NHS Central Manchester Clinical Commissioning Group

Transcription

1 NHS Central Manchester Clinical Commissioning Group Operational Plan April 2014 March 2016

2 Operational Plan 2014/ /16 1. Forward from the Chair and Chief Officer 1.1 The coming year will be one of the most challenging the health and social care system in Central Manchester will experience. As a Clinical Commissioning Group we have just completed our first year as the statutory commissioning organisation for health in Central Manchester. It has been a tough year but one we can be proud of. 1.2 In the coming year we seek to make significant improvements to the health outcomes for our population, see improvement in the quality of services and the experience people have of using them. This is in the context of a very challenging financial situation for ourselves as a CCG, those organisations we commission services from and other public sector organisations within Central Manchester. 1.3 Our key programmes of work for the year will focus upon hospital care through the Healthier Together Programme, community based care building upon our integrated care programme Living longer, living better and the success of the primary care demonstrator programme. In addition our desire to see a better mental health system will progress during the year as part of the Improvement programme. 1.4 These programmes are the means by which we make the significant change required to the health outcomes our population experience. They are also the means by which we ensure a sustainable health and social care system given increasingly challenging economic times. 1.5 Above all 2014 is the year of partnership. All we have achieved has been through working closely with member practices, other NHS organisations, Manchester City Council and most importantly working with patients, their carers and the general public. If we are to meet the challenges the year will bring us these partnership arrangements need to be stronger than ever. Dr Mike Eeckelaers Chair Ian Williamson Chief Officer

3 2. Our Mission and Vision 2.1 Central Manchester CCG s mission, vision and strategic aims are focused on improving the health and well being of our population. 2.2 Our Mission is Informed by the views of local people and working closely with other health and social care professionals, Central Manchester Clinical Commissioning Group will design and develop health services which are high quality, safe and affordable and which will support communities to be the healthiest they can be 2.3 Our Vision is to: Create healthier, more resilient communities in Central Manchester actively managing their own health Lead a network of health and social care providers who promote, measure, monitor and improve quality over quantity Create a better balanced system for Central Manchester by shifting hospital care to services delivered in the community Create, with our practices and our partners, affordable and sustainable health services in Central Manchester 2.4 These founding principles inform the organisational strategic aims for our local population. The CCG Strategic aims are summarised in Table 1. Table 1: Central Manchester CCG Strategic Aims To improve life expectancy by one year To improve quality of life for people with long term conditions by increasing identification of conditions and optimising treatment Ensuring effective recovery from ill health and injury by reducing hospital emergency readmissions by one third Improving patient experience in primary care and at the end of life Reducing avoidable harm by improving reporting and reducing incidence Delivering a balanced budget each year and shifting resource into out of hospital care 2.5 All of the work programmes in our operational plan will contribute towards one or more of our strategic aims. The work programmes have been developed taking into account the specific needs of our population, and the local, regional and national context within which we are operating (outlined in the section 3). Our progress as an organisation in achieving the aims year on year will be monitored using indicators that contribute to the aims, NHS specific ambitions 1 and measures outlined in the Table 2.

4 Table 2: CCG Measurable Ambitions Securing additional years of life for patients with treatable mental and physical health conditions Improving health related quality of life for people with one or more long term conditions, including mental health Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital Increasing the proportion of older people living independently at home following discharge from hospital Increasing the number of people with mental and physical health conditions having a positive experience of hospital Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community Making significant progress toward eliminating avoidable deaths in our hospitals caused by problems in care Improving Health: Working closely with Public Health* Reducing Health Inequalities * Moving toward a parity of esteem between physical and mental health* * - New measures outlined in the Everyone Counts Planning for Patients 2014/ /19 (NHS England 2013) 3. Strategic context Why our strategic aims matter 3.1 Our population suffers some of the worst health outcomes in the country. There are high levels of age specific chronic disease and high rates of mortality for cardiovascular disease, cancer and respiratory disease. Central Manchester follows the national trend of an aging population and with this comes an increasing number of people with multiple long term conditions, frailty and dementia which will create an increasing pressure on health and care services over time. Central Manchester also has significant numbers of children and young people who need and a significant student population who bring their own health challenges. 3.2 Central Manchester has many areas of deprivation some of the most economically deprived wards in the country. There is ethnic diversity with 30% of people being from BME backgrounds which means that our services need to be tailored to meet

5 needs effectively and there will be a different emphasis of health needs in different communities 3.3 Health outcomes are often below the England Average and also below areas which could be considered comparable demographically. Central Manchester falls short on key indicators such as life expectancy, quality of life, levels of emergency hospital admissions and some aspects of patient experience. We do perform well in some areas such as lower levels of hospital acquired infections and patient experience of some surgical procedures. These measures have improved over the years but often only to the same extent as the rest of the country. The gap remains and as a result there remains an inequality Overview of our transformational change work programmes 3.4 Fulfilling our strategic aims and ambitions requires a fundamental change in the way we deliver health services. We have two strategic change programmes; community based and hospital based care which will be achieved through three transformation change programmes; Developing Primary Care, Living longer, Living better, and Healthier Together (Figure 1). Figure 1: Key Strategic Programmes 3.5 Other significant programmes that will be implemented in 2014/15 and 2015/16 that will contribute to changes in our populations health are: Mental Health Improvement programme: Redesigning mental health care in the city around the needs of patients and carers MacMillan Cancer Improvement Partnership: Improving cancer care with a focus on out of hospital care Healthy Lifestyles services: Redesigning services which help people get, and stay, healthy CCG grants scheme: Grants being awarded to voluntary sector organisations for projects to address social isolation

6 Community Based Care 3.6 The community based care strategic change programme is comprised of two main work programmes, developing primary care and the Living Longer Living Better integrated care programme. The following sections will give an overview of these programmes. Developing Primary Care 3.7 The CCG developed its strategy for primary care last year, which is aligned to that of NHS England Greater Manchester Area Team, and to the GM system overall. Our vision is to make a difference for our whole community, through ensuring access to consistent high quality primary care. We were accepted as a Primary Care Demonstrator community, and are now implementing a major strategic change programme which focuses on Improving access and increasing availability of primary care Support and management for people with long term conditions Specialist primary care provided closer to home Supporting vulnerable people such as those in care homes, those with dementia and the homeless, and getting their voices heard. Figure 2: Objectives for primary care in Central Manchester: Access to Consistent High Quality Care Making a difference for our whole community 3.8 Through the Demonstrator programme we have seen the delivery of primary care at greater scale and enhanced access for our population, through Practices working to defined standards of responsiveness to urgent need and demand

7 Additional availability in the evenings and weekends through collaborative locality hubs Population coverage for long term conditions management 3.9 We are now looking to sustain these developments, following evaluation of effectiveness, and link them more closely to the Living Longer, Living Better integration programme We recognise that the provision of seven day services is not limited to acute providers, and the provision of this in primary care will be vital for in the transformational change across Central Manchester. We will be building on the existing provision including (but not exclusively) through the additional availability demonstrator work programme. Living longer, Living better 3.11 Living longer, Living better (LLLB) is a Manchester level programme focussed upon out of hospital health and social care. The goal is to provide integrated out of hospital care models which increase the quality of life for the people of Manchester and to tackle the low life expectancy of our population. A further aim is to reduce demand upon secondary care services in order to finance the investments required for an enhanced and sustainable out of hospital care system. The programme is collaboration between the three Manchester CCGs, Manchester City Council, the three acute trusts and the mental health trust The LLLB programme has identified a number of population groups as a means of tailoring our service offer best to peoples needs rather than structuring services around disease groups etc. This operational plan describes much of our work alongside these groups We have decided to focus much of our efforts in the coming year toward four key population groups. These are groups who have significant need where, we feel, if we develop out of hospital care coordinating the care provided by professionals significant improvement can be made Therefore, we are working with partner organisations to develop improved care for people:- With long term conditions Who are frail older people or have dementia Are at the end of their life Are homeless

8 Figure 3: Examples of population based new delivery models for implementation 2014/ This focus will cover both implementation of new out of hospital service models but also a development of a locality based provider model of care which will improve how organisations and professionals work more closely together to deliver care (Figure 4). Figure 4: Central Manchester Locality based provider model for integrated care.

9 In Hospital Care 3.16 The wider Healthier Together programme brings together the development of Community-based Care (Integrated Care and Primary care) with the reform of In Hospital care across Greater Manchester The re-design of in hospital services across Manchester is part of the Healthier Together programme, which is part of the Greater Manchester (GM) Programme for Health and Social Care (H&SC) Reform. The in-scope services under for reconfiguration are: Urgent, Acute and Emergency Medicine; General Surgery; and Women and Children s services Over the last 24 months, over twenty clinical congresses involving hundreds of clinicians have considered the issues facing the Greater Manchester health system. They have explored the potential solutions to ensure services remain high quality, safe and cost effective for future generations. This work, which has been based on evidence and best practice from around the world has developed and contributed to this case for change The proposals arising from these congresses are for services to be shared across a number of defined hospital sites, with clinicians working across those sites to provide seamless care, with the teams delivering the once-in-a-lifetime specialist care on a designated site. These single services are shared across the geographical footprint, and the clinical teams benefit from being part of a wider, sustainable and better supervised team, raising standards in the routine work in the District General Hospital as well as meeting the clinical standards at the specialist site, a win-win for patients. This should also significantly improve efficiency at all the sites (as routine activity would no longer be interrupted by emergencies), and it is expected that that the Trusts would share the financial risk to avoid the perception of winners and losers Central Manchester CCG is actively engaged with the Healthier Together Programme. Through 2014/15 there will be a process of public consultations and NHS assurance, with the planned final decision to be taken by the Committee in Common in December However, there are considerable risks in a programme of this size and complexity, and given the proximity of a general election there is a possibility that the formal consultation and decision will need to be postponed until 2015 this would clearly delay the programme and the delivery of the benefits expected to be realised. Characteristics of a high quality, sustainable health and care system 3.21 NHS England has identified six characteristics of a high quality, sustainable health and care system. These are: A completely new approach to ensuring that citizens are fully included in all aspects of service design and change and that patient s are fully empowered in their own care. Wider primary care, provided at scale. A modern model of integrated care.

10 Access to the highest quality urgent and emergency care. A step-change in the productivity of elective care. Specialised services concentrated 3.20 Through working with our partners in delivering the strategic change programmes described in this plan and focusing on delivering the essentials for our population, Central Manchester CCG will be able to say that the health and system that our population exhibit all of these characteristics. Shift in Approach to delivery 3.21 The scale of the challenge within this plan and our longer term strategy means that we can t deliver this on our own. We have strong partnership working arrangements with Manchester City Council and local NHS provider organisations. We seek to develop those arrangements further We recognise the influence contracting and funding have upon how care is resourced and, therefore, how that care is delivered. We have developed our thinking about how contracting and funding can be used as an enabler and will be progressing a pre-alliance contract in the early part of the year. This will mean developing a contract with a partnership of providers who are collectively responsible for delivering the outcomes and are incentivised to do so In contracting for outcomes this will mean the CCG will be giving freedom to the provider partnership to determine how they deliver against these outcomes and the CCG s role will be in holding the partnership to account and developing the vision and outcomes for the future. 4.0 Working with our population to inform what we do. 4.1 Working with our population so that they have the opportunity to take control is key to our approach. To do this we will: commission a range of services over the next two years that offer personal health budgets as part of its core offer to patients so they have the opportunity to take control and co-design their care support plans. continue to roll out the Personal Health Budget support application with budget holders so they can co-produce their support plan online. continue to co-design personalised care plans with patients and carers as part of the city-wide integration work and develop case studies to measure the impact of this ongoing work programme. use our existing engagement mechanisms of the city-wide Patient and Public Advisory Groups to scrutinise developing clinical pathways to ensure they meet the needs of patients, carers and the public. enable and support self-management and understanding of long term conditions by offering self care courses such as Expert Patient Programme or diabetes educational course as a key component of their clinical pathway.

11 ensure contractually that all of our providers involve and engage with patients and carers and actively collate patient experiences to demonstrate improvements in their services. continue to monitor Friends and Family Test results collected by our providers as one indication of satisfaction of a service we commission. continue to engage with patients, carers and the public through a range of mechanisms to gather their experiences to inform the commissioning cycle of the Clinical Commissioning Group. continue to develop the relationship between the Patient and Public Advisory Groups and the GP Patient Participation Groups in Manchester. There are currently members of the GP Patient Participation Groups sitting on the Advisory Groups and provides a stronger patient voice for each of the Clinical Commissioning Groups. commission voluntary and community sector groups to engage with patients and carers around a specific clinical pathway such as mental health or learning disabilities. undertake needs assessments and Equality Impact Assessments to ensure all communities have equal access to health services that we commission. continue to use information from Patient Services to inform quality and patient safety of our commissioned services. We will continue to develop case studies and patient stories to demonstrate the impact our commissioned services have on patients and carers. We will use referral data to understand existing patients preferences and choices for services. 4.2 We put real time patient and citizen voice at the heart of decision making. Examples of how we will do this are provided below: We will continue to map all available patient experiences and use them to inform business cases, specifications and developments of clinical pathways. We will continue to use social media to engage with patients, carers and the public and use experiences to inform developments and quality monitoring of services. We will continue to input all patient experiences into the Datix system to build a picture of quality and patient satisfaction of a particular service or provider. We will continue to develop relationships through our Communities of Interest work and co-design initiatives and targeted responses to ensure equitable access to healthcare services. We will continue to provide a generic online survey for gathering patient, carer and public experiences of NHS services and use this information to inform ongoing commissioning decisions. We will commission engagement activities through the voluntary and community sector to ensure we are engaging with diverse communities and hard to reach groups. We will work with existing and emerging structures such as the Health and Wellbeing Board and HealthWatch Manchester. 4.3 There are a number of ways in which we will include authentic citizen participation in the design of our plans:

12 We will continue developing and supporting our Patient and Public Advisory Groups and who are part of the governance arrangements in place Manchester Clinical Commissioning Groups. We will continue with the development of our virtual Expert Panel members. This panel allows patients, carers and the public who have a specific interest in an area of work or health condition to get involved through a range of ways and at their choosing, such as taking part in design workshops with clinical staff, completing a survey, invitations to a themed event. We will continue to include Patient and Public Advisory Group members in walk arounds of our acute hospital providers, and the development CQUINS. We will continue to involved Patient and Public Advisory Groups members in mystery shopper audits, such as same day access to GP appointments. We will continue to develop a range of mechanisms to ensure there are participation choices available to people to be informed, involved and engaged in the work of Clinical Commissioning Groups. We will build on our social media platforms and encourage initiative ways that people can participate in the design work. We will commission research work to engage with patients and the public in the design of new and ongoing work programmes, such as the Neighbourhood Teams. We will continue to use a variety of ways to collect patient, carer and public information such as focus groups, online and paper surveys, discovery interviews, case studies, information stalls and public events. 4.4 Transparency in local health services is key to developing the trust of our population in the services that we commission. To develop this aspect we will: We will continue to promote the NHS Constitution both online and in the all publications developed by the Clinical Commissioning Groups. We will build on our existing relationships with our stakeholders to share information and learning from our engagement work. We will continue to use a range of communication mechanisms to share learning, feedback, decision making from the Clinical Commissioning Groups. We will further develop and continue to use the Talking Health website to share feedback from engagement work, such as We asked, You said, We did. We will publish engagement reports sharing patient and carer experiences and actions / recommendations taken by the Clinical Commissioning Groups. We will publish feedback from HealthWatch Manchester and actions / recommendations taken to address issues raised. We will hold public events to feedback on our work and learning from developments and service redesign. 5.0 Our detailed 2 year operational plan The work programmes in place over the next 2 years that will deliver the CCGs strategic objectives, the NHS outcomes/ambitions and the essentials will be outlined in this section. The CCG is embedding the development of Community Based Care at the heart of its commissioning process, and therefore where possible the work

13 programmes have been aligned to the population groups in the Living Longer Living Better Programme. Where this has not been possible, programmes have been described as system wide. This section will describe in sections, firstly, how we will deliver the essentials with particular focus on quality, secondly, the work programmes aligned our populations groups, and finally the system wide work programmes. Appendix 1 details the work programmes aligned to ambitions and the CCG strategic outcomes for the next 2 years. Quality 5.1 Quality is at the heart of, and is the golden thread of everything we do as a CCG. We recognise that strong clinical leadership and engagement is critical in improving quality and improving outcomes for patients. As a CCG we recognise that we need to think, plan and act differently to improve quality. 5.2 With reduced resources and unprecedented financial savings needed the CCG needs to be more innovative utilising evidence based models to ensure sustained quality improvements for the population it serves. We have adopted and embedded the principles in the NHS Change Model (Figure 5) to better support the achievement of high quality care for all, now and for future generations. Figure 5: The NHS Change Model

14 Responses to Francis report, Transforming Care: A national response to the Winterbourne View Hospital, and Berwick Review on patient safety. 5.3 There have been numerous reports released in the last year some of which have shaken the NHS to its core. Scrutiny of the quality of care for our patients has never been greater and reports such as Winterbourne, Francis, Berwick and Keogh have highlighted failings in care provided to our most vulnerable patients and failings in those responsible for the regulation and commissioning of those providers. Although the reviews in the main have been focused on the acute providers the learning from these reviews are equally applicable to all NHS funded services. 5.4 As a CCG we have developed and implemented action plans in response to these national reviews of quality, however with the release of Hard Truths: the journey to putting patients first, DH January 2014, a different approach is needed. 5.5 As the recent stocktake by the Winterbourne Joint Improvement Team has confirmed, Manchester has developed a robust response to the challenges set out in Transforming Care. Manchester CCG s are working together with Manchester City Council (MCC) to transform learning disability services for Manchester residents. The CCGs and the Local Authority have reviewed all of the patients in secure and non secure care settings to ensure we meet the target date of 1 st June The Learning Disability Joint Commissioning Management Board has been reconstituted and will oversee the Winterbourne Transformation work. The Manchester Learning Disability Partnership Board, which includes learning disabled people and their carers, is also contributing to this work. Manchester City Council with support from the CCG s is also reviewing the local learning disability services with a view to potential re-procurement. Commissioners are also considering options to commission an acute inpatient service for learning disabled people who display very complex challenging behaviour with mental health problems either on a Manchester or Greater Manchester footprint. 5.7 The findings from the national reviews have informed the development of our organizational strategic aims and the work plans falling from these and they have changed and strengthened the way we commission providers through all aspects of the commissioning cycle. 5.8 To ensure that this continues the CCG will be refreshing its quality strategy. 5.9 We are committed to quality and improving this for our citizens. We have an ambitious quality strategy in place that has taken the first steps to address the issues and concerns outlined in these national reports. This now needs to go further and encompass all the learning from these national reviews, as outlined in Hard Truths, into one overarching strategy for quality with a robust implementation plan behind this incorporating strong metrics to enable us to monitor and measure success As part of this refreshed quality strategy the CCG intends to: Work with the local authority to develop a shared quality strategy, with shared values and shared aims. This would replace the CCG Quality Strategy

15 Further promote the use of the NHS Change Model and evidence based improvement tools within all our providers through NHS contract levers such as CQUINs and information requirements. Further develop the quality standards in place presently with providers, such as exploring how to measure the culture of a provider in a tangible way and how to identify and assess effective leadership. Develop and strengthen our provider quality dashboard, including data published by providers in relation to complaints, staffing, and safety. Continue to develop quality dashboards for community providers and small providers. Further develop commissioner walk-rounds in providers extending these further to small providers and community providers. Build stronger relationships with CQC, Monitor, TDA, Healthwatch and other partners who hold vital information about our providers in order to identify quality concerns earlier and work collaboratively to resolve these. With the release of a lot more information in the public domain strengthen processes for collating and triangulating all available data to better identify quality concerns in a timely manner and enable clinical leads to take prompt action to address these The CCG will have this refreshed quality strategy and implementation plan in place for the start of the contract year. Patient safety 5.12 The CCG has an ambition in the current quality strategy in relation to the development of an early warning system. This objective outlines the approach that the CCG takes in relation to being able to understand and measure the harm that can occur in healthcare services This involves the gathering of data from all available sources, analysis of this information to identify trends and themes through a CCG Quality Surveillance Group which results in actions for the CCG to take to inform, assure and improve quality and patient safety. This is represented pictorially in figure 6.

16 Figure 6: CCG Quality Assurance Group Methodology NPSA Serious incidents Information from PPAG Provider information Information from GP members Information from Healthwatch Monitor Mortality indicators Complaints and PALS CQC National Inquiries National audit Serious case reviews Supported by data from the quality and performance compendium CCG Quality Surveillance Group Supported by data from datix Quality Dashboards for CCG Committees and Board Queries to raise with providers that inform contract monitoring meetings Identification of trends across specialities Identification of issues that need escalation 5.14 The CCG Quality Surveillance Group has been developed across four CCGs (Central Manchester CCG, South Manchester CCG, North Manchester CCG and Trafford CCG) attended by the Clinical Directors of Quality. The role of this group is to review this information and identify any actions needed to improve quality. The group then determines where and when this information needs to feed into the commissioning cycle. This area is still in development in the CCG. The work in this year has focused mainly on the large acute and community provider. Work is to continue to further roll out this approach to all providers With the introduction of more real time data available in relation to quality such as published complaints reports, information on safe staffing, and information published under the transparency agenda this process will be developed further to ensure this information is captured and fed into the early warning system process The CCG has also purchased and is rolling out a system to allow us to capture real time concerns about other providers as identified by our GP members, members of the CCG Patient and Public Advisory Groups and Healthwatch. The implementation of this system across all GP practices will allow a further level of detail in relation patient safety. There is also collaboration with the Local Authority regarding the processes that are in place to monitor nursing home placements We work closely with the Local Authority in coordinating our response to serious case reviews and domestic homicide reviews against statutory timescales. The CCG ensures there is full cooperation with the statutory function of the safeguarding boards and compliance with statutory duties of the role particularly in work with providers The CCG coordinates reports and quality assures responses from across the health economy, providing expert input to panels. An important role is the, dissemination of

17 findings, influencing commissioning decisions, informing media management and monitoring the impact of learning. Patient experience 5.19 Measuring improvement in patient experience is a difficult task. Patient experience is subjective and involves multiple factors. The development of the Friends and Family Test has helped the CCG gain a tangible feel for how patients experience care in the acute sector. The real benefit of this has been the additional questions providers have included in this test allowing them to identify the areas of the patient experience that were not optimal and more importantly put plans in place to address these The information from the Friends and Family Test gathered this year gives us an indication of patient experience in the acute provider. The CCG will use this as a baseline to measure, monitor and improve patient experience in this setting. This measure gives the CCG the ability to measure improvement in patient experience but will not be looked at in isolation. All providers are required to work to address patient concerns and complaints and improve patient experience. To fully understand and improve patient experience all of this data needs to be looked at and analysed. This will be done as outlined in the CCG early warning system and Quality Surveillance Group and actions identified within this forum, these actions will then be scrutinised and agreed through the CCG Quality Committee and taken forward with our providers from there The CCG is committed to delivering the EDS2, and as part of this ensuring the quality of care experienced by vulnerable groups of patients will be improved. There are logistical challenges in achieving this which we are addressing. All providers are required to gather data about their patients in relation to the protected characteristics. As a CCG we have requested that this data be included in any report about patient safety, complaints or patient experience. This needs to be strengthened moving forward but is hampered by national electronic systems for capturing patient data which does not allow for data collection against all the protected characteristics. Providers have plans in place to improve the collection of this data against the 9 protected criteria and this will be monitored and built on. This information will be analysed by the CCG Quality Surveillance Group and actions identified within this forum, these actions will then be scrutinised and agreed through the CCG Quality Committee and taken forward with our providers from there A preventative framework for nursing and residential homes has been developed and will be implemented across nursing homes in Manchester. This aims to improve the governance processes and quality in the homes to improve patient safety and outcomes. The integration of the Quality Boards for the City and Local Authority further develops the links in relation to joint working, monitoring and sharing. By integrating these Boards intelligence can be shared as risks emerge to ensure that control measures are implemented at an early stage to improve outcomes for patients In addition to the patient and community experience information we gather from providers through contractual arrangements, considerable information is gathered through the public engagement work delivered by the CCG itself and the complaints and PALS information we gather as commissioners of services. This is gathered in

18 many formats including social media, surveys, film and meetings with community of interest specific voluntary sector groups. This is reported through to relevant committees including the quality committee, alongside provider generated data. We also have within the structure of the organisation, a Patient and Public Advisory Group, chaired by the Lay rep for PPI, which feeds in community experiences. On top of that, we receive and consider reports from voluntary sector bodies, some of whom we commission, about the experiences and preferences of the communities they represent. During 2013/14 we have implemented a DATIX risk management system within which we are now storing patient experience data. This enables triangulation with other indicators of quality such as complaints and serious incidents The Provider Quality Dashboard that the CCG currently has in place is reported on quarterly at the CCG Board. Included on this dashboard are the results from the Friends and Family Test and narrative in relation to what the provider has done based on the feedback from patients. Performance against this will continue to be monitored and reported against. These papers are in the public domain. Compassion in practice 5.25 The CCG has quality standards in all contracts. These cover areas such as safe staffing, culture, leadership, mortality etc. These are monitored on a quarterly basis with the providers and evidence on compliance against these is gathered in various ways such as the CCGs attendance at internal governance meetings, commissioner led walk rounds and formal reports. With the release of every new national review on quality or national strategy relating to quality the CCG requests providers to share their plan/ strategy to address these. This has included this year how trusts are going to implement Compassion in Practice The CCG will be monitoring the implementation of Compassion in Practice in the large acute and community sector through the quarterly quality assurance monitoring meetings led by the CCG Clinical Director for Quality This area needs to be further strengthened in relation to our smaller providers and will form part of the quality monitoring cycle Providers in the community are being monitored in relation to how they are implementing Compassion in Practice/6C s across their nursing staff. Providers have developed action plans to identify how they will address all areas and these will be monitored by the CCG through to completion. Staff satisfaction 5.29 We are able to benchmark staff satisfaction in some areas currently through the NHS staff survey. The weakness in this is that this is an annual survey, there is a significant lapse in relation to the time the survey is done and when the information is released and it does not cover all of our providers. We have and will continue to request assurance from providers in relation what steps they have put in place to address concerns identified through this survey Through the Friends and Family CQUIN in 2014/15 a Staff Friends and Family Test has been developed and will be implemented in the next year across acute,

19 community, care homes, ambulance and mental health providers. This will allow the CCG to truly benchmark staff satisfaction in a timely manor and identify what providers are doing to improve this. The score will be indicative of how staff are feeling, however the narrative will provide richer data to identify why and what factors have affected this As a CCG we will not look at this data in isolation but will also look at other available data sources such as published staffing levels within the provider, sickness rates, deanery reports and whistleblowing alerts. This will allow us to look in more detail at the factors affecting staff satisfaction and work with our providers to address these. Safeguarding 5.32 The safeguarding work plans reflect the priorities of the MSCB and MSAB and functions discharged in line with the accountability and assurance framework on the following ways: CCG accountability and governance arrangements reflects the requirements of the framework Other relevant work planning includes the appointment of named GP s which is in progress Application of the Mental Capacity Act will be reflected via Primary care training plans, feedback and response from incident reporting, development of multiagency procedures 5.33 There is an action plan for the Prevent agenda with clear and distinct timeframesthis will be monitored via Safeguarding Governance Group Access 5.34 The CCG will commission the required activity to ensure that patients have timely and convenient access to hospital and community services, and that there NHS constitutional rights are adhered to. We have robust processes and procedures in place through the CCG board to monitor adherence to the patient s rights, which have been tested, and proven effective in 13/ In ensuring access to health services, the CCG will adhere to the Improved patient access and experience goal outlined in the revised Equality Delivery System (EDS2) Through the Primary care programme, and the development of additional availability and responsive access; there will be evaluation of the programme, specifically on ensuring timely and convenient access to people who are covered by the EDS 2, with the protected characteristics. Given our particular population base, there will be focus on evaluating access of minority communities The detail of the work programmes that will deliver the access requirements for our population are detailed in Appendix 1.

20 Urgent and Emergency Care 5.38 The CCG s Urgent Care Board has reviewed its role, functions and priorities in the light of the Urgent and Emergency Care Review, and developed actions and programmes to ensure adherence to the recommendations which are within its purview, including Better support for self care Responsive urgent care services out of hospital A system which involves the key agencies and is connected together 5.39 The footprint of the urgent care network will be developed both locally by the CCG working with its key partners in the urgent care system; and also on a wider scale across Greater Manchester, linked to the Healthier Together programme. Data relating to need and patient flow will inform the decision. The process for the designation of facilities within the Greater Manchester Urgent and Emergency network will be undertaken through the Greater Manchester arrangement Other actions have been or are being addressed on a wider scale, such as Greater Manchester reconfiguration of major trauma care Oversight of 111 arrangements Development of a Greater Manchester wide urgent care system, through the Healthier Together programme. A step change in the productivity of elective care 5.41 The CCG s planned care strategy, as reflected in the work programmes detailed in Appendix 1, incorporates plans to achieve a step change in the productivity of elective care, through Reducing unnecessary activity; tackling areas which include consultant to consultant referrals and follow ups Managing demand where possible in primary care; for example, by maximising opportunities available through Manchester s Integrated care Referral gateway Developing services in primary care, through the LLLB and primary care programmes; examples include Dermatology and Persistent Pain Working through the Planned care and Long term Conditions Board with provider colleagues on efficiencies and new models of care; for example, tackling Do Not Attends 5.42 Our secondary care providers will also have their own efficiency programmes. We will be working with our partners to support the delivery of the required step change in productivity. Mental Health Improvement across the CCG: Achieving Parity of Esteem 5.43 Valuing mental health equally with physical health, i.e. achieving parity of esteem will be done through improving the quality of care and experience, improving the physical health of those with a mental health problem, the mental health of those with a physical health problem, and reducing the stigma and discrimination experienced by those with mental health problems.

21 5.44 To achieve this aim the CCGs commission services for the whole population including those at increased risk of mental health problems, such as people with intellectual disabilities, asylum-seekers, people within secure services, lesbian, gay, bisexual and transgender people, some Black and minority ethnic populations at greater risk, children in care, care leavers and others Through LLLB, CCGs and partner agencies are planning for integration by moving away from mental health, physical health and social care silos and considering mental health as integral to all health and social care services by: Investing in the prevention of mental health problems and promotion of mental wellbeing Commissioning for outcomes and an expectation that mental healthcare should continuously improve by commissioning services based on a Recovery Model Respect and dignity for those with mental health problems across all areas of health and social care 5.46 We recognise that there are particular requirements around Identification and support for young people with mental health problems. The CCG is working with partners across the city to look at this. For example, it is collaborating with the city council to conduct the CAMHS. The purpose of the review being to explore opportunities for integration and collaborative commissioning and to determine if better outcomes, pathways and value can be achieved. The thematic recommendations focus on improvements in system interfaces, education, training and the need to improve the universal offer in the school environment The Mental Health Improvement Programme is a whole systems review designed to integrate the mental health and well being system across Manchester. It will enable improved access to seamless care pathways. Through this programme the CCG will work to ensure that those in our population with mental health illness: Receive timely and appropriate treatment, as is expected for those with physical health problems Have parity of life expectancy and no higher rates of physical illness than those without these problems Be recognised as a risk factor in physical illness and vice versa Receive the same quality of physical healthcare as those without a mental health problem. Receive appropriate intervention and support to address the factors affecting their much higher rates of health risk behaviour Are assessed appropriately to identify potential ment al health problems, and appropriate intervention to prevent escalation of any existing mental health problem The improvement programme will be monitored against the 9 Protected Characteristics in the Equality Act and also an additional local Characteristic of carers. New care pathways will be in place for groups within the population who currently do not receive services locally e.g. People with autism.

22 5.49 Commissioned services are designed to help reduce the high rates of type 2 diabetes, cardiovascular disease in psychiatric patients treated with antipsychotic medication, improve the diagnosis and support for people with dementia, improve access to talking therapies, improve awareness of duties under the Mental Capacity Act and integrate mental health and physical health services These outcomes will be achieved by Liaison Psychiatry, A&E Liaison, IAPT, and Rapid Assessment, Interface and Discharge (RAID). Value for money, effectiveness and efficiency 5.51 The CCG has a strategy to work collaboratively with its partner organisations to ensure services are delivered as effectively and as efficiently as possible. It is anticipated that the work currently being done under the Healthier Together and the development of New Delivery Models under Living Longer, Living Better will release inefficiencies across the local health economy and accordingly deliver better value for money In addition, the CCG has a rigorous business case process for all new expenditure and a clear governance structure around approval. Value for money is assessed as part of this process. The CCG will in 2014/15 ensure that all new proposals are assessed to establish which outcome measures each proposal is addressing particularly in view of the significance of meeting the requirements around the Better Care Fund We have implemented a robust QIPP monitoring system and will continue to regularly report achievement to operational committees, executive Team, Finance Committee and to the Board. The CCG also recognises that 2015/16 will be a very difficult financial year once the transfer of resources around the Better Care Fund has occurred and consequently will during 2014/15 establish and implement a process to scrutinise areas of current expenditure to assess their impact, efficacy and demonstrates value for money The CCG will, in 2014/15 continue to get its procurement expertise from CSU, who are working to support the implementation of Better Procurement, Better Value, Better Care. We will ensure that the CCG operates within the procurement rules set out within our procurement policy. Population based work programmes and system wide based work programmes 5.55 The detail for the CCG work programmes for 2014/16 is provided in Appendix 1, and how the work programmes will contribute to the CCG strategic priorities and NHS ambitions is shown in Appendix These work programmes have been developed following engagement with our partners, professionals, our membership, and our population. For example, through the Living longer, Living better workshops and the Demonstrator Community Reference and Engagement Group in primary care.

23 5.57 The implementation of the work programmes and measurement of the contribution of these toward the CCG strategic aims and NHS outcomes will be monitored through the governance structures of the CCG. All of the work programmes/ deliverables (and their contribution to outcomes) are built into individual, team and directorate objectives, so direct linkage can be made for CCG staff to the contribution toward the organisational strategic aims. 6. Delivering the plan in partnership 6.1 Delivering transformation change across a health and care system can only be achieved through effective partnership working between the NHS, the public, local government, and wider partners such as the third sector. The CCG has effective and productive working relationships with the range of partners needed to drive these changes forward, within Central Manchester), across the City, across Greater Manchester and beyond. Working across Greater Manchester 6.2 The CCG is actively engaged and providing leadership in the Healthier Together programme. It will be working with NHS England to understand the impacts of Specialist Commissioning and Primary Care commissioning for our population. We will also be working with the Greater Manchester Lancashire & South Cumbria Strategic Clinical Networks, making appropriate linkage with their priority programmes to our work programmes. The CCG is an outward looking organisation, and works with organisations such as the Kings Fund, the Advancing Quality Alliance (AQUA), to inform and implement and evaluate evidenced based working practices from other health economies. Working Across the City 6.3 Central Manchester is a vibrant, dynamic part of the city and at the centre of Greater Manchester. We cannot work in isolation, and actively working in with our partners across the city to implement the transformation change programmes taking place over the next 5 years. 6.4 We play an active role in Manchester s Health and Wellbeing Board, which brings together Manchester City Council, Manchester s 3 CCGs, and the key healthcare providing organisations in the city. The CCGs work programmes align and will support the Health and Board priorities for the City s Health which are: Getting the youngest people in our communities off to the best start Educating, informing and involving the community in improving their own health and wellbeing Moving more health provision into to the community Providing the best treatment we can to people in the right place and at the right time Turning round the lives of troubled families Improving people's mental health and wellbeing Bringing people into employment and leading productive lives Enabling older people to keep well and live independently in their community

24 6.5 As previously described, Central Manchester s health outcomes are often below the England average and demographically comparable. We have agreed a local Memorandum of Understanding with Public Health Manchester, and work with them to understand what how to support this work across the city. For example, in response to the life expectancy segmentation data which provides information on the causes of death that are driving inequalities in life expectancy for our population, Public Health Manchester have identified work programmes to address these causes. We use this type of data to cross reference our work programmes and take the opportunity where possible to work together. Similarly we will work with our Public Health colleagues drive forward the Commissioning for Prevention framework. 6.6 The Living longer, Living better programme can only can only be delivered through partnership. The programme, as described in section 2 is collaboration between the three Manchester CCGs, Manchester City Council, the three acute trusts and the mental health trust. A citywide leadership group (CWLG) has been formed from the partner organisations, which Central Manchester CCG, is actively engaged in, and led for some of the New Delivery Models. Working within Central Manchester 6.7 In Central Manchester we believe in a collaborative approach to commissioning, and have built strong partnerships with local organisations, clinicians and providers. In particular we have developed a Clinical Integrated Care Board (CICB) along with partner agencies Central Manchester Foundation Trust (CMFT), Manchester City Council Adults and Children s services, Manchester Mental Health and Social Care Trust and the North West Ambulance Service (NWAS). This board oversees a range of the CCG boards which focus particularly on cross system improvement (e.g. Urgent Care Board, Reform and Re-design), placing partnerships at the heart of our approach. 6.8 Through developing and embedding strong relationships with our partner providers and commissioners, we are now taking things to the next level, developing new and innovative ways of commissioning and providing services. A Provider Partnership Board has been established which has key providers of care, secondary, primary, mental health, voluntary sector and patients represented. This board will oversee the implementation of the LLLB new delivery models in Central Manchester, and will also provide governance for an pre-alliance contract for Urgent Care (paragraph 11.8) 6.9 We know that to an effective organisation for we need to work closely with our member practices. Throughout our first year of operation we have done this both on an individual level and also through our locality arrangements; to ensure that practices and localities are fully engaged in all our commissioning activities, and inform our priorities and plans. We are continually striving to improve our methods and will be reviewing practice engagement through 2014/ Specialist Commissioning Intentions

25 7.1 Prescribed Specialist Commissioning Intentions 2014/15 to 2015/16 have been published by NHS England and are available for view at We will work with our colleagues in the Cheshire, Warrington and Wirral Area Team as they develop the work that they have indicated including the Call to Action and 5 year plan of reform. 8. Direct Commissioning Intentions 8.1 NHS England (Greater Manchester) have published their commissioning intentions for 2014/15 which cover: Changes to contracting for Primary Medical Services Local Professional Network Briefing for Greater Manchester CCGs Dental Commissioning Intentions GM Local Eye Network GM Local Pharmacy Network NHSE Health and Justice Commissioning Intentions 2014/15 North West Health and Justice Commissioning Intentions 2014/15 GM Public Health Commissioning intentions 2014/15 Health and Justice Framework Project 8.2 Further information on these can be obtained directly from the Area Team, and the CCG will engage with NHS England as required for our populations in these areas. 9. Activity and Finance Economic outlook for the NHS 9.1 The Planning document The NHS belongs to the people: a call to action says the NHS could face a funding gap of 30 billion by , as a result of the growing gulf between flat funding and rising demand, driven by an ageing population living with a growing burden of chronic disease. 9.2 In a statement on its website, NHS England states that this gap cannot be solved from the public purse, and that the NHS and the public will instead have to accept radical changes, freeing up NHS services and staff from old style practices and buildings. 9.3 Over the course of the 2010 Spending Review, local government funding will have reduced by 33 per cent in real terms. A further real term cut of 10 per cent is confirmed for most local government services for 2015/16, and a similar trajectory is projected for the period beyond. 9.4 In June 2013, the Institute for Fiscal Studies expressed the view that government spending cuts will continue until For local authorities the updated funding outlook model reveals that the financial black hole facing local government is widening by 2.1 billion a year and will reach 14.4 billion by It is in this financial context, that both national and local policy drivers are determinedly focussed upon making the most effective use of resources across health and social

26 care services, by integrating services wherever possible to enable local commissioners and providers to work collaboratively to resolve the financial pressures in their local systems. 9.5 A key enabler of the national policy is the creation of local Better Care Funds from 1 April In the city of Manchester (encompassing the City Council and three Manchester CCGs) the Better Care Fund, through a formal pooled budget arrangement, will see a combined transfer of 25.4m of CCG resources to this pooled fund. This funding will support the continued implementation of the Manchester wide integration programme, Living Longer, Living Better, as well as a range of key local and national conditions. 9.6 For Central Manchester CCG, the transfer to the Better Care Fund will mean that although combined two year growth of 8.9m has been announced for 2014/15 and 2015/16 (2.14% and 1.7% respectively), only 0.3m of this (or 0.1% growth on 2013/14 baselines) will be retained directly by the CCG in 2015/16, representing a reduction in funding in real terms of 1.5%. 9.7 This explicit efficiency challenge will require strong, cross organisational leadership to drive through better returns for each pound of investment not only by releasing cashable savings but also, ensuring that efficiency savings are generated through improved productivity and that these are reinvested in better quality, more effective and more efficient services for patients. Economy efficiency challenge 9.8 The efficiency challenge across the health and social care commissioners in Manchester, together with the three main acute providers, is in the region of 250m for the five year planning period: 70m local authority (to 2016/17); 20m for the Manchester CCGs (2014/15 to 2018/19); and 160m for the three main acute providers (2013/14 to 2017/18 source: Healthier Together). 9.9 The significant task of reducing and managing the City s financial pressures is being addressed through the three overlapping and inter-dependent programmes of work at a Greater Manchester level, as shown pictorially below, namely: Healthier Together Integration (Living longer, living better) Primary Care Strategy Other Quality, Innovation, Prevention and Productivity (QIPP) schemes 9.10 It is clear that the LLLB programme in isolation will not entirely address this significant challenge. Efficiencies must also be delivered through all of the programmes, as well as other cost improvement plans across all partners.

27 10 local models of integrated care with some commonality Clinically led In hospital redesign across GM Urgent, Emergency and Acute Medicine Acute Surgery Women s and Children s Primary Care Commissioning Strategy developed by NHS England working with CCGs, AGMA and others Joint Committee of Association of GM CCGs NHS England Living Longer Living Better contribution 9.11 Recognising the range of programmes running in parallel and the ongoing modelling work for each, the precise implications for the acute (and other) sectors are not fully quantified at this stage However, a series of strategic financial planning assumptions have been shared and agreed with key partners, including provider Trust Directors of Finance and local authority, to guide the range of affordability during development of the new delivery models These reflect the activity shift assumptions (Table 3 below) expected to be delivered through the above programmes over the planning period, as well as acknowledgement that reinvestment will be required in community and other services to secure reductions in hospital capacity. Table 3: Out of hospital activity shift assumptions STRATEGIC TARGETS Manchester CCGs (Gross % shift based on 2013/14 M8 Forecast SLAM outturn) TARGET REDUCTIONS - 5 YEAR PERIOD POD Agreed target shift %* Indicative average prices Target shift required 2014/15 to 2018/19 Activity Indicative tariff cost of activity shift Indicative cost North (All Trusts) Central (All Trusts) South (All Trusts) Activity Activity Activity A & E ,998 2,606,679 8,927 11,415 6,655 EL ,043 4,001 4,172,506 1,501 1,243 1,257 NEL ,733 11,098 19,231,730 4,228 3,546 3,325 OP ,998 7,964,718 25,481 25,957 27,560 TOTAL - ALL CCGs 121,095 33,975,633 40,137 42,161 38,797

28 * The targets are based on review of NHS Comparators information for NHS Manchester in 2012/ Work has been undertaken to ensure that assumptions remain consistent between the various aspects of planning wherever the scope of modelling is similar. At this stage, the planned efficiencies are based upon acute hospital based activity, valued at circa 34m. An assumption has been made that up to 50% of this will need to be reinvested in community services in order to sustain the acute activity shifts. Table 4 - CCG BCF transfers Better Care Fund Allocation 2015/16 North Central South Total CCG contributions k k k k Carers breaks and reablement 1,815 1,735 1,450 5,000 NHS funding transfer/integrated care 7,576 6,886 5,922 20,384 9,391 8,621 7,372 25,384 New social care transfer (from NHS England - formerly PCTs) 4,160 3,943 4,116 12,219 Total transfer to MCC 13,551 12,564 11,488 37,603 Effect of BCF on CCG growth monies: Growth 2014/15 5,318 4,943 4,312 14,573 Growth 2015/16 4,315 4,010 3,499 11,824 Total two year growth 9,633 8,953 7,811 26,397 CCG transfer (excl NHS England additional) 9,391 8,621 7,372 25,384 Net CCG growth remaining after BCF Finance 9.15 The CCG has undertaken a process to develop a financial plan for the next 5 years in line with national planning guidance.as outlined above, the position for the next 2 years will be extremely challenging as the requirement to develop at a locality level the Better Care Fund effectively transfers most of the CCG s growth. Allocations 9.16 Allocations for 2014/15 and 2015/16 were published on the 19 th December 2013 following agreement on the methodology to be used by the NHS commissioning

29 Board at its meeting in December. In summary the commissioning Board agreed the following; That in moving to the revised allocation formula all CCGs would receive a minimum uplift of 2.14% in 2014/15 and 1.7% in 2015/16, with those CCGs most under target receiving additional increases above this level. That in line with previous guidance, funds would transfer in 2015/16 to form a Better Care Fund. The Table 5 below summarises the allocations for Central Manchester CCG. Table 5: Central Manchester CCG allocations Central Distance from target % 000's 13/14 recurrent allocation 230,958 Distance from target 1.72% Growth 2.14% 4,943 14/15 allocation 0.63% 235,901 Growth 1.70% 4,010 Transfer in BCF 3,943 Revised allocation 243,854 Transfer out BCF -12,564 Revised allocation 15/ % -2.0% 231,290 % increase in allocations 13/14 to 15/16 0.1% /16 allocation per head 1,095 In addition to the above, the running cost allocation will be 5,029k in 2014/15 (2013/14 5,080k) and 4,516k in 2015/16, a 10% reduction. Planning assumptions 9.17 The planning guidance establishes that the CCG must plan the following: Table 6: Planning requirements 2014/ /16 Non recurrent reserve 1.5% 1.0% Call to action 1.0% 0 0.5% contingency 0.5% 0.5% Total non recurrent funds 3.0% 1.5% Surplus 1.0% 1.0% Tariff -1.2% -1.1%

30 9.18 This table (Table 6) indicates the significant level of non recurrent resources required in plans in 2014/15 and amount to 6.9m. This is prudent taking into account the overall 2 year settlement referred to above, but also needs to be used to ensure plans are in place to deliver efficiency requirements in future years The tariff deflator which is anticipated to continue at a similar level beyond 2015/16 will create a significant financial challenge to hospital service providers. Growth assumptions 9.20 The CCG has incorporated the following growth assumptions outlined in Table 7, into its financial plans the 5 year planning period. This effectively works out as a net overall growth on acute expenditure of 1.7% for 2014/15 and 2.3% for 2015/16. These growth rates have been agreed with our main provider CMFT. Table 7: CCG Growth Assumptions POD Population growth Residual growth Total growth Non-elective admissions 0.70% 1.30% 2.00% Paediatrics (all PODs including nonelectives) 1.40% 1.90% 3.30% Electives 0.70% 1.80% 2.50% A & E 0.70% 1.30% 2.00% Outpatients 0.70% 0.00% 0.70% 9.21 Other key growth assumptions factored into our financial plans are: Prescribing 3% Primary care 1% Continuing care, mental health 1% Investments 9.22 The CCG has set aside a resource of 3.4m for investments that will contribute to the shift required under the Better Care Fund in 2014/ The list of projects developed during 2013/14 including the demonstrator programme, ongoing programmes such as the integrated care teams together with new projects identified around the Living longer, living better population groups were assessed by partners within the Provider Partnership Board in terms of their potential impact on activity shifts required and whether they were already recurrently funded. This prioritised list has now been approved as our investment programme for 2014/15 (appendix 3). Further projects have been identified which will be implemented once resources become available As outlined above, in terms of activity levels in acute trusts the CCG has set five year targets to shift to the England average. Table 8 below shows the impact upon these targets from the current set of investments. Many of the investments focus on urgent care.

31 Table 8: Activity impacts A&E Non Elective Outpatients Elective Baseline 114,150 17, ,231 15,538 Target (11,415) (3,546) (25,957) (1,243) Investment Impact (8936) (3925) (605) 0 % shift on baseline 7.8% 22% 0.4% 0% % shift on target 78% 110% 2% 0% Contracts & activity planning 9.25 The CCG has negotiated a contract with CMFT whereby the urgent care and community services expenditure is blocked for the year The CCG has ensured that the activity reflected in the BCF submission, the financial plans and the activity plans are consistent 9.27 In order to meet the target activity shifts outlined in Table 8, the CCG needs to develop plans to meet a further shift of 2.2% in A & E, the outpatient target of 15.6% and the required elective shift of 8% over the last 3 years. It is presumed that the work currently being undertaken as part of the Healthier Together programme will deliver this shift. QIPP 9.28 The CCG has a QIPP target of 3.5m for 2014/15 and 4.0m for 2015/16. The CCG has plans to deliver these targets. 10 Making it happen Programme Management 10.1 Given the scale of pace and change of the transformational programmes that will be taking place over the next 2 years, effective programme and project management will be required throughout the organisation to monitor progress. In developing the operational plan for the next 2 years, teams have been explicit in linking work programmes to measurable outcomes, in addition to the strategic aims (Appendix 2). Whilst the work programmes are high level, each has a series of deliverables associated which are set out in personal objectives, and progress monitored through performance review system. In addition, dashboards are being developed from a bank of key performance indicators which will quantify the outcome of work programmes on their anticipated outcome Using this approach, progress and impact of work programmes can be monitored at individual, team, directorate and CCG board level. This approach will be applied to the programmes that span orgaisations, through to the Clinical Integrated Care Board.

32 Organisational Development (OD) 10.3 Organisational Development is planned organisation-wide intervention to ensure the development of people skills required to bring about improvements in the organisations effectiveness and viability in achieving strategic ambitions. Central Manchester CCG s overarching OD plan is structured around the McKinsey 7s model: Strategy the strategic direction we intend to take to be effective clinical commissioners Structure the shape, form, infrastructure, and governance of CMCCG now and in the future Systems the processes we have developed to enable us to meet out strategy Style how we present and engage with others and manage key relationships Staff how we lead, develop and support CCG staff and those from the wider health economy Skills the capabilities we need to continually develop as excellent clinical commissioners Shared values our guiding principles that shape how we work and that underpins everything we do 10.4 OD recognises that organisations do not exist in a vacuum but are part of an open system. Our OD plan focuses on ensuring the CCG is responsive to the world it operates in and that its internal capacity matches its strategic ambition. The key outcomes we are looking to achieve are; A sustainable high-performing organisation in which staff and members take an active part in achieving the required objectives An engaged, proactive and empowered staff and membership group An organisation that promotes diversity and inclusion for our staff and patients Effective two-way communication channels so information can flow upwards as well as downwards Building an organisational culture that will enable staff to achieve their full potential An organisation that fosters continuous learning An organisation that is healthy, sustainable and fit for future challenges 10.5 Our OD themes take into account the need to continue to develop workforce capability, motivation, engagement and organisational systems, processes and governance while also improving organisational efficiency. The success of our OD plan will depend on; An underlying integration and understanding of how we continue to enable our people to be engaged, supported and confident in what they do Continuing to shift work from a process to an outcome focus Having a shared and cohesive sense of purpose across the organisation

33 The diagram below (Figure 7) shows the key OD themes required to deliver these are the work steams that will support delivery. Figure 7: Central Manchester OD Themes and supporting work streams. Leaders hip and Management Engagement Leading and Deliv ering Effective Change Individual and Team Capabilities Improving Organisational Efficiency B oard/clinical Lead Development Shared Vision and Values High Performing Organisation Training Needs Analysis Review of Organisational Design Leadership Development Staff Engagement Equality and Inclusion Talent Management L and D Evaluation Management Development Clinical Engagement Member Practice Engagement Performance Management Framework Succession Planning Systems and Process Review Patient, Public & Stakeholders Engagement 10.6 A key element of the Equity and Inclusion work stream for 2014/15 will be to ensure delivery of the Equality Delivery System 2. In particular we will be working to ensure delivery of the outcomes aligned to the 4 goals in EDS2 which are Better Health Outcomes Improved Patient access and experience A representative and supported workforce Inclusive Leadership Innovative contracting models 10.7 Central Manchester CCG will be putting in place new contractual arrangements between commissioners and health and social care providers for the pre-alliance phase in the delivery of urgent care in Central Manchester. The aim of the prealliance is to bring closer contractual alignment between partners to facilitate the delivery of integrated care and achieve the targets to secure the Better Care Fund. In particular, we want to move away from the current situation where providers have individual contracts for their specific services, to one where providers sign up to a single, shared contract covering the whole system. In this way, providers have contractual and financial incentives for working together to deliver shared outcomes This will take time to implement fully and we are proposing a phased approach. Alliance partners have agreed in principle to a pre-alliance contract for urgent care in 14/15 that includes: (i) an agreed set of principles for working together; (ii) a shared performance framework; and (iii) some form of financial incentives to reward the

34 alliance if shared performance targets are met. The aim of this is to provide contractual and financial teeth or skin in the game to encourage integrated working whilst balancing the need for financial stability, not putting any partner at undue financial risk. Increases in risk and reward will then be phased as our understanding (and confidence) of delivering through an alliance contract increases. The prealliance framework is illustrated in Figure 8. Figure 8: The Pre Alliance Contract: Investment and Contractual Framework 10.9 We anticipate developing the model through a shift to a full alliance in 15/16 and beyond if the evidence and learning demonstrate success, moving from separate MCC and CCG contracting arrangements within the alliance to a single contract (Figure 9).

35 Figure 9: Pre Alliance to Alliance Contracting Governance structures are now in place to oversee and manage the delivery of integrated care in the pre-alliance: The Clinical Integrated Care Board (CICB) is made up of Executive level management/clinicians from all parties to the arrangements i.e. commissioners and providers. Whilst the commissioner(s) determine the direction in terms of outcome goals and the overall resource package the CICB is a key engagement mechanism where the system as a whole forms a consensus on the strategic direction and the high level means of getting there. The CICB will also be responsible for ensuring the alliance works to the principles and objectives of the contract. All organisations within the pre-alliance arrangements will be members of the CICB. The Provider Partnership Board is a provider led body which, at a senior level is responsible for delivery of the outcomes of the pre-alliance contract. This will include setting the direction in terms of the detailed service models to be developed and implemented in order to meet goals. Commissioners are members of the Board to ensure a continuous dialogue in between commissioner and provider. The Provider Partnership board will establish any operational governance arrangements required and will identify a Go to manager who is the point of contact for the alliance at an operational level.