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Key messages

• By the end of December 2015, we delivered a £450 million Transformation Fund from the Spending Review process and Strategic Plan endorsed by the GM system in December 2015

Since January 2016 we have: • Draft implementation plans being worked on, underpinned by a

financial framework which draws GM and locality plans together • Implementation governance agreed • Focus now on next steps of implementation plans both at GM

and locality level • Key task to align next steps of GM and locality plan

developments to relevant national planning processes • Transformation Fund criteria and agreement (including

Vanguards for example)

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Strategic Partnership Board Trusts Councils CCGs Partners

Partnership Board Executive

Joint Commissioning Board

Provider Federation Board

Transforming Community Based Care & Support

Self Care & community resilience

Early Intervention

Start well, Live Well, Age Well

Primary Care at Scale

LCO Development

Standardising Acute Care

LCO Links

Single Services

GM Level Services

Standardised Pathways

Standardising Clinical Support & Back Office

Back Office

Care Co-ordination Centres

Shared Clinical Services

Enabling better Care & Support

Contracts & Payments

Estate Organisational Form Workforce

transformation Health Innovation IM&T

Operational Management Team

Operating Plans

NHS Mandate & Constitution

Devolved responsibilities

Implementation Working Group

Financial duties

Assurance

Headline Governance & Delivery

An Implementation Working Group will co-ordinate the delivery of the strategic plan. An Operational Management Group will be established to manage quality, safety and transition, including the delivery of NHS E responsibilities at the GM level. Both will be supported as appropriate by relevant Task Groups for key programme areas with leadership from across the GM system. The Health & Social Care Team will co-ordinate implementation & operations reporting through the formal governance structures

Radical Upgrade in population health & prevention

OD & Culture Change A new deal with the public Communications GM Outcomes Framework Transformation Funding

GM Mental Health Strategy

GM Cancer Vanguard

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Key headlines from Locality Plans

• Locality plans have been developed and approved by Health and Well Being Board in the

context of amendments and improvements being required between now and the end of

February

• Variation in starting point, ambition and level of engagement of locality plans

• Amendments are required in light of

• Revised planning assumptions (e.g., tariff, LA financial settlement, allocations)

• NHS planning guidance including 9 ‘Must Do’s

• DCLG requirement to spend any council tax increase on social care

• Commitment to pursue a radical scale up of primary care

• Transformation Fund agreement for £450m with developing requirements for use

• Possibility that attendance allowance might transfer to LA

• Requirement from NHS is for

• One year operational plan by organisation in activity and finance by 8 Feb (draft)

• Aggregation in Strategic Planning Group

• Contracts agreed and signed and through boards by end of March

• Requirement for LA is for budgets to be set by 15 March including spending and council

tax limits having been consulted upon

December 2015 4

Locality Plan – Implementation & Next Steps

Locality Plan Delivery

Transformation Funding

2016-17 Planning

1. An Implementation Plan 2. Core Characteristics of the

LCO 3. An Operating Plan aligned to

the Locality Plan and StFF 4. Alignment & Triangulation

between Commissioner & Provider

5. Finalisation of Plans

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GM TRANSFORMATION FUND Overarching principles and implications for localities

Presentation 27th Jan 2016

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Contents

1. Reminder of the basis on which NHSE has approved the fund

2. Governing vision and principles for the fund

3. How the fund will be organised and structured

4. Process through which localities and providers can access the fund

5. Conditions for those in receipt of funds

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A key element of the CSR settlement is the creation of a £450m fund to support the transformation of health and social care

• GM has agreed a £450m fund to drive the transformation changes required to close the £2bn gap and improve health

• In agreeing the size of this fund specific objectives for the fund were identified covering:

• The purpose of the fund is not to let 1000 flowers bloom – rather it is to drive delivery of the strategic plan at pace

Enable one-time investment to unlock transformation

Plan assumptions:

• £30m to support GM wide provider reform (e.g., future stages of Healthier Together)

• £22m to support providers to delivering beyond “Business usual CIP”

• £24m to support the appropriate use of elective care across GM and in each locality

• £10m to support putting in place the flow of information and matched patient level data sets in localities

• £10m to support organisational development of providers including primary care coming together with others to work in new ways

• £5m to support new payment models design and implementation to be run across GM

Investment in prevention and double running as the shift to new models occur

Plan assumptions:

• £81m for investment in prevention at GM level;

• £213m to support localities in scaling up of primary and community based delivery models which would include investments in care coordination, case management, rapid response to support people at home, liaison psychiatry, etc.

• £55m to support localities in securing a reduction in long stays in hospital, including increased resources for discharge coordination, enhanced recovery, more investment in reablement, more support to keep people independent and at home as opposed to in the hospital and greater investment in step up/step down beds

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Assumptions on the time it will take to implement schemes and achieve costs reductions drive how NHSE will release funds to GM

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15/16 16/17 17/18 18/19 19/20 20/21 21/22 22/23

Double run subtotal Enabler support Additional programme support

Phasing of Funding Over the Next 5 Years

Year 1: £60m of transformation funding;

Year 2 :£120m of transformation funding;

Year 3: £153m of transformation funding;

Year 4: £70m of transformation funding;

Year 5: £48m of transformation funding;

*It is important to note that funding will be available yearly and will be fairly assessed to determine amount provided to localities

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GM must ensure that the fund is used to drive the shifts in activity and productivity required to close the gap – this will require strong oversight • To continue to have the confidence of HMT, DH, DCLG and NHSE and secure the shifts in activity and

productivity required to close the financial gap and improve outcomes – we must ensure that every pound of the transformation fund contributes to the delivery of the GM strategic plan

• In practice this will mean that:

– The fund should only support schemes that are wholly aligned to the broader vision for H&SC transformation in GM and the specific schemes identified in the strategic plan;

– Proposals developed by localities and providers must be supported by a robust, comprehensive delivery plan

– The cost of the proposed scheme, its impact on activity and productivity and the planned timeframe for capturing benefits can be benchmarked to best practice and the underlying opportunity in the locality,

– Unlike previous reform programmes there will be a concentrated focus on shifting the activity from today’s standards into a new model of care, true savings and improvements in care will be enabled

– Localities and providers will need to report on their progress against agreed milestones on a regular basis in order to secure additional funding

– Lessons from pioneers are captured quickly and passed on to those developing similar programmes

• Taken together, this creates a strong argument for administering the fund according to an agreed standard of operating principles and rules, and a rationale for making use of existing GM structures to oversee the distribution of the fund

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Contents

1. Reminder of the basis on which NHSE has approved the fund

2. Governing vision and principles for the fund

3. How the fund will be organised and structured

4. Process through which localities and providers can access the fund

5. Conditions for those in receipt of funds

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The fund should have a clear mission statement will underpin its strategy and guide its decision making

• An organisation’s vision statement summarises in a few words what it wants to be known for, what it wants to achieve and/or where it wants to be in the future.

• Our proposed mission statement for the fund:

“The fund enables localities to transform their services to deliver financially and clinically sustainable, place-based, proactive and person-centric care aligned to the

overarching vision for health and social care in Greater Manchester.”

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The fund should have a set of principles to help translate its vision into practical actions

• An organisation’s operating principles serve to translate its vision into a set of core values that all of its people can uphold. A succinct set of them can serve as guides, helping people make sound decisions, building trust and enabling greater innovation.

• Our proposed operating principles for the fund:

Deliver the GM vision

Enable transformational

change

Consolidate resources

Secure value for money

Facilitate learning for others

• The initiatives supported by the fund must be aligned with the transformation initiatives and the border vision for health and social care reform in GM

• The initiatives supported by the fund need to contribute to the GM Public Sector Reform programme

• The fund must drive forward shifts in activity and productivity required to close locality gaps • The fund should deliver initiatives that lead to lasting transformational change, as opposed to temporary or

“business as usual” activities • The fund must support change at pace – allowing progress to happen quickly with a shift from planning to

implementation

• The fund should be used to support scalable integration across health and social care boundaries, organisational boundaries and localities across Greater Manchester

• The fund should support organisations to remove waste and target resources to the front line

• The initiatives supported by the fund must deliver a high rate of return within the CSR period – and should benchmark well in relation to ambition and replacement costs.

• The fund should be managed and governed efficiently with a commercial discipline, which is underpinned by transparency, fairness and accountability

• The fund should support innovative initiatives which are evidence-based and take account of proven best-practice in their design

• The fund should seek to build an evidence base of what works and support the open sharing of this information to build a culture of learning

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Contents

1. Reminder of the basis on which NHSE has approved the fund

2. Governing vision and principles for the fund

3. How the fund will be organised and structured

4. Process through which localities and providers can access the fund

5. Conditions for those in receipt of funds

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The fund should be organised into five lots aligned to the transformation initiatives – different lots will be targeted to different organisations • We have split the fund into 5 lots of different sizes, aligned to the 5 transformation

initiatives

Funding lot Eligible applicants

1. Radical upgrade in population health prevention GM wide initiatives

Combinations of LCOs/localities

2. Transforming care in localities LCOs/localities

3. Standardising acute hospital care GM wide reconfiguration initiatives

4. Standardisation of clinical support and back office

functions

Provider collaborative

LCOs/localities collaborative (back office)

5. Enabling better care GM wide schemes

• Different applicants could be eligible for each lot and a fair allocation per locality will be assessed:

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In the early years the fund should prioritise schemes that are aligned to the vision and are ready to deliver to build a track record of delivery

• NHSE will phase delivery of the fund to GM:

• In the early years, the fund will prioritise investment for enablers and those with a track record of delivery

• The burden will be on localities and providers to demonstrate that they have a plan that is aligned to the transformation initiatives, and will deliver the activity and productivity shifts required to close the gap

• This requirement will also apply to vanguards and other pre-commitments

• At the same time we will seek to support localities to develop programmes, infrastructure and systems to drive the shifts in activity and productivity required

• This approach will help establish a track record and make most progress on closing the clinical and financial gap

• The process of iterating locality plans over the last 6 months has demonstrated that some localities are more advanced in the development of schemes than others.

• Equally it has become clear that localities have varying levels of opportunity / challenge to address.

• The result of this is that some localities are more likely than others to be in a place to implement schemes that can drive out the cost improvement required by NHSE.

• This is likely to be particularly the case for vanguards, and other national programmes – the funding for which is part of the £450m fund

Year 1 £60m

Year 2 £120m

Year 3 £153m

Year 4 £70m

Year 5 £48m

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Contents

1. Reminder of the basis on which NHSE has approved the fund

2. Governing vision and principles for the fund

3. How the fund will be organised and structured

4. Process through which localities and providers can access the fund

5. Conditions for those in receipt of funds

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Applications to the fund should be assessed against two sets of criteria

Alignment to GM strategy

Wider stakeholder support

Robust financials

Robust delivery plan

Foundation for further

transformation

• The applicant must demonstrate a credible strategy for enacting transformational change and alignment to GM’s vision for both H&SC reform and broader public sector reform

• The applicant’s scheme must be aligned to the relevant transformation initiative • The applicant must show how its LCO proposals are aligned with its neighbourhood strategy

• The applicant must demonstrate evidence of having sought the views of patients and professionals in the development of their proposals, thereby affirming their support to ensure its acceptance and smooth delivery

• The applicant must explain how the proposed initiative is focused on the interests and outcomes of the people of GM

• The applicant must provide an activity driven model that sets out the fund as required and explain how this will reduce future spending and maintain or improve quality.

• The applicant must demonstrate how a rate of return of £1:£3 will be achieved • The applicant must stress test its ambition and replacement costs against peers

• The applicant must be able to show a track record of successful change management and programme delivery • The applicant must set out a detailed, collaborative plan of action that shows how the initiative will be launched

and delivered on the ground • The applicant’s plan should be clear and precise about the resources required, the key activities taking place,

interim milestones, a risk register and outcomes

• The applicant must demonstrate how single patient records will be established and used • The applicant must explain how quality outcomes will be assured • The applicant must specify how progress will be evaluated and how learning will be provided to other localities

1) a set of minimum common criteria for all funding Lots (to ensure that proposals fit with GM’s overall vision)

• 2) a set of specific criteria applicable only to the Lot being applied for (to ensure the proposal’s alignment to a specific transformation initiative) – this is set out in the next slide

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As well as minimum common criteria, applicants will also have to fulfil a set of criteria specific to the Lot they are applying for

Funding lot Criteria

1. Radical

upgrade in

population health

prevention

Increase the range and profile of self-care support programmes Increase healthy eating and regular exercising behaviours Increase role of primary care in early intervention and prevention

Increase management of complex care and long-term conditions within planned packages of care Support older people to stay well longer and support them to cope better if they have a long-term illness

2. Transforming

care in localities

Deliver improvements in activity and underlying cost required to close a localities financial gap at reasonable replacement costs

Enable better management of conditions at home and in the community Help people return home earlier and stay well Provide alternatives to A&E when crises occur Strengthen community capacity to deliver more out of hospital services

3. Standardising

acute hospital

care

Consolidate specialised services where quality of care can be improved or cost reduced Support Trusts to unlock further cost improvement opportunities identified in the Strategic Financial Framework through collaboration

and standardisation Deliver more standardised treatment and care pathways Implement acute workforce collaborations which can deliver efficiency savings and/or better quality Support the delivery of seven-day services

4.

Standardisation

of clinical support

and back office

functions

Deliver benefits of acute care collaboration through single shared acute services e.g. finance function and HR Provide solutions to reduce variations in clinical support care, such as ensuring that care pathways are adopted consistently and

pathways are refined in line with the most effective interventions Implement plans which reduce excess costs in back office through acute collaboration or otherwise Enable consolidation of commissioner back office

Support the better use of NHS and local authority estate by ensuring it is utilised more efficiently or effectively or disposed if not used

5.Enabling better

care

Provide new contracting models which will deliver more integrated and aligned provider incentives Implement the delivery of a more efficient payment system Deliver a single patient level data set that can be accessed by all organisations within GM Deliver an estates approach plan which provides a more holistic approach to managing our public sector buildings Develop technology which enables one-time sharing of information across GM

• One or more sets of the criteria given below will also apply, depending on the funding Lot applied for

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Contents

1. Reminder of the basis on which NHSE has approved the fund

2. Governing vision and principles for the fund

3. How the fund will be organised and structured

4. Process through which localities and providers can access the fund

5. Conditions for those in receipt of funds

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Once applicants are selected to receive funds, a rigorous monitoring and evaluation process will be implemented to minimise delivery risk

The focus on delivery and value must continue once funds are allocated.

To support the fund in delivering:

• Strong senior accountability for both funding and delivery risk will be expected given the size of public funds involved and the political environment

• Recipients of funds will be required to enter into binding delivery agreements with the fund

• We will establish an effective monitoring and evaluation process including early warning indicators for initiatives that are going off track

• Investments judged to be under-delivering will be suspended

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Transformation Fund key messages and engagement

• Not a bidding process; the fund will be "Open for Business“ from 1st April 2016.

• Hard headed transformation based around the themes in our plan, not about allowing a 1000 flowers to bloom.

• Robust locality plans are a pre-requisite for successful access to the TF – they need to deliver system changes and outcomes within localities.

• Not all locality plans are ready for implementation, nor is this a "glossy brochure " test. We will work with localities to bring forward the right solutions over the next few months.

• The £3 of benefit for each £1 of TF spend, is the system impact in localities not the direct return from the TF spend itself.

• Room for innovation, but the programmes we will be supporting are being developed now.

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Transformation Fund key messages and engagement

• Need early adopters to facilitate learning and best practice but only where locality implementation plans and outputs are in line with the GM Plan

• Social care – this links to what LAs are doing on commissioning now and incrementally over the coming months - Social Care once rather than ten times, Public Health, other public services including services to Children.

Next Steps • Work continues to define the process and access criteria • A copy of the report detailing the work to date was shared with

SPB members last week, followed up by a system wide engagement session earlier this week to seek input and guidance.

• A final proposal is due back to the SPB in February.

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Focus for External Support

We should support localities to develop their Locality Plan / Implementation Plans to generate the strongest proposals for investment from the TF. That support should be focussed over the period of the next 2 months. We should seek to have a senior named lead from the H&SC Devolution Team to connect to individual localities to facilitate that support and plan development. With that in mind the external support should seek to bridge: • The process to develop the locality implementation plan, • The impacts plan implementation is intended to achieve in relation to prevalence,

activity and productivity • The investment proposition relating to the Transformation Fund and • The criteria for application of the Fund. This approach can be put to SROs at their regular meeting on 5th February. From there it is proposed that a short paper outlining the approach to support be developed with the SROs for consideration by the Partnership Board Executive at it’s next meting.

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End