Manchester Health and Care Commissioning Board
A partnership between Manchester
City Council and NHS Manchester Clinical Commissioning Group
Agenda Item:
3.1
Date:
Report Title:
Strategy Update
5 April 2017
Ed Dyson
Executive Director – Planning and Operations
Prepared by:
Presented by:
Summary of Report:
Leigh Latham
Head of Strategy and Planning
Dr Philip Burns – Chair
Ed Dyson - Executive Director – Planning and
Operations
This paper sets the scene, strategically, for
Manchester Health and Care Commissioning (MHCC).
It also sets the direction for MHCC as an organisation
based upon work progressed through its predecessor
organisations and external stakeholders.


Strategic Objective:



Board Assurance
Framework Risk:
Outcome of Impact
Assessments completed
(e.g. Quality IA or
Equality IA):
Outline public
engagement – clinical,
stakeholder and
public/patient:
To improve the health and wellbeing of people
in Manchester
To strengthen the social determinants of health
and promote healthy lifestyles
To ensure services are safe, equitable and of a
high standard with less variation
To enable people and communities to be active
partners in their health and wellbeing
To achieve a sustainable system
N/A
N/A
N/A
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Recommendation:
The MHCC Board is asked to discuss and endorse the
continued strategic direction set out in this paper.
1.0 Introduction
This paper sets out the strategic context for Manchester Health and Care
Commissioning (MHCC) and introduces its strategy, which is under continued
development.
The Board is asked to discuss the paper and endorse the continued strategic
direction set out in this paper.
2.0 Strategic Context
2.1
General overview
The strategic context in which MHCC operates is complex and changing. It has a
national, Greater Manchester and Manchester aspect to it. This context determines
how it guides the health and social care system toward our vision but also how we
guide the system through difficult times in terms of finance, service resilience and the
wider impacts of austerity.
2.2
City context
Our Manchester
The Our Manchester strategy sets out clear aims for the City of Manchester and also
a new way of approaching our work which builds upon assets in communities and a
new relationship with the public. The key strategic aims are:•
A thriving and sustainable city: supporting a diverse and distinctive
economy that creates jobs and opportunities
•
A highly skilled city: world class and home grown talent sustaining the city’s
economic success
•
A progressive and equitable city: making a positive contribution by
unlocking the potential of our communities
•
A liveable and low carbon city: a destination of choice to live, visit and work
•
A connected city: world class infrastructure and connectivity to drive growth
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MHCC needs to consider not only the effective commissioning of health and social
care but also the health and care system contribution to the City strategy and vice
versa. Health and social care organisations have a significant role in the delivery of
these aims.
Manchester public sector organisations will take a new approach to their work. It will
build upon the assets within neighbourhoods and create a new relationship with the
public by building a stronger understanding of people and communities. In the
development of Manchester Health and Care Commissioning, and its strategy, this
way of working has been used. Staff engagement with regard to development of
MHCC has used to start to instil these ways of working within teams as well as being
used as a mechanism to design the organisation.
The Manchester Locality Plan – A Healthier Manchester
The Manchester Locality plan was developed as Manchester’s response to the
devolution of health and social care to Greater Manchester. The plan sets out how
the health and social care system will become financially sustainable and improve
population health by 2021. This evolved from existing joint work led by Manchester’s
Health and Wellbeing Board. In essence the locality plan seeks to scale up our work
in order to completely transform the health and care system. This includes new
models of care and new organisational forms. These include a Local Care
Organisation (LCO) which will be a single provider of out of hospital care. In addition
a Single Hospital Service which will include Central Manchester Foundation Trust,
University Hospitals South Manchester and North Manchester General Hospital
becoming a single Foundation Trust for the City of Manchester. The plan includes a
proposal for a Single Commissioning Function which can commission health, social
care and public health for the City through one organisation. Manchester Health and
Care Commissioning is now established as this function.
The Locality Plan sets out the vision for achieving a financially sustainable system
and improved population health. It is important that productivity and efficiency
continues as a means of creating financial sustainability but the transformation of
care which achieves a healthier population will reduce the need for high cost acute
and long term care. Keeping people healthier enough not to need costly
interventions is the means by which we achieve these aims on a sustainable basis.
2.3
GM context
In February 2015, the 37 NHS organisations and local authorities in Greater
Manchester signed a landmark agreement with the Government to take charge of
health and social care spending and decisions; the Greater Manchester Health and
Social Care Partnership is the body which is overseeing devolution and the £6bn
health and social care budget.
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Through devolution, the GM partnership developed a comprehensive plan for health
and social care, ‘Taking charge of our Health and Social Care’ with the overall vision
to deliver the greatest and fastest possible improvement to the health and wellbeing
of the 2.8m people of Greater Manchester. The plan ultimately aims to secure
improvement in seven population health outcomes spanning the life course, outlined
below:
•
More GM children will reach a good level of development cognitively, socially
and emotionally.
•
Fewer GM babies will have a low birth weight resulting in better outcomes for
the baby and less cost to the health system.
•
More GM families will be economically active and family incomes will
increase.
•
Fewer will die early from cardio-vascular disease (CVD)
•
Fewer people will die early from cancer
•
Fewer people will die early from respiratory disease
•
More people will be supported to stay well and live at home for as long as
possible
The GM strategic plan set out five priority Transformation Themes through which the
work is being focused, outlined below in Figure 1, which also shows how these
priorities align the wider public sector reform agenda being driven by the Greater
Manchester Public Service Reform Team, who are supporting localities across
Greater Manchester to shape their reform plans.
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Essentially, the achievement of the GM plan it will be through the combined delivery
of programmes within the GM Transformation Themes; the 10 Locality Plans, of
which a Healthier Manchester is one; GM wide enablers; and cross cutting GM
Programmes.
Manchester will work as one of ten districts within Greater Manchester in delivery of
its own plan but also contributing towards the GM plan in terms of working within that
framework as well as supporting GM programmes. Our key programmes fit within
this framework and influenced its development.
2.4
National context
In October 2014 NHS England published the Five Year Forward View (5YFV), which
described the key aspiration of tackling the growing gaps in ‘health and wellbeing’,
‘care and quality’ and ‘funding and efficiency’. This key policy document sets out the
context within which the subsequent plans described above have been developed.
Locally, we are ensuring that both the development and implementation of plans are
aligned, e.g. the Greater Manchester reform Strategy ‘Stronger Together’ and the
Manchester Strategy ‘Our Manchester’.
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3.0 The Manchester Health and Care Commissioning Strategic Plan
3.1 Commissioning strategy
The commissioning strategy for Manchester is in a stage of both evolution and
revolution. In many respects the commissioning strategy is a continuation of the
strategic direction within the City for a number of years. Our focus is upon shifting
care upstream to prevent the levels of ill health our population experiences, to
provide integrate and proactive care whereby ill health is managed earlier and more
effectively. These approaches have been shown to reduce the need for high cost
acute care and long term care packages thus managing cost and improving health
and wellbeing. The new strategic aims are in some ways a natural progression of
this approach. However, there are some fundamental changes as part of the new
arrangements and the strategic direction.
MHCC is a partnership of Manchester City Council and Manchester CCGs which will
commission health, social care and public health together for the first time. Learning
from our integrated care programme will be applied, through the One Team
prospectus, to all out of hospital care and this will be secured through a single
contract holder. MHCC’s strategic aims will recognise that population health cannot
be achieved through provision of health and social care services alone. This can
only be achieved through linking strategy with housing, education, and employment
as well as being able to empower people and communities to be more active
partners in their health.
3.2 Mission, vision and values
During the development of MHCC the mission, vision and values of the organisation
were established. These were developed with staff, member practices and
stakeholders. This produced a set of statements by which we developed MHCC and
which guide our strategy and how we work.
MHCC Mission
We are determined to make Manchester a city where everyone can live a healthier
life
We will support you, and your loved ones, investing in what you tell us is important to
you
We will make sure you receive the right care, in the right place and at the right time
delivered by kind, caring people that you can trust
We will make the most of our money by reducing waste; testing new ways of working
that improve outcomes and funding things we know will work
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We will forge strong partnerships with people and organisations in the City and
across the region, and put health and wellbeing at the heart of plans for developing
Manchester’s future as a thriving city.
Vision
Our vision is the same as the Locality Plan – A Healthier Manchester
Values
The values by which MHCC will work are to be Positive, Collaborative and Fair
3.3 Strategic aims
The strategic aims have been developed in the context of existing strategy as set out
in section two. The strategic aims have also embraced the Our Manchester
approach and have been developed with community groups, voluntary sector,
patient public advisory groups etc. as well as through the executive team and
predecessor Boards. The strategic aims below are the result of that exercise. They
fit with the mission, vision and values of the organisation, they are congruent with
local, regional and national strategy and will enable MHCC to achieve its vision and
meet its duties.
MHCC draft strategic aims
1. To improve the health and wellbeing of the people in Manchester
2. To strengthen the social determinants of health and promote healthy lifestyles
3. To ensure services are safe, equitable and of a high standard with less variation
4. To enable people and communities to be active partners in their health and
wellbeing
5. To achieve a sustainable health and care system
These are shown in more detail in the figure below:-
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1. To improve the health and wellbeing of people in
Manchester
•Improving quality of life
•Reducing the healthy life expectancy gap between the healthy and least healthy
•Improving both mental and physical health and wellbeing
•Upstream, proactive and coordinated care
•Improvement across the life course of people in Manchester– i.e. starting well, living well, ageing well, and
end of life.
2. To strengthen the social determinants of health and
promote healthy lifestyles
•Prevention (e.g. in public heath, primary care)
•Social connectedness
•Enabling healthy life style choices
•Influencing across system for wider determinants of health, such as housing, employment, education finance.
3. To ensure services are safe, equitable and of a high
standard with less variation
•Proactive, integrated care, with smooth pathways across the system
•High quality and safe health and care provision meeting constitutional and statutory requirements
•Coordination of the system
•Equitable access to health and care taking regard diversity of population, protected characteristics
•Variation in outcomes within the city and nationally
•Value for money
4. Enable people and communities to be active partners in
their health and wellbeing
•Asset based approach / Our Manchester
•Investing in community assets
•Social networks
•Strengthening connections between health and care services, communities and VCSE sector.
•Carers
•Resilient communities
5. To achieve a sustainable system
•Transformed, integrated health and social care system
•Financial sustainability
•Innovative, adaptive, future proofed system
•Sustainable workforce (clinical and professional) across health and care.
The strategy will continue to be developed with partners and stakeholders with a
view to completing the strategy by the end of June.
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3.4 Strategic Commissioning
In developing Manchester Health and Care Commissioning there were four key
areas of benefit identified as part of its development.
A single commissioning voice:- given the change to provider arrangements in the
City, MHCC will have fewer, larger, longer term contractual arrangements. As
providers start to work on increasingly larger geographical footprints, at the City level
and greater, commissioners need to work more effectively together to create a clear
strategic and operational direction, means of quality assurance and synergy of
commissioned services.
Co-ordinated and proactive care:- is essential to achieving population health
improvements and to meet the needs of ageing population with increasing frailty and
co-morbidity. Integrated care is dependent on integrated commissioning and a
unified investment strategy.
A more strategic role:- is needed to ensure we can lead the scale of change
required and have a new relationship with providers. Closer alignment with broader
public sector strategy e.g. housing, education, and employment will enable a greater
improvement to population health.
Optimising our assets:- bringing together people, money and other resources to
create a more efficient and effective means of commissioning. It will also create
wider networks to organisations and groups who can support our work.
The Commissioning strategy will define clearly what our aspiration to be a strategic
commissioner is and the roadmap to get there. From the outset MHCC will take the
role of system leader it will also start to work more strategically. However, the
evolution of MHCC in this role will rely upon the development of the local care
organisation to undertake some of the roles currently undertaken within
commissioning. This is likely to develop over a number of years. The figure below is
an initial description of what we mean by strategic commissioning.
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4.0 A Healthier Manchester (locality plan) update
4.1
Development of Manchester Health and Care Commissioning
MHCC will be a live organisation from April 1st 2017. There is still work to do in
terms of developing its full staffing structure and its operating arrangements and this
will progress over the next three months. As noted in the constitution paper the
governance arrangements needed to be changed at a late stage by request of NHS
England. Attention is now turning towards delivering on the key challenges for the
first quarter of 2017/18 as well as further development of the commissioning
strategy. In the medium term the process towards our strategic role will be better
defined and implemented. The process to integrate children’s commissioning will
also be set out with intent for this to be complete by April 2018.
4.2
Development of a Local Care Organisation
The LCO provider selection procurement process is ongoing and is continuing to
planned timescales. The commissioners passed the first formal gateway of the new
NHS England ‘ISAP’ (Integrated Support and Assurance Process) Checkpoint 1. A
Prior Information Notice was issued on 10 March 2017 following the decision by the
former three CCGs and MCC executive. A critical risk for Board awareness is the
potential for additional VAT liabilities accruing in relation to the MHCC partnership
arrangements, as well as the future LCO organisational forms.
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4.3
Single Hospital Service
The three former CCGs and Manchester City Council requested the establishment of
a single hospital service for Manchester and this remains our clear aim. This brings
benefits relating to clinical standards, patient experience, workforce resilience and
efficiency which will directly improve care in the City. It will also create opportunities
to develop education and research which will benefit patient care and contribute to
the City Strategy in terms of jobs and economic growth.
The first part of this process is the merger of Central Manchester Foundation Trust
with University Hospitals South Manchester followed by North Manchester General
Hospital moving into the new trust at a later stage.
This process needs approval of the respective Trust Boards and NHS Improvement.
This is proceeding as planned. It also needs approval by the Competition and
Markets Authority (CMA). The CMA process is progressing well. The initial
assessment has confirmed that the merger will have an impact on competition. This
is as expected and has been an assumption within this work from the outset. The
CMA process will now assess the benefits of the merger, in terms of improved
patient care, to determine that these are greater than any potential downside of lost
competition. The case for the single hospital service is strong and therefore this
case is expected to be made. This second stage is expected to be complete by
August to enable the merger by October ’17. More specific timing for the North
Manchester transaction is expected to be clarified in the near future.
4.4
Investment and resourcing
Whilst 2017/18 will be a challenging year from a financial perspective. There are a
number of opportunities for MHCC to invest. Investment funds for community
services are expected to be drawn down from the GM Transformation Fund in the
next month; a recent announcement in the budget will see non-recurrent investment,
over a three year period, for adult social care; a favourable increase in the primary
care allocation will see growth in the budget; and investment funds set aside premerger for implementation of new care models in North Manchester.
Collectively these will create a significant opportunity. It is critical that these are not
used to plug financial gaps in the short term but that they are invested in delivery of
‘A Healthier Manchester’ to ensure financial stability and improved health over the
medium to long term. It is also important that these do not create isolated
investments but that they are seen collectively and that they act as a catalyst to
transform all commissioned services.
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To support this a Manchester Investment Agreement (MIA) will be established. This
will create a binding agreement between partners in the City to deliver upon these
investments. This will be underpinned by mechanisms to ensure a strong
performance framework linked to health improvement and the cost benefit analysis;
a benefits realisation plan to ensure impacts are clearly identified and that resource
can be shifted in order to sustain successful service models and close the financial
gap.
5.0 Recommendation
Board is asked to discuss the contents of this paper and to endorse the continued
strategic direction set out in this paper.
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