Bolton Locality Plan High Level Implementation Plan Version 1 1 April 2016
Contents Content Page 1. Strategic Context 3-8 2. Target outcomes for 2020 9-11 3. Key priorities for delivery by April 2016 12 14 4. Overview of workstreams and delivery 15 16 5. Governance framework, including responsibilities for delivery 17 6. Workstream and detailed activity plan 18-30 7. Enablers of change 31 34 8. Financial plan 35 36 9. Timeline for implementation 37 39 10. Communications and engagement schedule 40 2
1. Strategic Context The Bolton Locality Plan sits within the context of the Greater Manchester Devolution Programme which is aimed at driving the biggest and fastest improvement to the overall health and wellbeing of the GM population by the end of 2020. For Bolton, this plan sits within the GM context, but focusses on the elements which will be delivered locally, by all partners working together to deliver significant transformation change. It makes reference to the elements which will be delivered through the North West Acute Sector programme (under Healthier Together) and to the work programmes which are being developed and delivered on a GM footprint. The Locality Plan sits under the Vision Strategy. The latter being the 20 year strategy for the whole system reform across Bolton, including the Economic Strategy and Health and Wellbeing Strategy. The enabling workstreams (of IT, Estates, Workforce, Innovation and Engagement/Communication) underpin all of the strategies, including the NW Sector and GM programmes. The diagram shown on page 17 illustrates the current Bolton Vision Governance Structure and priorities up to 2016/17 and where the Locality Plan currently sits. The strategy and governance arrangements are currently under review and will become Bolton s Vision 2020 and will focus on people and place and growth and reform. The Health and Wellbeing Strategy is also currently under review to ensure it is aligned to both the refreshed Vision Strategy and the Locality Plan. The Financial Position There is an identified gap of 162m across the whole health and care economy in Bolton by 2020. Individual organisation and joint plans for cost improvement (through efficiency and effectiveness programmes, focus on improving quality and outcomes and vertical and horizontal integration opportunities) can reduce this recurrent gap by 84m (to 78m). With the requested 20m for the protection of social care this gap would reduce to 58m. However, the residual gap will require the whole system to reform which will only be possible with transitional investment particularly in early intervention and prevention services as well as in the estate and IT infrastructure. Population Health Improvement Programmes To commission for services to effectively meet the needs of the population of Bolton, we have segmented the locality population (of 300,000) into four tiers. The agreed strategy in the Locality Plan is to pump-prime the new delivery models which will enable the longer term shift in the proportion of funding from unplanned hospital admissions and long term care placements (reactive care in Tier 1 predominantly) to proactive and preventative care (Tier 2 for the neighbourhood working, Tier 3 for the medium term and specifically Tier 4 for the longer term) 3
1. Strategic context (cont.) Population Health Improvement Programmes (cont.) Tier 1 (2%): multiple Long Term Conditions, frail elderly individual Multi-disciplinary care plans Tier 2 (10%): developing significant risks associated with Long Term Conditions or frailty - need early intervention and tertiary prevention to prevent/delay progress of condition and for over 65s: to stay well Tier 3 (20%): secondary prevention and early identification: targeted interventions for individuals and communities at risk Tier 4 - System-wide interventions to improve health and wellbeing and prevent future ill-health (primary prevention) The top tier comprises of 2% of the population (6,000 people) who have two or more long term conditions, are the high risk frail elderly or those at the end of their life. There has been significant investment already made into services to support the individuals within this Tier, including: Admissions Avoidance Redesigned Intermediate care services (home and bed based) Services to support the most vulnerable and complex dependency The second tier is the population that has started to become ill or frail, but currently not requiring significant health treatment and/or hospital admission (and therefore will not necessarily have a risk stratification score) but are eligible for social care services. These individuals need preventative interventions to stop them moving into the top tier within the next few years requiring higher levels of health and social care resources. This is estimated to be about 10% of the population (30,000 people). The third tier is population wide early identification and prevention with targeted interventions for individuals for those at risk of poor health and wellbeing (20% of the population: 60.000 people). This tier includes a large proportion of the population who are at risk of long term conditions, for example due to smoking or being physically inactive, or who may already have long term conditions, such as hypertension, but don t yet have social care needs, and may not be accessing health services beyond primary care. Future demand on health and social care services could be prevented or delayed through targeted prevention and early intervention with this population. Tiers 2 and 3 are where transformation of existing services together with additional funding is required to commission new and enhanced interventions to be delivered at individual or on a wider scale. A business case covering all elements of the transformation programmes is in development. At high level this includes the following: Secondary and tertiary prevention, focusing on the specific long term conditions (and their risk factors) which are most prevalent across the locality: heart disease, respiratory disease and diabetes - delivered through Integrated Teams wrapped around general practice (on a neighbourhood basis) including Health Improvement Practitioners, ANPs, district nurses, pharmacists, mental health practitioners and MSK practitioners. This will include signposting people to the right provision of support, including social prescribing with a focus on emotional wellbeing and physical activity, to enable individuals to develop their health skills and knowledge to build their capacity to manage their own health and wellbeing including stopping smoking, reducing alcohol harm, eating healthily and becoming physically active. This will include Increasing dementia diagnosis and improving care, preventing falls, providing GP care to the frail elderly and ensuring people aged over 65 retain their independence for as long as possible through physical and mental activity and reducing social isolation through participation in activities/groups within the community (to be delivered though expansion of the Staying Well programme based around GP Practices and full roll out of the Safe, Warm and Dry initiative). 4
1. Strategic Context (cont.) Putting in place new service delivery models (with investment 23.75m over 5 years) aimed at reducing demand on the system for those currently in Tiers 1 and 2 now will start to pay back within 1 year and has been calculated to deliver savings of 26.545 over 5 years). 5
1. Strategic Context (cont.) Key programmes of work targeted at the tier 3 population include: Integrated Team model (also supporting Tier 2 as set out above), who will also focus on: Increasing uptake of screening, including cancer screening programmes, focusing on populations with low uptake rates Increasing uptake of vaccinations specifically flu and childhood immunisation Critical to the successful delivery of the new neighbourhood models of care is community development, capacity building and engagement. These are essential to improving the health of the population and reducing health inequalities. We will work with communities which face the poorest health outcomes, using asset based community development approaches to build resilience and empower communities to play an active role in improving their own health and wellbeing. This will include a focus on social prescribing, building on the strengths of the voluntary, community and social enterprise sector in engaging local communities, including hard to reach groups, and improving health and wellbeing. Additional investment could accelerate the development of these social prescribing and self-care programmes. 6
1. Strategic Context (cont.) The fourth tier is system-wide primary prevention to promote good health and wellbeing across the population. This includes population-wide strategies to promote good health and wellbeing and addressing the wider determinants of health. The Early Years New Delivery Model is key to this and is a key call on the GM Transformation fund for all localities. To secure a financially sustainable health and social care system, the impact of interventions in the short, medium and long term needs to be considered. Investment is needed both in interventions which are likely to deliver a return on investment in the timescale covered by the Locality Plan, as well as those interventions which will take longer to deliver returns on investment but have the potential to secure greater savings and significant improvements in population health. Critical to delivery of the locality aims is the fostering and implementation of a genuine whole system approach which includes the community and voluntary sector as a key driver. 7
2. Target outcomes for 2020 (cont.) Our locality plan prioritises a series of outcomes against which we will monitor our progress in improving health and reducing inequalities. We have set ambitious targets for each of these outcomes which aim to exceed or narrow the gap with the England average or our peer comparators, improving the overall health and wellbeing of the population and reducing demand on services. NB: Work has been commenced to look at key outcomes that will be measured across GM. The initial set of locality plan outcomes and targets may need to be revised as the GM work develops. Outcome Reduce local life expectancy gap to the Greater Manchester average: men Reduce local life expectancy gap to the Greater Manchester average: women Bolton to achieve Better than average yellow ranking on Longer Lives for heart disease and stroke when compared to similar areas Reduce the inequality gap between Bolton and England for premature respiratory mortality to half by 2020 Target Quantifiable benefit at year 5 Year 1 Year 2 Year 3 Year 4 Year 5 11.3 11.0 10.7 10.4 10.1 28,439 people in Bolton will live an average 1.2 years longer. 10.9 10.3 9.7 9.0 8.4 88.0 77.7 67.5 57.2 47.0 An additional 17 residents/year will live beyond age 75 years. 46.5 42.8 39.2 35.5 31.9 In 2020, 98 more people in Bolton will live to over 75 who would not have done previously. Reduce suicide rate 9.5 9.4 9.2 9.1 8.9 8 suicides will be avoided each year Related delivery programme Integrated Neighbourhood Health Improvement Staying Well Integrated Neighbourhood Health Improvement Staying Well Integrated Neighbourhood Health Improvement Reduce self-harm admissions in children 531.7 480.0 428.4 376.7 325.0 93 child admissions will be avoided each year Staying Well Early Years New Delivery Model 8
2. Target outcomes for 2020 Outcome Increase the percentage of people expected to have dementia being on the dementia register Target Year 1 Year 2 Year 3 Year 4 Year 5 Quantifiable benefit at year 5 0.73 0.75 0.77 0.78 0.80 2,834 people will be on the dementia register Improve breastfeeding at 6-8 weeks to England average 39.9 41.4 42.9 44.3 45.8 210 more mothers will breastfeed to 6-8 weeks Reduce smoking in pregnancy 15.1 13.8 12.6 11.3 10.0 228 fewer mothers will smoke in pregnancy Children achieving a good level of Original outcome target no longer development: narrow the attainment applicable. New target needs to be gap between children receiving free considered. school meals and children not in receipt of FSM at ages 2,3, 4 and EYFS. Reducing excess weight in school children Reduce the number of alcohol-related admissions (narrow definition) in Bolton back to the England average 33.6 32.1 30.5 29.0 27.4 234 fewer children will be of excess weight when they reach Year 6. 733.0 711.0 689.0 667.0 645.0 There will be 234 fewer alcoholrelated admissions per year. Reducing injuries due to falls 890 847 803 760 716 No increase in admissions due to falls per year. Without a comprehensive falls prevention strategy we would expect admissions to increase to 1082/year by 2020 due to demographic changes alone. Improving Flu vaccination uptake rate 74.1 75.6 77.1 78.5 80.0 2,874 more older people will receive flu vaccination per season. Related delivery programme Dementia Staying Well Early Years New Delivery Model Early Years New Delivery Model Early Years New Delivery Model Early Years New Delivery Model Integrated Neighbourhood Health Improvement Falls Staying Well Staying Well 9
3. Priorities for delivery by April 2016 There are priority areas which need to be in place by April 2016 (in high level form) to enable the collaborative design and delivery of the population health outcomes programmes. These include new contractual models, new commissioning models and new models of care and are set out below. Workstream Key Area Lead Actions by April 16 Outcomes RAG status Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes New Contractual Models New contractual model between Bolton CCG and Bolton FT AW (with SW) Agreement of new outcome based contractual model for 2016/17 Agreed contract within financial envelope to allow the focus on service redesign to reduce acute demand and overall cost of care to the system - within the agreed strategic aim of transformation of the system from reactive to proactive care which is based around a person and community centred approach Green Overall Financial Affordability Whole system financial modelling AW 5 year view of total cost of the system compared to the expected income to identify year on year affordability gap and therefore whole system savings required Identification of the combined efficiency savings required to bridge the significant financial gap to be bridged leading to whole system focus on solutions to deliver this. Green Implementation of the Bolton Offer. New Commissioning Models GM wide commissioning GM JCB Agree which areas will be commissioned locally and which will be on a GM wide basis Commissioning footprint for locality, sector and GM footprint agreed to allow for pooling of budgets and integrated delivery Amber (continued on next page) 10
3. Priorities for delivery by April 2016 (cont.) Workstream Key Area Lead Actions by April 16 Outcomes RAG status Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes New Commissioning Models Integrated Commissioning: locality ML (with AC) For locally commissioned services, agree which will be included within an integrated commissioning function across CCG and Council with pooled budgets and appropriate governance arrangements Fully integrated commissioning across health and care to ensure most efficient and effective use of available resources and commissioning for outcomes to deliver the Bolton vision Green Design and implement local integrated commissioning function and governance Amber Right Care ML Ensure full use of Right Care Commissioning for Value approach to identify areas for evidence based improvement whole system focus (to include decommissioning) Strategic whole system prioritisation of service transformation which is clinically driven and evidence based and is centred around improvement of population health outcomes Green Population Segmentation: macro and meso ML (with AC) Enhancement of population segmentation understanding across the 4 tiers, with commissioning based on this Commissioning appropriate services and care based on the understood needs of the population Amber Micro commissioning for outcomes ML (with AC) Significantly expand use of personal (health) budgets to maximise use of resources and ensure person-centred care to empower individuals Individuals and carers have control of their health and care through deciding on the services which meet their needs Amber Co-production and Social value at the heart of commissioning ML/AC/DK/A T Embed within commissioning full commitment to social value, maximising the impact of public expenditure and ensuring the best possible health and care outcomes. Revolutionise the local approach to service and system transformation Red Fully embed parity in decision making and developing outcomes locally. Develop a coproduction/user voice programme within the CVS and Healthwatch (continued on next page) 11
3. Priorities for delivery by April 2016 (cont.) Workstream Key Area Lead Actions by April 16 Outcomes RAG status Key Priorities for Delivery by April 2016 to enable collaborative design and delivery of population health outcomes programmes New Models of Care Local Care Organisation (LCO) model JLG Define and agree new model of care for locality (MCP or PACS) Appropriate provider models of care in place which are appropriate to Bolton as a place Amber Design and implement neighbourhood teams based on need LH (with RT/MC/ML and KS) Engagement of GP practices re new models of care / neighbourhood working Commence scoping of workforce requirements Commence scoping of health needs of the neighbourhoods (JSNA for populations to allow for commissioning of appropriate health and care teams for neighbourhoods based on these) Actions 2016/17: Agreement of defined neighbourhoods Determine health and care needs of defined neighbourhoods Alignment of Integrated Neighbourhood teams Alignment of wider community and social care providers including the voluntary and community sector Scope service delivery model including specialist input Understand and scope health and social care capitated budgets Neighbourhoods are appropriately resourced, centred around general practice, to meet the needs of the populations they are looking after. Reactive and proactive care models to make a significant impact on improving health and wellbeing Reduction in non-elective conditions for ACS conditions Information sharing agreements in place Access to health and social care records across the economy Patient experience measures Appropriate workforce in place, determined at scoping phase Amber 12
4. Overview of workstreams and delivery Where are we now Population growth: By 2020 Bolton s population is expected to reach 289,000, a 3.0% increase from today. Over the next 5-10 years pre-school, older teenager (16-19 years), and younger adult (20-24 years) populations will reduce, whilst primary, secondary school ages, and older age groups, increase. Ageing population: The population aged 65+ is expected to grow by almost 20% to around 57,300 people in 2025. This includes substantial growth in the population aged 80+ which will increase by over 40% to approximately 16,500 in 2025. Employment: After Manchester and Salford, Bolton is expected to experience the largest employment increase in Greater Manchester. Local employment growth is expected to be concentrated in professional and business services. Long-term conditions: Long-term conditions, especially cardiovascular disease (CVD), are the chief causes of Bolton s health inequalities. Diabetes and other forms of CVD are very strongly associated with ethnicity and deprivation e.g. risk of diabetes for people of South Asian ethnicity is about 6 times higher than for people of white ethnicity. Approximately 16,000 people in Bolton today have some form of CVD and this is likely to increase to over 17,000 people by 2020. The total number of people with diabetes is expected to reach 12,160 in the next four or five years. Trends in CVD and diabetes will also be strongly influenced by rising rates of obesity. Social care needs: An estimated 20,500 older people in Bolton have some social care need. This could grow to 27,100 people by 2030. Assuming continuation of current patterns of care: Local authority-commissioned home care hours would need to increase from 20,800/week to 27,600 by 2030 day care placements would need to increase from 410 to 540 supported residential placements from 840 to 1,100 150 additional care home places will be required by 2020 and a further 260 places by 2025. Dementia: Number of people aged 65+ with dementia is expected to grow by 35.9% to 4,203 in 2025. ¼ of hospital beds are occupied by patients with dementia and these patients stay in hospital longer than others with the same condition. Falls: 30% of people aged 65+ living at home and 50% of people aged 80+ living at home or in residential care will experience a fall at least once in a year. This equates to approximately 20,000 falls/year in Bolton now and 25,000/year by 2025. Social isolation: There are estimated to be between 3,670 (6%) and 4,705 (13%) people over 60 years who often or always feel lonely in Bolton today. These numbers are likely to increase with growth of older population. 13
The transformation worksteams 4. Overview of workstreams and delivery (cont.) Our vision is to significantly improve health and wellbeing outcomes for the whole population of Bolton. Within this our key aims are to improve life expectancy and experience for all people living in Bolton and reduce inequalities in life expectancy within the locality. To achieve this we are focussing on the key areas of transformational change noted in the Greater Manchester Plan, Taking charge of our Health and Social Care. These are: a) Population health/early intervention and prevention b) Transforming community based care and support c) Standardised acute and specialist care d) Standardised clinical support and back office On this page we have set out a high level overview of how we will achieve our vision in relation to the two areas of transformational change that are able to be influenced at the local level: population health/early intervention and prevention and transforming community based care and support. a) Population health/early intervention and prevention Early Years: New Delivery Model Increased physical activity Reduce levels of liver disease Emotional Wellbeing Early identification: find the missing 1000s Early intervention: secondary and tertiary prevention to prevent/delay progress of one or more long term conditions Social prescribing, self care Reduced social isolation and retention of independence A Healthy and Vibrant Bolton Locality b) Transforming community based care and support Improved assessment and care planning - frailty Improved and Sustainable Care Home Sector Improved Home Care Significant improvement in falls prevention care Improvement in dementia diagnosis and care Reactive care delivery: Reduction in unplanned hospital admissions and long term residential care placements Last Year of Life Care CASE FOR CHANGE PRIORITY POPULATION GROUPS STRATEGIC INITIATIVES 14
5. Governance framework Vision Steering Group Has overall responsibility for the strategy; provides strong leadership and challenge Public Sector Leadership Group Has specific leadership around key challenges across Bolton s public services overall Bolton Vision Strategy 2016/17 Bolton s current Community Strategy that focuses on the priorities of: Achieve economic prosperity and maximise local benefit Narrow the gap in outcomes between the least and most well off Priority themes: Prosperous Health & Wellbeing Children & Young People Clean & Green Safe Strong Partnerships: Economic Partnership Health & Wellbeing Board Children s Trust Cleaner & Greener Partnership Be Safe Stronger Partnership Economic Strategy Health & Wellbeing Strategy Locality Plan Bolton Community Homes Board Complex Dependency (including Family First and Working Well) 15
6. Workstream and detailed activity plan Based on the agreed vision for significant improvements across Bolton, the workstreams required to ensure delivery of these have been identified and set out below. The transformation workstreams have been broken down to align with the key areas of transformational change set out in the Greater Manchester strategy for reform: a) Population health/early intervention and prevention b) Place-based integration c) Standardised acute and specialist care d) Standardised clinical support and back office Transformation Workstreams a. Population health/early intervention and prevention Key Areas Lead Actions and Outcomes Year 1 (2016/17) Early Years NL GM bid to transformation fund for GMwide New Delivery implementation of EYNDM Model Learning from the Early Adopter area to inform full implementation of the EYNDM in Bolton from 2016/17 Include the development of a local service model for parent and infant mental health aligned with GM developments of peri-natal MH Actions and Outcomes Year 2 (2017/18) Scope plans for a re-designed integrated service for 0-19 year olds. Re-profiling of current investment and service re-design to focus on prevention. Identify investment required for peri-natal mental health Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Early Years New Delivery Model implemented as part of 0-19 integrated service. Reduce infant mortality Increase breastfeeding at 6-8 weeks to 45.8%. This equates to an additional 210 more mothers breastfeeding per annum. Reduce smoking in pregnancy to 10%. This equates to 228 fewer mothers smoking in pregnancy. Children achieving a good level of development: narrow the attainment gap between children receiving free school meals and children not in receipt of FSM at ages 2,3, 4 and EYFS. Requires investment of 2.15m per annum. Starts to pay back after 10 years with full savings being delivered at 20 years. 16
6. Workstream and detailed activity plan (cont.) Transformation Workstreams a. Population health/early intervention and prevention Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Increased physical activity b. Transforming Reduce levels community based of liver care and support disease amenable to health:- Alcohol related harm Blood borne viruses Non - alcoholic fatty NL Work with locality partners including the Leisure Trust and NHS providers to develop physical activity as a key pathway linked to redesigned health improvement services. KS & LH Develop local plans for family-focused approaches to increasing physical activity in response to new national obesity strategy. Include costs of programme within the new neighbourhood model (from GM Transformation Fund) Deliver and evaluate complex lifestyle service. Implement integrated liver group action plan. Include support for medium risk drinkers within re-designed health improvement service. Implementation of a revised Primary Care pathway Increased referrals into local health improvement services from GPs and PNs Development of a specialist liver workforce in primary care Develop a Fibroscanner Pathway for Primary Care to be used for a range of metabolic syndromes Develop a new workforce Health Improvement Practitioners (HIPs) to work at a Neighbourhood level to target specific interventions (Include costs within the new neighbourhood model [from GM Transformation Fund] Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Begin implementation of local plans. Reduce premature mortality from heart disease, respiratory disease, cancer and stroke. Reduce prevalence of heart disease, stroke and type 2 diabetes. 2-3 GPs with a special interest in liver disease Provision of 2-3 specialist liver disease clinics within primary care Implementation of a Fibroscanner Pathway for Primary Care Improved health outcomes within primary care closer to home Access to a range of specialist behaviour change services for people at increasing/high risk/dependent drinkers Reduce excess weight in school children to 27.4%. This equates to 234 children per year no longer being of excess weight in Year 6. Use evaluation results to inform future Re-designed service in place plans for complex lifestyle support. Reduce alcohol related Re-design/ re-tender specialist admissions to 645 per 100,000. services. This equates to 234 fewer alcohol related admissions per year Equity of access to targeted liver interventions across all neighbourhoods Early identification of alcohol related liver disease Whole system approach for tackling liver disease amenable to health 17
6. Workstream and detailed activity plan (cont.) Transformation Workstreams b. Transforming community based care and support Key Areas Lead Actions and Outcomes Year 1 (2016/17) Emotional KS Wellbeing Complete mental health and wellbeing needs assessment, including suicide audit. Develop local action plan to improve mental health and wellbeing. Include emotional wellbeing as a focus within plans for social prescribing and health improvement. Actions and Outcomes Year 2 (2017/18) Develop business case(s) to support implementation of local action plan. Continue to implement local action plan. Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Local plans fully implemented. Reduce suicide rate to 8.8 per 100,000. This equates to a reduction of 8 suicides per year. Reduce self harm admissions among children and young people to below 190 for ages 10-24. This equates to 93 child emergency admissions avoided per year. Develop local mental health action plan that speaks to the GM Mental Health Strategy Include costs of programme within the new neighbourhood model (from GM Transformation Fund) b. Transforming Sustain early LH community based identification care and support at scale and find the missing 1000s Scope work needed to improve uptake of NHS Health Check and screening programmes in populations with low uptake rates and/or increased risk Development of new strategies/campaigns to increase uptake in populations with low uptake rates and/or increased risk Ongoing review of NHS Check/screening programmes to improve uptake Reduce premature mortality from heart disease and stroke. An additional 17 residents/year will live beyond age 75. Increase % of people expected to have dementia who are on the dementia register to 80%, so that there are 2,834 people on the dementia register in Bolton. Ongoing review of NHS Health Check/screening programmes to improve uptake 18
6. Workstream and detailed activity plan (cont.) Transformation Workstreams b. Transforming community based care and support Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Increase early SL/LH/K Redesign health improvement services Evaluation of re-designed service. intervention at S to provide health Reduction in prevalence and improved scale and coaching/interventions for specific management of LTCs. secondary identified cohort of population (people and tertiary who are developing significant risks prevention to associated with Long Term Conditions) prevent/delay as key component of the primary care progress of Integrated Neighbourhood Teams. one or more Specific focus on reducing prevalence long term of and harm from respiratory disease, conditions CVD, cancer and type 2 diabetes Develop business case to redesign services and deliver secondary and tertiary prevention at scale. Maximise use of mental health expertise in integrated care teams Workforce modelling to deliver new primary care model Development of effective targeted interventions to communities of identity: use of VCSE and housing services All of the above elements included included within within the new neighbourhood model (from GM Transformation fund) Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Reduce internal life expectancy gap between most and least deprived areas to 10.1 years for men and 8.4 years for women. This equates to 28,439 people living on average 1.2 years longer. Improve flu vaccination update rates to over 80%. This equates to 2,874 more people being vaccinated per season. Reduce premature mortality from heart disease and stroke. An additional 17 residents/year will live beyond age 75. Reduce the inequality gap between Bolton and England for premature respiratory mortality to half by 2020. In 2020, 98 more people in Bolton will live to over 75 who would not have done previously. 19
6. Workstream and detailed activity plan (cont.) Transformation Workstreams b. Transforming community based care and support Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Social Begin implementation of social prescribing, prescribing and self care plan. self care People looking after themselves and each other SL/L Develop local plans for social prescribing. H/K Consider social marketing needed to S/D transform the population s approach to self K care and use of services. Agree a shared understanding across sectors of the appropriate model for social prescribing in Bolton. Develop a voluntary sector led model that can be accessed by multidisciplinary teams from the statutory and voluntary sector. All of the above elements included included within within the new neighbourhood model (from GM Transformation fund) Support neighbourhoods to take an asset based approach to improving self care.. Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Social prescribing and self care plans fully implemented. Reduce internal life expectancy gap between most and least deprived areas to 10.1 years for men and 8.4 years for women. This equates to 28,439 people living on average 1.2 years longer. Voluntary and community sector that can deliver goal orientated, outcomebased support services Align model to Staying Well, Integrated Neighbourhood Teams and new neighbourhoods (around GP Practices) Develop a voluntary sector pilot project for Bolton on a particular demographic to test the approach for effectiveness. Embed within the pilot the principle of self-care. CVS to build capacity within the sector and support and facilitate the sector to take a goal orientated, outcome-based approach. Invest in capacity work to enable individuals to recognise and realise their own assets in improving their health and wellbeing. 20
6. Workstream and detailed activity plan (cont.) Transformation Workstreams c. Standardised acute and specialist care Key Areas Lead Actions and Outcomes Year 1 (2016/17) Reduced RT More people remaining in their own social home isolation and retention of independence Improvement in Care and Repair Service (Home Improvement Agency) Increase in Safe Warm and Dry Initiative Local action plans to align to the Ageing Well GM Strategies and agenda Investment in Asset based approaches to reduce social isolation and build stronger community connections through the Ambition for Ageing Programme in Bolton Actions and Outcomes Year 2 (2017/18) Develop business case for GM transformation funding to expand Staying Well programme Applying learning from pilot projects in Ambition for Ageing identified areas and upscaling areas of effective delivery Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Staying Well implemented city wide. Increased number of older people connected in their communities Reduction in social isolation Reduction in demand on health and social care services Increased number of older people realising their assets to improve their own health and wellbeing Reduce internal life expectancy gap between most and least deprived areas to 10.1 years for men and 8.4 years for women. This equates to 28,439 people living on average 1.2 years longer. c. Standardised acute and specialist care Improved assessment and care planning - frailty AC/RT/ LH Investment in scaling up the innovation and demand reduction work through a programme of behaviour change/ workforce reform that alters the mindset of individual practitioners (micro-commissioners). This changes micro-commissioning behaviour and if wrapped around reformed primary care with community health partners, it will make a significant contribution to improved outcomes including reduced spend on items such as prescribing, acute care and adult social care 21
6. Workstream and detailed activity plan (cont.) Transformation Workstreams c. Standardised Improved and acute and Sustainable specialist care Care Home Sector c. Standardised Improved acute and Home Care specialist care Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Actions and Outcomes Years 3-5 (2018/19 to 2020/21) AC AC / ML Carry out a comprehensive review of the Care Home sector in Bolton Run market engagement events residential & nursing care. This will cover engagement with providers and also start discussions with service users around co-producing service specifications From the market engagement events we will identify forward thinking, innovative and creative providers to work with on co-producing service specifications and new funding models that incentivise improvements in quality, a reduction in hospital admissions and increases in preferred place of death. Alongside GM we will produce an ethical service specification for home care. This new service will be renamed to reflect a reformed approach involving a blended health and social care model with an integrated front line worker We will shape the home care market in ways that ensure that home care staff are full members of integrated neighbourhood teams, along with primary care, social care and community health Implement new funding models and monitor effectiveness Carry out Market Shaping to ensure future delivery of suitable in borough provision Explore new build opportunities and new capital funding models Manage poor provision out of the market As opportunity presents we will deliver the ethical service specification for reformed home care Moving away from time and task support will be flexible with use of PDA/smart phone technology to monitor compliance and facilitate time banking. Care will be proactive with carers encouraged to be intuitive and do what is required not what is on their task sheet. Carers to be upskilled to carry out lower level medical tasks reducing duplication and allowing district nurses to focus on higher prority patients Reduction in number of out of borough placements Sustainable high quality care home sector Sufficiency and stability ensured in the market. Work with the GM team and CQC to revise the regulatory framework to facilitate a blending of health and social care roles. 22
6. Workstream and detailed activity plan (cont.) Transformation Workstreams c. Standardised acute and specialist care Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Significant AC/M Complete falls needs assessment. Implement local plans to establish improvement L/KS a comprehensive falls prevention in falls Develop falls action plan. pathway. prevention care Review and re-design falls pathways. Develop business case to enhance falls prevention pathway/ services. Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Comprehensive falls pathway implemented. No increase in admissions due to falls per year. Without a comprehensive falls prevention strategy we would expect admissions to increase to 1082/year by 2020 due to demographic changes alone. c. Standardised acute and specialist care Improvement AC in dementia diagnosis and care Implement the home safety check service through the Care and Repair Home Improvement Agency Re-establish Bolton Dementia Partnership to oversee delivery of our ambition Develop business case for improved dementia support and care. Pilot Dementia Friendly Communities (DFC) approach in Horwich. Establish Dementia Action Alliance. Develop expertise within the local Participate in GM Dementia United programme workforce for dementia care Local work re dementia diagnosis improvement (within 12 weeks) and actions to improve care for people with dementia including helping them to remain at home. Achievement of waiting times from referral to diagnosis and ensure comprehensive post diagnostic support for dementia in place Develop plans to roll out DFC borough wide (subject to successful evaluation). Improve choice of specialist care locally (EMI Nursing/ challenging behaviour) including the development of specialist housing provision Ongoing improvement in case finding for dementia registers Implement 5 Dementia United Pledges across the whole system Implement Dementia Keyworker model This requires additional investment of 500k per annum and starts to pay back from year 1 ( 432k) with savings of 2.443m per annum being realised from year 5. DFC in place borough wide. GM Dementia Programme established Increase % of people expected to have dementia who are on a dementia register (from 68.5% to 80%. This equates to 2,834 people being on the dementia register. This requires additional investment of 500k per annum and starts to pay back from year 2 ( 366k) with savings of 1.11m per annum being realised from year 5. 23
6. Workstream and detailed activity plan (cont.) Transformation Workstreams d. Standardised clinical support and back office functions d. Standardised clinical support and back office functions Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) ML/AC Reduction in unplanned hospital admissions and long term residential care placements Reactive care delivery: Reduce, Prevent, Delay: Admission avoidance health and care teams and improved reablement and home based care for population most at risk of unplanned admission Last Year of Life Care ML/AC Housing VSCE Reduction in hospital length of stay Implement strategy Housing for Independence Strategy Homelessness help for single complete and being implemented homeless service implemented Disability Housing Registered updated working being undertaken jointly with Housing Stock condition survey completed Wigan and Rochdale and in Housing Needs survey completed collaboration with the Complex Home Improvement Agency/Safe Warm Lifestyles Project and Dry radical upgrade proposal underway and due for completion first quarter 16/17 for implementation throughout 16/17 All VSCE assets mapped across Bolton, Voluntary Sector Strategy - being written following refresh of Bolton Vision Strategy due for completion Q2 16/17 VSCE Provider group co-producing this VSCE grants changed to outcome focus and realigned to early intervention and prevention all grants awarded Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Reduce non elective admissions by x per year. Reduce long term residential placements by x per year Reduce length of stay by x days Social Isolation Public Health and Learning will be used to inform other Adult Social Care engaged with the initiatives across the rest of our wards Ambition for ageing partnership, ageing and adopted by other registered social and a VSCE and RSL (registered social landlords via the Bolton Community landlord) partnership working in 3 wards Homes board in Bolton. 24
6. Workstream and detailed activity plan (cont.) System Redesign In order to deliver the radical change in population outcomes, requiring a significant shift in the way we use of resources (moving from reactive to proactive care models), we need to redesign the current systems of care- from how services are commissioned and delivered, to how they interface and react with each other. Transforming Primary and Community Care in Bolton Central to the new system for Bolton is the redesign of a primary care system which has integrated working at the heart, around neighbourhoods of natural communities Phased Approach to the New Models of Care 25
6. Workstream and detailed activity plan (cont.) Actions from April 2016 (shadow year) to deliver step 1 Increase the Bolton Quality Contract payment level to 98 per weighted patient (i.e. paid difference between GMS/PMS/APMS and this level) additional payment this year reflects general practice team time required to give longer to frail elderly, complete standard care plan, sign up to info sharing, work with Integrated neighbourhood teams Organise all practices into neighbourhoods to develop modernised workforce, i.e. work together to employ pharmacists, health improvement practitioners, mental health workers, etc. to support GPs to spend more time with most complex patients and to fix workforce gaps that exist by thinking traditionally Support from current Staying Well team, Bolton CVS and HealthWatch Bolton to ensure neighbourhoods work on building community assets as part of their approach to meeting patient need. Actions from April 2016 (shadow year) to deliver step 2 Require practices in these neighbourhoods to direct and lead the integrated neighbourhood teams, and build their direction of district nursing etc. Both practices and their INTs will have KPIs relating to the production of Care Plans (this is a second step as the shift of leadership will take time to embed). Actions from April 2016 (shadow year) to deliver step 3 Support neighbourhoods to identify the specific needs of their patients and build outreach support from hospital based specialists in areas such as Heart Failure, COPD, to reduce hospital admissions Contractual arrangements will expect providers to work together to deliver outcomes: no change to current employment of any staff but alignment of incentives in this shadow year 2017/18 plan Opportunity to have agreed a new contractual form for a new model of provision (based on Multi-specialty community provider) that builds on weighted capitation basis that Bolton Quality contract has commenced, with sharing of system savings 26
6. Workstream and detailed activity plan (cont.) Transforming the Urgent Care System Bolton health and care economy has developed a strategic plan for the redesign of urgent care to ensure delivery of responsive, emergency and urgent care when this is required, with the ethos of primary and community based care being the first point of contact for non life threatening illness and injury. For patients who do enter the urgent care system, the focus is on ensuring that they get to the right service as rapidly as possible to enable them to return to their home in a timely fashion, with to maximum amount of independence retained. To this end, the first element of the system redesign is at the front door of the Emergency Department. Having a senior clinician undertaking a rapid clinical assessment of all those presenting to A&E will ensure that patients who enter the urgent care system are directed to the most appropriate place (and person) to deliver that care, including the patient s own GP for appropriate conditions/presentations. Senior Clinician front of A&E A&E stream Primary care stream Ambulatory Care Urgent Outpatient Alternative to Inpatient Admission Minors A&E see and treat within 4 hours Majors /Resus In hours Deflect back to primary care/other (including patients requiring referral for routine outpatient appointment Out of Hours If patients need to be seen within 24 hours appt in OOH in A&E Out of Hours If patients do not need to be seen within 24 hours refer back to own GP practice Ambulatory Care Centre 10am till 10pm Senior Clinicians All appropriate surgical and medical conditions adults and children (not initially assessed as requiring inpatient admission) For patients who require an urgent apt with a Consultant within 24 hours: Rapid Access Clinics (mornings 7 days per week) Immediate Referral to Admission Avoidance Team being expanded to provide 24/7 care 27
6. Workstream and detailed activity plan (cont.) The other key element of the redesign of the urgent care system locally is efficient and effective transfer of patients back to their own home (or usual place of residence). This involves appropriate usage of Intermediate Tier services with the focus on think home first. The following indicators will be used by the locality in measurement of the success of the urgent care system and all partners will hold each other to account for delivery of the new system. Outcome Domain Local Whole System Balance Measures Metrics SAFER metrics, including: o Senior clinician review within 2 hours of initial presentation o Maximum time from decision to admit in ED to transfer to a bed o Discharge of 40% of people before midday and 75% before 4pm Reduced Delayed Transfers of Care Reductions in time to put in place packages of care to keep people at home (maximum of x hours from decision of appropriate care package) Reduced time for assessment completion Reduced Acute Bed Days Reduced Non elective length of stay Reduction in Unplanned Hospital Admissions and Readmissions Number of care packages delivered per 1,000 population Increased proportion of people able to remain in their own home Improved support to carers Improved access to assistive technology Improved Supported Living Reduced number of falls Improved dementia care Patient survey results on Primary Care Access Number of additional primary care appointments filled Reduction in the number of long term placements to residential care on discharge Increased percentage of people remaining at home 91 days post discharge Reduced delayed transfer of care for people out of area Access to RAID services 24/7 National standards including A&E 4 hours target, ambulance handovers and ambulance response times Increase in the percentage of 111 dispositions to primary/community based care 28
7. Enablers of change There are a number of whole system strategic workstreams which underpin the delivery of the locality plan vision and outcomes. Each of these has a strategy in development with an underpinning governance structure and action plan. The high level deliverables of each of the workstreams is set out below. Enabling Workstreams Estates Key Areas Lead Actions and Outcomes Year 1 (2016/17) Reconfigure the Bolton Public Estate to provide patients and staff with safe, quality, health and care environments in an appropriate location ensuring facilities are fit for purpose for the services that are being delivered. ST Map current estate and utilisation Design future estate requirements (including asset disposal) in line with strategic estate plan Implement year 1 of the Estates plan IT Locality IT Strategy AU Implement Carecentric phase 1 - agree data sharing agreement and basic shared care plan to allow sharing across key workers (OOH, DNs, social care, integrated teams). Implement end of life plans within shared care plan. Implement GP feeds to populate integrated digital care record and provide staged access to health and social care Actions and Outcomes Year 2 (2017/18) Implement year 2 of Estates Plan Carecentric phase 2 - extend use of mobile apps to key groups Eg District Nurses. Implement additional feeds (adult social services, community and acute). Investigate Patient portals and apps and develop strategy for deployment. Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Implement years 3-5 of estates plan Efficiency savings of 2.4m realised Carecentric Phase 3 - implement patient portal to facilitate self-help. Implement further feeds (GMW, NWAS). Extend access to other key health and care professionals. Implement patient mobile apps 29
7. Enablers of change (cont.) Enabling Workstreams Key Areas Lead Actions and Outcomes Year 1 (2016/17) Actions and Outcomes Year 2 (2017/18) Actions and Outcomes Years 3-5 (2018/19 to 2020/21) Workforce Workforce Analysis and Planning HC Complete analysis of whole current workforce including the VCSE Complete analysis of future workforce requirements Communication and Engagement Communications Strategy and Plan NO / AT / Bolton CVS Develop strategic workforce plan to bridge gaps including a competency framework Development of robust communication and engagement plan Communications and engagement activity will look at raising awareness of the locality plan and the challenges facing our health and care services, whilst also encouraging people to get involved and make a #BoltonTakingCharge pledge. Implement communication and engagement plan. Roll out communications across all channels Monitor the success of communication activity and contimue rto focus on key internal and extern lines of communication North West Sector Partnership Bolton is working in collaboration with Salford and Wigan (acute Trusts and CCGs predominantly) under the Greater Manchester Healthier Together Programme to deliver significant changes in terms of health outcomes and clinical and financial sustainability. This North West Sector Partnership has its own strategy and governance infrastructure, and is interlinked with the Bolton Locality Plan, as the aims and outcomes detailed within the Locality Plan can only be achieved through collaborative working with other NHS and wider organisations. 30
7. Enablers of change (cont.) Key Enabling Objectives Transformation Workstreams Development of Shared Single Services Lead Actions by March 2017 Outcomes MW MW MW MW Establishment of Shadow Single Service Board for Priority Services Agreed system of performance management and governance for shared services Appointment of new consultants of a single service basis for identified priority services and those under the Healthier Together Programme Agreed clinical model to meet Healthier Together Standards Pilot of single service Board underway to roll out to future models Pilot of single service governance underway to roll out to future models All future appointments made on the assumption of the single service within the sector and recruitment processes and contracts adapted to be fit for the future Healthier Together Business case Completed. Services Identified for Potential Priority Review List of Services Rationale for inclusion Justification Planned year for delivery Breast Dermatology Lacks clinical resilience for long term: 12mth interim solution in place Lack of clinical resilience at WWL. SRFT gaps in capacity. National medical workforce shortage SRFT has an interim only solution. Need to develop options for sector specific services within 6 months to inform GM level strategy. Need to secure resilience Rapid review of options for improving resilience at WWL. Clinical quality and safety. Full sector review with sector solution within 12 months. Clinical resilience all sites. Urology Benign Lack medical workforce resilience x 2 FTs Service lacks resilience at BFT and WWL. Need to develop options for sector specific services within 6 months. Clinical Quality and Safety Year 1 (2016/17) Year 1 (2016/17) Year 1 (2016/17) Year 1 (2016/17) GM Led? YES NO NO NO 31
7. Enablers of change (cont.) Services Identified for Potential Priority Review (cont.) List of Services Rationale for inclusion Justification Planned year for delivery Interventional radiology non-vascular Paediatric General Surgery (emergency) Neuro-rehabilitation Cardiology Inadequate service across the sector. Unable to meet HT standards for General Surgery Adult GS service changes requires review of this service. There is no service at SRFT which is the high risk EGS site for the sector. Lack of capacity in line with demand. Patient not able to access right care, right place. High care costs of delayed transfers. Potential for changes within GM, which may affect volumes and accreditation of existing sector units. Non-vascular IR services are suboptimal across GM. There is a pressing need to make progress with solutions for NV IR services given the co-dependency with Emergency and Elective General Surgical services and delivery of the GM HT Standards of care. Workforce challenges and securing standards of care. The work will inform GM level work. SRFT is not and will not be a receiving site for Paediatric General Surgical emergencies. Wigan and Bolton provide services 24/7 7/7. Whilst GM level work will be required. Need to develop options for sector specific services within 6 months to inform Sector Business Case and to inform GM level work. Co-dependent service requiring a solution. Services across the sector are inadequate to meet the needs of the population. Funding arrangements are not workable. GM level work is underway but delivery will rely on a sector level review of services and pathways. Quality of care, Experience of Care and Costs The focus is on specialised cardiology. There is a need for greater information and engagement with specialised commissioners to understand what changes are proposed. Changes unclear at this time. Year 1 (2016/17) Year 1 (2016/17) Year 1 (2016/17) Year 2 (2017/18) GM Led? HT Prog HT Prog YES YES 32
Additional Savings Savings from Transformation Pump Priming 8. Financial plan Savings projected from transformation plans CCG 000's Reducing demand on hospital due to INT redesign LTC management etc 5,366 Stop increasing demand on hospital due to falls prevention management LA 000's Reducing demand on social care due to falls prevention over 5 years 4,588 Reducing demand on hospital due to dementia 1,583 Reducing demand on social care due to dementia 1,443 Reducing demand on hospital care due to Staying well 1,013 Reducing demand on social care due to Staying well 2,834 Reducing demand on hospital services due to health promotion and self care etc 1,013 Emotional wellbeing 3,525 2,179 FT 000's FT cost reduction reduced LoS, bed days 3,000 Total 000's Total Savings from Transformation Pump Priming 12,500 11,045 3,000 26,545 Redesign of Urgent Care 8,084 Right Care 3,356 Readmissions 43 Additional Local Authority Savings TBC Additional FT Savings (as per Bolton roll up) 30,000 Total Additional Savings 11,483 0 30,000 41,483 Total Savings 23,983 11,045 33,000 68,028 As the system starts to reduce the amount which is being spent on reactive care, more resource will be released back to invest in the schemes (targeted at the population at Tiers 3 and specifically 4) which will pay back in the medium to longer term (including the Early Years New Delivery model which starts to pay back within 10 years but delivers significant whole system cost reduction and improvements in whole population outcomes from year 20). 33
8. Financial plan (cont.) 10 - (10) (20) (30) (40) (50) (60) (70) (80) (90) -45-10 -83-28 -24 CCG 20/21 LA 20/21 Provider 20/21 Net 20/21 Position Whole locality do nothing income/expenditure and impact of plan ( m) CCG Improvement -11 LA Improvement -33 Provider Improvement -16-22 Net 20/21 Position after Improvement CCG Position after Improvement 1 5 LA Position Provider Position After Improvement 34
9. Timeline for implementation Transformation workstream Year 1 16/17 Year 2 17/18 Year 3 18/19 Early Years New Delivery Model GM bid to transformation fund for GM-wide implementation of EYNDM Scope plans for a re-designed integrated service for 0-19 year olds. Early Years New Delivery Model implemented as part of 0-19 integrated service Increased physical activity Develop local plans Begin implementation of local plans Reduce premature mortality from heart disease, respiratory disease, cancer and stroke. Reduce levels of liver disease Emotional Wellbeing Early identification: finding the missing 1000s Early intervention - secondary and tertiary prevention to prevent/delay progress of one or more long term conditions Social prescribing, self care Reduced social isolation and retention of independence Deliver and evaluate complex lifestyle service Develop local action plan to improve mental health and wellbeing. Scope work needed to improve uptake of NHS Health Check and screening programmes Redesign health improvement services to provide health coaching/interventions for specific identified cohort of population Develop local plans for social prescribing Local action plans to align to the Ageing Well GM Strategies and agenda Re-design/ re-tender specialist services Develop business case(s) to support implementation of local action plan. Development of new strategies/campaigns to increase uptake Evaluation of re-designed service Begin implementation of social prescribing and self care plan Develop business case for GM transformation funding to expand Staying Well programme Reduce alcohol related admissions to 645 per 100,000. Local plans fully implemented. Reduce premature mortality from heart disease and stroke Reduce internal life expectancy gap between most and least deprived areas Social prescribing and self care plans fully implemented Staying Well implemented city wide and reduction in social isolation 35
9. Timeline for implementation (cont.) Transformation workstream Year 1 16/17 Year 2 17/18 Year 3 18/19 Improved assessment and care planning - frailty Investment in scaling up innovation and demand reduction work through a programme of behaviour change / workforce reform Improved and Sustainable Care Home Sector Carry out a comprehensive review of the Care Home sector in Bolton Implement new funding models and monitor effectiveness Reduction in number of out of borough placements Improved Home Care Alongside GM we will produce an ethical service specification for home care As opportunity presents we will deliver the ethical service specification for reformed home care Sufficiency and stability ensured in the market. Significant improvement in falls prevention care Review and re-design falls pathways. Implement local plans to establish a comprehensive falls prevention pathway Comprehensive falls pathway implemented. Improvement in dementia diagnosis and care Develop business case for improved dementia support and care. Develop plans to roll out DFC borough wide (subject to successful evaluation). DFC in place borough wide and GM Dementia Programme established Reactive care delivery Reduction in unplanned hospital admissions and long term residential care placements Reduce non elective admissions and long term residential placements Last Year of Life Care Implement strategy 36
9. Timeline for implementation (cont.) Our plans for the implementation of the outlined transformation workstreams broadly follow a four stage approach. The delivery of this will differ according to the maturity across each workstream, the time taken to deliver may differ according to the complexity of the activities. The four stage implementation process 1. Assess current state 2. Outline interventions 3. Detailed design and implementation planning 4. Implement and monitor 3 4 2 1 1. Assess current state 2. Outline interventions 3. Detailed design and implementation planning 4. Implement and monitor Gain an understanding of the overall position in Bolton, evidenced issues, and scope for improvement. We will: Map the current state with clinical and operational teams. Look at enabling functions that also need to be considered as part of the transformation plan. Factoring in the impact of the wider GM strategy and other service improvement plans. Define the transformation interventions required in detail prioritising and agreeing the solutions that will achieve this. We will: Scope what is achievable within the required time and cost envelope. Define what are the most effective interventions to implement in order to achieve the required transformation. Develop detailed plans for implementation including defined KPIs, milestones and a robust quality impact assessment. We will: Develop a detailed business plan for each solution. Deliver the required communications, training and briefings to staff to ensure they have the understanding and skills to implement the revised ways of working. Implement the detailed plans and robustly monitor their completion, impact and outcomes. We will: Support the delivery owners in implementing transformation plans. Monitor the completion of actions and data analysis to confirm impacts. 37
10. Communications & engagement plan The communications and engagement activity outlined in this plan will be led by the CCG. As the Locality Plan itself is shared between the CCG, council, and FT we will seek to share it with our partner organisations and encourage them to support and participate in activities as far as possible. Communications and engagement objectives Raise awareness of the locality plan and the big challenges facing health and social care in the coming years. People have an enhanced understanding of how their own behaviour (for example in relation to their lifestyle or being active in their communities) directly contributes towards supporting the future of public services. This changes their perception of the relationship the individual and local services, which in turn influences and changes their behaviour. Obtain input from the public Feedback on the plan has anything been missed? Pledges for what they will do - #BoltonTakingCharge Stakeholders/Key Audiences Bolton s locality plan is relevant and likely to be of interest to everyone in Bolton as users of health and care services. There are nine protected characteristics set down by the Equality Act 2010 which are listed below - Age Disability Gender (male/female) Gender re-assignment (transgender issues) Pregnancy and maternity Race Religion or belief including lack of belief Sexual orientation (lesbian, gay, bisexual, heterosexual) Marriage and civil partnership It is vital that as part of any engagement planned, the above protected characteristics are targeted and given the chance to get involved. This may require additional work with certain groups, as they may struggle to engage or have never been involved with public service engagement of this kind before. 38
10. Communications & engagement plan (cont.) Key messages Doing what we have always done is now no longer an option. This is the start of an important journey for Bolton we re on the way to better health and care services, plus a healthier population. You ll be hearing a lot more about our vision for health and care in Bolton over the coming years. Challenges More people are living longer, often with complicated health problems, so they need more help and support to stay well. The health of residents in Greater Manchester lags behind the rest of the country we want to change this. Money We need to find ways to do more with less. If we don t make some big changes, Bolton will spend more and more on health and care in the coming years that s money we can t afford! By 2020, there will be a gap of 135m between the cost of health and care in Bolton and the money we have available to pay for it. Over the coming years, we will need to change the way we provide health and care in Bolton so we can balance the books. Money is tight so we need to look carefully at what the Bolton pound can, and should, be paying for when it comes to health and care. Public money should only be spent on treatments and services that have the most benefit for Bolton people. Aims We want everyone in Bolton to live longer and healthier lives. Our vision is all about changing health and care so we spend less on hospital care and more in the community. Our health and care services need to get involved earlier before someone gets so ill they need to be rushed into hospital. We plan to focus on people with the greatest need for extra help and support, to stay healthy and independent. This is likely to be older people with long term conditions. We want to offer more support to people who are at risk of developing health problems, before they become ill. This means more screening and vaccinations, as well greater support for those who want to lose weight, stop smoking, or drink less alcohol. This isn t just about physical health improving the mental health and wellbeing of Bolton people is a big priority too. We want to provide greater support and better care for those with mental health problems. This means getting the right care when it s needed - whether that s urgent support in a crisis or counselling sessions for anxiety. 39
10. Communications & engagement plan (cont.) Key messages (cont.) How To change things, we ll need to work differently. We want health and care services to work in a more joined up way, in Bolton, and right across Greater Manchester. We ve got lots of ideas for how things can change so your health and care services are even better. Now we want to know what you think. Nothing will change overnight. This is all about gradual service changes to meet the difficult challenges ahead. Taking Charge Bolton Taking Charge is part of a Greater Manchester wide movement in response to the significant challenges now facing our health and care services. Bolton Taking Charge is all about getting local people involved in thinking about and planning for the future of health and care in Bolton. We need to make big changes and we can t do it alone you have a big part to play. We want to change the way people and communities take charge of, and responsibility for, their own health and wellbeing - whether they are well or unwell. We want Bolton people to do more to take care of their own health and wellbeing, which could mean taking steps to stay healthy, managing a long term condition, or using health and care services appropriately. #BoltonTakingCharge pledges We can all make a difference - what will you do? How could you take charge of your own health? What could you do in your local community to support your health and care services? Examples: Pop in to see an elderly neighbour for a cup of tea. Set up a walking group in your community. Stop smoking. Reduce the amount of alcohol you drink. Call NHS 111 when your child is unwell, before heading straight to A&E. Make your pledge today on social media, the online forum, or by writing it on a pledge card. If pushed. This is not a consultation and we are not talking about specific service changes. If there are any future changes which may affect how services are provided there will be formal consultations with the public and affected staff. 40
10. Communications & engagement plan (cont.) Communication & Engagement Mechanisms Communications and engagement activity will look at raising awareness of the locality plan and the challenges facing our health and care services, whilst also encouraging people to get involved and make a #BoltonTakingCharge pledge. Putting more responsibility on members of the public to take action to protect their health and care services is a core element of the plan. This will be highlighted in Bolton by encouraging people to make their own pledges for what they will do. Pledges may relate to lifestyle changes or community activities. This will provide the CCG with valuable intelligence about the public s response to the core messages in the plan, as well as helping to grab people s attention and get them engaged. Members of the public will be encouraged to send their feedback and #BoltonTakingCharge pledges using social media, the online forum, the Let s Make It email address, or a freepost envelope. We will look into the use of post boxes distributed to GP practices for a previous campaign and whether these could be used for #BoltonTakingCharge. We will invite members of the public, GPs, CCG staff, and any local key influencers to be photographed with their pledge. The photographs will then be used for a range of purposes including social media and issued with press releases. Short films will also be made of individuals sharing their #BoltonTakingCharge pledges, including community group leaders and board members. This could include other languages, such as BSL and Urdu. Activity will begin mid-february to time with Greater Manchester led initiatives. There will follow a concentrated push from mid-february to April to grab attention and engage local people. We will then build on this foundation with continued activity and communications over the coming months. All of the communications and engagement activity set out in this plan will be rolled out under the Let s Make It brand. However, #BoltonTakingCharge will need a recognisable visual identity within this brand to help us to build familiarity and recognition with the public. Digital communications New, dedicated page on the new CCG corporate website. With link to the online forum on the Let s Make It website. Will be used as an opportunity to boost use of the Let s Make It forum. Tactics will include encouraging partner organisations to post and starting focused topic threads, with promotion via social media. Daily messaging using corporate and Let s Make It social media channels. This will be supported by images to ensure that posts are eye catching and more likely to be shared. Social media will be planned with a thematic focus for different weeks, reflecting the locality plan. The #BoltonTakingCharge call to action posts will continue throughout. Local partners will be asked to support by sharing posts and using a list of pre-prepared social media posts provided by the CCG on their own channels. 41
10. Communications and engagement plan (cont.) Digital communications (cont.) Members of the public will be encouraged to post their feedback and #BoltonTakingCharge pledges using social media or the online forum. New background images linking to the artwork and messages for this work will be used on CCG Facebook and Twitter channels for a preagreed length of time. Short filmed interview with Wirin and Paul Horrocks ( ) available online and screened at public meetings, events etc. Media relations The launch of the #BoltonTakingCharge initiative will be launched with a press release, which will be posted on the CCG s corporate website and the Let s Make It website, as well as a column in the Bolton News. The Bolton News and Bolton FM will be asked to support this initiative. We will also seek to utilise our relationship with the Bolton Wanderers Community Trust, as it may be possible for messages to go on their social media, matchday programmes, website etc. Other channels to consider: Xplode (there is a cost for coverage in the magazine) Bolton Carers Support newsletter Bolton CVS Tower FM Key 103 Bolton Live (online channel) Manchester Evening News Living in BL (free newspaper for West Bolton) Horwich Advertiser Further opportunities for media coverage will be sought, such as: Progress report on pledges received so far. Key 103 bus visit. Don t miss your chance towards the end of the designated period for submitting feedback. Link to national awareness days/weeks/months: National Salt Awareness Week week beginning 29 February Ovarian/Prostate Cancer Awareness Months March International Women s Day 8 March 42
10. Communications & engagement plan (cont.) Media relations (cont.) International Women s Day 8 March No Smoking Day 9 March Bowel Cancer Awareness Month April World Health Day 6 April European Immunization Week week beginning 25 April Follow up encourage media to attend board meeting where analysis will be presented. Feature Bolton Deaf Society recording their #BoltonTakingCharge pledge in BSL Design/print materials ( ) A3 poster distributed to usual locations (e.g. GP practices, pharmacies, libraries etc. plus others) Postcard with space for people to write their pledge Large pledge cards for use in photos and films Summary leaflet Presentation Social media images Internal communications GP practices are on the front line of local health services and practice staff are often a patient s main point of contact with the NHS. It is therefore important that practices are aware of and engaged with this initiative. The following will be undertaken to achieve this goal: Launch article and follow up articles in the Practice Bulletin. Presentation at a clinical leads meeting Email briefing from Wirin to GPs Many CCG staff are Bolton residents and key influencers as well informed individuals in their social networks and local communities. The issues raised in the locality plan will be relevant to the work of everyone in the organisation. The following will be undertaken to communicate with staff: Launch article and follow up articles in the Practice Bulletin. Presentation at staff briefing, with pledge cards handed out and a post box at the briefing and then placed in a central place in the building. Mention in Su s exec update emails. Posters around the building. 43
10. Communications & engagement plan (cont.) Paid advertising Paid advertising, such as on buses or on street, is expensive and not proposed for use as part of this project. However, two possibilities have been identified that would be more targeted and cost effective than other options. Life Channel Targets members of the public at their GP practice at a time when they are already thinking about their own health as well as local services. They are a captive audience waiting to see their GP, with fewer demands on their attention. Bolton News online adverts Website has high readership more likely to be younger? Online adverts allow people to click straight through to the website where they will find more information and be encouraged to make a pledge. Public engagement 1. Use our increasing contact lists and the Let s Make It Happen people bank to make sure that people are aware and how they could get involved. 2. Special edition of the LMI newsletter what does this mean for you? to encourage our contacts and panel to get involved, and an invite for us to visit to give a presentation. 3. A focus group with a presentation - aimed at those hard to reach groups. 4. ETAG - presentation, round table discussions and request further feedback. 5. Attend public events to hand out summary leaflet and collect pledges/feedback. Public events (so far): Health Mela (12th March), CCG roadshow (date tbc) 6. Roadshow use the campervan to interview the public and gather footage to include with the final report to Board. Also collect pledges and encourage people to have their pictures taken holding their pledges. 7. Presentation - includes the GM context and then more detail on the plan for Bolton. In simple but hard hitting language so that the public fully understand the situation, and understand what their role is. This presentation to be given to all groups visited and placed on the website. 8. Visuals to be sent to Bolton Uni/Bolton College for display on their screens. 9. Theme based focus groups held with the voluntary sector. A survey will be run at a GM level, along with a roadshow run by Key 103. 44
10. Communications & engagement plan (cont.) Feedback Process As the CCG will be gathering a lot of feedback from the public, it is important it is clear what will happen to the feedback, and we have a full process in place to collate and analyse everything that is received. All hand written views/pledges/feedback posted on our websites/twitter etc. will be inputted into an excel database and coded according to theme. This database will have a category for how the feedback was received. Admin support will be needed to input these responses and pledges, and a regular check done every week by the team to see what themes are emerging. A full report and analysis will be written and presented to the CCG s Board. The analysis of what is collected will be done by the CCG. This analysis will be published by using our normal channels such as the CCG and LMI websites. All feedback will also be sent onto the GM Devo team for them to take into consideration. Risks / challenges What s up for grabs? It is important to be clear that this is not a consultation and does not relate to specific service changes. We must manage expectations and be clear as to the process, what we are asking, and what can be influenced by the public. Limited resources The communications and engagement activity set out in this plan reflects a significant amount of resources in terms of both NHS funds and staff time. We must be clear at the outset as to what can be delivered and what budget is available, in order to manage the expectations of CCG senior managers and board members. It is also important to prevent cross over work being done by the CCG and those who are also involved from a local or GM level. It s just like Healthier Together This initiative will follow soon after the announcement of the Healthier Together judicial review. This process has meant that the controversial consultation has been in the public eye a great deal over recent months. Some people may view this as being similar to Healthier Together, impacting on how receptive they will be to our messages. GM influence and control Although this is a locally driven initiative, #BoltonTakingCharge links into a wider GM led programme of work. This means that our work in Bolton may be influenced and affected by other events outside of our control. It is important for the reputation of the CCG and the well established relationships with have local community groups that we complete the feedback loop and provide an update once all the feedback and pledges have been submitted. However, we will to an extent be reliant on GM bodies to feed back to us before we are able to do this. 45