The Greater Manchester Story Steve Wilson Executive Lead Finance & Investment

Size: px

Start display at page:

Download "The Greater Manchester Story Steve Wilson Executive Lead Finance & Investment"

Daniela Mosley
5 years ago
Views:

1 The Greater Manchester Story Steve Wilson Executive Lead Finance & Investment

2 Agenda Devolution The national context Greater Manchester The Story So Far The Future of Commissioning Local Care Provision Acute Strategy Transformation Funding Financial Planning & Reporting Capital

3 What is Devolution? Devolution of powers from central to local government emerged as flagship policy 2014 Two mutually reinforcing objectives Drive local economic growth Maximise contribution of and values derived from public services, inc health & social care Move towards place-based commissioning & decision making Drives integration of Health & Social care

4 Spectrum of Devolution Seat at the table for commissioning decisions Delegated commissioning arrangements Flexibilities within current legislative framework Devolution Act possibilities Co-commissioning or joint decision making Fully devolved commissioning (i.e. transfer of functions)

5 Principles & Decision Criteria The NHS England Board signed-off NHS England s position on devolution, including the principles and decision criteria we will apply to any devolution proposals with health in scope. Principles 1. All areas will remain part of the NHS, and are thus bound by national standards, statutory duties, the NHS Constitution and Mandate requirements 2. All parties have the opportunity to work together to shape the future of the local area 3. Principle of subsidiarity 4. Clear and appropriate accountability arrangements 5. Clear plan to support long term clinical and financial sustainability. 6. A governance model which is simple to operate and minimises bureaucracy and overheads in the system. Decision Criteria 1. Clarity of vision 2. A health geography that supports devolved decisionmaking 3. Quality and continuity of care 4. Impact on other populations 5. Financial risk management 6. Support of local health organisations 7. Demonstrable leadership capability and track record of collaboration between NHS bodies and local government 8. Demonstrable track record of collaboration and engagement with patients and local communities 9. Clear mitigation plan and exit route in the case of failure 4

6 System wide Policy Issues

7 Greater Manchester: a snapshot picture GVA Gross Value Added LEP Local Enterprise Partnership 6

Greater Manchester: a history of working together Metrolink Business Leadership Council Established Prosperity for All: GM Strategy GMCA & LEP established GM City Deal Growth & Reform Plan developed

8 Greater Manchester: a history of working together Metrolink Business Leadership Council Established Prosperity for All: GM Strategy GMCA & LEP established GM City Deal Growth & Reform Plan developed Growth Deal Interim Mayor appointed From AGMA, GMITA & Airport Thematic Commissions established Community Budget pilot Devolution Agreement Further Devolution announced Publication of the MIER TfGM established Refreshed New GM Strategy GM Strategy Health MoU

9 GM Devolution Background Greater Manchester Devolution Agreement settled with Government in November Powers over areas such as transport, planning and housing and a new elected mayor MOU Health and Social Care devolution signed February 2015: NHS England plus the 10 GM councils, 12 Clinical Commissioning Groups and 15 NHS and Foundation Trusts From April 1 st Greater Manchester has taken charge and taken responsibility in a historic first, devolution has handed the power and responsibility over to the people and the 37 local authorities and NHS organisations, primary care and other partners Local H&SC decision makers take control of estimated budget of 6 billion Overarching ambition is that all of GM public spend will be handed to GM ( 22bn)

10 GMHSCP Budgets 2016/17 9

11 What is different under devolution? GM Governance GM Partnership Team including a shared Director level appointment with NHSI Money flows in usual way through LA's or CCGs Adhere to national "business rules" for CCGs but at GM level, and GM carried out assurance of its CCGs. We are only assessed once at GM level against a bespoke accountability agreement. Place based assurance process CCG, LA, Providers Place based financial performance monitoring National decisions should be agreed with and communicated through GM 450m Transformation Fund deployed locally but need to meet national 5YFV objectives as part of overall transformation effort. RELATIONSHIPS 10

12 GM governance structure GM Elected Mayor 11

13 Finance Executive Group Membership drawn from Providers, CCGs and Local Authority Acts as Finance Committee to Partnership Board Provides sector financial leadership to and from GMHSCP back out to the system Advises on financial policy eg approach to stranded acute costs Monitors GM financial performance Oversight of financial strategy Identification and commissioning of task and focus groups to address specific areas of financial focus Capital, VAT etc 12

It was stressed that in order to deliver a sustainable health and social care

15 The Funding Gap The chart below sets out the funding gap at the time the GM CSR submission was made. It was stressed that in order to deliver a sustainable health and social care system, current levels of social care spend need to be protected in order to prevent further pressures falling on the NHS and the financial deficit widening. 14

16 A comprehensive framework for transformation underpins GM s Strategic Plan 1 RADICAL UPGRADE IN POPULATION HEALTH PREVENTION 2 TRANSFORMING COMMUNITY BASED CARE & SUPPORT 3 STANDARDISING ACUTE HOSPITAL CARE 4 STANDARDISING CLINICAL SUPPORT AND BACK OFFICE SERVICES 5 ENABLING BETTER CARE

17 Locality programmes Transformation Portfolio Bolton locality programme Salford locality programme Wigan locality programme Stockport locality programme Tameside & Glossop locality programme Trafford locality programme Manchester locality programme Bury locality programme Oldham locality programme Rochdale locality programme GM Transformation themes 1 RADICAL UPGRADE IN POPULATION HEALTH PREVENTION 2 TRANSFORMING COMMUNITY BASED CARE & SUPPORT 3 STANDARDISING ACUTE & SPECIALIST CARE 4 STANDARDISING CLINICAL SUPPORT AND BACK OFFICE SERVICES Enabling programmes GM Crosscutting programmes Enabling Better Care: IM&T; Workforce; Estates; Commissioning; Incentivising Reform; Medicines Optimisation Mental Health Cancer Transforming Care Children s services Maternity Diabetes 6

18 The Future of Commissioning Creation of 10 Integrated health and social care commissioning functions Responsible for strategic commissioning for locality Much tactical commissioning moves to local care organisations (LCOs) Standardisation of certain activities across GM Single GM commissioning hub, or Lead CCG commissioner Review of support functions across GM and within localities 17

19 Local Care Organisations Some form of LCO will emerge in each locality Integrated health & social care provision Will include primary care, community services, social care, urgent care and some acute services Will be a number of forms Single provider (could include acute) Lead provider Alliance contract 18

20 Future of Commissioner/Provider relationship 19

21 Locality Transformation Manchester 20

22 Locality Transformation Salford 21

23 Acute Strategy The Standardising Acute and Specialised Services Programme was set up to deliver the commitments outlined in the Greater Manchester Strategic Plan, Taking Charge and: 1. Radically improve the safety and quality of services and reduce variation 2. Improve productivity to achieve efficiency savings of 2.5 per cent in 2016/17, and 2 per cent per annum in subsequent years 3. Improve delivery and the interface with community based models. Trusts are working to deliver the four priority clinical standards for seven day working as part of the first phase of implementation by Increasing collaboration: trusts have agreed to a programme of collaborative efficiency and to joint working to achieve significant savings targets The GM Strategy for hospital based services will be completed by April

24 The strategy will: provide a GM wide framework for hospital based services describing the strategic direction, oversight and planning approach. Enable individual site blueprints to be produced to guide the commissioning of hospital based services in each locality. account for two thirds of all hospital activity and represent 61% of in scope acute costs in GM (in scope services represent 1.6bn of 2.7bn of in scope spend). There are also programmes of work within and across localities that are closely linked to this work: Single Hospital Service across the City of Manchester Development of the Salford/Pennine Group Greater Manchester cancer plan. 23

25 Transformation fund The opportunity areas will only be achieved with investment; a Transformation Fund of 450m has been secured. The fund will: 1. Focus on the delivery of the transformation programmes described in the Strategic Plan; 2. All applications to the fund will be independently verified to demonstrate value for money, strategic fit and robustness. 3. Be subject to a performance management framework, 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. 24

26 Transformation Fund 450m over 5 years All revenue funding All allocations supported by investment agreement Year Total Funding 1 60m 2 120m 3 153m 4 70m 5 48m Description Localities GM Wide Total 1. Radical Upgrade in Prevention 2. Transforming care in Localities Standardising Acute Care Standardising Clinical support and corporate functions Enabling better care Total

27 Financial reporting Integrated place based finance report produced monthly GM provider, commissioning and social care position Includes: Providers CIPS CCG risks LA budget Including use of reserves Transformation Fund finance report and five year model Next steps GM consolidated (health) accounts? GM control total 26

28 Capital Forecast of 1.6bn in the STP submission; 900m BAU and 700m transformational capital GM Capital strategy: Release and re-use as much capital as possible; Dispose of capital assets no-longer required to free up capital and release revenue to invest in new developments; Consider options for all sources of capital including private sector funding GM Strategic Estates Group GM prioritised capital pipeline 27

29 GM capital funding options NHS trust capital NHS England capital LA funding: prudential borrowing LIFT schemes PPP: Project Phoenix GM development partner 3 rd party development 28

30 Next Steps Future of Devolution? Refresh locality financial plans Implementation & Delivery Understanding interdependencies Secure GM digital funding Future of Specialised Commissioning 29

31 The End For further detail go to: 30

Delivering Devolution. 10 July

Delivering Devolution. 10 July Delivering Devolution 10 July Greater Manchester: Context 2.8m people 10 localities 56bn GVA Public sector spend approximately 22bn Unemployment above national average at 8.1% Health inequalities gap within