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GREATER MANCHESTER HEALTH AND SOCIAL CARE
STRATEGIC PARTNERSHIP BOARD
Date:
29 July 2016
Subject:
Update on development of GM Outcomes Framework
Report of:
Wendy Meredith, GM Director of Population Health Transformation – GM
Health and Social Care Partnership
PURPOSE OF REPORT
Previous papers have described the background and process used to develop the headline
outcome indicators for the GM health and social care devolution plan. This paper presents a
further update on this process.
RECOMMENDATIONS:
The Strategic Partnership Board is asked to:
i.
Note the development of a draft dashboard to measure the progress towards the
outcomes of the GM “Taking Charge” Health and Social Care Plan. Senior leaders are
invited to comment on the format so far, and to discuss how this might be used in the
governance processes being developed.
ii.
Note the draft outcomes framework and headline indicator set to be used in a
dashboard and scorecard. This was designed to balance breadth with coverage of key
areas.
iii.
Note that this work has been discussed at a GM task and finish group (lead by New
Economy) to align outcomes frameworks for the Greater Manchester Strategy, Health
and Social Care, Work and Skills, PSR and Life Chances work streams.
CONTACT OFFICERS:
Wendy Meredith, GM Director of Population Health Transformation
Email: [email protected]
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1. Background
1.1. Initial outcomes for the “Taking Charge” Health and Social Care Plan, published at
the end of 2015, were developed as indicative measures across the “Start/Live/Age
Well” themes of the plan. Projections about the rate of improvement needed to
narrow the gap between England and GM were made.
1.2. Further to this, it was agreed that there was a need to turn these overarching
indicators into a broader framework that would talk to both the GM Health and Social
Care Partnership Plan, and the Greater Manchester Strategy “Stronger Together”.
1.3. A working group was formed including representatives from New Economy, AQuA,
Salford City Council and the Health and Social Care Partnership to develop a
headline outcomes framework that would cover population, quality and
economic/financial outcomes. Sub-indicators were also proposed. This was
developed through use of a logic model that would link the Health and Social Care
Outcomes to the wider GM Strategy outcomes.
1.4. A headline logic model was developed to link the Health and Social Care Outcomes
to the wider GM Strategy outcomes. This is designed to show the “golden thread”
between the overarching GM Strategy vision and objectives, and the Health and
Social Care plan. Three specific logic maps underpin this – one for population
outcomes, one for quality of services (health and social care outcomes) and one for
economic / financial outcomes (See example below).
1.5. A workshop was held in April to consult partners of the approach, and the indicators
and sub-indicators have been refined further and a proposed headline outcomes
and indicator set was developed (Appendix 1)
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Example of Greater Manchester Health and Social Care Logic Map, linking HSCP to
GM Strategy
GM Strategy vision & objectives
H&SC devolution
objectives
GM is a fairer, healthier, safer
& more inclusive place to live
All GM
residents
are able to
contribute
to &
benefit
from
sustained
prosperity
& a good
quality of
life
Reform health & social care –
improved access to quality,
integrated services; greater
independence, improved
wellbeing & stronger
communities
Improve early years – support
parents to give children the best
start in life, & help workless
parents towards work
All people are valued & able to
fully participate in & benefit
from the city region’s success
– support unemployed
residents into work & enable
progression into higher skilled
& higher paid roles
Start
Well
Transforming
community
based
care &
support
Live
Well
GM is known for excellent,
efficient, value for money
services – encourage selfreliance & reduce demand
Create the conditions for growth
& place GM at the leading edge
of science & technology –
expand & accelerate the
commercialisation of research
Collaboration & partnerships –
strong collective & individual
leadership
Radical
upgrade in
population
health
prevention
School readiness;
prevention & early
intervention; behaviour
change; ‘missing
thousands’; addressing
CVD, diabetes &
dementia; healthy
workforce & supporting
older people into work
Standardising
acute
& specialist
care
Care closer to home;
LCOs, to integrate
provision across the
system; case
management;
alternatives to A&E;
effective discharge
Standardising
clinical
support &
back office
services
Services delivered at the
right level (GM, cluster,
local); consistent,
efficient, evidencebased pathways
Enabling
better
care
Age
Well
… supported by these
activities
A
financially
sustainable
health &
social care
system
GM level shared
service model; GM
care co-ordination
system; shared clinical
support services
New organisational,
contracting & payment
models; investment in
innovation & technology;
rationalised H&SC estate
… leading to these
outcomes
… impacting on
wider conditions
(GMS indicators)
Population health
outcomes
Increased
no. of
children
achieving a
good level of
development
(EYFS
attainment)
Increased
employment
(no. of FTE
jobs)
Clinical
outcomes
Reduced no.
of people
reliant on
out-of-work
benefits
Increased
median
salary
levels
Economic & financial
outcomes
Increased
GVA
growth
rate
Decreased
all-age, allcause
mortality
rates
2. Update on Progress
2.1. Further work has been completed on the sub-indicators to support the headline
indicators for the Health and Social Care Outcomes framework. This has included
further feedback from partners, and alignment to the Theme 2 work on outcomes.
2.2. A draft dashboard has been developed (see Appendix 2) for the Population strand of
the outcomes framework, which incorporates all of the headline and sub indicators.
However, this is very much a work in progress and needs further refinement to be
usable by senior leadership. It is presented here as a starting point for discussion
and consideration by senior leaders on the usability, usefulness and presentation of
this information, as well as how it might be used in governance processes moving
forward. An example of how this might also be presented in an overall scorecard is
also presented (Appendix 3)
2.3. A working group was formed at the end of June, lead by New Economy, to begin to
align the Greater Manchester Strategy outcomes framework to the frameworks that
have begun to develop across the Health and Social Care, Work and Skills, PSR
and Life Chances programmes of work. There will be an overarching framework
developed which will set the logic map framework for all of the programme specific
frameworks to feed into. This will create a “golden thread” from the Greater
Manchester Strategy through into each devolution programme. Further work that
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the group might complete includes developing support for measurement and
monitoring of the frameworks (including a consistent approach to dashboards) and
potentially guidance to support commissioners on how to show that services will
meet the GM outcomes.
3. Next Steps
3.1. The next steps are to:
a. Further develop the dashboard for each domain of the Health and Social Care
Outcomes framework (population, quality, economic).
b. Ensure that each theme of the Health and Social Care Partnership work is
aligned to the framework.
c. Senior leaders to consider the usability and usefulness of the framework , the
dashboard, and the scorecard, as well as the appropriate governance route for
these.
d. Further GM work to ensure that the Health and Social Care Outcomes align to
the Greater Manchester Strategy Outcomes and to other programmes of
devolution work.
4. Conclusion
4.1. There has been further progress in developing the GM outcomes for the GM health
and social care devolution plan. Work will continue to align this both to the Health
and Social Care Themes and to the GM Strategy outcomes.
5. Recommendations
5.1. The Strategic Partnership Board is asked to:
a. Note the development of a draft dashboard to measure the progress towards the
outcomes of the GM “Taking Charge” Health and Social Care Plan. Senior
leaders are invited to comment on the format so far, and to discuss how this
might be used in the governance processes being developed.
b. Note the draft outcomes framework and headline indicator set to be used in a
dashboard and scorecard. This was designed to balance breadth with coverage
of key areas.
c. Note that this work has been discussed at a GM task and finish group (lead by
New Economy) to align outcomes frameworks for the Greater Manchester
Strategy, Health and Social Care, Work and Skills, PSR and Life Chances work
streams.
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Appendix 1: Draft Outcomes and Headline Indicators to form a dashboard for Greater Manchester Health and Social Care Plan
Domain
Population
health
outcomes
GM Headline Outcomes
Headline Indicator (for Dashboard)
More GM Children will reach a good level of development cognitively, socially & emotionally
A1
Percentage of children achieving a good level of development
Fewer GM babies will have a low birth weight resulting in better outcomes for the baby & less cost to the
health system
A2
Low Birth Weight of Term Babies
More GM families will be economically active and family incomes will increase
A3
Children in poverty (under 16s)
A4
A5
A6
Under 75 mortality rate (disease considered preventable) from
•
cardiovascular disease
•
respiratory disease
•
cancer
More people will be supported to stay well and live at home for as long as possible
A7
Injuries due to falls in people aged 65 and over
Reduced non-elective hospital admissions / readmissions
B1
Number of admissions Due to Long Term Conditions and as rate per 100,000.
Reduced length of stay, emergency hospital admissions
B2
Reduced average length of stay for emergency admissions
Improved transition of care across health and social care
B3
Number of Delayed Transfers of Care
Reduced all cause mortality rates
B4
Standardised mortality rates for all causes
Increased cancer survival rates / reduced years of life lost from causes considered amenable to healthcare
B5
Cancer survival rates after one year and five years from diagnosis
Increased proportion of deaths occurring in (patient / carers’) place of choice
B6
Proportion dying in preferred place of death
Decreased variation in health outcomes across GM localities
B7
Improved Psychological Treatment recovery rates.
Improved outcomes for people with learning disabilities / mental health needs
B8
Patients with long term conditions feeling more supported to manage condition.
Improved patient / carer experience of care and increased patient empowerment
B9
Place Holder A workforce based survey to assess the barriers and engagement with
service transformation.
A healthy, happy workforce, fit for practice
B10
Percentage of care providers rated as good or outstanding.
More people will be in employment, with an increasing proportion in 'good work'
C1
Employment rate, resident population aged 16-64
More people will be able to stay in work for longer
C2
Employment rate, resident population aged 50-64
Reduced sickness absence, lower staff turnover and increased productivity, contributing to increased
economic growth
C3
(no robust headline indicator identified - sickness absence measure might be appropriate
- see the 'Related / subsidiary measures' column - but need to consider timeliness of
reporting)
Reduced demand for reactive health and social care services and a shift in spend to proactive provision
C4
(engage with finance colleagues to develop an appropriate headline indicator)
Accelerated development and implementation of new health and social care innovations, leading to
increased economic growth
C5
(engage with Health Innovation Manchester to develop an appropriate headline indicator)
Increased inward investment related to health innovation
C6
(engage with Health Innovation Manchester to develop an appropriate headline indicator)
Fewer people will die early from: cardio-vascular disease (CVD); cancer; and respiratory disease
Quality
Economic
/ financial
outcomes
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Appendix 2: Draft Dashboard for Population Domain of GM HSC Outcomes Framework
Below is an example of the Population Domain dashboard for the Health and Social Care Devolution Plan. This shows a worked example for Stockport LA.
This will be developed to include the sub-indicators for each of the headline indicators – e.g. for A2 a sub indicator is number of women smoking in pregnancy.
An overarching GM combined dashboard will also be created.
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Appendix 3: Example Scorecard for All Domains of GM HSC Outcomes Framework
This shows an example of how an overarching scorecard for all domains might be presented:
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