wards on CPA

Followed-up within 7 days95% Cumulative Qtr.

FFT Mental Health service users Friends and

Family Test - recommendIn month

N/A

Out of area placements- OAPs appropriate

and inappropriate

Additional Bed Occupancy by:

Adults

Older People

PICU

Cumulative

Qtr.

number of appropriate OAPS

placed in quarter period

Data under development

Data under development

Monthly

Does not

include out of

area LOS

number of inappropriate

OAPS placed in quarter

period

34

SERVICE KPI Target Reported as

21 18 8 42 45 43 40 55 11

A& E Following a referral to mental health

services the percentage of patients who see a

mental health practitioner within one hour of

referral

75% Monthly 79.85% 80.41% 72.00% 98.55% 53.00% 53.00% 53.00% 53.00% 62.00%

Data under

develop-

ment

A&E Following a referral to mental health

services the percentage of patients who see a

mental health practitioner within two hours

of referral

95% Monthly 91.03% 92.27% 82.00% 100.00% 86.00% 86.00% 86.00% 86.00% 80.00%

Data under

develop-

ment

% of patients discharged from A&E within 4

hours 95% Monthly 48.70% 94.65% 100.00% 100.00% 91.70% 91.70% 91.70% 91.70% 88.75%

Data under

develop-

ment

Readmissions : Percentage of patients

readmitted within 30 days of discharge 10%

Number in

quarter

period8.86% 10.43% 14.12% 7.40% 12.70% 12.70% 12.70% 12.70% 9.40% 9.00%

Unexpected DeathsNo in quarter

period 10 18 8 11 8 14 12 13 17

194/194 108/109 116/121 58/58 114/114 96/96 112/112 123/124 193/193

100.00% 99.08% 95.87% 100.00% 100.00% 100.00% 100.00% 99.19% 100.00%

N/A 357 219 181

94.30% 96.11% 95.55% 97.02% 94.60% 94.60% 94.60% 94.60% 94.60%

57/86 99/100 65/94 26/31 33/33

N/A N/A N/A N/A 66.30% 99.00% 69.10% 83.90% 100.00%

85/86 99/100 88/94 28/31 33/33

N/A N/A N/A N/A 98.80% 99.00% 93.60% 90.30% 100.00%

1/1 1/1 1/2

N/A N/A N/A N/A 100.00% 100.00% 50.00%

2/2 1/1 1/1 4/4 3/4

N/A N/A N/A N/A 100.00% 100.00% 100.00% 100.00% 75.00%

The proportion of CYP with ED (routine cases)

that wait 4 weeks or less from referral to start

of NICE-approved treatment.

95% Mar

EATI

NG

DIS

OR

DER

S

The proportion of CYP with ED (urgent cases)

that wait 1 week or less from referral to start

of NICE-approved treatment.

95% Mar

Treatment within 18 weeks 98% MarHEA

LTH

Y

YO

UN

G

MIN

DS First contact within 12 weeks 95% Mar

Bolton Salford

Section 136 number / 100,000 CCG 18+

populationNew Economy have supplied separate figures

Greater Manchester Mental Health (NHS Provider) Performance : Q4/March 2017 Manchester Trafford HMR

Patients requiring acute care who received a

gatekeeping assessment by a crisis resolution

and home treatment team in line with best

practice standards

95%Cumulative

Qtr.

Number of level 4 & 5 Incidents / 100,000 18+

population

Number in

quarter

period

Not available

BURY Stockport ( PCFT) T&G Oldham Wigan

Home Based Treatment Services- Treatment

episodes (ref + 2 contacts)

Number

treatments in

quarter

period

CPA Reviews in 12 Months 95%Number in

quarter

period

35

APPENDIX 2: COMMISSIONING FRAMEWORK IN GM FOR MENTAL HEALTH

36

APPENDIX 3: DRAFT MEW GOVERNANCE STRUCTURE FOR THE GM MENTAL HEALTH PROGRAMME

37

APPENDIX 4: NHS ENGLAND MENTAL HEALTH DELIVERY PLAN OBJECTIVES

2017/18

Children and Young People’s Mental Health Perinatal Mental Health Adult Mental Health: IAPT Adult Mental Health: Community, Acute and Crisis Care

Key Planning Guidance Deliverables: 17/18 • At least 30% of CYP with a diagnosable MH condition receive treatment from an NHS-funded

community MH service. • Commission 24/7 urgent and emergency mental health service for CYP and ensure submission

of data for the baseline audit in 2017. • All services working within the CYP IAPT programme. • Community eating disorder teams for CYP to meet access and waiting time standards: All

localities expected to baseline current performance against the new standard and start measurement against it.

Full FYFVMH Deliverables: 17/18 • Reduce the number of out of area placements for CYP and use of in-patient beds overall. • Mobilisation and implementation of the recommendations from the Tier 4 CAMHS review. • Monitor outcomes and progress in the new Crisis Care service models for CYP, in line with the

wider Crisis Care pathway.

Key Planning Guidance Deliverable: 17/18 • Increase access to evidence-based specialist perinatal mental health care: regional plans and

trajectories in plan to meet national ambition of 2,000 additional women accessing care. • Commission additional or expanded specialist perinatal mental health community services to

deliver care to more women within the locality. Full FYFVMH Deliverables: 17/18

• Build perinatal MH capability by developing a competence framework describing the skills needed in the workforce.

Key Planning Guidance Deliverable: 17/18 • Commission additional psychological therapies for people with anxiety and depression, with the

majority of the increase integrated with physical healthcare, so that at least 16.8% of people with common MH conditions access psychological therapies.

• Ensure local workforce planning includes the numbers of therapists needed and mechanisms are in place to fund trainees.

Full FYFVMH Deliverables: 17/18 • Up to £54 million in 2017/18 will go directly to training new staff and delivering new ‘early

implementer’ integrated services. Remaining funds in 2017/18 will support further training, quality improvement and expansion of current IAPT services.

• Increase the number of employment advisors in IAPT through funding, monitoring and reporting on Employment Advisors in the IAPT project.

Key Planning Guidance Deliverable: 17/18 • Expand capacity so that more than 50% of people experiencing a first episode of psychosis

start treatment within two weeks of referral with a NICE-recommended package of care. • Commission effective 24/7 CRHTTs as an alternative to acute in-patient admissions. • Reduce the number of OAPs for non-specialist acute care: localities plans in place to eliminate

appropriate OAPs by 2020/21. • Deliver integrated physical and mental health provision to people with SMI, in line with national

ambition of 140,000 people with SMI receiving a full annual physical health check. • Assure that service development plans are in place to meet ambition of all acute hospitals with

all-age liaison services by 2020/21 and 50% meeting Core 24 service standard for adults; assurance of successful Wave 1 bidders plans.

• Increased access to IPS: insure preparedness for IPS expansion; STP areas selected for targeted funding.

38

Suicide Prevention Older People and Dementia Secure Care, New Care Models and Health and Justice Infrastructure, Finance

Planning Guidance Deliverables: 17/18 • Reduce number of suicides compared to 2016/17 levels in line with national ambition to

reduce suicides by 10% by 2020/21: delivery of local implementation support which includes action to deliver the requirement that all local areas have local multi-agency suicide prevention plans by the end of 2017.

Full FYFVMH Deliverables: 17/18 • Support learning from suicides and preventing repeat events. • Contribute to the annual multi agency suicide prevention plans review, led by PHE. • Participate in the Prevention Concordat programme which will support the objective that all

local areas have a prevention plan in place.

Planning Guidance Deliverables: 17/18 • CCGs continue to work towards maintaining a dementia diagnosis rate of at least two-thirds of the

estimated number of people with dementia. • Increase the number of people being diagnosed with dementia, and starting treatment, within six

weeks from referral; with a suggested improvement of at least 5% compared to 2015/16.

Full FYFVMH Deliverables: 17/18 • Monthly reporting of diagnosis rate. • Update dementia extract. • Reduce variation between geographies.

Full FVFVMH Deliverables: 17/18 • Developing early stage regional plans for roll out of forensic community services. • Deliver community based alternatives to secure inpatient services such that people requiring

services receive high quality care in the least restrictive setting. • £36 million funding to support the Secure Care objective held centrally from 2017/18, allocation

to specific localities will be determined through a bidding process. • 75% of population with access to liaison and diversion. • Support learning from suicides and preventing repeat events. • 6 NCM sites chosen, going live in 2017 and supporting to delivery local services.

Planning Guidance Deliverables: 17/18 • Ensure data quality and transparency: ensure that providers are submitting a complete

accurate data return for all routine collections; development of quality and outcomes measures in line with national guidance; engage with CCQ in relation with EBTPs.

• Increase digital maturity in mental health in line with the national guidance. • Increase baseline spend on mental health to deliver the Mental Health Investment Standard.

Full FYFMH Deliverables : 17/18 • Ensure that MHSDS is delivering relevant, timely and accurate data. • Support delivery of national payment system, CQUINs and Quality premium schemes. • Support finance collections, including on programme lines of spend. • Develop a new annual schedule of updates to the MHSDS will allow NHS partners to work

together. • Development of oversight and assessment frameworks.

1


Date: 28 July 2017

Subject: Tobacco Free Greater Manchester Strategy

Report of: Sarah Price, Executive Lead, Population Health and Commissioning, GMHSC

Partnership

SUMMARY OF REPORT:

The Tobacco Free Greater Manchester Strategy sets out our ambition to reduce

smoking in our population by one third by 2021. This will result in 115,000 fewer

smokers, supporting a tobacco free generation and ultimately helping to make

smoking history.

Ambitions within the strategy take account of targets within the newly published Towards a

smoke-free generation: tobacco control plan for England. This will allow us to close the gap

with smoking prevalence in England, reducing inequalities and saving thousands of lives and

millions of pounds.

KEY MESSAGES:

We are learning from best practice in tobacco control locally in Greater Manchester, the UK

and globally to bring the very best evidence and innovation to our delivery. Stakeholder

engagement will continue through to September, with plans to launch a public conversation

to engage communities later in the summer.

Localities will continue to deliver local tobacco control and local stop smoking support which

is reducing smoking prevalence year on year. The aim of the tobacco control strategy is to

significantly accelerate the current rate of decline. Implementation planning is underway

involving a wide range of existing stakeholder groups and forums and specific task groups

with governance provided through the GM Population Health Programme Board. The VCSE

sector is a key partner due to their reach into the communities and priority groups outlined in

the strategy. Empowering individuals, families and communities to make smoking history

together across our conurbations in Greater Manchester can break an intergenerational

cycle of smoking in our poorest communities.

Detailed delivery planning will run through to September. A range of initiatives is planned for

implementation from September 2017. For example, this will include new and better help for

8

2

smokers who want to quit through a GM wide digital support offer. Piloting and evaluation of

an initiative with social housing providers and their tenants is also planned for Stoptober.

A business case for transformation funding alongside external funding cases will be part of

the population health strategic investment case which will be reviewed in September. An

evaluation and performance monitoring framework is in development for the strategy with

PHE and CRUK with outcome metrics/ interim milestones - both locality and GM.

PURPOSE OF REPORT:

The embedded document (Making Smoking History) sets out a tobacco control strategy for

Greater Manchester, taking into account Taking Charge in Greater Manchester and the

Greater Manchester Population Health Plan and the Greater Manchester cancer strategy,

Achieving world-class cancer outcomes: taking charge in Greater Manchester 2017-2021. A

shortened public friendly version of this strategy has also been produced for publication to

support engagement and is embedded here. The strategy documents describe our vision

and ambitions and an evidence based framework for how these will be achieved.

RECOMMENDATIONS:


Endorse the Tobacco Free Greater Manchester strategy.

CONTACT OFFICERS:

Jane Pilkington, Deputy Director Population Health, GMHSC Partnership [email protected]

Andrea Crossfield, Tobacco Strategic Lead, GMHSC Partnership [email protected]

https://greatermanchester-my.sharepoint.com/personal/jessicaowen_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0361b9869f7194329a241364af1cac3ac&authkey=AXYeszan5tJbUK81SwvJUT0

https://greatermanchester-my.sharepoint.com/personal/jessicaowen_gmhsc_org/_layouts/15/guestaccess.aspx?docid=073d21f9755f9416ba97dd9c038d396a0&authkey=AT5yGiyj3H-lrW9E9FakDrY

3

1.0 BACKGROUND

1.1. The development of the strategy has been led by the Population Health

Transformation team of the Greater Manchester Health and Social Care Partnership

on behalf of the Greater Manchester Cancer Board, and has been co-produced with

input from a wide range of partners across Greater Manchester localities and many

system and subject matter experts. This follows on from work undertaken with the

Greater Manchester Tobacco Control Leaders’ Network, starting in December 2015,

led by Steven Pleasant.

1.2. The strategy has been informed by the best international and as well as local

evidence and has been subject to an extensive consultation and engagement

period running from November 2016 to March 2017, including an expert stakeholder

development group and a key leaders workshop. The following groups and bodies

have been involved in its development or are part of its sign off: Action on Smoking

and Health; Association Governing Group of CCGs; Cancer Education Manchester;

Cancer Research UK; Directors of Public Health Group; Greater Manchester Health

& Social Care Partnership; Greater Manchester Combined Authority Executive;

Greater Manchester Population Health Programme Board; Greater Manchester

Cancer VCSE Advisory Group; Greater Manchester VCSE Devolution Reference

Group; Greater Manchester LGBT Foundation; Greater Manchester Fire and

Rescue Service; Greater Manchester Tobacco Control Commissioners Group;

Fresh Smokefree North East; HMRC; Healthier Futures CIC; Public Health England;

Trading Standards North West; Wider Leadership Team.

2.0 OUR APPROACH

2.1. The changes underway under Taking Charge create a golden opportunity for a new

and focussed approach to tackling tobacco harms across GM. The tobacco control

strategy graphically illustrates the human and financial costs incurred by a product

which kills more than 1 in 2 long-term users and debilitates many more. GM will

reduce smoking at a pace and scale faster than any other major global city with an

ambition to reduce smoking by around a third to 13% by 2021, closing the gap with

England, saving thousands of lives and millions of pounds.

2.2. A new tobacco control programme supports the aims of the wider Population Health

Plan and the GM Cancer Plan, as well as contributing to the far wider public service

reform agendas. A transformative programme of work delivered in collaboration

across the system will include a range of innovative and evidence based

interventions as outlined below.

4

3.0 NEXT STEPS

3.1. To turn this strategy into action, a delivery plan for the potential initiatives outlined in

section 4.1 to 4.7 of the strategy will be developed in sufficient detail to enable a

stakeholder supported and implementable programme of work. We are learning

from what’s working well in Greater Manchester, the UK and globally to bring the

very best evidence and innovation to our delivery. Further stakeholder consultation

and engagement is being undertaken to facilitate this during May-September 2017.

A transformation funding proposal will also be developed including full cost benefit

analysis and matched/alternative funding proposals. This phase of work will be

completed by September 2017.

4.0 RECOMMENDATIONS


Endorse the Tobacco Free Greater Manchester strategy.

1


Date: 28 July 2017

Subject: Greater Manchester Moving

Report of: Steven Pleasant MBE, Chief Executive TMBC, Accountable Officer Tameside

& Glossop CCG

SUMMARY OF REPORT:

To share the final version of the Greater Manchester Moving Plan (2017-21), before a

shared launch event with GMCA, Sport England, wider stakeholders and the public.

KEY MESSAGES:

‘Greater Manchester Moving: The Plan for Physical Activity and Sport’ 2017-21 (with

supporting presentation) is the comprehensive plan to reduce inactivity and increase

engagement in physical activity and sport. It is aligned to the Greater Manchester Population

Health Plan priority themes and the wider reform agenda.

A refresh of GM Moving has been taking place since April 2017, in the context of the Sport

England/GMCA/NHS MOU, The Population Health Plan, GM Mayoral Manifesto and a range

of other recent developments, bringing them into one place with the following ambition:

Everyone in Greater Manchester more active, to secure the fastest and greatest

improvement to the health, wealth and wellbeing of the 2.8 million people of Greater

Manchester.

An ambitious target to double the rate of past improvements, reaching the target of 75%

of people active, or fairly active by 2025. GM Moving 2017-21 and the implementation

plan outlines the journey we need to go on, to realise that ambition.

Greater Manchester Moving 2017-21 has been developed following an extensive

engagement process with cross sector partners across Greater Manchester and in localities.

Its development has been supported by the GM Moving Leadership group and other key

system leaders.

The final draft document has been signed off by the MOU Programme Board and GMHSC

Executive.

9

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0ff219605ef2f4184b2b6f2633ec491b4&authkey=ARSp5ofMiMvnrkVpJcre4Ws

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=02eab97f928aa42ba8dcaa6dc09a2c523&authkey=Ad791jhr2OOIwK23na0BBWI

2

The Plan is also being approved by GMCA at their 28 July meeting, prior to a joint launch

event following both meetings.

GM Moving outlines a whole system approach to tackling inactivity and increasing active

lives across the city-region. It presents an approach to transformational change, with people

at the heart, led by insight, to support positive behaviour change. It starts by celebrating

progress to date, whilst acknowledging the challenge that lies ahead.

The Plan outlines twelve priority areas, with priority actions identified to begin this work, at

scale and with pace.

A full detailed implementation plan is being developed, including leadership and investment

considerations. This is a working document, which will enable implementation to begin at the

end of July.

Outline governance arrangements for GM Moving have also been developed to refresh the

current Programme Board/Steering Group/Leadership Group arrangements. These will be

published online, once agreed.

PURPOSE OF REPORT:

The purpose of the report is to share the final GM Moving Plan, to further engage with all

health and social care partners in the shared ambition and approach. The report authors

seek continued leadership and engagement across the whole system to address inactivity

and physical activity engagement in Greater Manchester.

RECOMMENDATIONS:


Receive, endorse and offer their support to GM Moving 2017-21.

Continue to lead and support the implementation of GM Moving, further embedding

physical activity within the work of the Partnership, and continuing to work

collaboratively with GMCA and Sport England through the MOU.

Support the development of the implementation plan, which will go through the

Population Health Board.

CONTACT OFFICERS:

Steven Pleasant, Chief Executive TMBC, Accountable Officer Tameside & Glossop

CCG

[email protected]

3

Sarah Price, Executive Lead for Population Health & Commissioning, GMHSC

Partnership

[email protected]

Hayley Lever, Strategic Manager, Greater Manchester Moving

[email protected]

1


Date: 28 July 2017

Subject: Hospital Discharge Policies

Report of: Cara Pursall, Programme Manager for Urgent and Emergency Care, GMHSC

Partnership.

SUMMARY OF REPORT:

This paper introduces three standards which have been produced in partnership with

stakeholders from the wider health and social care community which are designed to reduce

the number of patients who wait in hospital unnecessarily and to improve patient flow,

improving patient experience and maximising the optimal use of health and social care

resources. These are Discharge to Assess, Trusted Assessment (attached) and Patient

Choice.

KEY MESSAGES:

In the previously agreed UEC Reform paper we agreed to establish GM Standards that

would reduce variation and enhance the ability of the Partnership to deliver effective and

timely care to our population. This paper introduces the first of the three standards for urgent

and emergency care which respond to variation in the discharge process and the national

drive to reduce delayed transferred of care through the implementation of best practice.

These documents have been developed using research in local and national best practice

and through discussion with stakeholders from Providers, CCGs, Local Authority and

Continuing Health Care (CHC).

It is anticipated that the Standards will be formally launched in July 2017 with plans to be

agreed by partners through the locality Urgent and Emergency Care Delivery Boards by

September 2017.

A number of performance indicators have been defined in order to monitor progress and

success of the standards and collection is planned to commence by Greater Manchester

Health and Social Care Partnership in September 2017.

10

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=054a4296a08104a8c8c3d11c9ed5cb836&authkey=AfA5G2P9W_Np9-49afrs70c

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=05f9a75a0a932402abda9eba36513c0be&authkey=ATkTVHXMGY_NvG6QcWKPfRc

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=05f9a75a0a932402abda9eba36513c0be&authkey=ATkTVHXMGY_NvG6QcWKPfRc

2

PURPOSE OF REPORT:

The purpose of the report is to seek endorsement from the Strategic Partnership Board for

implementation of the standards across Greater Manchester.

RECOMMENDATIONS:


Endorse the implementation of the standards from August 2017 across Greater

Manchester

CONTACT OFFICERS:

Colin Kelsey, Head of UEC & EPRR, GMHSC Partnership [email protected]

Cara Pursall, Programme Manager for Urgent and Emergency Care, GMHSC

Partnership

[email protected]

3

1.0 INTRODUCTION AND CONTEXT

1.1. Greater Manchester Health and Social Care Partnership have taken a focused

approach to the reduction of Delayed Transfers of Care (DToC) and the number of

patients waiting unnecessarily in hospital was during May 2017 was 3.5 % of all

occupied beds. Whilst this is lower than the North region rate of 3.8%, it is still too

high and Greater Manchester are working towards having less than 3.3% of the bed

stock occupied by patients whose transfer has been delayed.

1.2. Appropriate and effective implementation of Patient Choice, the Discharge to

Assess and Trusted Assessment models are identified as key to reducing the

number of DToCs. The standards are key elements of the Eight High Impact

Changes initiatives with both the Trusted Assessment model and Discharge to

Assess mandated as part of the NHS England Delivery Plan from September 2017.

1.3. All Trusts across the region have indicated that they either have the identified

models in place or have agreed plans to do so; however there is significant variation

in local practice across Greater Manchester and some areas are more developed

than others. The Standards have therefore been developed to support and

standardise the offer to the Greater Manchester population leading to improvements

in the quality of provision.

1.4. Appropriate implementation of Patient Choice, the Discharge to Assess and Trusted

Assessment model are identified nationally as key to reducing the number of

DToCs and improving patient flow.

2.0 PATIENT CHOICE

2.1. Around one in ten delayed patients is due to patients not wishing to leave the

hospital despite evidence that remaining is often detrimental to their clinical

condition.

2.2. The Patient Choice Policy has been designed to support people’s timely, effective

discharge from an NHS inpatient setting to a setting which meets their needs and is

their preferred choice amongst the options available.

2.3. The Policy establishes a best practice model for multi-disciplinary discharge

planning with a six-stage approach to managing choice issues that puts patients at

the heart of the process. It seeks to ensure that planning for safe, effective transfer

of care starts on admission and for elective patients before admission.

2.4. The attached Policy applies equally to all patients, whether or not they need

ongoing NHS or social care and whoever may be funding any such care. It is based

on national guidance and promotes movement from an acute hospital to an interim

placement until the permanent choice becomes available

4

3.0 DISCHARGE TO ASSESS

3.1. In Greater Manchester, we still have a significant number of people in acute beds,

whose medical episode is complete but who are awaiting further assessment. The

hospital is not the most appropriate environment for most assessments to happen.

3.2. Discharge to Assess is an integrated approach to the transfers of medically ready

patients, who still require further assessment, from an acute hospital setting to a

home or community setting which has been mandated by NHS England.

3.3. The Greater Manchester model present five pathways for patients, based on their

identified levels of need, that should be made available for patients to prevent long

stays in hospital whilst further assessments take place.

3.4. National and local implementation of the model has shown that patients who are

discharged through a Discharge to Assess model often have lower needs and are

less resource intensive than predicted in a hospital environment, reducing demand

on social care resources.

3.5. Local Authority and NHS Organisations are required to work together in the delivery

of Discharge to Assess pathways.

4.0 TRUSTED ASSESSMENT

4.1. The current process for undertaking assessments is largely inefficient and patients

undergo a number of assessments which can waste already scarce resources and

can cause additional distress to patients and families.

4.2. Furthermore, patients often wait for assessments to take place which can delay

their discharge from hospital. This is not in the best interests of the health and

social care system or the patient.

4.3. The Greater Manchester Standard for Trusted Assessment outlines a holistic

assessment of need being completed by an agreed professional with patients and

accepted by partner organisations.

4.4. Providers, CCGs and Local Authorities are required to work together to agree the

services that would most benefit from a Trusted Assessment model and to put in

place formal signed agreements between organisations to detail, amongst other

elements, the professionals who may undertake assessments on their behalf, the

quality requirements, and the payment models.

4.5. The Greater Manchester Standard for Trusted Assessment sets out the benefits,

standards and performance indicators that Greater Manchester seek to adopt to

ensure a standardised approach to national best practice in this regard.

1 Draft Version 2.1 6th of July 2017

Standards for a Greater Manchester Trusted

Assessment


Contents

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

2. Definition of the Trusted Assessment Model ................................................................................. 3

3. The Greater Manchester Approach to Trusted Assessment .......................................................... 5

4. Greater Manchester Standards for Trusted Assessment ................................................................ 5

5. Greater Manchester Performance Indicators for Trusted Assessment .......................................... 6


1. Introduction

The Trusted Assessment Model is a key element of the Eight High Impact Changes developed by

the Helping People Home Team1 in order to support the timely transfer of patients to the most

appropriate care setting and to effect a reduction in the number of delayed transfers of care.

The model is being supported nationally by the Emergency Care Improvement Programme. It is

also mandated in the Five Year Forward View.

Limited national guidance around the Trusted Assessment model was provided in March 2017

by the Emergency Care Improvement Programme and is referenced in this document; however

there is no nationally agreed model for the Trusted Assessment which allows a high risk of

variance across GM.

This document provides the GM standards against which set out how a Trusted Assessment

Model should be delivered by partners across Greater Manchester. This will ensure that a high

quality, consistent and standardised model is delivered and the identified benefits of the model

are realised.

It is expected that all health and social care systems in Greater Manchester will adopt these

Standards from September 2017. Robust plans to ensure that local arrangement meet or exceed

these standards should be in place by September 2017 and monitoring of performance

indicators identified in this document will commence at this stage.

2. Definition of the Trusted Assessment Model

In brief, a Trusted Assessment is an assessment that has been completed, through formal agreement

by a member of staff with the required competency levels, who has been ‘trusted to undertake

assessments on behalf of other organisations.

Patients often receive multiple assessments in hospital, for example a patient may be assessed by

different individuals for the following assessments:

Social Care Assessment

Nursing Care Assessment

Therapy/Community Health Assessment

Nursing/Residential Home Assessment

Equipment Assessments


Discharge/Transfer to Assess Assessments

CHC/Funded Nursing Care Assessments

These assessments are usually undertaken by identified individuals working in these environments

and a patient can be assessed a number of times by a number of different individuals.

The process is largely inefficient, as patients undergo a number of assessments which can waste

resources that are already challenged. It can also be unsettling and disturbing for the patient to

undergo a number of different assessments whilst recovering from an acute inpatient episode of

care. Furthermore, there can be a significant lead in time for these assessments and this can lead to

an unacceptable wait for care outside of the acute hospital setting and significant delays can occur

whilst patients wait for multiple assessments. This is not in the best interests of the health care

system or of the patient.

The Trusted Assessment model is the completion of a single holistic assessment which is accepted

and undertaken by all care providers in the system using pooled budgets.

Examples of this model include:

Acute-based therapy staff referring directly to local authority run enablement services,

without the need for direct social work input.

Social work staff assessing for and referring patients directly to NHS intermediate care beds.

NHS practitioners undertaking assessments on behalf of privately run care home

organisations.

NHS or social work staff assessing need and referring for equipment requirements.

Four key types of Trusted Assessment have been identified across Greater Manchester, these are:

a) Trusted Assessment between NHS organisations in the same locality e.g. Acute Trust to

Intermediate Care or Discharge to Assess Services.

b) Trusted Assessment between NHS and Local Authority Services

c) Trusted Assessment between NHS and Local Authority Providers and private care

organisations e.g. care and residential homes

i. Where a patient is already resident at the care or residential home and the

assessment seeks to confirm that they remain suitable for the provision

ii. Where a patient is a new referral to the care or residential home and the

assessment seeks to confirm that they are suitable for the provision

d) Trusted Assessment between the NHS and Local Authority to all out of area services,

including NHS, Local Authority and Private Care Organisations within Greater Manchester

and across its boundaries.


3. The Greater Manchester Approach to Trusted Assessment

All systems in Greater Manchester are required to implement a Trusted Assessment model that

effectively delivers the following key benefits:

Holistic Assessments of needs are completed with patients, and accepted by partner

organisations where there is the most need

Duplication of assessments is minimised

Response times for assessment are improved

Safe and Timely discharge is supported

The length of stay, reportable delayed transfers of care, and the percentage of stranded

patients are all reduced.

The standards that need to be achieved in relation to the Trusted Assessment model are set out

below:

4. Greater Manchester Standards for Trusted Assessment

4.1 Greater Manchester Urgent Care Delivery Boards are required to identify those organisations

with which they should implement a Trusted Assessment model.

The rationale for this decision should provide a balance between working with those

organisations where the most benefits from the model can be achieved and those

organisations where benefits could be achieved within short timescales.

This may require local mapping of services to take place, to obtain where the most benefit

could be achieved.

Decisions should be in line with national prioritisation, i.e. local authority reablement

services however should also consider the local picture.

Decisions should be made jointly between health and social care organisations.

4.2 A formal signed agreement should be put in place between identified providers of care that

outlines, as a minimum, the following elements:

The professional that will undertake the assessment on behalf of the provider

The competencies required to undertake the assessments

The training requirements and methods for staff undertaking the assessments

The process for assessment and referral to the identified services

The method through which the process will be reviewed

The process if the receiving service deems that the assessment is flawed and therefore does

not accept it

Information sharing arrangements and agreements, including IT access rights

Access to and training on appropriate electronic assessment and referral systems


Commissioning arrangements and payment models

The responsibilities for the roll-out of the process

4.3 A Holistic Assessment Form must be designed and agreed

A key element of the Trusted Assessment model is the use of an agreed holistic assessment tool

between providers; assessment documentation needs to be designed and formally agreed between

organisations.

4.4 Assessment and Referral Pathways must be clearly documented

Assessment and referral pathways should be designed and agreed between organisations, clearly

documented and communicated appropriately.

5. Greater Manchester Performance Indicators for Trusted

Assessment

The following metrics should be used to understand the impact and success of the Trusted

Assessment model:

a) The number of services where there is a signed formal agreement relating to Trusted

Assessment

b) The number/percentage of assessments completed using a Trusted Assessment model

c) The time from completion of the Trusted Assessment to the date of discharge

d) The average time taken to complete a Trusted Assessment

e) Compliments/complaints received around the assessment processes for services using the

Trusted Assessment model.

f) A reduction in the delays in discharge attributed to “waiting for assessment”

Systems will need to agree with GM Health & Social Care Partnership and locally how they

will determine and achieve an improvement trajectory in respect of delays for assessment in

both the acute and community environment.

1


Date: 28 July 2017

Subject: Transformation Theme 3 – Developing a Strategy for Hospital Based Services

Report of: Diane Whittingham, Associate Lead for Theme 3, GMHSC Partnership

SUMMARY OF REPORT:

This paper is an update and follow up to the paper presented to the Strategic Partnership

Board on 28 October 2016, and sets out the proposed approach to developing a GM

strategy for hospital based services under Theme 3, Standardising Acute and Specialised

Care.

This paper is the first step in a series of papers which will build the strategy for hospital

based services. This paper is complementary to and should be read in conjunction with the

governance paper (Theme 3 – Revised Governance to deliver the Theme 3 Strategy for

Hospital Based Services), which outlines what governance arrangements are needed to

support the strategy work and the inputs to it.

KEY MESSAGES:

This paper describes an approach and framework for developing a strategy for hospital

based services, and describes how this will be achieved such that all the work under Theme

3 is brought together and delivers under a single process.

The development of this paper marks the start of working and engaging differently with our

stakeholders across the GM Health and Social Care system. We have widely shared our

thinking within the health and social care system as the basis for discussion and feedback in

preparing this paper.

This paper has been discussed and supported by the Strategic Partnership Board Executive on the 12th April 2017 and the Joint Commissioning Board on the 18th April 2017.

PURPOSE OF REPORT:

The purpose of the report is to set out the proposed approach and process for developing a

GM strategy for hospital based services; to describe how this will be achieved such that all

11

2

the work under Theme 3 is brought together and delivers under a single process, with the

involvement and engagement of all key stakeholders across the Greater Manchester Health

& Social Care system, including service users, carers and the public.

RECOMMENDATIONS:


Approve the approach described above to develop a hospital based services

strategy.

Note the additional documentation to follow.

CONTACT OFFICERS:

Diane Whittingham, Associate Lead, Theme 3, GM H&SCP

[email protected]

Jen Parsons, Programme Lead, Theme 3, NHS Transformation Unit

[email protected]

3

1.0 INTRODUCTION

1.1. Theme 3 Standardising Acute & Specialist Care was set up by the GM Health and

Social Care Partnership to deliver commitments outlined in the GM 5 year strategic

plan ‘Taking Charge’. It brings together hospitals from across GM to work together

across a range of clinical services, to make sure expertise, experience and

efficiencies can be shared widely so that everyone in GM can benefit equally from

the same high standards of specialist care.

1.2. Why do we need a strategy for hospital based services?

1.2.1. Strategically we want to ensure that decisions about services result in the delivery

of improved and equitable services for patients across GM and the wider area that

GM hospitals serve; and that these services are clinically sustainable and financially

affordable across GM. This is a huge challenge for the GM Health and Social Care

System and how we work together as partners to achieve this. It means we need to

ensure that decisions about hospital based services in GM are not taken in

isolation, and that across the GM system we develop a coherent range of

hospital based services based on a ‘single service’ approach but that clinical

interdependencies are understood and recognised. We need to have a single

way of ensuring that, as a system, we understand the full impact of changes on

patients and carers; on wider health and care services; on our hospital

infrastructure and estate; on our organisations; and in each locality, such that the

costs of service change can be minimised and the benefits for patients are

maximised. The strategy will provide a GM wide framework for hospital based

services. Individual commissioners, Trusts and localities will then commission and

provide services within the agreed framework.

1.2.2. The Theme 3 projects that were prioritised in September 2016, cover services that

account for two thirds of all hospital activity and represent 61% of in scope acute

costs in GM (in scope services represent £1.6bn of £2.7bn of in scope spend). The

prioritised projects also represent all key components of hospital care (medicine,

surgery, women’s and children’s, and specialised services). There are also a

number of programmes of work that are very closely linked to Theme 3, for example

the development of the Single Hospital Service across the City of Manchester; the

establishment of Group arrangements between Salford Royal and Pennine Acute;

and the Greater Manchester cancer plan. Change in these areas will deliver

significant elements of the strategy.

1.2.3. More widely, many programmes of work connect to Theme 3 and will influence and

determine the future shape of hospital based services. This includes the

transformation of adult social care; cross-cutting work to deliver the GM mental

health strategy; work on maternity services; work to standardise clinical support and

corporate functions (Theme 4); place driven change in each of the 10 localities; the

transformation of community based care (Theme 2); and population health and

prevention (Theme 1). Hospital trusts are also working towards national

requirements such as the delivery of the 10 clinical standards for urgent and

4

emergency care, and the delivery of 7 day services. Each and all of these will

impact upon the shape of what care needs to be delivered in our hospitals in the

future.

1.2.4. The GM Mental Health and Wellbeing Strategy calls for greater integration across

mental and physical health and social care services within each of the ten GM

localities as well as across the wider GM conurbation; and for responsive and clear

access arrangements connecting people to the support that they need. With the

approach to developing a strategy for hospital based services described in this

paper, there is a clear opportunity and a need to ensure the links between physical

and mental health are considered in the design process; and that new models of

care in hospital based services pick up on patients mental health needs in a holistic

way that enables them to access the care that they require.

1.2.5. To effectively deliver the scale of change described above, making the links across

a complex system whilst maintaining patient safety and performance is a significant

challenge. Not only will this will require strategic co-ordination, it will also require

detailed operational coordination.

1.2.6. In addition, and crucially, a coherent message will need to be given to patients and

carers and staff about any potential change, what this means for them and how this

step on the journey contributes to delivery of the overall strategy. Therefore a GM

strategy for hospital based services is needed to provide the strategic direction,

oversight and planning described above.

1.3. Context

1.3.1. The Greater Manchester 5 year plan – ‘Taking Charge’ describes 5 themes or

programmes of change. These are shown below.

1.3.2. Theme 3 is Standardising Acute & Specialist Care and is described as “The

creation of “single shared services” for acute services and specialist services to

5

deliver improvements in patient outcomes and productivity, through the

establishment of consistent and best practice specifications that decrease

variation in care; enabled by the standardisation of information management and

technology.

1.3.3. The current transformation priorities for Theme 3 were developed with clinicians,

providers and commissioners over a number of months culminating in a proposal

from the Theme 3 Steering Group which was endorsed by the Association

Governance Group (AGG), Provider Federation Board, the Strategic Partnership

Board Executive on the 12th September 2016, and the Strategic Partnership Board

on the 28th October. The current transformation priorities are:

Paediatrics (including specialised children’s services), and maternity

Respiratory and cardiology

Benign urology

MSK and orthopaedics

Breast services

Neuro-rehabilitation

Vascular

HIV*

Ophthalmology*.

*Note that HIV and ophthalmology (specialised services) have been prioritised but will be initiated as part of a second wave.

1.3.4. A number of acute and specialised projects were previously underway some at

implementation stage; these have also been brought within the oversight and

leadership of Theme 3:

A&E, Acute Medicine and General Surgery (Healthier Together)

OG cancer

Urology cancer.

1.3.5. The standardisation of GM hospital services is one part of a much larger system

change driven by each of the 10 localities delivering improved primary, community

and social care services, with the interface between the two critical to delivering

improved care. The hospital based services strategy will not only need to describe

the impact of changes on GM hospital based services as a whole, but also what this

means in each of the 10 localities. The transformation priorities in Theme 1

(population health and prevention), Theme 2 (the transformation of community

based care) and Theme 4 (standardisation of clinical support and corporate

6

functions) will also drive changes that will impact in some way on hospital based

services and vice versa. At the appropriate point the impact on cornerstone services

such as critical care and diagnostics will also need to be understood, planned for

and implemented. These connections are illustrated in the diagram below:

1.4. The purpose of this paper

1.4.1. From early on in our discussions it became very clear that there are many different

views about what a GM strategy for hospital based services means to different

people and what it should and should not include.

1.4.2. The purpose of this paper is to set out our proposed approach for the strategy and

how it will be developed; and to describe how this will be achieved such that all the

work under Theme 3 is brought together and delivers under a single process, pulls

in the same direction, and does so with the involvement and engagement of all key

stakeholders across the Greater Manchester Health & Social Care system.

Governance and Decision making processes need to be clear and understood.

1.5. How we have developed this paper

1.5.1. The development of this paper has marked the start of working and engaging

differently with stakeholders across our GM Health and Social Care system. In early

February we developed a core presentation which outlined our thinking on the

content of a strategy for hospital based services, and a process for developing this.

We have widely shared this as the basis for discussion and feedback in 1:1s with

individuals and with key stakeholder groups across GM. These conversations have

shaped the slide presentation, and the content behind this paper. A full list of those

who have contributed to date can be found in the appendix. A summary is provided

below of the key groups we have engaged with or have scheduled.

7

Group Date

Theme 3 Delivery Board 22

nd February / 29

th March

2017

GM Association of Clinical Commissioning Groups (AGG) 7th March 2017

Finance Executive Group 2nd

March 2017

CCG Chief Officers 3rd

March 2017

Provider Transformation Leads for Theme 3 projects 10th March 2017

Theme 3 Clinical Reference Group 16th March 2017

GM Health and Social Care Partnership Senior

Management Team 4

th April 2017

Provider Federation Board 7th April 2017

Strategic Partnership Board Executive 12th April 2017

Joint Commissioning Board 18th April 2017

Joint Commissioning Board Executive 26th April 2017

Strategic Partnership Board 28th July 2017

8

2.0 WHAT NEEDS TO CHANGE

2.1. The GM Health and Social Care system is complex, with 37 different partner

organisations, each with different strategic priorities and statutory responsibilities.

Coupled with this is a considerable amount of transformation work that is already

underway across GM to deliver the strategic plan. Yet there is currently no single

way in which changes that impact on hospital based services can come together

and be understood as part of a single direction of travel that all stakeholders are

working towards. This has led to a lack of clarity about who should be doing what;

duplication of tasking in the system; and understandable frustrations about how to

navigate the governance at local, sector, and GM levels.

2.2. Our ambition is that all the work under Theme 3 impacting hospital based services

is brought together and delivers under a single process. This process will have the

involvement and engagement of all key stakeholders across the Greater

Manchester Health & Social Care system at its core.

2.3. As previously described, we are not starting from scratch, and are able to build on

existing work and decisions made. However, in order to achieve this ambition the

following issues need to be addressed.

2.4. Issues to address

2.4.1. Clear strategic context and approach

There is a need to ensure that the strategic context within which Theme 3 sits is

clearly described, including re-articulating the challenges set out in the strategic

plan, what Theme 3 needs to achieve to address these challenges, and the

implications of this for the system. There is also a need to clearly set out how we

intend to do this (this paper).

2.4.2. Where Theme 3 fits and links to other themes

Since Taking Charge was published in December 2015, locality plans have been

published, and much work has happened to define the priorities and work

programmes of each of the Themes (population health and prevention;

transformation of primary and community based care: transformation of clinical

support and corporate functions; as well as the cross cutting work streams mental

health, adult social care transformation etc.). There is a need now to describe this

context and the connections between these pieces of work so that it is clear where

Theme 3 and a hospital based services strategy fits.

2.4.3. The reconfiguration of A&E, Acute Medicine and General Surgery

The reconfiguration of A&E, Acute Medicine and General Surgery (Healthier

Together) is an integral part of Theme 3 and there is a strong commitment to

delivering the Healthier Together outcomes. The clinical case for change for

Healthier Together is strong, and the programme has not only provided the basis for

9

devolved working across GM, but the single service model of care has laid the

foundations for the development of new models of care within Theme 3, and

provides a building block for the strategy. It is also recognised however that the

changed environment requires that the reconfiguration of A&E, Acute Medicine and

General Surgery is taken forward in a pragmatic manner which allows for a

continued interaction with broader service reconfiguration plans so as to make

Healthier Together more affordable. Theme 3 is placing a high priority on this

through this work to develop the hospital based services strategy. A number of

governance issues will also need to be resolved quickly in order to support progress

on both Healthier Together and Theme 3, so that the two programmes are fully

brought together. Activities in both now need to be unified through a single

governance structure. The Theme 3 governance paper sets out how this will be

done.

2.4.4. Range of services in Theme 3

The prioritisation of services under review by Theme 3 took place in August and

September 2016. Since then questions have rightly been asked about connected

services, and whether there are any gaps in what Theme 3 should cover.

Considerations could include the ‘cornerstone’ services such as critical care, and

diagnostics and services that have been already identified as Theme 3 priorities but

were not part of ‘wave 1’ for example Ophthalmology and HIV. We propose that a

full assessment of the gaps is undertaken as part of the early work on the strategy,

and the range of services under Theme 3 may increase. A paper will be produced

describing any proposed changes.

2.4.5. Services outside of Theme 3

Hospital services are part of a dynamic system and business as usual must

continue whilst the strategy is being developed. It is therefore critical that we

understand what changes to services outside of Theme 3 are happening that will

impact upon hospital services and vice versa. We also need to be really clear how

and where decision making happens for such changes where a strategically

significant impact on hospital services is anticipated. It is important that progress is

not halted where this is required, but that changes are strategically aligned and

contribute to the overall direction of travel. Work is underway to ensure that decision

making and governance processes are clear so that short and medium term actions

are consistent with the strategic direction of travel.

2.4.6. Links with other work

Theme 3 needs to interface closely with Themes 1, 2 and 4 so that developments

and proposals emerging from these Themes are shared, and the implications for

hospital based services can be understood and addressed.

2.4.7. Current technology capability of organisations and desired future state

Hospitals across GM have a wide range of digital maturity levels and capability to

deliver digital transformation. Critical information flows will vary across GM from

10

paper processes through to electronic transfer of structured data. Any service

redesign that impacts across multiple hospitals (or any organisation) will have an

associated information flow. For high quality service redesign, this flow will need to

be digital; sufficient; of high value (concise); and standardised. Future service

capabilities will depend on further technological innovation, for instance, the ability

to automatically detect deteriorating patients, the ability to guide clinical staff

through standardised pathways and the ability to rapidly change a pathway and its

adoption in response to new evidence. Digital technology can help reduce variation

in standard processes and procedures, and there is an opportunity within Theme 3

to build such changes in at the design stage.

2.4.8. Workforce capability and capacity

Associated with service redesign and increasing digital maturity, it is important that

the hospital workforce also has a strong digital capability.

2.4.9. Workforce Strategy

The emerging clinical strategy for hospital based services will articulate changes

that will impact upon the workforce. At this stage, there is insufficient detail

regarding care models and new service models to provide a clear understanding of

the future workforce requirements. However, emerging locality workforce plans

have started to develop on the shape of future workforce models and new ways of

working to support the proposed changes.

The emerging GM Workforce Strategy will help identify workforce challenges and

opportunities such as expanding and developing the GM workforce; developing and

maximizing flexibility and inter-organisational mobility; introducing training and

development programmes to support new ways of working and/or preparing the

workforce for the future. Additionally, robust system leadership and organisational

development programmes supported by excellent people management processes

to support staff through changes will be critical to achieving success.

The establishment of a Workforce Reference Group involving key stakeholders

including trade union colleagues and clear strategies to engage staff in the co-

designing/co-creating the future workforce will be a vital part of the workforce

programme necessary to support Theme 3.

3.0 PROPOSED APPROACH TO DEVELOPING A STRATEGY FOR HOSPITAL

BASED SERVICES

3.1. Guiding principles

3.1.1. The approach we have developed to produce the strategy is underpinned by the

following guiding principles, formed out of our learning so far:

We build on existing good practice and approaches taken to date where we

have this experience already within the system. Good examples of this include

11

the Single Hospital Service work led by Sir Jonathan Michael and Healthier

Together. Further information on the learning from these programmes is in the

appendix.

We take account of existing commitments where service decisions have

already been made and commitments have been given to the public.

We allow momentum to be maintained. This could mean for example

identifying and supporting ‘quick wins’ for implementation and investment that

are clearly aligned to strategic direction alongside the development of the

strategy.

We position acute change as part of locality plans and recognise that while

some hospital based services may need to operate on a GM footprint, our

hospital services are fundamentally at the heart of the places in which the

people of GM live and work – the 10 localities.

We operate in a ‘real world’ context meaning that we must develop services

that are ambitious, but we must recognise the constraints in which we are

operating as our starting point: standards cannot be developed in isolation of

questions of affordability, understanding the limitations of our workforce and

maximising the use of our estate. Such constraints however can be seized as

an opportunity to think differently and innovate.

We share our proposed approach with all stakeholders so that everyone is

clear how they can input into the process. This paper has been the starting

point for this new way of working and a demonstration of how we intend to

continue.

We take advantage of new and existing digital technologies to maximise

clinical benefits and patient experience while reducing costs. Digital information

must be shared effectively to reduce duplication and improve quality. Digital

pathways will guide users in appropriate care and alert them to deteriorating

patients or actions that must be completed.

3.2. Scope of the strategy

3.2.1. The approach that we outline in the rest of this paper sets out the steps we believe

are needed to produce a strategy for hospital based services. .

3.2.2. The scope of the strategy will include all acute hospital sites and services; this

includes the post-acute neuro-rehabilitation units. Acute mental health inpatient

facilities will also need to be considered from an estates perspective as part of this

work. This is illustrated on the map below:

12

3.3. Developing the Strategy – Hospital based services strategy framework

Set out below are the elements of work we believe are needed to produce a

coherent strategy for hospital based services. Together these form a “framework”.

Each element is explained in detail in the rest of the paper.

13

3.3.1. Strategic context, and the strategic intent for Theme 3

This is important to ensure that the strategic context of all of the Themes is properly

understood and to describe and draw the connectivity between them in a way that

everyone can understand: A separate paper will be produced, led by Warren

Heppolette that will provide this context. The hospital based services strategy will

link back to this overarching paper and will address where Theme 3 work fits, the

strategic aims of Theme 3 and the success metrics against which Theme 3 will be

measured.

3.3.2. Reminder of the case for change, process to date, decisions taken and progress so

far (‘stock take’).

A piece of work will be undertaken to provide a ‘stock take’ of work to date. We

propose that this is a paper that covers the following content in order to provide a

firm foundation and understanding on which to base the next phases of work:

A stock take of strategic decisions taken to date and progress in implementing

these

Outline existing site visions following from the reconfiguration of A&E, Acute

Medicine and General Surgery (Healthier Together)

A summary of the prioritisation process to used to identify current priority

projects

Progress with the current priority projects

Exploration of working relationships with other themes and associated networks

and groups

Description of the emerging landscape

Design principles developed and agreed by providers and commissioners.

3.3.3. Identification of gaps

Following on from the context paper and the stocktake, we will identify services that

do not currently sit within Theme 3 but may need to be considered in order to

complete the strategy work. We propose to identify the gaps; assess how these

gaps should be considered by the programme; and incorporate any additional

services into the design programme as required.

3.3.4. Design of Theme 3 priority services

This is the continuation of the design work already started on Theme 3 priority

projects and any new work required from the assessment above. This design work

will need to be completed (e.g. design of new models of care) so that strategic

options can be developed. We propose that this work continues and completes late

14

2017. Providers and commissioners are developing a set of core design principles

that will inform this work. These are set out in section 3.4.

3.3.5. Development of options for Theme 3 services

It is anticipated that following the completion of design work and new models of

care a limited range of options will be identified that will need to be considered and

assessed.

The culmination of this work will be the collation of options to understand the overall

impact on hospital based services in GM.

3.3.6. The output from the process described above will be a GM wide commissioning

strategy for hospital based services. The strategy will cover all services within

Theme 3.

3.3.7. Enabler - Collaboration and engagement

A detailed collaboration and engagement plan will be developed, covering all

members of the Partnership – providers, commissioners and local authorities –

public, patients and carers, staff and politicians such that there is:

Clarity on strategic intent

Clarity on decisions already made and ‘anchor points’

Meaningful input to key decisions

Perspectives heard and responded to such that challenges are avoided

Service users are appropriately informed, and have the opportunity to

contribute appropriately and effectively as part of this process

3.3.8. Enabler - Governance and process

Governance and process will be reviewed, and a decision making framework

produced to ensure:

Decisions that are planned through this process can withstand challenge and

are legally sound

A record of engagement, assurance and decisions is kept such that should a

challenge arise it can be robustly defended

Compliance with regulatory assurance and other requirements

Legal advice is sought where required.

Further detail on this will be outlined in the governance paper.

15

3.4. Commissioning priority principles

3.4.1. The following priority principles have been developed following work completed by

both the Provider Federation Board (see letter attached in appendix 4.6), and

commissioners. We will use both to guide the development of the strategy:

Creating a system that is capable of delivering consistent quality standards for

all Greater Manchester patients, eliminating variation

Meeting access expectations of local people and the NHS Constitution

Delivering services at a population scale and geography that makes the best

use of evidence and skilled workforce

Creating an affordable, effective and financially sustainable system, that

successfully reduces costs in the acute sector as planned in the GM Strategy.

By, for example:

o Providing care and support in the lowest intensity and lowest cost,

clinically appropriate care setting, supporting patients to ‘choose

wisely’

o making best use of estates

o ensuring consistency and reducing duplication

Ensuring care in the most appropriate setting, and integration of physical,

mental health and social care are supported through strong involvement with

Local Care Organisations.

3.5. How will we involve clinicians, patients and carers?

3.5.1. Clinical and patient engagement is central to the approach outlined below. Our

approach is based on a process of ‘co-design’ with both clinicians, patients and

carers from the services concerned, and has been developed through our work on

OG Cancer, and Healthier Together to develop a set of clinician and patient-

designed deliverables that together will inform a future service specification and

business case. This includes the development of a case for change, clinical and

patient standards, a service access framework which describes all the service

dependencies, a model of care, and resulting business case. Overall we will ensure

that service users and the public are widely engaged with, appropriately informed,

and have the opportunity to contribute appropriately and effectively as part of the

process to develop the overall strategy.

3.5.2. In order for future decisions to stand up to scrutiny each element of the design

needs to be developed and then overseen by an appropriate group. Clinical

engagement is based around a wide and representative group of clinicians brought

together from across Greater Manchester in a Design Oversight Forum. This will be

the place where each of the design elements is developed and shared over the

16

course of a series of workshops. Independent clinical advice is sought in order to

test the clinical outputs from this group, while patients and carers who use the

service are engaged and involved in shaping proposals.

3.5.3. Once draft deliverables have been developed, oversight and assurance is required

from a number of different groups, including the Workforce Reference Group as a

key element of this change programme will be to engage the workforce in the

development of the new care models/services. Our approach is illustrated in

summary below, and will be outlined in full in a Clinical Approach Paper to be

developed by the Theme 3 Clinical Reference Group:

3.5.4. Involvement and participation of the population in decisions that affect them is at the

cornerstone of the NHS Constitution: Principle Four states that “the patient will be at

the heart of everything the NHS does”. Involvement is critically important in any

service redesign or service transformation due to the legislation in the Health Social

Care Act (2012) “Duty to promote involvement of each patient” and NHS England’s

Four Tests for Service Reconfiguration which include “strong public and patient

engagement. The graphic below illustrates the different levels of how the population

can be involved in every service transformation project.

NHS England’s ladder of participation (Transformation Participation in Health and

Care Guidance, 2013):

17

3.5.5. Our approach to the involvement of patients and carers in the design of services

has been developed through the transformation process for OG and Urology cancer

services under Theme 3. Patients and carers co-designed and developed a set of

patient standards as part of a new service specification. This approach promoted

the involvement of patients and carers; was endorsed by the GM Joint Health

Overview and Scrutiny Committee and led to a more efficient, faster, and robust

decision making process. This will be a core part of the design work on Theme 3

priority services.

3.5.6. For services to be truly patient-centred, patients and carers must be involved at the

design and planning stage. Engagement and participation mechanisms will be used

to listen to and involve patients and carers. This strengthens accountability to local

communities and creates more patient-responsive services. It is also promotes

transparency of decision making ensuring that changes to services focus on

standards that are important to patients, and carers.

3.5.7. In this way commissioners are enabled to meet their statutory duties regarding

population involvement and can confidently meet any legal challenge.

3.6. What governance is needed to support the development of this strategy?

3.6.1. Straightforward and transparent governance will be needed to support decision

making on the strategy, oversee this work, and the different inputs to it. A separate

paper outlines the proposed governance to support the strategy, and details how

Healthier Together and Theme 3 can be brought together in a common governance

structure.

3.7. Timescales

3.7.1. There is a significant amount of work involved to develop the strategy including the

completion of the clinical design work, and the development of options for activity,

workforce, finance and estates modelling. The outline timeline for the elements of

the framework is proposed as follows over the next 18 months:

18

3.8. Who will deliver this?

3.8.1. The diagram below shows the key elements of work that will need to be resourced

to deliver the Theme 3 programme. The first three elements – 1) Development of

the Strategy Approach, 2) Development of clinical models for Theme 3 priorities and

3) Modelling of activity, estate, workforce and finance - should run in parallel and

are then brought together and options developed. This work will be underpinned

throughout by robust programme management.

19

3.8.2. It is important that each group are clear about their respective roles and

responsibilities and this is set out in further detail below.

3.9. In house capability

3.9.1. We propose that the NHS Transformation Unit will continue to provide primary

support to the GM Health and Social Care Partnership to deliver the requirements

of Theme 3, working with colleagues across the Partnership, together with Provider

Transformation Leads and Commissioners. This support will need to be

supplemented by working with chosen external partners as well, where this

expertise is not available within the GM Health and Social Care Partnership or the

NHS.

3.10. Leadership

3.10.1. Overall leadership of the Theme 3 from the GM Health and Social Care Partnership

will be provided by Sarah Price, Executive Lead for Commissioning and Population

Health, and Diane Whittingham, Associate Lead for Theme 3.

3.11. Partners

3.11.1. A number of external partners will need to be appointed to support key elements of

the Theme 3 work. We propose support will need to be secured in the following

areas:

Overall leadership

o A credible experienced senior leader and clinician to act as advisor

to Theme 3

20

o Leadership, development and expert facilitation

Clinical leadership:

o Overall clinical lead for Theme 3

o Clinical leads for Theme 3 priority projects (for which an appointment

process is already underway, jointly led by Provider Transformation

Leads and the GM Health and Social Care Partnership)

Clinical assurance:

o Independent clinical advice for clinical deliverables– in the past this

has been sought via Royal Colleges, Senates and other national

bodies

o Assessment of clinical safety of options proposed – a partner would

need to be sought (akin to National Clinical Advisory Team) in order

to provide this assurance

Development and deployment of a dynamic activity, estates, finance and

workforce model- an external partner with significant experience in modelling

work will be commissioned

Legal advice for governance and decision making

Procurement advice

Financial assurance of deliverables

Patient involvement and engagement – appointment of patient involvement and

engagement facilitators to work with the NHS Transformation Unit lead to co-

ordinate the alignment of existing resources (e.g. established patient groups),

and to supplement this where necessary.

3.12. Links between Theme 3 and the Single Hospital Service

3.12.1. The GM Strategy for Hospital Based Services will provide the framework against

which the City of Manchester Single Hospital Service will develop plans for the

delivery of clinical services. This will include two specific areas of work; realisation

of the benefits described in the Sir Jonathan Michael Reports and the benefits set

out in the submission to the Competition and Markets Authority in support of the

proposed merger of Central Manchester University Hospitals NHS Foundation Trust

and University Hospital of South Manchester NHS Foundation Trust. Post-Merger

Integration Plans necessary to enable the establishment of a new NHS Foundation

Trust will embrace the principles set out in the GM Strategy for Hospital Based

Services without compromising the inherent responsibilities of the Board of

Directors to run the new organisation efficiently and safely in line with

commissioning plans and regulatory requirements. In essence the Single Hospital

21

Service will cooperate fully with the design and delivery of the GM Strategy for

Hospital Based Services for the benefit of Greater Manchester.

3.12.2. Given the significant scale of transformation required to deliver the Single Hospital

Service, and the fact it will impact on 40% of acute service provision across Greater

Manchester, collaborative effort between the GM team and the Single Hospital

Service is seen as essential. Access to intelligence, data and clinical expertise will

be a vital prerequisite to success. The Single Hospital Service is committed to this

degree of partnership and will strive to work with the GM team and other

stakeholders to avoid duplication and potentially contradictory strategic planning.

3.13. Links between Theme 3 and the Salford Royal and Pennine Group

3.13.1. Salford Royal has set out a clear strategy to develop a health and care Group,

leveraging a ‘standard operating model’ to deliver safe and sustainable care across

the north of Greater Manchester. The establishment of the Group model will enable

the provision of high quality acute services and the development of Local Care

Organisations, underpinned by a clear strategy, more rapid decision-making and

effective partnership arrangements within each Locality. This is entirely consistent

with focus of Theme 3 to deliver significant improvements in acute and specialist

care through the consistent application of best practice, as well as the commitment

in Theme 2 (the transformation of community based care) to develop Local Care

Organisations across GM.

3.13.2. The first step in this journey started last year, with Salford Royal NHS Foundation

Trust supporting the services provided by Pennine Acute, initially through a

management contract. Significant work has been undertaken with commissioners in

the North East sector to support stabilisation and improvement of services, which

will provide the foundation for the transformation of acute care and the

implementation of new models of care (consistent with Locality Plans).

3.13.3. Work is currently underway to develop an acute service strategy for the North East

sector, which will be aligned to both Theme 3 and local commissioning intentions.

This will complement the agreed programme of change that has been developed in

the North West sector, with partners in Bolton and Wigan. This work builds on and

supports the establishment of Healthier Together single services and the

designation of Salford Royal and Royal Oldham as high acuity hubs, which provides

the cornerstone for acute care reconfiguration. The Group’s standard operating

model will be used to support the delivery of the GM Strategy for hospital based

services and meet the requirements of local commissioners, with a focus on

ensuring the provision of high quality, resilient acute and specialist services and

supporting the provision of local integrated care arrangements. Salford Royal’s

designation as a Centre of Global Digital Excellence will be used to support the

application of digital solutions that transform the model of care, reduce variation and

improve productivity. The Group will work in close partnership with the GM team to

ensure this capability is leveraged across the city region.

22

3.14. Success factors

3.14.1. Achievement of the following will demonstrate the success of the strategy:

Entire pathways are considered and care is delivered in the most appropriate

setting

Variation is minimized and improvement is seen across Greater Manchester

Services are operationally deliverable and clinical services are coherent in that

interdependencies are understood and managed

Alignment of GM vision with locality and organisation vision such that all

change is pulling in the same direction

Stakeholders feel truly involved in the process and are able to offer meaningful

input to decisions

Ensuring that service users and the public are widely engaged with,

appropriately informed, and have the opportunity to contribute appropriately

and effectively as part of the process to develop the overall strategy.

Governance and decision making processes are clear

The implications for sites of new models of care are fully articulated and

understood

Change in the acute sector does not have unintended negative consequences

in primary / community and vice versa

Decisions are taken in timely manner whilst maintaining transparency such that

implementation can be achieved as quickly as possible

Estate is optimised and utilised.

3.14.2. Further detail on how we think these can be achieved is given in the appendix.

23

4.0 APPENDICES

4.1. Learning from the Single Hospital Service Review

4.1.1. Key features of the Single Hospital Service review are highlighted below:

Key role played by Local Authority CEs and leaders in supporting programme

as part of health and social care services as a whole

Senior independent leadership

Oversight from the SHS Review Steering Group and the SHS Clinical Advisory

Group

Full clinical stock take (long list of services) and selection of 8 exemplar

services based on criteria: Duplicated service / Quality / Financial / Size of

service line / Deliverability

Large plenary sessions held with all clinicians (120+) to review the exemplar

services, develop cases for change and collate all outputs

Qualitative input to reviews sought through interviews with key stakeholders

2 reporting points where work brought together from the review, and

communication to wider stakeholders at these key junctures.

4.2. Learning from Healthier Together

4.2.1. Key features from pre consultation, and from the decision making process are

highlighted below:

Partnership between locally elected politicians and NHS leaders allows change

in the acute sector to be part of a coherent whole that makes sense to local

places and the people who live there

Series of clinical congresses held to develop the future model of care individual

specialties, a Future Model of Care group to collate to a coherent model and a

Clinical Reference Group to sign off

Consultation clinically-led (clinical champions)

Consultation delivered by a whole team managing logistics etc.

Criteria for option appraisal developed in consultation with public and

stakeholders

Completion of NHSE Assurance processes including external clinical panel of

nationally recognised clinicians to check safety of proposals

24

Decision making plan and timescales agreed with the commissioners 9 months

in advance of decisions and shared with all stakeholders

All inputs to decision making overseen by a specific governance group e.g.

quality assessment overseen by Clinical Advisory Group, Transport data

analysis developed by Transport Advisory Group. All decisions of groups

minuted

All inputs to decision making shared in advance with commissioners to

familiarise with the data sets (series of 7 workshops over 2 months)

Robust and well documented processes, backed up through governance

Workforce issues debated and discussed in conjunction with Trade Union

colleagues leading to the development of jointly agreed protocols designed to

support consistency of approach and application of people management

arrangements.

4.3. How we agreed the current priorities

4.3.1. The steps taken to agree the current Theme 3 priorities are illustrated below,

together with the clinical prioritisation matrix that was developed by clinical experts

through the Theme 3 Clinical Reference Group in June 2016:

25

4.3.1.1. Clinical prioritisation matrix:

4.3.1.2. Strategy RACI matrix

26

4.4. How success factors will be achieved

4.5. Provider Federation Board principles can be viewed at this Link.

4.6. Stakeholders engaged to develop the strategy approach

The table below lists all of the individual stakeholders who we have also engaged

with to develop the approach for the strategy:

Stakeholder Organisation Date

Andrew Foster

Chief Executive, Wrightington

Wigan and Leigh NHS

Foundation Trust

14th March 2017

Ann Barnes Chief Executive, Stockport

NHS Foundation Trust 8

th March 2017

Ann Gibbs NHS Improvement 21st February 2017

Anthony Hassall Chief Officer, NHS Salford

Clinical Commissioning Group 16

th February 2017

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0df7d9a1d4e834faf99fae48584323b76&authkey=AdW6UDJhJKIaeGcbWPCWOaY

27

Bev Humphrey

Chief Executive, Greater

Manchester West Mental

Health NHS Foundation Trust

22nd

March 2017

Donna Hall Chief Executive Wigan

Council 15

th May 2017

Darren Banks

Director of Strategy, Central

Manchester University

Hospitals NHS Foundation

Trust

14th February 2017

Ian Williamson

Chief Officer, NHS Central

Manchester Clinical

Commissioning Group

14th March 2017

Jackie Bene Chief Executive, Bolton NHS

Foundation Trust 1

st March 2017

John Wilbraham Chief Executive, East

Cheshire NHS Trust 1

st March 2017

Jon Rouse Chief Officer, GM Health and

Social Care Partnership 13th February 2017

Karen James

Chief Executive, Tameside &

Glossop Integrated Care NHS

Foundation Trust

21st March 2017

Mike Deegan

Chief Executive, Central

Manchester University

Hospitals NHS Foundation

Trust

8th February 2017

Nicky O’Connor

Chief Operating Officer, GM

Health and Social Care

Partnership

13th February 2017

Ranjit Gill Chair, NHS Stockport Clinical

Commissioning Group 23

rd March 2017

28

Richard Jones

Executive Director for Adult

Social Care, GM Health and

Social Care Partnership

21st February 2017

Kiran Patel Chair, NHS Bolton Clinical

Commissioning Group 27

th March 2017

Dr Richard Preece

Executive Lead for Quality,

GM Health and Social Care

Partnership

13th February 2017

Sarah Price

Executive Lead for

Commissioning and

Population Health, GM Health

and Social Care Partnership

6th March 2017

Roger Spencer Chief Executive, The Christie

NHS Foundation Trust 22

nd March 2017

Silas Nichols

Chief Executive, University

Hospital of South Manchester

NHS Foundation Trust

8th March 2017

Sir David Dalton

Chief Executive, Salford

Royal NHS Foundation Trust

and Pennine Acute Hospitals

NHS Trust

27th February 2017

Steve Wilson

Executive Lead for Finance

and Investment, GM Health

and Social Care Partnership

13th February 2017

Steven Pleasant Chief Executive, Tameside

Metropolitan Borough Council 10

th May 2017

Su Long Chief Officer, NHS Bolton

Clinical Commissioning Group 2

nd March 2017

Dr Tracey Vell

Associate Lead in Primary

and Community Care, GM

Health and Social Care

Partnership

31st January 2017

29

5.0 RECOMMENDATIONS


Approve the approach described above to develop a hospital based services

strategy

Note the additional documentation to follow.

1


Date: 28 July 2017

Subject: Transformation Theme 3 – Revised Governance to deliver the Strategy for

Hospital Based Services

Report of: Diane Whittingham, Associate Lead for Theme 3, GMHSC Partnership

SUMMARY OF REPORT:

This paper is the second step in a series of papers which will build the strategy for hospital

based services. This paper is complementary to and should be read in conjunction with the

strategy approach paper (Transformation Theme 3 – A Strategy for Hospital Based

Services), which sets out the proposed approach to developing a GM strategy for hospital

based services under Theme 3, Standardising Acute and Specialised Care.

This paper details the results of a review of the Theme 3 governance required to support the

delivery of the strategy. In doing so it also describes the integrated governance of Theme 3

with the reconfiguration of A&E, Acute Medicine, and General Surgery (Healthier Together).

KEY MESSAGES:

Following communication to all key stakeholder groups about the strategy approach paper,

system stakeholders have been engaged about how the governance and decision making

needs to change to deliver the strategy. A series of governance working groups as well as

1:1 engagement and further feedback have informed the development of this paper.

The paper details the results of this review, and makes proposals for governance changes to

support the delivery of the strategy. This includes a proposed revised governance structure

and suggests roles and responsibilities of key groups, both within Theme 3 governance, and

wider Partnership governance. A summary of proposals is provided in the Executive

Summary (p4).

This paper has been discussed and supported by the Strategic Partnership Board Executive on the 12th May 2017.

12

2

PURPOSE OF REPORT:

The purpose of the report is to set out the proposed revised governance for Theme 3,

following a paper that set out the approach to developing the Strategy for Hospital Based

Services (Transformation Theme 3 – A Strategy for Hospital Based Services, April 2017).

RECOMMENDATIONS:


Endorse the content of the report and the proposed governance structure and

responsibilities

Approval to proceed with outlined next steps (p16).

CONTACT OFFICERS:

Diane Whittingham, Associate Lead for Theme 3

[email protected]

3

1.0 EXECUTIVE SUMMARY

1.1. Introduction

1.1.1. To ensure strategic coherence of all work under Theme 3 and other changes that

affect hospital based services, a GM Strategy for Hospital Based Services is being

developed. An approach paper (Transformation Theme 3 – A Strategy for Hospital

Based Services) was reviewed and fully supported by the GM Health & Social Care

Partnership Strategic Partnership Board Executive in April 2017. This paper

described how the strategy will be developed such that all the work under Theme 3

is brought together and delivers under a single process, pulls in one direction, and

does so with the involvement and engagement of all key stakeholders across the

Greater Manchester Health & Social Care system. Governance and Decision

making processes are integral to the achievement of this aim. In light of this the

governance and decision making for Theme 3 is being reviewed to ensure it is fit for

purpose. This paper outlines the results of this review and is complementary to the

strategy approach paper.

1.1.2. A key principle of Theme 3 is co-design between patients, commissioners and

providers of health and social care. However sound decision making requires the

use of constituted governance in accordance with the terms of reference of each

group. Where it is proposed, for example, that commissioners undertake decision

making in accordance with their statutory responsibilities, it should be understood

that this will always be following a period of co-design and involvement of providers.

1.2. Approach to reviewing the Theme 3 governance

1.2.1. Following communication to all key stakeholder groups about the strategy,

stakeholders have been engaged about how the governance and decision making

needs to change to deliver the strategy. A series of governance working groups

were held as well as 1:1 engagement and further feedback. See appendix 1 for a

list of who has been engaged in the process. This paper records the proposed

changes to the governance put forward by the working group and individuals

engaged on a 1:1 basis.

1.3. Issues to be considered

1.3.1. The following section details the challenges that this governance review is seeking

to resolve.

1.3.1.1. There is not a single view of the aims and objectives of Theme 3. Not all

stakeholders are aware of the aims of Theme 3 and are therefore not necessarily

bought in to the direction of travel

1.3.1.2. There is change underway that will affect hospital based services but that is not

currently reporting through the governance of Theme 3

1.3.1.3. There are some hospital based changes underway that are already in

implementation and have distinct governance processes (Healthier Together)

4

1.3.1.4. The Joint Commissioning Board has not yet been delegated authority for decisions

from the organisations it represents this is partly because there has not been clarity

on the decisions it is required to make

1.3.1.5. The relationship between SPB(E), JCB and the Theme 3 Board requires further

clarification. A review is underway.

1.3.1.6. Linkages between broader Trust, CCG, LA governance processes with Theme 3

requires clarification

1.3.1.7. Workforce is a key pillar in the success of Theme 3 and should be considered in

parallel with clinical and finance / estate considerations

1.3.1.8. There are some changes currently proposed that will be beneficial to patients that

could be implemented more quickly than the overall strategy – there is concern that

the strategy may delay delivery of these changes

1.3.1.9. Not all change will require decision making at the same level – locality / sector / GM

– there is not a consistent way to assess the appropriate level of decision making.

1.4. Summary of Proposals

1.4.1. The working group had a number of proposals to overcome the challenges outlined

above. These can be grouped as follows and are elaborated upon in the paper.

Note that we are seeking legal advice on these proposals, and therefore the

following should be read as guiding principles:

1.4.1.1. The complete integration of Healthier Together governance with Theme 3

governance so that the reconfiguration of A&E, Acute Medicine and General

Surgery services is accountable through the Theme 3 Board.

1.4.1.2. Use the component parts of the GM Health & Social Care Partnership governance

for decision making as outlined in this paper and update the terms of reference as

appropriate:

Strategic Partnership Board, supported by the Strategic Partnership Board

Executive – sets the overarching strategic vision and direction, and is the forum

for securing ownership and agreement to proposals from system partners

Joint Commissioning Board – enables delivery of the strategy through

commissioning decisions

1.4.1.3. Theme 3 Board – supported by a Theme 3 Executive, will hold the ring to provide

assurance that changes affecting hospital services are in line with the emerging

strategy. It is also the delivery architecture to oversee the production of the strategy.

1.4.1.4. Develop a decision making framework to determine the appropriate level for

decision making; and devolution of decision making to the most appropriate level

and define the involvement of each stakeholder group in each decision making

5

route. Endorsement of this framework would be sought from the Strategic

Partnership Board.

1.4.1.5. Review all material change affecting hospital services through a single forum to

ensure all material change is aligned to the strategy, and is understood and

captured in modelling of activity, estate, finance and workforce.

2.0 THEME 3 GOVERNANCE

2.1. Introduction

2.1.1. This section describes in detail proposals to revise the Theme 3 Governance to

ensure that it is fit for purpose to deliver the strategy as outlined in the recent

approach paper (Transformation Theme 3 – A Strategy for Hospital Based

Services) which was endorsed by the Strategic Partnership Board Executive in April

2017; and to address the issues highlighted in the Executive Summary. The

contents of this paper will require legal advice to ensure that the proposed

responsibilities can be legally constituted.

2.2. Decision making responsibilities of each group

2.2.1. It is proposed to use the component parts of the GM Health & Social Care

Partnership governance for decision making as outlined in this paper and review

role and terms of reference accordingly:

2.2.1.1. The key responsibilities of each group are outlined below.

2.2.1.2. Strategic Partnership Board – Strategy and Direction. Key responsibilities:

Sets the overarching strategic vision and direction, and is the forum for

securing ownership and agreement to proposals from system partners

Approval of decision making framework

2.2.1.3. Joint Commissioning Board – Delivery of the strategy through commissioning. Key

responsibilities:

Execution of decision making framework – determining appropriate level of

decision making for a change

Set GM standards and commissioning specification

Following a period of co-design led by Provider Transformation Leads

(involving GM patients, commissioners and providers of health and social care)

approve model of care (unless delegated to locality / sector for local design

where Joint Commissioning Board endorsement would be sought)

6

Decide preferred options (taking recommendations from work led by Provider

Transformation Leads and design oversight forums under Theme 3

governance)

Advises Strategic Partnership Board of preferred options, upcoming decisions,

and decision outcomes

2.2.1.4. It is recognised that the Joint Commissioning Board will need to be constituted to

allow it to discharge these functions and commissioners will need to delegate

authority for decision making to the Joint Commissioning Board to enable this to

happen.

2.2.1.5. It has been noted by the GM Health and Social Care Partnership that the terms of

reference for each of the groups outlined above are due to be reviewed and

updated. This reflects the changing and maturing nature of the Partnership itself

and the additional responsibilities it has taken on since it was initially established.

The terms of reference for both the Strategic Partnership Board and Strategic

Partnership Board Executive will be updated with approval sought in the autumn. In

addition to this further work will be undertaken in the coming months to outline a

scheme of delegation for the GM Health and Social Care partnership which sits

alongside and supports the governance structures and outlines the route for clear

decision making. Legal advice regarding the constitution of the Joint Commissioning

Board has been sought.

2.2.1.6. Theme 3 Board – Execution of Strategy. Key responsibilities:

Strategic Direction and Approach – recommendations to Joint Commissioning

Board on the strategic direction and approach of Theme 3

Alignment with strategy – recommendations to Joint Commissioning Board on

whether proposed changes (outside of Theme 3) are in line with the strategy

Alignment with strategy – provides assurance to the Transformation Portfolio

Board that changes proposed support the delivery of the hospital based

services strategy

Implementation – provides assurance that the process of implementation for

relevant projects is progressing to agreed timescales and outcomes.

2.2.2. The Theme 3 Board Terms of Reference and membership have been updated to

reflect the above proposals. A new group – the Theme 3 Executive has been

introduced to support the work of the Theme 3 Board.

2.3. Integration of governance for the reconfiguration of A&E, Acute Medicine and

General Surgery (Healthier Together)

2.3.1. The reconfiguration of A&E, Acute Medicine and General surgery is further

advanced in implementation than other programmes under Theme 3 and has

governance that pre-dates Theme 3. The programme represents a large scale

7

change affecting all GM providers and will include the movement of patients which

will require significant risk management.

2.3.2. It is proposed that the implementation of changes to A&E, Acute Medicine and

General surgery services will be accountable through Theme 3 governance with a

focus on delivery to publicised timescales and the management of patient risk

during the change. To support the Theme 3 Executive in this, it is proposed to

maintain the Healthier Together Delivery Board as chaired by David Fillingham.

This group will report progress and make recommendations to the Theme 3 Board

through the Theme 3 Executive and will act as the mechanism to share good

practice and resolve common issues across sectors.

2.3.3. It is proposed that the Healthier Together Executive is disbanded and its functions

absorbed into the new Theme 3 Executive.

2.3.4. The integrated governance structure is illustrated in Section 2.5.

2.4. Review of all material change affecting hospital services through a single

forum

2.4.1. Review all change affecting hospital services through a single forum to ensure

proposed changes are aligned to the strategy, are understood and are captured in

modelling of activity and estate.

2.4.2. The aim of the Theme 3 strategy is to determine the future shape of hospital based

services in GM. Therefore it is vital that all material (to be defined) changes

affecting the hospital sector are understood and assessed to understand alignment

with the strategy. This includes:

Clinical projects led by Theme 3

Locality proposals that move activity in / out of hospital

Sector / group proposals that move activity between hospitals

Other Theme / cross-cutting programmes that move activity in or out of hospital

or between hospitals

Changes already in implementation.

2.4.3. It is therefore proposed that the Theme 3 governance acts as this single forum to

understand how all material changes affecting hospital based services will impact

those services, and be able to advise on whether changes proposed will support

delivery of the hospital based services strategy (acting as a ‘Design Authority’). This

would involve the Theme 3 governance reviewing any proposed material change to

hospital based services to assess whether it follows the design principles for Theme

3 as agreed by Strategic Partnership Board, and be able to advise the Joint

Commissioning Board on alignment with the strategy. It is proposed that any

8

governance group could request the Theme 3 governance to review a proposed

change and provide advice on alignment.

2.4.4. To discharge this responsibility, the Theme 3 governance will require advice by

Clinical, Finance & Estates and Workforce Reference Groups.

2.4.5. Having a single forum for all proposed material changes affecting hospital based

services to be understood will also assist in ensuring all changes are captured in

the Theme 3 activity, workforce, estates and finance modelling.

2.5. Theme 3 governance structure

2.5.1. In light of these proposals, the Theme 3 governance has been updated – the

revised structure is illustrated overleaf as well as the relevant governance of the GM

Health and Social Care Partnership. This governance structure will be suitable for

development of the strategy and design of clinical projects. However this structure

may need to be further enhanced when GM options for services are developed and

considered.

2.5.2. The proposed responsibilities for the Theme 3 governance represent a significant

remit and as such, a Theme 3 Executive group is proposed to support the Theme 3

Board in discharging the portfolio, in line with the Executive functions of the SPB

and JCB. It is proposed that this Executive takes over the functions of the Healthier

Together Executive, once disbanded.

9

Proposed revised Theme 3 governance structure:

2.6. Role and constitution of groups

2.6.1. Theme 3 Executive

2.6.1.1. The governance working group recognise and support the continued representation

of commissioners, providers and regulators in the Theme 3 governance and

suggest that the proposed Theme 3 Executive includes:

GMHSCP Associate Lead for Theme 3 (Theme 3 Executive Chair)

GMHSCP Advisor to Theme 3 (Deputy Chair)

GMHSCP Executive Lead for Commissioning and Population Health

3 x Commissioners (1 with good working knowledge of Healthier Together)

Local Authority Representative

Provider Federation Board Representative

2 x Directors of Strategy

1 x Director of Operations

Clinical Representative (Chair of Clinical Reference Group)

10

Finance & Estates Representative (Chair of the Finance & Estates Reference

Group).

2.6.1.2. Individuals leading Theme 3 projects (Provider Transformation Leads) will not be

core members but will be invited to attend and present deliverables produced for

the clinical projects they lead.

2.6.1.3. Colleagues from the NHS Transformation Unit will regularly attend and support

meetings in an advisory capacity, but will not be core members of the Executive.

2.6.1.4. The key functions of the Executive are summarised below, full responsibilities are

detailed in the Terms of Reference:

Overseeing the development of a Greater Manchester Hospital based Services

Strategy for those services in Theme 3, including advice on emerging options

and how these contribute to clinical and financial sustainability across Greater

Manchester

Assessment of proposed changes to services to assess materiality and

alignment, and advise on appropriate level of decision making and governance

– making recommendations to the Theme 3 Board and, as appropriate, the

Joint Commissioning Board for decision making

Provide recommendations to the Theme 3 Board in relation to progress,

challenges, risks and issues for all Theme 3 work streams

Review models of care and service options - making recommendations to the

Theme 3 Board and, as appropriate, the Joint Commissioning Board for

decision making

Review all bids from Theme 3 programmes to the Transformation Fund and

other bids, as appropriate, where strategic changes are proposed that affect

acute hospital services

Review proposed changes to hospital services across Greater Manchester and

offer advice to relevant decision making forums

Receive and consider recommendations from subgroups including Workforce

Reference Group, Finance and Estates Reference Group and the Clinical

Reference Group

Receive and consider recommendations from the Healthier Together Delivery

Board and the Cancer Implementation Board in relation to progress and

challenges within the programme

Where appropriate, receive recommendations from FEG/TFOG regarding

business cases and action as appropriate.

2.6.2. Theme 3 Board

11

2.6.2.1. It is proposed that the Theme 3 Board assures the recommendations of the Theme

3 Executive before recommendations are made to the Strategic Partnership Board /

Executive and the Joint Commissioning Board.

2.6.2.2. Following the Theme 3 Task and Finish Group, it was agreed to amend the name of

the Theme 3 Delivery Board to the Theme 3 Board, to represent its broad

responsibilities.

2.6.2.3. The key functions of the Board are summarised below, full responsibilities are

detailed in the Terms of Reference:

Assure the development of the Greater Manchester Hospital Based Services

Strategy

Agree the scope of Theme 3 as outlined in the stocktake paper

Assure the delivery of those services within Theme 3 that are in implementation

phase

Ratify recommendations of the Theme 3 Executive in relation to Theme 3 and

other transformation programmes and advise the Joint Commissioning Board

and other boards as appropriate

Provide assurance to the Transformation Portfolio Board that the programme

plan is on track, to ensure achievement of pre-determined programme and

project milestones

Work holistically with the whole system and in particular Theme 2 where close

working will be required to realise proposed changes.

2.6.2.4. It is proposed that to discharge its responsibilities, a group of representatives of key

stakeholders is more appropriate rather than representation from all organisations.

The membership of the Board is therefore largely unchanged from the current

membership with the exception of a few additions and clarifications to ensure

connectivity with the new Theme 3 Executive. Membership is shown in Appendix 2.

2.6.2.5. Key decisions of the Board should be communicated to all stakeholders via the

existing GM Health and Social Care Partnership governance and ultimately via the

Strategic Partnership Board where all Partners are represented.

2.6.2.6. The proposed membership and Terms of Reference of both the Theme 3 Board and

the Theme 3 Executive have been reviewed and agreed with the existing Board

members, having been developed by a Theme 3 Governance Task and Finish

Group.

2.6.3. Other informal governance

2.6.3.1. The clinical projects in scope of Theme 3 are being led by nominated Provider

Transformation Leads. An informal monthly meeting is proposed between the

12

Provider Transformation Leads, Theme 3 Associate Lead and the NHS

Transformation Unit.

2.6.3.2. The NHS Transformation Unit provides services to support the GM Health and

Social Care Partnership to deliver Theme 3. As such it is proposed that there is a

Theme 3 Partner Management Forum between the GM Health and Social Care

Partnership and the NHS Transformation Unit (and any other contracted partners)

to manage the contracts between the Partnership and contracted organisations.

2.7. Wider involvement and engagement

2.7.1. Involvement and Engagement with Providers and Trust Boards

2.7.1.1. Trust leadership and Boards are vital stakeholders for Theme 3 and as such must

be fully engaged and involved. Trust Boards are responsible for delivery of the

terms of the NHS licence including maintenance of the financial position of the

organisation. Therefore it can prove challenging for Trust Boards to discharge this

responsibility and support changes that negatively impact a Trust’s financial or

clinical viability. A number of proposals are put forwards to mitigate this;

Early engagement with Trust leadership in setting the strategic direction for

Theme 3 including an exploration of the potential benefits for organisations in

working collaboratively across GM

Involvement of Provider representatives on the Theme 3 Executive and Board,

with formal feedback to be sought via the Provider Federation Board and fed

into Theme 3 via the provider members

Greater and targeted engagement with Trust Chairs and Non-Executive

Directors throughout and at each key stage of Theme 3 – Provider Federation

Board to advise Theme 3 on which GM Provider forums should be engaged at

each stage

Early involvement of the regulator in reviewing proposed changes to allow early

identification of proposals that may not be supported such that alternative

solutions can be sought.

Setting of conditions to mitigate negative impacts on the financial position at the

start – for example a policy on stranded costs such that there is agreement to

fund these for a set period whilst a longer term mitigation or solution for the

stranded estate can be found

Clear processes for the consideration and agreement of the financial

implications of changes

All proposed changes are analysed to determine the impact on GM and on

individual providers such that impacts on organisational viability are clearly

understood when decisions are taken.

13

2.7.1.2. See diagram overleaf illustrating governance of Theme 3, Providers and

Commissioners.

2.7.2. Involvement and Engagement with Commissioners and CCG Boards

2.7.2.1. As the decision makers in any proposed change, engagement and involvement of

commissioners will be key to the success of Theme 3. As such the following is

proposed:

Cross reference of these proposals with the GM commissioning review to

ensure alignment

Early engagement with CCG leadership in setting the strategic direction for

Theme 3 including an exploration of the potential benefits for organisations in

working collaboratively across GM

Involvement of CCG representatives on the Theme 3 Executive and Board,

with formal feedback sought via the AGG and fed into Theme 3 via the CCG

members

Greater and targeted engagement with CCG colleagues throughout and at

each key stage of Theme 3

All proposed changes are analysed to determine the impact on GM and on

individual CCGs such that impacts on organisational viability are clearly

understood when decisions are taken.

2.7.3. Involvement and Engagement of Local Authorities

2.7.3.1. Through their role in the devolution governance arrangements at GM level, Local

Authorities will be part of aligning the Theme 3 changes with changes driven by the

other GM themes, including population health and prevention and transforming

community based care.

2.7.3.2. The role of the 10 Council Leaders on the GM Strategic Partnership Board is

therefore fundamental to decision making and the essence of the partnership

between locally elected Councillors and local NHS leaders. The involvement of

Leaders and other Executive Councillors in the programme is therefore critical in

delivering the changes.

2.7.3.3. The implementation of the Theme 3 programme also needs to be incorporated into

the 10 locality plans so that changes can be seen as a coherent whole at place

level. The role of Health and Wellbeing Boards in approving Locality Plans is one of

the main ways in which the changes needed to transform health and care services

are made relevant to the needs and interests of local people and patients at this

level.

2.7.3.4. The diagram below illustrates the wider engagement and governance of Theme 3,

Providers, Commissioners, and localities. It is recognised that further work is

14

needed to fully describe the appropriate engagement between Theme 3, Executive

Councillors, Health and Wellbeing Boards and localities, and this is being taken

forward:

15

Theme 3, Provider and commissioner and local authority governance

2.7.4. Patient engagement and involvement; health scrutiny

2.7.4.1. Patient engagement and involvement will be key to shaping the Theme 3 proposals

and a separate paper is being drafted outlining in detail the approach that Theme 3

will take to this, building on national best practice, lessons learnt from previous

changes in GM and to meet national requirements of major transformation.

However, the diagram overleaf shows where patients are currently involved in the

governance, through the role of health scrutiny.

2.7.4.2. The primary aim of health scrutiny is to act as a lever to improve the health of local

people, ensuring their needs are considered as an integral part of the

commissioning, delivery and development of health services. However the GM

devolution agreement created a partnership between locally elected Councillors and

local NHS leaders, and the role of scrutiny in GM must set within this context.

Further work is needed to consider fully how Theme 3 governance should connect

to the GM Joint Health Scrutiny Committee in the context of GM devolution.

16

Patient and public scrutiny governance

2.7.5. Engagement with other Themes and cross-cutting work streams

2.7.5.1. To ensure delivery of the overall GM Strategy, Theme 3 will work closely with the

other Themes and cross-cutting programmes to ensure alignment of direction and

that key interdependencies are managed, engaging via the Portfolio Board to

highlight any areas requiring clarification between Themes and projects.

2.7.5.2. The interfaces with the other groups are illustrated overleaf:

17

Themes and Cross-Cutting programmes governance

2.7.6. Review of business cases

2.7.6.1. Changes proposed under Theme 3 may require production of GM capital business

cases. As such it is proposed that should GM business cases be required, the same

process is utilised. The governance for this is illustrated overleaf.

2.7.6.2. The development of the business cases would be managed through the Business

Case governance structure set out below. However, the approval of the business

case funding would be subject to the following:

The business case would need to be approved through the Theme 3

Governance process as required.

Any recurrent revenue consequences would need to be approved by the

relevant commissioning organisations.

Non recurrent Transformational Funding would be subject to the TFOG

Assessment process.

Should external capital be required within the business case, this would require

the case to be approved through the relevant capital funder, following their

bidding process.

Provider Boards would also be required to approve the business case for

individual capital investments and commit the resources required following

appropriate approval from NHS Improvement.

18

Theme 3 Business Case governance

19

3.0 3.0. NEXT STEPS

3.1. To complete this governance review the following next steps are proposed:

Presentation to Strategic Partnership Board for endorsement

Cross reference proposals with the GM commissioning review

Completion of further work to agree appropriate engagement and involvement

of health scrutiny

Sharing of this proposal with key governance groups to address any further

work, and agree how to operationalise (PFB, AGG, GMCA/AGMA)

Confirmation that Joint Commissioning Board can be constituted as proposed,

next steps to do this and timelines.

Confirmation that SPB/SPB/E Terms of reference and role support this process

Full legal review of proposals.

3.2. Once the above is complete:

Document the Theme 3 Board and Theme 3 Executive Terms of Reference

and agree membership

Work with the GM Health and Social Care Partnership Head of Workforce to

establish the appropriate workforce reference group

Convene the Finance & Estates Reference Group

Clarify the decisions required of the Joint Commissioning Board so that

authority can be delegated

Develop a Communications strategy to support Theme 3 work.

20

Appendix 1 – List of individuals engaged in the review

The following people have been engaged to date:

Working group 1, 29th March

Su Long – Bolton CCG

Kiran Patel – Bury CCG and Chair of AGG

Jack Sharp – SRFT

Chris Brookes – SRFT / PAHT, Principal Clinical Advisor to Theme 3

Rob Bellingham – Managing Director, Greater Manchester Association of CCGs

Mark Wilkinson – RBFT

John Wareing – CMFT

Emily Gardner – Programme Manager, Theme 3

Jen Parsons – Transformation Unit

Sophie Hargreaves – Transformation Unit

Working group 2, 20th April

Diane Whittingham - Associate Lead Theme 3 GMHSCP

Chris Brookes

Chris Brookes – SRFT / PAHT, Principal Clinical Advisor to Theme 3

Rob Bellingham – Managing Director, Greater Manchester Association of CCGs

Su Long – Bolton CCG

Darren Banks – Director of Strategy, CMFT

Stephen Kennedy – Financial Strategic Lead, GM Health and Social Care

Partnership

Clare Powell – Healthier Together Programme Director

Jen Parsons – Transformation Unit

Sophie Hargreaves – Transformation Unit

Further engagement and feedback

Anne Gibbs – NHS improvement

Geoff Little –GMCA

Matt Graham – UHSM

Anthony Hassall – Salford CCG

Sarah Price – GM Health and Social Care Partnership

Steve Wilson – GM Health and Social Care Partnership

Nicky O’Connor – GM Health & Social Care Partnership

Warren Heppolette – GM Health and Social Care Partnership

Helen Ibbott – GM Health and Social Care Partnership

Vicky Sharrock – GM Health and Social Care Partnership

21

Appendix 2 – Membership of the Theme 3 Board

The Theme 3 Board is chaired by the GM Health and Social Care Partnership Theme 3 Associate Lead.

Membership of the Board includes the Theme 3 Executive to ensure continuity between groups (members are marked with an asterisk).

Membership of the Board (below) also ensures representation from the following: provider Chief Executives (PFB); commissioning Chief Officers (AGG); AGMA; specialised commissioning; NHS Improvement; key functions including finance (FEG), strategy (Provider Directors of Strategy), operations (Provider Directors of Operations); Theme 2, Theme 5 (workforce, estates), Communications.

Colleagues from the NHS Transformation Unit will regularly attend and support meetings in

an advisory capacity, but will not be core members of the Board.

Board Membership Role Name Title

Theme 3 Associate Lead and Chair of Board

Diane Whittingham*/Sir Jonathan Michael*

Associate Lead, GMH&SCP

Advisor to Theme 3, GMH&SCP

Provider Executive Lead for Theme 3 and PFB chair

Ann Barnes* Chief Executive, Stockport NHS Foundation Trust

Principal Clinical Advisor to Theme 3/CRG Chair

Chris Brookes* Executive Medical Director, SRFT / PAHT

Executive Lead for Theme 3, GMH&SCP

Sarah Price* Executive Lead for Commissioning and Population Health

Representing AGMA

The representative for the Board and Executive is being confirmed

GM Health & Social Care Partnership Lead for Quality

Richard Preece Executive Lead for Quality, GM H&SCP

Representing Theme 1 and Theme 2

Warren Heppolette Executive Lead, Strategy & System Development, GMH&SCP

Dr Tracey Vell Associate Lead, Primary and Community Care, GMH&SP

Representing AGG (3 x Commissioners – also members of the Executive)

Representatives of the Board and Executive are being confirmed

22

Patient Representative Peter Denton GM Healthwatch

Specialised Commissioning

Andrew Bibby Assistant Regional Director Specialised Commissioning, NHS England

Healthier Together David Fillingham/Ed Dyson

Chair of the Healthier Together Delivery Board/Healthier Together SRO

NHS Improvement Ann Gibbs NHS Improvement

Representing Provider Directors of Strategy, and as Provider Transformation Leads

Jack Sharp * Director of Strategy SRFT

Darren Banks* Director of Strategy, CMFT

Provider Transformation Lead (MSK/Orthopaedics)

Richard Mundon Director of Strategy, WWL

Provider Transformation Lead (Breast Services)

Jane Woods Projects Director, UHSM

Representing Provider Directors of Operations

Mary Fleming* Director of Operations, WWL

Representing CCG Directors of Commissioning

Melissa Laskey Head of Commissioning, Bolton CCG

Representing Provider Directors of Finance

Claire Yarwood Executive Director of Finance, CMFT

Representing Chief Finance Officers (CFO group)

Steve Dixon CCG Chief Finance Officer

Chair of the Finance and Estates Reference Group

Steve Wilson*

Named deputy: Stephen Kennedy

Executive Lead for Finance and Investment, GM H&SCP

Representing Theme 5 Yvonne Rogers

Chair of the Workforce Group, GM H&SCP

Neil Grice Estates Lead

GM Mental Health Provider Representative

To be agreed

Theme 3 Communications Lead

Laura Conrad Communications Manager, GM H&SCP

1


Date: 28 July 2017

Subject: Workforce Strategy & 2017/18 Implementation Plan

Report of: Nicky O’Connor, Chief Operating Officer, GMHSC Partnership

SUMMARY OF REPORT:

The report presents the Greater Manchester Health & Social Care (GM HSC) workforce

strategy and outlines the implementation plan for 2017/18. The executive summary can be

accessed via the following link: Executive summary Workforce Strategy and Implementation

Plan

KEY MESSAGES:

The Strategic Partnership Board Executive, Strategic Workforce Board and wider groups

have been consulted on the workforce strategy and implementation plan. Four strategic

workforce priorities and eleven related action areas have been identified within the 2017/18

implementation plan. The current and projected future workforce is outlined, informed by 3

scenarios or ranges across GM and for each locality. Key feedback points from the May

SPBE have been addressed in the Strategy and are summarised in section 3 of this paper.

Overall feedback is also summarised in the main strategy documentation, slides 18 and 19.

PURPOSE OF REPORT:

The purpose of this report is to seek endorsement of the GM workforce strategy, the

implementation plan and the new Workforce Collaborative arrangements.

RECOMMENDATIONS:


Endorse the workforce strategy and 2017/18 implementation plan.

Endorse the new Workforce Collaborative and Strategic Workforce Board revised

governance arrangements.

13

https://greatermanchester-my.sharepoint.com/personal/rionagrainger_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0be32f6f51f4246a1a44eb872fc27600a&authkey=AdHnZx4FVBP-HTGha-fkCiI

https://greatermanchester-my.sharepoint.com/personal/rionagrainger_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0be32f6f51f4246a1a44eb872fc27600a&authkey=AdHnZx4FVBP-HTGha-fkCiI

2

Note the update on workforce planning scenarios and transformation themes and

consider how as a Board it can support ongoing workforce improvement

CONTACT OFFICERS:

Nicky O’Connor, Chief Operating Officer, GMHSC Partnership

[email protected]

Riona Grainger, Project Manager, GMHSC Partnership

[email protected]

3

1.0 INTRODUCTION

1.1. This paper provides an update on the development of the GM workforce strategy

outlining what has been amended and added since a previous version of the

emerging strategy was presented to the SPBE and Strategic Workforce Board in

May 2017. It also incorporates the 2017/18 implementation plan, the latest

workforce planning scenarios for GM and each locality as well as further details on

the GM Workforce Collaborative.

1.2. The full strategy document is included in a separate link to this paper and includes

an executive summary.

2.0 BACKGROUND AND CONTEXT

2.1. The GM workforce programme and emerging Workforce Strategy priorities,

supported by the SPBE in February 2017, was established to enable the fastest and

most comprehensive improvements in the capacity and capability of the whole GM

workforce (paid & unpaid) to support the achievement of the transformation

ambitions as defined in the GM strategic plan and the locality plans. The workforce

programme has 3 broad areas;

2.1.1. Developing a comprehensive workforce strategy: setting out the key priority

areas of the GM workforce programme based on a detailed appreciation of the

needs of localities, the transformation themes, the ambition of wider GM

stakeholders and key national priorities.

2.1.2. Supporting localities in improving and implementing their local

transformation plans: supporting the localities and GM transformation themes to

develop and implement comprehensive workforce transformation plans, insights

and interventions that are practical, implementable and address key strategic

challenges.

2.1.3. Establishing the GM Workforce Collaborative: bringing together all key

stakeholders across GM (localities, regional and national bodies across Health &

Social Care), leveraging collective expertise, capacity and resources to implement

initiatives, share best practice and accelerate the delivery of key workforce

priorities.

2.2. The target outcome is to enable GM to have a resilient paid and unpaid workforce

across Health & Social Care that feels sufficiently motivated, supported,

empowered and equipped to deliver safe and effective services, drive sustainable

improvements and positively influence the health & wellbeing of the population.

2.3. The four priorities endorsed in the emerging workforce strategy remain, as they

received positive support from stakeholders.

4

2

3

4

5

2.4. The supporting actions and analysis have been strengthened and incorporate the

recommendations and feedback from the various stakeholder groups.

2.5. To develop the picture of the Greater Manchester workforce we are creating a

shared narrative around the current and projected future workforce, based around 3

scenarios described at locality and GM levels. We have considered the emerging

scenarios around the likely future workforce needs based on current and emergent

plans. The 3 scenarios are based on:

2.5.1. New Economy projections: the policy, strategy and research group for Greater

Manchester, New Economy, has produced a view on workforce size and likely

workforce changes across Greater Manchester up to 2035, which includes the

health and social care sector. The information here is taken from their draft Labour

Market report, a final version of which will be produced in July 2017.

2.5.2. Provider projections: NHS Providers identify workforce trends through 2 systems,

of which we have used Unify as the data set. Unify is an NHSI online collection

system for data collating, sharing and reporting. For the purpose of this analysis, it

provides a strong picture of NHS provider views. Additional information has been

included from:

Social Care National Minimum Data Set: Provided by Skills for Care, the

Social Care NMDS includes current and future projections for local authority

staff.

CCG Plans: CCGs hold plans for changes in primary care workforce. This

includes General practice staff and CCG staff.

2.5.3. Locality projections: There are two potential locality views - locality workforce

plans and locality finance projections. For this analysis, we have used the locality

view obtained through the finance process. At present, this view is incomplete, and

the numbers for this scenario are therefore lower than the other scenarios. It will

develop over time.

2.6. The new Workforce Collaborative, essentially the Partnership delivery vehicle for

the strategy and implementation plan, is described in more detail, including the new

joint GMHSCP/HEE delivery team and the £3.2 million budget for 2017/18 and

beyond.

3.0 FEEDBACK FROM MAY SPBE

3.1. There were a number of key points raised at the May SPBE meeting, which were

subsequently discussed at various GMHSCP forums, including the Provider

Federation Board, the Strategic Workforce Board and Workforce Engagement

Forum, and have been addressed as follows:

3.1.1. Impact of Brexit - We have initially addressed the impact of Brexit within the

workforce section of the new version of the report recognising the emerging picture.

6

We have set out the workforce that works within the UK from Europe, and

highlighted the percentage that GM uses in 2 tables in a slide entitled “Context –

Global Workforce”. We have identified the immediate impact on nursing that the

Kings Fund identified in their article in June 2017(a 96% reduction in EU nationals

registering as nurses in the UK compared to pre-referendum levels). This is also

identified as a key strategic workforce risk, alongside the international recruitment of

key health and social care staff. We are also ensuring that we are working closely

with national organisations particularly NHSE (EP’s) NHSI and HEE to ensure GM

is well positioned to pilot international recruitment initiatives.

3.1.2. Funding for implementation plan - £3.2m has been identified for the Workforce

Collaborative to help ensure the delivery of the 2017/18 implementation plan and

beyond. This includes £1.0m from the GMHSCP Transformation Development Fund

and £1.0m match funding from HEE as well as funds for a core Workforce

Collaborative team. This matched funding comes as part of a unique new

agreement with HEE, developing on the existing MOU, and endorsed in a recent

meeting with Ian Cumming, CEO of HEE, Jon Rouse and Andrew Foster, Chair of

the GM Strategic Workforce Board

3.1.2.1. The principles for accessing further Transformation funding as well as financial

commitments from organisations, are also set out so that the economic case/ cost

benefit analysis is a future requirement, thus avoiding any repetition of the

continuity of service example. It is recognised that further work is required for

2018/19 and beyond, and that the £3.2m is likely to be committed into the next year.

This will be addressed in the 2018/19 implementation plan and on an annual basis

thereafter.

3.1.3. Enhancing social care - The Adult Social Care Transformation Programme has

seen system leaders, providers and commissioners come together to confront the

reality of the social care challenge, whilst seeking to design and implement

innovative solutions to radically improve outcomes for people across GM. Across

the four key workstreams - Care at Home; Residential & Nursing Care; Learning

Disabilities; and Support for Carers - delivery groups chaired by system leaders

have identified priorities and main areas of focus within these priorities that will

facilitate decision making processes during the Autumn. Feedback from the broader

system identified that there was insufficient focus on the adult social care workforce

pressures associated with these workstreams within the emerging GM Workforce

Strategy.

3.1.3.1. Although we still have much to do, we have now aligned the adult social care

workforce programme to the GM Workforce Strategy's four strategic priorities and

identified a series of delivery plans to enable achievement of the key workstreams

identified above. Two specific examples demonstrate how we have begun to embed

social care into the work programmes; firstly an invitation has been extended to

ADASS to attend the Strategic Workforce Board to represent adult social care

workforce issues and secondly, under strategic priority 4 - Employment Offer and

Brand(s) we are working to identify 3 local authority organisations to act as pilot

organisations to participate in a programme of work to build on the NHS Quest

7

initiative to establish a GM employer brand across health and social care focussing

on improving quality, safety, diversity and a healthy working culture. This latter point

aligns to the Mayor's priority - development of a GM Employment Charter - which

seeks, amongst other things, to build a health and well-being culture across all GM

employers. Additionally, we shall recruit an Adult Social Care Workforce Lead

during the summer to facilitate delivery of the work programmes.

3.1.4. Mayor’s manifesto commitments - The close alignment between the GM

Workforce Strategy and the new Mayor’s agenda is summarised in the document.

The Mayor has identified workforce as a key priority including;

Achieving the first fully integrated NHS and care service with single integrated

teams.

Championing unpaid carers – particularly young carers – ensure they are

identified ad supported

Increasing control over workforce planning

Introducing incentives for those in education to stay and more to encourage

young people to enter training and education

Over time working to bring social care staff into NHS family (training and

reward)

3.1.4.1. A joint working group has been established between the GMHSCP and Mayor’s

office, which will include workforce issues. A representative from the Mayor’s office

will join the GM Strategic Workforce Board. One practical example is that the

Strategic Workforce Board is commissioning a report on incentives and

disincentives for improving Nursing and AHP recruitment, retention and return to

practice, which will inform and influence the Mayor’s commitment to examining

Nurse Bursaries, as well as how we attract more people into the nursing profession.

3.1.5. Carers and Volunteers - Some concerns were raised about the inclusion of carers

and volunteers into a workforce strategy. However, there was also broad support for

the approach as it seeks to recognise and value their significant contribution to the

care and wellbeing of the population. We have sought to ensure we are aligning the

work with the GM Carers Strategy and MOU already agreed by the Strategic

Programme Board and Executive as well as the Adult Social Care Transformation

programme. In particular, we are focusing on:

Supporting and developing carers and volunteers through a new development

framework, including relevant training

Widening routes into health and social care employment and education for

carers and volunteers as part of our Grow Our Own

Ensuring we are applying best employer practices, for how we treat carers

and volunteers, through our employment brand initiatives.

8

4.0 GOVERNANCE AND WORKFORCE COLLABORATIVE

4.1. The slides on the governance and Workforce Collaborative relate to the revised

terms of reference and membership of the Strategic Workforce Board, which:

Improve the connection between localities & GM

Take into account the refreshed Memorandum of Understanding with HEE

Clarify governance arrangements with the Workforce Collaborative and

oversight responsibilities

Improve alignment with GM networks and wider partnerships; including the

and Workforce & Leadership agenda

Improve engagement and partnership working

Streamline strategy and delivery focus e.g. task and finish groups

Strengthen communications e.g. monthly briefings

4.2. The GM Workforce Collaborative will act as the creative space where partner

organisations across GM come together to drive the delivery of workforce

transformation programmes out of mutual gains and in pursuit of a common cause.

It will be directly responsible to the GMHSCP Strategic Workforce Board, which is

accountable to the GMHSCP Strategic Partnership Board and its Executive as well

as the GM Reform Board. The Strategic Workforce Board will also continue to be

accountable to Health Education England (HEE), as part of a unique MOU

agreement, for exercising jointly its national responsibilities locally including

ensuring an effective system is in place for planning education and training in the

NHS, quality improvement in education and training, managing the funding HEE

receives and discharging the Secretary of State’s duty to ensure the supply of staff

for the NHS. These statutory duties remain with Health Education England however

the GMHSCP Strategic Workforce Board is also the HEE Local Workforce Advisory

Board as part of the governance arrangements.

9

4.3. The Workforce Collaborative will be led by Janet Wilkinson, GMHSCP Director of

Workforce who will lead a small Collaborative team and manage the £3.2m fund

devolved to ensure the delivery of the workforce strategy on behalf of GMHSCP,

HEE and other partners

4.4. It is envisaged that in line with the Collaborative approach outlined that much of the

delivery of the Workforce Collaborative will be led by GM Localities working

together or leading on particular initiatives on behalf of colleagues.

4.5. Through the Collaborative, GM will establish a new Workforce Futures Centre from

October 2017 that will lead research and development of innovative insights on the

future of work and its implications for workforce development locally, nationally and

internationally.

4.6. The Workforce Collaborative will also launch its GM Workforce Awards in 2017 to

recognise and reward achievement and best practice.

5.0 RECOMMENDATIONS


Endorse the workforce strategy and 2017/18 implementation plan.

10

Endorse the new Workforce Collaborative and Strategic Workforce Board

revised governance arrangements.

Note the update on workforce planning scenarios and transformation themes

and consider how as a Board it can support ongoing workforce improvement

1

APPENDIX TO ITEM 13


The Executive summary of the Workforce Strategy & Implementation Plan is included as a

link with the cover paper of this item. To read the full document, please use the link below.

Workforce Strategy and Implementation Plan v3.2

13

https://greatermanchester-my.sharepoint.com/personal/rionagrainger_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0487f66c0279a45bc8eba6e6e99cd8160&authkey=AeJeiMRRyUycOahbGITa1jI

1


Date: 28 July 2017

Subject: GM Partnership Annual Report and Accounts 2016/17

Report of: Warren Heppolette, Executive Lead, Strategy & System Development,

GMHSC Partnership

SUMMARY OF REPORT:

The Annual Report 2016/17 describes the work of the GM Partnership. The SPB is asked to

endorse the report.

KEY MESSAGES:

The Annual Report describes the Partnership’s work in 2016/17 – the first year of its

operation.

PURPOSE OF REPORT:

The Annual Report sets out the work of the GM Health and Social Care Partnership in

2016/17

RECOMMENDATIONS:


Endorse the Annual Report 2016-17

CONTACT OFFICERS:

Helen Ibbott, Portfolio Manager, Strategy & System Development, GMHSC Partnership

[email protected]

Paul Lynch, Deputy Director, Strategy & System Development, GMHSC Partnership

[email protected]

14

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=00100de021b1142318045d9960db9f270&authkey=AedSVWWHFdHbcRTQIAA9zUY

1


Date: 28 July 2017

Subject: GM HSCP Business Plan 2017/18

Report of: Warren Heppolette, Executive Lead Strategy & System Development,

GMHSC Partnership

SUMMARY OF REPORT:

This report is the final version of the GMHSC Partnership Business Plan for 2017/18 for

consideration and endorsement by the Strategic Partnership Board.

It has been developed in conjunction with key leads and stakeholders from across the GM

Health and Social Care Partnership and has been subject to extensive review and comment

by the key GM leadership groups during May.

It outlines the key strategic activities that will take place during 2017/18, as Greater

Manchester moves into the second year of operation of the GMHSC Partnership and the

implementation of Taking Charge.

It is presented to the Strategic Partnership Board for consideration and approval prior to

publication.

KEY MESSAGES:

The GMHSC Partnership Business plan has been compiled using detail provided from

across the Partnership and key programmes at a GM and locality level, which have been

considered through the Partnership governance.

It has been reviewed by a range of stakeholders and all of the key GM leadership groups

during May and has been amended as a result of those discussions. Therefore the final

version is presented to the Strategic Partnership Board for consideration and approval.

The Plan outlines the key strategic activities that will take place during 2017/18, as Greater

Manchester moves into the implementation of Taking Charge.

15

https://greatermanchester-my.sharepoint.com/personal/stephendobson_gmhsc_org/_layouts/15/guestaccess.aspx?docid=0f397cd96aa604a4184779a40a2a6ebae&authkey=AVPEn6qZEA6DiGt2yYLAe3U

2

The 10 GM localities have also been asked to complete a template, which provides specific

detail relating to implementation within each locality. These form the appendix of the

Business Plan.

PURPOSE OF REPORT:

This business plan describes the key priorities of the Partnership for the coming year. It sets

out priorities, which are organised under the following headings:

Improving the health of all GM residents

Transforming care & support

Enabling better care

Research, Innovation and growth

Achieving financial balance & securing sustainability

It should be read in conjunction with previously published documents and the 2016/17

Annual Report of the GMHSC Partnership.

2017-18 is the second year of the operation of the GMHSC Partnership and its 5 year

Programme. Year one established the infrastructure and relationships to drive the work and

year two onwards will see implementation and the initial evidence of impact.

RECOMMENDATIONS:


Approve the 2017/18 GM Health and Social Partnership Business Plan for full

publication to be shared with our key stakeholders.

CONTACT OFFICERS:

Warren Heppolette, Executive Lead Strategy & System Development, GMHSC

Partnership

[email protected]

Helen Ibbott, Assistant Director Health and Social Care Reform, GMHSC Partnership

[email protected]

greater manchester health and social care … · 2020. 2. 20. · collective commitment against the...

Documents