Embed Size (px)
Citation preview
SALFORD HEALTH AND WELLBEING BOARD
DATE: Tuesday 19th January 2016 TIME: 3.15 – 5.00pm VENUE: The Salford Suite at Salford Civic Centre, Chorley Road, Swinton
AGENDA
Item Presented by Time
1. QUESTIONS – from members of the public Chair For action 5 minutes 2. Introduction and Apologies for absence. All
3. Declarations of Interest Chair 4. Minutes of the meeting held on 17 November
2015. Chair For
approval 5. Matters arising – review of Action Log Chair For noting 6. Salford’s Locality Plan -
Financial Planning overview
Steve Dixon For discussion
15 minutes
7. Salford’s Locality Plan - Transformation narrative and implementation planning
David Herne, Anthony Hassall
For discussion
15 minutes
8. Salford’s Locality Plan - Digital offer – preview of The Landing Community Portal
Debbie Brown, Jon Corner
For discussion
40 minutes
9. Salford’s Locality Plan - Outcome measures
David Herne, Siobhan Farmer
For discussion
10 minutes
10. Salford’s Locality Plan Engagement planning
Cllr Walsh, Lindsay Kirby
For discussion
10 minutes
11. Forward Look 2015/16 – verbal update David Herne For information
5 minutes
12. Any other business
Chair 5 minutes
13. Date and time of next meeting –
16th February 2016 – Strategy meeting
15th March 2016 – Business meeting
14. Update papers provided for information:
(a) Children and Young People’s Trust Update (b) Children and Families Act update - Implementation of SEND Reforms (c) Progress update – Health Watch Salford (d) Integrated Care Programme Annual Report (e) GM Strategic Plan (f) GM Strategic Plan - implementation
1 | P a g e
SALFORD HEALTH AND WELLBEING BOARD 17 November 2015 Meeting commenced: 2.30 p.m. “ ended: 4.25 p.m. PRESENT: Ian Stewart, City Mayor – in the Chair Members: David Herne Director of Public Health Clare Mayo Health Watch Chief Officer Alison Page Salford CVS Councillor David Lancaster Deputy City Mayor Councillor Paula Boshell Strategic Assistant Mayor, Executive Lead Member for Adults & Older People Councillor John Merry Executive Lead Member for Children’s Services Learning Skills Councillor Lisa Stone Executive Lead Member for Health & Wellbeing Sir David Dalton Salford Royal NHS Foundation Trust Chris Walker Greater Manchester Police Charlotte Ramsden Strategic Director for Children and Adult Services Dave Cummins City West Housing Trust Jill Green Greater Manchester West Mental Health NHS Foundation Trust Jack Sharp Salford Royal NHS Foundation Trust Paul Bishop Salford CCG Invitees: Councillor Gina Merrett Executive Lead Member for Housing & Environment Officers: Anne Lythgoe Health and Wellbeing Board & Strategy Manager Claire Edwards Senior Democratic Services Advisor Others in attendance: 3 observers (names to be inserted) CQC Two members of the public were in attendance (names to be inserted)
ITEM ACTION BY 1. PARIS TERRORIST ATTACKS
Members fell silent for a moment in tribute to the victims of the recent terrorist attacks in Paris.
Salford Health and Wellbeing Board
17 November 2015
2 | P a g e
ITEM ACTION BY 2. INTRODUCTIONS AND APOLOGIES FOR ABSENCE
The City Mayor welcomed Councillor Paula Boshell to her first meeting following her appointment as Executive Lead Member for Adults and Older People. He invited those present to introduce themselves. Apologies for absence were submitted on behalf of Councillors Collinson and Ferguson, and on behalf of Chris Dabbs, Anthony Hassall, Tony Holt and Hamish Stedman.
-
2. QUESTIONS FROM MEMBERS OF THE PUBLIC There were no questions from members of the public.
-
3. DECLARATIONS OF INTEREST There were no declarations of interest.
-
4. MINUTES OF PROCEEDINGS The minutes of the meeting held on 15 September 2015 were approved as a correct record.
-
5. (a)
MATTERS ARISING – REVIEW OF ACTION LOG Minute 7 – CAMHS Local Transformation Plan & Eating Disorder Guidance Charlotte Ramsden provided an update regarding funding that had been received following a successful bid, which she indicated was subject to amendment and was to be resubmitted in December 2015.
6. HOUSING Dave Cummings gave a presentation regarding the impacts of housing on wellbeing and health, which included particular reference to the following – • The Partnership • What we do • Establishing a link • Challenges • LIHC Fuel Poverty in Salford • Cumulative rise in UK housing stock since 2000 by tenure • Opportunities • Step Up / Down and Extra Care • Support to GPs and Hospitals
Salford Health and Wellbeing Board
17 November 2015
3 | P a g e
ITEM ACTION BY • Where do we go from here? Discussion took place which included reference to the following:- • Progress that had been made with regard to improving
communication between partners and more work that was required in relation to aligning systems and further developing information sharing.
• The impacts of – o Antisocial behaviour on wellbeing and health and ways in
which antisocial behaviour was tackled. o Government Housing Policy changes announced during the
summer of 2015, in particular, a change of definition of affordable housing to include starter homes as well as properties for rent.
o Reductions that had been made to the Homelessness Service.
o The loss of the Mortgage Rescue Fund. • People living in private landlord accommodation with long term
health conditions and them being less likely to receive a multidisciplinary approach to their situation.
• Support that was available to owner occupiers, enabling them to repair or make adaptations to their home, which involved a charge being taken against the property.
• The availability of a handyperson service for vulnerable people. • Responsibilities in terms of complaints against private landlords. • A programme relating to thermal efficiency and behavioural change
that had been undertaken on a number of high rise developments in Eccles. The programme had mainly been funded by energy companies and had had a significant impact on heating costs.
RESOLVED: (1) THAT the content of the presentation be noted and consideration be given to how the issues that it raises should be part of the Board’s work going forward.
(2) THAT a report be provided to the JSNA Executive on health and wellbeing issues mapped by housing tenure in Salford.
Board Members David Herne
7. DRAFT LOCAL SUSTAINABILITY PLAN David Herne reported on work towards the development of the Greater Manchester Health and Social Care Strategic Plan and the Salford Locality Plan. Discussion took place regarding the draft executive summary and the selection of priorities. David Herne gave a presentation which included reference to the following:-
Salford Health and Wellbeing Board
17 November 2015
4 | P a g e
ITEM ACTION BY � Greater Manchester Health & Social Care Devolution – locality
planning in Salford. � Greater Manchester – following Salford’s lead towards integration. � The Greater Manchester Strategic Plan Review Cycle – where are
we? � Current financial analysis original CSR bridge. � Progress on Locality Plans: first cut locality plan bridge. � Current financial analysis first cut locality plan bridge – achievement
of savings. � Key messages. � Salford’s locality plan. � Starting Well. � Living Well. � Aging Well. � Measuring outcomes. � Outcome measures – following the Integrated Care Programme
methodology. � Survey monkey. � Outcome measures – completing the survey. � Reminder – HWB Peer Challenge recommendations. � Next steps. � Outcome measures – methodology used by Integrated Care
Programme. Discussion took place regarding the process that was to be undertaken with regard to the selection of outcome measures and Members considered an outline timeline to Christmas 2015 for activities around the plan.
(1) THAT the progress to date be noted.
(2) THAT the proposed approach to developing
outcome priorities be noted. A link to the survey monkey questionnaire be circulated to Board Members for completion. Board Members are requested to complete the survey by 10.00 a.m. on Monday 23rd November 2015.
(3) THAT a ‘plan on a page’ be provided in respect of the Aging Well section of the Locality Plan for consideration at a December Health and Wellbeing Board Strategy Meeting.
(4) THAT the approximate timescales for producing the
final Locality Plan be noted.
Anne Lythgoe David Herne/ Anne Lythgoe
Salford Health and Wellbeing Board
17 November 2015
5 | P a g e
ITEM ACTION BY 8. HEALTH AND WELLBEING BOARD ENGAGEMENT POLICY AND
PLAN Clare Mayo submitted a report which had been developed in collaboration with engagement leads from all of the partner agencies and was grounded in the comments and views of local people. The report had been developed to support the work of the Locality Plan for Salford and provided an overview of the strategy for engagement over the next five years. The document underpinned Salford’s Locality Plan, describing the governance arrangements to support the progression of engagement and to link engagement via the Health and Wellbeing Board to the other structures in the city. Discussion took place regarding the importance of appropriate engagement to enable effective delivery of services. RESOVED: (1) THAT the outlined approach to engagement be endorsed and the paper be adopted as the underpinning policy to support the Locality Plan.
(2) THAT the proposed governance arrangements be endorsed and the implementation of the Engagement and Communication Sub Group to drive forward work around engagement be supported.
(3) THAT a meeting of the Engagement and Communication Sub Group be convened during December 2015.
Clare Mayo
9. FORWARD LOOK A brief update was provide relating to the Forward Look 2015/16. RESOLVED: THAT the update be noted.
10. ANY OTHER BUSINESS No items were raised.
11. DATE AND TIME OF NEXT MEETING 15th December 2015 – Strategy Meeting 19th January 2016 – Business Meeting 16th February 2016 – Strategy Meeting
12. UPDATES FOR INFORMATION
Salford Health and Wellbeing Board
17 November 2015
6 | P a g e
ITEM ACTION BY (a) Intelligence Newsletter/JSNA – update (b) Children and Young People’s Trust Update (c) Salford Safeguarding Children Board Annual Report (http://www.partnersinsalford.org/sscb/annualreport.htm) (d) Social Value in Health and Care update (e) CQC Quality in Place inspection (f) Health Protection Forum update – revised document to be
circulated by email.
Anne Lythgoe
1
ITEM 5 Salford Health and Wellbeing Board
Action Log Date of meeting 19th January 2015 (Prepared BEFORE meeting) Contact Officer Anne Lythgoe (Health and Wellbeing Board Strategy Manager)
Action Person taking lead responsibility
Progress update Completed or Due date
Pending items:
Monitor impact of proposed changes to FACS eligibility criteria on local voluntary and community sector and report to Board
Alison Page Feedback report to be presented to Board in November 2015 – now delayed until March 2016 as information not yet available
15th March 2016
Provide an update to the Board on progress towards the Complex dependencies programme, using learning gained from the Integrated Care Programme for older people.
David Herne / Mat Ainsworth
Complex Dependencies work across GM is to be re-profiled. An update will be brought to the Board when this becomes available.
To be confirmed
Report back to the Board to describe the full scope of work which is happening in the City to tackle the harmful effects of alcohol abuse
Ben Dolan, David Herne, Ian Ashworth
Scheduled for November Board meeting – delayed until meeting in March 2016
15th March 2016
A summary of Board members responses in relation to issues raised around the Living Wage be brought back to the Board for discussion, following issue of a template to each partner to capture impacts.
Chris Dabbs, Alison Page
Scheduled for the Board meeting in April 2016
April 2016
Circulate presentations provided by David Cummins and David Herne to all Board members
Anne Lythgoe Completed
Provide report to JSNA Exec on health and wellbeing issues mapped by housing tenure in Salford
David Herne, Siobhan Farmer
Spring 2016
Provide ‘plan on a page’ for Aging Well section of Locality Plan for December HWB meeting
David Herne, Anne Lythgoe
Completed
Circulate link to survey monkey questionnaire about Locality Plan outcome measures for Board members to complete
Anne Lythgoe, Lesley Waters
Board members completed the survey by Monday 23rd November, with the results informing the December HWB Strategy meeting
Completed
2
Action Person taking lead responsibility
Progress update Completed or Due date
Convene a meeting of the Communications and Engagement sub-group
Clare Mayo The sub-group has met on 18th December and will meet again on the morning of 19th January 2016.
December 2015
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
1
Greater Manchester Health and Social Care
Devolution
Locality Plan for Salford
Our Vision for a Healthier Salford
DRAFT
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
2
CONTENTS
1 STRATEGY AND OUTCOMES Page
1.1 EXECUTIVE SUMMARY – See separate document KEY TERMS – Glossary to be added
3
1.2 INTRODUCTION – PURPOSE 3 1.3 LOCAL CONTEXT 4 1.4 PARTNERS IN THIS LOCALITY PLAN 6 1.5 METHODOLOGY 7 1.6 RATIONALE – the case for change 8 1.7 VISION AND OUTCOMES 11 1.8 TIMESCALES FOR CHANGE 12 1.9 SETTING OUT OUR AMBITION 13 1.10 OUTCOME MEASURES 14
2 THE LIFE COURSE 2.1 STARTING WELL 16 2.2 LIVING WELL 20 2.3 AGEING WELL 24
3 TRANSFORMATION 3.1 TRANSFORMATION PRIORITIES 27 3.2 DRIVING CHANGE 28 3.3 ENABLING TRANSFORMATION
INTEGRATED COMMISSIONING
CO-PRODUCTION AND SOCIAL VALUE
INFORMATION MANAGEMENT AND TECHNOLOGY
ESTATES
WORK FORCE
INNOVATION
PUBLIC ENGAGEMENT
30
3.4 PREVENTION SOCIAL MOVEMENT FOR CHANGE
PLACE-BASED WORKING
BEST START IN LIFE
PROMOTING HEALTHY LIFESTYLES
SCREENING AND EARLY DETECTION
WIDER DETERMINANTS OF HEALTH AND WELLBEING
41
3.5 BETTER CARE QUALITY OF CARE
TRANSFORMING PRIMARY CARE
INTEGRATED CARE
HOSPITAL CARE
LONG TERM CONDITIONS
MENTAL HEALTH
53
4 GOVERNANCE and FINANCE 4.1 GOVERNANCE 61 4.2 PERFORMANCE REPORTING ARRANGEMENTS 62 4.3 GM GOVERNANCE ARRANGEMENTS 62 4.4 FINANCIAL PLAN 64
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
3
SECTION ONE – STRATEGY AND OUTCOMES
1.1 EXECUTIVE SUMMARY – See separate document
KEY TERMS – Glossary to be added
1.2 INTRODUCTION – PURPOSE
1.2.1 This Locality Plan – Our Vision for a Healthier Salford - details the strategic approach to
improving the health outcomes of residents of the City, while also moving towards financial
and clinical sustainability of health and care services. It is the blueprint for the health and
social care system in Salford for the next 5 years, and supports the development and delivery
of the Greater Manchester (GM) Health and Social Care Devolution Programme.
1.2.2 The Locality Plan develops from and now replaces our Joint Health and Wellbeing
Strategy 2013-2016, and has been led and coordinated by Salford’s Health and Wellbeing
Board. Setting out a clear set of priorities which will transform the commissioning of health
and wellbeing services, it focuses delivery around 9 outcome statements which put citizens at
the heart of this Plan.
1.2.3 We have described major changes in how the health and social care ‘system’ will
appear and operate, as well as looking beyond current provision, to ensure that the greatest
impact can be made through strategic influence across the wider determinants of health. It is
felt that this focus on citizen health and wellbeing not only provides a road map for future
action but encapsulates the drive and ambition of our city.
1.2.4 Partners will work together differently in the future, and the creation of an Integrated
Care Organisation, focus on place-based, neighbourhood focussed working and “Salford
Standard” for Primary Care, are all examples of the shift towards prevention, efficiency and
effective achievement of outcomes. We believe that integration should develop from a sound
foundation of co-operation and partnership in our city; focussing on a common aim we will be
able to really make a difference at a local level.
1.2.5 Salford locality currently spends £485m on Health and Social Care, with an estimated
financial shortfall of circa £157m over the 5 year period of this Plan unless we make changes
now. Our Plan focuses both on increasing efficiency through standardisation, use of digital
technology and reductions in variation, and on expanding co-production, personalisation and
social action in communities. It is supported by a sound financial plan, which can be found in
section 4.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
4
1.2.6 This Locality Plan is aligned with the GM Strategic Plan Taking Charge of our health
and social care in Greater Manchester, but has been tailored to the specific assets,
population and health characteristics of our City. It has been informed by our Joint Strategic
Needs Assessment (JSNA) and engagement with citizens, patients and service user groups.
1.3 LOCAL CONTEXT
1.3.1 Salford is growing - with a bold ambition to become a modern global city. More people
than ever before are choosing Salford as a place to live, work, invest and visit: today nearly
240,000 people call the city their home, an increase of 8.3% since 2001. These people are
the city’s greatest assets. The number of households in the city has already increased by
10% over the last ten years, and Salford's population is expected to increase faster than the
national average over the coming ten year period.
1.3.2 Encouragingly, our economy is also forecast to grow at a faster rate than the rest of the
UK. We have a strong and vibrant voluntary, community and social enterprise (VCSE)
sector, with Social Enterprise City status demonstrating that this a core part of the city’s
economic and social offer, as well as in this Plan. The city is embracing diversity as the
proportion of our population born outside the UK steadily increases.
1.3.4 The recent significant growth has been the result of sustained and well planned
investment in the city to attract businesses and residents alike, such as the development of
the Media City complex in Salford Quays, home to both the BBC and ITV which is expanding
Salford’s digital capability; as well as the increase of capacity at Port Salford. Over the past
five years, we have secured £1.3 billion of private sector investment and £425 million public
sector investment, creating over 5,000 jobs, encouraging new businesses, building new
homes and developing the city's education and health services. Some neighbourhoods of
the city are just minutes walk away from the business and shopping areas of Manchester and
this makes Salford an attractive place to set up business, live, work and study.
1.3.5 Half of the city is made up of green spaces including parks, forests and nature reserves
giving opportunities to enjoy the outdoors on the doorstep. Projects such as the new Royal
Horticultural Society’s planned new garden at Worsley New Hall provide opportunities to
further derive wider benefits for our citizens.
1.3.6 Continued growth is a sustainable answer to realising our ambitions for the city and for
our residents. However, we realise that this must be achieved in balance with the wider
social, environmental and economic wellbeing of the city and its residents.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
5
1.3.7 Salford’s changing demography brings new challenges in the provision of sufficient and
appropriate services for a population that, whilst improving overall in terms of wellbeing and
health, is still challenged by significant deprivation in parts of the city. This means that there
are significant inequalities within the City that will need to be considered in service planning.
1.3.8 There also exists a challenge to narrow the gap between Salford and the rest of
England in terms of access to opportunities, education, employment, health and wellbeing, as
well as within Salford where there is a huge diversity in social and economic characteristics
between neighbourhoods. The diagram below is taken from the 2015 Index of Multiple
Deprivation, which shows that Salford has some of the most (high numbers – pink) and some
of the least (low numbers – green) deprived neighbourhoods in England.
SOURCE: Index of Multiple Deprivation 2015
1.3.9 There is great interest in population health and wellbeing amongst our citizens, and our
Locality Plan has been informed by extensive public engagement around Salford’s Joint
Health and Wellbeing Strategy (JHWS), which has shown that there is a need to set a clear /
realistic ambition around tackling the inequalities in the City. There is agreement that ‘health
is everyone’s business’ and that more interaction is required with service users and the
public, so that people can see what is happening and have information to be able to play an
active role in developing solutions and approaches to the challenges in Salford.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
6
1.4 PARTNERS IN THIS LOCALITY PLAN
1.4.1 The development of Salford’s Locality Plan has involved representatives from all
partners in the Health and Wellbeing Board, which is described in the diagram below. The
final draft Plan has been endorsed by the Board and recommended for approval through the
relevant governance arrangements of the City Council, Clinical Commissioning Group and
key partners.
Salford Health
and Wellbeing
Board
Salford City Council
Salford Royal FT
Salford Clinical
Commissioning Group
Greater Manchester
West FT
NHS England
GM Fire and Rescue
ServiceGM Police
GM Chamber of
Commerce (represented
by Unlimited Potential)
Health Watch Salford
Voluntary, Community and
Social Enterprise Sector
(represented by Salford
CVS)
BENEFIT FOR THE CITIZENS OF SALFORD
Children and Young
People’s Trust
Salford Safeguarding
Children’s Board
Salford Adult
Safeguarding Board
Community Safety
Partnership
Strategic Housing
Partnership
Skills and Work
Board
JOINT STRATEGIC NEEDS ASSESSMENT, HEALTH AND WELLBEING
STRATEGY, INTEGRATED WORKING
Strategic Housing
Partnership (represented
by City West)
1.4.2 We will continue to strengthen and build on the strong partnerships that exist across
Salford between the VCSE sector, the Council, the Clinical Commissioning Group, NHS
providers and other statutory partners over the next five years through our collective and
joint commitment to:
· An Inclusive Approach: including all partners in decision-making at the early stages
of strategic planning and the development of new models of service delivery.
· Development of Alliances: within and across sectors, thematic, as well as population
and place-based, dependent on the issues presented and the solutions required.
· Recognition of Community and Individual Assets: Individuals’ and communities
assets are vital to improving Salford resident’s health outcomes
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
7
1.5 METHODOLOGY
1.5.1 Our Plan is structured as follows:
1.5.2 Our methodology has included:
· Citizen engagement through online surveys, citizen panels, members meetings and
service user / patient participation groups (summarised at Appendix xx)
· A review of health and wellbeing outcomes data available through our Joint Strategic
Needs Assessment and benchmarking with both Greater Manchester and national
comparator data sets
· Development of population, health and wellbeing projections, including a ‘State of the
City’ report which describes future demographic change, housing, employment,
education and other indicators.
· Analysis of programmes and services which are already in operation across the Start
Well, Live Well and Age Well system, including community asset mapping
· Looking at where we can learn from our existing programmes of work and expand the
approaches to create new transformation. This has included describing how Greater
Manchester level programmes will impact at a local level.
· We have used a rational approach to prioritisation of our interventions and outcomes,
based on guidance from NHSE and PHE, as well as practice tested through our
Integrated Care Programme.
1.5.3 Further details of data collection, analysis and engagement are contained within the
supporting papers to this Plan.
START WELL
Outcomes for people
AGE WELL
Outcomes for people
LIVING WELL
Outcomes for people
Prevention Better Care Enablers
VISION
TRANSFORMATIONSTRATEGIC AND DELIVERY PRINCIPLES
GOVERNANCE
FINANCIAL FRAMEWORK
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
8
1.6 RATIONALE – the case for change
1.6.1 From our JSNA, we know that in Salford:
· 70% of the population live in areas classified as highly deprived
· Over 25% of young people under 16 in the city (12,300 children) live in poverty
· But 5% of the population live in wards amongst least deprived in the country
· We have the second highest proportion of primary school children eligible for free
school meals in GM, at 24%, one and a half times the England average
· Early years & primary schools perform well – but success rates at GCSE are amongst
the lowest in England
· Nearly 10% of the working population is long-term unemployed
· Salford’s residents’ health and wellbeing that is worse than the national average
· Life expectancy is increasing, but for women is 2.5 years less than the England
average, for men 2.8 years less. The life expectancy gap within the City is increasing.
· Death rates are reducing but not fast enough to narrow the gap with the England
average
· The major causes of ill health include CHD/CVD/Cancers & respiratory conditions
1.6.2 Linked with inequalities in deprivation, Salford also faces a number of health
challenges, both in comparison to national outcomes and within the city itself. Further
information is provided in our supporting documentation.
1.6.3 There are extreme health inequalities within Salford, most notably between the east
and west of the city. The following map of life expectancy for males and females across the
city shows the difference between different parts of the city, currently around 11 years for
females and 14 years for males (2008-12).
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
9
1.6.4 The level of challenge is
reported in the 2015 Health
Profiles published by Public
Health England for each local
authority area. Salford’s relative
performance across the range of
health, wellbeing and lifestyle
outcomes is illustrated in the
2015 profile (left). We have also
mapped our direction of travel
against the other authorities in
Greater Manchester, helping us
to highlight where greater
improvement is needed.
1.6.5 Reducing the numbers of
people in Salford affected by the ‘biggest killers’ of cardiovascular disease, cancer and
respiratory disease remains our biggest challenge, and must be the way that we can narrow
the health gap between our residents and the rest of England. This means helping to prevent
people from becoming ill in the first place, by focussing efforts not only on addressing the key
lifestyle risks that cause these diseases i.e. smoking, excessive alcohol intake, physical
inactivity and poor diet, but also on the ‘causes of these causes’ which are factors
encountered throughout the life course.
1.6.6 For example, a good education can lead to better chances of employment and help
people to overcome the challenges of socioeconomic deprivation. Housing and the
environment are factors that can help people maintain wellbeing and support healthier
communities. Early detection and effective treatment of all the major preventable major
diseases will help to improve premature mortality rates, and investment in primary care and
community services will be required to achieve this.
1.6.7 It is essential therefore that our plan meets not only the short term challenges of
keeping people well, but tackles the longer term determinants of health such as education,
housing, support for children and the environment to ensure Salford residents have every
chance to stay healthy and live longer lives.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
10
1.6.8 Furthermore, Salford’s changing demography will present challenges in terms of
service design and modelling. Although there will be a higher number of older people in
Salford, it is predicted that the proportion of the population aged over 65 will increase at a
slower rate than both England and Greater Manchester. Instead, Salford will have a
population in 2021 which is young compared to the England average, containing a greater
number of people in the under 5 and 20 to 39 age group. This is illustrated in the following
population pyramids.
The Marmot review “Fair society healthy lives: strategic review of health inequalities in
England (2010)” has strongly influenced the development of this Locality Plan.
The review highlights that reducing health inequalities is an issue of fairness and social
justice. Many people die prematurely each year as a result of health inequalities and the
lower a person’s social position, the worse his or her health. The review advocates that
actions must be universal, but with a scale and intensity that is proportionate to the level of
disadvantage (proportionate universalism). Six policy objectives set the broad scope of the
report and a call to action for central and local government and the NHS in partnership with
wider agencies and local communities:
· Give every child the best start in life
· Enable all children, young people and adults to maximise their capabilities and have
control over their lives
· Create fair employment and good work for all
· Ensure healthy standard of living for all
· Create and develop healthy and sustainable places and communities
· Strengthen the role and impact of ill health prevention
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
11
1.7 VISION AND OUTCOMES
1.7.1 Our Plan describes a Vision for the people of Salford supported by Start Well, Live Well
and Age Well outcomes.
Vision
Start, live and age well in Salford - Citizens will get the best start in life, will go on to have a
fulfilling and productive adulthood, will be able to manage their health well into their older age
and die in a dignified manner in a setting of their choosing. People across Salford will
experience health on a parallel with the current “best” in Greater Manchester (GM), and the
gaps between communities will be narrower than they have ever been before.
1.7.2 We recognise however, that the current public sector financial pressures are significant.
Our aim is to achieve the required level of savings in a way that has the least impact on
achieving our vision for Salford. This will require transformational changes in service design
and usage, collaboration and co-operation across partner organisations, as well as
challenging conversations about shared priorities and services that will need to cease.
1.7.3 The overall aim of this Locality Plan remains as described in our previous Joint Health
and Wellbeing Strategy; to “improve health and wellbeing across the city and remove health
inequalities” in Salford. Our approach to achieve this prioritises prevention, self-care and
public health, whilst creating integrated, effective and financially sustainable health and care
services. It acknowledges the importance of both mental and physical health in achieving our
vision, and aligns with the priorities of the Salford Partnership; Wellbeing, Growth and Social
Value.
1.7.4 The Plan is built around a whole life course model:
Starting well - Children will have
the best start in life and continue to
develop well during their early years
Ageing Well - Older people will maintain
wellbeing and can access high quality health and
care, using it appropriately
Living Well - Citizens will achieve and maintain a sense of wellbeing by leading a healthy
lifestyle supported by resilient communities
1.7.5 In response to our public engagement, the life course model has been translated into
outcomes for the people of Salford. These are statements which put people at the heart of
our Plan:
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
12
Starting Well Outcomes:
• I am a child who is physically and emotionally healthy, feel safe and able to live life in a
positive way
• I am a young person who will achieve their potential in life, with great learning, and
employment opportunities
• I am as good a parent as I can be
Living Well Outcomes:
• I am able to take care of my own health and wellbeing, and am able to manage the
challenges that life gives me
• My lifestyle helps me to stop any Long Term Condition or disability getting worse, and
keeps the impact of this condition or disability from affecting my life
• I lead a happy, fulfilling and purposeful life
Ageing Well Outcomes:
• I am an older person who is looking after my health and delaying the need for care
• If I need it, I will be able to access high quality care and support
• I know that when I die, this will happen in the best possible circumstances
1.8 TIMESCALES FOR CHANGE
1.8.1 We have considered how our activity will be focused towards achieving outcomes and
impacts in three horizons: those that will impact immediately i.e. within 1-2 years; in the
medium term i.e. the next 5-10 years; and in the longer term i.e. 10 years and beyond. This
signals our recognition of the importance of making immediate improvements whilst being
careful to ensure we don’t lose sight of the prevention agenda and the importance that the
wider determinants of health will play. Our strategy is built on a three life stages model, each
of which will articulate our planning for the three horizons:
4
We need to understand Investment & return in ways
which change the nature of demand
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
13
1.8.2 Later in this Plan, we will further analyse our delivery proposals across the life course,
as we recognise the need to be clear about how we will practically keep an equal focus on
the medium-term and long-term horizons when short-term pressures may be intense.
1.9 SETTING OUT OUR AMBITION
1.9.1 The Public Health Outcomes Framework (PHOF) benchmarking tool has been used to
provide data to facilitate an analysis of how Salford is performing compared to other
authorities in Greater Manchester and compared to England. We have analysed Salford’s
relative performance across the range of health, wellbeing and lifestyle outcomes in
preparing this Locality Plan.
1.9.2 Whilst trend calculations have a number of caveats and the confidence intervals we can
apply to these projections are likely to be wide, we can use these data to set our ambition for
the improvement seen if Salford followed the trajectory of the best improving area in Greater
Manchester rather than following current trends:
• Nearly 7,500 fewer people would smoke and most of these (over 6,000) would be in the
routine and manual groups.
• Child Poverty could be reduced by half in nine years, taking an additional 5,350 children
out of poverty.
• Per year, by 2021 there would be 20 fewer deaths from CVD, 6 fewer from liver disease,
17 from respiratory disease and 31 from communicable disease.
• There would be double the reduction in hospital admissions for falls for over 65’s each
year i.e. 518 fewer admissions than Salford’s current prediction. Most of this reduction
would be in the over 80’s age group.
• Prevalence of both teenage conceptions and late stage HIV could be reduced 3 or 4
years sooner than if the current rate continues.
• Alcohol related hospital admissions will still increase, but if this matched the best in GM,
the increase would be reduced by one quarter.
1.9.3 Further work is now required to consider the full range of Adult Social Care indicators,
NHS Outcomes and Children’s Services data locally and across Greater Manchester in order
to fully articulate the scale of our ambition.
1.9.4 Background information about our ambition and potential scale of improvement is
contained within the supporting papers.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
14
1.10 OUTCOME MEASURES
1.10.1 We have applied a methodology used for our Integrated Care Programme in order to
select the outcome measures which we will use for this Plan:
Long list of potential outcomes
A long list was produced from the three national outcome frameworks and other indicator sets we are currently measured on, with indicators selected based on their fit to the target population (Starting Well, Living Well, Ageing Well) and the degree of dependency on partnership effort to secure improvement;
Medium list of outcomes
A medium list has been selected based on the fit to our triple aim (better outcomes, improving experience, and reducing costs) and the opportunity for improvement (Salford's distance from top quartile or decile performance in GM);
Engagement and support
Board members and partners were asked to vote on the medium list of indicators, with the results debated at the next Health and Wellbeing Board meeting, to ensure shared ownership and support. Bespoke engage is also being undertaken with Salford residents to ensure the indicators reflected areas they also feel are important;
Plausibility, evidence base and target setting
Each measure selected will be assessed for plausibility and cross referenced to the evidence base (what has been delivered in other systems). Targets were set on moving to either the top quartile or decile by 2021
1.10.2 Our approach gives us three levels of outcome measures:
· Priority outcome measures which we will use to understand the impacts of this Plan
on the health and wellbeing of Salford’s citizens
· Programme outcome measures, used in transformational programmes and
business plans of our partner organisations
· Outcome framework measures such as the PHOF or NHS Outcome Framework,
which we will use on an annual basis in ‘horizon scanning’ to check whether this Plan
is still focussing on the right issues.
1.10.3 It should be noted that we have used the healthy lifestyle outcome measures in Living
Well to underpin the whole life course, as for example, outcomes for children and young
people in the Starting Well age group will be impacted upon by smoking prevention,
avoidance of drug taking, reasonable use of alcohol and healthy eating in the household in
which they live.
1.10.4 The DRAFT priority outcome measures are described in the following tables. We will
continue to work on finalising the agreed basket of outcome indicators which our partnership
will sign up to, over the coming months. The indicators are currently best developed for
Ageing Well as they are an integral part of our existing Integrated Care Programme. We are
beginning to shape our performance priorities though wide engagement and evidence review
and will have completed this for March 2016.
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
15
O
utc
om
es
for
pe
op
le
Ou
tco
me
me
asu
res
- T
AR
GE
TS
SE
T F
OR
EA
CH
OU
TC
OM
E M
EA
SU
RE
AR
E C
ON
TA
INE
D A
T A
PP
EN
DIX
XX
Sta
rtin
g W
ell
Ch
ild
ren
wil
l h
ave
the
be
st s
tart
in
life
an
d c
on
tin
ue
to d
ev
elo
p w
ell
du
rin
g t
he
ir e
arl
y
ye
ars
I a
m a
yo
un
g p
ers
on
wh
o w
ill
ach
iev
e t
he
ir p
ote
nti
al
in l
ife
, w
ith
gre
at
lea
rnin
g,
an
d e
mp
loym
en
t
op
po
rtu
nit
ies
·
1.0
1i -
Ch
ild
ren
in
po
vert
y (
all
de
pe
nd
en
t ch
ild
ren
un
de
r 2
0)
·
1.0
5 -
16
-18
ye
ar
old
s n
ot
in e
du
cati
on
,
em
plo
yme
nt
or
tra
inin
g
·
Ch
ild
We
llb
ein
g I
nd
ex:
Ave
rag
e S
core
(re
pla
ced
by
na
tio
na
l ch
ild
me
nta
l we
llb
ein
g s
urv
ey
usi
ng
WE
MW
EB
S)
·
1.0
2i -
Sch
oo
l Re
ad
ine
ss:
Th
e p
erc
en
tag
e o
f ch
ild
ren
ach
iev
ing
a g
oo
d l
ev
el o
f d
ev
elo
pm
en
t a
t th
e e
nd
of
rece
pti
on
·
2.0
6ii
- E
xce
ss w
eig
ht
in 4
-5 a
nd
10
-11
ye
ar
old
s
·
4.0
2 -
To
oth
de
cay
in
ch
ild
ren
ag
ed
5
·
GC
SE
ach
iev
ed
(5
A*
-C i
ncl
ud
ing
En
gli
sh &
Ma
ths)
(o
r re
pla
cem
en
t)
·
2.0
7i -
Ho
spit
al
ad
mis
sio
ns
cau
sed
by
un
inte
nti
on
al
an
d d
eli
be
rate
in
juri
es
in
chil
dre
n (
ag
ed
0-1
4 y
ea
rs)
·
2.0
8 -
Em
oti
on
al
we
llb
ein
g o
f lo
ok
ed
aft
er
chil
dre
n
I a
m a
ch
ild
wh
o i
s p
hy
sica
lly a
nd
em
oti
on
all
y h
ea
lth
y,
fee
l sa
fe a
nd
ab
le t
o l
ive
lif
e i
n a
po
siti
ve w
ay
I a
m a
s g
oo
d a
pa
ren
t a
s I
can
be
Liv
ing
We
ll
Cit
ize
ns
wil
l
ach
iev
e a
nd
ma
inta
in a
se
nse
of
we
llb
ein
g b
y
lea
din
g a
he
alt
hy
life
sty
le
sup
po
rte
d b
y
resi
lie
nt
com
mu
nit
ies
I a
m a
ble
to
ta
ke
ca
re o
f m
y o
wn
he
alt
h,
we
llb
ein
g a
nd
am
ab
le t
o
ma
na
ge
s th
e c
ha
llen
ge
s th
at
life
giv
es
me
·
Sm
ok
ing
att
rib
uta
ble
ho
spit
al
ad
mis
sio
ns
·
Lon
g t
erm
un
em
plo
ym
en
t
·
2.1
2 E
xce
ss w
eig
ht
in a
du
lts
·
Mo
rta
lity
ra
tes
·
7.0
1 A
lco
ho
l-re
late
d h
osp
ita
l a
dm
issi
on
(B
roa
d)
·
Lon
g-t
erm
he
alt
h p
rob
lem
s o
r d
isa
bil
ity
: %
of
pe
op
le w
ho
se d
ay
-to
-da
y a
ctiv
itie
s a
re l
imit
ed
by
the
ir h
ea
lth
or
dis
ab
ilit
y
·
A&
E a
tte
nd
an
ces
·
1.1
1 -
Do
me
stic
ab
use
(a
ssu
min
g r
eli
ab
le d
ata
av
ail
ab
le)
·
2.1
3ii
- P
erc
en
tag
e o
f p
hys
ica
lly
act
ive
an
d i
na
ctiv
e
ad
ult
s (i
na
ctiv
e a
du
lts)
·
1.1
7 -
Fu
el
po
vert
y
·
2.2
3ii
i - S
elf
-re
po
rte
d w
ell
be
ing
- p
eo
ple
wit
h a
low
ha
pp
ine
ss s
core
OR
2.2
3v
- a
vera
ge
Wa
rwic
k-E
din
bu
rgh
Me
nta
l We
llb
ein
g S
cale
(WE
MW
BS
) sc
ore
PLU
S –
ov
era
rch
ing
me
asu
res
wh
ere
ch
an
ge
on
ly
see
n a
t e
nd
of
5 y
ea
rs:
·
De
pri
vati
on
sco
re (
IMD
20
10
)
·
Po
ten
tia
l ye
ars
of
life
lost
·
Life
exp
ect
an
cy /
He
alt
hy
Life
exp
ect
an
cy
·
Dis
ab
ilit
y fr
ee
lif
e y
ea
rs
My
lif
est
yle
he
lps
me
to
sto
p a
ny
Lon
g T
erm
Co
nd
itio
n o
r d
isa
bil
ity
ge
ttin
g w
ors
e,
an
d k
ee
ps
the
imp
act
of
this
co
nd
itio
n o
r
dis
ab
ilit
y f
rom
aff
ect
ing
my
life
I le
ad
a h
ap
py
, fu
lfil
lin
g a
nd
pu
rpo
sefu
l li
fe
Ag
ein
g W
ell
Old
er
pe
op
le w
ill
ma
inta
in
we
llb
ein
g a
nd
ca
n
acc
ess
hig
h
qu
ali
ty h
ea
lth
an
d
care
, u
sin
g i
t
ap
pro
pri
ate
ly
I a
m a
n o
lde
r p
ers
on
wh
o is
lo
ok
ing
aft
er
my
he
alt
h a
nd
de
lay
ing
th
e
ne
ed
fo
r ca
re
·
Re
du
ce e
me
rge
ncy
ad
mis
sio
ns
an
d r
e-a
dm
issi
on
s
·
Incr
ea
se t
he
pro
po
rtio
n o
f p
eo
ple
th
at
fee
l
sup
po
rte
d t
o m
an
ag
e o
wn
co
nd
itio
n
·
4.1
6 -
Est
ima
ted
dia
gn
osi
s ra
te f
or
pe
op
le w
ith
de
me
nti
a
·
Re
du
ce p
erm
an
en
t a
dm
issi
on
s to
re
sid
en
tia
l a
nd
nu
rsin
g c
are
·
Imp
rov
e Q
ua
lity
of
Life
fo
r u
sers
an
d c
are
rs
·
Incr
ea
se s
ati
sfa
ctio
n w
ith
ca
re &
su
pp
ort
pro
vid
ed
·
Incr
ea
se f
lu v
acc
ine
up
take
·
Incr
ea
se p
rop
ort
ion
of
pe
op
le t
ha
t d
ie a
t
ho
me
/in
usu
al
resi
de
nce
(o
r p
refe
rre
d p
lace
of
dy
ing
)
·
4.1
5i -
Exc
ess
Win
ter
De
ath
s In
de
x (s
ing
le y
ea
r,
all
ag
es)
·
Re
du
ctio
n i
n t
he
nu
mb
er
of
fall
s in
th
e o
ve
r
65
s o
r o
ve
r 8
0s
If I
ne
ed
it,
I w
ill b
e a
ble
to
acc
ess
hig
h q
ua
lity
ca
re a
nd
su
pp
ort
I k
no
w t
ha
t w
he
n I
die
, th
is w
ill
ha
pp
en
in
th
e b
est
po
ssib
le
circ
um
sta
nce
s
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
16
SECTION TWO – THE LIFE COURSE
2.1 STARTING WELL
2.1.1 There are just over 81,000 children and young people aged under 25 years old in
Salford; one third of the population. The proportion of young people ranges from 25% of the
population in Worsley to 41% in Kersal.
2.1.2 In Salford, there is a clear need to focus on children and young people:
· The infant mortality rate is better than England; between 2007-9 and 2011-13 the rate
fell from 6 to less than 4 per 1000 infants under one.
· Low birth weight at 6% of births is better than England but varies across Salford wards
from 2% to 12% of births.
· Salford is also the top performing Local Authority in GM for childhood immunisations.
· The percentage of women smoking at the time of delivery of their baby has reduced
from 25% in 2003/4 to 15% in 2013/14. However, this rate is still higher than England
and is the third highest in GM.
· The rate for women starting breastfeeding has fallen recently to 62% in 2015, which is
12% lower than the England average.
· 25% three year olds in Salford have decayed, missing or filled teeth, and Salford has
the second highest rate of its statistical neighbours for injuries in 0 – 14 year olds.
· Almost one in ten reception age children are obese in Salford which is similar to
England. However, when children reach year six, obesity levels increase to 21.1%,
which is significantly higher than England (18.9%).
· 11.5% of 15 year olds and 19% of 16-17 years olds are estimated to regularly smoke
in Salford compared to 8.7% and 14.8% for England.
· 21.3% of Salford children have special educational needs (18.6% England).
· The rate of Salford children achieving five GCSEs at A*-C grades, including English
and maths has fallen by 3% since 2010, and is amongst the worst local authority areas
nationally.
· Over the past 14 years there has been a 38.4% fall in teenage conceptions.
· Salford has a rate significantly higher than England of Looked After Children (161.8
per 10,000 children aged 16-17).
· At the end of September 2015 the number of young people Not in Education,
Employment or Training (NEET) in Salford was 8.4%, the highest in Greater
Manchester and well above the national and regional averages
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
17
2.1.3 Children have rights as stated in the United Nations Convention on the Rights of the
Child (UNCRC), which include “the right to be healthy, the right to be educated, the right to
be treated fairly, the right to be heard and the right not to be hurt.” We want to enable all
children and young people in Salford to achieve their potential.
2.1.4 We will build from the City’s new Early Help Strategy, and seek to ensure that:
· Citizens are healthy
· Citizens are safe
· Citizens enjoy and achieve
· Citizens make a positive contribution
· Citizens achieve economic well-being
2.1.5 One of the most important ways we can prevent ill-health in later life is by supporting all
children in Salford to have the best start in life. There is now considerable evidence
demonstrating that the care received during pregnancy and the early years is vital for the
future health, wellbeing, and development, as well as life chances of children. It will take a
decade of continued effort to realise the ambition set out below, but without this, Salford will
not be able to reduce the level of health inequality in the City.
2.1.6 Support both at the ante and post-natal stages is vital in ensuring parents are able to
maximise their role in promoting good physical and mental health for their children and in
identifying those that need additional support to do this. This must be delivered in a holistic,
preventative and seamless way if children are to maximise their future potential, with the right
support at the right time along the journey to adulthood:
· A healthy pregnancy, free from tobacco smoke, high rates of breastfeeding, good
early years provision and high levels of immunisation and vaccination
· A strong education with access to stimulating learning, plus physical activity and a
good diet
· An emotionally friendly environment in which the voice of all children is heard and
valued
These things help children to grow into healthy adults, preventing diseases both physical and
mental in later life.
2.1.7 We have undertaken a strategic review of the situation and provision for the 0-25 age
group, and will use the gaps identified from our evidence review and data analysis alongside
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
18
the evidence-based recommendations to reconfigure the services we offer for children and
young people in Salford. Detailed proposals are being developed which will build on initial
work prompted by the strategic review.
2.1.8 Three areas are being developed as test cases to explore the best pathways for
children and young people, and to improve effective collaborative working. These are:
· Emotional Health and Wellbeing, including Child and Adolescent Mental Health
Services (CAMHS)
· Children with disabilities
· Therapies (Speech and Language, physiotherapy, occupational therapy, audiology)
Work is also underway to explore the development of a place-based and a people-based
pilot; these will explore new ways of working and developing community capacity. We will use
family based approaches already in place from the Helping Families programme.
Case study: Early Break project
As part of the Achieve integrated drug and alcohol service, Early Break work with cohorts of 20
families at a time through a 6 month family therapy programme which is targeted at families with
children where there are drug and alcohol problems in the household. This ‘Holding Families’
programme….
Further text to be provided – shows the link between starting and living well
2.1.9 The key transformation initiatives within this programme are shown in the following
table:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
19
2.1
.10
ST
AR
TIN
G W
EL
L –
P
lan
on
a P
ag
e
VIS
ION
: C
hil
dre
n w
ill
ha
ve
th
e b
est
sta
rt i
n l
ife
an
d c
on
tin
ue
to
de
velo
p w
ell
du
rin
g t
he
ir e
arl
y y
ea
rs
CA
SE
FO
R C
HA
NG
E
OU
TC
OM
ES
FO
R P
EO
PLE
EN
AB
LER
S
PR
OG
RA
MM
E A
RE
AS
LE
AD
PA
RT
NE
R(S
)
TA
RG
ET
S
Inte
rde
pe
nd
en
cie
s
be
twe
en
ch
ild
ren
’s s
erv
ice
s
an
d a
du
lt s
erv
ice
s, w
hic
h
mu
st m
ee
t th
e n
ee
ds
of
all
fam
ily
me
mb
ers
I a
m a
ch
ild
wh
o i
s
ph
ysi
call
y a
nd
em
oti
on
all
y
he
alt
hy
, fe
el
safe
an
d a
ble
to l
ive
lif
e i
n a
po
siti
ve
wa
y
I a
m a
yo
un
g
pe
rso
n w
ho
wil
l a
chie
ve
the
ir p
ote
nti
al
in l
ife
, w
ith
gre
at
lea
rnin
g,
an
d
em
plo
ym
en
t
op
po
rtu
nit
ies
I a
m a
s g
oo
d a
pa
ren
t a
s I
can
be
Qu
ali
ty –
wh
ere
yo
un
g
pe
op
le a
cce
ss s
pe
cia
list
serv
ice
s, t
he
y w
ill
ha
ve
con
fid
en
ce i
n t
he
qu
ali
ty o
f
care
th
ey
wil
l re
ceiv
e
Pa
rtic
ipa
tio
n –
yo
un
g p
eo
ple
an
d t
he
ir c
are
rs a
re i
nvo
lve
d
in p
lan
nin
g a
nd
se
lf c
are
Te
chn
olo
gy
- d
eve
lop
ing
en
ha
nce
d d
igit
al
reso
urc
es
an
d p
ath
wa
ys
to m
axi
mis
e
op
tio
ns
for
self
-he
lp
Pa
rtn
ers
hip
– y
ou
ng
pe
op
le
wil
l h
av
e a
cce
ss a
mu
ch m
ore
inte
gra
ted
he
alt
h a
nd
so
cia
l
care
sy
ste
m,
wh
ich
is
be
tte
r
ab
le t
o a
nti
cip
ate
an
d
resp
on
d t
o t
he
ir n
ee
ds
Fin
an
cia
l –
po
ole
d b
ud
ge
t
arr
an
ge
me
nts
an
d i
nte
gra
ted
bu
sin
ess
an
d s
erv
ice
fin
an
cia
l
pla
nn
ing
Wo
rk f
orc
e –
in
teg
rate
d
wo
rkfo
rce
pla
nn
ing
, tr
ain
ing
an
d s
up
po
rt
So
cia
l V
alu
e –
en
suri
ng
th
at
com
mis
sio
nin
g m
axi
mis
es
soci
al,
en
vir
on
me
nta
l a
nd
eco
no
mic
va
lue
fro
m
inve
stm
en
t
Pre
ve
nti
on
: P
rom
oti
on
of
stro
ng
an
d
eff
ect
ive
pa
ren
tin
g a
pp
roa
che
s, a
sse
t
ba
sed
th
ink
ing
, im
ple
me
nti
ng
th
e E
arl
y
Ye
ars
Ne
w D
eliv
ery
mo
de
l a
nd
pre
ve
nti
ng
un
he
alt
hy
be
ha
vio
urs
in
all
en
vir
on
me
nts
an
d s
ett
ing
s.
?
·
?
Ne
ed
to
str
ea
mli
ne
serv
ice
s a
cro
ss t
he
lif
e
cou
rse
, re
du
cin
g t
he
imp
act
of
tra
nsi
tio
n
Arr
an
ge
me
nts
ne
ed
to
be
fle
xib
le a
s d
em
og
rap
hy,
ep
ide
mio
log
y a
nd
kn
ow
led
ge
ch
an
ge
s
Ea
rly
in
terv
en
tio
n:
Ide
nti
fyin
g h
ea
lth
,
soci
al c
are
an
d e
du
cati
on
ne
ed
s w
ith
in
fam
ilie
s e
arl
y,
an
d p
rov
idin
g s
up
po
rt
be
fore
pro
ble
ms
be
com
e c
om
ple
x a
nd
en
tre
nch
ed
.
?
Fin
an
cia
l a
nd
op
era
tio
na
l
sust
ain
ab
ilit
y o
f h
ea
lth
an
d
soci
al c
are
sy
ste
m f
or
yo
un
g p
eo
ple
‘T
he
Bri
dg
e’:
co
mp
risi
ng
bo
th t
he
exi
stin
g M
ult
i A
ge
ncy
Sa
feg
ua
rdin
g
Hu
b (
MA
SH
) a
nd
th
e P
ub
lic
Se
cto
r
Re
form
(P
SR
) H
ub
, p
rov
idin
g a
‘si
ng
le
fro
nt
do
or’
fo
r re
ceip
t o
f re
ferr
als
an
d
req
ue
sts
for
serv
ice
fro
m p
rofe
ssio
na
ls
an
d t
he
pu
bli
c a
nd
is
the
ga
tew
ay
in
to
spe
cia
list
an
d e
arl
y h
elp
su
pp
ort
.
?
Imp
rov
ed
he
alt
h a
nd
we
llb
ein
g o
utc
om
es
for
yo
un
ge
r p
eo
ple
an
d
fam
ilie
s
Ne
ed
to
ma
xim
ise
ind
ep
en
de
nce
an
d
resi
lie
nce
, a
nd
ma
ke
tra
nsp
are
nt
de
cisi
on
s
ab
ou
t fo
cuss
ed
use
of
reso
urc
es
Ea
rly
He
lp P
rov
isio
n:
Tie
r tw
o o
r e
arl
y
he
lp p
rov
isio
n w
ill
be
pro
vid
ed
in
loca
liti
es.
?
Sp
eci
ali
st p
rov
isio
n:
Tie
r 3
an
d 4
serv
ice
s, i
ncl
ud
ing
CA
MH
S,
wit
h t
he
aim
of
ma
na
gin
g f
am
ilie
s b
ack
to
se
lf-
sup
po
rt w
he
re a
pp
rop
ria
te.
?
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
20
2.2 LIVING WELL
2.2.1 Around three quarters of all deaths in Salford the last decade were due to
cardiovascular, cancer and respiratory disease. Whilst early death rates from cancer and
from heart disease and stroke have fallen, these remain worse than the average for England.
2.2.2 We know that:
· The mortality rate from cardio-vascular disease is the third highest across Greater
Manchester and is fourth highest in the country. That for cancer is over 30% higher
than the England average
· Salford is one of only two areas in Greater Manchester that has shown a reduction in
under 75s mortality from liver disease from 2001/3 to 2011/13.
· The rate of utilisation of outdoor space for exercise/health reasons is significantly
lower than England and the North West, as the rate in other areas has increased
greatly. However, the percentage of active adults within Salford has shown an
increase of 6.7% which is one of the highest increases across Greater Manchester.
· Smoking prevalence in Salford has fallen to around 23% in 2013 from 28.4% but this
is significantly higher than England, and is the second highest in Greater Manchester.
The rate of smoking related death is 43% higher than the England average.
· The rate of alcohol-related admissions to hospital is the highest in Greater Manchester
at 967.9 per 100,000 in 2012/13.
· Salford has shown a 5.4% increase in the rate of adult self harm, from 370.6 in
2012/13 to 390.8 in 2013/14, the rate is the highest in Greater Manchester.
· Nearly 5 in every 1,000 residents (aged 15-59) have HIV. This is more than twice the
national average (2.1 in every thousand) and equals approximately 700 people in
Salford (aged 15-59).
2.2.3 All residents regardless of their age should “live well” in Salford and this theme focuses
on positive investment in healthy lifestyles and behaviours as well as our residents’
neighbourhoods and working environments. This workstream runs through the start and age
well strands: parents need to be healthy themselves to care for their children and people
need to live as healthily as they can for as long as possible so that their whole adult life is a
healthy as it can be. This work includes commissioned services to raise awareness of
common conditions, supporting people to prevent these diseases through providing
opportunities to live a healthy lifestyle including reducing smoking, eating healthily, and
exercising appropriately.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
21
2.2.4 This programme will be delivered through activity led at a local, Greater Manchester
and national scale. It will include both direct and indirect intervention, with influencing the
activity of others being as important as commissioned services. Over time, budgets will need
to be ‘flexed’ to focus increasingly on prevention, and breaking out of the traditional ‘health’,
‘social care’ or other silos, so that our dwindling resources can be targeted where they will
make the most different. Further information about Salford’s place-based approaches is
contained in section 3.
2.2.5 Our engagement exercises show that local people feel that we should prioritise health
improvement programmes and initiatives to improve wellbeing in the community. This
included healthy eating and exercise programmes and also early diagnosis of long term
conditions and illnesses through screening programmes. They also wanted to see actions to
address the wider determinants of health e.g. reducing the barriers to work such as living
wage, work based childcare, addressing poverty and access to transport for older people.
2.2.6 Our ambition is that citizens will achieve and maintain a sense of wellbeing, feeling they
are valued and have a purpose in society. One of the key priorities proposed by citizens
through our engagement work was mental health across the life course. Our plan will
promote mental wellbeing and positive emotional health, signposting to services that can
support people to manage mental health conditions.
2.2.7 Each year one in four British adults experience at least one diagnosable mental health
problem. Salford has a higher prevalence of mental health than other parts of the UK with
around 36,500 adults and 6,000 children estimated to have some kind of mental wellbeing
need. Our Integrated Mental Health Commissioning Strategy 2013-2018 invests in the region
of £45m each year on mental health service provision and our vision is that all residents of
the city will have access to high quality, compassionate world-class mental health services.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
22
Case study: Costs of Smoking to the Social Care System
Research by Action on Smoking and Health (ASH) has shown that across England, local authorities
spend £600m every year on social care for people with health problems caused by smoking. This is
on top of a £450m annual bill faced by individuals to cover the cost of their own care for smoking-
related illnesses. In England, 47,000 people are receiving council-funded social care for health
problems caused by smoking including chronic obstructive pulmonary disease (COPD), while 846,000
are receiving unpaid care from friends or family members.
If the findings of this research are used to estimate the costs of social care for people with health
problems caused by smoking in Salford, we arrive at the following annual figures:
Social Care costs to the public sector for those aged 50+ £3,085,600/annum
Social Care costs to self-funders aged 50+ £2,287,812/annum
Number of people needing additional care from LA/Social Services 191
Number of people needing additional care from friends and family for smokers 2,211
Number of people needing additional care from friends and family for ex-smokers 2,080
Furthermore, it has been estimated that for every smoker who dies, 20 are living with a smoking-
related illness. This research shows that smokers are likely to need care on average 9 years earlier
than non-smokers. Being a smoker doubled the chances of receiving care of any sort and increased
the risk for ex-smokers by 25%.
2.2.8 The key transformation initiatives within this programme are shown in the following
table:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
23
2.2
.9 L
IVIN
G W
EL
L –
P
lan
on
a P
ag
e
VIS
ION
: C
itiz
en
s w
ill
ach
iev
e a
nd
ma
inta
in a
se
nse
of
we
llb
ein
g b
y le
ad
ing
a h
ea
lth
y l
ife
sty
le s
up
po
rte
d b
y re
sili
en
t
com
mu
nit
ies
CA
SE
FO
R
CH
AN
GE
OU
TC
OM
ES
FO
R P
EO
PLE
EN
AB
LER
S
PR
OG
RA
MM
E A
RE
AS
LE
AD
PA
RT
NE
R(S
) T
AR
GE
TS
Imp
ort
an
ce o
f
he
alt
hy
lif
est
yle
s
acr
oss
th
e l
ife
cou
rse
I a
m a
ble
to
take
ca
re o
f m
y
ow
n h
ea
lth
an
d
we
llb
ein
g,
an
d
am
ab
le t
o
ma
na
ge
th
e
cha
lle
ng
es
tha
t
life
giv
es
me
My
lif
est
yle
he
lps
me
to
sto
p a
ny
Lo
ng
Te
rm C
on
dit
ion
or
dis
ab
ilit
y
ge
ttin
g w
ors
e,
an
d k
ee
ps
the
imp
act
of
this
con
dit
ion
or
dis
ab
ilit
y f
rom
aff
ect
ing
my
life
I le
ad
a h
ap
py
,
fulf
illi
ng
an
d
pu
rpo
sefu
l life
Qu
ali
ty –
wh
ere
pe
op
le
acc
ess
se
rvic
es,
th
ey
wil
l
ha
ve
co
nfi
de
nce
in
th
e
qu
ali
ty o
f ca
re t
he
y w
ill
rece
ive
Pa
rtic
ipa
tio
n –
cit
ize
ns
are
inv
olv
ed
in
pla
nn
ing
an
d s
elf
care
Te
chn
olo
gy
– i
nte
gra
ted
syst
em
s to
su
pp
ort
be
tte
r
pa
tie
nt
care
, in
clu
din
g s
elf
care
Inte
gra
tio
n –
pe
op
le w
ill
ha
ve
acc
ess
a m
uch
mo
re
inte
gra
ted
he
alt
h a
nd
ca
re
syst
em
, w
hic
h i
s b
ett
er
ab
le
to a
nti
cip
ate
an
d r
esp
on
d t
o
the
ir n
ee
ds
Fin
an
cia
l –
po
ole
d b
ud
ge
t
arr
an
ge
me
nts
an
d
inte
gra
ted
bu
sin
ess
an
d
serv
ice
fin
an
cia
l p
lan
nin
g
Wo
rk f
orc
e –
in
teg
rate
d
wo
rkfo
rce
pla
nn
ing
, tr
ain
ing
an
d s
up
po
rt
So
cia
l V
alu
e –
en
suri
ng
th
at
com
mis
sio
nin
g m
axi
mis
es
soci
al,
en
vir
on
me
nta
l a
nd
eco
no
mic
va
lue
fro
m
inv
est
me
nt
Pre
ve
nti
on
: P
rog
ram
me
s to
sup
po
rt p
eo
ple
to
re
du
ce t
he
ir
cha
nce
s o
f d
ev
elo
pin
g t
he
co
mm
on
con
dit
ion
s o
f h
ea
rt d
ise
ase
, ca
nce
r
an
d r
esp
ira
tory
dis
ea
se,
as
we
ll a
s
pre
ve
nti
on
an
d t
rea
tme
nt
serv
ice
s,
an
d w
ork
wit
h p
art
ne
rs i
n h
ou
sin
g
to d
eliv
er
he
alt
h a
nd
we
llb
ein
g
me
ssa
ge
s to
re
sid
en
ts
SC
C,
CC
G,
·
Imp
rov
ed
he
alt
h
an
d w
ell
be
ing
ou
tco
me
s
Fin
an
cia
l a
nd
op
era
tio
na
l
sust
ain
ab
ilit
y o
f
he
alt
h a
nd
so
cia
l
care
sy
ste
m
Bu
ild
ing
re
sili
en
ce f
or
ind
ivid
ua
ls
an
d c
om
mu
nit
ies:
De
velo
pin
g
com
mu
nit
y a
sse
ts,
sig
np
ost
ing
serv
ice
s th
rou
gh
dig
ita
l me
dia
,
pa
tie
nt
an
d c
are
r e
du
cati
on
pro
gra
mm
es
an
d e
ng
ag
ein
g p
eo
ple
wit
h s
erv
ice
s th
rou
gh
th
e V
CS
E
sect
or
an
d f
ire
se
rvic
e
SC
C,
CC
G,
SC
VS
Re
cog
nit
ion
of
ass
et
ba
sed
ap
pro
ach
es
–
bu
ild
ing
fro
m
ind
ivid
ua
l a
nd
com
mu
nit
y
stre
ng
ths
Ea
rly
De
tect
ion
& P
rev
en
tati
ve
Ma
na
ge
me
nt:
NH
S H
ea
lth
Ch
eck
s,
en
cou
rag
ein
g u
pta
ke
of
na
tio
na
l
scre
en
ing
pro
gra
mm
es,
de
ve
lop
ing
a “
Sa
lfo
rd S
tan
da
rd”
for
GP
pra
ctic
es
an
d s
up
po
rtin
g t
ho
se w
ith
lea
rnin
g d
isa
bil
itie
s
SC
C,
CC
G,
Infl
ue
nce
of
‘wid
er
de
term
ina
nts
’ –
po
ve
rty
, h
ou
sin
g,
ed
uca
tio
n,
em
plo
yme
nt,
etc
Wid
er
De
term
ina
nts
: P
rog
ram
me
s
to s
up
po
rt w
ork
(p
aid
an
d u
np
aid
)
skil
ls,
lea
rnin
g a
nd
ro
ute
s b
ack
in
to
em
plo
yme
nt,
id
en
tify
ing
wa
ys
to
imp
rov
e t
he
qu
ali
ty o
f li
fe f
or
resi
de
nts
SC
C,
SC
VS
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
24
2.3 AGEING WELL
2.3.1 Salford has a resident adult population of 183,237, of which nearly 33,200 are aged 65
or older. Compared to other areas, Salford is in the worst quartile or decile for a number of
outcomes relating to long term conditions in the adult population:
· Health related quality of life for people with long term conditions.
· Unplanned hospitalisation for chronic ambulatory sensitive conditions.
· Under 75 mortality rate from both cardiovascular and respiratory disease.
· Potential years of life lost from causes considered amenable to healthcare.
2.3.2 The elderly population is projected to increase by almost 37%, to over 45,600, by 2030.
If no changes are made to the way we support adults and older people, there will be a
corresponding growth in ill-health and demand on services:
· There is likely to be a substantial growth in the number of older people with a limiting
long-term illness, from an estimated 20,712 in 2014 to 27,110 in 2030.
· It is estimated that 2,406 people currently live with dementia in Salford and this is set
to rise to 3,413 by 2030. People with dementia are over-represented in acute beds,
with longer lengths of stay.
· Disability-free life expectancy in Salford is 60 years for men and 58.4 for women – 3.6
and 6.4 years lower than the England average respectively.5
· The number of people aged 65 or over who live alone is projected to grow from 12,865
in 2014 to 16,643 in 2030. Older people often suffer from social isolation and have a
negative perception of crime and their safety.
· By 2030 an extra 5,318 people will have a hearing impairment, and there will be an
additional 3,044 falls in the elderly.
· In the same timeframe, an additional 4,653 people will be unable to manage at least
one domestic task, and 3,817 one self-care task or more. This will increase the need
for caring support in these communities.
2.3.3 Our local proposal is most fully developed for adults and older people, notably through
the move towards an Integrated Care System including Adults and the establishment of an
Integrated Care Organisation. These programmes have been nationally recognised for
leading the way in the integration of health and social care. Both are illustrated in some
detail in section 3 and are fully aligned with the GM PSR programme.
2.3.4 Salford's 2020 vision for older people is for a radically changed health and social care
system, where older people are enabled to retain their independence and take a much more
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
25
active role in their own care. Whilst specialist care and support will continue to be required for
those with the greatest need, the focus will include giving older people more control and
supporting them to be less dependent on services.
2.3.5 More care will be delivered in a community setting, largely in people's homes, with a
corresponding reduction in unplanned demand for hospital care and expensive packages of
social care. Where individuals need to access specialist services, they will have confidence in
the quality of care they will receive and be supported to return to their own home as soon as
possible. As a consequence, quality of life should improve for older people and their carers.
Older people should feel more able to manage their condition and service users should
benefit from being able to access a much more integrated health and social care system,
which is better able to anticipate and respond to their needs.
2.3.6 Salford’s Integrated Care Programme (ICP) for Older People aims to provide:
· Better outcomes for older people
· Improved experience for older people and their carers
· Better use of health and social care resources
Case Study: Dementia United
Dementia has been identified as an early win for the devolution programme, and a core team
has been working with a broad group of stakeholders to determine the components of a 5
year plan which will aim to improve the lived experience for people living with dementia and
their carers and reduce dependence on health and social care services
Salford will set out its improvement plans using the framework below and will describe a portfolio of
activity in each of the domain areas.
· Preventing Well – reducing the risk of dementia in the local population, particularly vascular
dementia
· Diagnosing Well – developing a robust seek and treat system that offers early,
comprehensive, evidence based assessment for all
· Living Well – establishing dementia friendly communities, networks and support AND
ensuring that EVERY person has access to tailored post diagnostic advice / support
· Supporting Well – regular access to the health and social care system as required which
reduce the number and duration of emergency admissions, re-admissions and care home
placement. Ensuring care continuity, irrespective of the location of the individual.
· Dying Well – Focusing on understanding where people living with dementia are dying and
continuously striving to ensure the place of death is aligned with the person and family
preference.
Further information is provided in section 3.
2.3.7 The key transformation initiatives within this programme are shown in the following
table:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
26
2.3
.8 A
GE
ING
WE
LL
–
Pla
n o
n a
Pa
ge
VIS
ION
: O
lde
r p
eo
ple
wil
l ma
inta
in w
ell
be
ing
an
d c
an
acc
ess
hig
h q
ua
lity
he
alt
h a
nd
ca
re,
usi
ng
it
ap
pro
pri
ate
ly
CA
SE
FO
R C
HA
NG
E
OU
TC
OM
ES
FO
R P
EO
PLE
EN
AB
LER
S
PR
OG
RA
MM
E A
RE
AS
LE
AD
PA
RT
NE
R(S
) T
AR
GE
TS
Ag
ein
g p
op
ula
tio
n –
incr
ea
sed
de
ma
nd
fo
r
old
er
pe
op
le’s
se
rvic
es
I a
m a
n o
lde
r
pe
rso
n w
ho
is
loo
kin
g a
fte
r m
y
he
alt
h a
nd
de
lay
ing
th
e n
ee
d
for
care
If I
ne
ed
it,
I w
ill
be
ab
le t
o a
cce
ss
hig
h q
ua
lity
ca
re
an
d s
up
po
rt
I k
no
w t
ha
t w
he
n
I d
ie,
this
wil
l
ha
pp
en
in
th
e
be
st p
oss
ible
circ
um
sta
nce
s
Qu
ali
ty –
wh
ere
old
er
pe
op
le
acc
ess
sp
eci
ali
st s
erv
ice
s, t
he
y
wil
l h
ave
co
nfi
de
nce
in
th
e
qu
ali
ty o
f ca
re t
he
y w
ill r
ece
ive
an
d b
e s
up
po
rte
d t
o r
etu
rn t
o
the
ir o
wn
ho
me
Pa
rtic
ipa
tio
n –
old
er
pe
op
le
an
d t
he
ir c
are
rs a
re i
nvo
lve
d i
n
pla
nn
ing
an
d s
elf
ca
re
Te
chn
olo
gy
– i
nte
gra
ted
syst
em
s to
su
pp
ort
be
tte
r
pa
tie
nt
care
, in
clu
din
g s
elf
ca
re
Inte
gra
tio
n –
old
er
pe
op
le w
ill
ha
ve
acc
ess
a m
uch
mo
re
inte
gra
ted
he
alt
h a
nd
so
cia
l
care
sy
ste
m,
wh
ich
is
be
tte
r
ab
le t
o a
nti
cip
ate
an
d r
esp
on
d
to t
he
ir n
ee
ds
Fin
an
cia
l –
po
ole
d b
ud
ge
t
arr
an
ge
me
nts
an
d i
nte
gra
ted
bu
sin
ess
an
d s
erv
ice
fin
an
cia
l
pla
nn
ing
Wo
rk f
orc
e –
in
teg
rate
d
wo
rkfo
rce
pla
nn
ing
, tr
ain
ing
an
d s
up
po
rt
So
cia
l V
alu
e –
en
suri
ng
th
at
com
mis
sio
nin
g m
axi
mis
es
soci
al,
en
vir
on
me
nta
l a
nd
eco
no
mic
va
lue
fro
m
inv
est
me
nt
Inte
gra
ted
Ca
re O
rga
nis
ati
on
-
bri
ng
ing
to
ge
the
r re
spo
nsi
bil
ity
fo
r
ad
ult
he
alt
h a
nd
so
cia
l ca
re p
rov
isio
n
thro
ug
h a
pri
me
pro
vid
er
mo
de
l
SC
C,
CC
G,
SR
FT,
GM
W F
T
·
19
.7%
re
du
ctio
n i
n
no
n-e
lect
ive
ad
mis
sio
ns
(fro
m
31
5 t
o 2
53
pe
r 1
00
0
65
+ p
pn
)
·
Re
du
ce
rea
dm
issi
on
s to
be
low
er
tha
n t
he
20
11
/12
ba
seli
ne
of
2,0
62
·
26
% r
ed
uct
ion
in
care
ho
me
ad
mis
sio
ns
(fro
m
94
6 t
o 6
99
pe
r
10
0,0
00
65
+ p
pn
·
Incr
ea
se f
lu
va
ccin
ati
on
up
take
rate
to
85
% (
fro
m
ba
seli
ne
po
siti
on
of
77
.2%
in
20
11
/12
).
·
Incr
ea
se t
o 5
0%
pro
po
rtio
n o
f
pe
op
le d
yin
g i
n
pre
ferr
ed
pla
ce
(fro
m b
ase
lin
e o
f
41
% i
n 2
01
1/1
2)
·
Incr
ea
se %
pa
tie
nts
wh
o r
ep
ort
‘li
vin
g
we
ll’
wit
h d
em
en
tia
Fin
an
cia
l a
nd
op
era
tio
na
l
sust
ain
ab
ilit
y o
f h
ea
lth
an
d s
oci
al c
are
sy
ste
m
Co
mm
un
ity
ass
ets
ne
two
rk -
a
fun
da
me
nta
l p
art
of
Sa
lfo
rd’s
Inte
gra
ted
Ca
re P
rog
ram
me
(IC
P)
for
old
er
pe
op
le w
hic
h h
elp
s su
pp
ort
old
er
pe
op
le t
o s
tay
he
alt
hy
an
d w
ell
,
thro
ug
h g
rea
ter
use
of
the
ass
ets
th
at
exi
st lo
cally
in
co
mm
un
itie
s
SC
C,
VC
SE
PA
RT
NE
RS
Imp
rov
ed
he
alt
h a
nd
we
llb
ein
g o
utc
om
es
for
old
er
pe
op
le
Ne
igh
bo
urh
oo
d C
on
ne
cto
rs a
nd
Am
bit
ion
fo
r A
ge
ing
- A
ge
UK
Sa
lfo
rd
ha
s b
ee
n c
om
mis
sio
ne
d t
o d
ev
elo
p a
ne
two
rk o
f N
eig
hb
ou
rly
Co
nn
ect
ors
acr
oss
th
e c
ity
. In
itia
lly
fo
cuse
d a
rou
nd
pro
mo
tin
g W
inte
r W
elf
are
th
is w
ill
be
de
ve
lop
ed
in
to w
ide
r th
em
es
to
sup
po
rt t
he
co
mm
un
ity
ass
et
ne
two
rk.
AG
E U
K,
GM
CV
O,
de
liv
ery
pa
rtn
ers
tb
c
Imp
rov
ed
pa
tie
nt
exp
eri
en
ce a
nd
acc
ess
to
care
En
d o
f Li
fe C
are
- E
ng
ag
em
en
t a
rou
nd
the
de
ve
lop
me
nt
of
Sa
lfo
rd’s
Inte
gra
ted
Ca
re P
rog
ram
me
sh
ow
ed
tha
t e
nd
of
life
ca
re w
as
imp
ort
an
t to
a l
arg
e n
um
be
r o
f p
eo
ple
. A
ll c
are
pla
ns
wil
l in
clu
de
fo
r e
nd
of
life
ca
re
un
de
r th
e P
rog
ram
me
SC
C,
CC
G,
SR
FT,
GM
W F
T
Incr
ea
sed
de
ma
nd
fo
r
care
in
a c
om
mu
nit
y
sett
ing
, la
rge
ly i
n
pe
op
le's
ho
me
s
De
me
nti
a U
nit
ed
- f
ocu
sin
g o
n
imp
rov
em
en
ts w
hic
h d
ire
ctly
im
pa
ct
on
th
e ‘
live
d e
xpe
rie
nce
’ fo
r p
eo
ple
wit
h d
em
en
tia
SR
FT
an
d G
M
Ste
eri
ng
Gro
up
,
Sa
lfo
rd D
em
en
tia
Act
ion
All
ian
ce
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
27
SECTION THREE - TRANSFORMATION
3.1 TRANSFORMATION PRIORITIES
3.1.1 The Nuka health system in Alaska sees the Southcentral Foundation arrange state-
funded health care to a population with extremely high levels of need, and is predicated in the
building of relationships to create a ‘multispecialty community provider’ offering expanded
and integrated primary and community services. We considered this and other innovative
systems in our ambition for social activation, design of services, and personalised care.
3.1.2 Our approach to local delivery and transformation is described under 3 broad areas:
Enabling transformation – underpinning everything will be a number of pieces of cross-
sector enabling work, including the following transformational initiatives:
· Integrated commissioning arrangements
· Co-production and social value
· Information management and use of digital technology
· Rationalisation of estates infrastructure
· Workforce capacity building
· Innovation
· Public engagement
Prevention – we are seeking a radical upgrade in population health through our prevention
work which aims to effectively manage demand for high cost, acute services. It includes:
· Social Movement for Change
· Place based working
· Best start in life
· Promoting healthy lifestyles
· Screening and early detection
· Wider determinants of health and wellbeing
Better Care – Our better care journey includes moving beyond current arrangements on a
trajectory towards integration of commissioning and provision. The work includes:
· Quality of Care
· Community based primary care
· Integrated care
· Hospital care
· Long term conditions
· Mental health
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
28
3.2 DRIVING CHANGE
3.2.1 In this Plan, we seek to push the boundaries and challenge current ways of working. In
order to do this, the Health and Wellbeing Board has endorsed a number of guiding principles
which will underpin the activities of all partners.
3.2.2 Our vision is therefore supported by the following high level strategic principles:
· Salford will have the safest most productive health and wellbeing system in England, with
consistently high quality service standards and metrics.
· Our local citizens will help to shape and be fully engaged in this system, but they will also
recognise the vital role they have in sustaining it by maintaining their own health,
supporting neighbours and friends, and contributing to the local economy.
· Across Salford, partners will come together across the public, private, faith, voluntary and
community sectors to create a fully integrated offer, local accountability and an
accompanying reduction in the acute health and care sector to reflect this shift.
3.2.3 Locally, partners across the city are developing proposals for transformation and reform
across all service areas and sectors – at city level and within individual organisations. We
will underpin the approach to our work going forward with the following delivery principles:
· Ensure care and services in Salford are financially and operationally sustainable,
allocating resources to achieve the best outcomes
· Deliver services are high quality, safe and effective
· Integrate activity wherever possible in planning, commissioning, and delivery
· Put outcomes for people at the heart of the way we work and the care we provide
· Maximise the use of effective digital technology
· Ensure Salford learns and develops, using data and intelligence sourced from across the
public, private and voluntary sectors
· Share leadership and responsibility across all sectors and stakeholders to achieve the
best results for Salford people
· Enable care and support to be accessed as close to home as possible
· Focus on prevention and early intervention
· Ensure the transformation of care delivers benefits in the short, medium and long term
· Work closely with the people of Salford to shape what it looks like
3.2.4 We will ensure that data and intelligence is used from across the public, private and
VCSE sectors to design, and target the available collective resources at those that need
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
29
them the most. There is a recognition that services work best when all aspects of people's
needs including psychological, physical and social factors are taken into account and seen as
a whole.
3.2.5 Our plans will be strongly aligned with local equality, diversity and human rights work in
order to target protected characteristic groups for their input and feedback. This includes
ensuring connectivity with the Salford Equality Strategy 2015 and the Salford Equality
Network. Our greatest asset is the people who live and work in Salford. Ensuring equality in
everything we do and recognising the rich diversity and opportunities provided by the
communities within Salford is vital for our city moving forward. We have prepared a
Community Impact Assessment, which is available at Appendix xx.
3.2.6 This Locality Plan is built on the principles of delivering the four objectives of our
Equality Strategy:
· Increasing voice and influence
· Promoting community cohesion
· Supporting and capacity building community organisations and individuals
· Maximising potential and realising aspiration
3.2.7 Our implementation will be guided by Salford’s Adult and Children’s Safeguarding
Boards towards compliance with relevant legislation, and uphold the six principles of
safeguarding:
1. Empowerment - presumption of person led decisions and informed consent
2. Prevention - it is better to take action before harm occurs
3. Proportionality - proportionate and least intrusive response appropriate to the risk
presented
4. Protection - support and representation for those in greatest need
5. Partnerships - local solutions through services working with their communities
6. Accountability - accountability and transparency in delivering safeguarding.
3.2.8 Each of the transformation programmes includes work which operates across both local
and Greater Manchester footprints. Where a Greater Manchester transformation programme
exists, this is referenced into the appropriate place in our Plan. We have also aligned this
Plan to the City Council-led ‘Shaping our City’ programme, which aims to transform public
services across the city, identifying, exploring and managing dependencies across
programme but also with GM work, partners, ensuring appropriate and sufficient resource to
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
30
deliver changes (eg PMs, ICT development, training, etc) and engaging and involving
members, residents, staff and partners.
3.2.9 We will also ensure that delivery happens across both the life course of Starting Well,
Living Well and Ageing Well, as well as in the short, medium and long time horizons
described in section 1.8. The following diagram examines how we have mapped this:
TIMESCALES – achieving impacts
START
WELL
• improved
schools
readiness
• improved
parenting
LIVE WELL • Reducing
repeat
admissions due
to alcohol
• Primary care
standards
•Alcohol and
tobacco controls
•Increasing
employment
AGE WELL •Falls reduction
2015 2020 2025 2030
3.2.10 Across the life course, we will align our work to achieve the outcomes described in
sections 1 and 2, through a Delivery Plan which is described in the table at Appendix xx.
3.2.11 We also recognise the need for de-commissioning in order to achieve the resource
shift required to drive change in Salford. We will need to make tough decisions about what to
stop, and will ensure safe removal of funds, managing the impact of this on outcomes.
3.3 ENABLING TRANSFORMATION
3.3.1 Our proposed transformation around prevention and better care would not be possible
without a number of enabling work streams operating at both a local and GM level. These will
be fundamental to unlocking system efficiencies and savings, as well as placing resources in
the most effective manner to achieve change. The following tables describe our enabling
programmes:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
31
3.3
.2 I
NT
EG
RA
TE
D C
OM
MIS
SIO
NIN
G
AIM
: st
rea
mli
nin
g,
join
ing
up
an
sh
ari
ng
re
spo
nsi
bil
ity
an
d b
ud
ge
ts f
or
com
mis
sio
nin
g o
f se
rvic
es
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Th
e d
eve
lop
me
nt
of
cle
ar
com
mis
sio
nin
g p
roce
sse
s; i
nv
olv
ing
co
mm
issi
on
ers
, V
CS
E p
rov
ide
rs a
nd
VC
SE
su
pp
ort
org
an
isa
tio
ns
is v
ita
l to
th
e s
ucc
ess
of
the
Lo
cali
ty P
lan
an
d t
his
wil
l h
elp
en
sure
re
cog
nit
ion
of
the
str
en
gth
of
loca
l p
rov
isio
n,
the
ir k
no
wle
dg
e a
nd
str
on
g c
on
ne
ctio
ns
to S
alf
ord
’s d
ive
rse
co
mm
un
itie
s. T
his
wo
rk w
ill
see
org
an
isa
tio
na
l ch
an
ge
on
ly w
he
re t
his
is
req
uir
ed
to
co
mp
lem
en
t sy
ste
m c
ha
ng
e,
an
d a
ims
to p
rote
ct a
nd
va
lue
go
od
pe
op
le.
Th
ere
is
a s
tro
ng
re
lati
on
ship
be
twe
en
Sa
lfo
rd C
ity
Co
un
cil
an
d S
alf
ord
CC
G a
s co
mm
issi
on
ers
of
he
alt
h a
nd
so
cia
l ca
re,
wit
h t
he
jo
int
com
mis
sio
nin
g o
f m
en
tal
he
alt
h
an
d l
ea
rnin
g d
isa
bil
ity
se
rvic
es
see
n a
s a
n e
xem
pla
r in
GM
. S
alf
ord
ha
s p
oo
led
bu
dg
et
arr
an
ge
me
nts
fro
m A
pri
l 2
01
6 f
or
mo
st a
du
lt h
ea
lth
an
d s
oci
al
care
se
rvic
es,
as
we
ll a
s co
lla
bo
rati
on
in
re
spe
ct o
f o
the
r a
spe
cts
of
com
mis
sio
nin
g –
in
clu
din
g c
hil
dre
n,
pu
bli
c h
ea
lth
an
d o
the
r a
rea
s. T
he
CC
G w
ill
ass
um
e r
esp
on
sib
ilit
y fo
r p
rim
ary
care
co
mm
issi
on
ing
(G
Ps)
fro
m N
HS
En
gla
nd
in
Ap
ril 2
01
6.
Cu
rre
nt
join
t co
mm
issi
on
ing
arr
an
ge
me
nts
are
un
de
rgo
ing
a c
om
pre
he
nsi
ve
re
de
sig
n t
o s
up
po
rt t
he
IC
O c
om
mis
sio
nin
g r
eq
uir
em
en
ts.
Th
ere
is
a c
lea
r lo
cal
am
bit
ion
to g
o b
eyo
nd
th
is,
bo
th i
n t
erm
s o
f lo
cal
po
oli
ng
arr
an
ge
me
nts
an
d i
n t
erm
s o
f fl
exi
ng
jo
int
com
mis
sio
nin
g a
rra
ng
em
en
ts o
nce
th
e I
CO
is
est
ab
lish
ed
an
d o
pe
rati
ng
eff
ect
ive
ly.
Ho
we
ver,
th
ere
is
als
o r
eco
gn
itio
n t
ha
t th
is i
s a
5 –
10
ye
ar
jou
rne
y,
wh
ich
wil
l b
uil
d o
n t
he
exp
eri
en
ce o
f o
the
rs,
an
d m
ust
be
su
pp
ort
ed
by
up
-fro
nt
fin
an
cia
l in
ve
stm
en
t. W
e a
im t
o a
chie
ve a
re
du
ctio
n i
n f
rag
me
nta
tio
n,
wit
h i
nce
nti
ve
s fo
r co
mm
un
ity
an
d p
rim
ary
ca
re p
rov
isio
n a
nd
re
du
ced
tra
nsa
ctio
na
l co
sts
of
con
tra
ctin
g a
nd
co
mm
issi
on
ing
an
d s
hif
t to
ou
tco
me
ba
sed
/ s
tra
teg
ic c
om
mis
sio
nin
g
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Ag
ree
ing
sh
are
d p
rio
riti
es
for
com
mis
sio
ne
rs,
wit
h a
pri
nci
pa
l fo
cus
on
imp
rov
ing
th
e h
ea
lth
of
the
wh
ole
po
pu
lati
on
·
Incr
ea
sin
gly
jo
inin
g u
p t
he
NH
S w
ith
th
e lo
cal a
uth
ori
ty c
om
mis
sio
nin
g r
ole
– b
uil
din
g o
n w
ha
t w
e h
ave
do
ne
alr
ea
dy
·
Lea
de
rsh
ip –
de
velo
pin
g ‘
syst
em
th
ink
ing
’ a
nd
co
lla
bo
rati
ve
lea
de
rsh
ip m
od
els
wh
ich
im
pa
ct o
n w
ho
le p
op
ula
tio
n h
ea
lth
an
d w
ell
be
ing
, b
ut
imp
ort
an
t to
re
tain
acc
ou
nta
bil
ity
fo
r p
ati
en
ts w
ith
in t
his
sy
ste
m (
ie w
ho
is t
he
na
me
d c
lin
icia
n r
esp
on
sib
le f
or
my
ca
re)
·
Cu
ltu
re –
de
ve
lop
ing
a v
isio
n w
hic
h d
eli
vers
ou
tco
me
s fo
r p
eo
ple
acr
oss
org
an
isa
tio
ns;
sp
eci
fica
lly
ad
dre
ssin
g t
he
‘fe
ar’
of
acu
te c
en
tra
lisa
tio
n a
nd
th
e f
act
th
at
pri
ma
ry c
are
is
no
t ‘o
ne
org
an
isa
tio
n’;
be
com
ing
an
att
ract
or
of
tale
nt
by
cre
ati
ng
a b
ran
d a
nd
‘cu
ltu
re’
of
be
ing
th
e b
est
·
Da
ta a
nd
in
form
ati
cs –
usi
ng
da
ta a
nd
IT
to
dri
ve
a ‘
po
pu
lati
on
he
alt
h’
ap
pro
ach
; u
sin
g d
ata
to
pre
dic
t d
em
an
d;
sta
nd
ard
s-b
ase
d a
pp
roa
ch t
o r
ed
uce
un
wa
rra
nte
d
va
ria
tio
n,
em
po
we
red
pa
tie
nts
dri
vin
g s
elf
-ca
re t
hro
ug
h p
ers
on
al
bu
dg
ets
·
Pa
ym
en
ts a
nd
in
cen
tiv
es
– o
utc
om
es
ba
sed
/ c
lea
r ri
sk s
ha
res
– c
lea
r li
nk
to
qu
ali
ty a
nd
imp
rov
em
en
t o
utc
om
es;
min
imis
ing
va
ria
tio
n a
cro
ss t
he
sy
ste
m
·
Ch
oic
e –
Pa
tie
nts
re
tain
ab
ility
to
ch
oo
se w
he
re t
o g
o f
or
the
ir c
are
– i
nce
nti
vis
ing
th
e s
yst
em
to
ke
ep
Sa
lfo
rd p
ati
en
ts i
n S
alf
ord
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Sta
nd
ard
s b
ase
d a
pp
roa
ch t
o d
eliv
er
imp
rov
ed
ou
tco
me
s –
in
clu
din
g P
rim
ary
Ca
re (
Sa
lfo
rd S
tan
da
rd)
·
Fu
ll i
nte
gra
tio
n o
f ca
re a
cro
ss p
rev
en
tio
n,
pri
ma
ry c
are
, co
mm
un
ity
he
alt
h,
soci
al c
are
, a
cute
ca
re,
me
nta
l h
ea
lth
·
Se
rvic
es
com
mis
sio
ne
d f
rom
a s
ing
le o
rga
nis
ati
on
or
thro
ug
h a
‘su
pp
ly c
ha
in’
– w
he
re p
rov
ide
rs w
ork
to
ge
the
r
·
Fe
ed
fro
m a
nd
fu
rth
er
de
velo
p a
rra
ng
em
en
ts a
s n
ext
ste
p a
lon
g j
ou
rne
y f
oll
ow
ing
est
ab
lish
me
nt
of
ICO
fro
m A
pri
l 20
16
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
32
3.3
.3 C
O-P
RO
DU
CT
ION
AN
D S
OC
IAL
VA
LUE
A
IM:
to w
ork
co
lla
bo
rati
ve
ly w
ith
VC
SE
an
d o
the
r lo
cal
pro
vid
ers
to
ma
xim
ise
re
ac
h,
ou
tco
me
s a
nd
im
pa
ct
be
yo
nd
sta
tuto
ry p
rov
isio
n.
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Co
-pro
du
ctio
n i
s a
te
rm t
ha
t re
fers
to
a w
ay
of
wo
rkin
g w
he
reb
y d
eci
sio
n-m
ak
ers
an
d c
itiz
en
s, o
r se
rvic
e p
rov
ide
rs a
nd
use
rs,
wo
rk t
og
eth
er
to c
rea
te a
de
cisi
on
or
a
serv
ice
wh
ich
wo
rks
for
the
m a
ll.
Th
e a
pp
roa
ch i
s va
lue
-dri
ve
n a
nd
bu
ilt
on
th
e p
rin
cip
le t
ha
t th
ose
wh
o a
re a
ffe
cte
d b
y a
se
rvic
e a
re b
est
pla
ced
to
he
lp d
esi
gn
it.
We
wil
l e
xplo
re a
nd
use
co
-pro
du
ctio
n a
pp
roa
che
s w
he
re t
he
se c
an
bri
ng
de
mo
nst
rab
le r
esu
lts
an
d i
mp
rove
me
nts
, in
clu
din
g p
art
icip
ato
ry a
pp
rais
al
an
d b
ud
ge
tin
g,
de
lib
era
tive
op
inio
n p
oll
s, c
itiz
en
s' j
uri
es,
Op
en
Sp
ace
an
d T
ime
ba
nk
ing
.
Sa
lfo
rd h
as
a w
ell
-est
ab
lish
ed
, a
ctiv
e a
nd
div
ers
e V
CS
E s
ect
or
wh
ich
is
we
ll p
lace
d t
o d
eliv
er
the
pro
act
ive
ag
en
da
th
at
tak
es
an
ass
et-
ba
sed
an
d p
ers
on
-ce
ntr
ed
ap
pro
ach
to
imp
rov
ing
he
alt
h o
utc
om
es
wit
h a
fo
cus
on
pre
ven
tio
n a
nd
ea
rly
in
terv
en
tio
n,
wh
ilst
ad
dre
ssin
g g
ap
s in
exi
stin
g p
rov
isio
n a
nd
me
eti
ng
ne
w a
nd
em
erg
ing
ne
ed
. I
nv
est
me
nt
in l
oca
l co
mm
un
itie
s a
nd
th
e l
oca
l V
CS
E o
rga
nis
ati
on
s th
at
sup
po
rt t
he
m w
ill
en
ab
le c
on
sid
era
ble
sa
vin
gs
fro
m a
re
du
ctio
n i
n d
em
an
d o
n e
xpe
nsi
ve
clin
ica
l /
pu
bli
c se
cto
r se
rvic
es.
Sa
lfo
rd e
mb
race
s th
e f
ind
ing
s a
nd
re
com
me
nd
ati
on
s co
nta
ine
d i
n t
he
re
cen
t U
CL
rep
ort
1,
an
d w
ill
ma
ke
co
nn
ect
ion
s b
etw
ee
n s
oci
al
va
lue
an
d h
ea
lth
eq
uit
y –
usi
ng
com
mis
sio
nin
g d
eci
sio
ns,
pro
cure
me
nt
pro
cess
es
an
d c
on
tra
ct m
an
ag
em
en
t to
se
ek
th
e m
axi
mu
m s
oci
al,
en
vir
on
me
nta
l a
nd
eco
no
mic
we
llb
ein
g b
en
efi
t fr
om
pu
bli
c
sect
or
spe
nd
ing
. W
e h
op
e t
ha
t h
av
ing
a b
roa
de
r u
nd
ers
tan
din
g o
f th
e w
ide
r d
ete
rmin
an
ts o
f h
ea
lth
, w
he
n l
ink
ed
wit
h a
n a
spir
ati
on
to
ma
xim
ise
so
cia
l v
alu
e,
wil
l le
ad
to s
ust
ain
ed
im
pa
cts
on
po
pu
lati
on
we
llb
ein
g,
an
d w
ill
use
so
cia
l v
alu
e t
o t
ake
act
ion
on
he
alt
h i
ne
qu
ali
tie
s. B
ud
ge
t sa
vin
gs
mu
st b
e m
ad
e,
bu
t a
bro
ad
er
focu
s o
n
ou
tco
me
s a
s w
ell
as
fisc
al
be
ne
fit
sho
uld
un
de
rpin
th
e d
eci
sio
n-m
ak
ing
an
d t
ran
siti
on
pro
cess
es,
if
the
we
llb
ein
g o
f th
e p
eo
ple
of
this
cit
y i
s n
ot
to s
uff
er.
We
wil
l
ma
xim
ise
th
e v
alu
e a
chie
ved
fro
m o
ur
red
uce
d r
eso
urc
es
thro
ug
h s
oci
al
va
lue
op
po
rtu
nit
ies
wh
ich
wil
l m
ake
th
e m
ost
dif
fere
nce
, in
clu
din
g a
fo
cus
on
be
ha
vio
ur
cha
ng
e,
com
mu
nit
y re
silie
nce
an
d t
he
wid
er
de
term
ina
nts
of
he
alt
h.
We
wil
l e
xplo
re w
ay
s to
mo
de
l so
cia
l v
alu
e a
nd
re
turn
on
in
ve
stm
en
t, i
ncl
ud
ing
th
e H
ea
lth
In
eq
ua
liti
es
too
l w
e h
ave
de
velo
pe
d i
n c
olla
bo
rati
on
wit
h L
JMU
. T
his
to
ol
all
ow
s u
s to
mo
de
l a
spir
ati
on
al
pe
rfo
rma
nce
ag
ain
st a
n a
gre
ed
in
dic
ato
r se
t a
nd
to
qu
an
tify
th
e l
ike
ly i
mp
rov
em
en
ts t
his
de
live
rs.
Th
is w
ill
info
rm t
he
wo
rk t
o p
red
ict
the
re
sult
ing
sa
vin
gs
in t
he
he
alt
h &
so
cia
l ca
re s
yst
em
if
tho
se t
arg
ets
are
ach
iev
ed
an
d b
e a
co
lla
bo
rati
ve
exe
rcis
e u
nd
ert
ake
n w
ith
Ne
w E
con
om
y,
Pu
bli
c H
ea
lth
En
gla
nd
an
d o
ur
loca
l in
telli
ge
nce
ne
two
rk.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
To
he
lp m
an
ag
e l
ow
leve
l d
em
an
d,
by
ma
kin
g t
his
pa
rt o
f ‘a
dd
ed
va
lue
’ to
se
rvic
e c
om
mis
sio
nin
g,
rath
er
tha
n r
eq
uir
ing
a s
pe
cifi
c ta
rge
ted
se
rvic
e
·
To
in
clu
de
a f
ocu
s o
n c
oll
ab
ora
tio
n a
nd
co
-pro
du
ctio
n
·
To
he
lp m
an
ag
e t
he
me
ssa
ge
s a
rou
nd
bu
dg
et
red
uct
ion
s, a
s w
e w
ill
be
se
en
to
be
ge
ttin
g b
ett
er
‘va
lue
fo
r m
on
ey
’ fr
om
in
ve
stm
en
ts a
nd
act
ivit
ies
·
To
be
pa
rt o
f th
e r
isk
mit
iga
tio
n f
or
seve
ral o
f th
e b
ud
ge
t o
pti
on
s
·
To
all
ow
lo
cal
VC
SE
pro
vid
ers
to
co
mp
ete
mo
re e
ffe
ctiv
ely
in
a t
en
de
r si
tua
tio
n,
an
d t
he
se p
rov
ide
rs w
ill
leve
r in
ad
dit
ion
al
fun
din
g f
rom
ch
ari
tab
le a
nd
oth
er
sou
rce
s o
uts
ide
of
the
sy
ste
m.
·
Sa
lfo
rd w
ill
en
sure
th
at
mo
ne
y sp
en
t b
y c
om
mis
sio
ne
rs i
s sp
en
t in
a w
ay
tha
t re
du
ces
ine
qu
ali
tie
s, i
mp
rove
s th
e w
ide
r h
ea
lth
be
ne
fit
to t
he
po
pu
lati
on
an
d
1 U
CL
Inst
itu
te o
f H
ea
lth
Eq
uit
y ‘U
sin
g t
he
So
cia
l V
alu
e A
ct t
o r
ed
uce
he
alt
h i
ne
qu
ali
tie
s in
En
gla
nd
th
rou
gh
act
ion
on
th
e s
oci
al
de
term
ina
nts
of
he
alt
h’
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
33
be
com
es
pa
rt o
f o
ur
pre
ve
nti
on
ag
en
da
go
ing
fo
rwa
rd.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
We
wil
l d
ev
elo
p a
Str
ate
gy
for
the
VC
SE
Se
cto
r –
fo
r it
s fu
ture
de
ve
lop
me
nt
of
act
ive
pa
rtic
ipa
tio
n i
n c
o-p
rod
uce
d s
erv
ice
s
·
Fu
rth
er
rais
ing
th
e p
rofi
le o
f so
cia
l v
alu
e b
en
efi
ts a
cro
ss t
he
he
alt
h a
nd
so
cia
l ca
re s
yst
em
, b
uil
d c
ap
aci
ty t
o e
va
lua
te a
nd
re
po
rt o
n s
oci
al
valu
e,
an
d e
xpa
nd
so
cia
l
va
lue
in
co
mm
issi
on
ing
, le
d b
y S
alf
ord
’s S
oci
al
Va
lue
All
ian
ce a
nd
su
pp
ort
ed
by
inv
est
me
nt
fro
m t
he
He
alt
h a
nd
We
llb
ein
g B
oa
rd’s
Str
ate
gy
Fu
nd
.
·
Pro
vid
er
org
an
isa
tio
ns
wil
l pu
bli
sh ‘
soci
al
acc
ou
nts
’ a
lon
gsi
de
th
eir
fin
an
cia
l a
cco
un
ts
·
In o
rde
r to
en
ab
le m
ore
pe
op
le,
an
d p
eo
ple
wh
o a
re f
art
he
st f
rom
vo
lun
tee
rin
g,
to c
on
trib
ute
, w
e w
ill
inve
st i
n t
he
de
velo
pm
en
t a
nd
on
go
ing
su
pp
ort
of
vo
lun
tee
rin
g i
n S
alf
ord
in
ord
er
to b
oth
su
sta
in c
urr
en
t vo
lun
tee
rin
g l
eve
ls a
nd
in
cre
ase
th
e n
um
be
r o
f p
eo
ple
un
de
rta
kin
g q
ua
lity
vo
lun
tee
rin
g.
Ca
se S
tud
y –
Th
e T
hir
d S
ect
or
Fu
nd
(in
ve
stm
en
t fr
om
NH
S S
alf
ord
CC
G,
20
14
/15
an
d 2
01
5/1
6
Th
e m
ain
aim
of
the
Th
ird
Se
cto
r F
un
d 2
01
4/1
5 w
as
to e
na
ble
Sa
lfo
rd C
VS
to
op
era
te a
ra
ng
e o
f g
ran
ts p
rog
ram
me
s th
at
we
re a
cce
ssib
le t
o V
CS
E o
rga
nis
ati
on
s
op
era
tin
g i
n S
alf
ord
an
d w
hic
h w
ou
ld e
na
ble
th
ose
org
an
isa
tio
ns
to c
on
trib
ute
to
ad
dre
ssin
g t
he
he
alt
h p
rio
riti
es
for
Sa
lfo
rd,
as
ide
nti
fie
d i
n t
he
jo
int
He
alt
h &
We
llb
ein
g S
tra
teg
y (J
HW
S).
Up
on
la
un
chin
g t
he
Th
ird
Se
cto
r F
un
d i
n 2
01
4 D
r H
am
ish
Ste
dm
an
, C
ha
ir o
f S
alf
ord
CC
G,
said
: “T
he
co
ntr
ibu
tio
n t
ha
t lo
cal
com
mu
nit
y a
nd
vo
lun
tee
rs g
rou
ps
ma
ke
to
pe
op
le’s
ha
pp
ine
ss a
nd
he
alt
h i
s cl
ea
r. T
he
CC
G i
s d
eli
gh
ted
to
be
ab
le t
o p
rovid
e a
dd
itio
na
l fu
nd
ing
so
th
at
such
gro
up
s m
ay f
lou
rish
an
d
be
ava
ila
ble
to
as
ma
ny p
eo
ple
in
Sa
lfo
rd a
s p
oss
ible
.”
In 2
01
5 N
HS
Sa
lfo
rd C
CG
’s P
erf
orm
an
ce M
an
ag
em
en
t G
rou
p m
ad
e t
he
fo
llo
win
g r
eco
mm
en
da
tio
n f
or
a f
urt
he
r in
ve
stm
en
t in
th
e V
CS
E s
ect
or
via
th
e T
hir
d S
ect
or
Fu
nd
. “P
MG
ack
no
wle
dg
es
the
in
ve
stm
en
t m
ad
e i
n t
he
vo
lun
tary
se
cto
r re
pre
sen
ted
re
al va
lue
fo
r m
on
ey a
nd
ha
s a
sig
nif
ica
nt
imp
act
on
ma
ny l
ive
s in
th
e
com
mu
nit
y.
PM
G a
lso
no
tes
furt
he
r fu
nd
ing
all
oca
tio
ns
wo
uld
su
pp
ort
gre
ate
r p
art
ne
rsh
ip w
ork
ing
in
ta
rge
tin
g h
ea
lth
in
eq
ua
liti
es
or
he
alt
h i
ssu
es
acr
oss
th
e c
ity.”
In 2
01
4/1
5,
mo
re t
ha
n 1
00
vo
lun
tary
org
an
isa
tio
ns,
co
mm
un
ity
gro
up
s, s
oci
al e
nte
rpri
ses
an
d s
cho
ols
be
ne
fite
d f
rom
th
e T
hir
d S
ect
or
Fun
d.
Th
ese
in
clu
de
d t
he
Incr
ed
ible
Ed
ible
’s T
ind
all
St
Pro
ject
wh
o u
sed
a g
ran
t to
su
pp
ort
mo
re v
olu
nte
ers
, a
nd
th
e L
ow
er
Ke
rsa
l Y
ou
ng
Pe
op
le’s
Gro
up
wh
o,
tha
nk
s to
a £
10
,00
0
Imp
rov
em
en
t F
un
d g
ran
t, w
ere
ab
le t
o w
ork
wit
h a
nu
mb
er
of
yo
un
g f
am
ilie
s to
he
lp t
he
m g
row
th
eir
ow
n f
ruit
an
d v
eg
eta
ble
s o
n a
ne
arb
y a
llotm
en
t, w
hic
h t
he
y
cou
ld t
he
n u
se t
o m
ake
th
eir
ow
n h
ea
lth
y m
ea
ls.
Pro
ject
s h
ave
ta
rge
ted
all
of
the
pri
ori
tie
s o
f th
e J
HW
S a
nd
acr
oss
th
e a
ge
ra
ng
e;
pro
vid
ing
su
pp
ort
fo
r lo
cal
pe
op
le
to m
an
ag
e l
on
g t
erm
he
alt
h c
on
dit
ion
s, s
uch
as
he
art
dis
ea
se a
nd
dia
be
tes;
ta
ke
mo
re e
xerc
ise
– e
nco
ura
ge
d b
y R
ug
by
Le
ag
ue
pla
ye
rs;
an
d r
ed
uce
th
e im
pa
cts
of
low
lev
el m
en
tal
he
alt
h c
on
dit
ion
s o
n p
eo
ple
’s l
ive
s.
3.3
.4 I
NF
OR
MA
TIO
N M
AN
AG
EM
EN
T A
ND
TE
CH
NO
LOG
Y
AIM
: m
ax
imis
e t
he
op
po
rtu
nit
ies
to a
chie
ve
eff
icie
ncy
th
rou
gh
th
e u
se o
f d
igit
al
tech
no
log
y
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Sa
lfo
rd s
tak
eh
old
ers
ha
ve
cre
ate
d a
co
mm
on
vis
ion
fo
r a
co
nn
ect
ed
cit
y: S
alf
ord
ian
s w
ill
live
, le
arn
an
d w
ork
in
th
e m
ost
co
nn
ect
ed
cit
y i
n t
he
wo
rld
. T
ech
no
log
y d
oe
s
no
t o
pe
rate
in
iso
lati
on
an
d w
ill
fea
ture
in
ma
ny
oth
er
sect
ion
s o
f th
is p
lan
. It
is
a p
rov
en
en
ab
ler
in t
ran
sfo
rmin
g h
ea
lth
an
d c
are
fo
r p
eo
ple
an
d w
e m
ust
de
live
r th
e
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
34
rig
ht
infr
ast
ruct
ure
, sy
ste
ms,
in
tell
ige
nce
an
d a
cce
ss t
o m
ee
t th
e n
ee
ds
of
the
fu
ture
mo
de
l of
he
alt
h a
nd
ca
re.
To
do
th
is w
e h
av
e f
ive
pro
gra
mm
es
of
wo
rk:
Bu
ild
ing
a c
on
ne
cte
d c
ity
to
ge
the
r fo
r S
alf
ord
Ov
er
the
la
st 1
2 m
on
ths
the
Sa
lfo
rd p
art
ne
rs h
av
e b
ee
n d
ev
elo
pin
g a
Cit
ywid
e I
M&
T s
tra
teg
y.
Th
e a
im o
f th
is s
tra
teg
y is
to
de
scri
be
ho
w p
art
ne
rs w
ill
wo
rk t
og
eth
er
to r
ea
lise
th
e c
on
ne
cte
d c
ity
am
bit
ion
, a
nd
is
wid
er
tha
n h
ea
lth
an
d i
ncl
ud
es
soci
al,
eco
no
mic
, a
nd
en
vir
on
me
nta
l h
ea
lth
of
Sa
lfo
rd r
esi
de
nts
. It
wil
l e
ng
ag
e c
itiz
en
s
an
d o
rga
nis
ati
on
s, b
usi
ne
ss a
nd
in
du
stry
.
Dig
ita
l Fi
rst
for
Sa
lfo
rdia
ns
We
are
aw
are
th
at
pro
gre
ssin
g t
o a
dig
ita
l fi
rst
solu
tio
n c
ou
ld e
xclu
de
so
me
pe
op
le.
To
th
is e
nd
Sa
lfo
rd r
un
s th
e ‘
Go
ON
’ P
rog
ram
me
, G
o O
N i
s a
na
tio
na
l ca
mp
aig
n
wh
ich
aim
s to
bri
ng
th
e b
en
efi
ts o
f d
igit
al
skil
ls,
incl
ud
ing
th
e i
nte
rne
t, t
o e
ve
ry i
nd
ivid
ua
l, o
rga
nis
ati
on
an
d c
om
mu
nit
y.
Loca
lly
, S
alf
ord
Cit
y C
ou
nci
l is
co
ord
ina
tin
g
act
ivit
y f
or
Sa
lfo
rd,
sup
po
rte
d b
y a
wid
e r
an
ge
of
org
an
isa
tio
ns
incl
ud
ing
Sa
lfo
rd C
ity
Co
lle
ge
, S
alf
ord
Co
mm
un
ity
Le
isu
re,
Un
ion
lea
rn,
soci
al
ho
usi
ng
pro
vid
ers
, th
e
De
pa
rtm
en
t fo
r W
ork
an
d P
en
sio
ns,
to
ge
the
r w
ith
nu
me
rou
s co
mm
un
ity
an
d v
olu
nta
ry o
rga
nis
ati
on
s in
clu
din
g A
ge
UK
Sa
lfo
rd.
Pro
act
ive
use
of
Inte
llig
en
ce -
Co
lla
bo
rati
on
o
n I
nfo
rma
tio
n,
da
ta s
ha
rin
g a
nd
in
no
va
tio
n
It i
s e
sse
nti
al
to u
nd
ers
tan
d o
ur
po
pu
lati
on
an
d i
ts h
ea
lth
, ca
re a
nd
wid
er
ne
ed
s a
nd
an
in
teg
rate
d a
pp
roa
ch t
o d
ata
so
urc
es
av
ail
ab
le i
s e
sse
nti
al.
Th
e C
ou
nci
l, C
CG
an
d S
RF
T h
av
e s
tro
ng
in
tell
ige
nce
an
d d
ata
te
am
s th
at
alr
ea
dy
wo
rk t
og
eth
er
to c
on
trib
ute
to
an
d r
ece
ive
JS
NA
pro
du
cts
to i
nfo
rm s
erv
ice
pla
nn
ing
. A
ke
y
req
uir
em
en
t is
a t
oo
l to
en
ab
le f
ull
an
aly
sis
of
po
pu
lati
on
he
alt
h a
nd
ne
ed
s to
su
pp
ort
co
mm
issi
on
ers
an
d p
rov
ide
rs t
o o
pe
rate
pro
act
ive
pre
ven
tio
n a
nd
dis
ea
se s
elf
-
ma
na
ge
me
nt
pro
gra
mm
es
wit
hin
Sa
lfo
rd.
Pre
dic
tive
an
aly
tics
is
the
use
of
da
ta s
cie
nce
te
chn
iqu
es
at
sca
le,
usi
ng
a v
ari
ety
of
da
ta s
ou
rce
s fr
om
th
e c
ity
in
clu
din
g
wid
er
pu
bli
c se
rvic
es,
(fi
re,
em
plo
yme
nt,
po
lice
he
alt
h a
nd
so
cia
l ca
re)
as
we
ll a
s co
nsu
me
r a
nd
su
rve
y d
ata
.
Dig
ita
l R
oa
dm
ap
/ I
M&
T S
tra
teg
y f
or
Pri
ma
ry C
are
Th
e G
rea
ter
Ma
nch
est
er
IM&
T s
tra
teg
y f
or
pri
ma
ry c
are
ha
s b
ee
n b
uil
t o
n t
o e
na
ble
it
to m
an
ag
e t
he
dig
ita
l ro
ad
ma
p a
cro
ss a
GM
fo
otp
rin
t, l
ed
by
Wig
an
CC
G.
Th
e
pla
n h
as
five
th
em
es
Co
nn
ect
, In
teg
rate
, E
mp
ow
er
an
d C
oll
ab
ora
te a
nd
Un
de
rsta
nd
. S
alf
ord
CC
G w
ill
act
as
a l
oca
l fa
cili
tato
r a
nd
th
e p
lan
wil
l b
e b
ase
d o
n p
rin
cip
les
set
at
a G
rea
ter
Ma
nch
est
er
lev
el
bu
t im
ple
me
nte
d a
nd
de
sig
ne
d f
or
ea
ch l
oca
lity
. S
alf
ord
wil
l co
nti
nu
e w
ork
ing
up
a l
oca
l st
rate
gy
an
d i
mp
lem
en
tati
on
pla
n w
hic
h
wil
l su
pp
ort
an
d d
eve
lop
th
ese
th
em
es
an
d e
nsu
re p
rim
ary
ca
re h
as
the
te
chn
olo
gy
to
fu
lly
en
ga
ge
wit
h n
ew
mo
de
ls o
f ca
re.
Sa
lfo
rd I
nte
gra
ted
Re
cord
Sa
lfo
rd p
eo
ple
acc
ess
ma
ny
se
rvic
es
wit
hin
Sa
lfo
rd a
nd
be
yo
nd
. T
he
NH
S w
ith
in S
alf
ord
ha
s th
ree
sig
nif
ica
nt
sets
of
pro
vid
ers
, P
rim
ary
ca
re d
eliv
ere
d b
y 4
7 G
P
Pra
ctic
es,
Se
con
da
ry a
nd
co
mm
un
ity
ca
re d
eli
vere
d b
y S
alf
ord
Ro
ya
l F
ou
nd
ati
on
Tru
st a
nd
me
nta
l h
ea
lth
de
liv
ere
d b
y G
rea
ter
Ma
nch
est
er
We
st N
HS
Tru
st.
Ea
ch o
f
the
se u
ses
a c
lie
nt
or
pa
tie
nt
reco
rd s
olu
tio
n w
hic
h e
na
ble
s re
cord
ing
an
d d
eli
ve
ry o
f sa
fe c
are
. S
alf
ord
So
cia
l C
are
als
o h
as
a s
yst
em
wh
ich
en
ab
les
ass
ess
me
nts
,
pa
ym
en
ts a
nd
pa
cka
ge
s o
f ca
re t
o b
e r
eco
rde
d.
Wh
at
the
se s
yst
em
s d
o n
ot
do
ea
sily
at
pre
sen
t is
lin
k e
asi
ly.
Sa
lfo
rd b
eg
an
a S
alf
ord
In
teg
rate
d R
eco
rd P
rog
ram
me
in
20
09
wh
ich
en
ab
les
reco
rd s
ha
rin
g b
etw
ee
n p
rim
ary
ca
re a
nd
se
con
da
ry c
are
. T
he
pu
bli
c w
ere
fu
lly
con
sult
ed
an
d h
av
e t
he
ch
oic
e t
o o
pt
ou
t (o
r b
ack
in
) a
t a
ny
tim
e.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
an
d t
he
se
rvic
es
an
d p
rog
ram
me
s w
hic
h w
ill d
eli
ver
the
se p
rio
riti
es
ove
r th
e n
ext
5 y
ea
rs i
ncl
ud
e:
Bu
ild
ing
a c
on
ne
cte
d c
ity
to
ge
the
r fo
r S
alf
ord
·
De
live
r a
Wi-
Fi
city
·
De
ve
lop
pa
rtn
ers
hip
s w
ith
SM
Es
an
d lo
cal
bu
sin
ess
es
·
De
ve
lop
a n
um
be
r o
f g
oo
d p
ract
ice
fu
lly i
nte
gra
ted
in
itia
tive
s to
te
st t
he
pri
nci
ple
s- f
irst
on
e b
ein
g d
em
en
tia
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
35
·
Re
vie
w o
pti
on
s fo
r a
ssis
tive
te
chn
olo
gy
an
d u
se o
f a
pp
s fo
r se
lf-c
are
an
d t
oo
ls f
or
rem
ote
ma
na
ge
me
nt
Dig
ita
l Fi
rst
for
Sa
lfo
rdia
ns
·
To
an
aly
se a
nd
un
de
rsta
nd
th
e n
atu
re o
f d
igit
al
skil
ls w
ith
in S
alf
ord
an
d e
nsu
re t
his
is
ext
en
de
d t
o r
ed
uce
th
e n
um
be
rs o
f d
igit
all
y e
xclu
de
d.
.
·
To
ma
ke a
ch
oic
e o
f a
cce
ss a
va
ila
ble
usi
ng
dig
ita
l a
s m
uch
a p
oss
ible
.
Pro
act
ive
use
of
Inte
llig
en
ce -
Co
lla
bo
rati
on
o
n I
nfo
rma
tio
n,
da
ta s
ha
rin
g a
nd
in
no
va
tio
n
·
Re
vie
w
soft
wa
re
an
d
reso
urc
es
req
uir
ed
to
u
nd
ert
ak
e
com
pre
he
nsi
ve
po
pu
lati
on
h
ea
lth
a
na
lyti
cs
to
sup
po
rt
targ
ete
d
inte
rve
nti
on
s fo
r th
e
Sa
lfo
rd
pro
gra
mm
es
of
Sta
rt W
ell
, Li
ve
We
ll a
nd
Ag
e W
ell
.
·
De
ve
lop
pre
dic
tiv
e a
na
lyti
c te
chn
iqu
es
for
use
in
Sa
lfo
rd,
in c
on
jun
ctio
n w
ith
pa
rtn
ers
.
·
Re
vie
w o
pp
ort
un
itie
s to
str
ea
mli
ne
da
ta f
low
s a
nd
da
ta a
na
lysi
s to
re
du
ce d
up
lica
tio
n.
·
Wo
rk w
ith
wid
er
GM
in
itia
tiv
es
an
d n
etw
ork
s to
re
de
sig
n s
erv
ice
s to
me
et
po
pu
lati
on
ne
ed
s.
Dig
ita
l R
oa
dm
ap
/ I
M&
T S
tra
teg
y f
or
Pri
ma
ry C
are
·
Pri
ma
ry C
are
IT
pla
n a
gre
ed
by
Ma
rch
20
16
to
ta
ke S
alf
ord
pri
ma
ry c
are
to
wa
rds
go
ld s
tan
da
rd d
igit
al m
atu
rity
.
·
Pu
bli
cati
on
of
the
GM
ro
ad
ma
p 2
01
6.
·
Imp
lem
en
tati
on
of
the
se p
lan
s 2
01
6-2
02
0 w
ith
an
nu
al
pro
gre
ss r
ep
ort
s a
nd
re
vie
w.
·
Inte
gra
ted
Ca
re O
rga
nis
ati
on
- t
o c
on
tin
ue
wh
at
sta
rte
d a
s se
pa
rate
jo
urn
ey
s to
pa
pe
r li
gh
t. T
he
IC
O w
ill
loo
k t
o s
ha
re l
ea
rnin
g a
nd
en
sure
co
mm
un
ity
ba
sed
serv
ice
s h
av
e m
ob
ile
acc
ess
to
re
cord
s.
·
Inte
gra
tio
n o
f p
ap
er
lig
ht
pla
ns
acr
oss
GM
an
d a
t se
cto
r a
nd
loca
lity
le
ve
l.
·
En
sure
co
nst
an
t re
vie
w o
f d
ev
elo
pm
en
ts s
uch
as
ass
isti
ve
te
chn
olo
gy
to
su
pp
ort
pa
tie
nt
care
an
d s
elf
-ca
re.
·
A p
rin
cip
le o
f in
tero
pe
rab
ilit
y f
irst
ap
pli
ed
to
all
in
ve
stm
en
ts m
ad
e i
n t
ech
no
log
y.
·
En
sure
un
de
rly
ing
te
chn
ica
l in
fra
stru
ctu
re i
s in
pla
ce t
o d
eliv
er
the
co
lla
bo
rati
on
re
qu
ire
d.
Sa
lfo
rd I
nte
gra
ted
Re
cord
·
Imp
lem
en
t a
n i
mp
rov
ed
Sa
lfo
rd I
nte
gra
ted
Re
cord
(S
IR)
wh
ich
lin
ks
acu
te,
pri
ma
ry c
are
, co
mm
un
ity
se
rvic
es,
me
nta
l h
ea
lth
an
d s
oci
al
care
re
cord
s, e
na
bli
ng
pro
fess
ion
als
to
se
e r
ele
van
t d
ata
ab
ou
t th
eir
pa
tie
nts
/use
rs/c
lien
ts f
rom
wh
ere
ver
the
y n
ee
d i
t. T
o b
e c
om
ple
ted
a
nd
in
use
by
Ma
rch
20
17
, w
ith
ke
y
mil
est
on
es
thro
ug
ho
ut
20
16
/17
·
To
fu
rth
er
stre
tch
in
form
ati
on
sh
ari
ng
to
cro
ss o
rga
nis
ati
on
al
pa
tie
nt
ma
na
ge
me
nt
i.e
. e
nsu
re t
ha
t te
chn
olo
gy
is
furt
he
r d
ev
elo
pe
d t
o a
llo
w i
nte
ract
ive
ta
sks
an
d m
ess
ag
es
rath
er
tha
n e
ve
rsio
n o
f le
tte
rs.
Th
is i
s th
e n
ext
sta
ge
of
clin
ica
l co
rre
spo
nd
en
ce d
ev
elo
pm
en
t.
·
En
sure
all
are
as
of
he
alt
h a
nd
so
cia
l ca
re c
an
co
mm
un
ica
te w
ith
ou
t p
ap
er
by
20
20
as
pe
r th
e n
ati
on
al a
nd
lo
cal
am
bit
ion
s.
3.3
.5 E
ST
AT
ES
A
IM:
to r
ati
on
ali
se t
he
use
of
pu
bli
c se
cto
r e
sta
te t
o a
chie
ve
eff
icie
nci
es
an
d e
ffe
ctiv
en
ess
in
de
liv
ery
acr
oss
all
sect
ors
an
d a
llo
w p
rov
isio
n o
f a
ra
ng
e o
f a
cce
ssib
le s
ett
ing
s.
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
A g
ap
an
aly
sis
wa
s u
nd
ert
ak
en
in
au
tum
n 2
01
4 r
eg
ard
ing
th
e q
ua
lity
of
mo
de
rn p
urp
ose
bu
ilt
he
alt
hca
re p
rem
ise
s a
cro
ss t
he
six
ne
igh
bo
urh
oo
ds
in S
alf
ord
. T
his
rev
ea
led
th
at
wh
ilst
a n
um
be
r o
f n
eig
hb
ou
rho
od
s w
ere
we
ll s
erv
ed
by
th
e G
ate
wa
y b
uil
din
gs
an
d o
the
r re
cen
t th
ird
pa
rty
de
ve
lop
me
nts
, th
ere
we
re t
hre
e a
rea
s o
f
ne
ed
:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
36
·
Litt
le H
ult
on
, w
he
re a
bid
fo
r a
he
alt
h c
en
tre
ha
s b
ee
n m
ad
e t
o b
oth
NH
S E
ng
lan
d’s
Pri
ma
ry C
are
In
fra
stru
ctu
re F
un
d a
nd
NH
S P
rop
ert
y S
erv
ice
s’ c
ust
om
er
cap
ita
l.
·
Low
er
Bro
ug
hto
n,
wh
ere
an
op
po
rtu
nit
y e
xist
s to
re
loca
te a
nd
exp
an
d p
rim
ary
an
d c
om
mu
nit
y c
are
pro
vis
ion
as
a r
esu
lt o
f si
gn
ific
an
t re
ge
ne
rati
on
in
th
e a
rea
.
·
Irla
m a
nd
Ca
dis
he
ad
, w
he
re p
relim
ina
ry d
iscu
ssio
ns
ha
ve
co
mm
en
ced
wit
h t
he
pra
ctic
es
in t
he
ne
igh
bo
urh
oo
d.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Th
e u
pd
ati
ng
of
curr
en
tly
ou
t o
f d
ate
in
form
ati
on
av
aila
ble
on
GP
ow
ne
d p
rem
ise
s to
de
term
ine
its
’ fu
nct
ion
al
suit
ab
ilit
y f
or
futu
re h
ea
lth
care
de
live
ry.
·
En
ga
ge
me
nt
of
ne
igh
bo
urh
oo
ds
in d
ete
rmin
ing
th
e o
ut
of
ho
spit
al
serv
ice
s to
be
co
mm
issi
on
ed
lo
cally
fo
r th
eir
po
pu
lati
on
an
d t
he
po
ten
tia
l lo
cati
on
of
the
se
serv
ice
s.
·
Dis
cuss
ion
s w
ith
pro
vid
ers
an
d t
he
lo
cal
au
tho
rity
on
th
e b
ett
er
uti
lisa
tio
n o
f p
rim
ary
an
d c
om
mu
nit
y s
erv
ice
s, t
o m
axi
mis
e e
ffic
ien
cy a
nd
th
e b
en
efi
ts o
f co
-
loca
tio
n o
f se
rvic
es
for
pa
tie
nts
.
·
Infl
ue
nci
ng
th
e p
rocu
rem
en
t o
f n
ew
ca
pit
al
inv
est
me
nt
into
Sa
lfo
rd t
o i
mp
rov
e t
he
qu
ali
ty o
f th
e a
cco
mm
od
ati
on
ava
ila
ble
an
d f
aci
lita
te p
rov
isio
n o
f se
rvic
es
at
sca
le.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
A S
alf
ord
Str
ate
gic
Est
ate
s G
rou
p i
s in
op
era
tio
n.
Me
mb
ers
hip
is
com
pri
sed
of
Sa
lfo
rd C
CG
, S
alf
ord
Cit
y C
ou
nci
l, S
RF
T a
nd
GM
W.
·
Incr
ea
se o
ccu
pa
tio
n o
f th
e G
ate
wa
y b
uil
din
gs,
wit
h p
rop
osa
ls b
ein
g d
ev
elo
pe
d f
or
the
Pe
nd
leto
n G
ate
wa
y i
n t
he
fir
st i
nst
an
ce.
·
Imp
lem
en
t th
e C
om
mu
nit
y B
ase
d C
are
Est
ate
s P
lan
3.3
.6 W
OR
K F
OR
CE
A
IM:
to e
na
ble
a s
uit
ab
ly s
kil
led
wo
rkfo
rce
an
d w
ork
ing
co
nd
itio
ns
in o
rde
r to
ach
iev
e t
ran
sfo
rma
tio
n a
nd
ne
w
wa
ys
of
wo
rkin
g
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
On
e o
f th
e l
imit
ing
fa
cto
rs f
or
ach
iev
ing
ou
r k
ey
ob
ject
ive
s is
th
e a
va
ila
bil
ity
of
a s
uit
ab
ly s
kil
led
wo
rkfo
rce
.
Th
e d
eve
lop
me
nt
of
sev
en
da
y se
rvic
es,
tra
nsf
orm
ing
pri
ma
ry c
are
at
sca
le a
nd
pa
ce a
nd
th
e i
nte
gra
tio
n o
f h
ea
lth
an
d s
oci
al
care
is
like
ly t
o n
ee
d n
ew
ro
les
as
we
ll a
s a
re
gu
lar
sup
ply
of
exi
stin
g r
ole
s.
Th
e k
ey
str
an
ds
of
an
em
erg
ing
wo
rkfo
rce
an
d o
rga
nis
ati
on
al
de
ve
lop
me
nt
stra
teg
y f
or
va
rio
us
org
an
isa
tio
ns
acr
oss
th
e c
ity
in
clu
de
:
Lea
de
rsh
ip a
nd
ma
na
ge
me
nt:
De
ve
lop
ing
le
ad
ers
hip
ca
pa
bil
ity
an
d c
on
ne
ctin
g p
rim
ary
an
d s
eco
nd
ary
ca
re l
ea
de
rs t
og
eth
er
at
all
le
vels
to
he
lp t
he
m t
hin
k d
iffe
ren
tly
be
op
en
to
ne
w i
de
as
an
d t
est
co
nce
pts
wit
ho
ut
the
fe
ar
of
fail
ure
. W
hil
st n
ot
forg
ett
ing
th
e i
mp
ort
an
ce o
f g
ett
ing
th
e b
asi
cs r
igh
t in
te
rms
of
go
od
pe
op
le
ma
na
ge
me
nt
pra
ctic
e,
em
plo
ye
e e
ng
ag
em
en
t, c
om
mu
nic
ati
on
an
d m
an
ag
ing
ch
an
ge
.
Cu
ltu
re:
De
velo
p a
sh
are
d c
ult
ure
th
at
pro
mo
tes
ass
et
ba
sed
th
ink
ing
, su
pp
ort
s in
no
va
tiv
e w
ay
s o
f w
ork
ing
, e
na
ble
s e
mp
loye
es
to w
ork
dif
fere
ntl
y,
an
d s
up
po
rts
sta
ff
to e
ng
ag
e w
ith
cit
ize
ns
in a
po
siti
ve
wa
y.
Em
plo
ye
e e
ng
ag
em
en
t: D
ev
elo
p a
pp
rop
ria
te e
mp
loy
ee
en
ga
ge
me
nt
stra
teg
ies
tha
t w
ill
en
ab
le t
he
tra
nsi
tio
n a
nd
tra
nsf
orm
ati
on
of
serv
ice
s w
hil
st m
ain
tain
ing
an
en
ga
ge
d a
nd
mo
tiv
ate
d w
ork
forc
e,
thro
ug
h e
arl
y i
nvo
lve
me
nt
all
ow
ing
sta
ff t
o c
o-p
rod
uce
th
e n
ew
mo
de
ls o
f d
eliv
ery
an
d j
ob
ro
les.
Lea
rnin
g a
nd
de
ve
lop
me
nt:
Pro
vid
e s
up
po
rt t
o a
ll e
mp
loy
ee
s, e
na
bli
ng
th
em
to
de
ve
lop
th
e s
kil
ls,
kn
ow
led
ge
an
d b
eh
av
iou
rs t
o o
pe
rate
in
dif
fere
nt
op
era
tin
g m
od
els
an
d a
cro
ss o
rga
nis
ati
on
al
an
d p
rofe
ssio
na
l b
ou
nd
ari
es.
Em
plo
ym
en
t co
nd
itio
ns:
We
wil
l u
tili
se e
vid
en
ce a
bo
ut
the
Liv
ing
Wa
ge
pro
du
ced
by
th
e I
nst
itu
te f
or
He
alt
h E
qu
ity
in
wo
rk t
o m
axi
mis
e a
do
pti
on
of
the
Liv
ing
Wa
ge
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
37
an
d t
he
be
st p
oss
ible
wo
rkin
g c
on
dit
ion
s fo
r o
ur
wo
rkfo
rce
acr
oss
th
e c
ity
, in
ord
er
to im
pro
ve
he
alt
h a
nd
we
ll-b
ein
g.
We
in
ten
d t
o w
ork
clo
sely
wit
h l
oca
l e
du
cati
on
pro
vid
ers
alo
ng
wit
h H
ea
lth
Ed
uca
tio
n N
ort
h W
est
(H
EN
W)
to p
rog
ress
th
ese
pla
ns.
T
he
“S
alf
ord
To
ge
the
r W
ork
forc
e
Str
ate
gy”
wil
l su
pp
ort
th
e d
ev
elo
pm
en
t o
f o
ur
Inte
gra
ted
Ca
re O
rga
nis
ati
on
an
d i
ncl
ud
es
all
fo
ur
pa
rtn
ers
(N
HS
Sa
lfo
rd C
CG
, SR
FT
, S
alf
ord
Cit
y C
ou
nci
l, G
MW
).
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
An
exp
an
sio
n o
f th
e w
ork
forc
e d
eli
veri
ng
pri
ma
ry m
ed
ica
l se
rvic
es
·
Incr
ea
sed
nu
mb
ers
of
sta
ff d
eli
ve
rin
g c
are
in
a c
om
mu
nit
y s
ett
ing
·
Sta
ff w
ith
a b
roa
de
r ra
ng
e o
f sk
ills
th
at
spa
n h
ea
lth
an
d c
are
·
Exp
lori
ng
op
po
rtu
nit
ies
for
inte
gra
ted
tra
inin
g a
nd
ed
uca
tio
n
·
Exp
lori
ng
op
po
rtu
nit
ies
for
sta
ff t
o g
ain
sk
ills
in
wo
rkin
g a
cro
ss a
ll a
rea
s o
f ca
re d
eli
ve
ry (
ho
spit
al,
co
mm
un
ity
an
d p
rim
ary
ca
re)
·
Exp
lori
ng
op
po
rtu
nit
ies
for
the
cre
ati
on
of
ne
w r
ole
s th
at
wil
l re
du
ce d
up
lica
tio
n a
nd
im
pro
ve
th
e e
xpe
rie
nce
of
pe
op
le u
sin
g h
ea
lth
an
d c
are
se
rvic
es
incl
ud
ing
;
ad
va
nce
d p
ract
itio
ne
rs,
ass
ista
nt
pra
ctit
ion
ers
an
d p
hy
sici
an
ass
oci
ate
s
·
Th
is p
rog
ram
me
of
wo
rk w
ill
be
a p
ote
nti
al
lon
g-t
erm
in
vest
me
nt
in i
mp
rov
ing
th
e h
ea
lth
of
Sa
lfo
rd p
eo
ple
, a
nd
we
aim
to
fu
lly
en
ga
ge
wit
h p
art
ne
rs a
rou
nd
wo
rkfo
rce
de
velo
pm
en
t a
nd
su
pp
ort
pa
thw
ay
in
itia
tiv
es
wit
h s
cho
ols
, co
lleg
es
an
d o
the
r tr
ain
ing
pro
vid
ers
in
ord
er
to c
an
de
ve
lop
ou
r h
ea
lth
an
d s
oci
al
care
wo
rkfo
rce
as
we
ll a
s co
ntr
ibu
tin
g t
o im
pro
vin
g s
oci
al v
alu
e i
n t
he
cit
y.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Th
e e
sta
bli
shm
en
t o
f a
Str
ate
gic
Wo
rkfo
rce
Bo
ard
th
at
wil
l a
ssis
t in
en
suri
ng
th
at
we
att
ract
, re
tain
an
d c
on
tin
ue
to
de
ve
lop
th
e f
utu
re h
ea
lth
an
d s
oci
al
care
wo
rkfo
rce
in
Sa
lfo
rd.
·
Pu
t in
pla
ce a
wo
rkfo
rce
an
d o
rga
nis
ati
on
al
de
ve
lop
me
nt
stra
teg
y a
cro
ss t
he
cit
y f
or
the
he
alt
h a
nd
so
cia
l ca
re w
ork
fo
rce
.
·
Wh
ilst
ack
no
wle
dg
ing
th
e c
on
stra
ints
of
na
tio
na
l p
ay
ba
rga
inin
g a
nd
re
vie
w b
od
ies,
ea
ch m
em
be
r o
f th
e H
ea
lth
an
d W
ell
be
ing
Bo
ard
wil
l w
ork
to
wa
rds:
intr
od
uci
ng
th
e L
ivin
g W
ag
e;
be
com
ing
an
acc
red
ite
d L
ivin
g W
ag
e E
mp
loy
er;
an
d i
nco
rpo
rati
ng
th
e L
ivin
g W
ag
e w
ith
in i
ts p
rocu
rem
en
t.
·
De
ve
lop
lo
cal
init
iati
ves
(fo
r e
xam
ple
Cli
nic
al
Ph
arm
aci
sts
in G
en
era
l P
ract
ice
) a
rou
nd
im
pro
ved
wo
rkfo
rce
de
velo
pm
en
t a
cro
ss G
en
era
l P
ract
ice
, a
lig
ne
d t
o
na
tio
na
l in
itia
tiv
es/
resu
lts
of
the
wo
rkfo
rce
sto
ckta
ke
·
Wo
rk w
ith
pa
rtn
ers
acr
oss
Gre
ate
r M
an
che
ste
r to
sco
pe
an
d d
eve
lop
an
ed
uca
tio
n p
rog
ram
me
fo
r p
rim
ary
ca
re
3.3
.7 I
NN
OV
AT
ION
A
IM:
bu
ild
fr
om
S
alf
ord
’s su
cce
ssfu
l in
no
va
tio
n a
nd
re
sea
rch
p
rog
ram
me
to
te
st a
nd
e
mb
ed
n
ew
w
ay
s o
f
wo
rkin
g t
o s
up
po
rt o
ur
tra
nsf
orm
ati
on
aim
s
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Th
e s
cale
of
tra
nsf
orm
ati
on
ne
cess
ary
to
de
live
r th
e a
mb
itio
n o
utl
ine
d w
ith
in t
his
pla
n i
s a
co
nsi
de
rab
le c
ha
lle
ng
e t
ha
t w
ill
req
uir
e w
ide
spre
ad
in
no
va
tio
n,
en
ha
nce
d
use
of
tech
no
log
y a
nd
a c
om
mit
me
nt
to r
ese
arc
h.
Ou
r e
xist
ing
pa
rtn
ers
hip
s, o
ur
rela
tio
nsh
ips
wit
h a
cad
em
ic o
rga
nis
ati
on
s a
nd
mo
st im
po
rta
ntl
y o
ur
inte
gra
ted
IM
&T
syst
em
, m
ea
n t
ha
t S
alf
ord
is
un
iqu
ely
pla
ced
wit
hin
Gre
ate
r M
an
che
ste
r to
be
a t
est
be
d f
or
inn
ov
ati
on
an
d r
ese
arc
h.
Th
e N
HS
co
nst
itu
tio
n r
eq
uir
es
tha
t re
sea
rch
is
see
n a
s co
re N
HS
bu
sin
ess
an
d s
tate
s th
at
ev
ery
pa
tie
nt
sho
uld
be
off
ere
d t
he
op
po
rtu
nit
y to
en
ga
ge
in
re
sea
rch
. H
igh
qu
ali
ty r
ese
arc
h u
nd
erp
ins
ad
van
ces
in h
ea
lth
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
38
an
d c
are
an
d s
ho
uld
be
use
d t
o i
nfl
ue
nce
th
e c
om
mis
sio
nin
g o
f e
vid
en
ce b
ase
d s
erv
ice
s.
Inn
ov
ati
on
acr
oss
th
e h
ea
lth
, so
cia
l ca
re a
nd
vo
lun
tary
se
cto
r is
su
pp
ort
ed
th
rou
gh
an
in
no
va
tio
n f
un
d c
rea
ted
by
NH
S S
alf
ord
CC
G.
Th
is h
as
en
ab
led
cre
ati
ve i
de
as
to
be
te
ste
d a
nd
ha
s re
sult
ed
in
th
e d
ev
elo
pm
en
t o
f n
ew
se
rvic
es.
N
HS
Sa
lfo
rd C
CG
an
d S
alf
ord
Ro
ya
l F
ou
nd
ati
on
Tru
st a
lso
ha
ve a
n i
nte
gra
ted
re
sea
rch
de
pa
rtm
en
t
ba
sed
at
SR
FT i
n p
art
ne
rsh
ip w
ith
Ma
nch
est
er
Un
ive
rsit
y
Sa
lfo
rd i
s o
ne
of
the
pa
rtn
ers
an
d s
tak
eh
old
ers
in
th
e r
ese
arc
h o
rga
nis
ati
on
s th
at
ha
ve
sig
ne
d u
p t
o H
ea
lth
In
no
va
tio
n M
an
che
ste
r (H
InM
) a
nd
co
nti
nu
e t
o b
e t
he
le
ad
CC
G f
or
rese
arc
h a
ctiv
ity
in
pri
ma
ry c
are
in
Gre
ate
r M
an
che
ste
r.
Th
is p
rov
ide
s a
pla
tfo
rm f
or
all
org
an
isa
tio
ns
invo
lve
d i
n r
ese
arc
h a
nd
in
no
va
tio
n a
cro
ss G
rea
ter
Ma
nch
est
er
to w
ork
co
lla
bo
rati
ve
ly s
up
po
rtin
g t
he
tra
nsf
orm
ati
on
of
he
alt
h a
nd
ca
re s
erv
ice
s.
Sa
lfo
rd i
s a
lso
ho
me
to
Ha
elo
, w
ho
se c
ore
pu
rpo
se i
s to
pro
vid
e a
n i
nn
ov
ati
on
hu
b f
or
Sa
lfo
rd p
art
ne
rs (
CC
G,
Cit
y C
ou
nci
l, G
M W
est
Me
nta
l H
ea
lth
Tru
st,
Un
ive
rsit
y o
f
Sa
lfo
rd a
nd
Sa
lfo
rd R
oy
al)
to
im
pro
ve h
ea
lth
an
d c
are
se
rvic
es
de
live
red
to
Sa
lfo
rdia
ns.
Ha
elo
’s e
xpe
rtis
e i
s in
th
ree
are
as:
i.
coll
ab
ora
tio
n –
bri
ng
ing
to
ge
the
r te
am
s
fro
m a
cro
ss t
he
he
alt
h e
con
om
y t
o i
mp
rov
e p
ath
wa
ys o
f ca
re u
sin
g i
mp
rov
em
en
t sc
ien
ce a
nd
in
cub
ati
ng
ne
w d
eli
ve
ry m
od
els
; ii
. ca
pa
bil
ity
bu
ild
ing
– e
nsu
rin
g t
ha
t
the
wo
rkfo
rce
in
Sa
lfo
rd a
re e
qu
ipp
ed
wit
h t
he
to
ols
an
d t
ech
niq
ue
s th
ey
ne
ed
to
im
pro
ve
in
th
eir
lo
cal
sett
ing
s; i
ii.
com
mu
nic
ati
on
an
d k
no
wle
dg
e m
an
ag
em
en
t –
ma
na
gin
g a
nd
sh
ari
ng
kn
ow
led
ge
ab
ou
t h
ow
to
ma
ke
im
pro
vem
en
t h
ap
pe
n u
sin
g i
nn
ov
ati
ve
so
cia
l me
dia
, fi
lm a
nd
dig
ita
l p
latf
orm
s.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Bu
ild
on
gro
un
d-b
rea
kin
g w
ork
on
in
teg
rate
d h
ea
lth
da
ta s
yste
ms
to e
xte
nd
it
to t
he
wh
ole
of
Gre
ate
r M
an
che
ste
r. T
his
wil
l e
na
ble
be
tte
r ca
re (
by
pro
vid
ing
mo
re
join
ed
-up
in
form
ati
on
to
GP
s a
nd
ho
spit
als
) a
nd
po
ten
tia
lly
he
lp i
de
nti
fy n
ew
wa
ys
of
tre
ati
ng
dis
ea
ses.
·
Imp
rov
e t
he
ab
ilit
y t
o u
se p
ers
on
ali
sed
me
dic
ine
, w
ith
mo
re t
arg
ete
d t
rea
tme
nts
fo
r th
ose
wh
o w
ill
be
ne
fit
mo
st f
rom
th
em
. Fo
r e
xam
ple
, th
is c
ou
ld i
nvo
lve
de
ve
lop
ing
ne
w m
ed
icin
es
to t
rea
t sp
eci
fic
gro
up
s o
f p
ati
en
ts o
r ta
rge
tin
g e
xist
ing
tre
atm
en
ts m
ore
eff
ect
ive
ly.
·
En
ha
nce
th
e t
est
ing
of
ne
w m
ed
icin
es
or
tre
atm
en
ts t
o e
na
ble
th
ose
wit
h t
he
big
ge
st p
osi
tiv
e i
mp
act
to
be
id
en
tifi
ed
an
d i
ntr
od
uce
d i
nto
ro
uti
ne
cli
nic
al
pra
ctic
e
acr
oss
th
e w
ho
le o
f G
rea
ter
Ma
nch
est
er
as
qu
ick
ly a
s p
oss
ible
, m
axi
mis
ing
th
e p
ati
en
t b
en
efi
ts.
·
Dig
ita
l so
luti
on
s w
ill
aid
ou
r v
isio
n t
o p
rov
ide
th
e s
afe
st h
ea
lth
an
d c
are
in
th
e C
ou
ntr
y a
nd
th
ere
is
an
op
po
rtu
nit
y t
o c
om
bin
e d
iffe
ren
t te
chn
olo
gie
s, c
ha
ng
ing
th
e
wa
y w
e w
ork
to
tra
nsf
orm
ca
re d
eliv
ery
to
imp
rov
e p
op
ula
tio
n h
ea
lth
.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Use
en
ha
nce
d i
nfo
rma
tics
as
a c
riti
cal
fou
nd
ati
on
to
un
de
rpin
sy
ste
m c
ha
ng
e,
an
d p
rov
ide
ra
pid
acc
ess
to
la
rge
se
ctio
ns
of
the
po
pu
lati
on
as
a t
est
be
d f
or
inn
ov
ati
on
an
d r
ese
arc
h.
·
De
ve
lop
a c
ity
-wid
e r
ese
arc
h a
nd
in
no
va
tio
n s
tra
teg
y t
o u
nd
erp
in o
ur
loca
lity
pla
n
·
Est
ab
lish
a R
ese
arc
h a
nd
In
no
va
tio
n F
oru
m t
ha
t w
ill
en
sure
a c
oll
ab
ora
tive
an
d c
on
sist
en
t a
pp
roa
ch e
na
bli
ng
us
to w
ork
wit
h H
InM
.
·
3.3
.8 P
UB
LIC
EN
GA
GE
ME
NT
A
IM:
to r
ad
ica
lly
ch
an
ge
en
ga
ge
me
nt
pra
ctic
e f
rom
co
nsu
lta
tio
n t
o i
nv
olv
em
en
t o
f th
e p
ub
lic
in a
n e
qu
al
con
ve
rsa
tio
n
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
39
Sa
lfo
rd’
He
alt
h a
nd
We
llb
ein
g B
oa
rd h
as
ag
ree
d a
co
nce
pt
for
en
ga
ge
me
nt
of
sta
ke
ho
lde
rs b
ase
d i
n ‘
invo
lve
, w
ork
in
pa
rtn
ers
hip
an
d t
ak
e r
esp
on
sib
ilit
y’
rath
er
tha
n
‘in
form
an
d c
on
sult
’. T
his
ap
pro
ach
is
ap
pli
cab
le t
o a
ll a
ge
ra
ng
es
an
d a
cro
ss t
he
Sta
rt W
ell
, Li
ve W
ell
an
d A
ge
We
ll l
ife
co
urs
e,
wit
h f
urt
he
r in
form
ati
on
is
pro
vid
ed
in
the
su
pp
ort
ing
pa
pe
rs.
We
wil
l w
ork
to
wa
rds
an
act
ive
pro
cess
wh
ere
by
th
e p
ati
en
t, c
are
r o
r m
em
be
r o
f th
e p
ub
lic
is a
n e
qu
al
pa
rtic
ipa
nt
in s
ha
pin
g a
n o
utc
om
e w
ith
a f
ocu
s o
n i
nv
olv
em
en
t ra
the
r th
an
in
form
ati
on
giv
ing
. O
ur
en
ga
ge
me
nt
stri
ves
to f
aci
lita
te t
he
hig
he
st l
ev
el
of
inv
olv
em
en
t a
pp
rop
ria
te f
or
the
sit
ua
tio
n.
Th
is w
ill
incr
ea
se t
he
acc
ou
nta
bil
ity
of
serv
ice
s a
nd
co
mm
issi
on
ing
to
lo
cal
pe
op
le,
an
d w
ill
sup
po
rt o
ur
am
bit
ion
to
de
ve
lop
a n
ew
re
lati
on
ship
be
twe
en
se
rvic
es,
pa
tie
nts
an
d
the
pu
bli
c.
To
do
th
is,
off
ice
rs a
nd
org
an
isa
tio
ns
resp
on
sib
le f
or
serv
ice
co
mm
issi
on
ing
an
d d
eli
ve
ry w
ill
als
o h
av
e t
o c
ha
ng
e t
he
ir b
eh
av
iou
rs i
n o
rde
r to
en
ab
le g
rea
ter
citi
zen
po
we
r a
nd
tru
e i
nvo
lve
me
nt.
We
wil
l p
rom
ote
ea
rly
jo
int
de
velo
pm
en
t o
f e
ng
ag
em
en
t p
lan
s, c
o-p
rod
uce
d a
pp
roa
che
s a
nd
jo
int
resp
on
sib
ilit
y w
ith
th
e l
oca
l
com
mu
nit
y i
n a
dd
itio
n t
o s
oci
al
mo
vem
en
t a
nd
ch
an
ge
s to
so
cia
l a
ttit
ud
es
ori
gin
ati
ng
wit
h c
itiz
en
s ra
the
r th
an
org
an
isa
tio
ns.
Th
ere
wil
l a
lso
be
ro
ute
s a
va
ila
ble
fo
r
soci
al m
ove
me
nt,
ori
gin
ati
ng
fro
m t
he
co
mm
un
ity
, to
in
flu
en
ce p
rio
riti
es
of
the
He
alt
h a
nd
We
llb
ein
g B
oa
rd.
Th
e e
ng
ag
em
en
t a
nd
in
vo
lve
me
nt
off
er
in S
alf
ord
is
ba
sed
on
a '
no
wro
ng
do
or'
po
licy
, e
nsu
rin
g t
ha
t th
e s
yst
em
wo
rks
tog
eth
er
to c
oll
ate
in
form
ati
on
re
ga
rdle
ss o
f
the
po
int
of
acc
ess
. T
he
in
form
ati
on
an
d l
ea
rnin
g o
bta
ine
d v
ia e
ng
ag
em
en
t a
ctiv
itie
s w
ill
no
t so
lely
re
ma
in w
ith
in
div
idu
al
org
an
isa
tio
ns,
bu
t w
ill
be
acc
ess
ible
to
pa
rtn
ers
to
re
du
ce d
up
lica
tio
n a
nd
fa
cili
tate
th
e s
ha
rin
g o
f k
no
wle
dg
e.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
Ba
sed
on
dis
cuss
ion
s w
ith
loca
l p
eo
ple
, th
e v
isio
n f
or
en
ga
ge
me
nt
ove
r a
on
e y
ea
r a
nd
fiv
e y
ea
r p
eri
od
sh
ou
ld a
im f
or
the
fo
llow
ing
:
·
On
e Y
ea
r ·
Fiv
e Y
ea
rs
·
Cle
ar,
acc
ess
ible
in
form
ati
on
pro
vid
ed
to
th
e w
ide
r co
mm
un
ity
to
su
pp
ort
info
rme
d d
iscu
ssio
ns
·
En
ga
ge
me
nt
sup
po
rte
d
on
a
n
eig
hb
ou
rho
od
le
vel,
v
ia
con
tact
w
ith
lo
cal
com
mu
nit
y a
sse
ts i
ncl
ud
ing
: co
mm
un
ity
cen
tre
s, p
ha
rma
cie
s, s
up
erm
ark
ets
,
leis
ure
act
ivit
ies,
·
Tim
ely
in
form
ati
on
on
th
e i
mp
act
of
en
ga
ge
me
nt
so t
ha
t th
e c
om
mu
nit
y a
re
ab
le t
o s
ee
th
eir
ro
le i
n c
ha
ng
es.
·
Incr
ea
sed
ch
an
ne
ls
for
en
ga
ge
me
nt
incl
ud
ing
: ra
dio
, o
nli
ne
, fa
ce
to
face
,
text
.
Th
is
sho
uld
a
lso
in
clu
de
a
re
cog
nit
ion
o
f th
e
me
dia
/
ap
pro
ach
es
alr
ea
dy
pre
ferr
ed
by
th
e l
oca
l p
ub
lic
·
De
ve
lop
ing
u
nd
ers
tan
din
g
of
ho
w
soci
al
mo
vem
en
ts
are
e
na
ble
d
an
d
em
po
we
red
·
Pil
ot
ap
pro
ach
es
to
exp
lore
m
eth
od
s o
f ch
an
gin
g
rela
tio
nsh
ips
be
twe
en
pu
bli
c a
nd
o
rga
nis
ati
on
s a
nd
to
e
xplo
re
me
tho
ds
to
en
ab
le
loca
l
com
mu
nit
ies
to s
ha
pe
th
eir
ow
n a
pp
roa
che
s.
Bu
ild
ing
on
th
e w
ork
in
th
e f
irst
ye
ar
an
d a
lso
in
clu
din
g:
·
Un
de
rsta
nd
ing
of
the
ch
an
gin
g c
om
mu
nit
ies
in S
alf
ord
an
d h
ow
be
st t
o
en
ga
ge
·
De
vo
lvin
g d
eci
sio
ns
to p
eo
ple
wh
o u
se t
he
se
rvic
es
·
Sh
are
d c
on
tro
l a
nd
co
-pro
du
ced
so
luti
on
s
·
Re
lati
on
ship
s b
etw
ee
n s
erv
ice
s a
nd
loca
l p
eo
ple
re
pla
cin
g c
on
sult
ati
on
·
Loca
l p
eo
ple
b
uil
din
g
the
ir
ow
n
soci
al
mo
ve
me
nts
a
nd
a
pp
roa
che
s to
cha
lle
ng
ing
so
cia
l a
ttit
ud
es
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
40
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Re
-la
un
ch o
f th
e H
ea
lth
an
d W
ell
be
ing
Bo
ard
Co
mm
un
ica
tio
ns
an
d E
ng
ag
em
en
t su
b-g
rou
p t
o d
riv
e f
orw
ard
en
ga
ge
me
nt
po
licy
an
d p
ract
ice
·
Pu
bli
sh a
n e
ng
ag
em
en
t p
olic
y a
nd
de
live
ry p
lan
to
su
pp
ort
th
is L
oca
lity
Pla
n (
see
Ap
pe
nd
ix x
x)
·
Em
be
dd
ing
of
rev
ise
d e
ng
ag
em
en
t p
ract
ice
in
all
oth
er
wo
rkst
rea
ms
·
Use
of
the
en
ga
ge
me
nt
infr
ast
ruct
ure
acr
oss
th
e c
ity
, w
hic
h i
ncl
ud
es
vo
lun
tary
an
d c
om
mu
nit
y s
ect
or,
loca
l Co
un
cill
ors
, H
ea
lth
Wa
tch
Sa
lfo
rd,
CC
G P
ati
en
ts’
pa
ne
l, S
RF
T M
em
be
rs g
rou
p,
an
d I
nte
gra
ted
En
ga
ge
me
nt
Bo
ard
, a
s w
ell
as
En
ga
ge
me
nt
Lea
ds
off
ice
rs g
rou
p.
Ca
se S
tud
y:
Yo
uth
Da
y –
sp
rea
din
g a
pu
bli
c h
ea
lth
me
ssa
ge
th
rou
gh
a d
ay
of
cele
bra
tio
n
Th
e S
alf
ord
Cit
y P
art
ne
rsh
ip (
thro
ug
h t
he
Ch
ild
ren
& Y
ou
ng
Pe
op
le’s
Tru
st)
wa
nte
d t
o e
mp
ow
er
you
ng
pe
op
le (
11
-25
) b
y r
eco
gn
isin
g a
nd
ce
leb
rati
ng
th
em
as
a f
orc
e
for
go
od
in
so
cie
ty.
We
cre
ate
d S
alf
ord
Yo
uth
Da
y t
o c
oin
cid
e w
ith
Un
ite
d N
ati
on
s In
tern
ati
on
al
Yo
uth
Da
y o
n 1
2 A
ug
ust
. 2
01
5 w
as
its
fou
rth
ye
ar,
an
d e
ach
ye
ar
the
me
ssa
ge
ha
s sp
rea
d f
urt
he
r.
Sa
lfo
rd Y
ou
th D
ay
is c
o-o
rdin
ate
d b
y a
ste
eri
ng
gro
up
in
clu
din
g t
he
VC
SE s
ect
or,
Ch
ild
ren
’s S
erv
ice
s, a
nd
Sa
lfo
rd Y
ou
th C
ou
nci
l.
Yo
un
g p
eo
ple
an
d y
ou
th w
ork
ers
(C
ity
Co
un
cil
an
d V
CS
E)
take
on
th
e b
ulk
of
the
wo
rk,
ma
inly
as
pa
rt o
f su
mm
er
you
th a
ctiv
itie
s th
ey
are
alr
ea
dy
fa
cili
tati
ng
(fo
r e
xam
ple
, N
ati
on
al
Cit
ize
n S
erv
ice
).
Wo
rk
go
es
on
be
hin
d t
he
sce
ne
s fo
r m
uch
of
the
ye
ar.
Th
e d
ay
incl
ud
es
a s
oci
al
me
dia
sto
rm,
yo
uth
-le
d c
om
mu
nit
y a
ctiv
itie
s, a
nd
an
‘A
fte
r P
art
y’.
T
wit
ter
ha
s p
rov
ed
to
be
a v
ery
ea
sy w
ay
to
co
mm
un
ica
te t
he
Yo
uth
Da
y
core
me
ssa
ge
, b
uil
d m
om
en
tum
, a
nd
ga
the
r e
vid
en
ce:
#S
alf
ord
Yo
uth
Da
y.
We
sp
en
d a
rou
nd
£5
,00
0 e
ach
ye
ar,
in
ad
dit
ion
to
yo
uth
wo
rke
rs’
tim
e f
rom
exi
stin
g
com
mit
me
nts
. F
or
mo
re i
nfo
rma
tio
n s
ee
ww
w.p
art
ne
rsin
salf
ord
.org
/yo
uth
da
y.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
41
3.4 PREVENTION
3.4.1 The NHS Five Year Forward View highlights strongly the need for a shift to more
preventative strategies: “The future health of millions of children, the sustainability of the NHS, and the
economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. Twelve
years ago, Derek Wanless’ health review warned that unless the country took prevention seriously we would be
faced with a sharply rising burden of avoidable illness. That warning has not been heeded - and the NHS is on
the hook for the consequences.”2
3.4.2 With 70% of the health care budget being used to support people with long term
conditions, there has never before been such a need for prevention that works to stop people
developing disease, support those with conditions to manage their own health where possible
and so reduce demand on the system, and to develop a new way for patients to engage with
the healthcare system both for acute and chronic illnesses.
3.4.3 The Forward View also highlights the importance of engaging with communities and
suggests that the following areas need to be built upon:
· Supporting carers – described further in section 3.5
· Encouraging community volunteering – described at section 3.4
· Stronger partnerships with VCSE sector organisations – a theme which underpins all
sections of this Plan
· The role of the NHS as a local employer – explored in section 3.3 above
· The NHS as social movement – further described below in section 3.4
3.4.4 Furthermore, whilst we recognise the importance of achieving growth and improved
economic efficiency, we also regard these as drivers for achieving a better quality of life and
better well-being for all local people. We believe that business success can be achieved
alongside community wellbeing and social improvement, with work being regarded a a
determinant of health. Indeed, we also believe that improved health and wellbeing is itself a
critical factor in delivering economic success.
3.4.5 The following section describes how prevention will underpin our whole approach,
thereby benefiting more people across the life course, and achieving a higher reduction in
demand. Our prevention activities won’t only focus on moving individuals’ who are high risk
or needing acute care zone (red in the following diagram) into the green ‘normal’ level of risk,
2 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
42
but will also look at population strategies that will shift the average for the population towards
a lower level of risk. These population based prevention approaches help to further manage
down demand for acute, more costly care and sees everyone move into a lower risk
category, not just those who need acute care.
3.4.6 Our citizen engagement has shown that prevention and sharing public health messages
is something that local people feel will be a critical success factor in our Locality Plan. The
need to educate and provide information to citizens came across very strongly in the
feedback and participants thought this should be a key theme of the plan with a focus on
working closely with schools and to educate parents and communities to promote health and
wellbeing.
3.4.7 Prevention is intrinsically linked with managing demand – for primary care, acute care
and the ‘expensive’ part of the system.
3.4.8 The key facets of our focus on prevention will be realised through the following group of
programmes:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
43
3.4
.8 S
OC
IAL
MO
VE
ME
NT
FO
R C
HA
NG
E
AIM
: to
use
be
ha
vio
ura
l a
pp
roa
che
s to
wa
rds
the
ach
iev
em
en
t o
f p
op
ula
tio
n s
cale
pre
ve
nti
on
an
d s
elf
ca
re
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Sa
lfo
rd w
ill
bu
ild
up
on
re
cen
t w
ork
by
th
e n
ew
eco
no
mic
s fo
un
da
tio
n3 w
hic
h c
on
clu
de
s th
at
the
re i
s a
ne
ed
fo
r a
re
sou
rce
sh
ift
tow
ard
s fi
nd
ing
wa
ys
of
tak
ing
lo
cal
ea
rly
act
ion
to
imp
rov
e p
eo
ple
’s q
ua
lity
of
life
an
d r
ed
uce
th
e s
tra
in o
n p
ub
lic
serv
ice
s. T
his
wil
l in
clu
de
:
• R
eso
urc
efu
l co
mm
un
itie
s, w
he
re r
esi
de
nts
an
d g
rou
ps
are
ag
en
ts o
f ch
an
ge
, re
ad
y t
o s
ha
pe
th
e c
ou
rse
of
the
ir o
wn
liv
es.
To
ach
iev
e t
his
pe
op
le n
ee
d a
ctu
al
reso
urc
es
(bu
t in
th
e b
roa
de
st s
en
se),
co
nn
ect
ion
s, a
nd
co
ntr
ol.
• P
rev
en
tati
ve
pla
ces,
wh
ere
th
e q
ua
lity
of
ne
igh
bo
urh
oo
ds
ha
s a
po
siti
ve
im
pa
ct o
n h
ow
pe
op
le f
ee
l a
nd
en
ab
les
the
m t
o l
ea
d f
ulf
illi
ng
liv
es
an
d t
o h
elp
the
mse
lve
s a
nd
ea
ch o
the
r.
• S
tro
ng
, co
lla
bo
rati
ve
pa
rtn
ers
hip
s, w
he
re o
rga
nis
ati
on
s w
ork
to
ge
the
r a
nd
sh
are
kn
ow
led
ge
an
d p
ow
er,
fo
ste
rin
g r
esp
ect
ful,
hig
h-t
rust
re
lati
on
ship
s b
ase
d o
n a
sha
red
pu
rpo
se.
• S
yst
em
s g
ea
red
to
ea
rly
act
ion
, w
he
re t
he
cu
ltu
re,
va
lue
s, p
rio
riti
es,
an
d p
ract
ice
s o
f lo
cal i
nst
itu
tio
ns
sup
po
rt e
arl
y a
ctio
n a
s th
e n
ew
‘n
orm
al’
wa
y o
f w
ork
ing
.
Ou
r a
pp
roa
ch i
s d
eve
lop
ed
fro
m t
he
NIC
E g
uid
an
ce h
ttp
s://
ww
w.n
ice
.org
.uk/
gu
ida
nce
/ph
6 a
nd
htt
ps:
//w
ww
.nic
e.o
rg.u
k/g
uid
an
ce/p
h4
9,
wh
ich
pro
vid
es
a s
yst
em
ati
c,
coh
ere
nt
an
d
ev
ide
nce
-ba
sed
a
pp
roa
ch,
con
sid
eri
ng
g
en
eri
c p
rin
cip
les
for
cha
ng
ing
p
eo
ple
's
he
alt
h-r
ela
ted
k
no
wle
dg
e,
att
itu
de
s a
nd
b
eh
av
iou
r,
at
ind
ivid
ua
l,
com
mu
nit
y a
nd
po
pu
lati
on
le
vels
. W
e w
ill
em
be
d t
his
ap
pro
ach
acr
oss
th
e w
ho
le l
ife
co
urs
e.
Ou
r st
aff
wil
l b
e t
rain
ed
to
su
pp
ort
be
ha
vio
ur
cha
ng
e a
nd
we
wil
l e
nsu
re
tha
t co
mm
issi
on
ed
se
rvic
es
follo
w t
his
ap
pro
ach
to
ach
iev
ing
ou
tco
me
s.
Wo
rk t
o e
ng
ag
e l
oca
l p
eo
ple
in
pre
ve
nta
tive
he
alt
h a
nd
se
lf c
are
ap
pro
ach
es
wil
l p
lay
a s
ign
ific
an
t p
art
in
re
du
cin
g t
he
de
ma
nd
an
d d
ep
en
de
ncy
on
all
Sa
lfo
rd a
nd
GM
he
alt
h a
nd
ca
re s
erv
ice
s. W
e w
ill t
ak
e a
bro
ad
ap
pro
ach
to
co
nsi
de
rin
g c
om
mu
nit
y a
sse
ts a
nd
th
e r
eso
urc
es
av
ail
ab
le t
o t
he
m.
Sa
lfo
rd w
ill
wo
rk t
ow
ard
s a
so
cia
l m
ove
me
nt
for
cha
ng
e w
hic
h a
pp
lie
s th
e p
rin
cip
les
evo
lvin
g a
t a
Gre
ate
r M
an
che
ste
r le
ve
l to
a S
alf
ord
ge
og
rap
hy
, li
nk
ing
wit
h
em
erg
ing
ev
ide
nce
fro
m t
he
GM
ISR
(G
rea
ter
Ma
nch
est
er
Ind
ep
en
de
nt
So
cie
tal
Re
vie
w).
It
wil
l li
nk
wit
h G
M P
ub
lic
Sect
or
Re
form
(P
SR
) w
ork
stre
am
s, a
s w
ell
as
Cit
y
Co
un
cil
‘Sh
ap
ing
ou
r C
ity’
tra
nsf
orm
ati
on
pla
ns.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Incr
ea
se t
he
le
ve
l o
f co
lla
bo
rati
on
an
d i
nte
gra
tio
n b
etw
ee
n ‘
life
sty
le’
/ p
rev
en
tio
n b
ase
d a
pp
roa
che
s a
nd
se
rvic
es,
an
d t
ho
se a
ge
nci
es
/ se
rvic
es
tha
t su
pp
ort
pe
op
le w
ith
ho
usi
ng
/ u
ne
mp
loy
me
nt
/ e
mp
loym
en
t is
sue
s.
·
Exp
lore
po
ten
tia
l fo
r a
ge
ne
ric
role
, b
ase
d o
n a
pp
lica
tio
n o
f co
ach
ing
te
chn
iqu
es,
to
su
pp
ort
pe
op
le t
o a
dd
ress
a r
an
ge
of
issu
es
an
d t
o m
ov
e f
orw
ard
s. T
his
reco
gn
ise
s th
e i
nte
rco
nn
ect
ed
ne
ss b
etw
ee
n l
ife
sty
le a
nd
wid
er
fact
ors
on
he
alt
h a
nd
we
llb
ein
g,
the
ass
ets
th
at
pe
op
le h
av
e o
r ca
n a
cce
ss a
nd
bu
ild
s o
n a
n
ap
pro
ach
th
at
is a
chie
vin
g c
ha
ng
e w
ith
cli
en
ts.
·
Ad
op
tin
g a
n a
pp
roa
ch i
n w
hic
h s
oci
al v
alu
e g
oe
s b
ey
on
d p
rocu
rem
en
t, t
o c
o-d
esi
gn
an
d c
o-p
rod
uct
ion
– p
art
icu
larl
y v
alu
ing
wh
at
is i
nh
ere
nt
in m
od
els
of
de
live
ry
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Exp
an
din
g w
ork
wit
h t
he
VC
SE
se
cto
r a
s a
ke
y st
rate
gic
an
d d
eliv
ery
pa
rtn
er
in t
he
tra
nsf
orm
ati
on
of
Sa
lfo
rd a
ime
d a
t sh
ifti
ng
sig
nif
ica
nt
de
ma
nd
fo
r h
ea
lth
an
d
3 L
oca
l e
arl
y a
ctio
n:
ho
w t
o m
ak
e i
t h
ap
pe
n
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
44
care
se
rvic
es
fro
m t
he
he
alt
h s
ect
or
to l
oca
l co
mm
un
itie
s, w
ith
th
e s
up
po
rt o
f th
e v
olu
nta
ry a
nd
co
mm
un
ity
se
cto
r; a
nd
re
qu
irin
g a
n a
cce
lera
ted
sh
ift
in r
eso
urc
es
to r
efl
ect
ch
an
gin
g d
em
an
d a
nd
pa
tte
rns
of
use
.
·
Cre
ati
on
of
an
‘In
ve
st t
o S
av
e’
fun
d,
aim
ed
at
(i)
imp
rov
ing
th
e c
ap
aci
ty a
nd
su
sta
ina
bil
ity
of
ke
y a
nch
or
com
mu
nit
y o
rga
nis
ati
on
s w
ith
a h
ea
lth
an
d w
ell
-be
ing
focu
s a
nd
su
pp
ort
ing
th
eir
de
live
ry o
f so
cia
l p
resc
rib
ing
an
d o
the
r co
mm
un
ity
cen
tre
d a
ctiv
itie
s; a
nd
(ii
) su
pp
ort
ing
vo
lun
tee
r-le
d,
sma
ll g
rou
ps
to t
ake
on
mo
re
vo
lun
tee
rs a
nd
in
cre
ase
lo
cal
pa
rtic
ipa
tio
n a
nd
en
ga
ge
me
nt.
Th
ese
in
vest
me
nts
in
tra
nsf
orm
ati
on
of
com
mu
nit
y c
en
tre
d a
ctiv
ity
wil
l a
llo
w S
alf
ord
to
sa
ve
mu
ch
mo
re m
on
ey i
n t
he
fu
ture
·
GM
Ne
w S
oci
ety
pro
gra
mm
e –
wh
ich
se
ek
s to
de
ve
lop
a s
oci
al
spin
e f
or
GM
, p
rom
ote
co
lla
bo
rati
on
aro
un
d P
SR
wo
rkst
rea
ms,
ch
alle
ng
e a
ssu
mp
tio
ns
an
ch
an
ge
be
ha
vio
ur,
un
lock
ing
th
e p
ote
nti
al
for
soci
al
gro
wth
.
Imp
rov
ing
fa
the
rs’
an
d c
hil
dre
n’s
we
llb
ein
g –
Sa
lfo
rd D
ad
z, L
ittl
e H
ult
on
'Sa
lfo
rd D
ad
z' i
s a
co
nst
itu
ted
gro
up
of
loca
l fa
the
rs b
ase
d i
n L
ittl
e H
ult
on
. It
em
erg
ed
fro
m a
pie
ce o
f a
ctio
n r
ese
arc
h c
om
mis
sio
ne
d i
n A
ug
ust
20
13
fro
m U
nli
mit
ed
Po
ten
tia
l (a
Sa
lfo
rd b
ase
d s
oci
al
en
terp
rise
) b
y S
alf
ord
CC
G.
Th
e p
urp
ose
of
the
re
sea
rch
is
to s
ee
wh
eth
er
the
we
llb
ein
g o
f ch
ild
ren
ma
y im
pro
ve b
y i
mp
rov
ing
th
e
we
llb
ein
g o
f th
eir
fa
the
rs.
Un
lim
ite
d P
ote
nti
al
use
d a
n a
sse
t-b
ase
d a
pp
roa
ch c
all
ed
'po
siti
ve
de
via
nce
' w
hic
h i
s b
ase
d a
rou
nd
th
e i
de
a o
f fi
nd
ing
an
d s
ha
rin
g t
he
wis
do
m o
f th
e c
om
mu
nit
y.
In t
his
ca
se t
he
fa
the
rs t
he
mse
lve
s se
ek
to
un
de
rsta
nd
wh
at
the
pro
ble
ms
faci
ng
lo
cal
fath
ers
are
.
Th
e p
roje
ct e
na
ble
d t
he
da
ds
to u
nco
ve
r a
n i
nte
rco
nn
ect
ed
pic
ture
of
mu
ltip
le d
isa
dv
an
tag
e:
dy
sfu
nct
ion
al
fam
ily
re
lati
on
ship
s, u
ne
mp
loym
en
t, p
ov
ert
y,
ho
usi
ng
an
d
me
nta
l h
ea
lth
. T
he
pro
ject
fo
un
d t
ha
t w
he
n t
hin
gs
go
wro
ng
me
n f
ee
l a
sha
me
d –
th
ey
bo
ttle
th
eir
fe
eli
ng
s u
p a
nd
th
is o
fte
n r
esu
lte
d i
n d
ep
ress
ion
, st
ress
, a
nxi
ety
an
d s
om
eti
me
s fe
eli
ng
of
suic
ide
. T
he
pre
sen
tin
g p
rob
lem
wa
s so
cia
l is
ola
tio
n:
fath
ers
ad
mit
ted
th
at
the
y d
o n
ot
talk
ab
ou
t fe
eli
ng
s li
ke m
oth
ers
mig
ht
do
, b
ut
iso
late
the
m o
r a
re i
nd
ee
d i
sola
ted
by
th
eir
ow
n f
am
ilie
s.
Sa
lfo
rd D
ad
z sh
ow
ed
th
at
wh
en
fa
the
rs o
verc
am
e t
he
ir p
rid
e a
nd
sh
am
e a
nd
ta
lk o
pe
nly
ab
ou
t th
eir
pro
ble
ms,
it
off
ere
d h
op
e.
Soci
al
na
rra
tiv
e,
or
sto
ry t
ell
ing
–
oft
en
in
pu
bli
c co
mm
un
ity
me
eti
ng
s a
nd
so
me
tim
es
very
pri
va
tely
, b
eca
me
th
e k
ey
. T
he
ea
rly
ad
op
ters
ha
ve
lit
era
lly
be
gu
n t
o t
ran
sfo
rm t
he
ir l
ive
s, o
ve
rco
min
g l
on
g
term
me
nta
l il
lne
ss,
vo
lun
tee
rin
g,
tra
inin
g a
nd
in
on
e c
ase
ge
ttin
g a
jo
b a
fte
r 1
2 y
ea
rs o
f u
ne
mp
loym
en
t.
A t
wo
ye
ar
ext
ern
al
aca
de
mic
ev
alu
ati
on
le
d b
y L
ee
ds
Be
cke
tt U
niv
ers
ity
ha
s b
ee
n p
ub
lish
ed
wh
ich
co
nfi
rms
tha
t ‘e
mo
tio
na
l o
pe
nn
ess
’ b
etw
ee
n f
ath
ers
ha
s b
ee
n t
he
ke
y t
o n
ot
on
ly o
verc
om
ing
so
cia
l is
ola
tio
n b
ut
in r
ais
ing
co
nfi
de
nce
an
d o
ve
rco
min
g ‘
ma
lad
ap
tiv
e c
op
ing
me
cha
nis
ms’
su
ch a
s e
xce
ssiv
e d
rin
kin
g,
dru
g t
ak
ing
an
d
ga
mb
lin
g.
Sa
lfo
rd D
ad
z h
as
giv
en
lo
cal
me
n i
n a
fa
the
r ro
le a
ne
w f
ou
nd
se
nse
of
resp
on
sib
ilit
y a
nd
id
en
tity
as
me
n a
nd
fa
the
rs.
Th
is i
n t
urn
is
tak
en
in
to t
he
fa
mil
y
ho
me
, w
he
re c
hil
dre
n l
ike
wis
e a
re o
verc
om
ing
str
ess
-re
late
d c
on
dit
ion
s su
ch a
s p
sori
asi
s a
nd
are
mo
re h
ap
py
an
d c
on
fid
en
t.
3.4
.9 P
LAC
E-B
AS
ED
WO
RK
ING
A
IM:
to
sup
po
rt
the
so
cia
l m
ov
em
en
t fo
r ch
an
ge
b
y
de
ve
lop
ing
a
n
inte
gra
ted
, p
lace
-ba
sed
a
pp
roa
ch
to
ach
iev
ing
im
pro
ve
me
nt
to p
eo
ple
’s w
ell
be
ing
in
th
e C
ity
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Sa
lfo
rd w
ill
use
th
e s
ha
rin
g o
f re
sou
rce
s to
ach
iev
e s
ha
red
ou
tco
me
s a
nd
pla
ce-b
ase
d w
ork
ing
is
ab
ou
t w
ho
le s
yst
em
ch
an
ge
in
wh
ich
in
div
idu
als
, o
rga
nis
ati
on
s a
nd
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
45
com
mu
nit
ies
wo
rk t
og
eth
er
to i
de
nti
fy a
nd
po
ol
the
ir c
ap
aci
ty,
skil
ls,
kn
ow
led
ge
, co
nn
ect
ion
s, a
sse
ts a
nd
re
sou
rce
s.
Bu
ild
ing
fro
m m
ap
pin
g t
o l
oca
l co
mm
un
ity
ass
ets
, p
art
ne
rs w
ill
wo
rk t
og
eth
er
to s
ha
re l
oca
l k
no
wle
dg
e,
com
pa
re w
ha
t th
ey
are
all
do
ing
an
d a
gre
e a
sh
are
d v
isio
n f
or
op
era
tin
g o
n a
ne
igh
bo
urh
oo
d f
oo
tpri
nt.
By
ta
kin
g a
n ‘
eve
ryth
ing
is
po
ssib
le’
ap
pro
ach
, w
e h
op
e t
o r
ed
uce
du
pli
cati
on
of
sta
ff a
nd
se
rvic
es,
ma
ke
acc
ess
an
d r
efe
rra
l
pa
thw
ay
s e
asi
er
an
d m
ore
un
de
rsta
nd
ab
le,
rati
on
ali
se t
he
use
of
bu
ild
ing
s b
y p
ub
lic
serv
ice
s a
nd
giv
e c
on
tro
l o
f p
hy
sica
l a
sse
ts t
o l
oca
l co
mm
un
itie
s. T
his
wo
rk w
ill
bu
ild
fro
m t
he
exp
eri
en
ce a
nd
kn
ow
led
ge
of
fro
nt-
line
wo
rke
rs,
serv
ice
use
rs a
nd
th
e w
ide
r p
ub
lic.
Th
e V
CS
E s
ect
or
is a
co
re p
art
ne
r in
de
ve
lop
ing
th
is w
ork
–
en
suri
ng
we
ca
n i
nco
rpo
rate
th
e l
ea
rnin
g a
nd
str
on
g t
rack
re
cord
on
so
cia
l e
nte
rpri
se a
nd
so
cia
l v
alu
e w
ith
in t
he
cit
y.
VC
SE
org
an
isa
tio
ns
bri
ng
exp
ert
ise
in
en
ga
gin
g
ind
ivid
ua
ls a
nd
co
mm
un
itie
s in
wa
ys
tha
t h
elp
pe
op
le l
oo
k a
fte
r th
eir
ow
n h
ea
lth
be
tte
r a
nd
pa
rtic
ipa
te i
n t
he
ir l
oca
l co
mm
un
ity
, th
us
red
uci
ng
so
cia
l is
ola
tio
n.
Th
ey
als
o b
rin
g a
dd
itio
na
l e
xpe
rtis
e i
n r
ea
chin
g o
ut
to t
ho
se c
om
mu
nit
ies
an
d i
nd
ivid
ua
ls w
ho
do
no
t tr
ad
itio
na
lly
en
ga
ge
wit
h s
tatu
tory
he
alt
h s
erv
ice
s.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
Cit
ize
ns
an
d v
olu
nta
ry,
com
mu
nit
y a
nd
so
cia
l e
nte
rpri
se o
rga
nis
ati
on
s w
ill
com
e t
og
eth
er
wit
h t
he
pu
bli
c se
cto
r o
n a
ne
igh
bo
urh
oo
d f
oo
tpri
nt
to w
ork
in
pa
rtn
ers
hip
in o
rde
r to
:
·
de
ve
lop
cre
ati
ve
wa
ys
of
wo
rkin
g,
wh
ich
ov
erc
om
e s
ect
ora
l, d
ep
art
me
nta
l o
r a
ge
ncy
sil
os
in o
rde
r to
ma
ke
be
st u
se o
f th
e r
eso
urc
es
av
ail
ab
le w
ith
in t
he
are
a
in q
ue
stio
n
·
bu
ild
an
d s
up
po
rt c
ap
aci
ty a
nd
so
cia
l ca
pit
al
in lo
cal c
om
mu
nit
ies
to e
na
ble
se
lf-h
elp
an
d i
nd
ep
en
de
nce
·
ad
op
t a
n a
sse
t-b
ase
d p
ers
pe
ctiv
e i
n o
rde
r to
bu
ild
on
wh
at
is a
lre
ad
y a
vail
ab
le a
nd
fu
nct
ion
ing
we
ll
·
de
plo
y e
arl
y in
terv
en
tio
n a
nd
pre
ve
nti
on
in
itia
tiv
es
wh
ich
ca
n c
on
tain
an
d r
ed
uce
th
e d
em
an
d f
or
hig
h-e
nd
an
d r
ela
tive
ly e
xpe
nsi
ve
pu
bli
cly
-fu
nd
ed
se
rvic
es.
·
inv
olv
e p
eo
ple
in
dis
cuss
ion
s a
bo
ut
ho
w t
o m
ak
e t
he
ir a
rea
a g
oo
d p
lace
to
liv
e in
…a
nd
do
all
of
the
ab
ov
e a
t b
oth
th
e s
tra
teg
ic a
nd
lo
cali
ty l
ev
els
.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
De
ve
lop
ing
an
on
lin
e C
om
mu
nit
y A
sse
ts p
ort
al,
wh
ich
wil
l a
llo
w u
sers
to
lo
cate
an
d c
om
me
nt
on
fa
cili
tie
s, g
rou
ps
an
d s
erv
ice
s a
va
ila
ble
to
lo
cal
pe
op
le,
bu
t w
hic
h
als
o h
as
the
po
ten
tia
l to
fa
cili
tate
GP
so
cia
l p
resc
rib
ing
in
a w
ay
no
t p
rev
iou
sly
av
ail
ab
le t
o t
he
m.
·
Te
stin
g t
he
ne
w p
lace
ba
sed
mo
de
l in
on
e n
eig
hb
ou
rho
od
are
a b
efo
re a
pp
lyin
g l
ea
rnin
g a
nd
pra
ctic
e a
cro
ss t
he
Cit
y.
·
Ou
r w
ork
wil
l li
nk
wit
h t
he
GM
PS
R w
ork
stre
am
aro
un
d p
lace
-ba
sed
wo
rkin
g w
hic
h i
s b
ein
g f
aci
lita
ted
by
Va
ng
ua
rd C
on
sult
ing
, a
pro
gra
mm
e t
o p
rom
ote
act
ive
citi
zen
ship
, a
nd
th
e G
M h
ea
lth
an
d s
oci
al
care
de
vo
luti
on
‘so
cia
l mo
vem
en
t fo
r ch
an
ge
’.
·
En
ga
gin
g l
oca
l co
mm
un
itie
s a
bo
ut
ho
w t
he
y w
ou
ld l
ike
se
rvic
es
de
live
red
·
Pu
t in
pla
ce a
ne
w n
eig
hb
ou
rho
od
mo
de
l a
nd
to
ols
th
at
red
uce
de
ma
nd
, re
mo
ve d
up
lica
tio
n a
nd
su
pp
ort
s co
mm
un
itie
s to
be
mo
re s
elf
su
ffic
ien
t a
nd
re
sili
en
t -
Th
e l
oca
l co
mm
un
ity
wil
l b
eco
me
mo
re e
ng
ag
ed
an
d in
vo
lve
d i
n t
he
are
a w
he
re t
he
y l
ive
an
d l
ess
re
lia
nt
on
th
e C
ou
nci
l a
nd
it
sta
tuto
ry p
art
ne
rs
3.4
.8 B
ES
T S
TA
RT
IN
LIF
E
AIM
: to
ra
ise
asp
ira
tio
ns
an
d p
ut
in p
lace
su
pp
ort
wh
ich
wil
l e
na
ble
yo
un
g p
eo
ple
to
ach
iev
e t
he
ir p
ote
nti
al
in
life
, a
s w
ell
as
red
uce
de
ma
nd
fo
r se
rvic
es
in t
he
me
diu
m t
o l
on
g t
erm
.
Sta
rtin
g W
ell
A 0
-25
in
teg
rate
d s
up
po
rt p
rog
ram
me
co
mm
en
ced
in
ea
rly
20
15
. T
his
se
ek
s to
re
vie
w a
nd
re
de
sig
n p
rov
isio
n a
nd
co
mm
issi
on
ing
of
serv
ice
s a
nd
se
ek
s n
ew
wa
ys o
f
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
46
sup
po
rtin
g c
om
mu
nit
ies
to r
ais
e a
spir
ati
on
s fo
r th
e 0
-25
ag
e r
an
ge
in
Sa
lfo
rd a
s a
wh
ole
sy
ste
m t
ran
sfo
rma
tio
n.
Th
is a
ims
to a
chie
ve t
he
be
st o
utc
om
es
for
chil
dre
n
an
d t
he
ir f
am
ilie
s in
th
e m
ost
co
st e
ffe
ctiv
e w
ay
po
ssib
le,
en
ab
lin
g a
ll c
hil
dre
n t
o a
chie
ve t
he
ir f
ull
po
ten
tia
l.
Th
e p
rin
cip
le o
f th
is i
nit
iati
ve
, w
ork
ing
acr
oss
pa
rtn
ers
, is
to a
lig
n t
he
wh
ole
-sy
ste
m r
eso
urc
es,
in
clu
din
g c
om
mu
nit
y a
sse
ts,
wit
h a
chie
vin
g t
he
rig
ht
ou
tco
me
s fo
r yo
un
g p
eo
ple
an
d t
he
ir f
am
ilie
s, m
ov
ing
aw
ay
fro
m h
isto
rica
l,
cult
ura
l a
nd
org
an
isa
tio
na
l co
nst
rain
ts.
It
incl
ud
es
Mid
wiv
es,
He
alt
h V
isit
ors
, G
Ps,
an
d C
hil
dre
n’s
Ce
ntr
es,
an
d s
erv
ice
s sh
ou
ld e
ng
ag
e w
ith
fa
mil
ies
as
soo
n a
s
po
ssib
le,
ide
all
y d
uri
ng
pre
gn
an
cy.
It i
s a
nti
cip
ate
d t
ha
t th
is a
pp
roa
ch w
ill
yie
ld s
ub
sta
nti
al
lon
g t
erm
be
ne
fits
, in
clu
din
g b
ett
er
ou
tco
me
s a
nd
sa
vin
gs
to t
he
wid
er
pu
bli
c se
cto
r a
nd
in
th
e s
ho
rt t
erm
will
rea
lise
eff
icie
nci
es
as
du
pli
cati
on
an
d c
om
ple
xity
are
re
mo
ved
fro
m t
he
exi
stin
g w
ay
s o
f w
ork
ing
.
Pla
cin
g g
rea
ter
acc
ou
nta
bil
ity
on
sch
oo
ls f
or
the
lo
ng
-te
rm d
est
ina
tio
ns
of
the
ir p
up
ils
is a
n a
rea
hig
hli
gh
ted
fo
r fu
rth
er
de
ve
lop
me
nt
by
th
e c
ou
nci
l a
nd
wil
l b
e d
riv
en
by
th
e p
ub
lica
tio
n o
f a
ne
w,
loca
lly
-de
ve
lop
ed
'sc
ore
card
', w
hic
h r
ate
s a
sch
oo
l's p
rog
ress
an
d p
erf
orm
an
ce i
n r
ela
tio
n t
o t
he
ed
uca
tio
na
l a
chie
ve
me
nts
of
pu
pil
s u
p t
o
thre
e y
ea
rs a
fte
r th
ey
ha
ve f
inis
he
d c
om
pu
lso
ry e
du
cati
on
, th
e l
on
g-t
erm
de
stin
ati
on
s a
nd
th
e s
cho
ol's
cu
rre
nt
lev
el
of
en
ga
ge
me
nt
wit
h c
are
ers
re
sou
rce
s a
nd
ind
ep
en
de
nt
info
rma
tio
n,
ad
vic
e a
nd
gu
ida
nce
(IA
G)
serv
ice
s.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
De
ve
lop
me
nt
of
a p
lace
ba
sed
, in
teg
rate
d a
pp
roa
ch a
cro
ss t
he
lif
e c
ou
rse
fro
m t
he
an
ten
ata
l pe
rio
d t
o a
du
lth
oo
d w
ith
se
am
less
pro
vis
ion
wh
ich
en
ab
les
yo
un
g
pe
op
le t
o m
ov
e f
rom
un
ive
rsa
l p
ro v
isio
n t
o t
ran
siti
on
to
ea
rly
he
lp a
nd
mo
re e
nh
an
ced
su
pp
ort
wh
ere
re
qu
ire
d.
·
Ass
ist
wit
h t
he
off
er
of
targ
ete
d s
up
po
rt f
or
NE
ET
yo
un
g p
eo
ple
an
d t
ho
se a
t ri
sk o
f b
eco
min
g N
EE
T;
·
To
me
et
org
an
isa
tio
na
l d
uti
es
to p
rom
ote
yo
un
g p
eo
ple
's e
ffe
ctiv
e p
art
icip
ati
on
in e
du
cati
on
an
d t
rain
ing
in
a m
ore
eff
ect
ive
an
d r
esp
on
siv
e w
ay
.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
A f
ocu
s o
n f
ou
r w
ork
str
ea
ms:
pa
ren
tin
g;
spe
ech
an
d la
ng
ua
ge
; in
teg
rate
d t
wo
ye
ar
old
pro
gre
ss c
he
cks;
an
d,
ma
pp
ing
an
d a
na
lysi
s o
f se
rvic
es
for
chil
dre
n a
ge
d 0
-
5 w
ith
in t
he
cit
y’s
Ch
ild
ren
’s C
en
tre
s
·
De
ve
lop
ing
th
ree
te
st c
ase
are
as
to t
est
co
lla
bo
rati
ve
wa
ys
of
wo
rkin
g a
cro
ss E
mo
tio
na
l H
ea
lth
an
d w
ell
be
ing
, C
hil
dre
n w
ith
dis
ab
ilit
ies
an
d t
he
rap
y se
rvic
es
·
Tra
nsi
tio
n o
f co
mm
issi
on
ing
fo
r H
ea
lth
Vis
itin
g a
nd
Fa
mil
y N
urs
e P
art
ne
rsh
ip t
o t
he
lo
cal a
uth
ori
ty t
o e
na
ble
clo
ser
inte
gra
tio
n a
cro
ss t
he
0-2
5 p
ath
wa
y.
·
Tra
nsf
orm
ati
on
of
the
Ch
ild a
nd
Ad
ole
sce
nt
me
nta
l He
alt
h S
erv
ice
s (C
AM
HS
)…
·
Su
pp
ort
th
e r
eq
uir
ed
gro
wth
in
ap
pre
nti
cesh
ips,
re
cog
nis
ing
ho
w t
he
se p
rop
osa
ls c
ou
ld b
e l
ink
ed
to
pro
gra
mm
es
for
yo
un
g p
eo
ple
, e
spe
cia
lly
th
ose
th
at
are
NE
ET
an
d/o
r fa
cin
g s
ign
ific
an
t b
arr
iers
to
en
try
to
th
e la
bo
ur
ma
rke
t;
CA
SE
ST
UD
Y:
All
in
th
e M
ind
In 2
01
2/1
3,
NH
S S
alf
ord
(n
ow
Sa
lfo
rd C
CG
) e
ng
ag
ed
wit
h y
ou
ng
pe
op
le a
cro
ss t
he
cit
y t
o u
nd
ers
tan
d t
he
ir h
ea
lth
co
nce
rns
an
d p
rio
riti
es,
an
d m
en
tal
he
alt
h e
me
rge
d
as
the
nu
mb
er
on
e p
rio
rity
fo
r th
is g
rou
p.
In r
esp
on
se,
Sa
lfo
rd C
CG
wo
rke
d i
n p
art
ne
rsh
ip w
ith
pu
bli
c h
ea
lth
, S
alf
ord
Cit
y C
ou
nci
l to
de
ve
lop
a ‘
Th
ea
tre
in
Ed
uca
tio
n’
pro
du
ctio
n a
ime
d a
t 1
3-1
4y
r o
lds
an
d t
he
wo
rksh
op
wa
s d
eli
vere
d i
n n
ine
Sa
lfo
rd s
cho
ols
an
d t
wo
Pu
pil
Re
ferr
al
Un
its
(PR
Us)
du
rin
g M
arc
h 2
01
4.
Th
e a
im w
as
to
incr
ea
se u
nd
ers
tan
din
g a
nd
sig
np
ost
to
lo
call
y co
mm
issi
on
ed
se
rvic
es
an
d l
oca
l a
nd
na
tio
na
l su
pp
ort
ne
two
rks.
Th
e f
ee
db
ack
fro
m s
cho
ols
wa
s v
ery
po
siti
ve a
nd
da
ta
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
47
fro
m 4
2n
d S
tre
et
als
o i
nd
ica
ted
a s
pik
e i
n t
he
nu
mb
er
of
refe
rra
ls,
the
refo
re t
he
de
cisi
on
wa
s m
ad
e t
o r
e-c
om
mis
sio
n t
he
wo
rksh
op
in
20
15
. In
Ma
rch
20
15
, th
e
dra
ma
wo
rksh
op
wa
s d
eliv
ere
d i
n s
ix s
eco
nd
ary
sch
oo
ls a
nd
all
th
ree
PR
Us
acr
oss
th
e c
ity
. A
to
tal
of
99
0 s
tud
en
ts p
art
icip
ate
d w
ith
alm
ost
ha
lf c
om
ple
tin
g
ev
alu
ati
on
s (b
elo
w).
96
% s
aid
th
at
the
pla
ys
ha
d s
ign
ific
an
tly
incr
ea
sed
th
eir
kn
ow
led
ge
of
self
-ha
rm.
Bo
th s
tud
en
ts a
nd
te
ach
ers
id
en
tifi
ed
bo
dy
ima
ge
an
d d
rug
s a
s
issu
es
the
y w
ou
ld l
ike
to
se
e c
ove
red
in
fu
ture
wo
rksh
op
s. T
he
wo
rksh
op
s w
ill b
e r
ep
ea
ted
ag
ain
in
20
16
, in
corp
ora
tin
g a
n e
ati
ng
dis
ord
er
the
me
.
3.4
.9 P
RO
MO
TIN
G H
EA
LTH
Y L
IFE
ST
YLE
S
AIM
: to
pu
t in
pla
ce p
ub
lic
he
alt
h p
rog
ram
me
s w
hic
h w
ill
pro
mo
te,
sup
po
rt a
nd
en
ab
le h
ea
lth
y l
ife
sty
les
at
all
ag
es,
in
ord
er
to i
mp
rov
e h
ea
lth
ou
tco
me
s a
nd
re
du
ce d
em
an
d f
or
pri
ma
ry a
nd
acu
te c
are
Sta
rtin
g,
Liv
ing
an
d A
ge
ing
We
ll
To
ba
cco
co
ntr
ol
an
d s
mo
kin
g c
ess
ati
on
: O
ur
stra
teg
y in
clu
de
s d
e-n
orm
ali
sin
g s
mo
kin
g b
y a
dd
ress
ing
ch
ea
p i
llic
it t
ob
acc
o s
ale
s, p
rote
ctin
g p
eo
ple
fro
m s
eco
nd
ha
nd
smo
ke
(p
art
icu
larl
y c
hil
dre
n a
nd
yo
un
g p
eo
ple
in
th
eir
ho
me
s) a
nd
pro
vid
ing
op
po
rtu
nit
ies
for
pe
op
le t
o q
uit
wh
en
th
ey
cho
ose
to
. D
esp
ite
a f
all
, th
e n
um
be
rs o
f
pe
op
le s
mo
kin
g i
n S
alf
ord
ha
ve
re
ma
ine
d s
ign
ific
an
tly
hig
he
r th
an
En
gla
nd
re
fle
ctin
g t
he
str
on
g c
orr
ela
tio
n b
etw
ee
n d
ep
riv
ati
on
an
d h
igh
er
smo
kin
g r
ate
s.
He
alt
hy
We
igh
t: S
cho
ols
an
d i
nd
ust
ry w
ill
pla
y a
pa
rt in
en
ab
lin
g h
ea
lth
ier
life
style
s a
nd
re
du
cin
g o
be
sity
acr
oss
th
e l
ife
co
urs
e,
an
d c
an
pro
vid
e g
rea
ter
un
de
rsta
nd
ing
of
the
in
terr
ela
tio
nsh
ip o
f h
ea
lth
y w
eig
ht
an
d d
ay
to
da
y l
ife
sty
les
an
d b
eh
av
iou
rs a
nd
th
is t
yp
e o
f in
itia
tive
an
d i
nv
est
me
nt
wil
l b
e e
xpa
nd
ed
to
ga
in a
mu
ch b
ett
er
an
d m
ore
un
ive
rsa
l co
ve
rag
e a
cro
ss t
he
Cit
y.
Fu
rth
erm
ore
, a
co
-ord
ina
ted
eff
ort
is
req
uir
ed
acr
oss
th
e p
ub
lic
an
d V
CS
E s
ect
ors
to
in
cre
ase
in
ord
er
to p
rom
ote
,
sup
po
rt a
nd
en
ab
le S
alf
ord
’s r
esi
de
nts
to
ta
ke
pa
rt i
n e
xerc
ise
an
d p
hy
sica
l a
ctiv
ity
, n
orm
ali
sin
g a
ctiv
e b
eh
av
iou
rs.
Th
ere
wil
l a
lso
be
wo
rk t
o e
nsu
re t
ha
t p
hys
ica
l
act
ivit
y i
s a
co
re e
lem
en
t o
f lo
ng
te
rm c
on
dit
ion
ma
na
ge
me
nt
pro
gra
mm
es.
Re
du
cin
g a
lco
ho
l re
late
d h
arm
: O
ur
red
esi
gn
ed
dru
g a
nd
alc
oh
ol
syst
em
, A
chie
ve
, d
eli
vers
am
on
gst
th
e b
est
tre
atm
en
t p
erf
orm
an
ce i
n t
he
co
un
try
. B
ut
we
ne
ed
to
go
fu
rth
er
an
d l
oo
k fo
rwa
rd t
o t
he
op
po
rtu
nit
ies
tha
t d
evo
luti
on
mig
ht
bri
ng
fo
r lo
cal
inn
ov
ati
on
aro
un
d l
ice
nsi
ng
, m
inim
um
un
it p
rici
ng
, a
nd
aw
are
ne
ss c
am
pa
ign
s.
Ach
iev
e i
ncl
ud
es
the
Alc
oh
ol
Ass
ert
ive
Ou
tre
ach
se
rvic
e,
wit
h e
ffic
ien
t ca
re p
ath
wa
ys
be
twe
en
ou
tre
ach
an
d t
he
Ach
ieve
ma
in t
rea
tme
nt
serv
ice
s, a
s w
ell
as
cro
ss
refe
rra
ls b
etw
ee
n l
ink
ed
se
rvic
es.
It
ha
s a
lso
em
be
dd
ed
an
ass
et
ba
sed
ap
pro
ach
, a
nd
in
clu
de
s a
re
cov
ery
fu
nd
fo
r co
mm
un
ity
de
ve
lop
me
nt
of
tre
atm
en
t a
nd
su
pp
ort
pro
ject
s.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
To
ma
ke a
ste
p c
ha
ng
e i
n lo
cal
smo
kin
g r
ate
s w
e w
ou
ld l
ike
to
se
e G
rea
ter
Ma
nch
est
er
fre
ed
om
s to
te
st t
he
lim
its
of
smo
ke
fre
e s
pa
ces
acr
oss
th
e e
con
om
y.
·
A f
ocu
s o
n h
elp
ing
wo
me
n t
o s
top
sm
ok
ing
in
pre
gn
an
cy –
ta
rge
ted
at
are
as
of
the
Cit
y w
he
re t
he
re is
a p
art
icu
larl
y h
igh
pre
vale
nce
.
·
Fo
cus
on
an
in
cre
ase
in
th
e u
se o
f g
ree
n s
pa
ce b
y lo
cal
pe
op
le,
Sa
lfo
rd i
s a
gre
en
cit
y a
nd
ye
t h
as
on
e o
f th
e l
ow
est
usa
ge
ra
tes
for
gre
en
sp
ace
in
GM
. C
o-
ord
ina
ted
, cr
oss
se
cto
r a
l wo
rk t
o n
orm
ali
se a
ctiv
e b
eh
av
iou
rs i
n t
he
po
pu
lati
on
.
·
We
als
o w
an
t to
se
e a
sig
nif
ica
nt
inv
est
me
nt
acr
oss
GM
in
in
terc
on
ne
cte
d a
ctiv
e t
rav
el
rou
tes
an
d p
ub
lic
tra
nsp
ort
, a
s w
ell
as
inve
stm
en
t in
in
fra
stru
ctu
re f
or
cycl
ing
, w
alk
ing
an
d p
hy
sica
l e
xerc
ise
.
·
We
wil
l a
lso
use
a c
on
sist
en
t a
nd
we
llb
ein
g f
ocu
s in
pla
nn
ing
gu
ida
nce
, d
raw
ing
on
th
e b
est
exa
mp
les
of
inn
ov
ati
on
, fo
r e
xam
ple
Sa
lfo
rd’s
su
pp
lem
en
tary
pla
nn
ing
gu
ida
nce
on
ho
t fo
od
ta
kea
wa
ys.
·
A f
ocu
s o
n a
dd
ress
ing
hy
pe
rte
nsi
on
in
alc
oh
ol
use
rs,
sav
ing
mo
re l
ive
s th
an
fo
cuss
ing
on
liv
er
dis
ea
se,
thro
ug
h t
he
ch
an
ge
of
tre
atm
en
t p
ath
wa
ys
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
48
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
We
wil
l d
ev
elo
p n
ew
mo
de
ls o
f st
op
sm
ok
ing
su
pp
ort
bo
th lo
call
y a
nd
at
sca
le a
cro
ss G
M t
o r
esp
on
d t
o t
he
ph
en
om
en
a o
f E
cig
s.
·
Co
nti
nu
ati
on
of
the
fa
mily
th
era
py
pro
gra
mm
e,
targ
ete
d a
t ch
ild
ren
an
d f
am
ilie
s w
ith
dru
g a
nd
alc
oh
ol
pro
ble
ms
in t
he
ho
use
ho
ld.
·
Co
-lo
cati
on
of
alc
oh
ol
serv
ice
s –
CC
G e
arl
y li
ver
dis
ea
se f
ibro
-sca
nn
ing
wit
h i
nte
gra
ted
dru
g a
nd
alc
oh
ol s
erv
ice
s
·
Join
t p
roto
col
aro
un
d a
sse
ssm
en
ts a
nd
re
ferr
als
wit
h c
hil
dre
n’s
se
rvic
es
– c
hil
dre
n l
ivin
g i
n f
am
ilie
s w
he
re t
he
re i
s a
lco
ho
l o
r d
rug
mis
use
. T
his
wil
l in
clu
de
mo
re
sha
rin
g o
f in
form
ati
on
wh
ere
ch
ild
ren
are
at
risk
·
Loca
l in
no
va
tio
n a
rou
nd
lic
en
sin
g,
min
imu
m u
nit
pri
cin
g,
an
d a
wa
ren
ess
ca
mp
aig
ns
to r
ed
uce
ha
rmfu
l u
se o
f a
lco
ho
l
·
Fu
rth
er
de
velo
p S
alf
ord
’s a
pp
roa
ch t
o m
ark
eti
ng
ph
ysi
cal
act
ivit
y m
ess
ag
es,
in
clu
din
g t
he
‘O
ne
Yo
u’
he
alt
h a
nd
exe
rcis
e P
HE
ca
mp
aig
n w
hic
h w
ill
be
la
un
che
d i
n
20
16
.
CA
SE
ST
UD
Y:
Cru
cia
l C
rew
en
ga
gin
g w
ith
ch
ild
ren
aro
un
d t
he
da
ng
ers
of
too
mu
ch s
ug
ar
Sa
lfo
rd C
CG
wo
rke
d w
ith
Pu
bli
c H
ea
lth
, S
alf
ord
Cit
y C
ou
nci
l to
id
en
tify
ke
y i
ssu
es
for
Sa
lfo
rd’s
yo
un
g p
eo
ple
. A
s a
re
sult
, th
rou
gh
ou
t N
ov
em
be
r 2
01
5,
Sa
lfo
rd C
CG
de
liv
ere
d i
nte
ract
ive
wo
rksh
op
s to
pri
ma
ry s
cho
ol
child
ren
fro
m a
cro
ss S
alf
ord
, id
en
tify
ing
th
e d
an
ge
rs o
f h
av
ing
to
o m
uch
su
ga
r in
th
eir
die
t, w
hic
h c
ou
ld i
ncr
ea
se
the
ch
an
ces
of
too
th d
eca
y, o
be
sity
an
d t
yp
e 2
dia
be
tes.
T
he
wo
rksh
op
s h
av
e a
lso
co
nsi
de
red
th
e d
an
ge
rs f
or
yo
un
g p
eo
ple
co
nsu
min
g e
ne
rgy
dri
nk
s, w
hic
h n
ot
on
ly
con
tain
a l
arg
e a
mo
un
t o
f su
ga
r b
ut
caff
ein
e t
oo
.
Th
ese
wo
rksh
op
s h
ave
be
en
de
liv
ere
d p
art
of
Ch
ild
ren
Sa
fety
Me
dia
’s,
Cru
cia
l Cre
w P
rog
ram
me
. T
he
se a
nn
ua
l S
alf
ord
ev
en
ts f
ocu
s o
n p
rev
en
tio
n a
nd
sta
yin
g s
afe
.
Du
rin
g t
his
tim
e o
ve
r 1
65
0 s
tud
en
ts a
nd
50
te
ach
ing
sta
ff h
av
e p
art
icip
ate
d i
n o
ur
inte
ract
ive
wo
rksh
op
s, w
he
re t
he
y w
ill
fin
d o
ut,
ho
w m
uc
h s
ug
ar
is c
on
tain
ed
in
po
pu
lar
soft
dri
nk
s.
Th
is i
s th
e f
irst
tim
e a
he
alt
h w
ork
sho
p h
as
be
en
de
live
red
at
Cru
cia
l C
rew
, o
the
r a
ge
nci
es
incl
ud
ing
GM
P,
Bri
tish
Tra
nsp
ort
Po
lice
, S
ali
x H
om
es,
Urb
an
Vis
ion
an
d R
NLI
als
o p
art
icip
ate
.
Alt
ho
ug
h d
eli
veri
ng
up
to
tw
elv
e b
ack
-ba
ck w
ork
sho
ps
is r
eso
urc
e i
nte
nsi
ve,
the
be
ne
fits
of
de
live
rin
g c
ruci
al
me
ssa
ge
s in
to o
ver
17
00
ho
use
ho
lds
cert
ain
ly o
ut
wa
ys
this
.
Th
ese
se
ssio
ns
ed
uca
te,
po
ten
tia
lly
ch
an
gin
g b
eh
av
iou
rs w
hic
h c
ou
ld p
reve
nt
life
ch
an
gin
g/t
hre
ate
nin
g c
on
dit
ion
s. T
he
co
st o
f tr
ea
tin
g p
rev
en
tab
le s
ug
ar-
rela
ted
illn
ess
es,
su
ch a
s o
be
sity
als
o c
om
es
at
a s
ign
ific
an
t fi
na
nci
al
cost
to
th
e N
HS
, u
p t
o 9
% o
f it
s a
nn
ua
l b
ud
ge
t.
3.4
.10
SC
RE
EN
ING
AN
D E
AR
LY D
ET
EC
TIO
N
AIM
: to
in
cre
ase
th
e e
ffe
ctiv
en
ess
of
scre
en
ing
an
d e
arl
y d
ete
ctio
n p
rog
ram
me
s so
th
at
dis
ea
se c
an
be
de
tect
ed
ea
rly
, m
ore
eff
ect
ive
ly a
nd
tre
ate
d w
ith
th
e m
inim
um
ne
ed
fo
r e
xp
en
siv
e a
nd
ag
gre
ssiv
e t
rea
tme
nts
Liv
ing
, A
ge
ing
We
ll
Ca
nce
r sc
ree
nin
g:
Ea
rly
de
tect
ion
of
can
cer
lea
ds
to l
ess
ag
gre
ssiv
e t
rea
tme
nts
, b
ett
er
surv
iva
l ra
tes
an
d l
on
ge
r li
fe e
xpe
cta
ncy
. In
Sa
lfo
rd (
an
d n
ati
on
all
y)
the
nu
mb
er
of
ne
w c
an
cer
case
s is
in
cre
asi
ng
. A
rou
nd
40
% o
f ca
nce
rs a
re a
ttri
bu
tab
le t
o l
ife
sty
le a
nd
en
vir
on
me
nta
l fa
cto
rs s
uch
as
smo
kin
g,
exc
ess
ive
alc
oh
ol
con
sum
pti
on
, d
iet
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
49
an
d e
xerc
ise
. S
alf
ord
ha
s a
mo
ng
st t
he
hig
he
st c
an
cer
de
ath
ra
tes
for
En
gla
nd
. O
ne
ye
ar
an
d f
ive
ye
ar
surv
iva
l a
re h
ow
ev
er
imp
rov
ing
an
d S
alf
ord
ha
s re
ach
ed
En
gla
nd
surv
iva
l ra
tes
ov
er
the
la
st 1
5 y
ea
rs f
or
mo
st c
an
cer
typ
es.
Ca
nce
r sc
ree
nin
g s
up
po
rts
de
tect
ion
of
cert
ain
ca
nce
r a
t a
n e
arl
y st
ag
e.
In S
alf
ord
bre
ast
, ce
rvic
al
an
d
bo
we
l sc
ree
nin
g u
pta
ke
are
cu
rre
ntl
y b
elo
w t
he
ta
rge
ts s
et
na
tio
na
lly.
Th
ere
ha
s a
lso
be
en
a d
ecl
ine
in
th
e u
pta
ke o
f b
rea
st a
nd
ce
rvic
al
scre
en
ing
ove
r th
e p
ast
fe
w
ye
ars
.
HIV
dia
gn
osi
s a
nd
pre
ve
nti
on
: S
alf
ord
ha
s a
hig
h r
ate
of
pe
op
le d
iag
no
sed
wit
h H
IV,
wit
h a
s m
an
y a
s 2
00
mo
re l
ivin
g w
ith
un
dia
gn
ose
d H
IV i
n S
alf
ord
in
20
13
. A
s w
ell
as
the
ris
ks
to t
he
in
div
idu
al
con
cern
ed
, u
nd
iag
no
sed
HIV
ha
s a
n i
mp
act
on
th
e w
ide
r p
ub
lic
he
alt
h;
Pe
op
le w
ho
do
n’t
kn
ow
th
ey
are
HIV
po
siti
ve
are
at
gre
ate
r ri
sk o
f
pa
ssin
g t
he
vir
us
on
to
oth
ers
. In
20
15
, S
alf
ord
Cit
y C
ou
nci
l a
nd
th
e S
alf
ord
He
alt
h a
nd
We
llb
ein
g B
oa
rd,
pa
sse
d t
he
Ha
lve
It
cam
pa
ign
mo
tio
n,
ple
dg
ing
to
ta
ke
act
ion
to h
alv
e t
he
pro
po
rtio
n o
f p
eo
ple
dia
gn
ose
d l
ate
wit
h H
IV b
y 2
02
0 a
nd
wo
rk w
ith
pa
rtn
ers
, to
wa
rds
ha
lvin
g t
he
pro
po
rtio
n o
f p
eo
ple
liv
ing
wit
h u
nd
iag
no
sed
HIV
.
Ca
rdio
va
scu
lar
dis
ea
se (
CV
D):
Sa
lfo
rd h
as
imp
lem
en
ted
th
e N
HS
he
alt
h c
he
cks
pro
gra
mm
e,
off
ere
d t
o a
ll 4
0-7
4 y
ea
r o
lds
in p
rim
ary
ca
re,
ph
arm
aci
sts
an
d a
lso
wit
hin
com
mu
nit
y s
ett
ing
s. T
he
He
alt
h C
he
cks
pro
gra
mm
e i
s a
n i
mp
rove
me
nt
pri
ori
ty w
hic
h h
as
be
en
su
pp
ort
ed
th
rou
gh
Ha
elo
. S
alf
ord
CC
G i
s co
ord
ina
tin
g d
ev
elo
pm
en
t o
f
a b
usi
ne
ss c
ase
th
at
wil
l p
ut
mo
re e
mp
ha
sis
on
co
mm
un
ity
ba
sed
se
rvic
es
an
d a
ctiv
itie
s fo
r p
eo
ple
wit
h d
iag
no
sed
CV
D.
Th
is i
ncl
ud
es
incr
ea
sed
em
ph
asi
s o
n p
hy
sica
l
act
ivit
y.
Dia
be
tes:
Sa
lfo
rd h
as
be
en
id
en
tifi
ed
as
a d
em
on
stra
tor
site
fo
r ta
ckli
ng
ty
pe
-2 d
iab
ete
s.
Th
is p
rog
ram
me
wil
l fo
cus
on
th
e i
de
nti
fica
tio
n,
recr
uit
me
nt,
in
terv
en
tio
n
an
d e
ng
ag
em
en
t w
ith
pa
tie
nts
wit
h I
mp
air
ed
Glu
cose
Re
gu
lati
on
. T
he
ob
ject
ive
is
to p
rev
en
t th
e d
ev
elo
pm
en
t o
f T
yp
e 2
dia
be
tes
thro
ug
h s
up
po
rtiv
e b
eh
av
iou
r
cha
ng
e a
nd
lif
est
yle
in
terv
en
tio
ns
pro
gra
mm
es.
De
me
nti
a:
Ou
r a
im i
s to
re
du
ce t
he
ris
k o
f d
em
en
tia
in
th
e l
oca
l p
op
ula
tio
n,
pa
rtic
ula
rly
va
scu
lar
de
me
nti
a t
hro
ug
h r
eli
ab
le i
mp
lem
en
tati
on
of
He
alt
h C
he
cks
an
d
ma
na
ge
me
nt
of
card
iov
asc
ula
r d
ise
ase
. T
his
wil
l b
e s
up
po
rte
d t
hro
ug
h t
he
GM
wid
e D
em
en
tia
Un
ite
d p
rog
ram
me
.
Liv
er
Dis
ea
se:
Re
spir
ato
ry d
ise
ase
:
Scr
ee
nin
g a
nd
Im
mu
nis
ati
on
: E
nh
an
ced
su
rve
illa
nce
an
d p
art
ne
rsh
ip w
ork
ing
to
re
du
ce c
om
mu
nic
ab
le d
ise
ase
, h
osp
ita
l-a
cqu
ire
d i
nfe
ctio
ns
an
d i
mp
rov
e q
ua
lity
in
all
sett
ing
s e
nsu
res
a j
oin
ed
up
ap
pro
ach
to
pre
ven
tio
n o
f d
ise
ase
. Im
mu
nis
ati
on
an
d v
acc
ina
tio
n u
pta
ke
in
Sa
lfo
rd h
as
tra
dit
ion
all
y b
ee
n h
igh
an
d c
oll
ab
ora
tive
ap
pro
ach
es
such
as
du
rin
g t
he
flu
va
ccin
ati
on
ca
mp
aig
n s
ee
ks t
o r
ed
uce
th
e im
pa
ct o
n a
cute
an
d c
om
mu
nit
y se
ttin
gs
an
d r
ed
uce
de
ath
an
d i
lln
ess
.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
We
we
lco
me
th
e o
pp
ort
un
itie
s th
at
GM
ap
pro
ach
es
mig
ht
bri
ng
, re
cog
nis
ing
bo
th t
he
op
po
rtu
nit
ies
we
ha
ve
to
re
-en
gin
ee
r o
ur
loca
l a
pp
roa
ch a
s p
art
of
the
“Sa
lfo
rd S
tan
da
rd”
bu
t a
lso
to
ma
tch
ou
r p
erf
orm
an
ce t
o t
ha
t se
en
in
ne
igh
bo
uri
ng
dis
tric
ts.
·
To
en
sure
su
pp
ort
fo
r h
ea
lth
pro
fess
ion
als
an
d l
oca
l o
rga
nis
ati
on
s to
en
ab
le e
arl
ier
dia
gn
osi
s in
clu
din
g e
du
cati
on
an
d t
rain
ing
an
d p
rov
isio
n o
f re
lev
an
t p
ath
wa
ys
an
d e
arl
y d
iag
no
sis
too
ls.
·
To
co
nti
nu
e t
o p
rov
ide
a p
roa
ctiv
e i
nfe
ctio
n p
rev
en
tio
n a
nd
co
ntr
ol
serv
ice
fe
ed
ing
in
to G
M d
ev
elo
pm
en
ts w
hic
h m
ay
en
ha
nce
pro
vis
ion
·
To
co
nti
nu
e t
est
ing
th
e s
yst
em
th
rou
gh
exe
rcis
ing
arr
an
ge
me
nts
as
pa
rt o
f th
e w
ide
r sy
ste
ms
resi
lie
nce
fo
rum
s a
nd
wit
h G
M C
CR
U
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Wo
rkin
g w
ith
th
e I
nte
gra
ted
Ca
re P
rog
ram
me
to
in
cre
ase
flu
va
ccin
ati
on
up
take
in o
ur
ove
r si
xty
fiv
e p
op
ula
tio
n w
ith
th
e a
im t
o i
ncr
ea
se v
acc
ina
tio
n u
pta
ke
ab
ove
th
e n
ati
on
al t
arg
et
of
75
% t
o 8
5%
by
20
20
.
·
Loca
l in
itia
tiv
es
an
d a
ctio
ns
wh
ich
aim
to
imp
rov
e c
an
cer
sym
pto
m a
wa
ren
ess
, p
rov
ide
me
ssa
ge
s a
rou
nd
pre
ve
nti
on
(ri
sk f
act
ors
fo
r ca
nce
r),
imp
rove
up
take
of
scre
en
ing
pro
gra
mm
es
an
d e
nco
ura
ge
ea
rly
sym
pto
m p
rese
nta
tio
n t
o G
Ps.
Th
is w
ill
be
co
mm
issi
on
ed
th
rou
gh
co
mm
un
ity
se
rvic
es
tha
t ca
n d
eli
ver
bri
ef
ad
vic
e
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
50
con
vers
ati
on
s a
nd
sig
n p
ost
to
re
lev
an
t sc
ree
nin
g s
erv
ice
s a
nd
GP
pra
ctic
es.
·
NH
S H
ea
lth
ch
eck
s p
rog
ram
me
3.4
.11
WID
ER
DE
TE
RM
INA
NT
S O
F H
EA
LTH
AN
D W
ELL
BE
ING
A
IM:
to w
ork
wit
h p
art
ne
rs t
o r
ed
uce
th
e h
arm
ful
imp
act
of
the
so
cia
l, e
nv
iro
nm
en
tal
an
d e
con
om
ic c
on
dit
ion
s
in w
hic
h p
eo
ple
liv
e o
n t
he
ir h
ea
lth
an
d w
ell
be
ing
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Ta
ckin
g p
ov
ert
y:
Sa
lfo
rd's
str
ate
gy
to
en
d f
am
ily
po
vert
y p
rov
ide
s a
ne
w f
ram
ew
ork
th
rou
gh
wh
ich
we
ca
n a
ll w
ork
to
ge
the
r to
im
pro
ve l
ife
ch
an
ces.
It
sets
ou
t h
ow
we
wil
l b
uil
d o
n w
ha
t w
e k
no
w w
ork
s, a
s w
ell
as
be
ing
in
no
va
tive
in
th
e w
ay
we
jo
in u
p i
nv
est
me
nt,
se
rvic
es
an
d c
om
mu
nit
y e
ffo
rt.
We
sp
eci
fica
lly r
eco
gn
ise
th
e
cen
tra
l co
nn
ect
ion
be
twe
en
po
vert
y a
nd
he
alt
h i
ne
qu
ali
ty (
Ma
rmo
t e
t a
l.).
Ma
ny
VC
SE
se
rvic
es,
sp
eci
fica
lly
ad
vic
e s
erv
ice
s, c
om
ba
t p
ove
rty
, e
nh
an
ce h
ea
lth
an
d
we
llb
ein
g t
hro
ug
h m
axi
mis
ing
in
com
es
(in
clu
din
g i
ncr
ea
sin
g n
ati
on
al
reso
urc
es
av
ail
ab
le l
oca
lly)
, a
nd
re
du
ce l
eve
ls o
f d
ep
riv
ati
on
, w
ith
a r
ed
uct
ion
in
de
bt
lev
els
pla
yin
g a
pa
rtic
ula
rly
imp
ort
an
t ro
le i
n i
mp
rov
ing
me
nta
l h
ea
lth
– a
nd
ma
kin
g s
ure
mo
re f
am
ily r
eso
urc
es
are
ke
pt
in S
alf
ord
ra
the
r th
an
in
se
rvic
ing
hig
h l
ev
els
of
pe
rso
na
l d
eb
t.
Ho
usi
ng
& i
ts H
ea
lth
Ro
le:
We
wil
l e
ng
ag
e w
ith
th
e h
ou
sin
g s
ect
or
in t
he
tra
nsf
orm
ati
on
of
he
alt
h a
nd
so
cia
l ca
re t
o m
axi
mis
e t
he
ir c
om
mu
nit
y a
sse
t b
ase
fo
r
en
ga
gin
g w
ith
co
mm
un
itie
s to
im
pro
ve h
ea
lth
an
d w
ell
be
ing
. E
xam
ple
s o
f th
e p
rop
ose
d w
ork
in
clu
de
s; t
ack
lin
g F
ue
l P
ove
rty
, p
rov
idin
g D
eb
t a
dv
ice
, H
om
ele
ssn
ess
pre
ve
nti
on
, M
ain
ten
an
ce a
nd
im
pro
ve
me
nt
to h
om
es,
Ho
me
fro
m h
osp
ita
l se
rvic
es
an
d T
ack
lin
g s
oci
al
iso
lati
on
.
Em
plo
ym
en
t a
nd
gro
wth
: Im
pro
vin
g t
he
eco
no
mic
pro
spe
rity
of
fam
ilie
s is
th
e k
ey
dri
ver
for
the
re
form
wo
rk i
n S
alf
ord
wit
h s
pe
cifi
c o
utc
om
es
focu
sed
on
re
du
cin
g
wo
rkle
ssn
ess
, im
pro
vin
g a
du
lt s
kil
ls a
nd
im
pro
vin
g h
ou
seh
old
in
com
e.
A c
oll
ab
ora
tiv
e,
mu
lti
ag
en
cy a
pp
roa
ch i
s b
ein
g u
nd
ert
ake
n t
o t
ack
le t
he
mu
ltip
le a
nd
co
mp
lex
ba
rrie
rs t
ha
t ca
n p
rev
en
t p
eo
ple
fro
m a
cce
ssin
g,
sust
ain
ing
an
d p
rog
ress
ing
in
wo
rk,
such
as
he
alt
h,
skil
ls,
ad
dic
tio
n,
ho
me
less
ne
ss,
chil
d c
are
pro
ble
ms
an
d d
eb
t.
Re
du
cin
g t
he
nu
mb
er
of
yo
un
g p
eo
ple
No
t in
Ed
uca
tio
n,
Em
plo
ym
en
t o
r T
rain
ing
(N
EE
T)
- S
alf
ord
ha
s co
nsi
ste
ntl
y r
ep
ort
ed
a h
igh
er
tha
n a
vera
ge
pro
po
rtio
n o
f
yo
un
g p
eo
ple
no
t in
ed
uca
tio
n,
em
plo
ym
en
t o
r tr
ain
ing
(N
EE
T)
wh
en
co
mp
are
d t
o l
oca
l a
nd
sta
tist
ica
l n
eig
hb
ou
rs o
ver
rece
nt
ye
ars
an
d a
lth
ou
gh
va
rio
us
ap
pro
ach
es
ha
ve
be
en
ta
ke
n t
o t
ry a
nd
ad
dre
ss t
he
pro
ble
m,
rece
nt
pa
rtic
ipa
tio
n d
ata
, a
lon
gsi
de
an
ecd
ota
l in
form
ati
on
fro
m l
oca
l p
art
ne
rs a
nd
se
rvic
es,
su
gg
est
th
e t
ren
d i
s
con
tin
uin
g t
o w
ors
en
. W
ork
wil
l in
clu
de
pro
mo
tin
g a
nd
en
forc
ing
th
e r
ais
ed
pa
rtic
ipa
tio
n a
ge
in
ed
uca
tio
n,
sch
oo
ls t
ak
ing
re
spo
nsi
bil
ity
fo
r tr
ack
ing
fo
rme
r p
up
ils,
targ
ete
d s
up
po
rt f
or
NE
ET
yo
un
g p
eo
ple
, p
ew
-em
plo
yme
nt
sup
po
rt,
ap
pre
nti
cesh
ips
an
d o
the
r se
rvic
es.
Ph
ysi
cal
En
vir
on
me
nt
– m
axi
mis
ing
th
e w
ell
be
ing
be
ne
fits
fro
m e
nv
iro
nm
en
tal
imp
rov
em
en
ts,
such
as
the
ne
w R
HS
ga
rde
n a
t W
ors
ley
Ne
w H
all
; e
tc?
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
To
fu
rth
er
inte
gra
te e
mp
loym
en
t a
nd
sk
ills
su
pp
ort
wit
h l
oca
l se
rvic
es
in o
rde
r to
pro
vid
e a
co
-ord
ina
ted
pa
cka
ge
of
sup
po
rt f
or
ind
ivid
ua
ls a
nd
fa
mil
ies
wit
h
mu
ltip
le a
nd
co
mp
lex
pro
ble
ms
ag
ain
st a
co
nte
xt o
f o
ng
oin
g w
elf
are
re
form
. I
n p
art
icu
lar,
to
wo
rk w
ith
Pu
bli
c H
ea
lth
co
mm
issi
on
ers
to
in
teg
rate
em
plo
ym
en
t
sup
po
rt w
ith
we
llb
ein
g s
erv
ice
s.
·
To
wo
rk w
ith
th
e G
rea
ter
Ma
nch
est
er
Pu
bli
c Se
rvic
e R
efo
rm T
ea
m t
o e
nsu
re t
ha
t S
alf
ord
re
sid
en
ts b
en
efi
t fr
om
th
e o
pp
ort
un
itie
s p
rese
nte
d b
y th
e d
evo
luti
on
of
Em
plo
yme
nt
an
d S
kil
ls i
n G
rea
ter
Ma
nch
est
er.
·
To
re
cog
nis
e t
he
im
po
rta
nce
of
en
suri
ng
th
at
the
jo
bs
tha
t a
re b
ein
g c
rea
ted
ha
ve
th
e h
igh
est
em
plo
yme
nt
sta
nd
ard
s, s
uch
as
wo
rkin
g t
ow
ard
s o
r p
ay
ing
th
e
Liv
ing
Wa
ge
.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
51
·
Po
ve
rty
tru
th c
om
mis
sio
n.
·
Th
e W
ork
ing
We
ll p
rog
ram
me
wil
l e
xpa
nd
fro
m F
eb
rua
ry 2
01
6.
Th
is w
ill p
rov
ide
an
In
ten
sive
Su
pp
ort
Se
rvic
e u
nd
erp
inn
ed
by
Me
nta
l He
alt
h T
he
rap
eu
tic
Inte
rve
nti
on
s a
nd
Sk
ills
fo
r E
mp
loym
en
t p
rov
isio
n,
pro
vid
ing
a h
oli
stic
ap
pro
ach
to
mo
vin
g p
eo
ple
in
to s
ust
ain
ab
le e
mp
loym
en
t.
It i
s a
nti
cip
ate
d t
ha
t 1
5,0
00
clie
nts
wil
l re
ceiv
e s
up
po
rt o
ver
the
fo
ur
ye
ars
, w
ith
an
asp
ira
tio
n o
f su
pp
ort
ing
a m
inim
um
of
15
% i
nto
su
sta
ine
d e
mp
loym
en
t.
·
An
d?
Ca
se s
tud
y –
Cit
y M
ay
or’
s E
mp
loy
me
nt
Sta
nd
ard
s C
ha
rte
r
In S
alf
ord
, b
usi
ne
sse
s a
nd
oth
er
org
an
isa
tio
ns
ha
ve
be
en
en
cou
rag
ed
to
se
ek
acc
red
ita
tio
n f
or
the
Cit
y M
ay
or’
s E
mp
loy
me
nt
Sta
nd
ard
s C
ha
rte
r, w
hic
h i
ncl
ud
es:
Pu
t S
alf
ord
Fir
st
·
Co
mm
it t
o c
rea
tin
g t
rain
ing
an
d e
mp
loym
en
t o
pp
ort
un
itie
s fo
r S
alf
ord
pe
op
le.
In p
art
icu
lar
for
the
lon
g-t
erm
un
em
plo
ye
d,
you
ng
pe
op
le n
ot
in e
du
cati
on
, w
ork
or
tra
inin
g (
NE
ET
); lo
oke
d a
fte
r ch
ild
ren
an
d lo
ne
pa
ren
ts.
·
Wo
rk i
n p
art
ne
rsh
ip t
o p
rom
ote
loca
l em
plo
ym
en
t o
pp
ort
un
itie
s a
nd
to
en
cou
rag
e a
nd
fa
cili
tate
le
arn
ing
an
d d
ev
elo
pm
en
t o
f th
e S
alf
ord
wo
rkfo
rce
.
·
En
cou
rag
e t
he
ir S
alf
ord
-ba
sed
su
b-c
on
tra
cto
rs t
o a
lso
be
com
e C
ha
rte
r M
ark
em
plo
yers
.
Se
t th
e S
tan
da
rd
·
Cre
ate
a p
osi
tive
wo
rkin
g e
nv
iro
nm
en
t b
y r
ew
ard
ing
ha
rd w
ork
an
d r
eco
gn
isin
g a
chie
ve
me
nt
by
pa
yin
g s
taff
ab
ove
th
e n
ati
on
al m
inim
um
wa
ge
an
d w
ork
ing
tow
ard
s th
e S
alf
ord
Liv
ing
Wa
ge
of
£8
.25
an
ho
ur.
·
En
cou
rag
e a
he
alt
hy w
ork
pla
ce,
go
od
wo
rk-l
ife
ba
lan
ce a
nd
fo
ste
r p
osi
tive
ma
na
ge
me
nt-
sta
ff r
ela
tio
ns
thro
ug
h r
eg
ula
r d
ialo
gu
e,
for
exa
mp
le,
wit
h r
eco
gn
ise
d
Tra
de
Un
ion
s.
·
Op
po
se t
he
use
of
zero
-ho
urs
co
ntr
act
s w
hic
h u
nd
erm
ine
de
cen
t w
ork
ing
co
nd
itio
ns
for
em
plo
yee
s.
·
Co
mm
it t
o t
he
era
dic
ati
on
of
ille
ga
l ‘b
lack
list
ing
’
Th
e C
ity
Ma
yor’
s C
ha
rte
r fo
r E
mp
loym
en
t St
an
da
rds
wa
s la
un
che
d i
n N
ov
em
be
r 2
01
3 a
nd
ov
er
the
la
st 2
ye
ars
, o
ve
r 8
0 o
rga
nis
ati
on
s h
ave
be
com
e C
ha
rte
r
Su
pp
ort
ers
an
d a
fu
rth
er
5 e
mp
loye
rs h
ave
be
en
aw
ard
ed
th
e C
ha
rte
r M
ark
.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
52
3.5 BETTER CARE
3.5.1 Organisational boundaries across Salford are being broken down to deliver care that is
person centred and proactively co-ordinated across different settings and providers alongside
a much greater emphasis on enabling people to enjoy a healthy and active life within their
communities, reducing the demand for health and care services. Our approach will seek to
use standardisation and a reduction in variation to drive increased effectiveness and
efficiency.
3.5.2 Over the next 5 years, communities will have greater control over the services they use
– including health and care. Working together we will transform communities from ‘recipients
of services’ to ‘owners’ of their health system playing a vital role in designing and
implementing new services and models of care described in this section. This cannot be
achieved without a bolder ambition on the role of data and digital technology enabling
patients and citizens to manage their health and wellbeing, such as the use of digital apps
which empower patients and support care professionals in the development of new
approaches to medicines and treatments. Complimenting improved access to information
and integrated patient records we will deliver 24 hour, 7 day services across the range of
primary, secondary and social care services so that whenever and wherever patients access
services, those caring for them we be able to easily access comprehensive, accurate and
timely information. Urgent care will be transformed to standardise and improve the quality of
life threatening emergency care with Salford Royal NHS Foundation Trust the lead provider
for major trauma services across Greater Manchester. And, elective care services will be
streamlined to drive efficiencies and improvements to clinical pathways supported by
proactive management of long term conditions including mental health and dementia to
ensure hospital services are used appropriately.
3.5.3 In Salford, we have already made significant progress over the last 3 years through the
‘Better Care Fund’ and Integrated Care Programme for Older People investing in an
improved health and social care system. This transformation has changed the way that
services are both paid for and delivered to drive improvements in quality, access, outcomes
and experience for elderly and vulnerable people. Working together with communities we will
grow the integrated care programme and build a joined-up system for everyone, shifting care
wherever possible from hospital settings to a home or community, when safe to do so,
promoting self-care and independent living.
3.5.4 Our focus on better care will be realised through the following group of programmes:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
53
3.5
.5 Q
UA
LIT
Y O
F C
AR
E
AIM
:to
be
th
e s
afe
st h
ea
lth
care
sy
ste
m i
n t
he
co
un
try
, co
mm
issi
on
ing
an
d p
rov
idin
g h
igh
qu
ali
ty h
ea
lth
se
rvic
es
an
d c
are
th
at
en
ab
le o
ur
po
pu
lati
on
to
liv
e l
on
ge
r h
ea
lth
ier
liv
es.
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Pro
vid
ers
an
d c
om
mis
sio
ne
rs i
n S
alf
ord
ha
ve a
tra
ck r
eco
rd o
f w
ork
ing
to
ge
the
r a
nd
th
e e
mp
ha
sis
on
sa
fety
im
pro
ve
me
nt
is a
ke
y t
he
me
un
de
rpin
nin
g o
ur
pla
ns
for
he
alt
h a
nd
ca
re i
nte
gra
tio
n.
Ha
rm s
om
eti
me
s o
ccu
rs w
he
re s
erv
ice
use
rs m
ov
e b
etw
ee
n s
erv
ice
s o
r w
he
n c
are
is
ha
nd
ed
ov
er.
E
rro
rs a
nd
om
issi
on
s in
ca
re l
ea
d t
o
incr
ea
sed
co
st a
cro
ss t
he
sy
ste
m a
nd
an
em
ph
asi
s o
n g
ett
ing
th
ing
s ri
gh
t fi
rst
tim
e a
nd
im
pro
vin
g c
om
mu
nic
ati
on
s w
ill
no
t o
nly
le
ad
to
im
pro
vem
en
ts i
n s
afe
ty,
bu
t
wil
l a
lso
im
pro
ve
eff
icie
ncy
. W
e w
ill
wo
rk t
o a
n i
nte
gra
ted
sa
fety
im
pro
ve
me
nt
pla
n w
hic
h d
esc
rib
es
ho
w w
e w
ill
join
tly
me
asu
re,
mo
nit
or
an
d i
mp
rove
sa
fety
alo
ng
the
en
tire
pa
tie
nt
pa
thw
ay.
In
de
ed
, th
is w
ork
ha
s a
lre
ad
y c
om
me
nce
d w
ith
Bo
ard
le
vel
com
mit
me
nt
acr
oss
pa
rtn
ers
to
th
e ‘
Ma
kin
g S
afe
ty V
isib
le’
pro
gra
mm
e.
We
inte
nd
to
de
ve
lop
a c
ult
ure
wh
ere
as
we
ll a
s le
arn
ing
fro
m p
ast
ha
rm,
we
ha
ve s
yste
ms
in p
lace
th
at
pre
dic
t w
he
the
r ca
re w
ill
be
sa
fely
de
liv
ere
d t
od
ay
an
d u
se t
oo
ls
to e
na
ble
us
to e
nsu
re t
ha
t n
ew
ca
re p
ath
wa
ys a
re d
eliv
ere
d s
afe
ly a
nd
re
lia
bly
in
th
e f
utu
re.
Scr
uti
ny
of
the
qu
ali
ty o
f ca
re i
s w
ritt
en
in
to p
rov
ide
r co
ntr
act
s a
nd
pro
vid
er
qu
ali
ty a
ssu
ran
ce i
ncl
ud
es
a r
an
ge
of
pro
cess
es
to c
oll
ate
an
d t
ria
ng
ula
te i
nfo
rma
tio
n
ga
the
red
fro
m r
eg
ula
r in
spe
ctio
ns
an
d q
ua
lity
wa
lk r
ou
nd
s fr
om
wit
hin
th
e s
yst
em
an
d b
y e
xte
rna
l b
od
ies
such
as;
CQ
C,
NH
S E
ng
lan
d a
nd
Mo
nit
or.
Sa
lfo
rd i
s o
ne
of
3
are
as
tak
ing
pa
rt i
n a
ne
w n
ati
on
al
CQ
C p
ilot
- 'Q
ua
lity
of
Ca
re i
n a
Pla
ce'.
Th
is i
s re
all
y a
bo
ut
incr
ea
sin
g t
ha
t le
ve
l o
f o
pe
nn
ess
ev
en
fu
rth
er
by
bu
ild
ing
a p
ictu
re o
f
wh
at
the
wh
ole
qu
ali
ty o
f ca
re i
s li
ke f
or
pe
op
le l
ivin
g i
n a
pa
rtic
ula
r a
rea
– i
ncl
ud
ing
ho
w w
ell
serv
ice
s a
re c
o-o
rdin
ate
d a
nd
wo
rkin
g t
og
eth
er.
So
ft i
nte
llig
en
ce
incl
ud
ing
pa
tie
nt
exp
eri
en
ce o
f ca
re,
frie
nd
s a
nd
fa
mil
y te
sts
an
d a
ra
ng
e o
f p
ati
en
t su
rve
ys
are
als
o u
sed
to
giv
e a
fu
ll p
ictu
re o
f th
e q
ua
lity
of
com
mis
sio
ne
d
serv
ice
s.
Wh
ilst
scr
uti
ny
of
pe
rfo
rma
nce
an
d p
ati
en
t in
sig
hts
pro
vid
e v
alu
ab
le u
nd
ers
tan
din
g o
f e
xpe
rie
nce
of
care
we
kn
ow
th
at
to a
chie
ve
ou
r a
im o
f b
eco
min
g t
he
sa
fest
he
alt
hca
re s
yst
em
in
th
e c
ou
ntr
y o
ur
list
en
ing
an
d i
nv
olv
em
en
t h
as
to b
e m
uch
mo
re a
mb
itio
us.
Acr
oss
co
mm
issi
on
ers
, th
e I
nte
gra
ted
En
ga
ge
me
nt
Te
am
ha
ve
est
ab
lish
ed
a n
um
be
r o
f jo
int
he
alt
h a
nd
so
cia
l ca
re f
oru
ms
for
en
ga
ge
me
nt
incl
ud
ing
; th
e l
iste
nin
g t
o p
eo
ple
le
arn
ing
dis
ab
ilit
y g
rou
p,
citi
zen
s re
fere
nce
gro
up
fo
r
inte
gra
ted
ca
re,
a y
ou
ng
pe
op
le’s
fo
rum
, a
co
mm
un
ity
rep
ort
er
sch
em
e,
GP
pra
ctic
e a
nd
ne
igh
bo
urh
oo
d P
ati
en
t P
art
icip
ati
on
Gro
up
s (P
PG
) a
nd
ha
s a
n a
ctiv
e P
ati
en
t
an
d C
itiz
en
en
ga
ge
me
nt
pa
ne
l w
ith
ove
r 2
,50
0 m
em
be
rs.
Th
e i
nco
rpo
rati
on
of
fee
db
ack
fro
m t
he
se g
rou
ps
is a
n i
nte
gra
l p
art
of
ou
r d
eci
sio
n m
ak
ing
pro
cess
th
rou
gh
the
fo
rma
l st
ruct
ure
s o
f th
e c
om
mis
sio
ne
r a
nd
pro
vid
er
org
an
isa
tio
ns.
Ea
ch y
ea
r th
e C
CG
pu
bli
she
s a
n e
ng
ag
em
en
t re
po
rt w
hic
h o
utl
ine
s th
e e
ng
ag
em
en
t w
ork
an
d
the
dif
fere
nce
th
e f
ee
db
ack
fro
m p
ati
en
ts
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Fu
lly
em
be
dd
ing
th
e u
se o
f a
qu
ali
ty a
ssu
ran
ce f
ram
ew
ork
fo
r co
mm
issi
on
ed
se
rvic
es
·
Fu
rth
er
de
velo
pin
g t
he
me
cha
nis
ms
to r
eg
ula
rly
re
ceiv
e a
nd
co
lla
te p
ati
en
t st
ori
es
on
th
eir
exp
eri
en
ce o
f u
sin
g s
erv
ice
s
·
Fu
rth
er
de
velo
pin
g t
he
sh
ari
ng
of
lea
rnin
g f
rom
in
cid
en
t in
ve
stig
ati
on
, e
nco
ura
gin
g a
n i
nte
gra
ted
ap
pro
ach
acr
oss
all
org
an
isa
tio
ns
·
Imp
lem
en
tin
g a
nd
co
nti
nu
e t
o d
ev
elo
p S
alf
ord
Sta
nd
ard
s fo
r p
rim
ary
ca
re q
ua
lity
·
De
ve
lop
ing
a c
ult
ure
wh
ere
th
e p
ote
nti
al
for
ha
rm i
s a
ctiv
ely
co
nsi
de
red
, p
roce
sse
s a
re e
mb
ed
de
d f
or
ea
rly
id
en
tifi
cati
on
of
risk
s a
nd
mit
iga
tio
n s
tra
teg
ies
imp
lem
en
ted
to
min
imis
e a
ny
ad
vers
e im
pa
ct o
n p
eo
ple
usi
ng
se
rvic
es.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
54
·
Ro
ll o
ut
of
the
‘p
rod
uct
ive
pra
ctic
e’
pro
gra
mm
e t
o h
elp
ge
ne
ral
pra
ctic
e c
on
tin
ue
to
de
live
r h
igh
qu
ali
ty c
are
wh
ilst
me
eti
ng
in
cre
asi
ng
le
vels
of
de
ma
nd
an
d
div
ers
e e
xpe
cta
tio
ns
·
De
ve
lop
an
d i
mp
lem
en
t a
pa
tie
nt
exp
eri
en
ce s
tra
teg
y
·
De
ve
lop
a
nd
im
ple
me
nt
an
e
con
om
y
wid
e
safe
ty
imp
rove
me
nt
pla
n
tha
t fo
cuse
s o
n
reli
ab
le
ha
nd
ove
r o
f ca
re
an
d
the
sa
fe
pre
scri
bin
g,
dis
pe
nsi
ng
,
ad
min
istr
ati
on
an
d r
ev
iew
of
me
dic
ati
on
.
·
Imp
lem
en
t th
e S
alf
ord
Qu
ali
ty &
Sa
fety
Str
ate
gy
3.5
.6 T
RA
NS
FO
RM
ING
PR
IMA
RY
CA
RE
A
IM:
Pri
ma
ry C
are
wil
l b
e t
he
fo
cal
po
int
of
ou
t o
f h
osp
ita
l a
nd
in
teg
rate
d c
are
, b
uil
t a
rou
nd
na
tura
l
com
mu
nit
ies
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
In S
alf
ord
, G
P p
ract
ice
s h
av
e b
ee
n w
ork
ing
clo
sely
in
ne
igh
bo
urh
oo
ds
to c
om
mis
sio
n h
ea
lth
se
rvic
es
for
seve
ral
yea
rs.
Th
is i
s a
so
un
d b
asi
s u
po
n w
hic
h t
o b
uil
d
com
mu
nit
y ca
pa
city
an
d d
eli
ve
r m
ore
sp
eci
ali
st s
erv
ice
s. I
nv
est
me
nt
is p
lan
ne
d t
o s
cale
up
mo
de
rn c
om
mu
nit
y-b
ase
d s
erv
ice
s in
clu
din
g G
Ps,
co
mm
un
ity
ph
arm
aci
sts,
op
tici
an
s a
nd
co
mm
un
ity
se
rvic
es
in o
rde
r to
in
cre
ase
th
e s
cop
e a
nd
sca
le o
f ca
re p
rov
ide
d o
uts
ide
of
ho
spit
al.
T
his
wil
l re
qu
ire
ke
y e
na
ble
rs i
ncl
ud
ing
hig
h q
ua
lity
pre
mis
es,
imp
rov
ed
te
chn
olo
gy
an
d a
n i
ncr
ea
sed
an
d s
ust
ain
ed
wo
rkfo
rce
.
Th
e a
spir
ati
on
is
tha
t g
en
era
l p
ract
ice
wil
l o
pe
rate
on
a l
arg
er
sca
le,
on
a f
ed
era
ted
ba
sis
po
ssib
ly a
t n
eig
hb
ou
rho
od
le
ve
l, a
nd
wil
l w
ork
in
a m
ore
in
teg
rate
d w
ay
wit
h
oth
er
serv
ice
s, w
ith
ge
ne
ral
pra
ctic
e b
ein
g a
t th
e h
ub
of
loca
l co
mm
un
itie
s a
nd
ne
two
rks
of
serv
ice
s. I
t w
ill
be
im
po
rta
nt
to b
uil
d u
po
n t
he
str
en
gth
s o
f p
rim
ary
ca
re,
reta
inin
g w
ha
t is
va
lue
d b
y t
he
pu
bli
c a
nd
th
e w
ide
r h
ea
lth
an
d s
oci
al
care
wo
rkfo
rce
. A
sig
nif
ica
nt
are
a f
or
de
ve
lop
me
nt
wil
l b
e t
he
“S
alf
ord
Sta
nd
ard
” fo
r p
rim
ary
care
wh
ich
wil
l in
clu
de
in
corp
ora
tin
g a
nd
lo
cali
sin
g s
tan
da
rds
fro
m t
he
Gre
ate
r M
an
che
ste
r P
rim
ary
Ca
re M
ed
ica
l st
an
da
rds,
in
ord
er
to i
mp
rov
e t
he
qu
ali
ty o
f
pro
vis
ion
an
d i
nve
st i
n p
rim
ary
ca
re.
Th
e o
ve
rarc
hin
g a
ims
of
the
Sta
nd
ard
are
to
:
·
Re
du
ce u
nw
arr
an
ted
va
ria
tio
n i
n q
ua
lity
of
care
acr
oss
Sa
lfo
rd
·
Ov
era
ll im
pro
ve t
he
he
alt
h o
utc
om
es
for
the
pe
op
le o
f S
alf
ord
·
Inv
est
me
nt
in p
rim
ary
ca
re f
or
the
fu
ture
to
en
sure
sta
bil
ity
an
d g
row
th
·
Re
du
ce a
void
ab
le a
dm
issi
on
s a
nd
re
ad
mis
sio
ns
to s
eco
nd
ary
ca
re
In a
dd
itio
n,
Sa
lfo
rd w
ill
wo
rk t
o i
mp
lem
en
t g
oo
d p
ract
ice
fro
m a
nu
mb
er
of
na
tio
na
l in
itia
tiv
es
such
as
“Tra
nsf
orm
ing
Pri
ma
ry C
are
” a
nd
th
e N
ati
on
al
Pri
ma
ry C
are
Str
ate
gic
F
ram
ew
ork
w
hic
h
is
curr
en
tly
in
de
ve
lop
me
nt.
D
uri
ng
2
01
5/1
6,
Salf
ord
C
CG
h
as
be
en
w
ork
ing
w
ith
N
HS
E
ng
lan
d’s
Su
b
Re
gio
na
l T
ea
m
un
de
r Jo
int
Co
mm
issi
on
ing
arr
an
ge
me
nts
an
d f
rom
20
16
on
wa
rds
is s
ee
kin
g d
ele
ga
ted
co
mm
issi
on
ing
re
spo
nsi
bil
ity
wh
ich
wil
l e
nsu
re g
rea
ter
eff
icie
nci
es
an
d s
ha
rin
g o
f v
alu
es
aro
un
d i
mp
rov
ing
qu
ali
ty in
pri
ma
ry c
are
.
Sa
lfo
rd C
CG
als
o h
as
a r
ole
to
ma
na
ge
lo
call
y co
mm
issi
on
ed
co
ntr
act
s w
ith
op
tici
an
s a
nd
ph
arm
aci
sts.
Th
rou
gh
th
e d
eve
lop
me
nt
of
Salf
ord
’s C
om
mu
nit
y B
ase
d C
are
Str
ate
gy
wil
l lo
ok
to
de
velo
p o
pp
ort
un
itie
s to
in
teg
rate
th
ese
pro
vid
ers
in
to c
om
mu
nit
y /
loca
l ne
igh
bo
urh
oo
d n
etw
ork
s.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
55
·
A p
ro-a
ctiv
e a
nd
co
ord
ina
ted
ap
pro
ach
to
ca
re,
esp
eci
all
y f
or
vu
lne
rab
le i
nd
ivid
ua
ls o
r th
ose
wit
h a
lo
ng
te
rm c
on
dit
ion
. T
his
in
volv
es
mu
ltip
le p
rofe
ssio
na
ls
wo
rkin
g i
n a
mo
re i
nte
gra
ted
wa
y a
cro
ss p
hy
sica
l h
ea
lth
, m
en
tal
he
alt
h a
nd
so
cia
l ca
re;
·
Ma
inta
inin
g a
fo
cus
on
th
e p
rev
en
tio
n o
f il
l-h
ea
lth
, w
ith
he
alt
h c
he
cks,
scr
ee
nin
g,
ea
rly
dia
gn
osi
s a
nd
lif
est
yle
ad
vic
e a
nd
fu
lly
em
be
dd
ing
th
e c
on
cep
t o
f “M
ak
ing
Ev
ery
Co
nta
ct C
ou
nt”
;
·
A h
oli
stic
ap
pro
ach
to
ca
re,
ma
kin
g s
ha
red
de
cisi
on
s w
ith
pa
tie
nts
an
d c
are
rs;
·
Imp
rov
ing
acc
ess
to
pri
ma
ry c
are
se
rvic
es,
in
clu
din
g o
pe
nin
g a
t w
ee
ken
ds
an
d t
he
ev
en
ing
an
d s
up
po
rtin
g t
he
de
live
ry o
f 7
-da
y a
cce
ss t
o h
ea
lth
an
d s
oci
al
care
;
·
Ra
isin
g t
he
sta
nd
ard
of
care
an
d r
ed
uci
ng
va
ria
tio
n t
hro
ug
h t
he
‘S
alf
ord
Sta
nd
ard
”
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
De
ve
lop
an
d i
mp
lem
en
t a
5 y
ea
r C
om
mu
nit
y B
ase
d C
are
Str
ate
gy
·
Pro
du
ce P
ha
se 2
of
the
Sa
lfo
rd P
rim
ary
Ca
re S
tra
teg
y b
y J
an
ua
ry 2
01
6
·
Pre
pa
re a
Pri
ma
ry C
are
“S
alf
ord
Sta
nd
ard
” to
be
re
sou
rce
d a
nd
co
mm
issi
on
ed
fro
m A
pri
l 20
16
·
Wo
rk w
ith
GP
pra
ctic
es
to d
esi
gn
ne
w m
eth
od
s o
f d
eli
ve
ry w
ith
in t
he
co
nte
xt o
f S
alf
ord
’s I
nte
gra
ted
Ca
re O
rga
nis
ati
on
(IC
O)
an
d c
on
tin
ue
to
wo
rk a
nd
bu
ild
on
the
Mu
ltid
isci
pli
na
ry T
ea
m W
ork
ing
as
pa
rt o
f th
e I
CP
fo
r O
lde
r P
eo
ple
·
Incr
ea
se a
nd
exp
an
d o
n e
xte
nd
ed
ho
urs
/ 7
da
y a
cce
ss i
n G
en
era
l Pra
ctic
e
·
Co
nti
nu
e t
o s
up
po
rt a
nd
wo
rk w
ith
a r
an
ge
of
Pri
ma
ry C
are
Pro
vid
er
Org
an
isa
tio
ns
·
Su
bje
ct t
o N
HS
En
gla
nd
ap
pro
va
l in
20
16
ta
ke
on
fu
lly
de
leg
ate
d c
om
mis
sio
nin
g a
rra
ng
em
en
ts f
or
ge
ne
ral
pra
ctic
e f
rom
Ap
ril 2
01
6
·
Wo
rk t
ow
ard
s e
nsu
rin
g t
ha
t p
ati
en
ts /
pu
bli
c h
av
e a
cce
ss t
o u
p t
o d
ate
an
d t
ime
ly i
nfo
rma
tio
n o
n p
rim
ary
ca
re –
th
is w
ill i
ncl
ud
e l
oca
l an
d n
ati
on
al m
ea
sure
s; a
nd
·
Co
nti
nu
e t
o w
ork
jo
intl
y w
ith
Pu
bli
c H
ea
lth
to
re
vie
w a
nd
de
ve
lop
ne
w i
nit
iati
ve
s o
n i
ll h
ea
lth
pre
ve
nti
on
fo
r th
e p
op
ula
tio
n o
f S
alf
ord
.
3.5
.6 I
NT
EG
RA
TE
D C
AR
E
AIM
: to
su
pp
ort
pe
op
le i
n r
eta
inin
g t
he
ir i
nd
ep
en
de
nce
an
d q
ua
lity
of
life
th
rou
gh
in
teg
rate
d h
ea
lth
an
d s
oci
al
care
se
rvic
es
wit
h p
art
ne
rs
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Sin
ce 2
01
0,
Sa
lfo
rd’s
Ad
ult
So
cia
l C
are
ha
s tr
an
sfo
rme
d i
ts p
ath
wa
y o
f ca
re a
nd
op
era
tin
g m
od
el
to f
ocu
s o
n i
nd
ivid
ua
l a
nd
co
mm
un
ity
ca
pa
city
, re
silie
nce
an
d
ind
ep
en
de
nce
. T
he
tra
nsf
orm
ati
on
ha
s b
ee
n u
nd
erp
inn
ed
by
ou
r tw
in p
rio
riti
es
- to
su
pp
ort
cit
ize
ns
to l
ive
in
de
pe
nd
en
tly
an
d e
njo
y t
he
be
st p
oss
ible
qu
ali
ty o
f li
fe
thro
ug
h c
on
ne
ctin
g p
eo
ple
to
th
e r
eso
urc
es
in t
he
ir l
oca
lity
, m
ain
tain
ing
re
lati
on
ship
s a
nd
act
ivit
y l
ev
els
of
ou
r ci
tize
ns
to h
elp
th
em
be
in
de
pe
nd
en
t a
nd
to
slo
w t
he
ne
ed
fo
r m
ore
fo
rma
l ca
re a
nd
su
pp
ort
.
In S
alf
ord
, a
sig
nif
ica
nt
pro
po
rtio
n o
f h
ea
lth
an
d s
oci
al
care
exp
en
dit
ure
re
late
s to
old
er
pe
op
le a
nd
th
is w
ill o
nly
in
cre
ase
as
the
po
pu
lati
on
co
nti
nu
es
to l
ive
lo
ng
er.
Bu
ild
ing
on
th
e s
ucc
ess
of
inte
gra
ted
wo
rkin
g a
lre
ad
y ta
kin
g p
lace
acr
oss
th
e c
ity
, S
alf
ord
Cit
y C
ou
nci
l, N
HS
Sa
lfo
rd C
lin
ica
l C
om
mis
sio
nin
g G
rou
p,
Sa
lfo
rd R
oy
al
NH
S
Fo
un
da
tio
n T
rust
an
d G
rea
ter
Ma
nch
est
er
We
st M
en
tal
He
alt
h N
HS
Fo
un
da
tio
n T
rust
ha
ve
in
itia
ted
a f
orm
al
pa
rtn
ers
hip
‘S
alf
ord
To
ge
the
r’ w
ith
po
ole
d f
un
din
g
ma
na
ge
d t
hro
ug
h a
n A
llia
nce
Bo
ard
to
tra
nsf
orm
he
alt
h a
nd
ca
re f
or
old
er
pe
op
le i
n S
alf
ord
.
Th
is n
ew
, in
teg
rate
d w
ay
of
wo
rkin
g i
s b
ein
g e
xpa
nd
ed
to
in
clu
de
th
e w
ho
le a
du
lt p
op
ula
tio
n.
Th
e p
rog
ram
me
wil
l in
corp
ora
te a
nd
en
ha
nce
exi
stin
g s
tra
teg
ies
for
me
nta
l h
ea
lth
, d
em
en
tia
, le
arn
ing
dif
ficu
ltie
s a
nd
ca
rers
wit
hin
th
e n
ew
ca
re m
od
el,
wh
ilst
tra
nsf
orm
ing
th
e w
ay
we
ma
na
ge
lo
ng
-te
rm c
on
dit
ion
s. T
he
am
bit
ion
is
for
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
56
all
ca
re t
ha
t d
oe
sn’t
re
qu
ire
ho
spit
al
faci
liti
es
to b
e d
eli
ve
red
at
a n
eig
hb
ou
rho
od
le
ve
l a
nd
fo
r p
ath
wa
ys o
f ca
re c
ross
ing
in
to h
osp
ita
l to
be
be
tte
r fo
r p
ati
en
ts.
Pe
rso
na
lise
d c
are
pla
nn
ing
in
wh
ich
th
e p
ers
on
s’ w
ish
es
an
d i
nfo
rme
d c
ho
ice
s w
ill
be
ce
ntr
al
an
d b
en
efi
t fr
om
a m
ult
i-p
rofe
ssio
na
l a
pp
roa
ch,
dra
win
g i
n s
pe
cia
list
exp
ert
ise
an
d r
eso
urc
es
as
ne
ed
ed
. T
he
co
mm
un
ity
ba
sed
ap
pro
ach
wil
l im
pro
ve
in
div
idu
al
ind
ep
en
de
nce
, re
du
ce d
em
an
d u
po
n s
erv
ice
s a
nd
ha
s th
e p
ote
nti
al
to
cre
ate
a m
ore
ho
list
ic a
pp
roa
ch t
o i
nd
ivid
ua
l h
ea
lth
an
d w
ell
be
ing
wit
h c
lose
r co
lla
bo
rati
on
acr
oss
oth
er
sect
ors
th
at
imp
act
up
on
he
alt
h,
such
as
ho
usi
ng
, e
du
cati
on
an
d e
mp
loym
en
t.
Th
rou
gh
th
e S
alf
ord
To
ge
the
r p
art
ne
rsh
ip w
e a
re w
ork
ing
clo
sely
wit
h a
du
lt h
ea
lth
an
d s
oci
al
care
te
am
s to
in
vest
iga
te h
ow
th
e c
rea
tio
n o
f a
n i
nte
gra
ted
org
an
isa
tio
n
cou
ld p
rov
ide
th
e r
esi
de
nts
of
Sa
lfo
rd w
ith
a h
igh
-qu
ali
ty a
nd
en
du
rin
g s
erv
ice
wh
ich
fu
lly
me
ets
th
eir
ne
ed
s.
Th
ere
is
a c
on
sen
sus
am
on
gst
pa
rtn
ers
th
at
Sa
lfo
rd
Ro
ya
l N
HS
Fo
un
da
tio
n T
rust
(S
RF
T)
is b
est
pla
ced
to
ta
ke
th
e l
ea
d r
ole
, w
ork
ing
in
pa
rtn
ers
hip
wit
h t
he
wh
ole
sy
ste
m.
Th
is w
ill
inv
olv
e a
co
mb
ina
tio
n o
f h
ea
lth
an
d
soci
al
care
sta
ff t
ran
sfe
rrin
g t
o S
RF
T a
nd
su
b-c
on
tra
ctin
g a
rra
ng
em
en
ts w
ith
oth
er
pro
vid
ers
. T
he
In
teg
rate
d C
are
Org
an
isa
tio
n (
ICO
) w
ou
ld b
e r
esp
on
sib
le f
or
ad
ult
ho
spit
al,
co
mm
un
ity
an
d m
en
tal
he
alt
h,
an
d s
oci
al
care
in
Sa
lfo
rd.
Th
e I
CO
do
es
no
t in
clu
de
ch
ild
ren
’s s
erv
ice
s o
r p
rim
ary
ca
re s
erv
ice
s. P
eo
ple
wh
o u
se o
ur
serv
ice
s,
clin
icia
n,
pra
ctit
ion
ers
, o
the
r st
aff
an
d s
take
ho
lde
rs w
ill
be
in
volv
ed
in
th
e d
eve
lop
me
nt
of
the
IC
O.
Re
gu
lar
up
da
tes
on
Sa
lfo
rd’s
in
teg
rate
d c
are
wo
rk c
an
be
fo
un
d
he
re.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Imp
lem
en
t th
e i
nte
gra
ted
ca
re s
yste
m t
o e
na
ble
th
e a
chie
ve
me
nt
of
the
In
teg
rate
d C
are
Pro
gra
mm
e im
pro
ve
me
nt
targ
ets
by
20
20
:
o
20
% r
ed
uct
ion
in
no
n-e
lect
ive
ad
mis
sio
ns
to h
osp
ita
l
o
26
% r
ed
uct
ion
in
ca
re h
om
e a
dm
issi
on
s
o
Ma
inta
in o
r im
pro
ve
po
siti
on
in
up
pe
r q
ua
rtil
e f
or
pa
tie
nt
me
asu
res
on
qu
ali
ty o
f li
fe,
sati
sfa
ctio
n a
nd
ma
na
gin
g o
wn
co
nd
itio
n
o
Incr
ea
se f
lu v
acc
ine
up
take
fo
r o
lde
r p
eo
ple
to
85
%
o
Incr
ea
se t
he
pro
po
rtio
n o
f o
lde
r p
eo
ple
ab
le t
o d
ie a
t h
om
e t
o 5
0%
·
Th
rou
gh
th
e i
nte
gra
ted
ca
re o
rga
nis
ati
on
, re
de
sig
n p
ers
on
ce
ntr
ed
se
rvic
es
thro
ug
h i
nte
gra
ted
pa
thw
ay
s, w
ork
forc
e a
lig
nm
en
t a
nd
su
pp
ly c
ha
in a
rra
ng
em
en
ts
·
De
ve
lop
an
d a
gre
e a
vis
ion
, o
bje
ctiv
es
an
d d
eliv
era
ble
s to
ext
en
t th
e S
alf
ord
in
teg
rate
d c
are
sys
tem
to
in
clu
de
su
pp
ort
fo
r ch
ild
ren
, yo
un
g p
eo
ple
a
nd
fa
mil
ies
·
Pu
bli
sh a
co
mp
reh
en
siv
e e
va
lua
tio
n (
Na
tio
na
l In
stit
ute
of
He
alt
h R
ese
arc
h)
on
th
e e
ffe
ctiv
en
ess
of
the
in
teg
rate
d c
are
pro
gra
mm
e b
y 2
01
7
·
De
sig
n a
nd
imp
lem
en
t th
e I
nte
gra
ted
Ca
re O
rga
nis
ati
on
Va
ng
ua
rd a
nd
ne
w m
od
els
of
pri
ma
ry c
are
wit
hin
a n
eig
hb
ou
rho
od
fo
otp
rin
t b
y 2
01
7
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Mu
ltid
isci
pli
na
ry G
rou
ps
(MD
Gs)
– M
DG
s in
clu
de
te
am
of
he
alt
h a
nd
ca
re p
ract
itio
ne
rs,
wh
o r
eco
rd f
ind
ing
s in
a S
ha
red
Ca
re R
eco
rd (
SC
R)
an
d a
re
cog
nis
ed
ca
re
co-o
rdin
ato
r w
ill
the
n t
ake
th
e l
ea
d.
·
Ce
ntr
e o
f C
on
tact
– T
he
Bri
dg
e w
ill
ev
en
tua
lly
pro
vid
e a
sin
gle
-po
int-
of-
en
try
to
th
e h
ea
lth
an
d s
oci
al
care
sy
ste
m,
off
eri
ng
ad
vic
e a
nd
su
pp
ort
to
th
e p
ub
lic
an
d
pro
fess
ion
als
on
a r
an
ge
of
he
alt
h a
nd
so
cia
l ca
re t
op
ics.
It
wil
l als
o p
rov
ide
a s
ing
le p
oin
t-o
f-co
nta
ct f
or
inte
rme
dia
te c
are
, so
cia
l ca
re a
nd
dis
tric
t n
urs
e s
erv
ice
s.
·
Co
mm
un
ity
Ass
ets
Gro
up
– T
his
gro
up
in
clu
de
s a
wid
e r
an
ge
of
pa
rtn
ers
an
d s
ee
ks
to s
tre
ng
the
n t
he
su
pp
ort
ne
two
rks
an
d g
rou
ps
alr
ea
dy
in p
lace
an
d a
lso
to
he
lp c
om
mu
nit
ies
wo
rk t
og
eth
er
to f
ind
so
luti
on
s to
th
ose
pro
ble
ms
tha
t cu
rre
ntl
y p
rev
en
t o
lde
r p
eo
ple
re
ma
inin
g a
ctiv
e a
nd
in
de
pe
nd
en
t m
em
be
rs o
f th
eir
com
mu
nit
y.
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
57
3.5
.7 H
OS
PIT
AL
CA
RE
A
IM:
to d
eli
ve
r im
pro
ve
me
nts
in
pa
tie
nt
ou
tco
me
s a
nd
eff
icie
ncy
th
rou
gh
sy
ste
ms
tha
t a
ssu
re h
igh
qu
ali
ty a
nd
reli
ab
le c
are
at
low
er
cost
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Sa
lfo
rd R
oy
al
NH
S F
ou
nd
ati
on
Tru
st (
SR
FT)
is t
he
pri
nci
pa
l p
rov
ide
r o
f a
cute
he
alt
h s
erv
ice
s w
ith
in S
alf
ord
an
d w
as
rece
ntl
y ra
ted
“o
uts
tan
din
g”
by
the
Ca
re Q
ua
lity
Co
mm
issi
on
. T
he
Tru
st h
as
an
am
bit
ion
to
be
th
e s
afe
st h
ea
lth
care
pro
vid
er
in E
ng
lan
d a
nd
to
co
ntr
ibu
te t
o S
alf
ord
be
ing
th
e h
igh
est
qu
ali
ty,
safe
st,
an
d m
ost
pro
du
ctiv
e h
ea
lth
an
d s
oci
al
care
sy
ste
m.
As
pa
rt o
f th
e I
nte
gra
ted
Ca
re P
rog
ram
me
an
d d
ev
elo
pm
en
t o
f a
n I
nte
gra
ted
Ca
re O
rga
nis
ati
on
, w
e w
ill
full
y i
nte
gra
te
he
alt
h a
nd
ca
re s
erv
ice
s w
ith
in S
alf
ord
. T
his
wil
l se
e m
ore
acu
te c
are
de
live
red
in
a c
om
mu
nit
y se
ttin
g,
wit
h l
on
g t
erm
co
nd
itio
ns
an
d e
lde
rly
ca
re s
pe
cia
list
s
incr
ea
sin
gly
wo
rkin
g o
n a
n o
utr
ea
ch b
asi
s w
ith
in S
alf
ord
’s n
eig
hb
ou
rho
od
s.
Gre
ate
r M
an
che
ste
r’s
‘He
alt
hie
r T
og
eth
er’
pro
gra
mm
e a
nd
th
e r
eco
nfi
gu
rati
on
of
Ma
jor
Tra
um
a s
erv
ice
s p
rov
ide
th
e b
lue
pri
nt
for
the
wa
y c
are
wil
l in
cre
asi
ng
ly b
e
pro
vid
ed
fo
r p
ati
en
ts t
ha
t h
av
e c
om
ple
x n
ee
ds
– b
oth
in
Sa
lfo
rd a
nd
acr
oss
th
e w
ide
r co
nu
rba
tio
n.
SR
FT
ha
s b
ee
n d
esi
gn
ate
d o
ne
of
fou
r h
igh
acu
ity
sit
es
in G
rea
ter
Ma
nch
est
er
an
d t
he
pri
nci
pa
l re
ceiv
ing
ce
ntr
e f
or
Ma
jor
Tra
um
a p
ati
en
ts.
A s
ect
or
ba
sed
ap
pro
ach
is
be
ing
ta
ke
n f
or
com
ple
x su
rge
ry a
nd
urg
en
t ca
re,
wit
h S
alf
ord
Ro
ya
l, B
olt
on
NH
S F
ou
nd
ati
on
Tru
st a
nd
Wri
gh
tin
gto
n,
Wig
an
an
d L
eig
h N
HS
Fo
un
da
tio
n T
rust
wo
rkin
g t
og
eth
er
to c
rea
te ‘
sin
gle
sh
are
d s
erv
ice
s’ f
or
the
co
mb
ine
d
po
pu
lati
on
s o
f S
alf
ord
, B
olt
on
an
d W
iga
n.
Bu
ild
ing
on
th
is a
pp
roa
ch,
the
th
ree
Fo
un
da
tio
n T
rust
s a
nd
th
ree
Cli
nic
al
Co
mm
issi
on
ing
Gro
up
s a
re a
lso
exp
lori
ng
th
e
po
ten
tia
l to
est
ab
lish
jo
ine
d-u
p s
urg
ica
l, m
ed
ica
l a
nd
cli
nic
al
sup
po
rt s
erv
ice
s. A
ny
re
con
fig
ura
tio
n o
f se
rvic
es
wil
l b
e s
ub
ject
to
pu
bli
c e
ng
ag
em
en
t.
As
pa
rt o
f th
e n
ati
on
al
acu
te c
are
co
lla
bo
rati
on
va
ng
ua
rd p
rog
ram
me
, S
alf
ord
Ro
ya
l a
nd
Wri
gh
tin
gto
n,
Wig
an
an
d L
eig
h N
HS
Fo
un
da
tio
n T
rust
s a
re w
ork
ing
to
ge
the
r
to t
est
th
e c
on
cep
t th
at
a s
tan
da
rd o
pe
rati
ng
mo
de
l d
eli
vers
sta
nd
ard
s-b
ase
d c
are
mo
re e
ffe
ctiv
ely
an
d r
eli
ab
ly t
ha
n c
urr
en
t m
od
els
. T
his
wil
l th
en
be
de
plo
yed
thro
ug
h a
Gro
up
mo
de
l o
f h
ea
lth
care
org
an
isa
tio
ns.
Th
is i
s co
nsi
ste
nt
wit
h N
HS
En
gla
nd
’s F
ive
Ye
ar
Fo
rwa
rd V
iew
an
d G
rea
ter
Ma
nch
est
er
De
volu
tio
n t
ran
sfo
rma
tio
n
pro
po
sals
, re
cog
nis
ing
th
at
the
de
live
ry o
f h
igh
qu
ali
ty,
reli
ab
le h
osp
ita
l ca
re w
ill i
ncr
ea
sin
gly
de
pe
nd
up
on
pa
rtn
ers
hip
wo
rkin
g a
nd
op
era
tin
g a
t a
sca
le m
uch
la
rge
r
tha
n a
ny
sin
gle
org
an
isa
tio
n c
an
ach
iev
e.
Th
is G
rou
p a
rra
ng
em
en
t b
uil
ds
on
th
e s
ucc
ess
ful
tra
ck r
eco
rd o
f th
e t
wo
Fo
un
da
tio
n T
rust
s, a
nd
th
eir
exp
eri
en
ce i
n d
eli
veri
ng
jo
ine
d-u
p s
erv
ice
s.
Th
e p
rin
cip
al
pu
rpo
se o
f th
is p
art
ne
rsh
ip i
s a
cce
lera
te i
mp
rov
em
en
ts i
n o
utc
om
es
an
d e
ffic
ien
cy t
hro
ug
h a
fo
cus
on
sta
nd
ard
isa
tio
n (
i.e
. re
du
cin
g u
nw
arr
an
ted
va
ria
tio
n)
an
d
incr
ea
sed
use
of
dig
ita
l te
chn
olo
gie
s th
at
en
ab
le t
he
ap
pli
cati
on
of
ev
ide
nce
-ba
sed
ca
re g
uid
eli
ne
s a
nd
pro
toco
ls a
nd
th
e m
ost
eff
ect
ive
de
plo
ym
en
t o
f h
ea
lth
care
reso
urc
es
to m
ee
t p
ati
en
ts’
ne
ed
s. T
his
wil
l b
e u
nd
erp
inn
ed
by
ne
w g
ove
rna
nce
arr
an
ge
me
nts
th
at
en
ab
le t
he
tw
o o
rga
nis
ati
on
s to
sh
are
de
cisi
on
ma
kin
g,
cre
ate
sha
red
sta
nd
ard
s a
nd
wh
ere
ap
pro
pri
ate
sh
are
ea
ch o
the
r's
serv
ice
s. W
ork
ing
to
ge
the
r in
th
is w
ay
wil
l m
ea
n t
ha
t q
ua
lity
, sa
fety
an
d p
ati
en
t e
xpe
rie
nce
sta
nd
ard
s ca
n
be
ach
iev
ed
mo
re r
eli
ab
ly,
an
d a
t lo
we
r co
st,
acr
oss
Sa
lfo
rd a
nd
Wig
an
.
Su
bje
ct t
o t
est
ing
th
e c
on
cep
t b
etw
ee
n S
alf
ord
Ro
ya
l a
nd
Wri
gh
tin
gto
n,
Wig
an
an
d L
eig
h N
HS
Fo
un
da
tio
n T
rust
, it
is
ou
r a
mb
itio
n t
o e
xte
nd
th
is a
pp
roa
ch t
o o
the
r
ho
spit
als
, d
eli
ve
rin
g e
con
om
ies
of
sca
le a
nd
en
suri
ng
th
at
the
be
ne
fits
of
reli
ab
le a
nd
hig
h q
ua
lity
ca
re a
re s
ha
red
acr
oss
th
e w
ide
r co
nu
rba
tio
n.
Th
e G
rou
p a
rra
ng
em
en
t co
mp
lem
en
ts o
ur
stra
teg
y t
o i
nte
gra
tin
g h
ea
lth
an
d s
oci
al
care
se
rvic
es
in S
alf
ord
an
d t
o c
lose
r w
ork
ing
wit
h p
art
ne
rs w
ith
in t
he
No
rth
We
st
sect
or,
an
d b
eyo
nd
, to
en
sure
mo
re r
esi
lien
t a
nd
su
sta
ina
ble
se
rvic
es.
O
ur
pla
ns
to r
ad
ica
lly
up
gra
de
ho
w w
e p
rev
en
t il
l h
ea
lth
an
d t
ran
sfo
rm c
are
do
no
t
com
pro
mis
e o
ur
com
mit
me
nt
to t
he
hig
he
st s
tan
da
rds
of
care
. N
ati
on
al
con
stit
uti
on
al
targ
ets
on
acc
ess
to
ca
re,
wa
itin
g t
ime
s, o
utc
om
es
follo
win
g t
rea
tme
nt,
an
d
qu
ali
ty o
f ca
re a
re a
giv
en
. W
ith
ou
r p
op
ula
tio
n p
red
icte
d t
o g
row
fa
ste
r th
an
th
e n
ati
on
al
av
era
ge
, e
nsu
rin
g w
e c
on
tin
ue
to
me
et
an
d e
xce
ed
th
ese
sta
nd
ard
s w
hil
st
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
58
tra
nsf
orm
ing
ca
re i
s fu
nd
am
en
tal t
o t
he
su
cce
ss o
f o
ur
pla
n.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
In a
dd
itio
n t
o o
ur
tra
nsf
orm
ati
on
pro
gra
mm
es
for
inte
gra
ted
an
d c
om
mu
nit
y b
ase
d m
od
els
of
care
, o
ur
pri
ori
tie
s fo
r in
ho
spit
al
care
are
fo
cuse
d o
n i
mp
rov
ing
ou
tco
me
s fo
r p
ati
en
ts.
Ove
r th
e n
ext
5 y
ea
rs,
the
se i
ncl
ud
e:
·
Em
erg
en
cy D
ep
art
me
nt
(ED
):
o
Re
du
ce t
ime
to
pa
tie
nt
ass
ess
me
nt
an
d i
ncr
ea
se t
he
pe
rce
nta
ge
of
pa
tie
nts
se
en
by
a s
en
ior
de
cisi
on
ma
ke
r
o
Incr
ea
se t
he
pe
rce
nta
ge
of
A &
E a
tte
nd
an
ces
wa
itin
g le
ss t
ha
n 4
ho
urs
·
Acu
te M
ed
icin
e:
o
Re
du
ce le
ng
th o
f st
ay
an
d p
ati
en
ts a
dm
itte
d f
rom
acu
te t
o o
the
r w
ard
s
o
Imp
rov
e m
ort
alit
y r
ate
s
·
Ge
ne
ral
Su
rge
ry:
o
Imp
rov
e m
ort
alit
y r
ate
s a
nd
em
erg
en
cy g
en
era
l su
rge
ry p
ati
en
ts s
ee
n b
y a
co
nsu
lta
nt
24
/7
o
Re
du
ce le
ng
th o
f st
ay
, re
-ad
mis
sio
n a
nd
ach
iev
e c
on
sist
en
t a
nd
tim
ely
acc
ess
to
th
ea
tre
, cr
itic
al c
are
an
d d
iag
no
stic
se
rvic
es
·
Pa
ed
iatr
ics:
o
Re
du
ce a
dm
issi
on
s w
ho
se n
ee
ds
cou
ld b
e m
et
in t
he
co
mm
un
ity
or
at
ho
me
o
Imp
rov
e m
ort
alit
y r
ate
s a
nd
em
erg
en
cy a
dm
issi
on
s se
en
by
a c
on
sult
an
t p
ae
dia
tric
ian
wit
hin
th
e f
irst
24
ho
urs
of
ad
mis
sio
n
·
Incr
ea
se p
ati
en
t sa
tisf
act
ion
an
d h
osp
ita
l st
aff
sa
tisf
act
ion
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
‘He
alt
hie
r T
og
eth
er’
pro
gra
mm
e
·
acu
te c
are
co
lla
bo
rati
on
va
ng
ua
rd p
rog
ram
me
·
NW
Se
cto
r G
rou
p a
rra
ng
em
en
t
3.5
.8 L
ON
G T
ER
M C
ON
DIT
ION
S
AIM
: a
chie
ve
a m
ore
pe
rso
na
lise
d a
nd
pa
tie
nt
cen
tre
d a
pp
roa
ch t
o c
ari
ng
fo
r p
eo
ple
wit
h l
on
g t
erm
co
nd
itio
ns
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
On
e i
n t
hre
e p
eo
ple
cu
rre
ntl
y h
ave
on
e o
r m
ore
Lo
ng
te
rm c
on
dit
ion
(LT
C)
an
d t
his
is
pre
dic
ted
to
ris
e t
o o
ne
in
tw
o o
ve
r th
e n
ext
25
ye
ars
. In
Sa
lfo
rd t
his
eq
ua
tes
to
just
ove
r 7
6,0
00
pe
op
le r
isin
g t
o a
rou
nd
12
5,0
00
wh
en
we
fa
cto
r in
th
e p
red
icte
d g
row
th i
n o
ur
po
pu
lati
on
. P
eo
ple
wh
o s
uff
er
fro
m a
LT
C a
re c
lass
ifie
d a
s “p
eo
ple
wh
o h
ave
an
ill
ne
ss t
ha
t ca
nn
ot
be
cu
red
”, b
ut
wh
o c
an
be
su
pp
ort
ed
, tr
ea
ted
an
d c
are
d f
or
in a
wa
y th
at
min
imis
es
the
im
pa
ct o
f th
at
illn
ess
bo
th o
n t
he
in
div
idu
al
an
d t
he
ir f
am
ilie
s a
nd
/ o
r ca
rers
.
Ov
er
the
ne
xt 5
ye
ars
we
aim
to
ma
xim
ise
th
e i
mp
rov
em
en
t in
th
e p
reve
nti
on
, e
arl
y d
iag
no
sis
an
d t
rea
tme
nt
of
con
dit
ion
s w
hic
h c
au
se t
he
ma
jori
ty o
f li
fe l
ost
. F
or
Sa
lfo
rd t
he
se i
ncl
ud
e D
iab
ete
s, C
an
cer,
Ca
rdio
vasc
ula
r D
ise
ase
, K
idn
ey
Dis
ea
se,
De
me
nti
a,
Liv
er
Dis
ea
se,
Lun
g D
ise
ase
(ch
ron
ic o
bst
ruct
ive
pu
lmo
na
ry d
ise
ase
(C
OP
D)
an
d a
sth
ma
); a
nd
En
d o
f Li
fe C
are
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
59
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Mo
ve
to
wa
rds
mo
re o
f a
pri
ma
ry c
are
fo
cus
for
the
ma
na
ge
me
nt
of
pa
tie
nts
wit
h L
TC
s is
a f
irst
ste
p t
ow
ard
ou
r a
mb
itio
n f
or
com
mu
nit
y b
ase
d c
are
wit
h g
rea
ter
inte
gra
tio
n a
cro
ss c
om
mu
nit
y a
rea
s a
nd
a s
hif
t to
wa
rds
mo
re p
roa
ctiv
e c
are
wit
h p
ati
en
ts b
ett
er
en
ab
led
to
se
lf-m
an
ag
e c
are
ne
ed
s.
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
Inco
rpo
rati
on
of
the
LT
C lo
call
y c
om
mis
sio
ne
d s
erv
ice
s in
to t
he
‘S
alf
ord
Sta
nd
ard
s’ f
or
pri
ma
ry c
are
·
Imp
rov
ing
th
e q
ua
lity
of
pre
scri
bin
g i
n g
en
era
l p
ract
ice
to
en
sure
co
mp
lia
nce
wit
h n
ati
on
al
Inst
itu
te f
or
Cli
nic
al
Exc
ell
en
ce (
NIC
E)
req
uir
em
en
ts a
nd
in
cre
ase
ca
re
pla
nn
ing
in
ge
ne
ral
pra
ctic
e f
or
all
pa
tie
nts
wit
h a
lon
g t
erm
co
nd
itio
n
·
Imp
rov
e s
cre
en
ing
, p
ati
en
t e
du
cati
on
, re
ferr
al
an
d p
ath
wa
ys
for
card
io v
asc
ula
r d
ise
ase
, ca
nce
r, c
hro
nic
kid
ne
y a
nd
lu
ng
dis
ea
se,
dia
be
tes
an
d l
ive
r d
ise
ase
·
Intr
od
uce
a n
ew
IG
R2
se
rvic
e a
nd
re
call
sy
ste
m f
or
dia
be
tes
·
De
ve
lop
an
d i
mp
lem
en
t a
24
/7 e
nd
of
life
su
pp
ort
se
rvic
e a
nd
ed
uca
tio
n f
or
ge
ne
ral
pra
ctit
ion
ers
on
en
d o
f li
fe c
are
·
Wo
rk t
hro
ug
h t
he
GM
wid
e D
em
en
tia
Un
ite
d p
rog
ram
me
3.5
.9 M
EN
TA
L H
EA
LTH
A
IM:
to e
nsu
re t
ha
t a
ll r
esi
de
nts
of
Sa
lfo
rd w
ill
ha
ve
acc
ess
to
hig
h q
ua
lity
, co
mp
ass
ion
ate
wo
rld
-cla
ss m
en
tal
he
alt
h s
erv
ice
s
Sta
rtin
g,
Liv
ing
, A
ge
ing
We
ll
Ea
ch y
ea
r o
ne
in
fo
ur
Bri
tish
ad
ult
s e
xpe
rie
nce
at
lea
st o
ne
dia
gn
osa
ble
me
nta
l h
ea
lth
pro
ble
m.
Sa
lfo
rd h
as
a h
igh
er
pre
va
len
ce o
f m
en
tal
he
alt
h t
ha
n o
the
r p
art
s o
f
the
UK
wit
h a
rou
nd
36
,50
0 a
du
lts
an
d 6
,00
0 c
hil
dre
n e
stim
ate
d t
o h
ave
so
me
kin
d o
f m
en
tal
we
llb
ein
g n
ee
d.
Ou
r In
teg
rate
d M
en
tal
He
alt
h C
om
mis
sio
nin
g S
tra
teg
y
20
13
-20
18
in
ve
sts
in t
he
re
gio
n o
f £
45
m e
ach
ye
ar
on
me
nta
l h
ea
lth
se
rvic
e p
rov
isio
n a
nd
ou
r v
isio
n i
s th
at
all
re
sid
en
ts o
f th
e c
ity
wil
l h
av
e a
cce
ss t
o h
igh
qu
ali
ty,
com
pa
ssio
na
te w
orl
d-c
lass
me
nta
l he
alt
h s
erv
ice
s.
Th
e c
om
mis
sio
nin
g s
tra
teg
y h
as
a p
rim
ary
fo
cus
on
ad
ult
s –
bu
t w
ill
als
o a
dd
ress
iss
ue
s co
nce
rnin
g t
he
me
nta
l h
ea
lth
of
yo
un
g p
eo
ple
ma
kin
g t
he
tra
nsi
tio
n t
o
ad
ult
ho
od
an
d a
du
lt s
erv
ice
s. I
n p
ara
lle
l to
th
is,
an
Em
oti
on
al
He
alt
h a
nd
We
llb
ein
g S
tra
teg
y f
or
Ch
ild
ren
an
d Y
ou
ng
Pe
op
le (
20
13
-20
15
) h
as
be
en
de
velo
pe
d b
y t
he
Ch
ild
ren
an
d Y
ou
ng
Pe
op
le’s
Em
oti
on
al
He
alt
h a
nd
We
llb
ein
g P
art
ne
rsh
ip,
wh
ich
re
po
rts
to t
he
Ch
ild
ren
an
d Y
ou
ng
Pe
op
le’s
Tru
st (
CY
PT
).
Sa
lfo
rd m
ak
es
a s
ign
ific
an
t fi
na
nci
al
inv
est
me
nt
in m
en
tal
he
alt
h s
erv
ice
s a
nd
ha
s lo
ng
-sta
nd
ing
an
d e
ffe
ctiv
e j
oin
t co
mm
issi
on
ing
arr
an
ge
me
nts
acr
oss
NH
S S
alf
ord
CC
G a
nd
Sa
lfo
rd C
ity
Co
un
cil
wh
ich
en
sure
s a
n i
nte
gra
ted
ap
pro
ach
to
co
mm
issi
on
ing
acr
oss
th
e c
ity
. H
ea
lth
an
d s
oci
al
care
se
rvic
es
can
be
exp
ect
ed
to
be
op
era
tin
g
in a
str
ing
en
t fi
na
nci
al
clim
ate
ov
er
the
lif
e-t
ime
of
this
Pla
n a
nd
th
ere
wil
l b
e a
n o
ng
oin
g n
ee
d f
or
eff
icie
nci
es
in h
ea
lth
an
d s
oci
al
care
se
rvic
es
thro
ug
h t
he
NH
S
Qu
ali
ty,
Inn
ov
ati
on
, P
rod
uct
ivit
y a
nd
Pre
ve
nti
on
(Q
IPP
) p
rog
ram
me
an
d t
he
re
du
ctio
n i
n f
un
din
g f
or
cou
nci
ls a
risi
ng
fro
m t
he
Go
ve
rnm
en
t’s
me
diu
m t
erm
fin
an
cia
l
pla
nn
ing
re
sult
ing
in
lo
we
r le
ve
ls o
f fu
nd
ing
th
rou
gh
th
e l
oca
l go
ve
rnm
en
t se
ttle
me
nt
pro
cess
.
We
wil
l e
nsu
re t
ha
t w
e t
arg
et
ou
r re
sou
rce
s a
t th
e m
ost
eff
ect
ive
wa
ys
to s
up
po
rt p
eo
ple
wit
h m
en
tal
he
alt
h n
ee
ds
an
d t
hro
ug
h c
om
mis
sio
nin
g a
rra
ng
em
en
ts t
ha
t
secu
re v
alu
e f
or
mo
ne
y fr
om
all
co
ntr
act
s a
nd
se
rvic
e p
rov
ide
rs.
De
spit
e t
he
on
go
ing
fin
an
cia
l co
nst
rain
ts w
ith
in w
hic
h m
en
tal
he
alt
h s
erv
ice
s a
re l
ike
ly t
o b
e
op
era
tin
g,
me
nta
l h
ea
lth
se
rvic
es
are
, a
nd
wil
l co
nti
nu
e t
o b
e,
a k
ey
pri
ori
ty i
n S
alf
ord
. W
e a
re c
om
mit
ted
to
pro
tect
ing
eff
ect
ive
se
rvic
es
an
d d
ev
elo
pin
g n
ew
se
rvic
es
wh
ere
ve
r p
oss
ible
. T
his
will
req
uir
e a
n i
ncr
ea
sed
fo
cus
on
bu
ild
ing
re
sili
en
ce f
or
com
mu
nit
ies
an
d i
nd
ivid
ua
ls,
tog
eth
er
wit
h p
rev
en
tio
n a
nd
ea
rly
in
terv
en
tio
n i
n
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
60
me
nta
l he
alt
h s
erv
ice
s to
me
et
risi
ng
de
ma
nd
wit
h t
he
re
sou
rce
s a
va
ila
ble
. T
his
is
cen
tra
l to
ou
r co
mm
issi
on
ing
in
ten
tio
ns.
Ou
r tr
an
sfo
rma
tio
n p
rio
riti
es
ov
er
the
ne
xt 5
ye
ars
are
:
·
Ea
rly
in
terv
en
tio
n –
me
eti
ng
ne
ed
s e
arl
y a
nd
pre
ven
tin
g t
he
esc
ala
tio
n o
f m
en
tal h
ea
lth
pro
ble
ms
(in
clu
din
g t
ran
siti
on
pla
nn
ing
fro
m c
hil
dre
n’s
se
rvic
es)
·
Ad
dre
ssin
g t
he
sti
gm
a a
nd
dis
crim
ina
tio
n t
ha
t su
rro
un
ds
me
nta
l h
ea
lth
·
Ra
pid
an
d c
on
ve
nie
nt
acc
ess
at
all
tim
es
(an
d i
n a
ll s
erv
ice
s, a
nd
re
lev
an
t se
ttin
gs)
·
Fa
ir a
cce
ss,
ba
sed
on
pe
op
le’s
ne
ed
s, n
ot
wh
o t
he
y a
re,
or
wh
ere
th
ey
liv
e i
n S
alf
ord
·
Re
cov
ery
– w
ith
se
rvic
e u
sers
re
turn
ing
to
fu
ll h
ea
lth
, m
ov
ing
th
rou
gh
se
rvic
es,
an
d b
ein
g d
isch
arg
ed
wh
ere
cli
nic
all
y a
pp
rop
ria
te
·
Re
cog
nit
ion
of
the
lin
ks
be
twe
en
ph
ysi
cal
he
alt
h a
nd
me
nta
l he
alt
h,
an
d t
he
go
vern
me
nt
ple
dg
e t
o a
chie
ve
pa
rity
of
est
ee
m
·
Su
pp
ort
to
re
ma
in i
n y
ou
r o
wn
ho
me
an
d t
o l
ive
in
de
pe
nd
en
tly
fo
r a
s lo
ng
as
po
ssib
le
·
Th
e l
ow
est
po
ssib
le n
um
be
r o
f p
eo
ple
pla
ced
ou
t o
f a
rea
(o
uts
ide
of
Sa
lfo
rd)
·
Th
e b
est
po
ssib
le o
utc
om
es
for
serv
ice
use
rs,
the
ir c
are
rs,
an
d t
he
ir f
am
ilie
s (
incl
ud
ing
fe
we
r sy
mp
tom
s o
f il
l-h
ea
lth
, th
e a
bil
ity
to
le
ad
as
no
rma
l a
lif
e a
s
po
ssib
le,
an
d m
ain
tain
co
nta
cts
wit
h f
am
ily,
fri
en
ds
an
d l
oca
l co
mm
un
itie
s)
·
Th
e l
ow
est
po
ssib
le n
um
be
r o
f co
mp
lain
ts a
nd
un
tow
ard
in
cid
en
ts
·
Exc
ell
en
t va
lue
fo
r m
on
ey
Th
e s
erv
ice
s a
nd
pro
gra
mm
es
wh
ich
wil
l d
eliv
er
the
se p
rio
riti
es
incl
ud
e:
·
En
sure
me
nta
l h
ea
lth
se
rvic
es
are
co
mm
issi
on
ed
in
co
mp
lia
nce
wit
h t
arg
ets
an
d s
tan
da
rds
ide
nti
fie
d i
n t
he
NH
S F
orw
ard
Vie
w (
Ea
rly
In
terv
en
tio
n i
n P
sych
osi
s;
IAP
T;
Me
nta
l H
ea
lth
Lia
iso
n)
·
En
ga
ge
wit
h c
om
mis
sio
ne
rs a
cro
ss G
M r
eg
ard
ing
th
e d
eve
lop
me
nt
of
a G
M m
en
tal
he
alt
h s
tra
teg
y,
GM
-wid
e m
en
tal
he
alt
h K
PIs
an
d C
QU
INs
an
d G
M-w
ide
stra
teg
ic i
nit
iati
ve
s re
ga
rdin
g m
en
tal h
ea
lth
(e
.g.
Em
plo
yme
nt;
Cri
sis
Ca
re C
on
cord
at)
·
Re
spo
nd
to
th
e D
em
en
tia
Gre
ate
r M
an
che
ste
r D
evo
luti
on
pro
gra
mm
e ‘
De
me
nti
a U
nit
ed
’ b
y im
ple
me
nti
ng
th
e a
gre
ed
pro
gra
mm
e o
bje
ctiv
es
·
Est
ab
lish
a c
lea
r, s
tra
teg
ic s
uic
ide
pre
ven
tio
n a
pp
roa
ch t
o r
ed
uce
su
icid
es
for
pe
op
le u
nd
er
me
nta
l h
ea
lth
se
rvic
es
·
Ov
ers
ee
th
e t
ran
siti
on
o
f m
en
tal
he
alt
h s
erv
ice
in
to t
he
In
teg
rate
d C
are
Org
an
isa
tio
n a
nd
pu
t in
pla
ce t
he
re
qu
ire
d a
ssu
ran
ce a
nd
go
ve
rna
nce
p
roce
ss t
o e
nsu
re
serv
ice
co
nti
nu
ity
an
d h
igh
qu
ali
ty s
erv
ice
de
live
ry
·
Imp
lem
en
t a
se
rie
s o
f q
ua
lity
vis
its
to a
ra
ng
e o
f m
en
tal
he
alt
h s
erv
ice
s w
hic
h i
nco
rpo
rate
pa
tie
nt
an
d c
are
r in
vo
lve
me
nt/
fee
db
ack
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
61
SECTION 4 – GOVERNANCE and FINANCE
4.1 GOVERNANCE
4.1.1 Salford has a long and strong history of partnership which has been built on strong
foundations of joint working between the various public, private and community sector
organisations in the city. Clarity in the governance mechanism and commitment to the
ongoing relationships– across the City Partnership and between individual organisations -
has been a key factor in the success of these arrangements.
4.1.2 The Health and Wellbeing Board is the lead partnership body to oversee and shape the
city wide approach to reform for Health and Social Care, combining commissioners and
providers in decision making. The Health and Wellbeing Board is chaired by the City Mayor,
with the deputy chair role shared between the Chair of NHS Salford CCG and a Local
Authority Elected Representative. The Health and Wellbeing Board reports to Cabinet within
Salford City Council, as well as being accountable to the CCG’s Governing Body.
4.1.3 Alongside these formal arrangements there is an informal Locality Leadership Group
which meets on a monthly basis and involves the leaders from each part of Salford’s Health
and Social Care system.
4.1.4 The Locality Plan will act as Salford’s Joint Health and Wellbeing Strategy and will be
used to inform business plans for the key partner agencies, as shown in the diagram above.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
62
4.1.5 Salford has put in place a Memorandum of Understanding between the Health and
Wellbeing Board, Health Watch Salford and the City’s Health and Adults Scrutiny Panel. This
agreement sets clear role and responsibilities for each, in the oversight of health and
wellbeing activity and the delivery of this Locality Plan on behalf of local citizens.
4.2 PERFORMANCE REPORTING ARRANGEMENTS
4.2.1 The outcomes and indicators stated for each of the life course areas described above
will be used to develop a performance dashboard for the Locality Plan. This will be
maintained jointly by the CCG and Salford City Council.
4.2.2 In order to maintain accountability to the stakeholder groups with an interest in this
Plan, and for oversight by members of the Health and Wellbeing Board, performance
reporting will include:
· Quarterly progress reports to the Health and Wellbeing Board
· Publicly focussed Annual Report of progress
· Periodic review through the various engagement structures which will be integral to the
delivery arrangements.
Reporting will focus on the outcomes framework described in section 1.10 above, and
enhanced by qualitative measures which will show how this Locality Plan is performing.
4.3 GM GOVERNANCE ARRANGEMENTS
4.3.1 GM has agreed that the Strategic Partnership Board will be responsible for setting the
overarching strategic vision for the Greater Manchester Health and Social Care economy. As
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
63
it is not a legal body, its decisions are not binding decisions of its members, but it will make
recommendations for its members to formally adopt following their own governance
procedures.
4.3.2 NHS Salford CCG, Salford City Council, Salford Royal Foundation Trust and Greater
Manchester West Foundation Trust represent Salford on the GM Strategic Partnership
Board. In its shadow form, the Board also has non-voting representatives from Greater
Manchester Centre for Voluntary Organisation, one of the GM Health watch organisations,
GM Fire and Rescue Service, and GM Police.
4.3.3 The GM Strategic Partnership Board has the following responsibilities:
• To set the framework within which the Strategic Partnership Executive will operate.
• To agree the GM Health and Social Care Strategic priorities in accordance with the NHS
five year forward view.
• To endorse the content of the GM Strategic Plan for financial and clinical sustainability.
• To agree the criteria that determine access to the Transformation fund.
• To ensure that there remains ongoing and significant organisational commitment across
the GM health economy to both the devolution agenda and a devolved health system.
• To agree an assurance framework, developed jointly with regulators where required, that
reflects the outcomes required by Greater Manchester.
• To provide leadership across the GM health economy to ensure that the key strategic
priorities for a GM health system are achieved.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
64
4.4 FINANCIAL PLAN
It should be notes that all figures contained within this section will be refreshed in
light of the CSR, Local Government settlement, and individual budget agreements. The
final version will be agreed in March 2016.
4.4.1 Baseline - Salford locality currently spends £485m on Health and Social Care, which is
shown in more detail in Appendix 1. It has been assumed that all of the budget savings
targets for the council and the CCG have been achieved in this baseline year. However,
there is currently a planned deficit in 2015/16 in the NHS provider sector in Salford.
Projecting the funding and expenditure forward up to 2020/21, the “do nothing” scenario
predicts an estimated financial shortfall of circa £157m for Salford Locality, which is
summarised in the table below.
Table 1: Salford Locality Position: Do Nothing Recurrent Baseline:
This financial gap is consistent with the financial challenge across Greater Manchester (GM),
which has a projected financial challenge of circa £2bn. As a sense check on the Salford
gap, a proportion of the GM gap would equate to around £190m for Salford on a population
basis. Salford CCG’s financial position is better than most CCGs in GM, therefore, the
Salford locality mapping of the finances across the locality feels consistent with the estimated
financial gap across GM.
4.4.2 Financial Challenges - Appendix 1 shows the financial baseline and 5 year projections
for Salford CCG, Salford Council (social care & public health) and the NHS providers in
Salford, as well as the aggregated Salford Locality position. Whilst the £157m gap is for the
Salford Locality, each of the sectors within Salford faces different financial challenges.
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
£m £m £m £m £m £m
Locality Funding £485 £480 £475 £477 £480 £483
Locality Expenditure £485 £501 £508 £521 £534 £547
Health and Social Care Gap £0 -£21 -£33 -£44 -£54 -£64
NHS Provider Gap -£22 -£41 -£50 -£65 -£79 -£93
Total Locality Gap: Do Nothing -£22 -£62 -£83 -£108 -£133 -£157
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
£m £m £m £m £m £m
Salford CCG £0 £0 -£0 -£0 £0 -£0
Salford City Council £0 -£21 -£33 -£44 -£54 -£64
Salford Royal- Salford locality share -£23 -£39 -£47 -£61 -£73 -£86
GMW- Salford locality share £1 -£2 -£2 -£4 -£5 -£7
Total Locality Gap: Do Nothing -£22 -£62 -£83 -£108 -£133 -£157
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
65
· Salford CCG- the financial health of the CCG is relatively strong. The CCG has
managed to generate a non recurrent surplus in previous years which has been
carried forward to enable investment in service transformation. The CCG is below its
target funding allocation and therefore benefited significantly in the 2015/16 financial
allocation as a result of the Department of Health awarding additional funds to those
CCGs that were significantly below target. Salford CCG therefore received recurrent
investment sooner than was previously anticipated. However, projecting forward 5
years, the financial position becomes more difficult to manage as a result of rising cost
pressures.
· Salford City Council- the total funding for the council has reduced significantly over
recent years and is predicted to continue to reduce in future years. The total savings
required that is currently forecast in the council’s medium term financial plan is £39m
over the next two years. Detailed budgets have not been agreed by the council, but a
proportion of this total savings requirement will be borne by Adult Social Care,
Children’s services (non education) and Public Health.
· Salford NHS Providers- NHS providers continue to face significant financial
challenges. The tariff income continues to reduce year on year (at a rate of circa 1.5%
per annum) with pay and price increases of circa 2.5% per annum. Therefore, there is
an implied efficiency target for providers to achieve 4% cost reductions each year.
Whilst providers have managed to achieve balanced financial positions in prior years,
2015/16 marks the first time that Salford Royal is forecasting a financial deficit (circa
£17m). Whilst GMW is planning to break even in 2015/16, it has signalled that future
years will be difficult to break even.
In light of the above financial challenges facing each of the sectors in Salford, it is imperative
that Salford locality works together to achieve the service transformation outlined in the
locality plan. This is not only to achieve the population health and wellbeing outcomes that
the population deserve but also to ensure financial sustainability for the locality.
4.4.3 Methodology and Assumptions - Appendix 1 details the methodology and
assumptions used in constructing the Salford Locality financial plan. This plan is the
recurrent financial plan for the locality, based on the do nothing option. This scenario has not
yet built in any impact of the service changes identified in the locality plan.
High level assumptions are as follows:
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
66
· CCG funding expected to grow by 2% each year over the next 5 years. This is
consistent with the minimum growth uplifts applied to the CCG sector over the last two
years
· CCG growth funding has been targeted at out of hospital care (community, primary
care and integrated care), in line with the CCG’s service strategy
· CCG has achieved current year and future year cost improvement/efficiency savings
within the five year plan
· Assumed continuation of council funding reductions. The assumed reduction
incorporates Local Government Association (LGA) predictions for core council funding
reductions and local projections of future public health funding reductions.
· Assumed cost pressures in council expenditure for pay inflation, activity demand and
specific amounts added for implications of implementing the living wage.
· The NHS provider position assumes continued tariff reductions of 1.5% each year over
the next 5 years with pay and price increases of 2.5% each year. Therefore there is
an assumed efficiency savings requirement of 4% each year for NHS providers.
4.4.4 Financial Impact of Delivering the Locality Plan - The impact of delivering and
investing in the priority areas identified in the locality and GM transformation plans has been
assessed and goes a long way to close the financial gap within Salford locality. The table
below shows that the £157m gap could be reduced to around £5m by 2020/21 if all of the
schemes deliver their intended outcomes.
Table 2: Closing the Gap:
However, this is an optimistic position and is predicated on:
· the service model delivering the expected outcomes: Appendix 2 shows the financial
contribution that each element of the locality plan contributes to closing the financial
gap. In addition, Appendix 3 shows the impact that the locality plan will have in
2020/21
£m
Baseline Position: Locality Shortfall -£157.0
Impact of Fair Shares and Funding Protection £48.7
Impact of Locality Plans: Prevention £15.9
Impact of Locality Plans: Better Care £18.2
Impact of Provider Efficiencies and Reform £69.7
Impact of Enablers £0.0
Impact of Greater Manchester Transformation £0.0
REVISED RECURRENT LOCALITY SHORTFALL -£4.6
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
67
reducing acute, hospital activity in future years to allow investment in community
based care. The financial model assumes prevention will deliver £15.9m in financial
savings over the 5 year period and the new service model (“Better Care”) will deliver
£18m savings.
· the locality receiving significant amounts of funding in future years: The financial
model assumes that adult social care funding will be protected (£17m) and that Salford
receives its fair share of the additional £8 billion funding announced for the NHS
(£31m). The Comprehensive Spending Review (CSR) announcement in November
2015 gave assurance on the additional funding being released for Health, although the
details on how much will flow to individual organisations is not yet clear. The funding
settlements for GM Devolution, as well as the individual funding allocations for both
the CCG and Council, are expected to be announced on 18 December 2015.
· the ability of providers to achieve year on year efficiency savings: The financial model
has assumed that providers will be able to achieve 2% cost improvement savings
each and every year over the next 5 years, which amounts to almost £70m of savings.
As organisations move into detailed planning for 2016/17, more detail is expected on
savings proposals and therefore Salford locality will be better placed to understand the
likelihood of delivering against this ambition.
4.4.5 Enabling Workstreams - In order to support the new models of care and to deliver
both the quality outcomes and financial benefits, significant amount of work is required in the
locality on enabling functions. The work underway within the locality on workforce, IT and
Estates is described are discussed in previous chapters of the Salford locality plan.
In addition, it is recognised that changes to contract and payment models are required in
order to reflect new models of care and changes to organisation form. The current models
for payment and contracting across Health and Social Care (for example, either paying on
activity based contracts or block payments) can sometimes discourage service change or not
create the right incentives to control demand for services at both commissioner and provider
level. It is important that contracts and payment mechanisms are developed to support the
new models of care and incorporate the right level of risks and rewards to encourage both
service change and deliver appropriate levels of efficiency savings. A piece of work is
underway at GM level to scope out changes to contract and payment mechanisms with an
aspiration to move towards outcome based contracts and payments.
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
68
4.4.6 Non Recurrent Investment Requirements - In order to deliver recurrent financial
savings, it is recognised that one off (non recurrent) investment is required over the next
couple of years in order to make the necessary changes and set up the new care models. As
part of GM Devolution, a request has been made to Treasury for a significant amount of non
recurrent funding, which will create a GM Transformation Fund, to facilitate service change
and deliver financial sustainability. If this funding is received, localities will be required to bid
against this fund. Salford has identified a need for £81m non recurrent funding to deliver the
requirements within the locality plan, as summarised in the table below.
Table 3: Non Recurrent Funding Required to deliver Recurrent Savings:
The details on the funding settlement for GM Devolution were not announced as part of the
Comprehensive Spending Review (CSR) on 25 November 2015. However, further details
are expected before Christmas. The above list is iterative and based at a point of time. Since
constructing the above, there are other things that should be considered for any bids against
the GM Transformation Fund, for example any non recurrent investment required to deliver
the prevention outcomes.
4.4.7 Next Stages - The locality plan is ambitious, as it needs to be, to meet the scale of the
outcomes gap and the financial challenge facing the locality. Clearly more work is required
over the coming months to articulate detailed schemes to deliver this level of ambition. More
clarity on the funding settlement for individual organisations as well as GM Devolution will be
known before Christmas. The financial model and assumptions underpinning the Salford
Capital Requirements £m
Salford Royal: Major Trauma Centre
and Healthier Together£35.0
£35m requirement for reconfiguration of A&E site/adjoining
building to enable implementation of Healthier Together, Major
Trauma and Salford Urgent Care Centre
Salford Royal: IT, standardisation and
reliability of care£10.0
£10m requirement- real time data. Scalability across other sites.
Working with WWL in first instance
Salford Royal and GMW:
reconfiguration of Meadowbrook£10.0
£10m to refurbish current Mental Health facility for wider health
and social care use
Community based estate £10.03 new build community hubs (Little Hulton, Lower Broughton and
Irlam)
TOTAL CAPITAL £65.0
Revenue Requirements
Vanguard programme £16.0Double running of current services and implementation of new
models of care
TOTAL REVENUE £16.0
TOTAL INVESTMENT REQUIRED £81.0
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
69
locality plan will be refreshed in light of this information and presented back to statutory
Health and Social care organisations as part of the 2016/17 planning round in March 2016.
GM
H&
SC
DE
VO
LUT
ION
– S
ALF
OR
D L
OC
ALI
TY
PLA
N
70
Ap
pen
dix
1:
Sa
lfo
rd L
oca
lity
5 Y
ea
r F
inan
cia
l P
lan
an
d A
ss
um
pti
on
s
Sa
lfo
rd L
oc
ality
: F
ina
nc
ial G
ap
: D
o N
oth
ing
Op
tio
n
£'0
00s
2015/1
62016/1
72017/1
82018/1
92019/2
02020/2
1
CC
G£000s
£000s
£000s
£000s
£000s
£000s
To
tal
fun
din
g£356,8
02
£363,9
38
£371,2
17
£378,6
41
£386,2
14
£393,9
38
Gro
wth
fro
m p
revi
ous y
ear
-2.0
%2.0
%2.0
%2.0
%2.0
%
Sp
en
din
g
Acute
£182,5
86
£184,8
31
£185,6
22
£187,9
58
£191,8
71
£195,7
84
Menta
l H
ealth
£37,0
94
£36,6
25
£37,1
43
£37,6
68
£38,2
01
£38,7
33
Prim
ary
and C
om
munity C
are
£44,2
44
£47,3
41
£48,7
52
£50,2
41
£50,3
97
£50,6
29
Prim
ary
care
inclu
ded in t
his
tota
l
Pre
scribin
g£40,7
58
£40,7
58
£41,9
80
£43,2
40
£44,5
37
£45,8
34
Inte
gra
ted C
are
£52,1
20
£54,3
83
£57,7
20
£59,5
35
£61,2
09
£62,9
58
To
tal
ex
pe
nd
itu
re£356,8
02
£363,9
38
£371,2
17
£378,6
41
£386,2
14
£393,9
38
CC
G s
ho
rtfa
ll£0
£0
-£0
-£0
£0
-£0
Co
un
cil
To
tal
fun
din
g£127,9
62
£115,9
11
£103,6
58
£98,4
75
£93,5
55
£89,1
86
Gro
wth
fro
m p
revi
ous y
ear
--9
.4%
-10.6
%-5
.0%
-5.0
%-4
.7%
Sp
en
din
g
Adult s
ocia
l care
£61,1
78
£65,7
99
£66,2
69
£69,8
67
£73,4
65
£77,0
64
Child
ren's
socia
l care
£45,5
64
£47,3
22
£46,8
75
£48,3
42
£49,8
09
£51,2
76
Public
Health
£21,2
21
£24,1
49
£23,7
68
£24,0
84
£24,4
04
£24,7
29
To
tal
ex
pe
nd
itu
re£127,9
62
£137,2
70
£136,9
12
£142,2
93
£147,6
78
£153,0
69
Co
un
cil
sh
ort
fall
£0
-£21,3
59
-£33,2
54
-£43,8
18
-£54,1
23
-£63,8
83
Sa
lfo
rd R
oya
l (C
CG
on
ly a
cti
vit
y)
Pro
vider
incom
e£291,7
02
£295,1
18
£303,8
41
£311,1
00
£311,2
22
£311,2
83
Localit
y %
of S
RF
T t
ota
l61%
Pro
vider
expenditure
£314,4
55
£334,3
41
£351,2
38
£371,8
56
£384,6
66
£397,7
81
Pro
vider
gro
ss s
hort
fall
-£22,7
53
-£39,2
23
-£47,3
97
-£60,7
56
-£73,4
44
-£86,4
98
Do N
oth
ing-
assum
e n
ot
achie
ve a
ny C
ost
Impro
vem
ent
(CIP
)
GM
W (
Sa
lfo
rd C
CG
on
ly)
Pro
vider
incom
e£33,3
80
£31,1
05
£30,6
54
£30,1
83
£29,7
32
£29,2
81
Localit
y %
of G
MW
Tota
l20%
Pro
vider
expenditure
£32,3
99
£32,6
15
£33,1
45
£34,0
27
£34,8
51
£35,9
10
Pro
vider
gro
ss s
hort
fall
£981
-£1,5
10
-£2,4
91
-£3,8
44
-£5,1
19
-£6,6
29
Do N
oth
ing-
assum
e n
ot
achie
ve a
ny C
ost
Impro
vem
ent
(CIP
)
To
tal
NH
S P
rovid
er
Sh
ort
fall
-£21,7
72
-£40,7
33
-£49,8
88
-£64,6
00
-£78,5
63
-£93,1
27
Do N
oth
ing-
assum
es N
HS
Pro
viders
to n
ot
achie
ve a
ny C
ost
Impro
vem
ent
(CIP
)
TO
TA
L L
OC
AL
ITY
SH
OR
TF
AL
L-£
21,7
72
-£62,0
92
-£83,1
42
-£108,4
18
-£132,6
86
-£157,0
10
Assum
ed m
inim
um
NH
S g
row
th a
t 2%
year
on y
ear-
ie 1
0%
(£37m
) ove
r 5 y
ear
period.
Now
assum
ed t
hat
this
uplif
t is
diff
ere
nt
to a
nnounced £
8bn a
dditio
nal N
HS
fundin
g (
Salfo
rd s
hare
=
£40m
). S
hare
of £8bn s
how
n o
n o
ther
sid
e o
f bridgin
g d
iagra
m
All
of th
ese fig
ure
s g
ross (
do n
ot
conta
in a
ny C
IP)-
there
fore
consis
tent
with d
o n
oth
ing o
ption.
Inclu
des d
em
and p
ressure
s a
nd liv
ing w
age
Assum
ed L
GA
% a
ssum
ptions t
o 1
8/1
9 a
nd c
ontinued w
ith 4
.7%
in 2
019/2
0 a
nd 4
.3%
2020/2
1.
In a
dditio
n,
applie
d P
H r
eduction 6
.2%
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
71
Appendix 2: Closing the Gap- Impact of Locality Plan Interventions
2020/21
£m
Baseline Position: Gross Locality Shortfall -£157.0
Impact of Fair Shares and Funding Protection
CCG Funding to Move to Fair Shares £0.0Salford CCG is within 5% of fair shares- therefore do not anticipate additional
growth over and above minimum NHS uplift or share of £8bn
CCG Funding- Share of £8bn Additional for Health £31.278% of £8bn to flow to CCGs (12% relates to spec comm). Salford CCG share of
national total 0.5%. Assumed 50% received in 2016/17 and 50% in 17/18
Request to Protect Social Care Funding for GM £17.5
This is an ask within Devolution- will not know until December 2015. Assumed
£179.7m across GM for Adult Scoial Care. Salford split provided by GM team
(£17.5m in total)
Sub Total £48.7
Impact of Locality Plans: Prevention
Start Well £1.3See Locality interventions worksheet for more details. Assumed 5 year lag for
impact
Live Well £14.6See Locality interventions worksheet for more details. Assumed 5 year lag for
impact
Age Well £0.0 £1m residential care savings included in Better Care savings below
Sub Total £15.9
Impact of Locality Plans: Better Care
Group of interventions 1: Community based care,
primary care, Salford standard£5.0
Plan to move some outpatient clinics into the community and redesign the
pathways to ensure different models of care, integrated with primary care. The
Salford standard should reduce variation in primary care and ensure consistent,
reliable care from gp practices. Aligning primary care with more community based
services will reduce the outpatient activity currently undertaken in the acute
setting. See "Better Care impact on Activity" sheet for detailed activity
assumptions
Group of interventions 2: Integrated Care (older
people and adults)£10.7
These interventions will contain population growth in terms of secondary care
activity and in addition deliver a reduction against 2014/15 levels. We have
planned on a reduction of 2 wards at Salford Royal. See "Better Care impact on
Activity" sheet for detailed activity assumptions.
Group of interventions 3: Medicine optimisation £2.5
Our do nothing finance model assumes year on year growth in primary care
prescribing...yet Salford has been very good at containing growth through robust
medicines management. Our strategic plan build on this. Within the workforce
section, it should describe additional investment in 20 clinical pharmacists
working I primary care. This should ensure consistency and reliable primary care
prescribing plus this workforce will interface with secondary care. This
intervention will contain prescribing growth, therefore can take £2.5m out of do
nothing financials against prescribing
CAMHS Transformation £0.0Nil impact on locality financial position. Potentially, over time, reduce spend on
Tier 4- but these savings accrue to Specialist/11th Locality plan
Sub Total £18.2
Impact of Provider Efficiency and Reform
Productivity Improvement (Cost improvement
programme)- SRFT- TOTAL£58.0 Internal CIP already identified/assumed- 2%
Productivity Improvement (Cost improvement
programme)- GMW- TOTAL£4.7 Internal CIP already identified/assumed- 2%
Productivity Improvement (Cost improvement
programme)- Council- ICO services£7.0
Assumed 2% CIP on adult social care element- will be part of ICO- therefore for
consistency, assume provider efficiency of 2% to be achieved year on year
Sub Total £69.7
REVISED LOCALITY SHORTFALL -£4.6
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
72
Appendix 3: Closing the Gap- Impact of Locality Plan Interventions on Hospital
Activity
POD
14/15
Baseline
Activity
20/21 Do
Nothing
Scenario
Activity
20/21 Activity
Post
Interventions
Intervention
Impact on
Activity
14/15
Baseline
Costs
20/21 Do
Nothing
Scenario
Costs
20/21 Costs
Post
Interventions
Intervention
Impact on
CostsNotes
£m £m £m £m
Critical Care 1,313 1,453 1,453 0 £1.20 £1.30 £1.30 £0.00
DirectAccess 1,942 2,150 2,150 0 £0.10 £0.10 £0.10 £0.00
Daycases 21,081 23,334 20,891 2,443 £16.10 £16.60 £14.86 £1.74 1
Elective 6,497 7,191 6,441 750 £11.90 £12.30 £11.02 £1.28 1
Emergency (A&E 106,000 117,331 98,700 18,631 £13.00 £13.40 £11.27 £2.13 2
Maternity 6,995 7,743 7,743 0 £7.60 £7.80 £7.80 £0.00
Non-Elective 36,056 39,910 34,056 5,854 £50.10 £51.50 £43.95 £7.55 2
Non-ElectiveShort Stay 3,523 3,900 3,900 0 £2.40 £2.50 £2.50 £0.00
First, Consultant 44,153 48,873 44,273 4,600 £7.10 £7.30 £6.61 £0.69 1
First, Non-Consultant 374 414 414 0 £0.00 £0.00 £0.00 £0.00
Follow-up, Consultant 122,568 135,669 121,343 14,326 £12.00 £12.40 £11.09 £1.31 1
Follow-up, Non-Consultant 1,290 1,428 1,277 151 £0.10 £0.10 £0.09 £0.01 1
Outpatient Procedures 33,426 36,999 36,999 0 £5.70 £5.90 £5.90 £0.00
Other 23,492 26,003 26,003 0 £18.20 £18.70 £18.70 £0.00
Outpatient Diagnostics 15,478 17,132 17,132 0 £1.40 £1.50 £1.50 £0.00
Diagnostic Imaging Outpatients 290 321 321 0 £0.00 £0.00 £0.00 £0.00
High Cost Drugs 4,181 4,628 4,628 0 £0.30 £0.30 £0.30 £0.00
Total £147.20 £151.70 £136.99 £14.71
Additional Impact on Costs:
Reduction in Residential Care £1.00 2
Medicines optimisation- reduction in CCG's prescribing spend £2.50 3
TOTAL LOCALITY BETTER CARE SAVINGS £18.21
NOTES:
£5.03
£10.68
£2.50
£18.21Total Better Care
Group of interventions 3: Medicine optimisation
Group of interventions 1: Community based care, primary care, Salford standard
Group of interventions 2: Integrated Care (older people and adults)
1
2
3
Our do nothing finance model assumes year on year growth in primary care prescribing...yet Salford has been very good at
containing growth through robust medicines management. Our strategic plan build on this. Within the workforce section, it should
describe additional investment in 20 clinical pharmacists working I primary care. This should ensure consistency and reliable
primary care prescribing plus this workforce will interface with secondary care. This intervention will contain prescribing growth,
therefore can take £2.5m out of do nothing financials against prescribing
These interventions will contain population growth in terms of secondary care activity and in addition deliver a reduction against
2014/15 levels. We have planned on a reduction of 2 wards at Salford Royal. The ambition is to impact on a&e and non elective
activity as follows:
Emergency a&e -18631
Non elective. -5854
In addition there will be planned reductions in residential care of c £1m (recorded above)
Plan to move some outpatient clinics into the community and redesign the pathways to ensure different models of care, integrated
with primary care. The Salford standard should reduce variation in primary care and ensure consistent, reliable care from gp
practices. Aligning primary care with more community based services will reduce the outpatient activity currently undertaken in the
acute setting. Planned activity reductions targeted at acute planned care as follows, should be c £4.9m
Daycases -2443
Elective -750
First consultant -4600
Follow up consultant -14326
Follow up non consultant -151
GM H&SC DEVOLUTION – SALFORD LOCALITY PLAN
73
APPENDICES
1. Salford Locality 5 Year Financial Plan and Assumptions
2. Closing the Gap- Impact of Locality Plan Interventions
3. Closing the Gap- Impact of Locality Plan Interventions on Hospital Activity
4. Summary of public engagement
5. Targets for outcome measures
6. Delivery Plan
7. Community Impact Assessment
LIST OF SUPPORTING PAPERS
· Agreeing priorities
· Comparator report
· Projections #phof
· Full engagement paper
· Role of VCSE paper
· Housing paper
· Detailed methodology
· Finance supporting papers
· ICO outline business case
GLOSSARY
Salford Locality Plan Communications Strategy
January – March 2016
Document Control Title: Salford Locality Plan Communications Strategy (Jan – Mar 2016) Status: Draft Version: 2.0 Date issued: 08/01/2016 Author: Lindsay Kirby – Communications Manager, Salford CCG
Change History Version Summary of changes Document status Date published 1.0 Additional comms
channels/update to #TakingCharge vs #OurSalford
Background ................................................................................................................ 2
Communications aim and objectives (Jan – Mar 2016) .............................................. 3
Audience .................................................................................................................... 3
Key messages ............................................................................................................ 3
Strategy ...................................................................................................................... 4
Tactics ........................................................................................................................ 6
Evaluation .................................................................................................................. 9
Appendix 1: Key messages from Sept – Dec 2015 .................................................. 10
Appendix 2: Healthwatch Priorities Questionnaire ................................................... 11
Appendix 3: Engagement plan ................................................................................. 15
Background Salford CCG is one of 12 Clinical Commissioning Groups to agree a framework with NHS England, 15 NHS providers and 10 local authorities across Greater Manchester to become the first English region to get full control over its £6bn health budget. In each of the ten areas of Greater Manchester, the council, Clinical Commissioning Group and community organisations are working together to write a ‘locality plan’ to explain how health and social care services will be provided over the next five years. These plans will be brought together to form the Greater Manchester Strategic Plan. Salford’s locality plan will explain how we will ensure quicker access to get better health and social care services in Salford. We know that there isn’t enough money to pay for everything, so the overall aim of the locality plans is to outline from existing strategies and programmes the breadth of activities taking place across the region in preparation for discussions with the Government about bridging the forecasted £2bn funding gap by 2017-18. Salford’s plan talks about how we will plan services differently to cost less and work better. The plan is patient centred with short, medium and long term priorities gathered under the themes of Start Well, Live Well and Age Well. It also means local people will have a bigger role in looking after their own health. The plan will effectively serve as an update and replacement of the city’s health and wellbeing strategy for 2016 onwards. Approach During September and October 2015, partner agencies began conversations with a wide range of communities including the voluntary and community sector (VCS), people with long term conditions, people with disabilities, patient participation groups, carers and citizens’ panels. The aim was to develop a shared vision for Salford and decide key priorities together. The feedback from this engagement was incorporated into the Salford Locality Plan, and the first draft has now been submitted to the Greater Manchester health and social care reform team. This strategy sets out the communications plan to support the next stage of engagement where, between January to March 2016, the locality plan will be presented to the Salford population. The communications strategy should be read in conjunction to the Salford Health and Social Care Devolution – Engagement paper (Appendix 1).
Communications aim and objectives (Jan – Mar 2016) The aim is to provide communication tools and channels to support the engagement work during January to March 2016 and determine whether the people of Salford are ‘on board’ with the city’s locality plan.
In alignment with the strategic principles outlined in the Salford Health and Social Care Devolution – Engagement paper, our communications objectives will be to:
• Create communication materials with clear, consistent and accessible language with no jargon or difficult words
• Ensure the materials are transparent on decision-making, what is being engaged on and why so that patients and the public clearly understand what can be influenced
• Ensure the communication tools can be tailored to meet the needs of a diverse population
Audience The communications plan will target the following groups:
• Citizens of Salford • Service users and patients • Health and Wellbeing Board • Salford City Council Members • Salford CCG Members • Healthwatch Salford • Service providers – NHS funded • Service providers – other • Voluntary, community and social enterprise sector • Staff groups • Local media
Key messages The key messages for the first stage of engagement (Sept – Dec 2015) aimed to answer the following:
(1) What is devolution/the Salford locality plan? (2) What does it mean for me/will I see any changes? (3) What do you want from me?
See Appendix 1 for full list of messages.
These messages will continue to be pertinent to the communications and engagement work, but as the draft locality plan is now being presented to the public, the key messages throughout our communications and engagement work will focus more on people in Salford needing to take charge and responsibility for their own health. These will broadly cover:
• You’ve told us [health priority] is a problem in Salford, what do you think the solution is?
• Little interventions matter
• How are you going to improve your own health and wellbeing?
Strategy This strategy will sit with the Health and Wellbeing Board Communications and Engagement sub-group who will meet monthly to review the plan and ongoing communications and engagement work.
The communications approach for promoting Salford’s plan needs to link in and complement the wider engagement work on the impact of devolution across Greater Manchester. A ‘central’ communications and engagement team is carrying out a number of activities between January to March, including a Key 103 media bus roadshow (likely to be mid-late February) and a crowdsourcing campaign (late February).
An engagement ‘pack’ of communication materials will be developed for partners’ stakeholder engagement in Salford made up of:
• An overview to devolution/purpose of the locality plan • The scope of the plan and the workstreams • FAQs based on the feedback from earlier engagement exercises • A timeline • Questions to ask recipients
The questions will be the same asked as part of Healthwatch Salford’s priorities questionnaire (see Appendix 2) and complement the questions devised by the GM devolution communications team to ask at a local level. A key element of the communications strategy is to make the materials as accessible as possible for people of all abilities. Therefore, budget permitting, a video explaining how the Salford Locality Plan will impact on the city’s citizens could be developed in a similar format to the one produced by the GM devolution communications team, https://www.youtube.com/watch?v=4fiRtxzWMkg, with subtitles/sign language. The Executive Summary of the plan can be designed into an ‘easy read’ document and supported by infographics which depict our key messages visually rather than reams of text. A key infographic, which can also be used for evaluation, is a ‘wellbeing star’ which will record how people feel about their health and wellbeing. The star will initially be
completed via Healthwatch Salford’s priorities questionnaire and can be repeated each year to hopefully show people’s attitudes changing and the star ‘growing’. The wellbeing star will add a valuable, locally sourced wellbeing measure to enhance the performance dashboard, which has been developed for the locality plan. See Appendix 2 for an example of a wellbeing star. In terms of branding, the central GM devolution communications team is adopting the banner #TakingCharge across their communications materials, particularly social media. However, the consensus amongst the HWB comms sub group is that this is too paternalistic and unclear about who ‘taking charge’ is referring to. Instead, #OurSalford has been chosen as an alternative. Social media is a huge strength for Salford with Salford CCG recently reaching the milestone of 10,000 Twitter followers, making us one of the most ‘followed’ CCGs in the UK. Combined with the number of followers for Salford Royal, Salford City Council, Greater Manchester West and Healthwatch Salford, we have more than 40,000 Twitter followers. One way to capitalise on this will be to instigate a social media ‘thunderclap’. The Thunderclap app collects all posts and tweets and publishes all of them in the very same moment. It is an effective way to get your message out to as many people as possible, because aggregating the posts allows breaking through the “noise” of general news. In other words: If you succeed it’s all over your networks and potentially all over the social web. More traditional forms of media will also be used, including press releases for the local media. Both Salford CCG and Salford Royal have fortnightly ‘health matters’ pages in the Salford edition of the Manchester Weekly News where key messages can be promoted. SalfordOnline.com is quickly becoming a key media outlet for Salford with 30k readers per week. The CCG pays for advertising on the website and, in return, SalfordOnline promotes our stories on their Twitter feed with 8.5k followers and 14k followers on Facebook. Potentially, we could plan a monthly Salford Locality Plan-specific press release/case study and theme it with the tagline #OurSalford and getting buy-in from the local media, but we would need to plan PR ideas to ensure we have enough to last the campaign and for it not tow dwindle to nothing.. It is also important, while social media and digital communications has its place, we should not forget the tools of leaflets and posters – especially when targeting minority communities. Research commissioned by the CCG to evaluate the best way to engage with the Jewish community in Salford found that half of those asked preferred to find out about health services in shops (30%) and libraries (19%) through leaflets/posters and information stands with the materials translated into Hebrew and Yiddish. Again, this will be budget-dependent on whether we can go down this route and we’d also need to assess if other predominant languages are being ignored if we only translate Hebrew/Yiddish. Many of these materials will be applicable to both public and staff groups, but we will also need to include internal communications tactics which address the questions raised by staff around how the locality plan will impact on their work.
Tactics Tactic Audience Deadline/Notes Cost Owner Complete Digital communications #OurSalford web banners used on partner websites
Public ASAP – can it be produced by in-house SCC design team?
TBC Anne Lythgoe
Locality Plan-specific page on Partners in Salford website
Staff and public
ASAP – dependent on the date the Executive Summary is available. Or, we could upload the ‘standard’ version in the interim so at least there is something
Free All partner comms teams
Locality Plan-specific page on all partner websites/staff intranets
Staff and public
A summary of the plan but signposting to Partners in Salford for the main information/latest updates. Again, ASAP but dependent on materials being ready
Free All partner comms teams
Create 5-slide PowerPoint presentation
Staff and public
X2 versions will need to be done – one for staff/one for public. To be completed by w/e 08 Jan
Free
Lindsay Kirby – public/ SRFT comms – staff?
Print materials ‘Easy read’ version of Locality Plan Executive Summary
Staff and public
ASAP – can it be produced by in-house SCC design team? TBC Lindsay Kirby
Produce a presentation ‘script’ Staff and public
ASAP - w/e 08 January 2016 Free Lindsay Kirby
Summary of engagement work for publication on websites
Staff and public
Free Lindsay/ Amanda
Advertising
Locality plan advert in CCG patient panel newsletter
Public Distributed to 1,500 members of CCG’s patient panel. Next deadline TBC, but scheduled for February
Free Lindsay Complete
Advert in Manchester Weekly News
Public Budget-dependent £600 per ½ page
Lindsay
Adverts on Salford Online Public 30k readers per wk £135 - £275
Lindsay
Media Take Care magazine feature on locality plan
Public Targets Jewish households. Next edition is ‘Winter’ distributed in January
Free Lindsay Complete
Article in Life In Salford Public All Salford households. Next edition published w/c 14 March.
Free Dependent on who’s ‘page’
Monthly PR with LP key messages/case studies Public
Manchester Weekly News health page/Salford Online
Free Comms leads
Salford Community Radio/Salford City Radio Public Need a GP to speak, or potentially advertise
TBC Lindsay
Visual/Talking Books Public TBC Lindsay
Adverts via Salford Sport Radio
Public (1.9m footfall)
SWTW key messages via 30-sec advert and 5 indents per hour from Nov - Mar
Approx £2.5k for 6 months
Lindsay
Community magazines – M44. M4
Public Free Salford CC
Partner newsletters – Salix, City West, GMP, fire service, Pendleton Together
Public Free
Salford CC
Council community newsletters Public
Free Salford CC
Social media Locality Plan tweet pack via social media channels (i.e. Facebook and Twitter)
Public Feb - Mar Free All comms leads
‘Thunderclap’ campaign Public Date TBC – dependent on the call to action Free All comms leads
Short vods added to social media/websites
Public Feb - Mar Free Lindsay
‘Internal’ comms
CCG GP and staff eBulletins Staff and GPs
Free
Lindsay
Intranets Staff and clinicians
Free
All
SCC internal newsletters Staff Free Jane SRFT internal newsletters (The Loop) Staff
Free Steph
ICP email updates Staff and carers
Free Rob
Desktop wallpapers Staff across all partners
Free All
Payslip advertising Staff TBC All Messages on rent statements (via ICP)
Public (over 65s) ICP
Total:
Evaluation Evaluation for the three-month period this communications strategy covers will include:
• Responses to Healthwatch questionnaire • Downloads of Salford Locality Plan • Social media analytics • YouTube hit rate on videos • Media coverage
Appendix 1: Key messages from Sept – Dec 2015
• ‘Devolution’ means Greater Manchester – not Westminster – will decide how every penny of its £6bn health and social care budget is spent in Greater Manchester
• Devolution is not about politicians taking over the NHS. We won’t be changing how the NHS works. Experienced health professionals, like GPs and hospital doctors, will still be involved in all decisions made.
• Across Greater Manchester, all councils and local NHS organisations (such as hospitals, GPs and community based care) will work more closely together so that the right support is offered at the right time and in the right place
• Salford has some of the worst health in the country. People living in poorer areas live up to 12 years less than those living in richer neighbourhoods. Devolution changes the way we can spend money giving us the freedom to shape our health and social care services around the needs of the people in Salford
• In each of the ten areas of Greater Manchester, the council, Clinical Commissioning Group and community organisations are working together to write a ‘locality plan’ to explain how health and social care services will be provided over the next five years. These plans will be brought together to form a Greater Manchester plan
• Salford’s locality plan will explain how we will make it quicker access to get better health and social care services in Salford. We know that there isn’t enough money to pay for everything. This means that our plan will need to talk about how we plan services differently to cost less and work better. It will also mean that local people will have a bigger role in looking after their own health.
• Devolution will put the patient at the heart of Greater Manchester’s health and social care services. Sometimes decisions will be made about Salford services. Sometimes decisions will be made about Greater Manchester services which Salford people will use.
We want to make sure that Salford people have a voice in decisions that are being made. Most of the decisions will be made locally. We want to work together with people in Salford to make sure you are partners in any decisions made.
Appendix 2: Healthwatch Priorities Questionnaire
Every year, Healthwatch Salford asks the people of Salford what you think we should all be working on to make Salford people’s health and wellbeing better.
All of the information from organisations and feedback from local people over the past year have told us what we need to work on. This has all been written up in a plan for Salford for the next 5 years. This is called a Locality Plan. It looks at how Salford people can ‘start well’, ‘live well’ and ‘age well’. You can read more about the Locality Plan on our web pages.
We want to know a bit more about how we do the things in the plan. By answering the questions below, you can help to make health and wellbeing better for everyone in Salford.
The first part of the Locality Plan is ‘Start Well’ . This means that young people should have a good s tart in life. This might include having a good education, feeling safe and b eing happy and positive. It might also mean that pa rents do the best they can for their children.
1. What do you think that we should be doing to help people have a good start in life? What is your solution to help people have a good start in life?
Click here to enter text.
2. Little things can make a big difference in these areas. What can you personally do to make things better?
Click here to enter text.
The second part of the Locality Plan is ‘Live Well’ . This means that people are able to have a happy, fulfilling life. It might also include taking care of your own health and wellbein g and managing any long term conditions.
1. What do you think that we should be doing to help people live well? What is your solution to help people live well?
Click here to enter text.
2. Little things can make a big difference in these areas. What can you personally do to make things better?
Click here to enter text.
The third part of the Locality Plan is ‘Age Well’. This means that as people get older, they will be a ble to get good quality care and support if they need it. It might also mean tha t older people are looking after their health so th at they don’t need as much care early on. It might also mean that when people die, it is in the best possible way.
1. What do you think that we should be doing to help people age well? What is your solution to help people age well?
Click here to enter text.
2. Little things can make a big difference in these areas. What can you personally do to make things better?
Click here to enter text.
We also want to find out how local people feel about their own health and wellbeing.
To do this, we can use a wellbeing star. This asks people to think about the questions on the star, and then circle the number that they think best describes how they feel.
• If you circle numbers 1 or 2, it means that you are not thinking about this topic at the minute.
• If you circle numbers 3 or 4, it means that you have been finding out about what you can do on this topic
• If you circle numbers 5 or 6, it means that you have started to make some changes
• If you circle numbers 7 or 8, it means that you are getting there with this topic and things are going well
• If you circle numbers 9 or 10, it means that things are as good as they can be.
How positive do you feel about your health and wellbeing?
Keeping active helps health and wellbeing. How active do you feel you are?
Learning something new helps health and wellbeing. How much do you feel that you learn new things?
Connecting with friends, neighbours and family helps health and wellbeing. How much do you feel that you connect with people?
How in control of your health and wellbeing do you feel?
Taking notice of things around you (e.g. green spaces / parks / taking time out) helps health and wellbeing. How much do you feel that you take notice and take time out?
Giving back and helping out friends / neighbours or volunteering helps our health and wellbeing. How much do you feel that you give back?
Appendix 3: Engagement plan Date w/c Phase Activity Who/where 14.12.15 Planning Agree questions H+WB Board / Engagement + Coms
Subgroup 18.01.16 Planning Agree where contacting / how engaging Healthwatch / Engagement Leads
21.12.15 Planning Develop surveys / feedback forms Healthwatch / Engagement Leads
21.12.15 Planning Develop newsletter / online content for Healthwatch to promote Healthwatch
04.01.16 Engagement: Week 1
Survey via email / online to all community groups Ask all groups to return at least 10 responses. Promote via social media
Healthwatch / Engagement Leads
Events /Focus Groups with: • Info to all gateways
Healthwatch
11.01.16 Engagement: Week 2
Reminders / prompts for online survey
Healthwatch
Training / Briefing session for Healthwatch volunteers. Agree for volunteers to collect x1 group and x10 individual responses
Healthwatch
18.01.16 Engagement: Week 3
Reminders / prompts for online survey / social media Healthwatch
Support to volunteers to gather information Replenish hard copies at gateways etc
Healthwatch
25.01.16 Engagement: Week 4
Reminders / prompts for online survey
Healthwatch
Send information received to date to public health to start analysis
Healthwatch
Event Engaging with people who have dementia Grass Roots (6 Degrees / Social Adventures) / Healthwatch
01.02.16 Engagement: Week 5
Reminders / prompts for online survey Phone calls to community organisations
Healthwatch
Events / Focus groups with hard to reach groups Info to all gateways
Healthwatch
Engagement / focus groups with community groups
Healthwatch
08.02.16 Engagement: Week 6
Reminders / prompts for online survey
Healthwatch
Mid-point review – which communities are we not hearing from? Specifically target those communities for the remaining weeks.
Healthwatch
15.02.16 Engagement: Week 7
Reminders / prompts for online survey
Healthwatch
Events / Focus Groups with identified hard to reach groups
Healthwatch
Independent Living Development Board Healthwatch / CCG
22.02.16 Engagement: Week 8
Reminders / prompts for online survey
Healthwatch
Events / Focus Groups with identified hard to reach groups
Healthwatch
Citizen Reference Group for older people Healthwatch / CCG
29.02.16 Analysis All info to public health for analysis Healthwatch Public Health
07.03.15 Analysis All info to public health for analysis Healthwatch Public Health
14.03.16 Report / Update / Feedback
Report findings back to Health and Wellbeing Board
Anne Lythgoe
Report findings back to public
Healthwatch / Engagement Teams / CVS / Health and Wellbeing Board
Project planning Healthwatch
21.03.16 Report / Update / Feedback
Report findings back to public
Healthwatch / Engagement Teams / CVS / Health and Wellbeing Board
Project planning Healthwatch
28.03.16 Report / Update / Feedback
Project planning Healthwatch
SALFORD’S HEALTH AND WELLBEING BOARD – BUSINESS PLAN FOR 2014/15
11/01/2016 1
FORWARD LOOK 2015/16 For approval / assurance For discussion For information
Date and time of
meeting
JSNA – understanding
needs, inequalities, risks
and assets (JSNA Exec)
JHWS - Priorities for local action
(JHWS subgroups, ICBHWB)
Integration and Partnership
(ICBHWB, ICB, JSNA Exec)
Governance, Accountability and
Assurance (HPF, Other Partnerships)
19 May 2015
Strategy meeting
(2.30 – 4.30 pm)
Purpose: to jointly explore the feedback report from the Peer Challenge
Content: facilitated discussion around the implications of the report, focussing on Board members’ expectations of each other and
how members / partners can better hold each other to account.
Output: an action plan to implement the recommendations from the Peer Challenge.
19 May 2015
Business meeting
(4.30 – 5.30 pm)
• Better Care Fund Assurance
(JMc)
• Licensing of alcohol outlets
(BD)
• ‘HalveIt’ HIV motion (DH)
• NHSE reassurance around
distinction between NHS charges
and charges for private care (RB)
• JSNA – update and
programme of needs
assessments (SF, SC)
• Adult Social Care User
survey (SL, SG)
• Integrated Commissioning
Board update
• CYPT update • Forward plan
16 June 2015
Strategy meeting
Purpose: to look at 3 major work streams going forward:
• Peer Challenge Action Plan
• Refresh of Joint Health and Wellbeing Strategy
• Preparation of the GM Devolution sustainability plan
Content:
Briefing on each of the above, followed by discussion about the best way to progress these work streams.
Output: steer from the Board about how to link all 3 and take these pieces of work forward
SALFORD’S HEALTH AND WELLBEING BOARD – BUSINESS PLAN FOR 2014/15
11/01/2016 2
21 July 2015
Business meeting
(2.30 – 4.30 pm)
• JSNA – update and
health statistics
comparator report (SF,
SC)
• Paying a Living wage –
understanding the Health
impacts (AP, CD)
• Integrated Care Programme
Service and Financial Plan
2015/16 (JMc/KP)
• Next steps – JHWS review, Peer
Challenge improvement plan
and GM sustainability plan –
(DH, JR)
• End Fuel Poverty Coalition
report
• CYPT update
• Forward plan
• HWB Board draft Annual Review
– for assurance
August 2015 No meeting
15 September 2015
Business meeting
(2.30 -4.30 pm)
• Salford – an Age Friendly City
(IA)
• CAMHS Transformation (AH)
• Greater Manchester devolution
update (DH)
• Primary care - The Salford
Standard
• Integrated Commissioning
Board update
• JHWS Work Plans progress
report (Priority 1)
• Update on Halve It
commitment
• SSCB Lesson Learnt bulletin
• CCG Annual report
• Forward plan
20 October 2015
Strategy meeting
Purpose: Testing the Salford Local Sustainability Plan
• Work through the draft propositions and discuss implications
17 November 2015
Business meeting
(2.30pm-4.30pm)
• Housing – impacts on
wellbeing and health (DC)
• Draft Local Sustainability Plan
(DH)
• Engagement Policy and Plan (Cllr
S, CM)
• Intelligence
Newsletter/JSNA –
update (SF, SC)
• Children and Young People’s
Trust Annual Report (DK)
• Social Value in Health and
Care update
• CQC Quality in a Place briefing • Forward plan
• Health Protection Forum update
SALFORD’S HEALTH AND WELLBEING BOARD – BUSINESS PLAN FOR 2014/15
11/01/2016 3
• Safeguarding Children Board
Annual Report
15 December 2015 –
Strategy meeting
(2.30pm – 4.30pm)
Discussion about Locality plan proposals
19 January 2016
Business meeting
(2.30pm-4.30pm)
• Locality Plan update (DH)
o Outcome measures
o Transformation
narrative
o Digital offer
o Financial Plan
o Engagement plan
•
• CYPT Newsletter
• Feedback/Progress Update from
Healthwatch Salford
• Children and Families Act update
• Integrated Care Programme
Annual Report
• GM Strategic Plan and
implementation
• Forward plan
16 February 2016
Strategy meeting
Purpose: Discussion around aspects of the Locality Plan implementation
Content:
Output:
16 March 2016
Business meeting
(2.30 – 4.30pm)
• Final Locality Plan (DH)
• Better Care Fund Plan 2016-17
(AH, KP)
• Intelligence
Newsletter/JSNA future
work streams (SF, SC)
• Supporting the needs of
Salford’s LGBT community in
the future (LM, LGBTF)
• Health Watch Salford – priorities
for 2016/17
• Proposed MOU between HWB
and Healthwatch & Scrutiny
Panel
• • Integrated Commissioning
Board update
• Fuel Poverty – health impacts
of cold homes in Salford (LL)
• Integrated Care Board update
• Skills and Work Board update
• Feedback/Progress Update from
Healthwatch Salford
• Forward plan
• Health Protection Forum update
SALFORD’S HEALTH AND WELLBEING BOARD – BUSINESS PLAN FOR 2014/15
11/01/2016 4
• CQC Quality in a Place inspection
• Primary Care Strategy update
Update on partner responses to implementing the Living Wage (CD, AP)
Salford Children and Young People’s Trust Newsletter April 2015 Issue 10
page 1 of 8
Contents
Newsletter December 2015 Issue 12
Foreword ............................................................................................. 2
CAF changes for Spring 2016 ................................................................. 2
Young Carers Day launches in Salford .................................................... 3
Young adult carers run Business Breakfast ............................................ 3
Working together to support young people across Salford ..................... 4
Listening to children and young people in emotional health services ..... 5
#SeldomHeard Salford .......................................................................... 6
Salford College students and staff clean up! .......................................... 7
2015 Anti-Bullying Conference round-up ............................................... 8
Young carers at the Lowry attending the fourth showcase event and the launch of the first Young Carers Day in Salford
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 2 of 8
Foreword The year is nearly over and I must say a lot has happened in recent months. #SeldomHeardSalford was a fantastic,
innovative event and I look forward to seeing the results of the pledges. We will be doing this again in 2016. Young
people have also been telling us about their experiences of emotional health support, with the help of Healthwatch.
The new Family Assessment tool goes online in the New Year, and I am confident this will further bring children and
young people’s voices into decisions about their lives.
Another first this autumn was Young Carers Day, and I also note how young adult carers created their own Business
Breakfast to help raise awareness among employers.
Salford College students have inspired again by cleaning up their local community. Practitioners said that this year’s
Anti-Bullying Conference provided useful information to help them support children & young people, and the
‘Salford Integrated Prevention Hub’ partnership has brought together organisations working with families across the
City.
May I wish the very best of the season to everyone who works to support children, young people and families.
Councillor John Merry, Assistant Mayor, Services for Children and Young People
Chair of Salford Children and Young People’s Trust
CAF changes for Spring 2016Salford CAF Team are developing an electronic family
assessment that will eventually replace the CAF in
Salford. The aim is to launch this in Spring 2016. We
have taken into account what professionals, children
& young people, and parents/carers have told us
about these plans.
The terminology will be “Family Assessment”, “Team
Around the Family” and “Lead Professional” when it
goes live.
The ’Signs of Safety’ (‘SOS’) model that is used within
Child Protection Conferences is being promoted and
used within ‘Team Around the Child’ (TAC) meetings
now. Feedback is very positive.
Sessions on SOS in TACs and the Family Assessment
will be offered early in 2016.
Voice of the Child is a priority in CAF and TAC. The
main message is to gain the child/young person’s
voice and submit this with the CAF once completed.
Pupils from Swinton High School designed some
young people’s tools to use when completing a
CAF/TAC.
These can be found at
www.salford.gov.uk/achildsvoice
Finally the CAF team have a new member to join Gary
Woodward and Natalie Lunn. This is Melanie King and
we are very happy to have her on board. If you need
any CAF support please call the CAF duty number on
0161 603 4239 and we will help as much as we can.
Natalie Lunn, CAF Coordinator
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 3 of 8
Young Carers Day
launches in Salford Tuesday 20 October was a huge day for young carers in the
city as Salford City Council held its first ever Young Carers
Day, a day of celebrating the role young carers play within
the city.
The first annual Young Carers Day was attached to the fourth
showcase event at the Lowry, which celebrates the
partnership between the Lowry and Gaddum’s Salford Young
Carers Service. This year saw the launch of a new interactive
toolkit for schools and youth groups to use to help raise
awareness of and identify the “Hidden” 70% of carers under
the age of 24.
Throughout the day local schools ran events to highlight
the issues and young carers themselves addressed special
assemblies, standing up and being proud of being a carer in
Salford.
The City Mayor addressed the showcase event at the Lowry
Theatre and told all the young carers “Be proud, as Salford is
proud of you”.
Paul Moran, Manager, Salford Young Carers Service
Young adult carers run Business Breakfast
On Wednesday 23 September
the Young Adult Carers Service
ran a Business Breakfast which
attracted 24 local firms and
organisations to listen to a
number of young adult carers
talk about the issues they face in
accessing employment due to
their caring roles and the affect
caring had had on their
education.
The event was also addressed by
the City Mayor and some of the
mentors who are support young
adult carers. The morning was a
great success with new mentors
and organisation links developed
from it.
To see the main messages from
the morning please visit
www.salfordyoungcarers.org/ne
ws/2015/9/25/business-
breakfast.
Paul Moran, Manager, Salford
Young Carers Service
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 4 of 8
Working together to support young people
across Salford
During October the Salford Integrated Prevention Hub (SIPH) team has interacted with many young people and
troubled families across Salford.
Across the four hubs, SIPH members work closely with those people who are referred to them to help with
education, crime and family related issues in the borough, as well as attend youth clubs and community events.
Since the project started in June 2015 there have been 2883 interactions. For further information on the work of the
Salford Integrated Prevention Hub visit www.manchesterfire.gov.uk/about_us/what_we_do/key-projects/siph/.
On Friday, October 9 2015, SIPH members were joined by White Watch from Salford for a visit to Oasis Academy,
where there were around 40
young people in attendance.
SIPH members talked with the
young people while
firefighters showed them
what kit was worn when
entering a burning property
and the specialist equipment
carried on GMFRS’ engines.
The young people had the
chance to see how heavy the
breathing apparatus was as
well as have a go on the hose.
Thanks to SIPH members,
visits to the Oasis Academy
take place frequently.
Andy Pownall, Prevention
Manager, Greater
Manchester Fire and Rescue
Service
v.uk
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 5 of 8
Listening to children and young people in
emotional health servicesEarlier this year, local people told
Healthwatch Salford that we needed
to do more to listen to children and
young people, particularly around
emotional wellbeing and mental
health. We worked with the Young
Carer’s Service and a small group of
young people. Young people wrote
and developed a survey to find out
experiences of wellbeing and mental
health. This included finding out
what children and young people
found stressful, what makes them
happy, who they might talk to when
things get difficult and what their
experiences of mental health
services were like. The questionnaire
was sent out across schools,
services, youth groups and activities
in Salford, mainly by the young
people themselves.
They did a tremendous job and we
received over 600 responses. Thank
you to everyone who shared their
experiences! We also ran focus
groups and discussion sessions.
From the things that people told us,
we have written a report which
suggests some recommendations to
improve services for the future. We
are still working with a small group
of young people to plan how best to
share the things we found in the
report. We hope that the
information we have gathered will
influence the Children and
Adolescence Mental Health services
review, as well as the 0-25 years
review in Salford.
Clare Mayo, Chief Officer for
Healthwatch Salford said “It has
been a really exciting project for us
and we are really proud of the work
that young people have done. They
have worked really hard to plan and
promote the project and that has led
to us getting lots of responses from
young people in Salford. We are
really keen to make sure that their
views are making a difference to
services for children and young
people”
You can read the report and find out
more about this project and the
other work we do at:
http://www.healthwatchsalford.co.u
k/projects
If you want to know more about
Healthwatch Salford, or share your
experiences, you can sign up as a
member for free on our webpages:
http://www.healthwatchsalford.co.u
k/sign-me-up or call 0330 355 0300.
Clare Mayo,
Healthwatch Salford, Chief Officer
o.uk
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 6 of 8
#SeldomHeardSalford
The Seldom Heard Event was put forward by VOCAL, representing the Voluntary and Community Sector in Salford,
as a means of trying to allow young people, who seldom had a voice in the city, and little means of accessing the
main city leaders, to meet with, and discuss with the leaders what their issues were and what they would like to see
developed within Salford.
Planning for the event was carried out by a small group of young people from both the Youth Council and Fight for
Change Council with support from Paul Moran from Salford Young Carers Service and Ed Coyne from 42nd
Street.
All high schools and alternative education provision settings were contacted and asked if they would like to bring
along young people who rarely had the opportunity either by their own behaviour or circumstances surrounding
their lives to have a voice.
The event was held at Swinton Park Golf Club and was attended by 46 young people from across the city which
included pupils from Albion Academy, All Hallows through the Ethnic Minority and Traveller Service (EMTAS), New
Park, Salford Foundation, OasisAcademy, Swinton High School, Walkden High School, young people from the Fight
for Change Council as well as five young people who acted as facilitators on the day.
The morning session with the young people conistsed of an of ice breaker exercise, followed by group work to gather
the issues they wanted to raise around four topics which were health, education, home and the environment. The
groups then planned and prepared a presentation ready for the arrival of the city leaders.
You can see the pledges made by the city leaders on the event Twitter feed #SeldomHeardSalford.
The event was funded and supported by Salford CVS, Salford Foundation, Salford City Council and the Salford
Safeguarding Children Board.
Paul Moran, Manager, Salford Young Carers Service
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 7 of 8
Salford College students and staff clean up!
A task force consisting of staff and students from
Salford City College have come together to kick off a
volunteering campaign to do a variety of projects
including litter picking, fundraising and engaging
further within the local community. Following a
number of public meetings with neighbours of the
College, it was found that local residents wanted to
see the College’s students more within the
community and see some of the great work that
comes from what they do.
“What we would love to achieve with this volunteer
project would be to change the perception that many
have of young people, and to show that they really do
have a compassion for the community,” explained Saf
Arfan, Vice Principal for Development and Innovation.
“We know how much they do and contribute, but this
is not always known by those outside the College.”
One of the student volunteers, 16-year-old Brogan
Carter, is no stranger to community work. The former
Harrop Fold Specialist Arts College pupil said: “I joined
the project because I like helping others. Last summer
I did National Citizen Service, and as part of that I
helped to fundraise for and create a play area in a
local primary school.”
Eleanor Linton, PR & Marketing Manager, Salford City
College
Staff and pupils outside Salford City College litter picking as part of their local community volunteering campaign
Salford Children and Young People’s Trust Newsletter December 2015 Issue 12
www.partnersinsalford.org/cyptrust page 8 of 8
2015 Anti-Bullying Conference round-up
90 professionals attended this
year’s conference. They came
from organisations including
Children’s Services, children’s
homes, schools, and youth
providers.
To set the scene, a young woman
from the ‘Fight for Change’
council spoke of her own
experiences of bullying in a
relationship. Feedback included
‘…so brave to stand up and tell a
real story.’
Salford Young Carers Forum
delivered an interactive
presentation on third party
bullying.
An introduction to the ‘RESPECT’
programme, detailing the
programme’s subject of
community and respect. The
presentation went on to
showcase two films created by
young people: ‘Really good –
will be in touch for use in
school.’
Salford Youth Council presented
on the subject of ‘sexting’,
leading a discussion about case
studies from real world
situations: ‘Highlighted that
adults don’t always understand
slang / what goes on.’
We finished with a presentation
on ‘E-safety and the deep web’.
This proved an eye opening
section, giving a good grounding
in the subject, and the kind of
issues the deep web can present
when working with young
people.
Next year professionals would
like more examples of strategies
that can be delivered with young
people.
Martyn Shaw, Youth Worker,
Salford City Council
The Children & Young People’s Trust is the City Partnership 'theme group' for children and young people. It has senior
responsibility in Salford for policy, strategy and achievement in services to children and young people.
Summaries of recent Children & Young People’s Trust board meetings are available on the Trust website
www.partnersinsalford.org/cyptrust.
Send news items to [email protected].
Item No
Salford Health and Wellbeing Board
Title of report IMPLEMENTATION OF THE SEND REFORMS Date JANUARY 2016 Contact Officer SUE WOODGATE
1. Executive Summary In September 2014 the Children and Families Act was implemented and a new Code of practice for SEND was introduced. Both of these sit in statute. This report is to update on the first full year since implementation and further changes and developments in this area. The presentation of this report will concentrate on highlights, challenges and the future.
Why is this report being brought to the Board? - Relevance of this report to the priorities of the Joint Health and Wellbeing Strategy, the Joint Strategic Needs Assessment or integrated working
The statutory partners in the implementation of the SEND reforms are represented at the HWBB and the Code states that all the following have a duty to have regard to the Code and its implementation.
• local authorities (education, social care and relevant housing and employment and other services)
• the National Health Service Commissioning Board
• Clinical Commissioning Groups (CCGs)
• NHS Foundation Trusts • Local Health Boards
Health and Wellbeing Board’s duties or responsibilities in this area
As Above
Key questions for the Health and Wellbeing Board to address – what action is needed from the Board and its members?
To note progress and the suggested new inspection framework.
What requirement is there for internal or external communication around this issue?
This is being done by the SEN Implementation Board
2. Introduction
This report is written at the end of the first year following the implementation of the Children and Families Act on the 1st September 2014. The Act changed the way in which the needs of Children and Young People with SEND were approached and met through statute and necessitated significant changes in philosophy, working practice and expectation from all stake holders.
For children and young people this means that their experiences will be of a system which is less confrontational and more efficient. Their special educational needs and disabilities will be picked up at the earliest point with support routinely put in place quickly, and their parents will know what services they can reasonably expect to be provided. Children and young people and their parents or carers will be fully involved in decisions about their support and what they want to achieve. Importantly, the aspirations for children and young people will be raised through an increased focus on life outcomes, including employment and greater independence.
The implementation of the Act involved the application of a new Code of Practice. This Code of Practice provides statutory guidance on duties, policies and procedures relating to Part 3 of the Children and Families Act 2014 and associated regulations and applies to England. The Local Authority is one named partners and must have regard to the Code of Practice. This means that whenever they are taking decisions they must give consideration to what the Code says. They cannot ignore it. They must fulfil their statutory duties towards children and young people with SEN or disabilities in the light of the guidance set out in it. They must be able to demonstrate in their arrangements for children and young people with SEN or disabilities that they are fulfilling their statutory duty to have regard to the Code. So, where the text uses the word ‘should’ it means that the guidance contained in this Code must be considered and that those who must have regard to it will be expected to explain any departure from it. This report demonstrates our commitment to ensuring that we meet the requirements of the Code of Practice and develop our working practice with that of our partners to ensure that the outcomes for Children and Young People with SEND in Salford are improved.
3. Key issues for the Board to consider This paper is an update on the progress towards the implementation of the reforms which have a 3 year timescale starting on the 1st September 2014. Highlights
• Successful implementation of a Strategic board to drive the developments. • Successful implementation on time of the Local Offer which has been maintained and
developed in response to comments and to meet need. • Successful ongoing training and development programme for practitioners in schools,
LA and Health Services. • Successful implementation of changed working practice in advice givers e.g.
Educational Psychologists and NHS Therapists. • Launch of specialist teams with in LSS to support schools and settings. • Launch of the ASD strategy for schools and the commencement of work with the
CCG to develop a shared pathway with Health for Children and Young People with ASD.
• Successful creation of the DMO / DCO (Designated Medical Officer and Designated Clinical Officer Roles) which are noted within the region as being particularly striong, well developed and exemplary practice.
• Development of strong monitoring of the above roles through the CCG. • Strong, effective working relationships between the LA and the CCG on both a
clinical and strategic level. • Further Development of the Parent Engagement Officer (PEO) role and success in
using that role to deflect the need for statutory intervention. • The development of the new role for SIASS working with young people as well as
Parents and Carers.
• Development of the role of the independent supporters ( Together Trust) for specific groups of families, children and young people.
• Engagement with external research commissioned by the DFE and implementation of their recommendations
• Positive feedback in moderation on the quality of Plans being produced. Challenges
• The high number of statements to be converted to EHCP’s over and above the creation of any new plans is creating significant pressures on the team.
• Running two parallel systems is creating pressures on the team. • Central changes before systems have been fully assimilated has created challenges. • The increase in age range from 0-25 is creating challenges for implementation. • Sitting outside the transformation agenda and yet being a key part of it is creating
issues in terms of prioritisation of resources. The Future
• The introduction of the local area inspection from May 2016 and additional responsibilities in this area is creating challenges both for the team and for the local area. The two key areas to be inspected across the local area are the:
• Effectiveness and timeliness of identification. • Effectiveness of implementation of the reforms in delivering outcomes. • Throughout the consultation information there is a clear focus on the Local Area
knowing itself and customer satisfaction.
4. Recommendations for action
1. To recognise the need for the HWBB to see itself as part of the governance of the
Local Area and accept its role in this.
2. To ensure an appropriate reporting schedule is in place so that it can assure itself of the effectiveness of delivery.
5. Contextual Information See previous reports to HWBB. BACKGROUND DOCUMENTS: SEN CODE OF PRACTICE JULY 2015 CHILDREN AND FAMILIES ACT 2014 CARE ACT 2014
STRATEGIC DRIVERS AND EVIDENCE OF NEED:
The duties and outcomes reported here are statutory under the above legislation.
THIS REPORT CONTENT HAS ALSO BEEN CONSIDERED BY:
EXECUTIVE LEAD MEMBER FOR CHLIDREN’S SERVICES
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: N/A
ASSESSMENT OF RISK:
A risk register is held by the SEND board currently there are no corporate risks flagged in this area but a risk does exist around the number of conversions from statements to ehcp’s which have been completed.
LEGAL IMPLICATIONS: N/A
FINANCIAL IMPLICATIONS: Funding in this area is provided from three sources, the core budget, DSG and the new burdens fund.
PROCUREMENT IMPLICATIONS: N/A
HR IMPLICATIONS: N/A
Healthwatch Salford c/o Unlimited Potential, Innovation Forum, 51 Frederick Road M6 6FP Tel 0330 355 0300 [email protected] www.healthwatchsalford.co.uk
FWe
Welcome to the first Healthwatch Salford Newsletter. Healthwatch Salford is the new people’s champion
for health and adult social care in Salford.
What is Healthwatch Salford?
A law was passed in 2012 that set up a Healthwatch in every area of England. Healthwatch Salford is an independent organization that will help local people with health and adult social care by gathering views and reporting back to those who provide care services. We have a place (along with the Council and the NHS) on the local Health & Wellbeing Board, and we have the ear of the Care Quality Commission (the government organization responsible for the standard of health and social care). So we have real influence.
But what does Healthwatch do?
We’re here to help. If you have a problem and you don’t know where to turn; or you want to know how to complain about a health or social care service; if you have had a bad (or good) experience with health or adult
Left: A Doctor’s Waiting Room by
L.S. Lowry.
Things have improved a lot since
Lowry’s day, but there is always
more we can do……
……that’s why Healthwatch
Salford is here.
© The Lowry Collection, Salford
0330 355 0300
.uk
www.healthwatchsalford.co.uk
December 2013
2
social care; we want to hear from you. Then we can let you know about what organizations are out there that can help – go to our website www.healthwatchsalford.co.uk or ring us on 0330 355 0300. We want to put local people at the heart of health and social care in Salford, that’s why Healthwatch Salford is ran by Salford people and is all about local people getting involved. After all who knows better than local people what is working and what is not.
You can help. Maybe you would like to take part in focus groups, conduct surveys, or visit health and social care providers. You could help with these or many other activities. See how you can volunteer and become a member in our ‘sign up’ section of our website
www.healthwatchsalford.co.uk We will be producing this Newsletter regularly to tell you about the up and coming events happening in your area, job opportunities in health and social care organizations, as well as important government announcements and where and when bodies like the NHS want to hear what you think about certain topics.
Claremont & Weaste Claremont & Weaste Community Drop-in Centre wants volunteers to help at their soon-to-open Drop-in Centre. They need people to welcome visitors and give out information. Training and support available if necessary. Contact Kay, email [email protected] or telephone on 0161 925 1118 / 07717 730746 Seedley & Langworthy Trust (SALT) are conducting a survey of working parents and their use of children’s facilities such as after schools clubs. Contact Adele via their website http://www.seedleytrust.co.uk/contact-us.html or ring 0161 745 7666
What’s happening in December
3
East Salford Coffee Morning at St. Georges Resource Centre, Cromwell Road. Everyone welcome – there will be a raffle and second hand sale so bring any unwanted items. 10:30am-12 Midday, Wednesday 18th December. Eccles Europia Winter Family Fun Day. Europia is an organization supporting speakers of eastern European languages, but all are welcome at their Winter wonderland event; there will be a Snow Queen, Mini Disco with Santa, Crafts, Games and Refreshments. Dress in costume (if you want), celebrate the season and learn about healthy eating. Go to www.europia.org.uk for more info or ring 07763 711888. Free Admission, 2:30pm-4:30pm, 14th December, the Youth Centre, 1 Gladstone Road, Eccles Irlam & Cadishead A Christmas Social Get Together hosted by Salford City Council will be held at Irlam Steelworks, 524-526 Liverpool Road. Admission is free and there will be Music and a sing-along, a raffle, bingo, Christmassy Quiz and light refreshments. Monday 30th December 1pm-3pm (contact Debbie Kemp 0161 686 5237 for further details). Ordsall & Langworthy Positive Changes Group is a group of ex-offenders based in Salford who are working to change the image of ex-offenders. They have got funding to run a 10 week course for people who have been on the wrong side of the law but wish to make positive changes in their lives and communities. All are welcome at an open event for anybody who is interested. There will be free refreshments (including mince pies) at 1pm-3pm, Pendleton Gateway, Community Room 2, Friday 13th December. Swinton Christmas Celebration at the Royal British Legion, Cheetham Road organized by Access 2 All Areas, a group of disabled people working to improve accessibility in Salford. There will be a buffet, entertainment and a raffle on Friday 20th December at 12:00pm-4:00pm. Contact Burt Shepherd 07852 299065.
4
Salford Young vocalists are invited to an exciting new weekly project run by Brighter Sound at the Lowry, Salford Quays. Vocalists, beatboxers, M.C.s, and writers 13-18 can attend FREE to learn new skills and share their own. Every Tuesday from Jan 14th 6pm-8pm. For more info, contact Brighter Sound (Swan Street, Mcr) 0161 830 3899 Salford Royal is conducting its annual membership survey. This is an opportunity to comment on the hospital’s future plans on issues such as care for older people, outpatients and car parking. To complete the survey go to https://www.surveymonkey.com/s/Q7ZSVQR or to get the survey in paper format ring 0161 206 3133 or email [email protected] . (Closing date 20th December) Blue Badge holders. Salford Royal also wants to know your views about car parking at the hospital for Blue Badge holders, and the discounted parking scheme. Please go to http://www.srft.nhs.uk/media-centre/latest-news/bbc/ to have your say. (Deadline 20th December) Salford Loaves & Fishes are raffling two tickets to see Manchester United play Tottenham Hotspur on New Year’s Day. Raffle tickets are £5 (all proceeds to Salford Loaves & Fishes). To buy a ticket email [email protected] or telephone 0161 661 0903 (closing date 21st December) Salford City Council are doing an important survey of the views of Salfordians. Following government cuts, S.C.C. has to make £75 million of savings in the next three years. They want to know what is important to you in the budget. Go to http://www.salford.gov.uk/bc2014-15.htm . (Closing date 10th January) Manchester United Foundation and the Football Association are asking if people are interested in taking part in a 10 week coaching course for people with disabilities (of any kind and both genders). The venue hasn’t been confirmed but anyone who wants to take part must be able to travel to the venue and be of reasonable fitness. Anybody who is interested phone Linzi Brook 0161 793 2120 Citizen Scientist Salford are asking for help with a research project regarding new born babies – they want your help designing a
5
questionnaire on the effects of fluoride in tap water. Please go to https://www.redcap.rss.mhs.man.ac.uk/surveys/?s=geN4bXI3tV (no deadline advertised). Manchester Citizen Scientist are looking for three members of the public to take part in the Research and Innovation Steering Group for patient / public involvement in research carried out by Central Manchester University NHS Foundation Trust. Go to http://www.cmft.nhs.uk/research-and-innovation/our-research for full details. (13th December deadline). England NHS England has begun work on a set of guidelines to help their staff make sure the language they use is easy to understand for everyone. You can help by filling in a very short questionnaire, go to http://www.england.nhs.uk/ourwork/patients/accessibleinfo-2/ and fill in the survey that is relevant to you (there are three: one for patients, carers and members of the public; one for healthcare professionals; and one for voluntary organizations). (Deadline for entries 21 February 2013) National Institute for Health & Care Excellence (NICE) want people’s views on public health topics ranging from heat wave planning to sexual health. If you would like to contribute, please see http://www.nice.org.uk/getinvolved/currentniceconsultations/QualityStandardPHTopicConsultation.jsp for further details. (closing date 20th December). Jack’s petition Nobody in our modern world should ever have to go hungry, let alone children. Please read and sign this petition via the link below. https://www.change.org/en-GB/petitions/parliament-debate-uk-hunger-and-rise-in-foodbank-use-jackspetition If enough signatures are received it will warrant a parliamentary debate.
JOB OPPORTUNITIES
Big Life Centres is working with Salford City Council to support the delivery of the Way 2 Wellbeing community website with the aim of helping people to manage their own health and wellbeing. They need 8 community researchers over the next 2 months to gather feedback on the website and how it could be used.
6
This post is one day a week. Training and expenses will be provided. Go to http://www.beingwellsalford.com/latest-news/ (deadline 16th December). Manchester YMCA is looking to recruit an experienced Trust and Statutory Fundraiser. If interested email Sarah Axford at [email protected] or telephone 0161 837 3538. (Deadline 9th January)
local people improving local health and care
Healthwatch Salford c/o Unlimited Potential, Innovation Forum, 51 Frederick Road,
Salford M6 6FP 0330 355 0300
www.healthwatchsalford.co.uk [email protected]
Healthwatch Salford (@HWSalford) on Twitter
A Partnership between Salford City Council, NHS Salford ClinicalCommissioning Group, Salford Royal NHS Foundation Trust andGreater Manchester West Mental Health NHS Foundation Trust.
02 SALFORD TOGETHER
ANNUAL REPORT 2014/15
The work has been led through three keyworkstreams:
• Community Assets - working closely with neighbourhoods to develop opportunities and activities where people are better able to support each other and themselves.• Centre of Contact - a single integrated hub for the co-ordination of social care and community health service provision.• Multi-disciplinary Groups (MDGs) - where those individuals deemed most vulnerable are supported through co-ordinated care and support plans. The MDGs include GPs, Social Workers, District Nurses, Practice Nurses Community Mental Health Workers, Community Geriatricians and a representative from the Health Improvement Team.
Teams across the city have worked extremelyhard during 2014/15 to bring about and startto embed changes which will provide strongbuilding blocks for the further development ofintegrated care across Salford going forward.
I would like to take this opportunity to thankSue Lightup, Strategic Director forCommunity Health and Social Care atSalford City Council, as the co-chair for theAlliance Board who has championed thisprogramme since its inception, prior to herretirement in June. Also, my thanks go toAlan Campbell, Chief Operating Officer atSalford Clinical Commissioning Group, whotoo has recently retired but who also withSue, has given leadership across the city toassist in ensuring the programme becamepart of the ‘day job’ in providing effective andresponsive support to those individualsrequiring it.
Though we talk about services and support,it is of paramount importance that weremember this is essentially about promotinghealth and independence in older peopleworking with all partners, community groupsand individuals to realise the potential in eachand all of us, to achieve this singular aim.
PAUL BISHOPStrategic Partnerships and Planning ClinicalLead, Salford Clinical Commissioning GroupCo-Chair Alliance Board Salford
The programme was initially overseenthrough the Older People’s Integrated CareBoard but as the partnership approach wasmore formally recognised through apartnership agreement, the Alliance Boardreplaced the Integrated Care Board in 2014to oversee the programme and delivery ofthe 7 Improvement targets to be achieved by 2020.
Supporting preparatory work wasundertaken from 2012-2014, with 2014-15being the first year that we have implementedand invested in changes to services. Thisreport highlights work undertaken acrosshealth and social care teams in developingmore joined up and responsive care for thepeople of Salford to date.
Introduction 04
Aims 05
Alliance Board The
Leadership Team 05
A partnership 06
What we are about 08-09
Our Achievements in 2014/15 10
Milestone Calender 2014/15 10
Finance and Service Plan 12
Leadership
Framework/Evaluation 12-13
Improving Health
and Wellbeing 14-23
Risks and Challenges 24
Building Wellbeing Together 25
Glossary of Terms 26
I am very pleased to
introduce the first
annual report on behalf of
Salford Together, the Older
People’s Integrated Care
Programme in Salford.
Salford Together represents
joint working between health
and social care partners in
Salford, namely Salford NHS
Clinical Commissioning
Group, Salford Royal
Foundation Trust, Salford City
Council and Greater
Manchester West Mental
Health Foundation Trust.
The partner organisations
have been working together
to better develop integrated
care since 2012.
03
04 SALFORD TOGETHER
Salford partners have been workingtogether for over two years to drive theimplementation of the Salford TogetherIntegrated Care for Older Peopleprogramme, through pooled health and social care budgets and jointdecision making.
This partnership brings together the workof GPs, District Nurses, social workers,mental health professionals, care homes,voluntary organisations and localhospitals into a more aligned system withthe aim of supporting those people whoare well and healthy to stay active so theystay healthier for longer, and to help thosewho have a health or social care needs to improve their quality of life andindependence, with an overall focus onimproving the health and wellbeing of all older people across the city.
Why the focus on older people?It is recognised that a variety of groupswould benefit from integrated care,however for the last 2 years the decisionhas been to focus on older people. There are a number of reasons for this.
1. Older people account for a high use of health and social care services.2. Older people often have long term care needs and are therefore more likely to benefit from better care planning and coordination across health and social care.3. There is good evidence that integrated care for older people can deliver better outcomes, improve experience and result in cost savings.4. Older people can be socially isolated with a reduced quality of life. Quite often, they receive fragmented care and are not supported to care for themselves. 5. Salford has some of the highest rates of emergency admissions and readmissions to hospital.6. Salford has some of the highest permanent admissions to residential and nursing care.7. Salford has too many people receiving end of life care in hospital rather than at home or their preferred place.8. A significant proportion of health and social care expenditure in Salford relates to older people and this will only increase as the population continues to live longer. Currently in Salford there are more than 35,000 people aged 65 or older and this number is set to rise. It is expected that by 2030, there will be more than 43,000 older people across the city and a large number of these will have long term health conditions.
Salford Together1is a
partnership between Salford
City Council, NHS Salford
Clinical Commissioning
Group, Salford Royal NHS
Foundation Trust and Greater
Manchester West Mental
Health NHS Foundation Trust.
1 - Salford Together is the logo and branding which was designed to represent the integrated working of all the main
partners. This logo was created after extensive professional public consultation. The design uses the S for Salford,
with blue at the top of the S which represents the NHS, the magenta at the bottom which represents Salford City
Council and the purple in the middle of the S which represents the integrated working of the statutory organisations.
ANNUAL REPORT 2014/15
Steve Dixon - Chief Finance Officer, Salford CCG
Karen Proctor - Head of Performance andCommissioning Support, Salford CCG
Alan Campbell - Chief Operating Officer, Salford CCG
Paul Newman - Lay Member, CCG
Hamish Stedman - Chair, Salford CCG
Keith Darragh - Assistant Director (Safeguarding, Quality and Business Strategy), SCC
Jennifer McGovern - Assistant Director / IntegratedCommissioning and Personalisation, SCC
Councillor Connor - SCC
Dave Clemmett - Assistant Director / OperationalServices, SCC
David Herne - Director of Public Health, SCC
Neil Thornton - Director of Finance and CorporateBusiness, SCC
Charlotte Ramsden - Strategic Director for Adult and Childrens Services, SCC
David Dalton - Chief Executive, SRFT
Ian Moston - Director of Finance, SRFT
Melanie Walters - ICP Programme Manager, SRFT
Jack Sharp - Executive Director of Service Strategy and Development
Chris Evans - Interim Divisional Managing Director forSalford Health Care, SRFT
Liz Calder - Associate Director of Strategy, SRFT
June Roberts - Assistant Director of Nursing AdultCommunity Services, Intermediate Care, Palliative CareTeam, Integrated IV Service and Salford Care HomesPractice, SRFT
Anne Williams - Non-Exec Director, SRFT
Elaine Inglesby-Burke - Executive Nurse Director
Ismail Hafeji - Director of Finance and IT, GMW
Gill Green - Director of Nursing and Operations, GMW
Penny Evans - Head of Operations, GMW
Dr Paul Bishop - Strategic Partnerships and PlanningClinical Lead CCG / Co-Chair Alliance Board
Jenny Walton - ICP Clinical Lead and LMCRepresentative
It has a triple aim to:
1. Deliver better health and social care outcomes.2. Improve the experience of service users and carers.3. Reduce overall health and social care costs.
Salford Together aim is to
transform local the health and
social care system, promoting
greater independence for
older people and delivering
more integrated care.
INTEGRATED CARE
PROGRAMME
05
Achieving greater
independence and
improved wellbeing
for older people in
Salford by
integrating care
within communities
Create greater
independence and
resilience within
communities through
the increased use of
local assets
Map existing assets within both neighbourhoods
Engage older people to identify those assets that are
most valued
Increase access to local community groups
Expand befriending and volunteer support
Develop inter-generational support through working
with local schools
Increase prevention and early intervention
Aim Primary Drivers Secondary Drivers
Implement solutions that support self care
Implement assistive living technologies
Develop an information portal and directory of
services / support
Rationalise the number of points of contact for older
people
Provide structured support post discharge from hospital
Risk stratification to identify people at risk of
hospitalisation or admission to care homes
Fortnightly multi-disciplinary reviews
Health screening
Develop shared care protocols and shared care plans
Timely management for individuals in a crisis
Establish mechanisms to share information between
care providers / professionals
Education and support for individuals and their carers
Increased access to community-based care and support
Increase prevention and early intervention
Help older people
navigate services and
support themselves
through the use of
new technologies and
the creation of an
integrated care hub
Deliver a structured
approach to
population health &
wellbeing, with
targeted support to
those most at risk and
their carers, through
multidisciplinary
working
06 SALFORD TOGETHER
There are however, many moreorganisations and community groups and local Salford citizens who are actively involved in working hard onintegrating health and social care servicesacross Salford.
These include but are not limited to:
Age UK
Citizens Reference Group
Barton Ladies Group
Care homes Sector
Chamber of Commerce
Citizens Advice Bureau
City West Housing Trust
Community Pharmacy
District Nurses
Domiciliary Care Providers
Fire Prevention Service
General Practitioners
Great Places
Helping Hands
Home Improvement Agency
Inspiring Communities Together
Local hospitals
Citizens Reference Group
Mental health professionals
Pendleton Together
Salford Community Leisure
Salford CVS
Salford Multi-Faith Forum
Salix Homes
Social Workers
Unlimited Potential
Your Housing Group
Other third sector organisations
A key component of the programme hasbeen listening to local citizens, andinvolving them in the co-production of theprogramme. Older people have beenengaged through two complementaryapproaches:
The Citizen Reference Group (CRG)This formal structure was established aspart of the ICP programme. The group oflocal older people are supported througha development worker and meet monthlyto look at aspects of the programme –acting as a critical friend. Membersengage with areas of work which interestthem and act as ambassadors for theprogramme by sharing key messagesfrom the programme with their ownnetworks.
The community asset work stream project group have engaged with olderpeople through the network of partnerswho attend the monthly meetings(housing providers, development workers,third sector organisations, health workersand Salford City Council).
Older people are invited to take part inworkshops and focus groups tounderstand what is important to them tosupport their own health and well being.
Older people have taken part in the wider lessons learnt events, taken part inpresentations on the ICP and worked with health professionals to coproducetools which support older people to stayhealthy and well.
As described in the
introduction there are four
statutory partners to Salford
Together, Salford City Council,
NHS Salford Clinical
Commissioning Group,
Salford Royal NHS Foundation
Trust and Greater Manchester
West NHS Mental Health
Foundation Trust.
ANNUAL REPORT 2014/15 07
08 SALFORD TOGETHER
For the individual, four levels of supportand need have been identified, with anemphasis on supporting citizens tomaintain their independence andwellbeing and when intervention isrequired it is at an early stage andcoordinated across health and social care teams to ensure proactive andappropriate support is received.
The four levels are set out below:
Further detail and progress to date isdescribed in the Improving Health and Wellbeing section on page 14. The five main workstreams have been summarised below:
1. Community Assets Group.2. Centre of Contact.3. Multidisciplinary Groups. 4. Housing Workstream.5. Care Home and Supported Living Workstream.
Focus starts on prevention throughcompletion of wellbeing plans,progressing through to advanced andend of life care planning as appropriate,supported by care services.
Standards are put in place to standardisethe quality of care across the City.
For Salford Together, our
focus is on promoting
wellbeing and independence
for everyone aged 65 and
older, looking at both the
individual and the
environment.
LEVEL OF INTERVENTION
BASED ON NEED.
SHARED CARE PLANS STANDARDS
Able Sally
71%: c. 24,850
Needs Some Help
17%: c.6,000
Needs More Help
9%: c.3100
Needs A Lot Of Help
3%: c.1050
Wellbeing Plan
Independence Plan
SupportedIndependence
Plan
Care Plan
Sally’sstandards
GP standards
Carer supportand diseasemanagement
Home care andintermediatecare standards
Care Homestandards
{{{{{
{
{
{
{
Supporting older people to stay healthy, happy andindependent In Salford.
ANNUAL REPORT 2014/15
Local community assets
Enable older people to remain
independent, with greater confidence to
manage their own care.
Centre of Contact
Acts as an central health and social care
hub, supporting Multi Disciplinary Groups,
helping people to navigate services and
support mechanisms, and coordinating
telecare monitoring.
Multi Disciplinary Groups
Provide targeted support to older people
who are most at risk and have a population
focus on screening, primary prevention
and signposting to community support
09
The wellbeing planThe ‘Wellbeing Plan’ was developed witholder people, to support them to helpthemselves and others understand what is important to keep them healthy andwell, now and in the future. The WellbeingPlan is based on the NHS Five Ways toWellbeing:
Emergency admissions andreadmissions• 19.7% reduction in NEL admissions (from 315 to 253 per 1000 ppn). • Reduce readmissions from baseline. • Cash-ability will be effected by a variety of factors
Permanent admissions to residential and nursing care• 26% reduction in care home admissions (from 946 to 699 per 100,000 ppn). • Savings directly cashable but need to be offset by cost of alternative care (especially increased domiciliary care)
Quality of Life, Managing own Condition, Satisfaction• Maintain or improve position in upper quartile for global measures.• Use of a variety of individual reported outcome measures
Flu vaccine uptake for Older People• Increase flu uptake rate to 85% (from baseline of 77.2%)
Proportion of Older People that areable to die at home• Increase to 50% (from baseline of 41%)
Additional local measure selected forBetter Care Fund• Diagnosis of Dementia against estimated prevalence rates - BCF.
2020 targets - what and why?
1
2 3
1
2
3
SALFORD’S INTEGRATED
PROGRAMME.
U n i v e r s i t y T e a c h i n g T r u s t
10 SALFORD TOGETHER
• Integrated Care Board transitioned into the Alliance Board May 2014.• Alliance Contract: Section 75 pooled budget arrangements in place from April 2015. Pooled budget of almost £98M, made up of services largely commissioned for older people by Salford City Council and Salford CCG, which includes some services provided by the third sector and independent providers. • The Alliance agreement was signed off by all partners in October 2014.• Salford Together branding introduced to represent partnership between the four partners.• Multi-disciplinary Groups are now active in all neighbourhoods in Salford.• Salford 65+ population has been segmented, using the risk stratification methodology, developed as part of the neighbourhood collaborative work.
• An electronic shared care summary record has been developed in the hospital electronic patient record which can be accessed by hospital, community, mental health, social workers, GPs and practice nurses for those patients under their care. • The Centre for Contact was established in November 2014 when Single Entry Point for Intermediate Care collocated with the Adult Social Care Contact Centre. • Dedicated housing workstream established which includes housing partners, Fire Prevention Service, Helping Hands, Home Improvement Agency, and Hospital Aftercare Service.• 4400 Older people living with 2 or more long term conditions are assisting in evaluating support provided by health and social care in Salford. The 2 year long evaluation is being undertaken by Manchester University with funding from the National Institute of Health Research. • Wellbeing plans were launched in Autumn 2014, following co-design with community organisations and older people.
• Age UK Salford with Salford Royal were jointly chosen as one of five Malnutrition pilots across the country. The initiatives taken forward during the pilot have been fully adopted within the Salford Together programme. • We recruited a development worker and volunteer co-ordinator to support the community asset work.• Carried out a number of small projects which are now being scaled up, including tech and tea, eating well in later life and improving access to physical activity.• Carried out community asset mapping across neighbourhoods.• The ICP/ICO Stakeholder Event Development Day held on the 26th March 2015 had approximately 140 attendees. Overall the feedback showed continued optimism and support for the benefits of integration and progression to even closer working as part of an ICO. The images below over were drawn by a scribe at the event, and assist in summarising key points discussed on the day.
February
Initial submission to Better Care Fund
agreed through Health and Wellbeing
Board.
March
Malnutrition Taskforce (1of 5 sites).
May
Integrated Care Board became the
Alliance Board.
Alliance Agreement -£98.7 M health and
social care spend for 65+ in a section 75.
June - July
Salford Together branding.
July - January
Business cases developed and approved
to support the model and implementation.
September
BCF refresh submitted & approved.
March
Cabinet visit from policy advisors
Salford Together website
‘CLASSIC’ National Institute for Health
Research - Manchester University,
evaluation of the programme, now
recruited their patient cohort.
Update from the individualworkstreams and programme
sub-groups can be found in‘Improving health
and Wellbeing’ section.
ANNUAL REPORT 2014/15 11
12 SALFORD TOGETHER
Part of this process has been to self-assess Salford’s position using AQuA’s‘Leadership for Integration’ framework.
The ‘Leadership for Integration’framework identifies eight domains thatplay an important role in the effectiveintegration of care within an economy.Each domain is scored on a 1-5 scale (1 being the least developed, 5 being themost progressed).
The December 2014 self-assessment wascompleted by 16 representatives from thepartner organisations.
Overall, there has been an improvementin the scores for all eight domains, withmost improvement in ‘user & carerexperience’, ‘workforce’ and ‘serviceredesign’. This would appear to reflect themove to implementation and rollout of themodel, which has included recruitment ofadditional staff and ‘new ways of working’for the Centre of Contact and theMultidisciplinary Groups. Although thescores for ‘leadership’ and ‘culture’ have
both improved, there is quite a degree ofvariation in individual scores. It is unclearwhether this reflects a perception thatabout how the overall programme iscurrently functioning against position on‘the journey’ or whether this is a productof different interpretations of the scoring criteria.
CLASSICIs the NIHR funded evaluation of theSalford Integrated Care Programme(NIHR HS&DR 12/130/33). It is a researchprogramme which incorporates:
• A cohort of over 4000 elderly people from Salford.• Process Evaluations of the ICP at both system wide and MDGs/Centre for Contact levels. • Health Economics Outcomes. • Health Coaching within the ICP Centre for Contact. • PPI work with elderly Salford Residents.
FINANCIAL INVESTMENTS 2014-15 £
Investments in new responsibilities and demographic pressures £215,000
New model of care in the community - Community Geriatrician and Elderly Care Physicians £12,000
Integrated Care Programme costs £556,000
Shared Care Records £140,000
Centre of Contact – additional investment £139,000
Community Assets £24,000
Multidisciplinary Teams – GP Backfill £111,000
Multidisciplinary Teams non-GP Backfill £169,000
Total spend 2014-15 £1,336,000
Since its establishment in
May 2012, the Integrated
Care Board has periodically
reviewed progress and
reflected on both the
Programme and the
functioning of the Board itself.
ANNUAL REPORT 2014/15
The period up to March 2015 saw thesetup of the Cohort with the assistance ofNWEH’s FARSITE and 33 of the 50Salford GPs. Over 13,000 surveys weremailed out to elderly people in Salfordbetween December 2014 and March 2015and 4380 (34%) responded.
This response forms the baseline for thecohort which will be followed up 4 times inthe period up to September 2015.
CLASSIC also looks at how the SICP wasset up and well as the results. The systemwide Process Evaluation involved 22 faceto face interviews with staff from the ICPand 22 observations of stakeholdermeetings. The initial findings from thisresearch have been presented at theHealth Services Research NetworkConference (Nottingham, July, 2015).
CLASSIC has been informed by PublicPatient Involvement work with a team ofSalford volunteers. The elderly peopleassist the research team by giving theiropinions on the nature and roll out of thesurvey and also any sub projects withinCLASSIC. The PPI team met the
CLASSIC team for the first official meetingat St Frederick’s community Centre on25th March to discuss our surveyresponses and approaches to elderlyresidents to take part in further research.
The period up to April 2015 saw CLASSICmaking good progress to the foundationsto complete the planned evaluation ofthree core SICP outcomes:
• Increasing satisfaction with the care and support provided to older people.• Increasing proportion of older people feeling supported to manage their own conditions.• Improving quality of life for users and carers.
The next phase of CLASSIC will involvethe Health Economic evaluations of theMDGs and a Health Coaching sub projectfor up to 250 elderly patients in the Centrefor Contact.
13
IntegrationFrameworkDomain
Leadership
Governance
Culture
User & CarerExperience
Financial &Contractual
Information & IT
Workforce
ServiceRedesign
2.13
2
2.33
1,25
2.08
2.08
1.88
1.54
2.71
2.71
2.74
2
2.21
2.03
2.03
1.84
3.08
2.81
2.92
2.28
2.8
2.17
1.84
1.84
3.21
3
3.05
2.48
3.14
2.4
2.31
2.51
3.4
3.3
3.3
3
3.5
2.8
3
3.2
Apr-12 Oct-12 May-13 Feb-14 Dec-14
Leadership
ServiceRedesign
Workforce
Information & IT
Financial &Contractual
User & CarerExperience
Culture
Governance
4
3
2
1
0
Apr-12
Oct-12
May-13
Feb-14
Dec-14
14 SALFORD TOGETHER
Community Assets
• The community asset work stream project group has a membership of 35 people from organisations across Salford who all bring different skills and knowledge. The network includes a wide range of partners ranging from mature people, Salford City Council, Salford University, Housing providers, Local Businesses, Charities, Social Enterprises, and Third Sector organisations, all working across a number of areas including housing, volunteering, befriending and Leisure and Health Improvement connections.
• Community asset model: - A Sally Friendly City - the commitment of the city to support older people to stay healthy and well. - Sally Standards and Sally well being plans - the commitment by older people to support their own health and well being. - A set of tools developed by and for older people based in local neighbourhoods - the commitment of community and deliverers to support older people to stay healthy and well The model developed by the community asset working group looks to address the barriers which effect older people and increase the risk of social isolation, loneliness or depression. - The barriers identified are: Limited physical activity, lack of access to information, not eating well, not engaged in activity,. By addressing these barriers we will be able to:
• Reduce emergency admissions. • Improved quality of life for users and carers. • Increase the proportion of people that feel supported to manage own condition. • Activity during 2014-15 - Limited physical activity – Step up classes. - Not eating well – Malnutrition tools. - Lack of access to information - Tech and tea. - Community asset mapping – Salford Together Development Worker. - Volunteering – Salford Together Volunteer Coordinator. - Engagement of older people.
• Initial investment saw a Salford Together Development worker hosted by Inspiring Communities Together and a Volunteer Co-ordinator post, hosted by Salford CVS.
Focus on work themes.
ANNUAL REPORT 2014/15 15
16 SALFORD TOGETHER
Centre for Contact
The Centre of Contact will deliver a joined-up approach to health information,advice and support for health and social care.
The Salford population, Salford Togetherstaff and clinicians will be able to accesshelp and advice through a web portal orover the telephone. While the rest of theintegrated care programme is aimed atolder people, this element is for the use of everyone in Salford, regardless of their age.
Progress to Date:
• Intermediate Care Single Entry Point, the Adult Social Care Contact Team and District Nurse Administration teams are now co-located and will be renamed S.I.R.P. (Salford Integrated Referral Point).• CareFirst and ELMS (Equipment Loan Management Service) integrated into CITIZEN – the Council’s Customer Relation Management System, as part of the Software Solution.• Health Coaching being developed, in conjunction with the CLASSIC research programme and Hitachi as a commercial partner.• Out of Hours work stream started, to ensure better join up of exiting services, including Care on Call.
Rapid Response referral
came in to the newly
collocated Intermediate Care
Single Entry Point.
The clinician and social worker
looked at the information and
discussed with the referrer (GP).
The response was a temporary
increase to the current support
package. The outcome for the
service user was that the increase to
the current support package was
instant; under the previous system
this would have involved a Rapid
Response triage, Rapid Response
attendance and then a referral to the
Adult Social Care Contact Team.
Benefits ––
The new pathway enabled
an immediate solution for the
service user and saved approx.
6 hours of professional time and up
to 1 day for the patient.
ANNUAL REPORT 2014/15
Multidisciplinary Groups ( MDGs)
A neighbourhood Multidisciplinary Groupor MDG, is a group of health care workersand social care professionals who uniteas a team to ensure the planning andimplementation of person-centred careand its delivery for individuals who requiresupport. The groups include:
• A GP and / or Practice Nurse.• Social care worker.• District Nurse.• Mental health worker.• Administrator.• Pharmacist• Community Geriatrician• Health Improvement Service representative
The Integrated Care Programme (ICP)Multi-Disciplinary Groups (MDGs) & CareCoordination Operational Procedure–wasdevised and implemented in December2014. The purpose of the operationalprocedure was to describe for MDGmembers, the six essential elements andprocess of the model required to deliverperson centred care for people requiringa level of care co-ordination betweenhealth and social care services topromote wellbeing and independence.The six elements are:
1. A holistic assessment of health and social care needs.2. Joint working, risk stratification and decision making with all organisations/agencies involved in order to deliver person centred co-ordinated care. 3. Regular MDG reviews to plan person centred care, review and amend care and to signpost to community support as required. 4. The appointment of a named Care Coordinator. 5. The development of an electronic summary Shared Care Record to enable essential information to be shared between statutory agencies.6. An agreed Shared Care Plan within the Shared Care Record based on Multi-Disciplinary (MDG) working.
Progress in 2014/15
• Rolled out MDGs across all neighbourhoods using a phased approach in 3 waves.• Recruited 3 x MDG Coordinator posts and provided training in order to facilitate MDGs in localities.• Electronic Shared Care Record went live in November 2014, giving access to Mental Health, Social Care and GPs to SRFT’s Electronic Patient Record ensures that activity recorded for a patient can now be shared with additional community services. This includes rolling out a training programme for the staff across the 4 partner organisations and negotiating access. Approximately 1400 shared care records have now been completed for level 3 (Needs More Help Sally) patients.• Development and sign off of a Data Sharing Agreement across the 47 partner organisations with further development to look at 3rd sector organisations such as Age UK who provide a hospital aftercare service.• Further engagement with additional GP practices across the city.• Developing tests of change to share information regarding patients who live on boundaries with neighbouring areas; i.e. Bolton, Warrington, North Manchester et.
17
This procedure has now
been implemented across
all 7 neighbourhood MDGs
and is due for evaluating and
updating shortly.
18 SALFORD TOGETHER
Housing
This includes providers of social housing(e.g. City West, Together Housing, Salixand Great Places) as well a representativefrom the City Council who works in thearea of people living in their own homesand privately rented housing.
The group has more recently recruitedmembers from the Fire PreventionService, Helping Hands, the HomeImprovement Agency and the HospitalAftercare Service. The group aims tostrengthen the links between health and housing to improve the care thatolder people receive.
Progress in 2014/15
• Health & Housing Strategic Partnership Group formed.• Housing work stream now linked into the CCG flu group. Tests of change carried out by the group have enabled the development of an action plan for the 2015/16 flu season. Helping Hands and the Home Improvement Agency have promoted the flu jab across their services.• Worked with Lombardy Court to carry out a ‘deep dive’ on data relating to falls, isolation, loneliness, equipment and the well-being plan in order to effect change.
Care Home and Supported Living Workstream
The Care Home and Supported LivingWorkstream is focused on the ‘needs a lot of help’ level, for people who require a high level of support from health andsocial care services either in extra carefacilities or residential or nesting carehomes.
The aim of the group is to support theimprovement of the quality of care onoffer in care homes and supportedaccommodations and decrease thevariance in quality across providers in the city.
Progress in 2014/15
• Managing Falls in Extra Care. following a successful test of change. Mangar Lifting cushions and training are now in place in all of the extra care facilities. Data is being to be collated by each care provider on usage and impact on reduction of calls to NWAS.• Volunteering in Care Home Pilot. Project. Work took place during 2014/15 to develop this scheme and two care homes are now participating on this pilot project. This project is being supported by Siobhan Foley - Volunteering Co-ordinator (Older People) Salford CVS as a test of change with a view to rolling out to more care homes which do not have in house Activity Coordinators. This test will also link with the START art lottery funded project for art activities in care homes.• Age UK Discharge and Reablement Service access to SCR. Work is progressing with Age UK, Discharge and Reablement Service, with a view to giving them access to input their assessments on to the ICP Shared Care Record. Patient profiling is underway of the patients that this service works with, in order to better understand this group.
The housing work stream
brings together partners from
health and housing.
ANNUAL REPORT 2014/15
• Care Homes Training Database. The workstream has collated information on the range of free planned and bespoke training on offer to care homes, with a view to having a more coordinated approach to the training offer in the future and to identify any gaps in provision, in order for care homes to meet the training requirements in the revised care home service specification. It also aims to identify the training that care homes buy in from private providers.• Salford Advance Care Planning Document has been jointly developed with the Dementia Champions Group. This document is based on the national Preferred Priorities for Care (PPC), called Planning My Future Care. This document will be launched in 15/16 and will be used by all the Salford providers.• Medical Advance care Plan. The Salford Care Homes Practice has developed and implemented a Medical Advance Care Plan.• Discharge Communication. Improved personalised discharge info is now being entered onto the discharge summary to assist patients and carers in the transition to home from hospital.• Risk Stratification. The Salford Care Homes Practice has READ coded all of their patients as Level 4 sally, N approx=1116.• MDG meeting with CHP and GMW now embedded in routine practice and can evidence early intervention and referral avoidance.
19
Care Homes Quality AssuranceDevelopment Group
As a result of some of the qualitativeissues identified in Care Homes throughthe work of the Care Homes andSupported Living Workstream, at therequest of the Steering Group a newmeeting was established within the ICPearly 2015 to oversee the development ofan integrated approach and system forthe performance and quality monitoringby care homes.
This has been established in the contextof the revised Care Homes contract offerand service specification. The ICP has setmoney aside to pay the sector a qualitypremium if they meet the standards setout in the revised service specification.
It was identified that there was no localmechanism for measuring this so thegroup has been tasked over the next 12 months to develop an integratedassurance process and to identify whatmarket support is required to enable theproviders to meet the agreed specificationand KPIs. The group meets on a bi weeklybasis and has now agreed a draft set ofKPIs, which will shortly go out to widermarker consultation.
20 SALFORD TOGETHER
2) E-learning package for carers on malnutrition and dysphagia.
3) Access to assisted shopping trips to local supermarkets.
During 2014/2015 the task force has:
• Developed a Malnutrition Care Bundle which includes:
1) A Salford nutritional armband©, which signposts adults with a BMI of <20kg/m² to the Salford Age UK website nutrition section by a QR code. This nutrition section on the Age UK Salford website contains public, service user and carer literature on how to identify and self-help for unplanned weight loss. The dietary information leaflets on the Age UK Salford website were written by Salford residents and dietitians.
Malnutrition Task Force
This was innovative as it was the first timepartner organisations in the integratedcare programme had come together toaddress malnutrition in the older adultpopulation (65 years and older).
It is estimated that one in 10 people aged65 years or older are suffering from, or areat risk of, under nutrition. This results inhigher numbers of hospital admissionswith longer stays in hospital, compared tothose who are well nourished.
Salford has one of the highest admissionrates related to malnutrition in the countyand in the North West.
The Salford Malnutrition Task Forceincludes staff from Age UK Salford,Salford Royal NHS Foundation Trust,Salford Clinical Commissioning Group,Salford City Council and GreaterManchester West Mental Health NHSFoundation Trust. The programme isdesigned to raise awareness of the signsof under nutrition and to develop tools to ensure older people receive the rightlevel of support to keep healthy and well.
In 2014 Salford was chosen as
one of the five pilot sites in a
national programme funded
by the Malnutrition Task Force
(MTF) to address malnutrition
across the city.
www.malnutritiontaskforce.org.uk/prevention-programme/
www.ageuk.org.uk/salford/news--campaigns/malnutrition-prevention-pilot
http://www.salford.gov.uk/sctp-elearning.htm
for detailswww.ageuksalford.org.ukSee Salford RSalford Royal NHS Founddation Trust ©
ANNUAL REPORT 2014/15 21
FluMDGs
orkers
MDGs
Flu
Re-ablement
delivered to over 65s in 201427898 seasonal influenza jab
rsW3 x Mental Health Wanced Pra6 x Social Care Advanced Practitioners
ty Nurses7 x District/Community Nurses2 x administrators
8 neighbourhoods.7 MDGs in operation across
4/2015bs
resilience
Community Assets
AssetsCommunityA
review run by GMPH looking at community (14 different organisations attending), peer No. of events held – well being training networkelected members older person champions
est 4 older people presented at The North Wesco to find out about well being plans,at TTe
50 older people attended drop in session No of older people attending events - draft model)tech and tea project, age friendly city
ogether logo, intergenerationerationalSalford Tell in latter life,
To(Sally Standards, eating well inpeople in community assets workstream -sets workstreamNo of projects developed with oldered with old
older peemale)(11 male, 12 F
schemes total of 23 older people attending18 sessions across 3 sheltered housing3 sheltNo. of people attended tech and tea - nded te
developogether development worker1 Salford T-
ToNo. of staff recruited -
Re-ablement
rvicesre-ablement servicesoing th1592 people going through
22 SALFORD TOGETHER
Celebration Event
With over 80 people in attendance from a range of statutory services, third sector,service providers and representation from the National MTF team and Age UKEngland. The event showcased the workand progress to date of the task forceover the last 12 months and promoted the range of public health and serviceprovider products that have beenproduced.
There were over 60 pledges fromattendees on how they plan to take thiswork forward and these have beenformatted into a word cloud and will befollowing up 6 months after the event.
Project Sustainability
The 12 month pilot project with supportfrom national Age UK and an AQUAaffiliate officially ended at the end ofMarch 2015. However the group havecommitted to continue this work. InFebruary 2015 a bid was submitted to theHealth Foundation for funding to create apost and process to evaluate theeffectiveness of the suite of products.
The task force held a very
successful celebration event
on the 18th March 2015 at
Albert’s Restaurant in Salford.
ANNUAL REPORT 2014/15 23
24 SALFORD TOGETHER
Risks• The Programme fails to deliver against its planned improvement measures, risking receipt of some performance related funding from the BCF.• Other, interdependent strategic change programmes (Greater Manchester Healthier Together and Primary Care Strategy) fail to deliver to planned timescales.• Full range of Adult Social Care statutory functions and responsibilities may not be fully recognised to manage risks to vulnerable people.• The cost of delivering the revised service model is greater than assumed in the financial model or there are ‘double running’ costs.• Sign up to the Avoidable Admissions Enhanced Service is optional and could affect the roll out/engagement of the MDGs if viewed in a negative way.• Partners not engaged in supporting Sally to complete wellbeing plans.• Lack of engagement from the services involved.
Challenges • Shortfall in recruitment of staff in primary care, district nursing and social care may cause difficulties in effectively delivering the model across primary and community services. • Maintaining older people in community based settings may compromise the safety of clinical care provided or delay access to necessary specialist hospital based services or nursing/residential care.• The introduction of the Care Act will result in a significant increase in the cost of care provision from April 2016 onwards, which is difficult to estimate at this stage. This will impact on the sustainability of current social care funding and plans.• Ensuring the planned health and social care savings within the ICP pooled budget are fully realised.• Providing an integrated IT solution that could auto-populate from existing operational systems used in services, to avoid duplication of work and reduce workload.• The key challenge for the community asset work stream is being able to evidence the impact the work is having on improving lives for older people against the key aims identified through the Integrated Care for older people programme. The community asset approach is developing evaluation tools by working with Manchester University along side collecting case studies and individual stories of peoples journey.• Staff and the public place too much unnecessary demand through the centre of contact instead of using other internal channels of communication available.• Approximately 80,000 dwellings in Salford are privately owned or private rented whilst only approximately 30,000 are social housing. This creates a challenge in terms of reaching and effecting change in the most vulnerable of our older people in Salford.
ANNUAL REPORT 2014/15
Looking forward:
PHASE ONE
TO MAY 2015 Due Diligence & Formal Decisions (OBC)
Shadow Governance, Commissioner and Provider
Establish commissioning systemCreate Integrated Care Provider Organisation
Evaluation / Review / Planning for the next stage
Salford Together has been selected to be involved in the National VanguardProgramme, which will provide additionalopportunities in Salford to redesignservices, to become more timely,responsive, and create an environmentwhere communities are connected and supported.
Citizens of Salford will be encouraged totake responsibility for their health andwellbeing, and the health and wellbeing of their communities. Salford Together willprovide an environment where taking thisresponsibility is enjoyable, rewarding andself-promoting.
25
The next stage of the
programme is the
development of the
Integrated Care
Organisation, which will
follow the process and
timescales outlined here.
PHASE TWO
MAY - SEPT 2015
PHASE THREE
BY END OF 2015/16
PHASE FOUR
2016/17
26 SALFORD TOGETHER
TERM DEFINITION
MDG Multi-Disciplinary Group
MDT Multi-Disciplinary Team
ICP Integrated Care Programme
BCF Better Care Fund
SCR Shared Care Record
SCP Shared Care Plan
RISK STRATIFICATION A statistical process to determine detectable characteristic associated with an increased chance of experiencing unwanted outcomes
PERSON CENTRED CARE The Health Foundation has identified a framework that comprises four principles of person-centred care:
1. Affording people dignity, compassion and respect. 2. Offering coordinated care, support or treatment. 3. Offering personalised care, support or treatment. 4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
ANNUAL REPORT 2014/15 27
U n i v e r s i t y T e a c h i n g T r u s t
1
GREATER MANCHESTER HEALTH AND SOCIAL CARE DEVOLUTION STRATEGIC
PARTNERSHIP BOARD
Date: 18 December 2015
Subject: Strategic Plan Final Draft Document (v11.1)
Report of: Katy Calvin Thomas PURPOSE OF REPORT
This paper provides SPB members with a final draft iteration of the GM Strategic Plan, in advance of wider public engagement from January 2016. RECOMMENDATIONS
The Board is asked to:
· Note the progress made in developing the final draft Plan
· Provide comments/feedback where necessary
· Support and endorse the contents of the Plan, subject to any required refinement/additions from the discussion today and in advance of wider stakeholder consultation from January 2016
· Take through own organisational/locality governance in advance of final signoff of the Plan by April 2016
CONTACT OFFICER: Katy Calvin Thomas [email protected]
Item [4a ]
2
Taking charge of our health and social care in Greater Manchester
FOREWORD
In February 2015 the 37 NHS organisations and local authorities in Greater Manchester signed a
landmark devolution agreement with the Government to take charge of health and social care
spending and decisions in our city region.
We wanted to do this because we believe having the freedom to radically transform the health of
our population and to build a clinically and financially sustainable model of health and social care, is
a huge opportunity, as well as a great responsibility.
Greater Manchester has the fastest growing economy in the country and yet people here die
younger than people in other parts of England. Cardiovascular and respiratory illnesses mean
people become ill at a younger age, and live with their illness longer than in other parts of the
country. Our growing number of older people often have many long term health issues to manage.
Thousands of people are treated in hospital when their needs could be better met elsewhere, care is
not joined up between teams and not always of a consistent quality. We also spend millions of
pounds dealing with illnesses caused by poverty, loneliness, stress, debt, smoking, drinking,
unhealthy eating and physical inactivity.
The £6 billion we currently spend on health and social care – and the way we spend it - has not
improved this picture across Greater Manchester.
The challenge is significant; if we don’t start to act now to radically change the way we do things, by
2021 more people will be suffering from poor health and we will be facing a £2 billion shortfall in
funding for health and social care services.
But like the challenge the opportunity is huge. Our goal is to see the greatest and fastest
improvement to the health, wealth and wellbeing of the 2.8 million people in the towns and cities of
Greater Manchester.
In order to achieve this, we know we need a radical change in how we build resilience in people and
communities, as well as providing safe, consistent and affordable health and social care. We need to
strike a new deal with people in Greater Manchester.
Our focus must be on our people and our places, not organisations. There will be a responsibility for
everyone to work together, from individuals, families and communities as well as the 80,000 staff
working in the NHS and social care, to the voluntary sector and the public bodies.
We want our city region to become a place which sits at the heart of the Northern Powerhouse, with
the size, economic influence and above all skilled and healthy people to rival any global city.
Put simply, skilled, healthy and independent people are crucial to bring jobs, investment and
therefore prosperity to Greater Manchester. We know that people who have jobs, good housing and
are connected to families and community feel and stay healthier.
3
So we need to take action not just in health and social care, but across the whole range of public
services so the people here can start well, live well and age well.
We are taking charge of GM through our strategy of growth and reform of public services. All 37
organisations in Greater Manchester are taking responsibility and working with their communities to
understand how every person here can play their role.
We hope you will support our bold and ambitious Strategic Plan; the first of its kind in the country.
We welcome the positive contribution of the Healthwatch and other patient groups as well as input
from voluntary, social care and 3rd
sector organisations. We look forward to continued and stronger
partnership working as we implement the Plan.
Lord Peter Smith
Leader Wigan Council
Chair of the Greater Manchester Health and Social Care Strategic Partnership Board
Hamish Stedman
Chair of NHS Salford Clinical Commissioning Group
Chair of the Greater Manchester Association of Clinical Commissioning Groups
Ann Barnes
Chief Executive Stockport NHS Foundation Trust
Chair of the Greater Manchester NHS Provider Trust Federation Board
Tracey Vell
Chair of the Association of Greater Manchester Local Medical Committee
GM Primary Care Representative
Sir Howard Bernstein
Chief Executive Manchester City Council
Head of Paid Service
Greater Manchester Combined Authority
Ian Williamson
Chief Officer
Greater Manchester Health and Social Care Devolution
4
Chapter 1 – The Greater Manchester context
Across Greater Manchester (GM) we are working together on the radical reform of public services.
Our ambition is to improve outcomes for our people, increasing independence and reducing
demand on public services. The £6 billion we currently spend on health and social care has not
improved the long term outcomes for people living in GM.
GM faces an unprecedented challenge now, and over the next five years, in health and social care
service provision. We know that if we don’t act now, not only will our outcomes remain worse than
the rest of the country, but by 2021 we will have a £2 billion gap in our public service finances.
Our response to this is to place health and social care reform at the heart of our city region reform
and growth agenda; healthy and independent people play a key part in enabling us to achieve our
ambition for a growing and sustainable GM in the future.
In order to achieve this, we know we need radical change at scale in how we provide health and
social care and a new deal with people in GM. Our focus must be on people and place, not
organisations. This is critical in helping us to achieve our vision ‘to deliver the fastest and greatest
improvement in the health and wellbeing’ of the 2.8 million people living across GM.
We need to take action across the whole range of care services; upgrading our approach to
prevention, early intervention and self-care; redefining how primary, community and social services
become the cornerstone of local care; standardising and building upon our specialist hospital
services through the development of shared hospital services; and creating efficient back office
support.
This plan explains how, as a system, we are going to approach and achieve this and how our
transformation fund will help us change, to radically shift the nature of demand and reform service
provision.
Our ambition for Greater Manchester
Our ambition is for GM to become a financially self-sustaining city region, sitting at the heart of the
Northern Powerhouse with the size, assets, skilled and healthy population, and political and
economic influence to rival any global city.
In April 2011, GM established the first combined authority in the country (GMCA), providing stable,
efficient and effective governance of our strategic agenda through the ten local authorities in GM.
In 2014, the Growth and Reform Plan, built on our long history of collaboration, was underpinned
by a common commitment by all of our local authorities to increase the prosperity of the people of
GM.
The 12 Greater Manchester clinical commissioning groups (CCGs) formed the Greater Manchester
Association of CCGs (GMACCG) in 2013, building upon a strong history of collaboration between NHS
commissioners in the region. It has been instrumental in planning and delivering a number of
significant transformation programmes within GM including: stroke reconfiguration, primary care
medical standards and Healthier Together.
5
GM has a strong track record of collaboration with all of its key stakeholders, particularly business.
The GM Local Enterprise Partnership (LEP) works constructively with the GMCA and with the
extensive network of business organisations to ensure not only that business plays a full part in
helping to shape the strategic direction of GM, but also through its participation in the Manchester
Growth Company where it plays an active role in overseeing the delivery of key investment and
growth responsibilities.
The reform of health and social care is vital to improving GM’s productivity by helping more
people to become fit for work, get jobs, get better jobs and stay in work for longer. It will also help
to manage the demand on services created by an ageing population. Addressing together the issues
of complex dependency will help those further away from the job market to move towards jobs and
assist the low paid into better jobs. Reform of Early Years provision is key to increasing productivity
of parents and, in the future, their children.
Why we need change
The NHS Five Year Forward View acknowledges that some improvements have been made in health
and social care over the last 15 years: cancer survival is its highest ever, early deaths from heart
disease are down by over 40%, and long waits for operations have reduced from 18 months to 18
weeks.
However, the current fragmented health and social care system has not enabled us to improve the
lives of people in GM at a scale and pace to realise our ambitions. The challenge we now face is
bigger than ever.
The health outcomes for GM people are worse than those in other parts of the country and health
inequalities are deep-rooted. Older women in Manchester have the worst life expectancy in
England. The high prevalence of long term conditions such as cardiovascular and respiratory disease
mean that GM people not only have a shorter life expectancy, but can expect to experience poor
health at a younger age than in other parts of the country. Our population has aged and our older
population will increase by 25% by 2015. As more people have developed multiple long term
conditions the focus has shifted from curing illnesses to helping individuals live with chronic ill
health.
Many people are treated in hospital when their needs could be better met in primary care or the
community. There is too little co-ordination between urgent and emergency services - A&E,
Ambulance, GP out of hours, and NHS 111. There are real risks of significant market failure in
domiciliary, residential and nursing care across social care and this impacts on system resilience
and hospital discharge planning. There is a rising burden of illness caused by lifestyle choices like
smoking, drinking and obesity. These changes have put the NHS and social care under increasing
pressure and a growing number of people with multiple problems receive care that is fragmented or
leads to wasteful duplication.
On present trends, if we do nothing, the GM health and social care system will face an estimated
financial deficit of £2 billion by 2020/21. That pattern of rising demand is connected to our current
organisation of services and the imbalance between preventive early help services and those which
6
respond when crisis occurs. The scale of the challenge demonstrates why radical change is needed,
both in the way services are delivered and in the way the public use them. This is why we must use
this opportunity to take charge.
Reforming our services
On 1 April 2016 a new era in GM’s history begins when it becomes the first region in the country to
have devolved control over integrated health and social care budgets, a combined sum of more than
£6 billion. For the first time, health and social care will become integrated and local people will be
taking charge of decisions on the health and care services for GM.
But GM is not just taking charge of health and social care provision. Fundamental to the success of
the ground-breaking agreement between Government and GM will be our ability to draw together a
much wider range of services that contribute to the health and wellbeing of GM residents.
The impact of air quality, housing, employment, early years, education and skills on health and
wellbeing is well understood. In GM, General Practitioners (GPs) spend around 40 per cent of their
time dealing with these non-medical issues. Therefore GM is embarking on a large scale programme
of whole-system public service reform, bringing together decision making, budgets and frontline
professionals to shape services in ways that better support local residents and communities.
With local services working together, focussed on people and place, we want to transform the role
of public services and take a more proactive approach rather than responding to crises. We want to
transform the way we use information, empowering our frontline workforce to make more informed
decisions about how and when they work with individuals and families. Building on the principles of
early intervention and prevention, GM aims to deliver the appropriate services at the right time,
supporting people to become healthier, resilient and empowered.
This Plan shows that GM has seized the unique opportunity to shape its future, drawing on the
assets of world-class public services, a strong business base, and healthy, strong communities. We
are taking charge of our future, working together to help GM thrive.
What we think is needed
Our vision is to deliver the fastest and greatest improvement in the health and wellbeing of the 2.8
million population of GM, creating a strong, safe and sustainable health and care system that is fit
for the future. To do this we have focussed on delivering change in two critical areas:
1. Creating a new health and care system
Our single integrated health and social care plan is a national first. The devolution agreement
means we can think differently and promote service and system change in ways that build on
people’s views, strengthen local decision-making and accountability to deliver significantly better
outcomes.
7
We want to see the gap in health inequalities and finances reduced further and faster, for the first
time, by providing joined up care from across the public sector and beyond.
We will take action across the whole range of care services, upgrading our approach to prevention,
early intervention and self-care; redefining how primary, community and social services become
the cornerstone of local care; standardising and building upon our specialist hospital services
through the development of shared hospital services; and creating efficient back office support.
These proposals are explained in Chapter 4.
By working together, unhindered by artificial and bureaucratic barriers, organisations will provide
integrated care to support physical, mental and social wellbeing, improving the lives of those who
need help most. Our new models of care will build on the NHS England’s Five Year Forward View by
re-orienting our health and care systems so that we focus on preventing the big health and care
problems, like cancer, cardiovascular disease, diabetes and respiratory, but also social isolation and
deprivation which undermine our prosperity as a city region, and investment in early years and
employment.
We know a critical enabler of the transformation we are pursuing is a fit for purpose health and
social care workforce. GM’s NHS and social care workforce is currently over 110,000 strong, but we
know we need to address some skills and capacity shortages going forward in all parts of the system
if we are to improve outcomes for people in GM.
The scale of change will impact significantly on our workforce and a key aspect of the Plan will focus
on how our workforce becomes an enabler to support the delivery of our ambition. We need a
workforce which is fit for purpose, able to adapt to changing demographics and embrace new
models of care. We need a more flexible workforce with a breadth of skills and knowledge that
enables to us transform, lead and develop new models of care.
2. Reaching a ‘new deal’ with public
At the heart of our approach to devolution is the brokering of a new relationship with the people of
GM.
The long term health and wellbeing of people will only be secured through a new relationship
between people and the services they use; striking a new deal which needs both sides to deliver on
its promises if we are going to transform the long-term health of GM.
In its simplest form public services will take charge of and responsibility for their localities, for
example:
· Ensure there are a wide range of facilities within local communities including parks, open spaces,
leisure, safe cycling routes, good quality housing.
· Ensure easy, timely access to good quality seven day a week primary care to screen, diagnose
and treat and prevent disease as early as possible.
· Support families to bring up their children to have the best start in life through our Early Years
New Delivery Model.
· Support all residents to live well, supporting unemployed people into work or training and
8
helping residents benefit from the fastest growing economy in the UK.
· Assist people to age well; keeping healthy and connected to their neighbours for as long as
possible at home.
At the same time the people of GM must take greater charge of, and responsibility for, their own
health and wellbeing. This could include:
· Keeping active and moving at whatever stage of life.
· Registering with a GP and going for regular check-ups, taking charge of their own health and
wellbeing.
· Drinking and eating sensibly, not smoking and encouraging their children to do the same.
· Taking time to be supportive parents, bonding with their babies and encouraging their children
to be the best they can be.
· Taking advantage of training and job opportunities setting high aspirations for themselves and
their families.
· Supporting their older relatives, friends and neighbours to be as independent for as long as
possible.
· Getting involved in their local communities.
Devolution of health and social care to GM provides the first opportunity to tackle the historic
fragmentation of leadership, planning and service delivery in our health and care services. By
working collaboratively and planning together for change, we will improve services to increase the
wellbeing of our residents and create a strong, safe and sustainable health and social care service
that is fit for the 21st
century.
Population Health Outcomes
We recognise that we generally have worse health outcomes than England. We will therefore
concentrate our efforts closing the gap between GM and England by raising population health
outcomes to those projected for England in five years’ time, in other words we will go further, faster.
The impact of housing, employment, air quality, early years services, education and skills on health
and wellbeing is well understood and we have organised our prevention and early intervention
work around a life course approach – Start Well, Live Well and Age Well.
Outcome Measure
START WELL
More GM Children will reach a good level of
development cognitively, socially and
emotionally.
Improving levels of school readiness to projected
England rates will result in 3250 more children,
with a good level of development by 2021.
Fewer GM babies will have a low birth weight
resulting in better outcomes for the baby and
less cost to the health system.
Reducing the number of low birth weight babies
in GM to projected England rates will result in
270 fewer very small babies (under 2500g) by
2021.
LIVE WELL
More GM families will be economically active
and family incomes will increase.
Raising the number of parents in good work to
projected England average will result in 16,000
fewer GM children living in poverty by 2021.
Fewer people will die early from Cardio-vascular Improving premature mortality from CVD to
9
disease (CVD). projected England average will result in 600
fewer deaths by 2021.
Fewer people will die early from Cancer. Improving premature mortality from Cancer to
projected England average will result in 1300
fewer deaths by 2021.
Fewer people will die early from Respiratory
Disease.
Improving premature mortality from Respiratory
Disease to projected England average will result
in 580 fewer deaths by 2021.
AGE WELL
More people will be supported to stay well and
live at home for as long as possible,
Reducing the number of people over 65
admitted to hospital due to falls to the projected
England average will result in 2,750 fewer
serious falls.
We will ensure that we are addressing the health outcomes which are important to the people of
Greater Manchester. We will therefore engage with the public to refine our outcomes frame work as
we develop our implementation plans - #takingcharge.
10
Chapter 2 – Our Leadership journey
On 25th
February 2015, the Chancellor George Osborne, the Secretary of State Jeremy Hunt, NHS
Chief Executive Simon Stevens and the Leaders of Greater Manchester announced ground-breaking
plans for the devolution of health and social care as part of the Northern Powerhouse.
NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities
entered into a landmark agreement - Memorandum of Understanding (MOU) – formally agreeing to
take control of the £6 billion of public money spent on health and social care to transform the
system and deliver radical change over the next five years.
We have committed to work together ‘to deliver the fastest and greatest improvement in the health
and wellbeing’ of people across GM.’
We have already achieved significant progress together, through eight early implementation work
streams, which have demonstrated our ambition, determination and capability to make rapid,
system-wide service change.
Our journey
The Greater Manchester Devolution Agreement was settled with the Government in November
2014. It describes how decisions around a range of public services (transport, planning and housing)
would be devolved to GMCA, giving people and their local representatives control over decisions
which have previously been taken at national.
The reform of health and social care is a key part of this and following the wider agreement, NHS
England, the 10 GM councils, 12 clinical commissioning groups and NHS and foundation trusts
agreed to work together to transform health and social care.
In February 2015, the Memorandum of Understanding (MoU) between the Government, the GM
health bodies and local authorities and NHS England, gave local control over an estimated budget of
£6 billion each year from April 2016. The MoU covered all services including acute care, primary
care, community services, mental health services, social care and public health.
Leadership challenge
In February 2015, we signed a historic agreement with the Government called a Memorandum of
Understanding (MOU) which gave a commitment to GM having devolved powers for health and
social care. We committed to the production, during 2015/16, of a comprehensive GM Strategic
Sustainability Plan for health and social care. This, aligned with NHS England’s Five Year Forward
View, will describe how a clinically and financially sustainable landscape of commissioning and
provision could be achieved over the subsequent five years, subject to the resource expectations set
out in the Five Year Forward View, appropriate transition funding being available and the full
involvement and support of national and other partners.
11
The 37 statutory organisations involved in health and social care across GM (listed at the back of the
document) have formally agreed to work together by taking control of the £6 billion of public money
spent on health and social care in GM. Working within the NHS Mandate, associated national policy
and quality assurance parameters, we will aim to deliver rapid and radical improvements over the
next five years.
Following the formal agreement to work together, the leadership and governance arrangements in
GM had to be developed at pace and scale to ensure the system could reach decisions together in a
robust, fair and equitable way. These governance arrangements were designed and agreed with the
full involvement of senior leaders across the health and social care system.
Following the signing in February, A Programme Board met for the first time on 20th
March 2015 to
oversee the transition to full health and social care devolution. Co-chaired by Sir Howard Bernstein,
Chief Executive of Manchester City Council and Simon Stevens, Chief Executive of NHS England it
includes representatives from the NHS and local authorities in GM, and NHS England.
Early implementation priorities
We agreed a set of early implementation priorities as a GM system to help us to test our devolved
arrangements and deliver change at pace and at scale.
In July 2015, we agreed and created a unified public health leadership for GM.
This is the first agreement of its kind in England and is between GM, NHS England and Public Health
England to place a greater leadership emphasis and focus on prevention and early intervention to
stop people in GM becoming ill, so that they can remain independent and have the best family, work
and lifestyle opportunities to contribute to a transformational and sustainable shift in the health and
wellbeing of the population.
By the end of 2015, everyone living in GM who needs medical help will have same day access to
primary care services, supported by diagnostic tests, seven days a week.
In February 2014, we published our GM Strategy for Primary Care, which outlined our primary care
commitments. As part of the delivery of this strategy, we developed the GM Primary Care Medical
Standards, which will be implemented in the ten GM localities by December 2017.
In January 2016, we will extend our Working Well pilot to an additional 15,000 out of work GM
residents.
In March 2014, GM established a Working Well pilot through a unique agreement with Government,
which supports residents who have been unemployed for a long time back into sustainable
employment.
Due to the success of the GM pilot, in January 2016, we will launch the expansion of the programme
to improve support for a further 15,000 out-of-work residents who face barriers to work. This
approach across health, employment and skills is the first example of its kind in England.
We have started the implementation of four shared, single site services as a result of the Healthier
Together programme. This will save up to 1,500 lives across GM over the next five years.
12
In 2012, the CCGs in GM embarked on a programme to develop single shared services (care will be
provided by a team of clinical staff working together across a network of linked hospitals) for urgent
and emergency care, acute medicine and general surgery across the acute trusts in GM because
there was variation in outcomes for patients undergoing abdominal general surgery at different
hospitals.
In July 2015, the 12 GM CCGs, through the decision making body the Committee in Common, agreed
to have four shared, single site services. As a result, hospitals will work in partnership to form
shared single services. One of the hospitals within each of the single services will specialise in
emergency medicine and abdominal surgery for patients with life-threatening conditions to ensure
quality and safety standards are met and all hospitals can continue to provide care to their local
population.
In September 2015, we launched Health Innovation Manchester – a partnership between leading
healthcare research, academia and industry organisations across GM.
Health Innovation Manchester has been established to accelerate the discovery, development and
implementation of new treatments and approaches, with a focus on improving health outcomes and
generating economic growth. The combination of our research strengths, business base and eco-
system and devolution makes this a unique opportunity within the UK and globally. We aim to be
one of the best regions in the world for partnerships with innovative lifescience companies, driving
economic growth and improving health outcomes.
Getting new ideas tested, adopted and widely used takes too long in the NHS – sometimes up to 20
years. To overcome this, GM has taken this unique step to accelerate health innovation into the local
health and social care system. It is already in a strong position with three teaching hospitals, a
research-led university base, a critical mass of life science firms and skilled workers, and a large and
diverse population.
We will identify and spread the interventions that will have the biggest impact on the greatest
number of people in GM. We will work to source the rapid take up of innovations on a large scale
and to achieve this, we will also work to create industry partnerships, to speed development and
attract inward investment.
There are a number of key enabling platforms that GM has that will be further developed to support
health innovation. The priorities are our informatics and clinical trial capability, which provide
essential underpinning for discovering, developing and delivering new therapies. Work is already
underway to identify those treatments or approaches that could be delivered at scale in the short
term and bring short term benefits while also testing the innovation system. These will be chosen
within the context of place-based priorities that focus on the particularly health needs of the
population.
We will set caps on locum and agency expenditure and develop a skills and employment passport
by April 2016 to enable more flexible movement of our workforce.
An agreement is being negotiated to cap locum and agency expenditure across GM by April 2016.
In November 2015, we launched the GM three year vision for Learning Disabilities to improve
independence for people living with learning disabilities and their families across GM.
13
Following the Winterbourne View scandal, a national strategy was announced to close long term
institutions for people with learning disabilities and care for them in their communities closer to
home.
There are currently 150 people with learning disabilities from GM in hospital who could more
appropriately live in the community. In addition some people are in hospitals far from GM and are
therefore unable to maintain good contact with their families and friends. There is a wide variation
between the localities in GM in how people access services such as health checks and day care. We
also have a higher number of children with learning disabilities in hospitals, compared to the average
for England and Wales.
Our vision sets out how we will provide each person with a learning disability with a supported place
to live, as close to their homes and families as possible. This should help people with complex
needs to live in local neighbourhoods, encourage the development of skills and of social
relationships, support them at times of crisis, and foster choice and independence.
This GM programme will align to the work taking place at a locality level to improve services for
people living with learning disabilities.
In March 2016, we will launch a five year GM programme – Dementia United, to improve the lived
experience of people with dementia and their families.
Dementia causes immense suffering to the individuals and families affected. To provide effective
support, integrated services are vital - across NHS and social care, hospital and community services
and physical and mental health services. Without good access, good co-ordination and good
support, suffering is increased and costs rise.
By 2021, it is estimated there will be nearly 35,000 people living with dementia in GM.
Nearly a third (30%) will have severe symptoms, requiring 24 hour care. By 2021 the cost of caring
for them is estimated to be around £375 million annually.
We will create a dementia service for GM that supports the delivery of the Prime Minister's
dementia challenge and serves as a beacon for the UK.
It will:
· identify patients early
· slow down deterioration through monitoring
· provide consistently high quality community care to prevent hospital admission
· provide consistently high quality hospital care to avoid increases in length of stay
Central to our five year programme is the theme of ‘connectedness’ within which we have identified
three key areas - Monitor my Health, Enrich my World, Connect me to my Support System.
To deliver this, we will create a single commissioning framework to support the following:
· Preventing well – reducing the risk of dementia, for example through health checks for vascular
dementia
· Diagnosing well – developing a “seek and treat” system offering early assessment
· Living well – establishing dementia friendly communities
· Supporting well – providing access to health and social care as necessary, to reduce emergency
admissions and care home placements
· Dying well – ensuring people die in the place of their choosing
14
We will support people newly diagnosed with dementia, with a case worker who will provide
increasing levels of support to them and their carers as the condition progresses.
A great example of how working together across GM can create improved services is the work we
are doing on cancer. Our goal is to push GM’s outcomes and survival rates to at least the national
average and to ensure, through prevention, that fewer people have cancer.
GM has some of the very best cancer services and clinical outcomes in the country. One year
survival rates have increased faster than elsewhere over the last 15 years and have now surpassed
the average for England. But it also has some of the worst rates of premature death from cancer
because of lifestyle factors for example smoking and delays in patients seeking help. More than a
quarter (28 per cent) of cases of cancer are diagnosed in A&E, when it is often too late for treatment
to be effective. We also know that how people access services varies across different places.
As part of a GM Cancer Strategy by 2021, our vision is that we will have:
- a single GM cancer commissioning organisation to manage and monitor cancer services across GM
- a system leader that will be accountable for integrating all elements of cancer prevention and care
- a strategy for partner engagement to drive improvement
- innovative models of care such as delivering services closer to home
- reduced delays in referrals for treatment
- improved outcomes and survival comparable with top European countries
- reduced inequity across the conurbation by tackling unacceptable variations in access and quality
of care
- a clear focus on prevention and rapid access to diagnostics
- support for education and research
- consistent quality standards
- a financially sustainable service
We will run a 3 year pilot (2015 – 2018) spanning the entire spectrum of cancer care from public
health and primary care through to diagnostics, treatment, long term support and end of life care.
We are leading the way in GM, with cancer services working with the Royal Marsden and University
College London Hospitals within a single National Cancer Vanguard established to test out new
models of care delivery across the entire cancer patient pathway. The aim of this is to bring
significant improvements in outcomes and patient experience through a strengthened focus on early
referral and rapid access to diagnostic services.
We have developed and agreed a GM Strategy for integrated mental health services across public
service provision. Implementation of this strategy will commence from April 2016.
Mental illness can seriously affect the lives of individuals and their families. People with mental
health problems are far more likely to suffer physical ill health. For example they are approximately
three times more likely to use emergency care, often for reasons not connected with their mental
state.
Health costs for people with long term conditions are at least 45 per cent higher if they also have a
mental health problem. Up to 18 per cent of all NHS spending on long term conditions is linked to
poor mental health – equivalent to £1.08 billion in GM. Employment rates are below the national
average (at 4.77 per cent of those on the Care Programme Approach) and sickness absence is high.
15
Life expectancy for those with severe mental illness is 10-15 per cent shorter than the general
population.
There are many examples of good practice in mental health across GM but quality, access and
support vary.
We will explore the integration of mental health service across the ten GM localities, and across the
wider GM conurbation, with a single point of contact making it easier for service users and
professionals to navigate.
Stronger links will be forged with the following programmes: Troubled Families, Working Well and
Complex Dependency.
We are committed to achieving parity of esteem for people with mental health issues in GM through
the development and agreement of a GM Mental Health Strategy. Through this we will focus on
four priority areas:
- Prevention and early intervention through strengthened community services and public health
campaigns
- Improved access through increased collaboration among services with 24/7 crisis support and
shorter waits for psychological therapies
- Creating a sustainable system with common standards and payments for outcomes
- Integrating care across the life course and with a focus on delivering the right care at the right time
in the right place
16
Chapter 3 – Building and governing the Plan
Following the signing of the MOU in February 2015, harnessing the strong leadership across the GM
system, we agreed that to transform our services we need to work across the pathway of
intervention and support.
This means we are working together to agree and define how we:
· Change our relationship with people, helping them to stay well, care for themselves and
prevent illness and intervene early
· Transform care in localities by integrating primary, community, acute, social and third sector
care through the development of new locally accountable platforms with single integrated
commissioning hubs to facilitate clinical co-ordination
· Standardise and create consistent evidence based hospital services
· Redesign our back office support to create the most efficient services we can
· Create systems once at GM level which incentivise our new models of care and support
This Plan has been built from ten locality plans, provider reform plans and a range of GM
strategies; it is complementary to and driven by what’s happening in each local area. It has been
developed with the input and support of national bodies and regulators, including NHS England, NHS
Improvement (Monitor and the Trust Development Authority) and the Care Quality Commission.
Principles of the Plan
All of our plans are focussed on people and places rather than the different organisations that
deliver services. This means we are thinking more innovatively about pulling services together and
integrating them around people’s homes, neighbourhoods and towns.
Our plans are developed on the principles of co-design and collaboration, all 37 statutory GM
organisations have been working together to agree how we do things once, collectively, to make our
current and future services work better.
We aim to secure financial sustainability through our plans and service reform.
Each locality is putting the money we have for health and social care into pooled budgets, so we can
buy health, care and support services once for a place in a joined up way.
We develop plans based on the principle of fairness to ensure that all the people of GM can have
timely access to the support they require.
We are innovative in our approach, using international evidence and proven best practice to shape
our services to achieve the best outcomes for people in the most cost effective way.
We aim to deliver the best quality, outcome based services within the resource available.
We have used this early work to begin to create a plan between commissioners and providers at a
GM level and submitted a bid as part of the government’s Comprehensive Spending Review (CSR).
This was our first piece of whole system modelling and financial planning and was submitted as part
of the overarching Devolution CSR bid.
17
Building the plan
Our Plan for health and social care in GM is built on a history of collaboration between health and
Local Authority partners, and we are used to working together.
We are working to ensure that we agree and take decisions in GM about GM at the right level – at
neighbourhood, locality (there are ten localities in GM see below), cluster (more than one locaility)
or GM wide.
We are working to agree the most appropriate levels of service delivery at which to plan, take
decisions and deliver.
This Plan marks a significant change in the approach to planning that has been in place in previous
years, where each statutory organisation developed its plans separately. This Plan describes how
the GM health, care and support system and its 37 statutory organisations will work together. They
will still have their own plans, as statutory bodies, but these individual plans will be shaped by the
strategic context of the locality plans as well as the overall GM Strategic Plan.
Following the signing of the MoU, we have worked with all of the national and regulatory bodies to
develop our plans at locality and GM level across commissioners and providers. This includes NHS
England, NHS Improvement (Monitor and Trust Development Authority) , Public Health England
(PHE), the Care Quality Commission CQC), National Institute for Health and Care Excellence (NICE),
Health Education England (HEE), the Department of Health (DH), Her Majesty’s Treasury (HMT) and
the Department for Communities and Local Government (DCLG). Their strong support and
commitment has been vital in achieving rapid progress and we will continue to work with them to
implement our plans. We have signed an agreement for how we will work with PHE as a devolved
system and will sign agreements with the remaining national bodies before the end of March 2016.
The Plan is built from locality plans, NHS provider plans and GM work stream plans.
Locality Plans
We have based this Plan on the ten localities - Bolton, Bury, Rochdale (including Heywood and
Middleton) Manchester, Oldham, Salford, Stockport, Tameside (including Glossop), Trafford and
Wigan.
Each of our ten localities has a place-based plan which will be signed off by their Health and
Wellbeing Board.
The Locality Plans form the bedrock of what will be delivered in their area and set out how the
savings from the integrated better care models and prevention will be delivered. The plans have
been developed from work already underway to develop Better Care Fund (the integration of health
and social care funding) plans, but have been radically extended across public sector services to
integrate social care, mental health and Learning Disability services.
Each locality will start to align the CCG and Local Authority commissioning functions from April 2016
to develop a single commissioning plan, pool budgets, integrate governance, decision-making and
commissioning skills. Across GM we have committed to pool £2.7 billion. This will ensure the
outcomes that health and wider public services aim to achieve are aligned.
18
The plans also outline the intention to create single service models in each locality delivered through
integrated neighbourhood teams to remove the fragmentation between services.
Work will focus on aligning primary and community care to ensure high quality re-ablement,
rehabilitation, discharges and referral management.
Sharing these plans has enabled us to see where there is best practice in our localities, identify
opportunities to scale up and roll out changes and determine the key priorities for delivery in the
next five years and beyond to integrate our public service offer.
Each locality plan includes a place-based ambition to contribute towards the delivery of the wider
GM ambition. They capture the full range of initiatives to improve health and wellbeing and many
go beyond traditional health services to include work on housing, employment, Early Years, Troubled
Families and community development.
NHS provider plans
All of the NHS providers in GM agree plans each year to run their services, including hospitals. These
have always been agreed in individual organisations and with the people who regulate trusts
(Monitor or the Trust Development Authority). For the first time, the 15 individual provider plans
have been shared across GM between providers and with commissioners. The providers are
working together with their commissioners to deliver local requirements, but are also working on
some key work streams together where this makes sense.
GM work stream plans
Work in our localities alone will not fully address our financial sustainability challenge and in some
cases there can be a greater benefit to plan and commission services at a cluster or GM level. We
are always striving to integrate and provide services at the level closest to where people receive
them, but how we change some services and connect people to the growth and economic reform
opportunities is better done once at a GM level. This approach enables us to understand when we
need to propose bold ideas that can only be planned and commissioned at a cluster or GM level, but
will need to be delivered in the context of our neighbourhoods and localities.
We have developed and agreed plans which are aiming to address some of the specific challenges
that exist across all localities in GM, like mental health, cancer, high levels of unemployment and
deprivation. We have focussed these on areas where it makes sense to do the thinking once and
agree how we can improve health care and support for people. The GM strategies include:
· Primary Care Strategy
· Specialised services
· Mental Health Strategy
· Public Service Reform programmes
· Cancer Strategy
· Learning Disability services
· Dementia services
· GM information sharing strategy: GM Connect
Agreeing how we work and take decisions
19
To successfully deliver our Plan and deliver the change that is required, the 37 statutory
organisations involved in health and social care across GM have formally agreed to a new
governance system – the first time this has been accomplished at this scale in England. This will
enable GM to establish integrated leadership founded upon collaboration and evidence-based
decisions about services delivered to GM residents. Commissioning will be undertaken in
accordance with statutory responsibilities at locality level or when it is most appropriate, by
commissioners collaborating at GM level.
Our governance system is based on the principles agreed in the MOU:
· GM NHS will remain within the NHS and subject to the NHS Constitution and Mandate
· Decisions will be taken at the most appropriate level
· GM will take decisions that are relevant to GM
· CCGs and local authorities will retain their statutory functions and their existing accountabilities
for current funding flows
· Clear agreements will be in place between CCGs and local authorities to underpin the
governance arrangements
· GM commissioners, providers, patients and public will shape the future of GM health and social
care together
· All decisions about GM health and social care to be taken with GM as soon as possible
The new governance structure has:
· A Strategic Partnership Board (SPB) which sets the vision, direction and strategy for GM health
and social care economy.
· A Strategic Partnership Board Executive (SPB Executive) which supports the SPB and will develop
policy and make recommendations to the Board. It will be the engine that drives delivery of the
Strategic Plan and ensures business at the Board is transacted efficiently.
· A Joint Commissioning Board (JCB) which commissions services at the GM level to deliver the
vision set out by the SPB. It will be the largest single commissioning vehicle in GM and will
produce a commissioning strategy in line with the Strategic Plan. The decisions it takes will be
joint and binding.
· An NHS Provider Trust Federation Board where the 15 Trusts in GM have joined together to
allow Trusts to work more effectively and efficiently.
· An overarching Provider Forum which will bring together NHS and non-NHS providers
(domiciliary providers, private sector health providers, voluntary and hospices) to be part of the
development of new models of care.
· Primary Care is represented at the SPB and SPB Executive and has also formed a Primary Care
Advisory Group made up of representatives from Dentistry, General Practice, Pharmacy and
Optometry
The members of these groups come from all 37 statutory GM health and social care organisations
plus national bodies as appropriate (NHS England, NHS Improvement and others), as well as other
providers, representatives from primary care, the voluntary sector and patients, including
Healthwatch.
A key principle of the governance arrangements is that local commissioning will remain a local
responsibility. The JCB will intervene in local decisions only where it agrees that it would be more
efficient and effective for decisions to be made at a GM level.
20
Some national services (for example highly specialised services) will remain within the remit of NHS
England, for practical and cost effectiveness reasons, and will be co-commissioned in many
circumstances.
These arrangements will enable us to be clear about responsibility, accountability and assurance
around the decisions that we take together.
21
Chapter 4 – Health and Social Care Reform
Our health and social care reform is built on the need to reimagine services across our whole care
system.
By upgrading prevention and self-care we are proposing to change the way GM people view and use
public services, creating a new relationship between people and the care system. This means more
people managing their health, looking after themselves and each other. This means increasing early
intervention at scale and finding the missing thousands who have conditions, but don’t know it yet.
We want to work across GM to have standardised support that helps people to start well, live well
and age well.
Through the transformation of community based care and support we are proposing to enhance
our primary care services, with local GPs driving new models of care and Local Care Organisations
(LCO) forming to include community, social care, acute, mental health services, the full range of
third sector providers and other local providers such schools. We want LCOs to be the place where
most people use and access services, in their communities, close to home.
Through the standardisation of acute and specialist care we are proposing that NHS providers
across GM increasingly work together and collaborate across a range of clinical services. We want a
hospital sector which is functioning to the best clinical pathways and the highest level of
productivity so people get the high quality care when they need it.
Through the standardisation of clinical support and back office functions we are proposing to
redesign our services to meet the delivery and efficiency challenges of a redesigned care system.
We want clinical support services which deliver at locality level and back office functions which drive
the best possible service models for procurement, pharmacy and estate management.
In enabling better care we are proposing to work together to look at the most effective way to
deliver our new care models and deliver standardised offers. We want a radically redesigned
payment system to drive care in localities, we want technology to support this, we want an
innovative and real time approach to research and development and we want one integrated
approach to managing our public sector buildings.
It is widely accepted that GM will not meet the challenges it faces over the next five years through
incremental change. Additionally, no single locality can deliver the scale of reform proposed here
acting alone. Our transformation must be comprehensive, covering all aspects of care and support
and all parts of Greater Manchester.
Engagement with NHS commissioners, providers and local authorities, alongside best practice from
national and international experts has identified five key areas for transformational change, as
indicated in the diagram below:
22
By upgrading prevention and self-care we are proposing to change the way GM people view and use
public services, creating a new relationship between people and the care system. This means more
people managing their health, people looking after themselves and each other. This means
increasing early intervention at scale and finding the ‘missing thousands’ who have diseases, but
don’t know it yet. We want to work across GM to have standardised support that helps people to
start well, live well and age well.
Through the transformation of community based care and support we are proposing to transform
our primary care services, with local GPs driving new models of care and Local Care Organisations
(LCO) forming to include community, social care, acute, mental health services and the full range of
third sector providers. We want LCOs to be the place where most people use and access services, in
their communities, close to home.
Each locality will have a joined up commissioning approach between the local authority and health
partners, using pooled funds for a substantive proportion of the health and social care spend. Joint
spending plans will be agreed to deliver shared improved outcomes for their local people.
These services will be delivered through the range of models described in the NHS England Five Year
Forward View. The choice of model will be relevant to the local circumstances (multi-specialty
community provider (MSCP), primary and acute care system (PACS), integrated care organisations
(ICO), accountable care organisations (ACO) and accountable healthcare management organisations
(AHMO)) but will hold a range of common features to ensure scale of impact. Across all the GM
localities, we will refer to these as Local Care Organisations.
Through the standardisation of acute and specialist care we are proposing that NHS providers
across GM increasingly work together and collaborate across a range of clinical services. We want a
hospital sector which is functioning to the best clinical pathways and the highest level of productivity
which means that people get the high quality care when they need it.
23
Through the standardisation of clinical support and back office functions we are proposing to
redesign our services to meet the delivery and efficiency challenges of a redesigned care system.
We want clinical support services which deliver at locality level and back office functions which drive
the best possible service models for procurement, pharmacy and estate management.
In enabling better care we are proposing to work together to look at the most effective way to
deliver our new care models and deliver standardised offers. We want a radically redesigned
payment system to drive care in localities, we want technology to support this, we want an
innovative and real time approach to research and development and we want one integrated
approach to managing our public sector buildings.
The future health of our children, the sustainability of the NHS and the economic prosperity of GM
all now depend on a radical upgrade in prevention and public health, as the NHS England Five Year
Forward View made clear.
Our progress in achieving wider public service integration is key to securing the health benefit of
non-medical support and helping our health and care system function better. This can span from
early help to crisis response across the whole public service, alongside the voluntary and community
sector, to ensure our blend of support is as effective and appropriate as it can be.
For example, connecting health and care to housing providers will extend their established role in
building communities and improving individual wellbeing by working in partnership across the region
to support health services, particularly around prevention, early intervention and re-ablement.
Additionally, GM is clear on the health benefit brought by the fire service as an expert in prevention
and community engagement. Greater Manchester Fire and Rescue Service now acts as a prevention
agent on behalf of all health and care partners whilst continuing to reduce demand relating to fire.
Our aim is to boost independence, improve health and reduce demand on services, through five key
themes:
1: More people managing health: people looking after themselves and each other
The influence of people’s behaviour on health outcomes can be seen in everything from preventing
illness through to the management of long term conditions. 60-70% of premature deaths are
caused by behaviours that could be changed and around 70-80% of all people with long term
conditions can be supported to manage their own condition.
Our ambition is to develop a whole systems approach to self-care, which can be adopted across
localities. This will entail driving changes in commissioning, organisational and clinical processes,
workforce development and the support provided to individuals and communities.
Key elements of our programme are:
• Working with Health Innovation Manchester to develop new digital technologies to allow people
to track and analyse their own health data and to share this with others to aid prevention and
management of long term illnesses.
24
• Large scale social marketing programmes, using behavioural insights, to support lifestyle change
and engage the population to be more active in promoting their own and others’ health.
• Developing a GM framework for ‘patient activation’, motivating people to take control and
supporting work to tackle health inequalities.
• Increasing the range and profile of self-care support programmes and train our workforce to
deliver them.
• Working with Health Education England to upskill up our public sector workforce in key areas of
practice such as self-management education, shared decision making, health coaching and
patient activation.
• Working to embed social responsibility across our public sector
2. Increasing early intervention at scale – finding the missing 1000s:
Late diagnosis causes unnecessary suffering and means diseases are harder and more expensive to
treat. We only know about half of the preventable disease that exists in our population. The people
with illnesses we – and often they - do not yet know about are called ‘the missing thousands’.
Finding people who already have, or who are at risk of developing, disease and successfully
managing their condition/s is crucial to prevent illnesses across GM and to reduce mortality,
morbidity and inequalities in health.
Key elements of our programme are:
• Bringing together our screening and immunisation commissioning and our public health people
to form an integrated commissioning team.
• Implementing the evidence base for early detection of disease through screening and case
finding to find the missing 1000’s who have a condition but have not yet been diagnosed. This
will be supported by better information on a range of conditions including online advice,
discussion forums and self-management programmes to empower people to look after
themselves.
• Proactively reaching out to people registered on a GP list who do not attend GP practices, to
engage with the community and create a cultural movement for health awareness and
improvement.
3. Starting Well – supporting parents to give their children the best possible start in life
GM has consistently recognised the importance of a child’s early years in achieving our long term
ambition for growth and reform. Enabling parents to give their children the best possible start in life
is essential in helping children reach a good level of development as measured by school readiness.
Children who do not achieve a good level of development at age five will struggle in later years with
social skills, reading, maths, physical skills, overall educational outcomes. They are more likely to
experience difficulties with the criminal justice system, have poorer health and ultimately die
younger.
Across GM the percentage of children achieving a Good Level of Development (GLD) is 62.4%
compared with 66% nationally. Within this there is significant variation across GM itself with some
localities achieving 73.4% whilst others only achieve 57.2%. Creating consistency of achievement
without stifling innovation and further progress in other areas is a key challenge to our GM
programme.
25
Our Early Years New Delivery Model is based on consistent age appropriate assessment measures
promoting early intervention and prevention, implemented through improved engagement with
families with young children from pre-birth to school. This is supported by a series of evidence
based interventions supporting short and long term benefits.
We will make sure children are ready to start school by:
· Prioritising delivery and effectiveness of universal and targeted services in the antenatal period
and to children age 0-5 and their families
· Early identification of risks and developmental delays supported by evidence based assessments
and interventions
· A GM wide approach to further improving high quality early education and child care and
increasing the skills and qualifications of the early years and child care workforce
· Helping parents who are out of work to access education and training to help them towards
work
· Focussing on prevention and early intervention through consistently high quality universal/early
help services through maternity services, health visiting, Children’s Centres and early education
providers
· Addressing health and social inequalities by improving the physical and emotional health and
wellbeing of the 0-5 population and their families
· Delivering integrated commissioning and provision across all Early Years services focussed on:
Parent and infant mental health; maternity/health visiting communication; speech,
communication and language; social, emotional and behavioural pathway including parenting;
High needs pathway for vulnerable children and complex families.
· Further improving the quality of early education for 2, 3 and 4 year olds including effective
support to providers to increase the accuracy and use of assessment tools and information to
improve outcomes for the most vulnerable children, making best use of the Early Years Pupil
Premium and supporting effective transition to primary school.
· In July, the Government and local authorities agreed to undertake a fundamental review of the
way that all our services to children are delivered. As a trailblazer, the Government will support
the GMCA to develop and implement an integrated approach to preventative services for
children and young people by April 2017.
4. Living well in Greater Manchester ‘Good work – good health’
A healthy workforce can reduce sickness absence, lower staff turnover and boost productivity - this
is good for employers, workers and the wider economy. We know that people in work tend to enjoy
healthier lives than those out of work, and people with health conditions such as back pain, stress,
depression and high blood pressure, find that getting back to work is often the best way to recover –
often it isn’t always necessary to be 100% fit before returning.
Approximately 683,000 adults in Greater Manchester have a mental health or wellbeing issue which
can affect everything from health, to employment, to parenting and housing.
Key elements of our programme are:
· In partnership with employers, we will establish a Workplace Wellbeing Charter which will
provide employers, of all sizes and from all sectors, with a way of driving improvements in
workplace health and wellbeing.
· We will roll out the Work for Health programme which helps patients to better manage their
health conditions and to stay in work by training front line health staff to consider work as part
of the therapeutic intervention, encouraging self-management and problem solving.
26
· We will launch a programme in a number of neighbourhoods to help older people into work.
· Expanding our Working Well programme will support up to 50,000 Greater Manchester
residents who are claiming a range of out of work benefits and experiencing barriers to
employment. The programme will fundamentally change how skills, health and employment
services function together.
· Establishing the Working Well Talking Therapies service, as part of our participation in the
national Mental Health Trailblazer programme. This aims to improve employment and health
outcomes for out-of-work claimants who face barriers to work due to common mental health
conditions.
· Improving mental wellbeing and providing high quality mental health services as part of the
overarching GM Mental Health Strategy.
· Supporting ‘Healthier Lifestyles’ will explore the potential of a devolved and flexible approach to
licensing, regulatory compliance and enforcement, particularly in support of the proposal to
introduce ‘Promoting Public Health’ as a fifth licensing objective across GM. This would enable
localities to consider the impact of alcohol consumption on communities, proactively encourage
licensed premises to promote responsible drinking and to play a key role in identifying and
supporting those for whom alcohol is a problem.
· ‘GM Moving’ our physical activity strategy outlines a series of ten pledges that will add value
locally and at a GM level. Already this has seen a significant increase in the number of
opportunities to participate in recreational cycling, with 4,000 ride opportunities being delivered
across GM by March 2016 through investment from the Department for Transport and British
Cycling.
5. Helping people age well:
GM has an ageing population and we know we need to focus on helping older people stay well
longer and supporting them to cope better if they have a long term illness, especially dementia.
More than a fifth of GM’s 50-64 age group are out of work and on benefits, many because of ill
health. The employment rate is 5.3 per cent below the England average and the gap has not
narrowed for ten years. Unemployment imposes a significant burden on health and care services
and the numbers in this age group are set to grow by 20 per cent in the next decade. Bringing the
employment rate for 50-64 year olds up to the UK average would boost GM’s earnings by £813.6
million.
By 2021, it is estimated there will be nearly 35,000 people living with dementia in GM, a quarter
(25%) with mild symptoms, almost half (45%) with moderate symptoms and nearly a third (30%)
with severe symptoms, requiring 24 hour care. The current cost of caring for them is estimated at
£270 million annually, rising to £375million in 2021. Integrated services are vital, without early
diagnosis, good access, good co-ordination, and good support, suffering is increased and costs rise.
From April 2016, we will:
· Launch a programme in a number of neighbourhoods to help older people into work. The
programme will be expanded as funds become available. We aim to increase the number of long
term workless adults in employment by eight percent over five years.
· Establish the GM Ageing Well Hub to make GM an age-friendly city region. It will provide links to
social movements, social isolation, loneliness and have a focus on dementia.
· The Dementia United programme for GM that serves as a beacon for the UK, supporting people
newly diagnosed with dementia with a case worker (further details are in Chapter 2).
27
GM has one of the highest rates of emergency hospital admission for conditions that would be
better treated in the community. At any one time an estimated 2500 patients are in an acute
hospital bed in GM, who could be treated more cost-effectively at home or in a community setting.
Fragmentation in services is seen most clearly in the referral into acute services and on discharge
from them; between primary, community and social care, between those services and wider public
services which can enhance health outcomes or prevent poor health emerging, such as housing, fire
and rescue and employment services.
A key aim of combining the health and social care budgets is to enable care to be moved out of
hospitals (where appropriate) into the community, closer to where patients want to be – at home.
Even more significant however, will be our ability to radically reduce the demand for acute services
through population level, integrated, community care and support which slows, or prevents
altogether, the development of poor health.
Bringing GPs, community pharmacists, social workers, hospital doctors and community nursing
teams together with a population focus, will help to make the connections between social and
medical support, tackle loneliness and strengthen communities.
The sustainability of our hospital system will increasingly depend upon our ability to secure the right
level of investment and capacity in community models to reduce demand on crisis and emergency
services and facilitate reliable discharge home. The contribution to mainstream savings in this and
the next CSR period are increasingly significant.
A focus on early intervention and prevention is a cornerstone of our approach to health and social
care reform, ensuring we identify and treat early, reducing escalation of need. But this approach will
only be successful if delivered alongside broader integration across local services. Across GM, we are
seeking to tackle the complex issues that lead to escalating public service pressure in an integrated
way. We will therefore not only bring together health and social care provision but a much wider
range of organisations and services, tackling broader forms of complex public service demand.
Our ten localities and the neighbourhoods within them, will develop and design delivery models that
fit the needs of their people and at a GM level. We will agree the core characteristics, common
standards and key outcomes that those models will aim to deliver. A reformed system must
recognise the limits of what formal care provision can offer and the important role of the ‘informal’
voluntary and community sector. The model of care needs to be built around the resident first and
foremost, bridging some of the unnecessary splits between ‘health’ services and ‘social care’
services.
Primary Care, Social Care and Community services
28
Primary care is the driving force behind our prevention-focussed approach within localities and
across GM. Primary care is working to integrate and lead a wider public service community-based
model, through the agreement of standards, which will be delivered within each locality of GM and
the testing of new models of contracts for GPs, which promote prevention and self-management.
This will be at the heart of a new model of care to predict and prevent ill health utilising the power
of the registered list.
Social care, both publicly and privately provided, will be an integral part of the community service
model working to reduce demand for acute services. Our new models will look to expand the role of
services like leisure and libraries and further develop alternative and preventative community-based
approaches from the voluntary and community sector. Assessment processes will concentrate on
the individual and their aspirations, maximising what they can do, not what they cannot do.
GM needs a system of community care that enables people to step up / step down their support
flexibly and easily, ensuring people receive the right type of care at the right time. Currently too
many people are going into residential and nursing care, particularly from hospital, in part because
of a lack of clear and planned alternatives.
· We will make every contact with public services count by ensuring our staff are able to
understand the needs of the people they come into contact with and signpost them to the most
appropriate service(s) for their needs.
· We will train our staff in recognising prevention, identifying risks, supporting discharge from
hospital and transfer between services.
· The development of our current and future workforce is core to the development of our
community services to enable our staff to work with communities and support people to have
the knowledge, skills and confidence to take an active role in managing their own health.
The establishment of fully integrated Local Care Organisations (LCOs).
The community service models chosen within each of our localities varies depending on the
objectives they are trying to achieve, but the essential characteristics of the models are the same.
Health and social care providers will work collaboratively to provide care to a defined population
(predominantly led by Primary Care). Local Care Organisations is a term developed at a GM level to
describe how across GM, we will secure, in all parts of the conurbation, the principal features of a
proactive, preventative, population health model, which delivers consistently high outcomes. It
takes the best of local, national and international learning from Accountable Care Organisations and
applies them to the GM context.
Primary Care standards agreed at a GM level will be delivered within each locality to ensure that
primary care drives our prevention-focussed approach within localities and across GM.
The LCO and its member organisations will be collectively accountable for delivery. The key elements
of our programme from April 2016 are:
1. Enable conditions to be managed at home and in the community
People will only need to tell their story once and self-care will be encouraged and enabled.
We will introduce multi-disciplinary neighbourhood integrated care teams, built from clustered
general practice, coordinating the care for a defined group of people (children and adults) using
evidence-based pathways.
29
The locality approach will facilitate strengthened links with community groups and the voluntary
sector and connect people to their local networks to promote independence and self-care.
The new models of provision in our localities will bring specialist acute-based consultants and nurses
into the neighbourhood model via technology or face to face visits where necessary.
Technology has a critical role to play. Assistive technology like telecare can reduce the number of
bed days and the level of home care needed. There is more detail later in this chapter.
2. Provide alternatives to A&E when crises occur
LCOs will develop models of care and support, which provide alternatives to hospital when crisis
occurs. It is acknowledged that no community model could keep us all well all of the time, but it can
provide safe, responsive and effective urgent care services that keep people out of hospital (unless it
is appropriate for them to be there) and at home. Our community services in our localities will use
different rapid response models, but they will all aim to achieve the same outcome to manage
people as close to home as possible.
These local models will ensure that the estimated 2500 patients in an acute hospital bed in any given
day in GM are treated more effectively and appropriately closer to home. The concept of ‘virtual
beds’ is already an established model, a model of care that manages both step-up and step-down
pathways for people with urgent care, rehabilitation and/or re-ablement needs.
We will ensure our system works to a common set of objectives, with an emphasis on improving
outcomes and the principles of re-ablement. It will meet the aspirations of people with care and
support needs, support people to live well in the community, prevent people with significant health
or care needs from having to use residential or nursing care and hospital; and help people with care
needs maintain themselves in the community.
3. Support effective discharge from hospital
Our staff in our hospitals and in our community services work hard on a daily basis to ensure that
patients are discharged in a safe and timely manner back to their chosen setting, but there are
challenges due to different processes and requirements for the agencies concerned.
Our hospitals will work with the patient, their family/support networks and their GP to a planned
date of discharge upon admission, they will ensure the patient is medically fit for transfer and then
work with community services to ensure that the support services are in place when they transfer to
their chosen next care setting.
We will build on work in our localities to introduce a standardised, streamlined discharge service and
aim to develop an agreed GM discharge framework, which is focussed on the standards that the
people of GM expect to be delivered when patients are discharged and help them return home
safely with a co-ordinated discharge plan.
4. Help people return home and stay well
It is important that patients leave hospital with a clear discharge plan that is communicated to their
GP, families, relevant agencies and support networks within their community, with a clear
understanding of who they need to contact if they are concerned.
30
This will require integrated working between integrated neighbourhood teams, GPs and hospital
teams to agree care or support programmes.
Vanguards
In GM, NHS England has announced four Vanguards which are testing the implementation of new
models of care to improve and integrate services as described in NHS England’s Five Year Forward
View:
· Salford Together (Integrated primary and acute care system – PACS).
· Stockport Together (Multi-specialty Community Provider - MSCP).
· Salford and Wigan Foundation Chain (Multispecialty chain).
· Accountable Clinical Network for Cancer (ACNC).
In GM, we recognise that new models of care need to be implemented in all our localities to address
our system challenges. This will require an open and transparent approach which supports
innovation and the testing of new ideas. The Vanguards have enabled work within 3 localities and
across GM to take forward the design and implementation of a variety of new models of care as
described in the NHS Five year Forward View, and share their learning and the input from the
national support team with the rest of the GM localities and our acute provider sectors.
There are 15 NHS Trusts and Foundation Trusts providing acute, mental health and community care
across GM. Their dedicated staff deliver high quality care to the population of the region in the face
of growing demand and tight budgets.
The present system is, however, not financially sustainable and it does not deliver the consistently
high standards our population deserve. The total forecast deficit for these provider organisations is
forecast to be £1.4 billion by 2020/21 before taking account of cost improvements. NHS Trusts in
Greater Manchester must change and evolve to meet today’s demands and the changing demands
of the future.
Plans for our acute services will be developed with the public, patients and carers. They will be
generated through the GM governance arrangements and by the Provider Federation Board to
enable greater collaboration between Trusts.
The focus of work for Trusts will cover:
· Improving the safety and quality of services
· Improving productivity: Hospitals are drawing up plans to achieve efficiency savings of 2.5 per
cent in 2016/17, and 2 per cent per annum in subsequent years.
· Improving delivery: Hospitals are working to introduce new care models to avoid emergency
admissions and cut very long lengths of acute hospital stays. Trusts are working to deliver the
four priority clinical standards for seven day working as part of the first phase of implementation
by 2017.
· Increasing collaboration: trusts have agreed to a programme of collaborative efficiency and to
joint working between trusts to achieve significant savings targets.
31
Whilst a large part of the improvement in GM will come from investment in and expansion of
prevention and integrated primary and community services, we want to improve the quality,
consistency and efficiency of services across the region and make sure there are adequate specialist
staff present at the time of high risk procedures. Providers in GM are already working together to a
greater extent, in order to spread good clinical practice. This focuses on maintaining local access to
clinical services which might otherwise not be sustainable due to workforce shortages as well as
achieving economies of scale through sharing services across GM. This ensures that the vast
majority of acute care remains accessible in local hospitals whilst only the more complex treatments
are provided in specialist centres.
The GM programme Healthier Together first initiated this concept with identification of urgent and
emergency care, acute medicine and general surgery as a single service; taking the first step towards
greater transformations that will be extended to other specialties.
GM will quickly establish the most appropriate governance form to secure provider collaboration
through the development of groups, multi-site providers, lead provider arrangements and specialty
service chains building on our learning from national Vanguards. This will be essential to allow the
benefits of standardisation to be achieved at scale. This reform can identify the best evidenced-
based practices for patients and provide decision support systems for clinicians. This means that key
scaled up functions can be delivered across organisations and operational delivery can continue to
be taken forward within organisations and at neighbourhood level. This will provide better
outcomes and implementing standardised processes across a chain or group of providers will deliver
better care at lower cost.
Organisations with a strong track record of high performance, able to support their staff to assist in
local improvement and with the capability to develop standardised operating procedures, will share
their skills and knowledge with organisations to support standardisation across the acute sector.
GM will develop a framework to determine which services will be delivered at which level;
neighbourhoods, localities, clusters and across GM. In summary:
· Care that does not require a hospital stay will be provided locally
· In-patient emergency care and all in-patient surgery would be organised at a cluster or group
level.
· Highly specialised services requiring specialist skills and infrastructure will be organised at a GM
level.
We know that basing clinical care protocols on evidence can help reduce variations in the delivery of
care, increase the quality of our services and reduce cost. GM will proactively enhance and
standardise care models and operating procedures across services beyond those which are included
within the shared service model so that procedures of the same type will follow an agreed protocol.
GM Trusts will develop a culture for improving standards. Clinicians will have to justify deviations
from the agreed evidence pathway and these deviations and the associated reasons will be
continuously monitored and reviewed (by shared clinical governance arrangements) to determine if
the pathways need to be improved, updated or amended. Clinical care protocols will provide a clear
audit trail, which can be used to quickly spot anything unusual and any decline in performance, as
well as providing real time insight into where improvements are needed. This data will be shared
with commissioners and regulators. This approach relies on improved methods to collect data, which
32
will be developed as part of this work. The adoption of evidence based protocols will be supported
by the role of Health Innovation Manchester.
From April 2016, we will:
· Deliver most services locally, in conjunction with each LCO.
· Build on Healthier Together to share acute services at scale. Providers will find new ways of
partnering and collaborating to improve acute and specialist services delivered to patients. This
will be achieved through consolidating services at a cluster and Greater Manchester level.
· Agree cluster level services. Trusts will work collaboratively to form cluster or group-level
services, and clinical staff will work together across a network of hospitals within the shared
single service. Based on clinical evidence, this will drive improvement in standards of care across
all hospitals as they follow a consistent approach for care delivery.
· Agree Greater Manchester level services. These services will be provided in one network across
Greater Manchester, potentially across multiple sites, but with a lead service provider
responsible and accountable for service delivery. We already have some services like this
including adult major trauma, paediatric services, secure mental health and most recently the
Cancer Vanguard.
· Develop standardised treatment and care pathways. Protocol based care will enable staff to
put evidence into practice by addressing the key questions of what should be done, when,
where and by whom. This standardisation of practice reduces variation in pathways and will
improve the quality of care uniformly across Greater Manchester.
The development of standardised clinical support and back office services across Greater
Manchester is a critical part of our transformation work.
Back Office
Shared services are no longer a radical new idea; they are an accepted part of business strategy that
has repeatedly demonstrated its value. All public sector organisations in Greater Manchester have a
common business platform including: finance; technology; business intelligence; HR; procurement;
transformation and property services. As such there is an opportunity to generate significant
efficiencies through organisational collaboration. Greater Manchester will pursue the potential
outlined in Lord Carter’s report and be an early, large scale delivery site for that work.
Developing a shared service model across GM level will drive greater efficiency while delivering
world class business solutions. A shared service centre will not only deliver consistency in back
office functions across Greater Manchester, but will deliver significant financial savings.
Care Co-ordination
Greater Manchester is clear that the integration of health and social care commissioning, whether at
a locality, cluster or GM level is key to delivering agreed and shared improvement outcomes for
residents. This joined up commissioning approach will deliver significant changes in commissioning
activity, with a greater emphasis and investment in prevention and early intervention. This will
33
allow GM commissioners to shift activity and expenditure from high cost parts of the system to
(where appropriate) care and services delivered closer to people’s homes.
This will need to be underpinned by an effective means of care co-ordination to consistently track
risk, activity, resources and outcomes across population segments. This will require the adoption of
a whole system approach and the establishment of a multi-agency care co-ordination centre,
encompassing primary, secondary and social care provision.
This would be able to:
· Track and co-ordinate patient care in a locality or cluster of localities.
· Utilise real time demand data to support more proactive care planning
· Reduce the variability in patient or cohort costs by limiting or avoiding high cost episodes.
· Generate total patient costing information to support lower average patient costs as more
efficient and preventative care is incentivised.
· A central clinical team would work to reduce variations in care, ensure that care pathways are
adopted consistently and refine pathways in line with the most effective interventions.
Shared Clinical Services
NHS Providers are already working together on radically reviewing how shared clinical services could
be provided at a pan GM level to enhance individual organisational efficiency. These are focussed
on:
· Procurement of goods and services through improvement in economies of scale and reductions
in product variation.
· Review of Private Finance Initiative arrangements across GM in order to gain greater value from
these contracts.
· Revised pharmacy arrangements through the improvement of drug procurement, logistics and
medicines optimisation.
· Centralisation of back office functions by coordinating and providing these services at the
appropriate geographical level
· Making better use of the public sector estate to ensure that estate owned and managed by NHS
and local authorities is utilised efficiently and effectively, or disposed where it is not needed.
· Appropriate centralisation of pathology and radiology services in line with the recommendations
set out in Lord Carter’s ‘Review of Operational Productivity in Hospitals.
From April 2016, we will be developing:
· A single Greater Manchester level Shared Service; bringing together a common platform for all
of the public sector in GM
· A care co-ordination system for GM
· Implementing shared clinical support services across GM.
The tolerance of variation across health and social care service provision is one of our biggest
challenges. In Greater Manchester, our approach will see us no longer accept this wide variation of
outcomes and service standards within and between organisations. Greater Manchester will need
to deliver a significant programme of standardisation.
34
New care organisations
Health and social care providers in Greater Manchester need to become more adept at
standardisation and reliable implementation of best practice. Through our revised working
arrangements, supported by our new governance arrangements, we will ensure that our new
models of care remove tolerance to variation both in service delivery and standards.
There is growing consensus in Greater Manchester that new organisational forms or delivery models
will be required to enable integration and standardisation. To ensure that such integration and
standardisation can occur, existing boundaries between organisations need to be removed. It is by
removing these boundaries that efficiencies can be delivered and standardisation is service
achieved.
We will develop any changes with full discussion and, where appropriate, consultation.
It is clear that integration is required across different levels; horizontally across similar services and
organisations, and vertically through different care settings.
There are a number of different options for organisational form, ranging from loose collaboration to
full consolidation. Analysis of the potential options for the different types of integration has been
undertaken and the table below represents the suggested models across each type of integration.
Contracts, payments and innovation
The successful delivery of new models of health and social care at locality, cluster and GM level will
need to be driven through new, innovative, evidence-based contracting models and pricing
35
mechanisms. The scope of these will need to be broad ranging covering all sectors and a wide range
of providers.
The current Payment by Results system, agreed at a national level, albeit with local variation where
appropriate, has created a system that incentivises different outcomes in different localities or
providers. As a result it has failed to deliver whole system outcomes.
Whilst there will not be a one-size fits all approach, there will be a set of common principles across
the whole of Greater Manchester, and a defined list of options around contracting and payment
choices. This will include primary care and specialised services as well as all the services currently
commissioned by CCGs and Local Authorities. All models should:
· Incentivise cost reductions from efficiency improvements and effective demand management
· Incentivise integration within and across the health social and care system
· Facilitate a transparent and accountable pathway for patient outcomes
· Incentivise prevention to counter rising acute hospital care activity
It is recognised that the design of any such payment system will be complex and require specialist
input through our partnerships established with national bodies including NHS Improvement, NHS
England and DH.
Technology
In Greater Manchester, many organisations still rely on inefficient paper based systems. Significant
investment will be required to enable digital operation, without this investment it will not be
possible to deliver a high quality efficient health and social care system.
Our new models of care will require technology enabled change. We will use technology to
understand patient needs, and develop services more efficiently and effectively as a result. We want
residents to have greater access, ownership and responsibility over their own data, generating
multiple ways to interact with the health and social care system and putting people at the heart of
how their information is collected, stored and used. More effective use of information across
organisations, driven by patient ownership, will reduce duplication and ensure more speedy access
to the right services.
We want technology to support self-management, from staying well to living well with long term
conditions. We need to share data and information across organisations on a day to day basis to
support assessment, triage and integrated multi-agency case management.
The Health and Social Care system in Greater Manchester will work with the wider public sector on
the implementation of GM-Connect. As part of the wider GM reform activity, GM-Connect will
establish a new data commission for GM that will own the data sharing mandate and will deliver GM
wide solutions for employees and residents to access, update and analyse data. Implementation on
GM-Connect will start in January 2016.
Accelerating discovery
Developing, testing and implementing new ideas takes too long. Fragmentation in funding,
organisation approach and regulatory systems all slow up the process. This needs to change.
36
Greater Manchester, supported by its three large teaching hospitals, a research-led university base,
a critical mass of life science firms and skilled workers, and a large and diverse population, is putting
innovation at the heart of its health and social care system.
Our academic, research and industrial assets have been brought together under the umbrella of
Health Innovation Manchester, launched in September 2015, to accelerate innovation into the local
health and social care system.
Health Innovation Manchester will draw on the collective expertise of all partners from health and
social care providers, academia and industry collaborators to address the health needs of the local
population.
At the same time it will deliver economic benefits through manufacture and commercialisation. We
aim to create one of the best regions in the world for innovative life science companies to be
involved as partners. Additional detail on this is in Chapter 2.
Buildings
The estate varies significantly in terms of quality, condition and suitability. Some of the estate is in
excellent condition providing state of the art facilities, whilst at the other end of the scale there are a
lot of properties that are in very poor condition and no-longer fit for purpose.
Estates is a critical enabler of the GM health and social care transformation programme which must
continue to be fully informed and led by frontline service strategy. Collaborative working across GM
agencies is well established and effective however it is recognised that a lot more is required to
improve health outcomes for the residents of Greater Manchester and to increase efficiency.
The public sector estate in Greater Manchester is under-used. Making the best use of the property
and space available is a key part of Greater Manchester’s health and social care transformation
plans. It is also key to supporting our economic growth. The GM One Public Estate initiative is
aimed at using public sector property assets as a single resource across organisations.
Integrating health and social care services across the region will mean changes are required to the
buildings from which the services are delivered. A focus on prevention and care provided nearer to
the home will mean that more facilities will be required in the community. This may result in the
way that land is used at hospital sites changing as we need to ensure that our estate is able to
respond to changing needs and demands of our residents.
A rationalisation of our public sector estate will inevitably free up much needed space that is
required to support our economic growth both through new housing and employment sites.
Current ownership and management of the public sector estate is complex. In the NHS, buildings
are owned and managed by NHS Trusts, Foundation Trusts, GPs, Community Health Partnerships,
private landlords, NHS England and NHS Property Services. To ensure we make best use of this
estate we will develop a NHS estates GM Delivery Team who will work closely with colleagues from
across the Public Sector to deliver a One Public Estate approach to property management.
A GM Strategic Estates Planning Board will be formed, which will be responsible for translating
strategic requirements into a set of GM Estates Targets, ensuring it meets local health and social
care needs. It will develop a clear framework to enable GM to make better investment decisions, for
example in primary care, and to ensure that the buildings required to deliver new models of care can
be realised.
37
To ensure we are able to reconfigure the GM public sector estate in a way that supports our
transformed services we have requested that any receipts received from disposing of capital assets
is be retained within Greater Manchester for re-investment.
From April 2016, we will:
· Develop one public estate for GM and agreement of a framework to make estate investment
decisions
· Develop the GM Estates Framework focussing on the following key elements:
o Control - Public bodies in GM have control over all estate policies, procedure, decision
making and allocation of resources
o Ability to incentivise - Ability to retain and share savings and value released to fund
change and align objectives across public bodies and departmental silos; Introduction of
locally aligned incentives
o Funding – Public bodies in GM have control over spending , Receipts and associated
revenue costs; Pump prime funding e.g. to support asset rationalisation and
improvements to the retained estate; Ability to recycle savings & receipts for estates
transformation.
· Each locality will have a draft Strategic Estates Plan by the end of December 2015, which will be
aligned to the locality and GM plan. In accordance with DH guidance with target
savings/utilisations applied to each to deliver over a period of time and these will be further
developed and implemented.
38
Chapter 5 - Financial Plan
In order to achieve our ambitions, we need the £6 billion invested in health and care to flow
differently round our system. We have produced a detailed GM financial plan which shows how we
see the £2 billion gap emerging over the next five years.
This integrated plan, the first of its kind, enables us to drive change within the transformation areas
described above and the actions we will take to close the gap over the next five years.
Central to the delivery of the Strategic Plan is the ability to access the Transformation Fund across
our GM system. This will enable us to develop new models of care to change the nature of demand
and keep services safe and sustainable, while we make this radical shift.
The Financial Challenge
The integration of health and social care is a fundamental part of the growth and reform strategy
essential to GM’s priority of reducing unemployment, supporting people back into work, and
providing growth through innovation. It is a key driver to ensure that the health and social care
system becomes financially sustainable over time.
The population of Greater Manchester is 2.8 million with forecast spend of £7.7 billion on health and
social care services. This includes £6.2 billion on health services including mental health, GP
services, specialist services and prescribed drugs and £1.5 billion on local authority public health and
social care services.
After taking into account the resources that are likely to be available and the pressures that the
health and social care system will face over the next five years it is estimated that there will be a
financial deficit of £2 billion by 2020/21. The scale of the challenge demonstrates why radical
change is needed, both in the way services are delivered and in the way people use them.
Comprehensive Spending Review assumptions
As described in Chapter 2, the MoU outlined a ‘road map’ leading to full devolution on 1st April
2016. A key element of the MOU was the development of a Plan, including access to a
transformation fund to enable us to deliver clinical and financial sustainability over the five years. In
order to support us to achieve this, the recent CSR Settlement proposed the following for GM:
· A fair share of the additional funding of £8 billion that had been identified for health care
· Funding to enable social care activity to continue at the current level in line with the NHSE
assumptions in the Five Year Forward View
· Additional one off transformation funding of £500m to support the delivery of the savings
opportunities
· Access to capital funding to support areas such as the development of a single patient record
and for the reconfiguration of the health and social care estate required.
GM submitted a high level Strategic Financial Plan in August 2015 to Government and NHS England
as part of the CSR. This set out how it intended to meet the clinical and financial challenges over the
CSR period and what was specifically required to significantly close the £2 billion financial gap.
39
Alongside GM's fair share of on-going funding in line with Five Year Forward View (which would
close the gap by £700m) proposals were shown to deliver a further £1.5 billion of savings, after
reprovision costs, from the following areas:
· £70 million from prevention
· £488 million from better care models delivered across NHS and local authority
commissioners and providers
· £139 million from reform of NHS Trusts
· £21 million from commissioner collaboration
· £836 million from NHS provider productivity savings and joint working
Delivering these changes is estimated to cost £200 million in capital charges leaving a net saving of
£1.3 billion.
In addition to the above, benefits to the wider economy are expected through increased
employment and productivity in the workplace, estimated at £160 million to £315 million.
The bridge diagram below summarises the Strategic Financial Framework that was submitted as part
of the CSR.
The Plan describes how these savings will be achieved. Key to this is the implementation of the new
models of care in line with the transformation themes outlined in Chapter 4 of this document.
These provide the framework for a radical transformation of health and social care and will
significantly impact upon patterns of demand. These are grouped into five main themes:
o Radical Upgrade in Population Health and Prevention
o Transforming Community Based Care and Support
o Standardising Acute and Specialist Care
o Standardising clinical support and back office services
40
o Enabling better care
The Transformation Fund described in the CSR is required to support the delivery of the significant
change that GM will start to deliver from 1 April 2016. Achieving transformation of this nature
requires critical enablers to be put in place, including an investment in the non-recurrent cost of
putting new delivery models in place (including funding costs of staff development and new
payment models), information and technology, community-based facilities and the renewal and
adjustment to hospital capacity.
The Transformation Fund will consist of £77m one off costs to enable delivery of change and £423m
double running costs to support the implementation the new service models and change to existing
models. In return for access to this funding, GM will deliver the £1.5bn cumulative savings, use of
the fund will be fiscally neutral and GM would be clinically and financially sustainable by 2020/21.
Fundamental to the delivery of transformation is the work set out in the Locality and Provider Plans
which is underpinned by the pooling of budgets at scale at locality level, access to transformation
funding for delivering the enablers and the dual running costs for moving to new models of care.
Financial assumptions to be agreed
The Strategic Financial Framework contains assumptions on:
· The future levels of funding available across health and social care
· Treatment of provider deficits
· Tariff deflator assumptions
· Level of transformation funding available
The expected changes to the above assumptions will have a significant impact on whether clinical
and financial sustainability can be achieved during the five year period and on the development of
detailed operational financial plans. The following key issues need to be resolved:
1. The level of the Transformation Fund
The amount of one off transformation funding (£500 million) was based on what was thought to be
the minimum amount required to deliver the change to achieve clinical and financial sustainability
over the five year period. If the amount or phasing changes then financial sustainability will not be
achieved over the five years and will be reflected in commissioning and NHS provider organisations
operating with financial deficits for a longer period.
The SPB Executive will propose allocation of the Transformation fund in accordance with criteria
agreed and will secure independent assurance on each of these investments.
The use of the Transformation Fund (TF) should be underpinned by the following principles:
· The total for the TF currently proposed by NHS England is £450m. This is lower than the
amount in the CSR submission and the TF is still the subject of discussion.
· The governance of the TF will be the responsibility of the SPB. The TF will be focussed on the
delivery of the transformation programmes described in the Plan; all proposals will be
independently verified to demonstrate value for money, strategic fit and robustness.
41
· The TF will be separate from the conventional funding allocation to CCGs etc, but at the
appropriate time CCGs will be expected to agree with NHS England how their budgets are
supporting the transformation programmes.
· NHS England has the right to determine the financing of the TF. However there must be the
necessary degree of flexibility to enable the TF deliver the transformation programmes set
out in the Plan. To the extent that any national programmes are used to support the
financing of the TF, then the TF will only fund those aspects of proposals which are wholly
consistent with the transformation programmes in the Plan. To the extent that any
proposals from these national programmes do not correspond to these programmes then
these will fall for consideration by NHS England separately.
· Deficit management will be the responsibility of the NHS and will be outside the funding
scope of the TF. GM will play a full part to ensure that detailed deficit arrangements are
aligned to the Plan.
· The TF will be subject to a performance management framework. Once the detailed profile
has been agreed, GM will produce a full range of outcomes across health and social care to
be delivered by the TF which will form part of the performance management framework, for
agreement by HMT, NHS England and DH.
The amount and phasing of the TF continues to be negotiated with NHS England.
2. Estates
The CSR proposals assumed access to capital funding to support both the enablers such as
development of a single patient record and for the reconfiguration of the estate required. The work
included funding for the recurring cost of capital, although the amount will vary depending on the
phasing of the transformation funding and implementation of change. The proposal is based around
the ability to bring together the estates function across GM into a single property management
function and the ability to retain any capital receipts. How this is implemented, alongside the
detailed work underway, will inform the exact nature of the investment required.
A key component of the work will be securing access to the national funding ‘pots’ which are
available with a proposal that GM requirements are ‘earmarked’ subject to the production of a
detailed business case to be agreed by NHS England, DH and HMT before the end of this financial
year.
A high level strategy will be developed by the 31 December 2015 and from this a business plan and
financial proposal will be developed by 31 March 2016 for discussion with HMT, DH and NHS
England.
3. Social Care
The underlying principle in the CSR is that the funding should enable the current level of activity, as
per the logic in the Five Year Forward View, to be delivered and for social care budgets to be
maintained at their current level. For adult social care this represented additional funding of £180m
for GM across the CSR period. This did not include funding for additional demographic pressures
and the cost of implementing the changes to the Minimum Wage. The scale of the funding gap is
linked to the overall outcome of the financial settlement so the numbers are subject to change.
42
There has always been some concern about how a national social care settlement could be
responsive to the particular circumstances in GM, given the status on devolution. Discussions are
ongoing as to the impact of the changes set out in the CSR. The early assessment is that the
proposals leave GM with a shortfall of funding for 2016/17 and 2017/18.
The CSR announcement included two additional areas for social care:
· The ability to raise an additional 2% in council tax over and above the referendum limit
· Additional £1.5bn BCF monies that will go direct to local authorities
Council Leaders are considering a further radical step to pool funding for the five years for the SR
period to use the income generated from the ‘social care precept’, or equivalent income, to establish
a platform for commissioning certain social care services on a GM wide basis. This is linked to there
being a comprehensive settlement.
The additional BCF funding for local authorities will start to come on stream from 1 April 2017, with
it being predominately back-loaded to the last two years of the CSR settlement. The phasing of the
BCF nationally will not deliver what GM requires given that our transformation journey will start on 1
April 2016.
GM, after it has evaluated the impacts of the local government finance settlement on social care,
will want to discuss with HMT, DH and DCLG the impact of the settlement on social care spend in the
early years of the transformation programme and whether the funding is sufficient to enable the
transformation objectives to be delivered.
Achieving transformation of this scale is a significant ambition, which will require leaders at all levels
across GM to promote the need for change and the development of detailed implementation plans
over the coming months.
43
Chapter 6 – Implementation
We have already started implementing some of the changes we need across the system. A critical
part of our work between January and March 2016 will be to engage with people across GM and
staff working in the health and care system, about the direction of travel and the changes we are
proposing. We have shared our thinking early so that people have a chance to be part of building
our plans for the future.
We are developing a draft high level implementation plan which describes what we think will need
to happen across the five years to create a clinically and financially sustainable GM health and
social care system. There will be a detailed work programme for each of the transformation themes
described in Chapter 3, outlining specific deliverables in years 1 and 2 and higher level deliverables
for years 3-5. This will ensure we can continue to review, refine and if necessary refresh our work
programme to reflect our system needs.
To find out more or get in touch with us please go to:
Website: www.gmhealthandsocialcaredevo.org.uk
Email: [email protected]
Twitter: @GMHSC_Devo
We have a bold, clear and ambitious plan for GM. All partners are working together to understand
how we can begin to deliver this plan.
Engaging people
Between January and March 2016, the partners across the ten localities of GM will be talking to their
staff and local people about these plans. At the same time we plan to run events and talk to people
about what would help them take charge of their own health and wellbeing – and get views on how
we might support people to do this.
We will be doing this under our Taking Charge theme, which sets out the idea that GM is taking
charge of a significant opportunity, as well as a significant challenge, and that as well as taking
charge the people of GM must also take responsibility – at an individual, community and wider level.
Thousands of conversations about health and social care, preventing ill health and integration of
services have been held in GM over recent years. They have included roadshows, citizen’s panels,
workshops, online forums and many other outlets and events, organised by public bodies and the
voluntary and community sector. The ideas set out in this plan are the culmination of those
conversations – and we will continue to build on them.
Examples include:
· In Bolton, the CCG launched “Let’s make it” with 120 events to give a voice to those who find it
hard to get heard
· In Manchester, the voluntary sector has led 22 workshops on improving mental health services
· In Rochdale 225 people have helped shape the locality plan, covering children’s services and end
of life care
· In Trafford, local people have been involved in creating a one-stop Care Co-ordination Centre for
booking appointments, patient transport and learning about services
44
The people of GM recognise the challenges facing the health and social care services from an ageing
population, advances in medicine and growing financial pressures. They accept that the rising
demand for services must be slowed, and say the way to achieve this is for people to take more
responsibility for their health.
Their priorities for the future, in relation to health and care services, include to:
· get appointments promptly and be seen within a reasonable time
· tell their story once and receive co-ordinated multidisciplinary care – with a single key worker
· have their families and carers involved
· have things explained, their questions answered and given choices about their care
· be supported to manage their own care
· have emotional and practical support recognised as important as medical treatment
· not to be blamed when costs and competing priorities interfere with their ability to look after
their health
· have everything in place when they are discharged from hospital
· be treated with dignity and respect
We will build on this engagement with people – at a local and GM level - to continue to better
understand what people need to take charge of their health and wider wellbeing in different places
across GM.
As well as using traditional engagement approaches we are also exploring a web-based,
crowdsourcing platform, and will link with national and potentially commercial partners, to ensure
our engagement is as broad and deep as possible.
Engaging with Staff
There are around 80,000 staff working in health and social care services in GM and they are a critical
group who are crucial to the success of our ambitions. Staff engagement will be led by their own
organisations so they are able to put the wider GM work in the context of what’s happening in their
own organisations and are able to understand what this means for them, their families and the
people they help care for.
Starting the work
Alongside the work we will be doing with residents, we will also be working across public sector
services in GM to begin to work through how we implement the changes described in this Plan.
Changes will happen across all parts of our health, care and support services. We are already
starting to make some of these a reality as we begin to deliver different service models which are
described in Locality Plans and to make better use of the resources we have to save across health
and social care.
We know that we need to begin work now on some areas that will take months or even years to
change and deliver.
Our approach to implementation will align to the 5 key areas for transformational change (as
described in chapter 4), delivered through reform across all parts of the care and treatment
pathway:
· Upgrading prevention and self-care
45
o Population Health and Prevention: High impact approaches and programmes to lift
life expectancy
· Transformation of community based care and support
o Place Based Commissioning: Place based commissioning in localities and a
consistent approach to GM population health
o Primary Care at Scale: The deployment of primary care at scale acting as the
foundation of integrated care in localities, organised with other Local Care
Organisations (LCO)
o Mental Health: Implementation of our GM Mental Health Strategy
· Standardising acute hospital care
o Acute & Specialist: Single shared acute services coming together under Acute Care
Collaborations
· Standardising clinical support and back office services
o Shared Services: A unified and evidence based approach to Lord Carter’s findings
· Enabling better care
o Health Innovation: Confirmation of priority programmes within the HInM pipeline
o Enablers: Pricing and contract approach that aligns incentives; common approach to
information to enable standardisation as scale. A single Estate Plan
· Programme implementation
o Engagement and Communications Plan
o Establishing the GM health and social care team
o Governance
It will describe the key deliverables for each part of the work that we are aiming to deliver by April
2016 and then years 1 and 2, with an outline for years 3-5.
Work to deliver this plan is happening now across our GM services. As we progress through the next
three months of this work, we expect our plans to be built on, expanded and improved based on the
views of residents who use services across health, social care and support services.
A significant proportion of delivery activity will take place within our localities, working with our staff
and our people to implement the reform in the context of local needs. Each locality will develop a
Locality Implementation Plan by April 2016. Each locality will be responsible for ensuring it has the
capacity and capability to implement its reform plan, drawing on local and national expertise as
appropriate.
We recognise the value in collaboration across GM, so in partnership with NHS England, we will
create the GM health and social care team. This team will be small in number and flexible, with
ability to source expertise from within and out with Greater Manchester to support delivery in the
localities and at a GM level. It will be responsible for driving the devolution, reform and
transformation agenda for the integration of health and social care services between 2016 – 2020.
From April 2016, the team will:
· Ensure delivery of the GM Financial Plan.
· Oversee and drive governance across GM.
· Enable the implementation of Locality Plans and ensure they support the direction of GM health
and social care.
· Assure the operational delivery of health and social care, in line with the devolved functions
from NHSE, such as Clinical Commissioning Group assurance, plus specialised and primary care
commissioning.
46
· Lead GM commissioning where agreed and endorsed by the Partnership Board and Joint
Commissioning Board.
· Sponsor, drive and facilitate GM transformational projects.
· Facilitate GM population and cross sector involvement in health and wellbeing improvements.
· Understand the overall performance and delivery of services across the whole system within GM
and therefore, identifying and managing risk.
· Establish effective working arrangements with health and social care regulators.
· Lead on the development and delivery of public and political engagement.
We will produce a refreshed version of this plan in March that includes more details of how we
propose to change our services over the next five years.
Assurance, accountability and implementation
Greater Manchester is our ‘Unit of Planning’ and we are working to the principle that GM is assured
once by national bodies as a place.
This approach does not compromise the statutory responsibilities of the 37 health and care
organisations in GM to the national bodies. However, as all of our 10 localities are moving towards
the establishment of pooled commissioning budgets, management arrangements, governance
structures and the development of Local Care Organisations, they will operate in a different ways
and the assurance and accountability processes will need to support these developments.
It is recognised that further work is required to understand and agree what this means for each of
the national bodies and how the individual processes could be brought together to achieve
assurance of GM as a place. This will be worked through as part of the implementation planning and
listening phase from January to March 2016.
Staying in touch and getting involved
We already have a range of ways to stay in touch with this work. These are:
Website: www.gmhealthandsocialcaredevo.org.uk
Email: [email protected]
Twitter: @GMHSC_Devo
Opportunities to engage in the work will be widely advertised following the publication of this Plan.
47
This 5 year strategic plan for the reform of health and social care in Greater Manchester has been
developed in consultation with and approved by the Greater Manchester Strategic Partnership
Board. This Board is chaired by Lord Peter Smith, the leader of Wigan Council and through the
membership of that Board; it has support of the 37 statutory organisations in Greater Manchester,
listed below:
Bolton Clinical Commissioning Group
Bolton Hospital NHS Foundation Trust
Bolton Metropolitan Borough Council
Bridgewater Community Healthcare NHS Trust
Bury Clinical Commissioning Group
Bury Metropolitan Borough Council
Central Manchester Clinical Commissioning Group
Central Manchester NHS Foundation Trust
Greater Manchester West Mental Health Foundation Trust
Heywood, Middleton and Rochdale Clinical Commissioning Group
Manchester City Council
Manchester Mental Health and Social Care NHS Trust
North Manchester Clinical Commissioning Group
North West Ambulance Service NHS Foundation Trust
Oldham Clinical Commissioning Group
Oldham Metropolitan Borough Council
Pennine Acute NHS Hospitals Trust
Pennine Care NHS Foundation Trust
Rochdale Metropolitan Borough Council
Salford City Council
Salford Clinical Commissioning Group
Salford Royal NHS Foundation Trust
South Manchester Clinical Commissioning Group
Stockport Clinical Commissioning Group
48
Stockport Metropolitan Borough Council
Stockport NHS Foundation Trust
Tameside and Glossop Clinical Commissioning Group
Tameside Hospital Foundation Trust
Tameside Metropolitan Borough Council
The Christie NHS Foundation Trust
Trafford Clinical Commissioning Group
Trafford Metropolitan Borough Council
University Hospitals of South Manchester NHS Foundation Trust
Wigan Clinical Commissioning Group
Wigan Borough Metropolitan Borough Council
Wrightington, Wigan and Leigh NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust
Wider partners in the GM Plan:
Greater Manchester Police
Greater Manchester Local Medical Committee
Greater Manchester Fire and Rescue Service
Healthwatch
Patient Groups
Social Care and Residential Providers
Voluntary Groups
3rd Sector Providers
1
GREATER MANCHESTER HEALTH AND SOCIAL CARE DEVOLUTION STRATEGIC
PARTNERSHIP BOARD Date: 18 December 2015 Subject: Implementing the GM Health and Social Care Strategic Plan Report of: Katy Calvin Thomas PURPOSE OF REPORT
This paper updates the Strategic Partnership Board (SPB) on the work that is underway to develop the implementation plan for the GM Health and Social Care Strategic Plan. The aim of this paper is to outline the critical work streams we need to begin and complete across the GM system in the December to March period, to enable us to begin implementing the agreed and prioritised work streams from April 2016. RECOMMENDATIONS
The Board is asked to:
· Note the progress made to establish a framework for the implementation of the GM Health and Social Care Strategic Plan.
· Approve the proposed framework for the implementation plan as attached in appendix A.
· Recommend that this framework is used by the each of the GM localities for their Locality implementation plan
· Note the key tasks identified that need to be undertaken before April 2016 to enable implementation of the GM Health and Social Care Strategic Plan, as listed in the draft implementation plan (Appendix A).
· Note that a fully drafted implementation plan will be presented to Partnership Board Executive and then Partnership Board in January.
CONTACT OFFICER: Katy Calvin Thomas [email protected]
4B
2
1. Introduction 1.1 This paper updates the Strategic Partnership Board (SPB) on the work that is
underway to develop the implementation plan for the GM Health and Social Care Strategic Plan.
1.2 The aim of this paper is to outline the critical work streams we need to begin
and complete across the GM system in the December to March period to enable us to begin implementing the agreed and prioritised work streams from April 2016.
1.3 It acknowledges that work during this period will be also part of a listening
exercise with local people and staff across GM who work in services across the public sector.
2. Engaging people 2.1 Between January and March 2016, we will work with local residents to support
them to think about, add to, influence and drive some of our thinking further. We will be doing this as part of our #taking charge campaign and expect that the plans we have today will be shaped and changed through this work.
2.2 Key to the success of plan is that it meets the needs of residents, patients,
carers and people who work in public services. To achieve that, we need to know what people want, and what they value.
2.3 We will build on this engagement with people, encouraging feedback and
monitoring responses as we get them. We will swiftly gather and analyse residents’ views from all our communities and begin to better understand what people need in different places across GM.
2.4 As well as using newspapers, roadshows and newsletters, we will launch a
web-based, crowdsourcing platform, linked with national and commercial partners, to ensure our engagement is as broad and deep as possible.
3. Engaging our health and social care system
Localities 3.1 A significant proportion of delivery activity will take place within our localities,
working with our staff and our people to implement the reform in the context of local needs.
3.2 Each locality will develop a Locality Implementation Plan by April 2016. 3.3 Each locality will be responsible for ensuring it has the capacity and capability
to implement its reform plan, drawing on local and national expertise as appropriate.
GM
3
3.4 Whilst it is acknowledged that a significant proportion of work will take place within localities, there is the recognition of the need to do appropriate work at a GM level.
3.5 It is therefore proposed that from April 2016, we will need in place a GM
Portfolio Management Plan and a team to deliver the following critical work streams: • Oversee and ensure delivery of the GM Financial plan. • Oversee and drive governance across GM. • Enable the implementation of locality plans and ensure they support
the direction of GM health and social care.
• Assure the operational delivery of health and social care, in line with the devolved functions from NHSE, such as Clinical Commissioning Group assurance, plus specialised and primary care commissioning.
• Lead GM commissioning where agreed and endorsed by the Partnership Board and Joint Commissioning Board.
• Sponsor, drive and facilitate GM transformational projects. • Facilitate GM population and cross sector involvement in health and
wellbeing improvements. • Understand the overall performance and delivery of services across the
whole system within GM and therefore, identifying and managing risk. • Establish effective working arrangements with health and social care
regulators. • Lead on the development and delivery of public and political
engagement. 3.6 We are constructing an overarching GM implementation plan, which is
attached at Appendix A. It is proposed that this framework is used by each of the GM localities to formulate their locality implementation plan.
3.7 We recognise the value in collaboration across GM, so in partnership with
NHS England, we will create the GM health and social care team. 3.8 This team will be small in number and flexible, with ability to source expertise
from within and out with Greater Manchester to support and compliment delivery in the localities and at a GM level. It will be responsible for driving the devolution, reform and transformation agenda for the integration of health and social care services between 2016 – 2020.
3.9 We will produce a refreshed version of this implementation plan in March that
includes more details of how we propose to change our services over the next five years.
4. Recommendations 4.1 The Strategic Partnership Board is asked to:
1) Note the progress made to establish a framework for the implementation of the GM Health and Social Care Strategic Plan.
2) Approve the proposed framework for the implementation plan as attached in appendix A.
4
3) Recommend that this framework is used by the each of the GM localities for their Locality implementation plan
4) Note the key tasks identified that need to be undertaken before April 2016 to enable implementation of the GM Health and Social Care Strategic Plan, as listed in the draft implementation plan (Appendix A).
5) Note that a fully drafted implementation plan will be presented to Partnership Board Executive and Partnership Board in January.
5
Ap
pe
nd
ix A
– D
raft
im
ple
me
nta
tio
n p
lan
GM
Tra
nsf
orm
ati
on
Pro
po
sals
B
y A
pri
l 2
01
7
Jan
ua
ry –
Ma
rch
20
16
De
sig
nin
g
Ap
ril –
Se
pte
mb
er
20
16
Mo
bil
isin
g
Oct
ob
er
20
16
– M
arc
h
20
17
Im
ple
me
nti
ng
Up
gra
din
g
pre
ven
tio
n a
nd
self
-ca
re
Po
pu
lati
on
He
alt
h
an
d P
rev
en
tio
n:
Hig
h
imp
act
ap
pro
ach
es
an
d p
rog
ram
me
s to
lift
lif
e e
xpe
cta
ncy
·
Ag
ree
d r
an
ge
of
GM
wo
rk s
tre
am
s o
n
po
pu
lati
on
he
alt
h
an
d p
reve
nti
on
,
imp
lem
en
tati
on
pla
n
an
d k
ey
wo
rk
stre
am
s a
gre
ed
.
·
Ke
y w
ork
str
ea
ms
com
me
nce
d.
·
Ag
ree
ing
fo
rma
t, c
on
ten
t a
nd
imp
lem
en
tati
on
of
pro
gra
mm
es
(pro
gra
mm
e
an
d i
mp
lem
en
tati
on
pla
n).
·
Ag
ree
ing
th
e G
M p
rog
ram
me
pri
ori
tie
s a
nd
ou
tco
me
s fo
r y
ea
rs 1
-5
ba
sed
on
lo
cali
ty
pri
ori
tie
s.
·
Ag
ree
a p
rog
ram
me
an
d o
utc
om
es
for
de
velo
pin
g s
elf
- ca
re t
rain
ing
fo
r ce
rta
in
clin
ica
l co
ho
rts.
·
Ag
ree
ove
rarc
hin
g t
rain
ing
acr
oss
th
e p
ub
lic
sect
or
to s
up
po
rt h
ea
lth
an
d w
ell
be
ing
.
·
De
ve
lop
in
ve
stm
en
t a
nd
co
st b
en
efi
t
an
aly
sis.
·
Ag
ree
at
a G
M l
eve
l th
e p
rin
cip
les
of
a r
isk
stra
tifi
cati
on
ap
pro
ach
fo
r lo
cal
imp
lem
en
tati
on
.
·
Co
nd
uct
a g
ap
an
aly
sis
at
a l
oca
lity
le
ve
l.
·
De
ve
lop
an
d a
gre
e a
se
t o
f K
PIs
to
tra
ck
pro
gre
ss a
nd
su
cce
ss.
·
Ro
ll o
ut
rou
tin
e h
ea
lth
ch
eck
s.
·
Imp
lem
en
t G
M
pre
ven
tio
n w
ork
Tra
nsf
orm
ati
on
of
com
mu
nit
y
ba
sed
ca
re a
nd
sup
po
rt
Pri
ma
ry C
are
at
Sca
le:
Th
e d
ep
loy
me
nt
of
pri
ma
ry c
are
at
sca
le
act
ing
as
the
fou
nd
ati
on
of
inte
gra
ted
ca
re i
n
loca
liti
es,
org
an
ise
d
wit
h o
the
r Lo
cal
Ca
re
Org
an
isa
tio
ns
(LC
O)
·
Pri
ma
ry C
are
– n
ew
con
tra
ct m
od
els
test
ed
an
d p
lan
to
roll
ou
t in
Ja
n –
Ma
rch
.
·
Fu
ll i
mp
lem
en
tati
on
of
Pri
ma
ry C
are
sta
nd
ard
s.
·
Pri
ma
ry C
are
pil
ot
EO
I re
ceiv
ed
.
·
En
ga
ge
me
nt
wit
h s
tak
eh
old
ers
re
Pri
ma
ry
Ca
re S
tra
teg
y.
·
Imp
lem
en
tati
on
pla
n a
gre
ed
.
·
Imp
lem
en
t re
vise
d
pri
ma
ry c
are
stra
teg
y
·
Co
mm
en
ce g
o l
ive
of
‘ne
w m
od
els
of
care
’
Fu
ll i
mp
lem
en
tati
on
of
GM
Pri
ma
ry C
are
Sta
nd
ard
s
LCO
- n
ew
ou
t o
f h
osp
ita
l
syst
em
im
ple
me
nta
tio
n
·
Ag
ree
fe
atu
res
of
a L
CO
in
clu
din
g I
nte
gra
ted
Ca
re (
lin
ke
d t
o T
F c
rite
ria
).
·
Imp
lem
en
t
sta
nd
ard
ise
d
Du
pli
cate
ca
re m
od
els
in p
lace
(p
rev
en
tio
n
6
com
me
nce
d
·
Ass
ess
pa
ym
en
t a
nd
co
ntr
act
op
tio
ns
for
LCO
s.
·
Ag
ree
go
ve
rna
nce
fo
r a
gre
ein
g s
ign
off
of
LCO
pla
ns
sub
mit
ted
.
·
De
sig
n i
nd
ep
en
de
nt
ass
ura
nce
pro
cess
fo
r
LCO
s.
·
10
Lo
cali
ty p
lan
s su
bm
itte
d a
nd
ass
ess
ed
.
·
Co
mp
leti
on
of
GM
tra
nsf
orm
ati
on
in
itia
tive
an
aly
sis.
·
Ag
ree
sta
nd
ard
ise
d m
od
els
fo
r P
rim
ary
/
inte
gra
ted
ca
re i
ncl
ud
ing
Acc
ess
Ta
rge
ts.
·
De
live
r p
lan
s fo
r a
gre
ed
pre
ve
nti
on
wo
rk
stre
am
s (
fro
m M
OU
).
mo
de
ls f
or
Pri
ma
ry/
inte
gra
ted
ca
re
an
d i
nte
gra
ted
ca
re)
Pla
ce B
ase
d
Co
mm
issi
on
ing
: P
lace
ba
sed
co
mm
issi
on
ing
in l
oca
liti
es
an
d a
con
sist
en
t a
pp
roa
ch
to G
M p
op
ula
tio
n
he
alt
h
Loca
lity
co
mm
issi
on
ing
pla
tfo
rms
est
ab
lish
ed
an
d i
mp
lem
en
tati
on
com
me
nce
d i
n s
om
e
loca
liti
es
·
Co
mp
leti
on
of
loca
lity
pla
ns
an
d
imp
lem
en
tati
on
pla
ns.
·
Ag
ree
pla
ce b
ase
d c
om
mis
sio
nin
g s
tra
teg
y –
incl
. b
ud
ge
ts,
go
ve
rna
nce
an
d m
an
ag
em
en
t
arr
an
ge
me
nts
.
·
Ag
ree
pre
ve
nti
on
pro
gra
mm
es.
·
Imp
lem
en
t P
B
Me
nta
l H
ea
lth
:
Imp
lem
en
tati
on
of
ou
r G
M M
en
tal
He
alt
h
Str
ate
gy
·
Imp
lem
en
tati
on
of
GM
Me
nta
l H
ea
lth
Str
ate
gy
ag
ree
d a
nd
in
pla
ce.
Sta
nd
ard
isin
g
acu
te h
osp
ita
l
care
A
cute
& S
pe
cia
list
:
Sin
gle
sh
are
d a
cute
serv
ice
s co
min
g
tog
eth
er
un
de
r A
cute
Ca
re C
oll
ab
ora
tio
ns
Th
e f
ou
nd
ati
on
fo
r
tra
nsf
orm
ati
on
of
ho
spit
al
serv
ice
s is
ag
ree
d a
nd
re
ad
y f
or
imp
lem
en
tati
on
·
Init
ial
dis
cuss
ion
s o
n n
ew
pro
vid
er
mo
de
ls.
·
Fu
rth
er
wo
rk o
n p
rovi
de
r co
lla
bo
rati
ve
op
po
rtu
nit
ies.
·
Ag
ree
me
nta
l h
ea
lth
pro
vid
er
coll
ab
ora
tio
n
(lin
ke
d t
o T
DA
).
·
Ag
ree
re
spo
nse
to
Ca
rte
r re
vie
w a
nd
pro
vid
er
pla
ns.
·
Ag
ree
ne
xt s
tep
s fo
r H
ea
lth
ier
To
ge
the
r
imp
lem
en
tati
on
.
·
Ag
ree
pro
cess
fo
r a
pp
rovi
ng
acu
te c
are
coll
ab
ora
tio
n.
·
Ag
ree
ne
xt s
tep
s fo
r V
an
gu
ard
s (S
alf
ord
,
·
Imp
lem
en
t C
art
er
Re
vie
w a
nd
pro
vid
er
pla
ns
·
Ag
ree
pla
ns
for
pro
vid
er
reco
nfi
gu
rati
on
·
Ag
ree
acu
te
coll
ab
ora
tio
n
7
Sto
ckp
ort
, C
hri
stie
).
·
En
ga
ge
cli
nic
ian
s in
de
fin
ing
cli
nic
al
mo
de
ls
an
d o
pti
on
s.
·
Pro
vid
er
pro
po
sals
fo
r Y
ea
r 1
CP
s –
ba
sed
in
gu
ida
nce
.
·
Ea
rlie
r th
an
usu
al
pla
ns
for
Pro
vid
er
CP
s.
·
Ag
ree
th
e a
cute
IM
&T
str
ate
gy
.
Sta
nd
ard
isin
g
clin
ica
l su
pp
ort
an
d b
ack
off
ice
serv
ice
s
Sh
are
d S
erv
ice
s: A
un
ifie
d a
nd
evi
de
nce
ba
sed
ap
pro
ach
to
Lord
Ca
rte
r’s
fin
din
gs
·
Re
vie
w e
ffic
ien
cy a
nd
eff
ect
ive
ne
ss o
f
curr
en
t o
pe
rati
on
s.
·
Pil
ot
Tra
ffo
rd C
are
Co
-Ord
ina
tio
n C
en
tre
.
·
Sta
rt t
o c
oll
ab
ora
te a
mo
ng
st a
cute
pro
vid
ers
.
·
Co
mm
un
ica
te t
o b
ack
off
ice
sta
ff,
en
ga
gin
g
sta
ff i
n t
he
pro
cess
.
En
ab
lin
g b
ett
er
care
He
alt
h I
nn
ov
ati
on
:
Co
nfi
rma
tio
n o
f
pri
ori
ty p
rog
ram
me
s
wit
hin
th
e H
ea
lth
Inn
ova
tio
n
Ma
nch
est
er
(Hin
M)
pip
eli
ne
Co
nfi
rm p
rio
rity
pro
gra
mm
es
wit
hin
th
e
HIn
M p
ipe
lin
e a
nd
imp
lem
en
tati
on
pla
ns
·
Ag
ree
pri
ori
ty o
f p
rog
ram
me
s.
·
Ag
ree
pla
n t
o i
mp
lem
en
t th
e p
rio
rity
pro
gra
mm
es.
En
ab
lers
: P
rici
ng
an
d
con
tra
ct a
pp
roa
ch
tha
t a
lig
ns
ince
nti
ve
s
Co
mm
on
ap
pro
ach
to
info
rma
tio
n t
o e
na
ble
sta
nd
ard
isa
tio
n a
s
·
Wo
rk s
tre
am
pla
n
est
ab
lish
ed
·
Qu
ick
win
s id
en
tifi
ed
for
16
/17
co
ntr
act
ing
rou
nd
·
Ke
y p
rio
riti
es
for
16
/17
an
d 1
7/1
8
ag
ree
d a
nd
com
me
nce
d
·
Co
ntr
act
op
tio
ns
ide
nti
fie
d a
nd
eva
lua
ted
.
·
Sco
pe
ne
w p
ay
me
nt
me
cha
nis
m o
pti
on
s fo
r
GM
.
·
Pa
ym
en
t m
od
el
op
tio
ns
ass
ess
ed
an
d
pre
ferr
ed
op
tio
n a
gre
ed
.
·
Ag
ree
pla
n t
o i
mp
lem
en
t p
ay
me
nt
an
d
con
tra
cts
syst
em
.
·
Ag
ree
fo
r p
ha
sed
in
tro
du
ctio
n o
f p
ay
me
nt,
pe
rfo
rma
nce
etc
.
·
De
plo
y r
evi
sed
se
t o
f co
ntr
act
ne
go
tia
tio
n
pri
nci
ple
s fo
r 1
6/1
7 a
nn
ua
l p
lan
nin
g
gu
ida
nce
/ro
un
d.
De
sig
n a
nd
te
st n
ew
pa
ym
en
t m
od
els
Imp
lem
en
t n
ew
pa
ym
en
t a
nd
co
ntr
act
mo
de
ls
Th
e k
ey
im
ple
me
nta
tio
n
en
ab
lers
are
in
pla
ce a
nd
GM
ap
pro
ach
to
pla
nn
ing
for
17
/18
ag
ree
d
·
Est
ate
s re
qu
ire
me
nt
an
aly
sed
, co
nte
xt a
nd
imp
lem
en
tati
on
pla
n a
gre
ed
.
·
Wo
rkfo
rce
im
pa
ct m
od
ell
ed
an
d h
igh
le
vel
stra
teg
y d
efi
ne
d.
Ma
tch
ed
pa
tie
nt
lev
el
da
tase
t to
en
ab
le
co-
ord
ina
tio
n o
f ca
re
Ma
tch
ed
pa
tie
nt
lev
el
da
tase
t to
en
ab
le
co-
ord
ina
tio
n o
f ca
re
8
sca
le.
A s
ing
le E
sta
te
Pla
n
·
Ag
ree
ad
dit
ion
al
reso
urc
ed
re
qu
ire
d t
o
en
ab
le ‘
do
ub
le r
un
nin
g’
·
De
fin
e s
pe
c fo
r m
atc
h p
ati
en
t le
ve
l d
ata
set
an
d a
gre
e s
tra
teg
y t
o d
eli
ver
pa
tie
nt
leve
l
cost
ing
s.
·
IM&
T k
ey
pri
ori
tie
s d
eci
de
d a
nd
imp
lem
en
tati
on
/ p
rocu
rem
en
t co
mm
en
ced
·
Fu
rth
er
de
ve
lop
exis
tin
g ‘
Da
ta w
ell
’ h
ea
lth
info
rma
tio
n e
xch
an
ge
.
Pro
gra
mm
e
imp
lem
en
tati
on
Co
mm
un
ica
tio
n P
lan
S
op
his
tica
ted
sta
ke
ho
lde
r e
ng
ag
em
en
t
an
d c
om
mu
nic
ati
on
s
pla
nn
ing
un
de
rwa
y
·
Ag
ree
an
d i
nit
iate
pu
bli
c e
ng
ag
em
en
t w
ork
.
·
De
ve
lop
cri
sp a
nd
co
mp
ell
ing
ca
se f
or
cha
ng
e.
·
Ra
pid
po
st s
pe
nd
ing
re
vie
w m
ess
ag
es.
·
Ga
the
r in
pu
t fr
om
re
pre
sen
tati
ves
acr
oss
clin
icia
ns,
pa
tie
nts
an
d l
ea
de
rsh
ip t
o d
eve
lop
the
6 -
10
ke
y m
ess
ag
es
an
d o
utc
om
es
of
de
volu
tio
n i
n G
M.
·
Init
iate
sta
ff c
om
mu
nic
ati
on
s.
Est
ab
lish
ing
th
e G
M
he
alt
h a
nd
so
cia
l ca
re
tea
m
Fu
ll t
ea
m i
n p
lace
wo
rkin
g a
cro
ss G
M a
nd
wit
hin
th
e l
oca
liti
es
·
Ch
ief
Off
ice
r a
dv
ert
ise
d a
nd
re
cru
ite
d.
Re
cru
itm
en
t to
oth
er
crit
ica
l ro
les.
·
Ag
ree
me
nt
of
reso
urc
es
to p
roje
ct m
an
ag
e
the
tra
nsf
orm
ati
on
pro
gra
mm
e.
·
Est
ab
lish
ove
rarc
hin
g c
lin
ica
l g
ove
rna
nce
fun
ctio
n a
nd
ag
ree
str
ate
gy
an
d i
mm
ed
iate
pri
ori
tie
s.
·
Cre
ate
th
e i
mp
lem
en
tati
on
pla
n.
·
PM
O e
sta
bli
she
d.
·
Tra
nsf
er
of
NH
SE
ro
le t
o G
M H
&S
C t
ea
m –
cre
ate
ch
eck
list
of
ke
y a
rea
s a
nd
tra
nsf
er
pla
n,
incl
ud
ing
win
ter
resi
lie
nce
, C
CG
pla
nn
ing
an
d a
ssu
ran
ce a
nd
Pri
ma
ry C
are
·
Ag
ree
an
d i
ssu
e G
M s
pe
cifi
c a
nn
ua
l p
lan
nin
g
gu
ida
nce
.
Go
ve
rna
nce
A
gre
e i
mp
lem
en
tati
on
en
ab
lers
·
Ag
ree
Go
ve
rna
nce
of
Tra
nsf
orm
ati
on
Fu
nd
(QA
, C
rite
ria
).
9
·
Ag
ree
Pro
gra
mm
e M
an
ag
em
en
t ca
pa
city
an
d
cap
ab
ilit
y.
·
Mo
bil
ise
pro
gra
mm
e f
or
con
fig
ura
tio
n i
n k
ey
are
as.
·
Est
ab
lish
a G
M d
esi
gn
au
tho
rity
.
·
Ag
ree
co
mm
issi
on
ing
fu
nct
ion
s a
t a
GM
an
d
loca
lity
le
ve
l.
·
Ag
ree
jo
int
com
mis
sio
nin
g a
rra
ng
em
en
ts
be
twe
en
CC
Gs
an
d l
oca
l a
uth
ori
tie
s.
