Greater Manchester’s Visionary Approach to Integrated Care – Local Care OrganisationsWarren Heppolette - Strategic Director Greater Manchester GMHSC Partnership Andrew Webb - Corporate Director, Services for People. Stockport CouncilKeith Darragh/Bernadette Enright - Divisional Directors-Salford Health & Social Care

GM Devolution – Background•Greater Manchester Devolution Agreement settled with Government in November 2014. Powers over areas such as transport, planning and housing – and a new elected mayor•Ambition for £22 billion to be handed to GM•MOU Health and Social Care devolution signed February 2015: NHS England plus the 10 GM councils, 12 Clinical Commissioning Groups and 15 NHS and Foundation Trusts•From April 1st - Greater Manchester has taken charge and taken responsibility – in a historic first, devolution has handed the power, responsibility and £6billion budget over to the people and the 37 local authorities and NHS organisations, primary care and other partners

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Greater Manchester: a snapshot picture

Aligning reform in GM

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VisionTo deliver the greatest and fastest possible improvement to the health and wellbeing of

the 2.8m people of Greater Manchester

CONTEXT• Systemic challenges; skills, work, health, housing,

inequalities

• Healthy life expectancy considerably lower than GM & England

• Facing unprecedented public sector austerity and questions over future viability

CLEAR AMBITION• GROWTH – post 16 learning, housing, improved transport

connectivity, investment in business, dark fibre.

• Leading INNOVATION – transforming public services / new models of service delivery.

• PLACE focus on improving HLE

• ONE SYSTEM approach to health and social care

• Aim - professional and financial SUSTAINABILITY

CARE TOGETHER• Health and Social Care REFORM, single system leadership

• Single commissioning function

• Risk stratification of population

• Active focus on PREVENTION of illness

• Increased volume and scope of care, treatment and rehabilitation in the HOME & COMMUNITY

• Excellent, responsive acute services when necessary

• Use of FT license to create ICO

ICO PROGRESS• Significant improvement in key metrics• Successful receipt of Community Services • Pilot schemes for transformational schemes commenced• Development of implementation plans to create integrated

neighbourhoods• Future organisational form (including new name) developed• Engagement and organisational development programmes

commenced

COMMISSIONING PROGRESS

• Integrated Commissioning Fund of £442m • Single, clinically led commissioning decision making• Single commissioning management structure in place • Co-location of commissioning teams• Approved 5 year Single Commissioning Strategy • Development of system wide outcome measures

Stockport Together structureJoint

Commissioning

MCP Board

Joint Provision through MCP

Integrated Multi-Disciplinary Neighbourhood Teams

GP clinical leadership

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Social Services

Mental Health Community Services

Pooled budget circa £200m

The business case• Three objectives:

• Create a new provider

form• Create a new contractual

form• Create a new care model

• Four workstreams:• Healthy Communities• Core Neighbourhoods• Borough-wide

Services• Acute Interface

Structure of the MCP

A&E All outpatients

Diagnostics Acute MedicineAll adult social care

All adult community services

All community mental health servicesAll Stockport GP practices

Step 1: Loose Alliance

Step 2: Formal Alliance

Step 3: Integrated Care Organisation (ICO)

Step 4: ICO plus budgets

Commissioning pledge

We pledge to develop an integrated commissioning function for health and care in Stockport that:is designed by the local experts and supports innovation is informed by local needs and views to look after the whole population and address health inequalitiescoproduces a system to improve outcomes for our populationensures that we meet all our statutory duties

…….and delivers our new model of a financially sustainable, democratically accountable, integrated system in Stockport.

The MCP will:• Invest more money in Primary, Community and Mental Health Care• Implement a new fully integrated model of health and social care that will

create the capacity and capability (the community alternatives) to deliver the right care and support in or close to peoples homes rather than in hospital

• Deliver a new model of care that is based on the best available evidence of what works

• Get organisations to work together to deliver this vision in a new type of organisation : a Multi Specialty Community Provider (MCP) and ultimately Accountable Care Organisation (ACO)

• Deliver £38m savings over the next 5 years by providing better care

GP Provider Organisation and

Neighbourhood model

Greater Manchester West• Creating optimistic futures for people• Through specialist services • Focusing on early intervention, prevention, recovery and support

Salford Royal NHS FT• Safe, clean and personal care• End-to-end provision based around patients and users• Better management of transitions• Developing the new workforce and integrating care records

Salford CCG• Improve health and wellbeing• Greater equity of care and outcomes• Citywide standards with neighbourhood provision• Developing model for GP services

Salford City Council• Population access to adult social care• Live at home for longer• Safeguarding with ‘just enough care’• Invest in health and wellbeing

ICO VisionTo deliver significant improvements in experience and outcomes for service users by - promoting prevention and independence- providing person-centred health and care services- delivering more care in our communities- supporting our staff through new models and integrated systems-using pooled resources more efficiently

Salford Integrated Care System – Vision for the ICO

Strategic Context including: Salford Locality Plan, Neighbourhood Focus, Vanguard and GM Devolution

Building on the ICP and from the

best of each partner

ICO Phasing

Maintain Quality and Assure Safety

ICO Implementation

Approvals•Due diligence – quality and sustainability of transferring services•NHS Improvement – authorisation requiredKey plans and agreements•Post Transaction Integration Plan – first 100 days, technical integration•Quality Governance Plan – maintaining quality and safety•System Governance Framework – transformation plan and decision-makingCommissioning and Operating Principles – framework for providers to integrate and transform services•Risk Share Agreement – managing the financial consequences of change at a system levelShadow arrangements - Opportunity to learn and test approach

ICO Quality Governance

• Framework:

• Initial focus on:• Serious Incidents• User experience• Complaints

• Key Issues:• Harmonisation of systems

and processes• Social Care “Voice”• Professional Accountability • Cultural Alignment• Quality and safety in the

supply chain

Local Transformation Approach

1. ICP for Older People 2. ICP for Adults3. Integrated

NeighbourhoodModel

GM Devolution Transformation Workstreams

Salford Together Alignment with GM Local Care Organisation model

Enable conditions to be managed at home and in the community

Provide alternatives to A&E when crises occur

Support effective discharge from hospital

Help people return home and stay well

The End

Any QuestionsEmail - GMHSCcomms@nhs.netWebsite - www.gmhsc.org.ukTwitter - @GM_HSC

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