Greater Manchester Health and Care Board

Transcription

1 Greater Manchester Health and Care Board 9 Date: 14 September 2018 Subject: Report of: Greater Manchester Estates Strategy Steve Wilson, Executive Lead, Finance & Investment, GMHSC Partnership SUMMARY OF REPORT: The aim of this report is to update the Greater Manchester Health and Care Board on the work being undertaken on developing the estates programme within theme 5. The paper focuses on the following key areas: The production of an updated GM Estates Strategy The development of the GM capital Pipeline and capital financing strategy RECOMMENDATIONS: The Health and Care Board is asked to note the GM Estates Strategy and progress of the estates programme. CONTACT OFFICERS: Steve Wilson, Executive Lead: Finance & Investment, GMHSC Partnership steve.wilson6@nhs.net Neil Grice, Area Director: Strategic Estates Planning, Community Health Partnerships n.grice@communityhealthpartnerships.co.uk Murray Carr, Director of Land and Property, Greater Manchester Combined Authority murray.carr@greatermanchester-ca.gov.uk 1

2 1.0 INTRODUCTION AND BACKGROUND 1.1. The GM Strategic Partnership Board Executive received and endorsed an estates strategy in April 2017 which set out the key work programmes for GM and considered the interdependencies between the estates work and emerging outputs from the wider GM Taking Charge strategy In particular the paper considered the crucial link between the development of local and GM wide estates solutions and the transformation of health and care as a result of the GM transformational themes The Greater Manchester health and social care strategic plan, Taking Charge describes how partners across GM will secure the clinical and financial sustainability of health and social care through a programme of transformational change between 2016/17 and 2020/21. The strategy outlined the themes through which transformation would be delivered. These themes are shown in the diagram below: 1.4. Enabling Better Care, details the changes which will be required to support the delivery of health and care in the future. In addition to work on workforce, digital, research and development, incentives and new organisational structures, this element of the strategy sets out the work that will be required to ensure the buildings from which we deliver care are appropriate for the services we will deliver as well as being of high quality and cost effective. 2

3 2.0 UPDATED GM ESTATES STRATEGY 2.1. The updated GM Estates Strategy approved by the Partnership Executive Board in June 2018 is attached as appendix 1. The key elements in the strategy are highlighted below: 2.2. Estates Vision The vision for Health and Care Estates in Greater Manchester is: Seek to drive maximum value from the public estate in order to enable the delivery of our local strategic & national policy objectives. Drive development of more 'fit for purpose' flexible & cost efficient estate. Long term this should lead to social & economic benefits including additional housing delivery; economic & employment growth. To move beyond the initial focus on health and care towards a broader, place based approach, strengthening links to the GMCA and the One Public Estate (OPE) Programme 2.3. Key Drivers of Estates Strategy The estates work stream is rightly considered an enabler to the delivery of Taking Charge. It is therefore critical it responds to the developing needs of a transformed model of delivery of health and care across GM and within individual localities The development of individual strategies across all GM themes and within clinical cross cutting areas will all have an impact on the requirements of our physical infrastructure across GM. In addition the work within the other enabling programmes, in particular the Digital and Workforce work streams will be significant drivers of the way we use our estate to deliver clinical and wider services The strategy sets out how these drivers have influenced our individual GM estates programme highlighting the following key implications: Reconfiguration of the estate to ensure the strategic plan can be delivered from a property base that is fit for purpose in terms of location, configuration and specification. Through the combined effect of a radical upgrade in prevention, scaling up primary care, integration of health & social care and the standardisation of clinical support and back office services, there should be a reduced need for hospital capacity due to inappropriate demand. There will be requirements for multi-purpose community based hubs accommodating integrated primary care, community health and adult social care services and enhanced provision of step down services preventing inappropriate demand for acute beds. 3

4 Provide increased economic and social value through the re-use of surplus land and property for housing and employment opportunities. Rationalise estate and maximise disposals. Efficient management and increased utilisation of the public estate to reduce total property 3.0 KEY ESTATES PROJECTS AND PROGRAMMES 3.1. The GM Strategic Estates Board has developed a range of projects and programmes to support delivery of the estates outcomes and they are outlined below Place-based Master Planning of Acute Sites A GM master planning Framework has been developed which involves undertaking reviews of acute sites to look at how the estate could be better used to support the delivery of the STP and locality strategies taking into account the wider public service context and linking to Locality Asset Review processes The key objectives are to identify opportunities for efficient and effective capital developments if required, improve utilisation of acute sites and identify land for disposal and housing development The master planning programme will ensure robust communications links with the Standardising Acute Hospital Care programme and involve their representatives in the programme governance to ensure that process and timings are aligned to ensure maximum mutual benefits for both work streams Improving Utilisation Work is ongoing to improve the utilisation of health and social care facilities across GM. The initial work has focussed on community based facilities but it is planned to roll this out to acute sites. Over the past couple of years utilisation studies have been undertaken at the key community sites across GM to identify a baseline position. We have established a key objective: To optimise the utilisation of modern, long-term, multi-use Health Centres to a target utilisation better than 80%. Going forward it will be important to carry out utilisation studies at acute sites to support reconfiguration and business development as well as re-visiting community sites to measure improvements in utilisation NHS Office Rationalisation A programme of work has commenced to rationalise the NHS owned and leased office estate across GM. This programme involves rationalisation of a number of (non-clinical) office sites owned or leased by NHS Property Services across Greater Manchester to generate savings on running costs. There is an aspirational target of 4

5 30% reduction that would achieve running cost savings in the region of 5m per annum In the past two years there have been over 2m savings achieved and a further 3m planned by December Locality Asset Reviews (LAR) Programme LARs offer an integrated place based approach to understand community performance and needs, public service delivery and service transformation. They take a holistic view across all public sector organisations and their combined asset base. This approach will contribute to the delivery of the ambitions and priorities of the Greater Manchester Strategy The primary purpose of LARs is to appraise all public sector estate within a locality or neighbourhood in order to ensure that it is effective, appropriate and fully utilised, and, working across all service sectors to assemble where appropriate, right- sized asset solutions to reinforce an integrated place based approach that underpins the ambitions for improved health and community outcomes, social and economic regeneration. LAR acts as a vehicle for maximising or unlocking value from the public estate. The completed LAR informs the development of subsequent business cases Surplus Land, Disposal and Development of Housing Units A GM working group has been established to support the identification of surplus land and disposal opportunities as part of the GM Devolution Deal Memorandum of Understanding with the Department of Health (DH) and GM Partners. The focus is on identifying land and buildings that will become surplus and progressing opportunities to release land for housing or employment opportunities where possible. The group works to collate information on housing numbers and capital receipts to meet the DH national target The objective of this programme is to identify opportunities for disposals or release of land for housing or employment opportunities. A surplus land and disposals list has been created for GM and target housing numbers and capital receipts established. Capital receipts and the associated revenue savings will be invested in improving service provision across GM GM Mapping - Health and Social care data mapping The aim of this work programme is to create an online map that captures: The entire public sector estate in Greater Manchester Infrastructure across the city region Public services and where they are delivered from Future investment opportunities in social and physical infrastructure 5

6 3.7.2 This will help to inform the strategic planning of estates including the delivery of the key programmes of work including LARs. The GM map takes information from the NHS SHAPE Dashboard, EPIMS, GMSF, and all other GP partner organisations. Layers of data have been created to capture specific estates and service data to inform the divestment and investment strategy It will enable us to have up to date, accurate information about our existing and planned future estate to inform strategic planning across health, and to utilise health data to inform strategic planning in other service areas Develop GM wide Mental Health Estates Strategy GM HSCP in partnership with Pennine Care and Greater Manchester Mental Health are developing a GM wide Mental Health Estates strategy. The strategy will cover the short, medium and long term to support investment that will see significant improvements in care and services for the next years. It will be for the whole of Greater Manchester (covering 2.8m population) embracing all NHS providers and commissioners of MH services including community provision The objectives of the work are to have a clear strategy for the GM Mental Health Estate and to identify opportunities for improvement. Key drivers include: An opportunity for the three main providers of Mental Services in GM to work together to develop an Estates Strategy linked to the Mental Health Service Strategy for GM Analysis of the estate portfolio - existing in-patient and community estate; data analysis; consultation & site visits; information consolidation The work will review existing services including where, what and length of contract; review service strategies for Adult MH, Older People, CAMHS, Specialist /Forensic services for each Trust and include consultation on capacity and estate challenges The aim of the programme will be to develop organisational estate strategies aligned with clinical / service strategy brought together to present a GM wide picture Supporting Locality Strategic Estates Groups Effective Strategic Estates Groups (SEGs) with the appropriate governance, leadership, membership and resources are crucial to driving forward the estates strategy in GM. A Health Check of each SEG was undertaken during 2017 and this has helped to identify the changes required to ensure they are fit for purpose and the recommendations arising have been actioned and will be included in their ongoing implementation plans The programme of work has included providing support including specialist estates advice and guidance to GM SEGs including supporting localities with recruitment processes as well as levering in capital and revenue funding. This also includes 6

7 supporting localities to set up Operational Working Groups to drive the delivery of estates projects. The work has also involved developing a prioritisation tool to assist localities prioritise community and acute capital estates developments. 4.0 DEVELOPMENT OF THE GM CAPITAL PIPELINE AND GM CAPITAL FINANCING STRATEGY 4.1. A robust and comprehensive capital pipeline is essential to the delivery of the GM estates strategy. A number of the transformation programmes across GM will be dependent on capital investment and new development The GM capital pipeline has been reviewed and subjected to an independent assurance process which has led to a more realistic profile of investments within localities. Work has also been undertaken with NHS providers to ensure that the pipeline captures all capital requirements from that sector Alongside work to develop a robust capital pipeline it is essential there is a clear understanding of the potential funding source for any future investments. SMHSCP will need to maximise the opportunity to access appropriate sources of capital GM has a successful track record of bidding for national NHS strategic capital funding, receiving approval for 93m of investment in the Major Trauma and Healthier Together programmes out of a total wave 1 national pot of 325m. We have submitted a number of bids as part of subsequent waves of national funding and expect a response in November, however it is clear additional sources of funding will need to be considered if the pipeline is to be realised in full. 5.0 RECOMMENDATIONS 5.1. The Health and Care Board is asked to note the GM estates strategy and progress of the estates programme. 7

8 Greater Manchester Estates Strategy July 2018

9 Greater Manchester Strategic Context

10 GM Strategic Plan: 'Taking Charge' Locality programmes Bolton; Salford; Wigan; Stockport; Tameside & Glossop; Trafford; Manchester; Bury; Oldham; Rochdale GM Transformation themes Enabling programmes GM Cross-cutting programmes Enabling Better Care; IM&T; Workforce; Estates; Commissioning; Incentivising Reform; Medicines Optimisation Mental Health; Cancer; Transforming Care; Children s Services; Maternity; Diabetes * * Information Management & Technology 3

11 Greater Manchester Estates Vision The Vision for Estates in Greater Manchester Drive maximum value from the public estate to enable the delivery of our local strategic & national policy objectives. Drive development of more 'fit for purpose', flexible & cost efficient estate. Long term this should lead to social & economic benefits including additional housing delivery, economic & employment growth. Now moving beyond the initial focus on Health and Social Care towards a broader, place-based approach, strengthening links to the GMCA and the One Public Estate (OPE) programme. Estates vision underpinned by a robust Finance Strategy on how GM intends to fund the pipeline with an initial priority to work with Department of Health & Social Care on agreeing how to structure Local Authority investment to minimise impact on Capital Departmental Expenditure Limit (CDEL). 4

12 GM Service Strategy & Estates Implications KEY STP SERVICE STRATEGY THEMES GM TRANSFORMATION THEMES a. Radical upgrade in population health prevention b. Transforming community based care & support c. Standardising acute & specialist care d. Standardising clinical support & back office services GM CROSS-CUTTING PROGRAMMES a. Mental Health b. Cancer c. Transforming Care d. Children s Services e. Maternity f. Diabetes STRATEGIC OBJECTIVES a. Transforming the H&SC system to help more people stay well & take better care of those who are ill b. Aligning our Health & Social Care system to education, skills, work & housing c. Creating a financially balanced & sustainable system d. Making sure our services are clinically safe throughout IMPLICATIONS FOR FUTURE ESTATE PRIORITY AREAS TO ADDRESS ARE: 1. COLLABORATION BETWEEN HEALTH AND OTHER PUBLIC SECTOR BODIES: Maximise opportunities around transport, housing etc. via SEG. Enable wider and more targeted use of existing facilities for the prevention agenda 2. HAVE A FLEXIBLE, RESPONSIVE ESTATE WITH SPECIALIST HUBS: Use high quality estate that is strategically located in order to maximise local offer 3. NEIGHBOURHOOD PROVISION RIGHT FOR PATIENTS AND PRACTICAL FOR STAFF 4. IMPLEMENT URGENT/EMERGENCY CARE MODEL: Enable delivery of appropriate urgent care strategies within high quality buildings 5. OUT OF HOSPITAL AND PRIMARY CARE: Strengthening primary care by consolidation into larger sustainable provision. Identifying non-inpatient services to be moved from hospital sites to the most appropriate location 6. INVESTMENT IN MENTAL HEALTH: Support mental health development around provision of community services and UC/A&E services 5 ESTATES STRATEGY DELIVERY ENABLERS PLACE-BASED STRATEGIC ESTATES PLANNING Grow Locality Strategic Estates Groups (SEGs) Locality Asset Reviews (LAR) Masterplanning of Acute Sites Mental Health Estates Strategy Health and Social Care Data Mapping DIVESTMENT Surplus Land, Disposal & Development of Housing Units NHS Office Rationalisation /Office Consolidation Utilisation & Estates Optimisation INVESTMENT Capital Investment Pipeline and Financing Strategy Delivery of Capital Estates Projects

13 Greater Manchester Estates Delivery

14 GM Estates Delivery Enablers PLACE-BASED STRATEGIC ESTATES PLANNING Grow Locality Strategic Estates Groups (SEGs) Locality Asset Reviews (LAR) Masterplanning of Acute Sites Mental Health Estates Strategy Health and Social Care Data Mapping Delivery DIVESTMENT Surplus Land, Disposal & Development of Housing Units NHS Office Rationalisation /Office Consolidation Utilisation & Estates Optimisation INVESTMENT Capital Investment Pipeline and Financing Strategy Delivery of Capital Estates Projects 7

15 Enablers: 1. Grow Strategic Estates Groups (SEGs) Summary SEGs are successfully established across all ten localities in GM with good governance and communications including a quarterly SEG Chairs Forum. They are at various stages of development and the GM Estates Delivery Unit has provided support including specialist estates advice and guidance to SEGs as well as supporting localities with recruitment processes and support to lever-in capital and revenue funding. Revenue funding of 4.875m secured over 3 years this funding is a combination of ETTF, OPE, CHP and Transformation Fund monies used to grow the Strategic Estates Groups and fund additional resources including staff to progress the estates work streams identified in the strategic estates plans in each Locality. Objectives To support and enable SEGs to develop and deliver locality and GM estates strategies, which contribute to achieving the estates vision. Outcomes The aim of this work is to support each of the SEGs to develop and drive the implementation of the estates strategy in their area: Completed support in 2017/18: Bespoke health checks completed for each locality SEG Workshops to review capital investment pipeline in each locality Bespoke workshops held with localities e.g. governance, hub development, senior stakeholder buyin ToR updated in line with a place-based approach SEG toolkit developed with standardised templates Project prioritisation checklist developed Operational Working Groups (OWGs) set up in most localities 8 Future support: Continuing support from GM Estates Delivery Unit Support with recruitment of estates roles in localities Ongoing reviews of investment pipeline and disinvestment plans Implement GM Project Governance approach Development of GM Capital Gateway Review Process Development of a GM Social Value Policy Development of an approach to support development of estates capacity and expertise

16 Enablers: 2. Locality Asset Reviews (LAR) Summary LARs offer an integrated place based approach to understand community performance and needs, public services delivery and service transformation, taking a holistic view across all public sector organisations and their combined asset base. Revenue funding of 770k from OPE and ETTF has been secured to roll-out the programme. A final report outlining GM Strategic Estates opportunities is to be completed end of 2018 / 2019, to feed into GM estates strategy. Objectives The need to undertake LARs has derived from other holistic strategies and national reviews such as the Five Year Forward View, Carter Review and Naylor Review. These strategies have identified the changing needs of residents, how services should be delivered and the means to enhance efficiency savings across localities. The primary purpose of LARs is to appraise all public sector estate within a locality or neighbourhood in order to ensure that it is effective, appropriate and fully utilised and, working across all service sectors to assemble where appropriate, right-sized asset solutions to reinforce an integrated place based approach that underpins the ambitions for improved health and community outcomes, social and economic regeneration. LARs act as a vehicle for maximising or unlocking value from the public estate. The completed LAR informs the development of subsequent business cases. Examples of outputs might be identifying opportunities for surplus land for housing and employment or developing a locality specific strategic outline case. Outcomes Contribute to an integrated place-based approach Undertake a health need analysis linked to Greater Manchester Spatial Framework (GMSF) and increased housing projections to 2035 Encourage service integration via co-location of services Deliver services in line with the needs of the local community within and across neighbourhoods Increase capacity for primary care services delivered out of an acute setting Contribute towards increased utilisation across the estate Align with OPE principles (e.g. release land for housing, job creation, annual revenue savings, capital receipts etc.) 9

17 Enablers: 3. Masterplanning of Acute Sites Summary Undertake place-based Masterplanning of acute sites to review usage of sites, dovetailing into the Locality Asset Reviews (LARs) in each locality and informing development of the GM Capital Financing Strategy. Revenue funding of 690k has been secured to deliver this programme of work during 2018/19. A final report outlining GM Strategic Estates opportunities is to be completed end of 2018 / this will feed into the GM estates strategy. Objectives To optimise support for modern health and social care delivery across the wider area, which each acute site serves, and to identify opportunities for efficient and effective capital developments if required, to improve utilisation and identify land for disposal. Outcomes Bolton FT Masterplan has already been completed and North Manchester General Hospital is underway. Masterplanning will be rolled out to all other acute sites in GM during 2018/19: total programme funding of c 690k has been secured from the GM Transformation Fund. Outcomes will include: Developing a phasing and implementation schedule to identify priorities for action Conceptualise and shape a three-dimensional site plan Determine the mix of uses and their physical relationship Engage the local community and act as builder of consensus Identify key collaboration opportunities via OPE Relate land disposal opportunities to the GM Spatial Framework 10

18 Enablers: 4. GM Mental Health Estates Strategy Summary GMHSC Partnership in partnership with the GM Mental Health providers is developing a GM-wide Mental Health Estates strategy. The strategy will cover the short, medium and long term to support investment that will see significant improvements in care and services for the next years. It will cover the whole of GM embracing all NHS providers and commissioners of Mental Health services including community provision. This will be completed by September The estates strategy is being developed in parallel with the GM mental health service strategy. Objectives To have a clear strategy for GM Mental Health Estate and to identify opportunities for improvement. Key drivers include: An opportunity for the three main providers of Mental Health Services in GM to work together to develop an Estates Strategy linked to the Mental Health Service Strategy for GM Creation of new Greater Manchester Mental Health NHS Foundation Trust (following Greater Manchester West NHS Foundation Trust s acquisition of Manchester Mental Health and Social Care Trust in 2017) Outcomes Analysis of estate portfolio - existing in-patient and community estate Review of existing services including where, what and length of contract: review service strategies for each Trust Development of organisational estate strategies aligned with clinical/service strategies brought together to present a GM wide picture Identification of urgent capital investment projects, i.e. female Psychiatric Intensive Care Units (PICU) beds (@c 5m) and the redevelopment of Park House in-patient unit at NMGH (c 70m) Identification of disposal opportunities Development of next steps and timescales Phase 1: In-patient February to April 2018 Phase 2: Community May to July 2018 Interim reports May 2018 Individual Trust Estates Strategies July to August 2018 Final report GM wide Strategy outlining GM wide strategic estate opportunities September

19 Enablers: 5. GM Health and Social Care Mapping Summary GM is engaged in a unique project to create online mapping tools that attempt to capture: the entire public sector estate in Greater Manchester; infrastructure across the city region; public services and where they are delivered from; and future investment opportunities in social and physical infrastructure. Layers of data have been created to capture specific estates and service data to inform the divestment and investment strategy. Localities can access these maps via an online portal to help with strategic estates planning. Revenue funding of 146k secured over 2 years. Objectives To have up-to-date, accurate information about our existing and planned future estate; to inform strategic planning across health; and to utilise health data to inform strategic planning in other service areas. Outcomes Mapping health, social care and wider public sector estate assets and services Identify relevant data schemas across the city region, standardising data collected Produce bespoke maps of existing hubs, new developments, investment and divestment proposals (including opportunities for housing development), Trust sites, Six Facet Survey ratings of GP premises and utilisation levels of sites The data gathered so far brings together existing data sets across GM, rather than on a CCG by-ccg basis. Two maps are currently open to access by those with a direct link (health and local government estates teams): 1. The Health Assets map pulls together all the data from SHAPE, alongside CCG boundaries, neighbourhood clusters (30,000-50,000 population groupings) and proposed new health and social care hub facilities developments from the capital pipeline 2. The Capital Investment Pipeline map pulls together data on the capital pipeline (including the entire pipeline, with a subset looking at proposed health and social care hub facilities), along with hospitals, GP practices, neighbourhood clusters, and CCG boundaries By collecting the data across GM, we can create a number of bespoke maps, showing a variety of these datasets together. 12

20 Data Mapping GM Health and Social Care Mapping Example 13

21 Delivery: Divestment - 1. Surplus Land & Disposals Summary A GM working group has been established to support the identification of surplus land and disposal opportunities as part of the GM Devolution Deal MOU with Department of Health and Social Care (DHSC) and GM Partners. The focus is on identifying land & buildings that will become surplus & progressing opportunities to release land for housing or employment opportunities where possible. The group works to collate information on Housing numbers and Capital receipts to meet the DHSC National Target. See slide 54 for further details. Objectives To identify opportunities for disposals or release of land for housing or employment opportunities. The Locality Asset Review (LAR) and Masterplanning programmes will provide significant additional opportunities as they are completed during 2018/19. To release Public Sector Land and Property for regeneration, housing and growth via the One Public Estate Programme. Outcomes The supported housing Completed: target is 17,500 additional Surplus Land and Disposals list created for GM and target Housing numbers and units up to 2023; circa 750 Capital receipts housing units can be GM Surplus Land and Disposals Group established delivered through the Ongoing/Future: release of surplus land Ongoing work to identify opportunities for surplus land and disposals Review GM Surplus Land and Disposals list and target Housing numbers and Capital receipts Work to bring together wider local authority and partner data and move towards broader, place-based approach in line with the principles of One Public Estate. LAR data and Acute Site Masterplans will dovetail into this process Develop disposal plans including transfer of sites to Homes England As part of the development of this revised STP estate strategy, there has been careful consideration of land likely to become surplus to requirements that can potentially be taken forward for planning and disposal in the next 5 year period. Land values in GM are significantly constrained compared to those in the South of England. The review has identified 52 sites that have the potential to release surplus land of 30.46ha that would allow development of c1,659 housing units and generate capital proceeds of c 37.66m subject to successful planning consents 14

22 Delivery: Divestment - 2. Office Rationalisation / Consolidation Summary GM wide programme to rationalise non-clinical office sites owned or leased by NHS Property Services. There is an aspirational target of a 30% costs reduction that would achieve running cost savings in the region of 5m pa m (net) savings have been achieved in the last 2 years and a further 3m (gross) planned by December Objectives To rationalise non-clinical office space at NHS PS sites to generate savings on running costs. Starting position: c50 property interests across 29 properties Total floor area of c42k sqm (would equate to c5k workstations at 8 sqm / ws) Total annual running costs of c 15m Majority of estate is leasehold with a number of contractual opportunities before 2020 Outcomes Key highlights are: New Century House, Tameside - the CCG has co-located with the LA, saving 660k p/a 3 Piccadilly Place - potential to vacate one floor at 2019 lease end date Silver Street, Bury - relocated to Townside & Knowsley Place in Bury making significant savings Shire Hill, Glossop - back office and services being moved to Glossop PCC. This achieves a saving, improves access to services, and improves utilisation of a LIFT building Project underway to relocate Bolton CCG from current St Peters House office accommodation Beckwith House & Kingsgate House, Stockport - NPV savings of 900k+ over 5 years 15

23 Delivery: Divestment - 3. Improving Utilisation Summary Making optimal use of the existing estate is a key enabler of the overall Estates Strategy. The GM estate varies considerably in terms of quality and suitability for service provision, with a number of good quality buildings under-utilised and others no longer fit for purpose. The public sector in GM is paying lease charges for facilities whether they are fully utilised or not. The difference in cost between average utilisation in key buildings of c.50% utilisation (over 50 buildings have been surveyed since 2015) and our target of >80% is c 17m p.a. Objectives To optimise the utilisation of modern, long-term, multi-use Health Centres to a target utilisation better than 80% and to relocate services from buildings which are no longer fit for purpose so that they can be rationalised or disposed of. This will make the most effective use of the public estate across GM and minimise running costs. SEG Operational Working Groups (OWGs) are a crucial means of improving utilisation within localities and are able to present study data when facilitating service moves and public sector co-location opportunities. A GM Utilisation Group oversees this work. Outcomes Completed: Over 50 utilisation studies completed at community sites. 17 of these were undertaken in March-April OWGs have used utilisation data to facilitate key projects. There has been work to improve utilisation levels at key sites. For example, the Walkden Gateway Centre in Salford has extended its out of hours provision. Secured funding for 3,200 utilisation sensors for use across GM so that reporting can become a continuous activity rather than a snap shot in time. Several organisations have developed agile working policies to encourage flexible use of space. Ongoing/future: A paper was endorsed at our Strategic Estates Board in June which proposes that we focus on five key workstreams: focusing on priority sites, stakeholder engagement, providing OWGs with support, monitoring progress and reporting. Working with property companies to develop a more flexible approach. This includes working with CHP to roll out Dynamic Capacity Management (flexible leasing/building stakeholder groups) in pilot areas of Wigan and Bury. NHS PS is also leading on Office Rationalisation and an initiative on sessional space. 16

24 Delivery Investment 1. Capital Investment Pipeline Strategy Future Proofed Capital Pipeline: Providing assurance, managing capital exposure risk and supports VFM funding framework Scope includes estates, medical equipment, IM&T and will cover social care in the future Assurance with capital pipeline aligned to influencing factors LAR, Masterplanning, Utilisation, Disposals, OPE Locality Plans Provider Capital & Finance Plans Pipeline Aligned to Influencing Factors Service Strategies & Commissioni ng Backlog Maintenance Medical Equipment IM&T Strategic Estates & Transformation Realisation Primary & Community Revised pipeline communicating deliverable schemes aligned to key drivers Mapping future strategic projects which will add to investment requirement Provider Capital pipeline based on three components: prioritised funded capital; unfunded capital risk; and strategic capital Linking asset registers to quantify future capital risk Engage & Refine Revised SEG Governance and assurance for future projects Inclusion of social care investment in future iterations 17

25 Delivery Investment 2. Funding Strategy Strategy Development of a strategic finance framework for existing and future capital investment using four building blocks set out here Using detail on assets (funding requirement, scope, ownership) in the pipeline to confirm investment quantum, finance terms and commercial structures with different providers of capital Initial focus on existing strategic partners in particular Local Authorities and GM LIFT companies and proposed RHIC procurement model Strategic Alignment Accounting Framework Value for Money Asset & Service Requirements Realisation Stage 1 Strategic Partner Assessment Agree with DHSC accounting treatment and CDEL impact of Local Authority Investment and leases Understand investment appetite of partners: Local Authorities, LIF, RHIC Stage 2 Quantify Quantify known Sources & Uses of capital funding and determine potential funding gap to source from alternative providers Develop funding strategy to bridge remaining funding gap Stage 3 Engage & Refine Develop market engagement strategy and engage with new providers and corporates Refine Funding Strategy 18

26 Wave 1 Strategic Capital Approvals

27 STP Capital Wave 1 Healthier Together GM was successful in attracting 63m of NHS Capital from Tranche 1 of the STP Capital allocation. This will be used to deliver the Healthier Together programme. Purpose Healthier Together was designed to address the following service issues: Variations of care across Greater Manchester reflected in high mortality rates for particular conditions. Lack of compliance with national standards that exist in Greater Manchester for General Surgery, Emergency Medicine and Acute Medicine. Variation in the number of emergency general surgical admissions. Variations in length of stay, average length of stay. Variation in the attainment of quality and safety standards for Emergency and Acute Medicine, with lower than national average performance against the 4 hour A&E waiting time target. Overview of Scheme 1. All hospitals in Greater Manchester will make a series of improvements to the way that they deliver Acute Medicine, A&E and General Surgery in order to deliver a step change in performance. 2. High risk elective and all emergency general surgery will be concentrated onto 4 hub sites. Expected Benefits Reliable care - elimination of variation, equitable care, accountability. Rapid senior decision making (General Surgery (GS) & Emergency Department (ED)) right care, right place, right time. Tangible outcomes which are visible to the service e.g. National Emergency Laparotomy Audit (NELA) audit outcomes access to CC, timely access to theatre, clinical risk management. Recent agreement to use Society for Acute Medicine Benchmarking Audit (SAMBA) indicators in clinical benefits dashboard. 300 lives pa (GS) upper quartile outcome performance Increase in ambulatory care (GS & ED). 20

28 STP Capital Wave 1 Major Trauma GM was successful in attracting 30m of NHS Capital from Tranche 1 of the STP Capital allocation. This will be used to deliver the Major Trauma project at Salford Royal (SRFT). Purpose Overview of Scheme Expected Benefits The Major Trauma Project was developed to address the following service issues: Review of adult Major Trauma services in Greater Manchester recommended that a single Principal Receiving Site (PRS) be established and that this Major Trauma Centre (MTC) for GM s adult population should be based at Salford Royal (SRFT). Once established, this would represent the largest Major Trauma Centre in the UK. The current A&E department at SRFT, opened in 2011, is now managing nearly 40% more attendances than it was designed for. Salford Royal, in July 2016, became an integrated provider of health and social care services. This closer working of Salford Services and the expansion of high acuity services and consequent increase in patient numbers requires a new and differentiated response for local and GM patient flows. 1. The vision, which aligns to one of the five transformation priorities in GM Standardising Acute and Specialist Care - is for a single service, delivered in partnership across organisational boundaries, for the adult Major Trauma patients in GM, with outcomes to match the best in the world. 2. Dedicated receiving facilities will enable time critical assessment with diagnostics, co-located with theatres and critical care to ensure optimal care is provided within the first few hours following injury by experienced staff for Major Trauma patients. Potential to save additional lives beyond those already saved through the existing major trauma arrangements. Reduction to A&E attendances. Reduced inter-trust patient transfers. Improved outcomes (e.g. less long term care required). Avoided capital investment at other centres. Improved productivity and recurrent revenue savings. 21