GM Devolution Darren Banks Executive Director of Strategy
Ground to be covered Greater Manchester The Devolution Journey What we are doing and the governance Manchester s Locality Plan 2
Greater Manchester: a snapshot picture GVA Gross Value Added LEP Local Enterprise Partnership 3
Greater Manchester: Our health and social care system 4
Greater Manchester: A history of working together Metrolink 1992 Business Leadership Council Established Prosperity for all GM Strategy GMCA and LEP established Healthier Together Manchester City Deal Growth & Reform Deal Growth Deal Centralised Stroke Service From 1986 2008 2009 2010 2011 2012 2013 2014 2012 2015 AGMA, GMITA & Airport Publication of the MIER Thematic Commissions Established Transport for GM Community Budget Pilot Major Trauma Network Devolution Agreement New GM Strategy Health and social care MOU Association of GM CCGs 5
GM Devolution the background Greater Manchester Devolution Agreement settled with Government in November 2014, building on GM Strategy development. Powers over areas such as transport, planning and housing and a new elected mayor. Ambition for 22 billion handed to GM. MoU Health and Social Care devolution signed February 2015: NHS England plus the 10 GM councils, 12 Clinical Commissioning Groups and NHS and Foundation Trusts MoU covers acute care, primary care, community services, mental health services, social care and public health. To take control of estimated budget of 6 billion each year from April 2016.
Timeline to Devolution Spring 2015 Summer 2015 Autumn 2015 Winter 2015 Spring 2016 Summer 2016 Autumn 2016 Winter 2016 Spring 2017 APRIL: Process for establishment Of Shadow Governance Arrangements Agreed and initiated DECEMBER: Production of the final agreed GM Strategic Sustainability Plan and individual Locality Plans ready for the start of the 2016/17 financial year DECEMBER: In preparation for devolution, GM and NHSE will have approved the details on the funds to be devolved and supporting governance, and local authorities and CCGs will have formally agreed the integrated health and social care arrangements. MAY-DECEMBER: Announcement of Early implementation Priorities OCTOBER: Governance structures fully established and operating in shadow form AUGUST: Production of an Outline Plan to support the CSR process which will Include a specific investment fund proposal to further support primary and community care and will be the first stage of the development of the full Strategic Plan. APRIL: Full devolution of agreed budgets, with the preferred governance arrangements and underpinning GM and locality S75 agreements in place.
Why Health & Social Care Devo for GM? Recognised conurbation with identity and sizeable population Recognised and (well-connected) stable Leadership Track record of executing strategic change Track Record of Collective Decision-making Well-established Combined Authority 10 Local Authorities Committees in Common 12 CCGs Proposal to establish collective decision-making for NHS Trusts Significant challenges and potential opportunities identified 8
Improving health outcomes, quality and experience in GM Health outcomes are poor and lag behind other parts of the country. Manchester women have the worst life expectancy in England and men the second worst Outcomes Patient Experience High prevalence of long term conditions such as cardiovascular and respiratory disease mean that Manchester residents not only have a shorter life expectancy but can expect to experience poor health at a younger age than in other parts of the country 7 of the 10 Greater Manchester Local Authorities have significantly higher levels of internal inequalities in life expectancy than the England average, while no Greater Manchester Authority has lower than average levels of internal inequalities Patient and representative groups, report that access to many services is fragmented and/or confusing, highlighting the current complexity of the system and lack of true integration Many patients receive care from a number of organisations under the umbrella of the NHS, however will often experience parts of the pathway that are not connected or duplicated 9
A significant financial challenge 500 - This is the GM financial gap 1 2 Radical upgrade in population health Transforming care in localities 3 4 Standardising acute hospital care Standardising back office 736 21 5 5 Enablers 100 269 - (500) (1,000) (1,500) (664) (817) (305) (444) (180) (1,162) (88) 1 (239) 2 (207) 2 (140) 3 (100) 4 Opportunities still return GM to financial balance, with significant contingency e.g. baseline expected to be updated further to reflect 15/16 actual outturn, additional pension pressures announced in 2016 budget, etc. (2,000) (1,786) 10
GM Vision To deliver the greatest and fastest possible improvement to the health and wellbeing of the 2.8m people of GM We will do this by: 1. Creating a transformed health and social care system 2. Aligning our health and social care system far more widely with education, skills, work and housing 3. Creating a financially balanced and sustainable system 4. Making sure the system remains clinically safe throughout 11
The opportunity for GM residents We are aiming for some big benefits for the people of GM by 2021, including the following: 1,300 fewer people dying from cancer 600 fewer people dying from cardiovascular disease 580 fewer people dying from respiratory disease 270 more babies being over 2,500g which makes a significant difference to their long term health More children reaching a good level of social and emotional development with 3,250 more children ready for the start of school aged five Raising the number of parents in good work to projected England average will result in 16,000 fewer GM children living in poverty Supporting people to stay well and live at home for as long as possible, with 2,750 fewer people suffering serious falls 12
Co Design: Commissioners, providers and residents working together will create better proposals and a quicker route to change First Principles People & Place: Our decisions must help the people and places of Greater Manchester achieve their own vision of the future Commissioning at the right level: Connects the macro (GM) and the micro (individuals/team) levels and makes best use of all assets. Subsidiarity agreements at the most appropriate level. De-commissioning: We will not deliver the strategy by commissioning more of the same. More of a focus on shared clinical excellence. Be Bold: Embrace new models (e.g. Outcome based commissioning) and learn from others, locally and globally. Going above and beyond national minimum standards - specialised 13 services.
GM approach to the STP challenge GM Strategic Plan Taking Charge The agreement of GM standards and approach including public health The construction and then alignment of 10 locality plans Place-based approach to district, primary and social care Transformation areas to be commissioned and organised at a GM level GM-wide approach to key enablers IT, Estates, Workforce, backoffice The establishment of a GM Transformation Fund rules based access and RoI monitoring/agreements With governance to support the above 14
A comprehensive framework for transformation underpins GM s Strategic Plan 1 RADICAL UPGRADE IN POPULATION HEALTH PREVENTION 2 TRANSFORMING COMMUNITY BASED CARE & SUPPORT 3 STANDARDISING ACUTE HOSPITAL CARE 4 STANDARDISING CLINICAL SUPPORT AND BACK OFFICE SERVICES 5 ENABLING BETTER CARE. 15
Transformation Programme 5: Enabling Better Care Contracting & Pricing Capitation based approach Risk share arrangements Prime provider/contractor models Aggregated control totals (?) 16
Transformation Fund GM share 450 million Rules base approach Bid Evaluation Investment Agreement Transformation Oversight Group 17
Governance: Overview GM Health & Social Care Strategic Partnership Board Joint Commissioning Board Membership includes: 12 CCGs 10 LAs NHS England 15 NHS Trusts 4 Primary Care Reps Voluntary Sector Healthwatch Transformation Fund Oversight Group Strategic Partnership Board Executive Provider Federation Board Transformation Fund Evaluation Performance and Delivery Portfolio Board Enablers Theme Theme (IM&T, 4 3 Estates) Theme Theme 21 Transformation Theme Theme 4 3 Themes 18
Strategic Partnership Board Standing Conference April 2015 - formal establishment of a Strategic Partnership Board. The Strategic Partnership Board is responsible for setting the overarching strategic vision for the Greater Manchester Health and Social Care economy. Non-legal body- adoption of governance procedures which includes delegation to a group of its members where possible. Strategic Partnership Board Executive A small and representative Executive that meet frequently to provide day to day guidance on the strategic work of the Transition Team and receive reports from the Programme Board (responsible for the co-ordination of the programme during the transitional year). 19
Joint Commissioning Board GMJCB has significant commissioning decision making responsibility as the largest single commissioning vehicle in GM. Its focus is on the wider programme of public service reform in Greater Manchester, recognising the opportunity that an aligned commissioning strategy has to influence the required reform and improvement. The key functions of the GMJCB are as follows: Development of a commissioning strategy based upon the agreed Strategic Plan. Be responsible for the commissioning of health and social care services on GM footprint Have strategic responsibility for commissioning across GM including agreed basket of specialised services Be responsible for the delivery of the pan GM strategy via its commissioning decisions (local commissioning will remain a local responsibility). To operate within existing commissioning guidelines following key principles of codesign, transparency, and broad engagement. 20
Provider Federation Board The Provider Federation Board established to: Enable providers to have a (single) voice in Greater Manchester Health and Social Care Devolution; Provide a strategic approach to transformation; Address provider quality and efficiency. Provide a clear mandate to provider representatives on the Strategic Partnership Board including how the provider vote should be exercised 21
Provider Federation Board - Remit PFB agrees on strategic decisions and the criteria and constraints in making them, including agreeing whether decisions will be binding on all members of the PFB Category 1 issues where future decisions will be binding on all trusts within the eligible constituency. Category 2 issues on which any future decisions will not be binding on all trusts Eligible constituency - trusts for which the matter is material and required to implement outcome Develop, explore and evaluate strategic ideas and levers for change Communicate the action and allocate resources (including potentially those of PFB members) to ensure delivery of the agreed actions 22
Provider Federation Board Decision Making Requires support of simple majority of PFB Cat 1 requires unanimous support. If not support of >75% of eligible constituency triggers Dispute Resolution Process. Cat 2 - requires unanimous support of the eligible constituency (self selected) Requires support of 75% eligible constituency Requires support of 75% eligible constituency Proceed Recommend to PFB Recommend to SPBE Recommend to JCB 23
Key Issues - PFB Monitor support Revised guidance Guidance for providers on good governance in local health economy working Risk Gain Share Principles and Approach Behaviours Secretariat PFB Director Other support 24
GM Challenges and Opportunities a provider perspective Provider footprints not coterminous with STP particular issue for specialised services ( 280m imported activity) Providers are heterogeneous and can be competitive Shifting landscape of provision/providers LCO / lead provider / single service arrangements NHSE initiatives/funding organisation v. system Regulation Subsidiarity End of the FT model? 25
Manchester Locality Plan 26
Single Commissioning Function CCGs and MCC together spend 1.2bn on health and social care for Manchester residents Single Integrated Commissioning System brings together North, South and Central Manchester CCGs and MCC to: Achieve aims of locality plan Deliver joined up health and social care services Get best value for money Joint Commissioning Board established to lead commissioning of H&SC Independent option appraisal of more formal integrated commissioning arrangements commissioned externally Will consider range of organisational and management models and deliver clear evidence-based recommendations on timescale road map for the transformation of commissioning in the city 27
Manchester Single Hospital Service Why change? Health outcomes in Manchester are poor. Care is fragmented with different standards of care are being provided to patients in different parts of the city. Opportunities to work together to improve services for patients are being missed. Duplication exists in some areas while there are gaps in others. System wide financial and operational pressure. What are the benefits? Quality of Care Patient Experience Workforce Financial and Operational Efficiency Training and Education Research and Innovation 28
Manchester Single Hospital Service SHS Programme is working on a two phase approach: Project 1 UHSM and CMFT merger Project 2 NMGH acquisition The merger requires three distinct approval processes: Trust internal risk assessment and decision-making CMA competition/benefits assessment and clearance NHS Improvement risk assessment and approval Programme Governance in place Collating benefits case for CMA process 29
Local Care Organisation Background Since September 2015 discussions have been taking place between providers and commissioners regarding the development of a Local Care Organisation (LCO). Overview Commissioning of a single contract for out of hospital services, including urgent care, from April 2016. Development of an LCO will facilitate the delivery of the One Team model, across 12 neighbourhood teams, to provide greater coordination between primary care, social care, community services, third sector partners, General Practice and Acute & Mental Health providers. The intention is that greater coordination of care will reduce acute admissions, remove duplication and fragmentation of care and reduce future demand for services. 30
Local Care Organisation Organisational Form Care Models Define Scope Phase 1 Integration of ASC Finalise design Phase 2 Primary Care Led Establish leadership Value Proposition Neighbourhood go-live Models of care design Operating Model Organisational Form Establish teams Establish / Incorporate Implement new models of care - Agree provider / commissioner governance arrangements - Finalise programme plan, defining milestones and completing detailed work up beneath - Agree commissioner and provider deliverables - Alignment with single commissioning and single hospital service programmes - LCO prospectus 31
Discussion 32