Commissioning Operational Plan 2017-18 Mission, Vision and Values; - - PowerPoint PPT Presentation

Manchester Health and Care Commissioning Operational Plan 2017-18

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Mission, Vision and Values; Working for a Healthier Manchester

• We are determined to make Manchester a City where everyone can live a healthier life.
• We will support you, and your loved ones, investing in what you tell us is important to you
• We will make sure you receive the right care in the right place and at the right time,

delivered by kind, caring people that you can trust.

• We will make the most of our money by reducing waste, testing new ways of working that

improve outcomes and funding the things we know will work.

• We will forge strong partnerships with people and organisations, in the City and across

the region, and put health and wellbeing at the heart of the plans for developing Manchester’s future as a thriving city. The values that will drive our behaviours, leading and influencing the transformation of health and care are:

Strategic Aims

To deliver the mission and vision for Manchester, our strategic aims are:

• To improve the health and wellbeing of people in Manchester
• To strengthen the social determinants of health and promote healthy lifestyles
• To ensure services are safe, equitable and of a high standard with less

variation

• To enable people and communities to be active partners in their health and

wellbeing

• To achieve a sustainable system

This Operational Plan describes the work we will be undertaking during 2017 – 2018 to ensure the delivery of our strategic aims.

Context

The Operational Plan has been developed in the context of a number of national, regional and local

• drivers. These include:

5 Year Forward View - sets out the strategic vision for the NHS by 2020/21. It details a shared view

• n how services need to change and the models of care that will be required in the future.

GM Strategic Plan - sets out the collective ambition for the region. It describes how aligning health and social care reform is a fundamental change in the way people and communities take charge of and responsibility for managing their own health and wellbeing. Our Manchester – Launched by the City Council, it describes the vision for the city up to 2025 and was based on consultation with residents, businesses, staff and partners. Manchester Locality Plan – A commissioning plan for Health and Social Care integration which sets

• ur plans for system transformation as well as service transformation over the next 5 years.

GM Devolution – It allows Greater Manchester to be innovative in using public sector finances to best effect. The Operational Plan 2017-18 has been developed taking into account all of the above.

Areas of Opportunity

The Operational Plan has also been informed by analysis of key benchmarking data, which indicate

• pportunities for savings and improving outcomes. For example Right-care uses benchmarking

information to compare CCGs to their 10 most similar peers to identify areas where:

• The CCG spends more than its comparators
• The CCG has worse outcomes than its comparators

The areas for improvement across Manchester based on right-care data are highlighted in the table

• below. Improvements against these areas have been used to inform the development of the

Operational Plan.

Spend and Outcomes Outcomes Spend Respiratory Trauma and Injuries Respiratory Neurological Neurological Gastro-intestinal Gastro-intestinal Respiratory Neurological Trauma and Injuries Gastro-intestinal Circulation Mental Health Mental Health Endocrine Circulation Circulation Cancer Endocrine Maternity Musculoskeletal Cancer Endocrine

Delivering the plan

The priority areas of work MHCC will deliver in 17/18 is focussed on ensuring:

• We deliver against all national requirements, which include the Must Dos, the national clinical

priorities and the constitutional standards.

• We deliver the required system change across the health and social care system and implement

the new models of integrated out of hospital care.

• We maximise opportunities where efficiencies can be made across the health and social care

system, whilst maintaining high quality services.

• We deliver the key enablers to allow for the transformational change to happen.
• We improve outcomes and achieve value for money through the allocated investment

programmes. All of the above form the basis of the MHCC Operational Plan.

National Requirements

The Operational Plan includes programmes of work which are focussed

• n delivering a number of national
• requirements. This includes delivery of

the NHS constitutional standards, a set of Must Do’s and achieving improvements across four domains detailed in the Improvement and Assessment Framework (see diagram opposite). Within this framework there is also a particular focus on achievement against six clinical priorities. These are detailed in the next slide. The work programmes in the Operational Plan are focused on ensuring we deliver against the Constitutional Standards, the IAF framework, including the clinical priorities and the Must Do requirements

PLACEMENT FOR IMAGE OR GRAPH

Clinical Priorities

Current performance (December 2016) against these are detailed below, as well as a summary

• f the 17/18 improvement plans.

Clinical Priority NMCCG Rating CMCCG Rating SMCCG Rating Work Programmes for 2017/18 Cancer Needs Improvement Needs Improvement Performing Well • Primary Care Standard for Cancer

• Improve planned cancer pathways
• Rollout of phase 2 Lung early diagnosis pilot
• Implement the Recovery package

Dementia Performing Well Top Performing Performing Well • Development of integrated care pathway for people with dementia

• Dementia awareness campaign
• Pilot post diagnostic support for people with

dementia from 3 GP practices Diabetes Needs Improvement Greatest Need for Improvement Needs Improvement

• Development of a Central Manchester

Community Service

• Review of community support and triage in

North Manchester Maternity Needs Improvement Needs Improvement Needs Improvement

• Implementation of findings from the national

maternity review across the acute providers

• Development of personal health budgets for

maternity services Mental Health Needs Improvement Needs Improvement Performing Well • Mental Health Improvement Programme

• Oversee implementation of services provided

by GMW

• Joint commissioning for mental health services

Learning Disabilities Needs Improvement Needs Improvement Needs Improvement

• LD Transformation programme
• Review of pathways and development of an
• utcome framework

National Must Dos

The table below summarises the national Must Do requirements. Further information on how we are meeting each of the ‘Must Dos’ is available on request from the Strategy and Planning Team.

Must Do Summary of Requirements Stocktake Reference

STPs Implementation of STP milestones and achievement of trajectories against the STP core metrics.

Page 1

Finance Deliver organisational and overall system control totals, implement local STP plans to moderate demand growth, demand reduction measures and provider efficiency measures

Page 1

Primary Care Ensure the sustainability of general practice by implementing General Practice Forward View, tackle workforce and workload issues, improve weekend and evening access and support general practice at scale and the expansion of new models of care.

Page 26

Urgent and Emergency Care Implementation of the Urgent and Emergency Care Review, deliver four-hour A&E Standard and response times for ambulance and by November 2017 meet the four priority standards for seven-day hospital services.

Page 4 and page 47

RTT and Elective Care Deliver the 92% standard in the NHS Constitution on RTT. Deliver patient choice on first outpatient appointment and achieve 100% of use of E-referrals by April 2018. Implement the national maternity services review.

Page 7

Cancer Implementation of the Cancer Taskforce, deliver the 62-day cancer standard and other constitutional standards, improving one-year survival rates. Ensuring that the Recovery Package is commissioned. Ensuring stratified follow up pathways for breast cancer patients are rolled out

Page 14

Mental Health Deliver the implementation plan for the Mental Health Five Year Forward View, ensuring delivery of access and quality standards, increase in baseline spend and maintaining dementia diagnosis rate of at least 2/3rds with due regard to forthcoming guidance.

Page 18

People with Learning Disabilities Deliver transforming care partnership plans, enhancing community provision, reduce premature mortality through improved access to healthcare and education.

Page 9

Improving Quality in Organisations Implement plans to improve quality of care particularly for organisations in special measures.

Page 12 and page 50

Efficiencies – 17/18 QIPP

For 17/18 MHCC faces a significant financial

• challenge. The combined QIPP savings required is

£23m across health and social care. Right Care analysis has been considered in the identification of QIPP schemes to help deliver the savings. All QIPP schemes have been categorised into five key areas as detailed in the table opposite. Schemes are in place to deliver the full requirement for the CCG, whilst there remains a pressure relating to

• MCC. The QIPP targets for the CCGs are £13.3m

and MCC £9.7m. Further work is ongoing to develop schemes to reduce the QIPP gap. See Efficiency Work Programmes for further detail.

Scheme Area Anticipated Savings Service Reviews/ Improvement £2.5m Referral Management £2.2m New models of care £3.7m Corporate/ Business as Usual £6m Contract/Tariff Management £2.8m Opportunities being scoped £5.8m Total: £23m Target Manchester CCGs £13.3m Manchester City Council £9.7m Total £23m

Operational Plan Priority Themes

A large number of work programmes within each priority theme contribute towards the delivery of the Must Dos including the national transformational requirements for cancer, mental health and GP Forward View. Further detail is provided in Appendix 1. A full list of work programmes and how they map against the Must Do, Clinical priorities, QIPP, Right-Care are detailed in Appendix 1. The Operational Plan consists of 5 priority themes. Under each priority theme sits a number of key work programmes to be delivered in 17/18. The next set of slides summarises the key programmes of work within each priority theme.

Transformation Delivery Efficiency

• System Change
• New Care Models
• Adult Social Care Priorities
• Urgent Care
• Primary Care
• Mental Health
• Learning Disabilities
• Constitutional Standards
• Quality Improvement
• System Resilience
• NHSE Clinical Priorities
• Social Care Procurement
• Care Act 2014
• Service

Review/Improvement

• Referral Management
• New Care Models
• Corporate/Business as

Usual

• Contract/Tariff Management

Organisational Development, Equality, Diversity & Human Rights, Estates, Primary Care Workforce, IM&T

Enablers Investment and Resourcing

North Manchester, Primary Care, GM Transformation Fund, Mental Health, Adult Social Care

Transformation

System Change

Single Hospital Service Single Commissioning Function Local Care Organisation (LCO)

Work with providers to create a Single Hospital Service, with the first stage involving the merger of Central Manchester Foundation Trust (CMFT) and University Hospital South Manchester (UHSM) and the second stage to include North Manchester General Hospital (NMGH). Establishment of Manchester Health and Care Commissioning (MHCC) through CCG merger and partnership agreement with Manchester City Council. This will bring together health, social care and public health commissioning together. The work plan for full financial integration across health and social care agreed, as well as the agreed timing for children’s integration. The provider selection process for identifying an LCO will be complete, with a full contract in place, subject to conclusion of procurement and assurance processes, for April 2018 start. The LCO will be responsible for delivering integrated Out of Hospital Care across Manchester.

Transformation

New Models of Care

New Models of Care Urgent Care First Response Strengthening Primary Care

GM transformation funding to deliver new models of care. These include High Impact Primary Care Model, Enhanced reablement services and intermediate care, Prevention Programmer and Frailty Service. Phased implementation an integrated primary care gateway in front of the City’s A&E. Implementation of the Short Term Support for Admission Avoidance Service in South and Central, similar to the existing North Manchester Crisis Response and initial phased implementation of a city-wide specification for Ambulatory Care Adult Medicine. Development of a partially integrated Multispecialty Community Provider (MCP) Contract with the LCO. Through the MCP contract deliver enhanced primary medical services and improved evening and weekend access to general practice. Implement the primary care based prevention programme.

Mental Health Improvement Programme

Work with providers to deliver improvements to integrate care for the three priority Mental Health Improvement Programme Pathways. Deliver the national Must Do's, including the increased access and treatment targets. Integrate appropriate mental health services through the LCO new care models. Development of an integrated care pathway for people with dementia. Implement all CAMHS project that sit under the CAMHS Transformation Programme

Transformation

Adult Social Care Priorities

Stabilise home care and care home markets. Develop and test new models of home

• care. Implement care home quality initiative to improve quality, outcomes and

experience, securing future supply. Extra care programme – enabling people to safely live independently for longer. Redesign MH housing related support – supporting reduced inpatient and out of area placements. Actively contribute to GM adult social care transformational priorities of: care at home, residential and nursing homes, carers and learning disability.

Transforming Care Learning Disabilities

Implement an integrated health and social care community learning disability service specification as well as development of a Quality and Outcomes Framework included into contracts with all providers of learning disability services. Commission a Crisis Prevention and Response Service.

Delivery

Delivery of Constitutional Standards

We will continue to work closely with providers to manage instances where constitutional standards are not being met through support and monitoring of actions plans where remedial action is needed.

Improving Quality

Development of new quality and performance assurance framework for health and social care; Work with CQC to improve the quality of in-house social care provision; Work with PAHT to ensure their plans to improve safety are delivered; Work with GMMH to ensure smooth transition of services and improvements in quality ; Support providers with poor CQC rating.

System Resilience

Deliver 4hr A&E standard and implement the five mandated initiatives to improve A&E

• performance. Maximise alternatives to hospital, deliver deflection schemes and

alternatives to conveyance and reduce inappropriate ambulance conveyances. Develop resilience schemes to help sustain A&E performance during winter pressures and implement system wide plans to reduce delayed transfers of care. Further embed Care Act requirements, in particular to identify and meet the needs of carers, further develop the process of transition from children’s to adults services, improve personalisation and provision of information and advice.

Care Act 2014 Social Care Procurement

The development and implementation of the social care procurement strategy.

NHSE Clinical Priorities

Continued improvements in Cancer, Dementia, Diabetes, Learning Disabilities, Maternity, Mental Health.

Efficiency – QIPP Plans

All 1718 QIPP schemes have been categorised into 5 programme areas.

Service Review/ Improvement

Right-Care methodology has been used to inform review and redesign of services. Schemes include respiratory, diabetes, urology and urgent care pathways. Saving: £2.5m

Referral Management

Schemes to improve patient referral processes and manage demand in elective care. These include reducing unwarranted variation in elective activity across primary care and effective triage through Manchester Integrated Care Gateway. Saving: £2.2m

Corporate/ Business as Usual

Savings from medicine management, high costs out of area placements, public health. Saving: £6m

Contract/Tariff Management

Review of tariffs or contractual arrangements of existing or redesigned commissioned services. These include the redesigned MSK pathway, laser eye treatment and Wet AMD Community service. Saving: £2.8m

New Models of Care

Schemes to support implementation of new care models. Saving: £3.7m

Efficiency (QIPP)

Primary Care Variation

Reduce variation in unwarranted elective activity across primary care through a neighbourhood based approach.

Priority QIPP Schemes Commissioning Review

Safely reduce placement/contract costs, determine and secure value for money, better matching of provision to needs to deliver improved outcomes and develop a combined approach to remodelling of future care provision.

Medicine Management

Ensuring the cost effective use of the CCG primary care prescribing budget, whilst improving patient care.

New Care Models

Schemes to support implementation of new care models.

Respiratory

A package of actions relating to increasing prevalence, improving uptake of vaccinations, reviewing of existing community services including Pulmonary Rehabilitation and Smoking Cessation across the city.

Children’s Improvement Programme

Review of children’s services across the city to inform development of integrated pathways for service delivery for 17/18 and ensure best value is achieved.

Enablers

Organisational Development

Embed values and behaviours across the Single Commissioning Function with an Organisational Development strategy aligned to the Manchester Workforce and an effective learning and development plan.

Estates

Continue to implement the Locality Estates Plans including developing business cases for integrated primary care hubs in North, Central and South Manchester, with the aim to begin construction of the Central (Gorton) hub in 17/18.

Primary Care Workforce

Develop a workforce strategy and plan for primary care which will include effective workforce modelling and a baseline audit of workforce equality groups. We will provide a Primary Care education programme which includes clinical and non-clinical disciplines.

IMT

Roll out the next phase of the Manchester Care Record to enable data sharing across health and social care. Develop Patient access to their GP Record and clinical

• information. Increase the use of electronic repeat prescriptions within GP Practices.

Equality, Diversity & Human Rights

Ensure EDHR assurance and governance processes are embedded into the Single Commissioning Function with all statutory and mandatory reporting requirements met. Employee competence and expertise will be increased via training provision.

There are number of important enablers that underpin the delivery of our priorities

Investment and Resourcing

Primary Care

Investment in 7 day access and primary care standards, funded through CCG allocations Investment: £7m

Transformation Fund

Commissioner contribution to Mental Health transaction, priority investments for community based health and social care interventions and contributions to LCO operational costs. Investment: £12m

Mental Health

There is a commitment to invest in the mental health investment standard in line with allocation growth, national guidance and 5YFV. Investment: Under Review

North Manchester Investments

Investment in a number of schemes aimed at reducing inequalities and improving health outcomes of people in North Manchester Investment: £9.35m

I7/18 investments are mainly focused on delivering out of hospital services. These investments are from both CCG allocations and Transformational funding.

Adult Social Care

Year 1 of a two year non-recurrent investments to support transformation in Adult Social Care (£2bn made available nationally). To be confirmed

Financial Plan

CCG allocations, including those allocations to support primary care delegated functions, were agreed by NHS England in December 2015. The newly formed CCG will inherit the allocations from the three legacy

• rganisations. These are shown in the table below:

NMCCG SMCCG CMCCG Total NMCCG SMCCG CMCCG Total £m £m £m £m £m £m £m £m

CCG core

288 239 260 787 294 244 266 804

Primary care

32.3 23.8 31.3 87.5 33.7 24.8 32.5 91

Running costs

4.12 3.65 4.47 12.2 4.12 3.66 4.46 12.2

Total

324 267 296 887 332 272 303 907 Draw down 3.04 3.04 HRG4+ 1.01 0.09 0.59 1.7 1.03 0.6 1.72 IR 1.26 -0.1 0.82 2.02 1.28 0.83 2.05 Total 5.32 0.03 1.41 6.76 2.32 0.03 1.43 3.77 Surplus cfwd 3.03 2.41 2.63 8.06 3.03 2.43 2.66 8.12 TOTAL 332 269 300 902 337 275 307 919 2017/18 Recurrent Non Recurrent 2018/19

NHS Manchester CCG will have a total allocation of £902 million in 2017/18 and £919m in 2018/19

Integrated Health and Social Care Budget

Work will continue in 2017/18 to fully integrate health and social care financial systems and staff. In the meantime MHCC will have oversight of all health, social care and public health commissioning budgets in scope. The detail of the MCC budgets in scope is included in the tables below.

2017/18 2018/19 £m £m Base Budget 157.69 156.63 Apportionment of pay and non-pay inflation 2.52 4.50 National Living Wage costs for commissioned services 4.26 8.52 Demographic pressures 10.26 12.91 Sub Total Additional Funding 17.04 25.93 Sub Total Contribution 174.73 182.56 Savings Target met from Local

• 5.00
• 8.00

Add Additional Social Care Pressures

• 4.68
• 4.75

Total Savings Requirement

• 9.68
• 12.75

Total Pooled Budget Contribution 165.05 169.81 MCC base budgets £m Care 32 Assessment care and Support 6 Learning disability services 36 mental health services 18 Business units 14 Homelessness 4 Commissioning 14 Public health 28 Safeguarding 2 Back Office 4 Total 158

Above table does not include Children’s Above represents 16/17 baseline

2017/18 Activity Plans - Methodology

The table below sets out the planned activity figures for 17/18. The annual growth figures shown are a result of the proposed impact of the transformational work identified through the cost benefit analysis undertaken (September 2016). The planned activity is also based on NHSE forecast outturn activity for 16/17, and demographic changes Baseline - CCG baseline (16/17 FOT) produced by NHSE from national SUS data Growth - % growth figures from the contract negotiations applied to NHSE SUS baselines to generate activity growth numbers Transformation - Activity numbers as per the contract CBA work, applied to the NHE SUS baselines 2017/18 Annual Plan - Baseline + growth - transformation

Appendix 1 – Full List of Work Programmes

The document below includes the full list of work programmes for 2017/18. These are divided into the categories of:

• Transformation
• Delivery
• Efficiency
• Enablers
• Investments
• Wider Work Programmes