The Oldham Ambition: Engagement Event 21 st October 2015 Why todays - - PowerPoint PPT Presentation

The Oldham Ambition:

Engagement Event

21st October 2015

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Why today’s event?

• 1. To set out the Greater Manchester ambitions and

the Oldham ambitions within this.

• 2. Have your say on the Greater Manchester agenda

and emerging health and social care devolution in- particular.

• 3. To inform and influence the Locality Plan for health

and social care devolution for Oldham.

• 4. To agree next steps and clarify how we might

engage with residents, staff and stakeholders on devolution over the next two years – the beginning not the end

The Greater Manchester and the Oldham Ambition

Member of GMC Authority

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GM is now “Officially the Most Exciting Place in the UK!” The Guardian – 25th Feb 2015

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From 1986 2008 2009 2010 2011 2012 2013 2014

AGMA, GMITA and Airport Prosperity for All Greater Manchester Strategy Publication

• f the MIER

Metrolink 2002 Business Leadership Council Established Thematic Comissions Established Manchester City Deal Community Budget Pilot Community Budget Pilot Growth Deal Growth and Reform Plan New GM Strategy Transport for GM GMCA and LEP established

GM: a strong history of co-operation

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GM : How has it helped Oldham.

• Extension of superfast fibre broadband which will extend

to 99.6% of all premises in Oldham by the end of 2017.

• Regional Growth Fund – Over £10m secured by

business and 600 jobs created with Council support.

• Metrolink and Transport for Greater Manchester
• £330m Skills and Business support (via ERDF and ESF)

– new programme to support growth for local companies December 2015

• GM support for Invest in Oldham including the Old Town

Hall, Princes Gate scheme and Transport Interchange.

• Increased reputation on the international stage.

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Why devolution?

• Signed up to by all the Leaders of the local authorities in

Greater Manchester including us.

• ‘Northern powerhouse’
• Already strong Greater Manchester – devolution driven from the

bottom up

• Evidence that cities with greater independence from central

government perform better economically.

• Austerity means there is an economic necessity to reform

public services

• Manchester devolution has twin objectives – faster economic

growth with more flexibility to reform public services. The 2 can

• nly be achieved together.
• Opportunity to re-engage residents who are disengaged from

central politics and systems.

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The GM Devolution Agreement

• New powers and functions from central government. The

existing powers of local authorities will be unaffected.

• Mostly in areas of spatial planning, housing, skills, transport,

children’s and health and social care

• Other powers include the potential for other public bodies to

deliver services – service transformation in its widest sense

• Estimated to be over £9 billion (£6 billion being health and

social care)

• Mayoral model will be part of the Agreement but as the Chair of

a Cabinet of the Greater Manchester Combined Authority with the Leaders of each authority forming the Cabinet.

• Cities and Local Devolution Bill: provides the legislative

framework for the devolution of additional powers to the GMCA and the directly elected Mayor

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Oldham Ambition: Co-operative Devolution

The Oldham Triple objectives – Growth and Reform through Co-

• peration.
• Not just ‘trickle’ down.
• The vehicle to do things differently, focus
• n issues that will result in the greatest

change and reduce inequality faster.

• Not new money but ability to shape our
• wn destiny.

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Co-operative devolution – making it happen

Three elements

• New Economy / New Society
• Transforming the relationship

between citizen, state and society

• Co-operative deal
• Everyone doing their bit
• New model of Leadership
• People of place, not of

professions or organisations

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We are already working together to make a difference…

Greater Manchester Health and Social Care Devolution,

Warren Heppolette, Strategic Director, Health and Social Care Reform Greater Manchester

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GVA – Gross Value Added LEP – Local Enterprise Partnership

Greater Manchester: a snapshot picture

• Greater Manchester Devolution Agreement

settled with Government in November 2014, building on GM Strategy development.

• Powers over areas such as transport, planning

and housing – and a new elected mayor.

• Ambition for £22 billion handed to GM.
• MoU Health and Social Care devolution signed

February 2015: NHS England plus the 10 GM councils, 12 Clinical Commissioning Groups and NHS and Foundation Trusts

• MoU covers acute care, primary care, community

services, mental health services, social care and public health.

• To take control of estimated budget of £6 billion

each year from April 2016.

• Commitment in July 2015 budget to align the

Spending Review process for health and social care to our Strategic Sustainability Plan

The background to GM Devolution

• Greater Manchester will remain within the NHS and social care systems

and continue to uphold standards in national guidance and statutory duties in NHS Constitution and Mandate – and for delivery of social care and public health services

• Decisions will continue to be made at the most appropriate level to the

benefit of people in GM – sometimes locally and sometimes at a GM level

• Organisations will work together to take decisions based on prioritising

their people and their place

• From 1 April 2015 ‘all decisions about GM nationally are taken with

GM’

What will – and won’t - this mean for the NHS and social care

• Devolving powers to GM will enable us to have a bigger impact, more

quickly, on the health, wealth and wellbeing of GM people

• It will allow us to respond to the needs of local people by using their

experience to help change the way we spend the money

• It will allow us to better co-ordinate services to tackle some of the major

challenges supporting physical, mental and social wellbeing How will we do this?

• By integrating our governance: being binding on all the partners, decisive

and bold

• By integrating planning: working across CCGs, local authorities and trusts

in our 10 areas to create aligned local plans feeding one GM strategic plan

• By integrating delivery: by doing best practice at pace and scale

Why do devolution?

• Improve the health and wellbeing of all Greater Manchester people – of all ages
• Close the health inequalities gap faster within GM, and between GM and the rest of

the UK

• Integrate physical health, mental health and social care services across GM
• Build on the Healthier Together programme
• Continue to shift the focus of care closer to homes and communities where possible
• Strengthen the focus on wellbeing, including a greater focus on prevention and public

health

• Contribute to growth and connect people to growth, eg helping people get in to and

stay in work

• Forge a partnership between the NHS, social care, universities and science and

knowledge industries for the benefit of the population

• Make significant progress on closing the financial gap

What have we said we’ll do in the MoU?

To ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester

The vision for GM Devolution

The Plan will support integration at all levels across all public services…

With individuals, their families and their communities - All parts

• f the public service, civic

society and business committed to improving the health of the population as part of a New Deal Local integrated care “Health Benefit Trusts” looking after the day to day care and support of a defined

• population. Incentivised &

accountable for keeping people well.

Activated Person

Community & Family School & workplace

Integrated Care Organisation

• Centres of

Excellence

• Hospital Groups/

service chains

• Specialist Treatment

Binding Provider governance that will deliver accelerated improvements in patient

• utcomes and productivity.
• Outcomes Framework
• Technology enabled,

proactive care co-

• rdination
• Capitated Budget &

bundled payments

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Oldham CCG:

Keeping our promises, delivering our plan

Denis Gizzi, Managing Director NHS Oldham Clinical Commissioning Group

What we said we’d do…

• Develop our “Wider Primary Care at Scale’ strategy
• Invest significantly in primary care, geared towards enhancing

capacity and access to GP Practice services in Oldham

• Reduce localised health inequalities through devolved, cluster-

based budgeting

• Develop a GM-aligned Primary Care Market Development

strategy

• Drive the innovation agenda forward, looking for new solutions
• Support the Multi-speciality Community Provider model as part
• f NHS England’s five year plan

Primary Care Investment

• We have invested £8.5m in primary care over the past year, which gives us

a strong platform on which to build our Accountable Care Organisation.

• Oldham CCG places primary care at the centre of patient care, and we are

already transforming our primary care services, so that out-of-hospital health care is seen as the norm, people’s health and social care needs are identified and managed collectively.

• Patient involvement will form the basis of all decision making, putting the

patients voice at the heart of our care.

• Seven day access model will enable patients in Oldham to access Primary

Care during evenings and weekends.

• Practices working together, with Cluster Based Budgeting driving

innovation, reduced health inequalities and better outcomes for patients.

Clinical Programme Successes

Many successes in delivering the best care, for the best value in Oldham…

• Improved outcomes include reductions in early deaths from heart disease,

stroke and cancer.

• Investment made and improvements delivered in mental health (RAID,

Street Triage, CAMHS, Dementia, IAPT and Parity of Esteem).

• Urgent Care model improved and streamlined by working collaboratively

with providers.

• Advice & guidance built into the newly designed Referral Gateway.
• Many more changes introduced through the Clinical Director leadership

model, because the CCG is led by clinicians who live and work in Oldham, understanding the needs of local people.

Quality Improvement

• By working with our GPs, healthcare workers, social care teams and
• ther staff, we’re identifying cohorts of patients who require the most

intensive support.

• Longer term we will work with all our care providers to integrate care

records making the care patients receive more joined up and responsive to their needs.

• We are currently trialing new technology within the borough to support

innovative working. These include video consultations and virtual clinics and waiting rooms, “surgery pods” for diagnostics and fully functional mobile working solutions for clinicians.

• We have also implemented telehealth for a cohort of patients with COPD

with the ethos being no unnecessary waiting, no unnecessary cost and no compromise on quality.

• We pride ourselves on looking for fresh, unique ways of working.
• We use multiple approaches to improving health in Oldham - over and

above enhancing existing healthcare services. Casting our partnership net more widely to embrace voluntary sector, community groups, businesses, traditional partners at local authorities and within healthcare

• Dragons’ Den delivering tangible improvements to health via creativity and

entrepreneurial spirit. Sustainable innovative health solutions to date…

• Outta Skool – BME focused diabetes and obesity programmes
• Duru Practice – Life Counselling service
• British Red Cross – Transfer to home service from Royal Oldham

Hospital

• Tameside & Glossop Mind – Mindfulness stress reduction course

Innovation: achievements

Innovation: Medtech launched

Dragons’ Den for Innovative Healthcare Technologies launched in March Enlisted the help of the NHS innovation experts, TRUSTECH, to design, develop and deliver the programmes’ call and assessment process, receiving more than 80 applications Six technologies selected to be evaluated in a clinical setting after they were deemed to potentially offer the most significant impact and align most closely with patient need:

• d-Nav Insulin Guidance Service – Hygieia Medical Ltd.
• Fall-Safe Assist – Hip Impact Protection Ltd.
• Patient Monitor – Message Dynamics Ltd.
• Noctura 400 Sleep Mask – PolyPhotonix Medical
• Proteus Discover – Proteus Digital Health UK Ltd
• Personal Care Record – Personal Care Record Company

Patients & Voluntary Sector

• Involving patients in procuring new contracts with providers, devising service

specifications and scoring different bids.

• We welcome patient stories at public meetings, inviting patients to speak

about their experience of health and healthcare in Oldham.

• We have regular contact with our members’ Patient Participation Groups

and welcome their perspectives on local health and healthcare.

• We’re recruiting a cohort of service users and carers, reflecting the make up
• f the local population. This will form a key resource, who we can work

collaboratively with and who may wish to lead their own engagement work supported by the CCG.

• We’ve formed a Voluntary Sector Health Network with Voluntary Action

Oldham and Oldham Healthwatch and facilitate an Equalities Group to help us understand the experience of Oldham’s diverse communities.

Moving to an ‘AHMO’ model

• The basic concept of an Accountable Healthcare Management

Organisation, is a single managed entity with a single, outcome driven contractual framework.

• This isn’t a new concept, and builds on what we’ve already begun to

deliver (see CCG in Oldham: A Strategy for an Accountable Care Organisation, 2011).

• This ambition is based on the premise, that all members share risk and

assume accountability for the resources spent caring for the population and the quality of that care.

• Recently, the CCG has engaged with partners in OMBC, and the Health and

Wellbeing Board to extend the scope of this ambition across the Borough, to include the Social Care and the prevention agenda.

The Big Idea: What do we mean by a AHMO? Accountable Health Management Organisation

A transformational organisational form to match the ambition

Patient / Consumer Engagement

Component 2: Multispecialty Community Provider (MCP)

Planning Programmes Creating Networks Engineering Contracts Planning Incentives Regulating Supply Managing System Resilience & Performance Economic Stability

Patient Centered Medical Home Direct Access Diagnostic Village

Pre & Post Acute Care

Integrated Healthcare Insight & Analytics System

The Emerging Oldham AHMO Model

Component 1: Managed Care Organiser (MCO)

Connecting Planning, Regulation and Delivery Together as a Integrated Accountable Health Management Organisation, with a single leadership infrastructure

MCO (Plan) MCP (deliver)

Care Delivery Ecosystem

The AHMO will have two arms:

Managed Care Organiser

• Planning Programmes of care
• Creating Networks
• Engineering Contracts
• Planning Incentives
• Regulating Supply
• Managing System Resilience & Performance
• Patient and consumer engagement
• Integrated Healthcare Insight & Analytics System

Multispecialty Community Provider

• Infrastructure and services wrapped Patient Centered Medical Home
• Pre and post acute care
• Home care
• The prevention agenda - soft (citizen behaviour) and hard (technical diagnostic)

What will it look like?

The MCP delivery model

What difference will AHMO make?

AHMO will make a difference to the health of our population by:

• Improving clinical outcomes, performance, and patients’ experiences of

care

• Setting quality as our business strategy, and enabling professionals to do

the right thing

• Being patient and public centred, with effective engagement process
• Enabling patients to make informed choices
• Being needs led and with solutions developed in conjunction with

providers

• Reducing unwarranted interventions (including hospital admissions)
• Reducing the rate at which costs are rising

Care Management Needs to Feel More Like this

Person In Need

Easily Accessible Self Care Primary Health & Social Care Home Planned Care Urgent Care

• Discuss
• Diagnose
• Explain
• Agree Plan
• Decide Together
• Independence
• Respond Quickly
• Diagnose
• Explain Actions
• Directed Care
• Organise Care
• Independence

Managed & Integrated Services More Specialised Service Required

Hospital Care

• Direct to Service
• Structured Care
• Integrated Records
• Organised Discharge
• Independence

All Arranged and Organised as part of a Single Organisation

Key Features

• A single organising body to plan and structure services across health & social care
• The same organisation has direct operational control over all out of hospital services
• A single population budget to replace multiple contracts
• A single pathway of care, managed & coordinated by a single organisation
• A model based around the evolution of Oldham Primary, Community and Social Care
• It is the Oldham CCG Response to NHS Five Year Forward View

A change to the way we deliver care

• A minimum standard of access and long term condition management being

delivered in primary care

• Reduction in the numbers of people admitted to hospital
• Greater Consultant input into the primary care based clinics supporting admission

avoidance, particularly for those with specific conditions and the older population, where hospital admission may not be the best place for them to receive care.

• GPs will also be given increased access to diagnostic facilities, helping them to

diagnose health issues in the community

Priorities for working with OMBC

• Transitions from children to adult services
• Continuing care (including continuing health care) and complex care
• Reablement and intermediate care
• Out of borough placements
• Children’s commissioning (including disability and mental health)
• Substance misuse (drug and alcohol services)
• Community Equipment
• Supported housing

• Part of the overall budget will be jointly managed between the CCG and OMBC.

Managing our contracts together will offer opportunities for a more joined up approach to care and potential efficiency savings.

• Establishing a network of providers with the same collective ambition and

incentives will help us to manage care more effectively, on behalf of our population.

• We will also work with other parts of the public sector to encourage and enable

people to stay mentally and physically healthy, tackle the physical, social and economic barriers to good health and empower people to take more control over their lives.

Working in partnership

Thank you

Greater Manchester Devolution & Oldham Locality Plan

Alan Higgins Director of Public Health & Oldham SRO

Where we’re up to…..

• Oldham Locality Plan – the remit and the response
• Transformational programmes

Oldham Locality Plan – The Remit

• Place based plan to improve health
• Secure clinical and financial sustainability
• Improve overall health of the Oldham population -

looking beyond the NHS and social care services.

Oldham Locality Plan – The Response

• Brought forward our plans for integration
• Brought forward our plans to reduce demand, to

change the publics relationship with public service providers

• Challenged our ideas on whole system working in

Oldham and Oldham as part of the GM system

• Challenged stakeholders to understand Oldham’s

financial position

Oldham Locality Plan – 2nd Draft

• Emphasis on linking the system elements together
• Four transformational programmes
• Financial planning started
• Engagement on the way to the final version

Oldham Locality Plan – Elevator Pitch

Purpose

• Transform the health & wellbeing of the population

and relationship between the public and the health & social care system and achieve service sustainability How

• Foster community resilience, best start in life and

mental wellbeing

• Services promoting independence and self care
• Transformation of the health and social care system

based on primary care led and community based care

• New, affordable business models

Transformation Programmes

• 1. Transforming primary, community and social care
• Setting up of an Accountable Health Management Organisation

(AHMO)

• Led by primary healthcare services and will seek to maximise the
• pportunities to pool budgets, if appropriate, and integrate

commissioning across the NHS and the Council.

• See the development of new and integrated models of care provided

at home or in the community.

• Transform how our workforce works with people, recognising their
• wn strengths and promoting independence,
• Recognise and mobilise a wider associated workforce, including

carers, social housing and voluntary and community organisations.

Transformation Programmes

• 2. Action to build resilient communities and early help
• Create a more empowered and independent population, thereby

reducing demand on expensive and institutionalised health and social care services.

• Up the capacity of the council, NHS, housing and voluntary sectors to

engage with communities to achieve social cohesion and empowerment.

• Foster a new relationship between the population and public services

and, linked with direct activity to change health behaviours, improve health outcomes and reduce dependency.

• Link this approach to increasing educational attainment and people’s

readiness for work by promoting self-efficacy and aspiration.

Transformation Programmes

• 3. Early Years
• Transform the way we support parents and families

to give our children the best start in life.

Transformation Programmes

• 4. Mental health is central to good health
• This programme recognises the centrality of good

mental health to overall health and wellbeing and to functioning within a community and relates closely to

• ur work on resilience.
• The transformation will be in how we discuss and

deal with mental illness and in how we ensure effective services are available for the detection, treatment and care of people with mental illness, ensuring as swift a recovery as possible is made.

Structure of the Plan

• Section 1: Strategic Direction

1.1 Our vision 1.2 The challenges we face in Oldham 1.3 Interface with GM programmes and how devolution can support us 1.4 Principles underpinning the Plan 1.5 Ways of working 1.6 Recognising the contribution of other sectors

• Section 2: Transformational Programmes

2.1 Transforming primary, community and social care 2.2 Action to build resilient communities and early help 2.3 Early years 2.4 Mental health is central to good health 2.5 System leadership and governance

Structure of the Plan (cont.)

• Section 3: Enablers

3.1 Workforce 3.2 Data and IM&T 3.3 Estates Appendix 1: Indicators of Success Appendix 2: The financial challenge

Oldham Timeline

• Engagement event at the Q.E.Hall 21st Oct
• Health & Wellbeing Board - 24th November
• Final plan submission to GM mid-December
• Implementation from April 2016

Key themes in the Oldham Locality Plan: Group discussions (1 hour)

• Over the next hour you will get the opportunity to

discuss the four transformational programmes highlighted in the plan

• A facilitator will come to your table and discuss the

theme for 15 minutes when the bell sounds you will move onto the next theme

• The main themes coming out the discussion will be

summarized at the end.

Summary of the discussions

• Main themes emerging from the discussion session
• How we plan to keep you informed and engaged in

the discussion as the plan takes shape

• Thank you for participating!