GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD

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1 5a GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD Date: 27 May 2016 Subject: Locality Plan Development and Process to Support Transformation Fund Consideration Report of: Katy Calvin-Thomas and Warren Heppolette PURPOSE OF REPORT The purpose of this paper is to describe to the Strategic Partnership Board the next steps following the assessment of Locality Plans; the support in place to assist in their further development; and the processes to secure their consideration for access to Transformation Fund Monies. RECOMMENDATIONS: The Strategic Partnership Board is asked to: I. Note the progress in applying support to the development of Locality Plans following the assessment; II. Recognise the request for localities and GM themes to confirm their consideration in line with the agreed Transformation Fund Financial Process; III. Support the development of a Transformation Fund Oversight Group to advise the Executive in taking their decisions about the Fund; IV. Note the work to develop documentation including an initial Proposal Template and draft Investment Agreement; and V. Support the development of a GM Dashboard to both inform decisions and monitor the application of the Fund against those agreements to track the impact of the Fund and the Locality Plans more broadly. CONTACT OFFICERS: Warren Heppolette 1 P a g e

2 1.0 INTRODUCTION 1.1 Achieving financial and clinical sustainability for GM is the touchstone for the implementation of the Strategic Plan and the development of the locality plans; and as a result it is achieving that sustainability that forms the basis for decisions on the Fund. The Fund has to be invested in those change programmes that can demonstrate they make a significant contribution to achieving our goal of clinical and financial sustainability. 1.2 The sustainability required needs to be seen in all parts of GM, with each of the themes set out in the Strategic Plan making a significant contribution towards that. The construct of the Fund therefore is based on supporting all ten localities and all five themes succeeding. 1.3 The fund cannot simply sit on top of existing mainstream funding; its usage has to drive change in the way that existing resources are used. It has to fund the creation of new service models. The GM Strategic Plan and Locality Plans therefore, must be reflected in the mainstream budgets and planning for each GM partner (LAs, CCGs and provider organisations). 1.4 Criteria for the Fund The proposed criteria for the fund (outlined below) have been confirmed. Deliver the GM vision Enable transformational change Consolidate resources Secure value for money Facilitate learning for others 2 P a g e

3 1.4 A good deal of work has been completed / is underway in localities and at GM level and that we are moving towards to making some decisions. The purpose of this paper is to seek approval to the decision-making process. 2.0 LOCALITY PLAN ASSESSMENT 2.1 The process to assess the development of locality plans explicitly recognised the criteria for the Fund and a common set of tests for plan completion which were derived from those criteria Figure 1 below sets out the criteria that has previously been agreed by the SPB. 2.2 The assessment process confirmed a number of key messages to inform the further development of Locality Plans: While all localities have made progress on their plans and in general locality plans are well aligned to the strategic plan; we are not yet in a position where collectively we have a set of plans that fully address the opportunities identified in the strategic plan and close the financial gap. Each locality has strengths in their approach that others could benefit from so plans were made available to all Locality Plan SROs. There is now a need to quickly transition from our strategic planning phase to developing detailed implementable schemes. The need to make this shift was reflected in our readiness to deliver scores, which were lower than might be expected. This has a knock on impact to the financial assessment. There is a particular need to support the translation of the GM level transformation work in themes three and four into the locality plan context. Within their plans localities have typically focused on developing out of hospital models or progressing single hospital models no locality has 3 P a g e

4 done both. Social care elements typically needed more emphasis and elaboration. Locality plans at this point require further development in terms of their linkage with the transformation themes, clinical strategies and our enabling programmes of work. This alignment will begin to take place as the implementation plans of transformation themes and enabling programmes are developed and shared. This integration will be regularly assessed. 2.3 To address the development needs of each plan each locality engaged in a process to confirm the nature of support that would be required to construct a final and robust plan. The Health and Social Care Partnership Team will provide a senior single point of contact for each locality to support the ongoing development of the plans. 2.4 This support involved a blend of the following packages which were designed to address common needs in each locality. Each locality has engaged with this process and has support in place: 2.5 Locality & GM Strategy Alignment The Locality Plan assessment emphasised the importance of alignment between the locality plan implementation and the collaboration across the GM enablers and further GM service strategies. Significantly these cover all areas of the transformation themes relating to Standardising Acute and Specialist Care, Standardising clinical and non-clinical support services and the Enabling Better Care. They also include those cross-theme service strategies developed across GM such as Cancer, Mental Health & Dementia, Learning Disabilities, Services for Children and the work developing as part of Health Innovation Manchester. GM Enablers Information Management & Technology Workforce Transformation GM Strategies Cancer Mental Health Dementia 4 P age

5 Estates Payment, Pricing and Contracting Services for Children Learning Disabilities Health Innovation Manchester 2.6 Good progress has been made in relation to the approach to estates which makes clear the connection between GM and localities. Equivalent clarity is being developed in relation to the further enablers. 2.7 Good progress has been made across a number of areas relating to clinical and non-clinical back office support and the summary of that early work was presented to Lord Carter of Coles last month to indicate GM s commitment to his national review. 2.8 The approach to the work to Standardise Acute and Specialist Care is now well underway with confirmed clinical and chief executive leadership. 2.9 It is proposed that criteria by which GM programmes are considered in relation to the Transformation Fund are consistent with those for Locality Plans. The process for accessing funding should also be the same as for localities with the same rigour of assessment. Appropriate support for GM level programmes to become fund ready should be developed akin to that provided to localities. 3.0 ESTABLISHING THE PIPELINE FOR LOCALITY PLANS TO ENTER FUND CONSIDERATION 3.1 The assessment of locality plans was undertaken explicitly to test readiness and relative completion against the Fund criteria. Localities seeking access to the Fund therefore, would be assessed on the relative completion and quality of the full Locality Plan and not a section of it. The support identified consequently was then gauged to complete that process of readiness. Judgements on the time required to complete that further work were confirmed as a matter for localities. 3.2 With that in mind, a number of localities have indicated a wish to pursue a submission to the Fund. The judgement made by those localities was based on their respective abilities to complete the remaining work identified through the assessment and the Fund process within a defined timeline. It is for localities to confirm the timing of their own submission to the Fund, subject to their ability to conclude the work to present a comprehensive and robust plan. 3.4 Greater Manchester has recognised processes already underway in a number of those areas as part of the National Vanguard developments which reinforced the need for early consideration of those plans. However, it should be noted that the locality plan assessment, and therefore definitive consideration of Transformation Funding has been and would continue to be undertaken on the basis of consistency with the rest of GM. 3.5 The principle requirement for localities is that the locality plan must show how, at a strategic level, clinical financial sustainability will be achieved by 20/21. Then within that context the need to show how the more specific to personals 5 P a g e

6 drawdown investment this year and next will produce a specific return on investment. Where the proposed investment is in to LCO/ICO services this will need metrics from CBA modelling of the expected impact on reduced demand in the acute and residential care sectors 3.5 Further discussions with localities will confirm the order of consideration for all localities as part of this pipeline; it is therefore for each locality to determine at which point in time they feel ready to access the Fund. Similarly, equivalent processes to assess and order the consideration of pan-gm thematic areas of the Strategic Plan would be developed and progressed. 4.0 THE TRANSFORMATION FUND FINANCE PROCESS (TFFP) 4.1 The process of proposal development, finalisation, testing and consideration will be consistent across locality plans and GM themes or strategies. The stages to the TFFP agreed by the Partnership Board in April include: a) Initial proposal: a short submission made by the applicant setting out how the scheme is defined in the locality plan and meets the Transformation Fund criteria; b) Advisory session: a discussion between the applicant and the devolution team regarding the costs and benefits of the scheme. This will identify areas where the applicant needs to do more work to align the proposal to the objectives of the plan; c) Final proposal: documentation of the aims, objectives, inputs, activities, milestones and outcomes of the proposal; and d) Assessment and confirmation: assessment of the proposed scheme and a final decision on funding. 4.2 We are currently working on a timeline to ensure the first definitive consideration of Fund proposals to be undertaken by the Partnership Executive at the end of June. The intensive work to confirm locality readiness and provide initial sifting is underway now and the independent assessment of those proposals is scheduled for mid-june. The process and timeline for this first wave of considerations is illustrated below. 6 P a g e

7 4.2 Transformation Fund Oversight Group The creation of an Oversight Group has been proposed with the purpose of supporting the Strategic Partnership Board Executive in executing their decision making responsibilities over the fund. The Oversight Group will have no decision making responsibility As described above role and function of the Oversight Group is advisory and has no powers to take decisions. The Oversight Group s function is to ensure that key stakeholders are involved in overseeing the detailed appraisal of Transformation Fund proposals. Its primary focus will be to ensure the work of the health and social care team and the independent scrutineers of the proposals has been properly informed and is comprehensive enough to enable the SPB Executive to undertake its decision making role. Its role is limited to oversight and is not there to substitute judgement of either the health and social care team or the independent assessors. 4.3 Documentation There are two key templates needed to support the fund approval process: Full Proposal Form A short document for localities to complete to outline their proposal. This will include: What the proposal is How it meets the agreed fund criteria How it will be implemented This will be supported by a range of other materials that have already been developed including: Locality strategic and implementation plan 5 year activity & finance plans ( locality roll-ups ) Governance arrangements 7 P a g e

8 Programme plans with key milestones and deliverables Programme risk log Financial Analysis Localities and themes should submit excel based returns that set out the necessary detail on: The resources being requested from the fund How these resources will be spent The impact of this spending on the 6bn H&SC funding The broader benefits that might be expected from the programme A profile of costs and benefits Return on investment (both cumulative and steady state) 4.4 Investment Agreement The evaluation will result in an Investment Agreement. This is a short document that, on funding award, will form the agreement between GM and localities. The agreement should set out: Who the parties to the agreement are What the specific scheme is What it is expected to deliver (financials and non-financials) and by when Key milestones for delivery expected reductions in demand improvements in outputs, outcomes, prevalence and impacts (specific metrics) expected decommissioning of existing resources and how resources will transfer between different organisations ways the impact will be tracked and evaluated over time expected changes in productivity Conditions of the agreement will be formed of expected outcomes from the financial modelling and the agreement will state that if a locality fails to meet the conditions GM reserves the right to review its funding Investment propositions for LCO / ICO implementation require the metrics derived from CBA modelling leading to demand reduction and decommissioning. Other investment propositions require agreement on the return on investment but may not require the CBA application to show the means of realising demand reduction objectives. This distinction will be made in the draft agreements This confirms a clear expectation of funding ceasing where system benefits are not being delivered. This will be strengthened by the new arrangements with NHSI having a visible role in the Devolution Team working closely with GM to secure collaboration and system improvement. The Investment Agreement, therefore, would also take into account relevant further agreements relating to external sources, in particular NHS Improvement allocations from the national Sustainability & Transformation Fund. 8 P a g e

9 4.4.3 The development of strong joint working with NHS Improvement will underpin the Investment Agreements. Places and institutions will assessed by NHS Improvement and NHS England on the basis of their performance and their commitment to collaboration and risk share will become more important. A further paper on the proposed arrangements for monitoring and oversight will be brought forward following consultation with stakeholders GM will, of course, recognise and pursue further opportunities to secure funding for programmes to support delivery of the Strategic Plan. Where opportunities to access national monies arise GM will pursue them to supplement the Transformation Fund investments and maximise the resources available to drive the changes. For example, GM is pursuing the possibility of support from the National Digital Transformation Fund to support the GM Connect ambitions The Investment Agreement will confirm the metrics to support monitoring of the Fund and, more broadly, of the Implementation of the Strategic Plan and Locality Plans. Work is underway to develop the dashboard which will support both a place based and GM level composite picture of the changes effected by implementation. These will include appropriate metrics to describe shifts in: The prevalence of health problems This will contribute to the wider GM outcomes framework being developed by the GM Reform Board; Healthcare Activity detailing shifts in demand across health and social care settings; Provider Productivity moving beyond the headline cost improvement programmes to track the impact of the Carter Review response and key spend areas; Configuration demonstrating changes in the distribution of capacity between preventive, anticipatory services and reactive services; and Overall finance financial balance and return on investment multiples. 5. Recommendations 5.1 The Strategic Partnership Board is asked to: I. Note the progress in applying support to the development of Locality Plans following the assessment; II. Recognise the request for localities and GM themes to confirm their consideration in line with the agreed Transformation Fund Financial Process; III. Support the development of a Transformation Fund Oversight Group to advise the Executive in taking their decisions about the Fund; IV. Note the work to develop documentation including an initial Proposal Template and draft Investment Agreement; and V. Support the development of a GM Dashboard to both inform decisions and monitor the application of the Fund against those agreements to track the impact of the Fund and the Locality Plans more broadly. 9 P a g e

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